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Board of Registration Board of Registration

in Nursingin Nursing

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Module 2: Module 2:

Standards for ConductStandards for Conduct 244 CMR 9.00244 CMR 9.00

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TrustTrust

• The citizens of Massachusetts The citizens of Massachusetts and the United States have a and the United States have a great deal of trust in nurses.great deal of trust in nurses.

• In Gallup’s annual survey on the In Gallup’s annual survey on the honesty and ethical standards of honesty and ethical standards of various professions, nurses have various professions, nurses have received top marks as the most received top marks as the most trusted profession in the US since trusted profession in the US since 1999, rating #1 in 2004.1999, rating #1 in 2004.

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IntegrityIntegrity

The Massachusetts Board The Massachusetts Board of Registration in Nursing of Registration in Nursing has determined that it is in has determined that it is in the best interest of the the best interest of the public to ensure the public to ensure the applicant meets the applicant meets the Good Good Moral CharacterMoral Character requirement prior to authorizingrequirement prior to authorizinga Registered Nurse to practice a Registered Nurse to practice in the Advanced Role.in the Advanced Role.

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Legal RequirementLegal Requirement

Massachusetts General Law Massachusetts General Law

chapter 112, sections 74, 74A, chapter 112, sections 74, 74A,

and 76 specifies all applicants and 76 specifies all applicants

for initial nursing licensure in for initial nursing licensure in

Massachusetts must Massachusetts must

demonstrate compliance with the demonstrate compliance with the

GoodGood Moral Character Moral Character

requirement.requirement.

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Good Moral CharacterGood Moral Character

Licensed nurses in Massachusetts who fulfill Licensed nurses in Massachusetts who fulfill the the Good Moral Character Good Moral Character requirement are requirement are honest, trustworthy, accountable, reliable, honest, trustworthy, accountable, reliable, have integrity, and are able to distinguish have integrity, and are able to distinguish between right and wrong. They also avoid between right and wrong. They also avoid aggression to self and others, and avoid aggression to self and others, and avoid injustice and deceit.injustice and deceit.

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Application ProcessApplication Process

The Board of Registration in The Board of Registration in

Nursing requires all applicants Nursing requires all applicants

to answer six (6) questions to answer six (6) questions

related to criminal convictions related to criminal convictions

and/or disciplinary actions by a and/or disciplinary actions by a

licensure or certification body.licensure or certification body.

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Good Moral Character Good Moral Character QuestionsQuestions

• 1. Has any disciplinary action ever been taken against you by a 1. Has any disciplinary action ever been taken against you by a professional and/or trade licensing/certification board located in the professional and/or trade licensing/certification board located in the United States or any country/foreign jurisdiction, including removal United States or any country/foreign jurisdiction, including removal from a long-term care nurse aide registry program? from a long-term care nurse aide registry program?

• 2. Are you the subject of pending disciplinary action by a 2. Are you the subject of pending disciplinary action by a professional and/or trade licensing/certification board located in the professional and/or trade licensing/certification board located in the United States or any country/foreign jurisdiction? United States or any country/foreign jurisdiction?

• 3. Have you ever applied for, and been denied, a professional and/or 3. Have you ever applied for, and been denied, a professional and/or trade license/certification in the United States or any other trade license/certification in the United States or any other country/foreign jurisdiction? country/foreign jurisdiction?

• 4. Have you ever surrendered or resigned a professional and/or 4. Have you ever surrendered or resigned a professional and/or trade license/certificate in the United States or any other trade license/certificate in the United States or any other country/foreign jurisdiction? country/foreign jurisdiction?

• 5. Have you ever been convicted of a felony or misdemeanor in the 5. Have you ever been convicted of a felony or misdemeanor in the United States or any other country/foreign jurisdiction? United States or any other country/foreign jurisdiction?

• 6. Are you the subject of any pending or open criminal case (s) or 6. Are you the subject of any pending or open criminal case (s) or investigation (s), (including for any felony or misdemeanor) in a investigation (s), (including for any felony or misdemeanor) in a jurisdiction in the United States or any country/foreign jurisdiction? jurisdiction in the United States or any country/foreign jurisdiction?

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Definition of Criminal ConvictionDefinition of Criminal Conviction

• A verdict or finding of guilty.A verdict or finding of guilty.• A plea of guilty.A plea of guilty.• A plea of nolo contendere (no contest).A plea of nolo contendere (no contest).• Any other plea treated by the court as a guilty Any other plea treated by the court as a guilty

plea regardless of the jurisdiction in which the plea regardless of the jurisdiction in which the conviction was entered.conviction was entered.

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Criminal Offender Record InformationCriminal Offender Record Information

http://www.mass.gov/eohhs/docs/dph/quality/boards/good-moral-info.http://www.mass.gov/eohhs/docs/dph/quality/boards/good-moral-info.pdfpdf

The applicant may be required to The applicant may be required to

complete a Criminal Offender complete a Criminal Offender

Record Information (CORI) form, Record Information (CORI) form,

which is a criminal background which is a criminal background

check, based on the responses to check, based on the responses to

the six (6) the six (6) Good Moral CharacterGood Moral Character

questions on the licensure questions on the licensure

application. application.

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All Criminal Cases and All Criminal Cases and Disciplinary Actions Must be ClosedDisciplinary Actions Must be Closed

• The applicant provides documentation The applicant provides documentation satisfactory to the Board that:satisfactory to the Board that:• all court-ordered requirements and that all all court-ordered requirements and that all

criminal matters involving the applicant criminal matters involving the applicant have been closed for at least one year; andhave been closed for at least one year; and

• All requirements imposed by a All requirements imposed by a licensure/certification body in connection licensure/certification body in connection with the disciplinary action involving the with the disciplinary action involving the applicant have been met. applicant have been met.

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Truthfulness on the ApplicationTruthfulness on the Application

• It is extremely important to answer It is extremely important to answer

truthfully to all questions on the truthfully to all questions on the

application for authorization and application for authorization and

the CORI form. the CORI form.

• Failure to be truthful may result in Failure to be truthful may result in

exclusion from practice for five (5) exclusion from practice for five (5)

years.years.

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Criminal ConvictionsCriminal Convictions

• Conviction for certain crimes will result in mandatory Conviction for certain crimes will result in mandatory permanent exclusion from becoming licensed as a permanent exclusion from becoming licensed as a nurse in Massachusetts. nurse in Massachusetts.

• In general, conduct underlying any violent crime In general, conduct underlying any violent crime against any person or persons that exhibits against any person or persons that exhibits intentional or deliberate disregard of human life is intentional or deliberate disregard of human life is considered grounds for exclusion from licensure. considered grounds for exclusion from licensure.

• In addition, if you have been convicted of a crime In addition, if you have been convicted of a crime within the last 5 years (excluding those that result in within the last 5 years (excluding those that result in permanent exclusion), you may be subject to permanent exclusion), you may be subject to mandatory mandatory temporary temporary exclusion from licensure.exclusion from licensure.

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Nursing Board’s WebsiteNursing Board’s Website

A complete list of A complete list of

specific crimes requiring specific crimes requiring

mandatory permanent mandatory permanent

exclusion from licensure exclusion from licensure

is available at the Board is available at the Board

of Registration websiteof Registration website

http://www.mass.gov/eohhs/docs/dph/quality/boards/nursing-good-moral-policy.pdfhttp://www.mass.gov/eohhs/docs/dph/quality/boards/nursing-good-moral-policy.pdf

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Right to ReviewRight to Review• If you are denied license If you are denied license

based on the Good Moral based on the Good Moral Character requirement, you Character requirement, you have the right to review of your have the right to review of your denial.denial.

• You will be required to provide You will be required to provide documentation which can documentation which can reasonably substantiate the reasonably substantiate the existence of specific areas of existence of specific areas of factual dispute relevant to the factual dispute relevant to the issue. issue.

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Legal vs. ProfessionalLegal vs. Professional

Legal StandardsLegal Standards• The rules of conduct, behaviors and The rules of conduct, behaviors and

expectations regarding the practice of nursing expectations regarding the practice of nursing

Professional StandardsProfessional Standards• Evidence based Evidence based authoritative statements that

describe a level of care or performance common to the profession of nursing by which the quality of nursing practice can be judged

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244 CMR 9.00:244 CMR 9.00:Standards of ConductStandards of Conducthttp://www.mass.gov/Eeohhs2/docs/dph/regs/244cmr009.phttp://www.mass.gov/Eeohhs2/docs/dph/regs/244cmr009.pdfdf

9.01: PURPOSE9.01: PURPOSE

Defines the standards for all Defines the standards for all nurses licensed by the Boardnurses licensed by the Board

9.02: DEFINITIONS9.02: DEFINITIONS

30 words or statements that form 30 words or statements that form the foundation of nursing the foundation of nursing regulationsregulations

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244 CMR 9.03244 CMR 9.03

9.03: STANDARDS OF CONDUCT FOR 9.03: STANDARDS OF CONDUCT FOR NURSES NURSES

Consists of 47 declarative statements Consists of 47 declarative statements regarding nursing practice and the regarding nursing practice and the expectation of how the nurse will expectation of how the nurse will

implement implement SAFE & EFFECTIVE CARESAFE & EFFECTIVE CARE

Review entire regulation!Review entire regulation!

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244 CMR 9.03244 CMR 9.03

Example of the standards related to Example of the standards related to daily practice include (but are not daily practice include (but are not limited to):limited to):

• (9) Responsibility & Accountability(9) Responsibility & Accountability• (11) Performance of Techniques & (11) Performance of Techniques &

Procedures Procedures • (14) Asepsis & Infection Control (14) Asepsis & Infection Control

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244 CMR 9.03 - continued244 CMR 9.03 - continued

• (18) Participation in Research(18) Participation in Research• (24) Professional Boundaries(24) Professional Boundaries• (35) Security of Controlled (35) Security of Controlled

SubstancesSubstances• (38) Administration of Drugs(38) Administration of Drugs• (39) Documentation of CS(39) Documentation of CS• (36) Practice While Impaired(36) Practice While Impaired• (44) Documentation(44) Documentation

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244 CMR 9.03 - continued244 CMR 9.03 - continued

Special ConsiderationSpecial Consideration

• (15) Patient Abuse, Neglect, (15) Patient Abuse, Neglect, Mistreatment, Abandonment, or Mistreatment, Abandonment, or Other HarmOther Harm

• (26) Duty to Report(26) Duty to Report

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244 CMR 9.04 – Specific to 244 CMR 9.04 – Specific to APRNAPRN

• (1) Practice with competence only in authorized (1) Practice with competence only in authorized APRN category (CNP, PCNS, CRNA, CNM, CNS)APRN category (CNP, PCNS, CRNA, CNM, CNS)

• (2) Do not practice without Board authorization(2) Do not practice without Board authorization• (3) Authorized prescribers comply with (3) Authorized prescribers comply with

additional federal and state laws and additional federal and state laws and regulationsregulations

• (4) Maintain current certification(4) Maintain current certification• (5) Fully disclose risks/benefits of treatment (5) Fully disclose risks/benefits of treatment

with documentationwith documentation• (6) Provide access to information regarding (6) Provide access to information regarding

charges and payment for servicescharges and payment for services

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244 CMR 7.00244 CMR 7.00http://www.mass.gov/Eeohhs2/docs/dph/regs/244cmr007.phttp://www.mass.gov/Eeohhs2/docs/dph/regs/244cmr007.pdfdf

Action on ComplaintsAction on Complaints

Non-Disciplinary – not public recordNon-Disciplinary – not public record• DismissalDismissal• Stayed ProbationStayed Probation• Stayed SuspensionStayed Suspension• Substance Abuse Rehabilitation Substance Abuse Rehabilitation

Program (SARP)Program (SARP)

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244 CMR 7.00 - continued244 CMR 7.00 - continued

Disciplinary – Remains as public Disciplinary – Remains as public recordrecord

• ReprimandReprimand• ProbationProbation• SuspensionSuspension• SurrenderSurrender• RevocationRevocation

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Review 4.00, 7.00 and 9.00Review 4.00, 7.00 and 9.00• Go to the Board’s website to review:Go to the Board’s website to review:

• 244 CMR 4.00: Massachusetts 244 CMR 4.00: Massachusetts Regulations Governing Advanced Regulations Governing Advanced Practice Registered NursingPractice Registered Nursing

• 244 CMR 7.00: Action on Complaints244 CMR 7.00: Action on Complaints• 244 CMR 9.00: Standards of Conduct244 CMR 9.00: Standards of Conduct

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Get into the habit of Get into the habit of Checking the Board’s WebsiteChecking the Board’s Website

www.mass.gov/dph/boards/rnwww.mass.gov/dph/boards/rn

• News and UpdatesNews and Updates• Practice IssuesPractice Issues• AlertsAlerts• Regulatory GuidanceRegulatory Guidance• Advisory RulingsAdvisory Rulings• NewslettersNewsletters

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Board of Registration in NursingBoard of Registration in Nursing239 Causeway Street239 Causeway Street22ndnd Floor, Suite 200 Floor, Suite 200Boston, MA 02114Boston, MA 02114

On-Line RenewalOn-Line Renewal

www.mass.gov/dph/boards/rnwww.mass.gov/dph/boards/rn(go to (go to On Line ServicesOn Line Services in right margin) in right margin)