Model Act and Rules Committee

Nathan Goldman, Chair

• According to the Michigan Law Revision Commission and the Harvard Law School, Model Acts are carefully drafted laws for potential enactment by state legislatures in whole or in part. Model Acts are experimental efforts to assist states in developing effective new approaches to a particular area of the law.

WHAT IS A MODEL ACT?

• Overall, the Model Act and Rules are intended to serve as a guide for Member Boards.

• However, NCSBN encourages all boards to adopt as much of the Model Act and Rules as possible.

Purpose of NCSBN’s Model Act and Rules

• First adopted in 1982.• Revised in 1988, 1993, 1994, 1997, and 2004.• CBCs added in 2006.• APRN Consensus Model language added in

2008.

NCSBN MODEL NURSING PRACTICE ACT

• Appointed in FY 2011• Charge: Review and revise the NCSBN Model

Act & Rules as needed

Rose Kearney-Nunnelly, Chair (FY 2011)

Nathan Goldman, Chair (FY 2012)

Model Act and Rules Committee

• Betsy Houchen, RN, JD, Ohio, Board Liaison• Kathleen Beebout, RN, JD, Iowa• Dusty Johnston, JD, Texas• Fred Knight, JD, Arkansas• Sandra Priebe, RN, Arkansas• Pamela Randolph, RN, Arizona• Laura Rhodes, RN, West Virginia• Caron Robertson, RN, Massachusetts• Peg Sheaffer, RN, JD, Pennsylvania

Committee Members

• Streamline• Reduce redundancy• Clarify• Organize• Update/conform with other NCSBN initiatives• Move detail from Act to Rule• Use legislative language

Committee’s Goals for Revisions

• Reformatted the Act and Rule into two separate documents

• Reordered and renumbered Articles and Chapters• Revised language in all Articles and Chapters,

except Nurse Licensure Compact and APRN Compact

• Removed all explanatory notes• Replaced the term “client” with “patient”

Overview of Major Changes

• Title and Purpose• Definitions• Scope of RN and LPN/VN Practice• Board of Nursing• RN and LPN/VN Licensure and Exemptions• Prelicensure Nursing Education• Discipline and Proceedings• Violations and Penalties• Implementation• Unlicensed Assistive Personnel• APRN• Nursing Licensure Compact• APRN Compact

New Organization

Highlighted Changes

• This Act shall be known and may be cited as <the JURISDICTION> Nurse Practice Act (NPA), which creates and empowers the board of nursing (BON) to regulate nursing and to enforce the provisions of this Act.

Title

• The purpose of this Act is to protect the health, safety and welfare of the residents* of this state.

• *The term “residents” was used instead of “citizens” based upon comments received at MYM

Purpose

• Deleted definitions that are commonly understood

• Deleted definitions that are defined beyond nursing law (ex. legal definitions)

• Deleted definitions for words not used in the text of the Act or Rules

• Removed NLC definitions for inclusion in that Article/Chapter

Definitions

• Advanced assessment• Clinical learning experiences• Competence• Comprehensive nursing assessment• Delegating• Eligible for graduation*• Encumbered• Focused nursing assessment• Inactive license• Internationally educated applicants

Revised/Maintained Act Definitions

• License• Nursing• Patient• Patient-centered health care plan • Reactivation• Reinstatement• Supervision • Unlicensed assistive personnel

Act Definitions, cont.

• Dual relationship • NCLEX-PN®• NCLEX-RN®• Nursing faculty• Preceptor• Professional boundaries • Professional-boundary crossing • Professional-boundary violation • Sexualized body part

Revised/Maintained Rule Definitions

• Deleted requirement that BON members must be eligible to vote

• Added authority to:– Share current significant investigative information with other

regulatory bodies and law enforcement entities – Withdraw a license issued in error– Conduct criminal background checks for nurse licensure in

accordance with state and federal law – Issue a cease and desist order for any violation of the Act and– Adopt criteria for recognizing national certifying bodies for

APRN roles and population foci

Board of Nursing

• Deleted specific requirements related to EOs:– RN license– Masters degree or higher– Certain years experience

• Kept language that requires EO to be “qualified”

• Added power to hire and fire

Executive Officer

• Revised Model Act and Rules to conform with the approved Uniform Licensure Requirements (ULRs) that were passed at Delegate Assembly in 2011.

• Removed all reference to a modified license per ULRs.

RN and LPN/VN Licensure and Exemptions

• Revised graduation language: Graduate from or be eligible for graduation

from a <your jurisdiction> BON-approved prelicensure program or a program that meets criteria comparable to those established by the <your jurisdiction> BON in its rules

Licensure by Examination

• Added the following requirements per the ULRs:– Report any substance use disorder in the last five

years– Report any action taken or initiated against a

professional or occupational license, registration or certification

– Graduates from an RN prelicensure program who take the LPN/VN exam must complete a role delineation course.

Licensure by Examination

• Graduation from a nursing program comparable to a BON approved prelicensure RN or LPN/VN program, whichever is applicable

• Applicant must submit to a credentials evaluation by a BON approved/authorized organization for the level of licensure being sought

• Successful passage of an English proficiency exam that includes the components of reading, speaking, writing and listening, except for applicants from countries where English is the native language, and the nursing program where the applicant attended was taught in English, used English textbooks and clinical experiences were conducted in English, and

• Disclosure of nursing licensure status in country of origin, if applicable

Internationally Educated Applicants

• Graduate from a <your jurisdiction> BON-approved prelicensure program or a program that meets criteria comparable to those established by the <your jurisdiction> BON in its rules

• Report current participation in an alternative to discipline program in any jurisdiction

• Submit verification of licensure status directly from the U.S. jurisdiction of licensure by examination

Licensure by Endorsement

• Applicant must report:– Criminal conviction, nolo contendere plea, Alford plea,

deferred judgment, or other plea arrangements in lieu of conviction

– Status of all nursing licenses, including any BON actions taken or any current or pending investigations

– Substance use disorder in the last five years– Actions taken or initiated against a professional or

occupational license, registration or certification and– Current participation in an alternative to discipline

program

Renewal and Reactivation

• Deleted specific practice hour requirements and inserted the following note as a placeholder:

***At the present time, evidence does not support any one mechanism for continued competence and further study is warranted.

Continued Competence

• Act: Each applicant for licensure shall submit a full set of fingerprints to the BON for the purpose of obtaining a state and federal criminal records check pursuant to <state statute> and Public Law 92-544. The <state agency respon sible for managing fingerprint data> may exchange this fingerprint data with the Federal Bureau of Investigation (FBI).

Criminal Background Checks

• Rule: All individuals convicted of a sexual offense involving a minor or performing a sexual act against the will of another person shall be subject to a BON order for evaluation by a qualified expert approved by the BON. If the evaluation identifies sexual behaviors of a predatory nature the BON shall deny licensure.

• Other criminal convictions may be reviewed by the BON on a case by case basis to determine eligibility for licensure

Criminal Background Checks

• Expanded authority of the BON• Modified grounds for discipline• Added additional immunity/protection from

retaliation• Revised portions of the Alternative to

Discipline Program requirements and criteria

Discipline and Proceedings

• Summarily issue emergency limitation or restriction of a license

• Summarily issue an emergency suspension of a license

• Reprimand or censure a license• Accept a voluntary surrender of a license• Accept other voluntary limitation or restriction of

a license• Place other limitations or restrictions on a license

Expanded Authority of BON

• Added:– Non-Compliance with federal, jurisdictional or contractual

requirements– Confidentiality, patient privacy, consent or disclosure

violations– Misconduct or abuse– Other violations of the Act or administrative rules

• Deleted requirement that the criminal conviction or adjudication relate to the practice of nursing or to the ability to practice nursing.

Grounds for Discipline

• A person may not suspend, terminate, or otherwise discipline, discriminate against, or retaliate against anyone who reports, or advises on reporting, in good faith under this section.

• Cause of action for good faith reporter against retaliator

Immunity/Retaliation

• Added detail to the functions and responsibilities of programs

• Modified the eligibility criteria to add specificity• Added screening and assessment requirements• Expanded contracts section• Added notification, monitoring and practice

requirements and limitations as well as standards for returning to work

Alternative to Discipline Monitoring Programs

• Deleted all reference to the CNA II role• Added specificity to the roles, duties and requirements

of CNAs and MACs• Expanded basic curriculum and training requirements• Added section to the Rules for CNA and MAC discipline• Limited what MACs can do to medication

administration and related tasks only • Removed all references to long-term care facilities

Unlicensed Assistive Personnel

• Additional Practice language added:– Delegating and assigning therapeutic measures to assistive

personnel– Consulting with other disciplines and providing referrals to health

care agencies, health care providers and community resources– Wearing identification which clearly identifies the nurse as an APRN

when providing direct patient care, unless wearing identification creates a safety or health risk for either the nurse or the patient and

– Other acts that require education and training consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies and experience

APRNs

• Added the following terms to what an APRN is authorized to prescribe, furnish, order, administer and dispense: – durable medical equipment– blood and blood products

APRN Prescribing

• Deleted the contact hours limitation related to herbal and complementary therapies from the endorsement and renewal rules

APRN Licensure

Questions?