GENERAL GOVERNMENT CABINET

Board Of Nursing

(Amendment)

201 KAR 20:057. Scope and standards of practice of advanced practice registered nurses.

      RELATES TO: KRS 314.011(7), 314.042, 314.193(2)

      STATUTORY AUTHORITY: KRS 314.131(1), 314.193(2)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 314.131(1) authorizes the Board of Nursing to promulgate administrative regulations necessary to enable it to carry into effect the provisions of KRS Chapter 314. KRS 314.193(2) authorizes the board to promulgate administrative regulations establishing standards for the performance of advanced practice registered nursing to safeguard the public health and welfare. This administrative regulation establishes the scope and standards of practice for an advanced practice registered nurse.

      Section 1. Definitions. (1) "Collaboration" means the relationship between the advanced practice registered nurse and a physician in the provision of prescription medication and includes 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 Nonscheduled Legend Drugs (CAPA-NS)" means the written document pursuant to KRS 314.042(8).

      (3) "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances (CAPA-CS)" means the written document pursuant to KRS 314.042(9).

      Section 2. The practice of the advanced practice registered nurse shall be in accordance with the standards and functions defined in the following scope and standards of practice statements for each specialty area:

      (1) Scope and Standards of Psychiatric-Mental Health Nursing Practice;

      (2) Nursing: Scope and Standards of Practice;

      (3) Scope and Standards for Nurse Anesthesia Practice;

      (4) Standards for Office-based Anesthesia Practice;

      (5) Standards for the Practice of Midwifery;

      (6) The Women's Health Nurse Practitioner: Guidelines for Practice and Education;

      (7) Scope and Standards of Practice: Pediatric Nurse Practitioner;

      (8) Standards of Practice for Nurse Practitioners;

      (9) Scope of Practice for Nurse Practitioners;

      (10) Standards of Clinical Practice and Scope of Practice for the Acute Care Nurse Practitioner;

      (11) Neonatal Nursing: Scope and Standards of Practice;

      (12) Scope of Practice and Standards of Professional Performance for the Acute and Critical Care Clinical Nurse Specialist; and

      (13) Statement on the Scope and Standards of Advanced Practice Nursing in Oncology.

      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 314.011(5).

      Section 6. (1) A CAPA-NS 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. An advanced practice registered nurse shall, upon request, furnish to the board or its staff, a copy of the CAPA-NS.

      (2) To notify the board of the existence of a CAPA-CS pursuant to KRS 314.042(9)(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-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.

      Section 7. Prescribing medications without a CAPA-NS or a CAPA-CS shall constitute a violation of KRS 314.091(1).

      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.

      Section 9. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) "Scope and Standards of Psychiatric-Mental Health Nursing Practice", 2007 Edition, American Nurses' Association;

      (b) "Nursing: Scope and Standards of Practice", 2010(2004) Edition, American Nurses' Association;

      (c) "Standards for Office-based Anesthesia Practice", 2010(2005) Edition, American Association of Nurse Anesthetists;

      (d) "Scope and Standards for Nurse Anesthesia Practice", 2010(2007) Edition, American Association of Nurse Anesthetists;

      (e) "Standards for the Practice of Midwifery", 2009(2003) Edition, American College of Nurse-midwives;

      (f) "The Women's Health Nurse Practitioner: Guidelines for Practice and Education", 2008 Edition, Association of Women's Health, Obstetric and Neonatal Nurses and National Association of Nurse Practitioners in Women's

Health;

      (g) "Pediatric Nursing: Scope and Standards of Practice", 2008 Edition, National Association of Pediatric Nurse Practitioners;

      (h) "Standards of Practice for Nurse Practitioners", 2010(2007)Edition, American Academy of Nurse Practitioners;

      (i) "Scope of Practice for Nurse Practitioners", 2010(2007) Edition, American Academy of Nurse Practitioners;

      (j) "Scope and Standards of Practice for the Acute Care Nurse Practitioner", 2006 Edition. American Association of Critical Care Nurses;

      (k) "Neonatal Nursing: Scope and Standards of Practice", 2004 Edition, American Nurses Association/National Association of Neonatal Nurses;

      (l) "Scope[of Practice] and Standards for[of Professional Performance for the] Acute and Critical Care Clinical Nurse Specialist Practice", 2010[2002] Edition, American Association of Critical-Care Nurses;

      (m) "Statement on the Scope and Standards of Advanced Practice Nursing in Oncology", 2003 Edition, Oncology Nursing Society; and

      (n) "Notification of a Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances (CAPA-CS)", 6/2010, 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 4:30p.m.

CAROL KOMARA, President

      APPROVED BY AGENCY: December 1, 2011.

      FILED WITH LRC: December 9, 2011 at 2 p.m.

      PUBLIC HEARING AND PUBLIC COMMENT PERIOD A public hearing on this administrative regulation shall be held on January 24, 2012 at 1:00 p.m. (EST) in the office of the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky. Individuals interested in being heard at this hearing shall notify this agency in writing by January 17, 2012, five workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted until close of business January 31, 2012. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.

      CONTACT PERSON: Nathan Goldman, General Counsel, Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky 40222, phone (502) 429-3309, fax (502) 564-4251,

email: nathan.goldman@ky.go.v

REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT

Contact Person: Nathan Goldman

      (1) Provide a brief summary of:

      (a) What this administrative regulation does: It sets scope and standards of practice for Advanced Practice Registered Nurses (APRN).

      (b) The necessity of this administrative regulation: The Board is required by statute to promulgate this regulation.

      (c) How this administrative regulation conforms to the content of the authorizing statutes: By setting standards.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: By setting standards.

      (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:

      (a) How the amendment will change this existing administrative regulation: The amendment incorporates the current edition of several Standards of Practice.

      (b) The necessity of the amendment to this administrative regulation: Several national organizations updated their Standards of Practice.

      (c) How the amendment conforms to the content of the authorizing statutes: The Board is required to incorporate current standards of practice for APRNs.

      (d) How the amendment will assist in the effective administration of the statutes: By incorporating the current edition of the appropriate APRN standards of practice.

      (3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation: APRNs, approximately 3000.

      (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:

      (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:

APRNs will follow the current standards of practice.

      (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There is no additional cost that would be required to comply with this amendment

      (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): They will be in compliance with the regulation.

      (5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:

      (a) Initially: There is no additional cost.

      (b) On a continuing basis: There is no additional cost.

      (6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: Agency funds.

      (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment: No increase is needed..

      (8) State whether or not this administrative regulation established any fees or directly or indirectly increased any fees: It does not.

      (9) TIERING: Is tiering applied? Tiering was not applied as the changes apply to all equally.

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

      1. Does this administrative regulation relate to any program, service, or requirements of a state or local government (including cities, counties, fire departments, or school districts)? Yes

      2. What units, parts or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? The Kentucky Board of Nursing.

      3. Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation. KRS 314.131.

      4. Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.

      (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? None.

      (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? None.

      (c) How much will it cost to administer this program for the first year? There are no additional costs.

      (d) How much will it cost to administer this program for subsequent years? There are no additional costs.

      Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.

      Revenues (+/-):

      Expenditures (+/-):

      Other Explanation: