S.F. _____ H.F. _____ Section 1. Section 125.2, subsection 11, Code 2015, is 1 amended to read as follows: 2 11. “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 mental health care and who is registered with 6 licensed by the board of nursing as an advanced registered 7 nurse practitioner. 8 Sec. 2. Section 135G.1, subsection 1, Code 2015, is amended 9 to read as follows: 10 1. “Advanced registered nurse practitioner” means a person 11 currently licensed as a registered nurse under chapter 152 or 12 152E who is registered with licensed by the board of nursing as 13 an advanced registered nurse practitioner. 14 Sec. 3. Section 147.107, subsection 8, Code 2015, is amended 15 to read as follows: 16 8. Notwithstanding subsection 1 , but subject to the 17 limitations contained in subsections 2 and 3 , a registered 18 nurse who is licensed and registered as an advanced registered 19 nurse practitioner and who qualifies for and is registered 20 in a recognized nursing specialty may prescribe substances 21 or devices, including controlled substances or devices, if 22 the nurse is engaged in the practice of a nursing specialty 23 regulated under rules adopted by the board of nursing in 24 consultation with the board of medicine and the board of 25 pharmacy. 26 Sec. 4. Section 152.1, Code 2015, is amended by adding the 27 following new subsection: 28 NEW SUBSECTION . 01. “Advanced registered nurse practitioner” 29 means a person who is currently licensed as a registered nurse 30 under chapter 152 or 152E who is licensed by the board of 31 nursing as an advanced registered nurse practitioner. 32 Sec. 5. Section 152.1, subsection 4, paragraph c, Code 2015, 33 is amended to read as follows: 34 c. Make the pronouncement of death for a patient whose death 35 -1- LSB 1216DP (7) 86 tr/nh 1/ 11

S.F. _____ H.F. _____ is anticipated if the death occurs in a licensed hospital, a 1 licensed health care facility, a Medicare-certified home health 2 agency, a Medicare-certified hospice program or facility, or 3 an assisted living facility or residential care facility, 4 with notice of the death to a physician and in accordance 5 with any directions of a physician , advanced registered nurse 6 practitioner, or physician assistant . 7 Sec. 6. Section 152.1, subsection 5, unnumbered paragraph 8 1, Code 2015, is amended to read as follows: 9 The “practice of nursing” means the practice of a registered 10 nurse , or a licensed practical nurse , or an advanced registered 11 nurse practitioner . It does not mean any of the following: 12 Sec. 7. Section 152.1, subsection 5, paragraph b, Code 2015, 13 is amended to read as follows: 14 b. The performance of nursing services by an unlicensed 15 student enrolled in a nursing education program if performance 16 is part of the course of study. Individuals who have been 17 licensed as registered nurses , or licensed practical or 18 vocational nurses , or advanced registered nurse practitioners 19 in any state or jurisdiction of the United States are not 20 subject to this exemption. 21 Sec. 8. Section 152.1, subsection 6, paragraph e, Code 2015, 22 is amended to read as follows: 23 e. Make the pronouncement of death for a patient whose death 24 is anticipated if the death occurs in a licensed hospital, a 25 licensed health care facility, a Medicare-certified home health 26 agency, a Medicare-certified hospice program or facility, an 27 assisted living facility, or a residential care facility, 28 with notice of the death to a physician and in accordance 29 with any directions of a physician , advanced registered nurse 30 practitioner, or physician assistant . 31 Sec. 9. Section 152.4, Code 2015, is amended to read as 32 follows: 33 152.4 Appropriations. 34 The board may apply appropriated funds to: 35 -2- LSB 1216DP (7) 86 tr/nh 2/ 11

S.F. _____ H.F. _____ 1. The administration and enforcement of the provisions of 1 this chapter and of chapter chapters 147 , 152E, and 272C . 2 2. The elevation of the standards of the schools of nursing. 3 3. The promotion of educational and professional standards 4 of nurses in this state. 5 4. The collection, analysis, and dissemination of nursing 6 workforce data. 7 Sec. 10. Section 152.5, Code 2015, is amended to read as 8 follows: 9 152.5 Education programs —— record checks . 10 1. All programs preparing a person to be a registered nurse 11 or a licensed practical nurse shall be approved by the board. 12 The board shall not recognize a program unless it: 13 a. Is of recognized standing. 14 b. Has provisions for adequate physical and clinical 15 facilities and other resources with which to conduct a sound 16 education program. 17 c. Requires, for graduation of a registered nurse applicant, 18 the completion of at least a two academic year course of study. 19 d. Requires, for graduation of a licensed practical nurse 20 applicant, the completion of at least a one academic year 21 course of study as prescribed by the board. 22 2. All advanced postlicense formal academic nursing 23 education programs shall also be approved by the board. 24 3. a. For the purposes of this subsection : 25 (1) “Nursing program” means a nursing program that is 26 approved by the board pursuant to subsection 1 or 2 . 27 (2) “Student” means a person applying for, enrolled in, 28 or returning to the clinical education component of a nursing 29 program. 30 b. A nursing program may access the single contact 31 repository established pursuant to section 135C.33 as necessary 32 for the nursing program to initiate record checks of students. 33 c. A nursing program shall request that the department 34 of public safety perform a criminal history check and the 35 -3- LSB 1216DP (7) 86 tr/nh 3/ 11

S.F. _____ H.F. _____ department of human services perform child and dependent adult 1 abuse record checks in this state on the nursing program’s 2 students. 3 d. If a student has a criminal record or a record of founded 4 child or dependent adult abuse, upon request of the nursing 5 program, the department of human services shall perform an 6 evaluation to determine whether the record warrants prohibition 7 of the person’s involvement in a clinical education component 8 of a nursing program involving children or dependent adults. 9 The department of human services shall utilize the criteria 10 provided in section 135C.33 in performing the evaluation and 11 shall report the results of the evaluation to the nursing 12 program. The department of human services has final authority 13 in determining whether prohibition of the person’s involvement 14 in a clinical education component is warranted. 15 Sec. 11. NEW SECTION . 152.5A Student record checks. 16 1. For the purposes of this section: 17 a. “Nursing program” means a nursing program that is 18 approved by the board pursuant to section 152.5. 19 b. “Student” means a person applying for, enrolled in, or 20 returning to the clinical education component of a nursing 21 program. 22 2. A nursing program may access the single contact 23 repository established pursuant to section 135C.33 as necessary 24 for the nursing program to initiate record checks of students. 25 3. A nursing program shall request that the department 26 of public safety perform a criminal history check and the 27 department of human services perform child and dependent adult 28 abuse record checks in this state on the nursing program’s 29 students. 30 4. If a student has a criminal record or a record of founded 31 child or dependent adult abuse, upon request of the nursing 32 program, the department of human services shall perform an 33 evaluation to determine whether the record warrants prohibition 34 of the person’s involvement in a clinical education component 35 -4- LSB 1216DP (7) 86 tr/nh 4/ 11

S.F. _____ H.F. _____ of a nursing program involving children or dependent adults. 1 The department of human services shall utilize the criteria 2 provided in section 135C.33 in performing the evaluation and 3 shall report the results of the evaluation to the nursing 4 program. The department of human services has final authority 5 in determining whether prohibition of the person’s involvement 6 in a clinical education component is warranted. 7 Sec. 12. Section 152.6, Code 2015, is amended to read as 8 follows: 9 152.6 Licenses —— professional abbreviations. 10 The board may license a natural person to practice as a 11 registered nurse , or as a licensed practical nurse , or as an 12 advanced registered nurse practitioner . However, only a person 13 currently licensed as a registered nurse in this state may use 14 that title and the letters “R.N.” after the person’s name; only 15 a person currently licensed as a licensed practical nurse in 16 this state may use that title and the letters “L.P.N.” after 17 the person’s name; and only a person currently licensed as an 18 advanced registered nurse practitioner may use that title and 19 the letters “A.R.N.P.” after the person’s name. For purposes 20 of this section , “currently licensed” includes persons licensed 21 in another state and recognized for licensure in this state 22 pursuant to the nurse licensure compact contained in section 23 152E.1 or pursuant to the advanced practice registered nurse 24 compact contained in section 152E.3 . 25 Sec. 13. Section 152.7, Code 2015, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 1A. An applicant to be licensed as an 28 advanced registered nurse practitioner shall have the following 29 qualifications: 30 a. Hold a current license as a registered nurse. 31 b. Satisfactory completion of a formal advanced practice 32 educational program of study in a nursing specialty area 33 approved by the board. 34 c. Hold an advanced level certification by a recognized 35 -5- LSB 1216DP (7) 86 tr/nh 5/ 11

S.F. _____ H.F. _____ national certifying body. 1 Sec. 14. Section 152.10, subsection 2, paragraph h, 2 subparagraph (2), Code 2015, is amended to read as follows: 3 (2) The board may, upon probable cause, request a 4 licensee to submit to an appropriate medical examination by 5 a designated physician health care provider . If requested 6 by the licensee, the licensee may also designate a physician 7 health care provider for an independent medical examination. 8 The reasonable costs of such examinations and medical reports 9 to the board shall be paid by the board. Refusal or failure 10 of a licensee to complete such examinations shall constitute 11 an admission of any allegations relating to such condition. 12 All objections shall be waived as to the admissibility of 13 the examining physicians’ health care provider’s testimony 14 or examination reports on the grounds that they constitute 15 privileged communication. The medical testimony or examination 16 reports shall not be used against a registered nurse , or 17 licensed practical nurse , or advanced registered nurse 18 practitioner in another proceeding and shall be confidential. 19 At reasonable intervals, a registered nurse , or licensed 20 practical nurse , or advanced registered nurse practitioner 21 shall be afforded an opportunity to demonstrate that the 22 registered nurse , or licensed practical nurse , or advanced 23 registered nurse practitioner can resume the competent practice 24 of nursing with reasonable skill and safety to patients. 25 Sec. 15. Section 225C.6, subsection 4, paragraph c, 26 subparagraph (1), Code 2015, is amended to read as follows: 27 (1) A comprehensive set of wraparound services for persons 28 who have had or are at imminent risk of having acute or 29 crisis mental health symptoms that do not permit the persons 30 to remain in or threatens removal of the persons from their 31 home and community, but who have been determined by a mental 32 health professional and a licensed health care professional, 33 subject to the professional’s scope of practice, not to need 34 inpatient acute hospital services. For the purposes of this 35 -6- LSB 1216DP (7) 86 tr/nh 6/ 11

S.F. _____ H.F. _____ subparagraph, “mental health professional” means the same as 1 defined in section 228.1 and “licensed health care professional” 2 means a person licensed under chapter 148 to practice medicine 3 and surgery or osteopathic medicine and surgery, an advanced 4 registered nurse practitioner licensed under chapter 152 or 5 152E and registered with the board of nursing , or a physician 6 assistant licensed to practice under the supervision of a 7 physician as authorized in chapters 147 and 148C . 8 Sec. 16. Section 228.1, subsection 6, paragraph b, Code 9 2015, is amended to read as follows: 10 b. The individual holds a current Iowa license if 11 practicing in a field covered by an Iowa licensure law and is 12 a psychiatrist, an advanced registered nurse practitioner who 13 holds a national certification in psychiatric mental health 14 care registered licensed by the board of nursing, a physician 15 assistant practicing under the supervision of a psychiatrist, 16 or an individual who holds a doctorate degree in psychology and 17 is licensed by the board of psychology. 18 Sec. 17. Section 229.1, subsection 13, Code 2015, is amended 19 to read as follows: 20 13. “Psychiatric advanced registered nurse practitioner” 21 means an individual currently licensed as a registered nurse 22 under chapter 152 or 152E who holds a national certification 23 in psychiatric mental health care and who is registered with 24 licensed by the board of nursing as an advanced registered 25 nurse practitioner. 26 Sec. 18. Section 231B.21, subsection 2, paragraph a, Code 27 2015, is amended to read as follows: 28 a. If administration of medications is delegated to 29 the elder group home by the tenant or tenant’s legal 30 representative, the medications shall be administered by 31 a registered nurse, licensed practical nurse, or advanced 32 registered nurse practitioner licensed or registered 33 in Iowa , or by the individual to whom such licensed or 34 registered individuals may properly delegate administration of 35 -7- LSB 1216DP (7) 86 tr/nh 7/ 11

S.F. _____ H.F. _____ medications. 1 Sec. 19. Section 231C.16A, subsection 2, paragraph a, Code 2 2015, is amended to read as follows: 3 a. If administration of medications is delegated to the 4 program by the tenant or tenant’s legal representative, the 5 medications shall be administered by a registered nurse, 6 licensed practical nurse, or advanced registered nurse 7 practitioner licensed or registered in Iowa , or by the 8 individual to whom such licensed or registered individuals may 9 properly delegate administration of medications. 10 Sec. 20. Section 231D.13A, subsection 2, paragraph a, Code 11 2015, is amended to read as follows: 12 a. If administration of medications is delegated to 13 the program by the participant or the participant’s legal 14 representative, the medications shall be administered by 15 a registered nurse, licensed practical nurse, or advanced 16 registered nurse practitioner licensed or registered 17 in Iowa , or by the individual to whom such licensed or 18 registered individuals may properly delegate administration of 19 medications. 20 Sec. 21. Section 235A.15, subsection 2, paragraph c, 21 subparagraph (14), Code 2015, is amended to read as follows: 22 (14) To a nursing program that is approved by the state 23 board of nursing under section 152.5 , if the data relates to a 24 record check performed pursuant to section 152.5 152.5A . 25 Sec. 22. Section 235B.6, subsection 2, paragraph e, 26 subparagraph (12), Code 2015, is amended to read as follows: 27 (12) A nursing program that is approved by the state board 28 of nursing under section 152.5 , if the information relates to a 29 record check performed pursuant to section 152.5 152.5A . 30 Sec. 23. Section 321.186, subsection 4, Code 2015, is 31 amended to read as follows: 32 4. A physician licensed under chapter 148 , an advanced 33 registered nurse practitioner licensed under chapter 152 and 34 registered with the board of nursing , a physician assistant 35 -8- LSB 1216DP (7) 86 tr/nh 8/ 11

S.F. _____ H.F. _____ licensed under chapter 148C , or an optometrist licensed under 1 chapter 154 may report to the department the identity of a 2 person who has been diagnosed as having a physical or mental 3 condition which would render the person physically or mentally 4 incompetent to operate a motor vehicle in a safe manner. The 5 physician, advanced registered nurse practitioner, physician 6 assistant, or optometrist shall make reasonable efforts 7 to notify the person who is the subject of the report, in 8 writing. The written notification shall state the nature of 9 the disclosure and the reason for the disclosure. A physician, 10 advanced registered nurse practitioner, physician assistant, or 11 optometrist making a report under this section shall be immune 12 from any liability, civil or criminal, which might otherwise 13 be incurred or imposed as a result of the report. A physician, 14 advanced registered nurse practitioner, physician assistant, 15 or optometrist has no duty to make a report or to warn third 16 parties with regard to any knowledge concerning a person’s 17 mental or physical competency to operate a motor vehicle in 18 a safe manner. Any report received by the department from a 19 physician, advanced registered nurse practitioner, physician 20 assistant, or optometrist under this section shall be kept 21 confidential. Information regulated by chapter 141A shall be 22 subject to the confidentiality provisions and remedies of that 23 chapter. 24 Sec. 24. Section 514F.6, subsection 2, paragraph a, Code 25 2015, is amended to read as follows: 26 a. “Advanced registered nurse practitioner” means a licensed 27 nurse who is also registered to practice in an advanced role 28 person currently licensed as a registered nurse under chapter 29 152 or 152E who is licensed by the board of nursing as an 30 advanced registered nurse practitioner . 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to persons and activities regulated by the 35 -9- LSB 1216DP (7) 86 tr/nh 9/ 11

S.F. _____ H.F. _____ board of nursing. 1 The bill revises several references to advanced registered 2 nurse practitioners throughout the Code. Currently, the Code 3 refers to advanced registered nurse practitioners as people 4 “registered” as such with the state board of nursing. The 5 bill replaces the term “registered” with “licensed” in such 6 references. 7 The bill defines “advanced registered nurse practitioner” as 8 a person currently licensed as a registered nurse under Code 9 chapter 152 or 152E who is licensed by the board of nursing as 10 an advanced registered nurse practitioner. 11 The bill includes the role of an advanced registered nurse 12 practitioner in the term “practice of nursing” along with the 13 roles of registered nurses and licensed practical nurses. 14 Individuals who have been licensed as advanced registered nurse 15 practitioners in any state are not covered by an exemption to 16 the “practice of nursing” that applies to unlicensed nursing 17 students. 18 The bill allows licensed practical nurses and registered 19 nurses to make pronunciations of death by reporting such 20 information to advanced registered nurse practitioners or 21 physician assistants. 22 The bill allows the state board of nursing to apply 23 appropriated funds to the administration of Code chapter 24 152E, nurse and advanced practice registered nurse licensure 25 compacts, and Code chapter 272C, regulation of licensed 26 professions and occupations. The bill also allows the state 27 board of nursing to apply appropriated funds to the collection, 28 analysis, and dissemination of nursing workforce data. 29 The bill requires that an applicant to be an advanced 30 registered nurse practitioner must hold a current license as 31 a registered nurse, have satisfactorily completed a formal 32 advanced practice educational program of study in a nursing 33 specialty area approved by the board, and hold an advanced 34 level certification by a recognized national certifying body. 35 -10- LSB 1216DP (7) 86 tr/nh 10/ 11

S.F. _____ H.F. _____ Currently, if someone licensed by the state board of 1 nursing is unable to practice nursing with reasonable skill 2 and safety due to illness, substance abuse, or a mental or 3 physical condition, the board may request the person to submit 4 to a medical examination at the board’s expense. The bill 5 eliminates the requirement that the board pay for such an exam. 6 Code section 152.10 currently allows the board of nursing to 7 require a licensee to submit to a medical examination performed 8 by a physician prior to revoking or suspending the licensee’s 9 license. The bill replaces the term “physician” with “health 10 care provider”. The bill adds advanced registered nurse 11 practitioners to a limitation on these examination reports that 12 currently applies to registered nurses and licensed practical 13 nurses. The bill also allows advanced registered nurse 14 practitioners to demonstrate their ability to resume practicing 15 their profession, a practice currently allowed for registered 16 nurses and licensed practical nurses. 17 -11- LSB 1216DP (7) 86 tr/nh 11/ 11