Senate Bill No. 52–Committee on Commerce and
Labor
Prefiled January 25, 2001
____________
Referred to Committee on Commerce and Labor
SUMMARY—Authorizes advanced practitioner of nursing
to prescribe controlled substances under certain circumstances. (BDR 54‑291)
FISCAL NOTE: Effect on Local Government: No.
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EXPLANATION
– Matter in bolded italics is new; matter
between brackets [omitted material] is material to be omitted.
Green numbers along
left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
AN ACT relating to advanced practitioners of nursing; authorizing an advanced practitioner
of nursing to prescribe controlled substances under certain circumstances; and
providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1-1 Section 1. NRS 632.237
is hereby amended to read as follows:
1-2 632.237 1. The board may grant a certificate of
recognition as an
1-3 advanced practitioner of
nursing to a registered nurse who has completed
1-4 an educational program
designed to prepare a registered nurse to:
1-5 (a) Perform designated acts
of medical diagnosis;
1-6 (b) Prescribe therapeutic or corrective measures; and
1-7 (c) Prescribe controlled substances,
poisons, dangerous drugs and
1-8 devices,
1-9 and who meets the other
requirements established by the board for such
1-10 certification.
1-11 2. An advanced practitioner of nursing may:
1-12 (a) Engage in selected medical diagnosis and treatment; and
1-13 (b) If authorized pursuant
to NRS 639.2351, prescribe
controlled
1-14 substances, poisons, dangerous drugs and devices,
1-15 pursuant to a protocol
approved by a collaborating physician. A protocol
1-16 must not include and an
advanced practitioner of nursing shall not engage
1-17 in any diagnosis, treatment
or other conduct which the advanced
1-18 practitioner of nursing is
not qualified to perform.
1-19 3. The board shall adopt regulations:
1-20 (a) Specifying the training,
education and experience necessary for
1-21 certification as an advanced
practitioner of nursing.
2-1 (b) Delineating the
authorized scope of practice of an advanced
2-2 practitioner of nursing.
2-3 (c) Establishing the procedure for application for certification as
an
2-4 advanced practitioner of
nursing.
2-5 Sec. 2. NRS 639.0125 is hereby amended to read as follows:
2-6 639.0125 “Practitioner”
means:
2-7 1. A physician, dentist, veterinarian
or podiatric physician who holds a
2-8 [valid] license to practice his
profession in this state;
2-9 2. A hospital, pharmacy or
other institution licensed, registered or
2-10 otherwise permitted to
distribute, dispense, conduct research with respect
2-11 to or administer drugs in
the course of professional practice or research in
2-12 this state;
2-13 3. An advanced practitioner
of nursing who has been authorized to
2-14 prescribe controlled substances, poisons,
dangerous drugs and devices; or
2-15 4. A physician’s assistant
who:
2-16 (a) Holds a license issued by the board of medical examiners or
2-17 certificate issued by the
state board of osteopathic medicine; and
2-18 (b) Is authorized by the board to possess, administer, prescribe or
2-19 dispense controlled
substances, poisons, dangerous drugs or devices under
2-20 the supervision of a
physician or osteopathic physician as required by
2-21 chapter 630 or 633 of NRS.
2-22 Sec. 3. NRS 639.2351 is hereby amended to read as follows:
2-23 639.2351 1. An advanced practitioner of nursing may
prescribe, in
2-24 accordance with NRS 454.695 [,] and 632.237, controlled substances,
2-25 poisons, dangerous drugs and
devices if he:
2-26 (a) Is authorized to do so by the state board of nursing in a
certificate
2-27 issued by that board; and
2-28 (b) Applies for and obtains a certificate of registration from the
state
2-29 board of pharmacy and pays
the fee set by a regulation adopted by the
2-30 board.
2-31 2. The state board of
pharmacy shall consider each application from an
2-32 advanced practitioner of
nursing separately, and may:
2-33 (a) Issue a certificate of registration; or
2-34 (b) Refuse to issue a certificate of registration, regardless of
the
2-35 provisions of the
certificate issued by the state board of nursing.
2-36 Sec. 4. NRS 453.038 is hereby amended to read as follows:
2-37 453.038 “Chart order” means
an order entered on the chart of a
2-38 patient:
2-39 1. In a hospital, facility
for intermediate care or facility for skilled
2-40 nursing which is licensed as
such by the health division of the department;
2-41 or
2-42 2. Under emergency
treatment in a hospital by a physician, advanced
2-43 practitioner of nursing, dentist or podiatric physician, or on the written
or
2-44 oral order of a physician,
physician’s assistant, advanced
practitioner of
2-45 nursing, dentist or podiatric physician authorizing the administration of a
2-46 drug to the patient.
2-47 Sec. 5. NRS 453.091 is hereby amended to read as follows:
2-48 453.091 1. “Manufacture” means the production,
preparation,
2-49 propagation, compounding,
conversion or processing of a substance, either
3-1 directly or indirectly by
extraction from substances of natural origin, or
3-2 independently by means of
chemical synthesis, or by a combination of
3-3 extraction and chemical
synthesis, and includes any packaging or
3-4 repackaging of the substance
or labeling or relabeling of its container.
3-5 2. “Manufacture” does not
include the preparation or compounding of
3-6 a substance by a person for
his own use or the preparation, compounding,
3-7 packaging or labeling of a
substance by a physician, physician’s assistant,
3-8 dentist, podiatric physician , advanced practitioner of nursing
or
3-9 veterinarian:
3-10 (a) As an incident to his administering or dispensing of a
substance in
3-11 the course of his
professional practice; or
3-12 (b) By his authorized agent under his supervision, for the purpose
of, or
3-13 as an incident to, research,
teaching or chemical analysis and not for sale.
3-14 Sec. 6. NRS 453.126 is hereby amended to read as follows:
3-15 453.126 “Practitioner”
means:
3-16 1. A physician, dentist,
veterinarian or podiatric physician who holds a
3-17 license to practice his
profession in this state and is registered pursuant to
3-18 this chapter.
3-19 2. An advanced practitioner
of nursing who holds a certificate from the
3-20 state board of nursing and a
certificate from the state board of pharmacy
3-21 authorizing him to dispense or to prescribe and dispense
controlled
3-22 substances.
3-23 3. A scientific
investigator or a pharmacy, hospital or other institution
3-24 licensed, registered or otherwise
authorized in this state to distribute,
3-25 dispense, conduct research
with respect to, to administer, or use in teaching
3-26 or chemical analysis, a
controlled substance in the course of professional
3-27 practice or research.
3-28 4. A euthanasia technician
who is licensed by the Nevada state board
3-29 of veterinary medical
examiners and registered pursuant to this chapter,
3-30 while he possesses or
administers sodium pentobarbital pursuant to his
3-31 license and registration.
3-32 5. A physician’s assistant
who:
3-33 (a) Holds a license from the board of medical examiners or a
certificate
3-34 from the state board of
osteopathic medicine; and
3-35 (b) Is authorized by the board to possess, administer, prescribe or
3-36 dispense controlled
substances under the supervision of a physician or
3-37 osteopathic physician as
required by chapter 630 or 633 of NRS.
3-38 6. An optometrist who is
certified by the Nevada state board of
3-39 optometry to prescribe and
administer therapeutic pharmaceutical agents
3-40 pursuant to NRS 636.288,
when he prescribes or administers therapeutic
3-41 pharmaceutical agents within
the scope of his certification.
3-42 Sec. 7. NRS 453.128 is hereby amended to read as follows:
3-43 453.128 1. “Prescription” means:
3-44 (a) An order given individually for the person for whom prescribed,
3-45 directly from a physician,
physician’s assistant, dentist, podiatric physician,
3-46 optometrist , advanced practitioner of nursing
or veterinarian, or his
3-47 agent, to a pharmacist or
indirectly by means of an order signed by the
3-48 practitioner or an
electronic transmission from the practitioner to a
3-49 pharmacist; or
4-1 (b) A chart order written for an inpatient specifying drugs which
he is to
4-2 take home upon his
discharge.
4-3 2. The term does not
include a chart order written for an inpatient for
4-4 use while he is an
inpatient.
4-5 Sec. 8. NRS 453.226 is hereby amended to read as follows:
4-6 453.226 1. Every practitioner or other person who
dispenses any
4-7 controlled substance within
this state or who proposes to engage in the
4-8 dispensing of any controlled
substance within this state shall obtain
4-9 biennially a registration
issued by the board in accordance with its
4-10 regulations.
4-11 2. A person registered by
the board in accordance with the provisions
4-12 of NRS 453.011 to 453.552,
inclusive, to dispense or conduct research with
4-13 controlled substances may
possess, dispense or conduct research with those
4-14 substances to the extent
authorized by the registration and in conformity
4-15 with the other provisions of
those sections.
4-16 3. The following persons
are not required to register and may lawfully
4-17 possess and distribute
controlled substances pursuant to the provisions of
4-18 NRS 453.011 to 453.552,
inclusive:
4-19 (a) An agent or employee of a registered dispenser of a controlled
4-20 substance if he is acting in
the usual course of his business or employment;
4-21 (b) A common or contract carrier or warehouseman, or an employee
4-22 thereof, whose possession of
any controlled substance is in the usual course
4-23 of business or employment;
4-24 (c) An ultimate user or a person in possession of any controlled
4-25 substance pursuant to a
lawful order of a physician, physician’s assistant,
4-26 dentist, advanced practitioner of nursing, podiatric
physician or
4-27 veterinarian or in lawful
possession of a schedule V substance; or
4-28 (d) A physician who:
4-29 (1) Holds a locum tenens license issued by the board of medical
4-30 examiners or a temporary
license issued by the state board of osteopathic
4-31 medicine; and
4-32 (2) Is registered with the Drug Enforcement Administration at a
4-33 location outside this state.
4-34 4. The board may waive the
requirement for registration of certain
4-35 dispensers if it finds it
consistent with the public health and safety.
4-36 5. A separate registration
is required at each principal place of business
4-37 or professional practice
where the applicant dispenses controlled
4-38 substances.
4-39 6. The board may inspect
the establishment of a registrant or applicant
4-40 for registration in
accordance with the board’s regulations.
4-41 Sec. 9. NRS 453.336 is hereby amended to read as follows:
4-42 453.336 1. A person shall not knowingly or intentionally
possess a
4-43 controlled substance, unless
the substance was obtained directly from, or
4-44 pursuant to, a prescription
or order of a physician, physician’s assistant,
4-45 dentist, podiatric
physician, optometrist , advanced
practitioner of nursing
4-46 or veterinarian while acting
in the course of his professional practice, or
4-47 except as otherwise
authorized by the provisions of NRS 453.011 to
4-48 453.552, inclusive.
5-1 2. Except as otherwise
provided in subsections 3, 4 and 5 and in NRS
5-2 453.3363, and unless a
greater penalty is provided in NRS 212.160,
5-3 453.3385, 453.339 or
453.3395, a person who violates this section shall be
5-4 punished:
5-5 (a) For the first or second offense, if the controlled substance is
listed in
5-6 schedule I, II, III or IV,
for a category E felony as provided in NRS
5-7 193.130.
5-8 (b) For a third or subsequent offense, if the controlled substance
is listed
5-9 in schedule I, II, III or
IV, or if the offender has previously been convicted
5-10 two or more times in the
aggregate of any violation of the law of the
5-11 United States or of any
state, territory or district relating to a controlled
5-12 substance, for a category D
felony as provided in NRS 193.130, and may
5-13 be further punished by a
fine of not more than $20,000.
5-14 (c) For the first offense, if the controlled substance is listed in
schedule
5-15 V, for a category E felony
as provided in NRS 193.130.
5-16 (d) For a second or subsequent offense, if the controlled substance
is
5-17 listed in schedule V, for a
category D felony as provided in NRS 193.130.
5-18 3. Unless a greater penalty
is provided in NRS 212.160, 453.337 or
5-19 453.3385, a person who is
convicted of the possession of flunitrazepam or
5-20 gamma-hydroxybutyrate, or
any substance for which flunitrazepam or
5-21 gamma-hydroxybutyrate is an
immediate precursor, is guilty of a category
5-22 B felony and shall be
punished by imprisonment in the state prison for a
5-23 minimum term of not less
than 1 year and a maximum term of not more
5-24 than 6 years.
5-25 4. Unless a greater penalty
is provided in NRS 212.160, a person who
5-26 is less than 21 years of age
and is convicted of the possession of less than 1
5-27 ounce of marijuana:
5-28 (a) For the first and second offense, is guilty of a category E felony
and
5-29 shall be punished as
provided in NRS 193.130.
5-30 (b) For a third or subsequent offense, is guilty of a category D
felony
5-31 and shall be punished as
provided in NRS 193.130, and may be further
5-32 punished by a fine of not
more than $20,000.
5-33 5. Before sentencing under
the provisions of subsection 4 for a first
5-34 offense, the court shall
require the parole and probation officer to submit a
5-35 presentencing report on the
person convicted in accordance with the
5-36 provisions of NRS 176A.200.
After the report is received but before
5-37 sentence is pronounced the
court shall:
5-38 (a) Interview the person convicted and make a determination as to
the
5-39 possibility of his
rehabilitation; and
5-40 (b) Conduct a hearing at which evidence may be presented as to the
5-41 possibility of
rehabilitation and any other relevant information.
5-42 6. As used in this section,
“controlled substance” includes
5-43 flunitrazepam,
gamma-hydroxybutyrate and each substance for which
5-44 flunitrazepam or
gamma-hydroxybutyrate is an immediate precursor.
5-45 Sec. 10. NRS 453.371 is hereby amended to read as follows:
5-46 453.371 As used in NRS
453.371 to 453.552, inclusive:
5-47 1. “Advanced practitioner of nursing” means a person who holds
a
5-48 certificate of recognition granted pursuant to NRS 632.237 and is
5-49 registered with the board.
6-1 2. “Medical intern” means a medical graduate acting as an assistant in
6-2 a hospital for the purpose of
clinical training.
6-3 [2. “Physician,” “physician’s assistant,”]
6-4 3. “Pharmacist” means a person who holds a
certificate of
6-5 registration issued pursuant to NRS 639.127 and is registered with
the
6-6 board.
6-7 4. “Physician,” “dentist,” “podiatric
physician,” [“veterinarian,”
6-8 “pharmacist”] “veterinarian” and “euthanasia technician”
mean persons
6-9 authorized by a [valid]
license to practice their respective professions in
6-10 this state who are
registered with the board.
6-11 5. “Physician’s assistant” means a person who is
registered with the
6-12 board and:
6-13 (a) Holds a license issued
pursuant to NRS 630.273; or
6-14 (b) Holds a certificate
issued pursuant to NRS 633.451.
6-15 Sec. 11. NRS 453.377 is hereby amended to read as follows:
6-16 453.377 A controlled
substance may be dispensed by:
6-17 1. A registered pharmacist
upon a legal prescription from a practitioner
6-18 or to a pharmacy in a
correctional institution upon the written order of the
6-19 prescribing practitioner in
charge.
6-20 2. A pharmacy in a
correctional institution, in case of emergency, upon
6-21 a written order signed by
the chief medical officer.
6-22 3. A practitioner.
6-23 4. A registered nurse, when
the state, county, city or district health
6-24 officer has declared a state
of emergency.
6-25 5. A medical intern in the
course of his internship.
6-26 6. [An advanced practitioner of nursing who holds a certificate
from
6-27 the state board of nursing and a certificate from the state board of
6-28 pharmacy permitting him to dispense controlled substances.
6-29 7.] A pharmacy in an institution
of the department of prisons to a
6-30 person designated by the
director of the department of prisons to
6-31 administer a lethal
injection to a person who has been sentenced to death.
6-32 [8.] 7. A registered pharmacist from an institutional
pharmacy,
6-33 pursuant to regulations
adopted by the board.
6-34 Sec. 12. NRS 453.381 is hereby amended to read as follows:
6-35 453.381 1. In addition to the limitations imposed by NRS
453.256, a
6-36 physician, physician’s
assistant, dentist , advanced
practitioner of nursing
6-37 or podiatric physician may
prescribe or administer controlled substances
6-38 only for a legitimate
medical purpose and in the usual course of his
6-39 professional practice, and
he shall not prescribe, administer or dispense a
6-40 controlled substance listed
in schedule II for himself, his spouse or his
6-41 children except in cases of
emergency.
6-42 2. A veterinarian, in the
course of his professional practice only, and
6-43 not for use by a human
being, may prescribe, possess and administer
6-44 controlled substances, and
he may cause them to be administered by a
6-45 veterinary technician under
his direction and supervision.
6-46 3. A euthanasia technician,
within the scope of his license, and not for
6-47 use by a human being, may
possess and administer sodium pentobarbital.
6-48 4. A pharmacist shall not
fill an order which purports to be a
6-49 prescription if he has
reason to believe that it was not issued in the usual
7-1 course of the professional
practice of a physician, physician’s assistant,
7-2 dentist, advanced practitioner of nursing, podiatric
physician or
7-3 veterinarian.
7-4 5. Any person who has
obtained from a physician, physician’s
7-5 assistant, dentist, advanced practitioner of nursing, podiatric
physician or
7-6 veterinarian any controlled
substance for administration to a patient during
7-7 the absence of the
physician, physician’s assistant, dentist, advanced
7-8 practitioner of nursing, podiatric physician or veterinarian shall return to
7-9 him any unused portion of
the substance when it is no longer required by
7-10 the patient.
7-11 6. A manufacturer,
wholesale supplier or other person legally able to
7-12 furnish or sell any
controlled substance listed in schedule II shall not
7-13 provide samples of such a
controlled substance to registrants.
7-14 7. A salesman of any
manufacturer or wholesaler of pharmaceuticals
7-15 shall not possess, transport
or furnish any controlled substance listed in
7-16 schedule II.
7-17 8. A person shall not
dispense a controlled substance in violation of a
7-18 regulation adopted by the board.
7-19 Sec. 13. NRS 453.391 is hereby amended to read as follows:
7-20 453.391 A person shall not:
7-21 1. Unlawfully take, obtain
or attempt to take or obtain a controlled
7-22 substance or a prescription
for a controlled substance from a manufacturer,
7-23 wholesaler, pharmacist,
physician, physician’s assistant, dentist, advanced
7-24 practitioner of nursing, veterinarian or any other person authorized to
7-25 administer, dispense or
possess controlled substances.
7-26 2. While undergoing
treatment and being supplied with any controlled
7-27 substance or a prescription
for any controlled substance from one
7-28 practitioner, knowingly
obtain any controlled substance or a prescription
7-29 for a controlled substance
from another practitioner without disclosing this
7-30 fact to the second
practitioner.
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