As used in the Oklahoma Nursing Practice Act: 1. “Board” means the Oklahoma Board of Nursing; 2. “The practice of nursing” means the performance of services provided for purposes of nursing diagnosis and treatment of human responses to actual or potential health problems consistent with educational preparation. Knowledge and skill are the basis for assessment, analysis, planning, intervention, and evaluation used in the promotion and maintenance of health and nursing management of illness, injury, infirmity, restoration of optimal function, or death with dignity. Practice is based on understanding the human condition across the human lifespan and understanding the relationship of the individual within the environment. This practice includes execution of the medical regime including the administration of medications and treatments prescribed by any person authorized by state law to so prescribe; 3. “Registered nursing” means the practice of the full scope of nursing which includes, but is not limited to: a. assessing the health status of individuals, families, and groups, b. analyzing assessment data to determine nursing care needs, c. establishing goals to meet identified health care needs, d. planning a strategy of care, e. establishing priorities of nursing intervention to implement the strategy of care, f. implementing the strategy of care, g. delegating such tasks as may safely be performed by others, consistent with educational preparation and that do not conflict with the provisions of the Oklahoma Nursing Practice Act, h. providing safe and effective nursing care rendered directly or indirectly, i. evaluating responses to interventions, j. teaching the principles and practice of nursing, k. managing and supervising the practice of nursing, l. collaborating with other health professionals in the management of health care, m. performing additional nursing functions in accordance with knowledge and skills acquired beyond basic nursing preparation, and n. delegating those nursing tasks as defined in the rules of the Board that may be performed by an Advanced Unlicensed Assistant; 4. “Licensed practical nursing” means the practice of nursing under the supervision or direction of a Registered Nurse, licensed physician, or dentist. This directed scope of nursing practice includes, but is not limited to: a. contributing to the assessment of the health status of individuals and groups, b. participating in the development and modification of the plan of care, c. implementing the appropriate aspects of the plan of care, d. delegating such tasks as may safely be performed by others, consistent with educational preparation and that do not conflict with the Oklahoma Nursing Practice Act, e. providing safe and effective nursing care rendered directly or indirectly, f. participating in the evaluation of responses to interventions, g. teaching basic nursing skills and related principles, h. performing additional nursing procedures in accordance with knowledge and skills acquired through education beyond nursing preparation, and i. delegating those nursing tasks as defined in the rules of the Board that may be performed by an Advanced Unlicensed Assistant; 5. “Advanced Practice Registered Nurse” means a licensed Registered Nurse: a. who has completed an advanced practice registered nursing education program in preparation for one of four recognized Advanced Practice Registered Nurse roles, b. who has passed a national certification examination recognized by the Board that measures the Advanced Practice Registered Nurse role and specialty competencies and who maintains recertification in the role and specialty through a national certification program, c. who has acquired advanced clinical knowledge and skills in preparation for providing both direct and indirect care to patients; however, the defining factor for all Advanced Practice Registered Nurses is that the education and practice focuses on direct care of individuals, d. whose practice builds on the competencies of Registered Nurses by demonstrating a greater depth and breadth of knowledge, a greater synthesis of data, and increased complexity of skills and interventions, and e. who has obtained a license as an Advanced Practice Registered Nurse in one of the following roles: Certified Registered Nurse Anesthetist, Certified Nurse-Midwife, Clinical Nurse Specialist, or Certified Nurse Practitioner. Only those persons who hold a license to practice advanced practice registered nursing in this state shall have the right to use the title Advanced Practice Registered Nurse and to use the abbreviation “APRN”. Only those persons who have obtained a license in the following disciplines shall have the right to fulfill the roles and use the applicable titles: Certified Registered Nurse Anesthetist and the abbreviation “CRNA”, Certified Nurse-Midwife and the abbreviation “CNM”, Clinical Nurse Specialist and the abbreviation “CNS”, and Certified Nurse Practitioner and the abbreviation “CNP”. It shall be unlawful for any person to assume the role or use the title Advanced Practice Registered Nurse or use the abbreviation APRN or use the respective specialty role titles and abbreviations or to use any other titles or abbreviations that would reasonably lead a person to believe the user is an Advanced Practice Registered Nurse, unless permitted by the Oklahoma Nursing Practice Act. Any individual doing so shall be guilty of a misdemeanor, which shall be punishable, upon conviction, by imprisonment in the county jail for not more than one (1) year or by a fine not less than One Hundred Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00), or by both such imprisonment and fine for each offense; 6. “Certified Nurse Practitioner” means an Advanced Practice Registered Nurse who performs in an expanded role in the delivery of health care: a. consistent with advanced educational preparation as a Certified Nurse Practitioner in an area of specialty, b. functions within the Certified Nurse Practitioner scope of practice for the selected area of specialization, and c. in accord with the standards for Certified Nurse Practitioners as identified by the certifying body and approved by the Board. A Certified Nurse Practitioner shall be eligible, in accordance with the scope of practice of the Certified Nurse Practitioner, to obtain recognition as authorized by the Board to prescribe, as defined by the rules promulgated by the Board pursuant to Section 567.4a of this title and Section 1 of this act. This authorization shall not include dispensing drugs, but shall not preclude, subject to federal regulations, the receipt of, the signing for, or the dispensing of professional samples to patients. The Certified Nurse Practitioner accepts responsibility, accountability, and obligation to practice in accordance with usual and customary advanced practice registered nursing standards and functions as defined by the scope of practice/role definition statements for the Certified Nurse Practitioner; 7. a. “Clinical Nurse Specialist” means an Advanced Practice Registered Nurse who holds: (1) a master’s degree or higher in nursing with clinical specialization preparation to function in an expanded role, (2) specialty certification from a national certifying organization recognized by the Board, and (3) an Advanced Practice Registered Nurse license from the Board. Any nurse holding a specialty certification as a Clinical Nurse Specialist valid on January 1, 1994, granted by a national certifying organization recognized by the Board, shall be deemed to be a Clinical Nurse Specialist under the provisions of the Oklahoma Nursing Practice Act. b. In the expanded role, the Clinical Nurse Specialist performs at an advanced practice level which shall include, but not be limited to: (1) practicing as an expert clinician in the provision of direct nursing care to a selected population of patients or clients in any setting, including private practice, (2) managing the care of patients or clients with complex nursing problems, (3) enhancing patient or client care by integrating the competencies of clinical practice, education, consultation, and research, and (4) referring patients or clients to other services. c. A Clinical Nurse Specialist in accordance with the scope of practice of such Clinical Nurse Specialist shall be eligible to obtain recognition as authorized by the Board to prescribe, as defined by the rules promulgated by the Board pursuant to Section 567.4a of this title and Section 1 of this act. This authorization shall not include dispensing drugs, but shall not preclude, subject to federal regulations, the receipt of, the signing for, or the dispensing of professional samples to patients. d. The Clinical Nurse Specialist accepts responsibility, accountability, and obligation to practice in accordance with usual and customary advanced practice nursing standards and functions as defined by the scope of practice/role definition statements for the Clinical Nurse Specialist; 8. “Certified Nurse-Midwife” means a nurse who has received an Advanced Practice Registered Nurse license from the Oklahoma Board of Nursing who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. A Certified Nurse-Midwife in accordance with the scope of practice of such Certified Nurse-Midwife shall be eligible to obtain recognition as authorized by the Board to prescribe, as defined by the rules promulgated by the Board pursuant to Section 567.4a of this title and Section 1 of this act. This authorization shall not include the dispensing of drugs, but shall not preclude, subject to federal regulations, the receipt of, the signing for, or the dispensing of professional samples to patients. The Certified Nurse-Midwife accepts responsibility, accountability, and obligation to practice in accordance with usual and customary advanced practice registered nursing standards and functions as defined by the scope of practice/role definition statements for the Certified Nurse-Midwife; 9. “Nurse-midwifery practice” means providing management of care of normal newborns and women, antepartally, intrapartally, postpartally, and gynecologically, occurring within a health care system which provides for medical consultation, medical management, or referral, and is in accord with the standards for nurse-midwifery practice as defined by the American College of Nurse-Midwives; 10. a. “Certified Registered Nurse Anesthetist” means an Advanced Practice Registered Nurse who: (1) is certified by the National Board of Certification and Recertification for Nurse Anesthetists as a Certified Registered Nurse Anesthetist within one (1) year following completion of an approved Certified Registered Nurse Anesthetist education program, and continues to maintain such recertification by the National Board of Certification and Recertification for Nurse Anesthetists, and (2) administers anesthesia in collaboration with a medical doctor, an osteopathic physician, a podiatric physician, or a dentist licensed in this state and under conditions in which timely on-site consultation by such doctor, osteopath, podiatric physician, or dentist is available. b. A Certified Registered Nurse Anesthetist, in collaboration with a medical doctor, osteopathic physician, podiatric physician, or dentist licensed in this state, and under conditions in which timely, on- site consultation by such medical doctor, osteopathic physician, podiatric physician, or dentist is available, shall be authorized, pursuant to rules adopted by the Oklahoma Board of Nursing, to order, select, obtain, and administer legend drugs, Schedules II through V controlled substances, devices, and medical gases only when engaged in the preanesthetic preparation and evaluation; anesthesia induction, maintenance, and emergence; and postanesthesia care. A Certified Registered Nurse Anesthetist may order, select, obtain, and administer drugs only during the perioperative or periobstetrical period. c. A Certified Registered Nurse Anesthetist who applies for authorization to order, select, obtain, and administer drugs shall: (1) be currently recognized as a Certified Registered Nurse Anesthetist in this state, (2) provide evidence of completion, within the two- year period immediately preceding the date of application, of a minimum of fifteen (15) units of continuing education in advanced pharmacology related to the administration of anesthesia as recognized by the National Board of Certification and Recertification for Nurse Anesthetists, and (3) complete and submit a notarized application, on a form prescribed by the Board, accompanied by the application fee established pursuant to this section. d. The authority to order, select, obtain, and administer drugs shall be terminated if a Certified Registered Nurse Anesthetist has: (1) ordered, selected, obtained, or administered drugs outside of the Certified Registered Nurse Anesthetist scope of practice or ordered, selected, obtained, or administered drugs for other than therapeutic purposes, or (2) violated any provision of state laws or rules or federal laws or regulations pertaining to the practice of nursing or the authority to order, select, obtain, and administer drugs. e. The Oklahoma Board of Nursing shall notify the State Board of Pharmacy after termination of or a change in the authority to order, select, obtain, and administer drugs for a Certified Registered Nurse Anesthetist. f. The Board shall provide by rule for biennial application renewal and reauthorization of authority to order, select, obtain, and administer drugs for Certified Registered Nurse Anesthetists. At the time of application renewal, a Certified Registered Nurse Anesthetist shall submit documentation of a minimum of eight (8) units of continuing education, completed during the previous two (2) years, in advanced pharmacology relating to the administration of anesthesia, as recognized by the National Board of Certification and Recertification for Nurse Anesthetists. g. This paragraph shall not prohibit the administration of local or topical anesthetics as now permitted by law. Provided further, nothing in this paragraph shall limit the authority of the Board of Dentistry to establish the qualifications for dentists who direct the administration of anesthesia. h. As used in this paragraph, “collaboration” means an agreement between a medical doctor, osteopathic physician, podiatric physician, or dentist performing the procedure or directly involved with the procedure and the Certified Registered Nurse Anesthetist working jointly toward a common goal providing services for the same patient. This collaboration involves the joint formulation, discussion, and agreement of the anesthesia plan by both parties, and the collaborating medical doctor, osteopathic physician, podiatric physician, or dentist performing the procedure or directly involved with the procedure and that collaborating physician shall remain available for timely on-site consultation during the delivery of anesthesia for diagnosis, consultation, and treatment of medical conditions; 11. “Supervising physician” means an individual holding a current license to practice as a physician from the State Board of Medical Licensure and Supervision or the State Board of Osteopathic Examiners, who supervises a Certified Nurse Practitioner, a Clinical Nurse Specialist, or a Certified Nurse-Midwife who has not obtained independent prescriptive authority under Section 1 of this act, and who is not in training as an intern, resident, or fellow. The supervising physician shall remain in compliance with the rules promulgated by the State Board of Medical Licensure and Supervision or the State Board of Osteopathic Examiners; 12. “Supervision” means assuring availability of the supervising physician to a Certified Nurse Practitioner, a Clinical Nurse Specialist, or a Certified Nurse-Midwife who has not obtained independent prescriptive authority under Section 1 of this act through direct contact, telecommunications, or other appropriate electronic means for consultation, assistance with medical emergencies, or patient referral with respect to written, telephonic, electronic, or oral prescriptions for drugs and other medical supplies, subject to a defined formulary; and 13. “Advanced Unlicensed Assistant” means any person who has successfully completed a certified training program approved by the Board that trains the Advanced Unlicensed Assistant to perform specified technical skills identified by the Board in acute care settings under the direction and supervision of the Registered Nurse, Licensed Practical Nurse, or Advanced Practice Registered Nurse.