HF 435

as introduced - 88th Legislature (2013 - 2014) Posted on 02/11/2013 02:11pm

A bill for an act
relating to health; improving access to health care delivered by advanced practice
registered nurses; providing penalties; amending Minnesota Statutes 2012,
sections 148.171, subdivisions 3, 5, 9, 10, 11, 13, 16, 21, by adding subdivisions;
148.181, subdivision 1; 148.191, subdivision 2; 148.211, subdivision 2, by
adding subdivisions; 148.231, subdivisions 1, 4, 5; 148.233, subdivision 2;
148.234; 148.235, by adding subdivisions; 148.251, subdivision 1; 148.261,
subdivision 1; 148.262, subdivisions 1, 2, 4; 148.271; 148.281, subdivision 1,
by adding a subdivision; repealing Minnesota Statutes 2012, sections 148.171,
subdivision 6; 148.235, subdivisions 1, 2, 2a, 4, 4a, 4b, 6, 7; 148.284.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2012, section 148.171, subdivision 3, is amended to read:

Subd. 3.

Advanced practice registered nurse.

"Advanced practice registered
nurse," abbreviated APRN, means an individual licensed as deleted text begin a deleted text end new text begin an advanced practice
new text end registered nurse by the board and certified by a national nurse certification organization
acceptable to the board to practice as a clinical nurse specialist, nurse anesthetist,
nurse-midwife, or nurse practitioner.

Sec. 2.

Minnesota Statutes 2012, section 148.171, subdivision 5, is amended to read:

Subd. 5.

Clinical nurse specialist practice.

"Clinical nurse specialist practice"
means deleted text begin the provision of patient care in a particular specialty or subspecialty of advanced
practice registered nursing within the context of collaborative management, and includes:
(1) diagnosing illness and disease; (2) providing nonpharmacologic treatment, including
psychotherapy; (3) promoting wellness; and (4) preventing illness and disease. The
certified clinical nurse specialist is certified for advanced practice registered nursing in a
specific field of clinical nurse specialist practice. deleted text end new text begin :
new text end

new text begin (1) the diagnosis and treatment of health and illness states;
new text end

new text begin (2) disease management;
new text end

new text begin (3) prescribing pharmacologic and nonpharmacologic therapies;
new text end

new text begin (4) ordering, performing, supervising, and interpreting diagnostic studies;
new text end

new text begin (5) prevention of illness and risk behaviors;
new text end

new text begin (6) nursing care for individuals, families, and communities;
new text end

new text begin (7) when necessary, consulting with other health care providers or making
appropriate referrals for patients and families; and
new text end

new text begin (8) integration of care across the continuum to improve patient outcomes.
new text end

Sec. 3.

Minnesota Statutes 2012, section 148.171, subdivision 9, is amended to read:

Subd. 9.

Nurse.

"Nurse" means new text begin advanced practice registered nurse, new text end registered
nurse, deleted text begin advanced practice registered nurse, deleted text end and licensed practical nurse unless the context
clearly refers to only one category.

Sec. 4.

Minnesota Statutes 2012, section 148.171, subdivision 10, is amended to read:

Subd. 10.

Nurse-midwife practice.

"Nurse-midwife practice" means deleted text begin the
management of women's primary health care, focusing on pregnancy, childbirth, the
postpartum period, care of the newborn, and the family planning and gynecological needs
of women and includes diagnosing and providing nonpharmacologic treatment within a
system that provides for consultation, collaborative management, and referral as indicated
by the health status of patients. deleted text end new text begin :
new text end

new text begin (1) the management, diagnosis, and treatment of women's primary health care
including pregnancy, childbirth, postpartum period, care of the newborn, family planning,
partner care management relating to sexual health, and gynecological care of women
across the life span;
new text end

new text begin (2) ordering, performing, supervising, and interpreting diagnostic studies;
new text end

new text begin (3) prescribing pharmacologic and nonpharmacologic therapies; and
new text end

new text begin (4) when necessary, consulting with other health care providers or making
appropriate referrals for patients and families.
new text end

Sec. 5.

Minnesota Statutes 2012, section 148.171, subdivision 11, is amended to read:

Subd. 11.

Nurse practitioner practice.

"Nurse practitioner practice" means deleted text begin ,
within the context of collaborative management: (1) diagnosing, directly managing, and
preventing acute and chronic illness and disease; and (2) promoting wellness, including
providing nonpharmacologic treatment. The certified nurse practitioner is certified for
advanced registered nurse practice in a specific field of nurse practitioner practice. deleted text end new text begin the
provision of care including:
new text end

new text begin (1) health promotion, disease prevention, health education, and counseling;
new text end

new text begin (2) providing health assessment and screening activities;
new text end

new text begin (3) diagnosing, treating, and facilitating patients' management of their acute and
chronic illnesses and diseases;
new text end

new text begin (4) ordering, performing, supervising, and interpreting diagnostic studies;
new text end

new text begin (5) prescribing pharmacologic and nonpharmacologic therapies; and
new text end

new text begin (6) when necessary, consulting with other health care providers or making
appropriate referrals for patients and families.
new text end

Sec. 6.

Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
to read:

new text begin Subd. 12a. new text end

new text begin Population focus. new text end

new text begin "Population focus" means the categories of patients
for which the advanced practice registered nurse has the educational preparation to
provide care and services. The categories of population foci are:
new text end

new text begin (1) family and individual across the life-span;
new text end

new text begin (2) adult-gerontology;
new text end

new text begin (3) neonatal;
new text end

new text begin (4) pediatrics;
new text end

new text begin (5) women's and gender-related health; and
new text end

new text begin (6) psychiatric and mental health.
new text end

Sec. 7.

Minnesota Statutes 2012, section 148.171, subdivision 13, is amended to read:

Subd. 13.

Practice of advanced practice registered nursing.

new text begin (a) new text end The "practice of
advanced practice registered nursing" means the performance of deleted text begin clinical nurse specialist
practice, nurse-midwife practice, nurse practitioner practice, or registered nurse anesthetist
practice as defined in subdivisions 5, 10, 11, and 21 deleted text end new text begin an expanded scope of nursing in a role
and for at least one population focus. The scope of advanced practice registered nursing
includes, but is not limited to, performing acts of advanced assessment, diagnosing,
prescribing, and ordering new text end . The practice includes functioning as a new text begin primary care provider,
new text end direct care provider, case manager, consultant, educator, and researcher. deleted text begin The practice of
advanced practice registered nursing also includes accepting referrals from, consulting
with, cooperating with, or referring to all other types of health care providers, including
but not limited to physicians, chiropractors, podiatrists, and dentists, provided that the
advanced practice registered nurse and the other provider are practicing within their scopes
of practice as defined in state law. The advanced practice registered nurse must practice
within a health care system that provides for consultation, collaborative management, and
referral as indicated by the health status of the patient. deleted text end new text begin An advanced practice registered
nursing practice requires the advanced practice registered nurse to be accountable: (1) to
patients for the quality of advanced nursing care rendered; (2) for recognizing limits of
knowledge and experience; and (3) for planning for the management of situations beyond
the advanced practice registered nurse's expertise. (b) The practice of advanced practice
registered nursing includes accepting referrals from, consulting with, cooperating with,
or referring to other health care providers as appropriate.
new text end

Sec. 8.

Minnesota Statutes 2012, section 148.171, subdivision 16, is amended to read:

Subd. 16.

Prescribing.

"Prescribing" means the act of generating a prescription for
the preparation of, use of, or manner of using a drug or therapeutic device in accordance
with the provisions of section 148.235. Prescribing does not include recommending the
use of a drug or therapeutic device which is not required by the federal Food and Drug
Administration to meet the labeling requirements for prescription drugs and devices.
Prescribing also does not include recommending or administering a drug or therapeutic
device deleted text begin perioperatively deleted text end new text begin for anesthesia care and related services new text end by a certified registered
nurse anesthetist.

Sec. 9.

Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
to read:

new text begin Subd. 17a. new text end

new text begin Primary care provider. new text end

new text begin "Primary care provider" means a licensed
health care provider who acts as the first point of care for comprehensive health
maintenance and promotion, preventative care, and undiagnosed health concerns and
who provides continuing care of varied health conditions not limited by cause, organ
systems, or diagnosis.
new text end

Sec. 10.

Minnesota Statutes 2012, section 148.171, subdivision 21, is amended to read:

Subd. 21.

Registered nurse anesthetist practice.

"Registered nurse anesthetist
practice" means the provision of anesthesia care and related services deleted text begin within the context
of collaborative management, deleted text end including new text begin :
new text end

new text begin (1) new text end selecting, obtaining, and administering drugs and therapeutic devices to facilitate
diagnostic, therapeutic, and surgical procedures deleted text begin upon request, assignment, or referral by a
patient's physician, dentist, or podiatrist. deleted text end new text begin ;
new text end

new text begin (2) ordering, performing, supervising, and interpreting diagnostic studies;
new text end

new text begin (3) prescribing pharmacologic and nonpharmacologic therapies; and
new text end

new text begin (4) when necessary, consulting with other health care providers or making
appropriate referrals for patients and families.
new text end

Sec. 11.

Minnesota Statutes 2012, section 148.171, is amended by adding a subdivision
to read:

new text begin Subd. 23. new text end

new text begin Roles of advanced practice registered nurses. new text end

new text begin "Role" means one of four
recognized advanced practice registered nurse roles: certified registered nurse anesthetist
(CRNA); certified nurse-midwife (CNM); certified clinical nurse specialist (CNS); or
certified nurse practitioner (CNP).
new text end

Sec. 12.

Minnesota Statutes 2012, section 148.181, subdivision 1, is amended to read:

Subdivision 1.

Membership.

The Board of Nursing consists of 16 members
appointed by the governor, each of whom must be a resident of this state. Eight members
must be registered nurses, each of whom must have graduated from an approved school of
nursing, must be licensed and currently registered as a registered nurse in this state, and
must have had at least five years experience in nursing practice, nursing administration, or
nursing education immediately preceding appointment. One of the eight must have had
at least two years executive or teaching experience in a baccalaureate degree nursing
program approved by the board under section 148.251 during the five years immediately
preceding appointment, one of the eight must have had at least two years executive or
teaching experience in an associate degree nursing program approved by the board under
section 148.251 during the five years immediately preceding appointment, one of the eight
must be practicing professional nursing in a nursing home at the time of appointment,
one of the eight must have had at least two years executive or teaching experience in
a practical nursing program approved by the board under section 148.251 during the
five years immediately preceding appointment, and one of the eight must new text begin be licensed
and new text end have national certification new text begin and recertification new text end as a registered nurse anesthetist, nurse
practitioner, nurse midwife, or clinical nurse specialist. Four of the eight must have had at
least five years of experience in nursing practice or nursing administration immediately
preceding appointment. Four members must be licensed practical nurses, each of whom
must have graduated from an approved school of nursing, must be licensed and currently
registered as a licensed practical nurse in this state, and must have had at least five years
experience in nursing practice immediately preceding appointment. The remaining four
members must be public members as defined by section 214.02.

A member may be reappointed but may not serve more than two full terms
consecutively. The governor shall attempt to make appointments to the board that reflect
the geography of the state. The board members who are nurses should as a whole reflect
the broad mix of practice types and sites of nurses practicing in Minnesota.

Membership terms, compensation of members, removal of members, the filling of
membership vacancies, and fiscal year and reporting requirements are as provided in
sections 214.07 to 214.09. Any nurse on the board who during incumbency permanently
ceases to be actively engaged in the practice of nursing or otherwise becomes disqualified
for board membership is automatically removed, and the governor shall fill the vacancy.
The provision of staff, administrative services, and office space; the review and processing
of complaints; the setting of board fees; and other provisions relating to board operations
are as provided in sections 148.171 to 148.285 and chapter 214. Each member of the
board shall file with the secretary of state the constitutional oath of office before beginning
the term of office.

Sec. 13.

Minnesota Statutes 2012, section 148.191, subdivision 2, is amended to read:

Subd. 2.

Powers.

(a) The board is authorized to adopt and, from time to time, revise
rules not inconsistent with the law, as may be necessary to enable it to carry into effect the
provisions of sections 148.171 to 148.285. The board shall prescribe by rule curricula and
standards for schools and courses preparing persons for licensure under sections 148.171
to 148.285. It shall conduct or provide for surveys of such schools and courses at such
times as it may deem necessary. It shall approve such schools and courses as meet the
requirements of sections 148.171 to 148.285 and board rules. It shall examine, license,
and renew the license of duly qualified applicants. It shall hold examinations at least once
in each year at such time and place as it may determine. It shall by rule adopt, evaluate,
and periodically revise, as necessary, requirements for licensure and for registration and
renewal of registration as defined in section 148.231. It shall maintain a record of all
persons licensed by the board to practice new text begin advanced practice, new text end professional new text begin , new text end or practical
nursing deleted text begin and all registered nurses who hold Minnesota licensure and registration and are
certified as advanced practice registered nurses deleted text end . It shall cause the prosecution of all persons
violating sections 148.171 to 148.285 and have power to incur such necessary expense
therefor. It shall register public health nurses who meet educational and other requirements
established by the board by rule, including payment of a fee. It shall have power to issue
subpoenas, and to compel the attendance of witnesses and the production of all necessary
documents and other evidentiary material. Any board member may administer oaths to
witnesses, or take their affirmation. It shall keep a record of all its proceedings.

(b) The board shall have access to hospital, nursing home, and other medical records
of a patient cared for by a nurse under review. If the board does not have a written consent
from a patient permitting access to the patient's records, the nurse or facility shall delete
any data in the record that identifies the patient before providing it to the board. The board
shall have access to such other records as reasonably requested by the board to assist the
board in its investigation. Nothing herein may be construed to allow access to any records
protected by section 145.64. The board shall maintain any records obtained pursuant to
this paragraph as investigative data under chapter 13.

(c) The board may accept and expend grants or gifts of money or in-kind services
from a person, a public or private entity, or any other source for purposes consistent with
the board's role and within the scope of its statutory authority.

(d) The board may accept registration fees for meetings and conferences conducted
for the purposes of board activities that are within the scope of its authority.

Sec. 14.

Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Initial advanced practice registered nurse licensure. new text end

new text begin (a) An applicant
for a license to practice as an advanced practice registered nurse (APRN) shall apply to
the board for a license in a format prescribed by the board and pay a fee in an amount
determined by statute. In no case may fees be refunded.
new text end

new text begin (b) To be eligible for licensure:
new text end

new text begin (1) the applicant must hold a current Minnesota professional nursing license or
demonstrate eligibility for licensure as a registered nurse in this jurisdiction;
new text end

new text begin (2) the applicant shall not hold an encumbered license as a registered nurse in any
state or territory;
new text end

new text begin (3) the applicant must have completed a graduate level APRN program accredited
by a nursing or nursing-related accrediting body that is recognized by the United States
Secretary of Education or the Council for Higher Education Accreditation as acceptable
to the board. The education will be in one of the four APRN roles and at least one
population focus;
new text end

new text begin (4) the applicant must be currently certified by a national certifying body recognized
by the board in the APRN role and population foci appropriate to educational preparation;
new text end

new text begin (5) the applicant must report any criminal conviction, nolo contendere plea, Alford
Plea, or other plea arrangement in lieu of conviction; and
new text end

new text begin (6) the applicant must have committed no acts or omissions which are grounds for
disciplinary action in another jurisdiction or, if such acts have been committed and would
be grounds for disciplinary action as set forth in section 148.261, the board has found,
after investigation, that sufficient restitution has been made.
new text end

new text begin (c) After December 31, 2015, all new graduates applying for advanced practice
registered nurse licensure must meet the licensure requirements in this chapter.
new text end

Sec. 15.

Minnesota Statutes 2012, section 148.211, is amended by adding a subdivision
to read:

new text begin Subd. 1b. new text end

new text begin Advanced practice registered nurse grandfather provision. new text end

new text begin Any
advanced practice registered nurse with authority to practice as an advanced practice
registered nurse in this state that is valid on December 31, 2015, shall be eligible to apply
for licensure as an advanced practice registered nurse under the provisions of this chapter
with current privileges and shall be eligible for license renewal under the conditions
and standards prescribed in this chapter.
new text end

Sec. 16.

Minnesota Statutes 2012, section 148.211, subdivision 2, is amended to read:

Subd. 2.

Licensure by endorsement.

new text begin (a) new text end The board shall issue a license to practice
new text begin advanced practice registered nursing, new text end professional nursing or practical nursing without
examination to an applicant who has been duly licensed or registered as a nurse under the
laws of another state, territory, or country, if in the opinion of the board the applicant has the
qualifications equivalent to the qualifications required in this state as stated in subdivision
1, all other laws not inconsistent with this section, and rules promulgated by the board.

new text begin (b) After December 31, 2015, an applicant for advanced practice registered nurse
licensure by endorsement will be eligible for licensure if the applicant demonstrates:
new text end

new text begin (1) current national certification or recertification in the advanced role and
population focus area; and
new text end

new text begin (2) compliance with the advanced practice nursing educational requirements that
were in effect in Minnesota at the time the advanced practice registered nurse completed
the advanced practice nursing education program.
new text end

Sec. 17.

Minnesota Statutes 2012, section 148.231, subdivision 1, is amended to read:

Subdivision 1.

Registration.

Every person licensed to practice new text begin advanced practice,
new text end professional new text begin , new text end or practical nursing must maintain with the board a current registration
for practice as deleted text begin a deleted text end new text begin an advanced practice registered nurse, new text end registered nurse new text begin , new text end or licensed
practical nurse which must be renewed at regular intervals established by the board by
rule. No registration shall be issued by the board to a nurse until the nurse has submitted
satisfactory evidence of compliance with the procedures and minimum requirements
established by the board.

The fee for periodic registration for practice as a nurse shall be determined deleted text begin by the
board by law deleted text end new text begin in statute new text end . Upon receipt of the application and the required fees, the board shall
verify the application and the evidence of completion of continuing education requirements
in effect, and thereupon issue to the nurse registration for the next renewal period. new text begin An
applicant for advanced practice registered nursing (APRN) renewal shall provide evidence
of current certification or recertification in the appropriate APRN role and at least one
population focus by a nationally accredited certifying body recognized by the board.
new text end

Sec. 18.

Minnesota Statutes 2012, section 148.231, subdivision 4, is amended to read:

Subd. 4.

Failure to register.

Any person licensed under the provisions of sections
148.171 to 148.285 who fails to register within the required period shall not be entitled
to practice nursing in this state as new text begin an advanced practice registered nurse, new text end a registered
nurse new text begin , new text end or new text begin a new text end licensed practical nurse.

Sec. 19.

Minnesota Statutes 2012, section 148.231, subdivision 5, is amended to read:

Subd. 5.

Reregistration.

A person whose registration has lapsed desiring to
resume practice shall make application for reregistration, submit satisfactory evidence
of compliance with the procedures and requirements established by the board, and pay
the reregistration fee for the current period to the board. A penalty fee shall be required
from a person who practiced nursing without current registration. Thereupon, registration
shall be issued to the person who shall immediately be placed on the practicing list as new text begin an
advanced practice registered nurse, new text end a registered nurse new text begin , new text end or new text begin a new text end licensed practical nurse.

Sec. 20.

Minnesota Statutes 2012, section 148.233, subdivision 2, is amended to read:

Subd. 2.

Advanced practice registered nurse.

deleted text begin An advanced practice registered
nurse certified as a certified clinical nurse specialist, certified nurse-midwife, certified
nurse practitioner, or certified registered nurse anesthetist shall use the appropriate
designation: RN,CNS; RN,CNM; RN,CNP; or RN,CRNA for personal identification and
in documentation of services provided. Identification of educational degrees and specialty
fields may be added. deleted text end new text begin (a) Only those persons who hold current licensure to practice
advanced practice registered nursing in this state may use the title advanced practice
registered nurse with the role designation of certified registered nurse anesthetist, certified
nurse-midwife, certified clinical nurse specialist, or certified nurse practitioner.
new text end

new text begin (b) An advanced practice registered nurse shall use the appropriate designation:
APRN, CNS; APRN, CNM; APRN, CNP; or APRN, CRNA for personal identification
and in documentation of services provided. Identification of educational degrees and
specialty fields may be added.
new text end

new text begin (c) The advanced practice registered nurse with an earned doctorate may use the
term "doctor" or abbreviation "Dr." When providing nursing care, APRNs shall provide
clear identification of advanced practice registered nurse designation.
new text end

Sec. 21.

Minnesota Statutes 2012, section 148.234, is amended to read:

148.234 STATE BOUNDARIES CONSIDERATION.

A nurse may perform deleted text begin medical deleted text end new text begin patient new text end care procedures and techniques at the direction
of a physician, new text begin a new text end podiatrist, deleted text begin or deleted text end new text begin a new text end dentist new text begin , or an advanced practice registered nurse new text end licensed
in another state, United States territory, or Canadian province if the physician, podiatrist,
deleted text begin or deleted text end dentist new text begin , or advanced practice registered nurse new text end gave the direction after examining the
patient and issued the direction in that state, United States territory, or Canadian province.

Nothing in this section allows a nurse to perform a deleted text begin medical procedure deleted text end new text begin patient care
procedure new text end or technique at the direction of a physician, new text begin a new text end podiatrist, deleted text begin or deleted text end new text begin a new text end dentist new text begin , or an
advanced practice registered nurse new text end that is illegal in this state.

Sec. 22.

Minnesota Statutes 2012, section 148.235, is amended by adding a subdivision
to read:

new text begin Subd. 7a. new text end

new text begin Diagnosis, prescribing, and ordering. new text end

new text begin Advanced practice registered
nurses are authorized to:
new text end

new text begin (1) diagnose, prescribe, and institute therapy or referrals of patients to health care
agencies and providers;
new text end

new text begin (2) prescribe, procure, sign for, record, administer, and dispense over-the-counter,
legend, and controlled substances, including sample drugs; and
new text end

new text begin (3) plan and initiate a therapeutic regimen that includes ordering and prescribing
durable medical devices and equipment, nutrition, diagnostic, and supportive services
including, but not limited to, home health care, hospice, physical, and occupational therapy.
new text end

Sec. 23.

Minnesota Statutes 2012, section 148.235, is amended by adding a subdivision
to read:

new text begin Subd. 7b. new text end

new text begin Drug Enforcement Administration requirements. new text end

new text begin (a) Advanced
practice registered nurses must:
new text end

new text begin (1) comply with federal Drug Enforcement Administration (DEA) requirements
related to controlled substances; and
new text end

new text begin (2) immediately file any and all of the nurse's DEA registrations and numbers with
the board.
new text end

new text begin (b) The board shall maintain current records of all advanced practice registered
nurses with DEA registration and numbers.
new text end

Sec. 24.

Minnesota Statutes 2012, section 148.251, subdivision 1, is amended to read:

Subdivision 1.

Initial approval.

An institution desiring to conduct a nursing
program shall apply to the board and submit evidence that:

(1) It is prepared to provide a program of theory and practice in new text begin advanced practice,
new text end professional new text begin , new text end or practical nursing that meets the program approval standards adopted by
the board. Instruction and required experience may be obtained in one or more institutions
or agencies outside the applying institution as long as the nursing program retains
accountability for all clinical and nonclinical teaching.

(2) It is prepared to meet other standards established by law and by the board.

Sec. 25.

Minnesota Statutes 2012, section 148.261, subdivision 1, is amended to read:

Subdivision 1.

Grounds listed.

The board may deny, revoke, suspend, limit,
or condition the license and registration of any person to practice new text begin advanced practice,
new text end professional, deleted text begin advanced practice registered, deleted text end or practical nursing under sections 148.171 to
148.285, or to otherwise discipline a licensee or applicant as described in section 148.262.
The following are grounds for disciplinary action:

(1) Failure to demonstrate the qualifications or satisfy the requirements for a license
contained in sections 148.171 to 148.285 or rules of the board. In the case of a person
applying for a license, the burden of proof is upon the applicant to demonstrate the
qualifications or satisfaction of the requirements.

(2) Employing fraud or deceit in procuring or attempting to procure a permit,
license, or registration certificate to practice new text begin advanced practice, new text end professional new text begin , new text end or practical
nursing or attempting to subvert the licensing examination process. Conduct that subverts
or attempts to subvert the licensing examination process includes, but is not limited to:

(i) conduct that violates the security of the examination materials, such as removing
examination materials from the examination room or having unauthorized possession of
any portion of a future, current, or previously administered licensing examination;

(ii) conduct that violates the standard of test administration, such as communicating
with another examinee during administration of the examination, copying another
examinee's answers, permitting another examinee to copy one's answers, or possessing
unauthorized materials; or

(iii) impersonating an examinee or permitting an impersonator to take the
examination on one's own behalf.

(3) Conviction of a felony or gross misdemeanor reasonably related to the practice
of professional, advanced practice registered, or practical nursing. Conviction as used in
this subdivision includes a conviction of an offense that if committed in this state would
be considered a felony or gross misdemeanor without regard to its designation elsewhere,
or a criminal proceeding where a finding or verdict of guilt is made or returned but the
adjudication of guilt is either withheld or not entered.

(4) Revocation, suspension, limitation, conditioning, or other disciplinary action
against the person's professional or practical nursing license or advanced practice
registered nursing credential, in another state, territory, or country; failure to report to the
board that charges regarding the person's nursing license or other credential are pending in
another state, territory, or country; or having been refused a license or other credential by
another state, territory, or country.

(5) Failure to or inability to perform professional or practical nursing as defined in
section 148.171, subdivision 14 or 15, with reasonable skill and safety, including failure
of a registered nurse to supervise or a licensed practical nurse to monitor adequately the
performance of acts by any person working at the nurse's direction.

(6) Engaging in unprofessional conduct, including, but not limited to, a departure
from or failure to conform to board rules of professional or practical nursing practice that
interpret the statutory definition of professional or practical nursing as well as provide
criteria for violations of the statutes, or, if no rule exists, to the minimal standards of
acceptable and prevailing professional or practical nursing practice, or any nursing
practice that may create unnecessary danger to a patient's life, health, or safety. Actual
injury to a patient need not be established under this clause.

(7) Failure of an advanced practice registered nurse to practice with reasonable
skill and safety or departure from or failure to conform to standards of acceptable and
prevailing advanced practice registered nursing.

(8) Delegating or accepting the delegation of a nursing function or a prescribed
health care function when the delegation or acceptance could reasonably be expected to
result in unsafe or ineffective patient care.

(9) Actual or potential inability to practice nursing with reasonable skill and safety
to patients by reason of illness, use of alcohol, drugs, chemicals, or any other material, or
as a result of any mental or physical condition.

(10) Adjudication as mentally incompetent, mentally ill, a chemically dependent
person, or a person dangerous to the public by a court of competent jurisdiction, within or
without this state.

(11) Engaging in any unethical conduct, including, but not limited to, conduct likely
to deceive, defraud, or harm the public, or demonstrating a willful or careless disregard
for the health, welfare, or safety of a patient. Actual injury need not be established under
this clause.

(12) Engaging in conduct with a patient that is sexual or may reasonably be
interpreted by the patient as sexual, or in any verbal behavior that is seductive or sexually
demeaning to a patient, or engaging in sexual exploitation of a patient or former patient.

(13) Obtaining money, property, or services from a patient, other than reasonable
fees for services provided to the patient, through the use of undue influence, harassment,
duress, deception, or fraud.

(14) Revealing a privileged communication from or relating to a patient except when
otherwise required or permitted by law.

(15) Engaging in abusive or fraudulent billing practices, including violations of
federal Medicare and Medicaid laws or state medical assistance laws.

(16) Improper management of patient records, including failure to maintain adequate
patient records, to comply with a patient's request made pursuant to sections 144.291 to
144.298, or to furnish a patient record or report required by law.

(17) Knowingly aiding, assisting, advising, or allowing an unlicensed person to
engage in the unlawful practice of professional, advanced practice registered, or practical
nursing.

(18) Violating a rule adopted by the board, an order of the board, or a state or federal
law relating to the practice of professional, advanced practice registered, or practical
nursing, or a state or federal narcotics or controlled substance law.

(19) Knowingly providing false or misleading information that is directly related
to the care of that patient unless done for an accepted therapeutic purpose such as the
administration of a placebo.

(20) Aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:

(i) a copy of the record of criminal conviction or plea of guilty for a felony in
violation of section 609.215, subdivision 1 or 2;

(ii) a copy of the record of a judgment of contempt of court for violating an
injunction issued under section 609.215, subdivision 4;

(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or

(iv) a finding by the board that the person violated section 609.215, subdivision
1 or 2. The board shall investigate any complaint of a violation of section 609.215,
subdivision 1 or 2.

(21) Practicing outside the scope of practice authorized by section 148.171,
subdivision 5, 10, 11, 13, 14, 15, or 21.

deleted text begin (22) Practicing outside the specific field of nursing practice for which an advanced
practice registered nurse is certified unless the practice is authorized under section 148.284.
deleted text end

deleted text begin (23) deleted text end new text begin (22) new text end Making a false statement or knowingly providing false information to the
board, failing to make reports as required by section 148.263, or failing to cooperate with
an investigation of the board as required by section 148.265.

deleted text begin (24) deleted text end new text begin (23) new text end Engaging in false, fraudulent, deceptive, or misleading advertising.

deleted text begin (25) deleted text end new text begin (24) new text end Failure to inform the board of the person's certification new text begin or recertification
new text end status as a new text begin certified registered new text end nurse anesthetist, new text begin certified new text end nurse-midwife, new text begin certified new text end nurse
practitioner, or new text begin certified new text end clinical nurse specialist.

deleted text begin (26) deleted text end new text begin (25) new text end Engaging in clinical nurse specialist practice, nurse-midwife practice, nurse
practitioner practice, or registered nurse anesthetist practice without current certification
by a national nurse certification organization acceptable to the board deleted text begin , except during the
period between completion of an advanced practice registered nurse course of study and
certification, not to exceed six months or as authorized by the board deleted text end .

deleted text begin (27) deleted text end new text begin (26) new text end Engaging in conduct that is prohibited under section 145.412.

deleted text begin (28) deleted text end new text begin (27) new text end Failing to report employment to the board as required by section 148.211,
subdivision 2a, or knowingly aiding, assisting, advising, or allowing a person to fail to
report as required by section 148.211, subdivision 2a.

Sec. 26.

Minnesota Statutes 2012, section 148.262, subdivision 1, is amended to read:

Subdivision 1.

Forms of disciplinary action.

When the board finds that grounds for
disciplinary action exist under section 148.261, subdivision 1, it may take one or more
of the following actions:

(1) deny the license, registration, or registration renewal;

(2) revoke the license;

(3) suspend the license;

(4) impose limitations on the nurse's practice of new text begin advanced practice, new text end professional,
deleted text begin advanced practice registered, deleted text end or practical nursing including, but not limited to, limitation
of scope of practice or the requirement of practice under supervision;

(5) impose conditions on the retention of the license including, but not limited to, the
imposition of retraining or rehabilitation requirements or the conditioning of continued
practice on demonstration of knowledge or skills by appropriate examination, monitoring,
or other review;

(6) impose a civil penalty not exceeding $10,000 for each separate violation, the
amount of the civil penalty to be fixed as to deprive the nurse of any economic advantage
gained by reason of the violation charged, to reimburse the board for the cost of counsel,
investigation, and proceeding, and to discourage repeated violations;

(7) order the nurse to provide unremunerated service;

(8) censure or reprimand the nurse; or

(9) any other action justified by the facts in the case.

Sec. 27.

Minnesota Statutes 2012, section 148.262, subdivision 2, is amended to read:

Subd. 2.

Automatic suspension.

Unless the board orders otherwise, a license to
practice new text begin advanced practice, new text end professional new text begin , new text end or practical nursing is automatically suspended if:

(1) a guardian of a nurse is appointed by order of a court under sections 524.5-101
to 524.5-502;

(2) the nurse is committed by order of a court under chapter 253B; or

(3) the nurse is determined to be mentally incompetent, mentally ill, chemically
dependent, or a person dangerous to the public by a court of competent jurisdiction within
or without this state.

The license remains suspended until the nurse is restored to capacity by a court and,
upon petition by the nurse, the suspension is terminated by the board after a hearing or
upon agreement between the board and the nurse.

Sec. 28.

Minnesota Statutes 2012, section 148.262, subdivision 4, is amended to read:

Subd. 4.

Reissuance.

The board may reinstate and reissue a license or registration
certificate to practice new text begin advanced practice, new text end professional new text begin , new text end or practical nursing, but as a
condition may impose any disciplinary or corrective measure that it might originally have
imposed. Any person whose license or registration has been revoked, suspended, or limited
may have the license reinstated and a new registration issued when, in the discretion of the
board, the action is warranted, provided that the person shall be required by the board to
pay the costs of the proceedings resulting in the revocation, suspension, or limitation of the
license or registration certificate and reinstatement of the license or registration certificate,
and to pay the fee for the current registration period. The cost of proceedings shall
include, but not be limited to, the cost paid by the board to the Office of Administrative
Hearings and the Office of the Attorney General for legal and investigative services, the
costs of a court reporter and witnesses, reproduction of records, board staff time, travel,
and expenses, and board members' per diem reimbursements, travel costs, and expenses.

Sec. 29.

Minnesota Statutes 2012, section 148.271, is amended to read:

148.271 EXEMPTIONS.

The provisions of sections 148.171 to 148.285 shall not prohibit:

(1) The furnishing of nursing assistance in an emergency.

(2) The practice of new text begin advanced practice, new text end professional new text begin , new text end or practical nursing by any
legally qualified new text begin advanced practice, new text end registered new text begin , new text end or licensed practical nurse of another state
who is employed by the United States government or any bureau, division, or agency
thereof while in the discharge of official duties.

(3) The practice of any profession or occupation licensed by the state, other than
new text begin advanced practice, new text end professional new text begin , new text end or practical nursing, by any person duly licensed to
practice the profession or occupation, or the performance by a person of any acts properly
coming within the scope of the profession, occupation, or license.

(4) The provision of a nursing or nursing-related service by a nursing assistant
who has been delegated the specific function and is supervised by a registered nurse or
monitored by a licensed practical nurse.

(5) The care of the sick with or without compensation when done in a nursing home
covered by the provisions of section 144A.09, subdivision 1.

(6) Professional nursing practice or advanced practice registered nursing practice by
a registered nurse or practical nursing practice by a licensed practical nurse licensed in
another state or territory who is in Minnesota as a student enrolled in a formal, structured
course of study, such as a course leading to a higher degree, certification in a nursing
specialty, or to enhance skills in a clinical field, while the student is practicing in the course.

(7) Professional or practical nursing practice by a student practicing under the
supervision of an instructor while the student is enrolled in a nursing program approved by
the board under section 148.251.

(8) Advanced practice registered nursing as defined in section 148.171, subdivisions
5, 10, 11, 13, and 21, by a registered nurse who is licensed and currently registered in
Minnesota or another United States jurisdiction and who is enrolled as a student in a
formal new text begin graduate new text end education program leading to eligibility for certification new text begin and licensure
new text end as an advanced practice registered nurse deleted text begin ; or by a registered nurse licensed and currently
registered in Minnesota who has completed an advanced practice registered nurse course
of study and is awaiting certification, the period not to exceed six months deleted text end .

Sec. 30.

Minnesota Statutes 2012, section 148.281, subdivision 1, is amended to read:

Subdivision 1.

Violations described.

It shall be unlawful for any person,
corporation, firm, or association, to:

(1) sell or fraudulently obtain or furnish any nursing diploma, license or record, or
aid or abet therein;

(2) practice new text begin advanced practice, new text end professional new text begin , new text end or practical nursing deleted text begin , deleted text end new text begin or new text end practice
as a public health nurse deleted text begin , or practice as a certified clinical nurse specialist, certified
nurse-midwife, certified nurse practitioner, or certified registered nurse anesthetist
deleted text end under cover of any diploma, permit, license, registration certificate, advanced practice
credential, or record illegally or fraudulently obtained or signed or issued unlawfully or
under fraudulent representation;

(3) practice new text begin advanced practice, new text end professional new text begin , new text end or practical nursing unless the person has
been issued a temporary permit under the provisions of section 148.212 or is duly licensed
and currently registered to do so under the provisions of sections 148.171 to 148.285;

(4) use the professional title nurse unless duly licensed to practice new text begin advanced practice,
new text end professional new text begin , new text end or practical nursing under the provisions of sections 148.171 to 148.285,
except as authorized by the board by rule;

(5) use any abbreviation or other designation tending to imply licensure as deleted text begin a deleted text end new text begin an
advanced practice registered nurse, a new text end registered nurse new text begin , new text end or new text begin a new text end licensed practical nurse unless
duly licensed and currently registered so to practice new text begin advanced practice, new text end professional new text begin , new text end or
practical nursing under the provisions of sections 148.171 to 148.285 except as authorized
by the board by rule;

(6) use any title, abbreviation, or other designation tending to imply certification
as a certified registered nurse as defined in section 148.171, subdivision 22, unless duly
certified by a national nurse certification organization;

(7) use any abbreviation or other designation tending to imply registration as a
public health nurse unless duly registered by the board;

(8) practice new text begin advanced practice, new text end professional, deleted text begin advanced practice registered, deleted text end or
practical nursing in a manner prohibited by the board in any limitation of a license or
registration issued under the provisions of sections 148.171 to 148.285;

(9) practice new text begin advanced practice, new text end professional, deleted text begin advanced practice registered, deleted text end or
practical nursing during the time a license or current registration issued under the
provisions of sections 148.171 to 148.285 shall be suspended or revoked;

(10) conduct a nursing program for the education of persons to become new text begin advanced
practice registered nurses, new text end registered nurses new text begin , new text end or licensed practical nurses unless the
program has been approved by the board; new text begin and
new text end

(11) knowingly employ persons in the practice of new text begin advanced practice, new text end professional new text begin ,
new text end or practical nursing who have not been issued a current permit, license, or registration
certificate to practice as a nurse in this state deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (12) knowingly employ a person in advanced practice registered nursing unless the
person meets the standards and practices of sections 148.171 to 148.285.
deleted text end

Sec. 31.

Minnesota Statutes 2012, section 148.281, is amended by adding a subdivision
to read:

new text begin Subd. 3. new text end

new text begin Penalty; advanced practice registered nurses. new text end

new text begin An advanced practice
registered nurse who practices advanced practice registered nursing without current
licensure and certification or recertification as an advanced practice registered nurse shall
pay a penalty fee of $200 for the first month or part of a month and an additional $100 for
each subsequent month or parts of months of practice. The amount of the penalty fee shall
be calculated from the first day the advanced practice registered nurse practiced without
current advanced practice registered nurse licensure and certification or recertification
to the date of last practice or from the first day the advanced practice registered nurse
practiced without the current licensure and certification or recertification.
new text end

Sec. 32. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2012, sections 148.171, subdivision 6; 148.235, subdivisions 1,
2, 2a, 4, 4a, 4b, 6, and 7; and 148.284, new text end new text begin are repealed.
new text end