1.1                          A bill for an act 
  1.2             relating to health occupations; certifying registered 
  1.3             nurse anesthetists; proposing coding for new law in 
  1.4             Minnesota Statutes, chapter 148. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  [148.213] [NURSE ANESTHETISTS.] 
  1.7      Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
  1.8   section, the definitions in this subdivision apply.  
  1.9      (b) "Health care services" means all anesthesia services 
  1.10  within the scope of practice of and properly delegated to nurse 
  1.11  anesthetists.  
  1.12     (c) "Medical direction" means the direction by an 
  1.13  anesthesiologist of health care services performed by up to four 
  1.14  nurse anesthetists to ensure that the continuous exercise of the 
  1.15  medical judgment of the anesthesiologist is provided throughout 
  1.16  the administration of the anesthesia and the anesthesiologist 
  1.17  performs a preanesthetic examination and evaluation, prescribes 
  1.18  the anesthesia plan, personally participates in the most 
  1.19  demanding procedures in the anesthesia plan including induction 
  1.20  and emergence, ensures that any procedures in the anesthesia 
  1.21  plan that are not performed by the anesthesiologist are 
  1.22  performed by a qualified individual, monitors the course of 
  1.23  anesthesia administration at frequent intervals, remains 
  1.24  physically available for immediate diagnosis and treatment of 
  1.25  emergencies, and provides indicated postanesthesia care. 
  2.1      (d) "Medical supervision" means the supervision by an 
  2.2   anesthesiologist or a qualified operating practitioner of health 
  2.3   care services performed by a nurse anesthetist to ensure that 
  2.4   the continuous exercise of the medical judgment of the 
  2.5   anesthesiologist or qualified operating practitioner is provided 
  2.6   throughout the administration of the anesthesia. 
  2.7      (e) "Qualified operating practitioner" means a physician 
  2.8   licensed under chapter 147, a dentist licensed under chapter 
  2.9   150A, or a podiatrist licensed under chapter 153 who has been 
  2.10  found qualified by the governing body and medical staff of a 
  2.11  health care facility in which the nurse anesthetist works to 
  2.12  supervise the administration of anesthetics and who agrees to 
  2.13  supervise the certified registered nurse anesthetist. 
  2.14     Subd. 2.  [CERTIFIED REGISTERED NURSE ANESTHETISTS.] A 
  2.15  registered nurse who meets the requirements of this section may 
  2.16  practice as a certified registered nurse anesthetist in this 
  2.17  state. 
  2.18     Subd. 3.  [SCOPE OF PRACTICE.] The practice of nurse 
  2.19  anesthesia shall be performed under the medical direction or 
  2.20  supervision of an anesthesiologist or, in the absence of an 
  2.21  anesthesiologist, under the medical supervision of a qualified 
  2.22  operating practitioner.  
  2.23     The practice of nurse anesthesia shall include: 
  2.24     (1) immediate preoperative evaluation of the patient and 
  2.25  preparation for the administration of anesthetic agents 
  2.26  prescribed by the anesthesiologist or qualified operating 
  2.27  practitioner who is medically directing or supervising the 
  2.28  procedure; 
  2.29     (2) providing, as requested by the anesthesiologist or 
  2.30  qualified operating practitioner, the following activities:  
  2.31  induction and maintenance of anesthesia to include support of 
  2.32  life functions during the induction and period of anesthesia, 
  2.33  including tracheal intubation; monitoring of blood loss and 
  2.34  replacement of fluids, electrolytes, and blood; monitoring and 
  2.35  maintenance of cardiovascular and respiratory functions; and 
  2.36  reporting abnormal patient responses to anesthesia, any 
  3.1   adjunctive medication, or other forms of therapy; 
  3.2      (3) providing professional observation and postoperative 
  3.3   resuscitative care and requesting consultation with the 
  3.4   anesthesiologist or qualified operating practitioner whenever 
  3.5   appropriate during the immediate postoperative period until the 
  3.6   patient's vital functions have stabilized; and 
  3.7      (4) other services delegated by the directing or 
  3.8   supervising anesthesiologist or qualified operating 
  3.9   practitioner, provided that such services are consistent with 
  3.10  this section, the rules promulgated by the board, and are within 
  3.11  the training and skills of the individual nurse anesthetist.  
  3.12  Nothing in this section shall be construed to limit the 
  3.13  anesthesiologist's or qualified operating practitioner's 
  3.14  liability for the health care services delegated to the nurse 
  3.15  anesthetist. 
  3.16     Subd. 4.  [REQUIREMENTS FOR CERTIFICATION.] For issuance of 
  3.17  a certificate to practice as a certified registered nurse 
  3.18  anesthetist under this section, the applicant shall: 
  3.19     (1) file an application with the board; 
  3.20     (2) be licensed as a registered nurse under section 
  3.21  148.211; 
  3.22     (3) have satisfactorily completed an educational program 
  3.23  accredited by a national accrediting body recognized by the 
  3.24  board or determined by the board to be the equivalent; and 
  3.25     (4) be currently certified by a national certifying body 
  3.26  recognized by the board.  
  3.27     Subd. 5.  [FEES.] Fees for certification to practice as a 
  3.28  certified registered nurse anesthetist shall be determined by 
  3.29  the board.  
  3.30     Subd. 6.  [USE OF TITLE.] Only a person certified under 
  3.31  this section shall use the title "nurse anesthetist" or 
  3.32  "certified registered nurse anesthetist." 
  3.33     Subd. 7.  [GRADUATE NURSE ANESTHETISTS.] A registered nurse 
  3.34  who has satisfactorily completed the educational requirements 
  3.35  described in subdivision 4 may, for a period not to exceed 18 
  3.36  months immediately following the completion of such education, 
  4.1   provide nurse anesthesia services as a graduate nurse 
  4.2   anesthetist under the supervision of a certified registered 
  4.3   nurse anesthetist or licensed physician anesthesiologist. 
  4.4      Subd. 8.  [STUDENT NURSE ANESTHETIST.] A registered nurse 
  4.5   enrolled in an educational program accredited by a national 
  4.6   accrediting body recognized by the board or determined by the 
  4.7   board to be the equivalent may provide nurse anesthesia services 
  4.8   as a student nurse anesthetist under the supervision of a 
  4.9   certified registered nurse anesthetist or licensed physician 
  4.10  anesthesiologist. 
  4.11     Subd. 9.  [RULEMAKING AUTHORITY.] The board may promulgate 
  4.12  rules to implement this section. 
  4.13     Subd. 10.  [CERTIFICATION BEFORE JULY 1, 1998.] 
  4.14  Notwithstanding any other provision of law to the contrary, a 
  4.15  registered nurse who is certified as a certified registered 
  4.16  nurse anesthetist before July 1, 1998, may practice nurse 
  4.17  anesthesia as a certified registered nurse anesthetist, and 
  4.18  shall be deemed to be certified as a certified registered nurse 
  4.19  anesthetist under this section until July 1, 1998, provided that 
  4.20  the registered nurse is certified by a national certifying body 
  4.21  that has been certifying registered nurse anesthetists for at 
  4.22  least five years.