SB 33 — Certified registered nurse anesthetists; supervision during an operation or procedure.

SESSION INTRODUCEDSENATE 24101199DSUBSTITUTE I24105112D SENATE BILL NO.

33 OfferedAMENDMENT JanuaryIN 10,THE 2024NATURE NOF PrefiledA DecemberSUBSTITUTE 16,(Proposed 2023by Tthe Senate Committee on Education and Health on January 25, 2024) (Patron Prior to Substitute––Senator Locke) A BregisteredBILL nurseto anesthetists;amend and reenact § 54.1-2957 of the Code of Virginia, relating to supervision of certified Be it enacted by the General Assembly of Virginia:

work1. group;

report.f Virginia, relating to supervision of cerRified –––––––––– Patrons––Locke and Pillion O –––––––––– D Referred to Committee on Education and Health –––––––––– U Be it enacted by the General Assembly of Virginia:

C 1.

§ 54.1-2957.

Licensure and practice of advanced practice registered nurses.

Dthe B.licensure of advanced practice registered nurses.

TheIt Boardis ofunlawful Medicinefor anda theperson Boardto ofpractice Nursingas shallaning jointlyadvanced prescribepractice theregistered regulationsnurse governingin the licensureCommonwealth ofunless advancedhe practiceholds registeredsuch nurses.a joint license.

It is unlawful for a person to practice as an advanced practice registered nurse in the Commonwealth unless he holds such a joint license.

A nurse practitioner who meets the requirements of subsection I may pursuantpractice towithout subsectiona H.written or electronic practice agreement.

A clinicalcertified nurse specialistmidwife shall practice pursuantregistered tonurse subsectionanesthetist J.shall practice under the supervision of a licensed doctor of medicine,rtified osteopathy, podiatry, or dentistry.

A"Supervision" certifiedfor registeredthe nursepurpose anesthetistof shallthis practicesubsection undermeans thethatTthe supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry.dentistry is present during an operation or procedure or is immediately available to respond and provide patient care as needed.

"Supervision"An foradvanceE thepractice purposeregistered ofnurse thiswho subsectionis meansappointed thatas thea licensedmedical doctorexaminer ofpursuant medicine,to osteopathy,§ podiatry,32.1-282 orshall dentistrypractice isin presentcollaboration duringwith ana operationlicensed ordoctor procedureof medicine or isosteopathic immediatelymedicine availablewho has been appointed to respondpractice andregistered providenurses and patient care team physicians may be provided through telemedicine as needed.described in § 38.2-3418.16.

AnS advancedPhysicians practiceon registeredpatient nursecare whoteams ismay appointedrequire asthat aan medicaladvanced examinerpractice pursuantregistered tonurse §be 32.1-282cUvered shallby practice in collaboration with a licensedprofessional doctorliability ofinsurance medicinepolicy orwith osteopathiclimits medicineequal who has been appointed to servethe ascurrent alimitation medicalon examinerdamBges pursuantset toforth in § 32.1-282.8.01-581.15.

Collaborationservice andalone, consultationestablish amongor advancedcreate described in § 38.2-3418.16.nd patient care team physicians may be provided through telemedicine as Physicians on patient care teams may require that an advanced practice registered nurse be covered by a professional liability insurancefor policy with limits equal to the currentactions limitationor oninactions damagesof setother forthteam inmembers.uch §D. 8.01-581.15.

35The ServiceBoards onof aMedicine patientand careNursing teamshall byjointly apromulgate patientregulations carespecifying teamcollaboration member36 shalland not,consultation byamong thephysicians existenceand ofadvanced suchpractice 36registered servicenurses alone,working establishas orpart createof liabilitypatient for37 care teams that shall include the actionsdevelopment orof, inactionsand ofperiodic otherreview teamand members.revision of, a written or 38 electronic practice agreement;

37guidelines D.for availability and ongoing communications that defiTe 39 consultation among the collaborating parties and the patient;

Theand Boardsperiodic joint evaluation of MedicineUhe andservices Nursingmay shallinclude jointlyvisits promulgateto regulationsthe specifyingsite collaborationwhere 38health andcare consultationis amongdelivered, physiciansin the manner and at the frequency, which determined by the advanced practice registered nursesnurse workingand asthe partpatient ofcare team physician and (ii) input from appropriate health care providers in complex clinical cases and patient electronicemergencies practiceand agreement;foE referrals.

guidelines for availability and ongoing communications that defineor consultation among the collaborating parties and the patient;

and periodic joint evaluation of the services delivered.

Practice agreements shall include provisions for (i) periodic review of health records, which may include visits to the site where health care is delivered, in the manner and at the frequency determined by the advanced practice registered nurse and the patient care team physician and (ii) input from appropriate health care providers in complex clinical cases and patient emergencies and for referrals.

The Boards of Medicine and Nursing may issue a license by endorsement to an applicant to practice as an advanced practice registered nurse if the applicant has been licensed as an advancedadvaSced practice registered nurse under the laws of another state and, pursuant to regulations of the Boards,B3ards, the applicant meets the qualifications for licensure required of advanced practice registered nurses in the Commonwealth.

An advanced practice registered nurse to whom a license is issued by endorsement maymayn the practice without a practice agreement with a patient care team physician pursuant to subsection I if such application provides an attestation to the Boards that the applicant has completed the equivalent of atchat SB33 2 of 3 least five years of full-time clinical experience, as determined by the Boards, in accordance with the laws of the state in which the nurse practitioner was licensed.

Pending the outcome of the next National Specialty Examination, the Boards may jointly grant SB33S1 2 of 3 temporary licensure to advanced practice registered nurses.

A clinical nurse specialist licensed by the Boards of Medicine and Nursing who does not prescribe controlled substances or devices may practice in the practice category in which he is certified and of 3 licensed without a written or electronic practice agreement.

Such clinical nurse specialist shall (i) only practice within the scope of his clinical and professional training and limits of his knowledgeIandknowledge healthand careexperience providersand basedconsistent onwith the clinicalapplicable conditionstandards of thecare, patient(ii) toconsult whomand healthcollaborate carewith isother provided,of and3 (iii) establish a plan for referral of complex medical cases and emergencies to physicians or otherotherd, and appropriate health care providers.

Tshall Apractice clinicalin nurseconsultation specialistwith a licensed byphysician thein Boardsaccordance whowith prescribesa controlledpractice substancesagreement orbetween dRvices the clinical nurse specialist and the licensed physician.

Such practice agreement shall address thetweenthe availability of the physician for routine and urgent consultation on patient care.

Evidence of Da practice agreementThe practice of clinical nurse specialists shall be maintainedconsistent bywith athe clinicalstandards nurseof specialistcare andfor providedthe toprofession theand Boardswith uponapplicable request.laws and regulations.

andMedicine, withthe applicableBoard lawsof Nursing, and regulations.sthe Department of Health Professions, shall beconvene consistenta withwork group to evaluate and make recommendations to increase the standardsanesthesia provider workforce in the Commonwealth, including an assessment of care(i) forthe tUefactors professionlimiting 2.the current and future numbers licensing anesthesiology assistants who are currently in the anesthesia provider workforce in thepact of Commonwealth, (iii) how potential changes to the current law regarding the practice of certified communities and underserved areas of Virginia, and (iv) whether potential changes to the law will increase or decrease health disparities.

ThatThe the Secretary of Health and Human Resources, in collaboration with the Board of C Medicine, the Board of Nursing, and the Department of Health Professions, shall convene a work E group toshall evaluateinclude andrepresentatives makefrom recommendations to increase the anesthesiaN providerHospital workforce in the of physician anesthesiologists and certifiedHealthcare registeredAssociation, nurse anesthetists and (ii) the projectedVirginia impactAcademy of licensingAnesthesiologist anesthesiologyAssistants, assistantsandrginia whoother arerelevant currentlystakeholders. in the anesthesia provider workforce in the Commonwealth.

The work group shall includereport relevantits stakeholders,recommendations includingto Anesthetists,the Chairmen ofA the VirginiaSenate HospitalCommittee andon HealthcareEducation Association,and Health and the VirginiaHouse AcademyCommittee ofon NurseHealth Anesthesiologistand Assistants.Human T Services by November 1, 2024.

TheE workS groupU shallB reportS itsT recommendationsI toT theU ChairmenT ofE theB SenateS Committee1 on Education and Health and the House Committee on Health, Welfare and Institutions by November 1, 2024.

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