MISSISSIPPI LEGISLATURE
2023 Regular Session
To: Public Health and Welfare
By: Senator(s) Blackwell
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 73-15-3, Mississippi Code of 1972, is amended as follows:
73-15-3. In order to safeguard life and health, any person practicing or offering to practice as a registered nurse, an advanced practice registered nurse or a licensed practical nurse in Mississippi for compensation shall hereafter be required to submit evidence of qualifications to practice and shall be licensed or hold the privilege to practice as hereinafter provided. It shall be unlawful for any person not licensed or holding the privilege to practice under the provisions of this article:
(a) To practice or offer to practice as a registered nurse, an advanced practice registered nurse or a licensed practical nurse;
(b) To use a sign, card or device to indicate that such person is a registered nurse, an advanced practice registered nurse or a licensed practical nurse.
Any person offering to practice nursing in Mississippi must be licensed or otherwise authorized to practice as provided in this article.
SECTION 2. Section 73-15-5, Mississippi Code of 1972, is amended as follows:
73-15-5. (1) "Board" means the Mississippi Board of Nursing.
(2) The "practice of nursing" by a registered nurse means the performance for compensation of services which requires substantial knowledge of the biological, physical, behavioral, psychological and sociological sciences and of nursing theory as the basis for assessment, diagnosis, planning, intervention and evaluation in the promotion and maintenance of health; management of individuals' responses to illness, injury or infirmity; the restoration of optimum function; or the achievement of a dignified death. "Nursing practice" includes, but is not limited to, administration, teaching, counseling, delegation and supervision of nursing, and execution of the medical regimen, including the administration of medications and treatments prescribed by any licensed or legally authorized physician, advanced practice registered nurse or dentist. The foregoing shall not be deemed to include acts of medical diagnosis or prescriptions of medical, therapeutic or corrective measures, except as may be set forth by rules and regulations promulgated and implemented by the Mississippi Board of Nursing.
* * *
( * * *3) "Advanced nursing practice"
means, in addition to the practice of professional nursing, the performance of
advanced-level nursing approved by the board which, by virtue of graduate
education and experience are appropriately performed by an advanced practice
registered nurse. The advanced practice registered nurse may diagnose, treat
and manage medical conditions. This may include prescriptive authority as
identified by the board. Except as otherwise authorized in Section 73-15-20(3),
advanced practice registered nurses must practice in a
collaborative/consultative relationship with a physician * * * dentist
with an unrestricted license to practice in the State of Mississippi and
advanced nursing must be performed within the framework of a standing protocol or
practice guidelines, as appropriate.
( * * *4) The "practice of nursing"
by a licensed practical nurse means the performance for compensation of
services requiring basic knowledge of the biological, physical, behavioral, psychological
and sociological sciences and of nursing procedures which do not require the
substantial skill, judgment and knowledge required of a registered nurse.
These services are performed under the direction of a registered nurse or a
licensed physician or licensed dentist and utilize standardized procedures in
the observation and care of the ill, injured and infirm; in the maintenance of
health; in action to safeguard life and health; and in the administration of
medications and treatments prescribed by any licensed physician * * *, licensed dentist or an advanced practice
registered nurse authorized by state law to prescribe. On a selected basis,
and within safe limits, the role of the licensed practical nurse shall be expanded
by the board under its rule-making authority to more complex procedures and
settings commensurate with additional preparation and experience.
( * * *5) A "license" means an
authorization to practice nursing as a registered nurse, an advanced practice registered nurse or
a licensed practical nurse designated herein.
( * * *6) A "registered nurse" is a
person who is licensed or holds the privilege to practice under the provisions
of this article and who practices nursing as defined herein. "RN" is
the abbreviation for the title of Registered Nurse.
( * * *7) A "licensed practical nurse"
is a person who is licensed or holds the privilege to practice under this article
and who practices practical nursing as defined herein. "LPN" is the
abbreviation for the title of Licensed Practical Nurse.
( * * *8) A "registered nurse in
clinical practice" is one who functions in any health care delivery system
which provides nursing services.
* * *
(9) "Collaboration" or "collaborate" means the act of communicating pertinent information or consulting with a licensed physician or other licensed health care provider with each provider contributing the provider's respective expertise to optimize the overall care delivered to the patient.
( * * *10) An "advanced practice
registered nurse" is a person who is licensed or holds the privilege to
practice under this article as a professional nurse and who is * * *
licensed as an advanced practice registered nurse or specialized nursing
practice and includes certified registered nurse midwives, certified registered
nurse anesthetists, clinical nurse specialists and certified nurse
practitioners. "APRN" is the abbreviation for the title of advanced
practice registered nurse. As used in this subsection (10):
(a) "Certified
registered nurse midwife" means a registered nurse who holds certification
as a certified registered nurse midwife by a nationally recognized certifying
body approved by the board and is licensed by the board to engage in advanced
practice nursing in this state. "CNM" is the abbreviation for
the title of Certified Nurse Midwife * * *.
(b) "Certified registered nurse anesthetist" means a registered nurse who holds certification as a certified registered nurse anesthetist by a nationally recognized certifying body approved by the board and is licensed by the board to engage in advanced practice nursing in this state. "CRNA" is the abbreviation for the title of Certified Registered Nurse Anesthetist.
(c) "Certified nurse practitioner" means a registered nurse who holds certification as a certified nurse practitioner by a nationally recognized certifying body approved by the board and is licensed by the board to engage in advanced practice nursing in this state. "CNP" is the abbreviation for the title of Certified Nurse Practitioner.
(d) "Clinical nurse specialist" means a registered nurse who holds certification as a clinical nurse specialist by a nationally recognized certifying body approved by the board and is licensed by the board to engage in advanced practice nursing in this state. "CNS" is the abbreviation for the title of Clinical Nurse Specialist.
( * * *11) A "nurse educator" is a
registered nurse who meets the criteria for faculty as set forth in a state-accredited
program of nursing for registered nurses, or a state-approved program of
nursing for licensed practical nurses, and who functions as a faculty member.
( * * *12) A "consumer representative"
is a person representing the interests of the general public, who may use
services of a health agency or health professional organization or its members
but who is neither a provider of health services, nor employed in the health
services field, nor holds a vested interest in the provision of health services
at any level, nor has an immediate family member who holds vested interests in
the provision of health services at any level.
( * * *13) "Privilege to practice"
means the multistate licensure privilege to practice nursing in the state as
described in the Nurse Licensure Compact provided for in Section 73-15-201.
( * * *14) "Licensee" is a person
who has been issued a license to practice nursing or advanced practice
nursing in the state or who holds the privilege to practice nursing in the
state.
(15) "Practice hours" include, but are not limited to: clinical practice hours completed in an APRN program, CRNA critical care nursing hours and practice hours completed as an authorized APRN in this state or any other state.
(16) "Critical care nursing hours" means any nursing hours received by a CRNA in a critical care setting required as a prerequisite for admission to a Nurse Anesthesia program.
SECTION 3. Section 73-15-9, Mississippi Code of 1972, is amended as follows:
73-15-9. (1) There is hereby
created a board to be known as the Mississippi Board of Nursing, composed of
thirteen (13) members, two (2) of whom shall be nurse educators; three (3) of
whom shall be registered nurses in clinical practice, two (2) to have as basic
nursing preparation an associate degree or diploma and one (1) to have as basic
nursing preparation a baccalaureate degree; one (1) of whom shall be a
registered nurse at large; one (1) of whom shall be a registered nurse practitioner; * * * three
(3) of whom shall be licensed practical nurses; one (1) of whom shall be
a certified registered nurse anesthetist; one (1) of whom shall be a licensed
physician who shall always be a member of the State Board of Medical Licensure;
and one (1) of whom shall represent consumers of health services. There shall
be at least one (1) board member from each congressional district in the state;
provided, however, that the physician member, the consumer representative
member and one (1) registered nurse member shall be at large always.
(2) Members of the
Mississippi Board of Nursing, excepting the member of the State Board of
Medical Licensure, shall be appointed by the Governor, with the advice and
consent of the Senate, from lists of nominees submitted by any Mississippi registered
nurse organization and/or association chartered by the State of Mississippi
whose board of directors is elected by the membership and whose membership
includes registered nurses statewide, for the nomination of registered nurses,
and by the * * *
National Association of Licensed Practical Nurses and the Mississippi Licensed
Practical Nurses' Association for the nomination of a licensed practical
nurse. Nominations submitted by any such registered nurse organization or
association to fill vacancies on the board shall be made and voted on by
registered nurses only. Each list of nominees shall contain a minimum of three
(3) names for each vacancy to be filled. The list of names shall be submitted at
least thirty (30) days before the expiration of the term for each position. If
such list is not submitted, the Governor is authorized to make an appointment
from the group affected and without nominations. Appointments made to fill vacancies
for unexpired terms shall be for the duration of such terms and until a
successor is duly appointed.
(3) Members of the board shall be appointed in staggered terms for four (4) years or until a successor shall be duly qualified. No member may serve more than two (2) consecutive full terms. Members of the board serving on July 1, 1988, shall continue to serve for their appointed terms.
(4) Vacancies occurring by reason of resignation, death or otherwise shall be filled by appointment of the Governor upon nominations from a list of nominees from the affected group to be submitted within not more than thirty (30) days after such a vacancy occurs. In the absence of such list, the Governor is authorized to fill such vacancy in accordance with the provisions for making full-term appointments. All vacancy appointments shall be for the unexpired terms.
(5) Any member may be removed from the board by the Governor after a hearing by the board and provided such removal is recommended by the executive committee of the affected group.
SECTION 4. Section 73-15-20, Mississippi Code of 1972, is amended as follows:
73-15-20. (1) Advanced
practice registered nurses. Any nurse desiring to be * * * licensed as an advanced
practice registered nurse shall apply to the board and submit proof that he or
she holds a current license * * * as a
registered nurse and that he or she meets one or more of the following
requirements:
(a) Satisfactory completion of a formal post-basic educational program of at least one (1) academic year, the primary purpose of which is to prepare nurses for advanced or specialized practice.
(b) Certification by a
board-approved certifying body. Such certification shall be required for
initial state * * * licensure and any * * * license renewal as a certified
registered nurse anesthetist, certified nurse practitioner, clinical nurse specialist or certified
nurse midwife. The board may by rule provide for provisional or temporary
state * * *
licensure of graduate * * * advanced practice registered nurses for a period of time
determined to be appropriate for preparing and passing the National
Certification Examination. Those with provisional or temporary * * * licenses must practice
under the direct supervision of a licensed physician or * * *
an advanced practice registered nurse
with at least five (5) years of experience.
(c) Graduation from a
program leading to a master's or post-master's degree in a * * * program of
study preparing for one (1) of the described advanced practice registered nurse
roles.
(2) Rulemaking. The
board shall provide by rule the appropriate requirements for advanced practice registered
nurses in the categories of certified registered nurse anesthetist, certified
nurse midwife, clinical nurse specialist
and * * * certified nurse
practitioner.
(3) Collaboration. Except
as otherwise authorized in this subsection (3), an advanced practice
registered nurse shall perform those functions authorized in this section
within a collaborative/consultative relationship with a dentist or physician
with an unrestricted license to practice dentistry or medicine in this state
and within an established protocol or practice guidelines, as appropriate, that
is filed with the board upon license application, license renewal, after
entering into a new collaborative/consultative relationship or making changes
to the protocol or practice guidelines or practice site. The board shall
review and approve the protocol to ensure compliance with applicable regulatory
standards. * * * After an advanced practice
registered nurse has completed six thousand two hundred forty (6,240) practice
hours, the advanced practice registered nurse, except certified registered
nurse anesthetists, shall be exempt from the requirement of entering and maintaining
a collaborative/consultative relationship with a licensed physician as provided
under this subsection (3). Certified registered nurse anesthetists shall be exempt
from maintaining a collaborative/consultative relationship with a licensed physician
as provided under subsection (3) upon completion of eight thousand (8,000) clinical
practice hours. Advanced practice registered nurses and certified registered nurse
anesthetists may apply hours worked before the effective date of this act to fulfill
their respective hour requirements.
(4) Renewal. The
board shall renew a license for an advanced practice registered nurse upon
receipt of the renewal application, fees and any required protocol or
practice guidelines. The board shall adopt rules establishing procedures for
license renewals. The board shall by rule prescribe continuing education
requirements for advanced practice registered nurses * * * as a
condition for renewal of * * * a license or certificate licensure.
(5) Reinstatement.
Advanced practice registered nurses may reinstate a lapsed privilege to
practice upon submitting documentation of a current active license to practice
professional nursing, a reinstatement application and fee, * * * any required protocol or practice
guidelines, documentation of current certification as an advanced practice registered
nurse in a designated area of practice by a national certification organization
recognized by the board and documentation of at least forty (40) hours of
continuing education related to the advanced clinical practice of the * * * advanced
practice registered nurse within the previous two-year period. The
board shall adopt rules establishing the procedure for reinstatement.
(6) Changes in status. * * * An advanced practice registered
nurse who is required to have a collaborative/consultative relationship with
a licensed physician shall notify the board immediately regarding changes
in the collaborative/consultative relationship * * *. If
changes leave the advanced practice registered nurse without a board-approved
collaborative/consultative relationship with a physician or dentist, the
advanced practice nurse may not practice as an advanced practice registered
nurse.
(7) Practice requirements. The advanced practice registered nurse shall practice as follows:
(a) According to standards and guidelines of their respective professional organization and the National Certification Organization.
(b) In a collaborative/consultative relationship with a licensed physician whose practice is compatible with that of the nurse practitioner, except as otherwise authorized in subsection (3) of this section. Certified registered nurse anesthetists may collaborate/consult with licensed dentists. The advanced practice registered nurse must be able to communicate reliably with a collaborating/consulting physician or dentist while practicing. Advanced practice registered nurses who are not required to have a collaborative/consultative relationship with a licensed physician or dentist shall collaborate with other health care providers and refer or transfer patients as appropriate.
(c) According to a board-approved protocol or practice guidelines, except as otherwise authorized in subsection (3) of this section.
(d) Advanced practice registered nurses practicing as certified registered nurse anesthetists must practice according to board-approved practice guidelines that address pre-anesthesia preparation and evaluation; anesthesia induction, maintenance, and emergence; post-anesthesia care; peri-anesthetic and clinical support functions.
(e) Except as otherwise authorized in subsection (3) of this section, advanced practice registered nurses practicing in other specialty areas must practice according to a board-approved protocol that has been mutually agreed upon by the nurse practitioner and a Mississippi licensed physician or dentist whose practice or prescriptive authority is not limited as a result of voluntary surrender or legal/regulatory order.
(f) Each required collaborative/consultative relationship shall include and implement a formal quality assurance/quality improvement program which shall be maintained on site and shall be available for inspection by representatives of the board. This quality assurance/quality improvement program must be sufficient to provide a valid evaluation of the practice and be a valid basis for change, if any.
(g) * * * Advanced practice registered nurses may not
write prescriptions for, dispense or order the use of or administration of any
schedule of controlled substances except as contained in this chapter.
(8)
Prescribing controlled substances and medications. * * * Advanced
practice registered nurses may apply for controlled substance
prescriptive authority after completing a board-approved educational program. * * *
Advanced practice registered nurses
who have completed the program and received prescription authority from the
board may prescribe Schedules II-V. The words "administer," "controlled
substances" and "ultimate user," shall have the same meaning as
set forth in Section 41-29-105, unless the context otherwise requires. The
board shall promulgate rules governing prescribing of controlled substances,
including distribution, record keeping, drug maintenance, labeling and
distribution requirements and prescription guidelines for controlled substances
and all medications. Prescribing any controlled substance in violation of the
rules promulgated by the board shall constitute a violation of Section 73-15-29(1)(f),
(k) and (l) and shall be grounds for disciplinary action. The prescribing,
administering or distributing of any legend drug or other medication in
violation of the rules promulgated by the board shall constitute a violation of
Section 73-15-29(1)(f), (k) and (l) and shall be grounds for disciplinary action.
Advanced practice registered nurses may issue written certifications for medical
cannabis in accordance with the provisions of the Mississippi Medical Cannabis Act.
SECTION 5. Section 73-15-29, Mississippi Code of 1972, is amended as follows:
73-15-29. (1) The board shall have power to revoke, suspend or refuse to renew any license issued by the board, or to revoke or suspend any privilege to practice, or to deny an application for a license, or to fine, place on probation and/or discipline a licensee, in any manner specified in this article, upon proof that such person:
(a) Has committed fraud or deceit in securing or attempting to secure such license;
(b) Has been convicted of a felony, or a crime involving moral turpitude or has had accepted by a court a plea of nolo contendere to a felony or a crime involving moral turpitude (a certified copy of the judgment of the court of competent jurisdiction of such conviction or pleas shall be prima facie evidence of such conviction);
(c) Has negligently or willfully acted in a manner inconsistent with the health or safety of the persons under the licensee's care;
(d) Has had a license or privilege to practice as a registered nurse, an advanced practice registered nurse or a licensed practical nurse suspended or revoked in any jurisdiction, has voluntarily surrendered such license or privilege to practice in any jurisdiction, has been placed on probation as a registered nurse, an advanced practice registered nurse or licensed practical nurse in any jurisdiction or has been placed under a disciplinary order(s) in any manner as a registered nurse, an advanced practice registered nurse or licensed practical nurse in any jurisdiction, (a certified copy of the order of suspension, revocation, probation or disciplinary action shall be prima facie evidence of such action);
(e) Has negligently or willfully practiced nursing in a manner that fails to meet generally accepted standards of such nursing practice;
(f) Has negligently or willfully violated any order, rule or regulation of the board pertaining to nursing practice or licensure;
(g) Has falsified or in a repeatedly negligent manner made incorrect entries or failed to make essential entries on records;
(h) Is addicted to or dependent on alcohol or other habit-forming drugs or is a habitual user of narcotics, barbiturates, amphetamines, hallucinogens, or other drugs having similar effect, or has misappropriated any medication;
(i) Has a physical, mental or emotional condition that renders the licensee unable to perform nursing services or duties with reasonable skill and safety;
(j) Has engaged in any other conduct, whether of the same or of a different character from that specified in this article, that would constitute a crime as defined in Title 97 of the Mississippi Code of 1972, as now or hereafter amended, and that relates to such person's employment as a registered nurse, an advanced practice registered nurse or licensed practical nurse;
(k) Engages in conduct likely to deceive, defraud or harm the public;
(l) Engages in any unprofessional conduct as identified by the board in its rules;
(m) Has violated any provision of this article; or
(n) Violation(s) of the provisions of Sections 41-121-1 through 41-121-9 relating to deceptive advertisement by health care practitioners. This paragraph shall stand repealed on July 1, 2025.
(2) When the board finds any person unqualified because of any of the grounds set forth in subsection (1) of this section, it may enter an order imposing one or more of the following penalties:
(a) Denying application for a license or other authorization to practice nursing or practical nursing;
(b) Administering a reprimand;
(c) Suspending or restricting the license or other authorization to practice as a registered nurse, an advanced practice registered nurse or licensed practical nurse for up to two (2) years without review;
(d) Revoking the license or other authorization to practice nursing, an advanced practice registered nurse or practical nursing;
(e) Requiring the disciplinee to submit to care, counseling or treatment by persons and/or agencies approved or designated by the board as a condition for initial, continued or renewed licensure or other authorization to practice nursing, an advanced practice registered nurse or practical nursing;
(f) Requiring the disciplinee to participate in a program of education prescribed by the board as a condition for initial, continued or renewed licensure or other authorization to practice;
(g) Requiring the disciplinee to practice under the supervision of a registered nurse or an advanced practice registered nurse for a specified period of time; or
(h) Imposing a fine not to exceed Five Hundred Dollars ($500.00).
(3) In addition to the grounds specified in subsection (1) of this section, the board shall be authorized to suspend the license or privilege to practice of any licensee for being out of compliance with an order for support, as defined in Section 93-11-153. The procedure for suspension of a license or privilege to practice for being out of compliance with an order for support, and the procedure for the reissuance or reinstatement of a license or privilege to practice suspended for that purpose, and the payment of any fees for the reissuance or reinstatement of a license or privilege to practice suspended for that purpose, shall be governed by Section 93-11-157 or 93-11-163, as the case may be. If there is any conflict between any provision of Section 93-11-157 or 93-11-163 and any provision of this article, the provisions of Section 93-11-157 or 93-11-163, as the case may be, shall control.
(4) If the public health, safety or welfare imperatively requires emergency action and the board incorporates a finding to that effect in an order, the board may order summary suspension of a license pending proceedings for revocation or other action. These proceedings shall be promptly instituted and determined by the board.
(5) The board may establish by rule an alternative to discipline program for licensees who have an impairment as a result of substance abuse or a mental health condition, which program shall include at least the following components:
(a) Participation in the program is voluntary with the licensee, and the licensee must enter the program before the board holds a disciplinary action hearing regarding the licensee;
(b) The full cost of participation in the program, including the cost of any care, counseling, treatment and/or education received by the licensee, shall be borne by the licensee;
(c) All of the procedures and records regarding the licensee's participation in the program shall be confidential, shall not be disclosed and shall be exempt from the provisions of the Mississippi Public Records Act of 1983; and
(d) A licensee may not participate in the program more often than one (1) time during any period of five (5) years or such longer period as set by the board.
(6) A nurse practitioner who provides a written certification as authorized under the Mississippi Medical Cannabis Act and in compliance with rules and regulations adopted thereunder shall not be subject to any disciplinary action under this section solely due to providing the written certification.
SECTION 6. Section 41-21-131, Mississippi Code of 1972, is amended as follows:
41-21-131. As used in Sections 41-21-131 through 41-21-143, the following terms shall have the meanings as defined in this section:
(a) "Crisis Intervention Team" means a community partnership among a law enforcement agency, a community mental health center, a hospital, other mental health providers, consumers and family members of consumers.
(b) "Participating partner" means a law enforcement agency, a community mental health center or a hospital that has each entered into collaborative agreements needed to implement a Crisis Intervention Team.
(c) "Catchment area" means a geographical area in which a Crisis Intervention Team operates and is defined by the jurisdictional boundaries of the law enforcement agency that is the participating partner.
(d) "Crisis Intervention Team officer" or "CIT officer" means a law enforcement officer who is authorized to make arrests under Section 99-3-1 and who is trained and certified in crisis intervention and who is working for a law enforcement agency that is a participating partner in a Crisis Intervention Team.
(e) "Substantial likelihood of bodily harm" means that:
(i) The person has threatened or attempted suicide or to inflict serious bodily harm to himself; or
(ii) The person has threatened or attempted homicide or other violent behavior; or
(iii) The person has placed others in reasonable fear of violent behavior and serious physical harm to them; or
(iv) The person is unable to avoid severe impairment or injury from specific risks; and
(v) There is substantial likelihood that serious harm will occur unless the person is placed under emergency treatment.
(f) "Single point of entry" means a specific hospital that is the participating partner in a Crisis Intervention Team and that has agreed to provide psychiatric emergency services and triage and referral services.
(g) "Psychiatric emergency services" means services designed to reduce the acute psychiatric symptoms of a person who is mentally ill or a person who has an impairment caused by drugs or alcohol and, when possible, to stabilize that person so that continuing treatment can be provided in the local community.
(h) "Triage and referral services" means services designed to provide evaluation of a person with mental illness or a person who has an impairment caused by drugs or alcohol in order to direct that person to a mental health facility or other mental health provider that can provide appropriate treatment.
(i) "Comprehensive psychiatric emergency service" means a specialized psychiatric service operated by the single point of entry and located in or near the hospital emergency department that can provide psychiatric emergency services for a period of time greater than can be provided in the hospital emergency department.
(j) "Extended observation bed" means a hospital bed that is used by a comprehensive psychiatric emergency service and is licensed by the State Department of Health for that purpose.
(k) "Psychiatric
nurse practitioner" means a registered nurse who has completed the
educational requirements specified by the State Board of Nursing, has
successfully passed either the adult or family psychiatric nurse practitioner examination
and is licensed by the State Board of Nursing * * *.
(l) "Psychiatric physician assistant" means a physician assistant who has completed the educational requirements and passed the certification examination as specified in Section 73-26-3, is licensed by the State Board of Medical Licensure, has had at least one (1) year of practice as a physician assistant employed by a community mental health center, and is working under the supervision of a physician at a single point of entry.
SECTION 7. This act shall take effect and be in force from and after July 1, 2023.