2013 -- S 0614 SUBSTITUTE A

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LC01636/SUB A

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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A N A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES

     Introduced By: Senators Miller, Doyle, Goldin, Pichardo, and Walaska

     Date Introduced: March 06, 2013

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 5-34-3, 5-34-4, 5-34-7, 5-34-40 and 5-34-43 of the General Laws

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

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

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

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

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

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     (APRN) is the title given to an individual licensed to practice advanced practice

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registered nursing within one of the following roles: certified nurse practitioner (CNP), certified

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registered nurse anesthetist (CRNA) as defined in chapter 5-34.2, or certified clinical nurse

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specialist (CNS), and who functions in a population focus. An APRN may serve as a primary or

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acute care provider of record.

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     (2) "Advanced practice registered nursing" means an independent and expanded scope of

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nursing in a role and population focus approved by the Board of Nurse Registration and Nursing

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Education that includes the registered nurse scope of practice and may include, but is not limited

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to, performing acts of advanced assessment, diagnosing, prescribing and ordering. Each APRN is

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accountable to patients, the nursing profession and the Board of Nursing for complying with the

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requirements of this chapter and the quality of advanced nursing care rendered; recognizing limits

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of knowledge and experience; planning for the management of situations beyond the APRN’s

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expertise; and for consulting with or referring patients to other health care providers as

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appropriate.

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

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official recognition to basic nursing education programs meeting established criteria and

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standards.

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      (3)(4) "Certified registered nurse practitioner" is an advanced practice nurse utilizing

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independent knowledge of physical assessment, diagnosis, and management of health care and

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illnesses. The practice includes prescriptive privileges. The practice includes collaboration with

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

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podiatrists, dentists and nurses. Certified nurse practitioners are members of the health care

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delivery system practicing in areas including, but not limited to: family practice, pediatrics, adult

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health care, geriatrics and women’s health care in primary, acute, long-term and critical care

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settings in health care facilities and the community. Certified nurse practitioners may be

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recognized as the primary care provider or acute care provider of record.

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     (5) "Certified Clinical Nurse Specialist" is an advanced practice registered nurse that

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independently provides care to clients, facilitates attainment of health goals, and provides

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innovation in nursing practice, based on clinical expertise, evidence-based decision-making, and

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leadership skills. The clinical nurse specialist practices with individual clients and populations;

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nurses and other multidisciplinary team members; and organizations to effect system-wide

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changes to improve programs of care. The practice may include prescriptive privileges.

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     (6) Certified registered nurse anesthetist is as defined in chapter 5-34.2 ("Nurse

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Anesthetist").

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

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

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

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individuals.

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      (7)(10) "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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      (8)(11) "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 health care plan of care prescribed by a licensed advanced

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practice registered nurse, certified nurse midwife, licensed physician, dentist, or podiatrist. It is a

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distinct component of health services. Nursing practice is based on specialized knowledge,

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

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biological, physical, social, and behavioral sciences.

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

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

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includes promotion, maintenance, and restoration of health and utilizes standardized procedures

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

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

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

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

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the nursing care rendered.

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     (13) "Population foci" means focus of the patient population. Population focus shall

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include:

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     (i) Family/Individual across the lifespan ;

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     (ii) Adult-gerontology;

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     (iii) Neonatal;

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     (iv) Pediatrics;

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     (v) Women’s health/gender-related; and

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     (vi) Psychiatric/mental health.

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      (10)(14) "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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      (11)(15) "Psychiatric and mental health nurse clinical specialist" is a certified clinical

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nurse specialist working in the population foci of psychiatric/mental health as an advanced

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practice nurse utilizing independent knowledge in psychiatric mental health assessment,

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diagnosis, health promotion, psychotherapeutic modalities and management of mental health and

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illnesses. The practice may include prescription privileges within their scope of practice of certain

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legend medications, controlled substances from Schedule II classified as stimulants, and

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controlled substances from Schedule IV within the scope of their practice. The practice may also

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include consultation and education. collaboration with other licensed health care professionals,

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including, but not limited to, psychiatrists, psychologists, physicians, pharmacists, and nurses.

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The psychiatric and mental health clinical specialist holds the qualifications defined in section 5-

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34-40.1.

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

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

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

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of nurse registration and nursing education, sometimes referred to herein as the "board of

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nursing". The board shall be composed of fifteen (15) members. The term of office shall be for

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three (3) years. No member shall serve more than two (2) consecutive terms. The member shall

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serve until a qualified successor is appointed to serve. In making those appointments, the director

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of the department of health shall consider persons suggested by professional nurse organizations

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and the practical nurse's association.

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

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

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

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

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

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

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

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

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

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

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and mental health certified clinical nurse clinical specialist. No educational program or

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cooperating agency shall have more than one 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 shall be

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

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

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the provisions of chapter 4 of title 36.

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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 the department of

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

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individual practice of licensees;

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      (4) Approve the examinations for licensure;

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

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

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license;

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

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persons giving testimony at hearings;

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

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      (9) Maintain a record of all its proceedings;

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

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

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

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

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

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

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nurse practitioners advanced practice registered nurses;

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      (14) Grant certified registered nurse practitioners prescriptive privileges to advanced

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practice registered nurses; and

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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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     (17) Adopt criteria for recognizing national certifying bodies for APRN roles and

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population foci.

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     5-34-40. Advanced practice nurse advisory committee. -- (a) The nine (9) seven (7)

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

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

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specialists, one physician and two (2) consumers and one consumer. The director of health shall

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appoint the committee. In making appointments to the committee, the director shall consider

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persons recommended by professional nurse organizations and professional medical associations.

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The professional members of the committee shall be currently engaged in practice. The consumer

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members shall be: (1) knowledgeable in consumer health concerns; (2) a resident of the state; (3)

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

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licensed as a health care practitioner, and not a student in a professional program; (5) not having a

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

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control of any public or private health care service.

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

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

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

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

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

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the following functions:

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

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

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

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

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

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

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

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and safety of persons entrusted to his or her care;

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

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revoked or suspended in another state;

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

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authorized by the provisions of this chapter;

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

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      (G) Mental incompetence; or

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

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

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

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regarding advanced nurse practice.

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     5-34-43. Criminal records review. -- (a) Notwithstanding any provision of law to the

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contrary contained in any general or public law, rule or regulation, any person seeking a license to

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practice under this chapter, or who is previously licensed and authorized to practice under this

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chapter and is seeking employment, shall undergo a federal and statewide criminal background

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check (BCI), which shall be processed prior to receiving a license to practice or to enter into

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employment.

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      (b) The applicant shall apply to the bureau of criminal identification for a national

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criminal records check that shall include fingerprints submitted to the federal bureau of

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investigation. Upon the discovery of any disqualifying information, the bureau of criminal

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identification will inform the applicant in writing of the nature of the disqualifying information;

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and, without disclosing the nature of the disqualifying information, will notify the licensing

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agency or the potential employer in writing that disqualifying information has been discovered.

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      (c) The applicant against whom disqualifying information has been found, may request

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that a copy of the criminal background report be sent to the licensing agency or the potential

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employer. The licensing agency or the potential employer shall make a judgment regarding the

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issuing of a license.

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      (d) In those situations in which no disqualifying information has been found, the bureau

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of criminal identification shall inform the applicant and the licensing agency or the potential

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employer in writing of this fact.

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     (e) It shall be the responsibility of the applicant to pay for the criminal records check.

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     5-34-44. Advanced practical registered nurses as independent practitioners. --

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APRNs are licensed independent practitioners within standards established or recognized by the

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board of nursing. Each APRN is accountable to patients, the nursing profession and the board of

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nursing for:

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     (1) Complying with the requirements of this chapter and the quality of advanced nursing

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care rendered ;

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     (2) Recognizing limits of knowledge and experience;

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     (3) Planning for the management of situations beyond the APRN’s expertise;

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     (4) Consulting with or referring patients to other licensed health care providers as

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appropriate.

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     (5) In the case of CRNAs, comply with the requirements of chapter 5-34.2 of the Rhode

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Island general laws, including subsection 5-34.2-5(b) regarding scope of practice. In the case of

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any conflict between this chapter and chapter 5-34.2 with regard to the licensure and practice of

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CRNAs, chapter 5-34.2 shall control.

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     5-34-45. Licensure of APRNs. -- (a) An applicant for initial licensure to practice as an

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APRN shall:

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     (1) Submit a completed written application and appropriate fees as established by the

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board of nursing;

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     (2) Hold a current RN license or privilege to practice and shall not hold an encumbered

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license or privilege to practice as an RN in any state or territory ;

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     (3) Have completed an accredited graduate or post-graduate level APRN program in one

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of the three roles (RNP, CRNA, or CNS) and at least one population focus;

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     (4) Be currently certified by a national certifying body recognized by the board of nursing

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in the APRN role and population foci appropriate to educational preparation;

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     (5) Report any criminal conviction, nolo contendere plea, Alford plea or other plea

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arrangement in lieu of conviction;

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     (6) Have committed no acts or omissions that are grounds for disciplinary action as set

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forth in this chapter; and

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     (7) Provide other evidence as required by regulation.

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     (b) The board of nursing may issue an initial APRN license to clinical nurse specialists

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without a certification exam when:

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     (1) A national certification exam does not exist for the current population foci; and

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     (2) The applicant has submitted a portfolio to the board of nursing that includes proof of

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graduation, course descriptions, official transcript that includes courses in pharmacology,

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pathophysiology and physical assessment, letters of recommendation from his/her employer

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attesting to the CNS’s practice at the advanced practice level.

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     (c) After January 1, 2015, all clinical nurse specialists seeking initial licensure as an

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APRN must meet all the criteria as stated in this chapter including national certification in a role

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and population foci recognized by the board of nursing.

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     (d) The board of nursing may issue a license by endorsement to an APRN licensed under

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the laws of another state if, in the opinion of the board of nursing, the applicant meets the

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qualifications for licensure in this jurisdiction. An applicant for APRN licensure by endorsement

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shall:

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     (1) Submit a completed written application and appropriate fees as established by the

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board of nursing;

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     (2) Hold a current license or privilege to practice as an RN and APRN in a state or

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territory;

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     (3) Not have an encumbered license or privilege to practice in any state or territory;

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     (4) Have completed an accredited graduate or post-graduate level APRN program in one

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of the three roles (CNP, CRNA or CNS) and at least one population focus or meets the standards

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for grandfathering as described in this chapter;

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     (5) Be currently certified by a national certifying body recognized by the board of nursing

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in the APRN role and at least one population focus appropriate to educational preparation ;

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     (6) Meet continued competency requirements as set forth in board of nursing regulations ;

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     (7) Report any conviction, nolo contendere plea, Alford plea or other plea arrangement in

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lieu of conviction ;

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     (8) Have committed no acts or omissions, which are grounds for disciplinary action in

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another jurisdiction; and

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     (9) Provide other evidence as required by the board of nursing in its regulations.

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     (e) APRN licenses issued under this chapter shall be renewed every two (2) years

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according to a schedule established by the BON. An applicant for APRN license renewal shall:

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     (1) Submit a renewal application as directed by the board of nursing and remit the

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required fee as set forth in regulation;

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     (2) Maintain national certification in the appropriate APRN role and at least one

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population focus, authorized by licensure, through an ongoing recertification maintenance

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program of a nationally recognized certifying body recognized by the board of nursing; and

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     (3) Meet other requirements set forth in regulations.

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     (f) The board of nursing may reactivate or reinstate an APRN license as set forth in BON

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regulation.

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     5-34-46. Status of current licensees. -- (a) Any person holding a license to practice

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nursing as a certified nurse practitioner ,psychiatric clinical nurse specialists, certified registered

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nurse anesthetist, as defined in this chapter and chapter 5-34.2, in this state that is valid upon

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passage of this chapter shall be deemed to be licensed as an APRN, with his or her current

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privileges and shall be eligible for renewal of such license as defined under the provisions of this

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chapter and chapter 5-34-2.

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

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

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certification related to his or her current practice setting as of (effective date of this act), as

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defined in chapters 5-35 or 5-34.2, shall be deemed to be eligible for to license as an APRN.

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     (c) After August 1, 2013, all new applicants for APRN licensure must meet the stipulated

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licensure requirements as stated in this chapter.

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     5-34-47. Titles and abbreviations. -- (a) Only those persons who hold a license or

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privilege to practice as advanced practice registered nurses in this state shall have the right to use

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the title "advanced practice registered nurse" and the roles of "certified registered nurse

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anesthetist," "clinical nurse specialist" and "certified nurse practitioner;" and the abbreviations

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"APRN," "CRNA," "CNS" and "CNP" respectively.

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     (b) The abbreviation for the APRN designation of a certified registered nurse anesthetist,

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a clinical nurse specialist and for a certified nurse practitioner will be APRN, plus the role title,

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i.e., CRNA, CNS, and CNP.

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     5-34-48. APRN education programs. -- (a) The standards for the establishment and

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outcomes of APRN education programs, including clinical learning experiences, shall be set by

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APRN national accrediting agencies recognized by the US Department of Education and the

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Council for Higher Education Accreditation.

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     (b) Compliance with the standards for the APRN program will be evidenced by official

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certification of accreditation by the appropriate national accrediting agency, a copy of such shall

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be submitted to the Board of Nursing. The Board of Nursing will act as the sole custodian of

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record for any and all documentation used to demonstrate such certification by the appropriate

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national accrediting agency.

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     5-34-49. Prescriptive authority. -- (a) The board of nursing shall grant prescribing,

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ordering, dispensing and furnishing authority .

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     (b) An APRN licensed by the board of nursing may prescribe, order, procure, administer,

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dispense and furnish over the counter, legend and controlled substances pursuant to applicable

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state and federal laws, when the APRN has completed an educational program as described in this

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chapter that includes courses in pathophysiology, pharmacology and physical assessment and is

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within the APRN’s role and population focus.

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     (c) Prescribing, ordering, dispensing and furnishing shall include the authority to:

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     (1) Diagnose, prescribe and institute therapy or referrals of patients to health care

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agencies, health care providers and community resources;

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     (2) Prescribe, procure, administer, dispense and furnish pharmacological agents,

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including over the counter, legend and controlled substances; and

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     (3) Plan and initiate a therapeutic regimen that includes ordering and prescribing non-

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pharmacological interventions, including, but not limited to, durable medical equipment, medical

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devices, nutrition, blood and blood products, and diagnostic and supportive services including,

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but not limited to, home health care, hospice, and physical and occupational therapy.

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     (d) Prescriptive privileges for the certified nurse practitioner shall include all the

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authority under the APRN license including:

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     (1) Prescription of legend medications and prescription of controlled substances from

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schedules II, Ill, IV and V that are established in regulation; and

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     (2) May be certified to prescribe controlled substances from Schedule I.

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     (e) Prescriptive privileges for APRNs with the population focus of psychiatric/mental

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health:

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     (1) Shall include prescription of certain psychotropic and certain legend medications,

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

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Schedule III and IV that are prescribed in regulations;

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     (2) Shall not include controlled substances from Schedules I, II, and V and those certain

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legend medications not included in subdivision (1) of this subsection.

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     (f) CRNAs may be granted prescriptive privileges in accordance with the provisions of

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chapter 5-34.2.

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     (g) Prescriptive privileges for certified clinical nurse specialist shall include:

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     (1) Diagnosing, prescribing and instituting therapy or referrals of patients to health care

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agencies, health care providers and community resources; and

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     (2) Planning and initiating a therapeutic regimen that includes ordering and prescribing

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non-pharmacological interventions, including, but not limited to, durable medical equipment,

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medical devices, nutrition, blood and blood products, and diagnostic and supportive services

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including, but not limited to, home health care, hospice, and physical and occupational therapy;

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and

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     (3) Prescription of over the counter medications within their population foci.

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     SECTION 3. Sections 5-34-35, 5-34-36, 5-34-39, 5-34-40.1, 5-34-40.2, 5-34-40.3, 5-34-

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40.4 and 5-34-41 of the General Laws in Chapter 5-34 entitled "Nurses" are hereby repealed.

11-22

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

11-23

An applicant for licensure to practice as a certified registered nurse practitioner shall submit to

11-24

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

11-25

division of professional regulation, verified by oath, that:

11-26

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

11-27

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

11-28

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

11-29

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

11-30

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

11-31

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

11-32

nurse registration and nursing education.

11-33

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

11-34

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

12-1

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

12-2

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

12-3

     5-34-36. Licensing of certified registered nurse practitioners. -- A license to practice

12-4

as a certified nurse practitioner shall be issued if the applicant meets the qualifications for the

12-5

certified registered nurse practitioner (R.N.P.). Persons who meet the qualifications of a certified

12-6

registered nurse practitioner, as stated in section 5-34-35, and are currently licensed as certified

12-7

registered nurse practitioners by examination or endorsement under the laws of another state of

12-8

the United States and/or the District of Columbia shall be allowed to practice as certified

12-9

registered nurse practitioners in this state for a period not to exceed ninety (90) days from the date

12-10

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

12-11

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

12-12

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

12-13

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

12-14

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

12-15

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

12-16

nurse registration and nurse education; and

12-17

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

12-18

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

12-19

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

12-20

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

12-21

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

12-22

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

12-23

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

12-24

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

12-25

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

12-26

pharmacology every six (6) years.

12-27

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

12-28

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

12-29

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

12-30

health, verified by oath, that the applicant:

12-31

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

12-32

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

12-33

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

13-34

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

13-35

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

13-36

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

13-37

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

13-38

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

13-39

resulting in a master's degree in nursing and must pass a national qualifying examination

13-40

recognized by the board.

13-41

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

13-42

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

13-43

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

13-44

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

13-45

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

13-46

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

13-47

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

13-48

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

13-49

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

13-50

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

13-51

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

13-52

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

13-53

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

13-54

nurse specialist, the renewal fee for a psychiatric and mental health clinical nurse specialist, and

13-55

the application fee for prescriptive privileges shall be as set forth in section 23-1-54.

13-56

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

13-57

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

13-58

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

13-59

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

13-60

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

13-61

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

13-62

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

13-63

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

13-64

specialist:

13-65

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

13-66

regulations, board of nurse registration and nurse education; and

13-67

      (2) Shall include prescription of certain psychotropic and certain legend medications,

13-68

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

14-1

Schedule IV, that are prescribed in regulations;

14-2

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

14-3

certain legend medications not included in subdivision (2) of this subsection; and

14-4

      (4) Shall be granted for psychiatric and mental health clinical nurse specialists who have

14-5

a master's degree in nursing.

14-6

      (b) A psychiatric and mental health clinical nurse specialist as stated in section 5-34-3

14-7

shall be permitted to prescribe in accordance with annually updated guidelines, written in

14-8

collaboration with the medical director or physician consultant of their individual establishments.

14-9

      (c) A psychiatric and mental health clinical nurse specialist in independent practice does

14-10

not have prescriptive privileges.

14-11

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

14-12

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

14-13

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

14-14

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

14-15

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

14-16

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

14-17

upon request of the board of nurse registration and nursing education evidence of thirty (30)

14-18

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

14-19

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

14-20

entitled "Nurse Anesthetists" are hereby amended to read as follows:

14-21

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

14-22

education established in section 5-34-4.

14-23

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

14-24

successfully met the requirements stated in this chapter.

14-25

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

14-26

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

14-27

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

14-28

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

14-29

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

14-30

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

14-31

also includes, in connection with the immediate perioperative care of a patient, the ability to issue

14-32

a medication order for drugs or medications to be administered by a licensed, certified, or

14-33

registered health care provider; to order and evaluate laboratory and diagnostic test results and

14-34

perform point of care testing that the CRNA is qualified to perform; and order and evaluate

15-1

radiographic imaging studies that the CRNA is qualified to order and interpret. For the purposes

15-2

of this section, the immediate perioperative care of a patient shall be defined as the period

15-3

commencing on the day prior to surgery and ending upon discharge of the patient from post-

15-4

anesthesia care. CRNAs shall comply with the requirements set forth in this chapter, including

15-5

subsection 5-34.2-5(b) regarding scope of practice, and the requirements set forth in chapter 5-34,

15-6

as applicable. In the case of any conflict between this chapter and chapter 5-34 with regard to the

15-7

licensure and practice of CRNAs, this chapter shall control.

15-8

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

15-9

licensure as a nurse anesthetist shall consist of the following:

15-10

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

15-11

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

15-12

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

15-13

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

15-14

anesthesia; and

15-15

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

15-16

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

15-17

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

15-18

successors.

15-19

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

15-20

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

15-21

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

15-22

educational program.

15-23

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

15-24

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

15-25

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

15-26

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

15-27

certified registered nurse anesthetist and anesthesiologist.

15-28

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

15-29

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

15-30

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

15-31

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

15-32

certified under this section shall become recertified as applicable.

15-33

     SECTION 4. This act shall take effect upon passage.

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LC01636/SUB A

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES

***

17-1

     This act would amend and greatly expand the role and duties of certain types of nurses in

17-2

the health care profession, especially the role and authority of advance practice registered nurses.

17-3

     This act would take effect upon passage.

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LC01636/SUB A

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