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SENATE FLOOR VERSION
February 9, 2023
COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 458 By: Stanley, Green, Hamilton,
and Young
[ nursing - prescriptive authority – application -
supervision - controlled dangerous substances -
supervision requirement – codification - effective
date ]
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 567.4c of Title 59, unless there
is created a duplication in numbering, reads as follows:
A. 1. An Advanced Practice Registered Nurse recognized by the
Oklahoma Board of Nursing as a Certified Nurse Practitioner ,
Clinical Nurse Specialist , or Certified Nurse-Midwife who has
completed a minimum of two thousand (2,000) hours of practice with
prescriptive authority supervised by a physician or a supervising
Advanced Practice Registered Nurse may apply to the Oklahoma Board
of Nursing for authority to prescribe and order independent of
supervision. This paragraph shall not be construed to exclude
practice hours with supervised prescriptive authority obtained prior
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to the effective date of this act from being counted toward the two -
thousand-hour requirement of t his paragraph.
2. The application for independent prescriptive authority shall
include proof that the Certified Nurse Practitioner , Clinical Nurse
Specialist, or Certified Nurse -Midwife:
a. holds a valid, current license in the appropriate
Advanced Practice Registered Nurse role issued by the
Board and is in good standing with the Board, and
b. has completed a minimum of two thousand (2,000) hours
of practice with prescriptive authority supervised by
a physician or supervising Advanced Practice
Registered Nurse.
3. Independent prescriptive authority granted under this
subsection shall be valid until the expiration of the cu rrent
license to practice and may be r enewed upon application to the Board
at the same time and for the same period as the renewal of the
license to practice.
B. 1. A Certified Nurse Practitioner, Clinical Nurse
Specialist, or Certified Nurse-Midwife who has obtained independent
prescriptive authority under subsection A of this section and who
has completed a minimum of eight thousand (8,000) hours of practice
with independent prescriptive authority may serve as a supervising
Advanced Practice Registered Nurse.
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2. Notwithstanding paragraph 1 of this subsection, an Advanced
Practice Registered Nurse who has been licensed and in practice for
a minimum of five (5) years as of the effective date of this act
without a lapse of work , upon obtainment of independent prescri ptive
authority under subsection A of this section , may serve as a
supervising Advanced Practice Registered Nurse.
3. The Board may at its discretion prescribe by rule additional
qualifications for supervising Advanced Practice Registered Nurses
including, but not limited to, qualifications pertaining to the
Advanced Practice Registered Nurse role or specialty.
C. The Board shall review any application submitted under this
section and shall approve or deny the application, stating the
reason or reasons for denial, if denied. If denied, the applicant
may reapply using the process prescribed b y subsection A of this
section.
D. The Board may suspend or revoke independent prescriptive
authority granted under this section for good cause at any time.
E. The Board may establish a fee for the review of initial and
renewal applications under the pro visions of this section.
SECTION 2. AMENDATORY 59 O.S. 2021, Section 353.1, as
amended by Section 6, Chap ter 288, O.S.L. 2022 (59 O.S. Supp. 2022,
Section 353.1), is amended to r ead as follows:
Section 353.1. For the purposes of the Oklahoma Pharmacy Act:
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1. “Accredited program” means those seminars, classes,
meetings, work projects, and other educational courses approved by
the Board State Board of Pharmacy for purposes of continuing
professional education;
2. “Act” means the Oklahoma Pharmacy Act;
3. “Administer” means the direct applicati on of a drug, whether
by injection, inhalation, ingestion or any other means, to the body
of a patient;
4. “Assistant pharmacist” means any person presently licen sed
as an assistant pharmacist in the State of Oklahom a this state by
the Board pursuant to S ection 353.10 of this title and for the
purposes of the Oklahoma Pharmacy Act shal l be considered the same
as a pharmacist, except where otherwise specified;
5. “Board” or “State Board” means the State Board of Pharmacy;
6. “Certify” or “certification of a prescription” means the
review of a filled prescription by a licensed pharmac ist or a
licensed practitioner with dispensing authority to confirm that the
medication, labeling and packaging of the filled prescription are
accurate and meet all requirement s prescribed by state and federal
law. For the purposes of this paragraph, “licensed practitioner”
shall not include optometrists with dispensing authority;
7. “Chemical” means any medicinal substance, whether simple or
compound or obtained through the p rocess of the science and art of
chemistry, whether of organic or inorganic ori gin;
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8. “Compounding” means the combining, admixing, mixing,
diluting, pooling, reconstituting or otherwise altering of a drug or
bulk drug substance to create a drug. Compounding includes the
preparation of drugs or devices in anticipation of prescript ion drug
orders based on routine, regularly observed prescribing patterns;
9. “Continuing professional education” means professional,
pharmaceutical education in the general are as of the socioeconomic
and legal aspects of health care; the properties and actions of
drugs and dosage forms; and the etiology, characteristics and
therapeutics of the dise ased state;
10. “Dangerous drug”, “legend drug”, “prescription drug” or “Rx
Only” means a drug:
a. for human use subject to 21 U.S.C. 353(b)(1), or
b. is labeled “Prescription Only”, or labeled with the
following statement: “Caution: Federal law restricts
this drug except for to use by or on the order of a
licensed veterinarian.”;
11. “Director” means the Executive Director of the State Board
of Pharmacy unless context clearly indicates otherwise;
12. “Dispense” or “dispensing” means the interpretation,
evaluation, and implementatio n of a prescription d rug order
including the preparati on and delivery of a drug or device to a
patient or a patient’s agent in a suitable container appropria tely
labeled for subsequent administration to, or use by, a patient .
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Dispense includes sell, distr ibute, leave with, gi ve away, dispose
of, deliver or supply;
13. “Dispenser” means a retail pharmacy, hospital pharmacy, a
group of chain pharmacies under c ommon ownership and control that do
not act as a wholesale distributor, or any other person authori zed
by law to dispense or administer prescription drug s, and the
affiliated warehouses or distributions of such entities under common
ownership and control t hat do not act as a wholesale distributor.
For the purposes of this pa ragraph, “dispenser” dispenser does not
mean a person who dispenses only products to be used in animals in
accordance with 21 U.S.C. 360b(a)(5);
14. “Distribute” or “distribution” means the sale, purchase,
trade, delivery, handling, storage, or receipt of a product , and
does not include the d ispensing of a product pursuant to a
prescription executed in accordance with 21 U.S. C. 353(b)(1) or the
dispensing of a product approved under 21 U.S.C. 360 b(b); provided,
taking actual physical possession of a product or title shall not be
required;
15. “Doctor of Pharmacy” means a person licensed by the Board
to engage in the practice of pharmacy. The terms “pharmacist”,
“D.Ph.”, and “Doctor of Pharmacy” shall be interchangeable and shall
have the same meaning wherever they appear in the Oklahoma Statu tes
and the rules promulgated by the Board;
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16. “Drug outlet” means all manufacturer s, repackagers,
outsourcing facilities, wholesale distributors, third-party
logistics providers, pharmacies, and all other facilities which are
engaged in dispensing, deli very, distribution or storage of
dangerous drugs;
17. “Drugs” means all medicinal su bstances and preparations
recognized by the United States Pharmacopoeia Pharmacopeia and
National Formulary, or any revision thereof, and all substances an d
preparations intended for external and/or internal us e in the cure,
diagnosis, mitigation, treatment or preventi on of disease in humans
or animals and all substances and preparations, other than food,
intended to affect the structure or any function of t he body of a
human or animals;
18. “Drug sample” means a unit of a prescription drug packaged
under the authority and responsibility of the manufacturer that is
not intended to be sold and is intended to promote the sale of the
drug;
19. “Durable medical equipment” has the same meaning as
provided by Section 2 of this act Section 375.2 of this title;
20. “Filled prescription” means a packaged prescription
medication to which a label has been affixed which contain s such
information as is required by the Oklahoma Pharmacy Act;
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21. “Hospital” means any institution licensed as a hospital by
this state for the care a nd treatment of patients, or a pharmacy
operated by the Oklahoma Department of Vet erans Affairs;
22. “Licensed practitioner” means:
a. an allopathic physician,
b. an osteopathic physician,
c. a podiatric physician,
d. a dentist,
e. a veterinarian or,
f. an optometrist, or
g. a Certified Nurse Practitioner, Clinical Nurse
Specialist, or Certified Nurse -Midwife who has
obtained independent prescriptive authority under
Section 1 of this act,
licensed to practice and authorized to prescribe dangerous drugs
within the scope of practice of such p ractitioner;
23. “Manufacturer” or “virtual manufacturer” means with respect
to a product:
a. a person that holds an application approved under 21
U.S.C. 355 or a license issued under 42 U.S.C. 262 for
such product, or if such product is not the subject of
an approved application or license, the person who
manufactured the pro duct,
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b. a co-licensed partner of the person described in
subparagraph a of this paragraph that obtains the
product directly from a person described in this
subparagraph or subparagraph a of this paragraph,
c. an affiliate of a person described in subpara graph a
or b of this paragraph who receives the product
directly from a person described in this s ubparagraph
or in subparagraph a or b of this paragraph, or
d. a person who contracts with another to manufacture a
product;
24. “Manufacturing” means the production, preparation,
propagation, compounding, conversion or processing of a device or a
drug, either directly or indirectly by extraction from substances of
natural origin or independently by means of chemic al or biological
synthesis and includes any packaging or repackaging of the
substances or labeling or relabeling of its container, and the
promotion and marketing of such drugs or devices. The term
“manufacturing” manufacturing also includes the preparation and
promotion of commercially available products from bulk compounds for
resale by licensed pharmacies, licensed practitioners or other
persons;
25. “Medical gas” means those gases including those in liquid
state upon which the manufacturer or distributor has placed one of
several cautions, such as “Rx Only”, in compliance with federal l aw;
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26. “Medical gas order” means an order for medical g as issued
by a licensed prescriber;
27. “Medical gas distributor” means a person licensed to
distribute, transfer, wholesale, deliver or se ll medical gases on
drug orders to suppliers or oth er entities licensed to use,
administer or distribute medical gas and may also include a patient
or ultimate user;
28. “Medical gas supplier” means a person who di spenses medical
gases on drug orders only to a patient or ultimate user;
29. “Medicine” means any drug or combination of drugs which has
the property of curing, preventing, treating, diagnosing or
mitigating diseases, or which is used for that purpose;
30. “Nonprescription drugs ” means medicines or drugs which are
sold without a prescription and which are prepackaged for use by the
consumer and labeled in ac cordance with the requirements of the
statutes and regulations of this state and the federal gov ernment.
Such items shall also include medi cal and dental supplies and
bottled or nonbulk chemicals which are sold or offered for sale to
the general public if such articles or preparations meet the
requirements of the Federal Food, Drug, and Cosmetic Act, 21
U.S.C.A., Section 321 et seq.;
31. “Outsourcing facility” including “virtual outsourcing
facility” means a facility at one geographic location or address
that:
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a. is engaged in the compounding of steril e drugs,
b. has elected to register as an outsourcing facility,
and
c. complies with all requ irements of 21 U.S.C. 353b;
32. “Package” means the smallest individual saleable unit of
product for distribution by a manufacturer or repackager that is
intended by the manufacturer for ultimate s ale to the dispenser of
such product. For the purposes of this paragraph, “individual
saleable unit” means the smallest container of a product introduced
into commerce by the manufacturer or repackager that is intended by
the manufacturer or repackager fo r individual sale to a dispenser;
33. “Person” means an individual, partnership, limited
liability company, corporation or association, unless the context
otherwise requires;
34. “Pharmacist-in-charge” or “PIC” means the pharmacist
licensed in this state responsible for the management control of a
pharmacy and all other aspects of the practice of pharmacy in a
licensed pharmacy as defined by Section 353.18 of this title;
35. “Pharmacy” means a place regularly licensed by the State
Board of Pharmacy in which prescriptions, drug s, medicines,
chemicals and poisons are compounded or dispensed or such place
where pharmacists practice the profession of pharmacy, or a pharmacy
operated by the Oklahoma Department of Veterans Affairs;
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36. “Pharmacy technician”, “technician”, “Rx tech”, or “tech”
means a person issued a Technician permit by the State Board of
Pharmacy to assist the pharmacist and perform nonjudgmental,
technical, manipulative, non-discretionary functions in the
prescription department under the immediate and direct super vision
of a pharmacist;
37. “Poison” means any substance which when introduced into the
body, either directly or by absorption, produces violent, morbid or
fatal changes, or which destroys living tissue with which such
substance comes into contact;
38. “Practice of pharmacy” means:
a. the interpretation and evaluation of prescription
orders,
b. the compounding, dispensing, administering and
labeling of drugs and devices, except labeling by a
manufacturer, repackager or distributor of
nonprescription drugs and commercially packaged legend
drugs and devices,
c. the participation in drug selection and drug
utilization reviews,
d. the proper and safe storage of drugs and devices and
the maintenance of proper records thereof,
e. the responsibility for advising by counseling and
providing information, where professionally necessary
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or where regulated, of therapeutic values, content,
hazards and use of drugs and devices,
f. the offering or performing of those ac ts, services,
operations or transactions necessary in the conduct,
operation, management and c ontrol of a pharmacy, or
g. the provision of those acts or services that are
necessary to provide pharmaceutical care;
39. “Preparation” means an article which may or may not contain
sterile products compounded in a licensed pharmacy pursuant to the
order of a licensed prescriber;
40. “Prescriber” means a person licensed in this state who is
authorized to prescribe dangerous drugs within the scope of practice
of the person’s profession;
41. “Prescription” means and includes any order for drug or
medical supplies written or signed, or transmitted by word of mouth,
telephone or other means of communication:
a. by a licensed prescriber,
b. under the supervision of an Oklahoma licensed
practitioner, an Oklahoma licensed advanced practice
registered nurse or an Oklahoma licensed a supervising
physician, by a physician assistant licensed in this
state, or
c. (1) under the supervision of a supervising physician
or supervising Advanced Practice Registered
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Nurse, by a Certified Nurse Practitioner,
Clinical Nurse Specialist, or Certified Nurse-
Midwife licensed in this state who has not
obtained independent prescriptive authority under
Section 1 of this act, or
(2) by a Certified Nurse Practitioner, Clinical Nurs e
Specialist, or Certified Nurse-Midwife licensed
in this state who has obtained independent
prescriptive authority under Section 1 of this
act, or
d. by an Oklahoma licensed wholesaler or distributor as
authorized in Section 353.29.1 of this title;
42. “Product” means a prescription drug in a finished dosage
form for administration to a patient w ithout substantial further
manufacturing, such as capsules, tablets, and lyophilized products
before reconstitution. “Product” does not include blo od components
intended for transfusion, radioactive drugs or biologics and medical
gas;
43. “Repackager”, including “virtual repackager”, means a
person who owns or operates an establishment that repacks and
relabels a product or package for further sale or distribution
without further transaction;
44. “Sterile drug” means a drug that is intended for parenteral
administration, an ophthalmic or oral inhalation drug in aqueous
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format, or a drug that is required to be sterile under sta te and
federal law;
45. “Supervising Advanced Practice Registered Nurse” has the
same meaning as provided by Section 567.3a of this title;
46. “Supervising physician” means an individual holding a
current license to practice as a physician from the State Board of
Medical Licensure and Supervision, pursuant to the provisions of the
Oklahoma Allopathic Medical and Surgical Licensur e and Supervision
Act, or the State Board of Osteopathic Examiners, pursuant to the
provisions of the Oklahoma Osteopathic Medicine Act, who supervises
an advanced practice registered nurse a Certified Nurse
Practitioner, Clinical Nurse Specialist, or Certified Nurse -Midwife
as defined in Section 567.3a of this title who has not obtained
independent prescriptive authority under Section 1 of this act,
and who is not in trai ning as an intern, resident, or fellow . To be
eligible to supervise an advanced practice registered nurse, such
The supervising physician shall remain in compliance with the rules
promulgated by the State Board of Medical Licensure and Supervision
or the State Board of Osteopathic Examiners;
46. 47. “Supportive personnel” means technicians and auxiliary
supportive persons who are regularly paid employees of a pharmacy
who work and perform tasks in the pharmacy as authorized by Section
353.18A of this title;
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47. 48. “Third-party logistics provider” including “virtual
third-party logistics provider” means an entity that provides or
coordinates warehousing, or other logistics services of a product in
interstate commerce on behalf of a manufacturer, wholesale
distributor, or dispenser of a produc t but does not take ownership
of the product, nor h ave responsibility to direct the sale or
disposition of the product. For the purposes of this paragraph,
“third-party logistics provider” does not include shippers and the
United States Postal Service;
48. 49. “Wholesale distributor” including “virtual wholesale
distributor” means a person other than a manufacturer, a
manufacturer’s co-licensed partner, a third-party logistics
provider, or repackager engaged in wholesale distribution as defined
by 21 U.S.C. 353(e)(4) as amended by the Drug Supply Chain Se curity
Act;
49. 50. “County jail” means a facility operated by a county for
the physical detention and correction of persons charged with, or
convicted of, criminal o ffenses or ordinance violations or per sons
found guilty of civil or criminal contempt;
50. 51. “State correctional facility” means a facility or
institution that houses a prisoner population under the jurisdiction
of the Department of Corrections;
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51. 52. “Unit dose package” means a package that contains a
single dose drug with the name, str ength, control number, and
expiration date of that drug on the label; and
52. 53. “Unit of issue package” means a package that provides
multiple doses of the same drug, but each drug is individually
separated and includes the name, lot number, and expirat ion date.
SECTION 3. AMENDATORY 59 O.S. 2021, Section 353.1a, is
amended to read as follows:
Section 353.1a. A. Prescribing 1. Prescriptive authority
shall be allowed, under th e medical direction of a supervising
physician or supervising Advanced Practice Registered Nurse, for an
advanced practice nurse a licensed Advanced Practice Registered
Nurse recognized by the Oklahom a Board of Nursing in one of the
following categories: advanced registered nurse practitioners,
clinical nurse specialists, or certified nurse-midwives as a
Certified Nurse Practitioner, Clinical Nurse Specialist, or
Certified Nurse-Midwife who has not obtained independent
prescriptive authority under Section 1 of this act.
2. Prescriptive authority shall be allowed, independent of the
medical direction of a supervising physician or supervising Advanced
Practice Registered Nurse, for a licensed Advanced Practice
Registered Nurse recognized by the Oklahoma Board of Nursing as a
Certified Nurse Practitioner, Clinical Nurse Special ist, or
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Certified Nurse-Midwife who has obtained independent prescriptive
authority under Section 1 of this act.
B. The advanced practice nurse Advanced Practice Registered
Nurse may write or sign, or transmit by word of mouth, telephone or
other means of communication an order for drugs or medical supplies
that is intended to be filled, compounded, or dis pensed by a
pharmacist. The supervising physician or supervising Advanced
Practice Registered Nurse, if applicable, and the advanced practice
nurse prescribing Advanced Practice Registered Nurse shall be
identified at the time of origination of the prescription and the
name of the advanced practice nurse prescribing Advanced Practice
Registered Nurse shall be printed on the prescription label.
B. C. Pharmacists may dispense prescriptions for non-controlled
prescription drugs authorized by an advanced practice nurse Advanced
Practice Registered Nurse or physician assistant, not located in
Oklahoma this state, provided that they are licensed in the state in
which they are actively prescribing.
C. D. 1. Pharmacists may only dispense prescriptions for
controlled dangerous substances prescribed by an advanced practice
nurse or physician assistant Advanced Practice Registered Nurse
licensed in the State of Oklahoma and supervised by an Oklahoma-
licensed practitioner this state who meets the criteria in paragraph
1 or 2 of subsection A of this section.
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2. Pharmacists may only dispense prescriptions for co ntrolled
dangerous substances prescribed by a physician assistant licensed in
this state and supervised by a supervising physician licensed in
this state.
SECTION 4. AMENDATORY 59 O.S. 2021, Section 567.3a, is
amended to read as f ollows:
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 diagnosis and treatment of human
responses to actual or potential health problems consistent wit h
educational preparation. Knowledge and skill are the basis for
assessment, analysis, planning, interven tion, and evaluation used in
the promotion and mainten ance of health and nursing management of
illness, injury, infirmity, restoration or optimal func tion, or
death with dignity. Practice is based on understanding the human
condition across the human life span and understanding the
relationship of the individ ual within the environment. This
practice includes execution of the medical regime including th e
administration of medications and treatments prescribed by any
person authorized by state law to so pres cribe;
3. “Registered nursing” means the practice of the full scope of
nursing which includes, but is not limited to:
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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 perfo rmed by
others, consistent with educational preparatio n 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 intervention s,
j. teaching the principles and practice of nursing,
k. managing and supervising the prac tice of nursing,
l. collaborating with other health profess ionals in the
management of health care,
m. performing additional nursing functions in accordance
with knowledge and skills acquired beyond basic
nursing preparation, and
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n. delegating those nursin g tasks as defined in the rules
of the Board that may be pe rformed by an advanced
unlicensed assistive person;
4. “Licensed practical nursing” means the practice of nursing
under the supervision or direction of a regis tered 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,
e. providing safe and effective nursing care r endered
directly or indirectly,
f. participating in the eva luation of responses to
interventions,
g. teaching basic nursing skills and related principles,
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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
Advanced Practice Registered Nurse roles,
b. who has passed a national certification examination
recognized by the Board that measures the advanced
practice registered nurse Advanced Practice Registered
Nurse role and specialty competencies and who
maintains recertification in the role and specialty
through a national certification program,
c. who has acquired advanced clinical knowledge and
skills in preparation for providing both direct and
indirect care to patients; however, the defining
factor for all Advanced Pr actice Registered Nurses is
that a significant compone nt of the education and
practice focuses on direct care of individuals,
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d. whose practice builds on the competencies of
Registered Nurses by demonstrating a greater depth and
breadth of knowledge, a gre ater synthesis of data, and
increased complexity of sk ills and interventions, and
e. who has obtained a license as an Advanced Practice
Registered Nurse in one of the following roles:
Certified Registered Nurse Anesthetist, Certified
Nurse-Midwife, Clinical Nurse Specialist, or Certified
Nurse Practitioner.
Only those persons who hold a license t o practice advanced
practice registered nursing in this s tate 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 lice nse
in the following disciplines shall have the right to fulfill the
roles and use the applicabl e titles: Certified Registered Nurse
Anesthetist and the abbreviation “CRNA”, Certified Nurse-Midwife and
the abbreviation “CNM”, Clinical Nurse Specialist and the
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 th e abbreviation
“APRN” or use the respective specialty role titles and abbreviations
or to use any other titles or abbreviations that would reasonably
lead a person to believe the user is an Advanced Practice Registered
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Nurse, unless permitted by the Oklaho ma Nursing Practice Act. Any
individual doing so shal l be guilty of a misdemeanor, which sha ll be
punishable, upon conviction, by imprisonment in the county jail for
not more than one (1) year or by a fine of not less than One Hundred
Dollars ($100.00) no r more than One Thousand Dollars ($1,000.00), or
by both such imprisonment and fine for each offense;
6. “Certified Nurse Practitioner” is means 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 Certified Nurse Practi tioner
scope of practice for the selected area of
specialization, and
c. is in accord with the standards f or Certified Nurse
Practitioners as identified by the certifying body and
approved by the Board.
A Certified Nurse Practitioner shall be eligible, in accordance
with the scope of practice of the Certified Nurse Practitioner, to
obtain recognition as author ized 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 su pervising
physician Section 567.4a of this title and Section 1 of this act.
This authorization shall not include dispensing drugs, but shall not
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preclude, subject to federal regulations, the receipt of, the
signing for, or the dispensing of professional s amples to patients.
The Certified Nurse Practitioner accepts responsibility,
accountability, and obligatio n to practice in accordance with usual
and customary advanced practice registered nursing sta ndards and
functions as defined by the scope of practice/ role definition
statements for the Certified Nurse Practitioner;
7. a. “Clinical Nurse Specialist ” is means an Advanced
Practice Registered Nurse who holds:
(1) a master’s degree or higher in nursi ng with
clinical specialization preparation to function
in an expanded role,
(2) specialty certification from a national
certifying organization recognized by the Board,
(3) an Advanced Practice Registered Nurse licen se
from the Board, and
(4) any nurse holding a specialty certification as a
Clinical Nurse Speci alist valid on January 1,
1994, granted by a national certifying
organization recognized by the Board, sha ll be
deemed to be a Clinical Nurse Specialist under
the provisions of the Oklahoma Nursing P ractice
Act.
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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 n ursing care to a selected
population of patients or clients in any setting,
including private pr actice,
(2) managing the care of patients or clients with
complex nursing problems,
(3) enhancing patient or client care by integrating
the competencies of clin ical practice, education,
consultation, and research, and
(4) referring patients or clients to o ther services.
c. A Clinical Nurse Specialist in accordance with the
scope of practice of such Clinical Nu rse Specialist
shall be eligible to obtain recognition as authorized
by the Board to prescrib e, as defined by the rules
promulgated by the Board pursu ant to this section, and
subject to the medical direction of a supervising
physician Section 567.4a of thi s title and Section 1
of this act. This authorization shall not include
dispensing drugs, bu t shall not preclude, subject to
federal regulations, the receipt of, the signing for,
or the dispensing of professional samples to patients.
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d. The Clinical Nurse Specialist accepts responsibility,
accountability, and obligation to practice in
accordance with usual and customary advanced practice
nursing standards and functions as defined by the
scope of practice/role definition statements for the
Clinical Nurse Specialist;
8. “Nurse-Midwife” is “Certified Nurse-Midwife” means 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 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 medical direction of a supervising physician Section
567.4a of this title and Section 1 of this act. This authorization
shall not include the dispensing of drugs, but shall not preclude,
subject to federal regu lations, the receipt of, the sig ning for, or
the dispensing of professional samples to patien ts.
The Certified Nurse-Midwife accepts responsibility ,
accountability, and obligation to practice in accordance with usual
and customary advanced practice registe red nursing standards and
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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, antepartally, intrapartally,
postpartally and gynecologicall y, occurring within a health care
system which provides for m edical consultation, medical 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 Anestheti st” 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 on e (1) year following
completion of an approved certified registered
nurse anesthetist Certified Registered Nurse
Anesthetist education program, and continues to
maintain such recertification by the National
Board of Certification and Recertification for
Nurse Anesthetists, and
(2) administers anesthesia in co llaboration with a
medical doctor, an o steopathic physician, a
podiatric physician or a dentis t licensed in this
state and under conditions in which timely onsite
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consultation by such doctor, osteopath, podiatric
physician or dentist i s available.
b. A Certified Registered Nurse Anesthetist, in
collaboration with a medical doctor, osteopathic
physician, podiatric physician or dentist licensed in
this state, and under conditions in which timely, on-
site consultation by such medical docto r, 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 substances, devices, and
medical gases only when engaged in the pr eanesthetic
preparation and evaluation; anesthesia i nduction,
maintenance and emergence; and postanesthesia care. A
Certified Registered Nurse Anesthetist may order,
select, obtain and adminis ter drugs only during the
perioperative or periobstetrical peri od.
c. A Certified Registered Nurse Anesthetist who applies
for authorization to order, select, obtain and
administer drugs shall:
(1) be currently recognized as a Certified Registered
Nurse Anesthetist in this state,
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(2) provide evidence of completion, wi thin the two-
year period immediately preceding the d ate of
application, of a minimum of fifteen (15) units
of continuing education in advanced pharmacology
related to the administration of anes thesia as
recognized by the Nation al Board of Certification
and Recertification for Nurse Anesthetists, and
(3) complete and submit a notarized application, on a
form prescribed by the Board, accompanied by the
application fee establish ed pursuant to this
section.
d. The authority to order , select, obtain and administ er
drugs shall be terminated if a Certified Register ed
Nurse Anesthetist has:
(1) ordered, selected, obtained or administered drugs
outside of the Certified Registered Nurse
Anesthetist scope of practice or ordered,
selected, obtained or administered drugs for
other than therapeutic purposes, or
(2) violated any provision of state laws or rules or
federal laws or regulations pertaining to the
practice of nursing or the author ity to order,
select, obtain and administer drugs.
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e. The Oklahoma Board of Nursing shall notify the State
Board of Pharmacy after terminatio n of or a change in
the authority to order, select, obtain and administer
drugs for a Certified Registered Nurse Anesthet ist.
f. The Board shall provide by rule for biennial
application renewal and reauth orization of authority
to order, select, obtain and administer drugs for
Certified Registered Nurse Anesthetists. At the time
of application renewal, a Certified Registered Nurse
Anesthetist shall submit documentation of a min imum of
eight (8) units of co ntinuing education, completed
during the previous tw o (2) years, in advanced
pharmacology relating to the administration of
anesthesia, as recognized by the Council on
Recertification of Nurse Anesthetists or the Council
on Certification of Nurse Anestheti sts National Board
of Certification and Recertification for Nurse
Anesthetists.
g. This paragraph shall not prohibit the administration
of local or topical anesthetics as now permitted by
law. Provided further , nothing in this paragraph
shall limit the authority of t he Board of Dentistry to
establish the qualifications for dentists who direct
the administration of anesthesia.
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h. As used in this paragraph, “collaboration” means an
agreement between a medical doc tor, osteopathic
physician, podiatric physician or dentist performing
the procedure or direc tly involved with the procedure
and the Certified Registered Nurse Anesthetist working
jointly toward a common goal providing services for
the same patient. This c ollaboration involves the
joint formulation, discussion an d agreement of the
anesthesia plan by both parties, and the collaborating
medical doctor, osteopathic physician, podiatric
physician or dentist performing the procedure or
directly involved with the procedure and that
collaborating physician shall re main available for
timely onsite consult ation during the delivery of
anesthesia for diagnosis, consultation, and treatment
of medical conditions;
11. “Supervising Advanced Practice Registered Nurse” means an
Advanced Practice Registere d Nurse holding a current license to
practice who has obtained independent prescriptive authority under
Section 1 of this act and who otherwise meets the qualification s of
a supervising Advanced Practice Registered Nur se under Section 1 of
this act who supervises a Certified Nurse Practitioner, a Clinical
Nurse Specialist, or a Certified Nurse-Midwife who has not obtained
independent prescriptive authority under Section 1 of this act ;
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12. “Supervising physician” means an individual holding a
current license to practice as a physi cian 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 who has not obtained
independent prescriptive authority under Section 1 of this act, and
who is not in training as an intern, resident, or fellow. To be
eligible to supervise such Advanced Practice Regi stered Nurse, such
The supervising physician shall remain in compliance with the rules
promulgated by the State Board of Medical Licensure and Supervision
or the State Board of Osteopathic Examiners;
12. 13. “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 Certified
Nurse-Midwife who has not obtained independent prescriptive
authority under Section 1 of this act of written, telephonic,
electronic or oral prescriptions for drugs and oth er medical
supplies, subject to a defined formulary; and
13. 14. “Advanced Unlicensed Assistant” means any person who
has successfully completed a certified training program approved by
the Board that trains the Advanced Unlicensed Assistant to perform
specified technical ski lls identified by the Board in acute care
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settings under the direction and supervision of the Registered Nurse
or Licensed Practical Nurse.
SECTION 5. AMENDATORY 59 O.S. 2021, Section 567.4a, is
amended to read as follows:
Section 567.4a. The Oklahoma Board of Nursing may grant
prescriptive authority through the Advanced Practice Registered
Nurse license to Certified Nurse Practitioners, Clinical Nurse
Specialists, and Certified Nurse-Midwives who meet the requirements
for prescriptive authority identified by law and in the Board’s
rules. The rules regarding prescriptive authority recognition
promulgated by the Oklahoma Board of Nursing pursuant to paragraphs
6 through 9, 11 and 12 of this section, Section 567.3a of this
title, and Section 1 of this act shall:
1. Define the procedure for documenting supervision by a
supervising physician licensed in Oklahoma to practice by the State
Board of Medical Licensure and Supervision or the State Board of
Osteopathic Examiners as defined in Section 567.3a of this title or
by a supervising Advanced Practice Registered Nurse as defined in
Section 567.3a of this t itle of a Certified Nurse Practitioner,
Clinical Nurse Specialist, or Certified Nurse-Midwife who has not
obtained independent prescriptive authority under Section 1 of this
act. Such procedure shall include a written statement that defines
appropriate referral, consultation, and collaboration between the
Advanced Practice Registered Nurse, recogni zed to prescribe as
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defined in paragraphs 6 through 9, 11 and 12 of Section 567.3a of
this title, and the supervising physician or supervising Advanced
Practice Registered Nurse. The written statement shall include a
method of assuring availability of the supervising physician or
supervising Advanced Practice Registered Nurse through direct
contact, telecommunications or other appropriate electronic means
for consultation, assistance with medical emergencies, or patient
referral. The written statement shall be part of the initial
application and the renewal application submitted to the Board for
recognition for prescriptive authority for the Advanced Practice
Registered Nurse. Changes to the written statement shall be filed
with the Board within thirty (30) day s of the change and shall be
effective on filing;
2. Define the procedure for documenting independent
prescriptive authority for Certified Nurse Practitioners, Clinical
Nurse Specialists, and Certified Nurse-Midwives who have obtained
independent prescriptive authority unde r Section 1 of this act;
3. Define minimal requirements for initial application for
prescriptive authority which shall in clude, but not be limited to,
evidence of completion of a minimum of forty-five (45) contact hours
or three (3) academic credit hours of education in
pharmacotherapeutics, clinical application, and use of
pharmacological agents in the prevention of illness , and in the
restoration and maintenance of health in a program beyond basic
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registered nurse preparation, approved by the Board. Such contact
hours or academic credits shall be obtained within a time period of
three (3) years immediately preceding the da te of application for
prescriptive authority ;
3. 4. Define minimal requirements for application for renewal
of prescriptive authority which shall include, but not be limited
to, documentation of a minimum of:
a. fifteen (15) contact hours or one (1) acade mic credit
hour of education in pharmacother apeutics, clinical
application, and use of pharmacological agents in the
prevention of illness, and in the restoration and
maintenance of health in a program beyond basic
registered nurse preparation, and
b. two (2) hours of education in pain management or two
(2) hours of education in opioid use or addiction,
unless the Advanced Practice Registered Nurse has
demonstrated to the satisfaction of the Board that the
Advanced Practice Registered Nurse does not current ly
hold a valid federal Drug Enforcement Adm inistration
registration number,
approved by the Board, within the two-year period immediately
preceding the effective date of application for renewal of
prescriptive authority;
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4. 5. Require that beginning July 1, 2002, an Advanced Practice
Registered Nurse shall demonstrate demonstrates successful
completion of a master’s degree or higher in a clinical nurse
specialty one of the following Advanced Practice Registered Nurse
roles:
a. Certified Nurse Practitioner,
b. Clinical Nurse Specialist, or
c. Certified Nurse-Midwife,
in order to be eligible for initial application fo r prescriptive
authority under the provisions of the Oklahoma Nursing Practice Act;
5. 6. Define the method for communicating authority to
prescribe or termination of same, and the formulary to the State
Board of Pharmacy, all pharmacies, and all registered pharmacists;
6. 7. Define terminology used in such rules;
7. 8. Define the parameters for the prescribing practices of
the Advanced Practice Re gistered Nurse;
8. 9. Define the methods for termination of prescriptive
authority for the Advanced Practice Registered Nurse; and
9. 10. a. Establish a Formulary Advisory Council that shall
develop and submit to the Board recommendations for an
exclusionary formulary that shall list drugs or
categories of drugs that shall not be prescribed by an
Advanced Practice Registered Nurse recognized to
prescribe by the Oklahoma Board of Nursing. The
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Formulary Advisory Council shall also develop and
submit to the Board recommendations for practice-
specific prescriptive standards for each category of
Advanced Practice Registered Nurse recognized to
prescribe by the Oklahoma Board of Nursing pursuant to
the provisions of the Oklahoma Nursing Practice Act.
The Board shall either accept or reject the
recommendations made by the Council. No amendments to
the recommended exclusionary formulary may be made by
the Board without the approval of the Formulary
Advisory Council.
b. The Formulary Advisory Council shall be compos ed of
twelve (12) members as follo ws:
(1) four members, to include a pediatrician, an
obstetrician-gynecological physician, a general
internist, and a family practice physician;
provided, that three of such members shall be
appointed by the Oklahoma State M edical
Association, and one shall be appointed by the
Oklahoma Osteopathic Association,
(2) four members who are registered pharmacists,
appointed by the Oklahoma Pharmaceutical
Association, and
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(3) four members, one of whom shall be a Certified
Nurse Practitioner, one of whom shall be a
Clinical Nurse Specialist, one of whom shall be a
Certified Nurse-Midwife, and one of whom shall be
a current member of the Oklahoma Board of
Nursing, all of whom shall be appointed by the
Oklahoma Board of Nursing.
c. All professional members of the Formul ary Advisory
Council shall be in active clinical practice, at least
fifty percent (50%) of the time, withi n their defined
area of specialty. The members of the Formulary
Advisory Council shall serve at the pleasure of the
appointing authority for a term o f three (3) years.
The terms of the members shall be staggered. Members
of the Council may serve beyond the expiration of
their term of office until a successor is appointed by
the original appointing authority. A vacan cy on the
Council shall be filled for the balance of the
unexpired term by the original appointing authority.
d. Members of the Council shal l elect a chair and a vice-
chair vice chair from among the membership of the
Council. For the transaction of business, at leas t
seven members, with a minimum of two members present
from each of the identified categories of physicians,
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pharmacists and advanced practice registered nurses
Advanced Practice Registered Nurses, shall constitute
a quorum. The Council shall recommend an d the Board
shall approve and impl ement an initial exclusionary
formulary on or before January 1, 1997. The Council
and the Board shall ann ually review the approved
exclusionary formulary and shall make any necessary
revisions utilizing the same procedure s used to
develop the initial excl usionary formulary.
SECTION 6. AMENDATORY 59 O.S. 2021, Section 567.5a, is
amended to read as follows:
Section 567.5a. A. All applicants for a license to practice as
an Advanced Practice Registered Nurse shall be subject to Section
567.8 of this title.
B. An applicant for an initial license to practice as an
Advanced Practice Regist ered Nurse shall:
1. Submit a completed written application and appropriate fees
as established by the Oklahoma Board of Nursing;
2. Submit a criminal history records check that compl ies with
Section 567.18 of this title;
3. Hold a current Registered Nurse license in this state;
4. Have completed an advanced practice registered nursing
education program in one of the four advanced practice regi stered
nurse Advanced Practice Registere d Nurse roles and a specialty area
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recognized by the Board. Effective January 1, 2016, the applicant
shall have completed an accredited graduate level advanced practice
registered nursing education program in at lea st one of the
following population foci: family/individual across the lifespan,
adult-gerontology, neonatal, pediatrics, women’s health/gender-
related, or psychiatric/mental health;
5. Be currently certified in an advanced practice specialty
certification consistent with educational preparatio n and by a
national certifying body recognized by the Board; and
6. Provide any and all other evidence as required by the Board
in its rules.
C. The Board may issue a license by endorsement to an Advanced
Practice Registered Nurse licensed under the laws of another state
if the applicant meets the qualifications for licensure in this
state. An applicant by endorsement shall:
1. Submit a completed written application and appr opriate fees
as established by the Board ;
2. Hold a current Registered Nurse li cense in this state;
3. Hold recognition as an Advanced Practice Registered Nurse in
a state or territory;
4. Have completed an advanced practice registered nursing
education program in one of the four roles and a specialty area
recognized by the Board. Effective January 1, 2016, the applicant
shall have completed an accredited graduate level advanced practice
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registered nursing education program in at least one of the
following population foci: family/individual across the lifespan,
adult-gerontology, neonatal, pediatrics, women’s health/gender-
related, or psychiatric/mental health;
5. Be currently certified in an advanced practice specialty
certification consistent with ed ucational preparation and by a
national certifying body recognized by the Board;
6. Meet continued competency requirements as set forth in Board
rules; and
7. Provide any and all other evidence as required by the Board
in its rules.
D. The Board may iss ue prescriptive authority recognition by
endorsement to an Advanced Practice Reg istered Nurse licensed as an
APRN-CNP, APRN-CNS, or APRN-CNM under the laws of another state if
the applicant meets the requirements set forth in this section. An
applicant for prescriptive authority recognition by endorsement
shall:
1. Submit a complete d written application and appropriate fees
as established by the Board;
2. Hold current Registered Nurse and Advanced Practice
Registered Nurse licenses (APRN-CNP, APRN-CNS, or APRN-CNM) in the
state;
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3. Hold current licensure or recognition as an Advanc ed
Practice Registered Nurse in the same role and specialty with
prescribing privileges in another state or territory;
4. Submit documentation verifying successful completion of a
graduate level advanced practice re gistered nursing education
program that included an academic course in pharmacotherapeutic
management, and didactic and clinical preparation for prescribing
incorporated throughout the program;
5. Submit a written statement from an Oklahoma licensed
physician or supervising Advanced Practice Registered Nurse
supervising prescriptive authority as required by the Board in its
rules, or submit documentation that the applicant meets the
requirements for independ ent prescriptive authority under Section 1
of this act;
6. Meet continued competency requirements as set forth in Board
rules; and
7. Provide any and all other evidence as required by the Board
in its rules.
E. An Advanced Practice Registered Nurse license issued under
this section shall be renewed concurrently with the regis tered nurse
license, provided that qualifying criteria continue to be met.
F. The Board may reinstate a license as set forth in Boa rd
rules.
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SECTION 7. AMENDATORY 63 O.S. 2021, Section 2-312, as
amended by Section 2, Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2022,
Section 2-312), is amended to read a s follows:
Section 2-312. A. A physician, podiatrist, optometrist or a
dentist who has complied with the registration requirements of the
Uniform Controlled Dange rous Substances Act, in good faith and in
the course of such person’s professional practice only, may
prescribe and administer controlled dangerous substances, or may
cause the same to be administered by medical or paramedical
personnel acting under the di rection and supervision of the
physician, podiatrist, optometrist or dentist, and only may d ispense
controlled dangerous substances pursuant to the provisions of
Sections 355.1 and 355.2 of Title 59 of the Oklahoma Statutes.
B. A veterinarian who has comp lied with the registration
requirements of the Uniform Controlled Dangerous Substances Act, in
good faith and in the course of the professional practice of the
veterinarian only, and not for use by a human being, may prescribe,
administer, and dispense con trolled dangerous substances and may
cause them to be administered by an assistant or orderly under the
direction and supervision of the veterinarian.
C. 1. An advanced practice nurse Advanced Practice Registered
Nurse who is recognized to prescribe by t he Oklahoma Board of
Nursing as an advanced registered nurse practitioner, clinical nurse
specialist or certified nurse-midwife, a Certified Nurse
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Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
but who has not obtained independent prescriptive authority under
Section 1 of this act and therefore is subject to medical direction
by a supervising physician, or supervising Advanced Prac tice
Registered Nurse pursuant to Section 567.3a of Title 59 of the
Oklahoma Statutes, and who has complied with the registration
requirements of the U niform Controlled Dange rous Substances Act, in
good faith and in the course of professional practice only, may
prescribe and administer Schedule III, IV and V controlled dangerous
substances.
2. An Advanced Practice Registered Nurse wh o is recognized to
prescribe by the Okla homa Board of Nursing as a Certified Nurse
Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
who has obtained independent prescriptive authority under Section 1
of this act, and who has complied with the regis tration requirements
of the Uniform Controlled Dangerous Subs tances Act, in good faith
and in the course of professional practice only, may prescribe and
administer Schedule III, IV, and V controlled dangerous substances.
D. An advanced practice nurse Advanced Practice Registered
Nurse who is recognized to order, select, obtain and administer
drugs by the Oklahoma Board of Nursing as a certified registered
nurse anesthetist Certified Registered Nurse Anesthetist pursuant to
Section 353.1b of Title 59 of the Oklahoma Statutes and who has
complied with the registra tion requirements of the Uniform
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Controlled Dangerous Substances Act, in good faith and in the course
of such practitioner’s professional practice only, may order,
select, obtain and administer S chedules II through V controlled
dangerous substances in a preanesthetic preparation or evaluation;
anesthesia induction, maintenance or emergence; or postanesthesia
care setting only. A certified registered nurse anestheti st
Certified Registered Nurse Anesthetist may order, select, obtain and
administer such drugs only during the perioperative or
periobstetrical period.
E. A physician assistant who is recognized to prescribe by the
State Board of Medical Licensure and Supe rvision under the medical
direction of a supervising physician, pursuant to Section 519.6 of
Title 59 of the Oklahoma Statutes, and who has complied w ith the
registration requirements of the Uniform Controlled Dangerous
Substances Act, in good faith and in the course of professiona l
practice only, may prescribe and administe r Schedule II through V
controlled dangerous substances.
SECTION 8. This act shall become effective November 1, 2023.
COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
February 9, 2023 - DO PASS AS AMENDED BY CS