CHAPTER 319

FORMERLY

HOUSE BILL NO. 427

AS AMENDED BY HOUSE AMENDMENT NO. 4

AN ACT TO AMEND TITLES 18 AND 24 OF THE DELAWARE CODE RELATING TO NURSING BY CHANGING THE QUALIFICATIONS AND AUTHORIZATION TO PRACTICE OF ADVANCED NURSES.

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

Section 1. Amend Subsection 2318, Title 18 of the Delaware Code by deleting the words "advanced registered nurses" in the title and inserting in lieu thereof the words "advanced practice nurses" and by deleting the words "advanced registered nurse practitioner" and inserting in lieu thereof the words "advanced practice nurse" wherever the same appear in said Subsection 2318.

Section 2. Amend Subsection 1901, Title 24 of the Delaware Code by deleting the last three sentences of said section in their entirety.

Section 3. Amend Subsection 1902(b) (6), Title 24 of the Delaware Code by deleting the word "or" and inserting a comma after the word "dentist" and by inserting the words or advanced practice nurse" after the word "podiatrist."

Section 4. Amend Subsection 1902(b) of Title 24 of the Delaware Code by adding the following:

"(8) Nothing contained in this Chapter shall be deemed to permit acts of surgery or medical diagnosis; nor shall it be deemed to permit dispensing of drugs, medications or therapeutics independent of the supervision of a physician who is licensed to practice medicine and surgery, or those licensed to practice dentistry or podiatry."

Section 5. Amend Subsection 1902(c) (5), Title 24 of the Delaware Code by deleting the word "or" and inserting a comma after the word "dentist" and inserting the words "or advanced practice nurse" after the word "podiatrist."

Section 6. Amend Subsection 1902(c), Title 24 of the Delaware Code by adding the following:

"(7) Nothing contained in this Chapter shall be deemed to permit acts of surgery or medical diagnosis; nor shall it be deemed to permit dispensing of drugs, medications or therapeutics independent of the supervision of a physician who is licensed to practice medicine and surgery, or those licensed to practice dentistry or podiatry.

Section 7. Amend Subsection 1902(d), Title 24 of the Delaware Code by deleting said subsection in its entirety and inserting in lieu thereof a new subsection (d) as follows;

"(d) (1) "Advanced Practice Nurse" means an individual whose education and certification meet criteria established by the Board of Nursing who is currently licensed as a registered nurse and has a Master's degree or a post—basic program certificate to a clinical nursing specialty with national certification. When no national certification at the advanced level exists, a Master's degree in a clinical nursing specialty will qualify an individual for advanced practice nurse licensure. "Advanced Practice Nurse" shall include, but not be limited to, nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, or clinical nurse specialists, Advanced practice nursing is the application of nursing principles, including those described in subsection §1902(b) of this section, at an advanced level and includes:

(a) For those Advanced Practice Nurses who do not perform independent acts of diagnosis or prescription, the authority as granted within the scope of practice rules and regulations promulgated by the Board of Nursing; andFor those Advanced Practice Nurses performing independent acts of diagnosis and/or prescription with the collaboration of a licensed physician, dentist, podiatrist or licensed Delaware health care delivery system without written guidelines or protocals and within the scope of practice as defined in the rules and regulations promulgated by the Joint Practice Committee and approved by the Board of Medical Practice.

(b) Nothing in this Act is to be construed to limit the practice of nursing by Advanced Practice Nurses as is currently being done or allowed including nursing diagnosis as pusuant to Section 1902(b)(2)."

Advanced Practice Nurses shall operate in collaboration with a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system to cooperate, coordinate, and consult with each other as appropriate pursuant to a collaborative agreement defined in the Rules and Regulations promulgated by the Board of Nursing, in the provision of health care to their patients. Advanced Practice Nurses desiring to practice independently or to prescribe independently must do so pursuant to Section 1906(20) of Title 24 of the Delaware Code.

(2) Those individuals who wish to engage in independent practice without written guidelines or protocols and/or wish to have independent prescriptive authority shall apply for such privilege or privileges to the Joint Practice Committee and do so only in collaboration with a licensed physician, dentist, podiatrist or licensed Delaware health care delivery system. This does not include those individuals who have protocols and/or waivers approved by the Board of Medical Practice."

Section 8. Amend Subsection 1906(7), Title 24 of the Delaware Code by

deleting the words "advanced registered nurse practitioner" and inserting in lieu thereof the words "advanced practice nurse."

Section 9. Amend Section 1906, Title 24 of the Delaware Code by adding thereto new subsections as follows:

"(20) Create a regulatory committee entitled 'Joint Practice Committee' to develop rules and regulations regarding the independent practice and prescriptive authority of 'Advance Practice Nurses.' The Committee shall consist of nine members and shall be as follows:

a. The Board of Nursing shall appoint one public member and five Advanced Practice Nurses.

b. The Board of Pharmacy shall appoint one pharmacist.

c. The Board of Medical Practice shall appoint two physicians.

(21) The 'Joint Practice Committee' with the approval of the Board of Medical Practice shall have the authority to grant, restrict, suspend or revoke practice or independent prescriptive authority and the Joint Practice Committee with the approval of the Board of Medical Practice shall be responsible for promulgating rules andregulations to implement the provisions of this Chapter regarding 'Advanced Practice Nurses' who have been granted authority for independent practice and/or Independent prescriptive authority.

(1) The rules and regulations and the granting, restricting, suspension or revocation of the independent practice and/or independent prescriptive authority shall be subject to the approval of the Board of Medical Practice."

Section 10. Amend Subsection 1909, Title 24 of the Delaware Code by

deleting said section in its entirety and inserting in lieu thereof a new section as follows:

"No unlicensed person, except those persons issued a temporary permit by the Board, shall practice advanced practice, professional, or practical nursing. Upon request, any person engaged in the practice of advanced practice, professional, or practical nursing shall exhibit a license authorizing such practice."

Section 11. Amend Subsection 1918(a), Title 24 of the Delaware Code by inserting the words "advanced practice nurse", after the word "Every" in the first sentence of this subsection and by inserting the following new sentence immediately after the first sentence of said subsection.

The Advanced Practice Nurses' independent practice and/or independent prescriptive authority shall be subject to biannual renewal upon application made to the 'Joint Practice Committee."

Section 12. Amend Subsection 1920(b), Title 24 of the Delaware Code by deleting said subsection in its entirety and inserting in lieu thereof a new subsection 1920(b) as follows:

"(b) no person shall engage in practice as an advanced practice nurse without a Board-issued license as an advanced practice nurse."

Section 15. The Board of Nursing and the Board of Medical Practice shall issue a report to the General Assembly three years from the date of the passage of this legislation which shall set forth the impact of this legislation on the health care delivery systems in this State."

Section 13. Amend Section 1902 of Title 24 by adding a new subsection as to read as follows:

"(k) Independent practice by an Advanced Practice Nurse shall

include those advance practice nurses who practice and prescribe without written guidelines or protocols but with a collaborative agreement with a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system and with the approval of the Joint Practice Committee."

Approved July 8, 1994.