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STATE OF OKLAHOMA
2nd Session of the 58th Legislature (2022)
HOUSE BILL 3683 By: Roberts (Sean)
AS INTRODUCED
An Act relating to nurse practitioners; amending 59
O.S. 2021, Section 567.3a, which relates to
definitions; modifying definition for Certified Nurse
Practitioner; modifying supervision req uirement after
two years of practice; and providing an effective
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 59 O.S. 2021, Section 567.3a, is
amended to read as follows :
Section 567.3a As used in the Oklahoma Nursing Practice Act:
1. "Board" means the Oklahoma Board of Nursing;
2. "The practice of nursing " means the performance of services
provided for purposes of nursing d iagnosis and treatment of human
responses to actual or potential health problems consistent with
educational preparation. Knowledge and skill are the basis for
assessment, analysis, planning, intervention, and evaluation used in
the promotion and maintena nce of health and nursing management of
illness, injury, infirmity, restoration or optimal function, or
death with dignity. Practice is based on understanding the human
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condition across the human lifespan and understanding the
relationship of the individu al within the environment. This
practice includes execution of the medical regime including the
administration of medications and treatments prescribed by any
person authorized by state law to so prescribe;
3. "Registered nursing" means the practice of t he full scope of
nursing which includes, but is not limited to:
a. assessing the health status of individuals, families
and groups,
b. analyzing assessment data to determine nursing care
needs,
c. establishing goals to meet identified health care
needs,
d. planning a strategy of care,
e. establishing priorities of nursing intervention to
implement the strategy of care,
f. implementing the strategy of care,
g. delegating such tasks as may safely be performed by
others, consistent with educational preparation and
that do not conflict with the p rovisions of the
Oklahoma Nursing Practice Act,
h. providing safe and effective nursing care rendered
directly or indirectly,
i. evaluating responses to interventions,
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j. teaching the principles and practice of nursing,
k. managing and supervising the prac tice of nursing,
l. collaborating with other health professionals in the
management of health care,
m. performing additional nursing functions in accordance
with knowledge and skills acquired beyond basic
nursing preparation, and
n. delegating those nursin g tasks as defined in the rules
of the Board that may be performed by an advanced
unlicensed assistive person;
4. "Licensed practical nursing " means the practice of nursing
under the supervision or direction of a regist ered nurse, licensed
physician or dentist. This directed scope of nursing practice
includes, but is not limited to:
a. contributing to the assessment of the health status of
individuals and groups,
b. participating in the development and modification of
the plan of care,
c. implementing the appropriate aspects of the plan of
care,
d. delegating such tasks as may safely be performed by
others, consistent with educational preparation and
that do not conflict with the Oklahoma Nursing
Practice Act,
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e. providing safe and effective nursing care r endered
directly or indirectly,
f. participating in the evaluation of responses to
interventions,
g. teaching basic nursing skills and related principles,
h. performing additional nursing procedures in accordance
with knowledge and skills acquired through education
beyond nursing preparation, and
i. delegating those nursing tasks as defined in the rules
of the Board that may be performed by an advanced
unlicensed assistive person;
5. "Advanced Practice Registered Nurse " means a licensed
Registered Nurse:
a. who has completed an advanced practice registered
nursing education program in preparation for one of
four recognized advanced practice registered nurse
roles,
b. who has passed a national certification examination
recognized by the Board that measures t he advanced
practice registered nurse role and specialty
competencies and who maintains recertification in the
role and specialty through a national certification
program,
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c. who has acquired advanced clinical knowledge and
skills in preparation for provid ing both direct and
indirect care to patients; however, the defining
factor for all Advanced Practice Registered Nurses is
that a significant component of the education and
practice focuses on direct care of individuals,
d. whose practice builds on the com petencies of
Registered Nurses by demonstrating a greater depth and
breadth of knowledge, a greater synthesis of data, and
increased complexity of skills and interventions, and
e. who has obtained a license as an Advance d Practice
Registered Nurse in one o f the following roles:
Certified Registered Nurse Anesthetist, Certified
Nurse-Midwife, Clinical Nurse Specialist, or Certified
Nurse Practitioner.
Only those persons who hold a license to practice advanced
practice registered nursing in this state shall have the right to
use the title "Advanced Practice Registered Nurse " and to use the
abbreviation "APRN". Only those persons who have obtained a license
in the following disciplines shall have the right to fulfill the
roles and use the applicable titles: Certified Registered Nurse
Anesthetist and the abbreviation "CRNA", Certified Nurse-Midwife and
the abbreviation "CNM", Clinical Nurse Specialist and the
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abbreviation "CNS", and Certified Nurse Practitioner and the
abbreviation "CNP".
It shall be unlawful for any person to assume the role or use
the title Advanced Practice Registered Nurse or use the abbreviation
"APRN" or use the respective specialty role titles and abbreviations
or to use any other titles or abbreviatio ns that would reasonably
lead a person to believe the user is an Advanced Practice Registered
Nurse, unless permitted by the Oklahoma Nursing Practice Act. Any
individual doing so shall be guilty of a misdemeanor, which shall be
punishable, upon convictio n, by imprisonment in the county jai l for
not more than one (1) year or by a fine of not less than One Hundred
Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00), or
by both such imprisonment and fine for each offense;
6. "Certified Nurse Practitioner" is an Advanced Practice
Registered Nurse who performs in an expanded role in the delivery of
health care:
a. consistent with advanced educational preparation as a
Certified Nurse Practitioner in an area of specialty,
b. functions within the Cer tified Nurse Practitioner
scope of practice for the selected area of
specialization, and
c. is in accord with the standards for Certified Nurse
Practitioners as identified by the certifying body and
approved by the Board.
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A Certified Nurse Practitioner sha ll be eligible, in accordance
with the scope of practice of the Certified Nurse Practitioner, to
obtain recognition as authorized by the Board to prescribe, as
defined by the rules promulgated by the Board pursuant to this
section and subject to the medica l direction of a supervising
physician. After two (2) years of supervision by a physician, a
Certified Nurse Practitioner may exercise his or her license without
the supervision and medical dir ection of a supervising physic ian.
This authorization shall n ot include dispensing drugs, but shall not
preclude, subject to federal regulations, the r eceipt of, the
signing for, or the dispensing of professional samples to patients.
The Certified Nurse Practitioner accepts responsibil ity,
accountability, and obliga tion to practice in accordance with usual
and customary advanced practice registered nursi ng standards and
functions as defined by the scope of practice/role definition
statements for the Certified Nurse Practitioner;
7. a. "Clinical Nurse Specialist " is an Advanced Practice
Registered Nurse who holds:
(1) a master's degree or higher in nursing with
clinical specialization preparation to function
in an expanded role,
(2) specialty certification from a national
certifying organization recognized by the Board ,
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(3) an Advanced Practice Registered Nurse license
from the Board, and
(4) any nurse holding a specialty certification as a
Clinical Nurse Specialist valid on January 1,
1994, granted by a national certifying
organization recognized by the Board, shall be
deemed to be a Clinical Nurse Specialist under
the provisions of the Oklahoma Nursing Pra ctice
Act.
b. In the expanded role, the Clinical Nurse Specialist
performs at an advanced practice level which shall
include, but not be limited to:
(1) practicing as an expert clinician in the
provision of direct nursing care to a selected
population of patients or clients in any setting,
including private practice,
(2) managing the care of patients or clients with
complex nursing proble ms,
(3) enhancing patient or cl ient care by integrating
the competencies of clinical practic e, education,
consultation, and research, and
(4) referring patients or clients to other services.
c. A Clinical Nurse Specialist in accordance with the
scope of practice of such Clinical Nurse S pecialist
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shall be eligible to obtain recognition as authoriz ed
by the Board to prescribe, as defined by the rules
promulgated by the Board pursuant to this section, and
subject to the medical direction of a supervising
physician. This authorization shall not include
dispensing drugs, but shall not preclude, subjec t to
federal regulations, the receipt of, the signing for,
or the dispensing of professional samples to patients.
d. The Clinical Nurse Specialist accepts responsib ility,
accountability, and obli gation to practice in
accordance with usual and customary adv anced practice
nursing standards and functions as defined by the
scope of practice/role definition statements for the
Clinical Nurse Specialist;
8. "Nurse-Midwife" is a nurse who has received an Advanced
Practice Registered Nurse license from the Oklahoma Board of Nursing
who possesses evidence of certification according to the
requirements of the American College of Nurse -Midwives.
A Certified Nurse-Midwife in accordance with the scope of
practice of such Certified Nurse -Midwife shall be eligible to obtai n
recognition as authorized b y the Board to prescribe, as defined by
the rules promulgated by the Board pursuant to this section and
subject to the medical directio n of a supervising physician. This
authorization shall not include the dispensing of drugs, but shall
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not preclude, subject to federal regulations, the receipt of, the
signing for, or the dispensing of professional samples to patients.
The Certified Nurse-Midwife accepts responsibility ,
accountability, and obligation to practice in accordance wi th usual
and customary advanc ed practice registered nursing standards and
functions as defined by the scope of practice/role definition
statements for the Certified Nurse-Midwife;
9. "Nurse-midwifery practice" means providing management of
care of normal newborns and women, anteparta lly, intrapartally,
postpartally and gynecologically, occurring within a health care
system which provides for medical consultation, me dical management
or referral, and is in accord with the standards for nurse -midwifery
practice as defined by the American College of Nurse-Midwives;
10. a. "Certified Registered Nurse Anesthetist " is an
Advanced Practice Registered Nurse who:
(1) is certified by the National Board of
Certification and Recertification for Nurse
Anesthetists as a Certified Registered Nurse
Anesthetist within one (1) year following
completion of an approved certified registered
nurse anesthetist education program, and
continues to maintain such recertificat ion by the
National Board of Certification and
Recertification for Nurse Anesthetists, and
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(2) administers anesthesia in collaboration with a
medical doctor, an osteopathic physician, a
podiatric physician or a dentist licens ed in this
state and under cond itions in which timely onsite
consultation by such doctor, os teopath, podiatric
physician or dentist is available.
b. A Certified Registered Nurse Anesthetist, in
collaboration with a medical doctor, osteopathic
physician, podiatric physician or dentist li censed in
this state, and under conditions in which timely, o n-
site consultation by such m edical doctor, osteopathic
physician, podiatric physician or dentist is
available, shall be authorized, pursuant to rules
adopted by the Oklahoma Board of Nursing, to order,
select, obtain and administer legend drugs, Schedules
II through V controlled subs tances, devices, and
medical gases only when engaged in the preanesthetic
preparation and evaluation; anesthesia induction,
maintenance and emergence; and postanesthe sia care. A
Certified Registered Nurse Anesthetist may order ,
select, obtain and administer drugs only during the
perioperative or periobstetrical period.
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c. A Certified Registered Nurse Anesthetist who applies
for authorization to order, select, obtain a nd
administer drugs shall:
(1) be currently recognized as a C ertified Registered
Nurse Anesthetist in this state,
(2) provide evidence of completion, within the two -
year period immediately preceding the date of
application, of a minimum of fifteen (15) uni ts
of continuing education in advanced pharmacology
related to the administration of anest hesia as
recognized by the National Board of Certification
and Recertification for Nurse Anesthetists, and
(3) complete and submit a no tarized application, on a
form prescribed by the Board, accompanied by the
application fee established pursuant to this
section.
d. The authority to order, select, obtain and administer
drugs shall be terminated if a Certified Registered
Nurse Anesthetist has:
(1) ordered, selected, obt ained or administered drugs
outside of the Certified Register ed Nurse
Anesthetist scope of practice or ordered,
selected, obtained or administered drugs for
other than therapeutic purposes, or
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(2) violated any provision of st ate laws or rules or
federal laws or regulations pertaining to the
practice of nursing or th e authority to order,
select, obtain and administer drugs.
e. The Oklahoma Board of Nursing shall notify the Board
of Pharmacy after termination of or a change in t he
authority to order, select, obtain and administer
drugs for a Certified Registered Nurse Anesthetist.
f. The Board shall provide by rule for biennial
application renewal and reauthorization of authority
to order, select, obtain and administer drugs for
Certified Registered Nurse Anes thetists. At the time
of application renewal, a Certified Re gistered Nurse
Anesthetist shall submit documentation of a minimum of
eight (8) units of continuing education, completed
during the previous two (2) years, in advan ced
pharmacology relating to th e administration of
anesthesia, as recognized by the Council on
Recertification of Nurse A nesthetists or the Council
on Certification of Nurse Anesthetists.
g. This paragraph shall not prohibit the administration
of local or topical anesthetics as now perm itted by
law. Provided further, nothing in this paragraph
shall limit the authority of the Board of Dentistry to
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establish the qualifications for dentists who direct
the administration of anesthesia.
h. As used in this parag raph, "collaboration" means an
agreement between a medical doctor, osteopathic
physician, podiatric physician or dentist performing
the procedure or directly involved with the procedure
and the Certified Registered Nurse Anesthetist working
jointly toward a common goal providing service s for
the same patient. This collaboration involves the
joint formulation, discussion and agreement of the
anesthesia plan by both parties, and the collaborating
medical doctor, osteopathic physician, podiatric
physician or dentist performing the procedur e or
directly involved with the procedure and that
collaborating physician shall remain av ailable for
timely onsite consultation during the delivery of
anesthesia for diagnosis, consultation, and treatment
of medical conditions;
11. "Supervising physician " means an individual holding a
current license to practice a s a physician from the State Board of
Medical Licensure and Supervision or the State Board of Osteopathic
Examiners, who supervises a Certified Nurse Practitioner, a Clinical
Nurse Specialist, or a Certified Nurse-Midwife, and who is not in
training as an intern, resident, or fellow. To be eligible to
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supervise such Advanced Practice Registered Nurse, such physician
shall remain in compliance with the rules promulga ted by the State
Board of Medical Licensure and Supervision or the State Board of
Osteopathic Examiners;
12. "Supervision of an Advanced Practice Registered Nurse with
prescriptive authority " means overseeing and accepting
responsibility for the ordering and transmission by a Certified
Nurse Practitioner, a Clinical Nurse Specialist, or a Certif ied
Nurse-Midwife of written, telephonic, electronic or oral
prescriptions for drugs and other medical supplies, subject to a
defined formulary; and
13. "Advanced Unlicensed Assistant " means any person who has
successfully completed a certified training p rogram approved by the
Board that trains the Advanced Unlicensed Assistant to perform
specified technical skills identified by the Board in acute care
settings under the direction and supervision of the Registered Nurse
or Licensed Practical Nurse.
SECTION 2. This act shall become effective November 1, 2022.
58-2-10188 KN 01/10/22