HB1756 - Relating to the licensing and authority of advanced practice registered nurses.

  89R2558 BEE-F     By: Manuel H.B. No. 1756       A BILL TO BE ENTITLED   AN ACT   relating to the licensing and authority of advanced practice   registered nurses.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:   ARTICLE 1. SHORT TITLE          SECTION 1.001.  This Act may be cited as the Healthcare   Expanded and Accessed Locally for Texans (HEAL Texans) Act.   ARTICLE 2. ADVANCED PRACTICE REGISTERED NURSES          SECTION 2.001.  Section 301.002, Occupations Code, is   amended to read as follows:          Sec. 301.002.  DEFINITIONS. In this chapter:                 (1)     "Advanced practice registered nurse" means a   registered nurse licensed by the board to practice as an advanced   practice registered nurse on the basis of completion of an advanced   educational program. The term includes a nurse practitioner, nurse   midwife, nurse anesthetist, and clinical nurse specialist.                 (2)  [ (1) ]  "Board" means the Texas Board of Nursing.                 (3)  [ (1-a) ]  "Chief nursing officer" means the   registered nurse who is administratively responsible for the   nursing services at a facility.                 (4)     "Controlled substance" has the meaning assigned by   Section 481.002, Health and Safety Code.                 (5)     "Dangerous drug" has the meaning assigned by   Section 483.001, Health and Safety Code.                 (6)     "Device" has the meaning assigned by Section   551.003 and includes durable medical equipment.                 (7)     "Nonprescription drug" has the meaning assigned by   Section 551.003.                 (8)     "Nurse" means a person required to be licensed   under this chapter to engage in professional or vocational nursing.                 (9)     "Nursing" means professional or vocational   nursing.                 (10)  [ (1-b) ]  "Patient safety committee" has the   meaning assigned by Section 303.001.                 (11)     "Prescribe or order a drug or device" has the   meaning assigned by Section 157.051.                 (12)  [ (2) ]  "Professional nursing" means the   performance of an act that requires substantial specialized   judgment and skill, the proper performance of which is based on   knowledge and application of the principles of biological,   physical, and social science as acquired by a completed course in an   approved school of professional nursing. The term does not include   acts of medical diagnosis or the prescription of therapeutic or   corrective measures , except as authorized for an advanced practice   registered nurse . Professional nursing involves:                      (A)  the observation, assessment, intervention,   evaluation, rehabilitation, care and counsel, or health teachings   of a person who is ill, injured, infirm, or experiencing a change in   normal health processes;                      (B)  the maintenance of health or prevention of   illness;                      (C)  the administration of a medication or   treatment as ordered by a health care practitioner legally   authorized to prescribe the medication or treatment [ physician,   podiatrist, or dentist ];                      (D)  the supervision or teaching of nursing;                      (E)  the administration, supervision, and   evaluation of nursing practices, policies, and procedures;                      (F)  [ the requesting, receiving, signing for, and   distribution of prescription drug samples to patients at practices   at which an advanced practice registered nurse is authorized to   sign prescription drug orders as provided by Subchapter B, Chapter   157;                      [ (G) ]  the performance of an act by an advanced   practice registered nurse [ delegated by a physician under Section   157.0512, 157.054, 157.058, or 157.059 ]; and                       (G)  [ (H) ]  the development of the nursing care   plan.                [ (3)     "Nurse" means a person required to be licensed   under this chapter to engage in professional or vocational nursing.                [ (4)     "Nursing" means professional or vocational   nursing. ]                 (13)  [ (5) ]  "Vocational nursing" means a directed   scope of nursing practice, including the performance of an act that   requires specialized judgment and skill, the proper performance of   which is based on knowledge and application of the principles of   biological, physical, and social science as acquired by a completed   course in an approved school of vocational nursing. The term does   not include acts of medical diagnosis or the prescription of   therapeutic or corrective measures. Vocational nursing involves:                      (A)  collecting data and performing focused   nursing assessments of the health status of an individual;                      (B)  participating in the planning of the nursing   care needs of an individual;                      (C)  participating in the development and   modification of the nursing care plan;                      (D)  participating in health teaching and   counseling to promote, attain, and maintain the optimum health   level of an individual;                      (E)  assisting in the evaluation of an   individual's response to a nursing intervention and the   identification of an individual's needs; and                      (F)  engaging in other acts that require education   and training, as prescribed by board rules and policies,   commensurate with the nurse's experience, continuing education,   and demonstrated competency.          SECTION 2.002.  Section 301.005(b), Occupations Code, is   amended to read as follows:          (b)  A reference in any other law to an "advanced nurse   practitioner , " [ or ] "advanced practice nurse , " or "advanced   practice registered nurse" means an advanced practice registered   nurse.          SECTION 2.003.  Section 301.152, Occupations Code, is   transferred to Subchapter H, Chapter 301, Occupations Code,   redesignated as Section 301.357, Occupations Code, and amended to   read as follows:          Sec. 301.357 [ 301.152 ].   ADVANCED PRACTICE REGISTERED NURSES   [ RULES REGARDING SPECIALIZED TRAINING ]. (a) Advanced practice   registered nursing includes:                 (1)     ordering, performing, and interpreting diagnostic   tests;                 (2)     formulating primary and differential medical   diagnoses and advanced assessments;                 (3)  treating actual and potential health problems;                 (4)     prescribing therapeutic and corrective measures,   including nutrition and diagnostic support services, home health   care, hospice care, physical therapy, and occupational therapy, and   delegating and assigning the performance of therapeutic and   corrective measures to assistive personnel;                 (5)     to the extent authorized by the board under   Section 301.358, prescribing, ordering, procuring, administering,   and dispensing drugs and devices, including blood and blood   products, controlled substances listed in Schedules II, III, IV,   and V, dangerous drugs, and nonprescription drugs;                 (6)     providing referrals to health care agencies,   health care providers, and community resources;                 (7)     serving as the primary care provider of record;   and                 (8)     performing other acts that require education and   training consistent with professional standards and that are   commensurate with the advanced practice registered nurse's   education, licensure, and demonstrated competencies and   experience. [ In this section, "advanced practice registered nurse"   means a registered nurse licensed by the board to practice as an   advanced practice registered nurse on the basis of completion of an   advanced educational program. The term includes a nurse   practitioner, nurse midwife, nurse anesthetist, and clinical nurse   specialist. The term is synonymous with "advanced nurse   practitioner" and "advanced practice nurse." ]          (b)  The board shall adopt rules to:                (1)  license a registered nurse as an advanced practice   registered nurse;                (2)  establish:                      (A)  any specialized education or training,   including pharmacology, that an advanced practice registered nurse   must have to prescribe or order a drug or device as authorized   [ delegated ] by the board [ a physician ] under Section 301.358   [ 157.0512 or 157.054 ];                      (B)  a system for approving an advanced practice   registered nurse to prescribe or order a drug or device as   authorized [ delegated ] by the board [ a physician ] under Section   301.358 [ 157.0512 or 157.054 ] on the receipt of evidence of   completing the specialized education and training requirement   under Paragraph (A); and                      (C)  a system for issuing a prescription   authorization number to an advanced practice registered nurse   approved under Paragraph (B); and                (3)  concurrently renew any license or approval granted   to an advanced practice registered nurse under this subsection and   a license renewed by the advanced practice registered nurse under   Section 301.301.          (c)  At a minimum, the rules adopted under Subsection (b)(2)   must:                (1)  require completion of pharmacology and related   pathophysiology education for initial approval; and                (2)  require continuing education in clinical   pharmacology and related pathophysiology in addition to any   continuing education otherwise required under Section 301.303.          (d)  The signature of an advanced practice registered nurse   attesting [Text truncated for display. 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