Missouri 2024 Regular Session

Missouri Senate Bill SB809 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
3	3	and is intended to be omitted in the law.
4	4	SECOND REGULAR SESSION
5	5	SENATE BILL NO. 809
6	6	102ND GENERAL ASSEMBLY
7	7	INTRODUCED BY SENATOR SCHROER.
8	8	3517S.01I KRISTINA MARTIN, Secretary
9	9	AN ACT
10	10	To repeal sections 334.104, 335.016, and 335.019, RSMo, and to enact in lieu thereof three new
11	11	sections relating to advanced practice registered nurses.
12	12
13	13	Be it enacted by the General Assembly of the State of Missouri, as follows:
14	14	Section A. Sections 334.104, 335.016, and 335.019, RSMo, 1
15	15	are repealed and three new sections enacted in lieu thereof, to 2
16	16	be known as sections 334.104, 335.016, and 335.019, to read as 3
17	17	follows:4
18	18	334.104. 1. A physician may enter into collaborative 1
19	19	practice arrangements with registered professional nurses. 2
20	20	Collaborative practice arrangements shall be in the form of 3
21	21	written agreements, jointly agreed-upon protocols, or 4
22	22	standing orders for the delivery of health care services. 5
23	23	Collaborative practice arrangements, which shall be in 6
24	24	writing, may delegate to a registered professional nurse the 7
25	25	authority to administer or dispense drugs and provide 8
26	26	treatment as long as the delivery of such health care 9
27	27	services is within the scope of practice of the registered 10
28	28	professional nurse and is consistent with that nurse's 11
29	29	skill, training and competence. 12
30	30	2. (1) Collaborative practice ar rangements, which 13
31	31	shall be in writing, may delegate to a registered 14
32	32	professional nurse the authority to administer, dispense or 15
33	33	prescribe drugs and provide treatment if the registered 16
34	34	professional nurse is an advanced practice registered nurse 17 SB 809 2
35	35	as defined in subdivision (2) of section 335.016. 18
36	36	Collaborative practice arrangements may delegate to an 19
37	37	advanced practice registered nurse, as defined in section 20
38	38	335.016, the authority to administer, dispense, or prescribe 21
39	39	controlled substances listed in Sc hedules III, IV, and V of 22
40	40	section 195.017, and Schedule II - hydrocodone; except that, 23
41	41	the collaborative practice arrangement shall not delegate 24
42	42	the authority to administer any controlled substances listed 25
43	43	in Schedules III, IV, and V of section 195.017 , or Schedule 26
44	44	II - hydrocodone for the purpose of inducing sedation or 27
45	45	general anesthesia for therapeutic, diagnostic, or surgical 28
46	46	procedures. Schedule III narcotic controlled substance and 29
47	47	Schedule II - hydrocodone prescriptions shall be limited to 30
48	48	a one hundred twenty -hour supply without refill. 31
49	49	(2) Notwithstanding any other provision of this 32
50	50	section to the contrary, a collaborative practice 33
51	51	arrangement may delegate to an advanced practice registered 34
52	52	nurse the authority to administer, dispe nse, or prescribe 35
53	53	Schedule II controlled substances for hospice patients; 36
54	54	provided, that the advanced practice registered nurse is 37
55	55	employed by a hospice provider certified pursuant to chapter 38
56	56	197 and the advanced practice registered nurse is providing 39
57	57	care to hospice patients pursuant to a collaborative 40
58	58	practice arrangement that designates the certified hospice 41
59	59	as a location where the advanced practice registered nurse 42
60	60	is authorized to practice and prescribe. 43
61	61	(3) Such collaborative practice ar rangements shall be 44
62	62	in the form of written agreements, jointly agreed -upon 45
63	63	protocols or standing orders for the delivery of health care 46
64	64	services. 47
65	65	(4) An advanced practice registered nurse may 48
66	66	prescribe buprenorphine for up to a thirty -day supply 49 SB 809 3
67	67	without refill for patients receiving medication -assisted 50
68	68	treatment for substance use disorders under the direction of 51
69	69	the collaborating physician. 52
70	70	3. The written collaborative practice arrangement 53
71	71	shall contain at least the following provisions: 54
72	72	(1) Complete names, home and business addresses, zip 55
73	73	codes, and telephone numbers of the collaborating physician 56
74	74	and the advanced practice registered nurse; 57
75	75	(2) A list of all other offices or locations besides 58
76	76	those listed in subdivision (1 ) of this subsection where the 59
77	77	collaborating physician authorized the advanced practice 60
78	78	registered nurse to prescribe; 61
79	79	(3) A requirement that there shall be posted at every 62
80	80	office where the advanced practice registered nurse is 63
81	81	authorized to prescribe, in collaboration with a physician, 64
82	82	a prominently displayed disclosure statement informing 65
83	83	patients that they may be seen by an advanced practice 66
84	84	registered nurse and have the right to see the collaborating 67
85	85	physician; 68
86	86	(4) All specialty or board certifications of the 69
87	87	collaborating physician and all certifications of the 70
88	88	advanced practice registered nurse; 71
89	89	(5) The manner of collaboration between the 72
90	90	collaborating physician and the advanced practice registered 73
91	91	nurse, including how the collaborating physician and the 74
92	92	advanced practice registered nurse will: 75
93	93	(a) Engage in collaborative practice consistent with 76
94	94	each professional's skill, training, education, and 77
95	95	competence; 78
96	96	(b) Maintain geographic proximity, except as speci fied 79
97	97	in this paragraph. The following provisions shall apply 80
98	98	with respect to this requirement: 81 SB 809 4
99	99	a. Until August 28, 2025, an advanced practice 82
100	100	registered nurse providing services in a correctional 83
101	101	center, as defined in section 217.010, and his or her 84
102	102	collaborating physician shall satisfy the geographic 85
103	103	proximity requirement if they practice within two hundred 86
104	104	miles by road of one another. An incarcerated patient who 87
105	105	requests or requires a physician consultation shall be 88
106	106	treated by a physicia n as soon as appropriate; 89
107	107	b. The collaborative practice arrangement may allow 90
108	108	for geographic proximity to be waived for a maximum of 91
109	109	twenty-eight days per calendar year for rural health clinics 92
110	110	as defined by Pub.L. 95 -210 (42 U.S.C. Section 1395x, as 93
111	111	amended), as long as the collaborative practice arrangement 94
112	112	includes alternative plans as required in paragraph (c) of 95
113	113	this subdivision. This exception to geographic proximity 96
114	114	shall apply only to independent rural health clinics, 97
115	115	provider-based rural health clinics where the provider is a 98
116	116	critical access hospital as provided in 42 U.S.C. Section 99
117	117	1395i-4, and provider-based rural health clinics where the 100
118	118	main location of the hospital sponsor is greater than fifty 101
119	119	miles from the clinic; 102
120	120	c. The collaborative practice arrangement may allow 103
121	121	for geographic proximity to be waived when the arrangement 104
122	122	outlines the use of telehealth, as defined in section 105
123	123	191.1145; 106
124	124	d. In addition to the waivers and exemptions provided 107
125	125	in this subsection, an application for a waiver for any 108
126	126	other reason of any applicable geographic proximity shall be 109
127	127	available if a physician is collaborating with an advanced 110
128	128	practice registered nurse in excess of any geographic 111
129	129	proximity limit. The board of nursing an d the state board 112
130	130	of registration for the healing arts shall review each 113 SB 809 5
131	131	application for a waiver of geographic proximity and approve 114
132	132	the application if the boards determine that adequate 115
133	133	supervision exists between the collaborating physician and 116
134	134	the advanced practice registered nurse. The boards shall 117
135	135	have forty-five calendar days to review the completed 118
136	136	application for the waiver of geographic proximity. If no 119
137	137	action is taken by the boards within forty -five days after 120
138	138	the submission of the appl ication for a waiver, then the 121
139	139	application shall be deemed approved. If the application is 122
140	140	denied by the boards, the provisions of section 536.063 for 123
141	141	contested cases shall apply and govern proceedings for 124
142	142	appellate purposes; and 125
143	143	e. The collaborating physician is required to maintain 126
144	144	documentation related to this requirement and to present it 127
145	145	to the state board of registration for the healing arts when 128
146	146	requested; and 129
147	147	(c) Provide coverage during absence, incapacity, 130
148	148	infirmity, or emergen cy by the collaborating physician; 131
149	149	(6) A description of the advanced practice registered 132
150	150	nurse's controlled substance prescriptive authority in 133
151	151	collaboration with the physician, including a list of the 134
152	152	controlled substances the physician authorize s the nurse to 135
153	153	prescribe and documentation that it is consistent with each 136
154	154	professional's education, knowledge, skill, and competence; 137
155	155	(7) A list of all other written practice agreements of 138
156	156	the collaborating physician and the advanced practice 139
157	157	registered nurse; 140
158	158	(8) The duration of the written practice agreement 141
159	159	between the collaborating physician and the advanced 142
160	160	practice registered nurse; 143
161	161	(9) A description of the time and manner of the 144
162	162	collaborating physician's review of the advanc ed practice 145 SB 809 6
163	163	registered nurse's delivery of health care services. The 146
164	164	description shall include provisions that the advanced 147
165	165	practice registered nurse shall submit a minimum of ten 148
166	166	percent of the charts documenting the advanced practice 149
167	167	registered nurse's delivery of health care services to the 150
168	168	collaborating physician for review by the collaborating 151
169	169	physician, or any other physician designated in the 152
170	170	collaborative practice arrangement, every fourteen days; 153
171	171	(10) The collaborating physician, or any other 154
172	172	physician designated in the collaborative practice 155
173	173	arrangement, shall review every fourteen days a minimum of 156
174	174	twenty percent of the charts in which the advanced practice 157
175	175	registered nurse prescribes controlled substances. The 158
176	176	charts reviewed under this subdivision may be counted in the 159
177	177	number of charts required to be reviewed under subdivision 160
178	178	(9) of this subsection; and 161
179	179	(11) If a collaborative practice arrangement is used 162
180	180	in clinical situations where a collaborating advanced 163
181	181	practice registered nurse provides health care services that 164
182	182	include the diagnosis and initiation of treatment for 165
183	183	acutely or chronically ill or injured persons, then the 166
184	184	collaborating physician or any other physician designated in 167
185	185	the collaborative practice arrangement shall be present for 168
186	186	sufficient periods of time, at least once every two weeks, 169
187	187	except in extraordinary circumstances that shall be 170
188	188	documented, to participate in a chart review and to provide 171
189	189	necessary medical direction, medical services, 172
190	190	consultations, and supervision of the health care staff. 173
191	191	4. The state board of registration for the healing 174
192	192	arts pursuant to section 334.125 and the board of nursing 175
193	193	pursuant to section 335.036 may jointly promulgate rules 176
194	194	regulating the use of c ollaborative practice arrangements. 177 SB 809 7
195	195	Such rules shall be limited to the methods of treatment that 178
196	196	may be covered by collaborative practice arrangements and 179
197	197	the requirements for review of services provided pursuant to 180
198	198	collaborative practice arrangements including delegating 181
199	199	authority to prescribe controlled substances. Any rules 182
200	200	relating to geographic proximity shall allow a collaborating 183
201	201	physician and a collaborating advanced practice registered 184
202	202	nurse to practice within two hundred miles by road of one 185
203	203	another until August 28, 2025, if the nurse is providing 186
204	204	services in a correctional center, as defined in section 187
205	205	217.010. Any rules relating to dispensing or distribution 188
206	206	of medications or devices by prescription or prescription 189
207	207	drug orders under this section shall be subject to the 190
208	208	approval of the state board of pharmacy. Any rules relating 191
209	209	to dispensing or distribution of controlled substances by 192
210	210	prescription or prescription drug orders under this section 193
211	211	shall be subject to the approval of the department of health 194
212	212	and senior services and the state board of pharmacy. In 195
213	213	order to take effect, such rules shall be approved by a 196
214	214	majority vote of a quorum of each board. Neither the state 197
215	215	board of registration for the healing arts nor the board of 198
216	216	nursing may separately promulgate rules relating to 199
217	217	collaborative practice arrangements. Such jointly 200
218	218	promulgated rules shall be consistent with guidelines for 201
219	219	federally funded clinics. The rulemaking authority granted 202
220	220	in this subsection sh all not extend to collaborative 203
221	221	practice arrangements of hospital employees providing 204
222	222	inpatient care within hospitals as defined pursuant to 205
223	223	chapter 197 or population -based public health services as 206
224	224	defined by 20 CSR 2150 - 5.100 as of April 30, 2008. 207
225	225	5. The state board of registration for the healing 208
226	226	arts shall not deny, revoke, suspend or otherwise take 209 SB 809 8
227	227	disciplinary action against a physician for health care 210
228	228	services delegated to a registered professional nurse 211
229	229	provided the provisions of this section and the rules 212
230	230	promulgated thereunder are satisfied. Upon the written 213
231	231	request of a physician subject to a disciplinary action 214
232	232	imposed as a result of an agreement between a physician and 215
233	233	a registered professional nurse or registered physician 216
234	234	assistant, whether written or not, prior to August 28, 1993, 217
235	235	all records of such disciplinary licensure action and all 218
236	236	records pertaining to the filing, investigation or review of 219
237	237	an alleged violation of this chapter incurred as a result of 220
238	238	such an agreement shall be removed from the records of the 221
239	239	state board of registration for the healing arts and the 222
240	240	division of professional registration and shall not be 223
241	241	disclosed to any public or private entity seeking such 224
242	242	information from the board or the div ision. The state board 225
243	243	of registration for the healing arts shall take action to 226
244	244	correct reports of alleged violations and disciplinary 227
245	245	actions as described in this section which have been 228
246	246	submitted to the National Practitioner Data Bank. In 229
247	247	subsequent applications or representations relating to his 230
248	248	or her medical practice, a physician completing forms or 231
249	249	documents shall not be required to report any actions of the 232
250	250	state board of registration for the healing arts for which 233
251	251	the records are subject to removal under this section. 234
252	252	6. Within thirty days of any change and on each 235
253	253	renewal, the state board of registration for the healing 236
254	254	arts shall require every physician to identify whether the 237
255	255	physician is engaged in any collaborative practice 238
256	256	arrangement, including collaborative practice arrangements 239
257	257	delegating the authority to prescribe controlled substances, 240
258	258	or physician assistant collaborative practice arrangement 241 SB 809 9
259	259	and also report to the board the name of each licensed 242
260	260	professional with whom the physician has entered into such 243
261	261	arrangement. The board shall make this information 244
262	262	available to the public. The board shall track the reported 245
263	263	information and may routinely conduct random reviews of such 246
264	264	arrangements to ensure that arrangeme nts are carried out for 247
265	265	compliance under this chapter. 248
266	266	7. Notwithstanding any law to the contrary, a 249
267	267	certified registered nurse anesthetist as defined in 250
268	268	subdivision (8) of section 335.016 shall be permitted to 251
269	269	provide anesthesia services without a collaborative practice 252
270	270	arrangement provided that he or she is under the supervision 253
271	271	of an anesthesiologist or other physician, dentist, or 254
272	272	podiatrist who is immediately available if needed. Nothing 255
273	273	in this subsection shall be construed to prohibit or prevent 256
274	274	a certified registered nurse anesthetist as defined in 257
275	275	subdivision (8) of section 335.016 from entering into a 258
276	276	collaborative practice arrangement under this section, 259
277	277	except that the collaborative practice arrangement may not 260
278	278	delegate the authority to prescribe any controlled 261
279	279	substances listed in Schedules III, IV, and V of section 262
280	280	195.017, or Schedule II - hydrocodone. 263
281	281	8. A collaborating physician shall not enter into a 264
282	282	collaborative practice arrangement with more than six full - 265
283	283	time equivalent advanced practice registered nurses, full - 266
284	284	time equivalent licensed physician assistants, or full -time 267
285	285	equivalent assistant physicians, or any combination 268
286	286	thereof. This limitation shall not apply to collaborative 269
287	287	arrangements of hospital e mployees providing inpatient care 270
288	288	service in hospitals as defined in chapter 197 or population - 271
289	289	based public health services as defined by 20 CSR 2150 - 272
290	290	5.100 as of April 30, 2008, or to a certified registered 273 SB 809 10
291	291	nurse anesthetist providing anesthesia servi ces under the 274
292	292	supervision of an anesthesiologist or other physician, 275
293	293	dentist, or podiatrist who is immediately available if 276
294	294	needed as set out in subsection 7 of this section. 277
295	295	9. It is the responsibility of the collaborating 278
296	296	physician to determine and document the completion of at 279
297	297	least a one-month period of time during which the advanced 280
298	298	practice registered nurse shall practice with the 281
299	299	collaborating physician continuously present before 282
300	300	practicing in a setting where the collaborating physicia n is 283
301	301	not continuously present. This limitation shall not apply 284
302	302	to collaborative arrangements of providers of population - 285
303	303	based public health services, as defined by 20 CSR 2150 - 286
304	304	5.100 as of April 30, 2008, or to collaborative practice 287
305	305	arrangements between a primary care physician and a primary 288
306	306	care advanced practice registered nurse or a behavioral 289
307	307	health physician and a behavioral health advanced practice 290
308	308	registered nurse, where the collaborating physician is new 291
309	309	to a patient population to which t he advanced practice 292
310	310	registered nurse is familiar. 293
311	311	10. No agreement made under this section shall 294
312	312	supersede current hospital licensing regulations governing 295
313	313	hospital medication orders under protocols or standing 296
314	314	orders for the purpose of deliveri ng inpatient or emergency 297
315	315	care within a hospital as defined in section 197.020 if such 298
316	316	protocols or standing orders have been approved by the 299
317	317	hospital's medical staff and pharmaceutical therapeutics 300
318	318	committee. 301
319	319	11. No contract or other term of emp loyment shall 302
320	320	require a physician to act as a collaborating physician for 303
321	321	an advanced practice registered nurse against the 304
322	322	physician's will. A physician shall have the right to 305 SB 809 11
323	323	refuse to act as a collaborating physician, without penalty, 306
324	324	for a particular advanced practice registered nurse. No 307
325	325	contract or other agreement shall limit the collaborating 308
326	326	physician's ultimate authority over any protocols or 309
327	327	standing orders or in the delegation of the physician's 310
328	328	authority to any advanced practice regi stered nurse, but 311
329	329	this requirement shall not authorize a physician in 312
330	330	implementing such protocols, standing orders, or delegation 313
331	331	to violate applicable standards for safe medical practice 314
332	332	established by hospital's medical staff. 315
333	333	12. No contract or other term of employment shall 316
334	334	require any advanced practice registered nurse to serve as a 317
335	335	collaborating advanced practice registered nurse for any 318
336	336	collaborating physician against the advanced practice 319
337	337	registered nurse's will. An advanced practice registered 320
338	338	nurse shall have the right to refuse to collaborate, without 321
339	339	penalty, with a particular physician. 322
340	340	13. (1) The provisions of this section shall not 323
341	341	apply to an advanced practice registered nurse who has been 324
342	342	in a collaborative practic e arrangement for a cumulative two 325
343	343	thousand documented hours with a collaborating physician and 326
344	344	whose license is in good standing. Any such advanced 327
345	345	practice registered nurse shall not be required to enter 328
346	346	into or remain in an arrangement in order to practice in 329
347	347	this state. Any other provisions of law requiring a 330
348	348	collaborative practice arrangement or delegation shall not 331
349	349	be required for an advanced practice registered nurse 332
350	350	described in this subsection. 333
351	351	(2) The provisions of this subsection shall not apply 334
352	352	to certified registered nurse anesthetists. 335
353	353	(3) Notwithstanding any provision of this section to 336
354	354	the contrary, an advanced practice registered nurse applying 337 SB 809 12
355	355	for licensure by endorsement may demonstrate to the state 338
356	356	board of nursing completion of a cumulative two thousand 339
357	357	documented hours of practice. Such advanced practice 340
358	358	registered nurses shall not be required to enter into a 341
359	359	collaborative practice arrangement in order to practice in 342
360	360	this state. 343
361	361	335.016. As used in this chapter, unless the context 1
362	362	clearly requires otherwise, the following words and terms 2
363	363	mean: 3
364	364	(1) "Accredited", the official authorization or status 4
365	365	granted by an agency for a program through a voluntary 5
366	366	process; 6
367	367	(2) "Advanced practice registered nurse" or "APRN", a 7
368	368	person who is licensed under the provisions of this chapter 8
369	369	to engage in the practice of advanced practice nursing as a 9
370	370	certified clinical nurse specialist, certified nurse 10
371	371	midwife, certified nurse practitioner , or certified 11
372	372	registered nurse anesthetist; 12
373	373	(3) "Approval", official recognition of nursing 13
374	374	education programs which meet standards established by the 14
375	375	board of nursing; 15
376	376	(4) "Board" or "state board", the state board of 16
377	377	nursing; 17
378	378	(5) "Certified clinical nurse specialist", a 18
379	379	registered nurse who is currently certified as a clinical 19
380	380	nurse specialist by a nationally recognized certifying board 20
381	381	approved by the board of nursing; 21
382	382	(6) "Certified nurse midwife", a registered nurse who 22
383	383	is currently certified as a nurse midwife by the American 23
384	384	Midwifery Certification Board, or other nationally 24
385	385	recognized certifying body approved by the board of nursing; 25 SB 809 13
386	386	(7) "Certified nurse practitioner", a registered nurse 26
387	387	who is currently certi fied as a nurse practitioner by a 27
388	388	nationally recognized certifying body approved by the board 28
389	389	of nursing; 29
390	390	(8) "Certified registered nurse anesthetist", a 30
391	391	registered nurse who is currently certified as a nurse 31
392	392	anesthetist by the Council on Certifi cation of Nurse 32
393	393	Anesthetists, the National Board of Certification and 33
394	394	Recertification for Nurse Anesthetists, or other nationally 34
395	395	recognized certifying body approved by the board of nursing; 35
396	396	(9) "Executive director", a qualified individual 36
397	397	employed by the board as executive secretary or otherwise to 37
398	398	administer the provisions of this chapter under the board's 38
399	399	direction. Such person employed as executive director shall 39
400	400	not be a member of the board; 40
401	401	(10) "Inactive license status", as define d by rule 41
402	402	pursuant to section 335.061; 42
403	403	(11) "Lapsed license status", as defined by rule under 43
404	404	section 335.061; 44
405	405	(12) "Licensed practical nurse" or "practical nurse", 45
406	406	a person licensed pursuant to the provisions of this chapter 46
407	407	to engage in the practice of practical nursing; 47
408	408	(13) "Licensure", the issuing of a license to 48
409	409	candidates who have met the requirements specified under 49
410	410	this chapter, authorizing the person to engage in the 50
411	411	practice of advanced practice, professional, or practi cal 51
412	412	nursing, and the recording of the names of those persons as 52
413	413	holders of a license to practice advanced practice, 53
414	414	professional, or practical nursing; 54
415	415	(14) "Practice of advanced practice nursing", the 55
416	416	performance for compensation of activities a nd services 56
417	417	consistent with the required education, training, 57 SB 809 14
418	418	certification, demonstrated competencies, and experiences of 58
419	419	an advanced practice registered nurse . In addition to the 59
420	420	practice of professional nursing and within the advanced 60
421	421	practice registered nurse role and population focus, the 61
422	422	term "practice of advanced practice nursing" shall include: 62
423	423	(a) Conducting an advanced assessment; 63
424	424	(b) Ordering and interpreting diagnostic procedures; 64
425	425	(c) Establishing primary and differentia l diagnoses; 65
426	426	(d) Prescribing, ordering, administering, dispensing, 66
427	427	and furnishing therapeutic measures; 67
428	428	(e) Delegating and assigning therapeutic measures to 68
429	429	assistive personnel; 69
430	430	(f) Consulting with other disciplines and providing 70
431	431	referrals to health care agencies, health care providers, 71
432	432	and community resources; and 72
433	433	(g) Other acts that require education and training 73
434	434	consistent with professional standards and commensurate with 74
435	435	the advanced practice registered nurse's education, 75
436	436	certification, demonstrated competencies, and experience ; 76
437	437	(15) "Practice of practical nursing", the performance 77
438	438	for compensation of selected acts for the promotion of 78
439	439	health and in the care of persons who are ill, injured, or 79
440	440	experiencing alterati ons in normal health processes. Such 80
441	441	performance requires substantial specialized skill, judgment 81
442	442	and knowledge. All such nursing care shall be given under 82
443	443	the direction of a person licensed by a state regulatory 83
444	444	board to prescribe medications and tr eatments or under the 84
445	445	direction of a registered professional nurse. For the 85
446	446	purposes of this chapter, the term "direction" shall mean 86
447	447	guidance or supervision provided by a person licensed by a 87
448	448	state regulatory board to prescribe medications and 88
449	449	treatments or a registered professional nurse, including, 89 SB 809 15
450	450	but not limited to, oral, written, or otherwise communicated 90
451	451	orders or directives for patient care. When practical 91
452	452	nursing care is delivered pursuant to the direction of a 92
453	453	person licensed by a state regulatory board to prescribe 93
454	454	medications and treatments or under the direction of a 94
455	455	registered professional nurse, such care may be delivered by 95
456	456	a licensed practical nurse without direct physical oversight; 96
457	457	(16) "Practice of professional nursing ", the 97
458	458	performance for compensation of any act or action which 98
459	459	requires substantial specialized education, judgment and 99
460	460	skill based on knowledge and application of principles 100
461	461	derived from the biological, physical, social, behavioral, 101
462	462	and nursing sciences, including, but not limited to: 102
463	463	(a) Responsibility for the promotion and teaching of 103
464	464	health care and the prevention of illness to the patient and 104
465	465	his or her family; 105
466	466	(b) Assessment, data collection, nursing diagnosis, 106
467	467	nursing care, evalua tion, and counsel of persons who are 107
468	468	ill, injured, or experiencing alterations in normal health 108
469	469	processes; 109
470	470	(c) The administration of medications and treatments 110
471	471	as prescribed by a person licensed by a state regulatory 111
472	472	board to prescribe medication s and treatments; 112
473	473	(d) The coordination and assistance in the 113
474	474	determination and delivery of a plan of health care with all 114
475	475	members of a health team; 115
476	476	(e) The teaching and supervision of other persons in 116
477	477	the performance of any of the foregoing; 117
478	478	(17) "Registered professional nurse" or "registered 118
479	479	nurse", a person licensed pursuant to the provisions of this 119
480	480	chapter to engage in the practice of professional nursing; 120 SB 809 16
481	481	(18) "Retired license status", any person licensed in 121
482	482	this state under this chapter who retires from such 122
483	483	practice. Such person shall file with the board an 123
484	484	affidavit, on a form to be furnished by the board, which 124
485	485	states the date on which the licensee retired from such 125
486	486	practice, an intent to retire from the practice f or at least 126
487	487	two years, and such other facts as tend to verify the 127
488	488	retirement as the board may deem necessary; but if the 128
489	489	licensee thereafter reengages in the practice, the licensee 129
490	490	shall renew his or her license with the board as provided by 130
491	491	this chapter and by rule and regulation. 131
492	492	335.019. 1. An advanced practice registered nurse's 1
493	493	prescriptive authority shall include authority to: 2
494	494	(1) Prescribe, dispense, and administer medications 3
495	495	and nonscheduled legend drugs, as define d in section 4
496	496	338.330, and controlled substances, as provided in 5
497	497	subsection 2 of section 195.070, within such APRN's practice 6
498	498	and specialty; and 7
499	499	(2) Notwithstanding any other provision of this 8
500	500	chapter to the contrary, receive, prescribe, administe r, and 9
501	501	provide nonscheduled legend drug samples from pharmaceutical 10
502	502	manufacturers to patients at no charge to the patient or any 11
503	503	other party. 12
504	504	2. In addition to advanced practice registered nurses 13
505	505	who have a collaborative practice arrangement, the 14
506	506	provisions of subsection 1 of this section shall apply to an 15
507	507	advanced practice registered nurse who meets the 16
508	508	requirements described in subsection 13 of section 334.104 17
509	509	and is no longer required to hold a collaborative practice 18
510	510	arrangement. 19 SB 809 17
511	511	3. The board of nursing may grant a certificate of 20
512	512	controlled substance prescriptive authority to an advanced 21
513	513	practice registered nurse who: 22
514	514	(1) Submits proof of successful completion of an 23
515	515	advanced pharmacology course that shall include preceptorial 24
516	516	experience in the prescription of drugs, medicines, and 25
517	517	therapeutic devices; and 26
518	518	(2) Provides documentation of a minimum of three 27
519	519	hundred clock hours preceptorial experience in the 28
520	520	prescription of drugs, medicines, and therapeutic devices 29
521	521	with a qualified preceptor; and 30
522	522	(3) Provides evidence of a minimum of one thousand 31
523	523	hours of practice in an advanced practice nursing category 32
524	524	prior to application for a certificate of prescriptive 33
525	525	authority. The one thousand hours shall not include 34
526	526	clinical hours obtained in the advanced practice nursing 35
527	527	education program. The one thousand hours of practice in an 36
528	528	advanced practice nursing category may include transmitting 37
529	529	a prescription order orally or telephonically or to an 38
530	530	inpatient medical re cord from protocols developed in 39
531	531	collaboration with and signed by a licensed physician; and 40
532	532	[(4)] (a) Has a controlled substance prescribing 41
533	533	authority delegated in the collaborative practice 42
534	534	arrangement under section 334.104 with a physician who h as 43
535	535	an unrestricted federal Drug Enforcement Administration 44
536	536	registration number and who is actively engaged in a 45
537	537	practice comparable in scope, specialty, or expertise to 46
538	538	that of the advanced practice registered nurse ; or 47
539	539	(b) Provides documentation of a minimum of two 48
540	540	thousand hours of practice in advanced practice nursing, as 49
541	541	provided in subsection 13 of section 334.104 . 50
542	542	