OK
Oklahoma House Bill HB3683

Oklahoma 2022 Regular Session

Oklahoma House Bill HB3683 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11
22
33 Req. No. 10188 Page 1 1
44 2
55 3
66 4
77 5
88 6
99 7
1010 8
1111 9
1212 10
1313 11
1414 12
1515 13
1616 14
1717 15
1818 16
1919 17
2020 18
2121 19
2222 20
2323 21
2424 22
2525 23
2626 24
2727
2828 STATE OF OKLAHOMA
2929
3030 2nd Session of the 58th Legislature (2022)
3131
3232 HOUSE BILL 3683 By: Roberts (Sean)
3333
3434
3535
3636
3737
3838 AS INTRODUCED
3939
4040 An Act relating to nurse practitioners; amending 59
4141 O.S. 2021, Section 567.3a, which relates to
4242 definitions; modifying definition for Certified Nurse
4343 Practitioner; modifying supervision req uirement after
4444 two years of practice; and providing an effective
4545 date.
4646
4747
4848
4949
5050 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
5151 SECTION 1. AMENDATORY 59 O.S. 2021, Section 567.3a, is
5252 amended to read as follows :
5353 Section 567.3a As used in the Oklahoma Nursing Practice Act:
5454 1. "Board" means the Oklahoma Board of Nursing;
5555 2. "The practice of nursing " means the performance of services
5656 provided for purposes of nursing d iagnosis and treatment of human
5757 responses to actual or potential health problems consistent with
5858 educational preparation. Knowledge and skill are the basis for
5959 assessment, analysis, planning, intervention, and evaluation used in
6060 the promotion and maintena nce of health and nursing management of
6161 illness, injury, infirmity, restoration or optimal function, or
6262 death with dignity. Practice is based on understanding the human
6363
6464 Req. No. 10188 Page 2 1
6565 2
6666 3
6767 4
6868 5
6969 6
7070 7
7171 8
7272 9
7373 10
7474 11
7575 12
7676 13
7777 14
7878 15
7979 16
8080 17
8181 18
8282 19
8383 20
8484 21
8585 22
8686 23
8787 24
8888
8989 condition across the human lifespan and understanding the
9090 relationship of the individu al within the environment. This
9191 practice includes execution of the medical regime including the
9292 administration of medications and treatments prescribed by any
9393 person authorized by state law to so prescribe;
9494 3. "Registered nursing" means the practice of t he full scope of
9595 nursing which includes, but is not limited to:
9696 a. assessing the health status of individuals, families
9797 and groups,
9898 b. analyzing assessment data to determine nursing care
9999 needs,
100100 c. establishing goals to meet identified health care
101101 needs,
102102 d. planning a strategy of care,
103103 e. establishing priorities of nursing intervention to
104104 implement the strategy of care,
105105 f. implementing the strategy of care,
106106 g. delegating such tasks as may safely be performed by
107107 others, consistent with educational preparation and
108108 that do not conflict with the p rovisions of the
109109 Oklahoma Nursing Practice Act,
110110 h. providing safe and effective nursing care rendered
111111 directly or indirectly,
112112 i. evaluating responses to interventions,
113113
114114 Req. No. 10188 Page 3 1
115115 2
116116 3
117117 4
118118 5
119119 6
120120 7
121121 8
122122 9
123123 10
124124 11
125125 12
126126 13
127127 14
128128 15
129129 16
130130 17
131131 18
132132 19
133133 20
134134 21
135135 22
136136 23
137137 24
138138
139139 j. teaching the principles and practice of nursing,
140140 k. managing and supervising the prac tice of nursing,
141141 l. collaborating with other health professionals in the
142142 management of health care,
143143 m. performing additional nursing functions in accordance
144144 with knowledge and skills acquired beyond basic
145145 nursing preparation, and
146146 n. delegating those nursin g tasks as defined in the rules
147147 of the Board that may be performed by an advanced
148148 unlicensed assistive person;
149149 4. "Licensed practical nursing " means the practice of nursing
150150 under the supervision or direction of a regist ered nurse, licensed
151151 physician or dentist. This directed scope of nursing practice
152152 includes, but is not limited to:
153153 a. contributing to the assessment of the health status of
154154 individuals and groups,
155155 b. participating in the development and modification of
156156 the plan of care,
157157 c. implementing the appropriate aspects of the plan of
158158 care,
159159 d. delegating such tasks as may safely be performed by
160160 others, consistent with educational preparation and
161161 that do not conflict with the Oklahoma Nursing
162162 Practice Act,
163163
164164 Req. No. 10188 Page 4 1
165165 2
166166 3
167167 4
168168 5
169169 6
170170 7
171171 8
172172 9
173173 10
174174 11
175175 12
176176 13
177177 14
178178 15
179179 16
180180 17
181181 18
182182 19
183183 20
184184 21
185185 22
186186 23
187187 24
188188
189189 e. providing safe and effective nursing care r endered
190190 directly or indirectly,
191191 f. participating in the evaluation of responses to
192192 interventions,
193193 g. teaching basic nursing skills and related principles,
194194 h. performing additional nursing procedures in accordance
195195 with knowledge and skills acquired through education
196196 beyond nursing preparation, and
197197 i. delegating those nursing tasks as defined in the rules
198198 of the Board that may be performed by an advanced
199199 unlicensed assistive person;
200200 5. "Advanced Practice Registered Nurse " means a licensed
201201 Registered Nurse:
202202 a. who has completed an advanced practice registered
203203 nursing education program in preparation for one of
204204 four recognized advanced practice registered nurse
205205 roles,
206206 b. who has passed a national certification examination
207207 recognized by the Board that measures t he advanced
208208 practice registered nurse role and specialty
209209 competencies and who maintains recertification in the
210210 role and specialty through a national certification
211211 program,
212212
213213 Req. No. 10188 Page 5 1
214214 2
215215 3
216216 4
217217 5
218218 6
219219 7
220220 8
221221 9
222222 10
223223 11
224224 12
225225 13
226226 14
227227 15
228228 16
229229 17
230230 18
231231 19
232232 20
233233 21
234234 22
235235 23
236236 24
237237
238238 c. who has acquired advanced clinical knowledge and
239239 skills in preparation for provid ing both direct and
240240 indirect care to patients; however, the defining
241241 factor for all Advanced Practice Registered Nurses is
242242 that a significant component of the education and
243243 practice focuses on direct care of individuals,
244244 d. whose practice builds on the com petencies of
245245 Registered Nurses by demonstrating a greater depth and
246246 breadth of knowledge, a greater synthesis of data, and
247247 increased complexity of skills and interventions, and
248248 e. who has obtained a license as an Advance d Practice
249249 Registered Nurse in one o f the following roles:
250250 Certified Registered Nurse Anesthetist, Certified
251251 Nurse-Midwife, Clinical Nurse Specialist, or Certified
252252 Nurse Practitioner.
253253 Only those persons who hold a license to practice advanced
254254 practice registered nursing in this state shall have the right to
255255 use the title "Advanced Practice Registered Nurse " and to use the
256256 abbreviation "APRN". Only those persons who have obtained a license
257257 in the following disciplines shall have the right to fulfill the
258258 roles and use the applicable titles: Certified Registered Nurse
259259 Anesthetist and the abbreviation "CRNA", Certified Nurse-Midwife and
260260 the abbreviation "CNM", Clinical Nurse Specialist and the
261261
262262 Req. No. 10188 Page 6 1
263263 2
264264 3
265265 4
266266 5
267267 6
268268 7
269269 8
270270 9
271271 10
272272 11
273273 12
274274 13
275275 14
276276 15
277277 16
278278 17
279279 18
280280 19
281281 20
282282 21
283283 22
284284 23
285285 24
286286
287287 abbreviation "CNS", and Certified Nurse Practitioner and the
288288 abbreviation "CNP".
289289 It shall be unlawful for any person to assume the role or use
290290 the title Advanced Practice Registered Nurse or use the abbreviation
291291 "APRN" or use the respective specialty role titles and abbreviations
292292 or to use any other titles or abbreviatio ns that would reasonably
293293 lead a person to believe the user is an Advanced Practice Registered
294294 Nurse, unless permitted by the Oklahoma Nursing Practice Act. Any
295295 individual doing so shall be guilty of a misdemeanor, which shall be
296296 punishable, upon convictio n, by imprisonment in the county jai l for
297297 not more than one (1) year or by a fine of not less than One Hundred
298298 Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00), or
299299 by both such imprisonment and fine for each offense;
300300 6. "Certified Nurse Practitioner" is an Advanced Practice
301301 Registered Nurse who performs in an expanded role in the delivery of
302302 health care:
303303 a. consistent with advanced educational preparation as a
304304 Certified Nurse Practitioner in an area of specialty,
305305 b. functions within the Cer tified Nurse Practitioner
306306 scope of practice for the selected area of
307307 specialization, and
308308 c. is in accord with the standards for Certified Nurse
309309 Practitioners as identified by the certifying body and
310310 approved by the Board.
311311
312312 Req. No. 10188 Page 7 1
313313 2
314314 3
315315 4
316316 5
317317 6
318318 7
319319 8
320320 9
321321 10
322322 11
323323 12
324324 13
325325 14
326326 15
327327 16
328328 17
329329 18
330330 19
331331 20
332332 21
333333 22
334334 23
335335 24
336336
337337 A Certified Nurse Practitioner sha ll be eligible, in accordance
338338 with the scope of practice of the Certified Nurse Practitioner, to
339339 obtain recognition as authorized by the Board to prescribe, as
340340 defined by the rules promulgated by the Board pursuant to this
341341 section and subject to the medica l direction of a supervising
342342 physician. After two (2) years of supervision by a physician, a
343343 Certified Nurse Practitioner may exercise his or her license without
344344 the supervision and medical dir ection of a supervising physic ian.
345345 This authorization shall n ot include dispensing drugs, but shall not
346346 preclude, subject to federal regulations, the r eceipt of, the
347347 signing for, or the dispensing of professional samples to patients.
348348 The Certified Nurse Practitioner accepts responsibil ity,
349349 accountability, and obliga tion to practice in accordance with usual
350350 and customary advanced practice registered nursi ng standards and
351351 functions as defined by the scope of practice/role definition
352352 statements for the Certified Nurse Practitioner;
353353 7. a. "Clinical Nurse Specialist " is an Advanced Practice
354354 Registered Nurse who holds:
355355 (1) a master's degree or higher in nursing with
356356 clinical specialization preparation to function
357357 in an expanded role,
358358 (2) specialty certification from a national
359359 certifying organization recognized by the Board ,
360360
361361 Req. No. 10188 Page 8 1
362362 2
363363 3
364364 4
365365 5
366366 6
367367 7
368368 8
369369 9
370370 10
371371 11
372372 12
373373 13
374374 14
375375 15
376376 16
377377 17
378378 18
379379 19
380380 20
381381 21
382382 22
383383 23
384384 24
385385
386386 (3) an Advanced Practice Registered Nurse license
387387 from the Board, and
388388 (4) any nurse holding a specialty certification as a
389389 Clinical Nurse Specialist valid on January 1,
390390 1994, granted by a national certifying
391391 organization recognized by the Board, shall be
392392 deemed to be a Clinical Nurse Specialist under
393393 the provisions of the Oklahoma Nursing Pra ctice
394394 Act.
395395 b. In the expanded role, the Clinical Nurse Specialist
396396 performs at an advanced practice level which shall
397397 include, but not be limited to:
398398 (1) practicing as an expert clinician in the
399399 provision of direct nursing care to a selected
400400 population of patients or clients in any setting,
401401 including private practice,
402402 (2) managing the care of patients or clients with
403403 complex nursing proble ms,
404404 (3) enhancing patient or cl ient care by integrating
405405 the competencies of clinical practic e, education,
406406 consultation, and research, and
407407 (4) referring patients or clients to other services.
408408 c. A Clinical Nurse Specialist in accordance with the
409409 scope of practice of such Clinical Nurse S pecialist
410410
411411 Req. No. 10188 Page 9 1
412412 2
413413 3
414414 4
415415 5
416416 6
417417 7
418418 8
419419 9
420420 10
421421 11
422422 12
423423 13
424424 14
425425 15
426426 16
427427 17
428428 18
429429 19
430430 20
431431 21
432432 22
433433 23
434434 24
435435
436436 shall be eligible to obtain recognition as authoriz ed
437437 by the Board to prescribe, as defined by the rules
438438 promulgated by the Board pursuant to this section, and
439439 subject to the medical direction of a supervising
440440 physician. This authorization shall not include
441441 dispensing drugs, but shall not preclude, subjec t to
442442 federal regulations, the receipt of, the signing for,
443443 or the dispensing of professional samples to patients.
444444 d. The Clinical Nurse Specialist accepts responsib ility,
445445 accountability, and obli gation to practice in
446446 accordance with usual and customary adv anced practice
447447 nursing standards and functions as defined by the
448448 scope of practice/role definition statements for the
449449 Clinical Nurse Specialist;
450450 8. "Nurse-Midwife" is a nurse who has received an Advanced
451451 Practice Registered Nurse license from the Oklahoma Board of Nursing
452452 who possesses evidence of certification according to the
453453 requirements of the American College of Nurse -Midwives.
454454 A Certified Nurse-Midwife in accordance with the scope of
455455 practice of such Certified Nurse -Midwife shall be eligible to obtai n
456456 recognition as authorized b y the Board to prescribe, as defined by
457457 the rules promulgated by the Board pursuant to this section and
458458 subject to the medical directio n of a supervising physician. This
459459 authorization shall not include the dispensing of drugs, but shall
460460
461461 Req. No. 10188 Page 10 1
462462 2
463463 3
464464 4
465465 5
466466 6
467467 7
468468 8
469469 9
470470 10
471471 11
472472 12
473473 13
474474 14
475475 15
476476 16
477477 17
478478 18
479479 19
480480 20
481481 21
482482 22
483483 23
484484 24
485485
486486 not preclude, subject to federal regulations, the receipt of, the
487487 signing for, or the dispensing of professional samples to patients.
488488 The Certified Nurse-Midwife accepts responsibility ,
489489 accountability, and obligation to practice in accordance wi th usual
490490 and customary advanc ed practice registered nursing standards and
491491 functions as defined by the scope of practice/role definition
492492 statements for the Certified Nurse-Midwife;
493493 9. "Nurse-midwifery practice" means providing management of
494494 care of normal newborns and women, anteparta lly, intrapartally,
495495 postpartally and gynecologically, occurring within a health care
496496 system which provides for medical consultation, me dical management
497497 or referral, and is in accord with the standards for nurse -midwifery
498498 practice as defined by the American College of Nurse-Midwives;
499499 10. a. "Certified Registered Nurse Anesthetist " is an
500500 Advanced Practice Registered Nurse who:
501501 (1) is certified by the National Board of
502502 Certification and Recertification for Nurse
503503 Anesthetists as a Certified Registered Nurse
504504 Anesthetist within one (1) year following
505505 completion of an approved certified registered
506506 nurse anesthetist education program, and
507507 continues to maintain such recertificat ion by the
508508 National Board of Certification and
509509 Recertification for Nurse Anesthetists, and
510510
511511 Req. No. 10188 Page 11 1
512512 2
513513 3
514514 4
515515 5
516516 6
517517 7
518518 8
519519 9
520520 10
521521 11
522522 12
523523 13
524524 14
525525 15
526526 16
527527 17
528528 18
529529 19
530530 20
531531 21
532532 22
533533 23
534534 24
535535
536536 (2) administers anesthesia in collaboration with a
537537 medical doctor, an osteopathic physician, a
538538 podiatric physician or a dentist licens ed in this
539539 state and under cond itions in which timely onsite
540540 consultation by such doctor, os teopath, podiatric
541541 physician or dentist is available.
542542 b. A Certified Registered Nurse Anesthetist, in
543543 collaboration with a medical doctor, osteopathic
544544 physician, podiatric physician or dentist li censed in
545545 this state, and under conditions in which timely, o n-
546546 site consultation by such m edical doctor, osteopathic
547547 physician, podiatric physician or dentist is
548548 available, shall be authorized, pursuant to rules
549549 adopted by the Oklahoma Board of Nursing, to order,
550550 select, obtain and administer legend drugs, Schedules
551551 II through V controlled subs tances, devices, and
552552 medical gases only when engaged in the preanesthetic
553553 preparation and evaluation; anesthesia induction,
554554 maintenance and emergence; and postanesthe sia care. A
555555 Certified Registered Nurse Anesthetist may order ,
556556 select, obtain and administer drugs only during the
557557 perioperative or periobstetrical period.
558558
559559 Req. No. 10188 Page 12 1
560560 2
561561 3
562562 4
563563 5
564564 6
565565 7
566566 8
567567 9
568568 10
569569 11
570570 12
571571 13
572572 14
573573 15
574574 16
575575 17
576576 18
577577 19
578578 20
579579 21
580580 22
581581 23
582582 24
583583
584584 c. A Certified Registered Nurse Anesthetist who applies
585585 for authorization to order, select, obtain a nd
586586 administer drugs shall:
587587 (1) be currently recognized as a C ertified Registered
588588 Nurse Anesthetist in this state,
589589 (2) provide evidence of completion, within the two -
590590 year period immediately preceding the date of
591591 application, of a minimum of fifteen (15) uni ts
592592 of continuing education in advanced pharmacology
593593 related to the administration of anest hesia as
594594 recognized by the National Board of Certification
595595 and Recertification for Nurse Anesthetists, and
596596 (3) complete and submit a no tarized application, on a
597597 form prescribed by the Board, accompanied by the
598598 application fee established pursuant to this
599599 section.
600600 d. The authority to order, select, obtain and administer
601601 drugs shall be terminated if a Certified Registered
602602 Nurse Anesthetist has:
603603 (1) ordered, selected, obt ained or administered drugs
604604 outside of the Certified Register ed Nurse
605605 Anesthetist scope of practice or ordered,
606606 selected, obtained or administered drugs for
607607 other than therapeutic purposes, or
608608
609609 Req. No. 10188 Page 13 1
610610 2
611611 3
612612 4
613613 5
614614 6
615615 7
616616 8
617617 9
618618 10
619619 11
620620 12
621621 13
622622 14
623623 15
624624 16
625625 17
626626 18
627627 19
628628 20
629629 21
630630 22
631631 23
632632 24
633633
634634 (2) violated any provision of st ate laws or rules or
635635 federal laws or regulations pertaining to the
636636 practice of nursing or th e authority to order,
637637 select, obtain and administer drugs.
638638 e. The Oklahoma Board of Nursing shall notify the Board
639639 of Pharmacy after termination of or a change in t he
640640 authority to order, select, obtain and administer
641641 drugs for a Certified Registered Nurse Anesthetist.
642642 f. The Board shall provide by rule for biennial
643643 application renewal and reauthorization of authority
644644 to order, select, obtain and administer drugs for
645645 Certified Registered Nurse Anes thetists. At the time
646646 of application renewal, a Certified Re gistered Nurse
647647 Anesthetist shall submit documentation of a minimum of
648648 eight (8) units of continuing education, completed
649649 during the previous two (2) years, in advan ced
650650 pharmacology relating to th e administration of
651651 anesthesia, as recognized by the Council on
652652 Recertification of Nurse A nesthetists or the Council
653653 on Certification of Nurse Anesthetists.
654654 g. This paragraph shall not prohibit the administration
655655 of local or topical anesthetics as now perm itted by
656656 law. Provided further, nothing in this paragraph
657657 shall limit the authority of the Board of Dentistry to
658658
659659 Req. No. 10188 Page 14 1
660660 2
661661 3
662662 4
663663 5
664664 6
665665 7
666666 8
667667 9
668668 10
669669 11
670670 12
671671 13
672672 14
673673 15
674674 16
675675 17
676676 18
677677 19
678678 20
679679 21
680680 22
681681 23
682682 24
683683
684684 establish the qualifications for dentists who direct
685685 the administration of anesthesia.
686686 h. As used in this parag raph, "collaboration" means an
687687 agreement between a medical doctor, osteopathic
688688 physician, podiatric physician or dentist performing
689689 the procedure or directly involved with the procedure
690690 and the Certified Registered Nurse Anesthetist working
691691 jointly toward a common goal providing service s for
692692 the same patient. This collaboration involves the
693693 joint formulation, discussion and agreement of the
694694 anesthesia plan by both parties, and the collaborating
695695 medical doctor, osteopathic physician, podiatric
696696 physician or dentist performing the procedur e or
697697 directly involved with the procedure and that
698698 collaborating physician shall remain av ailable for
699699 timely onsite consultation during the delivery of
700700 anesthesia for diagnosis, consultation, and treatment
701701 of medical conditions;
702702 11. "Supervising physician " means an individual holding a
703703 current license to practice a s a physician from the State Board of
704704 Medical Licensure and Supervision or the State Board of Osteopathic
705705 Examiners, who supervises a Certified Nurse Practitioner, a Clinical
706706 Nurse Specialist, or a Certified Nurse-Midwife, and who is not in
707707 training as an intern, resident, or fellow. To be eligible to
708708
709709 Req. No. 10188 Page 15 1
710710 2
711711 3
712712 4
713713 5
714714 6
715715 7
716716 8
717717 9
718718 10
719719 11
720720 12
721721 13
722722 14
723723 15
724724 16
725725 17
726726 18
727727 19
728728 20
729729 21
730730 22
731731 23
732732 24
733733
734734 supervise such Advanced Practice Registered Nurse, such physician
735735 shall remain in compliance with the rules promulga ted by the State
736736 Board of Medical Licensure and Supervision or the State Board of
737737 Osteopathic Examiners;
738738 12. "Supervision of an Advanced Practice Registered Nurse with
739739 prescriptive authority " means overseeing and accepting
740740 responsibility for the ordering and transmission by a Certified
741741 Nurse Practitioner, a Clinical Nurse Specialist, or a Certif ied
742742 Nurse-Midwife of written, telephonic, electronic or oral
743743 prescriptions for drugs and other medical supplies, subject to a
744744 defined formulary; and
745745 13. "Advanced Unlicensed Assistant " means any person who has
746746 successfully completed a certified training p rogram approved by the
747747 Board that trains the Advanced Unlicensed Assistant to perform
748748 specified technical skills identified by the Board in acute care
749749 settings under the direction and supervision of the Registered Nurse
750750 or Licensed Practical Nurse.
751751 SECTION 2. This act shall become effective November 1, 2022.
752752
753753 58-2-10188 KN 01/10/22