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New Hampshire Board of NursingNew Hampshire Board of Nursing
Everything You Ever Wanted Everything You Ever Wanted to Know about Licensing and to Know about Licensing and Practice RegulationsPractice Regulations
Welcome!Welcome! January 2010January 2010
New Hampshire Board of NursingNew Hampshire Board of Nursing 22
PART 1PART 1Mission of the BoardMission of the Board
Structure and FunctionStructure and Function
Nurse Practice ActNurse Practice Act
Administrative RulesAdministrative Rules
New Hampshire Board of NursingNew Hampshire Board of Nursing 33
Board StaffBoard Staff
Margaret Walker, Executive DirectorMargaret Walker, Executive DirectorNorma Blake, Assistant DirectorNorma Blake, Assistant DirectorPatricia Orzano, Assistant DirectorPatricia Orzano, Assistant DirectorLori Tetreault, Program Specialist IVLori Tetreault, Program Specialist IVSusan Goodness, Administrative Susan Goodness, Administrative SupervisorSupervisor
Attorney Laurel O’Connor, Prosecuting Attorney Laurel O’Connor, Prosecuting Attorney contracted by the BoardAttorney contracted by the Board
New Hampshire Board of NursingNew Hampshire Board of Nursing 44
Board StaffBoard Staff
Professional nursing staffProfessional nursing staff
Licensing clerks and secretarial staffLicensing clerks and secretarial staff
Responsible for implementing the rules, Responsible for implementing the rules,
including:including:– Licensing applicants,Licensing applicants,– Surveying education programsSurveying education programs– Conveying the Board’s decisions about Conveying the Board’s decisions about
practice issues to the publicpractice issues to the public
New Hampshire Board of NursingNew Hampshire Board of Nursing 55
Board MembersBoard Members
Have the responsibility of regulating Have the responsibility of regulating practice practice 11 members11 members
appointed by the governor for a 3 year termappointed by the governor for a 3 year term
5 RNs, one of which must be an ARNP5 RNs, one of which must be an ARNP
2 LPNs2 LPNs
2 LNA’s, one which should be a MNA if 2 LNA’s, one which should be a MNA if possiblepossible
2 public members2 public members
New Hampshire Board of NursingNew Hampshire Board of Nursing 66
Board PurposeBoard Purpose
Defined in RSA 326-B:1, aka the Defined in RSA 326-B:1, aka the Nurse Practice ActNurse Practice Act
Safeguard the public from…..Safeguard the public from…..– UnauthorizedUnauthorized
– UnqualifiedUnqualified
– Improper practice of nursingImproper practice of nursing
New Hampshire Board of NursingNew Hampshire Board of Nursing 77
How does the Board protect the How does the Board protect the public?public?
Licenses nurse and nursing assistantsLicenses nurse and nursing assistants
Defines the scope of nursing and nursing Defines the scope of nursing and nursing assistant practiceassistant practice
Enforces rules and governs practice and Enforces rules and governs practice and educationeducation
Reviews and approves schools of nursingReviews and approves schools of nursing
Sanctions licensees who violate the lawSanctions licensees who violate the law
New Hampshire Board of NursingNew Hampshire Board of Nursing 88
Board Meeting ScheduleBoard Meeting Schedule
3rd Thursday of every month3rd Thursday of every month
8:30 - 4:00 PM at the Board office at 8:30 - 4:00 PM at the Board office at
21 South Fruit Street, Concord, NH21 South Fruit Street, Concord, NH
Board meetings are open to the public!Board meetings are open to the public!
We strongly encourage you to attend!We strongly encourage you to attend!
New Hampshire Board of NursingNew Hampshire Board of Nursing 99
Committees of the BoardCommittees of the Board
Practice & Education CommitteePractice & Education Committee– reviews and recommends to the Board changes reviews and recommends to the Board changes
and clarification to scope of practice for all and clarification to scope of practice for all license categorieslicense categories
ARNP Liaison CommitteeARNP Liaison Committee– reviews ARNP license applicants and reviews ARNP license applicants and
recommends to the Board and makes recommends to the Board and makes recommendations about ARNP practice issuesrecommendations about ARNP practice issues
Education Advisory Education Advisory – makes recommendations to the Board regarding makes recommendations to the Board regarding
education standardseducation standards
New Hampshire Board of NursingNew Hampshire Board of Nursing 1010
Nurse Practice ActNurse Practice Act
The The Nurse Practice Act (NPA)Nurse Practice Act (NPA) is also known as is also known as::
– RSA 326-B orRSA 326-B or– Statute, Law Statute, Law
Revised Nurse Practice Act signed by the Revised Nurse Practice Act signed by the Governor in Summer 2005Governor in Summer 2005
The NPA must be voted on by the legislature and The NPA must be voted on by the legislature and signed/ not signed/ vetoed by the Governorsigned/ not signed/ vetoed by the Governor
Revisions of laws may take years!Revisions of laws may take years!
New Hampshire Board of NursingNew Hampshire Board of Nursing 1111
Nurse Practice Act: Nurse Practice Act: Legislative IssuesLegislative Issues
Any one can propose new legislation Any one can propose new legislation about nursing!about nursing!
Changes to the NPA are made through Changes to the NPA are made through the legislative process:the legislative process:– Amendments to the Nurse Practice ActAmendments to the Nurse Practice Act– Amendments to other House or Senate Amendments to other House or Senate
BillsBills
Practice acts from other disciplines Practice acts from other disciplines may affect nursing practicemay affect nursing practice
New Hampshire Board of NursingNew Hampshire Board of Nursing 1212
Administrative RulesAdministrative Rules
The board makes necessary revisions on The board makes necessary revisions on an ongoing basis.an ongoing basis.
The board appears before the Joint The board appears before the Joint Legislative Committee on Administrative Legislative Committee on Administrative Rules for any and all changes.Rules for any and all changes.
New Hampshire Board of NursingNew Hampshire Board of Nursing 1313
Administrative RulesAdministrative Rules
Chapter 100: Organization of the BoardChapter 100: Organization of the Board
Chapter 200: General Board ProceduresChapter 200: General Board Procedures
Chapter 300: Licensing RequirementsChapter 300: Licensing Requirements
Chapter 400: Continuing Status, DelegationChapter 400: Continuing Status, Delegation
Chapter 500: Ethical StandardsChapter 500: Ethical Standards
Chapter 600: EducationChapter 600: Education
Chapter 700: Nursing AssistantsChapter 700: Nursing Assistants
Chapter 800: Medication Nursing Chapter 800: Medication Nursing
AssistantsAssistants
New Hampshire Board of NursingNew Hampshire Board of Nursing 1414
Monitoring legislation:Monitoring legislation:
www.nh.govwww.nh.gov
www.nh.gov/nursingwww.nh.gov/nursing
Nurse Practice Act: Legislative IssuesNurse Practice Act: Legislative Issues
New Hampshire Board of NursingNew Hampshire Board of Nursing 1515
PART 2PART 2Licensure Requirements for RNs and LPNsLicensure Requirements for RNs and LPNs
Mutual Recognition Licensure: The Compact Mutual Recognition Licensure: The Compact
Examinations, Endorsements and Temporary Examinations, Endorsements and Temporary LicensesLicenses
Foreign educated nursesForeign educated nurses
Scope of Practice for RNs and LPNsScope of Practice for RNs and LPNs
Understanding “404.12”Understanding “404.12”
Reentry for RNs and PNsReentry for RNs and PNs
LPN IV Therapy RulesLPN IV Therapy Rules
New Hampshire Board of NursingNew Hampshire Board of Nursing 1616
RN & LPN Licensing RequirementsRN & LPN Licensing Requirements
No nurse may work in any capacity No nurse may work in any capacity without a temporary or permanent without a temporary or permanent active NH license or multi-state license active NH license or multi-state license issued by another compact stateissued by another compact stateLicense by Examination or EndorsementLicense by Examination or Endorsement2 status categories: active/ inactive2 status categories: active/ inactiveContinuing competence requirementsContinuing competence requirements– 400 hours active in practice - 4 years400 hours active in practice - 4 years– 30 continuing education hours - 2 years30 continuing education hours - 2 years
New Hampshire Board of NursingNew Hampshire Board of Nursing 1717
What is mutual recognition?What is mutual recognition?
Allows a nurse to practice in multiple Allows a nurse to practice in multiple states with one license states with one license Nurse maintains a “home state” a.k.a. Nurse maintains a “home state” a.k.a. “Primary residence” “Primary residence” Nurse can practice in other compact Nurse can practice in other compact states as long as license is in “good states as long as license is in “good standing” standing” Also known as Nurse Licensure Also known as Nurse Licensure Compact (NLC) or “Compact” Compact (NLC) or “Compact”
New Hampshire Board of NursingNew Hampshire Board of Nursing 1818
When did NH implement the Compact?When did NH implement the Compact?
The Compact was enacted through the The Compact was enacted through the state governmentstate government
The Compact in NH is part of the Nurse The Compact in NH is part of the Nurse Practice ActPractice Act
The Governor signed the Nurse Practice The Governor signed the Nurse Practice Act (SB 170) into law on July 25, 2005Act (SB 170) into law on July 25, 2005
Implementation of the compact in New Implementation of the compact in New Hampshire was on January 1, 2006Hampshire was on January 1, 2006
New Hampshire Board of NursingNew Hampshire Board of Nursing 1919
How does the Compact work?How does the Compact work?
License to practice is issued by the state License to practice is issued by the state in which you legally reside. in which you legally reside. Allows a nurse to practice in any other Allows a nurse to practice in any other compact statecompact stateIf a nurse moves to another compact state, If a nurse moves to another compact state, the nurse must apply for a multi-state the nurse must apply for a multi-state license in the newly adopted state and license in the newly adopted state and surrender the multi-state license from the surrender the multi-state license from the former state.former state.
New Hampshire Board of NursingNew Hampshire Board of Nursing 2020
How do I know which states belong How do I know which states belong to the Nurse Licensure Compact?to the Nurse Licensure Compact?Go to Go to www.ncsbn.comwww.ncsbn.com for a current listing for a current listing of the statesof the statesArizona, Arkansas, Colorado, Delaware, Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Nebraska, Mississippi, Nebraska, New HampshireNew Hampshire, , New Mexico, North Carolina, North Dakota, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, & Tennessee, Texas, Utah, Virginia, & Wisconsin currently belong to the compact Wisconsin currently belong to the compact with Missouri entering June 2010with Missouri entering June 2010..
New Hampshire Board of NursingNew Hampshire Board of Nursing 2121
How is primary residence How is primary residence determined?determined?
A nurse can have only one primary A nurse can have only one primary residence!residence!
Documentation establishing primary Documentation establishing primary residency includes:residency includes:–Driver’s licenseDriver’s license–Federal income tax returnFederal income tax return–Voter registrationVoter registration
New Hampshire Board of NursingNew Hampshire Board of Nursing 2222
What happened to the license What happened to the license of a nurse who of a nurse who lives in NH as lives in NH as
of January 1, 2006of January 1, 2006??Current license became a multi-state license Current license became a multi-state license issued by NH (with a few exceptions)issued by NH (with a few exceptions)
The nurse may practice nursing in NH or in The nurse may practice nursing in NH or in another compact state without having to apply another compact state without having to apply for a license in that compact statefor a license in that compact state
New Hampshire Board of NursingNew Hampshire Board of Nursing 2323
What happens to the license of a What happens to the license of a nurse who was nurse who was NOTNOT a resident a resident
of of New Hampshire on Jan. 1, New Hampshire on Jan. 1,
2006?2006?If If the nurse lived in the nurse lived in another compact stateanother compact state (such as (such as Maine): Maine): – The NH license became inactive on January 1, The NH license became inactive on January 1,
2006!2006!
– If the nurse wished to continue to practice as a If the nurse wished to continue to practice as a nurse in NH, s/he had to apply for a multi-state nurse in NH, s/he had to apply for a multi-state license in the state of residence.license in the state of residence.
New Hampshire Board of NursingNew Hampshire Board of Nursing 2424
What happens to the What happens to the license of license of a nurse who was a nurse who was NOTNOT a a
resident of NH on Jan. 1, resident of NH on Jan. 1, 2006?2006?
If the nurse lives in a If the nurse lives in a non-compact statenon-compact state (such as (such as Massachusetts or Vermont)Massachusetts or Vermont)– NH license became a “single state license” as of NH license became a “single state license” as of
January 1, 2006January 1, 2006
– A single state license in NH will allows the nurse A single state license in NH will allows the nurse to practice to practice onlyonly in NH. The nurse may NOT in NH. The nurse may NOT practice in other compact statespractice in other compact states
New Hampshire Board of NursingNew Hampshire Board of Nursing 2525
Does the compact change Does the compact change licensing requirements licensing requirements
in NH?in NH?NO!!NO!!
Everything stays the same for nurses Everything stays the same for nurses who live in NH and have a NH multi-state who live in NH and have a NH multi-state license or a NH single state license!license or a NH single state license!– Continuing education - 30 hours in 2 yearsContinuing education - 30 hours in 2 years– ““Active in practice” – 400 hours in 4 yearsActive in practice” – 400 hours in 4 years– Criminal background check required Criminal background check required
New Hampshire Board of NursingNew Hampshire Board of Nursing 2626
What about scope of practice?What about scope of practice?
You must comply with the practice You must comply with the practice regulations of the state in which the regulations of the state in which the care is provided!care is provided!
Nursing practice is not limited to Nursing practice is not limited to patient carepatient care
New Hampshire Board of NursingNew Hampshire Board of Nursing 2727
Who is included in the Who is included in the compact?compact?
Only RNs and LPNs are includedOnly RNs and LPNs are included
LNAs and MNAs are LNAs and MNAs are NOTNOT included included
ARNPs are ARNPs are NOT NOT included included
New Hampshire Board of NursingNew Hampshire Board of Nursing 2828
What if you are an ARNP?What if you are an ARNP?
New Hampshire is not part of the ARNP New Hampshire is not part of the ARNP nursing compact.nursing compact.
A nurse practitioner must have a valid RN A nurse practitioner must have a valid RN license which is in good standing. It does license which is in good standing. It does not need to be a NH-RN license when not need to be a NH-RN license when applying to NH for a ARNP license. applying to NH for a ARNP license.
New Hampshire Board of NursingNew Hampshire Board of Nursing 2929
ARNPs who live in NHARNPs who live in NH
No changes to current licensingNo changes to current licensing
You must maintain both your NH RN and You must maintain both your NH RN and your NH ARNP licensesyour NH ARNP licenses
New Hampshire Board of NursingNew Hampshire Board of Nursing 3030
ARNPs who live in another ARNPs who live in another statestate
Living in another Living in another compact compact state:state:
– Obtain / maintain RN license in compact Obtain / maintain RN license in compact statestate
– Obtain / maintain NH ARNP licenseObtain / maintain NH ARNP license
– Comply with NH ARNP licensing Comply with NH ARNP licensing requirementsrequirements
New Hampshire Board of NursingNew Hampshire Board of Nursing 3131
ARNPs who live in another ARNPs who live in another statestate
Living in a Living in a non-compactnon-compact state: state:
– Obtain / maintain NH RN single state Obtain / maintain NH RN single state licenselicense
– Obtain / maintain NH ARNP licenseObtain / maintain NH ARNP license
– Comply with NH RN and NH ARNP Comply with NH RN and NH ARNP licensing requirementslicensing requirements
New Hampshire Board of NursingNew Hampshire Board of Nursing 3232
Will NH continue to issue Will NH continue to issue temporary licenses?temporary licenses?
Yes, NH issues temporary licenses to new Yes, NH issues temporary licenses to new graduates and to applicants for license by graduates and to applicants for license by endorsementendorsement
As of January 1, 2006, all temporary As of January 1, 2006, all temporary licenses are single-state NH licenses only licenses are single-state NH licenses only
When the licensing process is complete When the licensing process is complete and a permanent license is issued to a NH and a permanent license is issued to a NH resident, it is a multi-state licenseresident, it is a multi-state license
New Hampshire Board of NursingNew Hampshire Board of Nursing 3333
How can an employer verify an How can an employer verify an employee’s license?employee’s license?
To verify a New Hampshire license:To verify a New Hampshire license:– www.nh.gov/nursingwww.nh.gov/nursing - on-line verification - on-line verification
To verify a non-resident multi-state To verify a non-resident multi-state license:license:– www.nursys.comwww.nursys.com (free) (free)
NurNursyssys® Licensure QuickConfirm® Licensure QuickConfirmI am an employer or recruiterI am an employer or recruiter who needs to who needs to verify the license of a nurse. verify the license of a nurse.
New Hampshire Board of NursingNew Hampshire Board of Nursing 3434
On-Line VerificationOn-Line Verification
Licensee Details: Licensee Details: Person Information Person Information Name: Margaret J. WalkerName: Margaret J. Walker
License InformationLicense Information License No: 018445-21License No: 018445-21
Profession: Nursing License Type: Registered NurseProfession: Nursing License Type: Registered Nurse
License Status: ActiveLicense Status: Active Issue Date: 8/28/1975 Issue Date: 8/28/1975
Expiration Date: 2/26/12Expiration Date: 2/26/12
Discipline InformationDiscipline Information
No Discipline InformationNo Discipline Information
New Hampshire Board of NursingNew Hampshire Board of Nursing 3535
Licensing by Examination NCLEXLicensing by Examination NCLEX
Required by all RN & LPN licenseesRequired by all RN & LPN licensees
Given 12 months/ yearGiven 12 months/ year
Computerized examComputerized exam
Applicant can access on-line verification Applicant can access on-line verification for license statusfor license status
Limitation on number of times taken are Limitation on number of times taken are noted in the Administrative Rules, 45 day noted in the Administrative Rules, 45 day waiting period waiting period
New Hampshire Board of NursingNew Hampshire Board of Nursing 3636
2008 Rules re: NCLEX2008 Rules re: NCLEX
May take 3 timesMay take 3 timesMust take and pass within 4 years of Must take and pass within 4 years of graduation or completion of CGFNS processgraduation or completion of CGFNS processAfter 3 failures, must complete remediation After 3 failures, must complete remediation planplanMay take one additional time after May take one additional time after remediationremediationNCLEX-PN for comparable education may NCLEX-PN for comparable education may be taken one time onlybe taken one time only
New Hampshire Board of NursingNew Hampshire Board of Nursing 3737
Temporary Licenses - for new Temporary Licenses - for new graduatesgraduates
New graduates are eligible for New graduates are eligible for ONEONE temporary license before they take NCLEXtemporary license before they take NCLEXValid for 120 days or until NCLEX takenValid for 120 days or until NCLEX takenRevoked if applicant fails NCLEXRevoked if applicant fails NCLEXMust be supervised by a RNMust be supervised by a RNWork within the scope of practice of the Work within the scope of practice of the license categorylicense categoryTitle is Graduate Nurse (GN) or Graduate Title is Graduate Nurse (GN) or Graduate Practice Nurse (GPN)Practice Nurse (GPN)May work only in New Hampshire – not in May work only in New Hampshire – not in other compact statesother compact states
New Hampshire Board of NursingNew Hampshire Board of Nursing 3838
EndorsementsEndorsements
Nurse from another compact state must Nurse from another compact state must apply for a NH if s/he moves to NHapply for a NH if s/he moves to NH
Require verification from original stateRequire verification from original state
May apply for a temporary license to May apply for a temporary license to bridge time before verification completebridge time before verification complete
Must meet all licensing requirements:Must meet all licensing requirements:– active in practiceactive in practice– continuing educationcontinuing education
New Hampshire Board of NursingNew Hampshire Board of Nursing 3939
Temporary Licenses – Temporary Licenses – for endorsementsfor endorsements
Eligible for Eligible for ONEONE temporary license temporary licenseMustMust have (and maintain)have (and maintain) an active license in an active license in another state if endorsing from a non-compact another state if endorsing from a non-compact statestateValid for 120 days or until permanent license Valid for 120 days or until permanent license issuedissuedWork within the scope of practice of the license Work within the scope of practice of the license categorycategoryMay work only in New Hampshire – not in other May work only in New Hampshire – not in other compact statescompact states
New Hampshire Board of NursingNew Hampshire Board of Nursing 4040
Nurses Educated in a Foreign CountryNurses Educated in a Foreign Country
Foreign educated (except Canada)Foreign educated (except Canada)– Must complete CGFNS process (credentials Must complete CGFNS process (credentials
review, English exam, predictor exam)review, English exam, predictor exam)– Must take NCLEXMust take NCLEX– May apply for a temporary licenseMay apply for a temporary license
Canadian educated on TN Visa (NAFTA)Canadian educated on TN Visa (NAFTA)– Have been able to use Canadian examHave been able to use Canadian exam– Now must take NCLEX (Immigration Services Now must take NCLEX (Immigration Services
requirement)requirement)
New Hampshire Board of NursingNew Hampshire Board of Nursing 4141
License RenewalLicense Renewal
Must meet continuing competence Must meet continuing competence requirements: continuing education and requirements: continuing education and active in practiceactive in practice
License must be renewed by midnight of License must be renewed by midnight of the birthday of the renewal yearthe birthday of the renewal year
License status can be checked 24-7 on License status can be checked 24-7 on the on-line verification sitethe on-line verification site
New Hampshire Board of NursingNew Hampshire Board of Nursing 4242
Reentry for RNs & LPNsReentry for RNs & LPNs
Board approved refresher course (theory and Board approved refresher course (theory and clinical) clinical)
ORORApproved self-study option (theory and Approved self-study option (theory and clinical)clinical)
ORORNCLEXNCLEX
ORORSpecified Excelsior College ExamsSpecified Excelsior College Exams
New Hampshire Board of NursingNew Hampshire Board of Nursing 4343
Scope of Practice for RN’s 326-BScope of Practice for RN’s 326-B
The law intent: “The law intent: “Registered nursingRegistered nursing”” means means the application of nursing knowledge, judgment the application of nursing knowledge, judgment and skill drawn from broad in-depth education in and skill drawn from broad in-depth education in the biological, psychological, social, and the biological, psychological, social, and physical sciences in assessing, diagnosing, physical sciences in assessing, diagnosing, planning, implementing, and evaluating care planning, implementing, and evaluating care which promotes optimum health, wellness, and which promotes optimum health, wellness, and independence of the individual, family and/or independence of the individual, family and/or communitycommunity
New Hampshire Board of NursingNew Hampshire Board of Nursing 4444
Scope of Practice for Scope of Practice for LPN’s 326-BLPN’s 326-B
The law intentThe law intent: “: “Practical nursingPractical nursing”” means a scope of means a scope of practice, practice, directed by a RN, ARNP, dentist, or MDdirected by a RN, ARNP, dentist, or MD, by , by an LPN who is prepared to function as a member of an LPN who is prepared to function as a member of the health care team by exercising sound nursing the health care team by exercising sound nursing judgment based on preparation, knowledge, skills, judgment based on preparation, knowledge, skills, understanding, and past nursing experience. understanding, and past nursing experience. Practical nursing by a LPN Practical nursing by a LPN contributes to the contributes to the assessment, planning, implementation and evaluation assessment, planning, implementation and evaluation of the patient careof the patient care. Practical nursing includes the . Practical nursing includes the delegation of nursing tasks that may be performed by delegation of nursing tasks that may be performed by others..... (paraphrased)others..... (paraphrased)
New Hampshire Board of NursingNew Hampshire Board of Nursing 4545
LPN IV RulesLPN IV Rules
Administrative RulesAdministrative RulesClients who weigh > 32 KgClients who weigh > 32 KgCentral lines Central lines notnot prohibited prohibited
RN does not have to give the first doseRN does not have to give the first dose
IV push, concentration, intermittent infusionIV push, concentration, intermittent infusionNo blood, no blood productsNo blood, no blood productsNo IV oncology medications or research medicationsNo IV oncology medications or research medications
New Hampshire Board of NursingNew Hampshire Board of Nursing 4646
Interpreting Scope of PracticeInterpreting Scope of Practice
Practice is dynamicPractice is dynamic
The Board determines practice The Board determines practice parameters within the confines of the parameters within the confines of the Nurse Practice Act and the Administrative Nurse Practice Act and the Administrative RulesRules
New Hampshire Board of NursingNew Hampshire Board of Nursing 4747
Clinical Practice
Opinion Has Been Rendered by the Board
Permitted – Under scope of
practice of licensee
Contact Board of Nursing staff
Clinical Practice question presented to Board of Nursing
Board consideration of Nurse Practice Act, National Standards
Prohibited Not within
scope of practice of
licensee
Stop
In compliance with Nur 305.01
Yes
Comply with
Nur 305.01 Permitted
No
Yes -Allowed within scope of
practice
Opinion Has Not Been Rendered by the Board
No -Prohibited not within scope of
practice of licensee
Stop
New Hampshire Board of NursingNew Hampshire Board of Nursing 4848
Nur 404.12 Nur 404.12
Guidelines for implementing additional Guidelines for implementing additional nursing interventions: nursing interventions:
describe the describe the education preparation and education preparation and practice historypractice history of the nurse (assistant) of the nurse (assistant) authorized to perform the activityauthorized to perform the activity
develop a develop a policy and procedurepolicy and procedure
write a plan for attaining and maintaining write a plan for attaining and maintaining competencecompetence
keep a keep a list of nurses authorized to performlist of nurses authorized to perform
update at least yearlyupdate at least yearly
New Hampshire Board of NursingNew Hampshire Board of Nursing 4949
PART 3PART 3Delegation RulesDelegation Rules
Licensing Requirements for LNAsLicensing Requirements for LNAs
Scope of Practice of Licensed Nursing Scope of Practice of Licensed Nursing AssistantsAssistants
Medication Nursing AssistantsMedication Nursing Assistants
Paid Feeding AssistantsPaid Feeding Assistants
LNA-Medication CertifiedLNA-Medication Certified
New Hampshire Board of NursingNew Hampshire Board of Nursing 5050
Nursing DelegationNursing Delegation
Pertains to delegation among licensees as Pertains to delegation among licensees as well as to delegation to unlicensed assistive well as to delegation to unlicensed assistive personnelpersonnel
Must be in keeping with Nur 404Must be in keeping with Nur 404
RSA-B:29 II “No person may coerce a RSA-B:29 II “No person may coerce a licensed nurse into compromising client licensed nurse into compromising client safety by requiring the nurse to delegate a safety by requiring the nurse to delegate a nursing activity or task when the nurse nursing activity or task when the nurse determines that it is inappropriate to do determines that it is inappropriate to do so…….”so…….”
New Hampshire Board of NursingNew Hampshire Board of Nursing 5151
What is Delegation?What is Delegation?
Nur 401.01(f):Nur 401.01(f): The transfer, The transfer, at the at the discretion of the nursediscretion of the nurse,, of of authority for the performance of a authority for the performance of a task of client care from the licensed task of client care from the licensed nurse with the authority to perform nurse with the authority to perform the task to someone who does not the task to someone who does not otherwise have such authorityotherwise have such authority
New Hampshire Board of NursingNew Hampshire Board of Nursing 5252
Nursing Delegation: Nur 404Nursing Delegation: Nur 404Nurse must determine:Nurse must determine:– Client stability, whether client’s nursing needs are Client stability, whether client’s nursing needs are
changingchanging– Delegate’s level of competencyDelegate’s level of competency– Complexity of taskComplexity of task– Familiarity of the delegate with the environmentFamiliarity of the delegate with the environment– Level of supervision neededLevel of supervision needed– On-going competencyOn-going competency– Need to rescind if the delegate proves unwilling or Need to rescind if the delegate proves unwilling or
incompetent, client objects, or nurse cannot provide incompetent, client objects, or nurse cannot provide adequate supervisionadequate supervision
New Hampshire Board of NursingNew Hampshire Board of Nursing 5353
Delegation……. Do it Right!Delegation……. Do it Right!
Right taskRight task
Right circumstanceRight circumstance
Right personRight person
Right communication/ directionRight communication/ direction
Right supervision and evaluationRight supervision and evaluation
New Hampshire Board of NursingNew Hampshire Board of Nursing 5454
What does it mean.....What does it mean.....responsibility =responsibility = a two-way process that a two-way process that must be allocated and acceptedmust be allocated and accepted
authority =authority = the right to act in areas one is the right to act in areas one is given and accepts responsibilitygiven and accepts responsibility
accountability = accountability = reviewing judgements and reviewing judgements and decisions, evaluating effectiveness, and decisions, evaluating effectiveness, and directing future effortsdirecting future efforts
YOU CAN’T GIVE AWAY ACCOUNTABILITY!YOU CAN’T GIVE AWAY ACCOUNTABILITY! MANTHEY & MILLER 1994MANTHEY & MILLER 1994
New Hampshire Board of NursingNew Hampshire Board of Nursing 5555
Levels of AuthorityLevels of Authority
Level 1Level 1 - Data gathering - Data gathering
Level 2Level 2 - Data gathering + recommendations - Data gathering + recommendations
Level 3Level 3 - Data + recommendation (pause) + - Data + recommendation (pause) + actact
Level 4Level 4 - Act and inform others after taking - Act and inform others after taking actionaction
LEVEL DEPENDS ON THE TASK, NOT THE LEVEL DEPENDS ON THE TASK, NOT THE LEVEL OF THE LICENSEELEVEL OF THE LICENSEE! ! MANTHEY & MILLER 1994MANTHEY & MILLER 1994
New Hampshire Board of NursingNew Hampshire Board of Nursing 5656
Licensed Nursing Assistants Licensed Nursing Assistants (LNA)(LNA)
Education and Licensing Requirements: Education and Licensing Requirements:
Nur 700Nur 700– Based on Federal StandardsBased on Federal Standards– Educational Programs are approved by the BON: Educational Programs are approved by the BON:
after program completion, apply for licensureafter program completion, apply for licensure– Must work under the supervision (direct or indirect) Must work under the supervision (direct or indirect)
of a licensed nurseof a licensed nurse– Must maintain 12 hrs of continuing education each Must maintain 12 hrs of continuing education each
year, 200 hrs/2 years active in practiceyear, 200 hrs/2 years active in practice
New Hampshire Board of NursingNew Hampshire Board of Nursing 5757
LNA Scope of PracticeLNA Scope of PracticeBased on activities taught during initial educational Based on activities taught during initial educational programprogramAdditional activities may be added based on specific Additional activities may be added based on specific BON approval, Nur 404.12 such as: .BON approval, Nur 404.12 such as: . Straight urinary catheters, foley irrigations, bladder scan Straight urinary catheters, foley irrigations, bladder scan
or doppler, application of TENS unit, feeding tubes, or doppler, application of TENS unit, feeding tubes, phlebotomy, wound care, vagus nerve stimulation, pulse phlebotomy, wound care, vagus nerve stimulation, pulse oximetry, incentive spirometry, oral suctioning, oxygen oximetry, incentive spirometry, oral suctioning, oxygen mask placement/cannula placement, chest mask placement/cannula placement, chest physiotherapy, peripheral vein IV removal, colostomy physiotherapy, peripheral vein IV removal, colostomy irrigations, medicated lotions, ointments and creams, irrigations, medicated lotions, ointments and creams, blood glucose monitoring, fingerstick PT/INR testing, blood glucose monitoring, fingerstick PT/INR testing, reminding clients to take their medications and reminding clients to take their medications and transcribing medical orders. transcribing medical orders.
This list should not be considered all inclusiveThis list should not be considered all inclusive
New Hampshire Board of NursingNew Hampshire Board of Nursing 5858
LNA Scope of PracticeLNA Scope of Practice
The LNA may also assist in oxygen as a treatment The LNA may also assist in oxygen as a treatment therapy and change the collar that holds a therapy and change the collar that holds a tracheostomy tube in place as delegated by the tracheostomy tube in place as delegated by the nurse.nurse.
It is It is notnot within the scope of practice within the scope of practice for a for a Licensed Nursing Assistant to engage in the Licensed Nursing Assistant to engage in the following activities: following activities: – Insertion of intravenous catheters, Insertion of intravenous catheters,
– Calling in Prescribing Practitioner orders to the Calling in Prescribing Practitioner orders to the Pharmacy Pharmacy
– Insertion of indwelling cathetersInsertion of indwelling catheters
New Hampshire Board of NursingNew Hampshire Board of Nursing 5959
Nursing Assistant RegistryNursing Assistant Registry
Federal RequirementFederal Requirement
Pertains to Nursing Assistants who are Pertains to Nursing Assistants who are suspected of abuse, neglect, exploitation suspected of abuse, neglect, exploitation or misappropriation or misappropriation
In collaboration with the Office of Long In collaboration with the Office of Long Term Care, DEAS, OLTCO, BHFATerm Care, DEAS, OLTCO, BHFA
BON may, in some cases, pursue BON may, in some cases, pursue additional disciplinary action against the additional disciplinary action against the Nursing Assistant’s LicenseNursing Assistant’s License
New Hampshire Board of NursingNew Hampshire Board of Nursing 6060
Medication Nursing AssistantsMedication Nursing Assistants
A Medication Nursing Assistant (MNA) is A Medication Nursing Assistant (MNA) is a Licensed Nursing Assistant (LNA) with a a Licensed Nursing Assistant (LNA) with a NH Board Approved Certificate to NH Board Approved Certificate to administer medications under the administer medications under the supervision of a RN/LPN to “stable” supervision of a RN/LPN to “stable” clients.clients.
New Hampshire Board of NursingNew Hampshire Board of Nursing 6161
Why was this new role developed?Why was this new role developed?
To provide safe medication administration To provide safe medication administration to to stablestable clients living in facilities and in clients living in facilities and in the community. the community.
The client whose health status is under The client whose health status is under control and raises no expectations that the control and raises no expectations that the client’s symptoms, vital signs or reactions client’s symptoms, vital signs or reactions to medications will suddenly change.to medications will suddenly change.
There are predictable outcomes to care.There are predictable outcomes to care.
New Hampshire Board of NursingNew Hampshire Board of Nursing 6262
Nur 405.02Nur 405.02
A MNA shall A MNA shall NOTNOT perform a task involving the perform a task involving the administration of medication if:administration of medication if:
-the task requires the determination of the -the task requires the determination of the client’s need for the medication, the calculation of client’s need for the medication, the calculation of the dosage or the conversion of the dosage;the dosage or the conversion of the dosage;
-the delegating nurse is unavailable to monitor -the delegating nurse is unavailable to monitor the progress of the client and the effect of the the progress of the client and the effect of the medication;medication;
-the client is not stable or has changing -the client is not stable or has changing needs.needs.
New Hampshire Board of NursingNew Hampshire Board of Nursing 6363
MNA CertificationMNA CertificationSelection of candidatesSelection of candidates- - Five years as a LNA in good standing or 2 years full time Five years as a LNA in good standing or 2 years full time - Two employer letters of reference- Two employer letters of reference- One letter of intent- One letter of intent
Course requirementsCourse requirements- 30 hours of clinical/30 hours of theory- 30 hours of clinical/30 hours of theory- Final exam 90% or greater- Final exam 90% or greater
Maintain the certificateMaintain the certificate- Renewed with LNA licensure- Renewed with LNA licensure- 4 of 12 CEs must be in medication administration topic- 4 of 12 CEs must be in medication administration topic
New Hampshire Board of NursingNew Hampshire Board of Nursing 6464
If the MNA makes a mistake, If the MNA makes a mistake, is the RN’s license at risk?is the RN’s license at risk?
A licensee who delegates or has A licensee who delegates or has delegated a specific nursing activity or delegated a specific nursing activity or task in compliance with this chapter (RSA task in compliance with this chapter (RSA 326) 326) shall notshall not be subject to disciplinary be subject to disciplinary action because of the performance of the action because of the performance of the person to whom the nursing activity or task person to whom the nursing activity or task is or was delegated.is or was delegated.
New Hampshire Board of NursingNew Hampshire Board of Nursing 6565
Paid Feeding AssistantsPaid Feeding Assistants
Paid Feeding Assistants are individuals who Paid Feeding Assistants are individuals who have been trained to provide feeding have been trained to provide feeding assistance to residents of Long Term Care assistance to residents of Long Term Care Facilities Facilities under the supervisionunder the supervision of the RN or of the RN or LPN.LPN.
The 8 hour NH BON approved training course The 8 hour NH BON approved training course is taught by Registered Nurses, Dieticians, is taught by Registered Nurses, Dieticians, Physical Therapists, Occupational Therapists, Physical Therapists, Occupational Therapists, Speech Therapists Speech Therapists OROR Licensed Practical Licensed Practical Nurses.Nurses.
New Hampshire Board of NursingNew Hampshire Board of Nursing 6666
Licensed Nursing Assistant Licensed Nursing Assistant Medication CertifiedMedication Certified
This role is designed to allow nursing This role is designed to allow nursing assistants with additional education to assistants with additional education to observe and document medication observe and document medication consumed by residents living in their consumed by residents living in their homes or residential care settings.homes or residential care settings.
Facilities and agencies provide board-Facilities and agencies provide board-approved education to their employeesapproved education to their employees
New Hampshire Board of NursingNew Hampshire Board of Nursing 6767
PART 4PART 4Criminal Background ChecksCriminal Background Checks
The Complaint ProcessThe Complaint Process
Discipline ProcessDiscipline Process
Nursing Assistant Registry Nursing Assistant Registry
New Hampshire Board of NursingNew Hampshire Board of Nursing 6868
Criminal Background ChecksCriminal Background Checks
required as of 9/1/2007required as of 9/1/2007
Renewals and Reinstatement applications Renewals and Reinstatement applications no longer require CBC. All new NH no longer require CBC. All new NH licensees are required to complete a CBC licensees are required to complete a CBC which includes FBI finger print technology. which includes FBI finger print technology. See applications for directionsSee applications for directions..
New Hampshire Board of NursingNew Hampshire Board of Nursing 6969
Bars to Licensing for Certain Bars to Licensing for Certain FeloniesFelonies
Murder Murder
Aggravated Robbery Aggravated Robbery
Felonious Assault Felonious Assault
Sexual Crimes Involving Children Sexual Crimes Involving Children
Kidnapping Kidnapping
Criminal Mistreatment of Children Criminal Mistreatment of Children
Aggravated Robbery or Vulnerable Adults Aggravated Robbery or Vulnerable Adults
Exploitation of Vulnerable Individuals Exploitation of Vulnerable Individuals
New Hampshire Board of NursingNew Hampshire Board of Nursing 7070
The Complaint Process:The Complaint Process:
Factors to Consider: Factors to Consider:
Does the act or omission violate the Does the act or omission violate the NPA or the rules?NPA or the rules?
Evaluate cause of incident:Evaluate cause of incident:– Licensee knowledge deficiencyLicensee knowledge deficiency– Licensee behavior problemLicensee behavior problem– Systems issues (or a combination of causes)Systems issues (or a combination of causes)
New Hampshire Board of NursingNew Hampshire Board of Nursing 7171
The Complaint Process:The Complaint Process:
Factors to ConsiderFactors to Consider
Is there objective evidence that the Is there objective evidence that the incident actually occurred?incident actually occurred?
Is there evidence that the licensee was Is there evidence that the licensee was responsible?responsible?
Was it a one-time incident or is there a Was it a one-time incident or is there a pattern of behavior?pattern of behavior?
New Hampshire Board of NursingNew Hampshire Board of Nursing 7272
The Complaint Process:The Complaint Process:
Factors to ConsiderFactors to Consider
Do any of the witnesses have personal Do any of the witnesses have personal motives for reporting the incident?motives for reporting the incident?
Would counseling, employment Would counseling, employment suspension, education or other measures suspension, education or other measures be more appropriate than sanctioning or be more appropriate than sanctioning or restricting the license?restricting the license?
New Hampshire Board of NursingNew Hampshire Board of Nursing 7373
The Complaint Process:The Complaint Process:
Factors to ConsiderFactors to Consider
Is it an employment/HR issue?Is it an employment/HR issue?
Is it a concern that should be reported to Is it a concern that should be reported to the Ombudsman/Division of Elderly and the Ombudsman/Division of Elderly and Adult Services?Adult Services?
If you are not sure, call the BON to If you are not sure, call the BON to discuss the incident. discuss the incident.
New Hampshire Board of NursingNew Hampshire Board of Nursing 7474
Filing a Complaint – Filing a Complaint – what happens next:what happens next:
DismissalDismissal
Dismissal with letter of concernDismissal with letter of concern
Settlement agreementSettlement agreement
HearingHearing
New Hampshire Board of NursingNew Hampshire Board of Nursing 7575
Possible Board ActionsPossible Board Actions
Letter of concernLetter of concern
ReprimandReprimand
ProbationProbation
SuspensionSuspension
RevocationRevocation
Monetary fineMonetary fine
New Hampshire Board of NursingNew Hampshire Board of Nursing 7676
If a license has been If a license has been suspended…….suspended…….
At end of suspended time, licensee At end of suspended time, licensee appeals to the Board for reinstatementappeals to the Board for reinstatement
Reinstatement may be granted with Reinstatement may be granted with restrictions & conditions (stipulations)restrictions & conditions (stipulations)
Licensee may later request removal of Licensee may later request removal of restrictions & conditionsrestrictions & conditions
New Hampshire Board of NursingNew Hampshire Board of Nursing 7777
What if you hire someone who hasWhat if you hire someone who has a history of Board discipline? a history of Board discipline?
Go to the website verification page at Go to the website verification page at www.state.nh.us/nursingwww.state.nh.us/nursing (located in quick link (located in quick link section of home page) for all disciplinary section of home page) for all disciplinary documents (located in discipline section of documents (located in discipline section of license verification)license verification)
The licensee will provide you with documents The licensee will provide you with documents from the Board which outline any from the Board which outline any restrictions/stipulations they must adhere to.restrictions/stipulations they must adhere to.
New Hampshire Board of NursingNew Hampshire Board of Nursing 7878
Examples of Stipulations...Examples of Stipulations...
–Quarterly performance reportsQuarterly performance reports
–Random drug screeningRandom drug screening
–Limitation on hours worked, night Limitation on hours worked, night shift work and the ability to float.shift work and the ability to float.
–Regular attendance with AA, NA, Regular attendance with AA, NA,
–CounselingCounseling
New Hampshire Board of NursingNew Hampshire Board of Nursing 7979
First Lab, IncFirst Lab, Inc
NH Board of Nursing has contracted with NH Board of Nursing has contracted with First Lab, Inc., an organization used by First Lab, Inc., an organization used by many boards in the U. S. They provide many boards in the U. S. They provide services and contact with the licensee who services and contact with the licensee who has stipulations from the Board for drug has stipulations from the Board for drug screening. This company reports to the screening. This company reports to the board on a daily basis.board on a daily basis.
New Hampshire Board of NursingNew Hampshire Board of Nursing 8080
Drug Diversion in your facilityDrug Diversion in your facility
Your facility realizes there is a problem…Your facility realizes there is a problem…what can you do to prove diversion? Who what can you do to prove diversion? Who to call?to call?
The Department of Justice has the ability The Department of Justice has the ability to assist with this investigation.to assist with this investigation.
Call James Brown, Investigator at 271-Call James Brown, Investigator at 271-1246 to discuss your facility problem.1246 to discuss your facility problem.
New Hampshire Board of NursingNew Hampshire Board of Nursing 8181
Board program to assist Board program to assist impaired nursesimpaired nurses
Road to Recovery has been in place since Road to Recovery has been in place since December 2004. This program is designed December 2004. This program is designed to assist nurses with problems of chemical to assist nurses with problems of chemical dependency, physical disorders, dependency, physical disorders, psychiatric impairments.psychiatric impairments.
The purpose of this program ensures The purpose of this program ensures public health and safety while providing public health and safety while providing assistance and support to the licensee.assistance and support to the licensee.
New Hampshire Board of NursingNew Hampshire Board of Nursing 8282
What Constitutes Client What Constitutes Client Abandonment?Abandonment?
ABANDONMENTABANDONMENT = "Leaving an assignment = "Leaving an assignment without notifying the appropriate authority, without notifying the appropriate authority, whereby such departure endangers the health, whereby such departure endangers the health, safety and welfare of those individuals entrusted to safety and welfare of those individuals entrusted to the licensee's care;…" [Nur 215.01(B)(2)]the licensee's care;…" [Nur 215.01(B)(2)]
Refusal to accept an assignment or refusal to work Refusal to accept an assignment or refusal to work overtime overtime does notdoes not constitute client abandonment constitute client abandonment
New Hampshire Board of NursingNew Hampshire Board of Nursing 8383
PART 5PART 5
Advanced Registered Nurse PracticeAdvanced Registered Nurse Practice
License RequirementsLicense Requirements
ARNP Practice IssuesARNP Practice Issues
New Hampshire Board of NursingNew Hampshire Board of Nursing 8484
ARNP License RequirementsARNP License Requirements
Complete advanced education program Complete advanced education program
Certification in specialtyCertification in specialty
Continuing competenceContinuing competence– active in practice - 400 hours in 4 yearsactive in practice - 400 hours in 4 years– continuing education - 60 hours in 2 years continuing education - 60 hours in 2 years
(certification counts for 30 hours) including (certification counts for 30 hours) including 5 hours in pharmacology 5 hours in pharmacology
– No endorsement No endorsement – ARNPs are not in the compactARNPs are not in the compact
New Hampshire Board of NursingNew Hampshire Board of Nursing 8585
ARNP Active in PracticeARNP Active in Practice
Must work in advanced roleMust work in advanced role
Does not include undergraduate faculty Does not include undergraduate faculty rolerole
New graduatesNew graduates– must apply for initial licensure within 2 must apply for initial licensure within 2
years of graduation, or must complete years of graduation, or must complete reentry programreentry program
New Hampshire Board of NursingNew Hampshire Board of Nursing 8686
ARNP Scope of PracticeARNP Scope of Practice
practice independentlypractice independently– history and physicalhistory and physical– initiate diagnostic testsinitiate diagnostic tests– formulate diagnosesformulate diagnoses– ID health problems and learning needsID health problems and learning needs– plan, teach, promote healthplan, teach, promote health– arrange referralsarrange referrals– emergency careemergency care– administer, dispense, procure and prescribe administer, dispense, procure and prescribe
medicationsmedications
New Hampshire Board of NursingNew Hampshire Board of Nursing 8787
General FormularyGeneral Formulary
exclusionary formularyexclusionary formulary
ARNPs may prescribe drugs ARNPs may prescribe drugs NOTNOT in the in the formularyformulary
ARNPs must follow restrictions as ARNPs must follow restrictions as described for drugs in the formularydescribed for drugs in the formulary
Joint Health Council reviews medications Joint Health Council reviews medications quarterlyquarterly
Part 6Part 6
What does the What does the future hold?future hold?
New Hampshire Board of NursingNew Hampshire Board of Nursing 8989
Nationally…….Nationally…….
More states initiating mandatory criminal More states initiating mandatory criminal background checks, particularly national FBI checksbackground checks, particularly national FBI checksMore focus on continuing competency requirements More focus on continuing competency requirements to ensure safe practitionersto ensure safe practitionersIncreased collaboration with health care agencies to Increased collaboration with health care agencies to increase patient safetyincrease patient safetyIncreasing interest in licensing NA’s in all statesIncreasing interest in licensing NA’s in all statesSpotlight on ARNP practiceSpotlight on ARNP practiceMore states joining the compactMore states joining the compact
New Hampshire Board of NursingNew Hampshire Board of Nursing 9090
In New Hampshire…..In New Hampshire…..
The board is studying the nursing The board is studying the nursing workforce and making recommendations workforce and making recommendations to ease the shortage. A demographic to ease the shortage. A demographic survey is required with each license survey is required with each license renewal to collect workforce datarenewal to collect workforce data
Board committees continue to study Board committees continue to study national standards of practice national standards of practice
New Hampshire Board of NursingNew Hampshire Board of Nursing 9191
Contact us........Contact us........
telephone: 271-2323 or 271-6282telephone: 271-2323 or 271-6282
mwalker@nursing.state.nh.usmwalker@nursing.state.nh.us
Norma.Blake@nursing.state.nh.usNorma.Blake@nursing.state.nh.us
Patricia.orzano@nursing.state.nh.usPatricia.orzano@nursing.state.nh.us
Lori.tetreault@nursing.state.nh.usLori.tetreault@nursing.state.nh.us
web site: web site: www. state.nh.us/nursing www. state.nh.us/nursing
email: email: boardquestions@nursing.state.nh.usboardquestions@nursing.state.nh.us
New Hampshire Board of NursingNew Hampshire Board of Nursing 9292
Conclusions...... Wrap-upConclusions...... Wrap-up
Questions????????Questions????????
Please complete the evaluation Please complete the evaluation
form and return it to us..... form and return it to us.....
Congratulations! You’ve just earned Congratulations! You’ve just earned contact hours!contact hours!
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