Florida Senate - 2022                                     SB 986
       By Senator Diaz
       36-00511-22                                            2022986__
    1                        A bill to be entitled                      
    2         An act relating to collaborative practice in health
    3         care; amending s. 395.0191, F.S.; specifying that
    4         certified registered nurse anesthetists administering
    5         anesthesia in hospital settings must be working in
    6         collaboration with, rather than under the direction
    7         of, certain health care practitioners; defining the
    8         term “collaboration”; amending s. 464.003, F.S.;
    9         revising the definition of the term “advanced or
   10         specialized nursing practice”; defining the term
   11         “collaboration”; amending s. 464.012, F.S.; exempting
   12         certified registered nurse anesthetists from specified
   13         protocol requirements under certain circumstances;
   14         authorizing certified registered nurse anesthetists to
   15         perform specified functions in collaboration with,
   16         rather than pursuant to an established protocol under,
   17         certain health care practitioners; amending s. 960.28,
   18         F.S.; conforming a cross-reference; providing an
   19         effective date.
   21  Be It Enacted by the Legislature of the State of Florida:
   23         Section 1. Paragraph (b) of subsection (2) of section
   24  395.0191, Florida Statutes, is amended to read:
   25         395.0191 Staff membership and clinical privileges.—
   26         (2)
   27         (b) An advanced practice registered nurse who is certified
   28  as a registered nurse anesthetist licensed under part I of
   29  chapter 464 shall administer anesthesia in collaboration with
   30  under the onsite medical direction of a health care practitioner
   31  professional licensed under chapter 458, chapter 459, or chapter
   32  466. For purposes of this paragraph, the term “collaboration”
   33  has the same meaning as in s. 464.003, and in accordance with an
   34  established protocol approved by the medical staff. The medical
   35  direction shall specifically address the needs of the individual
   36  patient.
   37         Section 2. Present subsections (10) through (22) of section
   38  464.003, Florida Statutes, are redesignated as subsections (11)
   39  through (23), respectively, a new subsection (10) is added to
   40  that section, and subsection (2) of that section is amended, to
   41  read:
   42         464.003 Definitions.—As used in this part, the term:
   43         (2) “Advanced or specialized nursing practice” means, in
   44  addition to the practice of professional nursing, the
   45  performance of advanced-level nursing acts approved by the board
   46  which, by virtue of postbasic specialized education, training,
   47  and experience, are appropriately performed by an advanced
   48  practice registered nurse. Within the context of advanced or
   49  specialized nursing practice, the advanced practice registered
   50  nurse may perform acts of nursing diagnosis and nursing
   51  treatment of alterations of the health status. The advanced
   52  practice registered nurse may also perform acts of medical
   53  diagnosis and treatment, prescription, and operation as
   54  authorized within the framework of an established supervisory
   55  protocol or in collaboration with a licensed health care
   56  practitioner as specified in subsection (10). The department
   57  may, by rule, may require that a copy of the protocol be filed
   58  with the department along with the notice required by s.
   59  458.348.
   60         (10) Collaboration” means the cooperative working
   61  relationship between a health care practitioner licensed under
   62  chapter 458, chapter 459, or chapter 466 who is performing a
   63  medical or surgical procedure, or is directly involved in such
   64  procedure, and a certified registered nurse anesthetist
   65  performing the functions described in s. 464.012(4)(b) before,
   66  during, or after a medical or surgical procedure. The term
   67  includes the shared formulation and discussion of patient
   68  treatment in which each practitioner contributes his or her
   69  respective expertise in the management and delivery of health
   70  care.
   71         Section 3. Subsection (3) and paragraph (b) of subsection
   72  (4) of section 464.012, Florida Statutes, are amended to read:
   73         464.012 Licensure of advanced practice registered nurses;
   74  fees; controlled substance prescribing.—
   75         (3) An advanced practice registered nurse shall perform
   76  those functions authorized in this section within the framework
   77  of an established protocol that must be maintained on site at
   78  the location or locations at which an advanced practice
   79  registered nurse practices, unless the advanced practice
   80  registered nurse is registered and practicing under s. 464.0123
   81  or is licensed and practicing as a certified registered nurse
   82  anesthetist in collaboration with a health care practitioner
   83  licensed under chapter 458, chapter 459, or chapter 466. In the
   84  case of an advanced practice registered nurse practicing under
   85  multiple supervising physicians in the same group, the an
   86  advanced practice registered nurse must enter into a supervisory
   87  protocol with at least one physician within the physician group
   88  practice. A practitioner currently licensed under chapter 458,
   89  chapter 459, or chapter 466 shall maintain supervision of the
   90  advanced practice registered nurse for directing the specific
   91  course of medical treatment. Within the established framework,
   92  an advanced practice registered nurse may:
   93         (a) Prescribe, dispense, administer, or order any drug;
   94  however, an advanced practice registered nurse may prescribe or
   95  dispense a controlled substance as defined in s. 893.03 only if
   96  the advanced practice registered nurse has graduated from a
   97  program leading to a master’s or doctoral degree in a clinical
   98  nursing specialty area with training in specialized practitioner
   99  skills.
  100         (b) Initiate appropriate therapies for certain conditions.
  101         (c) Perform additional functions as may be determined by
  102  rule in accordance with s. 464.003(2).
  103         (d) Order diagnostic tests and physical and occupational
  104  therapy.
  105         (e) Order any medication for administration to a patient in
  106  a facility licensed under chapter 395 or part II of chapter 400,
  107  notwithstanding any provisions in chapter 465 or chapter 893.
  108         (4) In addition to the general functions specified in
  109  subsection (3), an advanced practice registered nurse may
  110  perform the following acts within his or her specialty:
  111         (b) A The certified registered nurse anesthetist, in
  112  collaboration with a health care practitioner licensed under
  113  chapter 458, chapter 459, or chapter 466, may do, to the extent
  114  authorized by established protocol approved by the medical staff
  115  of the facility in which the anesthetic service is performed,
  116  perform any or all of the following:
  117         1. Determine the health status of the patient as it relates
  118  to the risk factors and to the anesthetic management of the
  119  patient through the performance of the general functions.
  120         2. Based on history, physical assessment, and supplemental
  121  laboratory results, determine, with the consent of the
  122  responsible physician, the appropriate type of anesthesia within
  123  the framework of the protocol.
  124         3. Order under the protocol preanesthetic medication.
  125         4. Perform under the protocol procedures commonly used to
  126  render the patient insensible to pain during the performance of
  127  surgical, obstetrical, therapeutic, or diagnostic clinical
  128  procedures. These procedures include ordering and administering
  129  regional, spinal, and general anesthesia; inhalation agents and
  130  techniques; intravenous agents and techniques; and techniques of
  131  hypnosis.
  132         5. Order or perform monitoring procedures indicated as
  133  pertinent to the anesthetic health care management of the
  134  patient.
  135         6. Support life functions during anesthesia health care,
  136  including induction and intubation procedures, the use of
  137  appropriate mechanical supportive devices, and the management of
  138  fluid, electrolyte, and blood component balances.
  139         7. Recognize and take appropriate corrective action for
  140  abnormal patient responses to anesthesia, adjunctive medication,
  141  or other forms of therapy.
  142         8. Recognize and treat a cardiac arrhythmia while the
  143  patient is under anesthetic care.
  144         9. Participate in management of the patient while in the
  145  postanesthesia recovery area, including ordering the
  146  administration of fluids and drugs.
  147         10. Place special peripheral and central venous and
  148  arterial lines for blood sampling and monitoring as appropriate.
  149         Section 4. Subsection (2) of section 960.28, Florida
  150  Statutes, is amended to read:
  151         960.28 Payment for victims’ initial forensic physical
  152  examinations.—
  153         (2) The Crime Victims’ Services Office of the department
  154  shall pay for medical expenses connected with an initial
  155  forensic physical examination of a victim of sexual battery as
  156  defined in chapter 794 or a lewd or lascivious offense as
  157  defined in chapter 800. Such payment shall be made regardless of
  158  whether the victim is covered by health or disability insurance
  159  and whether the victim participates in the criminal justice
  160  system or cooperates with law enforcement. The payment shall be
  161  made only out of moneys allocated to the Crime Victims’ Services
  162  Office for the purposes of this section, and the payment may not
  163  exceed $1,000 with respect to any violation. The department
  164  shall develop and maintain separate protocols for the initial
  165  forensic physical examination of adults and children. Payment
  166  under this section is limited to medical expenses connected with
  167  the initial forensic physical examination, and payment may be
  168  made to a medical provider using an examiner qualified under
  169  part I of chapter 464, excluding s. 464.003(16) s. 464.003(15);
  170  chapter 458; or chapter 459. Payment made to the medical
  171  provider by the department shall be considered by the provider
  172  as payment in full for the initial forensic physical examination
  173  associated with the collection of evidence. The victim may not
  174  be required to pay, directly or indirectly, the cost of an
  175  initial forensic physical examination performed in accordance
  176  with this section.
  177         Section 5. This act shall take effect July 1, 2022.