Board of Nursing Rules Revisons

STATE OF WISCONSIN
BOARD OF NURSING


IN THE MATTER OF RULE-MAKING PROCEEDINGS BEFORE THE BOARD OF NURSING
PROPOSED ORDER OF THE BOARD OF NURSING ADOPTING RULES (CLEARINGHOUSE RULE 15-099)

PROPOSED ORDER

An order of the Board of Nursing to repeal ch. N 5 and N 6.02 (4); to renumber N 6.02 (1); to amend N 6.02 (11) and (12), 6.03 (2) and (3), 6.04 (1), 6.04 (2) (intro), 6.04 (2) (b) and 6.04 (3) (intro), (a) and (b); to repeal and recreate N 6.02 (5) and 6.04 (3) (c); to create N 2 Subchapter V, N 6.02 (1) and 6.02 (10m), relating to renewal, reinstatement and standards of practice.

Analysis prepared by the Department of Safety and Professional Services.


ANALYSIS

Statutes interpreted: ss. 441.01 (7), 441.001 (3) and (4), Stats.

Statutory authority: ss. 15.08 (5) (b), and 441.01 (3), Stats.

Explanation of agency authority:
Each examining board shall promulgate rules for its own guidance and for the guidance of the profession to which it pertains and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the particular profession. s. 15.08 (5) (b)

The board may establish minimum standards or schools for professional nurses and schools for licensed practical nurses, including all related clinical units and facilities, and make and provide periodic surveys and consultations to such schools. It may also establish rules to prevent unauthorized persons from practicing professional nursing. It shall approve all rules for the administration of this chapter in accordance with ch. 227. s. 441.01(3), Stats.

Related statute or rule: n/a

Plain language analysis:
The Board updated the current renewal chapter to reflect current practices and remove outdate references. The Board also updated the standards of practice chapter to current nursing practice standards.

Sections 1 and 2 repeals the current chapter 5 relating to renewal and creates a new subchapter in Chapter 2. The placement of the renewal and reinstatement provisions as a subsection of the chapter on licensure makes sense as it relates to licensure. This section clarifies that a person who has an expired license may not reapply for a new credential under the initial application process. A person renewing a license within 5 years is required to pay a renewal fee, any late fees and the workforce survey fee and complete the workforce survey. A person renewing after 5 years is required to pay the renewal fee, late fee, and workforce survey fee and evidence of employment requiring a nursing license within the last five years or complete a nursing refresher course. A person who failed to renew a credential within 5 years with unmet disciplinary requirements or has a license which has been surrendered or revoked may apply for reinstatement by showing evidence of rehabilitation or change in circumstances, completing any unfilled disciplinary requirements and if the person has not had an active license in the past five years complete the requirements for renewal beyond 5 years. If a license has been revoked, the person’s license may not be reinstated earlier than one year following revocation.

Section 3 renumbers the definition of “basic nursing care” in order to make room alphabetically for a new definition.

Section 4 creates a definition for “advanced practice nurse prescriber”. An advanced practice nurse prescriber is a registered nurse who holds an advanced practice nurse prescriber certificate.

Section 5 repeals the definition of “delegated medical act”.

Section 6 repeals the definition of “delegated nursing act” and creates a definition of “delegated act”. A delegated act is an act delegated to a registered nurse or license practical nurse.

Section 7 creates a definition of “provider”. A provider is a physician, podiatrist, dentist, optometrist or advanced practice nurse prescriber.

Section 8 updates the definitions to reflect a R.N. or L.P.N. includes those who have the privilege to practice in Wisconsin under the Nurse Licensure Compact.

Sections 9 and 10 updates the delegated acts terminology by removing the references to medical and nursing acts, uses the term provider instead of listing the various professions and updates the formatting to current drafting style.

Section 11 updates to current drafting style by adding “do all of the following:”

Section 12 updates the delegated acts terminology.

Section 13 updates to current drafting style.

Section 14 repeals and recreates, a provision for an LPN to accept the charge nurse position in a nursing home only if prepared to do so based upon education, training and experience. The rewording of this provision is to provide more clarity.

Summary of, and comparison with, existing or proposed federal regulation: None

Comparison with rules in adjacent states:
Illinois: A license within 5 years of expiration is renewed by paying a fee and completion of 20 hours of continuing education. After 5 years a license is renewed by evidence of active practice in another state and completion of an approved licensure examination. A LPN accepts delegated acts from a RN, APN, or a physician assistant, physician, dentist or podiatrist. A delegated act, to or by an RN, is not distinguished as a medical or nursing delegated act. Practice as a RN means the full scope of nursing for which the registered nurse is properly trained.
Iowa: A license is renewed by paying a fee, attesting that Iowa is the primary state of residence and completion of continuing education and mandatory reporter training. RN minimum standards do not include practices ascribed to the advanced registered nurse practitioner. In executing the medical regimen prescribed, the RN shall notify the physician. A RN may delegate nursing tasks. An LPN shall perform services under the supervision of a RN or physician and may not perform any activity requiring the knowledge and skill ascribed to a RN.
Michigan: A license is renewed by payment of paying fees and completion of continuing education. Only a RN may delegate nursing acts, functions or tasks.
Minnesota: A license is renewed by paying a fee and completion of continuing education. Minnesota has a definition of delegation referring to the transfer of authority to another nurse or competent, unlicensed assistive person to perform a specific nursing task or activity in a specific situation. A LPN performs nursing standards at the direction of a registered nurse, advanced practice registered nurse or other licensed health care provider. A RN performs nursing standards recognized by the board. A RN receives delegations from a licensed health care provider and delegates nursing tasks. There is not a definition for health care provider.

Summary of factual data and analytical methodologies:
The Board conducted a comprehensive review and updated the renewal and standards of practice chapters in order to bring them up-to-date with current practice.

Analysis and supporting documents used to determine effect on small business or in preparation of economic impact analysis:

Fiscal Estimate and Economic Impact Analysis:
The Fiscal Estimate and Economic Impact Analysis is attached.

Effect on small business:
These proposed rules do not have an economic impact on small businesses, as defined in s. 227.114 (1), Stats. The Department’s Regulatory Review Coordinator may be contacted by email at Eric.Esser@wisconsin.gov, or by calling (608) 267-2435.

Agency contact person:
Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, Wisconsin 53708; telephone 608-261-2377; email at Sharon.Henes@wisconsin.gov.

Place where comments are to be submitted and deadline for submission:
Comments may be submitted to Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, WI 53708-8366, or by email to Sharon.Henes@wisconsin.gov. Comments must be received on or before the public hearing to be held on January 14, 2015 at 8:00 a.m. to be included in the record of rule-making proceedings.


TEXT OF RULE

SECTION 1. N 2 Subchapter V is created to read:

SUBCHAPTER V RENEWAL

N 2.40 Renewal. (1) GENERAL. A person with an expired credential may not reapply for a credential using the initial application process.
(2) RENEWAL WITHIN 5 YEARS. A person renewing the license within 5 years shall do all of the following:

(a) Pay the renewal fee as determined by the department under s. 440.03(9)(a), Stats. and any applicable late renewal fee.
(b) Pay a nursing workforce survey fee.
(c) Complete the nursing workforce survey to the satisfaction of the board.

(3) RENEWAL AFTER 5 YEARS. This subsection does not apply to credential holders who have unmet disciplinary requirements or whose credential has been surrendered or revoked. A person renewing the credential after 5 years shall do all of the following:

(a) Pay the renewal fee as determined by the department under s. 440.03(9)(a), Stats. and the late renewal fee.
(b) Pay a nursing workforce survey fee.
(c) Complete the nursing workforce survey to the satisfaction of the board.
(d) Meet one of the following requirements:

1. Documentation of employment requiring a nursing license within the last five years.
2. Completion of a board approved nursing refresher course or education equivalent to a nursing refresher course. A nursing refresher course requires a limited license for the purpose of completing the clinical component of the course.

N 2.41 Reinstatement. A credential holder who has unmet disciplinary requirements and failed to renew the credential within 5 years or whose credential has been surrendered or revoked may apply to have the credential reinstated in accordance with all of the following:
(1) Evidence of completion of the requirements in N 2.40(3) if the license has not been active within 5 years.
(2) Evidence of completion of the disciplinary requirements, if applicable.
(3) Evidence of rehabilitation or change in circumstances warranting reinstatement.
(4) A revoked license may not be reinstated earlier than one year following revocation. This subsection does not apply to a license that is revoked under s. 440.12.
SECTION 2. Chapter N 5 is repealed.
SECTION 3. N 6.02 (1) is renumbered to N 6.02 (1m).
SECTION 4. N 6.02(1) is created to read:
N 6.02 (1) “Advanced practice nurse prescriber” means a registered nurse who holds an advance practice nurse prescriber certificate under 441.16, Stats.
SECTION 5. N 6.02 (4) is repealed.
SECTION 6. N 6.02 (5) is repealed and recreated to read:
N 6.02 (5) “Delegated act” means acts delegated to a registered nurse or licensed practical nurse.
SECTION 7. N 6.02 (10m) is created to read:
N 6.02 (10m) “Provider” means a physician, podiatrist, dentist, optometrist or advanced practice nurse provider.
SECTION 8. N 6.02 (11) and (12) are amended to read:
N 6.02 (11) “R.N.” means a registered nurse licensed under ch. 441, Stats. or a nurse who has a privilege to practice in Wisconsin under s. 441.50, Stats.
(12) “L.P.N.” means a licensed practical nurse licensed under ch. 441, Stats. or a nurse who has a privilege to practice in Wisconsin under s. 441.50, Stats.
SECTION 9. N 6.03 (2) and (3) are amended to read:
N 6.03 (2) PERFORMANCE OF DELEGATED MEDICAL ACTS. In the performance of delegated medical acts an R.N. shall do all of the following:

(a) Accept only those delegated medical acts for which there are protocols or written or verbal orders;.
(b) Accept only those delegated medical acts for which the R.N. is competent to perform based on his or her nursing education, training or experience;.
(c) Consult with a physician, podiatrist, dentist, or optometrist provider in cases where the R.N. knows or should know a delegated medical act may harm a patient; and,.
(d) Perform delegated medical acts under the general supervision or direction of a physician, podiatrist, dentist or optometrist provider.

(3) SUPERVISION AND DIRECTION OF DELEGATED NURSING ACTS. In the supervision and direction of delegated nursing acts an R.N. shall do all of the following:

(a) Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised;.
(b) Provide direction and assistance to those supervised;.
(c) Observe and monitor the activities of those supervised; and,.
(d) Evaluate the effectiveness of acts performed under supervision.

SECTION 10. N 6.04 (1) is amended to read:
N 6.04 Standards of practice for licensed practical nursing. (1) PERFORMANCE OF ACTS IN BASIC PATIENT SITUATIONS. In the performance of acts in basic patient situations, the L.P.N., shall, under the general supervision of an R.N. or the direction of a physician, podiatrist, dentist or, optometrist provider:

(a) Accept only patient care assignments which the L.P.N. is competent to perform;.
(b) Provide basic nursing care;.
(c) Record nursing care given and report to the appropriate person changes in the condition of a patient;.
(d) Consult with an R.N., physician, podiatrist, dentist, optometrist a provider in cases where an L.P.N. knows or should know a delegated nursing or medical act may harm a patient; and.
(e) Perform the following other acts when applicable:

1. Assist with the collection of data;.
2. Assist with the development and revision of a nursing care plan;.
3. Reinforce the teaching provided by an R.N., physician, podiatrist, dentist or optometrist provider and provide basic health care instruction; or.
4. Participate with other health team members in meeting basic patient needs.

SECTION 11. N 6.04 (2) (intro) is amended to read:
N 6.04 (2) PERFORMANCE OF ACTS IN COMPLEX PATIENT SITUATIONS. In the performance of acts in complex patient situations the L.P.N. shall do all of the following:
SECTION 12. N 6.04 (2) (b) is amended to read:
N 6.04 (2) (b) Perform delegated nursing or medical acts beyond basic nursing care under the direct supervision of an R.N., physician, podiatrist, dentist or optometrist a provider. An L.P.N. shall, upon request of the board, provide documentation of his or her nursing education, training or experience which prepares the L.P.N. to competently perform these assignments.

SECTION 13. N 6.04 (3) (intro), (a) and (b) are amended to read:
N 6.04 (3) ASSUMPTION OF CHARGE NURSE POSITION IN NURSING HOMES. In assuming the position of charge nurse in a nursing home as defined in s. 50.04 (2) (b), Stats., an L.P.N. shall do all of the following:

(a) Follow written protocols and procedures developed and approved by an R.N.;.
(b) Manage and direct the nursing care and other activities of L.P.N.s and nursing support personnel under the general supervision of an R.N.; and,.

SECTION 14. N 6.04 (3) (c) is repealed and recreated to read:
N 6.04 (3) (c) Accept the charge nurse position only if prepared for the responsibilities of charge nurse based upon education, training and experience beyond the practical nurse curriculum. The L.P.N. shall, upon request of the board, provide documentation of the nursing education, training or experience which prepared the L.P.N. to competently assume the position of charge nurse.
SECTION 15. EFFECTIVE DATE. The rules adopted in this order shall take effect on the first day of the month following publication in the Wisconsin administrative register, pursuant to s. 227.22 (2) (intro.), Stats.

STATE OF WISCONSIN
BOARD OF NURSING


IN THE MATTER OF RULE-MAKING PROCEEDINGS BEFORE THE BOARD OF NURSING
PROPOSED ORDER OF THE BOARD OF NURSING ADOPTING RULES (CLEARINGHOUSE RULE 16-020)

PROPOSED ORDER

An order of the Board of Nursing to repeal N 8.04 and 8.05 (2); to renumber and amend N 8.03 (1); to amend N 8.02 (c), 8.02 (4), 8.03 (intro), 8.03 (2), (3), (4) and (5), 8.05 (1), 8.06 (3) (c), 8.06 (5), 8.07 (2), 8.09 (2), 8.10 (title) and 8.10 (4), (5)

Analysis prepared by the Department of Safety and Professional Services.


ANALYSIS

Statutes interpreted: s. 441.16, Stats.

Statutory authority: ss. 15.08 (5) (b) and 441.16 (3), Stats.

Explanation of agency authority:
The Board shall promulgate rules for its own guidance and for the guidance of the profession and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the profession. [s. 15.08 (5) (b), Stats.]

The Board shall promulgate rules necessary to administer s. 441.16, including rules for all of the following:

  • Establishing the education, training or experience requirements that a registered nurse must satisfy to be an advanced practice nurse. The rules shall require a registered nurse to have education, training or experience that is in addition to the education, training or experience required for licensure as a registered nurse.
  • Establish the appropriate education, training and examination requirements that an advanced practice nurse must satisfy to qualify for a certificate to issue prescription orders.
  • Defining the scope of practice within which an advanced practice nurse may issue prescription orders.
  • Specifying the classes of drugs, individual drugs or devices that may not be prescribed by an advanced practice nurse.
  • Establishing procedures for maintaining a certificate to issue prescription orders, including requirements for continuing education and a requirement to complete the nursing workforce survey and submit the fee required under s. 441.01 (7). [s. 441.16 (3), Stats]

Related statute or rule: n/a

Plain language analysis:
Section 1 adds doctoral degree in nursing or a related health field as a qualifying degree. The Board recognizes that some schools are offering doctoral degrees in lieu of master’s degrees and did not want those obtaining a higher degree to be ineligible for the certificate.

Section 2 modifies the definition of “clinical pharmacology or therapeutics” by changing the phrase “likelihood of success” to “efficacy” in order to be clearer and more accurate.

Sections 3, 4, 5, 6 and 7 consolidate the qualifications required for the certification and the application requirements into one section. Language to accommodate this consolidation has been updated. The degree required is updated to recognize a doctoral degree in addition to the master’s degree. The applicant is required to have obtained 45 contact hours in clinical pharmacology or therapeutics 5 years, instead of 3 years, preceding the application in order to accommodate graduates from programs which offer the pharmacology course early in the curriculum sequence rather than requiring the applicant to repeat the course creating unnecessary delay and expense.

Section 8 creates a renewal provisions. In order to renew an advance practice nurse prescriber certificate the certificate holder must pay a renewal fee, complete the nursing workforce survey, certify completion of the continuing education and provide evidence of current certification by an approved certifying body of nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.

Sections 9 and 10 updates the continuing education requirements. A nurse prescriber shall complete 16 contact hours during the biennium. It removes the provisions allowing for an average minimum number per year which is then reported on a schedule consistent with the national certifying body. The Board is requiring continuing education to be completed each biennium. In addition, two of those contact hours shall be in responsible prescribing of controlled substances The Board is requiring the specific hours in responsible prescribing of controlled substances due to the current prescription drug addiction public health crisis.

Section 11 clarifies that attention deficient hyperactivity disorder is included in hyperkinesis.

Section 12 updates language for the advance practice nurse prescriber to provide upon request evidence of the advance practice nurse prescriber certification.

Section 13 updates language to allow prescriptions to be submitted electronically as permitted by state and federal law and removes the outdated typewritten provision. It also updates language to require the drug enforcement agency number of the license.

Section 14 removes the mileage limitation but clarifies the dispensing of drugs is at the treatment facility.

Sections 15 and 16 update language. The word “care” is replaces “case” which is more reflective of current practice. One reference to advanced practice nurses is corrected to state advanced practice nurse prescribers. The Board removed the provision relating to notification to advanced practice nurses of mutual educational opportunities and available communication networks. The provisions regarding tests which may be ordered by an advanced practice nurse prescriber has been updated and clarified. The language regarding the collaborative relationship has been updated to reflect the standard language of “training, education and experience” instead of “professional expertise” and removing the requirement the physician shall document this relationship in recognition that the Board does not have jurisdiction over a physician.

Summary of, and comparison with, existing or proposed federal regulation: None

Comparison with rules in adjacent states:

Illinois: Illinois licenses nurses at three levels: licensed practice nurse, registered nurse and advance practice nurse. Illinois requires an advanced practice nurse to additionally hold a separate license for the prescribing of controlled substances. In Illinois a collaborating physician may delegate prescriptive authority to a nurse holding an advanced practice nurse license. An APN who has been given controlled substances prescriptive authority shall be required to obtain an Illinois mid-level practitioner controlled substances license. The requirements for obtaining a mid-level practitioner controlled substances license is to be a physician assistant or advanced practice nurse with an active license in good standing; provide the license number and controlled substances license number of the delegating or collaborating physician or podiatrist; written notice of delegation of prescriptive authority signed by the physician or podiatrist including the schedule of controlled substances or the specific Schedule II controlled substances that the mid-level practitioner may dispense or prescribe; and if license is issued with Schedule II authority, the advance practice nurse must have taken at least 45 hours of graduate contact hours in pharmacology. The mid-level practitioner controlled substances license requires 5 hours annually of continuing education in pharmacology. The mid-level practitioner controlled substances license only allows prescribing and dispensing of controlled substances the collaborating physician prescribes.
Iowa: Iowa licenses nurses at three levels: licensed practice nurse, registered nurse and advance registered nurse practitioner. The advanced registered nurse prescriber has a scope of practice which includes prescriptive authority. There is no equivalent certification in Iowa to the Wisconsin advance practice nurse prescriber certificate.
Michigan: Michigan licenses nurses at two levels: licensed practice nurse and registered nurse. Michigan has specialty certifications for a nurse anesthetist, nurse midwife and nurse practitioner. A physician who supervises a nurse practitioner or nurse midwife may delegate the prescribing of non-controlled prescriptions and Schedules 3-5 controlled substances if the delegating physician establishes a written authorization. A delegating physician may delegate the prescription of Schedule 2 controlled substances only if the nurse practitioner or nurse midwife is practicing in a surgical outpatient facility, hospital and hospice with the patient being located within the facility. There is no equivalent certification in Michigan to the Wisconsin advance practice nurse prescriber certificate.
Minnesota: Effective January 1, 2015, Minnesota licenses nurses at three levels: licensed practice nurse, registered nurse and advanced practice registered nurses. The advanced practice registered nurse has a scope of practice which includes prescriptive authority. There is no equivalent certification in Minnesota to the Wisconsin advance practice nurse prescriber certificate.

Summary of factual data and analytical methodologies:
The Board reviewed their rules and consulted with stakeholders.

Analysis and supporting documents used to determine effect on small business or in preparation of economic impact analysis:
This rule was posted for a period of 14 days for economic comments and none were received.

Fiscal Estimate and Economic Impact Analysis:
The Fiscal Estimate and Economic Impact Analysis is attached.

Effect on small business:
These proposed rules do not have an economic impact on small businesses, as defined in s. 227.114 (1), Stats. The Department’s Regulatory Review Coordinator may be contacted by email at Eric.Esser@wisconsin.gov, or by calling (608) 267-2435.

Agency contact person:

Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, Wisconsin 53708; telephone 608-261-2377; email at Sharon.Henes@wisconsin.gov.

Place where comments are to be submitted and deadline for submission:
Comments may be submitted to Sharon Henes, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, WI 53708-8366, or by email to Sharon.Henes@wisconsin.gov. Comments must be received at or before the public hearing to be held on March 10, 2016 to be included in the record of rule-making proceedings.


TEXT OF RULE

SECTION 1. N 8.02 (c) is amended to read:
N 8.02 (c) For applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, the registered nurse holds a master’s or doctoral degree in nursing or a related health field granted by a college or university accredited by a regional accrediting agency approved by the board of education in the state in which the college or university is located.

SECTION 2. N 8.02 (4) is amended to read:
N 8.02 (4) “Clinical pharmacology or therapeutics” means the identification of individual and classes of drugs, their indications and contraindications, their likelihood of success efficacy, their side-effects and their interactions, as well as, clinical judgment skills and decision-making, based on thorough interviewing, history-taking, physical assessment, test selection and interpretation, pathophysiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non-pharmacologic interventions.

SECTION 3. N 8.03 (intro) is amended to read:
N 8.03 Qualifications for certification Certification as an advanced practice nurse prescriber. An applicant for initial certification to issue prescription orders as an advanced practice nurse prescriber shall be granted a certificate by the board if the applicant complies with all of the following:

SECTION 4. N 8.03 (1) is renumberd to N 8.03 (1m) and amended to read:
N 8.03 (1) Has Provides evidence of holding a current license to practice as a professional nurse in this state or has a current license to practice professional nursing in another state which has adopted the nurse licensure compact.

SECTION 5. N 8.03 (1) is created to read:
N 8.03 (1) Submits an application form and the fee under s. 440.05(1), Stats.

SECTION 6. N 8.03 (2), (3), (4), and (5) are amended to read:
N 8.03 (2) Is currently certified Provides evidence of current certification by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.

(3) For applicants who receive national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist after July 1, 1998, holds Provides evidence of a master’s or doctoral degree in nursing or a related health field granted by a college or university accredited by a regional accrediting agency organization approved by the state board of education in the state in which the college or university is located Council for Higher Education Accreditation. This subs. does not apply to those who received national certification as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist before July 1, 1998.
(4) Has completed at least Provides evidence of completion of 45 contact hours in clinical pharmacology/ or therapeutics within 3 5 years preceding the application for a certificate to issue prescription orders.
(5) Has passed Evidence of passing a jurisprudence examination for advanced practice nurse prescribers.

SECTION 7. N 8.04 is repealed.

SECTION 8. N 8.045 is created to read:
N 8.045 Renewal. A person holding an advanced practice nurse prescriber may renew the certificate by doing all of the following:
(1) Pay the renewal fee as determined by the department under s. 440.03(9)(a), Stats., the workforce survey fee and any applicable late renewal fee.
(2) Complete the nursing workforce survey to the satisfaction of the board.
(3) Certify completion of the continuing education required under N 8.05.
(4) Provide evidence of current certification by a national certifying body approved by the board as a nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist.

SECTION 9. N 8.05 (1) is amended to read:
N 8.05 Continuing education. (1) Every advanced practice nurse prescriber shall submit to the board evidence of having completed an average of at least 8 complete 16 contact hours per year biennium in clinical pharmacology/ or therapeutics relevant to the advanced practice nurse prescriber’s area of practice, including at least 2 contact hours in responsible prescribing of controlled substances.

SECTION 10. N 8.05 (2) is repealed.

SECTION 11. N 8.06 (3) (c) is amended to read:
N 8.06 (3) (c) Treatment of hyperkinesis, including attention deficient hyperactivity disorder.

SECTION 12. N 8.06 (5) is amended to read:
N 8.06 (5) Shall, in prescribing or ordering a drug for administration by a registered nurse or licensed practical nurse under s. 441.16 (3) (cm), Stats. upon request, present evidence to the nurse and or to the administration of the facility where the prescription or order is to be carried out that the advanced practice nurse prescriber is properly certified to issue prescription orders.

SECTION 13. N 8.07 (2) is amended to read:
N 8.07 (2) Prescription orders issued by advanced practice nurse prescribers for a controlled substance shall be written in ink or indelible pencil or shall be typewritten submitted electronically as permitted by state and federal law, and shall contain the practitioner’s controlled substances drug enforcement agency number.

SECTION 14. N 8.09 (2) is amended to read:
N 8.09 (2) An advanced practice nurse prescriber may dispense drugs to a patient if at the treatment facility at which the patient is treated is located at least 30 miles from the nearest pharmacy.

SECTION 15. N 8.10 (title) is amended to read:
N 8.10 Case Care management and collaboration with other health care professionals.

SECTION 16. N 8.10 (4), (5), (6) and (7) are amended to read:
N 8.10 (4) Advanced practice nurse prescribers shall provide a summary of a patient’s health care records, including diagnosis, surgeries, allergies and urrent medications to other health care providers as a means of facilitating case care management and improved collaboration.
(5) The board shall promote communication and collaboration among advanced practice nurses nurse prescribers, physicians and other health care professionals, including notification to advanced practice nurses of mutual educational opportunities and available communication networks.
(6) To promote case management, the The advanced practice nurse prescriber may order treatment, therapeutics, laboratory and testing, radiographs or electrocardiograms appropriate to his or her area of competence as established by his or her education, training, or experience to provide care management.

(7) Advanced practice nurse prescribers shall work in a collaborative relationship with a physician. The collaborative relationship is a process in which an advanced practice nurse prescriber is working with a physician, in each other’s presence when necessary, to deliver health care services within the scope of the practitioner’s professional expertise training, education and experience. The advanced practice nurse prescriber and the physician must shall document this relationship.

SECTION 17. EFFECTIVE DATE. The rules adopted in this order shall take effect on the first day of the month following publication in the Wisconsin administrative register, pursuant to s. 227.22 (2) (intro.), Stats.