HOUSE BILL 433

51st legislature - STATE OF NEW MEXICO - first session, 2013

INTRODUCED BY

Thomas C. Taylor

AN ACT

RELATING TO NURSING SCOPE OF PRACTICE; AMENDING THE NURSING PRACTICE ACT TO INCLUDE ADVANCED PRACTICE REGISTERED NURSES; ALLOWING PROPERLY CREDENTIALED REGISTERED NURSES TO ADMINISTER ANESTHETICS; ELIMINATING THE REQUIREMENT THAT THE BOARD OF NURSING REGISTER NURSES PRACTICING UNDER THE NURSE LICENSURE COMPACT; ELIMINATING THE REQUIREMENT THAT THE BOARD OF NURSING ADOPT RULES ON A PRESCRIPTIVE FORMULARY FOR CERTIFIED REGISTERED NURSE ANESTHETISTS; RECONCILING MULTIPLE AMENDMENTS TO THE SAME SECTION OF LAW IN LAWS 2003.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. Section 61-3-3 NMSA 1978 (being Laws 1991, Chapter 190, Section 2, as amended) is amended to read:

     "61-3-3. DEFINITIONS.--As used in the Nursing Practice Act:

          A. "advanced practice" means the practice of professional registered nursing by a registered nurse who has been prepared through additional formal education as provided in Sections 61-3-23.2 through 61-3-23.4 NMSA 1978 to function beyond the scope of practice of professional registered nursing, including certified nurse practitioners, certified registered nurse anesthetists and clinical nurse specialists;

          B. "advanced practice registered nurse" means a nurse who practices professional registered nursing and who has been prepared through additional formal education to function beyond the scope of practice of professional registered nursing, including certified nurse practitioners, certified registered nurse anesthetists and clinical nurse specialists;

          [B.] C. "board" means the board of nursing;

          [C.] D. "certified hemodialysis technician" means a person who is certified by the board to assist in the direct care of a patient undergoing hemodialysis, under the supervision and at the direction of a registered nurse or a licensed practical nurse, according to the rules adopted by the board;

          [D.] E. "certified medication aide" means a person who is certified by the board to administer medications under the supervision and at the direction of a registered nurse or a licensed practical nurse, according to the rules adopted by the board;

          [E.] F. "certified nurse practitioner" means a registered nurse who is licensed by the board for advanced practice as a certified nurse practitioner and whose name and pertinent information are entered on the list of certified nurse practitioners maintained by the board;

          [F.] G. "certified registered nurse anesthetist" means a registered nurse who is licensed by the board for advanced practice as a certified registered nurse anesthetist and whose name and pertinent information are entered on the list of certified registered nurse anesthetists maintained by the board;

          [G.] H. "clinical nurse specialist" means a registered nurse who is licensed by the board for advanced practice as a clinical nurse specialist and whose name and pertinent information are entered on the list of clinical nurse specialists maintained by the board;

          [H.] I. "collaboration" means the cooperative working relationship with another health care provider in the provision of patient care, and such collaborative practice includes the discussion of patient diagnosis and cooperation in the management and delivery of health care;

          [I.] J. "licensed practical nurse" means a nurse who practices licensed practical nursing and whose name and pertinent information are entered in the register of licensed practical nurses maintained by the board or a nurse who practices licensed practical nursing pursuant to a multistate licensure privilege as provided in the Nurse Licensure Compact;

          [J.] K. "licensed practical nursing" means the practice of a directed scope of nursing requiring basic knowledge of the biological, physical, social and behavioral sciences and nursing procedures, which practice is at the direction of a registered nurse, physician or dentist licensed to practice in this state. This practice includes but is not limited to:

                (1) contributing to the assessment of the health status of individuals, families and communities;

                (2) participating in the development and modification of the plan of care;

                (3) implementing appropriate aspects of the plan of care commensurate with education and verified competence;

                (4) collaborating with other health care professionals in the management of health care; and

                (5) participating in the evaluation of responses to interventions;

          [K.] L. "Nurse Licensure Compact" means the agreement entered into between New Mexico and other jurisdictions permitting the practice of professional registered nursing or licensed practical nursing pursuant to a multistate licensure privilege;

          [L.] M. "nursing diagnosis" means a clinical judgment about individual, family or community responses to actual or potential health problems or life processes, which judgment provides a basis for the selection of nursing interventions to achieve outcomes for which the person making the judgment is accountable;

          [M.] N. "practice of nursing" means assisting individuals, families or communities in maintaining or attaining optimal health, assessing and implementing a plan of care to accomplish defined goals and evaluating responses to care and treatment. This practice is based on specialized knowledge, judgment and nursing skills acquired through educational preparation in nursing and in the biological, physical, social and behavioral sciences and includes but is not limited to:

                (1) initiating and maintaining comfort measures;

                (2) promoting and supporting optimal human functions and responses;

                (3) establishing an environment conducive to well-being or to the support of a dignified death;

                (4) collaborating on the health care regimen;

                (5) administering medications and performing

treatments prescribed by a person authorized in this state or in any other state in the United States to prescribe them;

                (6) recording and reporting nursing observations, assessments, interventions and responses to health care;

                (7) providing counseling and health teaching;

                (8) delegating and supervising nursing interventions that may be performed safely by others and are not in conflict with the Nursing Practice Act; and

                (9) maintaining accountability for safe and effective nursing care;

          [N.] O. "professional registered nursing" means the practice of the full scope of nursing requiring substantial knowledge of the biological, physical, social and behavioral sciences and of nursing theory and may include advanced practice pursuant to the Nursing Practice Act. This practice includes but is not limited to:

                (1) assessing the health status of individuals, families and communities;

                (2) establishing a nursing diagnosis;

                (3) establishing goals to meet identified health care needs;

                (4) developing a plan of care;

                (5) determining nursing intervention to implement the plan of care;

                (6) implementing the plan of care commensurate with education and verified competence;

                (7) evaluating responses to interventions;

                (8) teaching based on the theory and practice of nursing;

                (9) managing and supervising the practice of nursing;

                (10) collaborating with other health care

professionals in the management of health care; and

                (11) conducting nursing research;

          [O.] P. "registered nurse" means a nurse who practices professional registered nursing and whose name and pertinent information are entered in the register of licensed registered nurses maintained by the board or a nurse who practices professional registered nursing pursuant to a multistate licensure privilege as provided in the Nurse Licensure Compact;

          [P.] Q. "scope of practice" means the parameters within which nurses practice based upon education, experience, licensure, certification and expertise; and

          [Q.] R. "training program" means an educational program approved by the board."

     SECTION 2. Section 61-3-5 NMSA 1978 (being Laws 1968, Chapter 44, Section 4, as amended) is amended to read:

     "61-3-5. LICENSE REQUIRED.--

          A. Except as otherwise provided in the Nursing Practice Act, no person shall use the title "nurse" unless the person is licensed or has been licensed in the past as a registered nurse or licensed practical nurse under the Nursing Practice Act.

          B. Except as otherwise provided in the Nursing Practice Act, unless licensed as a registered nurse under the Nursing Practice Act, no person shall:

                (1) practice professional nursing;

                (2) use the title "registered nurse", "professional nurse", "professional registered nurse" or the abbreviation "R.N." or any other abbreviation thereof or use any other title, abbreviation, letters, figures, signs or devices to indicate or imply that the person is a registered nurse; or

                (3) engage in a nursing specialty as defined by the board.

          C. Except as otherwise provided in the Nursing Practice Act, unless licensed as a licensed practical nurse under the Nursing Practice Act, no person shall:

                (1) practice licensed practical nursing; or

                (2) use the title "licensed practical nurse" or the abbreviation "L.P.N." or any other abbreviation thereof or use any other title, abbreviation, letters, figures, signs or devices to indicate or imply that the person is a licensed practical nurse.

          D. Unless licensed as a certified nurse practitioner under the Nursing Practice Act, no person shall:

                (1) practice as a certified nurse practitioner; or

                (2) use the title "certified nurse practitioner" or the abbreviations "C.N.P." or "N.P." or any other title, abbreviation, letters, figures, signs or devices to indicate or imply that the person is a certified nurse practitioner.

          E. Unless licensed as a certified registered nurse anesthetist under the Nursing Practice Act, no person shall:

                (1) practice as a nurse anesthetist; or

                (2) use the title "certified registered nurse anesthetist" or the abbreviation "C.R.N.A." or any other title, abbreviation, letters, figures, signs or devices to indicate or imply that the person is a certified registered nurse anesthetist.

          F. Unless licensed as a clinical nurse specialist under the Nursing Practice Act, no person shall:

                (1) practice as a clinical nurse specialist; or

                (2) use the title "clinical nurse specialist" or the abbreviation "C.N.S." or any other title, abbreviation, letters, figures, signs or devices to indicate or imply that the person is a clinical nurse specialist.

          G. Unless licensed as an advanced practice registered nurse under the Nursing Practice Act, no person shall:

                (1) practice as an advanced practice registered nurse; or

                (2) use the title "advanced practice registered nurse" or the abbreviation "A.P.R.N." or any other title, abbreviation, letters, figures, signs or devices to indicate or imply that the person is an advanced practice registered nurse.

          [G.] H. No licensed nurse shall be prohibited from identifying [himself] the licensed nurse's own self or [his] the licensed nurse's licensure status."

     SECTION 3. Section 61-3-6 NMSA 1978 (being Laws 1973, Chapter 149, Section 2, as amended) is amended to read:

     "61-3-6. ADMINISTRATION OF ANESTHETICS.--[It is unlawful for any person, other than a person licensed in New Mexico to practice medicine, osteopathy or dentistry or a currently licensed certified registered nurse anesthetist to administer anesthetics to any person. Nothing in this section prohibits a person currently licensed pursuant to the Nursing Practice Act from using hypnosis or from administering local anesthetics or moderate sedation.]

          A. Nurses licensed pursuant to the Nursing Practice Act may practice hypnosis and administer local anesthetics.

          B. All other anesthetic agents shall only be administered independently by currently licensed certified registered nurse anesthetists.

          C. Registered nurses with the appropriate credentials, as authorized by the board through rules, may administer anesthetic agents under the following circumstances:

                (1) when performing sedation as a member of a team dedicated to medication administration and monitoring the patient under the direct supervision of a qualified licensed independent practitioner;

                (2) when sedating mechanically ventilated patients;

                (3) when performing advanced airway management as a member of a critical care transport team; and

                (4) by limiting all sedation outside of an emergency department to moderate sedation."

     SECTION 4. Section 61-3-10 NMSA 1978 (being Laws 1968, Chapter 44, Section 7, as amended by Laws 2003, Chapter 276, Section 4 and by Laws 2003, Chapter 307, Section 7) is amended to read:

     "61-3-10. POWERS--DUTIES.--The board:

          A. shall adopt and revise such rules [and regulations] as may be necessary to enable it to carry into effect the provisions of the Nursing Practice Act and to maintain high standards of practice;

          B. shall prescribe standards and approve curricula for educational programs preparing persons for licensure under the Nursing Practice Act;

          C. shall provide for surveys of educational programs preparing persons for licensure under the Nursing Practice Act;

          D. shall grant, deny or withdraw approval from educational programs for failure to meet prescribed standards, if a majority of the board concurs in the decision;

          E. shall provide for the examination, licensing and renewal of licenses of applicants;

          F. shall conduct hearings upon charges relating to discipline of a licensee or nurse not licensed to practice in New Mexico who is permitted to practice professional registered nursing or licensed practical nursing in New Mexico pursuant to a multistate licensure privilege as provided in the Nurse Licensure Compact or the denial, suspension or revocation of a license in accordance with the procedures of the Uniform Licensing Act;

          G. shall cause the prosecution of all persons, including firms, associations, institutions and corporations, violating the Nursing Practice Act and have the power to incur such expense as is necessary therefor;

          H. shall keep a record of all proceedings;

          I. shall make an annual report to the governor;

          J. shall appoint and employ a qualified registered nurse, who shall not be a member of the board, to serve as executive officer to the board, who shall define the duties and responsibilities of the executive officer, except that the power to grant, deny or withdraw approval for schools of nursing or to revoke, suspend or withhold any license authorized by the Nursing Practice Act shall not be delegated by the board;

          K. shall provide for such qualified assistants as may be necessary to carry out the provisions of the Nursing Practice Act. Such employees shall be paid a salary commensurate with their duties;

          L. shall, for the purpose of protecting the health and well-being of the citizens of New Mexico and promoting current nursing knowledge and practice, adopt rules [and regulations] establishing continuing education requirements as a condition of license renewal and shall study methods of monitoring continuing competence;

          M. may appoint advisory committees consisting of at least one member who is a board member and at least two members expert in the pertinent field of health care to assist it in the performance of its duties. Committee members may be reimbursed as provided in the Per Diem and Mileage Act;

          N. may adopt and revise rules [and regulations] designed to maintain an inactive status listing for registered nurses and licensed practical nurses;

          O. may adopt rules [and regulations] to regulate the advanced practice of professional registered nursing and expanded practice of licensed practical nursing;

          P. shall license qualified certified nurse practitioners, certified registered nurse anesthetists and clinical nurse specialists; and

          [Q. shall register nurses not licensed to practice in New Mexico who are permitted to practice professional registered nursing or licensed practical nursing in New Mexico pursuant to a multistate licensure privilege as provided in the Nurse Licensure Compact; and

          R.] Q. shall adopt rules [and regulations] establishing standards for authorizing prescriptive authority to certified nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists."

     SECTION 5. Section 61-3-23.2 NMSA 1978 (being Laws 1991, Chapter 190, Section 14, as amended) is amended to read:

     "61-3-23.2. CERTIFIED NURSE PRACTITIONER--QUALIFICATIONS--PRACTICE--EXAMINATION--ENDORSEMENT.--

          A. The board may license for advanced practice as a certified nurse practitioner an applicant who furnishes evidence satisfactory to the board that the applicant:

                (1) is a registered nurse;

                (2) has successfully completed a program for the education and preparation of nurse practitioners; provided that, if the applicant is initially licensed by the board or a board in another jurisdiction after January 1, 2001, the program shall be at the master's level or higher;

                (3) has successfully completed the national certifying examination in the applicant's specialty area; and

                (4) is certified by a national nursing organization.

          B. Certified nurse practitioners may:

                (1) perform an advanced practice that is beyond the scope of practice of professional registered nursing;

                (2) practice independently and make decisions regarding health care needs of the individual, family or community and carry out health regimens, including the prescription and distribution of dangerous drugs and controlled substances included in Schedules II through V of the Controlled Substances Act; and

                (3) serve as a primary acute, chronic long-term and end-of-life health care provider and as necessary collaborate with licensed medical doctors, osteopathic physicians or podiatrists.

          C. Certified nurse practitioners who have fulfilled requirements for prescriptive authority may prescribe in accordance with rules, regulations and guidelines [and formularies] for individual certified nurse practitioners promulgated by the board.

           D. Certified nurse practitioners who have fulfilled requirements for prescriptive authority may distribute to their patients dangerous drugs and controlled substances included in Schedules II through V of the Controlled Substances Act that have been prepared, packaged or fabricated by a registered pharmacist or doses of drugs that have been prepackaged by a pharmaceutical manufacturer in accordance with the Pharmacy Act and the New Mexico Drug, Device and Cosmetic Act.

          E. Certified nurse practitioners licensed by the board on and after December 2, 1985 shall successfully complete a national certifying examination and shall maintain national professional certification in their specialty area. Certified nurse practitioners licensed by a board prior to December 2, 1985 are not required to sit for a national certification examination or be certified by a national organization."

     SECTION 6. Section 61-3-23.3 NMSA 1978 (being Laws 1991, Chapter 190, Section 15, as amended) is amended to read:

     "61-3-23.3. CERTIFIED REGISTERED NURSE ANESTHETIST--

QUALIFICATIONS--LICENSURE--PRACTICE--ENDORSEMENT.--

          A. The board may license for advanced practice as a certified registered nurse anesthetist an applicant who furnishes evidence satisfactory to the board that the applicant:

                (1) is a registered nurse;

                (2) has successfully completed a nurse anesthesia education program accredited by the council on accreditation of nurse anesthesia education programs; provided that, if the applicant is initially licensed by the board or a board in another jurisdiction after January 1, 2001, the program shall be at a master's level or higher; and

                (3) is certified by the council on certification of nurse anesthetists.

          B. A certified registered nurse anesthetist may provide preoperative, intraoperative and postoperative anesthesia care and related services, including ordering of diagnostic tests, in accordance with the current American association of nurse anesthetists' guidelines for nurse anesthesia practice.

          C. Certified registered nurse anesthetists shall function in an interdependent role as a member of a health care team in which the medical care of the patient is directed by a licensed physician, osteopathic physician, dentist or podiatrist licensed in New Mexico pursuant to Chapter 61, Article 5A, 6, 8 or 10 NMSA 1978. The certified registered nurse anesthetist shall collaborate with the licensed physician, osteopathic physician, dentist or podiatrist concerning the anesthesia care of the patient. As used in this subsection, "collaboration" means the process in which each health care provider contributes [his] the health care provider's respective expertise. Collaboration includes systematic formal planning and evaluation between the health care professionals involved in the collaborative practice arrangement.

          D. A certified registered nurse anesthetist who has fulfilled the requirements for prescriptive authority in the area of anesthesia practice is authorized to prescribe and administer therapeutic measures, including dangerous drugs and controlled substances included in Schedules II through V of the Controlled Substances Act within the emergency procedures, perioperative care or perinatal care environments. Dangerous drugs and controlled substances, pursuant to the Controlled Substances Act, that have been prepared, packaged or fabricated by a registered pharmacist or doses of drugs that have been prepackaged by a pharmaceutical manufacturer in accordance with the Pharmacy Act and the New Mexico Drug, Device and Cosmetic Act may be prescribed and administered.

          E. A certified registered nurse anesthetist who has fulfilled the requirements for prescriptive authority in the area of anesthesia practice may prescribe in accordance with rules, regulations and guidelines. [The board shall adopt rules concerning a prescriptive authority formulary for certified registered nurse anesthetists that shall be based on the scope of practice of certified registered nurse anesthetists. The board, in collaboration with the New Mexico board of medical examiners, shall develop the formulary. Certified registered nurse anesthetists who prescribe shall do so in accordance with the prescriptive authority formulary.]

          F. A health care facility may adopt policies relating to the providing of anesthesia care.

          G. A certified registered nurse anesthetist licensed by the board shall maintain this certification with the American association of nurse anesthetists' council on certification."

     SECTION 7. Section 61-3-23.4 NMSA 1978 (being Laws 1991, Chapter 190, Section 16, as amended) is amended to read:

     "61-3-23.4. CLINICAL NURSE SPECIALIST--QUALIFICATIONS--ENDORSEMENT.--

          A. The board may license for advanced practice as a clinical nurse specialist an applicant who furnishes evidence satisfactory to the board that the applicant:

                (1) is a registered nurse;

                (2) has a master's degree or doctoral degree in a defined clinical nursing specialty;

                (3) has successfully completed a national certifying examination in the applicant's area of specialty; and

                (4) is certified by a national nursing organization.

          B. Clinical nurse specialists may:

                (1) perform an advanced practice that is beyond the scope of practice of professional registered nursing;

                (2) make independent decisions in a specialized area of nursing practice using expert knowledge regarding the health care needs of the individual, family and community, collaborating as necessary with other members of the health care team when the health care need is beyond the scope of practice of the clinical nurse specialist; and

                (3) carry out therapeutic regimens in the area of specialty practice, including the prescription and distribution of dangerous drugs.

          C. A clinical nurse specialist who has fulfilled the requirements for prescriptive authority in the area of specialty practice is authorized to prescribe, administer and distribute therapeutic measures, including dangerous drugs and controlled substances included in Schedules II through V of the Controlled Substances Act within the scope of specialty practice, including controlled substances pursuant to the Controlled Substances Act that have been prepared, packaged or fabricated by a registered pharmacist or doses of drugs that have been prepackaged by a pharmaceutical manufacturer in accordance with the Pharmacy Act and the New Mexico Drug, Device and Cosmetic Act.

          D. Clinical nurse specialists who have fulfilled the requirements for prescriptive authority in the area of specialty practice may prescribe in accordance with rules, regulations and guidelines [and formularies] based on scope of practice and clinical setting for individual clinical nurse specialists promulgated by the board.

          E. Clinical nurse specialists licensed by the board shall maintain certification in their specialty area."

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