Chapter 125
2003 -- S 0827 SUBSTITUTE B
Enacted 07/09/03
AN ACT
RELATING
TO BUSINESSES AND PROFESSIONS -- NURSES
Introduced
By: Senators Polisena, Roberts, Lanzi, Damiani, and
DaPonte
Date
Introduced: February 26, 2003
It
is enacted by the General Assembly as follows:
SECTION
1. Chapter 5-34 of the General Laws entitled "Nurses" is hereby
amended by
adding
thereto the following section:
5-34-1.1.
Title of act. – This act shall be known and may be cited as
"The Rhode Island
Nurse
Practice Act."
SECTION
2. Sections 5-34-3, 5-34-4, 5-34-5, 5-34-6, 5-34-7, 5-34-9, 5-34-14, 5-34-18,
5-34-19,
5-34-20, 5-34-24.1, 5-34-25, 5-34-26, 5-34-31, 5-34-35, 5-34-39, 5-34-40 and
5-34-41
of
the General Laws in Chapter 5-34 entitled "Nurses" are hereby amended
to read as follows:
5-34-3.
Definitions. -- (a) "Approval" means the process where the
board of nursing
evaluates
and grants official recognition to basic nursing education programs meeting
established
criteria
and standards.
(b) "Certified registered nurse practitioner" is an advanced role
practice nurse utilizing
independent
knowledge of physical assessment and management of health care and illnesses.
The
practice
includes prescriptive privileges. The practice includes collaboration with
other licensed
health
care professionals including, but not limited to, physicians, pharmacists,
podiatrists,
dentists
and nurses.
(c) "Health" means optimum well-being.
(d) "Healthcare" means those services provided to promote the optimum
well-being of
individuals.
(e) "Licensed" means the status of qualified individuals who have
completed a
designated
process by which the board of nursing grants permission to individuals
accountable
and/or
responsible for the practice of nursing and to engage in that practice,
prohibiting all others
from
legally doing so.
(f) "Nursing" means the provision of services that are essential to
the promotion,
maintenance,
and restoration of health throughout the continuum of life. It provides care
and
support
of individuals and families during periods of wellness, illness, and injury,
and
incorporates
the appropriate medical plan of care prescribed by a licensed physician, dentist,
or
podiatrist.
It is a distinct component of health services. Nursing practice is based on
specialized
knowledge,
judgment, and nursing skills acquired through educational preparation in
nursing and
in
the biological, physical, social, and behavioral sciences.
(g) "Practical nursing" is practiced by licensed practical nurses
(L.P.N.s). It is an integral
part
of nursing based on a knowledge and skill level commensurate with education. It
includes
promotion,
maintenance, and restoration of health and utilizes standardized procedures
leading to
predictable
outcomes which are in accord with the professional nurse regimen under the
direction
of a professional
registered nurse. In situations where professional registered
nurses are not
employed,
the licensed practical nurse functions under the direction of a licensed
physician,
dentist,
or podiatrist or other licensed health care providers authorized by
law to prescribe. Each
L.P.N.
is responsible for the nursing care rendered.
(h) "Professional nursing" is practiced by registered nurses (R.N.s).
The practice of
professional
nursing is a dynamic process of assessment of an individual's health status,
identification
of health care needs, determination of health care goals with the individual
and/or
family
participation and the development of a plan of nursing care to achieve these
goals. Nursing
actions,
including teaching and counseling, are directed toward the promotion,
maintenance, and
restoration
of health and evaluation of the individual's response to nursing actions and
the
medical
regimen of care. The professional nurse provides care and support of
individuals and
families
during periods of wellness and injury, and incorporates where appropriate, the
medical
plan
of care as prescribed by a licensed physician, dentist or podiatrist or other
licensed health
care
providers authorized by law to prescribe. Each R.N. is directly accountable and
responsible
to
the consumer for the nursing care rendered.
(i) "Psychiatric and mental health nurse clinical specialist" is an
advanced role practice
nurse utilizing independent
knowledge and management of mental health and illnesses. The
practice
including may include prescription privileges of certain legend
medications, controlled
substances
from Schedule II classified as stimulants, and controlled substances from Schedule
IV.
within
the scope of their practice. The practice may include collaboration with
other licensed
health
care professionals, including, but not limited to, psychiatrists,
psychologists, physicians,
pharmacists,
and nurses. The psychiatric and mental health clinical specialist has a
masters degree
in
nursing, has an active license as a registered nurse and is certified by a
national body as
approved
by the Rhode Island board of nurse registration and nursing education. holds the
qualifications
defined in section 5-34-40.1.
(j)
"Advanced practice nurse" means the status of qualified individuals
who hold an
active
license as a registered nurse and an active license as a nurse in an advanced
role as defined
under
the provisions of this chapter or chapter 5-34.2.
(k)
"Department" means the department of health.
5-34-4.
Board of nursing -- Establishment -- Composition -- Appointment, terms,
and
removal of members -- Director of nursing education Board of nursing --
Establishment
--
Composition -- Appointment, terms, and removal of members -- Director of nurse
registration
and nursing education. -- (a) Within the division of professional
regulation,
pursuant
to chapter 26 of this title, there is a board of nurse registration and nursing
education.
The
board is composed of eleven (11) fifteen (15) members. The term
of office is for three (3)
years.
No member serves more than two (2) consecutive terms. The member serves until a
qualified
successor is appointed to serve. In making those appointments, the director of
health
considers
persons suggested by professional nurse organizations and the practical nurse's
association.
(b) Present members of the board holding office under the provisions of this
chapter as
amended,
entitled "Nurses", serve as members of the board until the expiration
of their terms or
until
qualified successors are appointed. The eleven (11) fifteen (15)
member board includes:
seven
(7) eleven
(11) professional nurses, two (2) practical nurses appointed by the
director of
health
and approved by the governor and two (2) members of the general public
appointed by the
governor.
Three (3) professional nurses are from different basic education programs
preparing
students
to become professional nurses; one professional nurse is from a basic
education program
preparing
students to become practical nurses; one (1) professional nurse is from a
nursing
service
administration; and two (2) four (4) professional
nonadministrative, clinical nurses not
licensed
as advanced practice nurses, and three (3) professional advanced practice
nurses, one (1)
who
holds a license as a certified registered nurse anesthetist, one (1) who holds
a license as a
certified
registered nurse practitioner, and one (1) who holds a license as a psychiatric
and mental
health
nurse clinical specialist. No educational program or cooperating agency has more than
one
representative
on the board.
(c) The director of health may remove any member from the board for cause
including,
but
not limited to, neglect of any duty required by law, or incompetence, or
unprofessional
conduct,
or willful misconduct. A member subject to disciplinary proceedings is
disqualified from
board
business until the charge is adjudicated. There is also a director of nurse
registration and
nursing
education appointed by the director of health in accordance with the provisions
of chapter
4 of
title 36. , who serves as executive secretary of the board.
5-34-5.
Board of nursing -- Qualifications of members. -- (a) Each member of
the
board
of nurse registration and nursing education shall:
(1) Be a citizen of the United States;
(2) Be a resident of the state for at least one year immediately preceding
appointment;
(3) File the statutory oath of office with the secretary of state before
beginning the term
of
office; and
(4) Sign a conflict-of-interest statement.
(b) Each professional nurse member of the board is:
(1) Currently licensed as a registered nurse in the state; and
(2) Has at least five (5) years' experience in nursing practice or
administration, nursing
service,
or teaching or administration in a nursing education program and is currently
employed
in
nursing at the time of appointment and employed in nursing for at least three
(3) years
immediately
preceding appointment.
(c) Each practical nurse member of the board is:
(1) Currently licensed as a practical nurse in the state; and
(2) Has at least five (5) years' experience in practical nursing and is
currently employed
in
nursing for at least three (3) years immediately preceding appointment.
(d) Each advanced practice nurse member of the board:
(1) Is currently licensed as an advanced practice nurse in the state; and
(2) Has at least five (5) years experience in nursing practice and is
currently employed as
an
advanced practice nurse for at least three (3) years immediately preceding
appointment.
(e)
Neither member from the general public is a nurse or is enrolled in a nursing
education
program.
5-34-6.
Board of nursing -- Organization -- Meetings. -- The board of nurse
registration
and nursing education elects annually from its membership a president and vice-
president.
A secretary is also elected. The state director of nurse registration and
nursing
education
serves as executive secretary to the board but is not a member of the
board. Meetings
may
be called by the president, vice-president, executive secretary director
of nurse registration
and
nursing education,
director of health, or upon written request of five (5) members of the
board.
A majority constitutes a quorum at any meeting.
5-34-7.
Board of nursing -- General powers. -- The board of nurse registration
and
nursing
education is authorized, subject to the approval of the director of health, to:
(1) Adopt, review, or revise rules, and regulations consistent with the law
that may be
necessary
to effect provisions of the chapter;
(2)
Approve nursing education programs according to the rules established by the
board;
(2) Prescribe standards for nursing education programs preparing persons for
licensure
under
this chapter;
(3) Provide for evaluation of nursing education programs and related clinical
facilities at
those
times it may deem necessary;
(4) Approve nursing education programs that meet the requirements of the
chapter;
(5) Deny or withdraw approval from nursing education programs for failure to
meet or
maintain
prescribed standards; provided, that withdrawal of approval is effected only
after a
hearing
in accordance with the board's rules and regulations;
(6) (3) Require standards for nursing practice within organized
nursing services and the
individual
practice of licensees;
(7) (4) Approve and administer the examinations for
licensure;
(8) (5) Establish requirements to validate competence for
reinstatement to the active list;
(9) (6) Conduct hearings upon charges calling for discipline of a
licensee or revocation
of a
license;
(10) (7) Issue subpoenas to, compel the attendance of witnesses
at, and administer oaths
to
persons giving testimony at hearings;
(11) (8) Cause the prosecution or enjoinder of all persons
violating this chapter;
(12) (9) Maintain a record of all its proceedings;
(13) (10) Submit an annual report to the director of health;
(14) (11) Utilize other persons that may be necessary to carry on
the work of the board;
(15) (12) Conduct public hearings, investigations, and studies of
nursing practice,
nursing
education, and related matters and prepare and issue publications that, in the
judgment of
the
board, allowing the nursing profession to provide safe, effective
nursing services to the
public;
(16) (13) Determine qualifications necessary for prescriptive
privileges for certified
registered
nurse practitioners; and
(17) (14) Grant certified registered nurse practitioners
prescriptive privileges and
transmit
this information to the board of pharmacy. ;
(15)
Determine qualification necessary for the prescriptive privileges for
psychiatric and
mental
health clinical nurse specialists; and
(16)
Grant certified psychiatric and mental health clinical nurse specialists
prescriptive
privileges.
5-34-9.
Register of nurses -- Records -- Issuance of licenses. -- The administrator
of
professional
regulation
department licenses and renews licenses upon the recommendation of the
board
of nurse registration and nursing education and maintains a roster of all
applicants for
licensure
and all nurses licensed under this chapter, which is open at all reasonable
times to
public
inspection; and is custodian of all records pertaining to the roster and
licensing of all
nurses;
and has the custody of the official seal. He or she The department
issues all licenses to
practice
nursing only upon recommendation of the board of nurse registration and nursing
education.
5-34-14.
Qualifications of practical nurse applicants. -- An applicant for a license
to
practice
as a licensed practical nurse submits to the board of nurse registration and
nursing
education
written evidence on forms furnished by the division of professional
regulation
department, verified by oath, that
the applicant:
(1) Has completed the preliminary educational requirements prescribed by the
board;
(2) Has furnished satisfactory proof that he or she successfully
completed the prescribed
curriculum
in a an state-approved program of practical nursing and
holds a diploma or certificate
from
the program or is a graduate of an approved school of professional nursing
or was a student
in
good standing at an approved school of professional nursing before completing
the program of
studies
and, at the time of withdrawal, had completed a program of study, theory and
clinical
practice
equivalent to that required for graduation from an approved school of practical
nursing
if
the
applicant has not been previously licensed; and
(3) Is of good moral character.
5-34-18.
Signature on licenses for nursing. -- All original licenses to practice
nursing
either
as a professional or practical nurse under this chapter is are
signed by the president and
executive
secretary of the board the director of nurse registration and nursing
education, the
administrator
of professional regulation, and the director of health.
5-34-19.
Expiration and renewal of licenses. -- (a) The license of every person
licensed
under
this chapter expires on the first day of March of every other year following
the date of
license.
This will be determined on an odd-even basis. On or before the first day
of January of
every
year, the administrator of professional regulation the director
mails an application for
renewal
of license to people scheduled to be licensed that year on an odd-even basis
with respect
to
the license number.
Every person who wishes to renew his or her license files with the
administrator
of professional regulation department a renewal application duly executed
together
with
the renewal fee of sixty-two dollars and fifty cents ($62.50).
(b) Upon receipt of an application accompanied by payment of fees, the administrator
of
professional
regulation
department grants a renewal license effective March second and expiring
two
(2) years later on March first, and that renewal license renders the holder a
legal practitioner
of
nursing for the period stated on the certificate of renewal. ;
provided that every person seeking
renewal
of a license hereunder shall provide satisfactory evidence to the department
that in the
preceding
two (2) years the practitioner has completed the ten (10) required continuing
education
hours
as established by the department through rules and regulations. The department
may extend
for
only one (1) six (6) month period these educational requirements if the
department is satisfied
that
the applicant has suffered hardship which prevented meeting the educational
requirement.
(c) Any person practicing nursing during the time his or her license has lapsed
is
considered
an illegal practitioner and is subject to the penalties provided for violation
of this
chapter.
(d)
A licensee whose license has expired by failure to renew may apply for
reinstatement
according
to the rules established by the board. Upon satisfaction of the requirements
for
reinstatement,
the board shall issue a renewal of license.
5-34-20.
Transfer to inactive list -- Reinstatement. -- A nurse who does not
intend to
practice
nursing during the two (2) year period, upon written request to the administrator
of
professional
regulation
department, may have his or her name transferred to an inactive list and
is
not
required to pay the renewal fee for as long as the inactive status is
maintained. Should that
nurse
resume practice at some future time, he or she notifies the administrator of
professional
regulation
and remits the renewal fee, and the license is reinstated. A licensee whose
license has
been
transferred to the inactive list may apply for reactivation according to the
rules established
by
the board. Upon satisfaction of the requirements for reinstatement, the
department shall issue
a
renewal of license.
5-34-24.1.
Nondisciplinary alternative. -- The board of nurse registration and
nursing
education may provide for a
nondisciplinary alternative in situations involving alcohol and drug
abuse;
or any mental illness as listed in the most recent revised publication or
the most updated
volume
of either the Diagnostic and Statistical Manual of Mental Disorders (DSM)
published by
the
American Psychiatric Association or the International Classification of Disease
Manual (ICO)
published
by the World Health Organization and that substantially limits the life
activities of the
person
with the illness;
provided, that the nurse agrees to voluntarily participate in a program of
treatment
and rehabilitation. All records pertaining to a nurse's participation in the
nondisciplinary
program are confidential and not subject to discovery, subpoena or public
disclosure.
Provided, that information related to the nondisciplinary program is provided
to the
nurse's
employer to ensure adequate worksite monitoring and compliance.
5-34-25.
Procedure for discipline of licensees. -- (a) Upon filing a timely
sworn
complaint
within a time period the board considers reasonable with the board charging a
person
with
having been guilty of any of the actions specified in section 5-34-24, two (2)
or more
members
of the board of nurse registration and nursing education immediately shall
investigate
those
charges, or the board, after investigation, may institute charges.
(b)
In the event that investigation, in the opinion of the board, reveals
reasonable grounds
for
believing the applicant or licensee is guilty of the charges, the board fixes
a time and place for
a
hearing of the charges and causes a copy of the charges, together with a notice
of the time and
place
fixed for the hearing, to be personally served upon the accused shall notify the
licensee of
the
charges and the time and place for a hearing at least twenty (20) days prior to the
time fixed
for
the hearing. When personal service cannot be effected and that fact is
certified by oath by any
person
authorized to make service, the board causes to be published once in each of
two (2)
successive
weeks a notice of the hearing in a newspaper published in the county where the
defendant
last resided according to the records of the board and mails a copy of the
charges and
the
notice to the accused at his or her last known address. When publication of
notice is
necessary,
the date of the hearing is not less than twenty (20) days after the last date
of
publication
of the notice.
At the hearing, the accused has the right to appear personally, or by
counsel,
or both, to produce witnesses and to have subpoenas issued by the board. The
attendance
of
witnesses and the production of books, documents, and papers at the hearing may
be
compelled
by subpoenas issued by the board, which is served in accordance with the law.
At the
hearing,
the board administers oaths that may be necessary for the proper conduct of the
hearing.
The
board is not bound by the strict rules of procedure or by the laws of evidence
in the conduct
of
its proceedings, but the determination is based upon sufficient legal evidence
to sustain it. The
board
shall complete the investigation of each complaint and issue a decision within
six (6)
months
of the receipt of the complaint; provided, however, that the board may extend
the time for
issuing
its decision beyond the initial six (6) month period in documented cases in
which delays
in
the process are the direct result of requests or actions by the accused and/or
his or her
representative(s)
or other good cause. The board, on a case by case basis, for good cause shown
in
writing,
may extend the time for issuing its decision. If the accused is found guilty of
the charges,
the
board may revoke, suspend, or otherwise discipline a licensee. If the
accused is found guilty
of
the charges, the board may revoke, suspend, or discipline a licensee.
(b) Upon revocation or suspension of a license, the holder surrenders the
license to the
administrator
of professional regulation, who strikes the name of the holder from the current
roster
of licensed nurses. The date and action taken is recorded. The case of a
licensee with a
revoked
or suspended license is reviewed at the discretion of the board. The case of a
licensee
who
was reprimanded or disciplined by the board should be recorded as to the date
and the action
taken
and may be reviewed at the discretion of the board.
(c)
All hearings held under this section shall be conducted in accordance with the
provisions
of chapter 42-35 entitled "Administrative Procedures Act."
5-34-26.
Grounds for discipline without a hearing. -- In the event a person
is
hospitalized
for mental illness, or for substance abuse, the board may, without the necessity
of the
proceedings
provided for in section 5-34-25, suspend or refuse to renew the license of that
person
for
the duration of that confinement or until that person is medically discharged
from that
hospitalization. The director may
temporarily suspend the license of a nurse without a hearing if
the
director finds that evidence in his or her possession indicates that a nurse's
continuation in
practice
would constitute an immediate danger to the public. In the event that the
director
temporarily
suspends the license of a nurse without a hearing, a hearing by the board must
be held
within
ten (10) days after the suspension has occurred.
5-34-31.
Practices and persons exempt. -- No provisions of this chapter are
construed
as
prohibiting: (1) gratuitous nursing by friends or members of the family or as
prohibiting the
care
of the sick by domestic servants, housekeepers, nursemaids, companions, or
household aides
of
any type, whether employed regularly or because of an emergency of illness,
provided that
person
is employed primarily in a domestic capacity and does not hold himself or
herself out or
accept
employment as a person licensed to practice nursing for hire under the
provisions of this
chapter
or as prohibiting nursing assistants in the case of any emergency; (2) the
practice of
nursing
by students enrolled in approved educational programs of professional nursing
or
practical
nursing educational programs nor by graduates of those schools or courses
pending the
results
of the licensing examinations following that graduation, provided that they
are licensed in
this
state within ninety (90) days from the date on the application fee receipt, in accordance with
regulations
prescribed by the board; (3) the practice of nursing in this state by any
legally
qualified
nurse of another state whose engagement requires him or her to accompany and
care for
a
patient temporarily residing in this state during the period of this engagement
not to exceed six
(6)
months in length, provided that person does not represent or hold himself or
herself out as a
nurse
licensed to practice in this state; (4) the practice of any legally qualified
nurse of another
state
who is employed by the United States government or any bureau, division, or
agency of the
government
while in the discharge of his or her official duties; (5) persons employed in
state and
licensed
hospitals and sanatoria, licensed homes for the aged and/or convalescent
persons, and
recognized
public health agencies from assisting in the nursing care of patients if
adequate
medical
or nursing supervision is provided; (6) nursing care of the sick with or
without
compensation
or personal profit when done in connection with the practice of the religious
tenets
of
any recognized or established church by adherents as long as they do not engage
in the practice
of
nursing as defined in this chapter; (7) persons who provide acceptable evidence
of being
currently
licensed by examination or endorsement under the laws of other states of the
United
States
and the District of Columbia from practicing nursing in this state for a period
of ninety (90)
days
from the date on the application fee receipt, provided that they are licensed
in this state
within
ninety (90) days from the date on the application fee receipt. The original
privilege to
work
ninety (90) days from the date on the application fee receipt is not extended
or renewed.
5-34-35.
Qualifications of a certified registered nurse practitioner applicant. –
(a)
An
applicant for licensure to practice as a certified registered nurse
practitioner submits to the
board
of nurse registration and nursing education written evidence on forms furnished
by the
division
of professional regulation, verified by oath, that the applicant:
(1) Is The applicant is a registered nurse who has completed an
accredited educational
program
resulting in a master's degree in nursing and/or an approved nurse practitioner
course of
study.
This curriculum must include both a didactic component and supervised clinical
experience.
Effective January 1, 2004 all applicants for initial licensure must complete
an
accredited
educational program resulting in a master's degree with a major in nursing.
(2) Passed The applicant passed a national qualifying examination
recognized by the
board
of nurse registration and nursing education.
(b)
A license to practice as a certified registered nurse practitioner may be
issued to an
applicant
who is licensed by examination or endorsement as a certified registered nurse
practitioner
under the laws of another state or territory if, in the opinion of the board,
the
applicant
meets the qualifications required of certified registered nurse practitioners
in this state.
5-34-39.
Process for prescriptive privileges of certified registered nurse
practitioner
--
Formulary committee Process for prescriptive privileges of
certified registered nurse
practitioner.
-- (a)
Prescriptive privileges for the certified registered nurse practitioner:
(1) Are granted under the governance and supervision of the division of
professional
regulation department,
board of nurse registration and nurse education; and
(2) Include prescription of legend medications and prescription of controlled
substances
from
schedules II, III, IV and V that are established in regulation by the
director with the advice
of
the formulary committee established by this section; and
(3) Must not include controlled substances from Schedule I.
(b) The director of the department of health establishes a formulary
committee to
develop
a formulary to carry out the provisions of this section. The formulary is
updated annually
by
the formulary committee. Each setting where these privileges are allowed, may
further restrict
the
formulary according to their own protocols. The committee consists of two (2)
physicians,
from
a list submitted by the Rhode Island medical society, one pharmacist, from a
list submitted
by
the Rhode Island pharmaceutical association, two (2) certified registered nurse
practitioners,
from
a list submitted by the Rhode Island state nurses association and one who is
the department
of
health's drug control administrator or designee. The committee submits a
completed formulary
to
the director of the department of health of the state by September 1, 1996.
(c) Each committee member is initially appointed for a one year term by the
director of
the
department of health. At the expiration of the one year term, one certified
registered nurse
practitioner
is appointed for a three (3) year term, one certified registered nurse
practitioner is
appointed
for a two (2) year term; one physician is appointed for a three (3) year term,
one
physician
is appointed for a two (2) year term; one pharmacist is appointed for a three
(3) year
term.
Subsequently, each appointment is for three (3) years with no member serving
more than
two
(2) consecutive three (3) year terms.
(d) (b) A certified registered nurse practitioner (R.N.P.) as
stated in section 5-34-3 is
permitted
to prescribe from the formulary established by the formulary committee
in accordance
with
annually updated guidelines, written in collaboration with the medical director
or physician
consultant
of their individual establishments.
(e) (c) To qualify for prescriptive privileges an applicant must
submit on forms provided
by
the board of nurse registration and nursing education, verified by oath, that
the applicant has
evidence
of completion of thirty (30) hours of education in pharmacology within the
three (3)
year
period immediately prior to date of application. To maintain prescriptive
privileges the
certified
registered nurse practitioner (R.N.P.) must submit upon request of the board of
nurse
registration
and nursing education evidence of thirty (30) hours continuing education in
pharmacology
every six (6) years.
5-34-40.
Nurse practitioner joint practice advisory committee Certified
registered
nurse
practitioner joint practice advisory committee. -- (a) The seven (7)
member committee
consists
of three (3) physicians, three (3) certified registered nurse practitioners,
and one
consumer.
The governor appoints three (3) physicians to the committee from the following
specialties
-- adult medicine, pediatric medicine, and obstetrical-gynecological medicine.
The
governor
appoints three (3) certified registered nurse practitioners from the following
specialties -
-
adult nurse practitioner, pediatric nurse practitioner, and
obstetrical-gynecological nurse
practitioner.
The professional members of the committee are currently engaged in a
collaborative
certified
registered nurse practitioner-physician care practice. The consumer member is
appointed
by
the director of the department of health of the state. The consumer member is
(1)
knowledgeable
in consumer health concerns; (2) a resident of the state; (3) not licensed as a
health
care practitioner; (4) not a parent, spouse, sibling, or child of a person
licensed as a health
care
practitioner, and not a student in a professional program; (5) not having a
direct financial
interest
in health care services; (6) not a member or an employee of any board of control
of any
public
or private health care service.
(b) Each professional committee member and the consumer member are initially
appointed
for a one year term. At the expiration of the one year term, one certified
registered
nurse
practitioner and one physician shall be appointed for a three (3) year term,
one certified
registered
nurse practitioner and one physician are appointed for a two (2) year term, and
one
certified
registered nurse practitioner, one physician and the consumer member are appointed
for
a
one year term. Subsequently, each Each member appointment is for three (3)
years, with no
member
serving more than two (2) consecutive three (3) year terms.
(c) This committee must meet not fewer than two (2) times per year. The committee
has
the
following functions:
(1) To assess nurse practitioner joint primary care practice for the purpose of
improving
patient
care.
(2) Review complaints regarding certified registered nurse practitioners, and
recommend
any disciplinary
or corrective action that they deem appropriate, including revocation and
suspension
of certification, upon proof that a nurse practitioner has:
(i) Aided or abetted an uncertified person to practice as a nurse practitioner;
(ii) Become addicted to the use of liquor or controlled substances;
(iii) Negligently, willfully, or intentionally acted in a manner inconsistent
with the health
and
safety of persons entrusted to his or her care;
(iv) Had his or her authorization to practice as a nurse practitioner denied,
revoked or
suspended
in another state;
(v) Engaged in the performance of medical functions beyond the scope of
practice
authorized
by the provisions of this chapter;
(vi) Willfully failed to file or record medical records and reports; or
(vii) Mental incompetence.
(3) The recommendation is submitted to the board of nursing for
implementation,.
subject
to the approval of the director of health. Provided, that the board of nursing
may, if they
have
clear and convincing evidence that actions of the nurse practitioner that led
to the
recommendation
is more appropriately the responsibility of their board, request that the
director
of
health review the case and make a determination as to which entity has
responsibility for the
case.
(4) Report periodically to the board of nurse registration and nursing
education regarding
certified
registered nurse practitioner practice.
5-34-41.
Process for prescriptive privileges of psychiatric and mental health nurse
clinical
specialist -- Formulary committee Process for
prescriptive privileges of psychiatric
and
mental health clinical nurse specialist. -- (a) Prescriptive
privileges for the psychiatric and
mental
health clinical nurse clinical specialist:
(1) Are granted under the governance and supervision of the division of
professional
regulations,
board of nurse registration and nurse education; and
(2) Include prescription of certain psychotropic and certain legend medications;,
controlled
substances from Schedule II classified as stimulants, and prescription of
controlled
substances
from Schedule IV, that are prescribed in regulations by the director with
the advice
and
consent of the formulary committee established by this section; and
(3) Do not include controlled substances from Schedules I, II, III and V and
those certain
legend
medications not included in subdivision (2).
(4)
Are granted for psychiatric and mental health clinical nurse specialists who
have a
master's
degree in nursing.
(b) The director of the department of health establishes a formulary committee
to
develop
a formulary to carry out the provisions of this section. The formulary is updated
annually
by
the formulary committee. Each setting may further restrict the formulary
according to their
own
protocols. The committee consists of two (2) psychiatrists from a list
submitted by the R.I.
Medical
Society, two (2) psychiatric and mental health nurse clinical specialists, from
a list
submitted
by the R.I. State Nurses Association, one pharmacist, from a list submitted by
the R.I.
Pharmacists
Association, and one who is the department of health's chairperson of the board
of
pharmacy
or designee. The committee must submit a completed formulary to the director of
the
department
of health of the state of R.I. by September 1, 1997.
(c) Each committee member is initially appointed for a one year term by the
director of
the
department of health. At the expiration of the one year term, one psychiatrist
is appointed for
a
three (3) year term and one psychiatrist is appointed for a two (2) year term;
one psychiatric and
mental
health nurse clinical specialists is appointed for a three (3) year term and
one psychiatric
and
mental health nurse clinical specialists is appointed for a two (2) year term;
the pharmacist is
appointed
to a three (3) year term. Subsequently, each appointment is for three (3) years
with no
member
serving more than two (2) consecutive three (3) year terms.
(d) (b) A psychiatric and mental health clinical nurse clinical
specialist as stated in
section
5-34-3, is permitted to prescribe from the formulary established by the
formulary
committee in accordance with
annually updated guidelines, written in collaboration with the
medical
director or physician consultant of their individual establishments.
(e) (c) Provided, that a psychiatric and mental health clinical
nurse clinical specialist in
independent
practice does not have prescriptive privileges.
(f) (d) To qualify for prescriptive privileges a psychiatric and
mental health clinical nurse
clinical specialist, as stated in
section 5-34-3, submits on forms provided by the board of nurse
registration
and nursing education, verified by oath, that the applicant has evidence of
completion
of
thirty (30) hours of education in pharmacology of psychotropic drugs and
certain legend
medications
within the three (3) year period immediately prior to date of application. To
maintain
prescriptive
privileges the psychiatric and mental health clinical nurse clinical
specialist must
submit
upon request of the board of nurse registration and nursing education evidence
of thirty
(30)
hours continuing education in pharmacology of psychotropic drugs every six (6)
years.
SECTION
3. Chapter 5-34 of the General Laws entitled "Nurses" is hereby
amended by
adding
thereto the following sections:
5-34-24.2.
Immunity. – (a) The director of health, director of nursing
registration and
education,
board members, and their agents and employees are immune from suit in any
action,
civil
or criminal, based on any disciplinary proceeding or other official act
performed in good
faith
in the course of their duties under this chapter. There is no civil liability
on the part of, or
cause
of action of any nature against, the board, director, their agents or their
employees or
against
any organization or its members, peer review board or its members, or other
witnesses
and
parties to board proceedings for any statements made in good faith by them in
any reports,
communications,
or testimony concerning an investigation by the board of the conduct or
regarding
the competence of a licensed nurse.
(b)
No licensed health care provider, physician, or limited registrant may
discharge,
threaten
or discriminate against an employee, staff member or any other person for
making a
report
to, giving testimony to, or providing any other communication to the board, a
peer review
organization,
or any appropriate supervisory personnel concerning the unprofessional conduct
or
incompetence
or negligence of a nurse; provided, that the report, testimony or other
communication
was made in good faith.
5-34-40.1.
Qualifications of a psychiatric and mental health clinical nurse specialist
applicant.
– (a)
An applicant for licensure as a psychiatric and metal health clinical nurse
specialist
submits to the board written evidence on forms furnished by the department of
health,
verified
by oath, that the applicant: (1) Is a registered nurse who has completed an
accredited
educational
program resulting in a master's degree in psychiatric and mental health
nursing;
and/or
(2) Passed a national qualifying examination recognized by the board.
(b)
All persons who are engaged in the practice of a psychiatric and mental health
clinical
nurse
specialist on July 1, 2003 who meet the definition in section 5-34-3(i) may be
considered to
have
met the qualifications for licensure providing they have three (3) years
experience
acceptable
to the board between January 1, 1997 and January 1, 2003. After January 1,
2004, all
applicants
for initial licensure must complete an accredited educational program resulting
in a
master's
degree in nursing and must pass a national qualifying examination recognized by
the
board.
5-34-40.2.
Licensing of psychiatric and mental health clinical nurse specialists. –
A
license
to practice as a psychiatric clinical nurse specialist is issued if the
applicant meets the
qualifications
for the psychiatric and mental health clinical nurse specialist. Persons who
meet
the
qualifications of a psychiatric and mental health clinical nurse specialist, as
stated in section
5-34-40.1,
and are currently licensed as psychiatric and mental health clinical nurse
specialists by
examination
or endorsement under the laws of another state or territory of the United
States
and/or
the District of Columbia are allowed to practice as psychiatric and mental
health clinical
nurse
specialists in this state for a period not to exceed ninety (90) days from the
date of clearance
by
the board of nurse registration and nursing education of the Rhode Island
department of health,
provided
that they are licensed in this state within ninety (90) days. The original
privilege to
work
ninety (90) days from the date of clearance in not extended or renewed.
5-34-40.3.
Application fee for psychiatric and mental health clinical nurse
specialists.
–
The initial application fee for licensure as a psychiatric and mental health
clinical
nurse
specialist is ninety-three dollars and seventy-five cents ($93.75). The renewal
fee for a
psychiatric
and mental health clinical nurse specialist is eighty-seven dollars and fifty
cents
($87.50)
biennially, sixty-two dollars and fifty cents ($62.50) for the registered nurse
fee plus
twenty-five
dollars ($25.00) for the psychiatric and mental health clinical nurse
specialist. The
fee
for application for prescriptive privileges is thirty-one dollars and
twenty-five cents ($31.25).
5-34-40.4.
Right to use psychiatric and mental health clinical nurse specialist title. –
Any
person who holds a license to practice as a psychiatric and mental health
clinical nurse
specialist
in this state has the right to use the title psychiatric and mental health
clinical nurse
specialist
and use the abbreviation "P.C.N.S." No other person may assume that
title or use that
abbreviation
or any other words or letters, signs, figures, or devices to indicate that the
person
using
it is a psychiatric and mental health clinical nurse specialist.
SECTION
4. Sections 5-34-22, 5-34-23, 5-34-24.2, 5-34-24.3 and 5-34-24.4 of the
General
Laws in Chapter 5-34 entitled "Nurses" are hereby repealed.
5-34-22.
Application for evaluation and approval of basic nursing education
programs.
--
An institution desiring to conduct an educational program of professional or
practical
nursing applies to the board of nurse registration and nursing education and
submits
evidence
that:
(1) It is prepared to carry out the program in accordance with the
board-prescribed
curriculum
standards for professional or practical nursing education; and
(2) It is prepared to meet other standards and criteria established in
accordance with this
chapter
by the board.
5-34-23.
Process for initial and continuing evaluation and approval of basic nursing
education
programs. -- Utilizing the board-prescribed criteria and curriculum
standards for basic
professional
practical nursing education programs, a site visit and an initial evaluation of
a new
basic
nursing education program is made by the state director of nursing education
and/or another
authorized
representative of the board of nurse registration and nursing education, who
submits a
written
report of the findings to the board. If, in the opinion of the board, the criteria
are met by
the
institution, the board grants the program initial approval. Periodically, as
deemed necessary
by
the board, it is the duty of the board, through the state director of nursing
education or other
authorized
representative of the board, to re-evaluate all basic nursing education
programs in this
state.
Written reports of that evaluation are submitted to the board. If the board
determines that
any
approved program of basic nursing education is not maintaining the standards
prescribed by
the
board, notice, in writing, of that deficit is immediately communicated, in
writing, to the
program
director by the board. A program which fails to correct these conditions to the
satisfaction
of the board within a reasonable time and following a hearing on this may be
removed
from the list of state-approved programs of basic nursing education until the
time the
program
complies with the standards required by the board. All approved programs must
maintain
occurring or attempting to procure a license to practice nursing;
(2) Guilty of a crime of gross immorality;
(3) Unfit or incompetent by reason of negligence or habits;
(4) Habitually intemperate or is addicted to the use of habit-forming drugs;
(5) Mentally incompetent;
(6) Guilty of unprofessional conduct which includes, but is not limited to, all
of the
above
and also:
(i) Abandonment of a patient;
(ii) Willfully making and filing false reports or records in the practice of
nursing;
(iii) Willful omission to file or record nursing records and reports required
by law;
(iv) Failure to furnish appropriate details of a client's nursing needs to
succeeding nurses
legally
qualified to provide continuing nursing services to a client;
(v) Willful disregard of standards of nursing practice and failure to maintain
standards
established
by the nursing profession; or
(7) Guilty of and willfully or repeatedly violating any of the provisions of
this chapter
and/or
rule or regulation adopted thereunder.
5-34-24.2.
Criteria which disqualify a nurse from participating in a nondisciplinary
substance
abuse program. -- (1) Nurse previously enrolled in the
nondisciplinary program and
referred
to the board of action.
(2) Nurse who has diverted drugs;
(3) Nurse convicted of the sale, distribution or manufacture of illegal
substances;
(4) Severity of a chemical dependency problem that represents a clear and
present danger
to
patient health and safety;
(5) Any other criteria established by the board of nursing by regulation.
5-34-24.3.
Criteria for admission to the program. -- (a) A nurse may be
considered for
a
nondisciplinary program in the following ways:
(1) By self referral;
(2) By employer referral;
(3) By identification of chemical dependency in conjunction with a sworn
complaint
filed
against the nurse; or
(4) By referral from a family member, friend, nurse peer, another nurse or professional
nurse
association, or other health care provider.
(b) If the nurse does not agree to voluntarily participate in a treatment
program protocol
approved
by the board of nursing, or fails to satisfactorily complete a treatment
program, the
board
of nursing is informed and initiates disciplinary proceedings.
5-34-24.4.
Advisory panel. -- A nondisciplinary alternative advisory panel
is established
to
assist the department of health in developing rules and regulations pursuant to
this chapter. The
panel,
appointed by the director of the department of health, consists of eight (8)
members as
follows:
(1) One person who is a member of the nurse executive committee of the hospital
association
of Rhode Island designated by the president of the hospital association.
(2) One person who is a member of an employee assistance program in Rhode
Island
designated
by the director of the department of health.
(3) One person who is a member of the Rhode Island state nurses association
designated
by
its president.
(4) One person who is a member of the American federation of
teachers/federation of
health
professionals designated by its president.
(5) One person who is a member of the Rhode Island health care association designated
by
its president.
(6) One person who is a member of the Rhode Island association of facilities
for the
aging
designated by its president.
(7) One person who is a member of Rhode Island visiting nurse association
designated
by
its president.
(8) One person who is a member of New England health care employees union,
district
1199
designated by its president.
SECTION
5. This act shall take effect upon passage.
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LC02148/SUB
B
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