By: Turner, Bob H.B. No. 1161
73R5311 CAG-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the prescription of drugs or devices by an advanced
1-3 nurse practitioner.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 7, Article 4514, Revised Statutes, is
1-6 amended to read as follows:
1-7 Sec. 7. Rules. The board shall adopt rules establishing:
1-8 (1) any specialized education and training, including
1-9 pharmacology, a registered nurse must have to carry out a
1-10 prescription drug order pursuant to Subdivision (5), Subsection
1-11 (d), Section 3.06, Medical Practice Act (Article 4495b, Vernon's
1-12 Texas Civil Statutes); <and>
1-13 (2) any specialized education and training, including
1-14 pharmacology, a registered nurse must have to prescribe drugs or
1-15 devices, which must be at least as stringent as the education and
1-16 training required by the board for recognition as an advanced nurse
1-17 practitioner; and
1-18 (3) a system for assigning an identification number to
1-19 a registered nurse who provides the board with evidence of
1-20 completing any <the required> specialized education and training
1-21 required by Subsection (1) or (2) of this section.
1-22 SECTION 2. Sections 5 and 6, Article 4518, Revised Statutes,
1-23 are amended to read as follows:
1-24 Sec. 5. (a) Insofar as any of the following acts require
2-1 substantial specialized judgment and skill and insofar as the
2-2 proper performance of any of the following acts is based upon
2-3 knowledge and application of the principles of biological,
2-4 physical, and social science as acquired by a completed course in
2-5 an approved school of professional nursing, "Professional Nursing"
2-6 shall be defined as the performance for compensation of any nursing
2-7 act:
2-8 (1) <(a)> in the observation, assessment,
2-9 intervention, evaluation, rehabilitation, care and counsel and
2-10 health teachings of persons who are ill, injured or infirm or
2-11 experiencing changes in normal health processes;
2-12 (2) <(b)> in the maintenance of health or prevention
2-13 of illness;
2-14 (3) <(c)> in the administration of medications or
2-15 treatments as ordered by a licensed physician, including a
2-16 podiatric physician licensed by the Texas State Board of Podiatry
2-17 Examiners, or dentist;
2-18 (4) in the assessment of the need for and ordering of
2-19 or prescribing of treatments, drugs, or devices;
2-20 (5) <(d)> in the supervision or teaching of nursing;
2-21 and
2-22 (6) <(e)> in the administration, supervision, and
2-23 evaluation of nursing practices, policies, and procedures.
2-24 (b) A nursing act performed under Subsection (a) of this
2-25 section <The foregoing> shall not be deemed to include acts of
2-26 medical diagnosis or prescription of therapeutic or corrective
2-27 measures if those acts are also considered acts involving the
3-1 practice of professional nursing.
3-2 (c) Nothing in this section shall be construed as
3-3 prohibiting a registered nurse recognized by the board as having
3-4 the specialized education and training required under Section 7,
3-5 Article 4514, Revised Statutes, and functioning under adequate
3-6 physician supervision from carrying out prescription drug orders or
3-7 treatments under physician's orders, standing medical orders,
3-8 standing delegation orders, or other orders or protocols.
3-9 Sec. 6. Except for the practices of professional nursing
3-10 under Section 5 of this article that are also practices of
3-11 medicine, nothing <Nothing> in this chapter permits the practice of
3-12 medicine as defined by <the Acts of 1907, page 224, being> Article
3-13 4510, Revised <Civil> Statutes <of Texas, 1925, as amended by
3-14 Chapter 94, Acts of the 51st Legislature, Regular Session, 1949;
3-15 Chapter 426, Acts of the 53rd Legislature, Regular Session, 1953>;
3-16 and nothing in this chapter shall be construed to amend, modify, or
3-17 repeal <Chapter 118, Acts of the 52nd Legislature, Regular Session,
3-18 1951, known as> Article 4528c, Revised <Civil> Statutes <of Texas,
3-19 1925, as amended by Chapter 28, Acts of the 53rd Legislature, First
3-20 Called Session, 1954; Chapter 47, Acts of the 55th Legislature,
3-21 Regular Session, 1957, and Chapter 449, Acts of the 55th
3-22 Legislature, Regular Session, 1957>.
3-23 SECTION 3. Section 5(31), Texas Pharmacy Act (Article
3-24 4542a-1, Vernon's Texas Civil Statutes), is amended to read as
3-25 follows:
3-26 (31) "Practitioner" means:
3-27 (A) a physician, dentist, podiatrist,
4-1 veterinarian, registered nurse recognized by the Board of Nurse
4-2 Examiners as an advanced nurse practitioner, or other person
4-3 licensed or registered to prescribe, distribute, administer, or
4-4 dispense a prescription drug or device in the course of
4-5 professional practice in this state;
4-6 (B) a person licensed by another state in a
4-7 health field in which, under Texas law, licensees in this state may
4-8 legally prescribe dangerous drugs or a person practicing in another
4-9 state and licensed by another state as a physician, dentist,
4-10 veterinarian, or podiatrist, or as a registered nurse with
4-11 qualifications equivalent to those required in this state for
4-12 recognition as an advanced nurse practitioner by the Board of Nurse
4-13 Examiners, and having a current Federal Drug Enforcement
4-14 Administration registration number, and who may legally prescribe
4-15 Schedule II, III, IV, or V controlled substances in such other
4-16 state; or
4-17 (C) a person licensed in the Dominion of Canada
4-18 or the United Mexican States in a health field in which, under the
4-19 laws of this state, a licensee may legally prescribe dangerous
4-20 drugs. "Practitioner" does not include a person licensed under
4-21 this Act.
4-22 SECTION 4. Section 481.002(39), Health and Safety Code, is
4-23 amended to read as follows:
4-24 (39) "Practitioner" means:
4-25 (A) a physician, dentist, veterinarian,
4-26 podiatrist, scientific investigator, registered nurse recognized by
4-27 the Board of Nurse Examiners as an advanced nurse practitioner, or
5-1 other person licensed, registered, or otherwise permitted to
5-2 distribute, dispense, analyze, conduct research with respect to, or
5-3 administer a controlled substance in the course of professional
5-4 practice or research in this state;
5-5 (B) a pharmacy, hospital, or other institution
5-6 licensed, registered, or otherwise permitted to distribute,
5-7 dispense, conduct research with respect to, or administer a
5-8 controlled substance in the course of professional practice or
5-9 research in this state; or
5-10 (C) a person practicing in and licensed by
5-11 another state as a physician, dentist, veterinarian, or podiatrist,
5-12 or as a registered nurse with qualifications equivalent to those
5-13 required in this state for recognition as an advanced nurse
5-14 practitioner by the Board of Nurse Examiners, having a current
5-15 Federal Drug Enforcement Administration registration number, who
5-16 may legally prescribe Schedule II, III, IV, or V controlled
5-17 substances in that state.
5-18 SECTION 5. Section 483.001(12), Health and Safety Code, is
5-19 amended to read as follows:
5-20 (12) "Practitioner" means a person licensed:
5-21 (A) by the Texas State Board of Medical
5-22 Examiners, State Board of Dental Examiners, Texas State Board of
5-23 Podiatry Examiners, Texas Optometry Board, Board of Nurse Examiners
5-24 and recognized by the board as an advanced nurse practitioner, or
5-25 State Board of Veterinary Medical Examiners to prescribe and
5-26 administer dangerous drugs;
5-27 (B) by another state in a health field in which,
6-1 under the laws of this state, a licensee may legally prescribe
6-2 dangerous drugs; or
6-3 (C) in Canada or Mexico in a health field in
6-4 which, under the laws of this state, a licensee may legally
6-5 prescribe dangerous drugs.
6-6 SECTION 6. (a) This Act takes effect September 1, 1993.
6-7 (b) The Board of Nurse Examiners shall adopt, by January 1,
6-8 1994, rules establishing any specialized education and training an
6-9 advanced nurse practitioner must have to prescribe drugs or
6-10 devices.
6-11 SECTION 7. The importance of this legislation and the
6-12 crowded condition of the calendars in both houses create an
6-13 emergency and an imperative public necessity that the
6-14 constitutional rule requiring bills to be read on three several
6-15 days in each house be suspended, and this rule is hereby suspended.