Rule 64B9-4.021, FAC Standards for Autonomous Practice- Effective 10/26/2021
Advanced practice registered nurses who are registered pursuant to Section 464.0123, F.S., shall engage in autonomous practice only in a manner that meets the General Standard of Practice. The General Standard of Practice shall be that standard of practice, care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similarly situated, educated, and licensed Advanced Practice Registered Nurses.
Rulemaking Authority 464.0123 FS. Law Implemented 464.0123 FS. History–New 10-26-21.
Update on Rule 64B9-4.001, FAC – Definitions – Primary Care Practice; and Proposed Standards of Practice rule
The Board’s definition of “primary care practice” is now in effect (as of February 25, 2021).
(12) Primary care practice – includes physical and mental health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions.
[This definition would be read in conjunction with Section 464.0123(3), Florida Statutes.]
The Board’s proposed definition of “standards of practice” is the subject of correspondence from the Joint Administrative Procedures Committee and will be further discussed during the April 9, 2021, Board meeting.
Both of these items relate to the implementation of the 2020 APRN autonomous practice legislation.
Update on Rulemaking for Autonomous APRN Registrants
The Board of Nursing has voted to approve the following revised language for adoption by rule as the definition of “primary care practice”:
“Includes physical and mental health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions”.
This definition would be read in conjunction with Section 464.0123(3), Florida Statutes.
The Board also voted to accept the recommendation, also for adoption by rule, from the Council on APRN Autonomous Practice for “standards of practice” as:
“Advanced practice registered nurses who are registered pursuant to Section 464.0123, F.S., shall engage in autonomous practice only in a manner that meets the General Standard of Practice. The General Standard of Practice shall be that standard of practice, care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similarly situated health care providers.”
The Board will provide an update when the rule adoption process is concluded.
Autonomous APRN Registration Application Now Available
The registration application for autonomous APRNs is now available. The application can be found in both the MQA online system under “Manage My License” and under the Resources/Nursing Applications tab of the Board website.
Eligibility for registration as an autonomous APRN includes the following:
- at least 3,000 clinical practice hours under the supervision of an allopathic or osteopathic physician within the past 5 years. These hours may include clinical instructional hours. [See Section 464.0123(1)(c) F.S. for complete requirements];
- three graduate-level semester hours, or the equivalent, in differential diagnosis and 3 graduate-level semester hours, or the equivalent, in pharmacology completed within the past 5 years (documentation required); and
- not been subject to disciplinary action as specified in Section 456.072 F.S. or Section 464.018 F.S., or any similar disciplinary action in any state or jurisdiction within the past 5 years.
There is no fee associated with submitting the registration application.
Equivalency for the required semester hours is being defined by Board rule. The proposed language can be found at https://floridasnursing.gov/nursing-faqs/advanced-practice-registered-nurse-aprn/ .
The Board is also working towards adopting a definition of “primary care practice”. It was the subject of a rules workshop on October 9, 2020. We will update our website as the rule promulgation process continues.
The Council on APRN Autonomous Practice held its first meeting on August 28, 2020. It is awaiting the proposed definition of “primary care practice” prior to making recommendations to the Board on “standards of practice”. The Council is scheduled to meet again on November 19, 2020.
Updates to issues related to autonomous practice are posted at this website link – https://floridasnursing.gov/hb-607-passes-legislature-impact-to-rns-cnas-and-aprns/ .
The new law is at this link – http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.0123.html
Frequently Asked Questions are at this link – https://floridasnursing.gov/nursing-faqs/advanced-practice-registered-nurse-aprn/
Appointments Made to Autonomous APRN Council.
The Boards of Medicine, Nursing, and Osteopathic Medicine have made appointments to the Council on Advanced Practice Registered Nurse (APRN) Autonomous Practice. Legislation creating the Council went into effect on July 1, 2020. The Council will recommend standards of practice for APRNs who register with the Board of Nursing for autonomous practice as defined in Section 464.0123, FS.
Board of Medicine
Shailesh Gupta, MD (3 year term)
Hector Vila, MD (4 year term)
Board of Nursing
Charrita Ernewein, DNP, APRN, FNP (2 year term)
Vicky Stone-Gale, DNP, APRN, FNP (4 year term)
Sandra Williamson, APRN, CNM (3 year term)
Kathleen Wilson, PhD, APRN, FNP (2 year term)
Board of Osteopathic Medicine
Michelle Mendez, DO (4 year term)
Joel Rose, DO (2 year term)
Cassandra G. Pasley, BSN, JD, Director of the Division of Medical Quality Assurance, will serve as Chair of the Council as the State Surgeon General’s designee.
The Board of Nursing voted to initiate rulemaking on various aspects of HB 607 during its meetings on June 5, 2020. You can access the minutes of the full board and long-range policy planning discussions from the “meetings” link on the Board website.
The registration application for autonomous APRNs will be available after it has been adopted by rule, which is anticipated to take approximately 90 days. The Board voted to approve the application and move forward with rulemaking at its June 5th meeting. The Board also voted to define “primary care practice” to include “health promotion, disease prevention, health maintenance, counselling, patient education, and diagnosis and treatment of acute and chronic illnesses in a variety of healthcare settings”. This definition will also move through the rulemaking adoption process prior to becoming effective.
The Board determined that an equivalency to the required graduate level coursework required for registration would be 45 CE hours in each of the required subject areas. These hours must be offered by a Board-approved provider or a national organization empowered to accredit nursing CE. The courses must have been taken within the 5 years preceding the registration application. Submitted courses must have documentation of differential diagnosis and pharmacology in the course description and objectives.
Appointments to the Council on APRN Autonomous Practice will be finalized by the end of June 2020 and then a meeting of the Council will be scheduled and announced. The Council is charged with developing “standards of practice” to recommend to the Board for adoption by rule.
Additional discussions on HB 607 will take place during the Board’s August 6-7, 2020, meeting.
Governor DeSantis signed HB 607 into law on March 11, 2020.
Separate portions of HB 607, now referred to as Chapter 2020-9, Laws of Florida, impact Board of Nursing licensees. Please see below for highlights of the new legislation:
Sections 12-14 – went into effect on 3/11/20
An authorized RN may delegate tasks to CNAs or home health aides if the RN determines that the CNA or home health aide is competent to perform these tasks, that the tasks are delegable under applicable Federal law, and the tasks meet certain criteria designated in the law. The RN is not authorized to delegate the administration of Schedule II-IV controlled substances. The Board is directed to adopt rules implementing the new law in consultation with the Agency for Health Care Administration (AHCA). We anticipate the rulemaking will commence following the Board’s June 2020 meeting.
Training coursework is required in order for a CNA to administer medication under an RN’s delegation. CNAs will also be required to have 2 hours of in-service training in medication administration and medical error prevention on a yearly basis.
The Board, along with AHCA, will also create standards and procedures for CNAs to follow when administering medication in a home health setting.
Sections 22-26 – go into effect on 7/1/20
APRNs will have an opportunity to register for autonomous practice, which will remove the requirement to provide patient care within the framework of an established protocol with a supervising physician or dentist. Registration eligibility requirements are established in the legislation and include: no discipline within 5 years of applying for the registration; completion of 3,000 clinical practice hours as an APRN under the supervision of physician within the 5 years immediately preceding the registration request; and, within the past 5 years, completion of graduate-level semester hours, or the equivalent, in differential diagnosis and pharmacology (3 hours in each subject). The registration application will be available after July 1, 2020.
Financial responsibility requirements are established in the new law for APRN autonomous practice. Practice requirements are also in the legislation and will be interpreted by the Board during its June 2020 meeting as part of the implementation of the bill.
A Council on APRN Autonomous Practice is created within the Department of Health and will recommend standards of practice to the Board.
Additional continuing education (CE) requirements are put in place for autonomous practice. Ten hours of CE, approved by the Board, must be completed at each renewal in addition to completing the 30 hours of CE already in place, even if the APRN is exempt from existing CE requirements due to his or her national certification.
Autonomous APRNs must also now report adverse incidents as outlined in the legislation and additional disciplinary actions are added to the Nurse Practice Act.
Updates on the implementation of this law will be added to the website.