1st Engrossment - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to professions; regulating advanced practice 1.3 registered nursing; amending Minnesota Statutes 1998, 1.4 sections 62A.15, subdivision 3a; 148.171; 148.191, 1.5 subdivision 2; 148.235; 148.261, subdivisions 1 and 5; 1.6 148.262, subdivision 1; 148.263, subdivisions 3 and 4; 1.7 148.271; 148.281, subdivision 1; 148.283; 245.462, 1.8 subdivision 18; and 245.4871, subdivision 27; 1.9 proposing coding for new law in Minnesota Statutes, 1.10 chapter 148; repealing Minnesota Rules, chapter 6340. 1.11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.12 Section 1. Minnesota Statutes 1998, section 62A.15, 1.13 subdivision 3a, is amended to read: 1.14 Subd. 3a. [NURSING SERVICES.] All benefits provided by a 1.15 policy or contract referred to in subdivision 1, relating to 1.16 expenses incurred for medical treatment or services of a duly 1.17 licensed physician must include services provided by a 1.18 registered nurse who is licensed pursuant to section 148.171 and 1.19 who is certifiedby the profession to engage inas an advanced 1.20nursing practicepractice registered nurse. "Advancednursing1.21practicepractice registered nurse"means the performance of1.22health services by professional nurses who have gained1.23additional knowledge and skills through an organized program of1.24study and clinical experience preparing nurses for advanced1.25practice roles as nurse anesthetists, nurse midwives, nurse1.26practitioners, or clinical specialists in psychiatric or mental1.27health nursing. The program of study must be beyond the1.28education required for registered nurse licensure and must meet2.1criteria established by the professional nursing organization2.2having authority to certify the registered nurse in advanced2.3nursing practice. For the purposes of this subdivision, the2.4board of nursing shall, by rule, adopt a list of professional2.5nursing organizations which have the authority to certify nurses2.6in advanced nursing practicehas the meaning given in section 2.7 148.171, subdivision 2, paragraph (4). The advanced practice 2.8 registered nurse must meet the requirements of sections 148.171 2.9 to 148.285. 2.10 This subdivision is intended to provide payment of benefits 2.11 for treatment and services bya licensed registered nurse2.12certified in advanced nursing practicean advanced practice 2.13 registered nurse as defined in this subdivision and is not 2.14 intended to add to the benefits provided for in these policies 2.15 or contracts. 2.16 Sec. 2. Minnesota Statutes 1998, section 148.171, is 2.17 amended to read: 2.18 148.171 [DEFINITIONS; TITLE.] 2.19 Subdivision 1. [TITLE.] Sections 148.171 to 148.285 shall 2.20 be referred to as the Minnesota Nurse Practice Act. 2.21 Subd. 2. [SCOPE.] As used in sections 148.171 to 148.285:, 2.22 the definitions in this section have the meanings given. 2.23 (1) "Board" means the Minnesota board of nursing. 2.24 (2) "Registered nurse," abbreviated R.N., means an 2.25 individual licensed by the board to practice professional 2.26 nursing. 2.27 (3) The "practice of professional nursing" means the 2.28 performance for compensation or personal profit of the 2.29 professional interpersonal service of: (a) providing a nursing 2.30 assessment of the actual or potential health needs of 2.31 individuals, families, or communities; (b) providing nursing 2.32 care supportive to or restorative of life by functions such as 2.33 skilled ministration of nursing care, supervising and teaching 2.34 nursing personnel, health teaching and counseling, case finding, 2.35 and referral to other health resources; and (c) evaluating these 2.36 actions. The practice of professional nursing includes both 3.1 independent nursing functions and delegated medical functions 3.2 which may be performed in collaboration with other health team 3.3 members, or may be delegated by the professional nurse to other 3.4 nursing personnel. Independent nursing function may also be 3.5 performed autonomously. The practice of professional nursing 3.6 requires that level of special education, knowledge, and skill 3.7 ordinarily expected of an individual who has completed an 3.8 approved professional nursing education program as described in 3.9 section 148.211, subdivision 1. 3.10 (4) "Advanced practice registered nurse," abbreviated APRN, 3.11 means an individual licensed as a registered nurse by the board 3.12 and certified by a national nurse certification organization 3.13 acceptable to the board to practice as a clinical nurse 3.14 specialist, nurse anesthetist, nurse midwife, or nurse 3.15 practitioner. 3.16 (5) The "practice of advanced practice registered nursing" 3.17 means the performance of clinical nurse specialist practice, 3.18 nurse midwife practice, nurse practitioner practice, or 3.19 registered nurse anesthetist practice as defined in paragraphs 3.20 (6), (9), (10), and (12). The practice includes functioning as 3.21 a direct care provider, case manager, consultant, educator, and 3.22 researcher. The advanced practice registered nurse must 3.23 practice within a health care system that provides for 3.24 consultation, collaborative management, and referral as 3.25 indicated by the health status of the patient. 3.26 (6) "Clinical nurse specialist practice" means the 3.27 provision of patient care in a particular specialty or 3.28 subspecialty of advanced practice registered nursing within the 3.29 context of collaborative management, and includes: (i) 3.30 diagnosing illness and disease; (ii) providing nonpharmacologic 3.31 treatment, including psychotherapy; (iii) promoting wellness; 3.32 and (iv) preventing illness and disease. The certified clinical 3.33 nurse specialist is certified for advanced practice registered 3.34 nursing in a specific field of clinical nurse specialist 3.35 practice. 3.36 (7) "Collaborative management" is a mutually agreed upon 4.1 plan between an advanced practice registered nurse and one or 4.2 more physicians or surgeons licensed under chapter 147, dentists 4.3 licensed under chapter 150A, podiatrists licensed under chapter 4.4 153, or chiropractors licensed under sections 148.01 to 148.10 4.5 that designates the scope of collaboration necessary to jointly 4.6 manage the care of patients. The advanced practice registered 4.7 nurse and the one or more physicians, surgeons, podiatrists, 4.8 dentists, or chiropractors must have experience in providing 4.9 care to patients with the same or similar medical problems. 4.10 Certified registered nurse anesthetists must provide their 4.11 clinical services at the same hospital or clinic as the 4.12 physician or surgeon. 4.13 (8) "Consultation" means the process in which an advanced 4.14 practice registered nurse who maintains primary management 4.15 responsibility for a patient's care seeks advice or opinion of a 4.16 physician or another member of the health care team. 4.17 (9) "Nurse midwife practice" means the management of 4.18 women's primary health care, focusing on pregnancy, childbirth, 4.19 the postpartum period, care of the newborn, and the family 4.20 planning and gynecological needs of women and includes 4.21 diagnosing and providing nonpharmacologic treatment within the 4.22 context of collaborative management. 4.23 (10) "Nurse practitioner practice" means: (i) diagnosing, 4.24 directly managing, and preventing acute and chronic illness and 4.25 disease; and (ii) promoting wellness, including providing 4.26 nonpharmacologic treatment. The certified nurse practitioner is 4.27 certified for advanced registered nurse practice in a specific 4.28 field of nurse practitioner practice. 4.29 (11) "Referral" means the process in which an advanced 4.30 practice registered nurse directs a patient to a physician or 4.31 another health care professional for management of a particular 4.32 problem or aspect of the patient's care. 4.33 (12) "Registered nurse anesthetist practice" means the 4.34 provision of anesthesia care and related services within the 4.35 context of collaborative management, including selecting, 4.36 obtaining, and administering drugs and therapeutic devices to 5.1 facilitate diagnostic, therapeutic, and surgical procedures upon 5.2 request, assignment, or referral by a patient's physician, 5.3 dentist, chiropractor, podiatrist, or veterinarian. 5.4 (13) "Registered nurse, certified," abbreviated RN,C, means 5.5 a registered nurse who has received certification from a 5.6 national nursing organization or national nurse certification 5.7 organization for practice according to paragraph (3) in a 5.8 specialized field of professional nursing. A registered nurse, 5.9 certified, shall not practice advanced practice registered 5.10 nursing as described in paragraph (5), (6), (9), (10), or (12). 5.11(4)(14) "Licensed practical nurse," abbreviated L.P.N., 5.12 means an individual licensed by the board to practice practical 5.13 nursing. 5.14(5)(15) The "practice of practical nursing" means the 5.15 performance for compensation or personal profit of any of those 5.16 services in observing and caring for the ill, injured, or 5.17 infirm, in applying counsel and procedure to safeguard life and 5.18 health, in administering medication and treatment prescribed by 5.19 a licensed health professional, which are commonly performed by 5.20 licensed practical nurses and which require specialized 5.21 knowledge and skill such as are taught or acquired in an 5.22 approved school of practical nursing, but which do not require 5.23 the specialized education, knowledge, and skill of a registered 5.24 nurse. 5.25(6)(16) "Nurse" means registered nurse, advanced practice 5.26 registered nurse, and licensed practical nurse unless the 5.27 context clearly refers to only one category. 5.28(7)(17) "Nursing assistant" means an individual providing 5.29 nursing or nursing-related services that do not require the 5.30 specialized knowledge and skill of a nurse, at the direction of 5.31 a nurse, but does not include a licensed health professional or 5.32 an individual who volunteers to provide such services without 5.33 monetary compensation. 5.34(8)(18) "Public health nurse" means a registered nurse who 5.35 meets the voluntary registration requirements established by the 5.36 board by rule. 6.1 (19) "Prescribing" means the act of generating a 6.2 prescription for the preparation, use of, or manner of using a 6.3 drug or therapeutic device in accordance with the provisions of 6.4 section 148.235. Prescribing does not include recommending the 6.5 use of a drug or therapeutic device which is not required by the 6.6 federal Food and Drug Administration to meet the labeling 6.7 requirements for prescription drugs and devices or certified 6.8 registered nurse anesthetist practice preoperatively, 6.9 intraoperatively, or postoperatively. 6.10 (20) "Prescription" means a written direction or an oral 6.11 direction reduced to writing provided to or for an individual 6.12 patient for the preparation or use of a drug or therapeutic 6.13 device. 6.14 Sec. 3. Minnesota Statutes 1998, section 148.191, 6.15 subdivision 2, is amended to read: 6.16 Subd. 2. [POWERS.] (a) The board is authorized to adopt 6.17 and, from time to time, revise rules not inconsistent with the 6.18 law, as may be necessary to enable it to carry into effect the 6.19 provisions of sections 148.171 to 148.285. The board shall 6.20 prescribe by rule curricula and standards for schools and 6.21 courses preparing persons for licensure under sections 148.171 6.22 to 148.285. It shall conduct or provide for surveys of such 6.23 schools and courses at such times as it may deem necessary. It 6.24 shall approve such schools and courses as meet the requirements 6.25 of sections 148.171 to 148.285 and board rules. It shall 6.26 examine, license, and renew the license of duly qualified 6.27 applicants. It shall hold examinations at least once in each 6.28 year at such time and place as it may determine. It shall by 6.29 rule adopt, evaluate, and periodically revise, as necessary, 6.30 requirements for licensure and for registration and renewal of 6.31 registration as defined in section 148.231. It shall maintain a 6.32 record of all persons licensed by the board to practice 6.33 professional or practical nursing and all registered nurses who 6.34 hold Minnesota licensure and registration and are certified as 6.35 advanced practice registered nurses. It shall cause the 6.36 prosecution of all persons violating sections 148.171 to 148.285 7.1 and have power to incur such necessary expense therefor. It 7.2 shall register public health nurses who meet educational and 7.3 other requirements established by the board by rule, including 7.4 payment of a fee. Prior to the adoption of rules, the board 7.5 shall use the same procedures used by the department of health 7.6 to certify public health nurses. It shall have power to issue 7.7 subpoenas, and to compel the attendance of witnesses and the 7.8 production of all necessary documents and other evidentiary 7.9 material. Any board member may administer oaths to witnesses, 7.10 or take their affirmation. It shall keep a record of all its 7.11 proceedings. 7.12 (b) The board shall have access to hospital, nursing home, 7.13 and other medical records of a patient cared for by a nurse 7.14 under review. If the board does not have a written consent from 7.15 a patient permitting access to the patient's records, the nurse 7.16 or facility shall delete any data in the record that identifies 7.17 the patient before providing it to the board. The board shall 7.18 have access to such other records as reasonably requested by the 7.19 board to assist the board in its investigation. Nothing herein 7.20 may be construed to allow access to any records protected by 7.21 section 145.64. The board shall maintain any records obtained 7.22 pursuant to this paragraph as investigative data under chapter 7.23 13. 7.24 Sec. 4. [148.233] [IDENTIFICATION OF CERTIFIED REGISTERED 7.25 NURSES.] 7.26 Subdivision 1. [REGISTERED NURSE.] A registered nurse 7.27 certified in a specialized field of professional nursing as 7.28 described in section 148.171, subdivision 2, paragraph (13), 7.29 shall use the designation RN,C for personal identification and 7.30 in documentation of services provided. Identification of 7.31 educational degrees and specialty fields may be added. 7.32 Subd. 2. [ADVANCED PRACTICE REGISTERED NURSE.] An advanced 7.33 practice registered nurse certified as a certified clinical 7.34 nurse specialist, certified nurse midwife, certified nurse 7.35 practitioner, or certified registered nurse anesthetist shall 7.36 use the appropriate designation: RN,CNS; RN,CNM; RN,CNP; or 8.1 RN,CRNA for personal identification and in documentation of 8.2 services provided. Identification of educational degrees and 8.3 specialty fields may be added. 8.4 Sec. 5. Minnesota Statutes 1998, section 148.235, is 8.5 amended to read: 8.6 148.235 [PRESCRIBING DRUGS AND THERAPEUTIC DEVICES.] 8.7 Subdivision 1. [CERTIFIED NURSE-MIDWIVES.] Aregistered8.8nurse who has graduated from a program of study designed to8.9prepare registered nurses for advanced practice as8.10nurse-midwives and who is certified through the national8.11professional nursing organization for nurse-midwivescertified 8.12 nurse-midwife may prescribe and administer drugs and therapeutic 8.13 devices within practice as a certified nurse-midwife. 8.14 Subd. 2. [CERTIFIED NURSE PRACTITIONERS.] A 8.15registeredcertified nurse practitioner who(1) has graduated8.16from a program of study designed to prepare registered nurses8.17for advanced practice as nurse practitioners, (2) is certified8.18through a national professional nursing organization which8.19certifies nurse practitioners and is included in the list of8.20professional nursing organizations adopted by the board under8.21section 62A.15, subdivision 3a, and (3)has a written agreement 8.22 with a physician based on standards established by the Minnesota 8.23 nurses association and the Minnesota medical association that 8.24 defines the delegated responsibilities related to the 8.25 prescription of drugs and therapeutic devices, may prescribe and 8.26 administer drugs and therapeutic devices within the scope of the 8.27 written agreement and within practice as a certified nurse 8.28 practitioner. The written agreement required under this 8.29 subdivision shall be based on standards established by the 8.30 Minnesota nurses association and the Minnesota medical 8.31 association as of January 1, 1996, unless both associations 8.32 agree to revisions.The written agreement shall be maintained8.33at the certified nurse practitioner's place of employment and8.34does not need to be filed with the board of nursing.8.35 Subd. 2a. [CERTIFIED REGISTERED NURSE ANESTHETISTS.] A 8.36 certified registered nurse anesthetist who has a written 9.1 agreement with a physician based on standards established by the 9.2 Minnesota Nurses Association and the Minnesota Medical 9.3 Association that defines the delegated responsibilities related 9.4 to the prescription of drugs and therapeutic devices, may 9.5 prescribe and administer drugs and therapeutic devices within 9.6 the scope of the written agreement and within practice as a 9.7 certified registered nurse anesthetist. 9.8Subd. 3. [DISPENSING AUTHORITY.] An advanced practice9.9nurse who is authorized under this section to prescribe drugs is9.10authorized to dispense drugs subject to the same requirements9.11established for the prescribing of drugs. This authority to9.12dispense extends only to those drugs described in the written9.13agreement entered into under this section. The authority to9.14dispense includes, but is not limited to, the authority to9.15receive and dispense sample drugs.9.16 Subd. 4. [CERTIFIED CLINICAL NURSE SPECIALISTS IN 9.17 PSYCHIATRIC AND MENTAL HEALTH NURSING.] A registered nurse who 9.18 (1)has a masters degree, (2) is certified through a national9.19professional nursing organization which certifies clinical9.20specialists in psychiatric and mental health nursing and is9.21included in the list of professional nursing organizations9.22adopted by the board under section 62A.15, subdivision 3a, (3)9.23 has successfully completed no less than 30 hours of formal study 9.24 in the prescribing of psychotropic medications and medications 9.25 to treat their side effects which included instruction in health 9.26 assessment, psychotropic classifications, psychopharmacology, 9.27 indications, dosages, contraindications, side effects, and 9.28 evidence of application,; and(4)(2) has a written agreement 9.29 with a psychiatrist or other physician based on standards 9.30 established by the Minnesota Nurses Association and the 9.31 Minnesota Psychiatric Association that specifies and defines the 9.32 delegated responsibilities related to the prescription of drugs 9.33 in relationship to the diagnosis, may prescribe and administer 9.34 drugs used to treat psychiatric and behavioral disorders and the 9.35 side effects of those drugs within the scope of the written 9.36 agreement and within practice as a certified clinical nurse 10.1 specialist in psychiatric and mental health nursing. The 10.2 written agreement required under this subdivision shall be based 10.3 on standards established by the Minnesota Nurses Association and 10.4 the Minnesota Psychiatric Association as of January 1, 1996, 10.5 unless both associations agree to revisions.The written10.6agreement shall be maintained at the certified clinical nurse10.7specialist's place of employment and does not need to be filed10.8with the board of nursing.10.9 Nothing in this subdivision removes or limits the legal 10.10 professional liability of the treating psychiatrist, certified 10.11 clinical nurse specialist, mental health clinic or hospital for 10.12 the prescription and administration of drugs by a certified 10.13 clinical nurse specialist in accordance with this subdivision. 10.14 Subd. 4a. [OTHER CERTIFIED CLINICAL NURSE SPECIALISTS.] A 10.15 certified clinical nurse specialist who: (1) has successfully 10.16 completed no less than 30 hours of a formal course of study from 10.17 a college, university, or university health care institution, 10.18 which included the following: instruction in health assessment, 10.19 medication classifications, indications, dosages, 10.20 contraindications, and side effects; supervised practice; and 10.21 competence evaluation, including evidence of the application of 10.22 knowledge pertaining to prescribing and therapeutic management 10.23 of the clinical type of patients in the certified clinical nurse 10.24 specialist's practice; and (2) has a written agreement with a 10.25 physician based on standards established by the Minnesota Nurses 10.26 Association and the Minnesota Medical Association that defines 10.27 the delegated responsibilities related to the prescription of 10.28 drugs and therapeutic devices, may prescribe and administer 10.29 drugs and therapeutic devices within the scope of the written 10.30 agreement and within practice as a certified clinical nurse 10.31 specialist. 10.32 Subd. 4b. [DISPENSING AUTHORITY.] An advanced practice 10.33 registered nurse who is authorized under this section to 10.34 prescribe drugs is authorized to dispense drugs subject to the 10.35 same requirements established for the prescribing of drugs. 10.36 This authority to dispense extends only to those drugs described 11.1 in the written agreement entered into under this section. The 11.2 authority to dispense includes, but is not limited to, the 11.3 authority to receive and dispense sample drugs. 11.4Subd. 5. [RULES.] (a) The board shall promulgate rules to11.5provide for the following:11.6(1) a system of identifying advanced practice nurses11.7eligible to prescribe drugs as authorized under this section;11.8(2) a system of transmitting to pharmacists the identity of11.9advanced practice nurses eligible to prescribe drugs; and11.10(3) a fee to nurse practitioners and certified clinical11.11specialists in psychiatric and mental health nursing who seek11.12prescribing authority.11.13(b) The repeal of subdivision 2, paragraph (b), does not11.14automatically repeal rules adopted under that paragraph.11.15 Subd. 6. [STANDARDS FOR WRITTEN AGREEMENTS; REVIEW AND 11.16 FILING.] Written agreements requiredby subdivisions 2 and 411.17 under this section shall be maintained at the primary practice 11.18 site of thenurse practitioner, clinical specialist in11.19psychiatric and mental health nursing,advanced practice 11.20 registered nurse and of the collaborating physician. The 11.21 written agreement does not need to be filed with the board of 11.22 nursing, provided that the information required to be filed with11.23the board, either on initial application for prescribing11.24privileges or on renewal of privileges, has been submittedor 11.25 the board of medical practice. 11.26 Subd. 7. [FEDERAL REGISTRATION.] Any advanced practice 11.27 registered nurse who applies to the federal Drug Enforcement 11.28 Administration for a registration number shall submit to the 11.29 board: 11.30 (1) proof that requirements of this section are met; and 11.31 (2) a processing fee of $50. 11.32 Sec. 6. Minnesota Statutes 1998, section 148.261, 11.33 subdivision 1, is amended to read: 11.34 Subdivision 1. [GROUNDS LISTED.] The board may deny, 11.35 revoke, suspend, limit, or condition the license and 11.36 registration of any person to practice professional, advanced 12.1 practice registered, or practical nursing under sections 148.171 12.2 to 148.285, or to otherwise discipline a licensee or applicant 12.3 as described in section 148.262. The following are grounds for 12.4 disciplinary action: 12.5 (1) Failure to demonstrate the qualifications or satisfy 12.6 the requirements for a license contained in sections 148.171 to 12.7 148.285 or rules of the board. In the case of a person applying 12.8 for a license, the burden of proof is upon the applicant to 12.9 demonstrate the qualifications or satisfaction of the 12.10 requirements. 12.11 (2) Employing fraud or deceit in procuring or attempting to 12.12 procure a permit, license, or registration certificate to 12.13 practice professional or practical nursing or attempting to 12.14 subvert the licensing examination process. Conduct that 12.15 subverts or attempts to subvert the licensing examination 12.16 process includes, but is not limited to: 12.17 (i) conduct that violates the security of the examination 12.18 materials, such as removing examination materials from the 12.19 examination room or having unauthorized possession of any 12.20 portion of a future, current, or previously administered 12.21 licensing examination; 12.22 (ii) conduct that violates the standard of test 12.23 administration, such as communicating with another examinee 12.24 during administration of the examination, copying another 12.25 examinee's answers, permitting another examinee to copy one's 12.26 answers, or possessing unauthorized materials; or 12.27 (iii) impersonating an examinee or permitting an 12.28 impersonator to take the examination on one's own behalf. 12.29 (3) Conviction during the previous five years of a felony 12.30 or gross misdemeanor reasonably related to the practice of 12.31 professional, advanced practice registered, or practical nursing. 12.32 Conviction as used in this subdivision includes a conviction of 12.33 an offense that if committed in this state would be considered a 12.34 felony or gross misdemeanor without regard to its designation 12.35 elsewhere, or a criminal proceeding where a finding or verdict 12.36 of guilt is made or returned but the adjudication of guilt is 13.1 either withheld or not entered. 13.2 (4) Revocation, suspension, limitation, conditioning, or 13.3 other disciplinary action against the person's professional or 13.4 practical nursing license or advanced practice registered 13.5 nursing credential, in another state, territory, or country; 13.6 failure to report to the board that charges regarding the 13.7 person's nursing license or other credential are pending in 13.8 another state, territory, or country; or having been refused a 13.9 license or other credential by another state, territory, or 13.10 country. 13.11 (5) Failure to or inability to perform professional or 13.12 practical nursing as defined in section 148.171, subdivision 2, 13.13 paragraph (3) or(5)(15), with reasonable skill and safety, 13.14 including failure of a registered nurse to supervise or a 13.15 licensed practical nurse to monitor adequately the performance 13.16 of acts by any person working at the nurse's direction. 13.17 (6) Engaging in unprofessional conduct, including, but not 13.18 limited to, a departure from or failure to conform to board 13.19 rules of professional or practical nursing practice that 13.20 interpret the statutory definition of professional or practical 13.21 nursing as well as provide criteria for violations of the 13.22 statutes, or, if no rule exists, to the minimal standards of 13.23 acceptable and prevailing professional or practical nursing 13.24 practice, or any nursing practice that may create unnecessary 13.25 danger to a patient's life, health, or safety. Actual injury to 13.26 a patient need not be established under this clause. 13.27 (7) Failure of an advanced practice registered nurse to 13.28 practice with reasonable skill and safety or departure from or 13.29 failure to conform to standards of acceptable and prevailing 13.30 advanced practice registered nursing. 13.31(7)(8) Delegating or accepting the delegation of a nursing 13.32 function or a prescribed health care function when the 13.33 delegation or acceptance could reasonably be expected to result 13.34 in unsafe or ineffective patient care. 13.35(8)(9) Actual or potential inability to practice nursing 13.36 with reasonable skill and safety to patients by reason of 14.1 illness, use of alcohol, drugs, chemicals, or any other 14.2 material, or as a result of any mental or physical condition. 14.3(9)(10) Adjudication as mentally incompetent, mentally 14.4 ill, a chemically dependent person, or a person dangerous to the 14.5 public by a court of competent jurisdiction, within or without 14.6 this state. 14.7(10)(11) Engaging in any unethical conduct, including, but 14.8 not limited to, conduct likely to deceive, defraud, or harm the 14.9 public, or demonstrating a willful or careless disregard for the 14.10 health, welfare, or safety of a patient. Actual injury need not 14.11 be established under this clause. 14.12(11)(12) Engaging in conduct with a patient that is sexual 14.13 or may reasonably be interpreted by the patient as sexual, or in 14.14 any verbal behavior that is seductive or sexually demeaning to a 14.15 patient, or engaging in sexual exploitation of a patient or 14.16 former patient. 14.17(12)(13) Obtaining money, property, or services from a 14.18 patient, other than reasonable fees for services provided to the 14.19 patient, through the use of undue influence, harassment, duress, 14.20 deception, or fraud. 14.21(13)(14) Revealing a privileged communication from or 14.22 relating to a patient except when otherwise required or 14.23 permitted by law. 14.24(14)(15) Engaging in abusive or fraudulent billing 14.25 practices, including violations of federal Medicare and Medicaid 14.26 laws or state medical assistance laws. 14.27(15)(16) Improper management of patient records, including 14.28 failure to maintain adequate patient records, to comply with a 14.29 patient's request made pursuant to section 144.335, or to 14.30 furnish a patient record or report required by law. 14.31(16)(17) Knowingly aiding, assisting, advising, or 14.32 allowing an unlicensed person to engage in the unlawful practice 14.33 of professional, advanced practice registered, or practical 14.34 nursing. 14.35(17)(18) Violating a rule adopted by the board, an order 14.36 of the board, or a state or federal law relating to the practice 15.1 of professional, advanced practice registered, or practical 15.2 nursing, or a state or federal narcotics or controlled substance 15.3 law. 15.4(18)(19) Knowingly providing false or misleading 15.5 information that is directly related to the care of that patient 15.6 unless done for an accepted therapeutic purpose such as the 15.7 administration of a placebo. 15.8(19)(20) Aiding suicide or aiding attempted suicide in 15.9 violation of section 609.215 as established by any of the 15.10 following: 15.11 (i) a copy of the record of criminal conviction or plea of 15.12 guilty for a felony in violation of section 609.215, subdivision 15.13 1 or 2; 15.14 (ii) a copy of the record of a judgment of contempt of 15.15 court for violating an injunction issued under section 609.215, 15.16 subdivision 4; 15.17 (iii) a copy of the record of a judgment assessing damages 15.18 under section 609.215, subdivision 5; or 15.19 (iv) a finding by the board that the person violated 15.20 section 609.215, subdivision 1 or 2. The board shall 15.21 investigate any complaint of a violation of section 609.215, 15.22 subdivision 1 or 2. 15.23(20)(21) Practicing outside the scope of practice 15.24 authorized by section 148.171, subdivision 2, paragraph (3) 15.25or, (5), (6), (9), (10), (12), or (15). 15.26 (22) Practicing outside the specific field of nursing 15.27 practice for which an advanced practice registered nurse is 15.28 certified unless the practice is authorized under section 15.29 148.284. 15.30(21)(23) Making a false statement or knowingly providing 15.31 false information to the board, failing to make reports as 15.32 required by section 148.263, or failing to cooperate with an 15.33 investigation of the board as required by section 148.265. 15.34(22)(24) Engaging in false, fraudulent, deceptive, or 15.35 misleading advertising. 15.36 (25) Failure to inform the board of the person's 16.1 certification status as a nurse anesthetist, nurse midwife, 16.2 nurse practitioner, or clinical nurse specialist. 16.3 (26) Engaging in clinical nurse specialist practice, nurse 16.4 midwife practice, nurse practitioner practice, or registered 16.5 nurse anesthetist practice without current certification by a 16.6 national nurse certification organization acceptable to the 16.7 board, except during the period between completion of an 16.8 advanced practice registered nurse course of study and 16.9 certification, not to exceed six months or as authorized by the 16.10 board. 16.11 Sec. 7. Minnesota Statutes 1998, section 148.261, 16.12 subdivision 5, is amended to read: 16.13 Subd. 5. [EXAMINATION; ACCESS TO MEDICAL DATA.] The board 16.14 may take the following actions if it has probable cause to 16.15 believe that grounds for disciplinary action exist under 16.16 subdivision 1, clause(8)(9) or(9)(10): 16.17 (a) It may direct the applicant or nurse to submit to a 16.18 mental or physical examination or chemical dependency 16.19 evaluation. For the purpose of this subdivision, when a nurse 16.20 licensed under sections 148.171 to 148.285 is directed in 16.21 writing by the board to submit to a mental or physical 16.22 examination or chemical dependency evaluation, that person is 16.23 considered to have consented and to have waived all objections 16.24 to admissibility on the grounds of privilege. Failure of the 16.25 applicant or nurse to submit to an examination when directed 16.26 constitutes an admission of the allegations against the 16.27 applicant or nurse, unless the failure was due to circumstances 16.28 beyond the person's control, and the board may enter a default 16.29 and final order without taking testimony or allowing evidence to 16.30 be presented. A nurse affected under this paragraph shall, at 16.31 reasonable intervals, be given an opportunity to demonstrate 16.32 that the competent practice of professional, advanced practice 16.33 registered, or practical nursing can be resumed with reasonable 16.34 skill and safety to patients. Neither the record of proceedings 16.35 nor the orders entered by the board in a proceeding under this 16.36 paragraph, may be used against a nurse in any other proceeding. 17.1 (b) It may, notwithstanding sections 13.42, 144.651, 17.2 595.02, or any other law limiting access to medical or other 17.3 health data, obtain medical data and health records relating to 17.4 a registered nurse, advanced practice registered nurse, licensed 17.5 practical nurse, or applicant for a license without that 17.6 person's consent. The medical data may be requested from a 17.7 provider, as defined in section 144.335, subdivision 1, 17.8 paragraph (b), an insurance company, or a government agency, 17.9 including the department of human services. A provider, 17.10 insurance company, or government agency shall comply with any 17.11 written request of the board under this subdivision and is not 17.12 liable in any action for damages for releasing the data 17.13 requested by the board if the data are released pursuant to a 17.14 written request under this subdivision unless the information is 17.15 false and the provider giving the information knew, or had 17.16 reason to believe, the information was false. Information 17.17 obtained under this subdivision is classified as private data on 17.18 individuals as defined in section 13.02. 17.19 Sec. 8. Minnesota Statutes 1998, section 148.262, 17.20 subdivision 1, is amended to read: 17.21 Subdivision 1. [FORMS OF DISCIPLINARY ACTION.] When the 17.22 board finds that grounds for disciplinary action exist under 17.23 section 148.261, subdivision 1, it may take one or more of the 17.24 following actions: 17.25 (1) deny the license, registration, or registration 17.26 renewal; 17.27 (2) revoke the license; 17.28 (3) suspend the license; 17.29 (4) impose limitations on the nurse's practice of 17.30 professional, advanced practice registered, or practical nursing 17.31 including, but not limited to, limitation of scope of practice 17.32 or the requirement of practice under supervision; 17.33 (5) impose conditions on the retention of the license 17.34 including, but not limited to, the imposition of retraining or 17.35 rehabilitation requirements or the conditioning of continued 17.36 practice on demonstration of knowledge or skills by appropriate 18.1 examination, monitoring, or other review; 18.2 (6) impose a civil penalty not exceeding $10,000 for each 18.3 separate violation, the amount of the civil penalty to be fixed 18.4 as to deprive the nurse of any economic advantage gained by 18.5 reason of the violation charged, to reimburse the board for the 18.6 cost of counsel, investigation, and proceeding, and to 18.7 discourage repeated violations; 18.8 (7) order the nurse to provide unremunerated service; 18.9 (8) censure or reprimand the nurse; or 18.10 (9) any other action justified by the facts in the case. 18.11 Sec. 9. Minnesota Statutes 1998, section 148.263, 18.12 subdivision 3, is amended to read: 18.13 Subd. 3. [LICENSED PROFESSIONALS.] A person licensed by a 18.14 health-related licensing board as defined in section 214.01, 18.15 subdivision 2, shall report to the board personal knowledge of 18.16 any conduct the person reasonably believes constitutes grounds 18.17 for disciplinary action under sections 148.171 to 148.285 by any 18.18 nurse including conduct indicating that the nurse may be 18.19 incompetent, may have engaged in unprofessional or unethical 18.20 conduct, or may be mentally or physically unable to engage 18.21 safely in the practice of professional, advanced practice 18.22 registered, or practical nursing. 18.23 Sec. 10. Minnesota Statutes 1998, section 148.263, 18.24 subdivision 4, is amended to read: 18.25 Subd. 4. [INSURERS.] Four times each year, by the first 18.26 day of February, May, August, and November, each insurer 18.27 authorized to sell insurance described in section 60A.06, 18.28 subdivision 1, clause (13), and providing professional liability 18.29 insurance to registered nurses, advanced practice registered 18.30 nurses, or licensed practical nurses shall submit to the board a 18.31 report concerning any nurse against whom a malpractice award has 18.32 been made or who has been a party to a settlement. The report 18.33 must contain at least the following information: 18.34 (1) the total number of settlements or awards; 18.35 (2) the date settlement or award was made; 18.36 (3) the allegations contained in the claim or complaint 19.1 leading to the settlement or award; 19.2 (4) the dollar amount of each malpractice settlement or 19.3 award and whether that amount was paid as a result of a 19.4 settlement or of an award; and 19.5 (5) the name and address of the practice of the nurse 19.6 against whom an award was made or with whom a settlement was 19.7 made. 19.8 An insurer shall also report to the board any information 19.9 it possesses that tends to substantiate a charge that a nurse 19.10 may have engaged in conduct violating sections 148.171 to 19.11 148.285. 19.12 Sec. 11. Minnesota Statutes 1998, section 148.271, is 19.13 amended to read: 19.14 148.271 [EXEMPTIONS.] 19.15 The provisions of sections 148.171 to 148.285 shall not 19.16 prohibit: 19.17 (1) The furnishing of nursing assistance in an emergency. 19.18 (2) The practice of professional or practical nursing by 19.19 any legally qualified registered or licensed practical nurse of 19.20 another state who is employed by the United States government or 19.21 any bureau, division, or agency thereof while in the discharge 19.22 of official duties. 19.23 (3) The practice of any profession or occupation licensed 19.24 by the state, other than professional or practical nursing, by 19.25 any person duly licensed to practice the profession or 19.26 occupation, or the performance by a person of any acts properly 19.27 coming within the scope of the profession, occupation, or 19.28 license. 19.29 (4) The provision of a nursing or nursing-related service 19.30 by a nursing assistant who has been delegated the specific 19.31 function and is supervised by a registered nurse or monitored by 19.32 a licensed practical nurse. 19.33 (5) The care of the sick with or without compensation when 19.34 done in a nursing home covered by the provisions of section 19.35 144A.09, subdivision 1. 19.36 (6) Professional nursing practice or advanced practice 20.1 registered nursing practice by a registered nurse or practical 20.2 nursing practice by a licensed practical nurse licensed in 20.3 another state or territory who is in Minnesota as a student 20.4 enrolled in a formal, structured course of study, such as a 20.5 course leading to a higher degree, certification in a nursing 20.6 specialty, or to enhance skills in a clinical field, while the 20.7 student is practicing in the course. 20.8 (7) Professional or practical nursing practice by a student 20.9 practicing under the supervision of an instructor while the 20.10 student is enrolled in a nursing program approved by the board 20.11 under section 148.251. 20.12 (8) Advanced practice registered nursing as defined in 20.13 section 148.171, subdivision 2, paragraphs (5), (6), (9), (10), 20.14 and (12), by a registered nurse who is licensed and currently 20.15 registered in Minnesota or another United States jurisdiction 20.16 and who is enrolled as a student in a formal education program 20.17 leading to eligibility for certification as an advanced practice 20.18 registered nurse; or by a registered nurse licensed and 20.19 currently registered in Minnesota who has completed an advanced 20.20 practice registered nurse course of study and is awaiting 20.21 certification, the period not to exceed six months. 20.22 Sec. 12. Minnesota Statutes 1998, section 148.281, 20.23 subdivision 1, is amended to read: 20.24 Subdivision 1. [VIOLATIONS DESCRIBED.] It shall be 20.25 unlawful for any person, corporation, firm, or association, to: 20.26 (1) sell or fraudulently obtain or furnish any nursing 20.27 diploma, license or record, or aid or abet therein; 20.28 (2) practice professional or practical nursingor, practice 20.29 as a public health nurse, or practice as a certified clinical 20.30 nurse specialist, certified nurse midwife, certified nurse 20.31 practitioner, or certified registered nurse anesthetist under 20.32 cover of any diploma, permit, license, registration certificate, 20.33 advanced practice credential, or record illegally or 20.34 fraudulently obtained or signed or issued unlawfully or under 20.35 fraudulent representation; 20.36 (3) practice professional or practical nursing unless the 21.1 person has been issued a temporary permit under the provisions 21.2 of section 148.212 or is duly licensed and currently registered 21.3 to do so under the provisions of sections 148.171 to 148.285; 21.4 (4) use any abbreviation or other designation tending to 21.5 imply licensure as a registered nurse or licensed practical 21.6 nurse unless duly licensed and currently registered so to 21.7 practice professional or practical nursing under the provisions 21.8 of sections 148.171 to 148.285 except as authorized by the board 21.9 by rule; 21.10 (5) use any title, abbreviation, or other designation 21.11 tending to imply certification as a certified registered nurse 21.12 as defined in section 148.171, subdivision 2, paragraph (13), 21.13 unless duly certified by a national nurse certification 21.14 organization; 21.15(5)(6) use any abbreviation or other designation tending 21.16 to imply registration as a public health nurse unless duly 21.17 registered by the board; 21.18(6)(7) practice professional, advanced practice 21.19 registered, or practical nursing in a manner prohibited by the 21.20 board in any limitation of a license or registration issued 21.21 under the provisions of sections 148.171 to 148.285; 21.22(7)(8) practice professional, advanced practice 21.23 registered, or practical nursing during the time a license or 21.24 current registration issued under the provisions of sections 21.25 148.171 to 148.285 shall be suspended or revoked; 21.26(8)(9) conduct a nursing program for the education of 21.27 persons to become registered nurses or licensed practical nurses 21.28 unless the program has been approved by the board;and21.29(9)(10) knowingly employ persons in the practice of 21.30 professional or practical nursing who have not been issued a 21.31 current permit, license, or registration certificate to practice 21.32 as a nurse in this state; and 21.33 (11) knowingly employ a person in advanced practice 21.34 registered nursing unless the person meets the standards and 21.35 practices of sections 148.171 to 148.285. 21.36 Sec. 13. Minnesota Statutes 1998, section 148.283, is 22.1 amended to read: 22.2 148.283 [UNAUTHORIZED PRACTICE OF PROFESSIONAL, ADVANCED 22.3 PRACTICE REGISTERED, AND PRACTICAL NURSING.] 22.4 The practice of professional, advanced practice registered, 22.5 or practical nursing by any person who has not been licensed to 22.6 practice professional or practical nursing under the provisions 22.7 of sections 148.171 to 148.285, or whose license has been 22.8 suspended or revoked, or whose registration or national 22.9 credential has expired, is hereby declared to be inimical to the 22.10 public health and welfare and to constitute a public nuisance. 22.11 Upon complaint being made thereof by the board, or any 22.12 prosecuting officer, and upon a proper showing of the facts, the 22.13 district court of the county where such practice occurred may 22.14 enjoin such acts and practice. Such injunction proceeding shall 22.15 be in addition to, and not in lieu of, all other penalties and 22.16 remedies provided by law. 22.17 Sec. 14. [148.284] [CERTIFICATION OF ADVANCED PRACTICE 22.18 REGISTERED NURSES.] 22.19 (a) No person shall practice advanced practice registered 22.20 nursing or use any title, abbreviation, or other designation 22.21 tending to imply that the person is an advanced practice 22.22 registered nurse, clinical nurse specialist, nurse anesthetist, 22.23 nurse midwife, or nurse practitioner unless the person is 22.24 certified for such advanced practice registered nursing by a 22.25 national nurse certification organization. 22.26 (b) Paragraph (a) does not apply to an advanced practice 22.27 registered nurse who is within six months after completion of an 22.28 advanced practice registered nurse course of study and is 22.29 awaiting certification. 22.30 (c) An advanced practice registered nurse who has completed 22.31 a formal course of study as an advanced practice registered 22.32 nurse and has been certified by a national nurse certification 22.33 organization prior to January 1, 1999, may continue to practice 22.34 in the field of nursing in which the advanced practice 22.35 registered nurse is practicing as of July 1, 1999, regardless of 22.36 the type of certification held if the advanced practice 23.1 registered nurse is not eligible for the proper certification. 23.2 Sec. 15. Minnesota Statutes 1998, section 245.462, 23.3 subdivision 18, is amended to read: 23.4 Subd. 18. [MENTAL HEALTH PROFESSIONAL.] "Mental health 23.5 professional" means a person providing clinical services in the 23.6 treatment of mental illness who is qualified in at least one of 23.7 the following ways: 23.8 (1) in psychiatric nursing: a registered nurse who is 23.9 licensed under sections 148.171 to 148.285, and who is certified 23.10 as a clinical specialist in adult psychiatric and mental health 23.11 nursing bythe American nurses associationa national nurse 23.12 certification organization or who has a master's degree in 23.13 nursing or one of the behavioral sciences or related fields from 23.14 an accredited college or university or its equivalent, with at 23.15 least 4,000 hours of post-master's supervised experience in the 23.16 delivery of clinical services in the treatment of mental 23.17 illness; 23.18 (2) in clinical social work: a person licensed as an 23.19 independent clinical social worker under section 148B.21, 23.20 subdivision 6, or a person with a master's degree in social work 23.21 from an accredited college or university, with at least 4,000 23.22 hours of post-master's supervised experience in the delivery of 23.23 clinical services in the treatment of mental illness; 23.24 (3) in psychology: a psychologist licensed under sections 23.25 148.88 to 148.98 who has stated to the board of psychology 23.26 competencies in the diagnosis and treatment of mental illness; 23.27 (4) in psychiatry: a physician licensed under chapter 147 23.28 and certified by the American board of psychiatry and neurology 23.29 or eligible for board certification in psychiatry; 23.30 (5) in marriage and family therapy: the mental health 23.31 professional must be a marriage and family therapist licensed 23.32 under sections 148B.29 to 148B.39 with at least two years of 23.33 post-master's supervised experience in the delivery of clinical 23.34 services in the treatment of mental illness; or 23.35 (6) in allied fields: a person with a master's degree from 23.36 an accredited college or university in one of the behavioral 24.1 sciences or related fields, with at least 4,000 hours of 24.2 post-master's supervised experience in the delivery of clinical 24.3 services in the treatment of mental illness. 24.4 Sec. 16. Minnesota Statutes 1998, section 245.4871, 24.5 subdivision 27, is amended to read: 24.6 Subd. 27. [MENTAL HEALTH PROFESSIONAL.] "Mental health 24.7 professional" means a person providing clinical services in the 24.8 diagnosis and treatment of children's emotional disorders. A 24.9 mental health professional must have training and experience in 24.10 working with children consistent with the age group to which the 24.11 mental health professional is assigned. A mental health 24.12 professional must be qualified in at least one of the following 24.13 ways: 24.14 (1) in psychiatric nursing, the mental health professional 24.15 must be a registered nurse who is licensed under sections 24.16 148.171 to 148.285 and who is certified as a clinical specialist 24.17 in child and adolescent psychiatric or mental health nursing by 24.18the American nurses associationa national nurse certification 24.19 organization or who has a master's degree in nursing or one of 24.20 the behavioral sciences or related fields from an accredited 24.21 college or university or its equivalent, with at least 4,000 24.22 hours of post-master's supervised experience in the delivery of 24.23 clinical services in the treatment of mental illness; 24.24 (2) in clinical social work, the mental health professional 24.25 must be a person licensed as an independent clinical social 24.26 worker under section 148B.21, subdivision 6, or a person with a 24.27 master's degree in social work from an accredited college or 24.28 university, with at least 4,000 hours of post-master's 24.29 supervised experience in the delivery of clinical services in 24.30 the treatment of mental disorders; 24.31 (3) in psychology, the mental health professional must be a 24.32 psychologist licensed under sections 148.88 to 148.98 who has 24.33 stated to the board of psychology competencies in the diagnosis 24.34 and treatment of mental disorders; 24.35 (4) in psychiatry, the mental health professional must be a 24.36 physician licensed under chapter 147 and certified by the 25.1 American board of psychiatry and neurology or eligible for board 25.2 certification in psychiatry; 25.3 (5) in marriage and family therapy, the mental health 25.4 professional must be a marriage and family therapist licensed 25.5 under sections 148B.29 to 148B.39 with at least two years of 25.6 post-master's supervised experience in the delivery of clinical 25.7 services in the treatment of mental disorders or emotional 25.8 disturbances; or 25.9 (6) in allied fields, the mental health professional must 25.10 be a person with a master's degree from an accredited college or 25.11 university in one of the behavioral sciences or related fields, 25.12 with at least 4,000 hours of post-master's supervised experience 25.13 in the delivery of clinical services in the treatment of 25.14 emotional disturbances. 25.15 Sec. 17. [TRANSITION.] 25.16 The board of nursing may, for the purpose of obtaining the 25.17 proper certification, grant an extension of not more than three 25.18 years to a registered nurse who on July 1, 1999, has completed a 25.19 formal course of study as an advanced practice registered nurse 25.20 and is practicing as an advanced practice registered nurse, but 25.21 who is either practicing in a field of nursing in which a 25.22 national nurse certification does not yet exist or is qualified 25.23 for the proper certification but has not yet sought it. 25.24 Sec. 18. [REVISOR INSTRUCTION.] 25.25 The revisor shall alphabetize and place into subdivisions 25.26 the definitions in Minnesota Statutes, section 148.171, 25.27 subdivision 2. 25.28 Sec. 19. [REPEALER.] 25.29 Minnesota Rules, chapter 6340, is repealed. 25.30 Sec. 20. [EFFECTIVE DATE.] 25.31 Sections 1 to 17 are effective July 1, 1999.