Certify Nurse Anesthetists

Section 1. This act enacts into law major components of legislation relating to the practice of nurse anesthesia. Each component is wholly contained within a Part identified as Parts A through B. The effective date for each particular provision contained within such Part is set forth in the last section of such Part. Any provision in any section contained within a Part, including the effective date of the Part, which makes reference to a section "of this act", when used in connection with that particular component, shall be deemed to mean and refer to the corresponding section of the Part in which it is found. Section three of this act sets forth the general effective date of this act.

PART A

Section 1. Section 6902 of the education law is amended by adding a new subdivision 4 to read as follows:

4. (a) (i) The practice of registered professional nursing by a certified registered nurse anesthetist, certified under section sixty-nine hundred twelve of this article may include the practice of nurse anesthesia. Nurse anesthesia includes: the administration of anesthesia and anesthesia related care to patients; preanesthetics evaluation and preparation; anesthetic induction, maintenance and emergence; post anes-

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD03584-01-9

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thesia care; perianesthetics and clinical support functions; and pain management, in collaboration with a licensed physician qualified by law to determine the need for anesthesia services, provided such services are performed in accordance with a written practice agreement and written practice protocols except as permitted by paragraph (b) of this subdivision. The written practice agreement shall include explicit provisions for the resolution of any disagreement between the collaborating physician and the certified registered nurse anesthetist regarding a matter of anesthesia treatment that is within the scope of practice of both. To the extent the practice agreement does not so provide, then the collaborating physician's treatment shall prevail.

(ii) Prescriptions for drugs, devices and anesthetic agents may be issued by a certified registered nurse anesthetist, under this paragraph and section sixty-nine hundred twelve of this article, in accordance with the practice agreement and practice protocols, except as provided by paragraph (b) of this subdivision. The certified registered nurse anesthetist shall obtain a certificate from the department upon successfully completing a program including an appropriate pharmacology component, or its equivalent, as established by the commissioner's regulations, prior to prescribing under this paragraph. The certificate issued under section sixty-nine hundred twelve of this article shall state whether the certified registered nurse anesthetist has successfully completed such a program or equivalent and is authorized to prescribe under this subdivision.

(iii) Each practice agreement shall provide for patient records review by the collaborating physician in a timely fashion but in no event less often than every three months. The names of the certified registered nurse anesthetist and the collaborating physician shall be clearly posted in the practice setting of the certified registered nurse anesthetist.

(iv) The practice protocol shall reflect current accepted medical and nursing practice. The protocols shall be filed with the department within ninety days of the commencement of the practice and may be updated periodically. The commissioner shall make regulations establishing the procedure for the review of protocols and the disposition of any issues arising from such review.

(v) No physician shall enter into practice agreements with more than four certified registered nurse anesthetists who are not located on the same physical premises as the collaborating physician.

(b) Notwithstanding subparagraph (i) of paragraph (a) of this subdivision, a certified registered nurse anesthetist, certified under section sixty-nine hundred twelve of this article and practicing for more than three thousand six hundred hours may comply with this paragraph in lieu of complying with the requirements of paragraph (a) of this subdivision relating to collaboration with a physician, a written practice agreement and written practice protocols. A certified registered nurse anesthetist complying with this paragraph shall have collaborative relationships with one or more licensed physicians qualified by law to determine the need for anesthesia services or a hospital, licensed under article twenty-eight of the public health law, that provides services through licensed physicians qualified by law to determine the need for anesthesia services and having privileges at such institution. As evidence that the certified registered nurse anesthetist maintains collaborative relationships, the certified registered nurse anesthetist shall complete and maintain a form, created by the department, to which the certified registered nurse anesthetist shall attest, that describes such collabo-

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rative relationships. For purposes of this paragraph, "collaborative relationships" shall mean that the certified registered nurse anesthetist shall communicate, whether in person, by telephone or through written (including electronic) means, with a licensed physician qualified by law to determine the need for anesthesia services or, in the case of a hospital, communicate with a licensed physician qualified by law to determine the need for anesthesia services and having privileges at such hospital, for the purposes of exchanging information, as needed, in order to provide comprehensive patient care and to make referrals as necessary. Such form shall also reflect the certified registered nurse anesthetist's acknowledgement that if reasonable efforts to resolve any dispute that may arise with the collaborating physician or, in the case of a collaboration with a hospital, with a licensed physician qualified by law to determine the need for anesthesia services and having privileges at such hospital, about a patient's care are not successful, the recommendation of the physician shall prevail. Such form shall be updated as needed and may be subject to review by the department. The certified registered nurse anesthetist shall maintain documentation that supports such collaborative relationships. Failure to comply with the requirements of this paragraph by a certified registered nurse anesthetist, who is not complying with such provisions of paragraph (a) of this subdivision, shall subject the certified registered nurse anesthetist to the professional misconduct provisions set forth in article one hundred thirty of this title.

(c) Nothing in this subdivision shall be deemed to limit or diminish the practice of the profession of nursing as a registered professional nurse under this article or any other law, rule, regulation or certification, nor to deny any registered professional nurse the right to do any act or engage in any practice authorized by this article or any other law, rule, regulation or certification.

(d) The provisions of this subdivision shall not apply to any activity authorized, pursuant to statute, rule or regulation, to be performed by a registered professional nurse in a hospital as defined in article twenty-eight of the public health law.

§ 2. The education law is amended by adding a new section 6912 to read as follows:

§ 6912. Certificates for nurse anesthesia practice. 1. For issuance of a certificate to practice as a certified registered nurse anesthetist under subdivision four of section sixty-nine hundred two of this article, the applicant shall fulfill the following requirements:

(a) Application: file an application with the department;

(b) License: be licensed as a registered professional nurse in the state;

(c) Education: (i) have satisfactorily completed educational preparation for provision of these services in a program registered by the department or in a program accredited by a national body recognized by the department or determined by the department to be the equivalent; and (ii) submit evidence of current certification or recertification by a national certifying body, recognized by the department;

(d) Fees: pay a fee to the department of fifty dollars for an initial certificate authorizing nurse anesthesia practice and a triennial registration fee of thirty dollars.

After a certified registered nurse anesthetist's initial registration, registration under this section shall be coterminous with the certified registered nurse anesthetist's registration as a professional nurse.

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2. Only a person certified under this section shall use the title "certified registered nurse anesthetist".

3. The provisions of this section shall not apply to any act or practice authorized by any other law, rule, regulation or certification.

4. The provisions of this section shall not apply to any activity authorized, pursuant to statute, rule or regulation, to be performed by a registered professional nurse in a hospital as defined in article twenty-eight of the public health law.

5. An individual who is authorized to practice as a certified registered nurse anesthetist in a hospital under regulations of the department of health may use the title "certified registered nurse anesthetist" in connection with that practice. If such an individual applies for a certificate under this section, he or she may satisfy the education requirement of subdivision one of this section by presenting satisfactory evidence of such authority.

6. (a) A registered professional nurse licensed under section sixtynine hundred five of this article who has satisfactorily completed a program of educational preparation as provided in subdivision one of this section may, for a period not to exceed twenty-four months immediately following the completion of such educational program, practice nurse anesthesia under subdivision four of section sixty-nine hundred two of this article as a graduate nurse anesthetist in the same manner as a certified registered nurse anesthetist under that subdivision.

(b) A registered professional nurse licensed under section sixty-nine hundred five of this article who is duly enrolled in a program of educational preparation, may practice nurse anesthesia as a student nurse anesthetist under the supervision of an anesthesiologist or a certified registered nurse anesthetist, who is immediately available as needed.

7. The commissioner is authorized to promulgate regulations to implement the provisions of this section.

§ 3. This act shall take effect on the first of January next succeeding the date on which it shall have become a law. Effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized and directed to be made and completed on or before such effective date.

PART B

Section 1. Paragraph (b) of subdivision 4 of section 6902 of the education law is REPEALED.

§ 2. Subparagraphs (i) and (ii) of paragraph (a) of subdivision 4 of section 6902 of the education law, as added by section 1 of part A of this act, are amended to read as follows:

(i) The practice of registered professional nursing by a certified registered nurse anesthetist, certified under section sixty-nine hundred twelve of this article may include the practice of nurse anesthesia. Nurse anesthesia includes: the administration of anesthesia and anesthesia related care to patients; preanesthetics evaluation and preparation; anesthetic induction, maintenance and emergence; post anesthesia care; perianesthetics and clinical support functions; and pain management, in collaboration with a licensed physician qualified by law to determine the need for anesthesia services, provided such services are performed in accordance with a written practice agreement and written practice protocols [except as permitted by paragraph (b) of this subdivision]. The written practice agreement shall include explicit

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provisions for the resolution of any disagreement between the collaborating physician and the certified registered nurse anesthetist regarding a matter of anesthesia treatment that is within the scope of practice of both. To the extent the practice agreement does not so provide, then the collaborating physician's treatment shall prevail.

(ii) Prescriptions for drugs, devices and anesthetic agents may be issued by a certified registered nurse anesthetist, under this paragraph and section sixty-nine hundred twelve of this article, in accordance with the practice agreement and practice protocols[, except as provided by paragraph (b) of this subdivision]. The certified registered nurse anesthetist shall obtain a certificate from the department upon successfully completing a program including an appropriate pharmacology component, or its equivalent, as established by the commissioner's regulations, prior to prescribing under this paragraph. The certificate issued under section sixty-nine hundred twelve of this article shall state whether the certified registered nurse anesthetist has successfully completed such a program or equivalent and is authorized to prescribe under this subdivision.

§ 3. This act shall take effect June 30 of the sixth year after it shall have become a law.