SENATE/HOUSE FILE _____

BY  (PROPOSED DEPARTMENT OF PUBLIC HEALTH/BOARD OF NURSING BILL)

A BILL FOR

An Act relating to the practice of nursing, including defining the functions of an advanced registered nurse practitioner and requiring background checks on nursing students.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 125.2, subsection 14, Code Supplement 2011, is amended to read as follows:
   14.  “Psychiatric advanced registered nurse practitioner” means an individual currently licensed as a registered nurse under chapter 152 or 152E who holds a national certification in psychiatric health care and who is registered with
 
licensed by the board of nursing as an advanced registered nurse practitioner.
    Sec. 2.  Section 147.74, subsection 21, Code 2011, is amended to read as follows:
   21.  A registered nurse licensed under chapter 152 may use the words “registered nurse” or the letters “R.N.” after the person’s name. A licensed practical nurse licensed under chapter 152 may use the words “licensed practical nurse” or the letters “L.P.N.” after the person’s name.

An advanced registered nurse practitioner licensed under chapter 152 may use the words “advanced registered nurse practitioner” or the letters “A.R.N.P.” after the person’s name.
    Sec. 3.  Section 147.107, subsection 8, Code Supplement 2011, is amended to read as follows:
   8.  Notwithstanding subsection 1, but subject to the limitations contained in subsections 2 and 3, a registered nurse who is licensed and registered as an advanced registered nurse practitioner and who qualifies for and is registered in a recognized nursing specialty may prescribe substances or devices, including controlled substances or devices, if the nurse is engaged in the practice of a nursing specialty regulated under rules adopted by the board of nursing in consultation with the board of medicine and the board of pharmacy.
    Sec. 4.  Section 152.1, Code 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  3A.  The “practice of an advanced registered nurse practitioner” means the practice of an independent practitioner who is licensed by the board to do all of the following:
   a.  Use the title “advanced registered nurse practitioner” and the letters “A.R.N.P.” pursuant to section 152.6.
   b.  Practice independently in a specialty area approved by the board.
   c.  Prescribe, deliver, distribute, or dispense prescription drugs, devices, and medical gases when the nurse is engaged in the practice of a specialty area approved by the board pursuant to section 147.107.
   d.  Perform a physical or an advanced assessment; order and interpret diagnostic procedures; formulate a primary and differential diagnosis; order therapeutic treatments; educate and counsel patients and family members; delegate and assign therapeutic measures to assistive personnel; maintain hospital privileges; consult with other disciplines; provide referrals to health care agencies, health care providers, and community resources; and promote health maintenance.
   e.  Perform acts or nursing specialties that require education as prescribed by the board, commensurate with the advanced registered nurse practitioner’s education, continuing education, demonstrated competencies, and experience.
   f.  Sign death certificates, pursuant to section 144.26 or 144.28.
    Sec. 5.  Section 152.1, subsections 4 and 5, Code 2011, are amended to read as follows:
   4.  The “practice of a licensed practical nurse” means the practice of a natural person who is licensed by the board to do all of the following:
   a.  Perform services in the provision of supportive or restorative care under the supervision of a registered nurse or a physician.
   b.  Perform additional acts under emergency or other conditions which require education and training and which are recognized by the medical and nursing professions and are approved by the board, as being proper to be performed by a licensed practical nurse
 
that require education as prescribed by the board, commensurate with the licensed practical nurse’s education, continuing education, demonstrated competencies, and experience.
   c.  Make the pronouncement of death for a patient whose death is anticipated if the death occurs in a licensed hospital, a licensed health care facility, a Medicare-certified home health agency, a Medicare-certified hospice program or facility, or an assisted living facility or residential care facility, with notice of the death to a physician and in accordance with any directions of a physician, advanced registered nurse practitioner, or physician assistant.
   5.  The “practice of nursing” means the practice of a registered nurse, or a licensed practical nurse, or an advanced registered nurse practitioner. It does not mean any of the following:
   a.  The practice of medicine and surgery and the practice of osteopathic medicine and surgery, as defined in chapter 148, or the practice of pharmacy as defined in chapter 155A, except practices which are recognized by the medical and nursing professions and approved by the board as proper to be performed by a registered nurse.
   b.  The performance of nursing services by an unlicensed student enrolled in a nursing education program if performance is part of the course of study. Individuals who have been licensed as registered nurses, or licensed practical or vocational nurses, or advanced registered nurse practitioners in any state or jurisdiction of the United States are not subject to this exemption.
   c.  The performance of services by unlicensed workers employed in offices, hospitals, or health care facilities, as defined in section 135C.1, under the supervision of a physician or a nurse licensed under this chapter, or employed in the office of a psychologist, podiatric physician, optometrist, chiropractor, speech pathologist, audiologist, or physical therapist licensed to practice in this state, and when acting while within the scope of the employer’s license.
   d.  The practice of a nurse licensed in another state and employed in this state by the federal government if the practice is in discharge of official employment duties.
   e.  The care of the sick rendered in connection with the practice of the religious tenets of any church or order by the adherents thereof which is not performed for hire, or if performed for hire by those who depend upon prayer or spiritual means for healing in the practice of the religion of their church or denomination, so long as they do not otherwise engage in the practice of nursing as practical nurses.
    Sec. 6.  Section 152.1, subsection 6, paragraphs d and e, Code 2011, are amended to read as follows:
   d.  Perform additional acts or nursing specialties which
 
that require education and training under emergency or other conditions which are recognized by the medical and nursing professions and are approved by the board as being proper to be performed by a registered nurse, as prescribed by the board, commensurate with the registered nurse’s education, continuing education, demonstrated competencies, and experience.
   e.  Make the pronouncement of death for a patient whose death is anticipated if the death occurs in a licensed hospital, a licensed health care facility, a Medicare-certified home health agency, a Medicare-certified hospice program or facility, an assisted living facility, or a residential care facility, with notice of the death to a physician and in accordance with any directions of a, advanced registered nurse practitioner, or physician
 
assistant.
    Sec. 7.  Section 152.2, Code 2011, is amended to read as follows:
   152.2  Executive director —— assistants.
   The board shall appoint a full-time executive director. The executive director shall be a registered nurse and shall not be a member of the board. The governor, with the approval of the executive council pursuant to section 8A.413, subsection 3, under the pay plan for exempt positions in the executive branch of government, shall set the salary of the executive director.
    Sec. 8.  Section 152.4, Code 2011, is amended to read as follows:
   152.4  Appropriations
 
Use of funds.
   The board may apply appropriated
 
use any available funds to
 
and moneys retained by the board pursuant to section 147.82 for:
   1.  The administration and enforcement of the
 
applicable provisions of this chapter and of chapter
 
chapters 147, 152E, and 272C.
   2.  The elevation of the standards of the schools of nursing.
   3.  The promotion of educational and professional standards of nurses in this state.
   4.  The collection, analysis, and dissemination of nursing workforce data.
    Sec. 9.  Section 152.5, subsections 1 and 2, Code 2011, are amended to read as follows:
   1.  All programs preparing a person to be a registered nurse, or a licensed practical nurse, or an advanced registered nurse practitioner shall be approved by the board. The board shall not recognize a program unless it:
   a.  Is of recognized standing.
   b.  Has provisions for adequate physical and clinical facilities and other resources with which to conduct a sound education program.
   c.  Requires, for graduation of a registered nurse applicant, the completion of at least a two academic year course of study.
   d.  Requires, for graduation of a licensed practical nurse applicant, the completion of at least a one academic year course of study as prescribed by the board.
   e.  Requires, for graduation of an advanced registered nurse practitioner, satisfactory completion of a formal advanced practice educational program of study in a nursing specialty area approved by the board and appropriate clinical experience as approved by the board.
   2.  All advanced
 
postlicensure formal academic nursing education programs shall also be approved by the board.
    Sec. 10.  Section 152.5, subsection 3, Code 2011, is amended by striking the subsection.
    Sec. 11.  NEW SECTION.  152.5A  Student record checks.
   1.  For the purposes of this section:
   a.  “Nursing program” means a nursing program that is approved by the board pursuant to section 152.5.
   b.  “Student” means a person applying for, enrolled in, or returning to the clinical education component of a nursing program.
   2.  All nursing programs shall conduct record checks on students as provided in this section.
   3.  A nursing program may access the single contact repository established pursuant to section 135C.33 as necessary for the nursing program to initiate record checks of students.
   4.  A nursing program shall request that the department of public safety perform a criminal history check and the department of human services perform child and dependent adult abuse record checks in this state on the nursing program’s students.
   5.  If a student has a criminal record or a record of founded child or dependent adult abuse, upon request of the nursing program, the department of human services shall perform an evaluation to determine whether the record warrants prohibition of the person’s involvement in a clinical education component of a nursing program involving children or dependent adults. The department of human services shall utilize the criteria provided in section 135C.33 in performing the evaluation and shall report the results of the evaluation to the nursing program. The department of human services has final authority in determining whether prohibition of the person’s involvement in a clinical education component is warranted.
    Sec. 12.  Section 152.6, Code 2011, is amended to read as follows:
   152.6  Licenses —— professional abbreviations.
   The board may license a natural person to practice as a registered nurse, or as a licensed practical nurse, or an advanced registered nurse practitioner. However, only a person currently licensed as a registered nurse in this state may use that title and the abbreviation “RN”
 
letters “R.N.” after the person’s name; and only a person currently licensed as a licensed practical nurse in this state may use that title and the abbreviation “LPN”
 
letters “L.P.N.” after the person’s name; and only a person currently licensed as an advanced registered nurse practitioner may use that title and the letters “A.R.N.P.” after the person’s name. For purposes of this section, “currently licensed” includes persons licensed in another state and recognized for licensure in this state pursuant to the nurse licensure compact contained in section 152E.1 or pursuant to the advanced practice registered nurse compact contained in section 152E.3.
    Sec. 13.  Section 152.7, Code 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  1A.  An applicant to be licensed as an advanced registered nurse practitioner shall have the following qualifications:
   a.  Hold a current license as a registered nurse pursuant to this chapter. 
   b.  Complete an advanced practice educational program as set out in section 152.5.
    Sec. 14.  Section 152.10, subsection 2, paragraph d, Code 2011, is amended to read as follows:
   d.
  (1)  Having a license to practice nursing as a registered nurse or licensed practical nurse revoked or suspended, or having other disciplinary action taken by a licensing authority of another state, territory, or country. A certified copy of the record or order of suspension, revocation, or disciplinary action is prima facie evidence of such fact.
   (2)  Having a license to practice nursing as a registered nurse or licensed practical nurse revoked or suspended, or having other disciplinary action taken, by a licensing authority in another state which has adopted the nurse licensure compact contained in section 152E.1 or the advanced practice registered nurse compact contained in section 152E.3 and which has communicated information relating to such action pursuant to the coordinated licensure information system established by the compact. If the action taken by the licensing authority occurs in a jurisdiction which does not afford the procedural protections of chapter 17A, the licensee may object to the communicated information and shall be afforded the procedural protections of chapter 17A.
    Sec. 15.  Section 152.11, Code 2011, is amended to read as follows:
   152.11  Investigators for nurses.
   The board of nursing may appoint investigators, who shall not be members of the board, to administer and aid in the enforcement of the provisions of law related to those licensed to practice nursing. The amount of compensation for the investigators shall be determined pursuant to chapter 8A, subchapter IV. Investigators authorized by the board of nursing have the powers and status of peace officers when enforcing this chapter and chapters 147 and 272C.
    Sec. 16.  Section 229.1, subsection 12, Code Supplement 2011, is amended to read as follows:
   12.  “Psychiatric advanced registered nurse practitioner” means an individual currently licensed as a registered nurse under chapter 152 or 152E who holds a national certification in psychiatric health care and who is registered with
 
licensed by the board of nursing as an advanced registered nurse practitioner.
    Sec. 17.  Section 231B.21, subsection 2, paragraph a, Code 2011, is amended to read as follows:
   a.  If administration of medications is delegated to the elder group home by the tenant or tenant’s legal representative, the medications shall be administered by a registered nurse, licensed practical nurse, or advanced registered nurse practitioner licensed or registered in Iowa or by the individual to whom such licensed or registered individuals may properly delegate administration of medications.
    Sec. 18.  Section 231C.16A, subsection 2, paragraph a, Code 2011, is amended to read as follows:
   a.  If administration of medications is delegated to the program by the tenant or tenant’s legal representative, the medications shall be administered by a registered nurse, licensed practical nurse, or advanced registered nurse practitioner licensed or registered in Iowa or by the individual to whom such licensed or registered individuals may properly delegate administration of medications.
    Sec. 19.  Section 231D.13A, subsection 2, paragraph a, Code 2011, is amended to read as follows:
   a.  If administration of medications is delegated to the program by the participant or the participant’s legal representative, the medications shall be administered by a registered nurse, licensed practical nurse, or advanced registered nurse practitioner licensed or registered in Iowa or by the individual to whom such licensed or registered individuals may properly delegate administration of medications.
    Sec. 20.  Section 321.186, subsection 4, Code Supplement 2011, is amended to read as follows:
   4.  A physician licensed under chapter 148, an advanced registered nurse practitioner licensed under chapter 152 and registered with the board of nursing, a physician assistant licensed under chapter 148C, or an optometrist licensed under chapter 154 may report to the department the identity of a person who has been diagnosed as having a physical or mental condition which would render the person physically or mentally incompetent to operate a motor vehicle in a safe manner. The physician, advanced registered nurse practitioner, physician assistant, or optometrist shall make reasonable efforts to notify the person who is the subject of the report, in writing. The written notification shall state the nature of the disclosure and the reason for the disclosure. A physician, advanced registered nurse practitioner, physician assistant, or optometrist making a report under this section shall be immune from any liability, civil or criminal, which might otherwise be incurred or imposed as a result of the report. A physician, advanced registered nurse practitioner, physician assistant, or optometrist has no duty to make a report or to warn third parties with regard to any knowledge concerning a person’s mental or physical competency to operate a motor vehicle in a safe manner. Any report received by the department from a physician, advanced registered nurse practitioner, physician assistant, or optometrist under this section shall be kept confidential. Information regulated by chapter 141A shall be subject to the confidentiality provisions and remedies of that chapter.
    Sec. 21.  Section 514F.6, subsection 2, Code 2011, is amended to read as follows:
   2.  For purposes of this section, “physician” means a licensed doctor of medicine and surgery or a licensed doctor of osteopathic medicine and surgery; “advanced registered nurse practitioner” means a licensed
 
an advanced registered nurse who is also registered to practice in an advanced role
 
practitioner licensed under chapter 152, “physician assistant” means a person who is licensed to practice as a physician assistant under the supervision of one or more physicians; and “credentialing period” means the time period between the health insurer’s receipt of a physician’s, advanced registered nurse practitioner’s, or physician assistant’s application for credentialing and approval of that application by the health insurer. “Credentialing” means a process through which a health insurer makes a determination based on criteria established by the health insurer concerning whether a physician, advanced registered nurse practitioner, or physician assistant is eligible to provide health care services to an insured and to receive reimbursement for the health care services provided under an agreement entered into between the physician, advanced registered nurse practitioner, or physician assistant and the health insurer. “Clean claim” means the same as defined in section 507B.4A, subsection 2, paragraph “b”.
    Sec. 22.  TRANSITION PROVISIONS —— CONTINUING VALIDITY OF REGISTRATIONS.  A registration as an advanced registered nurse practitioner issued prior to July 1, 2012, remains valid until its expiration. A renewal shall be by license as provided in this Act.
EXPLANATION
   This bill contains various revisions to the nurse practice Act. The bill requires advanced registered nurse practitioners to be licensed by the board of nursing rather than registered, and authorizes the professional abbreviation “A.R.N.P.”.
   Current Code language authorizes nurses to perform acts or nursing specialties which are recognized by the medical and nursing professions and are approved by the board. The bill eliminates this provision and provides that the regulation of nursing is the authority and responsibility of the board to determine which acts or specialties may be performed by a nurse, commensurate with the nurse’s education, continuing education, demonstrated competencies and experience.
   The bill specifies the purposes for which licensing fees which are treated as return receipts may be used by the board.