Clarify regulatory autonomy of Advanced Practice Registered Nurses. Bring Michigan s APRN nursing regulations into alignment with national standards

Transcription

1 Dear APRN: Michigan ranks 44 th and receives an F because we are a state that severely restricts patient choice and regulatory autonomy for APRNs. It is time to recognize that nursing and medicine have distinct and overlapping scopes of practice. Nursing and medicine have different knowledge needs and requirements for education and training. To meet the oncoming tsunami of clients that Michigan will need to provide access to primary care we must correct the restrictive APRN regulatory environment in Michigan. The undersigned coalition of Advance Practice Registered Nursing (APRN) and Registered Nurse (RN) organizations fully supports amendments to PA 368, the Public Health code, that have been introduced in We ask that you support these changes that are designed to better the quality, cost and access of health care based on an improved regulatory practice climate for all APRNs. The goal of the legislation is to: Increase access to healthcare Improve Michigan s ability to attract and retain nurses Improve health care quality and reduce costs Clarify regulatory autonomy of Advanced Practice Registered Nurses Bring Michigan s APRN nursing regulations into alignment with national standards To ensure improved access to all of Michigan s citizens to high quality, cost effective and safe health care we propose the changes based on APRNs education, certification and experience. The following is a summary of the proposed changes to PA 368: Define APRN groups in the Public Health Code; Certified Nurse Practitioner (CNP), Certified Nurse Midwife (CNM), and Certified Clinical Nurse Specialist (CNSC) Protect the public through licensure of Advanced Practice Registered Nurses Establish an Advanced Practice Registered Nursing Task Force within the Michigan Board of Nursing to ensure practice oversight and compliance with the law. Implement prescriptive authority for pharmacological and non pharmacological interventions We ask that you contact your constituent association to become part of the solution to ensure that Michigan s nursing environment is among the best in the nation, that all citizens of the state have improved access to high quality, cost effective health care.

2 DRAFT 2 A bill to amend 1978 PA 368, entitled "Public health code," by amending sections 2701, 5119, 16327, 17201, 17210, 17211, 17221, 17708, and (MCL , , , , , , , , and ), section 2701 as added by 1990 PA 16, section 5119 as amended by 2000 PA 209, section as amended by 2009 PA 216, sections and as amended by 2006 PA 409, section as amended by 2009 PA 150, and section as amended by 2009 PA 55, and by adding sections 17202, 17222, and THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec As used in this part: 2 (a) "Board certified" means certified to practice in a 3 particular medical speciality by a national board recognized by 4 the American board of medical specialties or the American

3 2 1 osteopathic association. 2 (b) "Certified nurse midwife" means an individual licensed 3 as a registered professional nurse under part 172 who has been 4 issued a specialty certification in the practice of nurse 5 midwifery by the board of nursing under section THAT TERM 6 AS DEFINED IN SECTION (c) "Certified nurse practitioner" means an individual 8 licensed as a registered professional nurse under part 172 who 9 has been issued a specialty certification as a nurse practitioner 10 by the board of nursing under section THAT TERM AS DEFINED 11 IN SECTION (d) "Designated nurse" means a certified nurse midwife or 13 certified nurse practitioner. 14 (e) "Designated physician" means a physician qualified in 1 15 of the physician specialty areas identified in section (f) "Designated professional" means a designated physician, 17 designated nurse, or physician's assistant. 18 (g) "Health resource shortage area" means a geographic area, 19 population group, or health facility designated by the department 20 under section (h) "Medicaid" means benefits under the program of medical 22 assistance established under title XIX of the social security 23 act, 42 U.S.C to 1396d, 1396f to 1396g, and 1396i to 1396s, USC TO 1396W-2, and administered by the department of 25 social services under the social welfare act, Act No. 280 of the 26 Public Acts of 1939, being sections to of the 27 Michigan Compiled Laws PA 280, MCL TO B.

4 3 1 (i) "Medical school" means an accredited program for the 2 training of individuals to become physicians. 3 (j) "Medicare" means benefits under the federal medicare 4 program established under title XVIII of the social security act, 5 42 U.S.C to 1395b, 1395b-2 to 1395i, 1395i-1a to 1395i-2, j to 1395dd, 1395ff to 1395mm, and 1395oo to 1395ccc. 42 USC TO 1395JJJ. 8 (k) "National health service corps" means the agency 9 established under section 331 of title III of the public health 10 service act, 42 U.S.C. 254d. 42 USC 254D. 11 (l) "Nurse" means an individual licensed to engage in the 12 practice of nursing under part (m) "Nursing program" means an accredited program for the 14 training of individuals to become nurses. 15 (n) "Physician" means an individual licensed as a physician 16 under part 170 or an osteopathic physician under part (o) "Physician's assistant" means an individual licensed as 18 a physician's assistant under part 170 or part (p) "Physician's assistant program" means an accredited 20 program for the training of individuals to become physician's 21 assistants. 22 (q) "Service obligation" means the contractual obligation 23 undertaken by an individual under section 2705 or section 2707 to 24 provide health care services for a determinable time period at a 25 site designated by the department. 26 Sec (1) An individual applying for a marriage license 27 shall be advised through the distribution of written educational

5 4 1 materials by the county clerk regarding prenatal care and the 2 transmission and prevention of venereal disease and HIV 3 infection. The written educational materials shall describe the 4 availability to the applicant of tests for both venereal disease 5 and HIV infection. The information shall include a list of 6 locations where HIV counseling and testing services funded by the 7 department are available. The written educational materials shall 8 be approved or prepared by the department. 9 (2) A county clerk shall not issue a marriage license to an 10 applicant who fails to sign and file with the county clerk an 11 application for a marriage license that includes a statement with 12 a check-off box indicating that the applicant has received the 13 educational materials regarding the transmission and prevention 14 of both venereal disease and HIV infection and has been advised 15 of testing for both venereal disease and HIV infection, pursuant 16 to subsection (1). 17 (3) If either applicant for a marriage license undergoes a 18 test for HIV or an antibody to HIV, and if the test results 19 indicate that an applicant is HIV infected, the physician or a 20 designee of the physician, the physician's assistant, the 21 certified nurse midwife, or the certified nurse practitioner or 22 the local health officer or designee of the local health officer 23 administering the test immediately shall inform both applicants 24 of the test results, and shall counsel both applicants regarding 25 the modes of HIV transmission, the potential for HIV transmission 26 to a fetus, and protective measures. 27 (4) As used in this section:

6 5 1 (a) "Certified nurse midwife" means an individual licensed 2 as a registered professional nurse under part 172 who has been 3 issued a specialty certification in the practice of nurse 4 midwifery by the board of nursing under section THAT TERM 5 AS DEFINED IN SECTION (b) "Certified nurse practitioner" means an individual 7 licensed as a registered professional nurse under part 172 who 8 has been issued a specialty certification as a nurse practitioner 9 by the board of nursing under section THAT TERM AS DEFINED 10 IN SECTION (c) "Physician" means an individual licensed as a physician 12 under part 170 or an osteopathic physician under part (d) "Physician's assistant" means an individual licensed as 14 a physician's assistant under part 170 or part Sec Fees for a person licensed or seeking licensure 16 to practice nursing as a registered nurse, a licensed practical 17 nurse, or a trained attendant under part 172 are as follows: 18 (a) Application processing fee... $ (b) License fee, per year (c) Temporary license (d) Limited license, per year (e) Specialty certification AND ADVANCED 23 PRACTICE REGISTERED NURSE LICENSE 24 for registered nurse: 25 (i) Application processing fee (ii) Specialty certification AND ADVANCED 27 PRACTICE REGISTERED NURSE LICENSE,

7 6 1 per year Sec (1) As used in this part: 3 (A) "ADVANCED PRACTICE REGISTERED NURSE" OR "A.P.R.N." MEANS 4 AN INDIVIDUAL WHO IS LICENSED UNDER THIS PART AS A CERTIFIED 5 NURSE MIDWIFE, CERTIFIED NURSE PRACTITIONER, OR CERTIFIED 6 CLINICAL NURSE SPECIALIST. 7 (B) "CERTIFIED CLINICAL NURSE SPECIALIST" OR "C.C.N.S." 8 MEANS AN INDIVIDUAL WHO IS LICENSED UNDER THIS PART AS AN R.N., 9 WHO IS LICENSED AS AN A.P.R.N., AND WHO FOCUSES ON CONTINUOUS 10 IMPROVEMENT OF PATIENT OUTCOMES AND NURSING CARE WITH BROAD FOCUS 11 ACROSS THE AREAS OF DIRECT PATIENT CARE, PATIENT EDUCATION, 12 NURSING PRACTICE, AND ORGANIZATIONAL SYSTEMS. THE C.C.N.S. IS 13 RESPONSIBLE AND ACCOUNTABLE FOR DIAGNOSIS, INTERVENTION AND 14 TREATMENT OF HEALTH OR ILLNESS STATES, PHARMACOLOGICAL AND 15 NONPHARMACOLOGICAL DISEASE MANAGEMENT, HEALTH PROMOTION, AND 16 PREVENTION OF ILLNESS AND RISK BEHAVIOR AMONG INDIVIDUALS, 17 FAMILIES, GROUPS, AND COMMUNITIES. THE C.C.N.S. EVALUATES PATIENT 18 OUTCOMES; TRANSLATES EVIDENCE INTO PRACTICE; AND DEVELOPS, PLANS, 19 COORDINATES, AND DIRECTS PROGRAMS OF CARE FOR ACUTE AND 20 CHRONICALLY ILL PATIENTS AND THEIR FAMILIES. 21 (C) "CERTIFIED NURSE MIDWIFE" OR "C.N.M." MEANS AN 22 INDIVIDUAL WHO IS LICENSED UNDER THIS PART AS AN R.N., WHO IS 23 LICENSED AS AN A.P.R.N., AND WHO FOCUSES ON PRIMARY CARE SERVICES 24 FOR WOMEN THROUGHOUT THEIR LIFESPAN, INCLUDING COMPREHENSIVE 25 MATERNITY CARE THAT INCLUDES PRENATAL CARE, CHILDBIRTH IN DIVERSE 26 SETTINGS, POSTPARTUM CARE, AND NEWBORN CARE; GYNECOLOGICAL,

8 7 1 REPRODUCTIVE, AND CONTRACEPTIVE CARE; PHYSICAL EXAMS; DIAGNOSIS 2 AND TREATMENT OF COMMON HEALTH PROBLEMS WITH CONSULTATION OR 3 REFERRAL AS INDICATED; PRESCRIBING PHARMACOLOGICAL AND 4 NONPHARMACOLOGICAL INTERVENTIONS AND TREATMENTS; AND TREATMENT OF 5 MALE PARTNERS FOR SEXUALLY TRANSMITTED INFECTION AND REPRODUCTIVE 6 HEALTH. 7 (D) "CERTIFIED NURSE PRACTITIONER" OR "C.N.P." MEANS AN 8 INDIVIDUAL WHO IS LICENSED UNDER THIS PART AS AN R.N., WHO IS 9 LICENSED AS AN A.P.R.N., AND WHO FOCUSES ON THE PERFORMANCE OF 10 COMPREHENSIVE ASSESSMENTS; PROVIDING PHYSICAL EXAMINATIONS AND 11 OTHER HEALTH ASSESSMENTS AND SCREENING ACTIVITIES; AND 12 DIAGNOSING, TREATING, AND MANAGING PATIENTS WITH ACUTE AND 13 CHRONIC ILLNESSES AND DISEASES. NURSING CARE PROVIDED BY A C.N.P. 14 INCLUDES ORDERING, PERFORMING, SUPERVISING, AND INTERPRETING 15 LABORATORY AND IMAGING STUDIES; PRESCRIBING PHARMACOLOGICAL AND 16 NONPHARMACOLOGICAL INTERVENTIONS AND TREATMENTS THAT ARE WITHIN 17 THE C.N.P.'S SPECIALTY ROLE AND SCOPE OF PRACTICE; HEALTH 18 PROMOTION; DISEASE PREVENTION; HEALTH EDUCATION; AND COUNSELING 19 OF PATIENTS AND FAMILIES WITH POTENTIAL, ACUTE, AND CHRONIC 20 HEALTH DISORDERS. 21 (E) (a) "Practice of nursing" means the systematic 22 application of substantial specialized knowledge and skill, 23 derived from the biological, physical, and behavioral sciences, 24 to the care, treatment, counsel, and health teaching of 25 individuals who are experiencing changes in the normal health 26 processes or who require assistance in the maintenance of health 27 and the prevention or management of illness, injury, or

9 8 1 disability. 2 (F) (b) "Practice of nursing as a licensed practical nurse" 3 or "l.p.n." means the practice of nursing based on less 4 comprehensive knowledge and skill than that required of a 5 registered professional nurse and performed under the supervision 6 of a registered professional nurse, physician, or dentist. 7 (G) (c) "Registered professional nurse" or "r.n." means an 8 individual licensed under this article PART to engage in the 9 practice of nursing, which scope of practice includes the 10 teaching, direction, and supervision of less skilled personnel in 11 the performance of delegated nursing activities. 12 (2) In addition to the definitions in this part, article 1 13 contains general definitions and principles of construction 14 applicable to all articles in the code and part 161 contains 15 definitions applicable to this part. 16 SEC AN ADVANCED PRACTICE REGISTERED NURSE SHALL 17 PROVIDE SUCH FUNCTIONS COMMON TO THE POPULATION FOR WHICH 18 ADVANCED PRACTICE REGISTERED NURSES ARE EDUCATIONALLY AND 19 EXPERIENTIALLY PREPARED. AN A.P.R.N. SHALL DO ALL OF THE 20 FOLLOWING: 21 (A) COMPLY WITH THE STANDARDS ESTABLISHED FOR REGISTERED 22 NURSES AND WITH THE STANDARDS OF THE NATIONAL PROFESSIONAL 23 NURSING ASSOCIATIONS. 24 (B) CONSULT WITH OR REFER PATIENTS TO OTHER HEALTH CARE 25 PROVIDERS AS APPROPRIATE. 26 (C) SUPERVISE NURSES, NURSING PROFESSIONALS, AND HEALTH CARE 27 PROVIDERS AS APPROPRIATE.

10 9 1 Sec (1) The board of nursing may issue a specialty 2 certification to a registered professional nurse who has advanced 3 training beyond that required for initial licensure and who has 4 demonstrated competency through examination or other evaluative 5 processes and who practices in 1 of the following health 6 profession specialty fields: nurse midwifery, FIELD OF nurse 7 anesthetist., or nurse practitioner. 8 (2) THE BOARD SHALL ISSUE AN A.P.R.N. LICENSE TO A 9 REGISTERED PROFESSIONAL NURSE WHO MEETS ALL OF THE FOLLOWING 10 REQUIREMENTS: 11 (A) HAS COMPLETED AN ACCREDITED GRADUATE OR POSTGRADUATE 12 LEVEL NURSING EDUCATION PROGRAM PREPARING THE NURSE FOR THE ROLE 13 OF CERTIFIED NURSE MIDWIFE, CERTIFIED NURSE PRACTITIONER, OR 14 CERTIFIED CLINICAL NURSE SPECIALIST. 15 (B) IS CERTIFIED BY A NATIONALLY ACCREDITED CERTIFICATION 16 BODY AS DEMONSTRATING A.P.R.N. ROLE AND POPULATION FOCUSED 17 COMPETENCIES AND WHO MAINTAINS CONTINUED COMPETENCE AS EVIDENCED 18 BY RECERTIFICATION IN THE ROLE AND POPULATION THROUGH THE 19 NATIONAL CERTIFICATION PROGRAM. 20 (3) THE DEPARTMENT SHALL RENEW AN A.P.R.N. LICENSE UNDER 21 THIS PART CONCURRENTLY WITH THE REGISTERED PROFESSIONAL NURSE 22 LICENSE. 23 (4) FOR THE PURPOSE OF ADMINISTERING OTHER STATE LAW OR 24 RULES PROMULGATED BY THE BOARD OF NURSING, A REFERENCE TO A 25 SPECIALTY CERTIFICATION IS ALSO A REFERENCE TO AN A.P.R.N. 26 LICENSE ISSUED TO AN R.N. AND ENGAGING IN AN A.P.R.N. ROLE. 27 Sec (1) A person shall not engage in the practice of

11 10 1 nursing or the practice of nursing as a licensed practical nurse 2 unless licensed or otherwise authorized by this article. 3 (2) The following words, titles, or letters or a combination 4 thereof, with or without qualifying words or phrases, are 5 restricted in use only to those persons authorized under this 6 part to use the terms and in a way prescribed in this part: 7 "registered professional nurse", "registered nurse", "r.n.", 8 "licensed practical nurse", "l.p.n.", "nurse midwife", "CERTIFIED 9 NURSE MIDWIFE", "C.N.M.", "nurse anesthetist", "nurse 10 practitioner", "CERTIFIED NURSE PRACTITIONER", "C.N.P.", 11 "CERTIFIED CLINICAL NURSE SPECIALIST", "C.C.N.S.", "trained 12 attendant", and "t.a.". 13 Sec (1) The Michigan board of nursing is created in 14 the department and, BEGINNING 30 DAYS AFTER THE EFFECTIVE DATE OF 15 THE AMENDATORY ACT THAT ADDED THIS PHRASE, shall consist of the 16 following voting members who shall meet the requirements of 17 part 161: 9 10 registered professional nurses, 1 CERTIFIED nurse 18 midwife, 1 nurse anesthetist, 1 CERTIFIED nurse practitioner, 1 19 CERTIFIED CLINICAL NURSE SPECIALIST, 3 licensed practical nurses, 20 and 8 public members. Three of the registered professional nurse 21 members shall be engaged in nursing education, 1 of whom shall be 22 in less than a baccalaureate program, 1 in a baccalaureate or 23 higher program, and 1 in a licensed practical nurse program, and 24 each of whom shall have a master's degree from an accredited 25 college with a major in nursing. Three of the registered 26 professional nurse members shall be engaged in nursing practice 27 or nursing administration, each of whom shall have a

12 11 1 baccalaureate degree in nursing from an accredited college. Three 2 of the registered professional nurse members shall be engaged in 3 nursing practice or nursing administration, each of whom shall be 4 a nonbaccalaureate registered nurse. The 3 licensed practical 5 nurse members shall have graduated from a state approved program 6 for the preparation of individuals to practice as licensed 7 practical nurses. The CERTIFIED nurse midwife, the nurse 8 anesthetist, THE CERTIFIED CLINICAL NURSE SPECIALIST, and the 9 CERTIFIED nurse practitioner shall each have a specialty 10 certification AN A.P.R.N. LICENSE issued by the department in his 11 or her respective specialty field ROLE AND THE NURSE ANESTHETIST 12 SHALL HAVE A SPECIALTY CERTIFICATE ISSUED BY THE DEPARTMENT IN 13 THAT SPECIALTY FIELD. 14 (2) The terms of office of individual members of the board 15 created under this part, except those appointed to fill 16 vacancies, expire 4 years after appointment on June 30 of the 17 year in which the term expires. 18 SEC (1) AN ADVANCED PRACTICE REGISTERED NURSE TASK 19 FORCE IS CREATED UNDER THIS SECTION. THE ADVANCED PRACTICE 20 REGISTERED NURSE TASK FORCE SHALL CONSIST OF THE FOLLOWING MEMBERS WHO SHALL MEET THE REQUIREMENTS OF PART 161: 1 DOCTORATE 22 PREPARED REGISTERED PROFESSIONAL NURSE WHO IS NOT AN A.P.R.N., 1 23 REGISTERED PROFESSIONAL NURSE WHO IS A MEMBER OF THE BOARD OF 24 NURSING, 2 CERTIFIED NURSE MIDWIVES, 2 CERTIFIED NURSE 25 PRACTITIONERS, 2 CERTIFIED CLINICAL NURSE SPECIALISTS, AND 3 26 PUBLIC MEMBERS. ONE OF THE REGISTERED PROFESSIONAL NURSE MEMBERS 27 SHALL BE ENGAGED IN NURSING EDUCATION.

13 12 1 (2) THE ADVANCED PRACTICE REGISTERED NURSE TASK FORCE SHALL 2 DO ALL OF THE FOLLOWING: 3 (A) PERFORM THE ACTS AND MAKE THE DETERMINATIONS NECESSARY 4 FOR THE PROPER IMPLEMENTATION OF ITS POWERS AND DUTIES UNDER THIS 5 PART. 6 (B) PROMULGATE RULES AS FOLLOWS: 7 (i) THOSE NECESSARY FOR THE IMPLEMENTATION OF ITS POWERS AND 8 DUTIES UNDER THIS PART. 9 (ii) TO ESTABLISH THE REQUIREMENTS FOR THE EDUCATION, 10 TRAINING, AND EXPERIENCE OF A.P.R.N. LICENSURE IN THIS STATE. IN 11 DEVELOPING THE REQUIREMENTS UNDER THIS SUBPARAGRAPH, THE TASK 12 FORCE SHALL TAKE INTO ACCOUNT NATIONALLY RECOGNIZED STANDARDS FOR 13 EDUCATION, TRAINING, AND EXPERIENCE. 14 (iii) TO ESTABLISH CRITERIA FOR THE EVALUATION OF A.P.R.N. 15 EDUCATION AND TRAINING PROGRAMS. THE TASK FORCE SHALL ESTABLISH 16 CRITERIA THAT ARE SUBSTANTIALLY CONSISTENT WITH NATIONALLY 17 RECOGNIZED STANDARDS FOR EDUCATION AND TRAINING OF A.P.R.N.S. 18 UNTIL THE CRITERIA ARE ESTABLISHED UNDER THIS SUBPARAGRAPH, THE 19 STANDARDS DEVELOPED BY THE DEPARTMENT BEFORE THE EFFECTIVE DATE 20 OF THIS SECTION SHALL REMAIN IN EFFECT. 21 (C) DEVELOP AND MAKE PUBLIC GUIDELINES ON THE APPROPRIATE 22 SCOPE OF PRACTICE OF AN A.P.R.N. ACCORDING TO HIS OR HER 23 EDUCATION, TRAINING, AND EXPERIENCE. GUIDELINES DEVELOPED UNDER 24 THIS SUBDIVISION ARE NOT BINDING, BUT SHALL SERVE TO EXPLAIN THE 25 TASK FORCE'S CRITERIA FOR DETERMINING WHETHER AN A.P.R.N. IS 26 PRACTICING WITHIN HIS OR HER SCOPE OF PRACTICE. 27 (D) IN CONSULTATION WITH THE BOARD, DISCIPLINE AN A.P.R.N.

14 13 1 DETERMINED TO BE PRACTICING OUTSIDE THE RECOGNIZED SCOPE OF 2 PRACTICE FOR THE ROLE IN WHICH HE OR SHE IS LICENSED. 3 (E) DIRECT THE DEPARTMENT TO ISSUE A LICENSE TO AN APPLICANT 4 WHO MEETS THE REQUIREMENTS OF THIS PART AND RULES PROMULGATED 5 UNDER THIS PART FOR PRACTICE AND USE OF THE RECOGNIZED TITLE FOR 6 THE A.P.R.N. ROLE. 7 (F) MAKE WRITTEN RECOMMENDATIONS TO THE BOARD ON 8 REINSTATEMENT OF A.P.R.N. LICENSES AND NOTICES OF INTENT TO DENY 9 A.P.R.N. LICENSES. 10 (G) FILE AN ANNUAL REPORT WITH THE BOARD OF NURSING AND THE 11 DEPARTMENT CONTAINING MATTERS PRESCRIBED BY THE A.P.R.N. TASK 12 FORCE AND BOARD. 13 Sec (1) "Preceptor" means a pharmacist approved by 14 the board to direct the training of an intern in an approved 15 pharmacy. 16 (2) "Prescriber" means a licensed dentist, a licensed doctor 17 of medicine, a licensed doctor of osteopathic medicine and 18 surgery, a licensed doctor of podiatric medicine and surgery, a 19 licensed optometrist certified under part 174 to administer and 20 prescribe therapeutic pharmaceutical agents, A LICENSED ADVANCED 21 PRACTICE REGISTERED NURSE WHO MEETS THE REQUIREMENTS OF SECTION , a licensed veterinarian, or another licensed health 23 professional acting under the delegation and using, recording, or 24 otherwise indicating the name of the delegating licensed doctor 25 of medicine or licensed doctor of osteopathic medicine and 26 surgery. 27 (3) "Prescription" means an order for a drug or device

15 14 1 written and signed or transmitted by facsimile, electronic 2 transmission, or other means of communication by a prescriber to 3 be filled, compounded, or dispensed. Prescribing is limited to a 4 prescriber. An order transmitted in other than written form shall 5 be electronically recorded, printed, or written and immediately 6 dated by the pharmacist, and that record constitutes the original 7 prescription. In a health facility or agency licensed under 8 article 17 or other medical institution, an order for a drug or 9 device in the patient's chart constitutes for the purposes of 10 this definition the original prescription. Subject to section (2), prescription includes, but is not limited to, an order 12 for a drug, not including a controlled substance as defined in 13 section 7104 except under circumstances described in section (e), written and signed or transmitted by facsimile, 15 electronic transmission, or other means of communication by a 16 physician prescriber licensed to practice in a state other than 17 Michigan. 18 (4) "Prescription drug" means 1 or more of the following: 19 (a) A drug dispensed pursuant to a prescription. 20 (b) A drug bearing the federal legend "CAUTION: federal law 21 prohibits dispensing without prescription" or "Rx only". 22 (c) A drug designated by the board as a drug that may only 23 be dispensed pursuant to a prescription. 24 SEC (1) AN ADVANCED PRACTICE REGISTERED NURSE 25 LICENSED UNDER SECTION MAY POSSESS, PRESCRIBE, ADMINISTER, 26 AND DISPENSE AND DISTRIBUTE NONSCHEDULED PRESCRIPTION DRUGS AND 27 CONTROLLED SUBSTANCES INCLUDED IN SCHEDULES 2 TO 5 SUBJECT TO THE

16 15 1 REQUIREMENTS OF SECTION AND ALL OF THE FOLLOWING: 2 (A) HE OR SHE HAS COMPLETED GRADUATE LEVEL PHARMACOLOGY, 3 PATHOPHYSIOLOGY, AND PHYSICAL ASSESSMENT COURSES AND CLINICAL 4 PRACTICUM IN THE SPECIFIED A.P.R.N. ROLE. 5 (B) UNLESS OTHERWISE PROVIDED BY RULE, HE OR SHE HAS 6 COMPLETED THE NUMBER OF CONTACT HOURS IN PHARMACOLOGY AS PART OF 7 THE REQUISITE CONTINUING EDUCATION FOR CERTIFICATION AND 8 LICENSURE RENEWAL AS DETERMINED BY THE BOARD OF NURSING UNDER 9 PART (C) HE OR SHE HAS APPLIED FOR AND BEEN GRANTED PRESCRIPTIVE 11 AUTHORITY WITHIN HIS OR HER RESPECTIVE SCOPE OF PRACTICE AND 12 POPULATION, IF APPLICABLE. 13 (2) THE DEPARTMENT SHALL ISSUE A SPECIALTY CERTIFICATION TO 14 AN A.P.R.N. WHO APPLIES AND IS QUALIFIED UNDER SUBSECTION (1) TO 15 POSSESS, PRESCRIBE, ADMINISTER, AND DISPENSE AND DISTRIBUTE 16 NONSCHEDULED PRESCRIPTION DRUGS AND CONTROLLED SUBSTANCES 17 INCLUDED IN SCHEDULES 2 TO (3) THE AMENDATORY ACT THAT ADDED THIS SECTION DOES NOT 19 REQUIRE NEW OR ADDITIONAL THIRD-PARTY REIMBURSEMENT OR MANDATED 20 WORKER'S COMPENSATION BENEFITS FOR SERVICES RENDERED BY AN 21 INDIVIDUAL AUTHORIZED TO ACT AS A PRESCRIBER UNDER THIS SECTION. 22 Sec (1) A person shall not engage in the practice of 23 physical therapy or practice as a physical therapist assistant 24 unless licensed or otherwise authorized under this part. A person 25 shall engage in the actual treatment of an individual only upon 26 the prescription of an individual holding a license issued under 27 part 166, 170, 172, 175, or 180, or the equivalent license issued

17 16 1 by another state. 2 (2) The following words, titles, or letters or a combination 3 thereof, with or without qualifying words or phrases, are 4 restricted in use only to those persons authorized under this 5 part to use the terms and in a way prescribed in this part: 6 "physical therapy", "physical therapist", "physiotherapist", 7 "physiotherapy", "registered physical therapist", "licensed 8 physical therapist", "physical therapy technician", "physical 9 therapist assistant", "physical therapy assistant", 10 "physiotherapist assistant", "physiotherapy assistant", "p.t. 11 assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", 12 "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", 13 "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and 14 "p.t.t." '09 Draft 2 Final Page KKR