By Ellis S.B. No. 1393
74R3847 JMM-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the authority of certain nurses to exercise limited
1-3 authority to prescribe drugs.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Chapter 7, Title 71, Revised Statutes, is amended
1-6 by adding Article 4528b to read as follows:
1-7 Art. 4528b. ADVANCED NURSE PRACTITIONERS
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Advance practice nurse" or "advanced nurse
1-10 practitioner" means a registered nurse approved by the board as an
1-11 advanced nurse practitioner on the basis of completion of an
1-12 advanced educational program. The terms include a nurse
1-13 practitioner, nurse midwife, nurse anesthetist, and clinical nurse
1-14 specialist.
1-15 (2) "Board" means the Board of Nurse Examiners.
1-16 (3) "Clinical nurse specialist" means an advanced
1-17 nurse practitioner approved by the board in the category of
1-18 clinical nurse specialist.
1-19 (4) "Nurse anesthetist" means an advanced nurse
1-20 practitioner approved by the board in the category of nurse
1-21 anesthetist.
1-22 (5) "Nurse midwife" means an advanced nurse
1-23 practitioner approved by the board in the category of nurse
1-24 midwife.
2-1 (6) "Nurse practitioner" means an advanced nurse
2-2 practitioner approved by the board in the category of nurse
2-3 practitioner.
2-4 (7) "Scope of practice" means the scope of services
2-5 appropriate to be provided by a health professional to a client
2-6 population for whom those services are appropriate.
2-7 Sec. 2. ADVISORY COMMITTEE. (a) The board shall appoint an
2-8 advisory committee to advise the board on:
2-9 (1) the classification of drugs and categories of
2-10 devices that are appropriate to the scope of practice of each
2-11 category of advanced nurse practitioner; and
2-12 (2) other matters requested by the board relating to
2-13 the prescribing of drugs by advanced nurse practitioners.
2-14 (b) The advisory committee shall consist of at least one of
2-15 each of the following:
2-16 (1) a nurse practitioner;
2-17 (2) a nurse midwife;
2-18 (3) a clinical nurse specialist;
2-19 (4) a nurse anesthetist;
2-20 (5) a physician;
2-21 (6) a pharmacist; and
2-22 (7) a member of the public.
2-23 (c) A member of the advisory committee serves a two-year
2-24 term. A member of the advisory committee may not receive
2-25 compensation but is entitled to reimbursement for actual expenses
2-26 incurred in performing duties as an advisory committee member
2-27 subject to any limit in the General Appropriations Act.
3-1 Sec. 3. APPROVAL OF ADVANCED NURSE PRACTITIONER TO
3-2 PRESCRIBE. (a) The board shall adopt rules for the initial
3-3 approval of an advanced nurse practitioner to prescribe medications
3-4 and devices. The rules shall, at a minimum, require an advanced
3-5 nurse practitioner to successfully complete course work in
3-6 pharmacology and related pathology provided in a program approved
3-7 by the board.
3-8 (b) The board shall issue a prescription authorization
3-9 number to an advanced nurse practitioner approved under this
3-10 section.
3-11 (c) The board shall adopt rules for the biennial renewal of
3-12 an authorization under this section. As a condition of renewal,
3-13 the board shall adopt requirements for an advanced nurse
3-14 practitioner to participate in continuing education in clinical
3-15 pharmacology and related pathology in addition to any other
3-16 continuing requirements otherwise applicable to the nurse
3-17 practitioner.
3-18 Sec. 4. POWERS AND DUTIES OF ADVANCED NURSE PRACTITIONER.
3-19 (a) An advanced nurse practitioner may diagnose the need for health
3-20 care services and provide those services in the scope of practice
3-21 of the practitioner as provided by board rule, including
3-22 administering diagnostic tests, ordering treatments, and
3-23 prescribing medications under Subsection (b) of this section.
3-24 (b) An advanced nurse practitioner may prescribe medication
3-25 or a device in the scope of practice of the practitioner if the
3-26 advanced nurse practitioner is approved by the board to prescribe
3-27 medications and holds a valid prescription authority number.
4-1 (c) The board by rule may identify the classifications of
4-2 drugs and devices that are in the scope of practice of an advanced
4-3 nurse practitioner to prescribe. Rules adopted under this
4-4 subsection must be specific to the category of advanced nurse
4-5 practitioner recognized by the board.
4-6 SECTION 2. Sections 5 and 6, Article 4518, Revised Statutes,
4-7 are amended to read as follows:
4-8 Sec. 5. Insofar as any of the following acts require
4-9 substantial specialized judgment and skill and insofar as the
4-10 proper performance of any of the following acts is based upon
4-11 knowledge and application of the principles of biological,
4-12 physical, and social science as acquired by a completed course in
4-13 an approved school of professional nursing, "Professional Nursing"
4-14 shall be defined as the performance for compensation of any nursing
4-15 act (a) in the observation, assessment, intervention, evaluation,
4-16 rehabilitation, care and counsel and health teachings of persons
4-17 who are ill, injured or infirm or experiencing changes in normal
4-18 health processes; (b) in the maintenance of health or prevention of
4-19 illness; (c) in the administration of medications or treatments
4-20 under an order of a licensed health care practitioner or a
4-21 treatment or care plan developed collaboratively with a licensed
4-22 health care practitioner <as ordered by a licensed physician,
4-23 including a podiatric physician licensed by the Texas State Board
4-24 of Podiatry Examiners, or dentist>; (d) in the supervision or
4-25 teaching of nursing; (e) in the administration, supervision, and
4-26 evaluation of nursing practices, policies, and procedures; <or> (f)
4-27 in the requesting, receiving, and signing for professional samples
5-1 and distributing the samples to patients at a site serving
5-2 underserved populations, as provided by Section 3.06(d)(5), Medical
5-3 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
5-4 rules implementing that section or in conjunction with the
5-5 provision of services under Article 4528b, Revised Statutes; or
5-6 (g) in the provision of services under Article 4528b, Revised
5-7 Statutes. Except to the extent this section defines an act as
5-8 being within the scope of practice of professional nursing, the
5-9 <The> foregoing shall not be deemed to include acts of medical
5-10 diagnosis or prescription of therapeutic or corrective measures.
5-11 Nothing in this section shall be construed as prohibiting a
5-12 registered nurse recognized by the board as having the specialized
5-13 education and training required under Section 7, Article 4514,
5-14 Revised Statutes, and functioning under adequate physician
5-15 supervision from carrying out prescription drug orders or
5-16 treatments under physician's orders, standing medical orders,
5-17 standing delegation orders, or other orders or protocols.
5-18 Sec. 6. Except to the extent that Section 5 of this article
5-19 defines an act as being within the practice of nursing, nothing
5-20 <Nothing> in this chapter permits the practice of medicine as
5-21 defined by the Medical Practice Act (Article 4495b, Vernon's Texas
5-22 Civil Statutes) <Acts of 1907, page 224, being Article 4510,
5-23 Revised Civil Statutes of Texas, 1925, as amended by Chapter 94,
5-24 Acts of the 51st Legislature, Regular Session, 1949; Chapter 426,
5-25 Acts of the 53rd Legislature, Regular Session, 1953;> and nothing
5-26 in this chapter shall be construed to amend, modify, or repeal
5-27 Chapter 118, Acts of the 52nd Legislature, Regular Session, 1951
6-1 (Article<, known as Article> 4528c, Vernon's Texas <Revised> Civil
6-2 Statutes) <of Texas, 1925, as amended by Chapter 28, Acts of the
6-3 53rd Legislature, First Called Session, 1954; Chapter 47, Acts of
6-4 the 55th Legislature, Regular Session, 1957, and Chapter 449, Acts
6-5 of the 55th Legislature, Regular Session, 1957>.
6-6 SECTION 3. Section 5(39), Texas Pharmacy Act (Article
6-7 4542a-1, Vernon's Texas Civil Statutes), is amended to read as
6-8 follows:
6-9 (39) "Practitioner" means:
6-10 (A) a physician, dentist, podiatrist, or
6-11 veterinarian, an advanced nurse practitioner who has a prescription
6-12 authorization number issued by the Board of Nurse Examiners under
6-13 Article 4528b, Revised Statutes, or another <other> person licensed
6-14 or registered to prescribe, distribute, administer, or dispense a
6-15 prescription drug or device in the course of professional practice
6-16 in this state;
6-17 (B) a person licensed by another state in a
6-18 health field in which, under Texas law, licensees in this state may
6-19 legally prescribe dangerous drugs or a person practicing in another
6-20 state and licensed by another state as a physician, dentist,
6-21 veterinarian, or podiatrist, or as a registered nurse having
6-22 qualifications equal to those required in this state for
6-23 recognition by the Board of Nurse Examiners as an advanced nurse
6-24 practitioner who has a prescription authorization number under
6-25 Article 4528b, Revised Statutes, having a current Federal Drug
6-26 Enforcement Administration registration number, and who may legally
6-27 prescribe Schedule II, III, IV, or V controlled substances in such
7-1 other state; or
7-2 (C) a person licensed in the Dominion of Canada
7-3 or the United Mexican States in a health field in which, under the
7-4 laws of this state, a licensee may legally prescribe dangerous
7-5 drugs. "Practitioner" does not include a person licensed under
7-6 this Act.
7-7 SECTION 4. Section 481.002(39), Health and Safety Code, is
7-8 amended to read as follows:
7-9 (39) "Practitioner" means:
7-10 (A) a physician, dentist, veterinarian,
7-11 podiatrist, or scientific investigator, an advanced nurse
7-12 practitioner who has a prescription authorization number issued by
7-13 the Board of Nurse Examiners under Article 4528b, Revised Statutes,
7-14 or another <other> person licensed, registered, or otherwise
7-15 permitted to distribute, dispense, analyze, conduct research with
7-16 respect to, or administer a controlled substance in the course of
7-17 professional practice or research in this state;
7-18 (B) a pharmacy, hospital, or other institution
7-19 licensed, registered, or otherwise permitted to distribute,
7-20 dispense, conduct research with respect to, or administer a
7-21 controlled substance in the course of professional practice or
7-22 research in this state; or
7-23 (C) a person practicing in and licensed by
7-24 another state as a physician, dentist, veterinarian, or podiatrist,
7-25 or as a registered nurse having qualifications equal to those
7-26 required in this state for recognition by the Board of Nurse
7-27 Examiners as an advanced nurse practitioner who has a prescription
8-1 authorization number under Article 4528b, Revised Statutes, having
8-2 a current Federal Drug Enforcement Administration registration
8-3 number, who may legally prescribe Schedule II, III, IV, or V
8-4 controlled substances in that state.
8-5 SECTION 5. Section 483.001(12), Health and Safety Code, is
8-6 amended to read as follows:
8-7 (12) "Practitioner" means a person licensed:
8-8 (A) by the Texas State Board of Medical
8-9 Examiners, State Board of Dental Examiners, Texas State Board of
8-10 Podiatry Examiners, Texas Optometry Board, Board of Nurse Examiners
8-11 who is recognized by the board as an advanced nurse practitioner
8-12 having a prescription authorization number, or State Board of
8-13 Veterinary Medical Examiners to prescribe and administer dangerous
8-14 drugs;
8-15 (B) by another state in a health field in which,
8-16 under the laws of this state, a licensee may legally prescribe
8-17 dangerous drugs; or
8-18 (C) in Canada or Mexico in a health field in
8-19 which, under the laws of this state, a licensee may legally
8-20 prescribe dangerous drugs.
8-21 SECTION 6. (a) This Act takes effect September 1, 1995.
8-22 (b) The Board of Nurse Examiners shall adopt rules and
8-23 appoint the members of the advisory committee under Article 4528b,
8-24 Revised Statutes, as added by this Act, not later than January 1,
8-25 1996.
8-26 SECTION 7. The importance of this legislation and the
8-27 crowded condition of the calendars in both houses create an
9-1 emergency and an imperative public necessity that the
9-2 constitutional rule requiring bills to be read on three several
9-3 days in each house be suspended, and this rule is hereby suspended.