Update on Board of Registration in Nursing APRN Authorization

1. Update on Board of Registration in Nursing APRN Authorization

2. Learning Objectives • Enhanced knowledge of changes in APRN regulations • Understand Board’s process of primary source verification for authorization of APRN practice • Understand Board’s process for re-licensure of APRN • List document requirements for specific APRN categories

3. Mission Statement The mission of the Massachusetts Board of Registration in Nursing is to lead in the protection of the health, safety and welfare of the citizens of the Commonwealth through the fair and consistent application of the statutes and regulations governing nursing practice and education

4. Goals of the Board of Nursing • Ensure that persons licensed as nurses are qualified to provide the citizens of the Commonwealth with safe & effective nursing care. • Lead in state government and the public arena in the promotion of safe & effective nursing practice.

5. Selected Board of Nursing Statutes and RegulationsMassachusetts Nurse Practice Act M.G.L. Chapter 13, sections 13 - 15D Creation, and legal authority, of the Board of Nursing to administer and enforce the NPA, and regulate nursing practice and education M.G.L. Chapter 112, sections 74 - 81C Legal authority and requirements related to nursing licensure and practice, and the Nursing Board’s enforcement responsibilities

6. Functions of the Board • Makes, adopts, amends, repeals and enforces regulations • Issues advisory rulings and opinions to guide practice and education • Approves and monitors nursing education programs • Issues nursing licenses to qualified individuals • Authorizes nurses to practice in advanced roles

7. Functions (con’t) • License maintenance (initial, renewal, reciprocal, verification, fee collection) • Investigates and takes action against complaints • Audits competency • Administers SARP Program • Consults and conducts forums, studies and research on practice, education, patient safety and related matters

8. Board Regulations Governing Nursing244 Code of Massachusetts Regulations 3.00–9.00 3.00: RN and LPN Scope of Practice, Functions, and Delegation 4.00: Advance Practice Registered Nursing 5.00: Continuing Education 6.00: Schools of Nursing 7.00: Action on Complaints 8.00: Licensure Requirements 9.00: Standards of Conduct

9. Preparing for Practice as an Advanced Practice Registered Nurse (APRN): Board Authorization

10. Prohibition of Practice • Board authorization to practice must be obtained prior to: • Engaging in practice as an Advance Practice Nurse (APRN) • Using any APRN credentials • Identifying self as APRN by signs, name tag, stationary and similar devices

11. What is an APRN? • RN with post graduate education • prepared with expert knowledge, complex decision-making skills, and clinical competencies • pass a rigorous national certification examination • must demonstrate continued competency in order to maintain certification.

12. APRN Practice • Advanced assessment • Diagnosis • Treatment • Referrals • Consultations 

13. Who do they treat? • across the life span for health promotion or health maintenance • chronic disease, illness, trauma, or other life-altering event in which rehabilitative and/or palliative interventions are necessary.

14. MA authorizes 5 APRN clinical categories • Nurse Practitioners (CNP) – provides health care services to individuals throughout the lifespan, including health promotion, disease prevention, health education, counseling and making referrals to other members of the health care team, as well as the diagnosis and management of acute and chronic illness and disease. A CNP provides care in diverse settings, including, but not limited to, home, hospital, nursing facilities, and a variety of ambulatory care settings including private offices, community and public health clinics.

15. MA authorizes 5 APRN clinical categories • Certified Nurse-midwives (CNM) – provides primary health care services to women throughout the lifespan including gynecologic care, family planning services, preconception care, prenatal and postpartum care, childbirth, care of the newborn and treatment of the partner of their clients for sexually transmitted disease and reproductive health. A CNM practices within a healthcare system and develops clinical relationships with obstetrician-gynecologists to provide care in diverse settings, including, but not limited to, home, hospital, birth center, and a variety of ambulatory care settings including private offices, community and public health clinics.

16. MA authorizes 5 APRN clinical categories • Certified Nurse Anesthetists (CRNA) – provides anesthesia care and anesthesia-related care for individuals across the lifespan, whose health status may range from healthy through all recognized levels of acuity, including persons with immediate, severe, or life-threatening illness or injury. A CRNA provides care in diverse settings, including, but not limited to, hospital surgical suites and obstetrical delivery rooms; critical access hospitals; acute care; ambulatory centers; and the offices of dentists, podiatrists, and physicians.

17. MA authorizes 5 APRN clinical categories • Psychiatric Clinical Nurse Specialists (PCNS) – provides psychiatric health care services to individuals throughout the lifespan, including health promotion, disease prevention, health education, counseling and making referrals to other members of the health care team, as well as the diagnosis and management of acute and chronic psychiatric illness and psychiatric disease. A PCNS provides care in diverse settings, including, but not limited to, home, hospital, nursing facilities, and a variety of ambulatory care settings including private offices, community and public health clinics.

18. MA authorizes 5 APRN clinical categories • Clinical Nurse Specialists (CNS) – integrates an advanced level of direct and indirect nursing care beyond the scope of RN practice. In addition to the provision of assistance to other nurses and health professionals in establishing and meeting health goals of individuals and groups, a CNS may provide health care services to individuals throughout the lifespan, including health promotion, disease prevention, health education, counseling and making referrals to other members of the health care team, as well as the diagnosis and management of illness and disease. A CNS provides care in diverse settings, including, but not limited to home, hospital, nursing facilities, and a variety of ambulatory care settings including private offices and community, and public health clinics.

19. APRN Authorization Written authorization granted by the Massachusetts Board of Registration in Nursing to a Registered Nurse, under authority of M.G.L. C. 112, s. 80B to engage in advanced practice nursing as defined in 244 CMR 4.00

20. Graduation from formal education program which has as its objective the preparation of nurses to practice in a defined advanced practice role Current, unencumbered MA Registered Nurse (RN) licensure Determination of Good Moral Character (GMC) Attainment of certification from a nationally recognized accrediting body approved by the Board in a category recognized in regulation Payment of fees Becoming Authorized to Practice as an APRN

21. Verification of Massachusetts Registered Nurse license. APRNs seeking reciprocity must apply for and receive Massachusetts RN licensure prior to applying for APRN authorization. • Verification of the applicant’s current advanced practice certification by a national certifying organization. • Applicant’s official transcript contained in a sealed envelope sent directly to PCS by the APRN nursing education program the applicant graduated from. • If the applicant is or has been licensed as a nurse (LPN and/or RN) in any other state or jurisdiction, verification of licensure status must be completed. • If the applicant is authorized to practice as an APRN in any other state or jurisdiction, official verification of APRN status from each state or jurisdiction, or both. • answer “yes” to any questions related to the good moral character licensure requirement, Board must determine compliance with this requirement before authorizing APRN practice.

22. Educational Preparation • Satisfactory completion of a formal educational program which has as its objective the preparation of registered nurses to practice in the advanced role • Program must be Board recognized • Advanced physical assessment • Advanced pathophysiology • Advanced pharmacology

23. RN license • Active, unencumbered • Has met good moral character requirements

24. Application Process • Obtain instructions and application from Professional Credentialing Services (PCS) • www.pcshq.com • Read, complete in entirety, follow directions to avoid delay

25. Each application for initial, additional or reciprocal authorization must be received by PCS, fully completed and legible, with required documentation, before it will be reviewed.

26. Good Moral Character Licensed nurses in Massachusetts who fulfill the Good Moral Character requirement are honest, trustworthy, accountable, reliable, have integrity, and are able to distinguish between right and wrong. They also avoid aggression to self and others, and avoid injustice and deceit.

27. Application The Board of Registration in Nursing requires all applicants to answer six (6) questions related to criminal convictions and/or disciplinary actions by a licensure or certification body.

28. Good Moral Character Questions • 1. Has any disciplinary action ever been taken against you by a professional and/or trade licensing/certification board located in the United States or any country/foreign jurisdiction, including removal from a long-term care nurse aide registry program? • 2. Are you the subject of pending disciplinary action by a professional and/or trade licensing/certification board located in the United States or any country/foreign jurisdiction? • 3. Have you ever applied for, and been denied, a professional and/or trade license/certification in the United States or any other country/foreign jurisdiction? • 4. Have you ever surrendered or resigned a professional and/or trade license/certificate in the United States or any other country/foreign jurisdiction? • 5. Have you ever been convicted of a felony or misdemeanor in the United States or any other country/foreign jurisdiction? • 6. Are you the subject of any pending or open criminal case (s) or investigation (s), (including for any felony or misdemeanor) in a jurisdiction in the United States or any country/foreign jurisdiction?

29. Definition of Criminal Conviction • A verdict or finding of guilty. • A plea of guilty. • A plea of nolo contendere (no contest). • Any other plea treated by the court as a guilty plea regardless of the jurisdiction in which the conviction was entered.

30. Criminal Offender Record Information The applicant may be required to complete a Criminal Offender Record Information (CORI) form, which is a criminal background check, based on the responses to the six (6) Good Moral Character questions on the licensure application. www.mass.gov/dph/boards/rn Click on “Licensing”, then “Good Moral Character Licensure”, then “Good Moral Character Information Sheet”

31. All Criminal Cases and Disciplinary Actions Must be Closed • The applicant provides documentation satisfactory to the Board that: • all court-ordered requirements and that all criminal matters involving the applicant have been closed; and • All requirements imposed by a licensure/certification body in connection with the disciplinary action involving the applicant have been met.

32. Truthfulness on the Application • It is extremely important to answer truthfully to all questions on the application for authorization and the CORI form. • Failure to be truthful will result in exclusion from practice for five (5) years.

33. Criminal Convictions • Conviction for certain crimes will result in mandatory permanent exclusion from becoming licensed as a nurse in Massachusetts. • In general, conduct underlying any violent crime against any person or persons that exhibits intentional or deliberate disregard of human life is considered grounds for exclusion from licensure. • In addition, conviction of a crime within the last 5 years (excluding those that result in permanent exclusion) may subject to mandatory temporary exclusion from licensure.

34. Nursing Board’s Website A complete list of specific crimes requiring mandatory permanent exclusion from licensure is available at the Board of Registration website http://www.mass.gov/dph/boards/rn Click on “Licensing”, then “Good Moral Character”

35. Right to Review • If denied license based on the Good Moral Character requirement, applicant has the right to review denial. • Required to provide documentation which can reasonably substantiate the existence of specific areas of factual dispute relevant to the issue.

36. Authorization Documentation • Once authorized, the Board emails written notification of authorization approval • The Board no longer prints wallet sized documents • Board authorization appears on the Board’s website under “Check a License” and is considered the most “up to date” information

37. Authorization Renewal Requirements • Due on birthday in the even numbered years • Current MA registered nurse licensure • Current certification from a nationally recognized accrediting body approved by the Board • Signature attesting to compliance with Board laws and regulations. • Payment of fees

38. 244 CMR 9.00 – Specific to APRN • Practice with competence only in authorized APRN category (CNP, CRNA, CNM, PCNS, CNS) • Must not practice without Board authorization • Authorized prescribers comply with all federal and state laws and regulations • Maintain current certification • Fully disclose risks/benefits of treatment with documentation • Provide access to information regarding charges and payment for services

39. Competence: A Legal Requirement for Advanced Registered Nursing Scope of Practice

40. Competence 244 CMR 9.02 defines Competence as: “The application of knowledge and the use of affective, cognitive, and psychomotor skills required for the role of a nurse licensed by the Board and for the delivery of safe nursing care in accordance with accepted standards of practice.”

41. APRN Competence • Includes only those areas of practice for which the APRN has formal, advanced nursing education and documented competency • Certification is one measure of competence • Competence can be attained through continuing education and by on-the-job training • Demonstrate initial and continued competency

42. Competence Involves Responsibility: Responsible to self, patient, employer, profession (for example, following policies and procedures) and Accountability: Accountable to the Board, employer, profession (i.e. adhering to the regulations)

43. Continued Competence The application of knowledge and the interpersonal, decision-making, and psychomotor skill expected for nurse’s practice role, within the context of public health, welfare and safety. Ref: National Council of State Boards of Nursing, 1996

44. Certification • In order to maintain APRN authorization and to engage in advanced practice nursing, an APRN must hold current professional advanced practice certification and must submit documentation satisfactory to the Board of current certification with each authorization renewal.

45. Certification • Must have completed requirements and attained initial and continued certification from Board approved, national, professional certifying organization • Certification in Board recognized category in regulations at 244 CMR 4.00

46. Board Requirement for Certification in Category of Practice • The Board recognizes five APRN categories: • CNP (Nurse Practitioner) • CNM (Nurse Midwife) • CRNA (Nurse Anesthetist) • PCNS (Psychiatric Clinical Nurse Specialist) • CNS (Clinical Nurse Specialist)

47. Board Approved Professional Certifying Organizations CNP • American Academy of Nurse Practitioners (AANP) www.aanpcertification.org • American Nurses Credentialing Center (ANCC) www.nursecredentialing.org • National Certification Council (NCC) www.nccwebsite.org • Pediatric Nursing Certification Board (PNCB) www.pncb.org • American Association of Critical-Care Nurses (AACN) Certification Corporation www.aacn.org

48. Professional Certifying Organizations PCNS American Nurses Credentialing Center (ANCC) www.nursecredentialing.org

49. Professional Certifying Organizations CRNA Council on Certification and Recertification of Nurse Anesthetists (CCRNA) www.aana.com

50. Professional Certifying Organizations CNM American Midwifery Certification Board (AMCB) www.amcbmidwife.org