(a) The four areas
of advanced practice registered nurses recognized by the board from which the
practice specialties are derived are:
(1)
Nurse practitioner ("NP");
(2)
Certified registered nurse anesthetist ("CRNA");
(3) Certified nurse-midwife ("CNM");
and
(4) Clinical nurse specialist
("CNS").
(b) In addition
to those functions specified for the registered nurse, and in accordance with
appropriate nationally recognized standards of practice, the advanced practice
registered nurse may perform the following generic acts which include, but are
not limited to:
(1) Provide direct care by
utilizing advanced scientific knowledge, skills, nursing and related theories
to assess, plan, and implement appropriate health and nursing care to
patients;
(2) Provide indirect
care. Plan, guide, evaluate and direct the nursing care given by other
personnel associated with the health care team;
(3) Teach, counsel, or plan care for
individuals or group, utilizing a synthesis of advanced skills, theories, and
knowledge of biologic, pharmacologic, physical, sociocultural and psychological
aspects of care to accomplish desired objectives;
(4) Serve as a consultant and resource of
advanced clinical knowledge and skills to those involved directly or indirectly
in patient care;
(5) Participate in
joint and periodic evaluation of services rendered including, but not limited
to, chart reviews, case reviews, patient evaluations, and outcome of case
statistics;
(6) Establish
collaborative, consultative, and referral networks as appropriate with other
health care professionals. Patients who require care beyond the scope of
practice of an APRN shall be referred to an appropriate health care
provider;
(7) Manage the plan of
care prescribed for the patient;
(8) Initiate and maintain accurate records
and authorize appropriate regulatory and other legal documents;
(9) Recognize, develop, and implement
professional and community educational programs related to health
care;
(10) Conduct research and
analyze the health needs of individuals and populations and design programs
which target at-risk groups and cultural and environmental factors which foster
health and prevent illness;
(11)
Participate in policy analysis and development of new policy initiative in the
area of practice specialty; and
(12) Contribute to the development,
maintenance, and change of health care delivery systems to improve quality of
health care services and consumer access to services.
(c) The scope of practice for each of the
four areas of clinical practice specialties shall be in accordance with
nationally recognized standards of practice which are consistent with the
following:
(1) Nurse practitioner scope of
practice, depending on area of specialty, may include, but is not limited to:
(A) Evaluate the physical and psychosocial
health status of patients through a comprehensive health history and physical
examination, or mental status examination, using skills of observation,
inspection, palpation, percussion, and auscultation, and using diagnostic
instruments or procedures that are basic to the clinical evaluation of
physical, developmental, and psychological signs and symptoms;
(B) Order, interpret, or perform diagnostic,
screening, and therapeutic examinations, tests and procedures;
(C) Formulate a diagnosis;
(D) Plan, implement, and evaluate
care;
(E) Order or utilize medical,
therapeutic, or corrective measures including, but not limited to,
rehabilitation therapies, medical nutritional therapy, social services and
psychological and other medical services;
(F) Monitor the effectiveness of therapeutic
interventions;
(G) Assist in
surgery; and
(H) Admit and
discharge clients for inpatient care at facilities licensed as hospitals, long
term care facilities or hospice.
(2) Certified registered nurse anesthetist
scope of practice:
(A) Be responsible for
performing and documenting total anesthesia care of patient including, but not
limited to, pre-anesthetic preparation and evaluation, requesting consultations
and diagnostic studies, obtaining informed consent for anesthesia, and
selection and administration of anesthetic agents or other agents administered
in the management of anesthetic care, anesthesia induction, maintenance,
emergence, and post anesthesia care;
(B) Develop and implement an anesthetic care
plan;
(C) Select and initiate the
planned anesthesia technique which may include: general, regional, and local
anesthesia and sedation;
(D)
Select, apply, or insert appropriate non-invasive and invasive monitoring
modalities for collecting and interpreting patient physiological
data;
(E) Support life functions
during the peri-operative period;
(F) Select, obtain, and administer the
anesthetics, adjuvant drugs, accessory drugs, and fluids, necessary to manage
the anesthetic to maintain the patient's physiologic homeostasis, and to
correct abnormal responses to the anesthesia or surgery;
(G) Recognize and be able to take appropriate
action for untoward patient responses during anesthesia;
(H) Observe and manage the patient's
emergence from anesthesia by selecting, obtaining, ordering, or administering
medications, fluids, or ventilatory support in order to maintain
homeostasis;
(I) Discharge patients
from a post-anesthesia care area;
(J) Participate in the life support of the
patient including, but not limited to, peri-anesthetic and clinical support
functions;
(K) Implement acute and
chronic pain management modalities; and
(L) Respond to emergency situations by
providing airway management, administration of emergency fluids or drugs, or
using basic or advanced cardiac life support techniques.
(3) Certified nurse-midwife scope of
practice:
(A) Provide independent management
of women's health care, focusing particularly on pregnancy, childbirth, the
postpartum period, care of the newborn, and the family planning and
gynecological needs of women;
(B)
Practice in accordance with the standards for the practice of nurse-midwifery
of the American College of Nurse-Midwives, unless otherwise indicated by the
board. The standards include but do not limit the nurse midwife to:
(i) Provide primary care services for women
and newborns;
(ii) Take histories
and perform physical exams;
(iii)
Order and interpret diagnostic tests;
(iv) Operate within a health care system that
provides for consultation, collaborative management, or referral as indicated
by the status of the client; and
(v) Admit clients for inpatient care at
facilities licensed as hospitals or birth centers in the State; and
(C) Includes all of the functions
listed in paragraph (1) relating to nurse practitioner scope of
practice.
(4) Clinical
nurse specialist scope of practice, depending on area of specialty, may
include, but is not limited to:
(A) Evaluate
the physical, developmental, and psychosocial health status of patients through
a comprehensive health history, physical examination, or mental status
examination, using skills of observation, inspection, palpation, percussion,
and auscultation, and using diagnostic instruments or procedures that are basic
to clinical evaluation of physical, developmental, and psychological signs and
symptoms;
(B) Order, interpret, or
perform diagnostic and therapeutic examinations, tests and procedures, if CNS
educational preparation included pathophysiology, pharmacology, advanced health
promotion and disease prevention, differential diagnosis, and disease
management; formulate a diagnosis;
(C) Assess the normal and abnormal findings
from the history, physical, and mental status examinations, and diagnostic
reports;
(D) Plan, implement, and
evaluate the care of patients and groups of patients (including individuals,
couples, groups, families, and communities) with complex needs in the area of
practice specialty;
(E) Provide
advanced management of health care for selected client populations;
(F) Consult, as needed, with members of
health care teams concerning physiological, psychological, social, educational,
and ethical issues in area of expertise; and
(G) Initiate and maintain accurate records,
appropriate legal documents, and other health and nursing care
reports.
(d)
Nothing in this section shall allow an APRN to prescribe any substance included
in the current Exclusionary Formulary. It shall be unlawful for any nurse not
granted prescriptive authority under this chapter to prescribe, offer to
prescribe, or to use any sign, card, or device to indicate that the nurse is so
authorized.
(e) Nothing in this
section shall preclude a licensed nurse from carrying out prescribed medical
orders of a licensed dentist, physician, osteopath, or podiatrist licensed in
accordance with chapter
448,
453, or
463E, HRS, or the orders of a
recognized advanced practice registered nurse.
(f) Nothing in this section shall limit a
certified registered nurse anesthetist from providing total anesthesia care as
designated in subsection (c)(2).