GREEN SHEET REDIGEST
HB 495 2021 Regular Session Ivey
NURSES: Allows full practice authority for advanced practice registered nurses
DIGEST
Proposed law repeals from present law relative to the practice of nursing the term
"collaborative practice agreement".
Proposed law redefines "advanced practice registered nurse", "advanced practice registered
nursing", "collaboration", and "collaborative practice" and adds definitions for "collaborative
practice protocols" and "mentorship agreement".
Proposed law provides that the La. State Board of Nursing (LSBN) may conduct
unannounced inspections of current licensees at sufficient intervals to determine compliance
with state and federal requirements or as considered necessary. Proposed law provides that
the inspection may include random audits of the licensee's records, including but not limited
to the advanced practice registered nurse's collaborative practice protocols.
Present law provides for the licensure qualifications of registered nurses and advanced
practice registered nurses. Proposed law relocates the provisions relative to advanced practice
registered nurses to a newly created section of law.
Proposed law provides that an advanced practice registered nurse (APRN) who has not
completed a minimum of 4,000 hours of patient contact experience as an APRN shall receive
a license with a transitional status endorsement to practice pursuant to a mentorship
agreement and requires the APRN to submit all of the following to the LSBN:
(1)Proof that the APRN has entered into a mentorship agreement with a health care
provider as specified by the rules and regulations of the LSBN.
(2)An attestation that the APRN will practice in accordance with the standards of
practice and scope of practice established by the LSBN and the appropriate national
professional nursing organization from which he has received certification.
(3)An attestation that the APRN has collaborative practice protocols for consultation,
collaboration, and referral when appropriate.
(4)Proof that the APRN maintains or is otherwise covered by medical malpractice
liability coverage in an amount to be determined by the board, but not less than
$500,000 per claim with an aggregate liability for all claims during the year of
$1,500,000, or proof of participation in the Patient's Compensation Fund.
(5)Any other requirements as promulgated by the LSBN.
Proposed law provides that an APRN who has completed a minimum of 4,000 hours of
patient contact experience as an APRN shall apply for an initial or renewal license by
submitting all of the following to the LSBN:
(1)Proof that the APRN has completed a minimum of 4,000 hours of patient contact
experience as an APRN on a form required by the board's rules and regulations.
(2)An attestation that the APRN will practice in accordance with the standards of
practice and scope of practice established by the LSBN and the appropriate national
professional nursing organization from which he has received certification.
(3)An attestation that the APRN has collaborative practice protocols for consultation,
collaboration, and referral when appropriate.
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Prepared by Brandi Cannon. (4)Proof that the APRN maintains or is otherwise covered by medical malpractice
liability coverage in an amount to be determined by the board, but not less than
$500,000 per claim with an aggregate liability for all claims during the year of
$1,500,000, or proof of participation in the Patient's Compensation Fund.
(5)Any other requirements as promulgated by the LSBN.
Proposed law provides that an APRN shall diagnosis and prescribe only in accordance with
the standards of practice and scope of practice established by the LSBN and the appropriate
national professional nursing organization from which he has received certification.
Proposed law provides that the LSBN may establish, by rule, a patient contact experience
requirement greater than the minimum 4,000 hours when considered necessary.
Proposed law provides that the LSBN may promulgate all rules and regulations necessary to
implement proposed law.
Proposed law provides for an advanced practice registered nursing advisory subcommittee
composed of three members of the La. State Board of Nursing, appointed by the board's
president, and three members of the La. State Board of Medical Examiners, appointed by the
board's president.
Proposed law provides for the advisory subcommittee to meet at least once annually and to
alternate hosting sites between the two licensing boards with the president of the board
hosting the subcommittee designating a member to act as chairman.
Proposed law provides that the purpose of the advisory subcommittee shall be solely to
conduct a joint regulatory body review of the state laws relative to advanced practice
registered nursing and to facilitate a discussion on proposed revisions to the law.
Proposed law provides that no later than 30 days after a meeting, the chairman of the
advisory subcommittee shall submit a written report of recommendations to the La. State
Board of Nursing, the La. State Board of Medical Examiners, and the House and Senate
committees on health and welfare.
Effective on January 1, 2022.
(Amends R.S. 28:2(28), 51.1(A)(3), and 53(B)(1), R.S. 37:913(1)(intro. para.), (3), (7), (8),
and (9), 921(A), (B), and (E)(1), 925(C), and 930(E) and (F) and R.S. 40:2109.3(A)(2); adds
R.S. 37:913(17), 918(22), 936, 937, and 938)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare
to the original bill:
1. Delete proposed law which would have revised present law to authorize
certified registered nurse anesthetists to provide anesthesia care within their
scope of practice under the direction and supervision of a physician or dentist
who is licensed to practice under the laws of this state.
2. Revise present law to provide that certified registered nurse anesthetists shall
not be required to have prescriptive authority to provide anesthesia care
within their scope of practice under the direction and supervision of a
physician or dentist who is licensed to practice under the laws of this state.
The House Floor Amendments to the engrossed bill:
1. Restore to present law the defined term "collaboration" and its corresponding
definition which proposed law formerly repealed.
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Prepared by Brandi Cannon. 2. Establish the following transition to practice requirements for certain
advanced practice registered nurses:
a. Each nurse practitioner, certified nurse midwife, and clinical nurse
specialist shall collaborate for at least 6,000 hours with a licensed
physician or be employed by a clinic that has a medical director who
is a licensed physician.
b. Any nurse practitioner, certified nurse midwife, or clinical nurse
specialist who practices in any specialty and transitions to
independent practice shall do so in collaboration with a physician
who practices in that same specialty.
c. Each nurse practitioner, certified nurse midwife, and clinical nurse
specialist shall submit written evidence to the board upon completion
of the clinical experience required by proposed law.
d. Hours of clinical experience gained in another state may count toward
the clinical experience requirement provided in proposed law, subject
to approval by the board.
e. Any nurse practitioner, certified nurse midwife, or clinical nurse
specialist who did not complete 4,000 clinical hours as a registered
nurse prior to achieving advanced practice certification shall
collaborate for an additional 4,000 hours beyond the minimum 6,000-
hour requirement provided in proposed law.
f. A nurse practitioner, certified nurse midwife, or clinical nurse
specialist shall hold a current, unencumbered license issued by the La.
State Board of Nursing (board).
g. Any nurse practitioner, certified nurse midwife, or clinical nurse
specialist who is deemed by the board to have met the requirements
of proposed law necessary for independent practice on and after the
effective date of proposed law shall be eligible to transition to
independent practice.
3. Provide that no nurse practitioner, certified nurse midwife, or clinical nurse
specialist who has completed the requirements of proposed law and practices
independently in a specialty may practice independently in a different
specialty unless he completes all requirements of proposed law again for that
different specialty.
4. Stipulate that the board shall not prohibit an advanced practice registered
nurse from practicing under a collaborative practice agreement. Provide that
for purposes of proposed law, "collaborative practice agreement" means a
formal written statement addressing the parameters of collaboration, as
defined in present law, which are mutually agreed upon by an advanced
practice registered nurse and one or more licensed physicians which includes
but shall not be limited to the following provisions:
a. Availability of the collaborating physician for consultation, referral,
or both.
b. Methods of management of the collaborative practice which shall
include clinical practice guidelines.
c. Coverage of the healthcare needs of a patient during any absence of
the advanced practice registered nurse or physician.
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Prepared by Brandi Cannon. 5. Create within the La. Department of Health the Independent Practice
Advisory Panel (advisory panel) and provides for the membership of the
advisory panel to include three physicians, three advanced practice registered
nurses, the executive director of the La. State Board of Nursing, who shall be
a nonvoting member, and the executive director of the La. State Board of
Medical Examiners, who shall be a nonvoting member.
6. Provide that the advisory panel shall have the following duties and
responsibilities:
a. Ensure quality of care post discipline action.
b. Make recommendations on education items to reduce recurring
violations.
c. Review complaints and concerns regarding advanced practice
registered nurses who practice independently and regarding
physicians who collaborate with advanced practice registered nurses.
d. Develop advisory or practice opinions of any items brought before the
panel.
e. Make recommendations to the La. State Board of Nursing and the La.
State Board of Medical Examiners concerning administrative rules to
be jointly promulgated by both boards to govern independent practice
by advanced practice registered nurses.
7. Terminate proposed law creating and providing for the advisory panel on
Aug. 1, 2025.
8. Make technical changes.
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the reengrossed bill
1. Deletes references to collaborative practice agreements in present law.
2. Redefines advanced practice registered nurse, advanced practice registered
nursing, collaboration, and collaborative practice and defines collaborative
practice protocols and mentorship agreement.
3. Allows the LSBN to conduct unannounced inspections and random audits.
4. Relocates present law provisions relative to the licensure qualifications of an
APRN.
5. Allows the LSBN to require an APRN to practice pursuant to a mentorship
agreement after violating a provision of present law.
6. Provides for the designation of transitional status and practice pursuant to a
mentorship agreement for an APRN with less than 4,000 hours of experience.
7. Provides for provisional prescriptive authority for an APRN with transitional
status.
8. Provides for licensing requirements for an APRN with at least 4,000 hours
of experience.
9. Creates an advanced practice registered nursing advisory subcommittee.
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Prepared by Brandi Cannon. 10.Provides for an effective date.
11.Makes technical changes.
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Prepared by Brandi Cannon.