Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 287 Second Substitute (2021GS)

Sponsor

Rep. Welton, D.

Final action

Governor Signed 3/17/2021

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• modifies the requirements a nurse practitioner must meet before prescribing a Schedule II controlled substance; and
• makes technical changes.

Every vote on this bill

Bill text

NURSE PRACTICE ACT AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Douglas R. Welton
Senate Sponsor: 
Curtis S. Bramble
Cosponsors:
Kera Birkeland
Walt Brooks
Jefferson S. Burton
Jennifer Dailey-Provost
James A. Dunnigan
Marsha Judkins
Steven J. Lund
Phil Lyman
A. Cory Maloy
Carol Spackman Moss
Candice B. Pierucci
Paul Ray
Travis M. Seegmiller
V. Lowry Snow
Andrew Stoddard
Norman K. Thurston
Christine F. Watkins
Mike Winder
LONG TITLE
General Description:
This bill modifies the Nurse Practice Act.
Highlighted Provisions:
This bill:
▸ modifies the requirements a nurse practitioner must meet before prescribing a
Schedule II controlled substance; and
▸ makes technical changes. 
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
58-31b-102
, as last amended by Laws of Utah 2020, Chapter 314
58-31b-502
, as last amended by Laws of Utah 2020, Fifth Special Session, Chapter 4
58-31b-803
, as last amended by Laws of Utah 2020, Chapter 339
62A-4a-213
, as last amended by Laws of Utah 2019, Chapter 257
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
58-31b-102
 is amended to read:
58-31b-102.
Definitions.
In addition to the definitions in Section 
58-1-102
, as used in this chapter:
(1) "Administrative penalty" means a monetary fine or citation imposed by the division
for acts or omissions determined to be unprofessional or unlawful conduct in accordance with a
fine schedule established by division rule made in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, and as a result of an adjudicative proceeding conducted in
accordance with Title 63G, Chapter 4, Administrative Procedures Act.
(2) "Applicant" means an individual who applies for licensure or certification under
this chapter by submitting a completed application for licensure or certification and the
required fees to the department.
(3) "Approved education program" means a nursing education program that is
accredited by an accrediting body for nursing education that is approved by the United States
Department of Education.
(4) "Board" means the Board of Nursing created in Section 
58-31b-201
.
[
(5) "Consultation and referral plan" means a written plan jointly developed by an
advanced practice registered nurse and, except as provided in Subsection 
58-31b-803
(4), a
consulting physician that permits the advanced practice registered nurse to prescribe Schedule
II controlled substances in consultation with the consulting physician.
]
[
(6) "Consulting physician" means a physician and surgeon or osteopathic physician
and surgeon licensed in accordance with this title who has agreed to consult with an advanced
practice registered nurse with a controlled substance license, a DEA registration number, and
who will be prescribing Schedule II controlled substances.
]
[
(7)
] 
(5)
 "Diagnosis" means the identification of and discrimination between physical
and psychosocial signs and symptoms essential to the effective execution and management of
health care.
[
(8)
] 
(6)
 "Examinee" means an individual who applies to take or does take any
examination required under this chapter for licensure.
[
(9)
] 
(7)
 "Licensee" means an individual who is licensed or certified under this chapter.
[
(10)
] 
(8)
 "Long-term care facility" means any of the following facilities licensed by
the Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
Inspection Act:
(a) a nursing care facility;
(b) a small health care facility;
(c) an intermediate care facility for people with an intellectual disability;
(d) an assisted living facility Type I or II; or
(e) a designated swing bed unit in a general hospital.
[
(11)
] 
(9)
 "Medication aide certified" means a certified nurse aide who:
(a) has a minimum of 2,000 hours experience working as a certified nurse aide;
(b) has received a minimum of 60 hours of classroom and 40 hours of practical training
that is approved by the division in collaboration with the board, in administering routine
medications to patients or residents of long-term care facilities; and
(c) is certified by the division as a medication aide certified.
[
(12) "Pain clinic" means the same as that term is defined in Section 
58-1-102
.
]
[
(13)
] 
(10)
 (a) "Practice as a medication aide certified" means the limited practice of
nursing under the supervision, as defined by the division by rule made in accordance with Title
63G, Chapter 3, Utah Administrative Rulemaking Act, of a licensed nurse, involving routine
patient care that requires minimal or limited specialized or general knowledge, judgment, and
skill, to an individual who:
(i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
disability; and
(ii) is in a regulated long-term care facility.
(b) "Practice as a medication aide certified":
(i) includes:
(A) providing direct personal assistance or care; and
(B) administering routine medications to patients in accordance with a formulary and
protocols to be defined by the division by rule made in accordance with Title 63G, Chapter 3,
Utah Administrative Rulemaking Act; and
(ii) does not include assisting a resident of an assisted living facility, a long term care
facility, or an intermediate care facility for people with an intellectual disability to self
administer a medication, as regulated by the Department of Health by rule made in accordance
with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
[
(14)
] 
(11)
 "Practice of advanced practice registered nursing" means the practice of
nursing within the generally recognized scope and standards of advanced practice registered
nursing as defined by rule and consistent with professionally recognized preparation and
education standards of an advanced practice registered nurse by a person licensed under this
chapter as an advanced practice registered nurse. "Practice of advanced practice registered
nursing" includes:
(a) maintenance and promotion of health and prevention of disease;
(b) diagnosis, treatment, correction, consultation, and referral [
for common health
problems
];
(c) prescription or administration of prescription drugs or devices including:
(i) local anesthesia;
(ii) Schedule III-V controlled substances; and
(iii) Subject to Section 
58-31b-803
, Schedule II controlled substances; or
(d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
related services upon the request of a licensed health care professional by an advanced practice
registered nurse specializing as a certified registered nurse anesthetist, including:
(i) preanesthesia preparation and evaluation including:
(A) performing a preanesthetic assessment of the patient;
(B) ordering and evaluating appropriate lab and other studies to determine the health of
the patient; and
(C) selecting, ordering, or administering appropriate medications;
(ii) anesthesia induction, maintenance, and emergence, including:
(A) selecting and initiating the planned anesthetic technique;
(B) selecting and administering anesthetics and adjunct drugs and fluids; and
(C) administering general, regional, and local anesthesia;
(iii) postanesthesia follow-up care, including:
(A) evaluating the patient's response to anesthesia and implementing corrective
actions; and
(B) selecting, ordering, or administering the medications and studies listed in 
this
Subsection [
(14)
] 
(11)
(d); and
(iv) other related services within the scope of practice of a certified registered nurse
anesthetist, including:
(A) emergency airway management;
(B) advanced cardiac life support; and
(C) the establishment of peripheral, central, and arterial invasive lines; and
(v) for purposes of 
this
 Subsection [
(14)
] 
(11)
(d), "upon the request of a licensed health
care professional":
(A) means a health care professional practicing within the scope of the health care
professional's license, requests anesthesia services for a specific patient; and
(B) does not require an advanced practice registered nurse specializing as a certified
registered nurse anesthetist to [
enter into a consultation and referral plan or
] obtain additional
authority to select, administer, or provide preoperative, intraoperative, or postoperative
anesthesia care and services.
[
(15)
] 
(12)
 "Practice of nursing" means assisting individuals or groups to maintain or
attain optimal health, implementing a strategy of care to accomplish defined goals and
evaluating responses to care and treatment, and requires substantial specialized or general
knowledge, judgment, and skill based upon principles of the biological, physical, behavioral,
and social sciences. "Practice of nursing" includes:
(a) initiating and maintaining comfort measures;
(b) promoting and supporting human functions and responses;
(c) establishing an environment conducive to well-being;
(d) providing health counseling and teaching;
(e) collaborating with health care professionals on aspects of the health care regimen;
(f) performing delegated procedures only within the education, knowledge, judgment,
and skill of the licensee;
(g) delegating nursing tasks that may be performed by others, including an unlicensed
assistive personnel; and
(h) supervising an individual to whom a task is delegated under Subsection [
(15)
]
(12)
(g) as the individual performs the task.
[
(16)
] 
(13)
 "Practice of practical nursing" means the performance of nursing acts in the
generally recognized scope of practice of licensed practical nurses as defined by division rule
made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and as
provided in this Subsection [
(16)
] 
(13)
 by an individual licensed under this chapter as a
licensed practical nurse and under the direction of a registered nurse, licensed physician, or
other specified health care professional as defined by division rule made in accordance with
Title 63G, Chapter 3, Utah Administrative Rulemaking Act. Practical nursing acts include:
(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 appropriate aspects of the strategy of care;
(d) maintaining safe and effective nursing care rendered to a patient directly or
indirectly; and
(e) participating in the evaluation of responses to interventions.
[
(17)
] 
(14)
 "Practice of registered nursing" means performing acts of nursing as
provided in this Subsection [
(17)
] 
(14)
 by an individual licensed under this chapter as a
registered nurse within the generally recognized scope of practice of registered nurses as
defined by division rule made in accordance with Title 63G, Chapter 3, Utah Administrative
Rulemaking Act. Registered nursing acts include:
(a) assessing the health status of individuals and groups;
(b) identifying health care needs;
(c) establishing goals to meet identified health care needs;
(d) planning a strategy of care;
(e) prescribing nursing interventions to implement the strategy of care;
(f) implementing the strategy of care;
(g) maintaining safe and effective nursing care that is rendered to a patient directly or
indirectly;
(h) evaluating responses to interventions;
(i) teaching the theory and practice of nursing; and
(j) managing and supervising the practice of nursing.
[
(18)
] 
(15)
 "Routine medications":
(a) means established medications administered to a medically stable individual as
determined by a licensed health care practitioner or in consultation with a licensed medical
practitioner; and
(b) is limited to medications that are administered by the following routes:
(i) oral;
(ii) sublingual;
(iii) buccal;
(iv) eye;
(v) ear;
(vi) nasal;
(vii) rectal;
(viii) vaginal;
(ix) skin ointments, topical including patches and transdermal;
(x) premeasured medication delivered by aerosol/nebulizer; and
(xi) medications delivered by metered hand-held inhalers.
[
(19)
] 
(16)
 "Unlawful conduct" means the same as that term is defined in Sections
58-1-501
 and 
58-31b-501
.
[
(20)
] 
(17)
 "Unlicensed assistive personnel" means any unlicensed individual,
regardless of title, who is delegated a task by a licensed nurse as permitted by division rule
made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and the
standards of the profession.
[
(21)
] 
(18)
 "Unprofessional conduct" means the same as that term is defined in
Sections 
58-1-501
 and 
58-31b-502
 and as may be further defined by division rule made in
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
Section 2. Section 
58-31b-502
 is amended to read:
58-31b-502.
Unprofessional conduct.
(1) "Unprofessional conduct" includes:
(a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
diagnosis, personal effects, or any other matter about which the licensee is privileged to know
because of the licensee's or person with a certification's position or practice as a nurse or
practice as a medication aide certified;
(b) failure to provide nursing service or service as a medication aide certified in a
manner that demonstrates respect for the patient's human dignity and unique personal character
and needs without regard to the patient's race, religion, ethnic background, socioeconomic
status, age, sex, or the nature of the patient's health problem;
(c) engaging in sexual relations with a patient during any:
(i) period when a generally recognized professional relationship exists between the
person licensed or certified under this chapter and the patient; or
(ii) extended period when a patient has reasonable cause to believe a professional
relationship exists between the person licensed or certified under the provisions of this chapter
and the patient;
(d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using
information about a patient or exploiting the licensee's or the person with a certification's
professional relationship between the licensee or holder of a certification under this chapter and
the patient; or
(ii) exploiting the patient by use of the licensee's or person with a certification's
knowledge of the patient obtained while acting as a nurse or a medication aide certified;
(e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
(f) unauthorized taking or personal use of nursing supplies from an employer;
(g) unauthorized taking or personal use of a patient's personal property;
(h) unlawful or inappropriate delegation of nursing care;
(i) failure to exercise appropriate supervision of persons providing patient care services
under supervision of the licensed nurse;
(j) employing or aiding and abetting the employment of an unqualified or unlicensed
person to practice as a nurse;
(k) failure to file or record any medical report as required by law, impeding or
obstructing the filing or recording of such a report, or inducing another to fail to file or record
such a report;
(l) breach of a statutory, common law, regulatory, or ethical requirement of
confidentiality with respect to a person who is a patient, unless ordered by a court;
(m) failure to pay a penalty imposed by the division;
(n) prescribing a Schedule II controlled substance without complying with the
requirements in Section 
58-31b-803
, if applicable;
(o) violating Section 
58-31b-801
;
(p) violating the dispensing requirements of Section 
58-17b-309
 or Chapter 17b, Part
8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
applicable; 
or
[
(q) establishing or operating a pain clinic without a consultation and referral plan for
Schedule II or III controlled substances; or
]
[
(r)
] 
(q)
 falsely making an entry in, or altering, a medical record with the intent to
conceal:
(i) a wrongful or negligent act or omission of an individual licensed under this chapter
or an individual under the direction or control of an individual licensed under this chapter; or
(ii) conduct described in Subsections (1)(a) through [
(q)
] 
(o)
 or Subsection
58-1-501
(1).
(2) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, as that term
is defined in Section 
26-61a-102
, recommending the use of medical cannabis.
(3) Notwithstanding Subsection (2), the division, in consultation with the board and in
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
unprofessional conduct for an advanced practice registered nurse described in Subsection (2).
Section 3. Section 
58-31b-803
 is amended to read:
58-31b-803.
Limitations on prescriptive authority for advanced practice
registered nurses. 
(1) This section does not apply to an advanced practice registered nurse specializing as
a certified registered nurse anesthetist under Subsection 
58-31b-102
(14)(d).
(2) Except as provided in [
Subsections (3) and 
58-31b-502
(1)(q)
] 
Subsection (3)
, an
advanced practice registered nurse may prescribe or administer a Schedule II controlled
substance [
without a consultation and referral plan
].
(3) An advanced practice registered nurse described in Subsection (4) may not
prescribe or administer a Schedule II controlled substance unless the advanced practice
registered nurse [
prescribes or administers Schedule II controlled substances in accordance
with a consultation and referral plan.
]
:
(a) receives a board certification from a nationally recognized organization;
(b) completes at least 30 hours of instruction, or the equivalent number of credit hours,
pertaining to advanced pharmacology during a graduate education program;
(c) when obtaining licensure with the division, demonstrates completion of at least
seven hours of continuing education pertaining to prescribing opioids; and
(d) participates in a prescribing mentorship under which the advanced practice
registered nurse:
(i) is mentored by:
(A) a physician licensed in accordance with this title; or
(B) an advance practice registered nurse who has been licensed at least three years; and
(ii) periodically provides the mentor described in Subsection (4)(d)(i) timesheets that,
in total, demonstrate 1,000 hours of clinical experience.
(4) Subsection (3) applies to an advanced practice registered nurse who:
(a) [
(i)
] is engaged in independent solo practice; and
[
(ii) (A)
] 
(b) (i)
 has been licensed as an advanced practice registered nurse for less than
one year; or
[
(B)
] 
(ii)
 has less than 2,000 hours of experience practicing as a licensed advanced
practice registered nurse[
; or
].
[
(b) owns or operates a pain clinic.
]
[
(5) Notwithstanding Subsection 
58-31b-102
(5), an advanced practice registered nurse
with at least three years of experience as a licensed advanced practice registered nurse may
supervise a consultation and referral plan for an advanced practice registered nurse described in
Subsection (4)(a).
]
Section 4. Section 
62A-4a-213
 is amended to read:
62A-4a-213.
Psychotropic medication oversight pilot program.
(1) As used in this section, "psychotropic medication" means medication prescribed to
affect or alter thought processes, mood, or behavior, including antipsychotic, antidepressant,
anxiolytic, or behavior medication.
(2) The division shall, through contract with the Department of Health, establish and
operate a psychotropic medication oversight pilot program for children in foster care to ensure
that foster children are being prescribed psychotropic medication consistent with their needs.
(3) The division shall establish an oversight team to manage the psychotropic
medication oversight program, composed of at least the following individuals:
(a) an "advanced practice registered nurse," as defined in [
Subsection
] 
Section
58-31b-102
[
(14)
], employed by the Department of Health; and
(b) a child psychiatrist.
(4) The oversight team shall monitor foster children:
(a) six years old or younger who are being prescribed one or more psychotropic
medications; and
(b) seven years old or older who are being prescribed two or more psychotropic
medications.
(5) The oversight team shall, upon request, be given information or records related to
the foster child's health care history, including psychotropic medication history and mental and
behavioral health history, from:
(a) the foster child's current or past caseworker;
(b) the foster child; or
(c) the foster child's:
(i) current or past health care provider;
(ii) natural parents; or
(iii) foster parents.
(6) The oversight team may review and monitor the following information about a
foster child:
(a) the foster child's history;
(b) the foster child's health care, including psychotropic medication history and mental
or behavioral health history;
(c) whether there are less invasive treatment options available to meet the foster child's
needs;
(d) the dosage or dosage range and appropriateness of the foster child's psychotropic
medication;
(e) the short-term or long-term risks associated with the use of the foster child's
psychotropic medication; or
(f) the reported benefits of the foster child's psychotropic medication.
(7) (a) The oversight team may make recommendations to the foster child's health care
providers concerning the foster child's psychotropic medication or the foster child's mental or
behavioral health.
(b) The oversight team shall provide the recommendations made in Subsection (7)(a)
to the foster child's parent or guardian after discussing the recommendations with the foster
child's current health care providers.
(8) The division may adopt administrative rules in accordance with Title 63G, Chapter
3, Utah Administrative Rulemaking Act, necessary to administer this section.
(9) The division shall report to the Child Welfare Legislative Oversight Panel
regarding the psychotropic medication oversight pilot program by October 1 of each even
numbered year.