1. (1) Any nurse desiring to be certified as an advanced registered nurse practitioner shall apply to the department and submit proof that he or she holds a current license to practice professional nursing and that he or she meets one or more of the following requirements as determined by the board:

   1. (a) Satisfactory completion of a formal postbasic educational program of at least one academic year, the primary purpose of which is to prepare nurses for advanced or specialized practice.
   2. (b) Certification by an appropriate specialty board. Such certification shall be required for initial state certification and any recertification as a registered nurse anesthetist or nurse midwife. The board may by rule provide for provisional state certification of graduate nurse anesthetists and nurse midwives for a period of time determined to be appropriate for preparing for and passing the national certification examination.
   3. (c) Graduation from a program leading to a master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills. For applicants graduating on or after October 1, 1998, graduation from a master's degree program shall be required for initial certification as a nurse practitioner under paragraph (4)(c). For applicants graduating on or after October 1, 2001, graduation from a master's degree program shall be required for initial certification as a registered nurse anesthetist under paragraph (4)(a).
2. (2) The board shall provide by rule the appropriate requirements for advanced registered nurse practitioners in the categories of certified registered nurse anesthetist, certified nurse midwife, and nurse practitioner.

3. (3) An advanced registered nurse practitioner shall perform those functions authorized in this section within the framework of an established protocol. A practitioner currently licensed under chapter 458, chapter 459, or chapter 466 shall maintain supervision for directing the specific course of medical treatment. Within the established framework, an advanced registered nurse practitioner may:

   1. (a) Monitor and alter drug therapies.
   2. (b) Initiate appropriate therapies for certain conditions.
   3. (c) Perform additional functions as may be determined by rule in accordance with s. 464.003(3)(c).
   4. (d) Order diagnostic tests and physical and occupational therapy.

4. (4) In addition to the general functions specified in subsection (3), an advanced registered nurse practitioner may perform the following acts within his or her specialty:

   1. (a) The certified registered nurse anesthetist may, to the extent authorized by established protocol approved by the medical staff of the facility in which the anesthetic service is performed, perform any or all of the following:

      1. Determine the health status of the patient as it relates to the risk factors and to the anesthetic management of the patient through the performance of the general functions.

      2. Based on history, physical assessment, and supplemental laboratory results, determine, with the consent of the responsible physician, the appropriate type of anesthesia within the framework of the protocol.

      3. Order under the protocol preanesthetic medication.

      4. Perform under the protocol procedures commonly used to render the patient insensible to pain during the performance of surgical, obstetrical, therapeutic, or diagnostic clinical procedures. These procedures include ordering and administering regional, spinal, and general anesthesia; inhalation agents and techniques; intravenous agents and techniques; and techniques of hypnosis.

      5. Order or perform monitoring procedures indicated as pertinent to the anesthetic health care management of the patient.

      6. Support life functions during anesthesia health care, including induction and intubation procedures, the use of appropriate mechanical supportive devices, and the management of fluid, electrolyte, and blood component balances.

      7. Recognize and take appropriate corrective action for abnormal patient responses to anesthesia, adjunctive medication, or other forms of therapy.

      8. Recognize and treat a cardiac arrhythmia while the patient is under anesthetic care.

      9. Participate in management of the patient while in the postanesthesia recovery area, including ordering the administration of fluids and drugs.

      10. Place special peripheral and central venous and arterial lines for blood sampling and monitoring as appropriate.

   2. (b) The certified nurse midwife may, to the extent authorized by an established protocol which has been approved by the medical staff of the health care facility in which the midwifery services are performed, or approved by the nurse midwife's physician backup when the delivery is performed in a patient's home, perform any or all of the following:

      1. Perform superficial minor surgical procedures.

      2. Manage the patient during labor and delivery to include amniotomy, episiotomy, and repair.

      3. Order, initiate, and perform appropriate anesthetic procedures.

      4. Perform postpartum examination.

      5. Order appropriate medications.

      6. Provide family-planning services and well-woman care.

      7. Manage the medical care of the normal obstetrical patient and the initial care of a newborn patient.

   3. (c) The nurse practitioner may perform any or all of the following acts within the framework of established protocol:

      1. Manage selected medical problems.

      2. Order physical and occupational therapy.

      3. Initiate, monitor, or alter therapies for certain uncomplicated acute illnesses.

      4. Monitor and manage patients with stable chronic diseases.

      5. Establish behavioral problems and diagnosis and make treatment recommendations.

5. (5) The board shall certify, and the department shall issue a certificate to, any nurse meeting the qualifications in this section. The board shall establish an application fee not to exceed $100 and a biennial renewal fee not to exceed $50. The board is authorized to adopt such other rules as are necessary to implement the provisions of this section.

History.--ss. 1, 6, ch. 79-225; ss. 2, 3, ch. 81-318; s. 4, ch. 84-268; ss. 8, 17, 18, ch. 86-284; s. 58, ch. 91-137; s. 5, ch. 91-156; s. 4, ch. 91-429; s. 7, ch. 96-274; s. 1105, ch. 97-103; s. 80, ch. 97-264.