S.F. _____ H.F. _____ Section 1. Section 125.2, subsection 14, Code Supplement 1 2011, is amended to read as follows: 2 14. “Psychiatric advanced registered nurse practitioner” 3 means an individual currently licensed as a registered nurse 4 under chapter 152 or 152E who holds a national certification 5 in psychiatric health care and who is registered with licensed 6 by the board of nursing as an advanced registered nurse 7 practitioner. 8 Sec. 2. Section 147.74, subsection 21, Code 2011, is amended 9 to read as follows: 10 21. A registered nurse licensed under chapter 152 may use 11 the words “registered nurse” or the letters “R. N.” after the 12 person’s name. A licensed practical nurse licensed under 13 chapter 152 may use the words “licensed practical nurse” or 14 the letters “L. P. N.” after the person’s name. An advanced 15 registered nurse practitioner licensed under chapter 152 may 16 use the words “advanced registered nurse practitioner” or the 17 letters “A.R.N.P.” after the person’s name. 18 Sec. 3. Section 147.107, subsection 8, Code Supplement 19 2011, is amended to read as follows: 20 8. Notwithstanding subsection 1 , but subject to the 21 limitations contained in subsections 2 and 3 , a registered 22 nurse who is licensed and registered as an advanced registered 23 nurse practitioner and who qualifies for and is registered 24 in a recognized nursing specialty may prescribe substances 25 or devices, including controlled substances or devices, if 26 the nurse is engaged in the practice of a nursing specialty 27 regulated under rules adopted by the board of nursing in 28 consultation with the board of medicine and the board of 29 pharmacy. 30 Sec. 4. Section 152.1, Code 2011, is amended by adding the 31 following new subsection: 32 NEW SUBSECTION . 3A. The “practice of an advanced registered 33 nurse practitioner” means the practice of an independent 34 practitioner who is licensed by the board to do all of the 35 -1- LSB 5268DP (7) 84 jr/nh 1/ 11

S.F. _____ H.F. _____ following: 1 a. Use the title “advanced registered nurse practitioner” 2 and the letters “A.R.N.P.” pursuant to section 152.6. 3 b. Practice independently in a specialty area approved by 4 the board. 5 c. Prescribe, deliver, distribute, or dispense prescription 6 drugs, devices, and medical gases when the nurse is engaged in 7 the practice of a specialty area approved by the board pursuant 8 to section 147.107. 9 d. Perform a physical or an advanced assessment; order 10 and interpret diagnostic procedures; formulate a primary and 11 differential diagnosis; order therapeutic treatments; educate 12 and counsel patients and family members; delegate and assign 13 therapeutic measures to assistive personnel; maintain hospital 14 privileges; consult with other disciplines; provide referrals 15 to health care agencies, health care providers, and community 16 resources; and promote health maintenance. 17 e. Perform acts or nursing specialties that require 18 education as prescribed by the board, commensurate with the 19 advanced registered nurse practitioner’s education, continuing 20 education, demonstrated competencies, and experience. 21 f. Sign death certificates, pursuant to section 144.26 or 22 144.28. 23 Sec. 5. Section 152.1, subsections 4 and 5, Code 2011, are 24 amended to read as follows: 25 4. The “practice of a licensed practical nurse” means the 26 practice of a natural person who is licensed by the board to do 27 all of the following: 28 a. Perform services in the provision of supportive or 29 restorative care under the supervision of a registered nurse 30 or a physician. 31 b. Perform additional acts under emergency or other 32 conditions which require education and training and which are 33 recognized by the medical and nursing professions and are 34 approved by the board, as being proper to be performed by a 35 -2- LSB 5268DP (7) 84 jr/nh 2/ 11

S.F. _____ H.F. _____ licensed practical nurse that require education as prescribed 1 by the board, commensurate with the licensed practical nurse’s 2 education, continuing education, demonstrated competencies, and 3 experience . 4 c. Make the pronouncement of death for a patient whose death 5 is anticipated if the death occurs in a licensed hospital, a 6 licensed health care facility, a Medicare-certified home health 7 agency, a Medicare-certified hospice program or facility, or 8 an assisted living facility or residential care facility, 9 with notice of the death to a physician and in accordance 10 with any directions of a physician , advanced registered nurse 11 practitioner, or physician assistant . 12 5. The “practice of nursing” means the practice of a 13 registered nurse , or a licensed practical nurse , or an advanced 14 registered nurse practitioner . It does not mean any of the 15 following: 16 a. The practice of medicine and surgery and the practice of 17 osteopathic medicine and surgery, as defined in chapter 148 , 18 or the practice of pharmacy as defined in chapter 155A , except 19 practices which are recognized by the medical and nursing 20 professions and approved by the board as proper to be performed 21 by a registered nurse . 22 b. The performance of nursing services by an unlicensed 23 student enrolled in a nursing education program if performance 24 is part of the course of study. Individuals who have been 25 licensed as registered nurses , or licensed practical or 26 vocational nurses , or advanced registered nurse practitioners 27 in any state or jurisdiction of the United States are not 28 subject to this exemption. 29 c. The performance of services by unlicensed workers 30 employed in offices, hospitals, or health care facilities, as 31 defined in section 135C.1 , under the supervision of a physician 32 or a nurse licensed under this chapter , or employed in the 33 office of a psychologist, podiatric physician, optometrist, 34 chiropractor, speech pathologist, audiologist, or physical 35 -3- LSB 5268DP (7) 84 jr/nh 3/ 11

S.F. _____ H.F. _____ therapist licensed to practice in this state, and when acting 1 while within the scope of the employer’s license. 2 d. The practice of a nurse licensed in another state 3 and employed in this state by the federal government if the 4 practice is in discharge of official employment duties. 5 e. The care of the sick rendered in connection with the 6 practice of the religious tenets of any church or order by 7 the adherents thereof which is not performed for hire, or if 8 performed for hire by those who depend upon prayer or spiritual 9 means for healing in the practice of the religion of their 10 church or denomination, so long as they do not otherwise engage 11 in the practice of nursing as practical nurses. 12 Sec. 6. Section 152.1, subsection 6, paragraphs d and e, 13 Code 2011, are amended to read as follows: 14 d. Perform additional acts or nursing specialties which 15 that require education and training under emergency or other 16 conditions which are recognized by the medical and nursing 17 professions and are approved by the board as being proper to be 18 performed by a registered nurse , as prescribed by the board, 19 commensurate with the registered nurse’s education, continuing 20 education, demonstrated competencies, and experience . 21 e. Make the pronouncement of death for a patient whose death 22 is anticipated if the death occurs in a licensed hospital, a 23 licensed health care facility, a Medicare-certified home health 24 agency, a Medicare-certified hospice program or facility, an 25 assisted living facility, or a residential care facility, with 26 notice of the death to a physician and in accordance with any 27 directions of a , advanced registered nurse practitioner, or 28 physician assistant . 29 Sec. 7. Section 152.2, Code 2011, is amended to read as 30 follows: 31 152.2 Executive director —— assistants . 32 The board shall appoint a full-time executive director. The 33 executive director shall be a registered nurse and shall not 34 be a member of the board. The governor, with the approval of 35 -4- LSB 5268DP (7) 84 jr/nh 4/ 11

S.F. _____ H.F. _____ the executive council pursuant to section 8A.413, subsection 3 , 1 under the pay plan for exempt positions in the executive branch 2 of government, shall set the salary of the executive director. 3 Sec. 8. Section 152.4, Code 2011, is amended to read as 4 follows: 5 152.4 Appropriations Use of funds . 6 The board may apply appropriated use any available funds to 7 and moneys retained by the board pursuant to section 147.82 8 for : 9 1. The administration and enforcement of the applicable 10 provisions of this chapter and of chapter chapters 147 , 152E, 11 and 272C . 12 2. The elevation of the standards of the schools of nursing. 13 3. The promotion of educational and professional standards 14 of nurses in this state. 15 4. The collection, analysis, and dissemination of nursing 16 workforce data. 17 Sec. 9. Section 152.5, subsections 1 and 2, Code 2011, are 18 amended to read as follows: 19 1. All programs preparing a person to be a registered nurse , 20 or a licensed practical nurse , or an advanced registered nurse 21 practitioner shall be approved by the board. The board shall 22 not recognize a program unless it: 23 a. Is of recognized standing. 24 b. Has provisions for adequate physical and clinical 25 facilities and other resources with which to conduct a sound 26 education program. 27 c. Requires, for graduation of a registered nurse applicant, 28 the completion of at least a two academic year course of study. 29 d. Requires, for graduation of a licensed practical nurse 30 applicant, the completion of at least a one academic year 31 course of study as prescribed by the board. 32 e. Requires, for graduation of an advanced registered nurse 33 practitioner, satisfactory completion of a formal advanced 34 practice educational program of study in a nursing specialty 35 -5- LSB 5268DP (7) 84 jr/nh 5/ 11

S.F. _____ H.F. _____ area approved by the board and appropriate clinical experience 1 as approved by the board. 2 2. All advanced postlicensure formal academic nursing 3 education programs shall also be approved by the board. 4 Sec. 10. Section 152.5, subsection 3, Code 2011, is amended 5 by striking the subsection. 6 Sec. 11. NEW SECTION . 152.5A Student record checks. 7 1. For the purposes of this section: 8 a. “Nursing program” means a nursing program that is 9 approved by the board pursuant to section 152.5. 10 b. “Student” means a person applying for, enrolled in, or 11 returning to the clinical education component of a nursing 12 program. 13 2. All nursing programs shall conduct record checks on 14 students as provided in this section. 15 3. A nursing program may access the single contact 16 repository established pursuant to section 135C.33 as necessary 17 for the nursing program to initiate record checks of students. 18 4. A nursing program shall request that the department 19 of public safety perform a criminal history check and the 20 department of human services perform child and dependent adult 21 abuse record checks in this state on the nursing program’s 22 students. 23 5. If a student has a criminal record or a record of founded 24 child or dependent adult abuse, upon request of the nursing 25 program, the department of human services shall perform an 26 evaluation to determine whether the record warrants prohibition 27 of the person’s involvement in a clinical education component 28 of a nursing program involving children or dependent adults. 29 The department of human services shall utilize the criteria 30 provided in section 135C.33 in performing the evaluation and 31 shall report the results of the evaluation to the nursing 32 program. The department of human services has final authority 33 in determining whether prohibition of the person’s involvement 34 in a clinical education component is warranted. 35 -6- LSB 5268DP (7) 84 jr/nh 6/ 11

S.F. _____ H.F. _____ Sec. 12. Section 152.6, Code 2011, is amended to read as 1 follows: 2 152.6 Licenses —— professional abbreviations. 3 The board may license a natural person to practice as a 4 registered nurse , or as a licensed practical nurse , or an 5 advanced registered nurse practitioner . However, only a person 6 currently licensed as a registered nurse in this state may 7 use that title and the abbreviation “R N” letters “R.N.” after 8 the person’s name ; and only a person currently licensed as a 9 licensed practical nurse in this state may use that title and 10 the abbreviation “L P N” letters “L.P.N.” after the person’s 11 name ; and only a person currently licensed as an advanced 12 registered nurse practitioner may use that title and the 13 letters “A.R.N.P.” after the person’s name . For purposes of 14 this section , “currently licensed” includes persons licensed 15 in another state and recognized for licensure in this state 16 pursuant to the nurse licensure compact contained in section 17 152E.1 or pursuant to the advanced practice registered nurse 18 compact contained in section 152E.3 . 19 Sec. 13. Section 152.7, Code 2011, is amended by adding the 20 following new subsection: 21 NEW SUBSECTION . 1A. An applicant to be licensed as an 22 advanced registered nurse practitioner shall have the following 23 qualifications: 24 a. Hold a current license as a registered nurse pursuant to 25 this chapter. 26 b. Complete an advanced practice educational program as set 27 out in section 152.5. 28 Sec. 14. Section 152.10, subsection 2, paragraph d, Code 29 2011, is amended to read as follows: 30 d. (1) Having a license to practice nursing as a registered 31 nurse or licensed practical nurse revoked or suspended, or 32 having other disciplinary action taken by a licensing authority 33 of another state, territory, or country. A certified copy of 34 the record or order of suspension, revocation, or disciplinary 35 -7- LSB 5268DP (7) 84 jr/nh 7/ 11

S.F. _____ H.F. _____ action is prima facie evidence of such fact. 1 (2) Having a license to practice nursing as a registered 2 nurse or licensed practical nurse revoked or suspended, 3 or having other disciplinary action taken, by a licensing 4 authority in another state which has adopted the nurse 5 licensure compact contained in section 152E.1 or the advanced 6 practice registered nurse compact contained in section 152E.3 7 and which has communicated information relating to such 8 action pursuant to the coordinated licensure information 9 system established by the compact. If the action taken by 10 the licensing authority occurs in a jurisdiction which does 11 not afford the procedural protections of chapter 17A , the 12 licensee may object to the communicated information and shall 13 be afforded the procedural protections of chapter 17A . 14 Sec. 15. Section 152.11, Code 2011, is amended to read as 15 follows: 16 152.11 Investigators for nurses . 17 The board of nursing may appoint investigators, who shall 18 not be members of the board, to administer and aid in the 19 enforcement of the provisions of law related to those licensed 20 to practice nursing. The amount of compensation for the 21 investigators shall be determined pursuant to chapter 8A, 22 subchapter IV . Investigators authorized by the board of 23 nursing have the powers and status of peace officers when 24 enforcing this chapter and chapters 147 and 272C . 25 Sec. 16. Section 229.1, subsection 12, Code Supplement 26 2011, is amended to read as follows: 27 12. “Psychiatric advanced registered nurse practitioner” 28 means an individual currently licensed as a registered nurse 29 under chapter 152 or 152E who holds a national certification 30 in psychiatric health care and who is registered with licensed 31 by the board of nursing as an advanced registered nurse 32 practitioner. 33 Sec. 17. Section 231B.21, subsection 2, paragraph a, Code 34 2011, is amended to read as follows: 35 -8- LSB 5268DP (7) 84 jr/nh 8/ 11

S.F. _____ H.F. _____ a. If administration of medications is delegated to 1 the elder group home by the tenant or tenant’s legal 2 representative, the medications shall be administered by 3 a registered nurse, licensed practical nurse, or advanced 4 registered nurse practitioner licensed or registered in Iowa 5 or by the individual to whom such licensed or registered 6 individuals may properly delegate administration of 7 medications. 8 Sec. 18. Section 231C.16A, subsection 2, paragraph a, Code 9 2011, is amended to read as follows: 10 a. If administration of medications is delegated to the 11 program by the tenant or tenant’s legal representative, 12 the medications shall be administered by a registered 13 nurse, licensed practical nurse, or advanced registered 14 nurse practitioner licensed or registered in Iowa or by the 15 individual to whom such licensed or registered individuals may 16 properly delegate administration of medications. 17 Sec. 19. Section 231D.13A, subsection 2, paragraph a, Code 18 2011, is amended to read as follows: 19 a. If administration of medications is delegated to 20 the program by the participant or the participant’s legal 21 representative, the medications shall be administered by 22 a registered nurse, licensed practical nurse, or advanced 23 registered nurse practitioner licensed or registered in Iowa 24 or by the individual to whom such licensed or registered 25 individuals may properly delegate administration of 26 medications. 27 Sec. 20. Section 321.186, subsection 4, Code Supplement 28 2011, is amended to read as follows: 29 4. A physician licensed under chapter 148 , an advanced 30 registered nurse practitioner licensed under chapter 152 and 31 registered with the board of nursing , a physician assistant 32 licensed under chapter 148C , or an optometrist licensed under 33 chapter 154 may report to the department the identity of a 34 person who has been diagnosed as having a physical or mental 35 -9- LSB 5268DP (7) 84 jr/nh 9/ 11

S.F. _____ H.F. _____ condition which would render the person physically or mentally 1 incompetent to operate a motor vehicle in a safe manner. The 2 physician, advanced registered nurse practitioner, physician 3 assistant, or optometrist shall make reasonable efforts 4 to notify the person who is the subject of the report, in 5 writing. The written notification shall state the nature of 6 the disclosure and the reason for the disclosure. A physician, 7 advanced registered nurse practitioner, physician assistant, or 8 optometrist making a report under this section shall be immune 9 from any liability, civil or criminal, which might otherwise 10 be incurred or imposed as a result of the report. A physician, 11 advanced registered nurse practitioner, physician assistant, 12 or optometrist has no duty to make a report or to warn third 13 parties with regard to any knowledge concerning a person’s 14 mental or physical competency to operate a motor vehicle in 15 a safe manner. Any report received by the department from a 16 physician, advanced registered nurse practitioner, physician 17 assistant, or optometrist under this section shall be kept 18 confidential. Information regulated by chapter 141A shall be 19 subject to the confidentiality provisions and remedies of that 20 chapter. 21 Sec. 21. Section 514F.6, subsection 2, Code 2011, is amended 22 to read as follows: 23 2. For purposes of this section , “physician” means a 24 licensed doctor of medicine and surgery or a licensed doctor 25 of osteopathic medicine and surgery; “advanced registered 26 nurse practitioner” means a licensed an advanced registered 27 nurse who is also registered to practice in an advanced role 28 practitioner licensed under chapter 152 , “physician assistant” 29 means a person who is licensed to practice as a physician 30 assistant under the supervision of one or more physicians; 31 and “credentialing period” means the time period between the 32 health insurer’s receipt of a physician’s, advanced registered 33 nurse practitioner’s, or physician assistant’s application for 34 credentialing and approval of that application by the health 35 -10- LSB 5268DP (7) 84 jr/nh 10/ 11

S.F. _____ H.F. _____ insurer. “Credentialing” means a process through which a health 1 insurer makes a determination based on criteria established by 2 the health insurer concerning whether a physician, advanced 3 registered nurse practitioner, or physician assistant is 4 eligible to provide health care services to an insured and to 5 receive reimbursement for the health care services provided 6 under an agreement entered into between the physician, advanced 7 registered nurse practitioner, or physician assistant and the 8 health insurer. “Clean claim” means the same as defined in 9 section 507B.4A, subsection 2 , paragraph “b” . 10 Sec. 22. TRANSITION PROVISIONS —— CONTINUING VALIDITY OF 11 REGISTRATIONS. A registration as an advanced registered nurse 12 practitioner issued prior to July 1, 2012, remains valid until 13 its expiration. A renewal shall be by license as provided in 14 this Act. 15 EXPLANATION 16 This bill contains various revisions to the nurse practice 17 Act. The bill requires advanced registered nurse practitioners 18 to be licensed by the board of nursing rather than registered, 19 and authorizes the professional abbreviation “A.R.N.P.”. 20 Current Code language authorizes nurses to perform acts or 21 nursing specialties which are recognized by the medical and 22 nursing professions and are approved by the board. The bill 23 eliminates this provision and provides that the regulation 24 of nursing is the authority and responsibility of the board 25 to determine which acts or specialties may be performed by a 26 nurse, commensurate with the nurse’s education, continuing 27 education, demonstrated competencies and experience. 28 The bill specifies the purposes for which licensing fees 29 which are treated as return receipts may be used by the board. 30 -11- LSB 5268DP (7) 84 jr/nh 11/ 11