No. 28365 (Amendment): R156-31b. Nurse Practice Act Rules

DAR File No.: 28365
Filed: 11/21/2005, 02:38
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division and the Board of Nursing are proposing amendments to address concerns and issues presented by the Division of Substance Abuse and Mental Health, Senators, school nurses, and members of the public.

 

Summary of the rule or change:

In Section R156-31b-102, adds mental health therapists to the list of health care professionals who may direct a licensed practical nurse (LPN). This is in response to a proposed rule change by the Division of Substance Abuse and Mental Health to train and certify LPNs to be certified case managers. Also adds naturopathic physicians to the list. In Section R156-31b-302c, recognizes the certification examination required of certified nurse midwives (CNM) for licensure as an advanced practice registered nurse (APRN), thus allowing a CNM to be dual licensed as an APRN and hence be eligible to receive insurance reimbursement for well women health care. Also corrects a subsection numbering error. In Section R156-31b-306, clarifies the requirements for reactivation, reinstatement or relicensure, making the requirements the same and mandating completion of an approved nursing education program for an individual who has not practiced as a nurse for more than 15 years. In Section R156-31b-401, limits the number of times an individual can apply for relicensure following the surrender or revocation of a license. In Section R156-31b-502, provides that a nurse who trains/delegates the administration of glucagon in the school setting to an unlicensed person has not engaged in unprofessional conduct. In Section R156-31b-701, allows a nurse to delegate the administration of glucagon in an emergency situation by an unlicensed individual.

 

State statutory or constitutional authorization for this rule:

Section 58-31b-101 and Subsections 58-1-106(1)(a) and 58-1-202(1)(a)

 

Anticipated cost or savings to:

the state budget:

The Division of Occupational and Professional Licensing (DOPL) will incur costs of approximately $50 to reprint the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget. The Division of Substance Abuse and Mental Health may incur the costs of certifying licensed practical nurses (LPNs) to work as certified case managers; however, there may also be a savings to the Division of Substance Abuse and Mental Health by utilizing this level of provider to provide case management activities. DOPL is unable to the determine either the costs or savings applicable to the Division of Substance Abuse and Mental Health as a result of the proposed amendments which affect their agency.

 

local governments:

School boards would possibly see a savings if unlicensed individuals are prepared to administer glucagon in an emergency and not relying on licensed individuals to be readily available to respond to this type of an emergency. DOPL is unable to determine an exact amount of savings as it could vary between all local school boards.

 

other persons:

Dual licensure as a certified nurse midwife (CNM) and advanced practice registered nurse (APRN) will allow individuals to be eligible for insurance reimbursement (as an APRN) while sustaining the same type of CNM practice (well woman's health care). This may also increase the availability and access to providers of women's health care. CNMs desiring the dual licensure will incur the additional application cost of $100 and a biennial renewal fee of $68. Also, the requirement to complete a new approved nursing education program after 15 or more years of not practicing could cost an individual anywhere from $1,500 - $20,000 depending on the type of program and the school. Additionally, the limitation on the number of times an individual may reapply for licensure following disciplinary action could force a person with a significant disciplinary history to leave the nursing profession and become employed in a less paying occupation, thus having a direct impact on the person's ability to obtain employment. However, DOPL would see a savings in the time it takes to review applications, hold disciplinary hearings, monitor probation, and respond to appeals.

 

Compliance costs for affected persons:

Dual licensure as a CNM and an APRN will allow individuals to be eligible for insurance reimbursement (as an APRN) while sustaining the same type of CNM practice (well woman's health care). This may also increase the availability and access to providers of women's health care. CNMs desiring the dual licensure will incur the additional application cost of $100 and a biennial renewal fee of $68. Also, the requirement to complete a new approved nursing education program after 15 or more years of not practicing could cost an individual anywhere from $1,500 - $20,000 depending on the type of program and the school. Additionally, the limitation on the number of times an individual may reapply for licensure following disciplinary action could force a person with a significant disciplinary history to leave the nursing profession and become employed in a less paying occupation, thus having a direct impact on the person's ability to obtain employment. However, DOPL would see a savings in the time it takes to review applications, hold disciplinary hearings, monitor probation, and respond to appeals.

 

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule filing makes various substantive amendments as summarized in the rule filing summary. The summary also indicates the various costs incurred and savings to the state, local governments, and regulated industry. No additional fiscal impact to businesses is foreseen as a result of this filing. Francine A. Giani, Executive Director

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

 

Direct questions regarding this rule to:

Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at [e-mail]

 

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/17/2006

 

Interested persons may attend a public hearing regarding this rule:

12/16/2005 at 11:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 4B (fourth floor), Salt Lake City, UT

 

This rule may become effective on:

01/18/2006

 

Authorized by:

J. Craig Jackson, Director

 

 

RULE TEXT

R156. Commerce, Occupational and Professional Licensing.

R156-31b. Nurse Practice Act Rules.

R156-31b-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 31b, as defined or used in these rules:

(1) "Absolute discharge", as used in Subsection 58-31b-302(5)(b), means the completion of criminal probation or parole.

(2) "Affiliated with an institution of higher education", as used in Subsection 58-31b-601(1), means the general and science education courses required as part of a nursing education program are provided by an educational institution which is approved by the Board of Regents or an equivalent governmental agency in another state or a private educational institution which is regionally accredited by an accrediting board recognized by the Council for Higher Education Accreditation of the American Council on Education; and the nursing program and the institution of higher education are affiliated with each other as evidenced by a written contract or memorandum of understanding.

(3) "APRN" means an advanced practice registered nurse.

(4) "Approved continuing education" in Subsection R156-31b-303(3) means:

(a) continuing education that has been approved by a professional nationally recognized approver of health related continuing education;

(b) nursing education courses taken from an approved education program as defined in Section R156-31b-601; and

(c) health related course work taken from an educational institution accredited by a regional institutional accrediting body identified in the "Accredited Institutions of Postsecondary Education", 2003-04 edition, published by the American Council on Education.

(5) "Approved education program" as defined in Subsection 58-31b-102(3) is further defined to include any nursing education program published in the documents entitled "Directory of Accredited Nursing Programs", 2003, published by the National League for Nursing Accrediting Commission, which are hereby adopted and incorporated by reference as a part of these rules.

(6) "CCNE" means the Commission on Collegiate Nursing Education.

(7) "CGFNS" means the Commission on Graduates of Foreign Nursing Schools.

(8) "COA", as used in these rules, means the Council of Accreditation of Nurse Anesthesia Education Programs.

(9) "Clinical mentor/preceptor", as used in Section R156-31b-607, means an individual who is employed by a clinical health care facility and is chosen by that agency, in collaboration with the Parent-Program, to provide direct, on-site supervision and direction to a nursing student who is engaged in a clinical rotation, and who is accountable to both the clinical agency and the supervisory clinical faculty member.

(10) "Comprehensive nursing assessment", as used in Section R156-31b-704, means an extensive data collection (initial and ongoing) for individuals, families, groups and communities addressing anticipated changes in patient/client conditions as well as emergent changes in patient's/client's health status; recognizing alterations to previous patient/client conditions; synthesizing the biological, psychological, spiritual and social aspects of the patient's/client's condition; evaluating the impact of nursing care; and using this broad and complete analysis to make independent decisions and identification of health care needs; plan nursing interventions, evaluate need for different interventions and the need to communicate and consult with other health team members.

(11) "Contact hour" means 50 minutes.

(12) "CRNA" means a certified registered nurse anesthetist.

(13) "Delegation" means transferring to an individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.

(14) "Direct supervision" is the supervision required in Subsection 58-31b-306(1)(a)(iii) and means:

(a) the person providing supervision shall be available on the premises at which the supervisee is engaged in practice; or

(b) if the supervisee is specializing in psychiatric mental health nursing, the supervisor may be remote from the supervisee if there is personal direct voice communication between the two prior to prescribing a prescription drug.

(15) "Disruptive behavior", as used in these rules, means conduct, whether verbal or physical, that is demeaning, outrageous, or malicious and that places at risk patient care or the process of delivering quality patient care. Disruptive behavior does not include criticism that is offered in good faith with the aim of improving patient care.

(16) "Focused nursing assessment", as used in Section R156-31b-703, means an appraisal of an individual's status and situation at hand, contributing to the comprehensive assessment by the registered nurse, supporting ongoing data collection and deciding who needs to be informed of the information and when to inform.

(17) "Licensure by equivalency" as used in these rules means licensure as a licensed practical nurse after successful completion of course work in a registered nurse program which meets the criteria established in Sections R156-31b-601 and R156-31b-603.

(18) "LPN" means a licensed practical nurse.

(19) "NLNAC" means the National League for Nursing Accrediting Commission.

(20) "NCLEX" means the National Council Licensure Examination of the National Council of State Boards of Nursing.

(21) "Non-approved education program" means any foreign nurse education program.

(22) "Other specified health care professionals", as used in Subsection 58-31b-102(13), who may direct the licensed practical nurse means:

(a) advanced practice registered nurse;

(b) certified nurse midwife;

(c) chiropractic physician;

(d) dentist;

(e) osteopathic physician;

(f) physician assistant;

(g) podiatric physician;

(h) optometrist;

(i) certified registered nurse anesthetist;

(j) naturopathic physician; or

(k) mental health therapist as defined in Subsection 58-60-102(5).

(23) "Parent-program", as used in Section R156-31b-607, means a nationally accredited, Board of Nursing approved nursing education program that is providing nursing education (didactic, clinical or both) to a student and is responsible for the education program curriculum, and program and student policies.

(24) "Patient surrogate", as used in Subsection R156-31b-502(4), means an individual who has legal authority to act on behalf of the patient when the patient is unable to act or decide for himself, including a parent, foster parent, legal guardian, or a person designated in a power of attorney.

(25) "Postsecondary school", as used in Section R156-31b-607, means a program registered and in good standing with the Utah Department of Commerce, Division of Consumer Protection, that offers coursework to individuals who have graduated from high school or have been awarded a GED.

(26) "Psychiatric mental health nursing specialty", as used in Subsection 58-31b-302(3)(g), includes psychiatric mental health nurse specialists and psychiatric mental health nurse practitioners.

(27) "RN" means a registered nurse.

(28) "Supervision" in Section R156-31b-701 means the provision of guidance or direction, evaluation and follow up by the licensed nurse for accomplishment of a task delegated to unlicensed assistive personnel or other licensed individuals.

(29) "Supervisory clinical faculty", as used in Section R156-31b-607, means one or more individuals employed by an approved nursing education program who meet the accreditation and Board of Nursing specific requirements to be a faculty member and are responsible for the overall clinical experiences of nursing students and may supervise and coordinate clinical mentors/preceptors who provide the actual direct clinical experience.

(30) "Unprofessional conduct" as defined in Title 58, Chapters 1 and 31b, is further defined in Section R156-31b-502.

 

R156-31b-302c. Qualifications for Licensure - Examination Requirements.

(1) In accordance with Section 58-31b-302, the examination requirements for graduates of approved nursing programs are as follows.

(a) An applicant for licensure as an LPN or RN shall pass the applicable NCLEX examination.

(b) An applicant for licensure as an APRN shall pass one of the following national certification examinations consistent with his educational specialty:

(i) one of the following examinations administered by the American Nurses Credentialing Center Certification:

(A) Adult Nurse Practitioner;

(B) Family Nurse Practitioner;

(C) Pediatric Nurse Practitioner;

(D) Gerontological Nurse Practitioner;

(E) Acute Care Nurse Practitioner;

(F) Clinical Specialist in Medical-Surgical Nursing;

(G) Clinical Specialist in Gerontological Nursing;

(H) Clinical Specialist in Adult Psychiatric and Mental Health Nursing;

(I) Clinical Specialist in Child and Adolescent Psychiatric and Mental Health Nursing;

(J) Psychiatric and Mental Health Nurse Practitioner (Adult and Family);

(ii) Pediatric Nursing Certification Board;

(iii) American Academy of Nurse Practitioners;

(iv) the National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties;

(v) the Oncology Nursing Certification Corporation Advanced Oncology Certified Nurse if taken on or before July 1, 2005;

(vi) the Advanced Practice Certification for the Clinical Nurse Specialist in Acute and Critical Care; or

(vii) the Advanced Critical Care Examination administered by the American Association of Critical Care Nurses; or

(viii) the national certifying examination administered by the American Midwifery Certification Board, Inc.

([d]c) An applicant for licensure as a CRNA shall pass the examination of the Council on Certification of Nurse Anesthetists.

(2) In accordance with Section 58-31b-303, an applicant for licensure as an LPN or RN from a non-approved nursing program shall pass the applicable NCLEX examination.

 

R156-31b-306. Inactive Licensure, Reinstatement or Relicensure.

(1) In accordance with Subsection 58-1-305(1), an individual seeking activation of an inactive RN or LPN license must document current competency to practice as a nurse as defined in Subsection (3) below.

(2) An individual seeking reinstatement of RN or LPN licensure or relicensure as a RN or LPN in accordance with Subsection R156-1-308g(3)(b), R156-1-308i(3), R156-1-308j(3) and R156-1-308k(2)(c) shall document current competence as defined in Subsection (3) below.

(3) Documentation of current competency to practice as a nurse is established as follows:

(a) an individual who has not practiced as a nurse for five years or less must document current compliance with the continuing competency requirements as established in Subsection R156-31b-303(3);

(b) an individual who has not practiced as a nurse for more than five years but less than 10 years must pass the required examinations as defined in Section R156-31b-302c within six months prior to making application for licensure or successfully complete an approved re-entry program;

(c) an individual who has not practiced as a nurse for more than 10 years but less than 15 years must pass the required examinations as defined in Section R156-31b-302c within six months prior to making application for licensure or successfully complete an approved re-entry program;

(d) an individual who has not practiced as a nurse for more than 15 years shall repeat an approved nursing education program and pass the required examinations as defined in Section R156-31b-302c within six months prior to making application for licensure.[(1) A licensee may apply for inactive licensure status in accordance with Sections 58-1-305 and R156-1-305.

(2) To reactivate a license which has been inactive for five years or less, the licensee must document current compliance with the continuing competency requirements as established in Subsection R156-31b-303(3).

(3) To reactivate a RN or LPN license which has been inactive for more than five years but less than 10 years, the licensee must document active licensure in another state or jurisdiction, pass the required examinations as defined in Section R156-31b-302c within six months prior to making application to reactivate a license, or successfully complete an approved re-entry program.

(4) To reactivate a RN or LPN license which has been inactive for 10 or more years, the licensee must document active licensure in another state or jurisdiction, or pass the required examinations as defined in Section R156-31b-302c within six months prior to making application to reactivate a license and successfully complete an approved re-entry program.]

([5]4) To document current competency for activation, reinstatement or relicensure as an[reactivate an] APRN or CRNA, an individual must pass the required examinations as defined in Section R156-31b-302c and be currently certified or recertified[ license which has been inactive for more than five years, the licensee must document active licensure in another state or jurisdiction or pass the required examinations as defined in Section R156-31b-302c within six months prior to making application to reactivate a license].

 

R156-31b-401. Disciplinary Proceedings.

(1) An individual licensed as a LPN who is currently under disciplinary action and qualifies for licensure as an RN may be issued an RN license under the same restrictions as the LPN.

(2) A nurse whose license is suspended, may under Subsection 58-31b-401 petition the division at any time that he can demonstrate that he can resume competent practice.

(3) An individual who has had any license issued under Title 58, Chapter 31b revoked or surrendered two times or more as a result of unlawful or unprofessional conduct is ineligible to apply for relicensure.

 

R156-31b-502. Unprofessional Conduct.

(1) "Unprofessional conduct" includes:

([1]a) failing to destroy a license which has expired due to the issuance and receipt of an increased scope of practice license;

([2]b) a RN issuing a prescription for a prescription drug to a patient except in accordance with the provisions of Section 58-17b-620, or as may be otherwise provided by law;

([3]c) failing as the nurse accountable for directing nursing practice of an agency to verify any of the following:

([a]i) that standards of nursing practice are established and carried out so that safe and effective nursing care is provided to patients;

([b]ii) that guidelines exist for the organizational management and management of human resources needed for safe and effective nursing care to be provided to patients;

([c]iii) nurses' knowledge, skills and ability and determine current competence to carry out the requirements of their jobs;

([4]d) engaging in sexual contact with a patient surrogate concurrent with the nurse/patient relationship unless the nurse affirmatively shows by clear and convincing evidence that the contact:

([a]i) did not result in any form of abuse or exploitation of the surrogate or patient; and

([b]ii) did not adversely alter or affect in any way:

([i]A) the nurse's professional judgment in treating the patient;

([ii]B) the nature of the nurse's relationship with the surrogate; or

([iii]C) the nurse/patient relationship; and

([5]e) engaging in disruptive behavior in the practice of nursing.

(2) In accordance with a prescribing practitioner's order and a student care plan, a nurse who trains an unlicensed assistive personnel to administer medications under Section 53A-11-601 shall not be considered to have engaged in unprofessional conduct for inappropriate delegation.

 

R156-31b-701. Delegation of Nursing Tasks.

In accordance with Subsection 58-31b-102(11)(g), the delegation of nursing tasks is further defined, clarified, or established as follows:

(1) The nurse delegating tasks retains the accountability for the appropriate delegation of tasks and for the nursing care of the patient/client. The licensed nurse shall not delegate any task requiring the specialized knowledge, judgment and skill of a licensed nurse to an unlicensed assistive personnel. It is the licensed nurse who shall use professional judgment to decide whether or not a task is one that must be performed by a nurse or may be delegated to an unlicensed assistive personnel. This precludes a list of nursing tasks that can be routinely and uniformly delegated for all patients/clients in all situations. The decision to delegate must be based on careful analysis of the patient's/client's needs and circumstances.

(2) The licensed nurse who is delegating a nursing task shall:

(a) verify and evaluate the orders;

(b) perform a nursing assessment;

(c) determine whether the task can be safely performed by an unlicensed assistive personnel or whether it requires a licensed health care provider;

(d) verify that the delegatee has the competence to perform the delegated task prior to performing it;

(e) provide instruction and direction necessary to safely perform the specific task; and

(f) provide ongoing supervision and evaluation of the delegatee who is performing the task.

(3) The delegator shall evaluate the situation to determine the degree of supervision required to ensure safe care.

(a) The following factors shall be evaluated to determine the level of supervision needed:

(i) the stability of the condition of the patient/client;

(ii) the training and capability of the delegatee;

(iii) the nature of the task being delegated; and

(iv) the proximity and availability of the delegator to the delegatee when the task will be performed.

(b) The delegating nurse or another qualified nurse shall be readily available either in person or by telecommunication. The delegator responsible for the care of the patient/client shall make supervisory visits at appropriate intervals to:

(i) evaluate the patient's/client's health status;

(ii) evaluate the performance of the delegated task;

(iii) determine whether goals are being met; and

(iv) determine the appropriateness of continuing delegation of the task.

(4) Nursing tasks, to be delegated, shall meet the following criteria as applied to each specific patient/client situation:

(a) be considered routine care for the specific patient/client;

(b) pose little potential hazard for the patient/client;

(c) be performed with a predictable outcome for the patient/client;

(d) be administered according to a previously developed plan of care; and

(e) not inherently involve nursing judgment which cannot be separated from the procedure.

(5) If the nurse, upon review of the patient's/client's condition, complexity of the task, ability of the unlicensed assistive personnel and other criteria as deemed appropriate by the nurse, determines that the unlicensed assistive personnel cannot safely provide care, the nurse shall not delegate the task.

(6) In accordance with Section 53A-11-601 and a student care plan, it is appropriate for a nurse to provide training to an unlicensed assistive personnel which includes the administration of glucagon in an emergency situation provided any training regarding the administration of glucagon is updated at least annually.

 

KEY: licensing, nurses

[August 2, 2005]2006

Notice of Continuation June 2, 2003

58-31b-101

58-1-106(1)(a)

58-1-202(1)(a)