Senate Bill 986 (2022) — Collaborative practice in health care
SB 986
Florida Bills
Florida Senate - 2022 SB 986 By Senator Diaz 36-00511-22 2022986__ Page 1 of 7 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1
An act relating to collaborative practice in health 2 care; amending s. 395.0191, F.S.; specifying that 3 certified registered nurse anesthetists administering 4 anesthesia in hospital settings must be working in 5 collaboration with, rather than under the direction 6 of, certain health care practitioners; defining the 7 term “collaboration”; amending s. 464.003, F.S.; 8 revising the definition of the term “advanced or 9 specialized nursing practice”; defining the term 10 “collaboration”; amending s. 464.012, F.S.; exempting 11 certified registered nurse anesthetists from specified 12 protocol requirements under certain circumstances; 13 authorizing certified registered nurse anesthetists to 14 perform specified functions in collaboration with, 15 rather than pursuant to an established protocol under, 16 certain health care practitioners; amending s. 960.28, 17 F.S.; conforming a cross-reference; providing an 18 effective date. 19 20 Be It Enacted by the Legislature of the State of Florida: 21 22
Section 1. Paragraph (
b) of subsection (2) of
section 23 395.0191, Florida Statutes, is amended to read: 24 395.0191 Staff membership and clinical privileges.— 25 (2) 26 (
b) An advanced practice registered nurse who is certified 27 as a registered nurse anesthetist licensed under
part I of 28
chapter 464 shall administer anesthesia in collaboration with 29
Florida Senate - 2022 SB 986 36-00511-22 2022986__ Page 2 of 7 CODING: Words stricken are deletions; words underlined are additions. under the onsite medical direction of a health care practitioner 30 professional licensed under
chapter 458,
chapter 459, or
chapter 31 466. For purposes of this paragraph, the term “collaboration” 32 has the same meaning as in s. 464.003, and in accordance with an 33 established protocol approved by the medical staff. The medical 34 direction shall specifically address the needs of the individual 35 patient. 36
Section 2. Present subsections (10) through (22) of
section 37 464.003, Florida Statutes, are redesignated as subsections (11) 38 through (23), respectively, a new subsection (10) is added to 39 that section, and subsection (2) of that
section is amended, to 40 read: 41 464.003
Definitions.—As used in this part, the term: 42 (2) “Advanced or specialized nursing practice” means, in 43 addition to the practice of professional nursing, the 44 performance of advanced-level nursing acts approved by the board 45 which, by virtue of postbasic specialized education, training, 46 and experience, are appropriately performed by an advanced 47 practice registered nurse. Within the context of advanced or 48 specialized nursing practice, the advanced practice registered 49 nurse may perform acts of nursing diagnosis and nursing 50 treatment of alterations of the health status.
The advanced 51 practice registered nurse may also perform acts of medical 52 diagnosis and treatment, prescription, and operation as 53 authorized within the framework of an established supervisory 54 protocol or in collaboration with a licensed health care 55 practitioner as specified in subsection (10). The department 56 may, by rule, may require that a copy of the protocol be filed 57 with the department along with the notice required by s. 58
Florida Senate - 2022 SB 986 36-00511-22 2022986__ Page 3 of 7 CODING: Words stricken are deletions; words underlined are additions. 458.348. 59 (10) “Collaboration” means the cooperative working 60 relationship between a health care practitioner licensed under 61
chapter 458,
chapter 459, or
chapter 466 who is performing a 62 medical or surgical procedure, or is directly involved in such 63 procedure, and a certified registered nurse anesthetist 64 performing the functions described in s. 464.012(4)(
b) before, 65 during, or after a medical or surgical procedure. The term 66 includes the shared formulation and discussion of patient 67 treatment in which each practitioner contributes his or her 68 respective expertise in the management and delivery of health 69 care. 70
Section 3. Subsection (3) and paragraph (
b) of subsection 71 (4) of
section 464.012, Florida Statutes, are amended to read: 72 464.012 Licensure of advanced practice registered nurses; 73 fees; controlled substance prescribing.— 74
(3) An advanced practice registered nurse shall perform 75 those functions authorized in this
section within the framework 76 of an established protocol that must be maintained on site at 77 the location or locations at which an advanced practice 78 registered nurse practices, unless the advanced practice 79 registered nurse is registered and practicing under s. 464.0123 80 or is licensed and practicing as a certified registered nurse 81 anesthetist in collaboration with a health care practitioner 82 licensed under
chapter 458,
chapter 459, or
chapter 466. In the 83 case of an advanced practice registered nurse practicing under 84 multiple supervising physicians in the same group, the an 85 advanced practice registered nurse must enter into a supervisory 86 protocol with at least one physician within the physician group 87
Florida Senate - 2022 SB 986 36-00511-22 2022986__ Page 4 of 7 CODING: Words stricken are deletions; words underlined are additions. practice. A practitioner currently licensed under
chapter 458, 88
chapter 459, or
chapter 466 shall maintain supervision of the 89 advanced practice registered nurse for directing the specific 90 course of medical treatment. Within the established framework, 91 an advanced practice registered nurse may: 92 (
a) Prescribe, dispense, administer, or order any drug; 93 however, an advanced practice registered nurse may prescribe or 94 dispense a controlled substance as defined in s. 893.03 only if 95 the advanced practice registered nurse has graduated from a 96 program leading to a master’s or doctoral degree in a clinical 97 nursing specialty area with training in specialized practitioner 98 skills. 99 (
b) Initiate appropriate therapies for certain conditions. 100 (
c) Perform additional functions as may be determined by 101 rule in accordance with s. 464.003(2). 102 (
d) Order diagnostic tests and physical and occupational 103 therapy. 104 (
e) Order any medication for administration to a patient in 105 a facility licensed under
chapter 395 or
part II of
chapter 400, 106 notwithstanding any provisions in
chapter 465 or
chapter 893. 107
(4) In addition to the general functions specified in 108 subsection (3), an advanced practice registered nurse may 109 perform the following acts within his or her specialty: 110 (
b) A The certified registered nurse anesthetist, in 111 collaboration with a health care practitioner licensed under 112
chapter 458,
chapter 459, or
chapter 466, may do, to the extent 113 authorized by established protocol approved by the medical staff 114 of the facility in which the anesthetic service is performed, 115 perform any or all of the following: 116
Florida Senate - 2022 SB 986 36-00511-22 2022986__ Page 5 of 7 CODING: Words stricken are deletions; words underlined are additions. 1. Determine the health status of the patient as it relates 117 to the risk factors and to the anesthetic management of the 118 patient through the performance of the general functions. 119 2. Based on history, physical assessment, and supplemental 120 laboratory results, determine, with the consent of the 121 responsible physician, the appropriate type of anesthesia within 122 the framework of the protocol. 123 3. Order under the protocol preanesthetic medication. 124 4.
Perform under the protocol procedures commonly used to 125 render the patient insensible to pain during the performance of 126 surgical, obstetrical, therapeutic, or diagnostic clinical 127 procedures. These procedures include ordering and administering 128 regional, spinal, and general anesthesia; inhalation agents and 129 techniques; intravenous agents and techniques; and techniques of 130 hypnosis. 131 5. Order or perform monitoring procedures indicated as 132 pertinent to the anesthetic health care management of the 133 patient. 134 6.
Support life functions during anesthesia health care, 135 including induction and intubation procedures, the use of 136 appropriate mechanical supportive devices, and the management of 137 fluid, electrolyte, and blood component balances. 138 7. Recognize and take appropriate corrective action for 139 abnormal patient responses to anesthesia, adjunctive medication, 140 or other forms of therapy. 141 8. Recognize and treat a cardiac arrhythmia while the 142 patient is under anesthetic care. 143 9. Participate in management of the patient while in the 144 postanesthesia recovery area, including ordering the 145
Florida Senate - 2022 SB 986 36-00511-22 2022986__ Page 6 of 7 CODING: Words stricken are deletions; words underlined are additions. administration of fluids and drugs. 146 10. Place special peripheral and central venous and 147 arterial lines for blood sampling and monitoring as appropriate. 148
Section 4. Subsection (2) of
section 960.28, Florida 149 Statutes, is amended to read: 150 960.28 Payment for victims’ initial forensic physical 151 examinations.— 152
(2) The Crime Victims’ Services Office of the department 153 shall pay for medical expenses connected with an initial 154 forensic physical examination of a victim of sexual battery as 155 defined in
chapter 794 or a lewd or lascivious offense as 156 defined in
chapter 800. Such payment shall be made regardless of 157 whether the victim is covered by health or disability insurance 158 and whether the victim participates in the criminal justice 159 system or cooperates with law enforcement. The payment shall be 160 made only out of moneys allocated to the Crime Victims’ Services 161 Office for the purposes of this section, and the payment may not 162 exceed $1,000 with respect to any violation. The department 163 shall develop and maintain separate protocols for the initial 164 forensic physical examination of adults and children. Payment 165 under this
section is limited to medical expenses connected with 166 the initial forensic physical examination, and payment may be 167 made to a medical provider using an examiner qualified under 168
part I of
chapter 464, excluding s. 464.003(16) s. 464.003(15); 169
chapter 458; or
chapter 459. Payment made to the medical 170 provider by the department shall be considered by the provider 171 as payment in full for the initial forensic physical examination 172 associated with the collection of evidence. The victim may not 173 be required to pay, directly or indirectly, the cost of an 174
Florida Senate - 2022 SB 986 36-00511-22 2022986__ Page 7 of 7 CODING: Words stricken are deletions; words underlined are additions. initial forensic physical examination performed in accordance 175 with this section. 176