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Senate Engrossed House Bill |
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State of Arizona House of Representatives Fifty-fourth Legislature First Regular Session 2019
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CHAPTER 87
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HOUSE BILL 2068 |
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AN ACT
Amending sections 32‑1601, 32-1606, 32‑1631, 32‑1635.01 and 32‑1636, Arizona Revised Statutes; amending title 32, chapter 15, article 2, Arizona Revised Statutes, by adding section 32‑1651; amending sections 32‑1663, 32‑1666 and 32‑1921, Arizona Revised Statutes; relating to the Arizona state board of nursing.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 32-1601, Arizona Revised Statutes, is amended to read:
32-1601. Definitions
In this chapter, unless the context otherwise requires:
1. "Absolute discharge from the sentence" means completion of any sentence, including imprisonment, probation, parole, community supervision or any form of court supervision.
2. "Appropriate health care professional" means a licensed health care professional whose scope of practice, education, experience, training and accreditation are appropriate for the situation or condition of the patient who is the subject of a consultation or referral.
3. "Approval" means that a regulated training or educational program to prepare persons for licensure, certification or registration has met standards established by the board.
4. "Board" means the Arizona state board of nursing.
5. "Certified nurse midwife" means a registered nurse who:
(a) Is certified by the board.
(b) Has completed a nurse midwife education program approved or recognized by the board and educational requirements prescribed by the board by rule.
(c) Holds a national certification as a certified nurse midwife from a national certifying body recognized by the board.
(d) Has an expanded scope of practice in the provision of health care services for women from adolescence to beyond menopause, including antepartum, intrapartum, postpartum, reproductive, gynecologic and primary care, for normal newborns during the first twenty‑eight days of life and for men for the treatment of sexually transmitted diseases. The expanded scope of practice under this subdivision includes:
(i) Assessing patients, synthesizing and analyzing data and understanding and applying principles of health care at an advanced level.
(ii) Managing the physical and psychosocial health care of patients.
(iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting, implementing and evaluating appropriate treatment.
(iv) Making independent decisions in solving complex patient care problems.
(v) Diagnosing, performing diagnostic and therapeutic procedures and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances, within the scope of the certified nurse midwife practice after meeting requirements established by the board.
(vi) Recognizing the limits of the nurse's knowledge and experience by consulting with or referring patients to other appropriate health care professionals if a situation or condition occurs that is beyond the knowledge and experience of the nurse or if the referral will protect the health and welfare of the patient.
(vii) Delegating to a medical assistant pursuant to section 32‑1456.
(viii) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a certified nurse midwife.
6. "Certified nursing assistant" means a person who is registered on the registry of nursing assistants pursuant to this chapter to provide or assist in the delivery of nursing or nursing-related services under the supervision and direction of a licensed nursing staff member. Certified nursing assistant does not include a person who:
(a) Is a licensed health care professional.
(b) Volunteers to provide nursing assistant services without monetary compensation.
(c) Is a licensed nursing assistant.
7. "Certified registered nurse" means a registered nurse who has been certified by a national nursing credentialing agency recognized by the board.
8. "Certified registered nurse anesthetist" means a registered nurse who meets the requirements of section 32‑1634.03 and who practices pursuant to the requirements of section 32‑1634.04.
9. "Clinical nurse specialist" means a registered nurse who:
(a) Is certified by the board as a clinical nurse specialist.
(b) Holds a graduate degree with a major in nursing and completes educational requirements as prescribed by the board by rule.
(c) Is nationally certified as a clinical nurse specialist or, if certification is not available, provides proof of competence to the board.
(d) Has an expanded scope of practice based on advanced education in a clinical nursing specialty that includes:
(i) Assessing clients, synthesizing and analyzing data and understanding and applying nursing principles at an advanced level.
(ii) Managing directly and indirectly a client's physical and psychosocial health status.
(iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting appropriate nursing interventions.
(iv) Developing, planning and guiding programs of care for populations of patients.
(v) Making independent nursing decisions to solve complex client care problems.
(vi) Using research skills and acquiring and applying critical new knowledge and technologies to nursing practice.
(vii) Prescribing and dispensing durable medical equipment.
(viii) Consulting with or referring a client to other health care providers based on assessment of the client's health status and needs.
(ix) Facilitating collaboration with other disciplines to attain the desired client outcome across the continuum of care.
(x) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a clinical nurse specialist.
(xi) Prescribing, ordering and dispensing pharmacological agents subject to the requirements and limits specified in section 32‑1651.
10. "Conditional license" or "conditional approval" means a license or approval that specifies the conditions under which the regulated party is allowed to practice or to operate and that is prescribed by the board pursuant to section 32‑1644 or 32‑1663.
11. "Delegation" means transferring to a competent individual the authority to perform a selected nursing task in a designated situation in which the nurse making the delegation retains accountability for the delegation.
12. "Disciplinary action" means a regulatory sanction of a license, certificate or approval pursuant to this chapter in any combination of the following:
(a) A civil penalty for each violation of this chapter, not to exceed one thousand dollars $1,000 for each violation.
(b) Restitution made to an aggrieved party.
(c) A decree of censure.
(d) A conditional license or a conditional approval that fixed a period and terms of probation.
(e) Limited licensure.
(f) Suspension of a license, a certificate or an approval.
(g) Voluntary surrender of a license, a certificate or an approval.
(h) Revocation of a license, a certificate or an approval.
13. "Health care institution" has the same meaning prescribed in section 36‑401.
14. "Licensed nursing assistant" means a person who is licensed pursuant to this chapter to provide or assist in the delivery of nursing or nursing-related services under the supervision and direction of a licensed nursing staff member. Licensed nursing assistant does not include a person who:
(a) Is a licensed health care professional.
(b) Volunteers to provide nursing assistant services without monetary compensation.
(c) Is a certified nursing assistant.
15. "Licensee" means a person who is licensed pursuant to this chapter or in a party state as defined in section 32‑1668.
16. "Limited license" means a license that restricts the scope or setting of a licensee's practice.
17. "Medication order" means a written or verbal communication given by a certified registered nurse anesthetist to a health care professional to administer a drug or medication, including controlled substances.
18. "Practical nurse" means a person who holds a practical nurse license issued pursuant to this chapter or pursuant to a multistate compact privilege and who practices practical nursing as defined in this section.
19. "Practical nursing" includes the following activities that are performed under the supervision of a physician or a registered nurse:
(a) Contributing to the assessment of the health status of individuals and groups.
(b) Participating in the development and modification of the strategy of care.
(c) Implementing aspects of the strategy of care within the nurse's scope of practice.
(d) Maintaining safe and effective nursing care that is rendered directly or indirectly.
(e) Participating in the evaluation of responses to interventions.
(f) Delegating nursing activities within the scope of practice of a practical nurse.
(g) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a practical nurse.
20. "Presence" means within the same health care institution or office as specified in section 32‑1634.04, subsection A, and available as necessary.
21. "Registered nurse" or "professional nurse" means a person who practices registered nursing and who holds a registered nurse license issued pursuant to this chapter or pursuant to a multistate compact privilege.
22. "Registered nurse practitioner" means a registered nurse who:
(a) Is certified by the board.
(b) Has completed a nurse practitioner education program approved or recognized by the board and educational requirements prescribed by the board by rule.
(c) If applying for certification after July 1, 2004, holds national certification as a nurse practitioner from a national certifying body recognized by the board.
(d) Has an expanded scope of practice within a specialty area that includes:
(i) Assessing clients, synthesizing and analyzing data and understanding and applying principles of health care at an advanced level.
(ii) Managing the physical and psychosocial health status of patients.
(iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting, implementing and evaluating appropriate treatment.
(iv) Making independent decisions in solving complex patient care problems.
(v) Diagnosing, performing diagnostic and therapeutic procedures, and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances within the scope of registered nurse practitioner practice on meeting the requirements established by the board.
(vi) Recognizing the limits of the nurse's knowledge and experience by consulting with or referring patients to other appropriate health care professionals if a situation or condition occurs that is beyond the knowledge and experience of the nurse or if the referral will protect the health and welfare of the patient.
(vii) Delegating to a medical assistant pursuant to section 32‑1456.
(viii) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a nurse practitioner.
23. "Registered nursing" includes the following:
(a) Diagnosing and treating human responses to actual or potential health problems.
(b) Assisting individuals and groups to maintain or attain optimal health by implementing a strategy of care to accomplish defined goals and evaluating responses to care and treatment.
(c) Assessing the health status of individuals and groups.
(d) Establishing a nursing diagnosis.
(e) Establishing goals to meet identified health care needs.
(f) Prescribing nursing interventions to implement a strategy of care.
(g) Delegating nursing interventions to others who are qualified to do so.
(h) Providing for the maintenance of safe and effective nursing care that is rendered directly or indirectly.
(i) Evaluating responses to interventions.
(j) Teaching nursing knowledge and skills.
(k) Managing and supervising the practice of nursing.
(l) Consulting and coordinating with other health care professionals in the management of health care.
(m) Performing additional acts that require education and training as prescribed by the board and that are recognized by the nursing profession as proper to be performed by a registered nurse.
24. "Registry of nursing assistants" means the nursing assistants registry maintained by the board pursuant to the omnibus budget reconciliation act of 1987 (P.L. 100‑203; 101 Stat. 1330), as amended by the medicare catastrophic coverage act of 1988 (P.L. 100‑360; 102 Stat. 683).
25. "Regulated party" means any person or entity that is licensed, certified, registered, recognized or approved pursuant to this chapter.
26. "Unprofessional conduct" includes the following, whether occurring in this state or elsewhere:
(a) Committing fraud or deceit in obtaining, attempting to obtain or renewing a license or a certificate issued pursuant to this chapter.
(b) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission.
(c) Aiding or abetting in a criminal abortion or attempting, agreeing or offering to procure or assist in a criminal abortion.
(d) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public.
(e) Being mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public.
(f) Having a license, certificate, permit or registration to practice a health care profession denied, suspended, conditioned, limited or revoked in another jurisdiction and not reinstated by that jurisdiction.
(g) Wilfully or repeatedly violating a provision of this chapter or a rule adopted pursuant to this chapter.
(h) Committing an act that deceives, defrauds or harms the public.
(i) Failing to comply with a stipulated agreement, consent agreement or board order.
(j) Violating this chapter or a rule that is adopted by the board pursuant to this chapter.
(k) Failing to report to the board any evidence that a registered or practical nurse or a nursing assistant is or may be:
(i) Incompetent to practice.
(ii) Guilty of unprofessional conduct.
(iii) Mentally or physically unable to safely practice nursing or to perform nursing‑related duties. A nurse who is providing therapeutic counseling for a nurse who is in a drug rehabilitation program is required to report that nurse only if the nurse providing therapeutic counseling has personal knowledge that patient safety is being jeopardized.
(l) Failing to self‑report a conviction for a felony or undesignated offense within ten days after the conviction.
(m) Cheating or assisting another to cheat on a licensure or certification examination.
Sec. 2. Section 32-1606, Arizona Revised Statutes, is amended to read:
32-1606. Powers and duties of board
A. The board may:
1. Adopt and revise rules necessary to carry into effect this chapter.
2. Publish advisory opinions regarding registered and practical nursing practice and nursing education.
3. Issue limited licenses or certificates if it determines that an applicant or licensee cannot function safely in a specific setting or within the full scope of practice.
4. Refer criminal violations of this chapter to the appropriate law enforcement agency.
5. Establish a confidential program for the monitoring of licensees who are chemically dependent and who enroll in rehabilitation programs that meet the criteria established by the board. The board may take further action if the licensee refuses to enter into a stipulated agreement or fails to comply with its terms. In order to protect the public health and safety, the confidentiality requirements of this paragraph do not apply if the licensee does not comply with the stipulated agreement.
6. On the applicant's or regulated party's request, establish a payment schedule with the applicant or regulated party.
7. Provide education regarding board functions.
8. Collect or assist in the collection of collecting workforce data.
9. Adopt rules for conducting to conduct pilot programs consistent with public safety for innovative applications in nursing practice, education and regulation.
10. Grant retirement status on request to retired nurses who are or were licensed under this chapter, who have no open complaint or investigation pending against them and who are not subject to discipline.
11. Accept and spend federal monies and private grants, gifts, contributions and devises to assist in carrying out the purposes of this chapter. These monies do not revert to the state general fund at the end of the fiscal year.
B. The board shall:
1. Approve regulated training and educational programs that meet the requirements of this chapter and rules adopted by the board.
2. By rule, establish approval and reapproval processes for nursing and nursing assistant training programs that meet the requirements of this chapter and board rules.
3. Prepare and maintain a list of approved nursing programs for the preparation of to prepare registered and practical nurses whose graduates are eligible for licensing under this chapter as registered nurses or as practical nurses if they satisfy the other requirements of this chapter and board rules.
4. Examine qualified registered and practical nurse applicants.
5. License and renew the licenses of qualified registered and practical nurse applicants and licensed nursing assistants who are not qualified to be licensed by the executive director.
6. Adopt a seal, which the executive director shall keep.
7. Keep a record of all proceedings.
8. For proper cause, deny or rescind approval of a regulated training or educational program for failure to comply with this chapter or the rules of the board.
9. Adopt rules for the approval of to approve credential evaluation services that evaluate the qualifications of applicants who graduated from an international nursing program.
10. Determine and administer appropriate disciplinary action against all regulated parties who are found guilty of violating this chapter or rules adopted by the board.
11. Perform functions necessary to carry out the requirements of nursing assistant and nurse aide training and competency evaluation program as set forth in the omnibus budget reconciliation act of 1987 (P.L. 100‑203; 101 Stat. 1330), as amended by the medicare catastrophic coverage act of 1988 (P.L. 100‑360; 102 Stat. 683). These functions shall include:
(a) Testing and registration of registering certified nursing assistants.
(b) Testing and licensing of licensed nursing assistants.
(c) Maintaining a list of board‑approved training programs.
(d) Maintaining a registry of nursing assistants for all certified nursing assistants and licensed nursing assistants.
(e) Assessing fees.
12. Adopt rules establishing those acts that may be performed by a registered nurse practitioner or certified nurse midwife, except that the board does not have authority to decide scope of practice relating to abortion as defined in section 36‑2151.
13. Adopt rules that prohibit registered nurse practitioners, clinical nurse specialists or certified nurse midwives 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.
14. Adopt rules establishing educational requirements for the certification of to certify school nurses.
15. Publish copies of board rules and distribute these copies on request.
16. Require each applicant for initial licensure or certification to submit a full set of fingerprints to the board for the purpose of obtaining a state and federal criminal records check pursuant to section 41‑1750 and Public Law 92‑544. The department of public safety may exchange this fingerprint data with the federal bureau of investigation.
17. Except for a licensee who has been convicted of a felony that has been designated a misdemeanor pursuant to section 13‑604, revoke a license of a person, revoke the multistate licensure privilege of a person pursuant to section 32‑1669 or not issue a license or renewal to an applicant who has one or more felony convictions and who has not received an absolute discharge from the sentences for all felony convictions three or more years before the date of filing an application pursuant to this chapter.
18. Establish standards for approving to approve and reapproving reapprove nurse practitioner and clinical nurse specialist programs and provide for surveys of nurse practitioner and clinical nurse specialist programs as it deems necessary.
19. Provide the licensing authorities of health care institutions, facilities and homes with any information the board receives regarding practices that place a patient's health at risk.
20. Limit the multistate licensure privilege of any person who holds or applies for a license in this state pursuant to section 32‑1668.
21. Adopt rules to establish competency standards for obtaining and maintaining a license.
22. Adopt rules for the qualification to qualify and certification of certify clinical nurse specialists.
23. Adopt rules for approval to approve and reapproval of reapprove refresher courses for nurses who are not currently practicing.
24. Maintain a list of approved medication assistant training programs.
25. Test and certify medication assistants.
26. Maintain a registry and disciplinary record of medication assistants who are certified pursuant to this chapter.
27. Adopt rules to establish the requirements for a clinical nurse specialist to prescribe and dispense drugs and devices consistent with section 32‑1651 and within the clinical nurse specialist's population or disease focus.
C. The board may conduct an investigation on receipt of information that indicates that a person or regulated party may have violated this chapter or a rule adopted pursuant to this chapter. Following the investigation, the board may take disciplinary action pursuant to this chapter.
D. The board may limit, revoke or suspend the privilege of a nurse to practice in this state granted pursuant to section 32‑1668.
E. Failure to comply with any final order of the board, including an order of censure or probation, is cause for suspension or revocation of a license or a certificate.
F. The president or a member of the board designated by the president may administer oaths in transacting the business of the board.
Sec. 3. Section 32-1631, Arizona Revised Statutes, is amended to read:
32-1631. Acts and persons not affected by chapter
This chapter does not prohibit:
1. Auxiliary or supportive services by maids, porters, messengers, bus boys busboys, nurses aides or attendants working under competent supervision in a licensed hospital, or gratuitous care by friends or family members of the family of a sick or infirm person or incidental care of the sick by a domestic servant or person employed primarily as a housekeeper, as long as these persons do not practice registered nursing or claim to be licensed practical nurses.
2. Nursing assistance in cases of emergency.
3. Nursing by duly enrolled prelicensure students under competent supervision in approved nursing programs.
4. The practice of nursing in this state by any legally qualified nurse of another state whose engagement requires the nurse to accompany and care for a patient temporarily residing in this state during one such engagement not to exceed six months, if the nurse does not claim to be a nurse licensed to practice in this state.
5. Nursing by any legally qualified nurse of another state who is employed by the government of the United States or any bureau, division or agency of the United States government in the discharge of that person's official duties.
6. Caring for the sick in connection with the practice of religion or treatment by prayer.
7. Registered nurse practitioner, certified nurse midwife or clinical nurse specialist practice by duly enrolled students under competent supervision as part of a registered nurse practitioner, certified nurse midwife or clinical nurse specialist program if the program is approved by a United States nursing regulatory agency in the state of the parent institution and the student is authorized to practice registered nursing in this state.
8. Nursing education provided to students in this state that is provided electronically or in person by a person who resides in another state and who is licensed to practice registered nursing in that state if the provision of education does not exceed six consecutive months in any calendar year and does not include supervising or providing clinical care.
9. Consulting services that are provided to persons in this state electronically or in person by a person who resides in another state and who is licensed to practice registered nursing in that state if the provision of services does not exceed six consecutive months in any calendar year and does not include direct patient care.
Sec. 4. Section 32-1635.01, Arizona Revised Statutes, is amended to read:
32-1635.01. Temporary certifications; expiration
A. The board may issue a temporary nurse practitioner, certified nurse midwife or clinical nurse specialist certificate, including prescribing and dispensing authority, or a temporary clinical nurse specialist certificate to a registered nurse who holds an unencumbered temporary or permanent license and who meets the requirements for certification and prescribing and dispensing authority as prescribed by this chapter and board rules.
B. A temporary certificate expires on the date specified in the certificate and may be renewed at the discretion of the executive director.
Sec. 5. Section 32-1636, Arizona Revised Statutes, is amended to read:
32-1636. Use of titles or abbreviations
A. Only a person who holds a valid and current license to practice registered nursing in this state or in a party state pursuant to section 32‑1668 may use the title "nurse", "registered nurse", "graduate nurse" or "professional nurse" or the abbreviation "R.N.".
B. Only a person who holds a valid and current license to practice practical nursing in this state or in a party state as defined in section 32‑1668 may use the title "nurse", "licensed practical nurse" or "practical nurse" or the abbreviation "L.P.N.".
C. Only a person who holds a valid and current certificate issued pursuant to this chapter to practice as a registered nurse practitioner in this state may use the title "nurse practitioner", "registered nurse practitioner" or "nurse midwife", if applicable, or use any words or letters to indicate the person is a registered nurse practitioner. A person who is certified as a registered nurse practitioner shall indicate by title or initials the specialty area of certification.
D. Except as provided in subsection C of this section, only a person who holds a valid and current certificate issued PURSUANT TO this chapter to practice as a certified nurse midwife in this state may use the title "certified nurse midwife" or "nurse midwife" or use any words or letters to indicate the person is a certified nurse midwife.
D. E. Only a person who holds a valid and current certificate issued pursuant to this chapter to practice as a clinical nurse specialist may use the title "clinical nurse specialist" or use any words or letters to indicate the person is a clinical nurse specialist. A person who is certified as a clinical nurse specialist shall indicate by title or initials the specialty area of certification.
E. F. A nurse who is granted retirement status shall not practice nursing but may use the title "registered nurse‑retired" or "RN-retired" or "licensed practical nurse‑retired" or "LPN-retired", as applicable.
Sec. 6. Title 32, chapter 15, article 2, Arizona Revised Statutes, is amended by adding section 32-1651, to read:
32-1651. Clinical nurse specialists; prescribing and dispensing authority
A. The board shall grant to a clinical nurse specialist the privileges to prescribe and dispense pharmacological agents if the clinical nurse specialist has both of the following:
1. The education and training equivalent to the requirements to prescribe and dispense pharmacological agents of a registered nurse practitioner, including successful completion of a nationally accredited advanced practice nursing program.
2. Certification as a clinical nurse specialist by a nationally recognized certification entity approved by the state board of nursing.
B. A clinical nurse specialist may prescribe only for patients of a licensed health care institution that uses the services of the clinical nurse specialist as follows:
1. 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 clinical nurse specialist may prescribe or dispense only pursuant to the protocols or standards applicable to clinical nurse specialists of the health care institution and may not prescribe a schedule II controlled substance that is an opioid except pursuant to protocols or standing orders of the health care institution. The prescribing and dispensing of opioid or benzodiazepine prescriptions by a clinical nurse specialist shall be limited to the treatment of patients while at the licensed health care institution and shall not be for patients to use or fill outside of the licensed health care institution except pursuant to discharge protocols of the institution.
2. In a licensed outpatient treatment center that provides behavioral health services or qualifies pursuant to federal law as a community health center, the clinical nurse specialist may prescribe or dispense only pursuant to the protocols or standards applicable to clinical nurse specialists of the health care institution. The clinical nurse specialist may not prescribe a schedule II controlled substance that is an opioid except for an opioid that is for medication‑assisted treatment for substance use disorders.
C. A clinical nurse specialist shall report any required information relating to dispensing or prescribing medication pursuant to the health care institution's protocols.
D. For the purposes of this section, a health care institution's protocols relating to the dispensing and prescribing authority of a clinical nurse specialist shall be developed with the input of the institution's medical director.
Sec. 7. Section 32-1663, Arizona Revised Statutes, is amended to read:
32-1663. Disciplinary action
A. If an applicant for licensure or certification commits an act of unprofessional conduct, the board, after an investigation, may deny the application or take other disciplinary action.
B. In its denial order, the board shall immediately invalidate any temporary license or certificate issued to the applicant.
C. Any person aggrieved by an order of the board issued under the authority granted by subsection A of this section may request an administrative hearing pursuant to title 41, chapter 6, article 10.
D. If the board finds, after affording an opportunity to request an administrative hearing pursuant to title 41, chapter 6, article 10, that a person who holds a license or certificate issued pursuant to this chapter has committed an act of unprofessional conduct, it may take disciplinary action.
E. If the board finds after giving the person an opportunity to request an administrative hearing pursuant to title 41, chapter 6, article 10 that a nurse who practices in this state and is licensed by another jurisdiction pursuant to section 32‑1668 committed an act of unprofessional conduct, the board may limit, suspend or revoke the privilege of that nurse to practice in this state.
F. If the board determines pursuant to an investigation that reasonable grounds exist to discipline a person pursuant to subsection D or E of this section, the board may serve on the licensee or certificate holder a written notice that states:
1. That the board has sufficient evidence that, if not rebutted or explained, will justify the board in taking disciplinary actions allowed by this chapter.
2. The nature of the allegations asserted and that cites the specific statutes or rules violated.
3. That unless the licensee or certificate holder submits a written request for a hearing within thirty days after service of the notice by certified mail, the board may consider the allegations admitted and may take any disciplinary action allowed pursuant to this chapter without conducting a hearing.
G. If the Arizona state board of nursing acts to modify any registered nurse practitioner's or clinical nurse specialist's prescription writing privileges, it shall immediately notify the Arizona state board of pharmacy of the modification.
Sec. 8. Section 32-1666, Arizona Revised Statutes, is amended to read:
32-1666. Unlawful acts
A. It is unlawful for a person who is not licensed or certified under this chapter to:
1. Practice or offer to practice as a registered or practical nurse, registered nurse practitioner, certified nurse midwife or clinical nurse specialist in this state.
2. Represent or use any title, abbreviation, letters, figures, sign, card or device to indicate that the person or any other person is a registered nurse, graduate nurse, professional nurse, nurse practitioner, certified nurse midwife, nurse midwife, clinical nurse specialist, practical nurse, licensed nursing assistant or certified nursing assistant.
3. Represent or use any title, abbreviation, letters, sign, card or device to indicate that the person or any other person is certified pursuant to this chapter.
B. It is unlawful for a person to operate a training or educational program to prepare students for licensure or certification under this chapter unless it has been approved under this chapter.
Sec. 9. Section 32-1921, Arizona Revised Statutes, is amended to read:
32-1921. Exempted acts; exemption from registration fees; definition
A. This chapter does not prevent:
1. The prescription and dispensing of drugs or prescription medications by a registered nurse practitioner or clinical nurse specialist pursuant to rules adopted by the Arizona state board of nursing in consultation with the Arizona medical board, the Arizona board of osteopathic examiners in medicine and surgery and the Arizona state board of pharmacy.
2. The sale of nonprescription drugs that are sold at retail in original packages by a person holding a permit issued by the board under this chapter.
3. The sale of drugs at wholesale by a wholesaler or manufacturer that holds the required permit issued by the board to a person who holds the required permit issued under this chapter.
4. The manufacturing of drugs by a person who is not a pharmacist and who holds the required permit issued by the board under this chapter.
5. The following health professionals from dispensing or personally administering drugs or devices to a patient for a condition being treated by the health professional:
(a) A doctor of medicine licensed pursuant to chapter 13 of this title.
(b) An osteopathic physician licensed pursuant to chapter 17 of this title.
(c) A homeopathic physician licensed pursuant to chapter 29 of this title.
(d) A podiatrist licensed pursuant to chapter 7 of this title.
(e) A dentist licensed pursuant to chapter 11 of this title.
(f) A doctor of naturopathic medicine who is authorized to prescribe natural substances, drugs or devices and who is licensed pursuant to chapter 14 of this title.
(g) An optometrist who is licensed pursuant to chapter 16 of this title and who is certified for topical or oral pharmaceutical agents.
6. A veterinarian licensed pursuant to chapter 21 of this title from dispensing or administering drugs to an animal or from dispensing or administering devices to an animal being treated by the veterinarian.
7. The use of any pesticide chemical, soil or plant nutrient or other agricultural chemical that is a color additive solely because of its effect in aiding, retarding or otherwise affecting directly or indirectly the growth or other natural physiological process of produce of the soil and thereby affecting its color whether before or after harvest.
8. A licensed practical or registered nurse employed by a person licensed pursuant to chapter 7, 11, 13, 14, 17 or 29 of this title from assisting in the delivery of drugs and devices to patients, in accordance with chapter 7, 11, 13, 14, 17 or 29 of this title.
9. The use of any mechanical device or vending machine in connection with the sale of any nonprescription drug, including proprietary and patent medicine. The board may adopt rules to prescribe conditions under which nonprescription drugs may be dispensed pursuant to this paragraph.
B. A person who is licensed pursuant to chapter 7, 11, 13, 14, 17 or 29 of this title and who employs a licensed practical or registered nurse who in the course of employment assists in the delivery of drugs and devices is responsible for the dispensing process.
C. Pursuant to a prescription order written by a physician for the physician's patients and dispensed by a licensed pharmacist, a physical therapist licensed pursuant to chapter 19 of this title, an occupational therapist licensed pursuant to chapter 34 of this title or an athletic trainer licensed pursuant to chapter 41 of this title may procure, store and administer nonscheduled legend and topical anti‑inflammatories and topical anesthetics for use in phonophoresis and iontophoresis procedures and within the scope of practice of physical or occupational therapy or athletic training.
D. A public health facility operated by this state or a county and a qualifying community health center may dispense medication or devices to patients at no cost without providing a written prescription if the public health facility or the qualifying community health center meets all storage, labeling, safety and record keeping rules adopted by the board of pharmacy.
E. A person who is licensed pursuant to chapter 7, 11, 13, 14, 17 or 29 of this title, who is practicing at a public health facility or a qualifying community health center and who is involved in the dispensing of medication or devices only at a facility or center, whether for a charge or at no cost, shall register to dispense with the appropriate licensing board but is exempt from paying registration fees.
F. For the purposes of this section, "qualifying community health center" means a primary care clinic that is recognized as nonprofit under section 501(c)(3) of the United States internal revenue code and whose board of directors includes patients of the center and residents of the center's service area.
APPROVED BY THE GOVERNOR APRIL 16, 2019.
FILED IN THE OFFICE OF THE SECRETARY OF STATE APRIL 16, 2019.