WSR 08-16-128

PROPOSED RULES

DEPARTMENT OF HEALTH


[ Filed August 6, 2008, 8:04 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 07-17-037.

Title of Rule and Other Identifying Information: Chapter 246-840 WAC, Advanced registered nurse practitioners.

Amending: Adding: Repealing:
WAC 246-840-300 Advanced registered nurse practitioner. WAC 246-840-302 ARNP designations, certification and approved certification examinations. WAC 246-840-305 Criteria for formal advanced nursing education meeting the requirements for ARNP licensure.
WAC 246-840-310 Use of nomenclature. WAC 246-840-304 Certification and certification program requirements. WAC 246-840-320 Certification and certification program.
WAC 246-840-311 ARNP previously adopted specialties. WAC 246-840-342 ARNP application requirements for applicants licensed as advanced practice nurses from other states or jurisdictions. WAC 246-840-330 Commission approval of certification programs and commission recognition of new specialties.
WAC 246-840-340 Application requirements for ARNP. WAC 246-840-344 ARNP application requirements for advanced practice nurse applicants educated and licensed outside the United States. WAC 246-840-345 ARNP designation in more than one area of specialty.
WAC 246-840-350 Application requirements for ARNP interim permit. WAC 246-840-361 Continuing education requirements for ARNP license renewal. WAC 246-840-370 Termination of ARNP designation by the commission.
WAC 246-840-360 Renewal of ARNP designation. WAC 246-840-367 Expired license. WAC 246-840-425 Seventy-two hour limit.
WAC 246-840-365 Return to active ARNP status from inactive or expired status. WAC 246-840-451 Continuing education requirements for ARNP prescriptive authority.
WAC 246-840-370 Termination of ARNP designation by the commission. WAC 246-840-455 Requirements for advanced registered nurse practice programs in Washington state.
WAC 246-840-400 ARNP with prescriptive authorization.
WAC 246-840-410 Application requirements for ARNP with prescriptive authority.
WAC 246-840-420 Authorized prescriptions by the ARNP with prescriptive authority.
WAC 246-840-450 Renewal.

Hearing Location(s): Department of Transportation, 2714 North Mayfair, Spokane, WA 99207, on September 11, 2008, at 1:00 p.m.

Date of Intended Adoption: September 11, 2008.

Submit Written Comments to: Terry West, P.O. Box 47864, Olympia, WA 98504-7864, web site http://www3.doh.wa.gov/policyreview/, fax (360) 236-4723, by September 4, 2008.

Assistance for Persons with Disabilities: Contact Terry West by August 28, 2008, TTY (800) 833-6388 or 711.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule clarifies advanced registered nurse practitioner (ARNP) scope of practice and licensing requirements. The rule identifies ARNP designations and approved certification examinations. This eliminates psychiatric-mental health clinical nurse specialists. The rules provide for continued licensure of these practitioners as ARNP as long as certification and licensure are renewed. Minimum standards for advanced registered nurse educational programs as required by RCW 18.79.110 are established. The proposed rule amends the two hundred fifty hours of advanced clinical practice for expired or inactive licenses to require two hundred fifty hours of advanced clinical practice for each two-year period of time that the license is inactive or expired (up to 1000 hours). WAC 246-840-425 Seventy-two-hour limit requirements is repealed due to a legislative change.

Reasons Supporting Proposal: This proposal adds clarifying language to reduce confusion of rules. It updates the rules to reflect new certification areas and allows more flexibility in areas of practice. The proposed rules incorporate nursing or nursing related accrediting organizations recognized by the United States Department of Education or Council of Higher Education Accreditation in a cost-effective manner for ensuring compliance with minimum educational requirements. RCW 18.79.255 is repealed allowing ARNPs to dispense Schedule II - IV drugs for more than seventy-two hours, or as needed in the treatment of individual patients. This change is made to implement SB 6267 which passed in the 2008 legislative session.

Statutory Authority for Adoption: RCW 18.79.010, [18.79.]050, [18.79.]110, [18.79.]210, and chapter 154, Laws of 2008.

Statute Being Implemented: RCW 18.79.010, [18.79.]050, [18.79.]110, [18.79.]210, and chapter 154, Laws of 2008.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Washington state department of health, nursing care quality assurance commission, governmental.

Name of Agency Personnel Responsible for Drafting: Mindy Schaffner, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4988; Implementation and Enforcement: Terry West, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4712.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department of health has reviewed the proposal and determined that no small business economic impact statement is required because the rules do not impose more than minor costs on businesses within the industry.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Terry West, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4712, fax (360) 236-4738, e-mail terry.west@doh.wa.gov.

August 5, 2008

Judith D. Personett, EdD, RN, Chair

Nursing Care Quality Assurance Commission

OTS-1682.4


AMENDATORY SECTION(Amending WSR 00-21-119, filed 10/18/00, effective 11/18/00)

WAC 246-840-300   Advanced registered nurse practitioner (ARNP) scope of practice.   ((An advanced registered nurse practitioner is a registered nurse prepared in a formal educational program to assume primary responsibility for continuous and comprehensive management of a broad range of patient care, concerns and problems. Advanced registered nurse practitioners function within the specialty scopes of practice and/or description of practice and/or standards of care developed by national professional organizations and reviewed and approved by the commission. These statements form the basis for selection of test items or competency based evaluation processes and are derived from standard educational curricula for certain practice areas. ARNP members of the commission will review these statements on a biennial basis and will present substantive changes to the full commission for approval or disapproval. Advanced registered nurse practitioners are prepared and qualified to assume primary responsibility and accountability for the care of their patients. This practice is grounded in nursing and incorporates the use of independent judgment as well as collaborative interaction with other health care professionals when indicated in the assessment and management of wellness and conditions as appropriate to the ARNP's area of specialization.

Within the scope of the advanced registered nurse practitioner's knowledge, experience and specialty scope of practice statement(s), licensed advanced registered nurse practitioners may perform the following functions:

Examine patients and establish medical diagnoses by client history, physical examination and other assessment criteria;

Admit patients to health care facilities;

Order, collect, perform and interpret laboratory tests;

Initiate requests for radiographic and other testing measures;

Identify, develop, implement and evaluate a plan of care and treatment for patients to promote, maintain and restore health;

Prescribe medications when granted authority under this chapter;

Refer clients to other health care practitioners or facilities.

An advanced registered nurse practitioner:

(1) Shall hold a current license to practice as a registered nurse in Washington;

(2) Shall have completed a formal advanced nursing education meeting the requirements of WAC 246-840-305;

(3) Shall present documentation of initial certification credential granted by a national certifying body recognized by the commission, approved ARNP specialty whose certification program is approved by the commission and subsequently maintain currency and competency as defined by the certifying body;

(4) Copies of statements of scope of practice or practice descriptions are maintained in the nursing commission's office. Specialty designations recognized by the commission and the date of the commission approved statement of scope of practice or practice description are:

(a) Family Nurse Practitioner (FNP) (American Nurses Association, 1998; American Academy of Nurse Practitioners, 1992).

(b) Women's Health Nurse Practitioner (WHNP) (American Association of Women's Health, Obstetric, and Neonatal Nurses, 1997).

(c) Pediatric Nurse Practitioner (PNP) (National Association of Pediatric Nurse Associates and Practitioners, 2000; American Nurses Association, 1998).

(d) Adult Nurse Practitioner (ANP) (American Nurses Association, 1998; American Academy of Nurse Practitioners, 1992).

(e) Geriatric Gerontological Nurse Practitioner (GNP) (American Nurses Association, 1998).

(f) Certified Nurse Midwife (CNM) (American College of Nurse Midwives, 1997).

(g) Certified Registered Nurse Anesthetist (CRNA) (American Association of Nurse Anesthetists, 1996).

(h) School Nurse Practitioner (American Nurses Association, 1998).

(i) Neonatal Nurse Practitioner (NNP) (American Association of Women's Health, Obstetric, and Neonatal Nurses, 1997).

(j) Psychiatric Nurse Practitioner or Clinical Specialist in Psychiatric-Mental Health Nursing (American Nurses Association, 1998).

(k) Acute Care Nurse Practitioner (American Nurses Association, 1998).

(5) Shall be held individually accountable for practice based on and limited to the scope of his/her education, demonstrated competence, and advanced nursing experience;

(6) Shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices;

(7) Shall be responsible for maintaining current knowledge in his/her field of practice;

(8) Must be prepared to show documentation of any additional formal education, skills training, or supervised clinical practice beyond the basic ARNP preparation; and

(9) May choose to limit his or her area of practice within the recognized specialty or specialties.

(10) If recognized in more than one specialty area, must obtain and maintain certification in all areas and must obtain formal education and training for each area of specialization.)) (1) A licensed advanced registered nurse practitioner (ARNP) is a registered nurse prepared in a formal educational program to assume primary responsibility for continuous and comprehensive management of a broad range of patient care, concerns and problems.

(2) The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients.

(3) ARNP practice is grounded in nursing and incorporates the use of independent judgment as well as collaborative interaction with other health care professionals when indicated in the assessment and management of wellness and health conditions as appropriate to the ARNP's area of practice and certification.

(4) The ARNP functions within his or her scope of practice according to the commission approved certification program and standards of care developed by professional organizations.

(5) The ARNP shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices.

(6) Performing within the scope of the ARNP's knowledge, experience and practice, the licensed ARNP may perform the following:

(a) Examine patients and establish diagnoses by patient history, physical examination and other methods of assessment;

(b) Admit, manage and discharge patients to and from health care facilities;

(c) Order, collect, perform and interpret diagnostic tests;

(d) Manage health care by identifying, developing, implementing and evaluating a plan of care and treatment for patients;

(e) Prescribe therapies and medical equipment;

(f) Prescribe medications when granted authority under this chapter;

(g) Refer patients to other health care practitioners, services or facilities; and

(h) Perform procedures or provide care services that are within the scope of practice according to the commission approved certification program.

[Statutory Authority: RCW 18.79.110 and 18.79.050. 00-21-119, 246-840-300, filed 10/18/00, effective 11/18/00. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-300, filed 6/18/97, effective 7/19/97.]


NEW SECTION
WAC 246-840-302   ARNP designations, certification and approved certification examinations.   (1) ARNP designations recognized by the commission include:

(a) Nurse Practitioner (NP);

(b) Certified Nurse-midwife (CNM); and

(c) Certified Registered Nurse Anesthetist (CRNA).

(2) An ARNP must maintain current certification by an accredited certifying body as identified in subsection (3) of this section. An ARNP license becomes invalid when the certification expires.

(3) The commission approved certification examinations include those approved by the National Commission on Certifying Agencies or the American Boards of Nursing Specialties from the following programs:

(a) For NP designation, NP exams from:

(i) American Academy of Nurse Practitioners;

(ii) American Nurses Credentialing Center;

(iii) National Certification Corporation for Obstetric, Gynecological, and Neonatal Nursing; and

(iv) Pediatric Nursing Certification Board.

(b) For CNM designation, the CNM exam from American Midwifery Certification Board.

(c) For CRNA designation, the CRNA exam from Council on Certification of Nurse Anesthetists.

(4) An ARNP may choose to limit his or her area of practice within the commission approved certification program area of practice.

(5) If an ARNP is recognized in more than one certification area, he or she must obtain and maintain education, training and practice in each area.

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NEW SECTION
WAC 246-840-304   Certification and certification program requirements.   (1) Certification is a form of credentialing, under sponsorship of a commission approved certifying body that recognizes advanced nursing practice in one of the three ARNP designations identified in WAC 246-840-302(1). For example, nurse practitioner (NP); certified nurse midwife (CNM); or certified registered nurse anesthetist (CRNA).

(2) A certification program must:

(a) Ensure that examinations are based on a scope of practice statement that denotes the dimension and boundary, the focus, and the standards of advanced nursing practice in the area of certification. The examination must:

(i) Measure the theoretical and clinical content denoted in the scope of practice; and

(ii) Be developed in accordance with generally accepted standards of validity and reliability.

(b) Require completion of a graduate program of study in the area of certification. The graduate program must:

(i) Be based on measurable objectives that relate directly to the scope of practice;

(ii) Include theoretical and clinical content directed to the objectives; and

(iii) Be equivalent to at least one academic year and include at least five hundred hours of clinical practice under the supervision of preceptors.

(c) Meet the criteria of the National Commission on Certifying Agencies or the American Boards of Nursing Specialties.

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AMENDATORY SECTION(Amending WSR 00-21-119, filed 10/18/00, effective 11/18/00)

WAC 246-840-310   Use and protection of ((nomenclature)) professional titles.   (1) Any person who ((qualifies under WAC 246-840-300 and whose application for advanced registered nurse practitioner designation has been approved by the commission shall be designated as an advanced registered nurse practitioner and)) holds a license to practice as an ARNP shall have the right to use the title "advanced registered nurse practitioner" or "nurse practitioner" and the abbreviation following the nurse's name shall read "ARNP" ((and)) or "NP."

(2) The ARNP may also use the title or abbreviation designated by the approved ((national)) certifying body.

(3) No other person shall assume such titles or use such abbreviations. ((No other person shall use any other title, words, letters, signs or figures to indicate that the person using same is recognized as an advanced registered nurse practitioner and:

(1) Family nurse practitioner, FNP; or

(2) Women's health care nurse practitioner, WHNP; or

(3) Pediatric nurse practitioner/associate, PNP/PNA; or

(4) Adult nurse practitioner, ANP; or

(5) Geriatric nurse practitioner, GNP; or

(6) Certified nurse midwife/nurse midwife, CNM; or

(7) Certified registered nurse anesthetist, CRNA; or

(8) School nurse practitioner, SNP; or

(9) Neonatal nurse practitioner, NNP; or

(10) Clinical nurse specialist in psychiatric/mental health nursing or psychiatric nurse practitioners; or

(11) Acute care nurse practitioner, ACNP.))

[Statutory Authority: RCW 18.79.110 and 18.79.050. 00-21-119, 246-840-310, filed 10/18/00, effective 11/18/00. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-310, filed 6/18/97, effective 7/19/97.]


AMENDATORY SECTION(Amending WSR 02-20-077, filed 9/30/02, effective 10/31/02)

WAC 246-840-311   ARNP previously adopted specialties.   (1) ((The nursing care quality assurance commission recognizes the need to provide for renewing the licenses of advanced registered nurse practitioners certified in:)) On the effective date of this rule, an ARNP holding a license under one or more of the following certification categories may continue to renew his or her license:

(a) Community health nurse;

(b) Maternal/GYN/neonatal nurse;

(c) Medical/surgical nursing;

(d) Occupational health nurse;

(e) Neurosurgical nursing; ((or))

(f) Enterostomal therapy; or

(g) Psychiatric mental health clinical nurse specialist.

(2) ((Failure to renew. If any current credential holder of one or more of the above six categories fails to renew his or her credential(s), then upon the expiration of the current credential listed above, the nursing care quality assurance commission will not renew or recognize the specialty certification(s) listed above for that individual according to the requirements of WAC 246-840-360.

(3) Existing licenses only. This rule applies only to existing licensees issued credentials in the above six categories by the Washington state nursing care quality assurance commission. No new applications will be accepted for certification in the above six categories.)) Any lapse in certification identified in subsection (1)(a) through (g) of this section will result in an invalid ARNP license. The license will not be renewed.

(3) The commission will not accept initial ARNP licensure applications from individuals certified in the categories identified in subsection (1)(a) through (g) of this section.

[Statutory Authority: RCW 18.79.110. 02-20-077, 246-840-311, filed 9/30/02, effective 10/31/02.]


AMENDATORY SECTION(Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)

WAC 246-840-340   ARNP application requirements for ((ARNP)) new graduates of advanced registered nurse programs.   ((A registered nurse applicant for licensure as an ARNP shall:

(1) Submit a completed application and fee as specified in WAC 246-840-990.

(2) Meet the requirements of WAC 246-840-300 and 246-840-305. The following documents must be submitted as evidence to these requirements:

(a) An official transcript received by the commission directly from the formal advanced nursing education program showing all courses, grades, degree or certificate granted, official seal and appropriate registrar or program director's signature.

(b) Program objectives and course descriptions.

(c) Documentation from program director or faculty specifying the area of specialty, unless such is clearly indicated on the official transcript.

(3) Have graduated from an advanced nursing education program, as defined in WAC 246-840-300, within five years of application; if longer than five years have practiced a minimum of one thousand five hundred hours in an expanded specialty role within five years immediately preceding application.

(4) Submit evidence of certification by a certification program approved by the commission.

(5) Persons not meeting the educational requirements in subsection (2) of this section may be licensed if:

(a) Certified prior to December 31, 1994, by a national certifying organization recognized by the commission at the time certification was granted; and

(b) Recognized as an advanced registered nurse practitioner by another jurisdiction prior to December 31, 1994; and

(c) Completed an advanced registered nurse practitioner program equivalent to one academic year.

(6) Persons not meeting the requirements in subsection (3) of this section may be licensed following successful completion of five hundred hours of clinical practice supervised by an advanced registered nurse practitioner or a physician (licensed under chapter 18.71 or 18.57 RCW) in the same specialty area. Following completion of the supervised practice, the supervisor must submit an evaluation to the commission and verify that the applicant's knowledge and skills are at a safe and appropriate level.)) (1) An applicant for licensure as an ARNP must meet the following requirements:

(a) Hold a registered nurse license in the state of Washington that is not subject to sanctions or restrictions by the commission;

(b) Have graduated from an advanced nursing education program within the past year;

(i) For new graduates of advanced nursing education programs in the United States, the program must be accredited by a nursing or nursing-related accrediting organization recognized by the United States Department of Education (USDE) or the Council of Higher Education Accreditation (CHEA);

(ii) For new graduates of advanced nursing education programs outside the United States, the program must be equivalent to the advanced registered nurse education in Washington; and

(c) Hold certification from a commission approved certification program as identified in WAC 246-840-302.

(2) An applicant for ARNP licensure must:

(a) Apply for Washington state registered nurse licensure if not a current holder of the RN license;

(b) Submit a completed application to the commission;

(c) Submit the license fee as specified in WAC 246-840-990;

(d) Request the commission approved certification program as identified in WAC 246-840-302(3) to send official documentation of certification directly to the commission;

(e) Request the advanced nursing educational program to send an official transcript directly to the commission showing all courses, grades, degree or certificate granted, official seal and appropriate registrar or program director's signature;

(f) Submit documentation from the graduate program director or faculty identifying the area of practice, unless the area of practice is clearly indicated on the official transcript;

(g) Submit program objectives and course descriptions when requested by the commission; and

(h) Request a certificate or credential from a commission approved credential evaluating service if the applicant is a new graduate educated outside the United States.

(3) The ARNP applicant may petition the commission for an exemption to the requirement that application for licensure occur within one year of graduation if the applicant has had undue hardship.

(a) Undue hardship includes difficulty scheduling for the approved certification examination through no fault of his or her own, natural disaster, or an unexpected health or family crisis which caused him or her to delay completing the certification examination.

(b) Undue hardship does not include failure of the examination.

(c) The ARNP applicant shall provide evidence as requested by the commission of any undue hardship.

[Statutory Authority: RCW 43.70.280. 98-05-060, 246-840-340, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-340, filed 6/18/97, effective 7/19/97.]


NEW SECTION
WAC 246-840-342   ARNP application requirements for licensed advanced practice nurse applicants from other states or jurisdictions.   (1) An applicant who is currently licensed as an advanced practice nurse in another state or jurisdiction and who is applying for ARNP licensure in Washington, must meet the following requirements:

(a) Hold current registered nurse and advanced practice nurse licenses that are not subject to sanctions or restrictions by another state or jurisdiction licensing agency;

(b) Have graduated from an advanced nursing educational program that:

(i) Requires a minimum of one academic year for completion if graduated on or before December 31, 1994; or

(ii) Requires a graduate degree with a concentration in advanced nursing practice if graduated on or after January 1, 1995; or

(iii) Is equivalent to that leading to a graduate degree in advanced nursing practice if the formal educational program is taken after completion of the graduate degree;

(c) Have been practicing in direct patient care as a licensed nurse practitioner, certified nurse-midwife or certified nurse anesthetist in his or her state for at least two hundred fifty hours of direct patient services within the two years prior to the date of application for ARNP licensure; and

(d) Be currently certified as a nurse practitioner, nurse midwife or registered nurse anesthetist by a commission approved certification program as identified in WAC 246-840-302(3).

(2) An out-of-state applicant for ARNP licensure must:

(a) Apply for Washington state registered nurse licensure as identified in WAC 246-840-090;

(b) Submit a completed ARNP license application to the commission;

(c) Submit a license fee as specified in WAC 246-840-990;

(d) Request the commission approved certification program as identified in WAC 246-840-302(3) to send official documentation of certification directly to the commission;

(e) Request the advanced nursing educational program to send an official transcript directly to the commission showing all courses, grades, degree or certificate granted, official seal and appropriate registrar or program director's signature;

(f) Submit documentation from the graduate program director or faculty identifying the area of practice, unless the area of practice is clearly indicated on the official transcript;

(g) Submit educational program objectives and course descriptions when requested by the commission; and

(h) Submit evidence of at least two hundred fifty hours of direct patient care services as an advanced practice nurse within the two years prior to the date of application for ARNP licensure. The two hundred fifty hours may include teaching advanced nursing practice if the faculty member is providing patient care or serving as a preceptor.

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NEW SECTION
WAC 246-840-344   ARNP application requirements for advanced practice nurse applicants educated and licensed outside the United States.   (1) Persons educated outside the United States who are currently licensed in their country as advanced registered nurse practitioners, registered nurse midwives or registered nurse anesthetists and who are applying for ARNP licensure in Washington, must meet the following requirements:

(a) Hold current registered nurse and ARNP licenses that are not subject to sanctions or restrictions by a foreign nurse licensing agency;

(b) Have a certificate or credential from a commission approved credential evaluating service verifying that the educational program completed by the applicant is equivalent to the advanced registered nurse education identified in WAC 246-840-455;

(c) Have been practicing in direct patient care as a licensed nurse practitioner, certified nurse midwife or certified nurse anesthetist in his or her country for at least two hundred fifty hours of direct patient services within the two years prior to the date of application for ARNP licensure; and

(d) Be certified as a nurse practitioner, nurse midwife or registered nurse anesthetist by a commission approved certification program.

(2) The applicant must:

(a) Obtain registered nurse licensure as identified in WAC 246-840-045;

(b) Submit a completed ARNP application to the commission;

(c) Submit the application fee as specified in WAC 246-840-990;

(d) Submit a certificate or credential from a commission approved credential evaluating service;

(e) Request the commission approved certification program as identified in WAC 246-840-302(3) to send official documentation of certification directly to the commission; and

(f) Submit evidence of at least two hundred fifty hours of direct patient care services as an advanced practice nurse within the two years prior to the date of application for ARNP licensure. The two hundred fifty hours may include teaching advanced nursing practice if the faculty member is providing patient care or serving as a preceptor.

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AMENDATORY SECTION(Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)

WAC 246-840-350   Application requirements for ARNP interim permit.   (1) A registered nurse licensed in the state of Washington who has completed advanced ((formal)) graduate education and ((registered)) is scheduled for a commission approved ((national)) certification examination may be issued an interim permit ((to practice specialized and)) for advanced nursing practice pending notification of the results of the first certification examination. The holder of an ARNP interim permit must use the title graduate advanced registered nurse practitioner (((GRNP)) GARNP).

(((1))) (2) An applicant for ARNP interim permit must:

(a) Submit a completed application on a form provided by the commission ((accompanied by));

(b) Submit a fee as specified in WAC 246-840-990; ((and

(b))) (c) Submit ((documentation of completion of advanced formal education in the area of specialty)) an official transcript sent directly to the commission from the advanced nursing educational program showing all courses, grades, degree or certification granted, official seal and appropriate registrar or program director's signature;

(d) Submit educational program objectives and course descriptions when requested;

(e) Submit documentation from program director or faculty identifying the area of practice, unless the area of practice is clearly indicated on the official transcript; and

(((c))) (f) Submit documentation of ((registration)) scheduled date for the first certification examination administered by ((an)) a commission approved certification program following completion of advanced ((formal)) graduate education((; and

(d) Hold a current license to practice as a registered nurse in Washington)).

(((2))) (3) The interim GARNP permit expires when advanced registered nurse practitioner status is granted. If the applicant fails the examination, the interim permit will expire upon notification of failure either at the test site or by mail and is not renewable.

(((3))) (4) An applicant who does not ((write)) complete the examination on the date scheduled must immediately return the permit to the ((department of health)) commission.

(((4))) (5) The interim permit authorizes the holder to ((perform the functions of advanced and specialized nursing practice as described in this section)) practice as an ARNP, but does not include prescriptive authority.

[Statutory Authority: RCW 43.70.280. 98-05-060, 246-840-350, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-350, filed 6/18/97, effective 7/19/97.]


AMENDATORY SECTION(Amending WSR 00-21-119, filed 10/18/00, effective 11/18/00)

WAC 246-840-360   Renewal of ARNP ((designation)) license.   (1) For ARNP license renewal, the applicant must have:

(((1) Maintain a current)) (a) An active registered nurse license in Washington((.));

(((2))) (b) Maintained certification in area of practice from a commission approved certification program as identified in WAC 246-840-302;

(c) Obtained thirty contact hours of continuing education credit during the renewal period in each area of certification. ARNPs who have certification in more than one related area of practice may count the continuing education hours for more than one certification; and

(d) Practiced for at least two hundred fifty hours in independent clinical practice as an ARNP within the two-year licensing renewal cycle.

(i) Independent clinical practice includes the formulation, implementation and evaluation of plans of care for patients for whom the ARNP is responsible.

(ii) Independent clinical practice includes teaching advanced nursing practice if the faculty member is providing patient care or serving as a preceptor.

(2) The ARNP applicant must:

(a) Submit a renewal fee as specified in WAC 246-840-990;

(b) Submit evidence of current certification by ((her/his certifying body)) the commission approved certification program in all ((specialty)) areas((.

(3) Provide documentation)) of practice;

(c) Submit a written declaration, on forms provided by the commission, that he or she has completed thirty contact hours (((a contact hour is fifty minutes))) of continuing education during the renewal period in ((the)) each area of certification ((derived from any combination of the following approved by the commission:

(a) Formal academic study;

(b) Continuing education offerings.

(4) Attest,));

(d) Submit a written declaration on forms provided by the commission, to having within the last two years, a minimum of two hundred fifty hours of ((specialized and advanced nursing practice within the preceding biennium providing direct patient care services. The commission may perform random audits of licensee's attestations.

(5) Comply with the requirements of chapter 246-12 WAC, Part 2.)) independent clinical practice in the ARNP role;

(e) Submit evidence of completion of continuing education contact hours and independent clinical practice hours when requested by the commission; and

(f) Comply with the requirements of chapter 246-12 WAC, Part 2.

[Statutory Authority: RCW 18.79.110 and 18.79.050. 00-21-119, 246-840-360, filed 10/18/00, effective 11/18/00. Statutory Authority: RCW 43.70.280. 98-05-060, 246-840-360, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-360, filed 6/18/97, effective 7/19/97.]


NEW SECTION
WAC 246-840-361   Continuing education for ARNP license renewal.   The thirty contact hours of continuing education required for renewal of ARNP licensure must:

(1) Be acceptable to the commission approved certification program identified in WAC 246-840-302(3); and

(2) Be obtained from courses in which the contact hour is at least fifty minutes; and

(3) Not include the fifteen hours of continuing education required for ARNPs with prescriptive authority as identified in WAC 246-840-450 (1)(b); and

(4) Not include the same course taken more than once during the renewal cycle.

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AMENDATORY SECTION(Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)

WAC 246-840-365   ((Return to active ARNP status from)) Inactive ((or expired status)) credential.   ((Persons on inactive or expired status who do not hold a current active license in any other United States jurisdiction and who wish to return to active status must apply for reinstatement of ARNP licensure. This requires:

(1) Current RN license in the state of Washington.

(2) Evidence of current certification by his/her certifying body.

(3) Documentation of thirty contact hours of continuing education in the area of specialty during the last two years.

(4) Two hundred fifty hours of precepted/supervised advanced clinical practice supervised by an ARNP or physician in the same specialty within the last year.

(5) If the license has been expired, meet the requirements of chapter 246-12 WAC, Part 2.

(6) If the licensee has been on inactive status, meet the requirements of chapter 246-12 WAC, Part 4.

During the time of the preceptorship, the nurse will be practicing under RN license and will not use the designation ARNP.

ARNP licensure must be reinstated before reapplying for prescriptive authority. At that time the CE requirement will be the same as if applying for prescriptive authority for the first time, as in WAC 246-840-410.)) (1) An ARNP may apply for and renew an inactive credential as identified in chapter 246-12 WAC, Part 4.

(2) An ARNP may apply for an inactive credential if he or she meets the following criteria:

(a) Holds an active Washington state ARNP credential;

(b) Does not have any sanctions or restrictions issued on the current ARNP license; and

(c) Will not practice in Washington.

(3) Prior to returning to active status, the applicant must complete two hundred fifty hours for each two-year period of inactive license status for a maximum of one thousand hours of advanced clinical practice supervised by an ARNP or physician in the same practice area that the applicant is seeking licensure.

(i) The applicant must submit a written notification to the commission thirty days prior to the supervision experience identifying the name of the ARNP or physician who will be supervising the applicant.

(ii) The supervising ARNP or physician must submit a written evaluation to the commission verifying that the applicant has successfully completed the required hours of supervised clinical practice and that the applicant's knowledge and skills are at a safe and appropriate level to practice as an ARNP.

(iii) During the time of the supervision, the nurse will be practicing under his or her RN license and will not use the designation ARNP.

(4) A person with an inactive credential and who does not hold a current active advanced practice nursing license in any other United States jurisdiction, may return to active status. The applicant must:

(a) Meet the requirement identified in chapter 246-12 WAC, Part 4;

(b) Hold a registered nurse license in the state of Washington that is not subject to sanctions or restrictions;

(c) Submit a fee as identified in WAC 246-840-990;

(d) Submit evidence of current certification by the commission approved certification program identified in WAC 246-840-302(3);

(e) Submit a written declaration, on forms provided by the commission, of completion within the past two years of thirty contact hours of continuing education related to area of certification and practice; and

(f) Submit evidence of supervised advanced clinical practice.

(5) A person with an inactive credential and who has been in active practice in another United States jurisdiction may return to active status and must:

(a) Meet the requirements identified in chapter 246-12 WAC, Part 4;

(b) Meet the requirements of WAC 246-840-342; and

(c) Submit a fee as identified in WAC 246-840-990.

(6) To obtain prescriptive authority an applicant must apply as identified in WAC 246-840-410 once the ARNP license has been returned to active status.

[Statutory Authority: RCW 43.70.280. 98-05-060, 246-840-365, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-365, filed 6/18/97, effective 7/19/97.]


NEW SECTION
WAC 246-840-367   Expired license.   (1) If an ARNP license has expired for two years or less, the practitioner must:

(a) Meet the requirements of chapter 246-12 WAC, Part 2;

(b) Meet ARNP renewal requirements identified in WAC 246-840-360; and

(c) Meet the prescriptive authority requirements identified in WAC 246-840-450 if renewing prescriptive authority.

(2) Prior to returning to active status, the applicant must complete two hundred fifty hours for each two-year period of expired license status for a maximum of one thousand hours of advanced clinical practice supervised by an ARNP or physician in the same practice area that the applicant is seeking licensure.

(i) The applicant must submit a written notification to the commission thirty days prior to the supervision experience identifying the name of the ARNP or physician who will be supervising the applicant.

(ii) The supervising ARNP or physician must submit a written evaluation to the commission verifying that the applicant has successfully completed the required hours of supervised clinical practice and that the applicant's knowledge and skills are at a safe and appropriate level to practice as an ARNP.

(iii) During the time of the supervision, the nurse will be practicing under his or her RN license and will not use the designation ARNP.

(3) If the ARNP license has expired for more than two years and the practitioner has not been in active practice in another United States jurisdiction, the practitioner must:

(a) Meet the requirements of chapter 246-12 WAC, Part 2;

(b) Submit evidence of current certification by the commission approved certification program identified in WAC 246-840-302(3);

(c) Submit a written declaration, on forms provided by the commission, of completion within the past two years of thirty hours of continuing education related to area of certification and practice; and

(d) Submit evidence of the supervised advanced clinical practice hours.

(4) If the ARNP license has expired for more than two years and the practitioner has been in active advanced nursing practice in another jurisdiction, the practitioner must:

(a) Meet the requirements of chapter 246-12 WAC, Part 2;

(b) Meet the requirements of WAC 246-840-342; and

(c) Submit verification of active practice from any other United States jurisdiction.

(5) If the license has expired for two or more years, applicants may apply for prescriptive authority as identified in WAC 246-840-410 once the ARNP license has been returned to active status.

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AMENDATORY SECTION(Amending WSR 97-13-100, filed 6/18/97, effective 7/19/97)

WAC 246-840-400   ARNP ((with)) prescriptive ((authorization)) authority.   (1) An ((advanced registered nurse practitioner)) ARNP licensed under chapter 18.79 RCW when authorized by the nursing commission may prescribe drugs, medical equipment and therapies pursuant to applicable state and federal laws.

(2) The ARNP when exercising prescriptive authority is accountable for competency in:

(((1))) (a) Patient selection;

(((2))) (b) Problem identification through appropriate assessment;

(((3))) (c) Medication ((and/))or device selection;

(((4))) (d) Patient education for use of therapeutics;

(((5))) (e) Knowledge of interactions of therapeutics, if any;

(((6))) (f) Evaluation of outcome; and

(((7))) (g) Recognition and management of complications and untoward reactions.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-400, filed 6/18/97, effective 7/19/97.]


AMENDATORY SECTION(Amending WSR 00-21-119, filed 10/18/00, effective 11/18/00)

WAC 246-840-410   Application requirements for ARNP ((with)) prescriptive authority.   (1) An ((advanced registered nurse practitioner)) ARNP who applies for ((authorization to prescribe drugs)) prescriptive authority must:

(((1) Be currently designated)) (a) Have a current license as an ((advanced registered nurse practitioner)) ARNP in Washington((.

(2) Provide evidence of completion of)) that is not subject to sanctions or restrictions issued by the commission; and

(b) Complete thirty contact hours of education in pharmacotherapeutics related to the applicant's scope of ((specialized and advanced)) practice ((and:

(a))) within a two-year time period immediately prior to the date of application for prescriptive authority, unless the applicant has graduated within the past two years from a graduate program which meets the requirements identified in WAC 246-840-455 (11)(e).

The pharmacotherapeutic educational content shall include pharmacokinetic principles and their clinical application and the use of pharmacological agents in the prevention of illness, restoration, and maintenance of health.

(((b) Are obtained within a two-year time period immediately prior to the date of application for prescriptive authority.

(c) Are)) (2) The ARNP applying for prescriptive authority must:

(a) Submit a completed application on a form provided by the commission;

(b) Submit a fee as specified in WAC 246-840-990; and

(c) Submit evidence of completion of thirty contact hours of education in pharmacotherapeutics related to the applicants scope of practice.

(3) If an ARNP does not apply for prescriptive authority within two years of graduation from the advanced practice program, an additional thirty contact hours of pharmacotherapeutics shall be required.

(4) An ARNP who applies for a new or additional ARNP designation must send proof of pharmacology content appropriate to each designation.

(5) The thirty contact hours of pharmacotherapeutic education shall be obtained from the following:

(((i))) (a) Study within the advanced ((formal)) educational program; ((and/))or

(((ii))) (b) Continuing education programs.

((Exceptions shall be justified to and approved by the commission.

(3) Submit a completed, notarized application on a form provided by the commission accompanied by a fee as specified in WAC 246-840-990.)) (6) Applicants who hold prescriptive authority from another state at the time of application may request an exemption to subsection (1)(b) and (2)(c) of this section if he or she provides evidence of at least two hundred fifty hours of independent advanced registered nurse practice with prescriptive authority in his or her scope of practice within the two years prior to application for prescriptive authority.

[Statutory Authority: RCW 18.79.110 and 18.79.050. 00-21-119, 246-840-410, filed 10/18/00, effective 11/18/00. Statutory Authority: RCW 43.70.280. 98-05-060, 246-840-410, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-410, filed 6/18/97, effective 7/19/97.]


AMENDATORY SECTION(Amending WSR 06-01-102, filed 12/21/05, effective 1/21/06)

WAC 246-840-420   Authorized prescriptions by ((the)) ARNP with prescriptive authority.   (1) Prescriptions for drugs, medical equipment and therapies must comply with all applicable state and federal laws and be within the ARNP's scope of practice.

(2) The ((prescriber)) advanced registered nurse practitioner must sign all prescriptions and include the initials ARNP or NP.

(3) An ARNP may not, under RCW 18.79.240(1) and chapter 69.50 RCW, prescribe controlled substances in Schedule I.

(4) Any ARNP with prescriptive ((authorization)) authority who prescribes controlled substances must ((register)) be registered with the drug enforcement administration.

[Statutory Authority: RCW 18.79.240 and 2005 c 28. 06-01-102, 246-840-420, filed 12/21/05, effective 1/21/06. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-420, filed 6/18/97, effective 7/19/97.]


AMENDATORY SECTION(Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)

WAC 246-840-450   Renewal of ARNP prescriptive authority.   (1) ARNP ((with)) prescriptive ((authorization)) authority must be renewed ((every two years)) at the time of renewal of the ARNP license. For renewal of ARNP ((with)) prescriptive ((authorization)) authority, the licensee must:

(((1))) (a) Meet the requirements of WAC 246-840-360 (((1), (2), and (3).)); and

(((2))) (b) Provide ((documentation of fifteen additional)) a written declaration on forms provided by the commission of fifteen contact hours of continuing education during the renewal period in pharmacotherapeutics related to the licensee's scope of practice((. This continuing education must meet the requirements of WAC 246-840-410 (3)(a) and chapter 246-12 WAC, Part 7.

(3) Submit a completed and notarized renewal application with a nonrefundable fee as specified in WAC 246-840-990.)) that are in addition to the thirty contact hours of continuing education required for renewal of the ARNP license as identified in WAC 246-840-360 (1)(c) and (2)(c) and 246-840-361; and

(c) Submit evidence of completion of continuing education contact hours when requested by the commission.

(2) If the licensee fails to renew his or her prescriptive ((authorization)) authority prior to the expiration date, then the individual may not prescribe until the prescriptive authority is renewed and is subject to the late renewal fee specified in WAC 246-840-990 and chapter 246-12 WAC, Part 2.

[Statutory Authority: RCW 43.70.280. 98-05-060, 246-840-450, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-450, filed 6/18/97, effective 7/19/97.]


NEW SECTION
WAC 246-840-451   Continuing education requirements for ARNP prescriptive authority.   (1) The fifteen hours of pharmacotherapeutic continuing education must:

(a) Relate to the ARNP's scope of certification and scope of practice; and

(b) Be obtained from continuing education courses in which the contact hour time is not less than fifty minutes.

(2) The same course taken more than once during a reporting cycle shall be only counted once.

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NEW SECTION
WAC 246-840-455   Requirements for advanced registered nurse practice educational programs in Washington state.   (1) Advanced nursing practice educational programs shall include content that culminates in a graduate degree with a concentration in advanced nursing practice as defined in WAC 246-840-010(2).

(2) Postmasters advanced nursing practice programs must meet all competencies designated for the ARNP role including clinical practicum of no less than five hundred hours.

(3) The college or university graduate educational program shall have as its primary purpose the preparation of advanced practice nurses for roles as defined in WAC 246-840-300 and 246-840-302.

(4) Advanced nursing practice educational programs shall be accredited by a nursing or nursing-related accrediting organization recognized by the United States Department of Education (USDE) or the Council of Higher Education Accreditation (CHEA).

(5) Within ninety days from the effective date of this rule, existing accredited advanced practice educational programs shall submit to the commission current accreditation documentation from all accrediting bodies.

(6) Newly created advanced practice educational programs shall submit to the commission for review the following:

(a) Copies of the curricula within thirty days of sending the information to the accrediting agency;

(b) Other accreditation materials as requested by the commission; and

(c) Accreditation documentation from all accrediting agencies within thirty days from receipt of the report from the accreditation body.

(7) Advanced practice educational programs must submit to the commission for review the following:

(a) Accreditation documentation from all accrediting agencies, within thirty days from receipt of the report from the accreditation body; and

(b) For programs that are not fully accredited, the program must submit copies of self-evaluation report(s) and any interim report(s) provided to all nursing or nursing-related national accrediting agencies, at the time of notification from the accrediting agency that the program has not been fully accredited.

(8) Failure to submit curricula, self-evaluation report(s), interim report(s) or notice of accreditation reports and results as specified in subsections (5), (6) and (7) of this section, may result in the denial of ARNP initial licensure for the school's graduates until such time as the documentation is submitted.

(9) Advanced nursing practice educational programs shall meet the standards established by the national nursing or nursing-related accrediting agency.

(10) Failure to maintain accreditation status may result in denial of application of initial ARNP licensure for the school's graduates effective at the time in which the school became unaccredited.

(11) Advanced nursing practice educational course requirements shall include:

(a) Clinical and didactic course work that prepares the graduate to practice in the role of the ARNP consistent with the designation being sought for licensure;

(b) Advanced physiology/pathophysiology;

(c) Advanced health assessment;

(d) Diagnostic theory and management of health care problems;

(e) Advanced pharmacology which includes pharmacodynamics, pharmacokinetics, pharmacotherapeutics and pharmacological management of individual patients; and

(f) At least five hundred hours in direct patient care in the ARNP role with clinical preceptor supervision and faculty oversight.

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REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 246-840-305 Criteria for formal advanced nursing education meeting the requirement for ARNP licensure.
WAC 246-840-320 Certification and certification program.
WAC 246-840-330 Commission approval of certification programs and commission recognition of new specialties.
WAC 246-840-345 ARNP designation in more than one area of specialty.
WAC 246-840-370 Termination of ARNP designation by the commission.
WAC 246-840-425 Seventy-two-hour limit.

Washington State Code Reviser's Office