PROPOSED RULES
(Nursing Care Quality Assurance Commission)
Original Notice.
Preproposal statement of inquiry was filed as WSR 97-12-029.
Title of Rule: Advanced registered nurse practitioner rules, new WAC 246-840-299 Definitions, amending WAC 246-840-300, 246-840-305, 246-840-310, 246-840-320, 246-840-330, 246-840-340, 246-840-345, 246-840-360 and 246-840-410; and repealing WAC 246-840-315, 246-840-430, and 246-840-440.
Purpose: Define licensing requirements for advanced registered nurse practitioners.
Statutory Authority for Adoption: RCW 18.79.110, 18.79.050.
Statute Being Implemented: Chapter 18.79 RCW, RCW 18.79.050.
Summary: The Nursing Care Quality Assurance Commission has spent four years reviewing the ARNP rules, meeting with members of the public on at least eight occasions and researching ARNP rules in other states. After careful analysis and much input, the commission has decided that these rules should be amended to be more clear, concise and reflect current requirements.
Reasons Supporting Proposal: There have been at least eight ARNP round table meetings with the public to solicit input on how to amend these rules. A rules writing workshop was also held to help write the rules. These amendments represent the suggestions received from interested persons.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Terry J. West, P.O. Box 47864, Olympia, WA 98504, (360) 236-4712.
Name of Proponent: Nursing Care Quality Assurance Commission, governmental.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: The Department of Health and Nursing Care Quality Assurance Commission received a lot of public comment at the roundtable meetings and rules writing workshop. These comments have been incorporated into the draft rules.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: All eighteen of the existing ARNP rules were reviewed to determine if they were clear, concise and still relevant. After at least eight ARNP roundtable meetings with the public and one rules writing workshop, the consensus was to amend nine rules, repeal three, add one new rule regarding definitions and no changes to seven rules. When these rules are amended and adopted we believe that it will make rules that are easier to understand, more clear on expectations for ARNP licensees and allow greater flexibility for ARNP licensees. Several rules currently list the known specialties that ARNP's can become certified in. Three rules are identified as needing repeal because they are redundant and no longer necessary.
Proposal Changes the Following Existing Rules: Nine of the currently existing ARNP rules are identified to be amended to make them clearer, easier to understand and more flexible for ARNP licensees. This proposal also repeals three rules which have been identified as being redundant and no longer necessary.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
Therefore, there is no disproportionate cost for small businesses.
A copy of the statement may be obtained by writing to Terry J. West, Department of Health, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4712, fax (360) 236-4738.
RCW 34.05.328 applies to this rule adoption. These rules are significant under RCW 34.05.328 because they adopt substantive provisions which subject the violator to penalty or sanction and establish, alter or revoke qualification or standard for the issuance, suspension or revocation of a license.
Hearing Location: Cavanaugh's at Yakima Center, 607 East Yakima Avenue, Yakima, WA, on September 8, 2000, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Kris McLaughlin at (360) 664-4207 or (360) 236-4713, by September 1, 2000, TDD (360) 664-0064, or fax (360) 236-4738.
Submit Written Comments to: Terry J. West, Department of Health, P.O. Box 47864, Olympia, WA 98504, fax (360) 236-4738, by September 6, 2000.
Date of Intended Adoption: September 8, 2000.
June 21, 2000
Paula R. Meyer, RN, MSN
Executive Director
OTS-2503.7
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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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)) of 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.]
(((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.]
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.]
(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.]
(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.]
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.]
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.]
OTS-2420.3
REPEALER
The following sections of the Washington Administrative Code are repealed:
| WAC 246-840-315 | Clinical specialist in psychiatric/mental health nursing. |
| WAC 246-840-430 | Termination of ARNP prescriptive authorization. |
| WAC 246-840-440 | Prescriptive authorization period. |