In 2020, the Florida Legislature changed the law to allow Advanced Practice Registered Nurses (APRNs) who are eligible to hold the status of independent practitioner. Under the law as written APRNs who meet certain criteria to practice primary care or midwifery without physician supervision or a protocol are given this status. There are some limitations too.
A. What are Some Basic Requirements?
The Board of Nursing has preliminarily defined the term “primary care practice” to mean:
(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.
The law provides eligibility requirements to become an autonomous APRN. Those requirements, among others, include having:
- 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.
It should be pointed out that there is no fee for filing an application with the Department of Health (DOH) to become registered as an autonomous APRN. Once registered the autonomous APRN continues to be subject to review and investigation, and discipline for any violations of ethical standards and violations of the Nurse Practice Act, Chapter 464, Florida Statutes. Furthermore, the new law requires that an APRN practicing autonomously must report “adverse incidents” to the DOH , which must investigate each report and decide whether the APRN is subject to discipline.
B. Additional Information
Three excellent websites for information on autonomous APRNs in Florida and the new law are located at:
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/
Frequently Asked Questions are at this link – https://floridasnursing.gov/nursing-faqs/advanced-practice-registered-nurse-aprn/
C. Standards of Practice
At the beginning of 2021, the Board established a preliminary definition of “standards of practice” which states:
“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.”
All APRNs must carry malpractice insurance or demonstrate proof of financial responsibility. Any applicant for licensure must submit proof of coverage or financial responsibility as a prerequisite to licensure/certification and biennial renewal. The APRN must have professional liability coverage of at least $100,000 per claim, with a minimum annual aggregate of at least $300,000; or an unexpired irrevocable letter of credit in the amount of at least $100,000 per claim with a minimum aggregate availability of at least $300,000 and which is payable to the APRN as beneficiary.
When dealing with insurance coverage issues it is advisable to consult an experienced licensed insurance agent to make sure you are covered to the extent the law requires. Remember too, that this is a “minimum’ requirement for the level of insurance coverage mandated by law. Depending upon the type of practice and patient population, some ARPNs are wise to discuss with their insurance agent obtaining greater coverage depending upon the risk involved. Remember, this type of insurance coverage is to protect the APRN too, and coverage greater than $ 100, 000 per claim may be wise.
D. Scope of Practice for Autonomous APRNs.
The new law provides detailed requirements which set forth parameters of what an autonomous or independent APRN can do. Section 464.123, Florida Statutes states:
(3) PRACTICE REQUIREMENTS.-
(a) An advanced practice registered nurse who is registered under this section may:
1. Engage in autonomous practice only in primary care practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule.
2. For certified nurse midwives, engage in autonomous practice in the performance of the acts listed in s. 464.012(4)(c).
3. Perform the general functions of an advanced practice registered nurse under s. 464.012(3) related to primary care.
4. For a patient who requires the services of a health care facility, as defined in s. 408.032(8):
a. Admit the patient to the facility.
b. Manage the care received by the patient in the facility.
c. Discharge the patient from the facility, unless prohibited by federal law or rule.
5. Provide a signature, certification, stamp, verification, affidavit, or endorsement that is otherwise required by law to be provided by a physician, except an advanced practice registered nurse registered under this section may not issue a physician certification under s. 381.986.
(b) A certified nurse midwife must have a written patient transfer agreement with a hospital and a written referral agreement with a physician licensed under chapter 458 or chapter 459 to engage in nurse midwifery.
(c) An advanced practice registered nurse engaging in autonomous practice under this section may not perform any surgical procedure other than a subcutaneous procedure.
(d) The board shall adopt rules, in consultation with the council created in subsection (4), establishing standards of practice, for an advanced practice registered nurse registered under this section.
Florida law has been changed to allow APRNs to register as autonomous practitioners. The law contains both requirements and limitations. Not all APRNs may desire to register as an “autonomous” APRN. Naturally, those employed by an organization or healthcare facility, or physician clinic will see no need for this licensure status. Those wishing to “hang their own shingle,”form a clinic, or independent practice will have to abide by the requirements of the law as set forth in Section 464.123, Florida Statutes, see https://flsenate.gov/Laws/Statutes/2020/0464.0123 the rules of the Board of Nursing and other provisions of law. Additionally, the new Florida law does not override requirements set forth in CMS and DEA regulations.
If you wish to discuss this new change to the law contact us!
Contact the law offices of Howell, Buchan & Strong; Attorneys at Law for your free consultation at any one of our locations:
Orlando (407) 717-1773 |Tallahassee (850) 877-7776 | Tampa (813) 833-6726 | Sarasota (941) 779-4348