1. Model Act and Rules Committee Nathan Goldman, Chair

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

3. Overall, the Model Act and Rules are intended to serve as a guide for Member Boards. However, NCSBN encourages all boards to adopt as much of the Model Act and Rules as possible. Purpose of NCSBNs Model Act and Rules

4. First adopted in 1982. Revised in 1988, 1993, 1994, 1997, and 2004. CBCs added in 2006. APRN Consensus Model language added in 2008. NCSBN MODEL NURSING PRACTICE ACT

5. Appointed in FY 2011 Charge: Review and revise the NCSBN Model Act & Rules as needed Rose Kearney-Nunnelly, Chair (FY 2011) Nathan Goldman, Chair (FY 2012) Model Act and Rules Committee

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

7. Streamline Reduce redundancy Clarify Organize Update/conform with other NCSBN initiatives Move detail from Act to Rule Use legislative language Committees Goals for Revisions

8. Reformatted the Act and Rule into two separate documents Reordered and renumbered Articles and Chapters Revised language in all Articles and Chapters, except Nurse Licensure Compact and APRN Compact Removed all explanatory notes Replaced the term client with patient Overview of Major Changes

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

10. Highlighted Changes

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

12. The purpose of this Act is to protect the health, safety and welfare of the residents* of this state. *The term residents was used instead of citizens based upon comments received at MYM Purpose

13. Deleted definitions that are commonly understood Deleted definitions that are defined beyond nursing law (ex. legal definitions) Deleted definitions for words not used in the text of the Act or Rules Removed NLC definitions for inclusion in that Article/Chapter Definitions

14. Advanced assessment Clinical learning experiences Competence Comprehensive nursing assessment Delegating Eligible for graduation* Encumbered Focused nursing assessment Inactive license Internationally educated applicants Revised/Maintained Act Definitions

15. License Nursing Patient Patient-centered health care plan Reactivation Reinstatement Supervision Unlicensed assistive personnel Act Definitions, cont.

16. Dual relationship NCLEX-PN® NCLEX-RN® Nursing faculty Preceptor Professional boundaries Professional-boundary crossing Professional-boundary violation Sexualized body part Revised/Maintained Rule Definitions

17. Deleted requirement that BON members must be eligible to vote Added authority to: – Share current significant investigative information with other regulatory bodies and law enforcement entities – Withdraw a license issued in error – Conduct criminal background checks for nurse licensure in accordance with state and federal law – Issue a cease and desist order for any violation of the Act and – Adopt criteria for recognizing national certifying bodies for APRN roles and population foci Board of Nursing

18. Deleted specific requirements related to EOs: – RN license – Masters degree or higher – Certain years experience Kept language that requires EO to be qualified Added power to hire and fire Executive Officer

19. Revised Model Act and Rules to conform with the approved Uniform Licensure Requirements (ULRs) that were passed at Delegate Assembly in 2011. Removed all reference to a modified license per ULRs. RN and LPN/VN Licensure and Exemptions

20. Revised graduation language: Graduate from or be eligible for graduation from a BON-approved prelicensure program or a program that meets criteria comparable to those established by the BON in its rules Licensure by Examination

21. Added the following requirements per the ULRs: – Report any substance use disorder in the last five years – Report any action taken or initiated against a professional or occupational license, registration or certification – Graduates from an RN prelicensure program who take the LPN/VN exam must complete a role delineation course. Licensure by Examination

22. Graduation from a nursing program comparable to a BON approved prelicensure RN or LPN/VN program, whichever is applicable Applicant must submit to a credentials evaluation by a BON approved/authorized organization for the level of licensure being sought Successful passage of an English proficiency exam that includes the components of reading, speaking, writing and listening, except for applicants from countries where English is the native language, and the nursing program where the applicant attended was taught in English, used English textbooks and clinical experiences were conducted in English, and Disclosure of nursing licensure status in country of origin, if applicable Internationally Educated Applicants

23. Graduate from a BON- approved prelicensure program or a program that meets criteria comparable to those established by the BON in its rules Report current participation in an alternative to discipline program in any jurisdiction Submit verification of licensure status directly from the U.S. jurisdiction of licensure by examination Licensure by Endorsement

24. Applicant must report: – Criminal conviction, nolo contendere plea, Alford plea, deferred judgment, or other plea arrangements in lieu of conviction – Status of all nursing licenses, including any BON actions taken or any current or pending investigations – Substance use disorder in the last five years – Actions taken or initiated against a professional or occupational license, registration or certification and – Current participation in an alternative to discipline program Renewal and Reactivation

25. Deleted specific practice hour requirements and inserted the following note as a placeholder: ***At the present time, evidence does not support any one mechanism for continued competence and further study is warranted. Continued Competence

26. Act: Each applicant for licensure shall submit a full set of fingerprints to the BON for the purpose of obtaining a state and federal criminal records check pursuant to and Public Law 92-544. The may exchange this fingerprint data with the Federal Bureau of Investigation (FBI). Criminal Background Checks

27. Rule: All individuals convicted of a sexual offense involving a minor or performing a sexual act against the will of another person shall be subject to a BON order for evaluation by a qualified expert approved by the BON. If the evaluation identifies sexual behaviors of a predatory nature the BON shall deny licensure. Other criminal convictions may be reviewed by the BON on a case by case basis to determine eligibility for licensure Criminal Background Checks

28. Expanded authority of the BON Modified grounds for discipline Added additional immunity/protection from retaliation Revised portions of the Alternative to Discipline Program requirements and criteria Discipline and Proceedings

29. Summarily issue emergency limitation or restriction of a license Summarily issue an emergency suspension of a license Reprimand or censure a license Accept a voluntary surrender of a license Accept other voluntary limitation or restriction of a license Place other limitations or restrictions on a license Expanded Authority of BON

30. Added: – Non-Compliance with federal, jurisdictional or contractual requirements – Confidentiality, patient privacy, consent or disclosure violations – Misconduct or abuse – Other violations of the Act or administrative rules Deleted requirement that the criminal conviction or adjudication relate to the practice of nursing or to the ability to practice nursing. Grounds for Discipline

31. A person may not suspend, terminate, or otherwise discipline, discriminate against, or retaliate against anyone who reports, or advises on reporting, in good faith under this section. Cause of action for good faith reporter against retaliator Immunity/Retaliation

32. Added detail to the functions and responsibilities of programs Modified the eligibility criteria to add specificity Added screening and assessment requirements Expanded contracts section Added notification, monitoring and practice requirements and limitations as well as standards for returning to work Alternative to Discipline Monitoring Programs

33. Deleted all reference to the CNA II role Added specificity to the roles, duties and requirements of CNAs and MACs Expanded basic curriculum and training requirements Added section to the Rules for CNA and MAC discipline Limited what MACs can do to medication administration and related tasks only Removed all references to long-term care facilities Unlicensed Assistive Personnel

34. Additional Practice language added: – Delegating and assigning therapeutic measures to assistive personnel – Consulting with other disciplines and providing referrals to health care agencies, health care providers and community resources – Wearing identification which clearly identifies the nurse as an APRN when providing direct patient care, unless wearing identification creates a safety or health risk for either the nurse or the patient and – Other acts that require education and training consistent with professional standards and commensurate with the APRNs education, certification, demonstrated competencies and experience APRNs

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

36. Deleted the contact hours limitation related to herbal and complementary therapies from the endorsement and renewal rules APRN Licensure

37. Questions?