Florida Senate - 2024 SB 810
By Senator Ingoglia
11-00206A-24 2024810__
1 A bill to be entitled
2 An act relating to autonomous practice by advanced
3 practice registered nurses; amending s. 395.0191,
4 F.S.; exempting certain certified advanced practice
5 registered nurses from specified medical direction
6 requirements for clinical privileges in hospitals;
7 providing an exception; amending s. 464.012, F.S.;
8 revising the functions that certain certified
9 registered nurse anesthetists may perform without an
10 established protocol; providing construction; amending
11 s. 464.0123, F.S.; revising the scope of autonomous
12 practice for certain advanced practice registered
13 nurses; providing for the future expiration of the
14 Council on Advanced Practice Registered Nurse
15 Autonomous Practice; amending s. 1009.65, F.S.;
16 conforming a provision to changes made by the act;
17 providing an effective date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Paragraph (b) of subsection (2) of section
22 395.0191, Florida Statutes, is amended to read:
23 395.0191 Staff membership and clinical privileges.—
24 (2)
25 (b) An advanced practice registered nurse who is certified
26 as a registered nurse anesthetist licensed under part I of
27 chapter 464 shall administer anesthesia under the onsite medical
28 direction of a professional licensed under chapter 458, chapter
29 459, or chapter 466, and in accordance with an established
30 protocol approved by the medical staff. The medical direction
31 shall specifically address the needs of the individual patient.
32 This paragraph does not apply to an autonomous advanced practice
33 registered nurse registered under s. 464.0123 who is a certified
34 registered nurse anesthetist under part I of chapter 464, except
35 that a facility may require such certified registered nurse
36 anesthetist to perform specified acts under a protocol
37 established by the medical staff or governing board of the
38 facility.
39 Section 2. Paragraph (b) of subsection (4) of section
40 464.012, Florida Statutes, is amended to read:
41 464.012 Licensure of advanced practice registered nurses;
42 fees; controlled substance prescribing.—
43 (4) In addition to the general functions specified in
44 subsection (3), an advanced practice registered nurse may
45 perform the following acts within his or her specialty:
46 (b) The certified registered nurse anesthetist may perform
47 any of the following functions, to the extent authorized by
48 established protocol approved by the medical staff of the
49 facility in which the anesthetic service is performed or, if
50 registered and practicing as an autonomous advanced practice
51 registered nurse under s. 464.0123, without an established
52 protocol, perform any or all of the following:
53 1. Determine the health status of the patient as it relates
54 to the risk factors and to the anesthetic management of the
55 patient through the performance of the general functions.
56 2. Based on history, physical assessment, and supplemental
57 laboratory results, determine, with the consent of the
58 responsible physician, the appropriate type of anesthesia within
59 the framework of the protocol. A certified registered nurse
60 anesthetist registered and practicing under s. 464.0123 may make
61 this determination without an established protocol.
62 3. Order under the protocol preanesthetic medication. A
63 certified registered nurse anesthetist registered and practicing
64 under s. 464.0123 may order preanesthetic medication without an
65 established protocol.
66 4. Perform under the protocol, unless registered and
67 practicing under s. 464.0123 without an established protocol,
68 procedures commonly used to render the patient insensible to
69 pain during the performance of surgical, obstetrical,
70 therapeutic, or diagnostic clinical procedures. These procedures
71 include ordering and administering regional, spinal, and general
72 anesthesia; inhalation agents and techniques; intravenous agents
73 and techniques; and techniques of hypnosis.
74 5. Order or perform monitoring procedures indicated as
75 pertinent to the anesthetic health care management of the
76 patient.
77 6. Support life functions during anesthesia health care,
78 including induction and intubation procedures, the use of
79 appropriate mechanical supportive devices, and the management of
80 fluid, electrolyte, and blood component balances.
81 7. Recognize and take appropriate corrective action for
82 abnormal patient responses to anesthesia, adjunctive medication,
83 or other forms of therapy.
84 8. Recognize and treat a cardiac arrhythmia while the
85 patient is under anesthetic care.
86 9. Participate in management of the patient while in the
87 postanesthesia recovery area, including ordering the
88 administration of fluids and drugs.
89 10. Place special peripheral and central venous and
90 arterial lines for blood sampling and monitoring as appropriate.
91
92 A certified registered nurse anesthetist registered and
93 practicing as an autonomous advanced practice registered nurse
94 under s. 464.0123 may perform any of the functions specified in
95 this paragraph without an established protocol, but only to the
96 extent such functions are authorized under this part.
97 Section 3. Paragraph (a) of subsection (3) of section
98 464.0123, Florida Statutes, is amended, and paragraph (e) is
99 added to subsection (4) of that section, to read:
100 464.0123 Autonomous practice by an advanced practice
101 registered nurse.—
102 (3) PRACTICE REQUIREMENTS.—
103 (a) An advanced practice registered nurse who is registered
104 under this section may:
105 1. Engage in autonomous practice only in primary care
106 practice, including family medicine, general pediatrics, and
107 general internal medicine, and in anesthesia, as defined by
108 board rule.
109 2. For certified nurse midwives, engage in autonomous
110 practice in the performance of the acts listed in s.
111 464.012(4)(c).
112 3. Perform the general functions of an advanced practice
113 registered nurse under s. 464.012(3) related to primary care.
114 4. For certified registered nurse anesthetists, engage in
115 autonomous practice in the performance of the acts specified in
116 s. 464.012(4)(b).
117 5. For a patient who requires the services of a health care
118 facility, as defined in s. 408.032(8):
119 a. Admit the patient to the facility.
120 b. Manage the care received by the patient in the facility.
121 c. Discharge the patient from the facility, unless
122 prohibited by federal law or rule.
123 6.5. Provide a signature, certification, stamp,
124 verification, affidavit, or endorsement that is otherwise
125 required by law to be provided by a physician, except an
126 advanced practice registered nurse registered under this section
127 may not issue a physician certification under s. 381.986.
128 (4) COUNCIL ON ADVANCED PRACTICE REGISTERED NURSE
129 AUTONOMOUS PRACTICE.—
130 (e) The council shall dissolve, and this subsection
131 expires, on July 1, 2025.
132 Section 4. Paragraph (b) of subsection (1) of section
133 1009.65, Florida Statutes, is amended to read:
134 1009.65 Medical Education Reimbursement and Loan Repayment
135 Program.—
136 (1) To encourage qualified medical professionals to
137 practice in underserved locations where there are shortages of
138 such personnel, there is established the Medical Education
139 Reimbursement and Loan Repayment Program. The function of the
140 program is to make payments that offset loans and educational
141 expenses incurred by students for studies leading to a medical
142 or nursing degree, medical or nursing licensure, or advanced
143 practice registered nurse licensure or physician assistant
144 licensure. The following licensed or certified health care
145 professionals are eligible to participate in this program:
146 (b) Advanced practice registered nurses registered to
147 engage in autonomous practice under s. 464.0123 and practicing
148 in the primary care specialties of family medicine, general
149 pediatrics, general internal medicine, or midwifery, or
150 anesthesia. From the funds available, the Department of Health
151 shall make payments of up to $15,000 per year to advanced
152 practice registered nurses registered under s. 464.0123 who
153 demonstrate, as required by department rule, active employment
154 providing primary care services in a public health program, an
155 independent practice, or a group practice that serves Medicaid
156 recipients and other low-income patients and that is located in
157 a primary care health professional shortage area. Only loans to
158 pay the costs of tuition, books, medical equipment and supplies,
159 uniforms, and living expenses may be covered. For the purposes
160 of this paragraph:
161 1. “Primary care health professional shortage area” means a
162 geographic area, an area having a special population, or a
163 facility with a score of at least 18, as designated and
164 calculated by the Federal Health Resources and Services
165 Administration or a rural area as defined by the Federal Office
166 of Rural Health Policy.
167 2. “Public health program” means a county health
168 department, the Children’s Medical Services program, a federally
169 funded community health center, a federally funded migrant
170 health center, or any other publicly funded or nonprofit health
171 care program designated by the department.
172 Section 5. This act shall take effect July 1, 2024.