HB 879

1	A bill to be entitled
2	An act relating to nursing specialties; amending s.
3	464.003, F.S.; defining the terms "clinical nurse
4	specialist practice" and "clinical nurse specialist";
5	creating s. 464.0115, F.S.; providing requirements for
6	certification as a clinical nurse specialist; providing
7	fees; authorizing the Board of Nursing to adopt rules;
8	amending s. 464.012, F.S.; adding clinical nurse
9	specialist to the classifications of advanced registered
10	nurse practitioners; amending s. 464.015, F.S.;
11	restricting the use of professional titles and
12	abbreviations relating to practice by clinical nurse
13	specialists, certified registered nurse anesthetists, and
14	certified nurse midwives; providing penalties; amending s.
15	464.016, F.S.; prohibiting the use of any name or title
16	stating or implying that a person is a clinical nurse
17	specialist, certified registered nurse anesthetist, or
18	certified nurse midwife unless the person is licensed or
19	certified; providing penalties; reenacting s.
20	921.0022(3)(g), F.S., relating to the offense severity
21	ranking chart of the Criminal Punishment Code, to
22	incorporate the amendment to s. 464.016, F.S., in a
23	reference thereto; amending ss. 458.348 and 459.025, F.S.;
24	conforming cross-references; providing an effective date.
25
26	Be It Enacted by the Legislature of the State of Florida:
27
28	Section 1.  Section 464.003, Florida Statutes, is amended
29	to read:
30	464.003  Definitions.--As used in this part, the term:
31	(1)  "Department" means the Department of Health.
32	(2)  "Board" means the Board of Nursing.
33	(3)(a)  "Practice of professional nursing" means the
34	performance of those acts requiring substantial specialized
35	knowledge, judgment, and nursing skill based upon applied
36	principles of psychological, biological, physical, and social
37	sciences which shall include, but not be limited to:
38	1.  The observation, assessment, nursing diagnosis,
39	planning, intervention, and evaluation of care; health teaching
40	and counseling of the ill, injured, or infirm; and the promotion
41	of wellness, maintenance of health, and prevention of illness of
42	others.
43	2.  The administration of medications and treatments as
44	prescribed or authorized by a duly licensed practitioner
45	authorized by the laws of this state to prescribe such
46	medications and treatments.
47	3.  The supervision and teaching of other personnel in the
48	theory and performance of any of the above acts.
49	(b)  "Practice of practical nursing" means the performance
50	of selected acts, including the administration of treatments and
51	medications, in the care of the ill, injured, or infirm and the
52	promotion of wellness, maintenance of health, and prevention of
53	illness of others under the direction of a registered nurse, a
54	licensed physician, a licensed osteopathic physician, a licensed
55	podiatric physician, or a licensed dentist.
56
57	The professional nurse and the practical nurse shall be
58	responsible and accountable for making decisions that are based
59	upon the individual's educational preparation and experience in
60	nursing.
61	(c)  "Clinical nurse specialist practice" means the
62	delivery and management of expert-level nursing care to
63	individuals or groups, including the ability to:
64	1.  Assess the health status of individuals and families
65	using methods appropriate to the population and area of
66	practice.
67	2.  Diagnose human responses to actual or potential health
68	problems.
69	3.  Plan for health promotion, disease prevention, and
70	therapeutic intervention in collaboration with the patient or
71	client.
72	4.  Implement therapeutic interventions based on the nurse
73	specialist's area of expertise, including, but not limited to,
74	direct nursing care, counseling, teaching, and collaboration
75	with other licensed health care providers.
76	5.  Coordinate health care as necessary and appropriate and
77	evaluate with the patient or client the effectiveness of care.
78	(d)(c)  "Advanced or specialized nursing practice" means,
79	in addition to the practice of professional nursing, the
80	performance of advanced-level nursing acts approved by the board
81	which, by virtue of postbasic specialized education, training,
82	and experience, are proper to be performed by an advanced
83	registered nurse practitioner.  Within the context of advanced
84	or specialized nursing practice, the advanced registered nurse
85	practitioner may perform acts of nursing diagnosis and nursing
86	treatment of alterations of the health status.  The advanced
87	registered nurse practitioner may also perform acts of medical
88	diagnosis and treatment, prescription, and operation which are
89	identified and approved by a joint committee composed of three
90	members appointed by the Board of Nursing, two of whom shall be
91	advanced registered nurse practitioners; three members appointed
92	by the Board of Medicine, two of whom shall have had work
93	experience with advanced registered nurse practitioners; and the
94	secretary of the department or the secretary's designee. Each
95	committee member appointed by a board shall be appointed to a
96	term of 4 years unless a shorter term is required to establish
97	or maintain staggered terms. The Board of Nursing shall adopt
98	rules authorizing the performance of any such acts approved by
99	the joint committee. Unless otherwise specified by the joint
100	committee, such acts shall be performed under the general
101	supervision of a practitioner licensed under chapter 458,
102	chapter 459, or chapter 466 within the framework of standing
103	protocols which identify the medical acts to be performed and
104	the conditions for their performance.  The department may, by
105	rule, require that a copy of the protocol be filed with the
106	department along with the notice required by s. 458.348.
107	(e)(d)  "Nursing diagnosis" means the observation and
108	evaluation of physical or mental conditions, behaviors, signs
109	and symptoms of illness, and reactions to treatment and the
110	determination as to whether such conditions, signs, symptoms,
111	and reactions represent a deviation from normal.
112	(f)(e)  "Nursing treatment" means the establishment and
113	implementation of a nursing regimen for the care and comfort of
114	individuals, the prevention of illness, and the education,
115	restoration, and maintenance of health.
116	(4)  "Registered nurse" means any person licensed in this
117	state to practice professional nursing.
118	(5)  "Licensed practical nurse" means any person licensed
119	in this state to practice practical nursing.
120	(6)  "Clinical nurse specialist" means any person licensed
121	in this state to practice professional nursing and certified in
122	clinical nurse specialist practice.
123	(7)(6)  "Advanced registered nurse practitioner" means any
124	person licensed in this state to practice professional nursing
125	and certified in advanced or specialized nursing practice,
126	including certified registered nurse anesthetists, certified
127	nurse midwives, nurse practitioners, and clinical nurse
128	specialists.
129	(8)(7)  "Approved program" means a nursing program
130	conducted in a school, college, or university which is approved
131	by the board pursuant to s. 464.019 for the education of nurses.
132
133	Section 2.  Section 464.0115, Florida Statutes, is created
134	to read:
135	464.0115  Certification of clinical nurse specialists.--
136	(1)  Any nurse desiring to be certified as a clinical nurse
137	specialist must apply to the department and submit proof that he
138	or she holds a current license to practice professional nursing,
139	a master's degree in a clinical nursing specialty, and current
140	certification in a specialty area as a clinical nurse specialist
141	from a nationally recognized certifying body as determined by
142	the board.
143	(2)  The board shall certify, and the department shall
144	issue a certificate to, any nurse who fulfills the
145	qualifications in this section. The board shall establish an
146	application fee not to exceed $25 and a biennial renewal fee not
147	to exceed $10.
148	(3)  The board may adopt rules necessary to administer this
149	section pursuant to ss. 120.536(1) and 120.54.
150	Section 3.  Subsections (2) and (3) of section 464.012,
151	Florida Statutes, are amended to read:
152	464.012  Certification of advanced registered nurse
153	practitioners; fees.--
154	(2)  The board shall provide by rule the appropriate
155	requirements for advanced registered nurse practitioners in the
156	categories of certified registered nurse anesthetist, certified
157	nurse midwife, and nurse practitioner, and clinical nurse
158	specialist.
159	(3)  An advanced registered nurse practitioner shall
160	perform those functions authorized in this section within the
161	framework of an established protocol that is filed with the
162	board upon biennial license renewal and within 30 days after
163	entering into a supervisory relationship with a physician or
164	changes to the protocol. The board shall review the protocol to
165	ensure compliance with applicable regulatory standards for
166	protocols. The board shall refer to the department licensees
167	submitting protocols that are not compliant with the regulatory
168	standards for protocols. A practitioner currently licensed under
169	chapter 458, chapter 459, or chapter 466 shall maintain
170	supervision for directing the specific course of medical
171	treatment. Within the established framework, an advanced
172	registered nurse practitioner may:
173	(a)  Monitor and alter drug therapies.
174	(b)  Initiate appropriate therapies for certain conditions.
175	(c)  Perform additional functions as may be determined by
176	rule in accordance with s. 464.003(3)(d) s. 464.003(3)(c).
177	(d)  Order diagnostic tests and physical and occupational
178	therapy.
179	Section 4.  Section 464.015, Florida Statutes, is amended
180	to read:
181	464.015  Titles and abbreviations; restrictions; penalty.--
182	(1)  Only persons who hold licenses to practice
183	professional nursing in this state or who are performing nursing
184	services pursuant to the exception set forth in s. 464.022(8)
185	shall have the right to use the title "Registered Nurse" and the
186	abbreviation "R.N."
187	(2)  Only persons who hold licenses to practice as licensed
188	practical nurses in this state or who are performing practical
189	nursing services pursuant to the exception set forth in s.
190	464.022(8) shall have the right to use the title "Licensed
191	Practical Nurse" and the abbreviation "L.P.N."
192	(3)  Only persons who are graduates of approved programs or
193	the equivalent may use the term "Graduate Nurse" and the
194	abbreviation "G.N.," pending the results of the first licensure
195	examination for which they are eligible.
196	(4)  Only persons who are graduates of approved programs or
197	the equivalent may use the term "Graduate Practical Nurse" and
198	the abbreviation "G.P.N.," pending the results of the first
199	licensure examination for which they are eligible.
200	(5)  Only persons who hold valid certificates to practice
201	as clinical nurse specialists in this state may use the title
202	"Clinical Nurse Specialist" and the abbreviation "C.N.S."
203	(6)  Only persons who hold valid certificates to practice
204	as certified registered nurse anesthetists in this state may use
205	the title "Certified Registered Nurse Anesthetist" and the
206	abbreviations "C.R.N.A." or "anesthetist."
207	(7)  Only persons who hold valid certificates to practice
208	as certified nurse midwives in this state may use the title
209	"Certified Nurse Midwife" and the abbreviations "C.N.M." or
210	"nurse midwife."
211	(8)(5)  Only persons who hold valid certificates to
212	practice as advanced registered nurse practitioners in this
213	state may shall have the right to use the title "Advanced
214	Registered Nurse Practitioner" and the abbreviation "A.R.N.P."
215	(9)(6)  A No person may not shall practice or advertise as,
216	or assume the title of, registered nurse, licensed practical
217	nurse, clinical nurse specialist, certified registered nurse
218	anesthetist, certified nurse midwife, or advanced registered
219	nurse practitioner or use the abbreviation "R.N.," "L.P.N.,"
220	"C.N.S.," "C.R.N.A.," "C.N.M.," or "A.R.N.P." or take any other
221	action that would lead the public to believe that person was
222	certified as such or is performing nursing services pursuant to
223	the exception set forth in s. 464.022(8), unless that person is
224	licensed or certified to practice as such.
225	(10)(7)  A violation of this section is a misdemeanor of
226	the first degree, punishable as provided in s. 775.082 or s.
227	775.083.
228	Section 5.  Section 464.016, Florida Statutes, is amended
229	to read:
230	464.016  Violations and penalties.--
231	(1)  Each of the following acts constitutes a felony of the
232	third degree, punishable as provided in s. 775.082, s. 775.083,
233	or s. 775.084:
234	(a)  Practicing advanced or specialized, professional, or
235	practical nursing, as defined in this part, unless holding an
236	active license or certificate to do so.
237	(b)  Using or attempting to use a license or certificate
238	which has been suspended or revoked.
239	(c)  Knowingly employing unlicensed persons in the practice
240	of nursing.
241	(d)  Obtaining or attempting to obtain a license or
242	certificate under this part by misleading statements or knowing
243	misrepresentation.
244	(2)  Each of the following acts constitutes a misdemeanor
245	of the first degree, punishable as provided in s. 775.082 or s.
246	775.083:
247	(a)  Using the name or title "Nurse," "Registered Nurse,"
248	"Licensed Practical Nurse," "Clinical Nurse Specialist,"
249	"Certified Registered Nurse Anesthetist," "Certified Nurse
250	Midwife," "Advanced Registered Nurse Practitioner," or any other
251	name or title which implies that a person was licensed or
252	certified as same, unless such person is duly licensed or
253	certified.
254	(b)  Knowingly concealing information relating to
255	violations of this part.
256	Section 6.  For the purpose of incorporating the amendment
257	to section 464.016, Florida Statutes, in a reference thereto,
258	paragraph (g) of subsection (3) of section 921.0022, Florida
259	Statutes, is reenacted to read:
260	921.0022  Criminal Punishment Code; offense severity
261	ranking chart.--
262	(3)  OFFENSE SEVERITY RANKING CHART
	FloridaStatute FelonyDegree Description
263
	(g)  LEVEL 7
264
	316.027(1)(b) 1st Accident involving death, failure to stop; leaving scene.
265
	316.193(3)(c)2. 3rd DUI resulting in serious bodily injury.
266
	316.1935(3)(b) 1st Causing serious bodily injury or death to another person; driving at high speed or with wanton disregard for safety while fleeing or attempting to elude law enforcement officer who is in a patrol vehicle with siren and lights activated.
267
	327.35(3)(c)2. 3rd Vessel BUI resulting in serious bodily injury.
268
	402.319(2) 2nd Misrepresentation and negligence or intentional act resulting in great bodily harm, permanent disfiguration, permanent disability, or death.
269
	409.920(2) 3rd Medicaid provider fraud.
270
	456.065(2) 3rd Practicing a health care profession without a license.
271
	456.065(2) 2nd Practicing a health care profession without a license which results in serious bodily injury.
272
	458.327(1) 3rd Practicing medicine without a license.
273
	459.013(1) 3rd Practicing osteopathic medicine without a license.
274
	460.411(1) 3rd Practicing chiropractic medicine without a license.
275
	461.012(1) 3rd Practicing podiatric medicine without a license.
276
	462.17 3rd Practicing naturopathy without a license.
277
	463.015(1) 3rd Practicing optometry without a license.
278
	464.016(1) 3rd Practicing nursing without a license.
279
	465.015(2) 3rd Practicing pharmacy without a license.
280
	466.026(1) 3rd Practicing dentistry or dental hygiene without a license.
281
	467.201 3rd Practicing midwifery without a license.
282
	468.366 3rd Delivering respiratory care services without a license.
283
	483.828(1) 3rd Practicing as clinical laboratory personnel without a license.
284
	483.901(9) 3rd Practicing medical physics without a license.
285
	484.013(1)(c) 3rd Preparing or dispensing optical devices without a prescription.
286
	484.053 3rd Dispensing hearing aids without a license.
287
	494.0018(2) 1st Conviction of any violation of ss. 494.001-494.0077 in which the total money and property unlawfully obtained exceeded $50,000 and there were five or more victims.
288
	560.123(8)(b)1. 3rd Failure to report currency or payment instruments exceeding $300 but less than $20,000 by money transmitter.
289
	560.125(5)(a) 3rd Money transmitter business by unauthorized person, currency or payment instruments exceeding $300 but less than $20,000.
290
	655.50(10)(b)1. 3rd Failure to report financial transactions exceeding $300 but less than $20,000 by financial institution.
291
	775.21(10)(a) 3rd Sexual predator; failure to register; failure to renew driver's license or identification card; other registration violations.
292
	775.21(10)(b) 3rd Sexual predator working where children regularly congregate.
293
	775.21(10)(g) 3rd Failure to report or providing false information about a sexual predator; harbor or conceal a sexual predator.
294
	782.051(3) 2nd Attempted felony murder of a person by a person other than the perpetrator or the perpetrator of an attempted felony.
295
	782.07(1) 2nd Killing of a human being by the act, procurement, or culpable negligence of another (manslaughter).
296
	782.071 2nd Killing of human being or viable fetus by the operation of a motor vehicle in a reckless manner (vehicular homicide).
297
	782.072 2nd Killing of a human being by the operation of a vessel in a reckless manner (vessel homicide).
298
	784.045(1)(a)1. 2nd Aggravated battery; intentionally causing great bodily harm or disfigurement.
299
	784.045(1)(a)2. 2nd Aggravated battery; using deadly weapon.
300
	784.045(1)(b) 2nd Aggravated battery; perpetrator aware victim pregnant.
301
	784.048(4) 3rd Aggravated stalking; violation of injunction or court order.
302
	784.048(7) 3rd Aggravated stalking; violation of court order.
303
	784.07(2)(d) 1st Aggravated battery on law enforcement officer.
304
	784.074(1)(a) 1st Aggravated battery on sexually violent predators facility staff.
305
	784.08(2)(a) 1st Aggravated battery on a person 65 years of age or older.
306
	784.081(1) 1st Aggravated battery on specified official or employee.
307
	784.082(1) 1st Aggravated battery by detained person on visitor or other detainee.
308
	784.083(1) 1st Aggravated battery on code inspector.
309
	790.07(4) 1st Specified weapons violation subsequent to previous conviction of s. 790.07(1) or (2).
310
	790.16(1) 1st Discharge of a machine gun under specified circumstances.
311
	790.165(2) 2nd Manufacture, sell, possess, or deliver hoax bomb.
312
	790.165(3) 2nd Possessing, displaying, or threatening to use any hoax bomb while committing or attempting to commit a felony.
313
	790.166(3) 2nd Possessing, selling, using, or attempting to use a hoax weapon of mass destruction.
314
	790.166(4) 2nd Possessing, displaying, or threatening to use a hoax weapon of mass destruction while committing or attempting to commit a felony.
315
	796.03 2nd Procuring any person under 16 years for prostitution.
316
	800.04(5)(c)1. 2nd Lewd or lascivious molestation; victim less than 12 years of age; offender less than 18 years.
317
	800.04(5)(c)2. 2nd Lewd or lascivious molestation; victim 12 years of age or older but less than 16 years; offender 18 years or older.
318
	806.01(2) 2nd Maliciously damage structure by fire or explosive.
319
	810.02(3)(a) 2nd Burglary of occupied dwelling; unarmed; no assault or battery.
320
	810.02(3)(b) 2nd Burglary of unoccupied dwelling; unarmed; no assault or battery.
321
	810.02(3)(d) 2nd Burglary of occupied conveyance; unarmed; no assault or battery.
322
	812.014(2)(a)1. 1st Property stolen, valued at $100,000 or more or a semitrailer deployed by a law enforcement officer; property stolen while causing other property damage; 1st degree grand theft.
323
	812.014(2)(b)2. 2nd Property stolen, cargo valued at less than $50,000, grand theft in 2nd degree.
324
	812.014(2)(b)3. 2nd Property stolen, emergency medical equipment; 2nd degree grand theft.
325
	812.0145(2)(a) 1st Theft from person 65 years of age or older; $50,000 or more.
326
	812.019(2) 1st Stolen property; initiates, organizes, plans, etc., the theft of property and traffics in stolen property.
327
	812.131(2)(a) 2nd Robbery by sudden snatching.
328
	812.133(2)(b) 1st Carjacking; no firearm, deadly weapon, or other weapon.
329
	817.234(8)(a) 2nd Solicitation of motor vehicle accident victims with intent to defraud.
330
	817.234(9) 2nd Organizing, planning, or participating in an intentional motor vehicle collision.
331
	817.234(11)(c) 1st Insurance fraud; property value $100,000 or more.
332
	817.2341(2)(b) & (3)(b) 1st Making false entries of material fact or false statements regarding property values relating to the solvency of an insuring entity which are a significant cause of the insolvency of that entity.
333
	825.102(3)(b) 2nd Neglecting an elderly person or disabled adult causing great bodily harm, disability, or disfigurement.
334
	825.103(2)(b) 2nd Exploiting an elderly person or disabled adult and property is valued at $20,000 or more, but less than $100,000.
335
	827.03(3)(b) 2nd Neglect of a child causing great bodily harm, disability, or disfigurement.
336
	827.04(3) 3rd Impregnation of a child under 16 years of age by person 21 years of age or older.
337
	837.05(2) 3rd Giving false information about alleged capital felony to a law enforcement officer.
338
	838.015 2nd Bribery.
339
	838.016 2nd Unlawful compensation or reward for official behavior.
340
	838.021(3)(a) 2nd Unlawful harm to a public servant.
341
	838.22 2nd Bid tampering.
342
	847.0135(3) 3rd Solicitation of a child, via a computer service, to commit an unlawful sex act.
343
	872.06 2nd Abuse of a dead human body.
344
	893.13(1)(c)1. 1st Sell, manufacture, or deliver cocaine (or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4.) within 1,000 feet of a child care facility, school, or state, county, or municipal park or publicly owned recreational facility or community center.
345
	893.13(1)(e)1. 1st Sell, manufacture, or deliver cocaine or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4., within 1,000 feet of property used for religious services or a specified business site.
346
	893.13(4)(a) 1st Deliver to minor cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs).
347
	893.135(1)(a)1. 1st Trafficking in cannabis, more than 25 lbs., less than 2,000 lbs.
348
	893.135(1)(b)1.a. 1st Trafficking in cocaine, more than 28 grams, less than 200 grams.
349
	893.135(1)(c)1.a. 1st Trafficking in illegal drugs, more than 4 grams, less than 14 grams.
350
	893.135(1)(d)1. 1st Trafficking in phencyclidine, more than 28 grams, less than 200 grams.
351
	893.135(1)(e)1. 1st Trafficking in methaqualone, more than 200 grams, less than 5 kilograms.
352
	893.135(1)(f)1. 1st Trafficking in amphetamine, more than 14 grams, less than 28 grams.
353
	893.135(1)(g)1.a. 1st Trafficking in flunitrazepam, 4 grams or more, less than 14 grams.
354
	893.135(1)(h)1.a. 1st Trafficking in gamma-hydroxybutyric acid (GHB), 1 kilogram or more, less than 5 kilograms.
355
	893.135(1)(j)1.a. 1st Trafficking in 1,4-Butanediol, 1 kilogram or more, less than 5 kilograms.
356
	893.135(1)(k)2.a. 1st Trafficking in Phenethylamines, 10 grams or more, less than 200 grams.
357
	896.101(5)(a) 3rd Money laundering, financial transactions exceeding $300 but less than $20,000.
358
	896.104(4)(a)1. 3rd Structuring transactions to evade reporting or registration requirements, financial transactions exceeding $300 but less than $20,000.
359
	943.0435(4)(c) 2nd Sexual offender vacating permanent residence; failure to comply with reporting requirements.
360
	943.0435(8) 2nd Sexual offender; remains in state after indicating intent to leave; failure to comply with reporting requirements.
361
	943.0435(9)(a) 3rd Sexual offender; failure to comply with reporting requirements.
362
	943.0435(13) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
363
	943.0435(14) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
364
	944.607(9) 3rd Sexual offender; failure to comply with reporting requirements.
365
	944.607(10)(a) 3rd Sexual offender; failure to submit to the taking of a digitized photograph.
366
	944.607(12) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
367
	944.607(13) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
368
369	Section 7.  Paragraph (a) of subsection (1) and subsection
370	(2) of section 458.348, Florida Statutes, are amended to read:
371	458.348  Formal supervisory relationships, standing orders,
372	and established protocols; notice; standards.--
373	(1)  NOTICE.--
374	(a)  When a physician enters into a formal supervisory
375	relationship or standing orders with an emergency medical
376	technician or paramedic licensed pursuant to s. 401.27, which
377	relationship or orders contemplate the performance of medical
378	acts, or when a physician enters into an established protocol
379	with an advanced registered nurse practitioner, which protocol
380	contemplates the performance of medical acts identified and
381	approved by the joint committee pursuant to s. 464.003(3)(d) s.
382	464.003(3)(c) or acts set forth in s. 464.012(3) and (4), the
383	physician shall submit notice to the board. The notice shall
384	contain a statement in substantially the following form:
385
386	I,   (name and professional license number of physician)  ,
387	of   (address of physician)   have hereby entered into a formal
388	supervisory relationship, standing orders, or an established
389	protocol with   (number of persons)   emergency medical
390	technician(s),   (number of persons)   paramedic(s), or
391	(number of persons)   advanced registered nurse practitioner(s).
392	(2)  ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.--The
393	joint committee created by s. 464.003(3)(d) s. 464.003(3)(c)
394	shall determine minimum standards for the content of established
395	protocols pursuant to which an advanced registered nurse
396	practitioner may perform medical acts identified and approved by
397	the joint committee pursuant to s. 464.003(3)(d) s.
398	464.003(3)(c) or acts set forth in s. 464.012(3) and (4) and
399	shall determine minimum standards for supervision of such acts
400	by the physician, unless the joint committee determines that any
401	act set forth in s. 464.012(3) or (4) is not a medical act. Such
402	standards shall be based on risk to the patient and acceptable
403	standards of medical care and shall take into account the
404	special problems of medically underserved areas. The standards
405	developed by the joint committee shall be adopted as rules by
406	the Board of Nursing and the Board of Medicine for purposes of
407	carrying out their responsibilities pursuant to part I of
408	chapter 464 and this chapter, respectively, but neither board
409	shall have disciplinary powers over the licensees of the other
410	board.
411	Section 8.  Paragraph (a) of subsection (1) of section
412	459.025, Florida Statutes, is amended to read:
413	459.025  Formal supervisory relationships, standing orders,
414	and established protocols; notice; standards.--
415	(1)  NOTICE.--
416	(a)  When an osteopathic physician enters into a formal
417	supervisory relationship or standing orders with an emergency
418	medical technician or paramedic licensed pursuant to s. 401.27,
419	which relationship or orders contemplate the performance of
420	medical acts, or when an osteopathic physician enters into an
421	established protocol with an advanced registered nurse
422	practitioner, which protocol contemplates the performance of
423	medical acts identified and approved by the joint committee
424	pursuant to s. 464.003(3)(d) s. 464.003(3)(c) or acts set forth
425	in s. 464.012(3) and (4), the osteopathic physician shall submit
426	notice to the board. The notice must contain a statement in
427	substantially the following form:
428	I,   (name and professional license number of osteopathic
429	physician)  , of   (address of osteopathic physician)   have
430	hereby entered into a formal supervisory relationship, standing
431	orders, or an established protocol with   (number of persons)
432	emergency medical technician(s),   (number of persons)
433	paramedic(s), or   (number of persons)   advanced registered
434	nurse practitioner(s).
435	Section 9.  This act shall take effect July 1, 2007.

CODING: Words stricken are deletions; words underlined are additions.