An Act concerning nursing; relating to registered nurse anesthetists; amending K.S.A. 65- 1151, 65-1153, 65-1154, 65-1158, 65-1159 and 65-1163 and K.S.A. 1995 Supp. 65-1152 and repealing the existing sections; also repealing K.S.A. 65-1161.

Be it enacted by the Legislature of the State of Kansas:

Section 1. K.S.A. 65-1151 is hereby amended to read as follows: 65- 1151. As used in K.S.A. 65-1151 to 65-1163 65-1164, inclusive and amendments thereto: [j166] 179

(a) ``Registered nurse anesthetist'' means a licensed professional nurse who is authorized to practice as a registered nurse anesthetist.

(b) ``Board'' means the board of nursing.

[aw(c) ``Local anesthetic'' means infiltration anesthesia or anesthesia pro- duced by direct infiltration of local anesthetic solution into the operative site.

(d) ``Regional anesthesia'' means the use of local anesthetic solutions to produce loss of sensation in circumscribed areas.

(e) ``General anesthesia'' means one that is complete and affecting the entire body with the loss of consciousness.

(f) ``Active anesthesia practice'' means clinical practice and anesthesia related administration, educational and research activities.

Sec. 2. K.S.A. 1995 Supp. 65-1152 is hereby amended to read as follows: 65-1152. (a) In order to obtain authorization from the board of nursing to practice as a registered nurse anesthetist an individual shall meet the following requirements:

(1) Is Be licensed to practice professional nursing under the Kansas nurse practice act;

(2) has successfully completed a course of study in nurse anesthesia in a school of nurse anesthesia accredited or approved by the board; and

(3) has successfully completed an examination approved by the board or has been certified by a national organization whose certifying standards are approved by the board as equal to or greater than the corresponding standards established under this act for obtaining authorization to practice as a registered nurse anesthetist. ; and

(4) be required to successfully complete a refresher course as defined in rules and regulations of the board if the individual has not been in active anesthesia practice for five years preceding the application.

(b) Accreditation of schools of nurse anesthesia shall be based on accreditation standards specified in K.S.A. 65-1119 and amendments thereto.

(c) Schools of nurse anesthesia accredited or approved by the board under this section may offer, but shall not be required to shall offer, a masters level degree program in nurse anesthesia.

(d) For the purposes of determining whether an individual meets the requirements of item (2) of subsection (a), the board by rules and regu- lations shall establish criteria for determining whether a particular school of nurse anesthesia maintains standards which are at least equal to schools of nurse anesthesia which are accredited or approved by the board. The board may send a questionnaire developed by the board to any school of nurse anesthesia for which the board does not have sufficient information to determine whether the school meets the standards established under this subsection (d). The questionnaire providing the necessary informa- tion shall be completed and returned to the board in order for the school to be considered for approval. The board may contract with investigative agencies, commissions or consultants to assist the board in obtaining in- formation about schools of nurse anesthesia. In entering such contracts the authority to approve schools of nurse anesthesia shall remain solely with the board.

Sec. 3. K.S.A. 65-1153 is hereby amended to read as follows: 65- 1153. The board may grant a temporary authorization to practice nurse anesthesia as a registered nurse anesthetist: (a) For a period of not more than one year to (1) graduates of a school of nurse anesthesia accredited or approved by the board pending results of the initial examination,; or (2) nurse anesthetists currently licensed or otherwise credentialed in an- other state pending completion of the application for an authorization to practice nurse anesthesia as a registered nurse anesthetist in this state; and (b) for a period of not to exceed 180 days to an applicant for an authorization to practice nurse anesthesia as a registered nurse anesthetist who is enrolled in a refresher course required by the board for reinstate- ment of authorization which has lapsed for more than five years or for authorization in this state from another state if the applicant has not been engaged in the practice of nurse anesthesia for five years preceding ap- plication

(b) for 180 days for the clinical portion of a refresher course and the temporary authorization may be renewed by the board for one additional period of not to exceed 180 days; and

(c) for a period not to exceed 60 90 days when a reinstatement ap- plication has been made. The 90-day temporary permit may be renewed for an additional 30 days but not to exceed a combined total of 120 days.

Sec. 4. K.S.A. 65-1154 is hereby amended to read as follows: 65- 1154. Upon application to the board by any licensed professional nurse in this state and upon satisfaction of the standards and requirements es- tablished under this act and K.S.A. 65-1130 and amendments thereto, the board shall grant an authorization to the applicant to perform the duties of a registered nurse anesthetist and be certified as an advanced registered nurse practitioner. An application to the board for an authorization, for an authorization with temporary authorization, for biennial renewal of authorization, for reinstatement of authorization and for reinstatement of authorization with temporary authorization shall be upon such form and contain such information as the board may require and shall be accom- panied by a fee to assist in defraying the expenses in connection with the administration of the provisions of this act. The fee shall be fixed by rules and regulations adopted by the board in an amount fixed by the board under K.S.A. 65-1118 and amendments thereto. There shall be no fee assessed for the initial, renewal or reinstatement of the advanced regis- tered nurse practitioner certificate as long as the registered nurse anes- thetist maintains authorization. The executive administrator of the board shall remit all moneys received pursuant to K.S.A. 65-1151 to 65-1163, inclusive, and amendments thereto, to the state treasurer as provided by K.S.A. 74-1108 and amendments thereto.

Sec. 5. K.S.A. 65-1158 is hereby amended to read as follows: 65- 1158. (a) Upon the order of a physician or dentist requesting anesthesia or analgesia care, each registered nurse anesthetist shall:

(1) Conduct a pre- and post-anesthesia visit and assessment with ap- propriate documentation;

(2) develop an anesthesia care plan with the physician or dentist which includes procedures for administration of medications and anes- thetic agents a general plan of anesthesia care with the physician or den- tist;

(3) be authorized to select the method for administration of anesthesia or analgesia;

(4) be authorized to select appropriate medications and anesthetic agents;

(3) (5) induce and maintain anesthesia or analgesia at the required levels;

(4) (6) support life functions during the peri-operative period;

(5) (7) recognize and take appropriate action with respect to patient responses during anesthesia;

(6) (8) provide professional observation and management of the pa- tient's emergence from anesthesia; and

(7) (9) participate in the life support of the patient;.

(8) (b) Each registered nurse anesthetist may participate in periodic and joint evaluation of services rendered, including, but not limited to, chart reviews, case reviews, patient evaluation and outcome of case sta- tistics; and.

(9) participate in the joint reviews and revision of adopted protocols or guidelines.

(b) (c) A registered nurse anesthetist shall perform duties and func- tions in an interdependent role as a member of a physician or dentist directed health care team.

Sec. 6. K.S.A. 65-1159 is hereby amended to read as follows: 65- 1159. (a) The applicant for renewal of an authorization to practice as a registered nurse anesthetist shall:

(1) Shall Have met the continuing education requirements for a reg- istered nurse anesthetist as developed by the board or by a national or- ganization whose certifying standards are approved by the board as equal to or greater than the corresponding standards established under this act;

(2) shall be currently licensed as a professional nurse; and

(3) shall have paid all applicable fees provided for in this act as fixed by rules and regulations of the board.

(b) Continuing education credits approved by the board for purposes of this subsection may be applied to satisfy the continuing education requirements established by the board for licensed professional nurses under K.S.A. 65-1117 and amendments thereto if the board finds such continuing education credits are equivalent to those required by the board under K.S.A. 65-1117 and amendments thereto.

Sec. 7. K.S.A. 65-1163 is hereby amended to read as follows: 65- 1163. (a) Nothing in this act shall:

(a) Prohibit administration of a drug by a duly licensed professional nurse, licensed practical nurse or other duly authorized person for the alleviation of pain, including administration of local anesthetics.;

(b) Nothing in this act shall apply to the practice of anesthesia by a person licensed to practice medicine and surgery, a licensed dentist or a licensed podiatrist.;

(c) Nothing in this act shall prohibit the practice of nurse anesthesia by students enrolled in approved courses of study in the administration of anesthesia as a part of or incidental to such approved course of study.;

(d) Nothing in this act shall apply to the administration of a pudendal block by a person who holds a valid certificate of qualification as an ad- vanced registered nurse practitioner in the category of nurse-midwife.;

(e) Nothing in this act shall apply to the administration by a licensed professional nurse of an anesthetic, other than general anesthesia, for a dental operation under the direct supervision of a licensed dentist or for a dental operation under the direct supervision of a person licensed to practice medicine and surgery.;

(f) prohibit the practice by any registered nurse anesthetist who is employed by the United States government or in any bureau, division or agency thereof, while in the discharge of official duties; or

(g) prohibit a registered professional nurse from administering gen- eral anesthetic agents to a patient on ventilator maintenance in critical care units when under the direction of a person licensed to practice med- icine and surgery or a person licensed to practice dentistry.

Sec. 8. K.S.A. 65-1151, 65-1153, 65-1154, 65-1158, 65-1159, 65- 1161 and 65-1163 and K.S.A. 1995 Supp. 65-1152 are hereby repealed.

Sec. 9. This act shall take effect and be in force from and after its publication in the statute book.

Approved April 20, 1996.