Arkansas Administrative Code
Agency 067 - Board of Nursing
Rule 067.00.97-002 - Chapter 4: Licensure of Advanced Practice Nursing
Universal Citation: AR Admin Rules 067.00.97-002
Current through Register Vol. 49, No. 9, September, 2024
SECTION I SCOPE OF PRACTICE
The advanced practice nurse shall practice in a manner consistent with the definition of the practice of advanced practice nursing set forth in Ark. Code Ann. & 17-87-102(3).(A)(B)(C)(D), and in accordance with the scope of practice defined by the appropriate national certifying body and the standards set forth in these regulations. The advanced practice nurse may provide health care for which the APN is educationally prepared and for which competence has been attained and maintained.
SECTION II QUALIFICATIONS FOR LICENSURE
Advanced practice nurse (APN) licensure shall be designated in one of the four categories below. Current registered nurse licensure in Arkansas is required for all categories of advanced practice licensure. APN categories and their respective qualifications are:
A.
ADVANCED NURSE PRACTITIONER
(ANP)
1. Successful completion of an
organized program of nursing education that prepares nurses for the advanced
practice role of advanced nurse practitioner; and
2. Current certification as a nurse
practitioner by a nationally recognized certifying body which meets the
requirements of Section
VII of
this Chapter.
B.
CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
1. Satisfactory completion, beyond generic
nursing preparation, of a formal educational program that meets the standards
of the Council on Accreditation of Nurse Anesthesia Educational Programs or
another nationally recognized accrediting body that has as its objective
preparation of nurses to perform as nurse anesthetists; and
2. Current certification from the Council on
Certification of Nurse Anesthetists, Council on Recertification of Nurse
Anesthetists, or another nationally recognized certifying body which meets the
requirements of Section
VII of
this Chapter.
C.
CERTIFIED NURSE MIDWIFE (CNM)
1.
Successful completion of an organized program of nursing education that
prepares nurses for the advanced practice role of nurse midwife;
2. Current certification as a nurse midwife
from the American College of Nurse Midwives, or another
nationally recognized certifying body which meets the requirements of Section
VII of
this Chapter; and
3. Agreement with
a consulting physician.
D.
CLINICAL NURSE SPECIALIST
(CNS)
1. Master's degree evidencing
successful completion of a graduate program in nursing, which shall include
supervised clinical practice and classroom instruction in a nursing clinical
practice specialty; and
2. Current
certification in a specialty role as a clinical nurse specialist from a
nationally recognized certifying body which meets the requirements of Section
VII of
this Chapter.
SECTION III LICENSURE
A.
ELIGIBILITY
The applicant shall meet the licensure requirements of the Board.
B.
APPLICATION FOR INITIAL LICENSURE
In addition to current licensure as a registered nurse, the information submitted to the Board shall include:
1. A completed Board application
form;
2. An official transcript or
document from a nursing education program that meets the qualifications of
Section
II of
this Chapter in the category of advanced practice nursing for which the
applicant is seeking licensure. The transcript or document shall verify the
date of graduation and the degree or certificate conferred;
3. A statement directly from the national
certifying body evidencing current certification in good standing;
4. For the certified nurse midwife only: an
agreement with a consulting physician;
5. Payment of the nonrefundable
fee.
6. Upon application for
licensure, the Board may utilize the licensure documentation on file in the
Board office as a basis for licensure of advanced practice nurses in the
categories of certified nurse midwife and certified registered nurse
anesthetist who meet the requirements for initial licensure as advanced
practice nurses.
C.
TEMPORARY PERMITS
1. Upon
application and payment of the required temporary permit fee, the Board shall
issue a temporary permit to practice in an advanced practice nursing category
to a qualified applicant who:
a. Meets the
educational requirements set forth in Section
II of
this Chapter; and
b. Has been
accepted by the appropriate certification body to sit for the first national
certification exam he or she is eligible to take.
2. The permit shall expire upon notification
to the applicant of the results of the examination.
3. The permit is not renewable and does not
apply to prescriptive authority.
D.
RENEWALS
1. The date for renewal of licensure to
practice as an advanced practice nurse shall coincide with renewal of the
applicant's registered nurse license.
2. An applicant for renewal of an advanced
practice nurse license shall submit to the Board:
a. A completed Board renewal application
form;
b. Proof of current national
certification;
c. Payment of the
nonrefundable renewal fee.
3. Continuing education submitted to the
certifying body to meet the qualifications for recertification shall be
accepted as meeting the statutory requirement for continuing
education.
4. Upon request, an APN
shall submit documentation of continuing education to the Board.
E.
LAPSED LICENSE
1. The license is lapsed if not renewed or
placed in an inactive status by the expiration date.
2. Failure to receive the renewal notice
shall not relieve the licensee of the responsibility for renewing the license
by the expiration date.
3. Any
licensee whose license has lapsed shall submit to the Board:
a. A completed Board renewal application
form;
b. Proof of current national
certification;
c. The renewal fee
and the reinstatement fee.
4. Fees submitted to the Board are
nonrefundable.
5. Any person
engaged in advanced practice nursing during the time his or her license has
lapsed shall be considered an illegal practitioner and shall be subject to the
penalties provided for violation of the Nurse Practice Act.
F.
INACTIVE STATUS
1. Any licensee in good standing who desires
his or her advanced practice license to be Oplaced on inactive status may
submit a request in writing to the Board.
2. The current license shall be placed on
inactive status from the date of expiration.
3. While the license is inactive, the
licensee shall not engage in advanced practice nursing nor be subject to the
payment of renewal fees.
4. If the
nurse desires to resume practice in this state, he or she shall request a
renewal application, which shall be completed and submitted with a renewal fee
and the reinstatement fee. Fees are nonrefundable.
5. All certification and continuing education
requirements for renewal shall apply.
6. If disciplinary proceedings on an inactive
licensee have been initiated, the license shall not be reinstated until the
proceedings have been completed.
SECTION IV LOST, STOLEN OR DESTROYED CREDENTIALS
A. A duplicate license or
certificate shall be issued when the licensee submits a notarized statement to
the Board that the document is lost, stolen, or destroyed, and pays a duplicate
credential fee.
B. The credential
will be marked "duplicate" and date of issuance noted.
SECTION V NAME OR ADDRESS CHANGE
A. A licensee whose name is
legally changed shall be issued a replacement license following submission of
the current license, along with an affidavit, copy of marriage license or court
action, and the required fee.
B. A
licensee whose address changes from the address appearing on the current
license shall immediately notify the Board of the change. The Board shall not
issue a new license; but shall make such changes in current license
files.
SECTION VI STANDARDS OF NURSING PRACTICE
A.
PURPOSE
1. To establish
standards essential for safe practice by the advanced practice nurse,
2. To serve as a guide for evaluation of
advanced nursing practice.
B.
CORE STANDARDS FOR ALL CATEGORIES
OF ADVANCED PRACTICE NURSING
1. The
advanced practice nurse shall assess clients at an advanced level, identify
health status including abnormal conditions, establish a diagnosis, develop and
implement treatment plans and evaluate client outcomes.
2. The advanced practice nurse shall use
advanced knowledge and skills in teaching and guiding clients and other health
team members.
3. The advanced
practice nurse shall use critical thinking and decision making at an advanced
level, commensurate with the autonomy, authority and responsibility of his/her
practice category.
4. The advanced
practice nurse shall have knowledge of the statutes and regulations governing
advanced nursing practice, and function within the legal boundaries of the
appropriate advanced practice nursing category.
5. The advanced practice nurse shall
recognize the APN's limits of knowledge and experience, planning for situations
beyond expertise, and collaborating with or referring clients to other health
care providers as appropriate.
6.
The advanced practice nurse shall retain professional accountability for
advanced practice nursing care when delegating interventions.
7. The advanced practice nurse shall maintain
current knowledge and skills in the advanced practice nursing
category.
8. Regulations which
apply to registered nurses are hereby incorporated by reference.
C. In addition to the core
standards, the advanced practice nurse shall practice in accord with the
standards established by the national certifying body from which the APN holds
his or her certification required for licensure. These standards shall have
been reviewed and accepted by the Board.
SECTION VII PROFESSIONAL CERTIFICATION PROGRAMS
A. A national certifying body
which meets the following criteria shall be recognized by the Board to satisfy
Section
II of
these regulations.
B. The national
certifying body:
1. Is national in the scope
of its credentialing;
2. Has no
requirement for an applicant to be a member of any organization;
3. Has an application process and credential
review which includes documentation that the -applicant's education is in the
advanced practice nursing category being certified, and that the applicant's
clinical practice is in the certification category;
4. Uses an examination as a basis for
certification in the advanced practice nursing category which meets the
following criteria:
a. The examination is
based upon job analysis studies conducted using standard methodologies
acceptable to the testing community;
b. The examination represents the knowledge,
skills and abilities essential for the delivery of safe and effective advanced
nursing care to clients;
c. The
examination content and its distribution are specified in a test plan
(blueprint), based on the job analysis study, that is available to
examinees;
d. Examination items are
reviewed for content validity and correct scoring using an established
mechanism, both before use and periodically;
e. Examinations are evaluated for
psychometric performance;
f. The
passing standard is established using acceptable psychometric methods, and is
reevaluated periodically; and
g.
Examination security is maintained through established procedures.
5. Issues certification based upon
passing the examination and meeting all other certification
requirements;
6. Provides for
periodic recertification which includes review of continued education,
qualifications and continued competence;
7. Has mechanisms in place for communication
to the Board for timely verification of an individual's certification status,
changes in certification status, and changes in the certification program,
including qualifications, test plan and scope of practice; and
8. Has an evaluation process to provide
quality assurance in its certification program.
SECTION VIII PRESCRIPTIVE AUTHORITY
A. REQUIREMENTS FOR A
CERTIFICATE OF PRESCRIPTIVE AUTHORITY
An applicant for a certificate of prescriptive authority shall:
1. Be currently licensed as an
advanced practice nurse in Arkansas.
2. Provide evidence from the national
certifying body that differential diagnosis and prescribing practices are
recognized as being within the scope of practice for the applicant's
certification category.
3. Provide
documentation of successful completion of pharmacology coursework which shall
include pharmacokinetics principles and their clinical application and the
prescription of pharmacological agents in the prevention and treatment of
illness, and the restoration and maintenance of health. The coursework shall
contain a minimum of:
a. Three (3) graduate
credit hours of a post-baccalaureate pharmacology course offered by an
accredited college or university within two years immediately prior to the date
of application to the Board; or
b.
Forty-five (45) contact hours [a contact hour is fifty (50 minutes] of
continuing education in pharmacology, offered by an accredited college or
university, or sanctioned by a nationally recognized continuing education
accrediting body acceptable to the Board, within two (2) years immediately
prior to the date of application to the Board; or
c. Three (3) graduate credit hours
pharmacology course, included as part of an advanced practice nursing education
program, within five (5) years immediately prior to the date of application to
the Board; or
4. Up to,
including and terminating after December 31, 1997, evidence of successful
completion of:
a. Two (2) graduate credit
hours of a post-baccalaureate pharmacology course, offered by an accredited
college or university, within three (3) years immediately prior to the date of
application to the Board; or
b.
Thirty (30) contact hours (a contact hour is fifty (50) minutes) of continuing
education in pharmacology, offered by an accredited college or university or
sanctioned by a nationally recognized continuing education accrediting body
acceptable to the Board, within three (3) years immediately prior to the date
of application to the Board.
5. Provide documentation of a minimum of
three hundred (300) clock hours preceptorial experience in the prescription of
drugs, medicines and therapeutic devices with a qualified preceptor, completed
as corequisite with the required pharmacology course or as a part of the formal
educational program in which the pharmacology is taught.
6. Provide evidence of a minimum of one
thousand (1000) hours of practice in an advanced practice nursing category
prior to application for a certificate of prescriptive authority. The 1,000
hours shall not include clinical hours obtained in the advanced practice
nursing education program.
7.
Submit to the Board the applicant's current collaborative practice agreement
with a physician who is licensed under the Arkansas Medical Practices Act,
&
17-93-201 et
seq., and who has a practice comparable in scope, specialty or expertise to
that of the advanced practice nurse. APIM's who will prescribe controlled
substances should seek a collaborative practice with a physician who has an
unrestricted DEA registration number. The collaborative practice agreement
shall include, but not be limited to:
a.
Availability of the collaborating physician(s) for consultation or referral or
both;
b. Methods of management of
the collaborative practice, which shall include the use of protocols for
prescriptive authority;
c. Plans
for coverage of the health care needs of a client in the emergency absence of
the advanced practice nurse or physician;
d. Provision for quality assurance;
and
e. Signatures of the advanced
practice nurse and collaborating physician(s), signifying mutual agreement to
the terms of the collaborative practice.
8. Submit the nonrefundable processing fee
with the application for a certificate of prescriptive authority.
B.
PROTOCOLS FOR
PRESCRIPTIVE AUTHORITY
Protocols shall be made available upon request of the Board. Such protocols shall, at a minimum, include:
1. Indications for and classifications of
legend drugs, controlled substances (if prescriber holds a DEA registration
number and therapeutic devices which will be prescribed or administered by the
APN;
2. Date the protocol was
adopted or last reviewed, which shall be at least annually.
C.
PRESCRIBING
PRIVILEGES
1. The APN, applying for a
certificate of prescriptive authority, shall acknowledge in the application
that he/she is familiar with all state and federal laws and regulations
regarding prescribing; and shall agree to comply with these laws and
regulations.
2. An advanced
practice nurse with a certificate of prescriptive authority may receive and
prescribe legend drugs, medicines or therapeutic devices appropriate to the
APN's area of practice. The prescriptive authority for controlled drugs shall
only extend to drugs listed in Schedules 111 through V.
3. Prescribing stipulations are as follows:
a. Legend drugs and therapeutic devices that
are prescribed by the APN shall be included in the protocols as outlined in
Subsection B. of this Section.
b.
Controlled substances (Schedules III-V), defined by the state and/or federal
controlled substances lists, will be prescribed, administered or ordered as
established in protocols provided that the APN has an assigned DEA registration
number which is entered on each written prescription for a controlled
substance.
c. The APN shall file
his/her DEA registration number with the Board upon receipt.
d. Advanced practice nurses shall not
delegate to unlicensed ancillary staff the calling in of prescriptions to the
pharmacy.
e. The APN shall consult
the Board for direction the next working day following termination of the
collaborative practice agreement.
4. The APN may prescribe a legend drug,
medicine or therapeutic device not included in the written protocols only as
follows:
a. Upon a specific written or verbal
order obtained from the collaborating physician before the prescription or
order is issued by the APN; and
b.
Include documentation of consultation as described above in the client's
medical record to be signed by the APN;
c. Schedules I and II controlled substances
shall not be prescribed under the APN's certificate of prescriptive
authority.
5. The APN
shall note prescriptions on the client's medical record and include the
following information:
a. Medication and
strength;
b. Dose;
c. Amount prescribed;
d. Directions for use;
e. Number of refills; and
f. Initials or signature of APN.
6. The Board shall be responsible
for keeping an up-to-date record, available to the public, of the advanced
practice nurses authorized to prescribe in the state.
7. Advanced practice nurses in the category
of certified registered nurse anesthetists shall not be required to have
prescriptive authority to provide anesthesia care, including the administration
of drugs or medicines necessary for such care.
D.
WRITTEN PRESCRIPTION FORMAT
1. All written prescriptions issued by the
APN shall contain the name of the client, and the APN's name, telephone number,
signature with the initials "APN", prescribing identification number issued by
the Board, and should include information contained in Subsection C.5.a-e of
this Section.
2. All prescriptions
for controlled substances shall be written in accordance with federal
regulations. The APN's assigned DEA registration number shall be written on the
prescription form when a controlled substance is prescribed.
E.
RECEIVING PREPACKAGED
DRUG SAMPLES
1. APN's who have
fulfilled requirements for prescriptive authority may receive legend drug
samples and therapeutic devices appropriate to their area of practice,
including controlled substances contained in Schedules 111 through V of the
Controlled Substance Act, which have been prepared, packaged, or fabricated by
a pharmaceutical manufacturer in accordance with the Arkansas pharmacy laws and
regulations.
2. Records must comply
with all applicable federal and state laws and regulations.
F.
TERMINATION OF
PRESCRIPTIVE AUTHORITY
Prescriptive authority may be terminated by the Board when the prescriber:
1. Fails to maintain
current active licensure as an advanced practice nurse;
2. Violates provisions of this Act and/or
regulations established by the Arkansas Department of Health, Nursing or
Pharmacy Boards;
3. Violates any
state or federal law or regulations applicable to prescriptions; or
4. Fails to follow any conditions
imposed.
SECTION IX PRESCRIPTIVE AUTHORITY ADVISORY COMMITTEE
A.
PURPOSE
The purpose of this committee shall include functioning in an advisory capacity to assist the Board with oversight and implementation of the provisions regarding prescriptive authority.
B.
COMPOSITION
The Advisory Committee shall be composed of five (5) members appointed by the Board and approved by the Governor. Three (3) members shall be advanced practice nurses holding certificates of prescriptive authority, except that the initial advanced practice nurse appointees shall be exempt from holding a certificate. The Board shall issue certificates of prescriptive authority to the initial three (3} advanced practice nurse appointees based on the criteria in Chapter Four, Section IX. One (1) committee member shall be a licensed physician who has been involved in a collaborative practice with a registered nurse practitioner for at least five (5) years. One member shall be a licensed pharmacist who has been in practice for a least five (5) years. The Board shall select the initial chairperson.
C.
TERMS OF OFFICE
The five (5) initial members appointed to the committee shall draw lots to determine staggered lengths of their initial terms. Successive members shall serve three (3} year terms. The Board may remove any advisory committee member, after notice and hearing, for incapacity, incompetence, neglect of duty or malfeasance in office.
D.
COMPENSATION
Advisory committee members shall serve without compensation; but may be reimbursed to the extent special monies are appropriated therefor for actual and necessary expenses incurred in the performance of their official Board duties.
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