1Amending the act of May 22, 1951 (P.L.317, No.69), entitled, as
2amended, "An act relating to the practice of professional
3nursing; providing for the licensing of nurses and for the
4revocation and suspension of such licenses, subject to
5appeal, and for their reinstatement; providing for the
6renewal of such licenses; regulating nursing in general;
7prescribing penalties and repealing certain laws," further
8providing for definitions; providing for nomenclature; and
9further providing for clinical nurse specialist and
10qualifications and for scope of practice for clinical nurse
11specialist.

12The General Assembly of the Commonwealth of Pennsylvania
13hereby enacts as follows:

14Section 1. Section 2 of the act of May 22, 1951 (P.L.317,
15No.69), known as The Professional Nursing Law, amended December
1620, 1985 (P.L.409, No.109), June 29, 2002 (P.L.651, No.99),
17December 9, 2002 (P.L.1567, No.206) and July 20, 2007 (P.L.320,
18No.49) is amended to read:

19Section 2. Definitions.--When used in this act, the
20following words and phrases shall have the following meanings
21unless the context provides otherwise:

1(1) The "Practice of Professional Nursing" means diagnosing
2and treating human responses to actual or potential health
3problems through such services as casefinding, health teaching,
4health counseling, and provision of care supportive to or
5restorative of life and well-being, and executing medical
6regimens as prescribed by a licensed physician or dentist. The
7foregoing shall not be deemed to include acts of medical
8diagnosis or prescription of medical therapeutic or corrective
9measures, except as performed by a certified registered nurse
10practitioner acting in accordance with rules and regulations
11promulgated by the Board.

12(2) "Board" means the State Board of Nursing.

13(3) "Approved" means approved by the State Board of Nursing.

14(4) "Diagnosing" means that identification of and
15discrimination between physical and psychosocial signs and
16symptoms essential to effective execution and management of the
17nursing regimen.

18(5) "Treating" means selection and performance of those
19therapeutic measures essential to the effective execution and
20management of the nursing regimen, and execution of the
21prescribed medical regimen.

22(6) "Human responses" means those signs, symptoms and
23processes which denote the individual's interaction with an
24actual or potential health problem.

25(7) The "Practice of dietetics-nutrition" means the
26integration and application of principles derived from the
27sciences of food nutrition, biochemistry, physiology, management
28and behavior to provide for all aspects of nutrition therapy for
29individuals and groups, including nutrition therapy services and
30medical nutrition therapy, compatible with dietitian-

1nutritionist education and professional competence.

2(8) "Department" means the Department of State of the
3Commonwealth.

4(9) "Licensed dietitian-nutritionist" means a dietitian-
5nutritionist who holds a current license under this act.

6(10) "Medical nutrition therapy" means the component of
7nutrition therapy that concerns determining and recommending
8nutrient needs based on nutritional assessment and medical
9problems relative to diets prescribed by a licensed physician,
10including:

11(i) tube feedings;

12(ii) specialized intravenous solutions;

13(iii) specialized oral solutions; and

14(iv) interactions of prescription drugs with food or
15nutrients.

16(11) "Nutrition therapy services" means assessing the
17nutritional needs of individuals and groups, considering the
18resources and constraints in the practice setting, providing
19nutrition counseling in health and disease, developing,
20implementing and managing:

21(i) nutrition therapy of; and

22(ii) food service systems for

23individuals and groups and maintaining appropriate standards of
24quality in food and nutrition therapy services for individuals
25and groups.

26(12) "Certified registered nurse practitioner" means a
27registered nurse licensed in this Commonwealth who is certified
28by the board in a particular clinical specialty area.

29(13) "Collaboration" means a process in which a certified
30registered nurse practitioner works with one or more physicians

1to deliver health care services within the scope of the
2certified registered nurse practitioner's expertise. The process
3includes all of the following:

4(i) Immediate availability of a licensed physician to a
5certified registered nurse practitioner through direct
6communications or by radio, telephone or telecommunications.

7(ii) A predetermined plan for emergency services.

8(iii) A physician available to a certified registered nurse
9practitioner on a regularly scheduled basis for referrals,
10review of the standards of medical practice incorporating
11consultation and chart review, drug and other medical protocols
12within the practice setting, periodic updating in medical
13diagnosis and therapeutics and cosigning records when necessary
14to document accountability by both parties.

15(14) "Drug Review Committee" means the committee established
16in section 8.4 whose function is to approve or disapprove, by
17addition or deletion, the categories of drugs that may be
18prescribed by certified registered nurse practitioners.

19(15) "Clinical nurse specialist" or "advanced practice 
20registered nurse-clinical nurse specialist" means a registered
21nurse licensed in this Commonwealth [who is certified by the
22State Board of Nursing as a clinical nurse specialist.] to 
23practice independently in a particular clinical specialty area 
24in which the registered nurse is certified.

25(16) "Mental health diagnosis" means the selection of a
26disorder from the most recent version of the Diagnostic &
27Statistical Manual of Mental Disorders.

28(17) "Non-proprietary drug" means a drug containing any 
29quantity of any controlled substance or any drug which is 
30required by any applicable Federal or State law to be dispensed
 

1only by prescription.

2(18)  "Proprietary drug" means a non-prescription, non-
3narcotic medicine or drug which may be sold without a
4prescription and which is prepackaged for use by the consumer
5and labeled in accordance with Federal and State law.

6Section 2. The act is amended by adding a section to read:

7Section 3.2. Use of Title and Abbreviation "A.P.R.N.-C.N.S."

8A registered nurse who is licensed and certified by the board
9as a clinical nurse specialist in a particular clinical
10specialty area is entitled to use the title "advanced practice
11registered nurse-clinical nurse specialist" and the letters
12"A.P.R.N.-C.N.S." It shall be unlawful for any other person to
13use the title "advanced practice registered nurse-clinical nurse
14specialist" or the letters "A.P.R.N.-C.N.S."

15Section 3. Sections 8.5 and 8.6 of the act, added July 20,
162007 (P.L.320, No.49), are amended to read:

17Section 8.5. Clinical Nurse Specialist; Qualifications.--(a)
18The board may certify a licensed registered nurse as a clinical
19nurse specialist if the nurse satisfies the requirements
20established by this act. Certification of a clinical nurse
21specialist by the board shall expire on the same date as the
22license of that nurse expires. Beginning on the effective date
23of this section, a nurse shall not qualify for initial
24certification by the board unless the nurse holds a master's
25degree, doctoral degree or post-master's certificate from an
26educational program in nursing that has been approved by the
27board and that prepares graduates to practice as a clinical
28nurse specialist and:

29(1) holds current [national certification as a clinical
30nurse specialist in a designated specialty or in an area

1pertinent to the designated specialty;] certification as a 
2clinical nurse specialist from a board-recognized national 
3certification program that requires passing a national 
4certifying examination in the particular clinical specialty area 
5in which the nurse is seeking licensure by the board. This 
6paragraph shall not apply to a licensed registered nurse who 
7holds current certification by the board as a clinical nurse 
8specialist on the effective date of this paragraph. The board 
9shall issue appropriate written notice of the validity of the 
10certification to any person who is certified as a clinical nurse 
11specialist on the effective date of this paragraph. The issuance 
12of the notice shall not be a condition precedent to practice as 
13a clinical nurse specialist;

14(2) meets equivalence requirements as specified in
15regulations of the board where there is no certification
16examination available in the specialty area; and

17(3) meets all other board requirements to practice as a
18clinical nurse specialist.

19(b) Individuals who completed an educational program in a
20related discipline previously recognized for national
21certification as a clinical nurse specialist from a board-
22recognized national certification organization shall be issued
23certification by the board upon:

24(1) submitting evidence of having current American Nurses
25Association or American Nurses Credentialing Center
26certification; and

27(2) submitting an application to the board.

28(c) As a condition of biennial certificate renewal by the
29board, a clinical nurse specialist shall:

30(1) Pay a renewal fee as set by the board.

1(2) In the two years prior to certification renewal,
2complete at least thirty (30) hours of continuing education
3approved by the board, as required by section 12.1. A clinical 
4nurse specialist who has prescriptive authority shall complete 
5at least sixteen (16) hours of board-approved continuing 
6education in pharmacology in the two-year biennial renewal date 
7of the certification.

8(d) For certification under this act, a licensed registered
9nurse shall file a board-prepared application with the board and
10pay a fee as established by the board by regulation.

11(e) A clinical nurse specialist practicing in this
12Commonwealth shall maintain a level of professional liability
13coverage as required for a nonparticipating health care provider
14under the act of March 20, 2002 (P.L.154, No.13), known as the
15"Medical Care Availability and Reduction of Error (Mcare) Act,"
16and shall not be eligible to participate in the Medical Care
17Availability and Reduction of Error (Mcare) Fund.

18Section 8.6. Scope of Practice for Clinical Nurse
19Specialist.--(a) [Nothing] Except as authorized under this 
20section, nothing in this act shall permit a clinical nurse
21specialist to engage in the practice of medicine or surgery as
22defined in the act of December 20, 1985 (P.L.457, No.112), known
23as the "Medical Practice Act of [1985"; perform acts of medical
24diagnosis; or prescribe medical therapeutic or corrective
25measures. The restrictions in this subsection apply to both
26physical and mental disorders.] 1985."

27(b) Nothing in this act shall be construed to limit or
28prohibit a clinical nurse specialist from engaging in those
29activities which normally constitute the practice of nursing,
30including a nursing diagnosis, as defined in section 2.

1(c) In addition to all other tasks in which a licensed
2registered nurse is authorized to perform, a clinical nurse
3specialist may manage preventive health care services and
4diagnose and manage deviations from wellness and long-term
5illnesses based on the needs of the patient and consistent with
6clinical practice as defined by the national certifying agency
7by all of the following:

8(1) Initiating laboratory and other diagnostic tests.

9(2) Prescribing or ordering medications and devices as
10authorized under subsection (d).

11(3) Ordering treatments.

12(4) Making referrals to other licensed health care
13professionals and receiving referrals from the licensed
14health care professionals.

15(5) Establishing a mental health diagnosis.

16(6) Seeking consultations to other licensed health care
17professionals and receiving consultations from the licensed
18health care professionals.

19(7) Performing specific procedures as needed.

20(8) Conducting physical or psychiatric examinations.

21(d) Notwithstanding section 8.4, a clinical nurse specialist
22may prescribe and dispense proprietary and non-proprietary drugs
23if the clinical nurse specialist:

24(1) has successfully completed at least forty-five (45) 
25hours of coursework specific to advanced pharmacology at a 
26level above that required by a professional nursing education 
27program; and

28(2) acts in accordance with regulations promulgated by
29the board.

30The subsection is subject to any restrictions imposed by Federal

1law or board regulations.

2(e) A clinical nurse specialist is entitled to:

3(1) practice as a licensed independent practitioner 
4within the scope of practice of the particular clinical 
5specialty area or population-focus area in which the nurse is 
6certified by the board; and

7(2) be reimbursed directly by insurers and other third-
8party payors.

9Section 4. This act shall take effect in 60 days.