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ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
clinical nurse specialists; prescribing authority
Purpose
Directs the Arizona Board of Nursing (AZBN) to grant prescription and dispensing privileges to clinical nurse specialists (CNSs) who meet required criteria. Allows CNSs to prescribe and dispense in specified health care institutions pursuant to applicable protocols, standards and limitations.
Background
The AZBN was established in 1921 to regulate the practice of nursing in Arizona through licensure, complaint investigation and the approval of nursing education programs. The AZBN is comprised of 11 Governor-appointed members who serve five-year terms (A.R.S. § 32-1602).
An
advanced practice registered nurse is a registered nurse (RN) who has a
master's degree, post-master's certificate or practice-focused doctorate of nursing
in one of the following roles:
1) a registered nurse practitioner; 2) a certified registered nurse
anesthetist; 3) a certified nurse midwife (CNM); or 4) a CNS. A CNS must be AZBN
certified, hold a graduate degree with a major in nursing, complete AZBN-prescribed
education requirements, be nationally certified as a CNS and have an expanded
scope of practice that is based on advanced education in a clinical nurse
specialty (A.R.S.
§ 32-1601). According to the AZBN there are 174 CNSs in Arizona.
In 2018, the Arizona Nurse's Association submitted a sunrise report seeking an increased scope of practice for CNSs (A.R.S. § 32-3104).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires the AZBN to grant CNSs privileges to prescribe and dispense pharmacological agents if the CNS has:
a) education and training that is equivalent to the prescribing and dispensing requirements for registered nurse practitioners; and
b) certification as a CNS by a nationally recognized certification entity that is approved by the AZBN.
2. Permits a CNS to only prescribe for patients in the following licensed health care institutions that use CNS services:
a) in a
licensed hospital, hospital-affiliated outpatient treatment center, behavioral
health inpatient facility, nursing care institution, recovery care center,
behavioral health residential facility or hospice a CNS is authorized to
prescribe and dispense pursuant to applicable protocols and standards. A CNS is
prohibited from prescribing Schedule
II controlled substances that are opioids
except pursuant to protocols or standing orders; and
b) in a licensed outpatient treatment center that provides behavioral health services or that qualifies as a community health center a CNS is authorized to prescribe or dispense pursuant to applicable protocols and standards. A CNS is prohibited from prescribing Schedule II controlled substances that are opioids except for an opioid that is for medication-assisted treatment for substance use disorders.
3. Requires a CNS to report any required information relating to dispensing or prescribing medication pursuant to the health care institution's protocols.
4. Stipulates that a health care institution's protocols for CNS dispensing and prescribing authority must be developed with the input of the institution's medical director.
5. Directs the AZBN to adopt rules that:
a) prohibit CNSs from dispensing Schedule II controlled substances that are opioids, with certain exceptions; and
b) establish requirements for a CNS to prescribe and dispense drugs and devices within that CNS's population or disease focus.
6. Authorizes the AZBN to issue temporary CNM and CNS certificates, including prescribing and dispensing authority, to RNs who meet prescribed criteria.
7. Requires that the AZBN notify the Board of Pharmacy if a CNS's prescription writing privileges are modified.
8. Adds that a CNS's advanced scope of practice must be based on advanced education in a clinical nursing specialty that includes prescribing, ordering and dispensing pharmacological agents.
9. Permits CNM practice by duly enrolled students who are under competent supervision as part of a CNM program, if the program is approved by a U.S. nursing regulatory agency in Arizona and the student is authorized to practice registered nursing in Arizona.
10. Stipulates that only a person who holds a valid and concurrent certificate to practice as a CNM in Arizona is authorized to utilize the title CNM, nurse midwife or any other indication that the person is a CNM.
11. Makes technical and conforming changes.
12. Becomes effective on the general effective date.
House Action
HHS 1/31/19 DPA 9-0-0-0
3rd Read 3/4/19 47-10-3
Prepared by Senate Research
March 25, 2019
CRS/kja