How Does a Nurse Practitioner Establish an Independent Practice in Florida?

Effective July 1, 2020, Advanced Practice Registered Nurses (“APRN”) will be able to register their own autonomous practice throughout Florida with the passage of House Bill 607. No longer will the APRN have to provide patient care within the framework of an established protocol with a supervising physician if they are properly registered. If the APRN is not registered then an established protocol will still be required. The term Health Care Provider has been re-defined to mean a physician, osteopathic physician, podiatric physician or an APRN registered under Florida Statute §464.0123.

Registering your Autonomous Practice

Autonomous Practice is defined as an advanced nursing practice by an advanced practice registered nurse who is registered under Florida Statute §464.0123 and who is not subject to supervision by a physician or a supervisory protocol. In order to be registered by the Board of Nursing as an autonomous practice the APRN has to demonstrate the following:

1. Hold an active and unencumbered license to practice advanced nursing.
2. Not be subject to any disciplinary action in Florida or any other state or territory within the 5 years immediately preceding the registration filing.
3. Completed in any state, territory or jurisdiction of the United States, at least 3,000 clinical practice hours within the 5 years immediately preceding the registration request while practicing as an APRN under the supervision of an M.D. or D.O.
4. Completed within the past 5 years 3 graduate-level semester hours, or the equivalent, in differential diagnosis and 3 graduate-level semester hours or the equivalent, in pharmacology.
5. And any other additional registration requirements issued by the Board of Nursing.

After obtaining your registration certificate, an APRN must biennially renew the registration, which must coincide with the APRNs biennial renewal period for licensure. To renew the registration, an APRN must complete at least 10 hours of continuing education, in addition to completing 30 hours of usual continuing education requirements.

Financial Responsibility

An APRN registered to maintain an autonomous practice must demonstrate that they are financially responsible to pay claims and costs that may arise out of their rendering of care, treatment or services. An APRN can demonstrate this in one of two ways:

1. Obtain and maintain professional liability coverage in an amount not less than $100,000 per claim, with a minimum annual aggregate of not less than $300,000.

2. Obtain and maintain an unexpired, irrevocable letter of credit in an amount of not less than $100,000 per claim, with a minimum aggregate availability of credit of not less than $300,000, payable to the APRN.

These financial responsibility requirements do not apply to: (1) registered APRNs who practice exclusively for the Federal Government or the state; (2) APRNs who are inactive; (3) APRNs practicing only in teaching environments at an accredited school or teaching hospital; and (4) an APRN who is registered but is not engaged in autonomous practice.

Registered APRN Permitted Activities

A registered APRN may only establish an autonomous practice in primary care, including family medicine, general pediatrics, and general internal medicine. APRNs certified as nurse midwives may engage in the practice of midwifery in accordance with Florida Statute §464.012(4)(c). APRNs engaging in autonomous practice must provide information in writing to a new patient about his or her qualifications and the nature of the autonomous practice before or during the initial patient encounter.

A registered APRN may also (1) admit a patient to a health care facility; (2) manage the care that the patient receives at the facility: and (3) discharge the patient from the facility, unless prohibited by federal law. The ARPN may provide a signature, certification, stamp, etc., that is otherwise required by law to be provided by a physician so long as the APRN is not issuing a physician certification.

Adverse Incidents and Disciplinary Actions

Registered APRNs must report adverse incidents to the Department of Health in writing within 15 days after the occurrence of the adverse incident if the adverse incident occurred when the patient was in the direct care of the APRN. If not in the direct care of the APRN, the report must be postmarked within 15 days after the APRN discovered or reasonably should have discovered the occurrence of the adverse incident. An adverse incident occurs when a patient: (a) is transferred from the APRN practice location to a hospital; (b) suffers permanent physical injury; and/or (c) dies.

A registered APRN may be subject to disciplinary action if he or she:

1. Pays or receives a kickback or any type of split-fee arrangement for referring patients to providers for healthcare goods or services.
2. Uses their influence to engage a patient in sexual activity.
3. Makes deceptive, untrue or fraudulent representations.
4. Solicits patients by use of fraud, intimidation or undue influence.
5. Fails to maintain legible medical records
6. Uses their influence to exploit the patient for financial gain.
7. Performs unauthorized professional services.
8. Performs experimental therapies or procedures without first obtaining fill informed consent.
9. Delegates professional responsibilities to a person that is not qualified by training to perform those activities.
10. Acts in a manner that coerces or intimidates another APRN from advertising his or her services.
11. Advertises that they have a certification that he or she has not received.
12. Fails to inform patients about their rights and how to file a complaint.
13. Provides deceptive or fraudulent expert witness testimony.

Conclusion

There are many other requirements that an APRN has to comply with in order to legally establish and operate their autonomous practice in Florida. As more APRNs register I’m confident that additional laws and/or rules will be created to further regulate the practice area. It is important to hire a health law attorney who has the requisite experience, knowledge and training required to help you navigate the laws.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.