S. B. No. 89 As Introduced

As Introduced

128th General Assembly

Regular Session

2009-2010

S. B. No. 89

Senator Morano

Cosponsors: Senators Fedor, Cafaro, Schiavoni, Miller, R., Miller, D., Kearney, Turner, Sawyer, Wilson, Wagoner

A BILL

To amend sections 3333.28, 4723.48, 4723.482, and

4723.50 and to enact section 3333.29 of the

Revised Code with respect to prescriptive

authority of out-of-state advanced practice

nurses, cooperation among hospitals and state

institutions of higher education with nursing

education programs, and allocations from the Nurse

Education Assistance Fund.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3333.28, 4723.48, 4723.482, and	9
4723.50 be amended and section 3333.29 of the Revised Code be	10
enacted to read as follows:	11

Sec. 3333.28. (A) The chancellor of the Ohio board of	12
regents shall establish the nurse education assistance program,	13
the purpose of which shall be to make loans to students enrolled	14
in prelicensure nurse education programs at institutions approved	15
by the board of nursing under section 4723.06 of the Revised Code	16
and postlicensure nurse education programs approved by the	17
chancellor under section 3333.04 of the Revised Code or offered by	18
an institution holding a certificate of authorization issued under	19
Chapter 1713. of the Revised Code. The board of nursing shall	20
assist the chancellor in administering the program.	21

(B) There is hereby created in the state treasury the nurse	22
education assistance fund, which shall consist of all money	23
transferred to it pursuant to section 4743.05 of the Revised Code.	24
The fund shall be used by the chancellor for loans made under	25
division (A) of this section and for expenses of administering the	26
loan program.	27

(C) Between July 1, 2005, and January 1, 2012, the chancellor	28
shall distribute money in the nurse education assistance fund in	29
the following manner:	30

(1)(a) Fifty per cent of available funds shall be awarded as	31
loans to registered nurses enrolled in postlicensure nurse	32
education programs described in division (A) of this section. To	33
be eligible for a loan, the applicant shall provide the chancellor	34
with a letter of intent to practice as a faculty member at a	35
prelicensure or postlicensure program for nursing in this state	36
upon completion of the applicant's academic program.	37

(b) If the borrower of a loan under division (C)(1)(a) of	38
this section secures employment as a faculty member of an approved	39
nursing education program in this state within six months	40
following graduation from an approved nurse education program, the	41
chancellor may forgive the principal and interest of the student's	42
loans received under division (C)(1)(a) of this section at a rate	43
of twenty-five per cent per year, for a maximum of four years, for	44
each year in which the borrower is so employed. A deferment of the	45
service obligation, and other conditions regarding the forgiveness	46
of loans may be granted as provided by the rules adopted under	47
division (D)(7) of this section.	48

(c) Loans awarded under division (C)(1)(a) of this section	49
shall be awarded on the basis of the student's expected family	50
contribution, with preference given to those applicants with the	51
lowest expected family contribution. However, the chancellor may	52
consider other factors the chancellor determines relevant in	53
ranking the applications.	54

(d) Each loan awarded to a student under division (C)(1)(a)	55
of this section shall be not less than five thousand dollars per	56
year.	57

(2) Twenty-five per cent of available funds shall be awarded	58
to students enrolled in prelicensure nurse education programs for	59
registered nurses, as defined in section 4723.01 of the Revised	60
Code.	61

(3) Twenty-five per cent of available funds shall be awarded	62
to students enrolled in ~~prelicensure professional~~ nurse education	63
programs ~~for licensed practical nurses, as defined in section~~	64
~~4723.01 of the Revised Code~~as determined by the chancellor, with	65
preference given to programs aimed at increasing enrollment in an	66
area of need.	67

After January 1, 2012, the chancellor shall determine the	68
manner in which to distribute loans under this section.	69

(D) Subject to the requirements specified in division (C) of	70
this section, the chancellor shall adopt rules in accordance with	71
Chapter 119. of the Revised Code establishing:	72

(1) Eligibility criteria for receipt of a loan;

(2) Loan application procedures;

(3) The amounts in which loans may be made and the total	75
amount that may be loaned to an individual;	76

(4) The total amount of loans that can be made each year;

(5) The percentage of the money in the fund that must remain	78
in the fund at all times as a fund balance;	79

(6) Interest and principal repayment schedules;

(7) Conditions under which a portion of principal and	81
interest obligations incurred by an individual under the program	82
will be forgiven;	83

(8) Ways that the program may be used to encourage	84
individuals who are members of minority groups to enter the	85
nursing profession;	86

(9) Any other matters incidental to the operation of the	87
program.	88

(E) The obligation to repay a portion of the principal and	89
interest on a loan made under this section shall be forgiven if	90
the recipient of the loan meets the criteria for forgiveness	91
established by division (C)(1)(b) of this section, in the case of	92
loans awarded under division (C)(1)(a) of this section, or by the	93
chancellor under the rule adopted under division (D)(7) of this	94
section, in the case of other loans awarded under this section.	95

(F) The receipt of a loan under this section shall not affect	96
a student's eligibility for assistance, or the amount of that	97
assistance, granted under section 3333.12, 3333.122, 3333.22,	98
3333.26, 3333.27, 5910.03, 5910.032, or 5919.34 of the Revised	99
Code, but the rules of the chancellor may provide for taking	100
assistance received under those sections into consideration when	101
determining a student's eligibility for a loan under this section.	102

Sec. 3333.29. (A) As used in this section, "state institution	103
of higher education" has the same meaning as in section 3345.011	104
of the Revised Code.	105

(B) The chancellor of the Ohio board of regents shall	106
establish, within the Ohio skills bank, a mechanism to facilitate	107
communication, cooperation, and partnerships among state	108
institutions of higher education with nursing education programs	109
and between state institutions of higher education and hospitals	110
in this state to meet regional and statewide nursing education	111
needs.	112

Sec. 4723.48. (A) A clinical nurse specialist, certified	113
nurse-midwife, or certified nurse practitioner seeking authority	114
to prescribe drugs and therapeutic devices shall file with the	115
board of nursing a written application for a certificate to	116
prescribe. The board of nursing shall issue a certificate to	117
prescribe to each applicant who meets the requirements specified	118
in section 4723.482 or 4723.484 of the Revised Code.	119

Except as provided in division (B) of this section, the	120
initial certificate to prescribe that the board issues to an	121
applicant shall be issued as an externship certificate. Under an	122
externship certificate, the nurse may obtain experience in	123
prescribing drugs and therapeutic devices by participating in an	124
externship that evaluates the nurse's competence, knowledge, and	125
skill in pharmacokinetic principles and their clinical application	126
to the specialty being practiced. During the externship, the	127
nurse may prescribe drugs and therapeutic devices only when one or	128
more physicians are providing supervision in accordance with rules	129
adopted under section 4723.50 of the Revised Code.	130

After completing the externship, the holder of an externship	131
certificate may apply for a new certificate to prescribe. On	132
receipt of the new certificate, the nurse may prescribe drugs and	133
therapeutic devices in collaboration with one or more physicians	134
or podiatrists.	135

(B) In the case of an applicant who on May 17, 2000, was	136
approved to prescribe drugs and therapeutic devices under section	137
4723.56 of the Revised Code, as that section existed on that date,	138
the initial certificate to prescribe that the board issues to the	139
applicant under this section shall not be an externship	140
certificate. The applicant shall be issued a certificate to	141
prescribe that permits the recipient to prescribe drugs and	142
therapeutic devices in collaboration with one or more physicians	143
or podiatrists.	144

(C) In the case of an applicant who meets the requirements of	145
division (C) of section 4723.482 of the Revised Code, the initial	146
certificate to prescribe that the board issues to the applicant	147
under this section shall not be an externship certificate. The	148
applicant shall be issued a certificate to prescribe that permits	149
the recipient to prescribe drugs and therapeutic devices in	150
collaboration with one or more physicians or podiatrists.	151

Sec. 4723.482. (A) AnExcept as provided in division (C) of	152
this section, an applicant shall include with the application	153
submitted under section 4723.48 of the Revised Code all of the	154
following:	155

(1) Subject to section 4723.483 of the Revised Code, evidence	156
of holding a current, valid certificate of authority issued under	157
this chapter to practice as a clinical nurse specialist, certified	158
nurse-midwife, or certified nurse practitioner;	159

(2) Except for a person who on May 17, 2000, was approved to	160
prescribe drugs and therapeutic devices under section 4723.56 of	161
the Revised Code, as that section existed on that date, evidence	162
of successfully completing the instruction in advanced	163
pharmacology and related topics specified in division (B) of this	164
section;	165

(3) The fee required by section 4723.08 of the Revised Code	166
for a certificate to prescribe;	167

(4) Any additional information the board requires pursuant to	168
rules adopted under section 4723.50 of the Revised Code.	169

(B) All of the following apply to the instruction required	170
under division (A)(2) of this section:	171

(1) The instruction must be obtained not longer than three	172
years before the application for the certificate to prescribe is	173
filed.	174

(2) The instruction must be obtained through a course of	175
study consisting of planned classroom and clinical study that is	176
approved by the board of nursing in accordance with standards	177
established in rules adopted under section 4723.50 of the Revised	178
Code.	179

(3) The content of the instruction must be specific to the	180
applicant's nursing specialty and include all of the following:	181

(a) A minimum of thirty contact hours of training in advanced	182
pharmacology that includes pharmacokinetic principles and clinical	183
application and the use of drugs and therapeutic devices in the	184
prevention of illness and maintenance of health;	185

(b) Training in the fiscal and ethical implications of	186
prescribing drugs and therapeutic devices;	187

(c) Training in the state and federal laws that apply to the	188
authority to prescribe;	189

(d) Any additional training required pursuant to rules	190
adopted under section 4723.50 of the Revised Code.	191

(C) An applicant who practiced or is practicing as a clinical	192
nurse specialist, certified nurse-midwife, or certified nurse	193
practitioner in another jurisdiction or as an employee of the	194
United States government, and is not seeking authority to	195
prescribe drugs and therapeutic devices by meeting the	196
requirements of division (A) of this section, shall include with	197
the application submitted under section 4723.48 of the Revised	198
Code all of the following:	199

(1) Subject to section 4723.483 of the Revised Code, evidence	200
of holding a current, valid certificate of authority issued under	201
this chapter to practice as a clinical nurse specialist, certified	202
nurse-midwife, or certified nurse practitioner;	203

(2) The fee required by section 4723.08 of the Revised Code	204
for a certificate to prescribe;	205

(3) Either of the following:

206

(a) Evidence of having held, for a continuous period of at	207
least one year, valid authority issued by another jurisdiction to	208
prescribe drugs and therapeutic devices;	209

(b) Evidence of having been employed by the United States	210
government and authorized, for a continuous period of at least one	211
year, to prescribe drugs and therapeutic devices in conjunction	212
with that employment.	213

(4) If the applicant includes the evidence described in	214
division (C)(3)(a) of this section, documentation from a physician	215
in a form acceptable to the board that the prescribing component	216
of the nurse's practice was, for at least one thousand hours,	217
overseen or supervised by a physician in the other jurisdiction;	218

(5) If the applicant includes the evidence described in	219
division (C)(3)(b) of this section, documentation from a physician	220
employed by the United States government in a form acceptable to	221
the board that the prescribing component of the nurse's practice	222
was, for at least one thousand hours, overseen or supervised by a	223
physician employed by the United States government;	224

(6) Any additional information the board requires pursuant to	225
rules adopted under section 4723.50 of the Revised Code.	226

Sec. 4723.50. (A) In accordance with Chapter 119. of the	227
Revised Code, the board of nursing shall adopt rules as necessary	228
to implement the provisions of this chapter pertaining to the	229
authority of clinical nurse specialists, certified nurse-midwives,	230
and certified nurse practitioners to prescribe drugs and	231
therapeutic devices and the issuance and renewal of certificates	232
to prescribe. Initial rules shall be adopted not later than twenty	233
months after ~~the effective date of this section~~May 17, 2000.	234

The board shall adopt rules that are consistent with the	235
recommendations the board receives from the committee on	236
prescriptive governance pursuant to section 4723.492 of the	237
Revised Code. After reviewing a recommendation submitted by the	238
committee, the board may either adopt the recommendation as a rule	239
or ask the committee to reconsider and resubmit the	240
recommendation. The board shall not adopt any rule that does not	241
conform to a recommendation made by the committee.	242

(B) The board shall adopt rules under this section that do	243
all of the following:	244

(1) Establish a formulary listing the types of drugs and	245
therapeutic devices that may be prescribed by a clinical nurse	246
specialist, certified nurse-midwife, or certified nurse	247
practitioner. The formulary may include controlled substances, as	248
defined in section 3719.01 of the Revised Code. The formulary	249
shall not permit the prescribing of any drug or device to perform	250
or induce an abortion.	251

(2) Establish safety standards to be followed by a nurse when	252
personally furnishing to patients complete or partial supplies of	253
antibiotics, antifungals, scabicides, contraceptives, prenatal	254
vitamins, antihypertensives, drugs and devices used in the	255
treatment of diabetes, drugs and devices used in the treatment of	256
asthma, and drugs used in the treatment of dyslipidemia.	257

(3) Establish criteria for the components of the standard	258
care arrangements described in section 4723.431 of the Revised	259
Code that apply to a nurse's authority to prescribe. The rules	260
shall be consistent with that section and include all of the	261
following:	262

(a) Quality assurance standards;

263

(b) Standards for periodic review by a collaborating	264
physician or podiatrist of the records of patients treated by the	265
nurse;	266

(c) Acceptable travel time between the location at which the	267
nurse is engaging in the prescribing components of the nurse's	268
practice and the location of the nurse's collaborating physician	269
or podiatrist;	270

(d) Any other criteria recommended by the committee on	271
prescriptive governance.	272

(4) Establish standards and procedures for issuance and	273
renewal of a certificate to prescribe, including specification of	274
any additional information the board may require under division	275
(A)(4) or (C)(6) of section 4723.482 or division (B)(3) of section	276
4723.484 of the Revised Code;	277

(5) Establish requirements for board approval of the	278
instruction in advanced pharmacology and related topics required	279
by section 4723.482 of the Revised Code;	280

(6) Establish standards and procedures for the appropriate	281
conduct of anthe externship ~~required by~~that a nurse must	282
successfully complete to be eligible for a subsequent certificate	283
to prescribe, as provided in division (B)(1) of section 4723.484	284
of the Revised Code, including the following:	285

(a) Standards and procedures to be used in evaluating a	286
nurse's participation in an externship. Regardless of the method	287
of evaluation used, a nurse shall not be required to participate	288
in an externship longer than one thousand eight hundred hours.	289

(b) Standards and procedures for the supervision that a	290
physician must provide during an externship, including supervision	291
provided by working with the nurse and supervision provided by	292
making timely reviews of the records of patients treated by the	293
nurse. The manner in which supervision must be provided may vary	294
according to the location where the nurse is practicing and with	295
the nurse's level of experience.	296

Section 2. That existing sections 3333.28, 4723.48, 4723.482,	297
and 4723.50 of the Revised Code are hereby repealed.	298

Section 3. Notwithstanding the requirement of division (A) of	299
section 4723.50 of the Revised Code that the Board of Nursing	300
adopt rules consistent with the recommendations the Board receives	301
from the Committee on Prescriptive Governance, the Board shall	302
amend the rules that were adopted under section 4723.50 of the	303
Revised Code to reflect the amendment by this act of sections	304
4723.48 and 4723.482 of the Revised Code. Until the rules have	305
been amended accordingly, the Board shall not enforce any rule	306
that is inconsistent with sections 4723.48 and 4723.482 of the	307
Revised Code as amended by this act.	308