ARIZONA
HOUSE OF REPRESENTATIVES
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HB 2068: clinical nurse specialists; prescribing authority |
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PRIME SPONSOR: Representative Barto, LD 15 BILL STATUS: Senate Engrossed Senate 3rd Read: 28-0-2-0 |
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Allows a clinical nurse
specialist (CNS) to prescribe and dispense pharmacological agents if the CNS
has met educational and training requirements and holds a national
certification. 
History
An advanced practice registered nurse (APRN) is a nurse who has a master's, post-master's certificate, or practice-focused Doctor of Nursing in one of four specific roles. APRN roles include a registered nurse practitioner, a certified registered nurse anesthetist, a certified nurse midwife, or a CNS.
A CNS is board certified by the Arizona State Board of Nursing (Board), holds a graduate degree with a major in nursing and completes educational requirements prescribed by the Board, is nationally certified as a CNS, and has an expanded scope of practice based on advanced education in a clinical nurse specialty A.R.S. § 32-1601.
Pursuant to A.R.S. § 32-3104 the Arizona Nurses Association filed a sunrise application seeking an increased scope of practice for CNS'.
Provisions
1. Permits a CNS who has an expanded scope of practice based on advanced education in a clinical nurse specialty that includes prescribing, ordering and dispensing pharmacological agents subject to limitations. (Sec. 1)
2. Requires the Arizona State Board of Nursing (Board) to adopt rules that prohibit a CNS from dispensing a Schedule II controlled substance that is an opioid, except for an implantable device or an opioid that is for medication-assisted treatment for substance use disorders. (Sec. 2)
3. Requires the Board to adopt rules to establish the requirements for a CNS to prescribe and dispense drugs and devices within the CNS' population or disease focus. (Sec. 2)
4. Clarifies that certified nurse midwife (CNM) practice by duly enrolled students under competent supervision as part of a CNM program, if the program is approved by a United States nursing regulatory agency in the state and the student is authorized to practice registered nursing in Arizona. (Sec. 3)
5. Allows the Board to issue a temporary CNM or CNS certificate. (Sec. 4)
6. Clarifies that only a person who holds a valid and current certificate to practice as a CNM may use the title certified nurse midwife or nurse midwife or use any words or letters to indicate the person is a CNM. (Sec. 5)
7. Requires the Board to grant to a CNS the privileges to prescribe and dispense pharmacological agents if the CNS has both the following:
a. The education and training equivalent to the requirements to prescribe and dispense pharmacological agents of a registered nurse practitioner. This includes the successful completion of a nationally accredited advance practice nursing program.
b. Certification as a CNS by a nationally recognized certification entity, approved by the Board. (Sec. 6)
8. Limits a CNS' prescribing authority to patients of a licensed health care institution that uses the services of a CNS as follows:
a. In a licensed hospital or hospital-affiliated outpatient treatment center, a behavioral health inpatient facility, a nursing care institution, a recovery care center, a behavioral health residential facility or a hospice. The CNS may only prescribe or dispense pursuant to the protocols or standards applicable to the CNS of the health care institution and the following limitations;
i. A CNS is prohibited from prescribing a Schedule II controlled substance that is an opioid except pursuant to protocols or standing orders of the health care institution; and
ii. The prescribing and dispensing of opioid or benzodiazepine prescriptions by a CNS must be limited to the treatment of patients while at the licensed health care institution and cannot be used or filled outside of the institution by the patients, except pursuant to the institution's discharge protocols; and
b. In a licensed outpatient treatment center that provides behavioral health services or qualifies as a community health center, the CNS may prescribe or dispense only pursuant to the protocols or standards applicable to the CNS of the health care institution. The CNS may not prescribe a Schedule II controlled substance that is an opioid except for an opioid for medication assisted treatment for substance use disorders. (Sec. 6)
9. Requires a CNS to report any required information relating to dispensing or prescribing medication pursuant to the health care institution's protocols. (Sec. 6)
10. Specifies that a health care institution's protocols relating to the dispensing and prescribing authority of a CNS must be developed with the input of the institution's medical director. (Sec. 6)
11. Requires the Board to notify the Arizona State Board of Pharmacy if the Board modifies a CNS' prescription writing privileges. (Sec. 7)
12. Clarifies that it is unlawful for a person not certified or licensed to represent or use any title to indicate that the person is a CNM or a nurse midwife. (Sec. 8)
13. Makes technical and conforming changes. (Sec. 1, 2, 3, 5, 7)
Senate Amendments
1. Provides that the prescribing and dispensing of opioid or benzodiazepine prescriptions by a clinical nurse specialist must be limited to the treatment of patients while at the licensed health care institution and must not be for patients use or fill outside of the licensed health care institution except pursuant to discharge protocols of the institution.
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5. Fifty-fourth Legislature HB 2068
6. First Regular Session Version 4: Senate Engrossed
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