2003 -- S 0827 SUBSTITUTE A AS AMENDED

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LC02148/SUB A/4

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2003

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A N A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES

     Introduced By: Senators Polisena, Roberts, Lanzi, Damiani, and DaPonte

     Date Introduced: February 26, 2003

     Referred To: Senate Commerce, Housing & Municipal Government

It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 5-34 of the General Laws entitled "Nurses" is hereby amended by

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adding thereto the following section:

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     5-34-1.1. Title of act. – This act shall be known and may be cited as "The Rhode Island

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Nurse Practice Act."

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     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,

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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

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of the General Laws in Chapter 5-34 entitled "Nurses" are hereby amended to read as follows:

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     5-34-3. Definitions. -- (a) "Approval" means the process where the board of nursing

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evaluates and grants official recognition to basic nursing education programs meeting established

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criteria and standards.

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      (b) "Certified registered nurse practitioner" is an advanced role practice nurse utilizing

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

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practice includes prescriptive privileges. The practice includes collaboration with other licensed

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health care professionals including, but not limited to, physicians, pharmacists, podiatrists,

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dentists and nurses.

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

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

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individuals.

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

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designated process by which the board of nursing grants permission to individuals accountable

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

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from legally doing so.

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

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

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

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

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

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

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

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

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

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

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

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of a professional registered nurse. In situations where professional registered nurses are not

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employed, the licensed practical nurse functions under the direction of a licensed physician,

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dentist, or podiatrist or other licensed health care providers authorized by law to prescribe. Each

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L.P.N. is responsible for the nursing care rendered.

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

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

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

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

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

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

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

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

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

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

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to the consumer for the nursing care rendered.

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

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

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

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substances from Schedule II classified as stimulants, and controlled substances from Schedule IV.

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within the scope of their practice. The practice may include collaboration with other licensed

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health care professionals, including, but not limited to, psychiatrists, psychologists, physicians,

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pharmacists, and nurses. The psychiatric and mental health clinical specialist has a masters degree

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in nursing, has an active license as a registered nurse and is certified by a national body as

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approved by the Rhode Island board of nurse registration and nursing education. holds the

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qualifications defined in section 5-34-40.1.

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

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

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

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

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

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and removal of members -- Director of nursing education Board of nursing -- Establishment

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-- Composition -- Appointment, terms, and removal of members -- Director of nurse

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registration and nursing education. -- (a) Within the division of professional regulation,

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pursuant to chapter 26 of this title, there is a board of nurse registration and nursing education.

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The board is composed of eleven (11) fifteen (15) members. The term of office is for three (3)

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years. No member serves more than two (2) consecutive terms. The member serves until a

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qualified successor is appointed to serve. In making those appointments, the director of health

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considers persons suggested by professional nurse organizations and the practical nurse's

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association.

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

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amended, entitled "Nurses", serve as members of the board until the expiration of their terms or

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until qualified successors are appointed. The eleven (11) fifteen (15) member board includes:

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seven (7) eleven (11) professional nurses, two (2) practical nurses appointed by the director of

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health and approved by the governor and two (2) members of the general public appointed by the

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governor. Three (3) professional nurses are from different basic education programs preparing

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students to become professional nurses; one professional nurse is from a basic education program

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preparing students to become practical nurses; one (1) professional nurse is from a nursing

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service administration; and two (2) four (4) professional nonadministrative, clinical nurses not

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licensed as advanced practice nurses, and three (3) professional advanced practice nurses, one (1)

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who holds a license as a certified registered nurse anesthetist, one (1) who holds a license as a

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certified registered nurse practitioner, and one (1) who holds a license as a psychiatric and mental

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health nurse clinical specialist. No educational program or cooperating agency has more than one

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representative on the board.

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

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

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conduct, or willful misconduct. A member subject to disciplinary proceedings is disqualified from

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board business until the charge is adjudicated. There is also a director of nurse registration and

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nursing education appointed by the director of health in accordance with the provisions of chapter

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4 of title 36. , who serves as executive secretary of the board.

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     5-34-5. Board of nursing -- Qualifications of members. -- (a) Each member of the

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board of nurse registration and nursing education shall:

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      (1) Be a citizen of the United States;

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      (2) Be a resident of the state for at least one year immediately preceding appointment;

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      (3) File the statutory oath of office with the secretary of state before beginning the term

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of office; and

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      (4) Sign a conflict-of-interest statement.

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      (b) Each professional nurse member of the board is:

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      (1) Currently licensed as a registered nurse in the state; and

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      (2) Has at least five (5) years' experience in nursing practice or administration, nursing

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service, or teaching or administration in a nursing education program and is currently employed

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in nursing at the time of appointment and employed in nursing for at least three (3) years

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immediately preceding appointment.

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      (c) Each practical nurse member of the board is:

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      (1) Currently licensed as a practical nurse in the state; and

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      (2) Has at least five (5) years' experience in practical nursing and is currently employed

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in nursing for at least three (3) years immediately preceding appointment.

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      (d) Each advanced practice nurse member of the board:

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      (1) Is currently licensed as an advanced practice nurse in the state; and

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      (2) Has at least five (5) years experience in nursing practice and is currently employed as

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an advanced practice nurse for at least three (3) years immediately preceding appointment.

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     (e) Neither member from the general public is a nurse or is enrolled in a nursing

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education program.

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     5-34-6. Board of nursing -- Organization -- Meetings. -- The board of nurse

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registration and nursing education elects annually from its membership a president and vice-

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president. A secretary is also elected. The state director of nurse registration and nursing

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education serves as executive secretary to the board but is not a member of the board. Meetings

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may be called by the president, vice-president, executive secretary director of nurse registration

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and nursing education, director of health, or upon written request of five (5) members of the

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board. A majority constitutes a quorum at any meeting.

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

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nursing education is authorized, subject to the approval of the director of health, to:

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

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necessary to effect provisions of the chapter;

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

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      (2) Prescribe standards for nursing education programs preparing persons for licensure

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under this chapter;

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      (3) Provide for evaluation of nursing education programs and related clinical facilities at

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those times it may deem necessary;

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      (4) Approve nursing education programs that meet the requirements of the chapter;

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      (5) Deny or withdraw approval from nursing education programs for failure to meet or

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maintain prescribed standards; provided, that withdrawal of approval is effected only after a

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hearing in accordance with the board's rules and regulations;

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

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individual practice of licensees;

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      (7) (4) Approve and administer the examinations for licensure;

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

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

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of a license;

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

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to persons giving testimony at hearings;

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

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      (12) (9) Maintain a record of all its proceedings;

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

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

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

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

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the board, allowing the nursing profession to provide safe, effective nursing services to the

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public;

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

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registered nurse practitioners; and

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      (17) (14) Grant certified registered nurse practitioners prescriptive privileges and

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transmit this information to the board of pharmacy. ;

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

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mental health clinical nurse specialists; and

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

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privileges.

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     5-34-9. Register of nurses -- Records -- Issuance of licenses. -- The administrator of

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professional regulation department licenses and renews licenses upon the recommendation of the

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board of nurse registration and nursing education and maintains a roster of all applicants for

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licensure and all nurses licensed under this chapter, which is open at all reasonable times to

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public inspection; and is custodian of all records pertaining to the roster and licensing of all

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nurses; and has the custody of the official seal. He or she The department issues all licenses to

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practice nursing only upon recommendation of the board of nurse registration and nursing

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education.

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     5-34-14. Qualifications of practical nurse applicants. -- An applicant for a license to

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practice as a licensed practical nurse submits to the board of nurse registration and nursing

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

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department, verified by oath, that the applicant:

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      (1) Has completed the preliminary educational requirements prescribed by the board;

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      (2) Has furnished satisfactory proof that he or she successfully completed the prescribed

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curriculum in a an state-approved program of practical nursing and holds a diploma or certificate

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from the program or is a graduate of an approved school of professional nursing or was a student

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in good standing at an approved school of professional nursing before completing the program of

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studies and, at the time of withdrawal, had completed a program of study, theory and clinical

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practice equivalent to that required for graduation from an approved school of practical nursing if

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the applicant has not been previously licensed; and

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      (3) Is of good moral character.

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     5-34-18. Signature on licenses for nursing. -- All original licenses to practice nursing

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either as a professional or practical nurse under this chapter is are signed by the president and

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executive secretary of the board the director of nurse registration and nursing education, the

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administrator of professional regulation, and the director of health.

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     5-34-19. Expiration and renewal of licenses. -- (a) The license of every person licensed

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under this chapter expires on the first day of March of every other year following the date of

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license. This will be determined on an odd-even basis. On or before the first day of January of

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every year, the administrator of professional regulation the director mails an application for

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renewal of license to people scheduled to be licensed that year on an odd-even basis with respect

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to the license number. Every person who wishes to renew his or her license files with the

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administrator of professional regulation department a renewal application duly executed together

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with the renewal fee of sixty-two dollars and fifty cents ($62.50).

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      (b) Upon receipt of an application accompanied by payment of fees, the administrator of

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professional regulation department grants a renewal license effective March second and expiring

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two (2) years later on March first, and that renewal license renders the holder a legal practitioner

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of nursing for the period stated on the certificate of renewal. provided that every person seeking

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renewal of a license hereunder shall provide satisfactory evidence to the department that in the

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preceding two (2) years the practitioner has completed the ten (10) required continuing education

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hours as established by the department through rules and regulation. The department may extend

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for only one (1) six (6) month period these educational requirements if the department is satisfied

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that the applicant has suffered hardship which prevented meeting the educational requirement.

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      (c) Any person practicing nursing during the time his or her license has lapsed is

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considered an illegal practitioner and is subject to the penalties provided for violation of this

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chapter.

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     (d) A licensee whose license has expired by failure to renew may apply for reinstatement

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according to the rules established by the board. Upon satisfaction of the requirements for

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reinstatement, the board shall issue a renewal of license.

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     5-34-20. Transfer to inactive list -- Reinstatement. -- A nurse who does not intend to

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practice nursing during the two (2) year period, upon written request to the administrator of

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professional regulation department, may have his or her name transferred to an inactive list and is

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not required to pay the renewal fee for as long as the inactive status is maintained. Should that

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nurse resume practice at some future time, he or she notifies the administrator of professional

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regulation and remits the renewal fee, and the license is reinstated. A licensee whose license has

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been transferred to the inactive list may apply for reactivation according to the rules established

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by the board. Upon satisfaction of the requirements for reinstatement, the department shall issue

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a renewal of license.

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     5-34-24.1. Nondisciplinary alternative. -- The board of nurse registration and nursing

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education may provide for a nondisciplinary alternative in situations involving alcohol and drug

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abuse; or any mental illness as listed in the most recent revised publication or the most updated

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volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by

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the American Psychiatric Association or the International Classification of Disease Manual (ICO)

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published by the World Health Organization and that substantially limits the life activities of the

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person with the illness; provided, that the nurse agrees to voluntarily participate in a program of

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treatment and rehabilitation. All records pertaining to a nurse's participation in the

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nondisciplinary program are confidential and not subject to discovery, subpoena or public

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disclosure. Provided, that information related to the nondisciplinary program is provided to the

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nurse's employer to ensure adequate worksite monitoring and compliance.

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     5-34-25. Procedure for discipline of licensees. -- (a) Upon filing a timely sworn

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complaint within a time period the board considers reasonable with the board charging a person

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with having been guilty of any of the actions specified in section 5-34-24, two (2) or more

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members of the board of nurse registration and nursing education immediately investigate those

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charges, or the board, after investigation, may institute charges.

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     (b) In the event that investigation, in the opinion of the board, reveals reasonable grounds

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for believing the applicant or licensee is guilty of the charges, the board fixes a time and place for

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a hearing of the charges and causes a copy of the charges, together with a notice of the time and

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place fixed for the hearing, to be personally served upon the accused shall notify the licensee of

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the charges and the time and place for a hearing at least twenty (20) days prior to the time fixed

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for the hearing. When personal service cannot be effected and that fact is certified by oath by any

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person authorized to make service, the board causes to be published once in each of two (2)

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successive weeks a notice of the hearing in a newspaper published in the county where the

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defendant last resided according to the records of the board and mails a copy of the charges and

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the notice to the accused at his or her last known address. When publication of notice is

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necessary, the date of the hearing is not less than twenty (20) days after the last date of

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publication of the notice. At the hearing, the accused has the right to appear personally, or by

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counsel, or both, to produce witnesses and to have subpoenas issued by the board. The attendance

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of witnesses and the production of books, documents, and papers at the hearing may be

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compelled by subpoenas issued by the board, which is served in accordance with the law. At the

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hearing, the board administers oaths that may be necessary for the proper conduct of the hearing.

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The board is not bound by the strict rules of procedure or by the laws of evidence in the conduct

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of its proceedings, but the determination is based upon sufficient legal evidence to sustain it. The

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board shall complete the investigation of each complaint and issue a decision within six (6)

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months of the receipt of the complaint; provided, however, that the board may extend the time for

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issuing its decision beyond the initial six (6) month period in documented cases in which delays

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in the process are the direct result of requests or actions by the accused and/or his or her

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representative(s) or other good cause. The board, on a case by case basis, for good cause shown in

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writing, may extend the time for issuing its decision. If the accused is found guilty of the charges,

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the board may revoke, suspend, or otherwise discipline a licensee. If the accused is found guilty

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of the charges, the board may revoke, suspend, or discipline a licensee.

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      (b) Upon revocation or suspension of a license, the holder surrenders the license to the

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administrator of professional regulation, who strikes the name of the holder from the current

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roster of licensed nurses. The date and action taken is recorded. The case of a licensee with a

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revoked or suspended license is reviewed at the discretion of the board. The case of a licensee

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who was reprimanded or disciplined by the board should be recorded as to the date and the action

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taken and may be reviewed at the discretion of the board.

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     (c) All hearings held under this section shall be conducted in accordance with the

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provisions of chapter 42-35 entitled "Administrative Procedures Act."

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     5-34-26. Grounds for discipline without a hearing. -- In the event a person is

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hospitalized for mental illness, or for substance abuse, the board may, without the necessity of the

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proceedings provided for in section 5-34-25, suspend or refuse to renew the license of that person

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for the duration of that confinement or until that person is medically discharged from that

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hospitalization. The director may temporarily suspend the license of a nurse without a hearing if

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the director finds that evidence in his or her possession indicates that a nurse's continuation in

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practice would constitute an immediate danger to the public. In the event that the director

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temporarily suspends the license of a nurse without a hearing, a hearing by the board must be held

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within ten (10) days after the suspension has occurred.

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     5-34-31. Practices and persons exempt. -- No provisions of this chapter are construed

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as prohibiting: (1) gratuitous nursing by friends or members of the family or as prohibiting the

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care of the sick by domestic servants, housekeepers, nursemaids, companions, or household aides

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of any type, whether employed regularly or because of an emergency of illness, provided that

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person is employed primarily in a domestic capacity and does not hold himself or herself out or

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accept employment as a person licensed to practice nursing for hire under the provisions of this

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chapter or as prohibiting nursing assistants in the case of any emergency; (2) the practice of

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nursing by students enrolled in approved educational programs of professional nursing or

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practical nursing educational programs nor by graduates of those schools or courses pending the

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results of the licensing examinations following that graduation, provided that they are licensed in

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this state within ninety (90) days from the date on the application fee receipt, in accordance with

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regulations prescribed by the board; (3) the practice of nursing in this state by any legally

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qualified nurse of another state whose engagement requires him or her to accompany and care for

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a patient temporarily residing in this state during the period of this engagement not to exceed six

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(6) months in length, provided that person does not represent or hold himself or herself out as a

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nurse licensed to practice in this state; (4) the practice of any legally qualified nurse of another

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state who is employed by the United States government or any bureau, division, or agency of the

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government while in the discharge of his or her official duties; (5) persons employed in state and

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licensed hospitals and sanatoria, licensed homes for the aged and/or convalescent persons, and

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recognized public health agencies from assisting in the nursing care of patients if adequate

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medical or nursing supervision is provided; (6) nursing care of the sick with or without

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compensation or personal profit when done in connection with the practice of the religious tenets

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of any recognized or established church by adherents as long as they do not engage in the practice

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of nursing as defined in this chapter; (7) persons who provide acceptable evidence of being

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currently licensed by examination or endorsement under the laws of other states of the United

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States and the District of Columbia from practicing nursing in this state for a period of ninety (90)

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days from the date on the application fee receipt, provided that they are licensed in this state

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within ninety (90) days from the date on the application fee receipt. The original privilege to

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work ninety (90) days from the date on the application fee receipt is not extended or renewed.

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

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An applicant for licensure to practice as a certified registered nurse practitioner submits to the

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board of nurse registration and nursing education written evidence on forms furnished by the

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division of professional regulation, verified by oath, that the applicant:

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

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program resulting in a master's degree in nursing and/or an approved nurse practitioner course of

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study. This curriculum must include both a didactic component and supervised clinical

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experience. Effective January 1, 2004 all applicants for initial licensure must complete an

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accredited educational program resulting in a master's degree with a major in nursing.

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

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board of nurse registration and nursing education.

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

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applicant who is licensed by examination or endorsement as a certified registered nurse

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practitioner under the laws of another state or territory if, in the opinion of the board, the

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applicant meets the qualifications required of certified registered nurse practitioners in this state.

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

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-- Formulary committee Process for prescriptive privileges of certified registered nurse

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practitioner. -- (a) Prescriptive privileges for the certified registered nurse practitioner:

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      (1) Are granted under the governance and supervision of the division of professional

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regulation department, board of nurse registration and nurse education; and

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      (2) Include prescription of legend medications and prescription of controlled substances

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from schedules II, III, IV and V that are established in regulation by the director with the advice

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of the formulary committee established by this section; and

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

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      (b) The director of the department of health establishes a formulary committee to

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develop a formulary to carry out the provisions of this section. The formulary is updated annually

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by the formulary committee. Each setting where these privileges are allowed, may further restrict

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the formulary according to their own protocols. The committee consists of two (2) physicians,

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from a list submitted by the Rhode Island medical society, one pharmacist, from a list submitted

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by the Rhode Island pharmaceutical association, two (2) certified registered nurse practitioners,

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from a list submitted by the Rhode Island state nurses association and one who is the department

11-11

of health's drug control administrator or designee. The committee submits a completed formulary

11-12

to the director of the department of health of the state by September 1, 1996.

11-13

      (c) Each committee member is initially appointed for a one year term by the director of

11-14

the department of health. At the expiration of the one year term, one certified registered nurse

11-15

practitioner is appointed for a three (3) year term, one certified registered nurse practitioner is

11-16

appointed for a two (2) year term; one physician is appointed for a three (3) year term, one

11-17

physician is appointed for a two (2) year term; one pharmacist is appointed for a three (3) year

11-18

term. Subsequently, each appointment is for three (3) years with no member serving more than

11-19

two (2) consecutive three (3) year terms.

11-20

      (d) (b) A certified registered nurse practitioner (R.N.P.) as stated in section 5-34-3 is

11-21

permitted to prescribe from the formulary established by the formulary committee in accordance

11-22

with annually updated guidelines, written in collaboration with the medical director or physician

11-23

consultant of their individual establishments.

11-24

      (e) (c) To qualify for prescriptive privileges an applicant must submit on forms provided

11-25

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

11-26

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

11-27

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

11-28

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

11-29

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

11-30

pharmacology every six (6) years.

11-31

     5-34-40. Nurse practitioner joint practice advisory committee Certified registered

11-32

nurse practitioner joint practice advisory committee. -- (a) The seven (7) member committee

11-33

consists of three (3) physicians, three (3) certified registered nurse practitioners, and one

11-34

consumer. The governor appoints three (3) physicians to the committee from the following

12-1

specialties -- adult medicine, pediatric medicine, and obstetrical-gynecological medicine. The

12-2

governor appoints three (3) certified registered nurse practitioners from the following specialties -

12-3

- adult nurse practitioner, pediatric nurse practitioner, and obstetrical-gynecological nurse

12-4

practitioner. The professional members of the committee are currently engaged in a collaborative

12-5

certified registered nurse practitioner-physician care practice. The consumer member is appointed

12-6

by the director of the department of health of the state. The consumer member is (1)

12-7

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

12-8

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

12-9

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

12-10

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

12-11

public or private health care service.

12-12

      (b) Each professional committee member and the consumer member are initially

12-13

appointed for a one year term. At the expiration of the one year term, one certified registered

12-14

nurse practitioner and one physician shall be appointed for a three (3) year term, one certified

12-15

registered nurse practitioner and one physician are appointed for a two (2) year term, and one

12-16

certified registered nurse practitioner, one physician and the consumer member are appointed for

12-17

a one year term. Subsequently, each Each member appointment is for three (3) years, with no

12-18

member serving more than two (2) consecutive three (3) year terms.

12-19

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

12-20

the following functions:

12-21

      (1) To assess nurse practitioner joint primary care practice for the purpose of improving

12-22

patient care.

12-23

      (2) Review complaints regarding certified registered nurse practitioners, and recommend

12-24

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

12-25

suspension of certification, upon proof that a nurse practitioner has:

12-26

      (i) Aided or abetted an uncertified person to practice as a nurse practitioner;

12-27

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

12-28

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

12-29

and safety of persons entrusted to his or her care;

12-30

      (iv) Had his or her authorization to practice as a nurse practitioner denied, revoked or

12-31

suspended in another state;

12-32

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

12-33

authorized by the provisions of this chapter;

12-34

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

13-1

      (vii) Mental incompetence.

13-2

      (3) The recommendation is submitted to the board of nursing for implementation,.

13-3

subject to the approval of the director of health. Provided, that the board of nursing may, if they

13-4

have clear and convincing evidence that actions of the nurse practitioner that led to the

13-5

recommendation is more appropriately the responsibility of their board, request that the director

13-6

of health review the case and make a determination as to which entity has responsibility for the

13-7

case.

13-8

      (4) Report periodically to the board of nurse registration and nursing education regarding

13-9

certified registered nurse practitioner practice.

13-10

     5-34-41. Process for prescriptive privileges of psychiatric and mental health nurse

13-11

clinical specialist -- Formulary committee Process for prescriptive privileges of psychiatric

13-12

and mental health clinical nurse specialist. -- (a) Prescriptive privileges for the psychiatric and

13-13

mental health clinical nurse clinical specialist:

13-14

      (1) Are granted under the governance and supervision of the division of professional

13-15

regulations, board of nurse registration and nurse education; and

13-16

      (2) Include prescription of certain psychotropic and certain legend medications;,

13-17

controlled substances from Schedule II classified as stimulants, and prescription of controlled

13-18

substances from Schedule IV, that are prescribed in regulations by the director with the advice

13-19

and consent of the formulary committee established by this section; and

13-20

      (3) Do not include controlled substances from Schedules I, II, III and V and those certain

13-21

legend medications not included in subdivision (2).

13-22

     (4) Are granted for psychiatric and mental health clinical nurse specialists who have a

13-23

master's degree in nursing.

13-24

      (b) The director of the department of health establishes a formulary committee to

13-25

develop a formulary to carry out the provisions of this section. The formulary is updated annually

13-26

by the formulary committee. Each setting may further restrict the formulary according to their

13-27

own protocols. The committee consists of two (2) psychiatrists from a list submitted by the R.I.

13-28

Medical Society, two (2) psychiatric and mental health nurse clinical specialists, from a list

13-29

submitted by the R.I. State Nurses Association, one pharmacist, from a list submitted by the R.I.

13-30

Pharmacists Association, and one who is the department of health's chairperson of the board of

13-31

pharmacy or designee. The committee must submit a completed formulary to the director of the

13-32

department of health of the state of R.I. by September 1, 1997.

13-33

      (c) Each committee member is initially appointed for a one year term by the director of

13-34

the department of health. At the expiration of the one year term, one psychiatrist is appointed for

14-1

a three (3) year term and one psychiatrist is appointed for a two (2) year term; one psychiatric and

14-2

mental health nurse clinical specialists is appointed for a three (3) year term and one psychiatric

14-3

and mental health nurse clinical specialists is appointed for a two (2) year term; the pharmacist is

14-4

appointed to a three (3) year term. Subsequently, each appointment is for three (3) years with no

14-5

member serving more than two (2) consecutive three (3) year terms.

14-6

      (d) (b) A psychiatric and mental health clinical nurse clinical specialist as stated in

14-7

section 5-34-3, is permitted to prescribe from the formulary established by the formulary

14-8

committee in accordance with annually updated guidelines, written in collaboration with the

14-9

medical director or physician consultant of their individual establishments.

14-10

      (e) (c) Provided, that a psychiatric and mental health clinical nurse clinical specialist in

14-11

independent practice does not have prescriptive privileges.

14-12

      (f) (d) To qualify for prescriptive privileges a psychiatric and mental health clinical nurse

14-13

clinical specialist, as stated in section 5-34-3, submits on forms provided by the board of nurse

14-14

registration and nursing education, verified by oath, that the applicant has evidence of completion

14-15

of thirty (30) hours of education in pharmacology of psychotropic drugs and certain legend

14-16

medications within the three (3) year period immediately prior to date of application. To maintain

14-17

prescriptive privileges the psychiatric and mental health clinical nurse clinical specialist must

14-18

submit upon request of the board of nurse registration and nursing education evidence of thirty

14-19

(30) hours continuing education in pharmacology of psychotropic drugs every six (6) years.

14-20

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

14-21

adding thereto the following sections:

14-22

     5-34-24.2. Immunity. – (a) The director of health, director of nursing registration and

14-23

education, board members, and their agents and employees are immune from suit in any action,

14-24

civil or criminal, based on any disciplinary proceeding or other official act performed in good

14-25

faith in the course of their duties under this chapter. There is no civil liability on the part of, or

14-26

cause of action of any nature against, the board, director, their agents or their employees or

14-27

against any organization or its members, peer review board or its members, or other witnesses

14-28

and parties to board proceedings for any statements made in good faith by them in any reports,

14-29

communications, or testimony concerning an investigation by the board of the conduct or

14-30

regarding the competence of a licensed nurse.

14-31

     (b) No licensed health care provider, physician, or limited registrant may discharge,

14-32

threaten or discriminate against an employee, staff member or any other person for making a

14-33

report to, giving testimony to, or providing any other communication to the board, a peer review

14-34

organization, or any appropriate supervisory personnel concerning the unprofessional conduct or

15-1

incompetence or negligence of a nurse; provided, that the report, testimony or other

15-2

communication was made in good faith.

15-3

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

15-4

applicant. – (a) An applicant for licensure as a psychiatric and metal health clinical nurse

15-5

specialist submits to the board written evidence on forms furnished by the department of health,

15-6

verified by oath, that the applicant: (1) Is a registered nurse who has completed an accredited

15-7

educational program resulting in a master's degree in psychiatric and mental health nursing;

15-8

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

15-9

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

15-10

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

15-11

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

15-12

acceptable to the board between January 1, 1997 and January 1, 2003. After January 1, 2004, all

15-13

applicants for initial licensure must complete an accredited educational program resulting in a

15-14

master's degree in nursing and must pass a national qualifying examination recognized by the

15-15

board.

15-16

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

15-17

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

15-18

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

15-19

the qualifications of a psychiatric and mental health clinical nurse specialist, as stated in section

15-20

5-34-40.1, and are currently licensed as psychiatric and mental health clinical nurse specialists by

15-21

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

15-22

and/or the District of Columbia are allowed to practice as psychiatric and mental health clinical

15-23

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

15-24

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

15-25

provided that they are licensed in this state within ninety (90) days. The original privilege to

15-26

work ninety (90) days from the date of clearance in not extended or renewed.

15-27

     5-34-40.3. Application fee for psychiatric and mental health clinical nurse

15-28

specialists. – The initial application fee for licensure as a psychiatric and mental health clinical

15-29

nurse specialist is ninety-three dollars and seventy-five cents ($93.75). The renewal fee for a

15-30

psychiatric and mental health clinical nurse specialist is eighty-seven dollars and fifty cents

15-31

($87.50) biennially, sixty-two dollars and fifty cents ($62.50) for the registered nurse fee plus

15-32

twenty-five dollars ($25.00) for the psychiatric and mental health clinical nurse specialist. The

15-33

fee for application for prescriptive privileges is thirty-one dollars and twenty-five cents ($31.25).

15-34

     5-34-40.4. Right to use psychiatric and mental health clinical nurse specialist title. –

16-1

Any person who holds a license to practice as a psychiatric and mental health clinical nurse

16-2

specialist in this state has the right to use the title psychiatric and mental health clinical nurse

16-3

specialist and use the abbreviation "P.C.N.S." No other person may assume that title or use that

16-4

abbreviation or any other words or letters, signs, figures, or devices to indicate that the person

16-5

using it is a psychiatric and mental health clinical nurse specialist.

16-6

     SECTION 4. Sections 5-34-22, 5-34-23, 5-34-24.2, 5-34-24.3 and 5-34-24.4 of the

16-7

General Laws in Chapter 5-34 entitled "Nurses" are hereby repealed.

16-8

     5-34-22. Application for evaluation and approval of basic nursing education

16-9

programs. -- An institution desiring to conduct an educational program of professional or

16-10

practical nursing applies to the board of nurse registration and nursing education and submits

16-11

evidence that:

16-12

      (1) It is prepared to carry out the program in accordance with the board-prescribed

16-13

curriculum standards for professional or practical nursing education; and

16-14

      (2) It is prepared to meet other standards and criteria established in accordance with this

16-15

chapter by the board.

16-16

     5-34-23. Process for initial and continuing evaluation and approval of basic nursing

16-17

education programs. -- Utilizing the board-prescribed criteria and curriculum standards for basic

16-18

professional practical nursing education programs, a site visit and an initial evaluation of a new

16-19

basic nursing education program is made by the state director of nursing education and/or another

16-20

authorized representative of the board of nurse registration and nursing education, who submits a

16-21

written report of the findings to the board. If, in the opinion of the board, the criteria are met by

16-22

the institution, the board grants the program initial approval. Periodically, as deemed necessary

16-23

by the board, it is the duty of the board, through the state director of nursing education or other

16-24

authorized representative of the board, to re-evaluate all basic nursing education programs in this

16-25

state. Written reports of that evaluation are submitted to the board. If the board determines that

16-26

any approved program of basic nursing education is not maintaining the standards prescribed by

16-27

the board, notice, in writing, of that deficit is immediately communicated, in writing, to the

16-28

program director by the board. A program which fails to correct these conditions to the

16-29

satisfaction of the board within a reasonable time and following a hearing on this may be

16-30

removed from the list of state-approved programs of basic nursing education until the time the

16-31

program complies with the standards required by the board. All approved programs must

16-32

maintain occurring or attempting to procure a license to practice nursing;

16-33

      (2) Guilty of a crime of gross immorality;

16-34

      (3) Unfit or incompetent by reason of negligence or habits;

17-1

      (4) Habitually intemperate or is addicted to the use of habit-forming drugs;

17-2

      (5) Mentally incompetent;

17-3

      (6) Guilty of unprofessional conduct which includes, but is not limited to, all of the

17-4

above and also:

17-5

      (i) Abandonment of a patient;

17-6

      (ii) Willfully making and filing false reports or records in the practice of nursing;

17-7

      (iii) Willful omission to file or record nursing records and reports required by law;

17-8

      (iv) Failure to furnish appropriate details of a client's nursing needs to succeeding nurses

17-9

legally qualified to provide continuing nursing services to a client;

17-10

      (v) Willful disregard of standards of nursing practice and failure to maintain standards

17-11

established by the nursing profession; or

17-12

      (7) Guilty of and willfully or repeatedly violating any of the provisions of this chapter

17-13

and/or rule or regulation adopted thereunder.

17-14

     5-34-24.2. Criteria which disqualify a nurse from participating in a nondisciplinary

17-15

substance abuse program. -- (1) Nurse previously enrolled in the nondisciplinary program and

17-16

referred to the board of action.

17-17

      (2) Nurse who has diverted drugs;

17-18

      (3) Nurse convicted of the sale, distribution or manufacture of illegal substances;

17-19

      (4) Severity of a chemical dependency problem that represents a clear and present danger

17-20

to patient health and safety;

17-21

      (5) Any other criteria established by the board of nursing by regulation.

17-22

     5-34-24.3. Criteria for admission to the program. -- (a) A nurse may be considered for

17-23

a nondisciplinary program in the following ways:

17-24

      (1) By self referral;

17-25

      (2) By employer referral;

17-26

      (3) By identification of chemical dependency in conjunction with a sworn complaint

17-27

filed against the nurse; or

17-28

      (4) By referral from a family member, friend, nurse peer, another nurse or professional

17-29

nurse association, or other health care provider.

17-30

      (b) If the nurse does not agree to voluntarily participate in a treatment program protocol

17-31

approved by the board of nursing, or fails to satisfactorily complete a treatment program, the

17-32

board of nursing is informed and initiates disciplinary proceedings.

17-33

     5-34-24.4. Advisory panel. -- A nondisciplinary alternative advisory panel is established

17-34

to assist the department of health in developing rules and regulations pursuant to this chapter. The

18-1

panel, appointed by the director of the department of health, consists of eight (8) members as

18-2

follows:

18-3

      (1) One person who is a member of the nurse executive committee of the hospital

18-4

association of Rhode Island designated by the president of the hospital association.

18-5

      (2) One person who is a member of an employee assistance program in Rhode Island

18-6

designated by the director of the department of health.

18-7

      (3) One person who is a member of the Rhode Island state nurses association designated

18-8

by its president.

18-9

      (4) One person who is a member of the American federation of teachers/federation of

18-10

health professionals designated by its president.

18-11

      (5) One person who is a member of the Rhode Island health care association designated

18-12

by its president.

18-13

      (6) One person who is a member of the Rhode Island association of facilities for the

18-14

aging designated by its president.

18-15

      (7) One person who is a member of Rhode Island visiting nurse association designated

18-16

by its president.

18-17

      (8) One person who is a member of New England health care employees union, district

18-18

1199 designated by its president.

18-19

     SECTION 5. This act shall take effect upon passage.

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LC02148/SUB A/4

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES

***

19-1

     This act would amend the nursing statute to establish licensure for clinical nurse

19-2

specialists as a basis for granting prescribing privileges, would enhance the diversion program to

19-3

allow the broadest possible scope for assisting nurses with substance abuse and mental health

19-4

problems, would revise board membership for the board of nursing registration and nursing

19-5

education and would require a completion of ten (10) hours of continuing education classes two

19-6

(2) years before (or an extension in cases of hardship) an application for licensing renewal.

19-7

     This act would take effect upon passage.

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LC02148/SUB A/4

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