WSR 16-08-042 PERMANENT RULES DEPARTMENT OF HEALTH (Nursing Care Quality Assurance Commission) [Filed March 30, 2016, 1:50 p.m., effective April 30, 2016] Effective Date of Rule: Thirty-one days after filing.
Purpose: WAC 246-840-010, 246-840-020, 246-840-300, 246-840-302, 246-840-304, 246-840-310, 246-840-311, 246-840-340, 246-840-342, 246-840-344, 246-840-350, 246-840-360, 246-840-361, 246-840-365, 246-840-367, 246-840-400, 246-840-410 and 246-840-420, the revised rule will add a new advanced registered nurse practitioner (ARNP) designation of clinical nurse specialist (CNS). The revised rule establishes the education, examination, licensing, practice requirements, and other qualifications for the ARNP CNS designation. The revised rules also clarify and update ARNP related rules through general housekeeping.
Citation of Existing Rules Affected by this Order: Repealing WAC 246-840-304 and 246-840-350; and amending WAC 246-840-010, 246-840-020, 246-840-300, 246-840-302, 246-840-310, 246-840-311, 246-840-340, 246-840-342, 246-840-344, 246-840-360, 246-840-361, 246-840-365, 246-840-367, 246-840-400, 246-840-410, and 246-840-420.
Adopted under notice filed as WSR 15-24-117 on December 1, 2015.
Changes Other than Editing from Proposed to Adopted Version: All the changes are editorial to clarify the rules and ensure that they are consistent with other nursing commission rules.
WAC 246-840-010(23), changed "enrolled as a nursing student" to "enrolled as a student";
WAC 246-840-010(25), changed "national nursing accreditation body" to "national nursing education accreditation body";
WAC 246-840-302(1), change to write out and use abbreviation:
(a) Nurse practitioner (NP);
(b) Certified nurse-midwife (CNM);
(c) Certified registered nurse anesthetist (CRNA);
(d) Clinical nurse specialist (CNS).
A final cost-benefit analysis is available by contacting Debbie Carlson, Washington State Nursing Commission, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4725, fax (360) 236-4738, e-mail debbie.carlson@doh.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 16, Repealed 2.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 16, Repealed 2.
Date Adopted: January 8, 2016.
Paula Meyer, MSN, RN, FRE
Executive Director
AMENDATORY SECTION (Amending WSR 13-15-064, filed 7/15/13, effective 8/15/13)
WAC 246-840-010 Definitions.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) ((An)) "Advanced clinical practice" means practicing at an advanced level of nursing in a clinical setting performing direct patient care.
(2) "Advanced nursing practice" means the delivery of nursing care at an advanced level of independent nursing practice that maximizes the use of graduate educational preparation, and in-depth nursing knowledge and expertise in such roles as autonomous clinical practitioner, professional and clinical leader, expert practitioner, and researcher.
(3) "Advanced registered nurse practitioner (ARNP)" is a registered nurse ((who has had)) (RN) as defined in RCW 18.79.050, 18.79.240, 18.79.250, and 18.79.400 who has obtained formal graduate education and ((has achieved)) national specialty certification ((for the nurse practitioner, nurse anesthetist, or nurse midwife role. A nurse with this preparation may qualify as an ARNP as described in WAC 246-840-300.
(2) "Advanced nursing practice" is the delivery of nursing care by registered nurses who have acquired experience and formal education that prepares them for independent practice.
(3))) through a commission approved certifying body in one or more of the designations described in WAC 246-840-302, and who is licensed as an ARNP as described in WAC 246-840-300. The designations include the following:
(a) Nurse practitioner (NP);
(b) Certified nurse midwife (CNM);
(c) Certified registered nurse anesthetist (CRNA); and
(d) Clinical nurse specialist (CNS).
(4) "Associate degree registered nursing education program" means a nursing education program which, upon successful completion of course work, that includes general education and core nursing courses that provide a sound theoretical base combining clinical experiences with theory, nursing principles, critical thinking, and interactive skills, awards an associate degree in nursing (ADN) to prepare its graduates for initial licensure and entry level practice as an RN.
(5) "Bachelor of science degree registered nursing education program" means a nursing education program which, upon successful completion of course work taught in an associate degree nursing education program, as defined in subsection (28) of this section, plus additional courses physical and social sciences, nursing research, public and community health, nursing management, care coordination, and the humanities, awards a bachelor of science in nursing (BSN) degree, to prepare its graduates for a broader scope of practice, enhances professional development, and provides the nurse with an understanding of the cultural, political, economic, and social issues that affect patients and influence health care delivery.
(6) "Certifying body" means a nongovernmental agency using predetermined standards of nursing practice to validate an individual nurse's qualifications, knowledge, and practice in a defined functional or clinical area of nursing.
(7) "Client advocate" means a licensed ((registered nurse or practical)) nurse who actively supports client's rights and choices, including the client's right to receive safe, high quality care, and who facilitates the client's ability to exercise those rights and((/or)) choices by providing the client with adequate information about their care and options.
(((4))) (8) "Commission" means the Washington state nursing care quality assurance commission.
(((5))) (9) "Competency" means demonstrated knowledge, skill and ability in the practice of nursing.
(((6))) (10) "Conditional approval" ((of a school of nursing)) is the approval given a ((school of)) nursing education program that has not met the requirements of the law and the rules ((and regulations)) of the commission((;)). Conditions are specified that must be met within a designated time to rectify the deficiency.
(((7))) (11) "Dedicated education unit" means a clinical learning experience within a health care facility, as part of the curriculum of a nursing education program.
(12) "Delegation" means the licensed ((practical nurse or registered)) nurse transfers the performance of selected nursing tasks to competent individuals in selected situations. The ((licensed practical nurse or registered nurse delegating the task retains the responsibility and accountability)) nurse delegating the task is responsible and accountable for the nursing care of the client. The ((licensed practical nurse or registered)) nurse delegating the task supervises the performance of the unlicensed person. Nurses must follow the delegation process following the RCW 18.79.260. Delegation in community and in-home care settings is defined by WAC 246-840-910 through 246-840-970.
(((a) Nursing acts delegated by the licensed practical nurse or registered nurse shall:
(i) Be within the area of responsibility of the licensed practical nurse or registered nurse delegating the act;
(ii) Be such that, in the opinion of the licensed practical nurse or registered nurse, it can be properly and safely performed by the unlicensed person without jeopardizing the patient welfare;
(iii) Be acts that a reasonable and prudent licensed practical nurse or registered nurse would find are within the scope of sound nursing judgment.
(b) Nursing acts delegated by the licensed practical nurse or registered nurse shall not require the unlicensed person to exercise nursing judgment nor perform acts which must only be performed by a licensed practical nurse or registered nurse, except in an emergency situation (RCW 18.79.240 (1)(b) and (2)(b)).
(c) When delegating a nursing act to an unlicensed person it is the licensed practical nurse or the registered nurse who shall:
(i) Make an assessment of the patient's nursing care need before delegating the task;
(ii) Instruct the unlicensed person in the delegated task or verify competency to perform or be assured that the person is competent to perform the nursing task as a result of the systems in place by the health care agency;
(iii) Recognize that some nursing interventions require nursing knowledge, judgment, and skill and therefore may not lawfully be delegated to unlicensed persons.
(8) "Faculty" means persons who are responsible for the educational nursing program and who hold faculty appointment in the school.
(9))) (13) "Distance education" or "distance learning" means instruction offered by any means where the student and faculty are in separate physical locations. Teaching methods may be synchronous, where the teacher and student communicate at the same time, or asynchronous, where the student and teacher communicate at different times, and shall facilitate and evaluate learning in compliance with nursing education rules.
(14) "Full approval" of a ((school of)) nursing education program is the approval signifying that a nursing program meets the requirements of the law and the rules ((and regulations)) of the commission.
(((10))) (15) "Good cause" as used in WAC 246-840-860 for extension of a nurse technician registration means that the nurse technician has had undue hardship such as difficulty scheduling the examination through no fault of their own((,)); receipt of the examination results after thirty days after the nurse technician's date of graduation((,)); or an unexpected family crisis which caused him or her to delay sitting for the examination. Failure of the examination is not "good cause."
(((11))) (16) "Good standing" as applied to a nursing technician, means the nursing technician is enrolled in a registered nursing program approved by the commission and is successfully meeting all program requirements.
(((12))) (17) "Health care professional" means the same as "health care provider" as defined in RCW 70.02.010(18).
(18) "Home state" is defined as where the nursing education program has legal domicile.
(19) "Host state" is defined as the state jurisdiction outside the home state where a student participates in clinical experiences or didactic courses.
(20) "Immediately available" as applied to nursing technicians, means that ((a registered nurse)) an RN who has agreed to act as supervisor is on the premises and is within audible range and available for immediate response as needed((. This)) which may include the use of two-way communication devices which allow conversation between the nursing technician and ((a registered nurse)) an RN who has agreed to act as supervisor.
(a) In a hospital setting, ((a registered nurse)) the RN who has agreed to act as supervisor is on the same patient care unit as the nursing technician and the patient has been assessed by the ((registered nurse)) RN prior to the delegation of duties to the nursing technician.
(b) In a nursing home or clinic setting, ((a registered nurse)) an RN who has agreed to act as supervisor is in the same building and on the same floor as the nursing technician and the patient has been assessed by the ((registered nurse)) RN prior to the delegation of duties to the nursing technician.
(((13))) (21) "Initial approval" of nursing education program((s)) is the approval ((given)) status conferred by the commission to a new nursing program based on its proposal prior to the graduation of its first class.
(((14))) (22) "Licensed practical nurse (LPN)" is a nurse licensed as defined in RCW 18.79.030(3), with a scope of practice defined in RCW 18.79.020 and 18.79.060.
(23) "Limited educational authorization" is an authorization to perform clinical training when enrolled as a student through a commission approved refresher course. This authorization does not permit practice for employment. ((A limited educational authorization may be issued to:
(a) A person whose Washington state license has been expired or inactive for three years or more and who applies for reinstatement and enrolls in a refresher course; or
(b) An applicant endorsing from another state or territory if the applicant's license from that jurisdiction is on inactive or expired status. The applicant must be enrolled in a refresher course.
(15))) (24) "Minimum standards of competency" means the knowledge, skills, and abilities that are expected of the beginning practitioner.
(((16))) (25) "National nursing education accreditation body" means an independent nonprofit entity, approved by the United States Department of Education as a body that evaluates and approves the quality of nursing education programs within the United States and territories.
(26) "Nontraditional program of nursing" means a school that has a curriculum which does not include a faculty supervised teaching((/)) and learning component in clinical settings.
(((17) "Nurse)) (27) "Nursing education program administrator" is an individual who ((meets the qualifications contained in WAC 246-840-555 and who has been designated as the person primarily responsible for the direction of the program in nursing. Titles for this position may include, among others, dean, director, coordinator or chairperson.
(18))) has the authority and responsibility for the administration of the nursing education program.
(28) "Nursing education program" means a division or department within a state supported educational institution or other institution of higher learning, charged with the responsibility of preparing nursing students and nurses to qualify for initial licensing or higher levels of nursing practice.
(29) "Nursing faculty" means an individual employed by a nursing education program who is responsible for developing, implementing, evaluating, updating, and teaching nursing education program curricula.
(30) "Nursing technician" means a nursing student preparing for ((registered nurse)) RN licensure who meets the qualifications for licensure under RCW 18.79.340 who is employed in a hospital licensed under chapter 70.41 RCW or a nursing home licensed under chapter 18.51 RCW, or clinic((, and who:
(a) Is currently enrolled in good standing and attending a nursing program approved by the commission and has not graduated; or
(b) Is a graduate of a nursing program approved by the commission who graduated:
(i) Within the past thirty days; or
(ii) Within the past sixty days and has received a determination that there is good cause to continue the registration period; or
(c) Is enrolled in an approved school of nursing in the United States or its territories. Approved schools for nursing technicians include the list of registered nursing programs (schools) approved by state boards of nursing in the United States or its territories as preparation for the NCLEX registered nurse examination, and listed in the NCLEX bulletin as meeting minimum standards. Approved schools do not include nontraditional schools as defined in subsection (16) of this section.
(19))). The nursing student must be in a nursing educational program in the United States or its territories that is approved by the National Council Licensure Examination-RN. Approved nursing education programs do not include nontraditional schools as defined in subsection (27) of this section.
(31) "Philosophy" means the beliefs and principles upon which ((the)) a nursing education program curriculum is based.
(((20) "Program" means a division or department within a state supported educational institution, or other institution of higher learning charged with the responsibility of preparing persons to qualify for the licensing examination.
(21))) (32) "Practical nursing education program" means a nursing education program which, upon successful completion of course work that includes core nursing course to provide a sound theoretical base combining clinical experiences with nursing principles, critical thinking, and interactive skills for entry level practical nursing, awards a certificate that the graduate is prepared for interdependent practice to prepare a practical nurse for interdependent practice as an LPN.
(22))) or "RN" is a licensed nurse as defined in RCW 18.79.030(1), 18.79.040, 18.79.240, and 18.79.260.
(34) "Supervision" of licensed or unlicensed nursing personnel means the provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action.
(a) "Direct supervision" means the licensed ((registered nurse)) RN who provides guidance to nursing personnel and evaluation of nursing tasks is on the premises, is quickly and easily available, and has assessed the patient prior to the delegation of the duties.
(b) "Immediate supervision" means the licensed ((registered nurse)) RN who provides guidance to nursing personnel and evaluation of nursing tasks is on the premises, is within audible and visual range of the patient, and has assessed the patient prior to the delegation of duties.
(c) "Indirect supervision" means the licensed ((registered nurse)) RN who provides guidance to nursing personnel and evaluation of nursing tasks is not on the premises but has given either written or oral instructions for the care and treatment of the patient and the patient has been assessed by the registered nurse prior to the delegation of duties.
(((23))) (35) "Traditional ((program of)) nursing education program" means a program that has a curriculum which includes a faculty supervised teaching((/)) and learning component in clinical settings.
AMENDATORY SECTION (Amending WSR 10-24-047, filed 11/24/10, effective 1/1/11)
WAC 246-840-020 Credentials issued to ((nurses)) an LPN, RN, or ARNP in Washington state.
The following credentials are issued to nurses in Washington state.
(1) Active status license for LPN or RN. A license is issued upon completion of ((all requirements for)) licensure requirements. The license holder may use the title licensed practical nurse or registered nurse and the use of its abbreviation, LPN or RN. The license allows practice as ((a licensed practical nurse or registered nurse)) an LPN or RN in the state of Washington. ((See WAC 246-840-201 through 246-840-207 for continuing competency program requirements.))
A student who has graduated from a basic professional nursing course and who is pursuing a baccalaureate degree in nursing, an advanced degree in nursing or an advanced certification in nursing must hold an active Washington RN license before participating in the practice of nursing as required to fulfill the learning objectives in a clinical course.
(2) ((Inactive status license. A license issued to a person previously holding an active license in this state, is in good standing, and does not practice in Washington state. Refer to chapter 246-12 WAC, Part 4.
(3))) Advanced registered nurse practitioner (ARNP) license. An ARNP license may be issued to ((any person)) an individual who meets the requirements of the commission as contained in WAC 246-840-300 through 246-840-365. Only persons holding this license have the right to use the title "advanced registered nurse practitioner" or the abbreviation "ARNP" or any title or abbreviation which indicates that the ((person)) individual is entitled to practice at an advanced and specialized role as ((a nurse practitioner, a nurse midwife, or a nurse anesthetist. The ARNP may engage in the scope allowed for his or her area of national certification as approved by the commission)) a NP, CNM, CRNA, or CNS. The license is valid only with a current ((registered nurse)) RN license. The ARNP's scope of practice is defined by ((national certification standards and)) a national certifying body approved by the commission.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-300 ((Advanced registered nurse practitioner (ARNP))) ARNP scope of practice.
(((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.
(1) The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients.
(((3))) (2) ARNP practice is grounded in nursing process and incorporates the use of independent judgment ((as well as)). Practice includes 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))).
(3) 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)) following the standards of care defined by the applicable certifying body as defined in WAC 246-840-302. An ARNP may choose to limit the area of practice within the commission approved certifying body's practice.
(4) An ARNP shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices.
(((6))) (5) 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 prescriptive 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 ARNP's scope of practice according to the commission approved ((certification program)) certifying body as defined in WAC 246-840-302.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
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); and
(d) Certified nurse specialist (CNS).
(2) An ARNP must maintain current certification within his or her designation(s) by ((an accredited)) a commission approved 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:)) To be eligible for licensure as an ARNP, an applicant must pass an examination from one of the following certifying bodies within the ARNP's specialty designation:
(a) For NP designation((, NP exams from)):
(i) The American Academy of Nurse Practitioners;
(ii) The American Nurses Credentialing Center;
(iii) The National Certification Corporation ((for Obstetric, Gynecological, and Neonatal Nursing; and));
(iv) The Pediatric Nursing Certification Board;
(v) The American Association of Critical Care Nurses; or
(vi) The Oncology Nursing Certification Corporation.
(b) For CNM designation, the ((CNM exam from)) American Midwifery Certification Board.
(c) For CRNA designation, the ((CRNA exam from Council on)) National Board of Certification ((of)) and Recertification for Nurse Anesthetists.
(d) For CNS designation:
(i) The American Nurses Credentialing Center;
(ii) The American Association of Critical Care Nurses; or
(iii) The Oncology Nursing Certification Corporation.
(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)) designation must obtain and maintain education, training, and practice in each area.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-310 Use and protection of professional titles.
(((1) Any)) A person who 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" or "NP."
(((2) The)) An ARNP may also use the applicable title or abbreviation ((designated by the approved certifying body.
(3))), or designation as defined in WAC 246-840-302.
No other person shall assume such titles or use such abbreviations.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-311 ARNP previously adopted specialties.
(1) ((On the effective date of this rule,)) An ARNP holding ((a)) an active license, without sanctions or restrictions, under one or more of the following previously existing advanced practice certification ((categories)) designations, may continue to renew his or her license as an ARNP:
(a) Community health ((nurse));
(b) ((Maternal/GYN/neonatal nurse)) Maternal-gynecological-neonatal;
(c) Medical((/))-surgical ((nursing));
(d) Occupational health ((nurse));
(e) Neurosurgical ((nursing)); or
(f) Enterostomal therapy((; or
(g) Psychiatric mental health clinical nurse specialist)).
(2) ((Any lapse in certification)) An expired license identified in subsection (1)(a) through (((g))) (f) 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))) (f) of this section.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-340 Initial ARNP ((application)) requirements ((for new graduates of advanced registered nurse programs)).
(1) An applicant for licensure as an ARNP must ((meet)) have the following ((requirements)) qualifications:
(a) ((Hold a registered nurse license in the state of Washington that is not subject to)) An active Washington state RN license, without sanctions or restrictions ((by the commission));
(b) ((Have graduated)) A graduate degree 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)) accredited by a national nursing accreditation body recognized by the United States Department of Education;
(c) Certification from a certifying body as identified in WAC 246-840-302;
(d) Completion of advanced clinical practice hours, when applicable, in situations under subsection (3) of this section.
(2) An applicant for ARNP licensure must submit:
(a) ((Apply for Washington state registered nurse licensure if not a current holder of the RN license;
(b) Submit)) A completed ARNP application for licensure to the commission;
(((c) Submit)) (b) The license fee as specified in WAC 246-840-990;
(((d) Request the commission approved certification program)) (c) A request to the certifying body, as identified in WAC 246-840-302(((3))), to send official documentation of certification directly to the commission;
(((e) Request)) (d) A request to 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)); and
(e) 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)).
(3) To be granted a license without meeting the advanced clinical practice requirements identified in subsection (4) of this section, the ARNP shall initiate the application process within one year of earning a graduate degree from an advanced nursing education program.
(4) An ARNP applicant who does not apply within one year of earning a graduate degree from an advanced nursing education program must complete one hundred twenty-five hours of advanced clinical practice for each additional year following graduation, not to exceed one thousand hours.
(a) An ARNP applicant's clinical practice must be supervised by an ARNP, a physician licensed under chapter 18.71 RCW, an osteopathic physician licensed under chapter 18.57 RCW, or equivalent licensure in another state or United States jurisdiction. The ARNP must complete supervised advanced clinical practice as defined in subsections (3) through (5) of this section.
(b) The supervisor must be in the same practice specialty in which the applicant is seeking licensure. The supervising ARNP or physician must:
(i) Have an active ARNP or physician license, without sanctions or restrictions, for two or more years;
(ii) Not be a relative of the applicant;
(iii) Not have a personal or financial relationship with the applicant;
(iv) Not have current disciplinary action on their license;
(v) Submit a written evaluation to the commission verifying the applicant's successful completion of the required supervised clinical practice hours and that the applicant's knowledge and skills are at a safe and appropriate level to practice as an ARNP.
(5) An ARNP applicant needing to complete supervised advanced clinical practice must:
(a) Meet the requirements of subsection (1)(a) and (b) of this section; and
(b) Have commission approval for the following:
(i) The clinical site in which the supervision will take place; and
(ii) The supervising ARNP or physician.
(6) The nursing commission may request additional evidence supporting the applicant's completion of advanced clinical practice hours for the purposes of this section. The commission reserves the right to conduct on-site visits.
(7) The nurse will not use the designation ARNP during the time of the supervised practice hours.
(8) An applicant holding an active RN license, without sanctions or restrictions, and current national certification as a CNS, and is practicing in Washington state in an advanced nursing role, will be exempt from the supervised practice requirement if they can provide evidence of two hundred fifty hours of advanced clinical practice within the last two years.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-342 ((ARNP application requirements for licensed advanced practice nurse applicants from other states or jurisdictions.)) Licensure for ARNP applicants by interstate endorsement.
(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,)) for interstate endorsement for Washington state licensure as an ARNP must meet the following requirements:
(a) ((Hold current registered nurse and advanced practice nurse licenses that are not subject to sanctions or restrictions by)) Have an active RN and ARNP license, or recognition in another state or jurisdiction ((licensing agency)), as practicing in an advanced practice role, without sanctions or restrictions;
(b) Have ((graduated)) a graduate degree 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)) education program as identified in WAC 246-840-340 (1)(b);
(c) Hold certification from a certifying body as identified in WAC 246-840-302(3); and
(d) Have been ((practicing in direct patient care)) performing advanced clinical practice as a licensed ((nurse practitioner, certified nurse-midwife or certified nurse anesthetist in his or her state)) ARNP, or in the role of an advanced practice nurse, 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)) applicant for an ARNP license through interstate endorsement must:
(a) Apply for and be granted a Washington state ((registered nurse licensure)) RN license as identified in WAC 246-840-090;
(b) Submit a completed ARNP ((license)) application for licensure to the commission;
(c) Submit ((a)) the license fee as specified in WAC 246-840-990;
(d) Request the ((commission approved certification program)) certifying body, 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)) nursing education program objectives and course descriptions when requested by the commission; and
(((h))) (g) Submit evidence of at least two hundred fifty hours of ((direct patient care services as an advanced practice nurse)) advanced clinical practice as an ARNP, or at an advanced nursing practice level, 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 in a clinical setting.
(3) An ARNP applicant who does not meet practice requirements must complete two hundred fifty hours of advanced clinical practice for each two years the applicant may have been out of practice, not to exceed one thousand hours.
(4) An ARNP applicant needing to complete the supervised advanced clinical practice must meet the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-344 ((ARNP application requirements for advanced practice nurse)) Licensure for ARNP 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)) An applicant for ARNP licensure in Washington state, educated and licensed outside the United States, must:
(a) Apply for and be granted an active RN license, or recognition in another state or jurisdiction, without sanctions or restrictions ((by a foreign nurse licensing agency)), issued by a regulatory entity outside the United States, and have been practicing at an advanced practice level;
(b) ((Have a certificate or credential)) Submit a course-by-course evaluation of education from a commission approved credential evaluating service verifying ((that)) the advanced nursing educational program completed by the applicant is equivalent to the ((advanced registered nurse)) ARNP education identified in WAC 246-840-455;
(c) Hold certification from a certifying body as identified in WAC 246-840-302(3); and
(d) Have been ((practicing in direct patient care as a licensed nurse practitioner, certified nurse midwife or certified nurse anesthetist)) performing advanced clinical practice 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 educated and licensed outside of the United States must:
(a) ((Obtain registered nurse licensure)) Apply for and be granted a Washington state RN license, without sanctions or restrictions, as identified in WAC 246-840-045;
(b) Submit a completed ARNP application to the commission;
(c) Submit the ((application)) license fee as specified in WAC 246-840-990;
(d) Submit a ((certificate or credential)) course-by-course evaluation of education completed from a commission approved credential evaluating service;
(e) Request the ((commission approved certification program)) certifying body, 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)) advanced clinical practice as an ((advanced practice nurse)) ARNP, or in an advanced practice role, 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 in a clinical setting.
(3) Internationally educated ARNP applicants who do not meet advanced clinical practice requirements must complete two hundred fifty hours of advanced clinical practice for each two years the applicant may have been out of practice, not to exceed one thousand hours.
(4) The ARNP applicant needing to complete supervised advanced clinical practice must meet the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-360 Renewal of ARNP ((license)) licensure.
(1) An applicant applying for ARNP license renewal, ((the applicant)) must have:
(a) An active ((registered nurse license in)) Washington state RN license, without sanctions or restrictions;
(b) ((Maintained)) Current certification ((in area of practice from a commission approved certification program)) from a certifying body 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)) ARNP designation. An ARNP who has certification in more than one ((related)) area of practice may count the continuing education hours for more than one certification when applicable to each area of practice; and
(d) Practiced for at least two hundred fifty hours in advanced clinical practice ((as an)) for each ARNP designation within the two-year licensing renewal cycle. The two hundred fifty hours may include teaching advanced nursing practice only when the faculty member is providing patient care or serving as a preceptor in a clinical setting.
(((i) Clinical practice includes the formulation, implementation and evaluation of plans of care for patients for whom ARNPs are responsible.
(ii) 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)) (2) An applicant for ARNP licensure renewal must comply with the requirements of chapter 246-12 WAC, Part 2 and submit:
(a) The renewal license fee as specified in WAC 246-840-990; and
(b) ((Submit)) Evidence of current certification by the commission approved ((certification program in all areas of practice)) certifying body for each designation;
(c) ((Submit)) A written declaration, on forms provided by the commission((, that he or she has completed)) attesting to:
(i) Completion of thirty contact hours of continuing education during the renewal period ((in each area of certification;)) for each ARNP designation; and
(ii) Completion of a minimum of two hundred fifty hours of advanced clinical practice for each designation in the ARNP role within the last two years.
(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 independent clinical practice in the ARNP role;
(e) Submit)) Evidence of completion of continuing education contact hours and ((independent)) advanced clinical practice hours when requested by the commission((; and
(f) Comply with the requirements of chapter 246-12 WAC, Part 2)).
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-361 Continuing education for ARNP license renewal.
The thirty contact hours of continuing education required for the two-year renewal of ARNP licensure must:
(1) Be acceptable to the ((commission approved certification program)) certifying body 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 an ARNP((s)) 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.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-365 Inactive ((credential)) and reactivating an ARNP license.
(((1) An ARNP may apply for and renew an inactive credential as identified in chapter 246-12 WAC, Part 4.
(2))) To apply for an inactive ARNP license, an ARNP must comply with WAC 246-12-090 or 246-12-540, as appropriate.
(1) An ARNP may apply for an inactive ((credential)) license 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.
(a) 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.
(b) 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.
(c) 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)) license without sanctions or restrictions.
(2) To return to active status the nurse must:
(a) Meet the requirement identified in chapter 246-12 WAC, Part 4;
(b) Hold an active RN license under chapter 18.79 RCW without sanctions or restrictions;
(c) Submit the fee as identified in WAC 246-840-990;
(d) Submit evidence of current certification by the commission approved certifying body identified in WAC 246-840-302(1);
(e) Submit evidence of thirty contact hours of continuing education for each designation within the past two years; and
(f) Submit evidence of two hundred fifty hours of advanced clinical practice for each designation within the last two years.
(3) An ARNP applicant who does not have the required practice requirements, must complete two hundred fifty hours of advanced clinical practice for each two years the applicant may have been out of practice, not to exceed one thousand hours.
(4) The ARNP applicant needing to complete supervised advanced clinical practice must meet the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).
(5) To regain prescriptive authority ((an)) after inactive status, the applicant must ((apply as identified in WAC 246-840-410 once the ARNP license has been returned to active status)) meet prescriptive authority requirements identified in WAC 246-840-410.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-367 Expired license.
(((1) If)) When an ARNP license ((has expired for two years or less, the practitioner must)) is not renewed, it will be in expired status and the nurse must not practice as an ARNP.
(1) To return to active status when the license has been expired for less than two years, the nurse 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))) Applicants not meeting the required advanced clinical practice requirements must complete two hundred fifty hours of advanced clinical practice for each two years the applicant may have been out of practice, not to exceed one thousand hours.
(2) The ARNP applicant needing to complete supervised advanced clinical practice must meet the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).
(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)) or more, the applicant must:
(a) Meet the requirements of chapter 246-12 WAC, Part 2;
(b) Submit evidence of current certification by the commission approved ((certification program)) certifying body identified in WAC 246-840-302(3);
(c) Submit ((a written declaration, on forms provided by the commission, of completion)) evidence of thirty contact hours of continuing education for each designation 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));
(d) Submit evidence of two hundred fifty hours of advanced clinical practice completed within the past two years; and
(e) Submit evidence of an additional thirty contact hours in pharmacology if requesting prescriptive authority ((as identified in WAC 246-840-410 once the ARNP license has been returned to active status)), which may be granted once the ARNP license is returned to active status.
(4) If the applicant does not meet the required advanced clinical practice hours, he or she must complete the supervised advanced clinical practice as defined in WAC 246-840-340 (4) and (5).
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-400 ARNP prescriptive authority.
(1) An ARNP licensed under chapter 18.79 RCW when authorized by the nursing commission may prescribe drugs((,)) and medical ((equipment and therapies)) devices pursuant to applicable state and federal laws.
(2) The ARNP when exercising prescriptive authority is accountable for competency in:
(a) ((Patient selection;
(b))) Problem identification through appropriate assessment;
(((c))) (b) Medication ((or)) and device selection;
(((d))) (c) Patient education for use of therapeutics;
(((e))) (d) Knowledge of interactions of therapeutics((, if any));
(((f))) (e) Evaluation of outcome; and
(((g))) (f) Recognition and management of side effects, adverse reactions, and complications ((and untoward reactions)).
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-410 Application requirements for ARNP prescriptive authority.
(1) An ARNP who applies for prescriptive authority must:
(a) ((Have a current)) Hold an active Washington state ARNP license ((as an ARNP in Washington that is not subject to)), without sanctions or restrictions, issued by the commission; ((and))
(b) ((Complete)) Provide evidence of thirty contact hours of education in ((pharmacotherapeutics related to the applicant's scope of practice)) pharmacology, including didactic and clinical application, and consisting of pharmacodynamics, pharmacokinetics, pharmacotherapeutics, and pharmacological management of individual patients related to the applicant's scope of practice.
(2) Pharmacology education must be completed 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.
(2))) unless the applicant has graduated within the past two years from an advanced nursing education program meeting requirements identified in WAC 246-840-455 (11)(e).
(3) If an ARNP applicant does not have advanced pharmacology education, the applicant must complete:
(a) Advanced pharmacology education of at least thirty contact hours, including pharmacodynamics, pharmacokinetics, pharmacotherapeutics and pharmacological management of individual patients, differential diagnosis, and applied pharmacological management of patients consistent with the applicant's area of certification.
(b) Supervised advanced clinical practice of no less than one hundred fifty hours that meets the requirements of WAC 246-840-340 (4) and (5). The clinical practice hours shall occur after completion of the thirty hours of advanced pharmacology education under the direct supervision of an ARNP with prescriptive authority, a physician as identified in chapter 18.71 RCW, an osteopathic physician as identified in chapter 18.57 RCW, or equivalent in other states or jurisdictions. The thirty contact hours of advanced pharmacology education is obtained from the following:
(i) Study within the advanced nursing education program; or
(ii) Continuing education programs accepted by a national credentialing body.
(4) The ARNP applying for prescriptive authority must submit:
(a) ((Submit)) A completed application on a ((form provided by the)) commission approved form;
(b) ((Submit a)) The 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))) required advanced pharmacology education hours and supervised advanced clinical practice hours identified in subsection (3)(a) and (b) of this section.
(5) If an ARNP does not apply for prescriptive authority within two years of graduation from ((the)) an advanced practice program, an additional thirty contact hours of ((pharmacotherapeutics)) advanced pharmacology education shall be required.
(((4))) (6) An ARNP who applies for a new or additional ARNP designation must send proof of advanced pharmacology educational content appropriate to each designation.
(((5) The thirty contact hours of pharmacotherapeutic education shall be obtained from the following:
(a) Study within the advanced educational program; or
(b) Continuing education programs.
(6))) (7) Applicants who hold prescriptive authority from another state at the time of application may request an exemption to subsection (((1)(b) and (2)(c))) (3)(a) and (b) of this section if he or she provides evidence of at least two hundred fifty hours of ((independent advanced registered nurse practice)) advanced clinical practice in an ARNP role with prescriptive authority in his or her scope of practice within the two years prior to application for prescriptive authority.
AMENDATORY SECTION (Amending WSR 09-01-060, filed 12/11/08, effective 1/11/09)
WAC 246-840-420 Authorized prescriptions by ARNP with prescriptive authority.
(((1))) Prescriptions for drugs((,)) and medical ((equipment and therapies)) devices must comply with all applicable state and federal laws and be within the ARNP's scope of practice.
(((2) The advanced registered nurse practitioner)) (1) An ARNP must sign ((all)) prescriptions and include the initials ARNP or NP.
(((3))) (2) An ARNP may not, under RCW 18.79.240(1) and chapter 69.50 RCW, prescribe controlled substances in Schedule I.
(((4) Any)) (3) An ARNP with prescriptive authority who prescribes controlled substances must be registered with the drug enforcement administration.
REPEALER
The following sections of the Washington Administrative Code are repealed:
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