Florida Senate - 2012                          SENATOR AMENDMENT
       Bill No. SB 1988
                                Barcode 174054                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Floor: WD/2R          .                                
             02/23/2012 06:11 PM       .                                

       Senator Bennett moved the following:
    1         Senate Amendment (with title amendment)
    3         Between lines 1855 and 1856
    4  insert:
    5         Section 19. Subsection (3) and paragraph (a) of subsection
    6  (4) of section 464.012, Florida Statutes, are amended to read:
    7         464.012 Certification of advanced registered nurse
    8  practitioners; fees.—
    9         (3) An advanced registered nurse practitioner shall perform
   10  those functions authorized in this section within the framework
   11  of an established protocol that is filed with the board upon
   12  biennial license renewal and within 30 days after entering into
   13  a supervisory relationship with a physician or changes to the
   14  protocol. The board shall review the protocol to ensure
   15  compliance with applicable regulatory standards for protocols.
   16  The board shall refer to the department licensees submitting
   17  protocols that are not compliant with the regulatory standards
   18  for protocols. A practitioner currently licensed under chapter
   19  458, chapter 459, or chapter 466 shall maintain supervision for
   20  directing the specific course of medical treatment. Within the
   21  established framework, an advanced registered nurse practitioner
   22  may:
   23         (a) Order, administer, monitor, and alter any drug or drug
   24  therapies that are necessary for the proper medical care and
   25  treatment of a patient, including Schedule II through Schedule V
   26  controlled substances under chapter 893 and those drugs agreed
   27  upon by the advanced registered nurse practitioner and the
   28  supervising practitioner and specified in the protocol. An
   29  advanced registered nurse practitioner may order or administer
   30  such drugs under the following conditions:
   31         1.The drugs are ordered or administered by an advanced
   32  registered nurse practitioner in accordance with a protocol
   33  developed by the advanced registered nurse practitioner and the
   34  supervising practitioner, and the drugs ordered are consistent
   35  with the advanced registered nurse practitioner’s educational
   36  preparation or for which clinical competency has been
   37  established and maintained.
   38         2. The protocol covering the order or administration of
   39  drugs specifies the name of the advanced registered nurse
   40  practitioner who may administer or order drugs, the drugs that
   41  may be ordered and the circumstances under which they may be
   42  ordered, the extent of the practitioner’s supervision of the
   43  advanced registered nurse practitioner, and the method for
   44  periodic reviewing the advanced registered nurse practitioner’s
   45  competence, including peer review. The protocol for
   46  administering Schedule II controlled substances must address the
   47  illness, injury, or condition for which a Schedule II controlled
   48  substance is administered.
   49         3. The administering or ordering of drugs by an advanced
   50  registered nurse practitioner occurs under practitioner
   51  supervision. As used in this paragraph, the term “practitioner
   52  supervision” means a collaboration between the advanced
   53  registered nurse practitioner and the supervising practitioner
   54  on the development of the protocol and the availability of the
   55  supervising practitioner via telephonic contact at the time the
   56  patient is examined by the advanced registered nurse
   57  practitioner. The term does not mean that the physical presence
   58  of the supervising practitioner is required. A practitioner may
   59  not supervise more than four advanced registered nurse
   60  practitioners at any one time.
   61         4. The controlled substances are administered or ordered in
   62  accordance with a patient-specific protocol approved by the
   63  treating or supervising practitioner if Schedule II or Schedule
   64  III controlled substances are administered or ordered by the
   65  advanced registered nurse practitioner. A copy of the section of
   66  the advanced registered nurse practitioner’s protocol relating
   67  to controlled substances must be provided upon request to the
   68  licensed pharmacist who dispenses the drugs.
   69         5. The board has certified that the advanced registered
   70  nurse practitioner has satisfactorily completed:
   71         a.At least 6 months of direct supervision in the
   72  administering and ordering of drugs; and
   73         b. A course in pharmacology covering the order, use,
   74  administration, and dispensing of controlled substances.
   76  The board shall adopt rules to administer this paragraph.
   77         (b) Initiate appropriate therapies for certain conditions.
   78         (c) Perform additional functions as may be determined by
   79  rule in accordance with s. 464.003(2).
   80         (d) Order diagnostic tests and physical and occupational
   81  therapy.
   82         (4) In addition to the general functions specified in
   83  subsection (3), an advanced registered nurse practitioner may
   84  perform the following acts within his or her specialty:
   85         (a) The certified registered nurse anesthetist may, to the
   86  extent authorized by established protocol approved by the
   87  medical staff of the facility in which the anesthetic service is
   88  performed, perform any or all of the following:
   89         1. Determine the health status of the patient as it relates
   90  to the risk factors and to the anesthetic management of the
   91  patient through the performance of the general functions.
   92         2. Based on history, physical assessment, and supplemental
   93  laboratory results, determine, with the consent of the
   94  responsible physician, the appropriate type of anesthesia within
   95  the framework of the protocol.
   96         3. Order under the protocol preanesthetic medication.
   97         4. Perform under the protocol procedures commonly used to
   98  render the patient insensible to pain during the performance of
   99  surgical, obstetrical, therapeutic, or diagnostic clinical
  100  procedures. These procedures include ordering and administering
  101  regional, spinal, and general anesthesia; inhalation agents and
  102  techniques; intravenous agents and techniques; and techniques of
  103  hypnosis.
  104         5. Order or perform monitoring procedures indicated as
  105  pertinent to the anesthetic health care management of the
  106  patient.
  107         6. Support life functions during anesthesia health care,
  108  including induction and intubation procedures, the use of
  109  appropriate mechanical supportive devices, and the management of
  110  fluid, electrolyte, and blood component balances.
  111         7. Recognize and take appropriate corrective action for
  112  abnormal patient responses to anesthesia, adjunctive medication,
  113  or other forms of therapy.
  114         8. Recognize and treat a cardiac arrhythmia while the
  115  patient is under anesthetic care.
  116         9. Participate in management of the patient while in the
  117  postanesthesia recovery area, including ordering the
  118  administration of fluids and drugs, including those drugs that
  119  are commonly used to alleviate pain.
  120         10. Place special peripheral and central venous and
  121  arterial lines for blood sampling and monitoring as appropriate.
  123  ================= T I T L E  A M E N D M E N T ================
  124         And the title is amended as follows:
  125         Delete line 80
  126  and insert:
  127         Department of Elderly Affairs; amending s. 464.012,
  128         F.S.; expanding the scope of practice to authorize an
  129         advanced registered nurse practitioner to order,
  130         administer, monitor, and alter any drug or drug
  131         therapies that are necessary for the proper medical
  132         care and treatment of a patient under specified
  133         circumstances; requiring that the Board of Nursing
  134         adopt rules; authorizing a certified registered nurse
  135         anesthetist, while participating in the management of
  136         a patient in the postanesthesia recovery area, to
  137         order the administration of drugs that are commonly
  138         used to alleviate pain; amending s. 31, chapter