SB52_EN

Senate Bill No. 52–Committee on Commerce and Labor

CHAPTER..........

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:

Section 1. NRS 632.237 is hereby amended to read as follows:

632.237 1. The board may grant a certificate of recognition as an

advanced practitioner of nursing to a registered nurse who has completed

an educational program designed to prepare a registered nurse to:

(a) Perform designated acts of medical diagnosis;

(b) Prescribe therapeutic or corrective measures; and

devices,

and who meets the other requirements established by the board for such

certification.

2. An advanced practitioner of nursing may:

(a) Engage in selected medical diagnosis and treatment; and

(b) If authorized pursuant to NRS 639.2351, prescribe controlled

substances, poisons, dangerous drugs and devices,

pursuant to a protocol approved by a collaborating physician. A protocol

must not include and an advanced practitioner of nursing shall not engage

in any diagnosis, treatment or other conduct which the advanced

practitioner of nursing is not qualified to perform.

3. The board shall adopt regulations:

(a) Specifying the training, education and experience necessary for

certification as an advanced practitioner of nursing.

(b) Delineating the authorized scope of practice of an advanced

practitioner of nursing.

advanced practitioner of nursing.

Sec. 2. NRS 639.0125 is hereby amended to read as follows:

639.0125 “Practitioner” means:

1. A physician, dentist, veterinarian or podiatric physician who holds a

[valid] license to practice his profession in this state;

2. A hospital, pharmacy or other institution licensed, registered or

otherwise permitted to distribute, dispense, conduct research with respect

to or administer drugs in the course of professional practice or research in

this state;

3. An advanced practitioner of nursing who has been authorized to

prescribe controlled substances, poisons, dangerous drugs and devices; or

4. A physician’s assistant who:

(a) Holds a license issued by the board of medical examiners or

certificate issued by the state board of osteopathic medicine; and

(b) Is authorized by the board to possess, administer, prescribe or

dispense controlled substances, poisons, dangerous drugs or devices under

the supervision of a physician or osteopathic physician as required by

chapter 630 or 633 of NRS.

Sec. 3. NRS 639.2351 is hereby amended to read as follows:

639.2351 1. An advanced practitioner of nursing may prescribe, in

accordance with NRS 454.695[,] and 632.237, controlled substances,

poisons, dangerous drugs and devices if he:

(a) Is authorized to do so by the state board of nursing in a certificate

issued by that board; and

(b) Applies for and obtains a certificate of registration from the state

board of pharmacy and pays the fee set by a regulation adopted by the

board.

2. The state board of pharmacy shall consider each application from an

advanced practitioner of nursing separately, and may:

(a) Issue a certificate of registration; or

(b) Refuse to issue a certificate of registration, regardless of the

provisions of the certificate issued by the state board of nursing.

Sec. 4. NRS 453.038 is hereby amended to read as follows:

453.038 “Chart order” means an order entered on the chart of a

patient:

1. In a hospital, facility for intermediate care or facility for skilled

nursing which is licensed as such by the health division of the department;

2. Under emergency treatment in a hospital by a physician, advanced

practitioner of nursing, dentist or podiatric physician, or on the written or

oral order of a physician, physician’s assistant, advanced practitioner of

nursing, dentist or podiatric physician authorizing the administration of a

drug to the patient.

Sec. 5. NRS 453.091 is hereby amended to read as follows:

453.091 1. “Manufacture” means the production, preparation,

propagation, compounding, conversion or processing of a substance, either

directly or indirectly by extraction from substances of natural origin, or

independently by means of chemical synthesis, or by a combination of

extraction and chemical synthesis, and includes any packaging or

repackaging of the substance or labeling or relabeling of its container.

2. “Manufacture” does not include the preparation or compounding of

a substance by a person for his own use or the preparation, compounding,

packaging or labeling of a substance by a physician, physician’s assistant,

dentist, podiatric physician , advanced practitioner of nursing or

veterinarian:

(a) As an incident to his administering or dispensing of a substance in

the course of his professional practice; or

(b) By his authorized agent under his supervision, for the purpose of, or

as an incident to, research, teaching or chemical analysis and not for sale.

Sec. 6. NRS 453.126 is hereby amended to read as follows:

453.126 “Practitioner” means:

1. A physician, dentist, veterinarian or podiatric physician who holds a

license to practice his profession in this state and is registered pursuant to

this chapter.

2. An advanced practitioner of nursing who holds a certificate from the

state board of nursing and a certificate from the state board of pharmacy

authorizing him to dispense or to prescribe and dispense controlled

substances.

3. A scientific investigator or a pharmacy, hospital or other institution

licensed, registered or otherwise authorized in this state to distribute,

dispense, conduct research with respect to, to administer, or use in

teaching or chemical analysis, a controlled substance in the course of

professional practice or research.

4. A euthanasia technician who is licensed by the Nevada state board

of veterinary medical examiners and registered pursuant to this chapter,

while he possesses or administers sodium pentobarbital pursuant to his

license and registration.

5. A physician’s assistant who:

(a) Holds a license from the board of medical examiners or a certificate

from the state board of osteopathic medicine; and

(b) Is authorized by the board to possess, administer, prescribe or

dispense controlled substances under the supervision of a physician or

osteopathic physician as required by chapter 630 or 633 of NRS.

6. An optometrist who is certified by the Nevada state board of

optometry to prescribe and administer therapeutic pharmaceutical agents

pursuant to NRS 636.288, when he prescribes or administers therapeutic

pharmaceutical agents within the scope of his certification.

Sec. 7. NRS 453.128 is hereby amended to read as follows:

453.128 1. “Prescription” means:

(a) An order given individually for the person for whom prescribed,

directly from a physician, physician’s assistant, dentist, podiatric

physician, optometrist , advanced practitioner of nursing or veterinarian,

or his agent, to a pharmacist or indirectly by means of an order signed by

the practitioner or an electronic transmission from the practitioner to a

pharmacist; or

(b) A chart order written for an inpatient specifying drugs which he is to

take home upon his discharge.

2. The term does not include a chart order written for an inpatient for

use while he is an inpatient.

Sec. 8. NRS 453.226 is hereby amended to read as follows:

453.226 1. Every practitioner or other person who dispenses any

controlled substance within this state or who proposes to engage in the

dispensing of any controlled substance within this state shall obtain

biennially a registration issued by the board in accordance with its

regulations.

2. A person registered by the board in accordance with the provisions

of NRS 453.011 to 453.552, inclusive, to dispense or conduct research

with controlled substances may possess, dispense or conduct research with

those substances to the extent authorized by the registration and in

conformity with the other provisions of those sections.

3. The following persons are not required to register and may lawfully

possess and distribute controlled substances pursuant to the provisions of

NRS 453.011 to 453.552, inclusive:

(a) An agent or employee of a registered dispenser of a controlled

substance if he is acting in the usual course of his business or employment;

(b) A common or contract carrier or warehouseman, or an employee

thereof, whose possession of any controlled substance is in the usual

course of business or employment;

substance pursuant to a lawful order of a physician, physician’s assistant,

dentist, advanced practitioner of nursing, podiatric physician or

veterinarian or in lawful possession of a schedule V substance; or

(d) A physician who:

(1) Holds a locum tenens license issued by the board of medical

examiners or a temporary license issued by the state board of osteopathic

medicine; and

(2) Is registered with the Drug Enforcement Administration at a

location outside this state.

4. The board may waive the requirement for registration of certain

dispensers if it finds it consistent with the public health and safety.

5. A separate registration is required at each principal place of business

or professional practice where the applicant dispenses controlled

substances.

6. The board may inspect the establishment of a registrant or applicant

for registration in accordance with the board’s regulations.

Sec. 9. NRS 453.336 is hereby amended to read as follows:

453.336 1. A person shall not knowingly or intentionally possess a

controlled substance, unless the substance was obtained directly from, or

pursuant to, a prescription or order of a physician, physician’s assistant,

dentist, podiatric physician, optometrist , advanced practitioner of

nursing or veterinarian while acting in the course of his professional

practice, or except as otherwise authorized by the provisions of NRS

453.011 to 453.552, inclusive.

2. Except as otherwise provided in subsections 3, 4 and 5 and in NRS

453.3363, and unless a greater penalty is provided in NRS 212.160,

453.3385, 453.339 or 453.3395, a person who violates this section shall be

punished:

(a) For the first or second offense, if the controlled substance is listed in

schedule I, II, III or IV, for a category E felony as provided in NRS

193.130.

(b) For a third or subsequent offense, if the controlled substance is listed

in schedule I, II, III or IV, or if the offender has previously been convicted

two or more times in the aggregate of any violation of the law of the

United States or of any state, territory or district relating to a controlled

substance, for a category D felony as provided in NRS 193.130, and may

be further punished by a fine of not more than $20,000.

V, for a category E felony as provided in NRS 193.130.

(d) For a second or subsequent offense, if the controlled substance is

listed in schedule V, for a category D felony as provided in NRS 193.130.

3. Unless a greater penalty is provided in NRS 212.160, 453.337 or

453.3385, a person who is convicted of the possession of flunitrazepam or

gamma-hydroxybutyrate, or any substance for which flunitrazepam or

gamma-hydroxybutyrate is an immediate precursor, is guilty of a category

B felony and shall be punished by imprisonment in the state prison for a

minimum term of not less than 1 year and a maximum term of not more

than 6 years.

4. Unless a greater penalty is provided in NRS 212.160, a person who

is less than 21 years of age and is convicted of the possession of less than 1

ounce of marijuana:

(a) For the first and second offense, is guilty of a category E felony and

shall be punished as provided in NRS 193.130.

(b) For a third or subsequent offense, is guilty of a category D felony

and shall be punished as provided in NRS 193.130, and may be further

punished by a fine of not more than $20,000.

5. Before sentencing under the provisions of subsection 4 for a first

offense, the court shall require the parole and probation officer to submit a

presentencing report on the person convicted in accordance with the

provisions of NRS 176A.200. After the report is received but before

sentence is pronounced the court shall:

(a) Interview the person convicted and make a determination as to the

possibility of his rehabilitation; and

(b) Conduct a hearing at which evidence may be presented as to the

possibility of rehabilitation and any other relevant information.

6. As used in this section, “controlled substance” includes

flunitrazepam, gamma-hydroxybutyrate and each substance for which

flunitrazepam or gamma-hydroxybutyrate is an immediate precursor.

Sec. 10. NRS 453.371 is hereby amended to read as follows:

453.371 As used in NRS 453.371 to 453.552, inclusive:

1. “Advanced practitioner of nursing” means a person who holds a

certificate of recognition granted pursuant to NRS 632.237 and is

registered with the board.

2. “Medical intern” means a medical graduate acting as an assistant in

a hospital for the purpose of clinical training.

[2. “Physician,” “physician’s assistant,”]

3. “Pharmacist” means a person who holds a certificate of

registration issued pursuant to NRS 639.127 and is registered with the

board.

4. “Physician,” “dentist,” “podiatric physician,” [“veterinarian,”

“pharmacist”] “veterinarian” and “euthanasia technician” mean persons

authorized by a [valid] license to practice their respective professions in

this state who are registered with the board.

5. “Physician’s assistant” means a person who is registered with the

board and:

(a) Holds a license issued pursuant to NRS 630.273; or

(b) Holds a certificate issued pursuant to NRS 633.451.

Sec. 11. NRS 453.377 is hereby amended to read as follows:

453.377 A controlled substance may be dispensed by:

1. A registered pharmacist upon a legal prescription from a practitioner

or to a pharmacy in a correctional institution upon the written order of the

prescribing practitioner in charge.

2. A pharmacy in a correctional institution, in case of emergency, upon

a written order signed by the chief medical officer.

3. A practitioner.

4. A registered nurse, when the state, county, city or district health

officer has declared a state of emergency.

5. A medical intern in the course of his internship.

6. [An advanced practitioner of nursing who holds a certificate from

the state board of nursing and a certificate from the state board of

pharmacy permitting him to dispense controlled substances.

7.] A pharmacy in an institution of the department of prisons to a

person designated by the director of the department of prisons to

administer a lethal injection to a person who has been sentenced to death.

[8.] 7. A registered pharmacist from an institutional pharmacy,

pursuant to regulations adopted by the board.

Sec. 12. NRS 453.381 is hereby amended to read as follows:

453.381 1. In addition to the limitations imposed by NRS 453.256, a

physician, physician’s assistant, dentist , advanced practitioner of nursing

or podiatric physician may prescribe or administer controlled substances

only for a legitimate medical purpose and in the usual course of his

professional practice, and he shall not prescribe, administer or dispense a

controlled substance listed in schedule II for himself, his spouse or his

children except in cases of emergency.

2. A veterinarian, in the course of his professional practice only, and

not for use by a human being, may prescribe, possess and administer

controlled substances, and he may cause them to be administered by a

veterinary technician under his direction and supervision.

3. A euthanasia technician, within the scope of his license, and not for

use by a human being, may possess and administer sodium pentobarbital.

4. A pharmacist shall not fill an order which purports to be a

prescription if he has reason to believe that it was not issued in the usual

course of the professional practice of a physician, physician’s assistant,

dentist, advanced practitioner of nursing, podiatric physician or

veterinarian.

5. Any person who has obtained from a physician, physician’s

assistant, dentist, advanced practitioner of nursing, podiatric physician or

veterinarian any controlled substance for administration to a patient during

the absence of the physician, physician’s assistant, dentist, advanced

practitioner of nursing, podiatric physician or veterinarian shall return to

him any unused portion of the substance when it is no longer required by

the patient.

6. A manufacturer, wholesale supplier or other person legally able to

furnish or sell any controlled substance listed in schedule II shall not

provide samples of such a controlled substance to registrants.

7. A salesman of any manufacturer or wholesaler of pharmaceuticals

shall not possess, transport or furnish any controlled substance listed in

schedule II.

8. A person shall not dispense a controlled substance in violation of a

regulation adopted by the board.

Sec. 13. NRS 453.391 is hereby amended to read as follows:

453.391 A person shall not:

1. Unlawfully take, obtain or attempt to take or obtain a controlled

substance or a prescription for a controlled substance from a manufacturer,

wholesaler, pharmacist, physician, physician’s assistant, dentist, advanced

practitioner of nursing, veterinarian or any other person authorized to

administer, dispense or possess controlled substances.

2. While undergoing treatment and being supplied with any controlled

substance or a prescription for any controlled substance from one

practitioner, knowingly obtain any controlled substance or a prescription

for a controlled substance from another practitioner without disclosing this

fact to the second practitioner.

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