An Overview of The Kentucky Board of Nursing

An Overview of The Kentucky Board of Nursing
Pamela C. Hagan, MSN, RN APRN Education & Practice Consultant Kentucky Board of Nursing June 22, 2015

Mission Statement The Kentucky Board of Nursing protects the well-being of the public by development and enforcement of state law governing the safe practice of nursing, nursing education and credentialing.

Role of the Professional Organization Vs. Regulatory Agency
Society PROFESSIONAL REGULATORY Defines nature and scope of nursing practice Statutory definition of nursing practice Standards of Practice Laws and Regulations Quality Assurance Licensure Public Protection

Standards of Care KRS (6)(e)- …which are consistent either with American Nurses’ Association Standards of Practice or with Standards of Practice established by nationally accepted organizations of registered nurses.

Who is “The Board”? State government agency
16 members appointed by the Governor Members serve four (4) year terms Ten (10) Registered Nurse Members One (1) APRN Member Three (3) Licensed Practical Nurse Members Two (2) Citizens-at-Large KRS

OPEN MEETINGS All meetings of the Board and its advisory councils or committees are open to the public.

Kentucky Board of Nursing Activities
Promulgate Kentucky Nursing Law through the creation of regulations Issue Advisory Opinions about safe practice Approve Prelicensure PN, RN, APRN/MSN, APRN/DNP Programs of Nursing Issue RN, LPN and APRN licenses Issue DT and SANE Credentials

Kentucky Board of Nursing Activities (Cont’d)
Approve Continuing Education Providers Renew licenses Administer special programs as directed by legislature Investigate Complaints/take Disciplinary Action Administer the Nursing Incentive Scholarship Fund Maintain the SRNA registry

Advisory Opinion Statements
Issued by the Board Provide guidelines for safe patient care Reflect statutes & administrative regulations Do not have force and effect of law

Questions?

APRN Consensus Model & APRN Practice in Kentucky
Introduction, Overview SB 65, effective date July 12, 2006, DEA#s not issued until early August 2006.

APRN Consensus Model Framework that allows for a consistent definition of advanced nursing practice for quality and safety across jurisdictions, employers, and settings…..towards uniformity The primary mission of the Board, performed through its regulation of nurses, and nursing education and practice, is to protect the public. There, the purpose of the the Board is to assure that safe and effective nursing care is provided by nurses for the citizens of the Commonwealth. And specific to day, to assure that ARNPS prescribe controlled substances in a safe manner and in compliance with the laws governing this practice.

Consensus Model for APRN Regulation
1993 NCSBN Position Paper on APRN Licensure 1995 NCSBN worked to ensure certification exams legally defensible and psychometrically sound for regulatory purposes Simultaneous Groups working on topic Joint Dialogue Group (national nursing groups and NCSBN) 2006 NCSBN APRN Vision Paper 2008 Consensus Document Published

Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education July 7, 2008 FINAL APRN Consensus Document APRN Consensus Document

KBN Implementation of Consensus Model
2009 NCSBN Model Legislative Language 2010 KBN Adopted Model 2011 KY Law – KRS Chapter 314 [KRS (8)]

Regulatory Components
Licensure Accreditation Certification Education LACE

Elements of APRN Regulation in Consensus Model
Title -- APRN Roles -- CNP, CNS, CRNA, CNM Licensure -- RN + APRN Education -- Graduate Degree Certification – Advanced Certification DT= Dialysis Technician

Elements of APRN Regulation in Consensus Model
Independent Practice –without MD oversight or written collaborative agreement Full Prescriptive Authority –without MD oversight or written collaborative agreement

APRN Educational Preparation
Clinical and didactic coursework must be comprehensive and sufficient to prepare the graduate to obtain certification for licensure in and to practice in the APRN role and population focus.

APRN Roles CNP – certified nurse practitioner
CRNA –certified registered nurse anesthetist CNM – certified nurse midwife CNS – clinical nurse specialist (certified)

Population Foci for APRN
In addition to the role, each APRN is educated in one of 6 population foci. These foci are: Family/individual across the lifespan Adult-gerontology Neonatal Pediatrics Women’s health/gender related Psychiatric/Mental Health

Population Foci for APRN
Family/individual across the lifespan Adult-gerontology Acute Primary Neonatal Pediatrics Women’s health/gender related Psychiatric/Mental Health

Specialty Education and Practice
Specialty focus is on practice beyond role and population focus & linked to healthcare needs Preparation in a specialty area of practice is optional, but if included must build on the APRN role/population-focus competencies. Example: palliative care, oncology, diabetes

Core Educational Goals
Ensure 3 P’s –advanced physical/health assessment, advanced pathophysiology, advanced pharmacology –separate courses Ensure APRN role and population focused competencies attained Integrate adult and older adult Psychiatric-mental health across the lifespan

Relationship Between Education, Competencies, Licensure and Certification
Measures of Competencies Identified by Professional Organizations (e.g. oncology, palliative care, CV) Specialty Certification* Specialty CNP, CRNA, CNM, CNS in Population context Population Foci Licensure: Based on Education and Certification** Role APRN Core Courses: Pathophysiology, Pharmacology, Physical/health assess. APRN

Licensure at levels of role and population foci
APRN Regulatory Model Nurse Anesthetist Midwife Clinical Nurse Specialist+ Nurse Practitioner ++ Adult-++ Gerontology* Women’s Health/ Gender Related Family/Individual Across Lifespan Neonatal Pediatrics ++ Psych/Mental Health** Licensure at levels of role and population foci POPULATION FOCI APRN ROLES APRN Specialties Focus of Practice beyond role and population focus Linked to health care needs Examples include but are not limited to: Oncology, Diabetes, Orthopedics, Nephrology, Palliative care Primary care Acute care

Population Focus * The population focus, adult-gerontology, encompasses the young adult to the older adult, including the frail elderly. APRNs educated and certified in the adult-gerontology population are educated and certified across both areas of practice and are titled Adult-Gerontology CNP or CNS. In addition, all APRNs in any of the four roles providing care to the adult population, e.g., family or gender specific, must be prepared to meet the growing needs of the older adult population. Therefore, the education program should include didactic and clinical education experiences necessary to prepare APRNs with these enhanced skills and knowledge. ** The population focus, psychiatric/mental health, encompasses education and practice across the lifespan. + The Clinical Nurse Specialist (CNS) is educated and assessed through national certification processes across the continuum from wellness through acute care.

Acute vs. Primary ++The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP competencies. As of 2008 Consensus Document, the acute care and primary care CNP delineation applies only to the pediatric and adult-gerontology CNP population foci. Scope of practice of the primary care or acute care CNP is not setting specific but is based on patient care needs. Programs may prepare individuals across both the primary care and acute care CNP competencies. If programs prepare graduates across both sets of roles, the graduate must be prepared with the consensus-based competencies for both roles and must successfully obtain certification in both the acute and the primary care CNP roles. CNP certification in the acute care or primary care roles must match the educational preparation for CNPs in these roles.

KY APRN Scope of Practice
Performance of additional acts by registered nurses who have gained added [advanced clinical] knowledge and skills through an approved [accredited education program that prepares the registered nurse for one (1) of the four (4) APRN roles] the organized postbasic program of study and clinical experience Limited to certified population foci, and as described in applicable national scope and standards of practice

KY APRN Scope of Practice
Performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program that prepares the registered nurse for one (1) of the four (4) APRN roles.

Kentucky’s Scorecard on Meeting Elements of Consensus

LACE Network Lace Network Site

Kentucky Nursing Practice Act
Kentucky Nursing Laws

Kentucky Revised Statutes
Kentucky Nursing Laws Chapter 314 Kentucky Administrative Regulations Nursing Regulations 201 KAR Chapter 20 KRS 156- not a nursing law but the Board had to attend to it as it had a nursing component Law defines the destination- non negotiable Regulation gives us the directions on how to get there safely

Kentucky Nursing Laws APRN Nursing Education

KRS 314.011(8) "Advanced practice registered nursing" means
the performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program that prepares the registered nurse for one (1) of the four (4) APRN roles. who are certified by the American Nurses' Association or other nationally established organizations or agencies recognized by the board to certify registered nurses for advanced practice registered nursing as a certified nurse practitioner, certified nurse anesthetist, certified nurse midwife, or clinical nurse specialist; and who certified in at least one (1) population focus.

201 KAR 20:062. Standards for advanced practice registered nurse (APRN) programs of nursing.
KRS Nursing school approval -- Standards -- Administrative hearing. (1) An institution desiring to conduct a school of nursing shall apply to the board and submit evidence that it is prepared to carry out the minimum approved basic curriculum in nursing and that it is prepared to fulfill other requirements of standards which are established by KRS to and KRS and the administrative regulations promulgated by the board. No person shall operate a nursing education program or school of nursing without complying with the provisions of this section. ….(3) The board shall, by administrative regulations promulgated pursuant to KRS Chapter 13A, set standards for the establishment and outcomes of nursing education programs that prepare advanced practice registered nurses, including clinical learning experiences, and shall approve such programs that meet the standards.

Authority of the Board to Approve Programs of Nursing
KRS Board meetings -- Officers -- Quorum -- Duties -- Executive director -- Compensation of members -- Liability insurance -- Expunging of disciplinary action records. …(2) The board shall approve programs of nursing and shall monitor compliance with standards for nurse competency under this chapter. It shall examine, license, and renew the license of duly-qualified applicants; … issue advisory opinions or declaratory rulings dealing with the practice of nursing; register and designate those persons qualified to engage in advanced nursing practice; and it shall conduct administrative hearings in accordance with KRS Chapter 13B upon charges calling for discipline of a licensee and cause the prosecution of all persons violating any provisions of this chapter. It shall keep a record of all its proceedings and make an annual report to the Governor.

201 KAR 20:062 Standards for advanced practice registered nurse (APRN) programs of nursing.
… Section 2. Requirements for Advanced Practice Registered Nursing Programs. (1) An educational institution that offers an APRN program of nursing shall ensure that the program: (a) Is offered by or affiliated with a college or university that is accredited under 201 KAR 20:260, Section 2(1);

201 KAR 20:260 Organization and administration standards for prelicensure programs of nursing.
…Section 2. Organization or Administration Standards for Prelicensure Registered Nurse and Practical Nurse Programs. To be eligible for approval by the board, a program shall have: (1) A governing institution. (a) The governing institution that establishes and conducts the program of nursing shall hold accreditation as a postsecondary institution, college, or university by an accrediting body recognized by the U.S. Department of Education. (b) The governing institution shall assume full legal responsibility for the overall conduct of the program of nursing. The program of nursing shall have comparable status with the other programs in the governing institution and the relationship shall be clearly delineated….

Section 1. Definitions (1) APRN program of nursing (2) APRN program coordinator (3) Designated chief nursing academic officer (4) National nursing accrediting body

Section 2. Requirements for APRN Programs
201 KAR 20:062 Standards for advanced practice registered nurse (APRN) programs of nursing. Section 2. Requirements for APRN Programs (1) (a) Affiliated with accredited college or university (b) Part of doctoral, master’s program, or a postmaster’s program, APRN concentration and population foci (c) Evidence applied for nursing program accreditation (d) Curriculum covers APRN role and population foci

(2) Clinical practice component of curriculum congruent with national professional orgs. and nursing accrediting body standards applicable to role and population focus. (3) Program notify board of any changes in hours of clinical, accreditation status, and respond to board requests for information. (4) Financial resources sufficient to support educational goals (5) Establish academic and professional standards for admission, progression, and graduation. (6) Notify board of plans to expand program e.g. locations, enrollment  50%

Section 3. Establishing a New APRN Program May receive consultation from Board Accredited program of nursing Fee Initiate with accreditation body following board notification Submit no less than 12 mos. prior to first admissions

(6) Submit under chief academic officer or APRN coordinator (7) Board shall have granted developmental status before advertising or enrolling students (8) Information to establish program includes general info about governing institution …7. Faculty qualifications

8. Resources (b) organizaitonal chart (c) identified accrediting body (d) description and rationale for proposed APRN program (e) approval from governing body (f) CV of APRN program coordinator

(g) Needs assessment, including potential students and employment opportunities (h) Evidence of community support/interest (i) Timeline for admission, graduation, expansion (j) Physical/virtual resources for faculty and students (k) Sound financial base, fiscal stability

(l) Program philosophy and outcomes for graduates
201 KAR 20:062 Standards for advanced practice registered nurse (APRN) programs of nursing. (l) Program philosophy and outcomes for graduates (m)Curriculum design- each track 1. course sequence 2. description of courses 3. credit hours theory and practice (n) Availability of sufficient clinical experiences (o) 5 year plan for recruiting/retaining faculty (p) 5 year plan for recruiting students

(9) Met requirements, designated status of developmental approval for 2 years, pending accreditation (10) Proceed with implementation, admission of students. PON must notify Board of admission and graduation of first class. (11) If no admissions, developmental approval expires after 18 months (12) Formal communication with accrediting body forwarded to Board within 30 days

(13) APRN coordinator notify Board within 5 days of accreditation status (14) APRN coordinator notify Board of pending site visits (15) APRN coordinator provide copy of visit accreditation report within 10 days of receipt (16) Full approval based on: (a) achievement and continued full approval (b) site visit by Board (17) Full approval may be granted, not to exceed accrediting body approval period

Section 4 Administrative Structure of Program Chief academic officer: (a) current, active, unencumbered RN license in KY (b) doctoral degree (c) educational preparation/experience in teaching & learning principles for adults, curriculum development, administration (d) minimum 2 years clinical experience (e) current knowledge of APRN practice

(2) Qualifications of APRN coordinator (a) current, active, unencumbered RN license in KY (b) minimum of master’s degree in nursing, health – related field in the clinical specialty (c) educational preparation/experience in teaching & learning principles for adults, curriculum development, administration (d) at least 2 years clinical experience

(3) Board shall be notified in writing of vacancy or pending vacancy in position of APRN coordinator within 15 days of awareness. Chief nursing academic officer shall submit in writing: Effective date of vacancy (b) Name of APRN who is designated to assume administrative duties with copy of CV (c) Status reports submitted to Board from accrediting body (4) If there is a lapse between vacancy and appointment, chief nursing academic officer submits plan of transition to ensure continuity (5) Progress reports submitted (6) Appointment not exceed 6 months (7) Additional 6 months may be granted

Section 5 Faculty, Adjuncts, and Clinical Preceptors Qualifications for nursing faculty (a) current, active, unencumbered APRN license to practice in KY, unless the nurse faculty member will teach solely on-line and will not physically practice in KY in which case the nurse faculty member shall hold a current, active, unencumbered APRN license in the state in which they are located. (b) minimum of a master’s degree in nursing or health related field in the clinical specialty (c) 2 years APRN clinical experience (d) current knowledge, competence, certification as APRN in role and population foci consistent with teaching responsibilities

(2) Adjunct clinical faculty employed solely to supervise clinical nursing experiences shall meet all the faculty qualifications for the program level they are teaching (3) Other qualified individuals may teach a non-clinical course or assist in teaching a clinical course in an APRN program within their area of expertise

(4) Clinical preceptors may be used to enhance faculty-directed clinical learning experiences. Shall have demonstrated competencies related to assigned clinical teaching responsibilities, serve as role model, educator. Shall be approved by the faculty and meet the following requirements:

Clinical preceptor (con’t) (a) holds an active, unencumbered or multi-state privilege to practice as a RN and an APRN or physician in the state in which the preceptor practices or if employed by the federal government, hold an unencumbered active RN and an APRN or physician license in the US. (b) has a minimum of 1 year full time clinical experience in current practice as a physician or ARPN within the role/population focus.

(5) Clinical preceptor shall function as a supervisor teacher and evaluate the student’s performance in the clinical setting. The program faculty shall retain ultimate responsibility for student learning and evaluation. (6) The preceptor may be a practicing physician or other licensed, graduate-prepared health care provider with comparable practice focus. A majority of the preceptors shall be nurses. (7) A clinical preceptor who is an APRN shall: (a) national certification in the advanced practice category in which the student is enrolled; or (b) Current board licensure in the advanced practice category in which the student is enrolled.

Section 5 (cont’d) (8) A complete list of faculty members, clinical faculty, adjuncts, and preceptor appointments shall be reported to the board in writing annually.

Section 6 Curriculum. (1) An educational program offering a graduate degree or post-master’s certificate with a concentration in the APRN role and at least one population foci shall include the following components: (a) Clinical supervision (b) Curriculum congruent with: 1. AACN Essentials for Masters Education for APN or Essentials for Doctoral Education 2. NLNAC Standards and Criteria for Master’s and Post- Master’s Certificate or Criteria for Clinical Doctorate

APRN programs preparing for 2 population foci or combined nurse practitioner/nurse specialist [roles] shall include content and clinical experience in both functional roles and population foci Each instructional track shall have a minimum of 500 supervised clinical hours directly related to the role and population foci, including pharmacotherapeutic management of patients.

(4) The curriculum shall contain the 3 separate graduate level courses in addition to APRN core courses: (a) advanced physiology/pathophysiology, across the lifespan (b) advanced health assessment, including all health systems, advanced techniques, concepts and approaches (c) advanced pharmacology….of all broad categories of agents

(5) Content specific to role and population focus shall be integrated throughout the didactic and clinical courses. (6) Curriculum shall include: (a) Diagnosis and management of disease across practice settings and representative of all systems and caused by major morbidities (b) Preparation that provides a basic understanding of principles for decision making in the identified role (c) Role preparation in 1 of the 6 population foci (7) Specialty area preparation is optional, should build on role/population –focus competencies. Clincal and didactic coursework shall be comprehensive and sufficient….

Section 7. Students. (1) A student shall have an active, unencumbered registered nurse license. (2) A student who wishes to complete a clinical experience in this state but is enrolled in an out of state APRN program shall have an active unencumbered RN license in another jurisdiction, either in the US or in another country. The following criteria shall be met: The APRN program of nursing is accredited The PON advises the student of expectations regarding student practice and required supervision. The PON provides direct supervision of the clinical experience and informs faculty, preceptors, and clinical facilities that the student is practicing under this limited exemption The student limits practice to what is required for completion of the graduate requirements. .

Section 8. Ongoing approval. (1) Approved APRN programs of nursing accredited by national nursing accrediting body may be subject to a site visit at intervals associated with their national nursing accreditation. (2) Board requires continuous accreditation

(3) Factors that may indicate the need for a focused site visit and that jeopardize program approval status shall include: (a) Reported deficiencies in compliance with this regulation. (b) Noncompliance with the governing institution or PON’s philosophy, mission, program design, objectives, outcomes, policies (c) Continual failure to submit records or reports to the board within the designated timeframe.

(d) Failure to provide sufficient clinical learning opportunities for students to achieve stated outcomes. (e) Failure to comply with requirements of the board or to respond to recommendations of the board within the specified time. (f) Failure to submit communication from the accrediting agencies within the time frames identified (g) Withdrawal of accreditation for either the college/university or the PON, or if accredited for less than the maximum accreditation period, may require additional reports re: noncompliance.

(h) Failure to obtain approval of a change that requires approval prior to implementation (i) Providing false or misleading information to students or the public concerning the PON (j) A change in ownership or organizational restructuring of the governing institution (k) Changes necessary to evaluate compliance with referenced standards

If the APRN program achieves reaccreditation and the Board finds the requirements have been met, the program shall be eligible for continuing full approval.

(5) The Board may visit a PON on an announced or unannounced basis. (6) Board action following a site visit: Evaluate in terms of compliance Draft site visit report shall be made available to the APRN program coordinator for review and correction of fact APRN program coordinator shall be available during discussion of the report at the board committee Following board’s review and decision, letter sent to APRN program coordinator and head of governing institution regarding approval status and any requirements and timelines. (e) Program may present evidence of correction and petition to restore full approval.

Section 9. Approval Status and Withdrawal of Approval. (1) The Board shall approve the program if the requirements of the administrative regulations are met. The Board may grant developmental approval for a period of 2 years or less for an APRN program. (2) Full approval may be granted for the same period of time that is designated by the national nursing accrediting body.

(3)(a) The APRN program coordinator of a PON that has its continuing approval status rescinded shall meet with board representatives to evaluate actions needed to be taken. (b) The program may request a hearing within 30 days (4) Conditional approval shall be granted if one or more of the standards have not been met. APRN program coordinator notified of areas of deficiencies and time frame allowed for corrective action. APRN program coordinator file a plan within 30 days to meet deficiencies. APRN program coordinator may request to appear before the Board to contest the deficiencies (d) If contested, or deficiencies upheld, Board may conduct periodic evaluations (e) If compliance not satisfied within time frame, the Board may adjust approval status to probational.

(5) Probational approval is status if one or more of the standards remain unmet. (a) The APRN program coordinator shall be notified of continued areas of deficiencies. A new student shall not be admitted until the program comes into compliance, not to exceed 1 year. (b) The APRN program coordinator shall have 30 days to file a corrective plan (c) The APRN program coordinator may request within 30 days to appear before the Board (d) If uncontested or deficiencies upheld, the Board may conduct periodic evaluations

(6) If the program has not corrected the deficiencies within 1 year of being placed on probational status, a hearing shall be conducted to evaluate whether to withdraw approval of the program. (7) If approval withdrawn, program is removed from official approved status listing. A program shall: Allow a student who is currently enrolled in a class to complete the program, or Assist a currently enrolled student to transfer to an approved program of nursing. (8) A program whose approval has been withdrawn shall be continuously monitored until the program closes. (9) The Board may return a APRN program to full approval status if the program attains and maintains adherence. …………..

TO BE REPEALED 201 KAR 20:061. Approval of Doctor of Nursing Practice (DNP) degree programs.
KRS (1) requires the Board of Nursing to collaborate with the Council on Postsecondary Education to establish standards for the doctor of nursing practice (DNP) degree. KRS (3) requires the board to promulgate by administrative regulations standards set for the establishment and outcomes of nursing education programs that prepare an advanced practice registered nurse.

Section 1. Notification and Initial Approval for Accredited Programs. (1)(a) A postsecondary education institution that is currently accredited by the National League for Nursing Accrediting Commission (NLNAC), now known as the Accreditation Commission for Education in Nursing (ACEN), or the Commission on Collegiate Nursing Education (CCNE) and wishes to offer the doctor of nursing practice (DNP) degree shall notify the board in writing of its intent. (b) The notification letter shall be accompanied by the fee required by 201 KAR 20:240, Section 1(2)(p)-(q).

(2) The notification letter shall include the following: (a) The desired date for the admission of the first class; (b) That the Council on Postsecondary Education has been notified; (c) That the postsecondary education institution intends to apply for additional accreditation for the DNP degree; and (d) How the proposed track or degree complies with the provisions outlined in Section 2(2) of this administrative regulation; (3) When the notification letter is received by the board, the board shall grant the institution initial approval.

Section 2. Initial Approval for Nonaccredited Programs. (1) An institution not presently accredited by NLNAC or CCNE that desires to establish a DNP degree shall meet the following requirements: (a) It shall be accredited as established in 201 KAR 20:260, Section 2; (b) It shall submit information to establish a DNP degree which shall be accompanied by the fee required by 201 KAR 20:240; (c) If the information is submitted to the board, the institution seeking program approval shall begin the application process with NLNAC or CCNE; (d) The information shall be submitted to the board no less than twelve (12) months prior to the first intended admission of students;

(e) The information shall be completed under the direction of the registered nurse who shall serve as the designated chief nursing academic officer as defined in 201 KAR 20:062; and (f) The institution seeking approval of a program shall not advertise or enroll students until the board has granted initial approval status.

(2) The information shall include: (a) General information about the institution including: 1. Mission; 2. Ownership; 3. Method of financing; 4. Accreditation; 5. Enrollment; 6. Area served; 7. Institutional faculty qualifications; and

8. Resources that are sufficient to support defined outcomes and goals; (b) An organizational chart of the institution and a written plan which describes the organization of the program of nursing and its relationship to the institution; (c) A designation of NLNAC or CCNE as the national nursing accrediting body to be used in the development of the program; (d) A description and rationale for the proposed DNP degree; (e) Approval from the governing body of the institution proposing the DNP degree or other empowered approval bodies as applicable; (f) A copy of the curriculum vitae of the registered nurse identified as the chief nursing academic officer;

(g) Results of a needs assessment, including availability of an adequate number of potential students and employment opportunities for program graduates; (h) Evidence of support from the community of interest; (i) A timeline for the admission of students, projected graduation of the first class, and any plans for expansion; (j) A description of physical or virtual resources adequate to meet the needs of the faculty and students; (k) Evidence of a sound financial base and demonstrated financial stability available for planning, implementing, and maintaining the proposed program of nursing; (l) The philosophy of the DNP program and program outcomes for graduates;

(m) Curriculum design for each identified track to include: 1. Proposed course sequence; 2. Description of courses; and 3. Credit hours delineating those credits assigned to theory and practice; (n) Availability of experiential practice activities sufficient to accommodate the number of students and program outcomes; (o) A five (5) year plan for recruiting and retaining qualified nurse faculty; and (p) A recruitment plan and five (5) year projection for student enrollment and policies and procedures for student selection and progression. (3) A proposed DNP program that has met all the requirements of this administrative regulation including evidence that it has applied for accreditation from NLNAC or CCNE shall be granted initial approval. This designation shall be for no more than a two (2) year period of time pending review and approval by NLNAC or CCNE.

(4) If initial approval has been granted by the board, the program may proceed with implementation including the admission of students. It shall be the responsibility of the designated chief nursing academic officer to notify the board of the admission and graduation of the first class. (5) The initial approval of a DNP program shall expire eighteen (18) months from the date of approval if a class of students is not admitted. (6) All formal communication between the DNP program and the national nursing accrediting body shall be forwarded to the board within thirty (30) days of receipt. (7) The designated chief nursing academic officer shall notify the board within five (5) business days of any change in accreditation status. (8) The designated chief nursing academic officer shall notify the board of pending visits by the national nursing accrediting body. (9) The designated chief nursing academic officer shall provide the board with a copy of the national nursing accrediting body’s report within ten (10) days of its receipt by the program.

Section 3. Standards and Final Approval. (1) In order to receive final approval, a postsecondary education institution shall provide to the board evidence that it has met the accreditation standards for doctoral education of either: (a) The National League for Nursing Accrediting Commission; or (b) The Commission on Collegiate Nursing Education. (2) This evidence shall be in the form of a copy of the letter of accreditation from either organization identified in subsection (1) of this section. (3) A postsecondary education institution that has offered a DNP degree prior to the effective date of this administrative regulation may receive final approval from the board by submitting a copy of its letter of accreditation from either organization identified in subsection (1) of this section. (4) Failure to maintain accreditation standards may result in withdrawal of approval by the board.

Section 4. Advanced Practice Registered Nurse Tracks. A postsecondary education institution that offers tracks within the DNP degree that lead to licensure as an advanced practice registered nurse (APRN) shall meet the standards in 201 KAR 20:062 in addition to the standards set forth in this administrative regulation. (37 Ky.R. 635; Am.1413; eff ; 40 Ky.R. 1326; 1707; eff ) …………

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (1) An applicant for licensure to practice as an advanced practice registered nurse shall file with the board a written application for licensure and submit evidence, verified by oath, that the applicant has completed an approved organized postbasic program of study and clinical experience; has fulfilled the requirements of KRS (1); is certified by a nationally established organization or agency recognized by the board to certify registered nurses for advanced practice registered nursing; and is able to understandably speak and write the English language and to read the English language with comprehension.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (2) The board may issue a license to practice advanced practice registered nursing to an applicant who holds a current active registered nurse license issued by the board or holds the privilege to practice as a registered nurse in this state and meets the qualifications of subsection (1) of this section. An advanced practice registered nurse shall be: (a) Designated by the board as a certified nurse anesthetist, certified nurse midwife, certified nurse practitioner, or clinical nurse specialist; and (b) Certified in a least one (1) population focus.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (3) The applicant for licensure or renewal thereof to practice as an advanced practice registered nurse shall pay a fee to the board as set forth in regulation by the board. (4) An advanced practice registered nurse shall maintain a current active registered nurse license issued by the board or hold the privilege to practice as a registered nurse in this state and maintain current certification by the appropriate national organization or agency recognized by the board. (5) Any person who holds a license to practice as an advanced practice registered nurse in this state shall have the right to use the title "advanced practice registered nurse" and the abbreviation "APRN." No other person shall assume the title or use the abbreviation or any other words, letters, signs, or figures to indicate that the person using the same is an advanced practice registered nurse. No person shall practice as an advanced practice registered nurse unless licensed under this section.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (6) Any person heretofore licensed as an advanced practice registered nurse under the provisions of this chapter who has allowed the license to lapse may be reinstated on payment of the current fee and by meeting the provisions of this chapter and regulations promulgated by the board pursuant to the provisions of KRS Chapter 13A. (7) The board may authorize a person to practice as an advanced practice registered nurse temporarily and pursuant to applicable regulations promulgated by the board pursuant to the provisions of KRS Chapter 13A if the person is awaiting the results of the national certifying examination for the first time or is awaiting licensure by endorsement. A person awaiting the results of the national certifying examination shall use the title "APRN Applicant" or "APRN App."

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (8) (a) Except as authorized by KRS and subsection (9) of this section, before an advanced practice registered nurse engages in the prescribing or dispensing of nonscheduled legend drugs as authorized by KRS (8), the advanced practice registered nurse shall enter into a written "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Nonscheduled Legend Drugs" (CAPA-NS) with a physician licensed in Kentucky that defines the scope of the prescriptive authority for nonscheduled legend drugs. (b) The advanced practice registered nurse shall notify the Kentucky Board of Nursing of the existence of the CAPA-NS and the name of the collaborating physician and shall, upon request, furnish to the board or its staff a copy of the completed CAPA-NS. The Kentucky Board of Nursing shall notify the Kentucky Board of Medical Licensure that a CAPA-NS exists and furnish the collaborating physician's name.

KBN Notification of CAPA-NS
Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Nonscheduled Legend Drugs (CAPA–NS) APRN signature MD signature Date(s) signed

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (c) The CAPA-NS shall be in writing and signed by both the advanced practice registered nurse and the collaborating physician. A copy of the completed collaborative agreement shall be available at each site where the advanced practice registered nurse is providing patient care. (d) The CAPA-NS shall describe the arrangement for collaboration and communication between the advanced practice registered nurse and the collaborating physician regarding the prescribing of nonscheduled legend drugs by the advanced practice registered nurse. (e) The advanced practice registered nurse who is prescribing nonscheduled legend drugs and the collaborating physician shall be qualified in the same or a similar specialty.

Defining Same or Similar “Specialty” for Prescribing Purposes
KBN Guideline: APRN’s population foci certification MD determines MD’s population Population foci must overlap minimally

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (f) The CAPA-NS is not intended to be a substitute for the exercise of professional judgment by the advanced practice registered nurse or by the collaborating physician.

Responsibility and Accountability
KY Nursing Laws, in KRS (2), holds each [APRN] individually responsible and accountable for making decisions based on educational preparation and experience, and require each [APRN] to practice with reasonable skill and safety.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (g) The CAPA-NS shall be reviewed and signed by both the advanced practice registered nurse and the collaborating physician and may be rescinded by either party upon written notice via registered mail to the other party, the Kentucky Board of Nursing, and the Kentucky Board of Medical Licensure.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (9) (a) Before an advanced practice registered nurse may discontinue or be exempt from a CAPA-NS required under subsection (8) of this section, the advanced practice registered nurse shall have completed four (4) years of prescribing as a nurse practitioner, clinical nurse specialist, nurse midwife, or as a nurse anesthetist. For nurse practitioners and clinical nurse specialists, the four (4) years of prescribing shall be in a population focus of adult-gerontology, pediatrics, neonatology, family, women's health, acute care, or psychiatric-mental health. [4 years from licensure]

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (b) After four (4) years of prescribing with a CAPA-NS in collaboration with a physician: 1. An advanced practice registered nurse whose license is in good standing at that time with the Kentucky Board of Nursing and who will be prescribing nonscheduled legend drugs without a CAPA-NS shall notify that board that the four (4) year requirement has been met and that he or she will be prescribing nonscheduled legend drugs without a CAPA-NS;

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (c) An advanced practice registered nurse wishing to practice in Kentucky through licensure by endorsement is exempt from the CAPA-NS requirement if the advanced practice registered nurse: 1. Has met the prescribing requirements in a state that grants independent prescribing to advanced practice registered nurses; and 2. Has been prescribing for at least four (4) years. (d) An advanced practice registered nurse wishing to practice in Kentucky through licensure by endorsement who had a collaborative prescribing agreement with a physician in another state for at least four (4) years is exempt from the CAPA-NS requirement.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (e) After July 15, 2014: 1. An advanced practice registered nurse whose license is in good standing at that time with the Kentucky Board of Nursing and who will be prescribing nonscheduled legend drugs without a CAPA-NS shall notify that board that the four (4) year requirement has been met and that he or she will be prescribing nonscheduled legend drugs without a CAPA-NS;

Notify KBN of Discontinuation of CAPA-NS
Notification to Discontinue the CAPA-NS After Four Years Signed by APRN Dated by APRN

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. 2. An advanced practice registered nurse who has maintained a CAPA-NS for four (4) years or more will no longer be required to maintain a CAPA-NS and shall not be compelled to maintain a CAPA-NS as a condition to prescribe after the four (4) years have expired, but an advanced practice registered nurse may choose to maintain a CAPA-NS indefinitely after the four (4) years have expired; and

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. 3. An advanced practice registered nurse who has maintained a CAPA-NS for less than four (4) years shall be required to continue to maintain a CAPA-NS until the four (4) year period is completed, after which the CAPA-NS will no longer be required.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (10) (a) Before an advanced practice registered nurse engages in the prescribing of Schedules II through V controlled substances as authorized by KRS (8), the advanced practice registered nurse shall enter into a written "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances" (CAPA-CS) with a physician licensed in Kentucky that defines the scope of the prescriptive authority for controlled substances.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (b) The advanced practice registered nurse shall notify the Kentucky Board of Nursing of the existence of the CAPA-CS and the name of the collaborating physician and shall, upon request, furnish to the board or its staff a copy of the completed CAPA-CS. The Kentucky Board of Nursing shall notify the Kentucky Board of Medical Licensure that a CAPA-CS exists and furnish the collaborating physician's name.

Notify KBN of CAPA-CS Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse Prescriptive Authority for Controlled Substances (CAPA –CS) Notification of CAPA-CS

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (c) The CAPA-CS shall be in writing and signed by both the advanced practice registered nurse and the collaborating physician. A copy of the completed collaborative agreement shall be available at each site where the advanced practice registered nurse is providing patient care. (d) The CAPA-CS shall describe the arrangement for collaboration and communication between the advanced practice registered nurse and the collaborating physician regarding the prescribing of controlled substances by the advanced practice registered nurse.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (e) The advanced practice registered nurse who is prescribing controlled substances and the collaborating physician shall be qualified in the same or a similar specialty. (f) The CAPA-CS is not intended to be a substitute for the exercise of professional judgment by the advanced practice registered nurse or by the collaborating physician.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (g) Before engaging in the prescribing of controlled substances, the advanced practice registered nurse shall: 1. Have been licensed to practice as an advanced practice registered nurse for one (1) year with the Kentucky Board of Nursing; or 2. Be nationally certified as an advanced practice registered nurse and be registered, certified, or licensed in good standing as an advanced practice registered nurse in another state for one (1) year prior to applying for licensure by endorsement in Kentucky. (h) Prior to prescribing controlled substances, the advanced practice registered nurse shall obtain a Controlled Substance Registration Certificate through the U.S. Drug Enforcement Agency.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (i) The CAPA-CS shall be reviewed and signed by both the advanced practice registered nurse and the collaborating physician and may be rescinded by either party upon written notice via registered mail to the other party, the Kentucky Board of Nursing, and the Kentucky Board of Medical Licensure.

Notify KBN Rescinding CAPA-CS
RESCISSION of a Collaborative Agreement for the Prescriptive Authority for Controlled Substances (CAPA –CS) Rescission of CAPA-CS

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (j) The CAPA-CS shall state the limits [if any]on controlled substances which may be prescribed by the advanced practice registered nurse, as agreed to by the advanced practice registered nurse and the collaborating physician. The limits so imposed may be more stringent than either the schedule limits on controlled substances established in KRS (8) or the limits imposed in regulations promulgated by the Kentucky Board of Nursing thereunder.

License to practice as an advanced practice registered nurse -- Application -- Renewal -- Reinstatement -- Use of "APRN" -- Prescriptive authority under CAPA-NS and CAPA-CS -- Exemption from CAPA-NS requirement. (11) Nothing in this chapter shall be construed as requiring an advanced practice registered nurse designated by the board as a certified registered nurse anesthetist to enter into a collaborative agreement with a physician, pursuant to this chapter or any other provision of law, in order to deliver anesthesia care.

201 KAR 20:057. Scope and standards of practice of advanced practice registered nurses.
Section 1. Definitions. (1) "Collaboration" means the relationship between the advanced practice registered nurse and a physician in the provision of prescription medication, including both autonomous and cooperative decision-making, with the advanced practice registered nurse and the physician contributing their respective expertise. (2) "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances" or “CAPA-CS” means the written document pursuant to KRS (9). (3) "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Nonscheduled Legend Drugs" or “CAPA-NS” means the written document pursuant to KRS (8).

Section 2. (1) The practice of the advanced practice registered nurse shall be in accordance with the standards and functions defined in scope and standards of practice statements adopted by the board in subsection (2) of this section. (2) The following scope and standards of practice statements shall be adopted: (a) AACN Scope and Standards for Acute Care Nurse Practitioner Practice; (b) AACN Scope and Standards for Acute and Critical Care Clinical Nurse Specialist Practice; (c) Neonatal Nursing: Scope and Standards of Practice; (d) Nursing: Scope and Standards of Practice; (e) Pediatric Nursing: Scope and Standards of Practice; (f) Psychiatric-Mental Health Nursing Practice: Scope and Standards of Practice; ;

(g) Scope of Practice for Nurse Practitioners; (h) Standards of Practice for Nurse Practitioners; (i) Scope of Nurse Anesthesia Practice; (j) Standards for Nurse Anesthesia Practice; (k) Standards for Office Based Anesthesia Practice; (l) Standards for the Practice of Midwifery; (m) Statement on the Scope and Standards of Oncology Nursing Practice: Generalist and Advanced Practice; and (n) The Women's Health Nurse Practitioner: Guidelines for Practice and Education

Section 3. In the performance of advanced practice registered nursing, the advanced practice registered nurse shall seek consultation or referral in those situations outside the advanced practice registered nurse's scope of practice. Section 4. Advanced practice registered nursing shall include prescribing medications and ordering treatments, devices, and diagnostic tests which are consistent with the scope and standard of practice of the advanced practice registered nurse. Section 5. Advanced practice registered nursing shall not preclude the practice by the advanced practice registered nurse of registered nursing practice as defined in KRS (5).

Section 6. (1) A CAPA-NS and a CAPA-CS shall include the name, address, phone number, and license number of both the advanced practice registered nurse and each physician who is a party to the agreement. It shall also include the specialty area of practice of the advanced practice registered nurse. (2)(a) To notify the board of the existence of a CAPA-NS pursuant to KRS (8)(b), the APRN shall file with the board the Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Nonscheduled Legend Drugs (CAPA-NS). (b) To notify the board that the requirements of KRS (9) have been met and that the APRN will be prescribing nonscheduled legend drugs without a CAPA-NS, the APRN shall file the Notification to Discontinue the CAPA-NS After Four Years. (c) To notify the board of the existence of a CAPA-CS pursuant to KRS (10)(a), the APRN shall file with the board the Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances (CAPA-CS).

(3) For purposes of the CAPA-NS and the CAPA-CS, in determining whether the APRN and the collaborating physician are qualified in the same or a similar specialty, the board shall be guided by the facts of each particular situation and the scope of the APRN's and the physician's actual practice. (4)(a) An APRN with a CAPA-CS shall report all of his or her United States Drug Enforcement Agency (DEA) Controlled Substance Registration Certificate numbers to the board when issued to the APRN by mailing a copy of each registration certificate to the board within thirty (30) days of issuance. (b) Any change in the status of a DEA Controlled Substance Registration Certificate number shall be reported in writing to the board within thirty (30) days.

Section 7. Prescribing medications without a CAPA-NS or a CAPA-CS shall constitute a violation of KRS (1), except when a CAPA-NS has been discontinued pursuant to KRS (9) or the provisions of KRS (4)(b) apply. Section 8. The board may make an unannounced monitoring visit to an advanced practice registered nurse to determine if the advanced practice registered nurse's practice is consistent with the requirements established by 201 KAR Chapter 20, and patient and prescribing records shall be made available for immediate inspection.

Section 9. Prescribing Standards for Controlled Substances.
201 KAR 20:057. Scope and standards of practice of advanced practice registered nurses. Section 9. Prescribing Standards for Controlled Substances. (1)(a) This section shall apply to an APRN with a CAPA-CS if prescribing a controlled substance other than a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone. (b) The APRN shall practice according to the applicable scope and standards of practice for the APRN’s role and population focus.

(2) This section shall not apply to: [KASPER REQUIREMENTS] (a) An APRN prescribing or administering a controlled substance immediately prior to, during, or within the fourteen (14) days following an operative or invasive procedure or a delivery if the prescribing or administering is medically related to the operative or invasive procedure or the delivery and the medication usage does not extend beyond the fourteen (14) days; (b) An APRN prescribing or administering a controlled substance necessary to treat a patient in an emergency situation; or

(c) An APRN prescribing a controlled substance:
201 KAR 20:057. Scope and standards of practice of advanced practice registered nurses. (c) An APRN prescribing a controlled substance: 1. For administration in a hospital or long-term-care facility with an institutional account, or an APRN in a hospital or facility without an institutional account, if the hospital, long-term-care facility, or licensee queries KASPER for all available data on the patient or resident for the twelve (12) month period immediately preceding the query within twelve (12) hours of the patient's or resident's admission and places a copy of the query in the patient's or resident's medical records during the duration of the patient's stay at the facility; 2. As part of the patient's hospice or end-of-life treatment; 3. For the treatment of pain associated with cancer or with the treatment of cancer; 4. In a single dose to relieve the anxiety, pain, or discomfort experienced by a patient submitting to a diagnostic test or procedure;

5. Within seven (7) days of an initial prescribing pursuant to subsection (1) of this section if the prescribing: a. Is done as a substitute for the initial prescribing; b. Cancels any refills for the initial prescription; and c. Requires the patient to dispose of any remaining unconsumed medication; 6. Within ninety (90) days of an initial prescribing pursuant to subsection (1) of this section if the prescribing is done by another licensee in the same practice or in an existing coverage arrangement, if done for the same patient for the same medical condition; 7. To a research subject enrolled in a research protocol approved by an institutional review board that has an active federal-wide assurance number from the United States Department of Health and Human Services, Office for Human Research Protections if the research involves single, double, or triple blind drug administration or is additionally covered by a certificate of confidentiality from the National Institutes of Health;

8. During the effective period of any disaster or situation with mass casualties that have a direct impact on the APRN’s practice; 9. Administering or prescribing controlled substances to prisoners in a state, county, or municipal correctional facility; 10. Prescribing a Schedule IV controlled substance for no longer than three (3) days for an established patient to assist the patient in responding to the anxiety of a nonrecurring event; or 11. That has been classified as a Schedule V controlled substance.

(3) The APRN shall, prior to initially prescribing a controlled substance for a medical complaint for a patient: (a) Obtain the patient’s medical history and conduct an examination of the patient and document the information in the patient’s medical record. An APRN certified in psychiatric/mental health shall obtain a medical and psychiatric history, perform a mental health assessment, and document the information in the patient’s medical record; (b) Query KASPER for all available data on the patient; (c) Make a written treatment plan stating the objectives of the treatment and further diagnostic examinations required; (d) Discuss with the patient, the patient’s parent if the patient is an unemancipated minor child, or the patient’s legal guardian or health care surrogate: 1. The risks and benefits of the use of controlled substances, including the risk of tolerance and drug dependence; 2. That the controlled substance shall be discontinued when the condition requiring its use has resolved; and 3. Document that the discussion occurred and that the patient consented to the treatment.

(4) The treatment plan shall include an exit strategy, if appropriate, including potential discontinuation of the use of controlled substances. (5) For subsequent or continuing long-term prescriptions of a controlled substance for the same medical complaint, the APRN shall: (a) Update the patient’s medical history and document the information in the patient’s medical record; (b) Modify the treatment plan as clinically appropriate; and (c) Discuss the risks and benefits of any new controlled substances prescribed with the patient, the patient’s parent if the patient is an unemancipated minor child, or the patient’s legal guardian or health care surrogate, including the risk of tolerance and drug dependence.

(6) During the course of treatment, the APRN shall query KASPER no less than once every three (3) months for all available data on the patient before issuing a new prescription or a refill for a controlled substance. (7) These requirements may be satisfied by other licensed practitioners in a single group practice if: (a) Each licensed practitioner involved has lawful access to the patient’s medical record; (b) Each licensed practitioner performing an action to meet these requirements is acting within the scope of practice of his or her profession; and (c) There is adequate documentation in the patient’s medical record reflecting the actions of each practitioner

(8) If prescribing a controlled substance for the treatment of chronic, noncancer pain, the APRN, in addition to the requirements of this section, shall obtain a baseline drug screen or further random drug screens if the APRN: (a) Finds a drug screen to be clinically appropriate; or (b) Believes that it is appropriate to determine whether or not the controlled substance is being taken by the patient. (9) If prescribing a controlled substance for the treatment of a mental health condition, the APRN shall meet the requirements of this section.

(10) If prescribing a controlled substance for a patient younger than sixteen (16) years of age, the APRN shall obtain and review an initial KASPER report. If prescribing a controlled substance for an individual sixteen (16) years of age or older, the requirements of this section shall apply. (11) Prior to prescribing a controlled substance for a patient in the emergency department of a hospital that is not an emergency situation as specified in subsection (2) of this section, the APRN shall: (a) Obtain the patient’s medical history, conduct an examination of the patient and document the information in the patient’s medical record. An APRN certified in psychiatric/mental health shall obtain a medical and psychiatric history, perform a mental health assessment, and document the information in the patient’s medical record; (b) Query KASPER for all available data on the patient; (c) Make a written treatment plan stating the objectives of the treatment and further diagnostic examinations required; (d) Discuss the risks and benefits of the use of controlled substances with the patient, the patient’s parent if the patient is an unemancipated minor child, or the patient’s legal guardian or health care surrogate, including the risk of tolerance and drug dependence, and document that the discussion occurred and that the patient consented to the treatment

Section 10. Prescribing Standards for Controlled Substances from Schedule II and Schedule III Containing Hydrocodone. (1)(a) This section shall apply to an APRN with a CAPA-CS if prescribing a controlled substance from Schedule II or Schedule III controlled substance containing hydrocodone. (b) The APRN shall practice according to the applicable scope and standards of practice for the APRN’s role and population focus. (2) This section shall not apply to: [KASPER REQUIREMENTS] (a) An APRN prescribing or administering a controlled substance immediately prior to, during, or within the fourteen (14) days following an operative or invasive procedure or a delivery if the prescribing or administering is medically related to the operative or invasive procedure or the delivery and the medication usage does not extend beyond the fourteen (14) days; (b) An APRN prescribing or administering a controlled substance necessary to treat a patient in an emergency situation; or

(c) An APRN prescribing a controlled substance: 1. For administration in a hospital or long-term-care facility with an institutional account, or an APRN in a hospital or facility without an institutional account, if the hospital, long-term-care facility, or licensee queries KASPER for all available data on the patient or resident for the twelve (12) month period immediately preceding the query within twelve (12) hours of the patient's or resident's admission and places a copy of the query in the patient's or resident's medical records during the duration of the patient's stay at the facility; 2. As part of the patient's hospice or end-of-life treatment; 3. For the treatment of pain associated with cancer or with the treatment of cancer;

4. In a single dose to relieve the anxiety, pain, or discomfort experienced by a patient submitting to a diagnostic test or procedure; 5. Within seven (7) days of an initial prescribing pursuant to subsection (1) of this section if the prescribing or dispensing: a. Is done as a substitute for the initial prescribing; b. Cancels any refills for the initial prescription; and c. Requires the patient to dispose of any remaining unconsumed medication

6. Within ninety (90) days of an initial prescribing pursuant to subsection (1) of this section if the prescribing is done by another licensee in the same practice or in an existing coverage arrangement, if done for the same patient for the same medical condition; or 7. To a research subject enrolled in a research protocol approved by an institutional review board that has an active federal-wide assurance number from the United States Department of Health and Human Services, Office for Human Research Protections if the research involves single, double, or triple blind drug administration or is additionally covered by a certificate of confidentiality from the National Institutes of Health.

(3) Prior to the initial prescribing of a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone to a human patient, an APRN shall: (a) Obtain a medical history and conduct a physical or mental health examination of the patient, as appropriate to the patient's medical complaint, and document the information in the patient's medical record; (b) Query the electronic monitoring system established in KRS 218A.202 for all available data on the patient for the twelve (12) month period immediately preceding the patient encounter and appropriately utilize that data in the evaluation and treatment of the patient; (c) Make a written plan stating the objectives of the treatment and further diagnostic examinations required; (d) Discuss the risks and benefits of the use of controlled substances with the patient, the patient's parent if the patient is an unemancipated minor child, or the patient's legal guardian or health care surrogate, including the risk of tolerance and drug dependence; and (e) Obtain written consent for the treatment.

(4)(a) An APRN prescribing an additional amount of a Schedule II controlled substance or Schedule III controlled substance containing hydrocodone for the same medical complaint and related symptoms shall: 1. Review the plan of care at reasonable intervals based on the patient's individual circumstances and course of treatment; 2. Provide to the patient any new information about the treatment; and 3. Modify or terminate the treatment as appropriate. (b) If the course of treatment extends beyond three (3) months, the licensee shall: 1. Query KASPER no less than once every three (3) months for all available data on the patient for the twelve (12) month period immediately preceding the query; and 2. Review that data before issuing any new prescription or refills for the patient for any Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone.

(5) For each patient for whom an APRN prescribes a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone, the licensee shall keep accurate, readily accessible, and complete medical records, which include, as appropriate: (a) Medical history and physical or mental health examination; (b) Diagnostic, therapeutic, and laboratory results; (c) Evaluations and consultations; (d) Treatment objectives; (e) Discussion of risk, benefits, and limitations of treatments; (f) Treatments; (g) Medications, including date, type, dosage, and quantity prescribed; (h) Instructions and agreements; and (i) Periodic reviews of the patient's file.

Section 11. Incorporation by Reference. (1) The following material is incorporated by reference: (a) "AACN Scope and Standards for Acute Care Nurse Practitioner Practice", 2012 Edition, American Association of Critical-Care Nurses; (b) "AACN Scope and Standards for Acute and Critical Care Clinical Nurse Specialist Practice", 2010 Edition, American Association of Critical-Care Nurses; (c) "Neonatal Nursing: Scope and Standards of Practice", 2013 Edition, American Nurses Association/National Association of Neonatal Nurses; (d) "Nursing: Scope and Standards of Practice", 2010 Edition, American Nurses Association; (e) "Pediatric Nursing: Scope and Standards of Practice", 2008 Edition, American Nurses Association/Society of Pediatric Nursing/National Association of Pediatric Nurse Practitioners; (f) "Psychiatric-Mental Health Nursing Practice: Scope and Standards of Practice", 2014 Edition, American Nurses Association/American Psychiatric Nursing Association; (g) "Scope of Practice for Nurse Practitioners", 2013 Edition, American Association of Nurse Practitioners; (h) "Standards of Practice for Nurse Practitioners", 2013 Edition, American Association of Nurse Practitioners; (i) "Scope of Nurse Anesthesia Practice", 2013 Edition, American Association of Nurse Anesthetists; (j) "Standards for Nurse Anesthesia Practice", 2013 Edition, American Association of Nurse Anesthetists; (k) "Standards for Office Based Anesthesia Practice", 2013 Edition, American Association of Nurse Anesthetists; (l) "Standards for the Practice of Midwifery"; 2011 Edition, American College of Nurse-Midwives;

(m) "Statement on the Scope and Standards of Oncology Nursing Practice: Generalist and Advanced Practice", 2013 Edition, Oncology Nursing Society; (n) "The Women's Health Nurse Practitioner: Guidelines for Practice and Education", 2008 Edition, Association of Women’s Health, Obstetric and Neonatal Nurses/Nurse Practitioners in Women’s Health (o) "Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances (CAPA-CS)", 12/2014, Kentucky Board of Nursing; (p) "Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Nonscheduled Legend Drugs (CAPA-NS)", 12/2014, Kentucky Board of Nursing; and (q) "Notification to Discontinue the CAPA-NS After Four Years", 12/2014, Kentucky Board of Nursing. (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky 40222, Monday through Friday, 8 a.m. to 4:30 p.m.

201 KAR 20:059. Advanced practice registered nurse controlled substances prescriptions.
Section 1. Specific Controlled Substances. The following controlled substances have been identified as having the greatest potential for abuse or diversion: (1) Diazepam (Valium), a Schedule IV medication; (2) Clonazepam (Klonopin), a Schedule IV medication; (3) Lorazepam (Ativan), a Schedule IV medication; (4) Alprazolam (Xanax), a Schedule IV medication; and (5) Carisoprodol (Soma), a Schedule IV medication. Section 2. Limitations. Prescriptions for the medications listed in Section 1 of this administrative regulation shall be limited to a thirty (30) day supply without any refills.

Licensure Requirements

201 KAR 20:056. Advanced practice registered nurse licensure and certification requirements.
Section 1. An applicant for licensure as an advanced practice registered nurse in Kentucky shall: (1)(a) Complete an Application for Licensure as an Advanced Practice Registered Nurse as required by 201 KAR 20:370, Section 1(1); (b) Provide a copy of a current active Registered Nurse license or validation of Registered Nurse licensure if the state of licensure does not issue licensure cards; (c) Submit the fee required by 201 KAR 20:240, Section 1(2)(k); and (d) Comply with the requirements established in KRS and this administrative regulation.

(2) If the applicant is applying only for a license as an advanced practice registered nurse, the applicant shall also provide: (a) A completed Federal Bureau of Investigation (FBI) Applicant Fingerprint Card and the fee required by the FBI that is within six (6) months of the date of the application; (b) A report from the Kentucky Administrative Office of the Courts, Courtnet Disposition System that is within six (6) months of the date of the application; (c) A certified copy of the court record of any misdemeanor or felony conviction as required by 201 KAR 20:370, Section 1(3); and (d) A letter of explanation that addresses each conviction, if applicable.

(3) An applicant shall not be licensed until: (a) A report is received from the FBI pursuant to the request submitted under subsection (2)(a) of this section and any conviction is addressed by the board; and (b) A query is completed to the board’s reporting agent to the National Practitioner Data Bank of the United States Department of Health and Human Services pursuant to KRS 218A.205(3)(g) and any relevant data on the applicant is received

Section 2. Postbasic Program of Study and Clinical Experience. (1) An applicant for licensure as an advanced practice registered nurse shall complete an organized postbasic program of study and clinical experience. This program shall conform to 201 KAR 20:062 or its substantial equivalence if from an out of state program. (2)(a) If the applicant for licensure as an advanced practice registered nurse completed a postbasic program of study after January 1, 2005, the applicant shall hold a master’s degree, doctorate, or postmaster’s certificate awarding academic credit by a college or university related to the advanced practice registered nurse designation. (b) If the applicant for licensure as an advanced practice registered nurse completed a postbasic program of study before January 1, 2005, the program shall be evaluated by the board on an individual basis to find if the program sufficiently prepares a student for advanced practice registered nursing by complying with the requirements of 201 KAR 20:062.

Section 3. National Certifying Organizations. (1) A nationally established organization or agency which certifies registered nurses for advanced practice registered nursing shall be recognized by the board if it meets the following criteria: (a) The certifying body is an established national nursing organization or a subdivision of this type of organization; (b) Eligibility requirements for certification are delineated; (c) Certification is offered in a role as defined by KRS (2)(a) and in a population focus as defined by KRS and with primary or acute care competencies; (d) Scope and standards of practice statements are promulgated; (e) Mechanism for determining continuing competency is established; and (f) The certifying body is accredited by the American Board of Nursing Specialties or the National Commission for Certifying Agencies.

(2) The board recognizes the following national certifying organizations: (a) American Nurses Credentialing Center; (b) American Midwifery Certification Board; (c) National Board on Certification and Recertification of Nurse Anesthetists; (d) Pediatric Nursing Certification Board; (e) National Certification Corporation; (f) American Association of Nurse Practitioners; and (g) American Association of Critical-Care Nurses Certification Corporation. (3) The board recognizes the Oncology Nursing Certification Corporation only for an individual who has received certification prior to December 15, 2010 and who has continually renewed his or her Kentucky advanced practice registered nurse license since that date.

Section 4. Practice Pending Licensure. (1) A registered nurse who meets all the requirements for practice as an advanced practice registered nurse, and who holds a registered nurse temporary work permit issued pursuant to 201 KAR 20:110 pending licensure by endorsement or a privilege to practice as a registered nurse, shall be authorized to practice as an advanced practice registered nurse for a period of time not to exceed the expiration date of the temporary work permit. (2) Authorization to practice pursuant to this section shall be in the form of a letter from the board acknowledging that the applicant has met all the requirements of this section. An applicant shall not practice until the authorization letter has been issued. (3) An individual authorized to practice pursuant to subsection (1) of this section may use the title "APRN Applicant“ or "APRN App.". (endorsement only)

Section 5. License Renewal. (1) The advanced practice registered nurse license shall expire or lapse when the registered nurse license or privilege expires or lapses. (2) To be eligible for renewal of the license as an advanced practice registered nurse, the applicant shall: (a) Renew the registered nurse license or privilege on an active status; (b) Submit a completed Annual Licensure Renewal Application: RN and APRN or a completed Annual Licensure Renewal Application: APRN with RN Compact License (not Kentucky) form, as applicable, and as required by 201 KAR 20:370, Section 1(1); (c) Submit the current renewal application fee, as established in 201 KAR 20:240, Section 1(2)(l); and (d) Maintain current certification by a recognized national certifying organization.

(3) An advanced practice registered nurse who fails to renew the registered nurse license or privilege or is otherwise unable to legally practice as a registered nurse shall not practice as or use the title of advanced practice registered nurse until: (a) A current active license has been issued by the board or a privilege is recognized by the board; and (b) The advanced practice registered nurse license has been reinstated. (4) An advanced practice registered nurse shall provide evidence of current certification by a recognized national certifying organization upon recertification and at the request of the board.

Section 6. License Reinstatement. (1) If a nurse fails to renew the advanced practice registered nurse license as prescribed by KRS and this administrative regulation, the license shall lapse on the last day of the licensure period. (2) To be eligible for reinstatement of the advanced practice registered nurse license, the applicant shall: (a) Submit a completed Application for Licensure as an Advanced Practice Registered Nurse form as required by 201 KAR 20:370, Section 1(1); (b) Submit the current reinstatement application fee, as established in 201 KAR 20:240, Section 1(2)(m); and (c) Maintain current certification by a recognized national certifying organization.

(3) If the applicant is applying for reinstatement of a license as an advanced practice registered nurse, the applicant shall also provide a: (a) Completed Federal Bureau of Investigation (FBI) Applicant Fingerprint Card and the fee required by the FBI that is within six (6) months of the date of the application; (b) Report from the Kentucky Administrative Office of the Courts, Courtnet Disposition System that is within six (6) months of the date of the application; (c) Certified copy of the court record of any misdemeanor or felony conviction as required by 201 KAR 20:370, Section 1(3); and (d) Letter of explanation that addresses each conviction, if applicable. (4) The license shall not be issued until a report is received from the FBI and any conviction is addressed by the board.

Section 7. Certification or Recertification. (1)(a) An advanced practice registered nurse shall maintain current certification or recertification from one (1) of the national organizations recognized in Section 3 of this administrative regulation throughout the licensure period. (b) The board shall conduct an audit to verify that an advanced practice registered nurse has met the requirements of subsection (1)(a) of this section. (2)(a) A nurse who fails to attain current, active certification or recertification from one (1) of the national organizations recognized in Section 3 of this administrative regulation shall not practice or use the title of advanced practice registered nurse (APRN) until current certification or recertification is obtained. (b)1. An APRN whose certification or recertification lapses prior to the expiration of the APRN license and who does not provide evidence of current certification or recertification prior to its expiration date after a request by the board shall have the APRN license voided. This action shall not be considered to be a disciplinary action.

2. The APRN may request a hearing on this action by submitting the request in writing. If the action is upheld or not challenged, the APRN may seek reinstatement of the license in accordance with Section 6 of this administrative regulation, except as provided in subparagraph 3 of this paragraph. 3. If, after the APRN license has been voided, the APRN provides evidence that the certification had not lapsed, then the APRN shall meet the requirements of Section 6 of this administrative regulation except for Section 6(4) of this administrative regulation. A license may be issued prior to receipt of the FBI report. (3) An advanced practice registered nurse who is decertified by the appropriate national organization shall: (a) Notify the board of that fact; and (b) Not practice as or use the title of advanced practice registered nurse during the period of decertification.

Section 8. (1) An application shall be valid for a period of one (1) year from the date of submission to the board. (2) After one (1) year from the date of application, the applicant shall be required to reapply.

Section 9. The requirements of this administrative regulation shall not prohibit the supervised practice of a nurse enrolled in: (1) A postbasic educational program for preparation for advanced practice registered nursing; or (2) An advanced practice registered nurse refresher course.

Section 10. A registered nurse who holds himself or herself out as a clinical [nurse] specialist or is known as a clinical [nurse] specialist shall be required to be licensed as an advanced practice registered nurse if his or her practice includes the performance of advanced practice registered nursing procedures.

Section 11. A nurse practicing as an advanced practice registered nurse who is not licensed as an advanced practice registered nurse by the board, an advanced practice registered nurse whose practice is inconsistent with the specialty to which he or she has been designated, or an advanced practice registered nurse who does not recertify and continues to practice as an advanced practice registered nurse shall be subject to the disciplinary procedures established in KRS

Section 12. Dual designations. (1) An advanced practice registered nurse who wishes to practice in more than one (1) designation shall complete an approved organized postbasic program of study and clinical experience for each desired designation in compliance with the educational requirements [an accredited education program that prepares the registered nurse for one (1) of the four (4) APRN roles ] established in KRS Chapter 314 and 201 KAR 20:062 and meet all the requirements for licensure for each designation. (2) To apply for licensure for more than one (1) designation, the applicant shall submit a separate application and fee for each desired designation. (3) To renew each designation, the APRN shall pay a separate licensure fee as set forth in 201 KAR 20:240, Section 1(2)(l).

(4) For the purposes of Section 7(2)(b) of this administrative regulation, if the APRN does not provide evidence of current recertification in a designation, then that designation shall be voided. The license shall not be voided if the other designation is maintained. All other provisions of Section 7(2)(b) of this administrative regulation shall apply to the voided designation. (5) Designations shall be the Nurse Anesthetist, Nurse Midwife, Nurse Practitioner, and Clinical Nurse Specialist pursuant to KRS

APRN Inquiries Collaborating Physician Applying for CAPA-CS privileges
Same or similar specialty Scope of Practice KASPER Serial prescribing

Scope of Practice Determination Guidelines
Decision-Making Model KY Nursing Laws? Advanced education –population foci? Scope of practice support? Personal knowledge, competence and skill? Reasonable/Prudent? Accountability assumed?

Contact Information Pamela C. Hagan, MSN, RN APRN Education & Practice Consultant Phone:

An Overview of The Kentucky Board of Nursing

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An Overview of The Kentucky Board of Nursing

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