PRINTER'S NO. 1633
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1238
Session of
2015
INTRODUCED BY BARRAR, CARROLL, COHEN, GERGELY, GIBBONS,
GINGRICH, HARKINS, McGINNIS, MILLARD, MULLERY, MURT, ROEBUCK,
SAYLOR, TOPPER AND KORTZ, MAY 28, 2015
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, MAY 28, 2015
AN ACT
Amending the act of May 22, 1951 (P.L.317, No.69), entitled, as
amended, "An act relating to the practice of professional
nursing; providing for the licensing of nurses and for the
revocation and suspension of such licenses, subject to
appeal, and for their reinstatement; providing for the
renewal of such licenses; regulating nursing in general;
prescribing penalties and repealing certain laws," further
providing for definitions; providing for use of title and
abbreviation; and further providing for clinical nurse
specialist and qualifications and for scope of practice for
clinical nurse specialist.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2(15) of the act of May 22, 1951
(P.L.317, No.69), known as The Professional Nursing Law, added
July 20, 2007 (P.L.320, No.49), is amended and the section is
amended by adding clauses to read:
Section 2. Definitions.--When used in this act, the
following words and phrases shall have the following meanings
unless the context provides otherwise:
* * *
(15) "Clinical nurse specialist" means a registered nurse
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
licensed in this Commonwealth [who is certified by the State
Board of Nursing as a clinical nurse specialist] to practice in
a particular clinical specialty area in which the registered
nurse is certified.
(16) "Mental health diagnosis" means the selection of a
disorder from the most recent edition of the Diagnostic and
Statistical Manual of Mental Disorders.
(17) "Nonproprietary drug" means a drug containing any
quantity of a controlled substance or any drug which requires a
prescription pursuant to an applicable Federal or State law.
(18) "Proprietary drug" means a nonprescription, nonnarcotic
medicine or drug which is prepackaged for use by the consumer
and labeled in accordance with Federal and State laws.
Section 2. The act is amended by adding a section to read:
Section 3.2. Use of title and abbreviation.
A registered nurse who is licensed and certified by the board
as a clinical nurse specialist in a particular clinical
specialty is entitled to use the title "advanced practice
registered nurse-clinical nurse specialist" and the letters
"A.P.R.N.-C.N.S." It shall be unlawful for any other person to
use the title "advanced practice registered nurse-clinical nurse
specialist" or the letters "A.P.R.N.-C.N.S."
Section 3. Sections 8.5 and 8.6 of the act, added July 20,
2007 (P.L.320, No.49), are amended to read:
Section 8.5. Clinical Nurse Specialist; Qualifications.--(a)
The board may certify a licensed registered nurse as a clinical
nurse specialist if the nurse satisfies the requirements
established by this act. Certification of a clinical nurse
specialist by the board shall expire on the same date as the
license of that nurse expires. Beginning on the effective date
20150HB1238PN1633 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
of this section, a nurse shall not qualify for initial
certification by the board unless the nurse holds a master's
degree, doctoral degree or post-master's certificate from an
educational program in nursing that has been approved by the
board and that prepares graduates to practice as a clinical
nurse specialist and:
(1) holds current [national certification as a clinical
nurse specialist in a designated specialty or in an area
pertinent to the designated specialty] certification as a
clinical nurse specialist from a board-recognized national
certification program that requires passing a national
certifying examination in the particular clinical specialty area
in which the nurse is seeking licensure by the board;
(2) meets equivalence requirements as specified in
regulations of the board where there is no certification
examination available in the specialty area; and
(3) meets all other board requirements to practice as a
clinical nurse specialist.
(a.1) Subsection (a)(1) may not apply to a licensed
registered nurse who holds certification by the board to
practice as a clinical nurse on the effective date of this
subsection. The board shall issue appropriate written notice of
the validity of the certification to any person who is certified
as a clinical nurse specialist on the effective date of this
subsection. The issuance of the notice may not be a condition to
practice as a clinical nurse specialist.
(b) Individuals who completed an educational program in a
related discipline previously recognized for national
certification as a clinical nurse specialist from a board-
recognized national certification organization shall be issued
20150HB1238PN1633 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
certification by the board upon:
(1) submitting evidence of having current American Nurses
Association or American Nurses Credentialing Center
certification; and
(2) submitting an application to the board.
(c) As a condition of biennial certificate renewal by the
board, a clinical nurse specialist shall:
(1) Pay a renewal fee as set by the board.
(2) In the two years prior to certification renewal,
complete at least thirty (30) hours of continuing education
approved by the board, as required by section 12.1. A clinical
nurse specialist who has prescriptive authority shall complete
at least sixteen (16) hours of board-approved continuing
education in pharmacology in the biennial renewal date of the
certification.
(d) For certification under this act, a licensed registered
nurse shall file a board-prepared application with the board and
pay a fee as established by the board by regulation.
(e) A clinical nurse specialist practicing in this
Commonwealth shall maintain a level of professional liability
coverage as required for a nonparticipating health care provider
under the act of March 20, 2002 (P.L.154, No.13), known as the
"Medical Care Availability and Reduction of Error (Mcare) Act,"
and shall not be eligible to participate in the Medical Care
Availability and Reduction of Error (Mcare) Fund.
Section 8.6. Scope of Practice for Clinical Nurse
Specialist.--(a) Nothing in this act shall permit a clinical
nurse specialist to engage in the practice of medicine or
surgery as defined in the act of December 20, 1985 (P.L.457,
No.112), known as the "Medical Practice Act of [1985"; perform
20150HB1238PN1633 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
acts of medical diagnosis; or prescribe medical therapeutic or
corrective measures. The restrictions in this subsection apply
to both physical and mental disorders.] 1985."
(b) [Nothing] Except as provided under this section, nothing
in this act shall be construed to limit or prohibit a clinical
nurse specialist from engaging in those activities which
normally constitute the practice of nursing, including a nursing
diagnosis, as defined in section 2.
(c) In addition to all other tasks which a licensed
registered nurse is authorized to perform, a clinical nurse
specialist may manage preventive health care services, diagnose
and manage deviations from wellness and long-term illnesses
based on the needs of the patient and shall be consistent with
clinical practice as defined by the national certifying agency
by all of the following:
(1) Initiating laboratory and other diagnostic tests.
(2) Prescribing or ordering medications and devices as
authorized under subsection (d).
(3) Ordering treatments.
(4) Making referrals to other licensed health care
professionals and receiving referrals from the licensed health
care professionals.
(5) Establishing a mental health diagnosis.
(6) Seeking consultations to other licensed health care
professionals and receiving consultations from the licensed
health care professionals.
(7) Performing specific procedures as needed.
(8) Conducting physical or psychiatric examinations.
(d) Notwithstanding section 8.4 and subject to any
restrictions imposed by Federal law or board regulations, a
20150HB1238PN1633 - 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
clinical nurse specialist may prescribe and dispense proprietary
and nonproprietary drugs if the clinical nurse specialist:
(1) has successfully completed at least forty-five (45)
hours of coursework specific to advanced pharmacology at a level
above that required by a professional nursing education program;
and
(2) acts in accordance with regulations promulgated by the
board.
(e) A clinical nurse specialist is entitled to:
(1) practice within the scope of practice of the particular
clinical specialty area or population-focus area in which the
nurse is certified by the board; and
(2) be reimbursed directly by insurers and other third-party
payors.
Section 4. This act shall take effect in 60 days.
20150HB1238PN1633 - 6 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15