WSR 00-21-119

PERMANENT RULES

DEPARTMENT OF HEALTH


(Nursing Care Quality Assurance Commission)

[ Filed October 18, 2000, 11:39 a.m. ]

Date of Adoption: September 8, 2000.

Purpose: Define licensing requirements for advanced registered nurse practitioners.

Citation of Existing Rules Affected by this Order: Repealing WAC 246-840-315, 246-840-430 and 246-840-440; and amending WAC 246-840-299, 246-840-300, 246-840-305, 246-840-310, 246-840-320, 246-840-330, 246-840-360, and 246-840-410.

Statutory Authority for Adoption: RCW 18.79.110.

Other Authority: RCW 18.79.050.

Adopted under notice filed as WSR 00-16-107 on August 2, 2000.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 9, Repealed 3. Effective Date of Rule: Thirty-one days after filing.

September 8, 2000

Frank T. Maziarski, Chair

Nursing Care Quality Assurance Commission

OTS-2503.8


NEW SECTION
WAC 246-840-299
Definitions.

(1) Advanced nursing practice: Advanced nursing practice is the delivery of expert nursing care by registered nurses who have acquired experience and formal education in specialized areas. A nurse with this preparation may qualify as ARNP as delineated in WAC 246-840-300.

(2) Advanced registered nurse practitioner (ARNP): An ARNP is a registered nurse who has had formal graduate education and has achieved national specialty certification for the nurse practitioner, nurse anesthetist or nurse midwife role.

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

WAC 246-840-300
Advanced registered nurse practitioner.

An advanced registered nurse practitioner is a registered nurse prepared in a formal educational program to assume ((an expanded role in providing health care services)) primary responsibility for continuous and comprehensive management of a broad range of patient care, concerns and problems. Advanced registered nurse practitioners function within the ((scope of practice reviewed and approved by the commission. Those scopes reviewed are the statements of scope accepted by the certifying bodies as the basis for their test plan and selection of test items)) 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 ((shall)):

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

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

(3) Shall present documentation of initial certification credential ((for specialized and advanced nursing practice)) granted by a national certifying body ((whose certification program is approved by)) 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; ((and))

(4) ((Be held accountable to scope of practice and the standards of care established for the specialty as reviewed and approved by the commission.)) 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.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-300, filed 6/18/97, effective 7/19/97.]


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

WAC 246-840-305
Criteria for formal advanced nursing education meeting the requirement for ARNP licensure.

(((1))) The college or university graduate education program which prepares the registered nurse for ((advanced nursing practice)) eventual licensure as an ARNP shall have as its primary purpose the preparation of advanced practice nurses for ((the expanded nursing role as an advanced registered nurse practitioner)) roles as defined in WAC 246-840-300. Documentation that may be requested to substantiate preparation for the ARNP role may include, but shall not be limited to:

(((a))) (1) The philosophy, purpose, and objectives of the program, which are clearly defined and available in written form.

(((b))) (2) The objectives reflecting the philosophy which are written in outcomes that describe the competencies of the graduate.

(((c))) (3) Administrative policies of the program, which include:

(((i))) (a) Clearly stated admission criteria, available in written form.

(((ii))) (b) Provision of official evidence that the student has completed the program successfully.

(((iii))) (c) Documentation that the program is conducted by an accredited college or university.

(((d))) (4) Evidence that faculty meet the following requirements:

(((i))) (a) Inclusion of faculty who are currently authorized to assume primary responsibility for patient care in the given specialty.

(((ii))) (b) Only medical faculty who are authorized to practice.

(((iii))) (c) The number of qualified faculty in the specialty area available to develop and implement the program is adequate.

(((iv))) (d) Preceptors who participate in teaching, supervising, and evaluating students. Criteria are in place for selection and functioning of preceptors. Preceptors guide students and communicate with faculty regarding student progress.

(((e))) (5) Curriculum of the advanced nursing practice program which reflects:

(((i))) (a) Course content that is consistent with the philosophy and objectives of the program.

(((ii) Theory and clinical experience relevant to the specialized area of advanced practice and leading to achievement of the defined outcome competencies. These shall include content in biological, behavioral, nursing, medical, pharmacological, and regulation of the advanced practice role.

(iii))) (b) The coordinated, formal program of study shall be based on defined outcome competencies. Minimal course requirements shall include:

Advanced physiology/pathophysiology

Advanced health assessment

Diagnostic theory and medical management of health care problems

Advanced pharmacotherapeutics

A minimum of 500 hours in direct patient care in the ARNP role with clinical preceptor supervision and faculty oversight

Role of the ARNP.

(c) Before January 1, 1995, content that requires a minimum of one academic year for completion.

(((iv))) (d) After January 1, 1995, content that culminates in a graduate degree with a concentration in advanced nursing practice.

(((v))) (e) If the formal educational program to prepare for the advanced nursing practice role is taken after completion of the graduate degree, the candidate must submit evidence that the practitioner preparation program, as stated in (e)(ii) of this subsection, is equivalent to that leading to a graduate degree in advanced practice specialty.

(((f))) (6) Outlines and descriptions of curriculum content which are available in written form.

(((2) The commission will review educational programs that an applicant is considering for preparation for advanced practice to assist in selection of a program that meets requirements. All requests for review must be in writing. Written response will be provided to all applicants in this category and maintained in applicant's file at the board of nursing.))

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-305, filed 6/18/97, effective 7/19/97.]


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

WAC 246-840-310
Use of nomenclature.

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 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 the title or abbreviation designated by the approved national certifying body. ((No other initials or abbreviations shall legally denote advanced nursing practice.)) No other person shall assume such title or use such abbreviation. 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, WHCNP; 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: Chapter 18.79 RCW. 97-13-100, 246-840-310, filed 6/18/97, effective 7/19/97.]


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

WAC 246-840-320
Certification and certification program.

(1) Certification is a form of credentialing, under sponsorship of a national certifying body that recognizes specialized and advanced nursing practice.

(2) ((A certification program is used by a national certifying body to grant the certification credential.)) A certification program shall be based on:

(a) A scope of practice statement as identified in WAC 246-840-300 shall denote the dimension and boundary, the focus, and the standards of specialized and advanced nursing practice in the area of certification.

(b) A formal program of study requirement in the area of certification which shall:

(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. A preceptorship which is part of the formal program shall be included as part of the academic year. Current practice in the area of certification will not be accepted as a substitute for the formal program of study.

(c) ((An examination in the area)) The process of certification ((which)) shall:

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

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

(iii) Be ((open)) only to registered nurses who have successfully completed the program of study referred to in (b) of this subsection; and

(iv) The certification program must successfully meet the criteria of the National Commission on Certifying Agencies, the third-party organization which periodically reviews the exam integrity, exam content and administrative processes of the certifying organization.

(3) The commission shall periodically review each certification program and may discontinue approval in the event that a certification program no longer meets the requirements of subsection (2) of this section.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-320, filed 6/18/97, effective 7/19/97.]


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

WAC 246-840-330
Commission approval of certification programs and commission recognition of new specialties.

(1) ((A licensee may request that a certification program be considered for approval and shall submit documentation showing that the program meets the requirements of WAC 246-840-320(2).

(2) The commission shall periodically review each certification program and may discontinue approval in the event that a certification program no longer meets the requirements of WAC 246-840-320(2).

(3) The commission shall notify licensees of pending review and may request that further information be provided regarding continued compliance with the provisions of WAC 246-840-320(2).))

The commission shall review each certification program at least once every four years. The review will occur at a commission business meeting. The commission may discontinue approval in the event that a certification program no longer meets the criteria of WAC 246-840-320.

(2) The commission shall notify licensees of pending review and may request that further information be provided regarding compliance with the provisions of WAC 246-840-320(2).

(3) Schools contemplating the development of a new ARNP specialty may request that new specialties and related certification programs be considered for ARNP designation through the rule-making process.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-330, filed 6/18/97, effective 7/19/97.]


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

WAC 246-840-360
Renewal of ARNP designation.

The applicant must:

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

(2) Submit evidence of current certification by her/his certifying body in all specialty areas.

(3) Provide documentation of thirty contact hours (a contact hour is fifty minutes) of continuing education during the renewal period in the area of certification derived from any combination of the following approved by the commission:

(a) Formal academic study;

(b) Continuing education offerings.

(4) Attest, on forms provided by the commission, to having 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.

[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.]


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

WAC 246-840-410
Application requirements for ARNP with prescriptive authority.

An advanced registered nurse practitioner who applies for authorization to prescribe drugs must:

(1) Be currently designated as an advanced registered nurse practitioner in Washington.

(2) ((Be designated by their national certifying body as:

(a) A family nurse practitioner; or

(b) A women's health care nurse practitioner; or

(c) A pediatric nurse practitioner/associate; or

(d) An adult nurse practitioner; or

(e) A geriatric nurse practitioner; or

(f) A nurse midwife; or

(g) A nurse anesthetist; or

(h) A school nurse practitioner; or

(i) A clinical specialist in psychiatric and mental health nursing; or

(j) A neonatal nurse practitioner.

(3))) Provide evidence of completion of thirty contact hours of education in pharmacotherapeutics related to the applicant's scope of specialized and advanced practice and:

(a) 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 obtained from the following:

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

(ii) Continuing education programs.

Exceptions shall be justified to and approved by the commission.

(((4))) (3) Submit a completed, notarized application on a form provided by the commission accompanied by a fee as specified in WAC 246-840-990.

[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.]

Washington State Code Reviser's Office