Chapter 125

Chapter 125

2003 -- S 0827 SUBSTITUTE B

Enacted 07/09/03

 

AN ACT

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES

          

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

     Date Introduced: February 26, 2003

 

 

It is enacted by the General Assembly as follows:

 

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

adding thereto the following section:

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

Nurse Practice Act."

     SECTION 2. Sections 5-34-3, 5-34-4, 5-34-5, 5-34-6, 5-34-7, 5-34-9, 5-34-14, 5-34-18,

5-34-19, 5-34-20, 5-34-24.1, 5-34-25, 5-34-26, 5-34-31, 5-34-35, 5-34-39, 5-34-40 and 5-34-41

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

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

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

criteria and standards.

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

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

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

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

dentists and nurses.

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

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

individuals.

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

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

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

from legally doing so.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

to the consumer for the nursing care rendered.

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

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

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

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

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

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

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

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

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

qualifications defined in section 5-34-40.1.

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

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

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

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

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

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

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

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

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

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

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

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

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

association.

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

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

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

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

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

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

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

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

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

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

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

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

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

representative on the board.

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

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

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

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

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

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

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

board of nurse registration and nursing education shall:

      (1) Be a citizen of the United States;

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

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

of office; and

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

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

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

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

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

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

immediately preceding appointment.

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

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

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

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

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

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

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

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

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

education program.

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

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

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

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

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

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

board. A majority constitutes a quorum at any meeting.

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

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

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

necessary to effect provisions of the chapter;

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

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

under this chapter;

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

those times it may deem necessary;

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

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

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

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

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

individual practice of licensees;

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

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

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

of a license;

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

to persons giving testimony at hearings;

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

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

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

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

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

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

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

public;

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

registered nurse practitioners; and

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

transmit this information to the board of pharmacy. ;

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

mental health clinical nurse specialists; and

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

privileges.

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

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

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

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

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

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

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

education.

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

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

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

department, verified by oath, that the applicant:

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

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

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

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

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

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

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

the applicant has not been previously licensed; and

      (3) Is of good moral character.

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

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

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

administrator of professional regulation, and the director of health.

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

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

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

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

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

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

administrator of professional regulation department a renewal application duly executed together

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

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

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

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

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

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

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

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

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

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

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

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

chapter.

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

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

reinstatement, the board shall issue a renewal of license.

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

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

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

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

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

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

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

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

a renewal of license.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

board of nurse registration and nursing education.

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

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

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

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

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

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

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

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

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

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

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

of the formulary committee established by this section; and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

consultant of their individual establishments.

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

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

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

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

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

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

pharmacology every six (6) years.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

public or private health care service.

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

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

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

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

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

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

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

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

the following functions:

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

patient care.

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

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

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

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

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

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

and safety of persons entrusted to his or her care;

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

suspended in another state;

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

authorized by the provisions of this chapter;

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

      (vii) Mental incompetence.

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

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

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

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

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

case.

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

certified registered nurse practitioner practice.

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

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

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

mental health clinical nurse clinical specialist:

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

regulations, board of nurse registration and nurse education; and

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

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

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

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

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

legend medications not included in subdivision (2).

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

master's degree in nursing.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

medical director or physician consultant of their individual establishments.

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

independent practice does not have prescriptive privileges.

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

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

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

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

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

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

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

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

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

adding thereto the following sections:

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

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

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

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

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

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

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

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

regarding the competence of a licensed nurse.

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

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

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

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

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

communication was made in good faith.

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

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

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

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

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

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

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

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

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

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

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

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

board.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

evidence that:

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

curriculum standards for professional or practical nursing education; and

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

chapter by the board.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      (2) Guilty of a crime of gross immorality;

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

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

      (5) Mentally incompetent;

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

above and also:

      (i) Abandonment of a patient;

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

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

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

legally qualified to provide continuing nursing services to a client;

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

established by the nursing profession; or

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

and/or rule or regulation adopted thereunder.

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

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

referred to the board of action.

      (2) Nurse who has diverted drugs;

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

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

to patient health and safety;

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

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

a nondisciplinary program in the following ways:

      (1) By self referral;

      (2) By employer referral;

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

filed against the nurse; or

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

nurse association, or other health care provider.

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

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

board of nursing is informed and initiates disciplinary proceedings.

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

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

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

follows:

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

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

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

designated by the director of the department of health.

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

by its president.

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

health professionals designated by its president.

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

by its president.

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

aging designated by its president.

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

by its president.

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

1199 designated by its president.

     SECTION 5. This act shall take effect upon passage.

     

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LC02148/SUB B

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