2012 -- S 2558

=======

LC01837

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

____________

A N A C T

RELATING TO BUSINESSES AND PROFESSIONS - NURSES AND NURSE

ANESTHETISTS

     

     

     Introduced By: Senators Doyle, and Gallo

     Date Introduced: February 28, 2012

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

1-1

     SECTION 1. Sections 5-34-3, 5-34-4, 5-34-7, 5-34-35, 5-34-36, 5-34-36, 5-34-37, 5-34-

1-2

38, 5-34-39, 5-34-40 and 5-34-42 of the General Laws in Chapter 5-34 entitled “Nurses” are

1-3

hereby amended to read as follows:

1-4

     5-34-3. Definitions. -- As used in this chapter:

1-5

     (1) "Advanced practice nurse" means the status of qualified individuals who hold an

1-6

active license as a registered nurse and an active license as a nurse in an advanced role as defined

1-7

under the provisions of this chapter or chapter 5-34.2.

1-8

     (2) "Approval" means the process where the board of nursing evaluates and grants

1-9

official recognition to basic nursing education programs meeting established criteria and

1-10

standards.

1-11

     (3) "Certified registered nurse practitioner" “Advanced Practice Registered Nurse

1-12

(APRN) (including Certified Nurse Practitioner (CNP); Certified Registered Nurse Anesthetist

1-13

(CRNA); Certified Clinical Nurse Specialist, (CNS))” is an advanced practice nurse utilizing

1-14

independent knowledge of physical assessment and management of health care and illnesses. The

1-15

practice may include includes prescriptive privileges. The practice includes collaboration with

1-16

other licensed health care professionals including, but not limited to, physicians, pharmacists,

1-17

podiatrists, dentists and nurses. Practice as an APRN means an expanded scope of nursing in a

1-18

role and population focus accepted by the BON with or without compensation or personal profit,

1-19

and includes the RN scope of practice. The scope of an APRN includes, but is not limited to,

2-1

performing acts of advanced assessment, diagnosing, prescribing and ordering. APRNs may serve

2-2

as primary care providers of record.

2-3

     APRNs are expected to practice as licensed practitioners within their scope of practice

2-4

recognized by the BON or state statute. Each APRN is accountable to patients, the nursing

2-5

profession and the BON for complying with the requirements of this section and the quality of

2-6

advanced nursing care rendered; for recognizing limits of knowledge and experience; planning

2-7

for the management of situations beyond the APRN’s expertise; and for consulting with or

2-8

referring patients to other health care providers as appropriate.

2-9

     (4) "Department" means the department of health.

2-10

     (5) "Health" means optimum well-being.

2-11

     (6) "Healthcare" means those services provided to promote the optimum well-being of

2-12

individuals.

2-13

     (7) "Licensed" means the status of qualified individuals who have completed a designated

2-14

process by which the board of nursing grants permission to individuals accountable and/or

2-15

responsible for the practice of nursing and to engage in that practice, prohibiting all others from

2-16

legally doing so.

2-17

     (8) "Nursing" means the provision of services that are essential to the promotion,

2-18

maintenance, and restoration of health throughout the continuum of life. It provides care and

2-19

support of individuals and families during periods of wellness, illness, and injury, and

2-20

incorporates the appropriate medical plan of care prescribed by a licensed physician, dentist, or

2-21

podiatrist. It is a distinct component of health services. Nursing practice is based on specialized

2-22

knowledge, judgment, and nursing skills acquired through educational preparation in nursing and

2-23

in the biological, physical, social, and behavioral sciences.

2-24

     (9) "Practical nursing" is practiced by licensed practical nurses (L.P.N.s). It is an integral

2-25

part of nursing based on a knowledge and skill level commensurate with education. It includes

2-26

promotion, maintenance, and restoration of health and utilizes standardized procedures leading to

2-27

predictable outcomes, which are in accord with the professional nurse regimen under the direction

2-28

of a registered nurse. In situations where registered nurses are not employed, the licensed

2-29

practical nurse functions under the direction of a licensed physician, dentist, podiatrist or other

2-30

licensed health care providers authorized by law to prescribe. Each L.P.N. is responsible for the

2-31

nursing care rendered.

2-32

     (10) "Professional nursing" is practiced by registered nurses (R.N.s). The practice of

2-33

professional nursing is a dynamic process of assessment of an individual's health status,

2-34

identification of health care needs, determination of health care goals with the individual and/or

3-1

family participation and the development of a plan of nursing care to achieve these goals. Nursing

3-2

actions, including teaching and counseling, are directed toward the promotion, maintenance, and

3-3

restoration of health and evaluation of the individual's response to nursing actions and the

3-4

medical regimen of care. The professional nurse provides care and support of individuals and

3-5

families during periods of wellness and injury, and incorporates where appropriate, the medical

3-6

plan of care as prescribed by a licensed physician, dentist or podiatrist or other licensed health

3-7

care providers authorized by law to prescribe. Each R.N. is directly accountable and responsible

3-8

to the consumer for the nursing care rendered.

3-9

     (11) "Psychiatric and mental health nurse clinical specialist" is an advanced practice

3-10

nurse utilizing independent knowledge and management of mental health and illnesses. The

3-11

practice may include prescription privileges of certain legend medications, controlled substances

3-12

from Schedule II classified as stimulants, and controlled substances from Schedule IV within the

3-13

scope of their practice. The practice may include collaboration with other licensed health care

3-14

professionals, including, but not limited to, psychiatrists, psychologists, physicians, pharmacists,

3-15

and nurses. The psychiatric and mental health clinical specialist holds the qualifications defined

3-16

in § 5-34-40.1.

3-17

     5-34-4. Board of nursing – Establishment – Composition – Appointment, terms, and

3-18

removal of members – Director of nurse registration and nursing education. -- (a) Within the

3-19

division of professional regulation, pursuant to chapter 26 of this title, there is a board of nurse

3-20

registration and nursing education. The board shall be composed of fifteen (15) members. The

3-21

term of office shall be for three (3) years. No member shall serve more than two (2) consecutive

3-22

terms. The member shall serve until a qualified successor is appointed to serve. In making those

3-23

appointments, the director of the department of health shall consider persons suggested by

3-24

professional nurse organizations and the practical nurse's association.

3-25

     (b) Present members of the board holding office under the provisions of this chapter shall

3-26

serve as members of the board until the expiration of their terms or until qualified successors are

3-27

appointed. The fifteen (15) member board shall include: eleven (11) professional nurses, two (2)

3-28

practical nurses appointed by the director of health and approved by the governor and two (2)

3-29

members of the general public appointed by the governor. Three (3) professional nurses shall be

3-30

from different basic education programs preparing students to become nurses; one professional

3-31

nurse shall be from a nursing service administration; four (4) professional non-administrative,

3-32

clinical nurses not licensed as advanced practice nurses, and three (3) professional advanced

3-33

practice nurses, one who holds a license as a certified registered nurse anesthetist, one who holds

3-34

a license as a certified registered nurse practitioner, and one who holds a license as a psychiatric

4-1

and mental health nurse clinical nurse specialist. No educational program or cooperating agency

4-2

shall have more than one representative on the board.

4-3

     (c) The director of health may remove any member from the board for cause including,

4-4

but not limited to, neglect of any duty required by law, or incompetence, or unprofessional

4-5

conduct, or willful misconduct. A member subject to disciplinary proceedings shall be

4-6

disqualified from board business until the charge is adjudicated. There shall also be a director of

4-7

nurse registration and nursing education appointed by the director of health in accordance with

4-8

the provisions of chapter 4 of title 36.

4-9

     5-34-7. Board of nursing – General powers. -- The board of nurse registration and

4-10

nursing education is authorized, subject to the approval of the director of the department of

4-11

health, to:

4-12

     (1) Adopt, review, or revise rules, and regulations consistent with the law that may be

4-13

necessary to effect provisions of the chapter;

4-14

     (2) Approve nursing education programs according to the rules established by the board;

4-15

     (3) Require standards for nursing practice within organized nursing services and the

4-16

individual practice of licensees;

4-17

     (4) Approve the examinations for licensure;

4-18

     (5) Establish requirements to validate competence for reinstatement to the active list;

4-19

     (6) Conduct hearings upon charges calling for discipline of a licensee or revocation of a

4-20

license;

4-21

     (7) Issue subpoenas to, compel the attendance of witnesses at, and administer oaths to

4-22

persons giving testimony at hearings;

4-23

     (8) Cause the prosecution or enjoinder of all persons violating this chapter;

4-24

     (9) Maintain a record of all its proceedings;

4-25

     (10) Submit an annual report to the director of the department of health;

4-26

     (11) Utilize other persons that may be necessary to carry on the work of the board;

4-27

     (12) Conduct public hearings, investigations, and studies of nursing practice, nursing

4-28

education, and related matters and prepare and issue publications that, in the judgment of the

4-29

board, allow the nursing profession to provide safe, effective nursing services to the public;

4-30

     (13) Determine qualifications necessary for prescriptive privileges for certified registered

4-31

nurse practitioners APRNs;

4-32

     (14) Grant certified registered nurse practitioners APRNs prescriptive privileges;

4-33

     (15) Determine qualification necessary for the prescriptive privileges for psychiatric and

4-34

mental health clinical nurse specialists; and

5-1

     (16) Grant certified psychiatric and mental health clinical nurse specialists prescriptive

5-2

privileges.

5-3

     5-34-35. Qualifications of a certified registered nurse practitioner applicant

5-4

Qualifications of an APRN applicant. -- (a) An applicant for licensure to practice as a certified

5-5

registered nurse practitioner APRN shall submit to the board of nurse registration and nursing

5-6

education written evidence on forms furnished by the division of professional regulation, verified

5-7

by oath, that:

5-8

     (1) The applicant is a registered nurse who has completed an accredited educational

5-9

program resulting in a master's degree, and/or a doctoral degree, in nursing and/or an approved

5-10

nurse practitioner APRN course of study. This curriculum must include both a didactic

5-11

component and supervised clinical experience that includes nationally recognized education

5-12

standards and core competencies for programs preparing individuals in the role. Effective January

5-13

1, 2004 2014, all applicants for initial licensure must complete an accredited educational program

5-14

resulting in a master's degree with a major in nursing.

5-15

     (2) The applicant passed a national qualifying examination recognized by the board of

5-16

nurse registration and nursing education.

5-17

     (b) A license to practice as a certified registered nurse practitioner an APRN may be

5-18

issued to an applicant who is licensed by examination or endorsement as a certified registered

5-19

nurse practitioner an APRN under the laws of another state or territory if, in the opinion of the

5-20

board, the applicant meets the qualifications required of certified registered nurse practitioners

5-21

APRNs in this state.

5-22

     5-34-36. Licensing of certified registered nurse practitioners. Licensing of APRN --

5-23

A license to practice as a certified nurse practitioner an APRN shall be issued if the applicant

5-24

meets the qualifications for the certified registered nurse practitioner (R.N.P.) APRN license.

5-25

Persons who meet the qualifications of a certified registered nurse practitioner, as stated in § 5-

5-26

34-35, and are currently licensed as certified registered nurse practitioners by examination or

5-27

endorsement under the laws of another state of the United States and/or the District of Columbia

5-28

shall be allowed to practice as certified registered nurse practitioners in this state for a period not

5-29

to exceed ninety (90) days from the date of clearance by the board of nurse registration and

5-30

nursing education of the department of health, provided that they are licensed in this state within

5-31

ninety (90) days. The original privilege to work ninety (90) days from the date of clearance shall

5-32

not be extended or renewed.

5-33

     5-34-37. Application fee for certified registered nurse practitioners. Application fee

5-34

for APRN.-- The initial application fee for licensure as a certified registered nurse practitioner an

6-1

APRN shall be one hundred and thirty dollars ($130). The renewal fee for a certified registered

6-2

nurse practitioner an APRN shall be one hundred and thirty dollars ($130) biennially, ninety

6-3

dollars ($90.00) for registered nurse fee plus forty dollars ($40.00) for the certified registered

6-4

nurse practitioner APRN license. The fee for application for prescriptive privileges shall be fifty

6-5

dollars ($50.00).

6-6

     5-34-38. Right to use certified registered nurse practitioner title. Right to use

6-7

advanced practice registered nurse title – Any person who holds a license to practice as a

6-8

certified registered nurse practitioner an APRN in this state has the right to use the title certified

6-9

registered nurse practitioner an advanced practice registered nurse and use the abbreviation

6-10

"R.N.P". "APRN". No other person may assume that title or use that abbreviation or any other

6-11

words or letters, signs, figures, or devices to indicate that the person using it is a certified

6-12

registered nurse practitioner an advanced practice registered nurse.

6-13

      Individuals are licensed or granted privilege to practice as APRNs in the roles of

6-14

Certified Registered Nurse Anesthetist (CRNA), Certified Clinical Nurse Specialist (CNS), and

6-15

Certified Nurse Practitioner (CNP), and in the population foci of family/individual across the

6-16

lifespan, adult-gerontology, neonatal, pediatrics, women’s health/gender-related, or psychiatric/

6-17

mental health.

6-18

     Each APRN shall use the designation “APRN” plus role title as a minimum for puposes

6-19

of identification and documentation. When providing nursing care, the APRN shall provide clear

6-20

identification that indicates his/her APRN designation. The APRN with an earned doctorate in

6-21

nursing may use the term doctor or abbreviation “Dr.” when providing nursing care.

6-22

     5-34-39. Process for prescriptive privileges of certified registered nurse. Process for

6-23

prescriptive privileges of APRN. -- (a) Prescriptive privileges for the certified registered nurse

6-24

practitioner APRN:

6-25

     (1) Shall be granted under the governance and supervision of the department, board of

6-26

nurse registration and nurse education; and

6-27

     (2) Shall include prescription of legend medications and prescription of controlled

6-28

substances from schedules II, III, IV and V that are established in regulation; and

6-29

     (3) Must not include controlled substances from Schedule I.

6-30

     (b) To qualify for prescriptive privileges an applicant must submit on forms provided by

6-31

the board of nurse registration and nursing education, verified by oath, that the applicant has

6-32

evidence of completion of thirty (30) hours of education in pharmacology within the three (3)

6-33

year period immediately prior to date of application. To maintain prescriptive privileges the

6-34

certified registered nurse practitioner (R.N.P.) must submit upon request of the board of nurse

7-1

registration and nursing education evidence of thirty (30) hours continuing education in

7-2

pharmacology every six (6) years.

7-3

     5-34-40. Advanced practice nurse advisory committee. -- (a) The nine (9) member

7-4

committee consists of two (2) certified registered nurse practitioners, two (2) certified registered

7-5

nurse anesthetists, two (2) psychiatric and mental health certified clinical nurse specialists, one

7-6

physician and two (2) consumers. The director of health shall appoint the committee. In making

7-7

appointments to the committee, the director shall consider persons recommended by professional

7-8

nurse organizations and professional medical associations. The professional members of the

7-9

committee shall be currently engaged in practice. The consumer members shall be: (1)

7-10

knowledgeable in consumer health concerns; (2) a resident of the state; (3) not licensed as a

7-11

health care practitioner; (4) not a parent, spouse, sibling, or child of a person licensed as a health

7-12

care practitioner, and not a student in a professional program; (5) not having a direct financial

7-13

interest in health care services; (6) not a member or an employee of any board of control of any

7-14

public or private health care service.

7-15

     (b) Each member appointment shall be for three (3) years, with no member serving more

7-16

than two (2) consecutive three (3) year terms except that in making the initial appointments the

7-17

director designates: four (4) members for a term of two (2) years; three (3) members for a term of

7-18

three (3) years; and the consumer members for three (3) year terms.

7-19

     (c) This committee must meet not fewer than two (2) times per year. The committee has

7-20

the following functions:

7-21

     (1) To assess advanced nursing practice for the purpose of improving patient care.

7-22

     (2) To review all complaints regarding advanced practice nurses, and recommend any

7-23

and all disciplinary or corrective action that they deem appropriate, including revocation and

7-24

suspension of license, upon proof that an advanced practice nurse has:

7-25

     (A) Aided or abetted an uncertified person to practice as an advanced practice nurse;

7-26

     (B) Become addicted to the use of liquor or controlled substances;

7-27

     (C) Negligently, willfully, or intentionally acted in a manner inconsistent with the health

7-28

and safety of persons entrusted to his or her care;

7-29

     (D) Had his or her authorization to practice as an advanced practice nurse denied,

7-30

revoked or suspended in another state;

7-31

     (E) Engaged in the performance of medical functions beyond the scope of practice

7-32

authorized by the provisions of this chapter;

7-33

     (F) Willfully failed to file or record medical records and reports;

8-34

     (G) Mental incompetence; or

8-35

     (H) Willfully failed to maintain standards established by the nursing profession.

8-36

     (ii) The recommendation shall be submitted to the board of nursing for implementation.

8-37

     (3) To advise periodically to the board of nurse registration and nursing education

8-38

regarding advanced nurse practice.

8-39

     5-34-42.Global signature authority of certified registered nurse. Global signature

8-40

authority of APRN -- Whenever any provision of the general or public law, or regulation

8-41

requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, it

8-42

shall be deemed to include a signature, certification, stamp, verification, affidavit or endorsement

8-43

by a certified registered nurse practitioner an advanced practice registered nurse; provided,

8-44

however, that nothing in this section shall be construed to expand the scope of practice of nurse

8-45

practitioners APRNS.

8-46

     SECTION 2. Sections 5-34-40.1 and 5-34-40.2 of the General Laws in Chapter 5-34

8-47

entitled “Nurses” are hereby repealed in its entirety.

8-48

     5-34-40.1.Qualifications of a psychiatric and mental health clinical nurse specialist

8-49

applicant. -- (a) An applicant for licensure as a psychiatric and mental health clinical nurse

8-50

specialist shall submit to the board written evidence on forms furnished by the department of

8-51

health, verified by oath, that the applicant:

8-52

     (1) Is a registered nurse who has completed an accredited educational program resulting

8-53

in a master's degree in psychiatric and mental health nursing; and/or

8-54

     (2) Passed a national qualifying examination recognized by the board.

8-55

     (b) All persons who are engaged in the practice of a psychiatric and mental health clinical

8-56

nurse specialist on July 1, 2003, who meet the definition in § 5-34-3(i) may be considered to have

8-57

met the qualifications for licensure providing they have three (3) years experience acceptable to

8-58

the board between January 1, 1997, and January 1, 2003. After January 1, 2004, all applicants for

8-59

initial licensure must complete an accredited educational program resulting in a master's degree in

8-60

nursing and must pass a national qualifying examination recognized by the board.

8-61

     5-34-40.2. Licensing of psychiatric and mental health clinical nurse specialists. -- A

8-62

license to practice as a psychiatric clinical nurse specialist shall be issued if the applicant meets

8-63

the qualifications for the psychiatric and mental health clinical nurse specialist. Persons who meet

8-64

the qualifications of a psychiatric and mental health clinical nurse specialist, as stated in § 5-34-

8-65

40.1, and are currently licensed as psychiatric and mental health clinical nurse specialists by

8-66

examination or endorsement under the laws of another state or territory of the United States

8-67

and/or the District of Columbia shall be allowed to practice as psychiatric and mental health

8-68

clinical nurse specialists in this state for a period not to exceed ninety (90) days from the date of

9-1

clearance by the board of nurse registration and nursing education of the Rhode Island department

9-2

of health, provided that they are licensed in this state within ninety (90) days. The original

9-3

privilege to work ninety (90) days from the date of clearance shall not be extended or renewed.

9-4

     SECTION 3. Chapter 5-34 of the General Laws entitled “Nurses” is hereby amended by

9-5

adding thereto the following section:

9-6

     5-34-44. Status of current licensees.-- (a) Any person holding a license to practice

9-7

nursing as a Registered Nurse Practitioner (RNP), Psychiatric Clinical Nurse Specialist, Certified

9-8

Registered Nurse Anesthetist in this state that is valid on December 31, 2013 shall be deemed to

9-9

be licensed as an APRN, with his or her current privileges and shall be eligible for renewal of

9-10

such license as defined under the provisions of this chapter or chapter 5-34.2.

9-11

     (b) Any person holding a valid license to practice nursing, having graduated from an

9-12

accredited course of study, actively practicing in an advanced practice role, and holding national

9-13

certification related to his or her current practice setting, as of Dec. 31, 2013, as defined in

9-14

chapters 5-34 or 5-34.2 shall be deemed to be eligible to license as an APRN.

9-15

     (c) After December 31, 2013, all new applicants for APRN licensure must meet the

9-16

stipulated licensure requirements.

9-17

     (d) An APRN applying for licensure by endorsement in another state would be eligible

9-18

for licensure if he/she demonstrates that the following criteria have been met:

9-19

     (1) Current, active practice in the advanced role; and

9-20

     (2) Current active national certification, or recertification as applicable, in the advanced

9-21

role.

9-22

     SECTION 4. Sections 5-34.2-2 and 5-34.2-3 of the General Laws in Chapter 5-34.2

9-23

entitled “Nurse Anesthetists” are hereby amended to read as follows:

9-24

     5-34.2-2. Definitions. -- (a) "Board" means the board of nurse registration and nurse

9-25

education established in § 5-34-4.

9-26

       (b) "Certified registered nurse anesthetist" (CRNA) means a registered nurse who has

9-27

successfully met the requirements stated in this chapter.

9-28

       (c) "Practice of certified registered nurse anesthesia" means providing certain health

9-29

care services under the supervision of in collaboration with anesthesiologists, licensed physicians,

9-30

or licensed dentists in accordance with § 5-31.1-1(16) which requires substantial specialized

9-31

knowledge, judgment and skill related to the administration of anesthesia, including preoperative

9-32

and postoperative assessment of patients; administering anesthetics; monitoring patients during

9-33

anesthesia; management of fluid in intravenous therapy and management of respiratory care.

10-34

     5-34.2-3. Requirements for licensure of the nurse anesthetist. -- Requirements for

10-35

licensure as a nurse anesthetist shall consist of the following:

10-36

       (1) Current licensure as a professional registered nurse in the state; and

10-37

       (2) Graduation from an educational program accredited by the American Association of

10-38

Nurse Anesthetists council on accreditation of nurse anesthesia educational programs or its

10-39

predecessors or successors, and which has as its objective preparation of nurses to practice nurse

10-40

anesthesia; and

10-41

       (3)(2) Initial certification by the American Association of Nurse Anesthetists council on

10-42

certification of nurse anesthetists and recertification, as applicable by the American Association

10-43

of Nurse Anesthetists council on recertification of nurse anesthetists or their predecessors or

10-44

successors.

10-45

       (4) The requirements stated in subdivision (3) of this section do not apply to a graduate

10-46

nurse anesthetist awaiting initial certification results, providing that initial certification is

10-47

accomplished within ninety (90) days upon completion of an accredited nurse anesthesia

10-48

educational program.

10-49

       (5)(3)The requirements stated in subdivisions (2) and (3) of this section do not apply to

10-50

a professional registered nurse who practices nursing in accordance with the provisions of the

10-51

Nurse Practice Act, chapter 34 of this title, and who is enrolled as a bona fide student in an

10-52

accredited nurse anesthesia program providing nurse anesthesia under the supervision of a

10-53

certified registered nurse anesthetist and anesthesiologist.

10-54

       (6)(4) Beginning July 21, 1992, all nurse anesthetists shall be afforded the same period

10-55

of time to become licensed. Notwithstanding the provisions of this section, no person practicing

10-56

as a nurse anesthetist in Rhode Island on July 1, 1991, shall be required to obtain proper

10-57

certification under this chapter. However, as required by subdivision (3) of this section, persons

10-58

who become certified under this section shall become recertified as applicable.

10-59

     SECTION 2. This act shall take effect upon passage.

     

=======

LC01837

=======

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO BUSINESSES AND PROFESSIONS - NURSES AND NURSE

ANESTHETISTS

***

11-1

     This act would amend the general laws to recognize the Advanced Practice Registered

11-2

Nurse.

11-3

     This act would take effect upon passage.

     

=======

LC01837

=======

S2558