Minnesota Session Laws - 1999, Regular Session

                            CHAPTER 172-H.F.No. 718 
                  An act relating to professions; regulating advanced 
                  practice registered nursing; amending Minnesota 
                  Statutes 1998, sections 62A.15, subdivision 3a; 
                  148.171; 148.191, subdivision 2; 148.235; 148.261, 
                  subdivisions 1 and 5; 148.262, subdivision 1; 148.263, 
                  subdivisions 3 and 4; 148.271; 148.281, subdivision 1; 
                  148.283; 245.462, subdivision 18; and 245.4871, 
                  subdivision 27; proposing coding for new law in 
                  Minnesota Statutes, chapter 148; repealing Minnesota 
                  Rules, chapter 6340. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 1998, section 62A.15, 
        subdivision 3a, is amended to read: 
           Subd. 3a.  [NURSING SERVICES.] All benefits provided by a 
        policy or contract referred to in subdivision 1, relating to 
        expenses incurred for medical treatment or services of a duly 
        licensed physician must include services provided by a 
        registered nurse who is licensed pursuant to section 148.171 and 
        who is certified by the profession to engage in as an advanced 
        nursing practice registered nurse.  "Advanced nursing practice 
        registered nurse" means the performance of health services by 
        professional nurses who have gained additional knowledge and 
        skills through an organized program of study and clinical 
        experience preparing nurses for advanced practice roles as nurse 
        anesthetists, nurse midwives, nurse practitioners, or clinical 
        specialists in psychiatric or mental health nursing.  The 
        program of study must be beyond the education required for 
        registered nurse licensure and must meet criteria established by 
        the professional nursing organization having authority to 
        certify the registered nurse in advanced nursing practice.  For 
        the purposes of this subdivision, the board of nursing shall, by 
        rule, adopt a list of professional nursing organizations which 
        have the authority to certify nurses in advanced nursing 
        practice has the meaning given in section 148.171, subdivision 
        2, paragraph (4).  The advanced practice registered nurse must 
        meet the requirements of sections 148.171 to 148.285.  
           This subdivision is intended to provide payment of benefits 
        for treatment and services by a licensed registered nurse 
        certified in advanced nursing practice an advanced practice 
        registered nurse as defined in this subdivision and is not 
        intended to add to the benefits provided for in these policies 
        or contracts. 
           Sec. 2.  Minnesota Statutes 1998, section 148.171, is 
        amended to read: 
           148.171 [DEFINITIONS; TITLE.] 
           Subdivision 1.  [TITLE.] Sections 148.171 to 148.285 shall 
        be referred to as the Minnesota Nurse Practice Act. 
           Subd. 2.  [SCOPE.] As used in sections 148.171 to 148.285:, 
        the definitions in this section have the meanings given. 
           (1) "Board" means the Minnesota board of nursing. 
           (2) "Registered nurse," abbreviated R.N., means an 
        individual licensed by the board to practice professional 
        nursing.  
           (3) The "practice of professional nursing" means the 
        performance for compensation or personal profit of the 
        professional interpersonal service of:  (a) providing a nursing 
        assessment of the actual or potential health needs of 
        individuals, families, or communities; (b) providing nursing 
        care supportive to or restorative of life by functions such as 
        skilled ministration of nursing care, supervising and teaching 
        nursing personnel, health teaching and counseling, case finding, 
        and referral to other health resources; and (c) evaluating these 
        actions.  The practice of professional nursing includes both 
        independent nursing functions and delegated medical functions 
        which may be performed in collaboration with other health team 
        members, or may be delegated by the professional nurse to other 
        nursing personnel.  Independent nursing function may also be 
        performed autonomously.  The practice of professional nursing 
        requires that level of special education, knowledge, and skill 
        ordinarily expected of an individual who has completed an 
        approved professional nursing education program as described in 
        section 148.211, subdivision 1.  
           (4) "Advanced practice registered nurse," abbreviated APRN, 
        means an individual licensed as a 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. 
           (5) The "practice of advanced practice registered nursing" 
        means the performance of clinical nurse specialist practice, 
        nurse-midwife practice, nurse practitioner practice, or 
        registered nurse anesthetist practice as defined in paragraphs 
        (6), (9), (10), and (12).  The practice includes functioning as 
        a direct care provider, case manager, consultant, educator, and 
        researcher.  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. 
           (6) "Clinical nurse specialist practice" means the 
        provision of patient care in a particular specialty or 
        subspecialty of advanced practice registered nursing within the 
        context of collaborative management, and includes:  (i) 
        diagnosing illness and disease; (ii) providing nonpharmacologic 
        treatment, including psychotherapy; (iii) promoting wellness; 
        and (iv) 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.  
           (7) "Collaborative management" is a mutually agreed upon 
        plan between an advanced practice registered nurse and one or 
        more physicians or surgeons licensed under chapter 147 that 
        designates the scope of collaboration necessary to manage the 
        care of patients.  The advanced practice registered nurse and 
        the one or more physicians must have experience in providing 
        care to patients with the same or similar medical problems, 
        except that certified registered nurse anesthetists may continue 
        to provide anesthesia in collaboration with physicians, 
        including surgeons, podiatrists licensed under chapter 153, and 
        dentists licensed under chapter 150A.  Certified registered 
        nurse anesthetists must provide anesthesia services at the same 
        hospital, clinic, or health care setting as the physician, 
        surgeon, podiatrist, or dentist. 
           (8) "Consultation" means the process in which an advanced 
        practice registered nurse who maintains primary management 
        responsibility for a patient's care seeks advice or opinion of a 
        physician or another member of the health care team. 
           (9) "Nurse-midwife practice" means 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.  
           (10) "Nurse practitioner practice" means, within the 
        context of collaborative management:  (i) diagnosing, directly 
        managing, and preventing acute and chronic illness and disease; 
        and (ii) 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.  
           (11) "Referral" means the process in which an advanced 
        practice registered nurse directs a patient to a physician or 
        another health care professional for management of a particular 
        problem or aspect of the patient's care. 
           (12) "Registered nurse anesthetist practice" means the 
        provision of anesthesia care and related services within the 
        context of collaborative management, including selecting, 
        obtaining, and administering drugs and therapeutic devices to 
        facilitate diagnostic, therapeutic, and surgical procedures upon 
        request, assignment, or referral by a patient's physician, 
        dentist, or podiatrist.  
           (13) "Registered nurse, certified," abbreviated RN,C, means 
        a registered nurse who has received certification from a 
        national nursing organization or national nurse certification 
        organization for practice according to paragraph (3) in a 
        specialized field of professional nursing.  A registered nurse, 
        certified, shall not practice advanced practice registered 
        nursing as described in paragraph (5), (6), (9), (10), or (12). 
           (4) (14) "Licensed practical nurse," abbreviated L.P.N., 
        means an individual licensed by the board to practice practical 
        nursing. 
           (5) (15) The "practice of practical nursing" means the 
        performance for compensation or personal profit of any of those 
        services in observing and caring for the ill, injured, or 
        infirm, in applying counsel and procedure to safeguard life and 
        health, in administering medication and treatment prescribed by 
        a licensed health professional, which are commonly performed by 
        licensed practical nurses and which require specialized 
        knowledge and skill such as are taught or acquired in an 
        approved school of practical nursing, but which do not require 
        the specialized education, knowledge, and skill of a registered 
        nurse. 
           (6) (16) "Nurse" means registered nurse, advanced practice 
        registered nurse, and licensed practical nurse unless the 
        context clearly refers to only one category. 
           (7) (17) "Nursing assistant" means an individual providing 
        nursing or nursing-related services that do not require the 
        specialized knowledge and skill of a nurse, at the direction of 
        a nurse, but does not include a licensed health professional or 
        an individual who volunteers to provide such services without 
        monetary compensation. 
           (8) (18) "Public health nurse" means a registered nurse who 
        meets the voluntary registration requirements established by the 
        board by rule.  
           (19) "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 perioperatively by a certified registered 
        nurse anesthetist. 
           (20) "Prescription" means a written direction or an oral 
        direction reduced to writing provided to or for an individual 
        patient for the preparation or use of a drug or therapeutic 
        device. 
           Sec. 3.  Minnesota Statutes 1998, 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 
        professional or practical nursing and all registered nurses who 
        hold Minnesota licensure and registration and are certified as 
        advanced practice registered nurses.  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.  Prior to the adoption of rules, the board 
        shall use the same procedures used by the department of health 
        to certify public health nurses.  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. 
           Sec. 4.  [148.233] [IDENTIFICATION OF CERTIFIED REGISTERED 
        NURSES.] 
           Subdivision 1.  [REGISTERED NURSE.] A registered nurse 
        certified in a specialized field of professional nursing as 
        described in section 148.171, subdivision 2, paragraph (13), 
        shall use the designation RN,C for personal identification and 
        in documentation of services provided.  Identification of 
        educational degrees and specialty fields may be added. 
           Subd. 2.  [ADVANCED PRACTICE REGISTERED NURSE.] 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. 
           Sec. 5.  Minnesota Statutes 1998, section 148.235, is 
        amended to read: 
           148.235 [PRESCRIBING DRUGS AND THERAPEUTIC DEVICES.] 
           Subdivision 1.  [CERTIFIED NURSE-MIDWIVES.] A registered 
        nurse who has graduated from a program of study designed to 
        prepare registered nurses for advanced practice as 
        nurse-midwives and who is certified through the national 
        professional nursing organization for nurse-midwives certified 
        nurse-midwife may prescribe and administer drugs and therapeutic 
        devices within practice as a certified nurse-midwife. 
           Subd. 2.  [CERTIFIED NURSE PRACTITIONERS.] A 
        registered certified nurse practitioner who (1) has graduated 
        from a program of study designed to prepare registered nurses 
        for advanced practice as nurse practitioners, (2) is certified 
        through a national professional nursing organization which 
        certifies nurse practitioners and is included in the list of 
        professional nursing organizations adopted by the board under 
        section 62A.15, subdivision 3a, and (3) has a written agreement 
        with a physician based on standards established by the Minnesota 
        Nurses Association and the Minnesota Medical Association that 
        defines the delegated responsibilities related to the 
        prescription of drugs and therapeutic devices, may prescribe and 
        administer drugs and therapeutic devices within the scope of the 
        written agreement and within practice as a certified nurse 
        practitioner.  The written agreement required under this 
        subdivision shall be based on standards established by the 
        Minnesota Nurses Association and the Minnesota Medical 
        Association as of January 1, 1996, unless both associations 
        agree to revisions.  The written agreement shall be maintained 
        at the certified nurse practitioner's place of employment and 
        does not need to be filed with the board of nursing. 
           Subd. 2a.  [CERTIFIED REGISTERED NURSE ANESTHETISTS.] A 
        certified registered nurse anesthetist who has a written 
        agreement with a physician based on standards established by the 
        Minnesota Nurses Association and the Minnesota Medical 
        Association that defines the delegated responsibilities related 
        to the prescription of drugs and therapeutic devices, may 
        prescribe and administer drugs and therapeutic devices within 
        the scope of the written agreement and within practice as a 
        certified registered nurse anesthetist. 
           Subd. 3.  [DISPENSING AUTHORITY.] An advanced practice 
        nurse who is authorized under this section to prescribe drugs is 
        authorized to dispense drugs subject to the same requirements 
        established for the prescribing of drugs.  This authority to 
        dispense extends only to those drugs described in the written 
        agreement entered into under this section.  The authority to 
        dispense includes, but is not limited to, the authority to 
        receive and dispense sample drugs. 
           Subd. 4.  [CERTIFIED CLINICAL NURSE SPECIALISTS IN 
        PSYCHIATRIC AND MENTAL HEALTH NURSING.] A registered nurse 
        certified clinical nurse specialist who (1) has a masters 
        degree, (2) is certified through a national professional nursing 
        organization which certifies clinical specialists in psychiatric 
        and mental health nursing and is included in the list of 
        professional nursing organizations adopted by the board under 
        section 62A.15, subdivision 3a, (3) has successfully completed 
        no less than 30 hours of formal study in the prescribing of 
        psychotropic medications and medications to treat their side 
        effects which included instruction in health assessment, 
        psychotropic classifications, psychopharmacology, indications, 
        dosages, contraindications, side effects, and evidence of 
        application,; and (4) (2) has a written agreement with a 
        psychiatrist or other physician based on standards established 
        by the Minnesota Nurses Association and the Minnesota 
        Psychiatric Association that specifies and defines the delegated 
        responsibilities related to the prescription of drugs in 
        relationship to the diagnosis, may prescribe and administer 
        drugs used to treat psychiatric and behavioral disorders and the 
        side effects of those drugs within the scope of the written 
        agreement and within practice as a certified clinical nurse 
        specialist in psychiatric and mental health nursing.  The 
        written agreement required under this subdivision shall be based 
        on standards established by the Minnesota Nurses Association and 
        the Minnesota Psychiatric Association as of January 1, 1996, 
        unless both associations agree to revisions.  The written 
        agreement shall be maintained at the certified clinical nurse 
        specialist's place of employment and does not need to be filed 
        with the board of nursing. 
           Nothing in this subdivision removes or limits the legal 
        professional liability of the treating psychiatrist, certified 
        clinical nurse specialist, mental health clinic or hospital for 
        the prescription and administration of drugs by a certified 
        clinical nurse specialist in accordance with this subdivision. 
           Subd. 4a.  [OTHER CERTIFIED CLINICAL NURSE SPECIALISTS.] A 
        certified clinical nurse specialist who:  (1) has successfully 
        completed no less than 30 hours of formal study from a college, 
        university, or university health care institution, which 
        included the following:  instruction in health assessment, 
        medication classifications, indications, dosages, 
        contraindications, and side effects; supervised practice; and 
        competence evaluation, including evidence of the application of 
        knowledge pertaining to prescribing for and therapeutic 
        management of the clinical type of patients in the certified 
        clinical nurse specialist's practice; and (2) has a written 
        agreement with a physician based on standards established by the 
        Minnesota Nurses Association and the Minnesota Medical 
        Association that defines the delegated responsibilities related 
        to the prescription of drugs and therapeutic devices, may 
        prescribe and administer drugs and therapeutic devices within 
        the scope of the written agreement and within practice as a 
        certified clinical nurse specialist. 
           Subd. 4b.  [DISPENSING AUTHORITY.] An advanced practice 
        registered nurse who is authorized under this section to 
        prescribe drugs is authorized to dispense drugs subject to the 
        same requirements established for the prescribing of drugs.  
        This authority to dispense extends only to those drugs described 
        in the written agreement entered into under this section.  The 
        authority to dispense includes, but is not limited to, the 
        authority to receive and dispense sample drugs. 
           Subd. 5.  [RULES.] (a) The board shall promulgate rules to 
        provide for the following: 
           (1) a system of identifying advanced practice nurses 
        eligible to prescribe drugs as authorized under this section; 
           (2) a system of transmitting to pharmacists the identity of 
        advanced practice nurses eligible to prescribe drugs; and 
           (3) a fee to nurse practitioners and certified clinical 
        specialists in psychiatric and mental health nursing who seek 
        prescribing authority. 
           (b) The repeal of subdivision 2, paragraph (b), does not 
        automatically repeal rules adopted under that paragraph. 
           Subd. 6.  [STANDARDS FOR WRITTEN AGREEMENTS; REVIEW AND 
        FILING.] Written agreements required by subdivisions 2 and 4 
        under this section shall be maintained at the primary practice 
        site of the nurse practitioner, clinical specialist in 
        psychiatric and mental health nursing, advanced practice 
        registered nurse and of the collaborating physician.  The 
        written agreement does not need to be filed with the board of 
        nursing, provided that the information required to be filed with 
        the board, either on initial application for prescribing 
        privileges or on renewal of privileges, has been submitted or 
        the board of medical practice. 
           Subd. 7.  [FEDERAL REGISTRATION.] Any advanced practice 
        registered nurse who applies to the federal Drug Enforcement 
        Administration for a registration number shall submit to the 
        board: 
           (1) proof that requirements of this section are met; and 
           (2) a processing fee of $50. 
           Sec. 6.  Minnesota Statutes 1998, 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 professional, advanced 
        practice registered, 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 professional 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 during the previous five years 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 2, 
        paragraph (3) or (5) (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. 
           (8) (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.  
           (9) (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.  
           (10) (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.  
           (11) (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.  
           (12) (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. 
           (13) (14) Revealing a privileged communication from or 
        relating to a patient except when otherwise required or 
        permitted by law. 
           (14) (15) Engaging in abusive or fraudulent billing 
        practices, including violations of federal Medicare and Medicaid 
        laws or state medical assistance laws. 
           (15) (16) Improper management of patient records, including 
        failure to maintain adequate patient records, to comply with a 
        patient's request made pursuant to section 144.335, or to 
        furnish a patient record or report required by law.  
           (16) (17) Knowingly aiding, assisting, advising, or 
        allowing an unlicensed person to engage in the unlawful practice 
        of professional, advanced practice registered, or practical 
        nursing.  
           (17) (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. 
           (18) (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. 
           (19) (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. 
           (20) (21) Practicing outside the scope of practice 
        authorized by section 148.171, subdivision 2, paragraph (3) 
        or, (5), (6), (9), (10), (12), or (15). 
           (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. 
           (21) (23) 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. 
           (22) (24) Engaging in false, fraudulent, deceptive, or 
        misleading advertising.  
           (25) Failure to inform the board of the person's 
        certification status as a nurse anesthetist, nurse-midwife, 
        nurse practitioner, or clinical nurse specialist. 
           (26) 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, 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. 
           (27) Engaging in conduct that is prohibited under section 
        145.412. 
           Sec. 7.  Minnesota Statutes 1998, section 148.261, 
        subdivision 5, is amended to read: 
           Subd. 5.  [EXAMINATION; ACCESS TO MEDICAL DATA.] The board 
        may take the following actions if it has probable cause to 
        believe that grounds for disciplinary action exist under 
        subdivision 1, clause (8) (9) or (9) (10): 
           (a) It may direct the applicant or nurse to submit to a 
        mental or physical examination or chemical dependency 
        evaluation.  For the purpose of this subdivision, when a nurse 
        licensed under sections 148.171 to 148.285 is directed in 
        writing by the board to submit to a mental or physical 
        examination or chemical dependency evaluation, that person is 
        considered to have consented and to have waived all objections 
        to admissibility on the grounds of privilege.  Failure of the 
        applicant or nurse to submit to an examination when directed 
        constitutes an admission of the allegations against the 
        applicant or nurse, unless the failure was due to circumstances 
        beyond the person's control, and the board may enter a default 
        and final order without taking testimony or allowing evidence to 
        be presented.  A nurse affected under this paragraph shall, at 
        reasonable intervals, be given an opportunity to demonstrate 
        that the competent practice of professional, advanced practice 
        registered, or practical nursing can be resumed with reasonable 
        skill and safety to patients.  Neither the record of proceedings 
        nor the orders entered by the board in a proceeding under this 
        paragraph, may be used against a nurse in any other proceeding. 
           (b) It may, notwithstanding sections 13.42, 144.651, 
        595.02, or any other law limiting access to medical or other 
        health data, obtain medical data and health records relating to 
        a registered nurse, advanced practice registered nurse, licensed 
        practical nurse, or applicant for a license without that 
        person's consent.  The medical data may be requested from a 
        provider, as defined in section 144.335, subdivision 1, 
        paragraph (b), an insurance company, or a government agency, 
        including the department of human services.  A provider, 
        insurance company, or government agency shall comply with any 
        written request of the board under this subdivision and is not 
        liable in any action for damages for releasing the data 
        requested by the board if the data are released pursuant to a 
        written request under this subdivision unless the information is 
        false and the provider giving the information knew, or had 
        reason to believe, the information was false.  Information 
        obtained under this subdivision is classified as private data on 
        individuals as defined in section 13.02.  
           Sec. 8.  Minnesota Statutes 1998, 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 
        professional, advanced practice registered, 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. 9.  Minnesota Statutes 1998, section 148.263, 
        subdivision 3, is amended to read: 
           Subd. 3.  [LICENSED PROFESSIONALS.] A person licensed by a 
        health-related licensing board as defined in section 214.01, 
        subdivision 2, shall report to the board personal knowledge of 
        any conduct the person reasonably believes constitutes grounds 
        for disciplinary action under sections 148.171 to 148.285 by any 
        nurse including conduct indicating that the nurse may be 
        incompetent, may have engaged in unprofessional or unethical 
        conduct, or may be mentally or physically unable to engage 
        safely in the practice of professional, advanced practice 
        registered, or practical nursing. 
           Sec. 10.  Minnesota Statutes 1998, section 148.263, 
        subdivision 4, is amended to read: 
           Subd. 4.  [INSURERS.] Four times each year, by the first 
        day of February, May, August, and November, each insurer 
        authorized to sell insurance described in section 60A.06, 
        subdivision 1, clause (13), and providing professional liability 
        insurance to registered nurses, advanced practice registered 
        nurses, or licensed practical nurses shall submit to the board a 
        report concerning any nurse against whom a malpractice award has 
        been made or who has been a party to a settlement.  The report 
        must contain at least the following information: 
           (1) the total number of settlements or awards; 
           (2) the date settlement or award was made; 
           (3) the allegations contained in the claim or complaint 
        leading to the settlement or award; 
           (4) the dollar amount of each malpractice settlement or 
        award and whether that amount was paid as a result of a 
        settlement or of an award; and 
           (5) the name and address of the practice of the nurse 
        against whom an award was made or with whom a settlement was 
        made. 
           An insurer shall also report to the board any information 
        it possesses that tends to substantiate a charge that a nurse 
        may have engaged in conduct violating sections 148.171 to 
        148.285. 
           Sec. 11.  Minnesota Statutes 1998, 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 professional or practical nursing by 
        any legally qualified registered 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 professional 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, subdivision 2, paragraphs (5), (6), (9), (10), 
        and (12), 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 education program 
        leading to eligibility for certification as an advanced practice 
        registered nurse; 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. 
           Sec. 12.  Minnesota Statutes 1998, 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 professional or practical nursing or, practice 
        as a public health nurse, or practice as a certified clinical 
        nurse specialist, certified nurse-midwife, certified nurse 
        practitioner, or certified registered nurse anesthetist 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 professional 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 any abbreviation or other designation tending to 
        imply licensure as a registered nurse or licensed practical 
        nurse unless duly licensed and currently registered so to 
        practice professional or practical nursing under the provisions 
        of sections 148.171 to 148.285 except as authorized by the board 
        by rule; 
           (5) use any title, abbreviation, or other designation 
        tending to imply certification as a certified registered nurse 
        as defined in section 148.171, subdivision 2, paragraph (13), 
        unless duly certified by a national nurse certification 
        organization; 
           (6) use any abbreviation or other designation tending to 
        imply registration as a public health nurse unless duly 
        registered by the board; 
           (6) (7) practice professional, advanced practice 
        registered, 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; 
           (7) (8) practice professional, advanced practice 
        registered, 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; 
           (8) (9) conduct a nursing program for the education of 
        persons to become registered nurses or licensed practical nurses 
        unless the program has been approved by the board; and 
           (9) (10) knowingly employ persons in the practice of 
        professional or practical nursing who have not been issued a 
        current permit, license, or registration certificate to practice 
        as a nurse in this state; and 
           (11) knowingly employ a person in advanced practice 
        registered nursing unless the person meets the standards and 
        practices of sections 148.171 to 148.285. 
           Sec. 13.  Minnesota Statutes 1998, section 148.283, is 
        amended to read: 
           148.283 [UNAUTHORIZED PRACTICE OF PROFESSIONAL, ADVANCED 
        PRACTICE REGISTERED, AND PRACTICAL NURSING.] 
           The practice of professional, advanced practice registered, 
        or practical nursing by any person who has not been licensed to 
        practice professional or practical nursing under the provisions 
        of sections 148.171 to 148.285, or whose license has been 
        suspended or revoked, or whose registration or national 
        credential has expired, is hereby declared to be inimical to the 
        public health and welfare and to constitute a public nuisance.  
        Upon complaint being made thereof by the board, or any 
        prosecuting officer, and upon a proper showing of the facts, the 
        district court of the county where such practice occurred may 
        enjoin such acts and practice.  Such injunction proceeding shall 
        be in addition to, and not in lieu of, all other penalties and 
        remedies provided by law.  
           Sec. 14.  [148.284] [CERTIFICATION OF ADVANCED PRACTICE 
        REGISTERED NURSES.] 
           (a) No person shall practice advanced practice registered 
        nursing or use any title, abbreviation, or other designation 
        tending to imply that the person is an advanced practice 
        registered nurse, clinical nurse specialist, nurse anesthetist, 
        nurse-midwife, or nurse practitioner unless the person is 
        certified for such advanced practice registered nursing by a 
        national nurse certification organization. 
           (b) Paragraph (a) does not apply to an advanced practice 
        registered nurse who is within six months after completion of an 
        advanced practice registered nurse course of study and is 
        awaiting certification.  
           (c) An advanced practice registered nurse who has completed 
        a formal course of study as an advanced practice registered 
        nurse and has been certified by a national nurse certification 
        organization prior to January 1, 1999, may continue to practice 
        in the field of nursing in which the advanced practice 
        registered nurse is practicing as of July 1, 1999, regardless of 
        the type of certification held if the advanced practice 
        registered nurse is not eligible for the proper certification. 
           Sec. 15.  Minnesota Statutes 1998, section 245.462, 
        subdivision 18, is amended to read: 
           Subd. 18.  [MENTAL HEALTH PROFESSIONAL.] "Mental health 
        professional" means a person providing clinical services in the 
        treatment of mental illness who is qualified in at least one of 
        the following ways:  
           (1) in psychiatric nursing:  a registered nurse who is 
        licensed under sections 148.171 to 148.285, and who is certified 
        as a clinical specialist in adult psychiatric and mental health 
        nursing by the American nurses association a national nurse 
        certification organization or who has a master's degree in 
        nursing or one of the behavioral sciences or related fields from 
        an accredited college or university or its equivalent, with at 
        least 4,000 hours of post-master's supervised experience in the 
        delivery of clinical services in the treatment of mental 
        illness; 
           (2) in clinical social work:  a person licensed as an 
        independent clinical social worker under section 148B.21, 
        subdivision 6, or a person with a master's degree in social work 
        from an accredited college or university, with at least 4,000 
        hours of post-master's supervised experience in the delivery of 
        clinical services in the treatment of mental illness; 
           (3) in psychology:  a psychologist licensed under sections 
        148.88 to 148.98 who has stated to the board of psychology 
        competencies in the diagnosis and treatment of mental illness; 
           (4) in psychiatry:  a physician licensed under chapter 147 
        and certified by the American board of psychiatry and neurology 
        or eligible for board certification in psychiatry; 
           (5) in marriage and family therapy:  the mental health 
        professional must be a marriage and family therapist licensed 
        under sections 148B.29 to 148B.39 with at least two years of 
        post-master's supervised experience in the delivery of clinical 
        services in the treatment of mental illness; or 
           (6) in allied fields:  a person with a master's degree from 
        an accredited college or university in one of the behavioral 
        sciences or related fields, with at least 4,000 hours of 
        post-master's supervised experience in the delivery of clinical 
        services in the treatment of mental illness.  
           Sec. 16.  Minnesota Statutes 1998, section 245.4871, 
        subdivision 27, is amended to read: 
           Subd. 27.  [MENTAL HEALTH PROFESSIONAL.] "Mental health 
        professional" means a person providing clinical services in the 
        diagnosis and treatment of children's emotional disorders.  A 
        mental health professional must have training and experience in 
        working with children consistent with the age group to which the 
        mental health professional is assigned.  A mental health 
        professional must be qualified in at least one of the following 
        ways:  
           (1) in psychiatric nursing, the mental health professional 
        must be a registered nurse who is licensed under sections 
        148.171 to 148.285 and who is certified as a clinical specialist 
        in child and adolescent psychiatric or mental health nursing by 
        the American nurses association a national nurse certification 
        organization or who has a master's degree in nursing or one of 
        the behavioral sciences or related fields from an accredited 
        college or university or its equivalent, with at least 4,000 
        hours of post-master's supervised experience in the delivery of 
        clinical services in the treatment of mental illness; 
           (2) in clinical social work, the mental health professional 
        must be a person licensed as an independent clinical social 
        worker under section 148B.21, subdivision 6, or a person with a 
        master's degree in social work from an accredited college or 
        university, with at least 4,000 hours of post-master's 
        supervised experience in the delivery of clinical services in 
        the treatment of mental disorders; 
           (3) in psychology, the mental health professional must be a 
        psychologist licensed under sections 148.88 to 148.98 who has 
        stated to the board of psychology competencies in the diagnosis 
        and treatment of mental disorders; 
           (4) in psychiatry, the mental health professional must be a 
        physician licensed under chapter 147 and certified by the 
        American board of psychiatry and neurology or eligible for board 
        certification in psychiatry; 
           (5) in marriage and family therapy, the mental health 
        professional must be a marriage and family therapist licensed 
        under sections 148B.29 to 148B.39 with at least two years of 
        post-master's supervised experience in the delivery of clinical 
        services in the treatment of mental disorders or emotional 
        disturbances; or 
           (6) in allied fields, the mental health professional must 
        be a person with a master's degree from an accredited college or 
        university in one of the behavioral sciences or related fields, 
        with at least 4,000 hours of post-master's supervised experience 
        in the delivery of clinical services in the treatment of 
        emotional disturbances. 
           Sec. 17.  [TRANSITION.] 
           The board of nursing may, for the purpose of obtaining the 
        proper certification, grant an extension of not more than three 
        years to a registered nurse who on July 1, 1999, has completed a 
        formal course of study as an advanced practice registered nurse 
        and is practicing as an advanced practice registered nurse, but 
        who is either practicing in a field of nursing in which a 
        national nurse certification does not yet exist or is eligible 
        for the proper certification but has not yet obtained it. 
           Sec. 18.  [REVISOR INSTRUCTION.] 
           The revisor shall alphabetize and place into subdivisions 
        the definitions in Minnesota Statutes, section 148.171, 
        subdivision 2.  
           Sec. 19.  [REPEALER.] 
           Minnesota Rules, chapter 6340, is repealed. 
           Sec. 20.  [EFFECTIVE DATE.] 
           Sections 1 to 17 are effective July 1, 1999. 
           Presented to the governor May 13, 1999 
           Signed by the governor May 17, 1999, 4:39 p.m.