THE BILL ITSELF
HB 375
Autonomous Practice by a Certified Registered Nurse Anesthetist
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A bill to be entitled
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An act relating to autonomous practice by a certified
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registered nurse anesthetist; amending s. 395.0191,
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F.S.; revising staff membership and clinical
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privileges for certain certified registered nurse
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anesthetists; amending s. 464.012, F.S.; authorizing
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certain certified registered nurse anesthetists to
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perform specified acts under certain circumstances;
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amending s. 464.0123, F.S.; revising practice
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requirements for autonomous advanced practice
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registered nurses; authorizing autonomous advanced
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practice registered nurses to perform certain acts;
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providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Paragraph (b) of subsection (2) of section
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395.0191, Florida Statutes, is amended to read:
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395.0191 Staff membership and clinical privileges.—
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(2)
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(b) An advanced practice registered nurse who is certified
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as a registered nurse anesthetist licensed under part I of
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chapter 464 shall administer anesthesia under the onsite medical
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direction of a professional licensed under chapter 458, chapter
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459, or chapter 466, and in accordance with an established
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protocol approved by the medical staff. The medical direction
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shall specifically address the needs of the individual patient.
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This paragraph does not apply to an autonomous advanced practice
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registered nurse registered under s. 464.0123 who is certified
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as a registered nurse anesthetist licensed under part I of
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chapter 464; however, a facility may require a certified
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registered nurse anesthetist who is registered and practicing
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under s. 464.0123 to perform acts under an established protocol
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approved by the medical staff or the governing board of the
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facility.
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Section 2. Paragraph (b) of subsection (4) of section
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464.012, Florida Statutes, is amended to read:
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464.012 Licensure of advanced practice registered nurses;
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fees; controlled substance prescribing.—
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(4) In addition to the general functions specified in
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subsection (3), an advanced practice registered nurse may
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perform the following acts within his or her specialty:
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(b) A The certified registered nurse anesthetist may, to
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the extent authorized by an established protocol approved by the
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medical staff of the facility in which the anesthetic service is
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performed, or a certified registered nurse anesthetist that is
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registered and practicing under s. 464.0123 without an
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established protocol, may perform any or all of the following:
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1. Determine the health status of the patient as it
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relates to the risk factors and to the anesthetic management of
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the patient through the performance of the general functions.
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2. Based on history, physical assessment, and supplemental
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laboratory results, determine, with the consent of the
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responsible physician, the appropriate type of anesthesia under
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within the framework of the protocol unless the certified
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registered nurse anesthetist is registered and practicing under
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s. 464.0123 without an established protocol.
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3. Order under the protocol preanesthetic medication under
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the protocol unless the certified registered nurse anesthetist
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is registered and practicing under s. 464.0123 without an
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established protocol.
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4. Perform under the protocol procedures commonly used to
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render the patient insensible to pain during the performance of
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surgical, obstetrical, therapeutic, or diagnostic clinical
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procedures under the protocol unless the certified registered
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nurse anesthetist is registered and practicing under s. 464.0123
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without an established protocol. These procedures include
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ordering and administering regional, spinal, and general
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anesthesia; inhalation agents and techniques; intravenous agents
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and techniques; and techniques of hypnosis.
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5. Order or perform monitoring procedures indicated as
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pertinent to the anesthetic health care management of the
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patient.
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6. Support life functions during anesthesia health care,
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including induction and intubation procedures, the use of
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appropriate mechanical supportive devices, and the management of
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fluid, electrolyte, and blood component balances.
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7. Recognize and take appropriate corrective action for
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abnormal patient responses to anesthesia, adjunctive medication,
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or other forms of therapy.
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8. Recognize and treat a cardiac arrhythmia while the
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patient is under anesthetic care.
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9. Participate in management of the patient while in the
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postanesthesia recovery area, including ordering the
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administration of fluids and drugs.
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10. Place special peripheral and central venous and
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arterial lines for blood sampling and monitoring as appropriate.
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A certified registered nurse anesthetist registered and
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practicing under s. 464.0123 without an established protocol may
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only perform acts authorized under part I of this chapter.
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Section 3. Paragraph (a) of subsection (3) of section
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464.0123, Florida Statutes, is amended to read:
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464.0123 Autonomous practice by an advanced practice
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registered nurse.—
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(3) PRACTICE REQUIREMENTS.—
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(a) An advanced practice registered nurse who is
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registered under this section may:
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1. Engage in autonomous practice only in primary care
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practice, including family medicine, general pediatrics, and
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general internal medicine, as defined by board rule.
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2. For certified nurse midwives, engage in autonomous
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practice in the performance of the acts listed in s.
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464.012(4)(c).
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3. Perform the general functions of an advanced practice
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registered nurse under s. 464.012(3) related to primary care.
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4. For certified registered nurse anesthetists registered
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and practicing under this section, perform the acts listed in s.
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464.012(4)(b).
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5.4. For a patient who requires the services of a health
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care facility, as defined in s. 408.032(8):
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a. Admit the patient to the facility.
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b. Manage the care received by the patient in the
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facility.
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c. Discharge the patient from the facility, unless
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prohibited by federal law or rule.
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6.5. Provide a signature, certification, stamp,
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verification, affidavit, or endorsement that is otherwise
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required by law to be provided by a physician, except an
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advanced practice registered nurse registered under this section
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may not issue a physician certification under s. 381.986.
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Section 4. This act shall take effect July 1, 2026.