AN
ACT Relating to completion of prescriptive authority for advanced registered
nurse practitioners; amending RCW 18.79.050, 18.79.240, and 18.79.250; adding
new sections to chapter 18.79 RCW; adding a new section to chapter 18.71 RCW;
adding a new section to chapter 18.57 RCW; and providing an effective date.
BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. A
new section is added to chapter 18.79 RCW to read as follows:
The
dispensing of Schedules II through IV controlled substances subject to RCW
18.79.240(1)(s) is limited to a maximum of a seventy-two-hour supply of the
prescribed controlled substance.
Sec.
2. RCW
18.79.050 and 1994 sp.s. c 9 s 405 are each amended to read as follows:
"Advanced
registered nursing practice" means the performance of the acts of a
registered nurse and the performance of an expanded role in providing health
care services as recognized by the medical and nursing professions, the scope
of which is defined by rule by the commission. Upon approval by the
commission, an advanced registered nurse practitioner may prescribe legend
drugs and controlled substances contained in Schedule V of the Uniform
Controlled Substances Act, chapter 69.50 RCW, and Schedules II through IV
subject to RCW 18.79.240(1) (r) or (s).
Nothing
in this section prohibits a person from practicing a profession for which a
license has been issued under the laws of this state or specifically authorized
by any other law of the state of Washington.
This
section does not prohibit (1) the nursing care of the sick, without
compensation, by an unlicensed person who does not hold himself or herself out
to be an advanced registered nurse practitioner, or (2) the practice of
registered nursing by a licensed registered nurse or the practice of licensed
practical nursing by a licensed practical nurse.
Sec.
3. RCW
18.79.240 and 1994 sp.s. c 9 s 424 are each amended to read as follows:
(1)
In the context of the definition of registered nursing practice and advanced
registered nursing practice, this chapter shall not be construed as:
(a)
Prohibiting the incidental care of the sick by domestic servants or persons
primarily employed as housekeepers, so long as they do not practice registered
nursing within the meaning of this chapter;
(b)
Preventing a person from the domestic administration of family remedies or the
furnishing of nursing assistance in case of emergency;
(c)
Prohibiting the practice of nursing by students enrolled in approved schools as
may be incidental to their course of study or prohibiting the students from
working as nursing aides;
(d)
Prohibiting auxiliary services provided by persons carrying out duties
necessary for the support of nursing services, including those duties that
involve minor nursing services for persons performed in hospitals, nursing homes,
or elsewhere under the direction of licensed physicians or the supervision of
licensed registered nurses;
(e)
Prohibiting the practice of nursing in this state by a legally qualified nurse
of another state or territory whose engagement requires him or her to accompany
and care for a patient temporarily residing in this state during the period of
one such engagement, not to exceed six months in length, if the person does not
represent or hold himself or herself out as a registered nurse licensed to practice
in this state;
(f)
Prohibiting nursing or care of the sick, with or without compensation, when
done in connection with the practice of the religious tenets of a church by
adherents of the church so long as they do not engage in the practice of nursing
as defined in this chapter;
(g)
Prohibiting the practice of a legally qualified nurse of another state who is
employed by the United States government or a bureau, division, or agency
thereof, while in the discharge of his or her official duties;
(h)
Permitting the measurement of the powers or range of human vision, or the
determination of the accommodation and refractive state of the human eye or the
scope of its functions in general, or the fitting or adaptation of lenses for
the aid thereof;
(i)
Permitting the prescribing or directing the use of, or using, an optical device
in connection with ocular exercises, visual training, vision training, or
orthoptics;
(j)
Permitting the prescribing of contact lenses for, or the fitting and adaptation
of contact lenses to, the human eye;
(k)
Prohibiting the performance of routine visual screening;
(l)
Permitting the practice of dentistry or dental hygiene as defined in chapters
18.32 and 18.29 RCW, respectively;
(m)
Permitting the practice of chiropractic as defined in chapter 18.25 RCW
including the adjustment or manipulation of the articulation of the spine;
(n)
Permitting the practice of podiatric medicine and surgery as defined in chapter
18.22 RCW;
(o)
Permitting the performance of major surgery, except such minor surgery as the
commission may have specifically authorized by rule adopted in accordance with
chapter 34.05 RCW;
(p)
Permitting the prescribing of controlled substances as defined in Schedules I through
IV of the Uniform Controlled Substances Act, chapter 69.50 RCW, except as
provided in (r) or (s) of this subsection;
(q)
Prohibiting the determination and pronouncement of death;
(r)
Prohibiting advanced registered nurse practitioners, approved by the commission
as certified registered nurse anesthetists from selecting, ordering, or
administering controlled substances as defined in Schedules II through IV of
the Uniform Controlled Substances Act, chapter 69.50 RCW, consistent with their
commission-recognized scope of practice; subject to facility-specific
protocols, and subject to a request for certified registered nurse anesthetist
anesthesia services issued by a physician licensed under chapter 18.71 RCW, an
osteopathic physician and surgeon licensed under chapter 18.57 RCW, a dentist
licensed under chapter 18.32 RCW, or a podiatric physician and surgeon licensed
under chapter 18.22 RCW; the authority to select, order, or administer Schedule
II through IV controlled substances being limited to those drugs that are to be
directly administered to patients who require anesthesia for diagnostic,
operative, obstetrical, or therapeutic procedures in a hospital, clinic,
ambulatory surgical facility, or the office of a practitioner licensed under
chapter 18.71, 18.22, 18.36, 18.36A, 18.57, 18.57A, or 18.32 RCW;
"select" meaning the decision-making process of choosing a drug,
dosage, route, and time of administration; and "order" meaning the process
of directing licensed individuals pursuant to their statutory authority to
directly administer a drug or to dispense, deliver, or distribute a drug for
the purpose of direct administration to a patient, under instructions of the
certified registered nurse anesthetist. "Protocol" means a statement
regarding practice and documentation concerning such items as categories of
patients, categories of medications, or categories of procedures rather than
detailed case-specific formulas for the practice of nurse anesthesia;
(s)
Prohibiting advanced registered nurse practitioners from ordering or
prescribing controlled substances as defined in Schedules II through IV of the
Uniform Controlled Substances Act, chapter 69.50 RCW, if and to the extent:
(i) Doing so is permitted by their scope of practice; (ii) it is in response to
a combined request from one or more physicians licensed under chapter 18.71 or
18.57 RCW and an advanced registered nurse practitioner licensed under this
chapter, proposing a joint practice arrangement under which such prescriptive
authority will be exercised with appropriate collaboration between the
practitioners; and (iii) it is consistent with rules adopted under this
subsection. The medical quality assurance commission, the board of osteopathic
medicine and surgery, and the commission are directed to jointly adopt by
consensus by rule a process and criteria that implements the joint practice
arrangements authorized under this subsection. This subsection (1)(s) does not
apply to certified registered nurse anesthetists.
(2)
In the context of the definition of licensed practical nursing practice, this
chapter shall not be construed as:
(a)
Prohibiting the incidental care of the sick by domestic servants or persons
primarily employed as housekeepers, so long as they do not practice practical
nursing within the meaning of this chapter;
(b)
Preventing a person from the domestic administration of family remedies or the
furnishing of nursing assistance in case of emergency;
(c)
Prohibiting the practice of practical nursing by students enrolled in approved
schools as may be incidental to their course of study or prohibiting the
students from working as nursing assistants;
(d)
Prohibiting auxiliary services provided by persons carrying out duties
necessary for the support of nursing services, including those duties that
involve minor nursing services for persons performed in hospitals, nursing
homes, or elsewhere under the direction of licensed physicians or the
supervision of licensed registered nurses;
(e)
Prohibiting or preventing the practice of nursing in this state by a legally
qualified nurse of another state or territory whose engagement requires him or
her to accompany and care for a patient temporarily residing in this state during
the period of one such engagement, not to exceed six months in length, if the
person does not represent or hold himself or herself out as a licensed
practical nurse licensed to practice in this state;
(f)
Prohibiting nursing or care of the sick, with or without compensation, when
done in connection with the practice of the religious tenets of a church by
adherents of the church so long as they do not engage in licensed practical
nurse practice as defined in this chapter;
(g)
Prohibiting the practice of a legally qualified nurse of another state who is
employed by the United States government or any bureau, division, or agency
thereof, while in the discharge of his or her official duties.
Sec.
4. RCW
18.79.250 and 1994 sp.s. c 9 s 425 are each amended to read as follows:
An
advanced registered nurse practitioner under his or her license may perform for
compensation nursing care, as that term is usually understood, of the ill,
injured, or infirm, and in the course thereof, she or he may do the following
things that shall not be done by a person not so licensed, except as provided
in RCW 18.79.260 and 18.79.270:
(1)
Perform specialized and advanced levels of nursing as recognized jointly by the
medical and nursing professions, as defined by the commission;
(2)
Prescribe legend drugs and Schedule V controlled substances, as defined in the
Uniform Controlled Substances Act, chapter 69.50 RCW, and Schedules II
through IV subject to RCW 18.79.240(1) (r) or (s) within the scope of
practice defined by the commission;
(3)
Perform all acts provided in RCW 18.79.260;
(4)
Hold herself or himself out to the public or designate herself or himself as an
advanced registered nurse practitioner or as a nurse practitioner.
NEW
SECTION. Sec. 5. A
new section is added to chapter 18.71 RCW to read as follows:
The
commission is directed to jointly adopt by consensus, with the board of
osteopathic medicine and surgery and the Washington state nursing care quality
assurance commission, a process and criteria that implements the joint practice
arrangements authorized under RCW 18.79.240(1)(s).
NEW
SECTION. Sec. 6. A
new section is added to chapter 18.57 RCW to read as follows:
The
board is directed to jointly adopt by consensus, with the medical quality
assurance commission and the Washington state nursing care quality assurance
commission, a process and criteria that implements the joint practice
arrangements authorized under RCW 18.79.240(1)(s).
NEW
SECTION. Sec. 7. A
new section is added to chapter 18.79 RCW to read as follows:
The
commission is directed to jointly adopt by consensus, with the medical quality
assurance commission and the board of osteopathic medicine and surgery, a
process and criteria that implements the joint practice arrangements authorized
under RCW 18.79.240(1)(s).
NEW
SECTION. Sec. 8.
Sections 1 through 3 of this act take effect July 1, 2000.
NEW SECTION. Sec. 9. If
any provision of this act or its application to any person or circumstance is
held invalid, the remainder of the act or the application of the provision to
other persons or circumstances is not affected.
