1     
NURSE ANESTHETIST PRESCRIBING AMENDMENTS

2     
2024 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Curtis S. Bramble

5     
House Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill modifies provisions related to nurse anesthetists.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     clarifies provisions regarding the authority of nurse anesthetists to prescribe;
14          ▸     removes provisions related to advance practice registered nurses that do no have
15     prescriptive authority; and
16          ▸     makes technical and conforming changes.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          58-31b-102, as last amended by Laws of Utah 2023, Chapters 223, 329
24          58-31b-301, as last amended by Laws of Utah 2022, Chapter 277
25          58-31b-803, as last amended by Laws of Utah 2023, Chapter 223
26     

27     Be it enacted by the Legislature of the state of Utah:
28          Section 1. Section 58-31b-102 is amended to read:
29          58-31b-102. Definitions.
30          In addition to the definitions in Section 58-1-102, as used in this chapter:
31          (1) "Administrative penalty" means a monetary fine or citation imposed by the division
32     for acts or omissions determined to be unprofessional or unlawful conduct in accordance with a
33     fine schedule established by division rule made in accordance with Title 63G, Chapter 3, Utah
34     Administrative Rulemaking Act, and as a result of an adjudicative proceeding conducted in
35     accordance with Title 63G, Chapter 4, Administrative Procedures Act.
36          (2) "Applicant" means an individual who applies for licensure or certification under
37     this chapter by submitting a completed application for licensure or certification and the
38     required fees to the department.
39          (3) "Approved education program" means a nursing education program that is
40     accredited by an accrediting body for nursing education that is approved by the United States
41     Department of Education.
42          (4) "Board" means the Board of Nursing created in Section 58-31b-201.
43          (5) "Diagnosis" means the identification of and discrimination between physical and
44     psychosocial signs and symptoms essential to the effective execution and management of
45     health care.
46          (6) "Examinee" means an individual who applies to take or does take any examination
47     required under this chapter for licensure.
48          (7) "Licensee" means an individual who is licensed or certified under this chapter.
49          (8) "Long-term care facility" means any of the following facilities licensed by the
50     Department of Health and Human Services pursuant to Title 26B, Chapter 2, Part 2, Health
51     Care Facility Licensing and Inspection:
52          (a) a nursing care facility;
53          (b) a small health care facility;
54          (c) an intermediate care facility for people with an intellectual disability;
55          (d) an assisted living facility Type I or II; or
56          (e) a designated swing bed unit in a general hospital.
57          (9) "Medication aide certified" means a certified nurse aide who:
58          (a) has a minimum of 2,000 hours experience working as a certified nurse aide;
59          (b) has received a minimum of 60 hours of classroom and 40 hours of practical training
60     that is approved by the division in collaboration with the board, in administering routine
61     medications to patients or residents of long-term care facilities; and
62          (c) is certified by the division as a medication aide certified.
63          (10) (a) "Practice as a medication aide certified" means the limited practice of nursing
64     under the supervision, as defined by the division by rule made in accordance with Title 63G,
65     Chapter 3, Utah Administrative Rulemaking Act, of a licensed nurse, involving routine patient
66     care that requires minimal or limited specialized or general knowledge, judgment, and skill, to
67     an individual who:
68          (i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
69     disability; and
70          (ii) is in a regulated long-term care facility.
71          (b) "Practice as a medication aide certified":
72          (i) includes:
73          (A) providing direct personal assistance or care; and
74          (B) administering routine medications to patients in accordance with a formulary and
75     protocols to be defined by the division by rule made in accordance with Title 63G, Chapter 3,
76     Utah Administrative Rulemaking Act; and
77          (ii) does not include assisting a resident of an assisted living facility, a long term care
78     facility, or an intermediate care facility for people with an intellectual disability to self
79     administer a medication, as regulated by the Department of Health and Human Services by rule
80     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
81          (11) (a) "The practice of administering anesthesia" means an advanced practice
82     registered nurse specializing as a certified registered nurse anesthetist selecting, administering,
83     or providing preoperative, intraoperative, and postoperative anesthesia care and related services
84     in accordance with Section 58-31b-803.
85          (b) "The practice of administering anesthesia" includes:
86          (i) preanesthesia preparation and evaluation including:
87          (A) performing a preanesthetic assessment of the patient;
88          (B) ordering and evaluating appropriate lab and other studies to determine the health of
89     the patient; and
90          (C) selecting, ordering, or administering appropriate medications;
91          (ii) anesthesia induction, maintenance, and emergence, including:
92          (A) selecting and initiating the planned anesthetic technique;
93          (B) selecting and administering anesthetics and adjunct drugs and fluids; and
94          (C) administering general, regional, and local anesthesia;
95          (iii) postanesthesia follow-up care, including:
96          (A) evaluating the patient's response to anesthesia and implementing corrective
97     actions; and
98          (B) selecting, ordering, or administering the medications and studies listed in this
99     subsection; and
100          (iv) other related services within the scope of practice of a certified registered nurse
101     anesthetist, including:
102          (A) emergency airway management;
103          (B) advanced cardiac life support; and
104          (C) the establishment of peripheral, central, and arterial invasive lines.
105          [(11)] (12) (a) "Practice of advanced practice registered nursing" means the practice of
106     nursing within the generally recognized scope and standards of advanced practice registered
107     nursing as defined by rule and consistent with professionally recognized preparation and
108     education standards of an advanced practice registered nurse by a person licensed under this
109     chapter as an advanced practice registered nurse.
110          (b) "Practice of advanced practice registered nursing" includes:
111          [(a)] (i) maintenance and promotion of health and prevention of disease;
112          [(b)] (ii) diagnosis, treatment, correction, consultation, and referral;
113          [(c)] (iii) prescription or administration of prescription drugs or devices including:
114          [(i)] (A) local anesthesia; and
115          [(ii)] (B) Schedule [III-V] II-V controlled substances; [and] or
116          [(iii) Schedule II controlled substances; or]
117          [(d)] (iv) [the provision of preoperative, intraoperative, and postoperative anesthesia
118     care and related services upon the request of a licensed health care professional by an advanced
119     practice registered nurse specializing as a certified registered nurse anesthetist, including:] the
120     practice of administering anesthesia by an advanced practice registered nurse specializing as a
121     certified registered nurse anesthetist.
122          [(i) preanesthesia preparation and evaluation including:]
123          [(A) performing a preanesthetic assessment of the patient;]
124          [(B) ordering and evaluating appropriate lab and other studies to determine the health
125     of the patient; and]
126          [(C) selecting, ordering, or administering appropriate medications;]
127          [(ii) anesthesia induction, maintenance, and emergence, including:]
128          [(A) selecting and initiating the planned anesthetic technique;]
129          [(B) selecting and administering anesthetics and adjunct drugs and fluids; and]
130          [(C) administering general, regional, and local anesthesia;]
131          [(iii) postanesthesia follow-up care, including:]
132          [(A) evaluating the patient's response to anesthesia and implementing corrective
133     actions; and]
134          [(B) selecting, ordering, or administering the medications and studies listed in this
135     Subsection (11)(d);]
136          [(iv) other related services within the scope of practice of a certified registered nurse
137     anesthetist, including:]
138          [(A) emergency airway management;]
139          [(B) advanced cardiac life support; and]
140          [(C) the establishment of peripheral, central, and arterial invasive lines; and]
141          [(v) for purposes of this Subsection (11)(d), "upon the request of a licensed health care
142     professional":]
143          [(A) means a health care professional practicing within the scope of the health care
144     professional's license, requests anesthesia services for a specific patient; and]
145          [(B) does not require an advanced practice registered nurse specializing as a certified
146     registered nurse anesthetist to obtain additional authority to select, administer, or provide
147     preoperative, intraoperative, or postoperative anesthesia care and services.]
148          [(12)] (13) "Practice of nursing" means assisting individuals or groups to maintain or
149     attain optimal health, implementing a strategy of care to accomplish defined goals and
150     evaluating responses to care and treatment, and requires substantial specialized or general
151     knowledge, judgment, and skill based upon principles of the biological, physical, behavioral,
152     and social sciences. "Practice of nursing" includes:
153          (a) initiating and maintaining comfort measures;
154          (b) promoting and supporting human functions and responses;
155          (c) establishing an environment conducive to well-being;
156          (d) providing health counseling and teaching;
157          (e) collaborating with health care professionals on aspects of the health care regimen;
158          (f) performing delegated procedures only within the education, knowledge, judgment,
159     and skill of the licensee;
160          (g) delegating nursing tasks that may be performed by others, including an unlicensed
161     assistive personnel; and
162          (h) supervising an individual to whom a task is delegated under Subsection [(12)(g)]
163     (13)(g) as the individual performs the task.
164          [(13)] (14) "Practice of practical nursing" means the performance of nursing acts in the
165     generally recognized scope of practice of licensed practical nurses as defined by division rule
166     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and as
167     provided in this Subsection [(13)] (14) by an individual licensed under this chapter as a
168     licensed practical nurse and under the direction of a registered nurse, licensed physician, or
169     other specified health care professional as defined by division rule made in accordance with
170     Title 63G, Chapter 3, Utah Administrative Rulemaking Act. Practical nursing acts include:
171          (a) contributing to the assessment of the health status of individuals and groups;
172          (b) participating in the development and modification of the strategy of care;
173          (c) implementing appropriate aspects of the strategy of care;
174          (d) maintaining safe and effective nursing care rendered to a patient directly or
175     indirectly; and
176          (e) participating in the evaluation of responses to interventions.
177          [(14)] (15) "Practice of registered nursing" means performing acts of nursing as
178     provided in this Subsection [(14)] (15) by an individual licensed under this chapter as a
179     registered nurse within the generally recognized scope of practice of registered nurses as
180     defined by division rule made in accordance with Title 63G, Chapter 3, Utah Administrative
181     Rulemaking Act. Registered nursing acts include:
182          (a) assessing the health status of individuals and groups;
183          (b) identifying health care needs;
184          (c) establishing goals to meet identified health care needs;
185          (d) planning a strategy of care;
186          (e) prescribing nursing interventions to implement the strategy of care;
187          (f) implementing the strategy of care;
188          (g) maintaining safe and effective nursing care that is rendered to a patient directly or
189     indirectly;
190          (h) evaluating responses to interventions;
191          (i) teaching the theory and practice of nursing; and
192          (j) managing and supervising the practice of nursing.
193          [(15)] (16) "Registered nurse apprentice" means an individual licensed under
194     Subsection 58-31b-301(2)(b) who is learning and engaging in the practice of registered nursing
195     under the indirect supervision of an individual licensed under:
196          (a) Subsection 58-31b-301(2)(c)[,] or (e)[, or (f)];
197          (b) Chapter 67, Utah Medical Practice Act; or
198          (c) Chapter 68, Utah Osteopathic Medical Practice Act.
199          [(16)] (17) "Routine medications":
200          (a) means established medications administered to a medically stable individual as
201     determined by a licensed health care practitioner or in consultation with a licensed medical
202     practitioner; and
203          (b) is limited to medications that are administered by the following routes:
204          (i) oral;
205          (ii) sublingual;
206          (iii) buccal;
207          (iv) eye;
208          (v) ear;
209          (vi) nasal;
210          (vii) rectal;
211          (viii) vaginal;
212          (ix) skin ointments, topical including patches and transdermal;
213          (x) premeasured medication delivered by aerosol/nebulizer; and
214          (xi) medications delivered by metered hand-held inhalers.
215          [(17)] (18) "Unlawful conduct" means the same as that term is defined in Sections
216     58-1-501 and 58-31b-501.
217          [(18)] (19) "Unlicensed assistive personnel" means any unlicensed individual,
218     regardless of title, who is delegated a task by a licensed nurse as permitted by division rule
219     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and the
220     standards of the profession.
221          [(19)] (20) "Unprofessional conduct" means the same as that term is defined in
222     Sections 58-1-501 and 58-31b-502 and as may be further defined by division rule made in
223     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
224          Section 2. Section 58-31b-301 is amended to read:
225          58-31b-301. License or certification required -- Classifications.
226          (1) A license is required to engage in the practice of nursing, except as specifically
227     provided in Sections 58-1-307 and 58-31b-308.
228          (2) The division shall issue to an individual who qualifies under this chapter a license
229     or certification in the classification of:
230          (a) licensed practical nurse;
231          (b) registered nurse apprentice;
232          (c) registered nurse;
233          (d) advanced practice registered nurse intern;
234          (e) advanced practice registered nurse; or
235          [(f) advanced practice registered nurse - CRNA without prescriptive practice; and]
236          [(g)] (f) medication aide certified.
237          (3) An individual holding an advanced practice registered nurse license as of July 1,
238     1998, who cannot document the successful completion of advanced course work in patient
239     assessment, diagnosis and treatment, and pharmacotherapeutics, may not prescribe and shall be
240     issued an "APRN - without prescriptive practice" license.
241          (4) The division shall grant an advanced practice registered nurse license to any
242     licensed advanced practice registered nurse currently holding prescriptive authority under any
243     predecessor act.
244          [(5) An individual holding a certified registered nurse anesthetist license as of July 1,
245     2007, shall be issued an "APRN - CRNA - without prescriptive practice" license.]
246          Section 3. Section 58-31b-803 is amended to read:
247          58-31b-803. Advanced practice registered nurse prescriptive authority --
248     Certified registered nurse anesthetists.
249          (1) Except as provided in Subsection (2), a licensed advanced practice registered nurse
250     may prescribe or administer a Schedule II controlled substance.
251          (2) [This section does not apply to an advanced practice registered nurse specializing as
252     a certified registered nurse anesthetist under Subsection 58-31b-102(11)(d)] Subsection (1)
253     does not require an advanced practice registered nurse specializing as a certified registered
254     nurse anesthetist to obtain any prescriptive authority to engage in the practice of administering
255     anesthesia.
256          (3) A licensed health care professional, acting within the scope of the health care
257     professional's license, must request anesthesia services be provided before an advanced
258     practice registered nurse described in Subsection (2) may engage in the practice of
259     administering anesthesia.
260          Section 4. Effective date.
261          This bill takes effect on May 1, 2024.