GENERAL GOVERNMENT CABINET

Board of Nursing

(Amendment)

 

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

 

      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 registered nursing practice to safeguard the public health and welfare. This administrative regulation establishes the scope and standards of practice for an advanced registered nurse practitioner.

 

      Section 1. Definitions. (1) "Collaboration" means the relationship between the advanced registered nurse practitioner and a physician in the provision of prescription medication and includes both autonomous and cooperative decision-making, with the advanced registered nurse practitioner and the physician contributing their respective expertise.

      (2) "Collaborative Agreement for the Advanced Registered Nurse Practitioner'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 Registered Nurse Practitioner'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 registered nurse practitioner 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 registered nursing practice, the advanced registered nurse practitioner shall seek consultation or referral in those situations outside the advanced registered nurse practitioner's scope of practice.

 

      Section 4. Advanced registered nursing practice shall include prescribing medications and ordering treatments, devices, and diagnostic tests which are consistent with the scope and standard of practice of the advanced registered nurse practitioner.

 

      Section 5. Advanced registered nursing practice shall not preclude the practice by the advanced registered nurse practitioner 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 or registration number of both the advanced registered nurse practitioner and each physician who is a party to the agreement. It shall also include the specialty area of practice of the advanced registered nurse practitioner. An advanced registered nurse practitioner 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 ARNP shall file with the board the "Notification of a Collaborative Agreement for the Advanced Registered Nurse Practitioner's Prescriptive Authority for Controlled Substances (CAPA-CS)".

      (3) For purposes of the CAPA-CS, in determining whether the ARNP 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 ARNP'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 registered nurse practitioner to determine if the advanced registered nurse practitioner'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[2000] Edition, American Nurses' Association;

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

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

      (d) "Scope and Standards for Nurse Anesthesia Practice", 2007[2005] Edition, American Association of Nurse Anesthetists;

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

      (f) "The Women's Health Nurse Practitioner: Guidelines for Practice and Education", 2008[2002] 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[: Pediatric Nurse Practitioner]", 2008[2004] Edition, National Association of Pediatric Nurse Practitioners;

      (h) "Standards of Practice for Nurse Practitioners", 2007[2006] Edition, American Academy of Nurse Practitioners;

      (i) "Scope of Practice for Nurse Practitioners", 2007[2006] Edition, American Academy of Nurse Practitioners;

      (j) "Scope and Standards of Practice[Standards of Clinical Practice and Scope of Practice] for the Acute Care Nurse Practitioner", 2006[1995] Edition. [American Nurses' Association/]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 of Professional Performance for the Acute and Critical Care Clinical Nurse Specialist", 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 Registered Nurse Practitioner's Prescriptive Authority for Controlled Substances (CAPA-CS)", 8/2006, 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.

 

JIMMY ISENBERG, President

      APPROVED BY AGENCY: April 23, 2009

      FILED WITH LRC: May 12, 2009 at 9 a.m.

      PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall be held on June 22, 2009, at 10 a.m. 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 June 15, 2009, 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 June 30, 2009. 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) 696-3938.

 

REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT

 

Contact Person: Nathan Goldman, General Counsel

      (1) Provide a brief summary of:

      (a) What this administrative regulation does: It implements requirements for Advanced Registered Nurse Practitioners (ARNP) and recognizes scope and practice statements from national organizations.

      (b) The necessity of this administrative regulation: It is required by statute.

      (c) How this administrative regulation conforms to the content of the authorizing statutes: It sets requirements for ARNPs and adopts scope and practice statements.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: By setting requirements and adopting scope and practice statements.

      (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: It adopts the current edition of several scope and standards of practice statements from national organizations.

      (b) The necessity of the amendment to this administrative regulation: Several statements have been updated.

      (c) How the amendment conforms to the content of the authorizing statutes: The board Is required to adopt these statements.

      (d) How the amendment will assist in the effective administration of the statutes: By adopting the most recent statement.

      (3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation: All current and future ARNPs. Currently there are approximately 3,000 ARNPs in Kentucky.

      (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: They will have to conform their practice to the current statement.

      (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 cost to the ARNP 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: No additional cost.

      (b) On a continuing basis: 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 will be necessary.

      (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? No revenue will be generated.

      (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? No revenue will be generated.

      (c) How much will it cost to administer this program for the first year? This amendment will not require additional costs to administer.

      (d) How much will it cost to administer this program for subsequent years? This amendment will not require additional costs to administer.

      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: