As Reported by the House Health Committee

128th General Assembly Regular Session 2009-2010

Sub. S. B. No. 89

Senator Morano 

Cosponsors: Senators Fedor, Cafaro, Schiavoni, Miller, R., Miller, D., Kearney, Turner, Sawyer, Wilson, Wagoner, Gillmor, Schuring, Carey, Gibbs, Harris, Hughes, Niehaus, Patton, Schaffer, Strahorn, Smith 

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A BILL

To amend sections 3333.28, 4723.01, 4723.06, 4723.48,

1

4723.482, and 4723.50; to amend, for the purpose

2

of adopting new section numbers as indicated in

3

parentheses, sections 4723.484 (4723.485) and

4

4723.485 (4723.486); and to enact new section

5

4723.484 and section 3333.29 of the Revised Code

6

regarding prescriptive authority of out-of-state

7

advanced practice nurses, cooperation among

8

hospitals and state institutions of higher

9

education with nursing education programs, and

10

allocations from the Nurse Education Assistance

11

Fund.

12

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

Section 1. That sections 3333.28, 4723.01, 4723.06, 4723.48,	13
4723.482, and 4723.50 be amended; sections 4723.484 (4723.485),	14
and 4723.485 (4723.486) be amended for the purpose of adopting new	15
section numbers as indicated in parentheses; and new section	16
4723.484 and section 3333.29 of the Revised Code be enacted to	17
read as follows:	18

Sec. 3333.28.  (A) The chancellor of the Ohio board of	19
regents shall establish the nurse education assistance program,	20
the purpose of which shall be to make loans to students enrolled	21
in prelicensure nurse education programs at institutions approved	22
by the board of nursing under section 4723.06 of the Revised Code	23
and postlicensure nurse education programs approved by the	24
chancellor under section 3333.04 of the Revised Code or offered by	25
an institution holding a certificate of authorization issued under	26
Chapter 1713. of the Revised Code. The board of nursing shall	27
assist the chancellor in administering the program.	28

(B) There is hereby created in the state treasury the nurse	29
education assistance fund, which shall consist of all money	30
transferred to it pursuant to section 4743.05 of the Revised Code.	31
The fund shall be used by the chancellor for loans made under	32
division (A) of this section and for expenses of administering the	33
loan program.	34

(C) Between July 1, 2005, andUntil January 1, 2012, the	35
chancellor shall distribute money in the nurse education	36
assistance fund in the following manner:	37

(1)(a) Fifty per cent of available funds shall be awarded as	38
loans to registered nurses enrolled in postlicensure nurse	39
education programs described in division (A) of this section. To	40
be eligible for a loan, the applicant shall provide the chancellor	41
with a letter of intent to practice as a faculty member at a	42
prelicensure or postlicensure program for nursing in this state	43
upon completion of the applicant's academic program.	44

(b) If the borrower of a loan under division (C)(1)(a) of	45
this section secures employment as a faculty member of an approved	46
nursing education program in this state within six months	47
following graduation from an approved nurse education program, the	48
chancellor may forgive the principal and interest of the student's	49
loans received under division (C)(1)(a) of this section at a rate	50
of twenty-five per cent per year, for a maximum of four years, for	51
each year in which the borrower is so employed. A deferment of the	52
service obligation, and other conditions regarding the forgiveness	53
of loans may be granted as provided by the rules adopted under	54
division (D)(7) of this section.	55

(c) Loans awarded under division (C)(1)(a) of this section	56
shall be awarded on the basis of the student's expected family	57
contribution, with preference given to those applicants with the	58
lowest expected family contribution. However, the chancellor may	59
consider other factors the chancellor determines relevant in	60
ranking the applications.	61

(d) Each loan awarded to a student under division (C)(1)(a)	62
of this section shall be not less than five thousand dollars per	63
year.	64

(2) Twenty-five per cent of available funds shall be awarded	65
to students enrolled in prelicensure nurse education programs for	66
registered nurses, as defined in section 4723.01 of the Revised	67
Code.	68

(3) Twenty-five per cent of available funds shall be awarded	69
to students enrolled in prelicensure professional nurse education	70
programs for licensed practical nurses, as defined in section	71
4723.01 of the Revised Code, or as determined by the chancellor	72
with preference given to nurse education programs aimed at	73
increasing enrollment in an area of need.	74

After January 1, 2012, the chancellor shall determine the	75
manner in which to distribute loans under this section.	76

(D) Subject to the requirements specified in division (C) of	77
this section, the chancellor shall adopt rules in accordance with	78
Chapter 119. of the Revised Code establishing:	79

(1) Eligibility criteria for receipt of a loan;

80

(2) Loan application procedures;

81

(3) The amounts in which loans may be made and the total	82
amount that may be loaned to an individual;	83

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

84

(5) The percentage of the money in the fund that must remain	85
in the fund at all times as a fund balance;	86

(6) Interest and principal repayment schedules;

87

(7) Conditions under which a portion of principal and	88
interest obligations incurred by an individual under the program	89
will be forgiven;	90

(8) Ways that the program may be used to encourage	91
individuals who are members of minority groups to enter the	92
nursing profession;	93

(9) Any other matters incidental to the operation of the	94
program.	95

(E) The obligation to repay a portion of the principal and	96
interest on a loan made under this section shall be forgiven if	97
the recipient of the loan meets the criteria for forgiveness	98
established by division (C)(1)(b) of this section, in the case of	99
loans awarded under division (C)(1)(a) of this section, or by the	100
chancellor under the rule adopted under division (D)(7) of this	101
section, in the case of other loans awarded under this section.	102

(F) The receipt of a loan under this section shall not affect	103
a student's eligibility for assistance, or the amount of that	104
assistance, granted under section 3333.12, 3333.122, 3333.22,	105
3333.26, 3333.27, 5910.03, 5910.032, or 5919.34 of the Revised	106
Code, but the rules of the chancellor may provide for taking	107
assistance received under those sections into consideration when	108
determining a student's eligibility for a loan under this section.	109

Sec. 3333.29. (A) As used in this section, "state institution	110
of higher education" has the same meaning as in section 3345.011	111
of the Revised Code.	112

(B) The chancellor of the Ohio board of regents shall	113
establish, within the Ohio skills bank, a mechanism to facilitate	114
communication, cooperation, and partnerships among state	115
institutions of higher education with nursing education programs	116
and between state institutions of higher education and hospitals	117
in this state to meet regional and statewide nursing education	118
needs.	119

Sec. 4723.01.  As used in this chapter:

120

(A) "Registered nurse" means an individual who holds a	121
current, valid license issued under this chapter that authorizes	122
the practice of nursing as a registered nurse.	123

(B) "Practice of nursing as a registered nurse" means	124
providing to individuals and groups nursing care requiring	125
specialized knowledge, judgment, and skill derived from the	126
principles of biological, physical, behavioral, social, and	127
nursing sciences. Such nursing care includes:	128

(1) Identifying patterns of human responses to actual or	129
potential health problems amenable to a nursing regimen;	130

(2) Executing a nursing regimen through the selection,	131
performance, management, and evaluation of nursing actions;	132

(3) Assessing health status for the purpose of providing	133
nursing care;	134

(4) Providing health counseling and health teaching;

135

(5) Administering medications, treatments, and executing	136
regimens authorized by an individual who is authorized to practice	137
in this state and is acting within the course of the individual's	138
professional practice;	139

(6) Teaching, administering, supervising, delegating, and	140
evaluating nursing practice.	141

(C) "Nursing regimen" may include preventative, restorative,	142
and health-promotion activities.	143

(D) "Assessing health status" means the collection of data	144
through nursing assessment techniques, which may include	145
interviews, observation, and physical evaluations for the purpose	146
of providing nursing care.	147

(E) "Licensed practical nurse" means an individual who holds	148
a current, valid license issued under this chapter that authorizes	149
the practice of nursing as a licensed practical nurse.	150

(F) "The practice of nursing as a licensed practical nurse"	151
means providing to individuals and groups nursing care requiring	152
the application of basic knowledge of the biological, physical,	153
behavioral, social, and nursing sciences at the direction of a	154
licensed physician, dentist, podiatrist, optometrist,	155
chiropractor, or registered nurse. Such nursing care includes:	156

(1) Observation, patient teaching, and care in a diversity of	157
health care settings;	158

(2) Contributions to the planning, implementation, and	159
evaluation of nursing;	160

(3) Administration of medications and treatments authorized	161
by an individual who is authorized to practice in this state and	162
is acting within the course of the individual's professional	163
practice, except that administration of intravenous therapy shall	164
be performed only in accordance with section 4723.17 or 4723.171	165
of the Revised Code. Medications may be administered by a licensed	166
practical nurse upon proof of completion of a course in medication	167
administration approved by the board of nursing.	168

(4) Administration to an adult of intravenous therapy	169
authorized by an individual who is authorized to practice in this	170
state and is acting within the course of the individual's	171
professional practice, on the condition that the licensed	172
practical nurse is authorized under section 4723.17 or 4723.171 of	173
the Revised Code to perform intravenous therapy and performs	174
intravenous therapy only in accordance with those sections;	175

(5) Delegation of nursing tasks as directed by a registered	176
nurse;	177

(6) Teaching nursing tasks to licensed practical nurses and	178
individuals to whom the licensed practical nurse is authorized to	179
delegate nursing tasks as directed by a registered nurse.	180

(G) "Certified registered nurse anesthetist" means a	181
registered nurse who holds a valid certificate of authority issued	182
under this chapter that authorizes the practice of nursing as a	183
certified registered nurse anesthetist in accordance with section	184
4723.43 of the Revised Code and rules adopted by the board of	185
nursing.	186

(H) "Clinical nurse specialist" means a registered nurse who	187
holds a valid certificate of authority issued under this chapter	188
that authorizes the practice of nursing as a clinical nurse	189
specialist in accordance with section 4723.43 of the Revised Code	190
and rules adopted by the board of nursing.	191

(I) "Certified nurse-midwife" means a registered nurse who	192
holds a valid certificate of authority issued under this chapter	193
that authorizes the practice of nursing as a certified	194
nurse-midwife in accordance with section 4723.43 of the Revised	195
Code and rules adopted by the board of nursing.	196

(J) "Certified nurse practitioner" means a registered nurse	197
who holds a valid certificate of authority issued under this	198
chapter that authorizes the practice of nursing as a certified	199
nurse practitioner in accordance with section 4723.43 of the	200
Revised Code and rules adopted by the board of nursing.	201

(K) "Physician" means an individual authorized under Chapter	202
4731. of the Revised Code to practice medicine and surgery or	203
osteopathic medicine and surgery, except as used in divisions (C)	204
and (D) of section 4723.482 of the Revised Code.	205

(L) "Collaboration" or "collaborating" means the following:

206

(1) In the case of a clinical nurse specialist, except as	207
provided in division (L)(3) of this section, or a certified nurse	208
practitioner, that one or more podiatrists acting within the scope	209
of practice of podiatry in accordance with section 4731.51 of the	210
Revised Code and with whom the nurse has entered into a standard	211
care arrangement or one or more physicians with whom the nurse has	212
entered into a standard care arrangement are continuously	213
available to communicate with the clinical nurse specialist or	214
certified nurse practitioner either in person or by radio,	215
telephone, or other form of telecommunication;	216

(2) In the case of a certified nurse-midwife, that one or	217
more physicians with whom the certified nurse-midwife has entered	218
into a standard care arrangement are continuously available to	219
communicate with the certified nurse-midwife either in person or	220
by radio, telephone, or other form of telecommunication;	221

(3) In the case of a clinical nurse specialist who practices	222
the nursing specialty of mental health or psychiatric mental	223
health without being authorized to prescribe drugs and therapeutic	224
devices, that one or more physicians are continuously available to	225
communicate with the nurse either in person or by radio,	226
telephone, or other form of telecommunication.	227

(M) "Supervision," as it pertains to a certified registered	228
nurse anesthetist, means that the certified registered nurse	229
anesthetist is under the direction of a podiatrist acting within	230
the podiatrist's scope of practice in accordance with section	231
4731.51 of the Revised Code, a dentist acting within the dentist's	232
scope of practice in accordance with Chapter 4715. of the Revised	233
Code, or a physician, and, when administering anesthesia, the	234
certified registered nurse anesthetist is in the immediate	235
presence of the podiatrist, dentist, or physician.	236

(N) "Standard care arrangement" means a written, formal guide	237
for planning and evaluating a patient's health care that is	238
developed by one or more collaborating physicians or podiatrists	239
and a clinical nurse specialist, certified nurse-midwife, or	240
certified nurse practitioner and meets the requirements of section	241
4723.431 of the Revised Code.	242

(O) "Advanced practice nurse" means a certified registered	243
nurse anesthetist, clinical nurse specialist, certified	244
nurse-midwife, or certified nurse practitioner.	245

(P) "Dialysis care" means the care and procedures that a	246
dialysis technician is authorized to provide and perform, as	247
specified in section 4723.72 of the Revised Code.	248

(Q) "Dialysis technician" means an individual who holds a	249
current, valid certificate or temporary certificate issued under	250
this chapter that authorizes the individual to practice as a	251
dialysis technician in accordance with section 4723.72 of the	252
Revised Code.	253

(R) "Certified community health worker" means an individual	254
who holds a current, valid certificate as a community health	255
worker issued by the board of nursing under section 4723.85 of the	256
Revised Code.	257

Sec. 4723.06.  (A) The board of nursing shall:

258

(1) Administer and enforce the provisions of this chapter,	259
including the taking of disciplinary action for violations of	260
section 4723.28 of the Revised Code, any other provisions of this	261
chapter, or rules adopted under this chapter;	262

(2) Develop criteria that an applicant must meet to be	263
eligible to sit for the examination for licensure to practice as a	264
registered nurse or as a licensed practical nurse;	265

(3) Issue and renew nursing licenses, dialysis technician	266
certificates, and community health worker certificates, as	267
provided in this chapter;	268

(4) Define the minimum curricula and standards for	269
educational programs of the schools of professional nursing and	270
schools of practical nursing in this state;	271

(5) Survey, inspect, and grant full approval to prelicensure	272
nursing education programs that meet the standards established by	273
rules adopted under section 4723.07 of the Revised Code.	274
Prelicensure nursing education programs include, but are not	275
limited to, associate degree, baccalaureate degree, diploma, and	276
doctor of nursing programs leading to initial licensure to	277
practice nursing as a registered nurse and practical nurse	278
programs leading to initial licensure to practice nursing as a	279
licensed practical nurse.	280

(6) Grant conditional approval, by a vote of a quorum of the	281
board, to a new prelicensure nursing education program or a	282
program that is being reestablished after having ceased to	283
operate, if the program meets and maintains the minimum standards	284
of the board established by rules adopted under section 4723.07 of	285
the Revised Code. If the board does not grant conditional	286
approval, it shall hold an adjudication under Chapter 119. of the	287
Revised Code to consider conditional approval of the program. If	288
the board grants conditional approval, at its first meeting after	289
the first class has completed the program, the board shall	290
determine whether to grant full approval to the program. If the	291
board does not grant full approval or if it appears that the	292
program has failed to meet and maintain standards established by	293
rules adopted under section 4723.07 of the Revised Code, the board	294
shall hold an adjudication under Chapter 119. of the Revised Code	295
to consider the program. Based on results of the adjudication, the	296
board may continue or withdraw conditional approval, or grant full	297
approval.	298

(7) Place on provisional approval, for a period of time	299
specified by the board, a program that has ceased to meet and	300
maintain the minimum standards of the board established by rules	301
adopted under section 4723.07 of the Revised Code. At the end of	302
the period, the board shall reconsider whether the program meets	303
the standards and shall grant full approval if it does. If it does	304
not, the board may withdraw approval, pursuant to an adjudication	305
under Chapter 119. of the Revised Code.	306

(8) Approve continuing nursing education programs and courses	307
under standards established in rules adopted under section 4723.07	308
of the Revised Code;	309

(9) Approve peer support programs, under rules adopted under	310
section 4723.07 of the Revised Code, for nurses, for dialysis	311
technicians, and for certified community health workers;	312

(10) Establish a program for monitoring chemical dependency	313
in accordance with section 4723.35 of the Revised Code;	314

(11) Establish the practice intervention and improvement	315
program in accordance with section 4723.282 of the Revised Code;	316

(12) Issue and renew certificates of authority to practice	317
nursing as a certified registered nurse anesthetist, clinical	318
nurse specialist, certified nurse-midwife, or certified nurse	319
practitioner;	320

(13) Approve under section 4723.46 of the Revised Code	321
national certifying organizations for examination and	322
certification of certified registered nurse anesthetists, clinical	323
nurse specialists, certified nurse-midwives, or certified nurse	324
practitioners;	325

(14) Issue and renew certificates to prescribe in accordance	326
with sections 4723.48 and 4723.4854723.486 of the Revised Code;	327

(15) Grant approval to the planned classroom and clinical	328
study required by section 4723.4834723.482 of the Revised Code to	329
be eligible for a certificate to prescribe;	330

(16) Make an annual edition of the formulary established in	331
rules adopted under section 4723.50 of the Revised Code available	332
to the public either in printed form or by electronic means and,	333
as soon as possible after any revision of the formulary becomes	334
effective, make the revision available to the public in printed	335
form or by electronic means;	336

(17) Provide guidance and make recommendations to the general	337
assembly, the governor, state agencies, and the federal government	338
with respect to the regulation of the practice of nursing and the	339
enforcement of this chapter;	340

(18) Make an annual report to the governor, which shall be	341
open for public inspection;	342

(19) Maintain and have open for public inspection the	343
following records:	344

(a) A record of all its meetings and proceedings;

345

(b) A file of holders of nursing licenses, registrations, and	346
certificates granted under this chapter; dialysis technician	347
certificates granted under this chapter; and community health	348
worker certificates granted under this chapter. The file shall be	349
maintained in the form prescribed by rule of the board.	350

(c) A list of prelicensure nursing education programs	351
approved by the board;	352

(d) A list of approved peer support programs for nurses,	353
dialysis technicians, and certified community health workers.	354

(B) The board may fulfill the requirement of division (A)(8)	355
of this section by authorizing persons who meet the standards	356
established in rules adopted under section 4723.07 of the Revised	357
Code to approve continuing nursing education programs and courses.	358
Persons so authorized shall approve continuing nursing education	359
programs and courses in accordance with standards established in	360
rules adopted under section 4723.07 of the Revised Code.	361

Persons seeking authorization to approve continuing nursing	362
education programs and courses shall apply to the board and pay	363
the appropriate fee established under section 4723.08 of the	364
Revised Code. Authorizations to approve continuing nursing	365
education programs and courses shall expire, and may be renewed	366
according to the schedule established in rules adopted under	367
section 4723.07 of the Revised Code.	368

In addition to approving continuing nursing education	369
programs under division (A)(8) of this section, the board may	370
sponsor continuing education activities that are directly related	371
to the statutes and rules pertaining to the practice of nursing in	372
this state.	373

Sec. 4723.48.  (A) A clinical nurse specialist, certified	374
nurse-midwife, or certified nurse practitioner seeking authority	375
to prescribe drugs and therapeutic devices shall file with the	376
board of nursing a written application for a certificate to	377
prescribe. The board of nursing shall issue a certificate to	378
prescribe to each applicant who meets the requirements specified	379
in section 4723.482 or 4723.4844723.485 of the Revised Code.	380

Except as provided in division (B) of this section, the	381
initial certificate to prescribe that the board issues to an	382
applicant shall be issued as an externship certificate. Under an	383
externship certificate, the nurse may obtain experience in	384
prescribing drugs and therapeutic devices by participating in an	385
externship that evaluates the nurse's competence, knowledge, and	386
skill in pharmacokinetic principles and their clinical application	387
to the specialty being practiced. During the externship, the	388
nurse may prescribe drugs and therapeutic devices only when one or	389
more physicians are providing supervision in accordance with	390
rules adopted under section 4723.50 of the Revised Code.	391

After completing the externship, the holder of an externship	392
certificate may apply for a new certificate to prescribe. On	393
receipt of the new certificate, the nurse may prescribe drugs and	394
therapeutic devices in collaboration with one or more physicians	395
or podiatrists.	396

(B) In the case of an applicant who on May 17, 2000, was	397
approved to prescribe drugs and therapeutic devices under section	398
4723.56 of the Revised Code, as that section existed on that date,	399
the initial certificate to prescribe that the board issues to the	400
applicant under this section shall not be an externship	401
certificate. The applicant shall be issued a certificate to	402
prescribe that permits the recipient to prescribe drugs and	403
therapeutic devices in collaboration with one or more physicians	404
or podiatrists.	405

In the case of an applicant who meets the requirements of	406
division (C) of section 4723.482 of the Revised Code, the initial	407
certificate to prescribe that the board issues to the applicant	408
under this section shall not be an externship certificate. The	409
applicant shall be issued a certificate to prescribe that permits	410
the recipient to prescribe drugs and therapeutic devices in	411
collaboration with one or more physicians or podiatrists.	412

Sec. 4723.482.  (A) AnExcept as provided in divisions (C)	413
and (D) of this section, an applicant shall include with the	414
application submitted under section 4723.48 of the Revised Code	415
all of the following:	416

(1) Subject to section 4723.483 of the Revised Code, evidence	417
of holding a current, valid certificate of authority issued under	418
this chapter to practice as a clinical nurse specialist, certified	419
nurse-midwife, or certified nurse practitioner;	420

(2) Except for a person who on May 17, 2000, was approved to	421
prescribe drugs and therapeutic devices under section 4723.56 of	422
the Revised Code, as that section existed on that date, evidence	423
of successfully completing the instruction in advanced	424
pharmacology and related topics specified in division (B) of this	425
section;	426

(3) The fee required by section 4723.08 of the Revised Code	427
for a certificate to prescribe;	428

(4) Any additional information the board of nursing requires	429
pursuant to rules adopted under section 4723.50 of the Revised	430
Code.	431

(B) All of the following apply to the instruction required	432
under division (A)(2) of this section:	433

(1) The instruction must be obtained not longer than three	434
years before the application for the certificate to prescribe is	435
filed.	436

(2) The instruction must be obtained through a course of	437
study consisting of planned classroom and clinical study that is	438
approved by the board of nursing in accordance with standards	439
established in rules adopted under section 4723.50 of the Revised	440
Code.	441

(3) The content of the instruction must be specific to the	442
applicant's nursing specialty and include all of the following:	443

(a) A minimum of thirty contact hours of training in advanced	444
pharmacology that includes pharmacokinetic principles and clinical	445
application and the use of drugs and therapeutic devices in the	446
prevention of illness and maintenance of health;	447

(b) Training in the fiscal and ethical implications of	448
prescribing drugs and therapeutic devices;	449

(c) Training in the state and federal laws that apply to the	450
authority to prescribe;	451

(d) Any additional training required pursuant to rules	452
adopted under section 4723.50 of the Revised Code.	453

(C) An applicant who practiced or is practicing as a clinical	454
nurse specialist, certified nurse-midwife, or certified nurse	455
practitioner in another jurisdiction or as an employee of the	456
United States government, and is not seeking authority to	457
prescribe drugs and therapeutic devices by meeting the	458
requirements of division (A) or (D) of this section, shall include	459
with the application submitted under section 4723.48 of the	460
Revised Code all of the following:	461

(1) Subject to section 4723.483 of the Revised Code, evidence	462
of holding a current, valid certificate of authority issued under	463
this chapter to practice as a clinical nurse specialist, certified	464
nurse-midwife, or certified nurse practitioner;	465

(2) The fee required by section 4723.08 of the Revised Code	466
for a certificate to prescribe;	467

(3) Either of the following:

468

(a) Evidence of having held, for a continuous period of at	469
least one year during the three years immediately preceding the	470
date of application, valid authority issued by another	471
jurisdiction to prescribe therapeutic devices and drugs,	472
including at least some controlled substances;	473

(b) Evidence of having been employed by the United States	474
government and authorized, for a continuous period of at least one	475
year during the three years immediately preceding the date of	476
application, to prescribe therapeutic devices and drugs, including	477
at least some controlled substances, in conjunction with that	478
employment.	479

(4) If the applicant includes the evidence described in	480
division (C)(3)(a) of this section, documentation from a licensed	481
physician in a form acceptable to the board that the prescribing	482
component of the nurse's practice was overseen or supervised by	483
a licensed physician in the other jurisdiction;	484

(5) If the applicant includes the evidence described in	485
division (C)(3)(b) of this section, documentation from a licensed	486
physician employed by the United States government in a form	487
acceptable to the board that the prescribing component of the	488
nurse's practice was overseen or supervised by a licensed	489
physician employed by the United States government;	490

(6) Evidence of having completed a two-hour course of	491
instruction approved by the board in the laws of this state that	492
govern drugs and prescriptive authority;	493

(7) Any additional information the board requires pursuant to	494
rules adopted under section 4723.50 of the Revised Code.	495

(D) An applicant who practiced or is practicing as a clinical	496
nurse specialist, certified nurse-midwife, or certified nurse	497
practitioner in another jurisdiction or as an employee of the	498
United States government, and is not seeking authority to	499
prescribe drugs and therapeutic devices by meeting the	500
requirements of division (A) or (C) of this section, shall include	501
with the application submitted under section 4723.48 of the	502
Revised Code all of the following:	503

(1) Subject to section 4723.483 of the Revised Code, evidence	504
of holding a current, valid certificate of authority issued under	505
this chapter to practice as a clinical nurse specialist, certified	506
nurse-midwife, or certified nurse practitioner;	507

(2) The fee required by section 4723.08 of the Revised Code	508
for a certificate to prescribe;	509

(3) Either of the following:

510

(a) Evidence of having held, for a continuous period of at	511
least one year during the three years immediately preceding the	512
date of application, valid authority issued by another	513
jurisdiction to prescribe therapeutic devices and drugs,	514
excluding controlled substances;	515

(b) Evidence of having been employed by the United States	516
government and authorized, for a continuous period of at least one	517
year during the three years immediately preceding the date of	518
application, to prescribe therapeutic devices and drugs, excluding	519
controlled substances, in conjunction with that employment.	520

(4) If the applicant includes the evidence described in	521
division (D)(3)(a) of this section, documentation from a licensed	522
physician in a form acceptable to the board that the prescribing	523
component of the nurse's practice was overseen or supervised by	524
a licensed physician in the other jurisdiction;	525

(5) If the applicant includes the evidence described in	526
division (D)(3)(b) of this section, documentation from a licensed	527
physician employed by the United States government in a form	528
acceptable to the board that the prescribing component of the	529
nurse's practice was overseen or supervised by a licensed	530
physician employed by the United States government;	531

(6) Any additional information the board requires pursuant to	532
rules adopted under section 4723.50 of the Revised Code.	533

Sec. 4723.484. (A) Except as provided in division (B) of this	534
section, to successfully complete an externship as required under	535
section 4723.485 of the Revised Code, the holder of an externship	536
certificate must complete at least one thousand five hundred hours	537
during which the certificate holder's prescribing practices are	538
supervised in accordance with division (A) of section 4723.48 of	539
the Revised Code.	540

(B) A holder of an externship certificate who obtained the	541
certificate by meeting the requirements of division (D) of section	542
4723.482 of the Revised Code, to successfully complete an	543
externship as required under section 4723.485 of the Revised Code,	544
must do both of the following:	545

(1) Complete at least five hundred hours during which the	546
certificate holder's prescribing practices are supervised in	547
accordance with division (A) of section 4723.48 of the Revised	548
Code;	549

(2) Complete a two-hour course of instruction approved by the	550
board of nursing in the laws of this state that govern drugs and	551
prescriptive authority.	552

Sec. 4723.484.        Sec. 4723.485.  (A) A certificate to prescribe	553
issued under section 4723.48 of the Revised Code as an externship	554
certificate is valid for not more than one year, unless earlier	555
suspended or revoked by the board of nursing. The certificate may	556
be extended for an additional year if the holder submits to the	557
board evidence of continued participation in an externship. If an	558
externship is terminated for any reason, the nurse shall notify	559
the board.	560

(B) To be eligible for a certificate to prescribe after	561
receiving an externship certificate, an applicant shall include	562
with the application submitted under section 4723.48 of the	563
Revised Code all of the following:	564

(1) A statement from a supervising physician attesting to the	565
applicant's successful completion of the externship;	566

(2) The fee required by section 4723.08 of the Revised Code	567
for a certificate to prescribe;	568

(3) Any additional information the board requires pursuant to	569
rules adopted under section 4723.50 of the Revised Code.	570

Sec. 4723.485.        Sec. 4723.486.  (A) A certificate to prescribe	571
issued under section 4723.48 of the Revised Code that is not	572
issued as an externship certificate is valid for two years, unless	573
otherwise provided in rules adopted under section 4723.50 of the	574
Revised Code or earlier suspended or revoked by the board. The	575
board of nursing shall renew certificates to prescribe according	576
to procedures and a renewal schedule established in rules adopted	577
under section 4723.50 of the Revised Code.	578

(B) The board may renew a certificate to prescribe if the	579
holder submits to the board all of the following:	580

(1) Evidence of having completed during the previous two	581
years at least twelve hours of continuing education in advanced	582
pharmacology, or, if the certificate has been held for less than a	583
full renewal period, the number of hours required by the board in	584
rules adopted under section 4723.50 of the Revised Code;	585

(2) The fee required under section 4723.08 of the Revised	586
Code for renewal of a certificate to prescribe;	587

(3) Any additional information the board requires pursuant to	588
rules adopted under section 4723.50 of the Revised Code.	589

(C) The continuing education in pharmacology required under	590
division (B)(1) of this section must be received from an	591
accredited institution recognized by the board. The hours of	592
continuing education required are in addition to any other	593
continuing education requirement that must be completed pursuant	594
to this chapter.	595

Sec. 4723.50.  (A) In accordance with Chapter 119. of the	596
Revised Code, the board of nursing shall adopt rules as necessary	597
to implement the provisions of this chapter pertaining to the	598
authority of clinical nurse specialists, certified nurse-midwives,	599
and certified nurse practitioners to prescribe drugs and	600
therapeutic devices and the issuance and renewal of certificates	601
to prescribe. Initial rules shall be adopted not later than twenty	602
months after the effective date of this sectionMay 17, 2000.	603

The board shall adopt rules that are consistent with the	604
recommendations the board receives from the committee on	605
prescriptive governance pursuant to section 4723.492 of the	606
Revised Code. After reviewing a recommendation submitted by the	607
committee, the board may either adopt the recommendation as a rule	608
or ask the committee to reconsider and resubmit the	609
recommendation. The board shall not adopt any rule that does not	610
conform to a recommendation made by the committee.	611

(B) The board shall adopt rules under this section that do	612
all of the following:	613

(1) Establish a formulary listing the types of drugs and	614
therapeutic devices that may be prescribed by a clinical nurse	615
specialist, certified nurse-midwife, or certified nurse	616
practitioner. The formulary may include controlled substances, as	617
defined in section 3719.01 of the Revised Code. The formulary	618
shall not permit the prescribing of any drug or device to perform	619
or induce an abortion.	620

(2) Establish safety standards to be followed by a nurse when	621
personally furnishing to patients complete or partial supplies of	622
antibiotics, antifungals, scabicides, contraceptives, prenatal	623
vitamins, antihypertensives, drugs and devices used in the	624
treatment of diabetes, drugs and devices used in the treatment of	625
asthma, and drugs used in the treatment of dyslipidemia.	626

(3) Establish criteria for the components of the standard	627
care arrangements described in section 4723.431 of the Revised	628
Code that apply to a nurse's authority to prescribe. The rules	629
shall be consistent with that section and include all of the	630
following:	631

(a) Quality assurance standards;

632

(b) Standards for periodic review by a collaborating	633
physician or podiatrist of the records of patients treated by the	634
nurse;	635

(c) Acceptable travel time between the location at which the	636
nurse is engaging in the prescribing components of the nurse's	637
practice and the location of the nurse's collaborating physician	638
or podiatrist;	639

(d) Any other criteria recommended by the committee on	640
prescriptive governance.	641

(4) Establish standards and procedures for issuance and	642
renewal of a certificate to prescribe, including specification of	643
any additional information the board may require under division	644
(A)(4), (C)(7), or (D)(6) of section 4723.482 or division (B)(3)	645
of section 4723.4844723.485 of the Revised Code;	646

(5) Establish requirements for board approval of the	647
instruction in advanced pharmacology and related topics required	648
by section 4723.482 of the Revised Code;	649

(6) Establish requirements for board approval of the two-hour	650
course of instruction in the laws of this state as required under	651
division (C)(6) of section 4723.482 of the Revised Code and	652
division (B)(2) of section 4723.484 of the Revised Code;	653

(7) Establish standards and procedures for the appropriate	654
conduct of an externship required by division (B)(1) ofas	655
described in section 4723.484 of the Revised Code, including the	656
following:	657

(a) Standards and procedures to be used in evaluating a	658
nurse's participation in an externship. Regardless of the method	659
of evaluation used, a nurse shall not be required to participate	660
in an externship longer than one thousand eight hundred hours.;	661

(b) Standards and procedures for the supervision that a	662
physician must provide during an externship, including supervision	663
provided by working with the nurse and supervision provided by	664
making timely reviews of the records of patients treated by the	665
nurse. The manner in which supervision must be provided may vary	666
according to the location where the nurse is practicing and with	667
the nurse's level of experience.	668

Section 2. That existing sections 3333.28, 4723.01, 4723.06,	669
4723.48, 4723.482, 4723.484, 4723.485, and 4723.50 of the Revised	670
Code are hereby repealed.	671

Section 3. Notwithstanding the requirement of division (A) of	672
section 4723.50 of the Revised Code that the Board of Nursing	673
adopt rules consistent with the recommendations the Board receives	674
from the Committee on Prescriptive Governance, the Board shall	675
amend the rules that were adopted under section 4723.50 of the	676
Revised Code to reflect the amendment by this act of sections	677
4723.48 and 4723.482 and the enactment by this act of new section	678
4723.484 of the Revised Code. Until the rules have been amended	679
accordingly, the Board shall not enforce any rule that is	680
inconsistent with sections 4723.48 and 4723.482 of the Revised	681
Code as amended by this act and new section 4723.484 as enacted by	682
this act.	683