Looking for Florida Advanced Practice Nurses to Have an Expanded Role? You May Have to Wait

Tuesday, March 4, 2014
By Joanne Kenna, R.N., J.D., The Health Law Firm

Although there has been renewed interest and activity during the current legislative session to expand the roles of Florida advanced nursing practitioners, it seems unlikely that these efforts will result in any changes in the ways these nurses practice in the near future.  

A bill (PCB SCHCWI 14-01) was recently passed by the House Select Committee on Health Care Workforce Innovation.  It had bipartisan support.  The bill proposed  some significant changes in how Florida Advanced Registered Nurse Practitioners (ARNPs), as they are currently known, would be allowed to practice in Florida.  Key provisions of the bill would:

    1.    Allow Florida ARNPs to practice independently;
    2.    Allow Florida ARNP's the authority to write prescriptions for controlled substances; and
    3.    Change the nomenclature by which these nurses are licensed from ARNPs to APRNs.

Current Scope of Practice for ARNPs in Florida.

At present, Florida ARNPs must practice under the supervision of a physician.  This requires the ARNP to have a protocol on record.  The protocol must be signed by both the nurse practitioner and by his or her physician supervisor.  The protocol identifies the parameters under which the ARNP can practice.  Advanced practice nurses in many states already do practice independently.   
Currently Florida ARNPs can only prescribe drugs within the categories of medications identified in their practice protocols.  Importantly, Florida ARNP's cannot prescribe controlled substances.  A Florida ARNP licensure does not qualify ARNPs to register and obtain a Drug Enforcement Agency (DEA) number.  Advanced practice nurses in many states can register with the DEA and can prescribe controlled substances.

The State of Florida licenses its advanced practice nurses as Advanced Registered Nurse Practitioners  (ARNPs).  Most other states use the nomenclature Advanced Practice Registered Nurses (APRNs) for their licenses.  Not only is APRN the predominantly used name, but it is the title recommended by The APRN Consensus Model in the push for uniformity among the states and is endorsed by the American Nurse Credentialing Center, the national certifying body for advanced practice nurses. In Florida, Certified Registered Nurse Anesthetists (CRNAs) and Certified Nurse Midwives (CNMs) are licensed as ARNPs.[1]  

Opposition Will Most Likely Kill the Bill.

The present Florida House bill is being supported as a means to fulfill the anticipated growing need for medical services expected with the implementation of the Affordable Care Act, commonly referred to as ObamaCare.  Especially in certain segments of the medical population, ARNP's are already providing a large amount of this care and the bill acknowledges and grants the authority for this.  

But, the opposition to this effort is strong and vocal, with the various state medical associations leading the way.  For these groups, the issue is one of preservation of the practice of medicine as the domain of the physician.  They are accepting of medical practice by physician "extenders,"  but not by "providers" who are not physicians.  The members of these opposition  groups are a formidable force, respected in their communities and able to make significant  political contributions.  These are not people many legislators will want to rankle.

Future Prediction Regarding the Scope of Practice for Advanced Practice Nurses.

So, the question is now how far this bill and the present movement for more autonomy and prescriptive power for ARNPs will go in the coming weeks and months.  The short answer is that it is unlikely to be successful anytime soon.  But, there are signs that change will come.  Just the fact this present bill was able to pass outside its committee with bipartisan support  is a reflection of that.  In the meantime, you can be sure that the nursing lobby will continue to try to push such efforts forward and the opposition will continue to organize its forces to prevent change.  It is perhaps optimistic, but the hope would be that meaningful dialogue on the issue will result.

Be sure to check our website regularly for updates.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent registered nurses, nurse practitioners, advanced registered nurse practitioners, certified registered nurse anesthetists, midwives and licensed practical nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


What are your thoughts on the bill? Do you think nurse practitioners should have more autonomy? Or do you believe nurse practitioners should be supervised by physicians? Please leave any thoughtful comments below.

About the Author: Joanne Kenna is a nurse-attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

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[1]  Additionally, Florida will certify as a clinical nurse specialist (CNS) those nurses who hold a master's degree in a clinical specialty and current certification from a nationally recognized certifying body approved by the Board of Nursing in that specialty or a master's degree in a clinically specialty for which there is no certification as a clinical nurse specialist and proof of 1000 hours of clinical experience in the clinical specialty for which the nurse is academically prepared, with a minimum of 500 hours of clinical practice after graduation.  These CNSs are not licensed as ARNPs and the proposed legislative changes would not apply to them. 
"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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