STATE OF WISCONSIN
Board of Nursing
IN THE MATTER OF RULE-MAKING
PROCEEDINGS BEFORE THE
BOARD OF NURSING
ORDER OF THE
BOARD OF NURSING
ADOPTING RULES
(CLEARINGHOUSE RULE 16-020)
ORDER
An order of the
Board of Nursing
to
repeal N 8.04 and 8.05 (2); to renumber and amend N 8.03 (1); to amend N 8.02
(1)
(c), 8.02 (4), 8.03 (intro
.
), 8.03 (2)
to
(5), 8.05 (1), 8.06 (3) (c), 8.06 (5), 8.07 (2), 8.09 (2), 8.10 (title) and 8.10 (4)
to
(7); and to create N 8.03 (1) and 8.045
relating to advanced practice nurse prescribers
.
Analysis prepared by the Department of
Safety and Professional Services
.
---------------------------------------------------------------------------------------------------------------------
ANALYSIS
Statutes interpreted:
s.
441.16
, Stats.
Explanation of agency authority:
The Board shall
promulgate rules for its own guidance and for the guidance of the profession and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the profession. [s.
15.08 (5) (b)
, Stats.]
The Board shall promulgate rules necessary to administer s.
441.16
, including rules for all of the following:
•
Establishing
the education, training or experience requirements that a registered nurse must satisfy to be an advanced practice nurse. The rules shall require a registered nurse to have education, training or experience that is in addition to the education, training or experience required for licensure as a registered nurse.
•
Establish
the appropriate education, training and examination requirements that an advanced practice nurse must satisfy to qualify for a certificate to issue prescription orders.
•
Defining
the scope of practice within which an advanced practice nurse may issue prescription orders.
•
Specifying
the classes of drugs, individual drugs or devices that may not be prescribed by an advanced practice nurse.
•
Establishing procedures for maintaining a certificate to issue prescription orders, including requirements for continuing education and a requirement to complete the nursing workforce survey and submit the fee required under s.
441.01 (7)
. [s.
441.16 (3)
, Stats]
Related statute or rule:
n/a
Plain language analysis:
Section 1 adds
a
doctoral degree in nursing or a related health field as a qualifying degree. The Board recognizes that some schools are offering doctoral degrees in lieu of master’s degrees and did not want those
obtaining
a higher degree to be ineligible for the certificate.
Section 2 modifies the definition of “clinical
pharmacology
or therapeutics” by changing the phrase “likelihood of success” to “efficacy” in order to be clearer and more accurate.
Sections 3, 4, 5, 6 and 7 consolidate
the qualifications required for the certification and the application requirements into one section. Language to accommodate this consolidation has been updated.
The
degree required
is updated to recognize a
doctoral
degree in addition to the master’s degree. The applicant is required to have obtained 45 contact hours in clinical
pharmacology
or therapeutics
in the
5 years, instead of 3 years, preceding the application in order to accommodate graduates from programs which offer the pharmacology course early in the curriculum sequence rather than requiring the applicant to repeat the course creating unnecessary delay and expense.
Section 8 creates renewal provisions. In order to renew an advance practice nurse prescriber
certificate
the certificate holder must pay a renewal fee, complete the nursing workforce survey, certify completion of the continuing education and provide evidence of current certification by an approved
certifying
body of nurse practitioner, certified
nurse
-midwife, certified registered nurse anesthetist or clinical nurse specialist.
Sections 9 and 10 updates the continuing education requirements.
A nurse prescriber shall complete 16 contact hours during the biennium.
The Sections remove
the provisions allowing for an average minimum number per year which is then reported on a schedule consistent with the national certifying body. The Board is requiring
continuing
education to be completed each biennium. In addition, t
wo of those contact hours shall be in responsible prescribing of controlled substances
.
The Board is requiring the specific hours in responsible prescribing of controlled substances due to the
current
prescription drug addict
ion
public health crisis
.
Section 11 clarifies that attention deficit hyperactivity disorder is included in
hyperkinesis
.
Section 12 updates language for the advance practice nurse prescriber to provide upon request evidence of the advance practice nurse prescriber certification.
Section 13 updates language to allow prescriptions to be submitted electronically as permitted by state and federal law and removes the outdated typewritten provision.
It also updates language to require the drug enforcement agency number of the license.
Section 14
removes the mileage limitation but clarifies the dispensing of drugs is at the treatment facility.
Sections 15 and 16 update
language. The word “care” replaces “case” which is more reflective of current practice.
One reference to advanced practice nurses is corrected to state advanced practice nurse prescribers.
The Board removed the provision relating to notification to advanced practice nurses of mutual educational opportunities and available communication networks. The provisions regarding tests which may be ordered by an advanced practice nurse prescriber
have
been updated and clarified.
The language regarding the
collaborative
relationship has been updated to reflect the standard language of “training, education and experience” instead of “professional expertise” and
to remove
the requirement
that the physician document
this relationship in
recognition
that the Board does not have
jurisdiction
over a physician.
Summary of, and comparison with, existing or proposed federal regulation:
None
Comparison with rules in adjacent states:
Illinois
:
Illinois licenses nurses at three levels: licensed practice nurse, registered nurse and advance practice nurse
. Illinois requires an advanced practice nurse to additionally hold a separate license for the prescribing of
controlled
substances.
In Illinois a collaborating physician may delegate prescriptive authority to a nurse holding an advanced practice nurse license. An APN who has been given controlled
substances
prescriptive authority shall be required to obtain an Illinois mid-level practitioner controlled substances license.
The requirements for obtaining a mid-level practitioner controlled substances license
are
to be a physician assistant or advanced practice nurse with an active license in good standing; provide the license number and controlled substances license number of the delegating or collaborating physician or podiatrist; written notice of delegation of prescriptive authority signed by the physician or podiatrist including the schedule of controlled substances or the specific Schedule II controlled
substances
that the mid-level practitioner may dispense or prescribe; and if license is issued with Schedule II authority, the advance practice nurse
must
have taken at least 45 hours of graduate contact hours in pharmacology. The mid-level practitioner controlled substances license requires 5 hours annually of continuing education in pharmacology. The
mid-level practitioner controlled substances license only allows
prescribing and dispensing of controlled substances the collaborating physician prescribes.
Iowa
:
Iowa licenses nurses at three levels: licensed practice nurse, registered nurse and advance registered nurse practitioner.
The advanced registered nurse prescriber has a scope of practice
which
includes prescriptive authority. There is no equivalent certification in Iowa to the
Wisconsin
advance practice nurse prescriber certificate.
Michigan
:
Michigan licenses nurses at two levels: licensed practice nurse and registered nurse. Michigan has specialty certifications for a nurse anesthetist, nurse midwife and nurse practitioner. A physician who supervises a nurse practitioner or nurse midwife may delegate the prescribing of non-controlled prescriptions and Schedules 3-5 controlled substances if the delegating physician establishes a written authorization. A delegating physician may delegate the prescription of Schedule 2
controlled
substances only if the nurse practitioner or nurse midwife is practicing in a surgical outpatient facility, hospital and hospice with the patient being located within the facility. There is no equivalent certification in Michigan to the
Wisconsin
advance practice nurse prescriber certificate.
Minnesota:
Effective January 1, 2015, Minnesota
licenses nurses at three levels: licensed practice nurse, registered nurse and advanced practice registered nurse.
The advanced practice
registered
nurse has a scope of practice which includes prescriptive authority. There is no equivalent certification in Minnesota to the Wisconsin advance practice nurse prescriber certificate.
Summary of factual data and analytical methodologies:
The Board reviewed their rules and consulted with stakeholders.
Analysis and supporting documents used to determine effect on small business or in preparation of economic impact
analysis
:
This rule was posted for a period of 14 days for economic comments and none were received.
Fiscal Estimate and Economic Impact Analysis:
The Fiscal Estimate and Economic Impact Analysis is attached.
Effect on small business
:
These proposed rules
do
not
have
an economic impact on small businesses, as defined in s.
227.114 (1)
, Stats. The Department’s Regulatory Review Coordinator may be contacted by email at
Eric.Esser
@wisconsin.gov
, or by calling (608) 26
7-2435
.
TEXT OF RULE
Section
1. N 8.02
(1)
(c) is amended to read:
N 8.02
(1)
(c
) For
applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, the registered nurse holds a master’s
or doctoral
degree in nursing or a related health field granted by a college or university accredited by a regional accrediting agency approved by the board of education in the state in which the college or university is located.
Section
2. N 8.02 (4) is amended to read:
N 8.02
(4)
“Clinical pharmacology or therapeutics” means the identification of individual and classes of drugs, their indications and contraindications, their
likelihood of success
efficacy
, their side-effects and their interactions, as well as, clinical judgment skills and decision-making, based on thorough interviewing, history-taking, physical assessment, test selection and interpretation, pathophysiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non-pharmacologic interventions.
Section
3. N 8.03 (intro) is amended to read:
N 8.03
Qualifications for certification
Certification
as an advanced practice nurse prescriber.
An applicant for initial certification
to issue prescription orders
as an advanced practice nurse prescriber
shall be granted a certificate by the board if the applicant complies with all of the following:
Section
4. N 8.03 (1) is renumber
e
d to N 8.03 (1m) and amended to read:
N 8.03
(1
m
)
Has
Provides evidence of holding
a current license to practice as a professional nurse in this state or
has
a current license to practice professional nursing in another state which has adopted the nurse licensure compact.
Section
5. N 8.03 (1) is created to read:
N 8.03 (1
)
Submits
an application form and the fee under s.
440.05(1)
, Stats.
Section
6. N 8.03 (2)
to
(5) are amended to read:
N 8.03
(2
)
Is currently certified
Provides evidence of current certification
by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.
(3)
For applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, holds
Provides evidence
of
a master’s
or doctoral
degree in nursing or a related health field granted by a college or university accredited by a regional accrediting
agency
organization
approved by the
state board of education in the state in which the college or university is located
Council for Higher Education Accreditation
.
This subs
ection
does not apply to those who received national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist before July 1, 1998.
(4
)
Has completed
at least
Provides evidence of completion of
45 contact hours in clinical pharmacology
/
or
therapeutics within
3
5
years preceding the application for a certificate
to issue prescription orders
.
(5
)
Has passed
Provides e
vidence of passing
a jurisprudence examination for advanced practice nurse prescribers.
Section
7. N 8.04 is repealed.
Section
8. N 8.045 is created to read:
N 8.045 Renewal.
A person holding an advanced practice nurse prescriber
certficate
may renew the certificate by doing all of the following:
(1)
Pay the renewal fee as determined by the department under s.
440.03(9
)(
a)
, Stats., the workforce survey fee
,
and any applicable late renewal fee.
(2)
Complete the nursing workforce survey to the satisfaction of the board.
(3)
Certify completion of the continuing education required under N 8.05.
(4)
Provide evidence of current certification by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist
,
or clinical nurse specialist.
Section
9. N 8.05 (1) is amended to read:
N 8.05
Continuing education.
(1)
Every advanced practice nurse prescriber shall
submit to the board evidence of having completed an average of at least
8
complete 16
contact hours per
year
bie
nni
um
in clinical pharmacology
/
or
therapeutics relevant to the advanced practice nurse prescriber’s area of practice
, including at least 2 contact hours in responsible prescribing of controlled substances
.
s
ection
10
.
N 8.05 (2) is repealed.
Section
11. N 8.06 (3) (c) is amended to read:
N 8.06 (3)
(c
) Treatment
of
hyperkinesis
, including attention deficit hyperactivity disorder
.
Section
12. N 8.06 (5) is amended to read:
N 8.06
(5)
Shall,
in prescribing or ordering a drug for administration by a registered nurse or licensed practical nurse under s.
441.16 (3) (cm)
, Stats.
upon
request
, present evidence to the nurse
and
or
to the administration of the facility where the prescription or order is to be carried out that the advanced practice nurse prescriber is properly certified to issue prescription orders.
Section
13. N 8.07 (2) is amended to read:
N 8.07
(2)
Prescription orders issued by advanced practice nurse prescribers for a controlled substance shall be written in ink or indelible pencil or shall be
typewritten
submitted
electronically as permitted by state and federal law
, and shall contain the practitioner’s
controlled substances
drug enforcement agency
number.
Section
14. N 8.09 (2) is amended to read:
N 8.09
(2
)
An advanced practice nurse prescriber may dispense drugs to a patient
if
at
the treatment facility at which the patient is treated
is located at least 30 miles from the nearest pharmacy
.
Section
15. N 8.10 (title) is amended to read:
N
8.10
Case
Care
management and collaboration with other health care professionals.
Section
16. N 8.10 (4)
to
(7) are amended to read:
N 8.10 (
4
)
Advanced practice nurse prescribers shall provide a summary of a patient’s health care records, including diagnosis, surgeries, allergies and
c
urrent medications to other health care providers as a means of facilitating
case
care
management and improved collaboration.
(5
)
T
h
e board shall
promote
communication and collaboration among advanced practice
nurses
nurse prescribers
, physicians
,
and other health care professionals
, including notification to advanced practice nurses of mutual educational opportunities and available communication networks
.
(6)
To promote case management, the
The
advanced practice nurse prescriber may order
treatment, therapeutics,
laboratory
and
testing,
radiographs
or electrocardiograms
appropriate to his or her area of competence as established by his or her education, training, or experience
,
to provide care management
.
(7)
Advanced practice nurse prescribers shall work in a collaborative relationship with a physician. The collaborative relationship is a process in which an advanced practice nurse prescriber is working with a physician, in each other’s presence when necessary, to deliver health care services within the scope of the practitioner’s
professional expertise
training, education
,
and experience
. The advanced practice nurse prescriber
and the physician must
shall
document this relationship.
Section
17.
EFFECTIVE DATE.
The rules adopted in this order shall take effect on the first day of the month following publication in the
Wisconsin
A
dministrative
R
egister, pursuant to s.
227.22 (2) (intro.)
, Stats.
(END OF TEXT OF RULE)
