DAR File No. 32662

Commerce, Occupational and Professional Licensing

R156-31b

Nurse Practice Act Rule

NOTICE OF PROPOSED RULE

DAR File No.: 32662
Filed: 05/12/2009, 01:42
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division reviewed the rule and determined that changes needed to be made. The proposed amendments add the Division as a provider of approved continuing education and eliminate the Psychiatric Mental Health Nursing Peer Committee as a peer committee of the Board of Nursing.

Summary of the rule or change:

Adds Subsection R156-31b-102(5)(d) to the definition of approved continuing education which recognizes and approves training or educational presentations offered by the Division of Occupational and Professional Licensing. In Section R156-31b-202, eliminates the Psychiatric Mental Health Nursing Peer Committee. This peer committee has not met for over five years. It was originally implemented when the Division was working with the mental health professions to improve and make consistent the licensure requirements and scope of practice of the various mental health professions. Since that time there has not been a reason to convene a meeting. Should the need for such a peer committee be identified in the future, the rule could be amended and a new committee appointed.

State statutory or constitutional authorization for this rule:

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

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $50 to print the rule and distribute it once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget. The Division currently has the staff and resources to provide educational training on a variety of topics; however, the Controlled Substance Database improvements and recent statute changes will be emphasized at this time. Although the Committee has not met for several years, Division staff was required to ensure the Committee had appointments and every year would contact a number of associations requesting nominations. Elimination of the Committee will save a little staff time. Eliminating the Committee could also be viewed as down-sizing government and eliminating an unnecessary Committee. The Division will not see any budget reduction as a result of the elimination of this Committee since service on the Committee was voluntary.

local governments:

The proposed amendments only apply to licensed nursing classifications and applicants for licensure in those classifications. The only effect on local government would be if the government agency paid for its nurses' continuing education courses. If that were the case, the continuing education to be provided by the Division would be offered at no cost, thus saving the agency the usual cost of continuing education courses which range from $30 to $300 depending on the topic and length of the course.

small businesses and persons other than businesses:

The proposed amendments only apply to licensed nursing classifications and applicants for licensure in those classifications. The Division anticipates no effect on small businesses as a result of the proposed amendments unless the business pays for continuing education credits for nurse employees. As a result of the proposed amendments, licensees will now have an additional option with respect to obtaining required continuing education hours as a result of the Division being added as an approved continuing education provider. Licensees may see minimal savings in continuing education costs as a result of the Division now providing continuing education training for the profession. However, any exact amount of savings is unable to be determined. Also, the Division will be able to offer continuing education credit as a "carrot" to licensees to entice them to attend any continuing education courses that are offered by the Division. Any organization or association that currently offers continuing education courses for a cost may see more and more licensees taking advantage of continuing education offered by the Division and could thus experience a slight decrease in continuing education revenue. This scenario is highly unlikely though because the Division currently has plans to offer only a 1-2 hour course regarding the Controlled Substance Database.

Compliance costs for affected persons:

The proposed amendments only apply to licensed nursing classifications and applicants for licensure in those classifications. Any continuing education offering provided by the Division of Occupational and Professional Licensing should have low or no cost thus helping licensees accumulate the required number of continuing education hours needed for renewal of licensure. Given the Psychiatric Mental Health Nursing Peer Committee has not met for years, there should be no effect on those licensed in that specialty or those applying for licensure in that specialty.

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

This rule filing permit the Division to provide continuing education and eliminates a peer advisory committee that is no longer necessary. As more fully discussed in the rule filing, these changes will likely result in a cost savings to licensees and to the nursing industry. No other fiscal impact to businesses is anticipated. Francine A. Giani, Executive Director

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

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

Direct questions regarding this rule to:

Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at lpoe@utah.gov

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

07/01/2009

Interested persons may attend a public hearing regarding this rule:

6/11/2009 at 9:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 474 (fourth floor), Salt Lake City, UT

This rule may become effective on:

07/08/2009

Authorized by:

Thad LeVar, Deputy Director

R156. Commerce, Occupational and Professional Licensing.

R156-31b. Nurse Practice Act Rule.

R156-31b-102. Definitions.

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

(1) "Academic year", as used in Section R156-31b-601, means three quarters or two semesters or 900 clock hours. A quarter is defined to be equal to ten weeks and a semester is defined to be equal to 14 or 15 weeks.

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

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

(4) "APRN-CRNA" means an advanced practice registered nurse specializing and certified as a certified registered nurse anesthetist.

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

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

(b) nursing education courses taken from an approved education program as defined in Subsection R156-31b-102(6);[ and]

(c) health related course work taken from an educational institution accredited by a regional or national institutional accrediting body recognized by the U.S. Department of Education; and

(d) training or educational presentations offered by the division.

(6) "Approved education program" as defined in Subsection 58-31b-102(3) is further defined to include any nursing education program located within the state of Utah which meets the standards established in Sections R156-31b-601, 602 and 603; and any nursing education program located outside of Utah which meets the standards established in Section R156-31b-607.

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

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

(9) "COA", as used in this rule, means the Council of Accreditation of Nurse Anesthesia Education Programs.

(10) "Clinical preceptor", as used in Section R156-31b-608, means an individual who is employed by a clinical health care facility and is chosen by that agency, in collaboration with the Parent Nursing Education-Program, to provide direct, on-site supervision and direction to a nursing student who is engaged in a clinical rotation, and who is accountable to both the clinical agency and the supervisory clinical faculty member.

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

(12) "Contact hour" means 60 minutes.

(13) "Delegatee", as used in Sections R156-31b-701 and 701a, means one or more competent persons receiving a delegation who acts in a complementary role to the delegating nurse, who has been trained appropriately for the task delegated, and whom the delegating nurse authorizes to perform a task that the delegates is not otherwise authorized to perform.

(14) "Delegation" means transferring to delegates the authority to perform a selected nursing task in a selected situation. The delegating nurse retains accountability for the delegation.

(15) "Delegator", as used in Sections R156-31b-701 and 701a, means the nurse making the delegation.

(16) "Diabetes medical management plan (DMMP), as used in this rule, means an individualized plan that describes the health care services that the student is to receive at school. The plan is developed and signed by the student's parent or guardian and health care team. It provides the school with information regarding how the student will manage diabetes at school on a daily basis. The DMMP shall be incorporated into and shall become a part of the student's IHP.

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

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

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

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

(19) "Equivalent to an approved practical nursing education program", as used in Subsection 58-31b-302(2)(e), means the applicant for licensure as an LPN by equivalency is currently enrolled in an RN education program with full approval status, and has completed course work which is equivalent to the course work of an NLNAC accredited practical nursing program.

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

(21) "Individualized healthcare plan (IHP), as used in Section R156-31b-701a, means a plan for managing the health needs of a specific student, written and reviewed at least annually by a school nurse. The IHP is developed by a nurse working in a school setting in conjunction with the student and the student's parent or guardian to guide school personnel in the care of a student with medical needs. The plan shall be based on the student's practitioner's orders for the administration of medications or treatments for the student, or the student's DMMP.

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

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

(24) "MA-C" means a medication aide - certified.

(25) "Medication", as used in Sections R156-31b-701 and 701a, means any prescription or nonprescription drug as defined in Subsections 58-17b-102(39) and (61) of the Pharmacy Practice Act.

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

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

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

(29) "Nurse", as used in this rule, means an individual licensed under Title 58, Chapter 31b as a licensed practical nurse, registered nurse, advanced practice registered nurse, or advanced practice registered nurse-certified registered nurse anesthetist, or a certified nurse midwife licensed under Title 58, Chapter 44a.

(30) "Nurse accredited", as used in this rule, means accreditation issued by NLNAC, CCNE or COA.

(31) "Other specified health care professionals", as used in Subsection 58-31b-102(15), who may direct the licensed practical nurse means:

(a) advanced practice registered nurse;

(b) certified nurse midwife;

(c) chiropractic physician;

(d) dentist;

(e) osteopathic physician;

(f) physician assistant;

(g) podiatric physician;

(h) optometrist;

(i) naturopathic physician; or

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

(32) "Parent academic institution", as used in this rule, means the educational institution which grants the academic degree or awards the certificate of completion.

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

(34) "Patient", as used in this rule, means a recipient of nursing care and includes students in a school setting or clients of a health care facility, clinic, or practitioner.

(35) "Patient surrogate", as used in Subsection R156-31b-502(1)(d), means an individual who has legal authority to act on behalf of the patient when the patient is unable to act or decide for himself, including a parent, foster parent, legal guardian, or a person designated in a power of attorney.

(36) "Psychiatric mental health nursing specialty", as used in Subsection 58-31b-302(4)(g), includes psychiatric mental health nurse specialists and psychiatric mental health nurse practitioners.

(37) "Practitioner", as used in Sections R156-31b-701 and 701a, means a person authorized by law to prescribe treatment, medication, or medical devices, and who acts within the scope of such authority.

(38) "RN" means a registered nurse.

(39) "School", as used in Section R156-31b-701a, means any private or public institution of primary or secondary education, including charter schools, pre-school, kindergarten, and special education programs.

(40) "Supervision", as used in this rule, means the provision of guidance and review by a licensed nurse for the accomplishment of a nursing task or activity, including the provision for the initial direction of the task, periodic inspection of the actual act of accomplishing the task or activity, and evaluation of the outcome.

(41) "Supervisory clinical faculty", as used in Section R156-31b-608, means one or more individuals employed by an approved nursing education program who meet the accreditation and Board of Nursing specific requirements to be a faculty member and are responsible for the overall clinical experiences of nursing students and may supervise and coordinate clinical preceptors who provide the actual direct clinical experience.

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

 

R156-31b-202. Advisory Peer Committee created - Membership - Duties.

(1) In accordance with Subsection 58-1-203(1)(f), there is created [the Psychiatric Mental Health Nursing Peer Committee and ]the Nursing Education Peer Committee.[

(2) Psychiatric Mental Health Nursing Peer Committee.

(a) The duties and responsibilities of the Psychiatric Mental Health Nursing Peer Committee are to:

(i) review applications for licensure as an APRN specializing in psychiatric mental health nursing when appropriate; and

(ii) advise the board and division regarding practice issues.

(b) The composition of the Psychiatric Mental Health Nursing Peer Committee shall be:

(i) three APRNs specializing in psychiatric mental health nursing;

(ii) at least one member shall be a faculty member actively teaching in a psychiatric mental health nursing program; and

(iii) at least one member shall be actively participating in the supervision of an APRN intern.

(3) Nursing Education Peer Committee.]

([a]2) The duties and responsibilities of the Nursing Education Peer Committee are to:

([i]a) review applications for approval of nursing education programs;

([ii]b) advise the board and division regarding standards for approval of nursing education programs; and

([iii]c) assist the board and division to conduct site visits of nursing education programs.

([b]3) The composition of the Nursing Education Peer Committee shall be:

([i]a) five RNs or APRNs actively involved in nursing education; and

([ii]b) members of the board may also serve on this committee.

 

KEY: licensing, nurses

Date of Enactment or Last Substantive Amendment: [May 1, ]2009

Notice of Continuation: April 1, 2008

Authorizing, and Implemented or Interpreted Law: 58-31b-101; 58-1-106(1)(a); 58-1-202(1)(a)