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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsMay 2014

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24 DE Admin. Code 1900
The Delaware Board of Nursing pursuant to 24 Del.C. §1904(c), proposed to revise Regulations 2.4.1.7.4, 7.2.3, and 8.0 et seq. The proposed change to Regulation 2.4.1.7.4 clarifies that LPN practice does not equate to RN practice for purposes of nursing educational programs, and the proposed change at 7.2.3 clarifies that the practice of nursing occurs at the location of the patient regardless of the location of the nurse. The proposed changes to Regulation 8.0 et seq. create four types of APN licenses with specific population foci, update the national certification bodies recognized by the Board, and update the entire regulation regarding advance practice nursing licensure requirements.
Following publication of the proposed amendments to Section 9.0 in the Delaware Register of Regulations on November 1, 2013 a public hearing was held on January 8, 2014. Written comment periods were held open for thirty days, and an additional fifteen days following the public hearing. At the hearing, the Board accepted as evidence documentation of publication of the notice of the public hearing in the News Journal and the Delaware State News (Board Exhibit 1). At the hearing, the Board Liaison confirmed on the record that no written public comment was received during the initial 30 day public comment period. No public comment was received by the Board during the public hearing and no public comment was received during the additional fifteen day comment period.
Following publication of the proposed amendments to Sections 2.0, 7.0 and 8.0 in the Delaware Register of Regulations on January 1, 2014 a public hearing was held on February 12, 2014. Written comment periods were held open for thirty days, and an additional fifteen days following the public hearing. At the hearing, the Board accepted as evidence and marked as the Board's Exhibit 1 documentation of publication of the notice of the public hearing in the News Journal and the Delaware State News. During the written public comment period, a comment was received from Jana Conover, Assistant Director of State Government Affairs. Ms. Conover's comment was marked as Board's Exhibit 2. Ms. Conover had a question regarding the proposed changes to 8.11.2 and whether applicants for licensure by endorsement will be granted licensure if they can demonstrate either a master's degree or a postbasic program certificate or whether applicants will be limited to a graduate or post-graduate degree. In addition, Ms. Conover questioned the requirement for completion of three separate courses in "advanced physiology and pathophysiology, advanced health assessment, advanced pharmacokinetics and pharmacotherapeutics" as this was not made part of the APRN consensus model until 2008. Prior to that time, many CRNAs would have completed coursework that included this subject content, but this would not necessarily have occurred in three separate courses with these titles. While Ms. Conover has no issue with including these requirements in Regulation 8.9 "Application for Initial Licensure to Practice as an Advanced Practice Nurse," for new applicants for initial licensure. She believes these proposed endorsement requirements seem to be problematic, however, for CRNAs who graduated prior to 1999 (for the graduate degree requirement) and those who graduated prior to the consensus model (for the three separate course requirement). No public comment was received by the Board during either public hearing.
Board” the Delaware Board of Nursing
Conditional Approval” the status granted to a program that is determined to be deficient in a specified area or areas. When this determination is made by the Board, written notice shall be sent to the program specifying the deficient areas, and the time limit within which the deficiencies are to be corrected. May apply to any program either holding “full” or “initial” approval and may also apply to Delaware Board-approved RN or LPN Refresher Programs.
Full Approval” the status granted to a program that meets the requirements of the Law and the Rules and Regulations of the Board. Continuation of full approval is contingent upon annual review of the program and continuing to meet the criteria.
Initial Approval” authorization to admit students and enter into contractual agreements for clinical facilities. It is granted only after an application has been submitted, reviewed and a survey visit made by the Board. No students shall be admitted to the program until the institution has received written notification that initial approval has been granted. Failure to comply will delay initial approval.
National Accrediting Agency for Nursing Education” a national accrediting agency for nursing education that is recognized by the Council on Postsecondary Accreditation and by the U.S. Department of Education.
Nursing Education Program” as defined in 24 Del.C. Ch. 19.
Preceptor” a nurse, who holds a BSN or higher degree, and a valid license to practice. Clinical preceptors shall have demonstrated competencies in the area of practice to which the student is assigned. Clinical preceptors may be used to accomplish faculty directed clinical learning experiences.
2.2 Authority Designated to the Board of Nursing
In accordance with 24 Del.C. Ch. 19, the Board may:
2.2.3 Approve such program to meet the requirements of the Chapter and of the Board; and
2.2.4 Deny or withdraw approval for nursing education programs for failure to meet prescribed curriculum or other standards. (Subsections 1906 (b), (c), (e)).
2.3.2 Provide for the criteria for the development, evaluation and improvement of new and established nursing education programs.
2.3.3 Assure candidates are educationally prepared for licensure and recognition at the appropriate level.
All nursing education programs shall meet these standards:
The purpose and outcomes of the nursing programs shall be consistent with the Nurse Practice Act and Board promulgated administrative rules, regulations and other relevant state statutes.
The purpose and outcomes of the nursing program shall be consistent with generally accepted standards of nursing practice appropriate for graduates of the type of nursing program offered.
The curriculum shall provide diverse didactic and clinical learning experiences consistent with program outcomes.
Professionally, academically and clinically qualified nurse faculty shall be sufficient in number and expertise to accomplish program outcomes and quality improvement. (Section 2.4.1.6 – Faculty Qualifications)
Program information communicated by the nursing program shall be accurate, complete, consistent and readily available.
2.4.1 Required Criteria for Nursing Education Programs – The organization and administration of the nursing education shall be consistent with the law governing the practice of nursing. The nursing education program shall be an integral part of a governing institution with appropriate accreditation. The following minimum criteria serve to support the implementation of the Nursing Education Standards:
2.4.1.1.1 By December 1 of each year, a copy of an annual report of the nursing education program shall be sent to the Board, using the format supplied by the Board. The report will include information from the previous academic year and is required of new programs as well. This is a comprehensive education program self-evaluation and shall include but not be limited to:
2.4.1.2.1 A nursing education program shall maintain a system of records which shall contain all data relating to approval by any agency or body. The data shall include, but not be limited to, course outlines, minutes of faculty and committee meetings, pertinent correspondence, reports of standardized tests and survey reports. Such data shall be available to the Board representatives during the course of a survey or site visit subject to applicable provisions of state and federal law.
2.4.1.3 Student Records
2.4.1.3.1 The school shall maintain a record for each student subject to applicable provisions of law, such records shall be available to Board representatives during the course any survey or site visit.
2.4.1.7.1 The curriculum of the nursing education program shall enable the student to develop the nursing knowledge, skills and competencies necessary for the level, scope and standards of nursing practice consistent with the level of licensure.
2.4.1.7.3 Clinical experiences shall include preventive aspects of illness, nursing care of persons with acute and chronic illnesses and rehabilitative care. Opportunities shall be provided for the student to participate in patient teaching in a variety of settings with individuals, families and groups.
2.4.1.7.4 A minimum of 200 hours of clinical experience is required for LPN students and a minimum of 400 hours of clinical experience is required for RN students. Simulation – high fidelity and/or standardized patient – clinical experiences may be used for a portion of the clinical experience requirements. LPN clinical does not equate to RN clinical and may not be substituted or included for RN clinical in an educational program nor as RN clinical practice to meet the practice hour requirement for relicensure.
2.4.1.7.5.1 Content regarding legal and ethical issues, history and trends in nursing and health care, and professional responsibilities.
2.4.1.8.1 Evaluation as a basis for curriculum revision and change in practices is a continuous process and an inherent responsibility of the faculty. The degree to which the faculty accomplishes its objectives shall be determined through evaluation of curriculum content, teaching methodologies, clinical and other learning experiences, student progress, success of graduates on the licensing examination, promotion, retention and degree of nursing competence of the graduate.
2.4.1.9.3.1 Learning resources must be recent, pertinent and sufficient to meet the learning needs of students and faculty.
2.4.1.9.3.1.1 Provisions shall be made for regular additions to and deletions from the resource collection.
2.4.1.9.3.1.2 Learning facilities and policies shall be conducive to effective use.
2.4.1.9.4.1.1.3 Other community based opportunities such as home health, hospices, health maintenance organizations, day care centers, schools/school systems, senior centers and correctional facilities.
2.4.1.9.4.1.3 Hospital facilities shall be accredited by the Joint Commission or the American Osteopathic Association. Other facilities such as specialized hospitals, long term and extended care facilities and community health agencies shall be licensed or accredited by the appropriate approving authority.
2.4.1.9.4.1.4 Facilities used for clinical experience shall be approved by the Board prior to the assignment of students. Approval shall be based on information provided by the school on forms furnished by the Board. A visit by Board representatives to the clinical site may be scheduled.
2.4.1.9.4.1.5 Use of clinical facilities in another state or jurisdiction requires written notification to that jurisdiction’s Board of Nursing. Likewise, out of state schools requesting use of clinical facilities in Delaware will notify the Board prior to utilization.
2.4.1.9.4.1.6.1 Ensure that the faculty is ultimately responsible for the students’ learning experiences.
2.4.2 Purpose of New Nursing Education Program Approval. The State requires that new nursing education programs be approved in order to: promote the safe practice of nursing by implementing standards for individuals seeking licensure as registered nurses and licensed practical nurses; grant legal recognition to nursing education programs that the board determines have met the standards; assure graduates that they meet the education and legal requirements for the level of licensure for which they are preparing and to facilitate their endorsement to other states and countries; assure continuous evaluation and improvement of nursing education programs; provide the public and prospective students with a list of nursing programs that meets the standards established by the Board.
2.5 Procedure for Establishing (New) Nursing Education Programs
2.5.2.1 The institution shall notify the Board of the appointment of a qualified nurse as director of the program at least five (5) months in advance of the anticipated enrollment of students in nursing courses.
2.5.2.8 The Board shall review the application and supporting information at the regularly scheduled meeting and determine if the program is prepared to admit students. If it is so determined, initial approval will be granted.
2.5.4.3.3 Such nursing education program may request, upon written application, a hearing on the Board’s proposal to withdraw.
2.5.5.1 Each nursing education program shall be accredited by a Board-approved national accrediting agency for nursing education and must submit a copy of the self-study document and the letter of notification of accreditation status following the accreditation/re-accreditation visit. This is contingent on the program remaining accredited and sharing copies of all correspondence related to compliance with the national accrediting agency’s recommendations. Extraneous material will be disseminated to Board Members at the discretion of the Executive Director in consultation with the Board President.
2.5.5.3 Interim (site) visits may be made at any time either by request or as deemed necessary by the Board, with advance notice. At least one of the visitors shall be a nurse educator who has curriculum expertise at the level of the program being reviewed.
2.5.6.1 The Practice and Education Committee of the Board shall review the annual and self-evaluation reports of the programs. They will compile a summary with recommendations to report to the Board of Nursing.
2.5.6.2 Following review of the reports from the programs, written notification of the action taken at the regularly scheduled board meeting, including any recommendations, shall be sent to the appropriate administrative officers of the school. This will include notification of either continuing full approval or conditional approval (probation). This could include notification of the Board’s intention to conduct a site visit.
2.5.7.1 For any site visit, the Board President shall designate the Board members who are to make the site visits and the chair person of the site visit team. At least one member of each team shall be a nurse educator who has curriculum expertise at the level of the program being reviewed.
2.5.7.2 The site visit may be made by a Board member(s) and an optional nursing education consultant, the latter with special expertise at the same level of nursing education as the program. The consultant shall be selected from a list of qualified persons submitted by the nursing program and approved by the Board. Costs associated with the hiring of the consultant shall be borne by the program.
2.5.10.1.5 Notify the Board in writing as to the location of records and where requests for records may be sent.
3.2.5 Each course shall include sufficient theory and supervised clinical practice to meet the course objectives.
3.6.3.3 The course director, faculty and preceptor(s) must submit their curriculum vitae to the Board and meet all requirements as identified in Section 2.0.
3.6.6 The entity offering the course shall submit a copy of an Annual Report every year prior to December 1 using a format supplied by the board.
“Assistance with medications” means a situation where a designated care provider functioning in a setting authorized by 24 Del.C. §1921 of this Chapter, who has taken a Board approved medication training program, or a designated care provider who is otherwise exempt from the requirement of having to take the Board approved self administration of medication training program, assists the patient in self-administration of medication other than by injection, provided that the medication is in the original container with a proper label and directions. The designated care provider may hold the container for the patient, assist with the opening of the container, and assist the patient in taking the medication.
6.3.1 Notification occurs for the successful candidate in the following order: the candidate and director of the school program, and for the unsuccessful candidate: the candidate, employer and the director of the school program.
6.4.1.5 Must submit evidence that the program from which applicant is a graduate meets the approved standards adopted by the Board (24 Del.C. §§1910, 1914) and Rules and Regulations: 2.4. (If the program does not include the areas specified in the above curricula, the deficiencies must be made up before the applicant is eligible to take NCLEX);
6.4.2 RN applicants who meet the requirements listed in 6.4.1 are eligible to take NCLEX-RN. LPN applicants who meet the requirements listed in 6.4.1 are eligible to take the NLCEX-PN. Applicants will be issued a license upon successful completion of the respective NCLEX.
6.6.1.1 In order to practice nursing in Delaware with or without financial compensation, Registered Nurses or Licensed Practical Nurses who are duly licensed under any provision of 24 Del.C. Ch. 19 shall renew their licenses biennially, on dates established by the Division of Professional Regulation. In the event that applicant for renewal or reinstatement of licensure has not been actively employed/practicing in professional or practical nursing in the past five years, the applicant will be required to give evidence of satisfactory completion of a board-approved professional or practical nursing refresher program within a two-year period prior to the application for renewal before licensure will be granted, In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge in professional or practical nursing.
6.6.1.5 Renewal application, along with the required non-refundable fee, shall be completed online by midnight of the last day of the month before the month of expiration, or a penalty fee will be assessed.
7.1 Definitions
Standards of Nursing Practice” are those standards adopted by the Board that interpret the legal definitions of nursing, as well as provide criteria against which violations of the law can be determined. Such standards shall not be assumed the only evidence in civil malpractice litigation, nor shall they be given a different weight than any other evidence
Nursing Process includes assessment, diagnosis, outcome identification, planning, implementation and evaluation.
7.3 Standards of Practice, Competencies and Responsibilities for the Registered and Licensed Practical Nurse
7.4 Standards related to the Registered Nurse.
7.4.1 The Registered Nurse shall conduct and document nursing assessments in accordance with the nursing process. The registered nurse shall assess the health status of individuals and groups by:
7.4.1.1 Collecting objective and subjective data from observations, examinations, interviews, in person or by electronic communication and written records in an accurate and timely manner. The data include but are not limited to:
7.4.1.1.1 Biophysical and emotional status and observed changes;
7.4.1.1.2 Growth and development;
7.4.1.1.3 Ethno-cultural, spiritual, socio-economic and ecological background;
7.4.1.1.4 Family health history;
7.4.1.1.5 Information collected by other health team members;
7.4.1.1.6 Ability to perform activities of daily living;
7.4.1.1.7 Consideration of client’s health goals;
7.4.1.1.8 Client knowledge and perception about health status and potential, or maintaining health status;
7.4.1.1.9 Available and accessible human and material resources;
7.4.1.1.10 Patterns of coping and interaction.
7.4.1.2 Sorting, selecting, reporting, and recording the data.
7.4.1.3 Analyzing data.
7.4.1.4 Validating, refining and modifying the data by using available resources including interactions with the client, family, significant others, and health team members.
7.4.1.5 Evaluating data.
7.4.2 Registered Nurses shall establish and document nursing diagnoses that serve as the basis for the strategy of care.
7.4.3 Registered Nurses shall develop strategies of care based on the nursing process. This includes, but is not limited to:
7.4.3.1 Prescribing nursing intervention(s).
7.4.3.2 Initiating nursing interventions through giving, assisting and/or delegating care.
7.4.3.3 Identifying priorities in the plan of care.
7.4.3.4 Setting realistic and measurable goals for implementation.
7.4.3.5 Identifying measures to maintain comfort, to support human functions and responses, to maintain an environment conducive to well being, and to provide health teaching and counseling.
7.4.4 Registered Nurses shall participate in the implementation of the strategy of care by:
7.4.4.1 Providing care for clients whose conditions are stabilized or predictable.
7.4.4.2 Providing care for clients whose conditions are critical and/or fluctuating, under the direction and supervision of a recognized licensed authority.
7.4.4.3 Providing an environment conducive to safety and health.
7.4.4.4 Documenting nursing interventions and client outcomes.
7.4.4.5 Communicating nursing interventions and client outcomes to appropriate health team members.
7.4.5 Registered Nurses shall evaluate outcomes, which may include the client, family, significant others and health team members.
7.4.5.1 Evaluation data shall be documented and communicated appropriately;
7.4.5.2 Evaluation data shall be used as a basis for modifying health care strategies including but not limited to reassessing client health status, modifying nursing diagnoses, or prescribing changes in nursing interventions.
Accountability - The state of being accountable, answerable, or legally liable for actions and decisions, including supervision.
Delegation - Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act.
Supervision - The guidance by a registered nurse (RN) for the accomplishment of a function or activity. The guidance consists of the activities included in monitoring as well as establishing the initial direction, delegating, setting expectations, directing activities and courses of action, critical watching, overseeing, evaluating, and changing a course of action.
Unlicensed Assistive Personnel - Individuals not licensed to perform nursing tasks that are employed to assist in the delivery of client care. The term “unlicensed assistive personnel” does not include members of the client’s immediate family, guardians, or friends; these individuals may perform incidental care of the sick in private homes without specific authority from a licensed nurse (as established in 24 Del.C. §1921(a)(4) of the Nurse Practice Act).
7.5 Standards of Practice for the Licensed Practical Nurse
7.5.1 Standards related to the Licensed Practical Nurse’s contributions to the nursing process.
7.5.1.1 At the direction and under the supervision of a recognized licensed authority, the Licensed Practical Nurse shall contribute to the nursing process and document nursing assessments of individuals and groups by:
7.5.1.1.1 Collecting objective and subjective data from observations, examinations, interview and written records in an accurate and timely manner. The data include but are not limited to:
7.5.1.1.1.1 Biophysical and emotional status and observed changes;
7.5.1.1.1.2 Growth and development;
7.5.1.1.1.3 Ethno-cultural, spiritual, socio-economic, and ecological background;
7.5.1.1.1.4 Family health history;
7.5.1.1.1.5 Information collected by other health team members;
7.5.1.1.1.6 Ability to perform activities of daily living;
7.5.1.1.1.7 Consideration of client’s health goals;
7.5.1.2 Licensed Practical Nurses shall participate in establishing and documenting nursing diagnoses that serve as the basis for the strategy of care.
7.5.1.3 Licensed Practical Nurses shall participate in developing strategies of care based on assessment and nursing diagnoses.
7.5.1.3.1 Contributing to setting realistic and measurable goals for implementation.
7.5.1.3.2 Participating in identifying measures to maintain comfort, to support human functions and responses to maintain an environment conducive to well-being, and to provide health teaching and counseling.
7.5.1.3.3 Contributing to setting client priorities.
7.5.1.4 Licensed Practical Nurses shall participate in the implementation of the strategy of care by:
7.5.1.4.1 Providing care for clients whose conditions are stabilized or predictable.
7.5.1.4.2 Providing care for clients whose conditions are critical and/or fluctuating, under the directions and supervision of a recognized licensed authority.
7.5.1.4.3 Providing an environment conducive to safety and health.
7.5.1.4.4 Documenting nursing interventions and outcomes.
7.5.1.4.5 Communicating nursing interventions and outcomes to appropriate health team members.
7.5.1.5 Licensed Practical Nurses shall contribute to evaluating outcomes through appropriate documentation and communication.
7.6.1.1Dispensing means providing medication according to an order of a practitioner duly licensed to prescribe medication. The term shall include both the repackaging and labeling of medication from bulk to individual doses.
7.6.1.2Prescription Label - a label affixed to every prescription or drug order which contains the following information at a minimum.
7.6.1.3 “Standing order” - An order written by the practitioner which authorizes a designated registered nurse or nurses to dispense prescription drugs to his/her patients(s) according to the standards listed below.
7.7 Intravascular Therapy by Licensed Nurses. Intravascular therapy encompasses several components, some of which require primarily skill proficiency with a minimum of critical judgment. Other aspects of intravascular therapy require skill proficiency and more importantly a high degree of knowledge, critical judgement and decision making to perform the function safely.
7.7.1 Definition of Terms.
7.7.1.1 Intravascular therapy (IV) - is the broad term including the administration of fluids and medications, blood and blood derivatives into an individual's vascular system.
7.7.1.2 Intravascular therapy maintenance - Monitoring of the therapy for changes in patient's condition, appropriate flow rate, equipment function, the hanging of additional fluid containers and the implementation of site care.
7.7.1.3 Intravenous and intra-arterial medications - are drugs administered into an individual's vascular system by any one of the following methods:
7.7.1.3.1 By way of infusion diluted in solution or suspended in fluid and administered over a specified time at a specified rate.
7.7.1.3.2 Through an established intra-vascular needle or catheter (referred to as "IV push").
7.7.1.3.3 By venipuncture carried out for the sole purpose of administering the medication. This method is referred to as direct medication injection (direct IV push).
7.7.1.4 Intravenous fluids - include solutions, vitamins, nutrient preparations, and commercial blood fractions designed to be administered into an individual's vascular system. Whole blood and blood components, which are administered in the same manner, are considered intravenous fluids in this definition.
7.7.1.5 Subcutaneous Infusion- Continuous infusion or intermittent injection of medication into the layer of fatty tissue between the skin and muscle using a subcutaneous needle.
7.7.1.6 Supervision - a registered nurse, licensed physician or dentist is physically present in the unit where the patient is being provided care, or within immediate electronic/telephone contact.
7.7.1.7 Termination of intravascular therapy - Cessation of the therapy either by withdrawing a needle or catheter from an individual’s vascular system or by discontinuing the infusion and maintaining the device as a reservoir.
7.7.1.8 Vascular access - Utilization of an established device or the introduction of a needle or catheter into an individual’s vascular system.
7.7.1.9 Vascular system - is composed of all peripheral and central veins and arteries.
7.7.1.10 Venipuncture - Introduction of a needle or catheter into an individual's peripheral vein for the purpose(s) of withdrawing blood or establishing an infusion or administering medications.
7.7.2 Conditions Of Performing Intravascular Therapy Procedures By Licensed Nurses
7.7.2.1 Intravascular therapy must be authorized by a written order from a state licensed and authorized prescriber.
7.7.2.2 The performance of any procedures of intravascular therapy by a licensed practical nurse will be done under the supervision of a registered nurse, APN, or person licensed to practice medicine, surgery, or podiatry.
7.7.2.3 Admixed intravascular solutions documented and instituted by one licensed nurse and subsequently interrupted may be re-instituted by another licensed nurse after confirmation with the state licensed and authorized prescriber's order.
7.7.2.4 Admixed intravascular solutions documented and prepared by one licensed nurse may be initiated or continued by another licensed nurse after confirmation with the state licensed and authorized prescriber's order.
7.7.2.5 Intradermal or topical anesthetics may be used by the RN or LPN when initiating vascular access therapy in various situations or settings, provided there is an authorized prescriber’s order and organizational policy/procedure to support use of these medications. All RNs and LPNs must have documented educational preparation according to the employing agency’s policies and procedures. Documented evidence must include both theoretical instruction including anatomy and physiology, pharmacology, nursing management and education of patients and demonstration of clinical proficiency in performance of the task.
7.7.3 Functional Scope of Responsibility for Intravascular Therapy Procedures
7.7.3.1 Registered Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following:
7.7.3.1.1 Assessment of the patient and the prescribed intravascular therapy before, during and after the therapy is carried out.
7.7.3.1.2 Acceptance and confirmation of intravascular therapy order(s).
7.7.3.1.3 Calculation of medication dosage and infusion rate for intravascular therapy administration.
7.7.3.1.4 Confirmation of medication dosage and infusion rate for intravascular therapy administration.
7.7.3.1.5 Addition of prescribed medications in intravascular solution, labeling and documenting appropriately.
7.7.3.1.6 Start initial solution or add replacement fluids to an existing infusion as prescribed.
7.7.3.1.7 Vascular access for establishing an infusion or administering medications.
7.7.3.1.8 Administration of medications by "IV push".
7.7.3.1.9 Intravascular therapy maintenance.
7.7.3.1.10 Termination of intravascular therapy, including the removal of subclavian and PICC lines.
7.7.3.1.11 Access the vascular system for the purpose of the withdrawal of blood and to monitor the patient's condition before, during, and after the withdrawal of blood.
7.7.3.2 Licensed Practical Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following for peripheral lines:
7.7.3.2.1 Acceptance and confirmation of intravascular therapy order(s).
7.7.3.2.2 Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration.
7.7.3.2.3 Confirmation of medication dosage and infusion rate for intravascular therapy administration.
7.7.3.2.4 Addition of medications in intravascular solutions, label and document appropriately.
7.7.3.2.5 Venipuncture with needle device to establish access to the peripheral vascular system.
7.7.3.2.6 Start initial solution or add replacement fluids to an existing infusion as prescribed.
7.7.3.2.7 Intravascular therapy maintenance including the flushing of peripheral lines with Heparin and/or saline solution.
7.7.3.2.8 Termination of peripheral intravascular therapy.
7.7.3.2.9 Performance of venipuncture for the purpose of the withdrawal of blood and to monitor the patient's condition before, during and after the withdrawal of blood.
7.7.3.3 The Licensed Practical Nurse is permitted to perform the following procedures for central lines:
7.7.3.3.1 Acceptance of intravascular therapy order(s).
7.7.3.3.2 Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration.
7.7.3.3.3 Confirmation of medication dosage and infusion rate for intravascular therapy administration.
7.7.3.3.4 Addition of medications in intravascular solutions, label and document appropriately.
7.7.3.3.5 Intravascular therapy maintenance, including the flushing of central lines with Heparin and/or saline solution.
7.7.3.3.6 Dressing and tubing changes, including PICC lines.
7.7.3.3.7 Addition of replacement fluids to an existing infusion as prescribed.
7.7.4 Special Infusion Therapy Procedures by Registered Nurses
7.7.4.1 Chemotherapy - Only intravascular routes are addressed in these rules. Review of the Oncology Nursing Society’s current guidelines is recommended before the administration of anti-neoplastic agents.
7.7.4.1.1 Definition of Terms
7.7.4.1.1.1 Cancer Chemotherapy - is the broad term including the administration of anti-neoplastic agents into an individual's vascular system.
7.7.4.1.1.2 Anti-neoplastic agents - are those drugs which are administered with the intent to control neoplastic cell growth.
7.7.4.1.2 The Registered Nurse who administers cancer chemotherapy by the intravascular route must have documented educational preparation according to the employing agency's policies and procedures.
7.7.4.1.3 The Registered Nurse must have documented evidence of knowledge and skill in the following:
7.7.4.1.3.1 Pharmacology of anti-neoplastic agents
7.7.4.1.3.2 Principles of drug handling and preparation
7.7.4.1.3.3 Principles of administration
7.7.4.1.3.4 Vascular access
7.7.4.1.3.5 Side effects of chemotherapy on the nurse, patient, and family
7.7.4.2 Central Venous Access Via Peripheral Veins
7.7.4.2.1 Definition of Terms
7.7.4.2.1.1 Central venous access - is that entry into an individual's vascular system via the insertion of a catheter into a peripheral vein threaded through to the superior vena cava with placement confirmed by x-ray.
7.7.4.2.2 The Registered Nurse who performs central venous access via peripheral veins must have documented educational preparation according to the employing agency's policies and procedures.
7.7.4.2.3 Documented evidence must include, but is not limited to, evidence of both theoretical instruction and clinical proficiency in performance of the task.
7.7.4.2.3.1 Theoretical instruction must include, but is not limited to, anatomy and physiology, pharmacology, nursing management, and education of patients as they relate to central venous access via peripheral veins.
7.7.4.2.3.2 A preceptor must supervise the learning experience and must document the Registered Nurse's competency in the performance of the procedure.
7.7.4.3 Pain Management via Epidural Catheter
7.7.4.3.1 It is within the scope of practice of a Registered Nurse to instill analgesics (opiates)/low dose anesthetics at analgesic levels into an existing catheter under the following conditions/exceptions:
7.7.4.3.1.1 The epidural catheter is in place.
7.7.4.3.1.2 The position of the epidural catheter was verified as correct by a physician at the time of insertion.
7.7.4.3.1.3 Bolus doses and/or continuous infusions, as pre-mixed by anesthesiologists, C.R.N.A.s, or pharmacists, of epidural analgesics/low does anesthetics at analgesic levels can be administered by the Registered Nurse only after the initial dose has been administered. Changes in medication and/or dosage of the same medication are not defined as the initial dose.
7.7.4.3.1.4 Only analgesics (opiates)/low dose anesthetics at analgesic levels will be administered via this route for acute and chronic pain management.
7.7.4.3.1.5 The Registered Nurse must complete a course that includes, but is not limited to, a) anatomy, physiology, pharmacology, nursing management, assessment, and education of patients as they relate to epidural administration of opiates/low dose anesthetics at analgesic levels; b) a credentialed preceptor must supervise the learning experience and must document the Registered Nurse's clinical competency in the performance of the procedure.
7.7.4.3.1.6 The Registered Nurse may not insert or remove epidural catheters.
7.8 Exclusions of Health Care Acts pursuant to 24 Del.C. §1921(a)(19)
7.8.1 Health care acts that shall not be delegated by a competent individual who does not reside in a medical facility or a facility regulated pursuant to Chapter 11 of Title 16 include the following:
7.8.1.1 original intravenous insertion
7.8.1.2 original suprapubic catheter insertion or removal
7.8.1.3 newly established gastrostomy or jejunostomy tube feeding
7.8.1.4 original nasogastric and gastrostomy tube insertion or removal
7.8.1.5 any jejunostomy tube insertion or removal
7.8.1.6 sterile invasive procedures not normally taught to patients and caregivers by licensed health care professionals
8.3.1 These rules and regulations govern the educational and experience requirements and standards of practice for the Advanced Practice Nurse. Prescribing medications and treatments independently is pursuant to the Rules and Regulations promulgated by the Joint Practice Committee as defined in 24 Del.C. §1906(20). The Advanced Practice Nurse is responsible and accountable for her or his practice. Nothing herein is deemed to limit the scope of practice or prohibit a Registered Nurse from engaging in those activities that constitute the practice of professional nursing and/or professional nursing in a specialty area.
“Advanced Practice Nurse” as defined in 24 Del.C. §1902(d)(1). Such a nurse will be given the title Advanced Practice Nurse by state licensure, and may use the title Advanced Practice Nurse within his/her specific specialty area.
Advanced Practice Nurse Role and Population Focus” Advanced practice roles include the C.R.N.A., C.N.M., C.N.S. and N.P. Population foci include: adult/gerontology, family/individual across the lifespan, neonatal, pediatric, psychiatric/mental health, or women’s health/gender related.
“Audit” The verification of existence of a collaborative agreement for a minimum of 10% of the total number of licenses issued during a specified time period.
“Board” The Delaware Board of Nursing
“Certified Nurse Midwife (C.N.M.)” A Registered Nurse who is a provider for normal maternity, newborn and well-woman gynecological care. The CNM designation is received after completing an accredited post-basic nursing program in midwifery at schools of medicine, nursing or public health, and passing a certification examination administered by the ACNM Certification Council, Inc. or other nationally recognized, Board of Nursing approved certifying organization.
“Certified Registered Nurse Anesthetist (C.R.N.A.)” A Registered Nurse who has graduated from a nurse anesthesia educational program accredited by the American Association of Nurse Anesthetists’ Council on Accreditation of Nurse Anesthesia Educational programs, and who is certified by the American Association of Nurse Anesthetists’ Council on Certification of Nurse Anesthetists or other nationally recognized, Board of Nursing approved certifying organization.
“Clinical Nurse Specialist (C.N.S.)” A Registered Nurse with advanced nursing educational preparation who functions in primary, secondary, and tertiary settings with individuals, families, groups, or communities. The CNS designation is received after graduation from a Master’s degree program in a clinical nurse specialty or post Master’s certificate, such as gerontology, maternal-child, pediatrics, psych/mental health, etc. The CNS must have national certification in the area of specialization at the advanced level if such a certification exists or as specified in 8.9.4.1 of these Rules and Regulations. The certifying agency must meet the established criteria approved by the Delaware Board of Nursing.
“Clinical Nursing Specialty” a delimited focus of advanced nursing practice. Specialty areas can be identified in terms of population, setting, disease/pathology, type of care or type of problem. Nursing administration does not qualify as a clinical nursing specialty.
“Collaborative Agreement” Written verification of health care facility approved clinical privileges; or health care facility approved job description; or a written document that outlines the process for consultation and referral between an Advanced Practice Nurse and a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system.
“Guidelines/ Protocols” Suggested pathways to be followed by an Advanced Practice Nurse for managing a particular medical problem. These guidelines/protocols may be developed collaboratively by an Advanced Practice Nurse and a licensed physician, dentist or a podiatrist, or licensed Delaware health care delivery system.
“National Certification” That credential earned by a nurse who has met requirements of a Board approved certifying agency.
American Association of Critical Care Nurses (AACN) Certification Corporation
American Academy Association of Nurse Practitioners Certification Board
American Midwifery Certification Board
American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists
American Association of Nurse Anesthetists Council on Recertification of Nurse Anesthetists
National Board of Certification and Recertification for Nurse Anesthetists
National Certification Board of Pediatric Nurse Practitioners and Nurses.
Pediatric Nursing Certification Board
ACNM Certification Council, Inc.
“Nurse Practitioner (N.P.)” A Registered Nurse with advanced nursing educational preparation who is a provider of primary healthcare in a variety of settings with a focus on a specific area of practice. The NP designation is received after graduation from a Master’s program or from an accredited post-basic NP certificate program of at least one academic year in length in a nurse practitioner specialty such as acute care, adult, family, geriatric, pediatric, or women’s health, etc. The NP must have national certification in the area of specialization at the advanced level by a certifying agency which meets the established criteria approved by the Delaware Board of Nursing.
“Scope of Specialized Practice” That area of practice in which an Advanced Practice Nurse has a Master’s degree or a post-basic program certificate in a clinical nursing specialty with national certification.
“Supervision” Direction given by a licensed physician or Advanced Practice Nurse to an Advanced Practice Nurse practicing pursuant to a temporary permit. The supervising physician or Advanced Practice Nurse must be periodically available at the site where care is provided, or available for immediate guidance.
8.5.1 Any person holding a certificate of state licensure as an Advanced Practice Nurse that is valid on July 8, 1994 July 31, 2014 shall be eligible for renewal of such licensure under the conditions and standards prescribed herein for renewal of licensure.
8.6 Standards for the Advanced Practice Nurse. APNs shall comply with the standards for RNs as well as the standards of the national professional nursing associations recognized by the Board of Nursing. Standards for a specific role and population focus supersede standards for RNs where conflict between the standards, if any, exists. APNs shall practice within standards established by the Board of Nursing and assure patient care is provided according to relevant patient care standards recognized by the Board of Nursing, including standards of national professional nursing associations.
8.7 Generic Functions of the Advanced Practice Nurse Wwithin the Specialized Scope of Practice include but are not limited to:
8.8.2.3 Has educational requirements which are consistent with the requirements of these rules the advanced practice nurse role and population focus.
8.8.2.4 Has an application process and credential review which includes documentation that the applicant’s education is in the advanced nursing practice category role and population focus being certified, and that the applicant’s clinical practice is in the certification category same role and population focus.
8.9 Application for Initial Licensure to Practice as an Advanced Practice Nurse
8.9.1 Application for licensure as a Registered Nurse shall be made on forms supplied by the Board. An applicant for initial licensure shall:
8.9.2 In addition, an aApplication for licensure to practice as an Advanced Practice Nurse shall be made submitted on forms supplied by the Board. along with the required non-refundable fee. A completed application provides the following information: Graduation from an APN graduate or post-graduate program accredited by a nursing accrediting body that is recognized by the U.S. Secretary of Education and/or the Council for Higher Education Accreditation (CHEA), or its successor organization; documentation shall verify date of graduation, credential conferred, number of clinical hours completed, completion of three separate graduate level courses in advanced physiology and pathophysiology, advanced health assessment, advanced pharmacokinetics and pharmacotherapeutics of all broad categories of agents, role and population focus of the education program, and evidence of meeting the standards of nursing education in this state.
8.9.2.13 The APN applicant shall be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system with whom a current collaborative agreement exists.
8.9.2.24 Notification of changes in the name of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system shall be forwarded to the Board office.
8.9.35 Each application shall be returned to the Board office together with appropriate documentation and non-refundable fees. In order to be licensed, all APN applicants must be currently licensed as an RN or hold a privilege to practice as an RN in this state and take and pass the appropriate national certification examination in the role and population focus congruent with educational preparation.
8.9.46 A Registered Nurse meeting the practice requirement as listed in 8.11 and all other requirements set forth in these Rules and Regulations may be issued a license as an Advanced Practice Nurse in the specific area of specialization role and population focus in which the nurse has been nationally certified at the advanced level and/or has earned a Master’s degree in a clinical nursing specialty thesame role and population.
8.9.67 The Board may refuse to issue, revoke, suspend or refuse to renew the license as an Advanced Practice Nurse or otherwise discipline an applicant or a practitioner who fails to meet the requirements for licensure as an Advanced Practice Nurse or as a registered nurse, or who commits any disciplinary offense under the Nurse Practice Act, 24 Del.C. Ch. 19, or the Rules and Regulations promulgated pursuant thereto. All decisions regarding independent practice and/or independent prescriptive authority are made by the Joint Practice Committee as provided in 24 Del.C. §1906(20) - (22).
8.10.1.54 Application(s) and fee(s) are on file in the Board office.
8.112 Maintenance of Licensure Status: Renewal; Reinstatement
8.112.1 To maintain licensure, the Advanced Practice Nurse must meet the requirements for recertification as established by the certifying agency.
8.112.2 The Advanced Practice Nurse must have practiced a minimum of 1500 hours in the past five years or no less than 600 hours in the past two years in the area of specialization role and population focus in which licensure has been granted.
8.112.2.1 Faculty members teaching in graduate level clinical courses may count a maximum of 500 didactic course contact hours in the past five years or 200 in the past two years and all hours of direct on-site clinical supervision of students to meet the practice requirement.
8.112.2.2 An Advanced Practice Nurse who does not meet the practice requirement may be issued a temporary permit to practice under the supervision of a person licensed to practice medicine, surgery, dentistry, or advanced practice nursing, as determined on an individual basis by the Board.
8.112.3 The Advanced Practice Nurse will be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system with whom a current collaborative agreement exists.
8.112.45 Advanced Practice Nurses who fail to renew their licenses by February 28, May 31, or September 30 of the renewal period shall be considered to have lapsed licenses but they may renew during the sixty day late period. After the late period ends, they must reinstate the license to practice. After February 28, May 31, or September 30 of the current licensing period, any requests for reinstatement of a lapsed license shall be presented to the Board for action.
8.112.56 To reinstate licensure status as an Advanced Practice Nurse, the requirements for recertification and 1500 hours of practice in the past five years or no less than 600 hours in the past two years in the specialty area role and population must be met or the process in 8.11.4 followed.
8.112.67 An application for reinstatement of licensure must be filed and the appropriate non-refundable fee paid.
8.123 Audit of Licensees
8.123.1 The Board may select licensees for audit two months prior to renewal in any biennium. The Board shall notify the licensees that they are to be audited for compliance of having a collaborative agreement.
8.123.1.1 Upon receipt of such notice, the licensee must submit a copy of a current collaborative agreement(s) within three weeks of receipt of the notice.
8.123.1.2 The Board shall notify the licensee of the results of the audit immediately following the Board meeting at which the audits are reviewed.
8.123.1.3 An unsatisfactory audit shall result in Board action.
8.123.1.4 Failure to notify the Board of a change in mailing address will not absolve the licensee from audit requirements.
8.123.2 The Board may select licensees for audit throughout the biennium.
8.20 Renewal of Prescriptive Authority
8.21.1 Pursuant to 24 Del.C. §1906(19)(c), the Joint Practice Committee is statutorily empowered, with the approval of the Board of Medical Practice Licensure and Discipline, to grant independent practice and/or prescriptive authority to nurses who qualify for such authority. The Joint Practice Committee is also empowered to restrict, suspend or revoke such authority also with the approval of the Board of Medical Practice Licensure and Discipline.
8.21.3.4 Use, distribution, administration or prescription of any drugs or medical devices other than for therapeutic, prophylactic, or diagnostic purposes;
8.21.3.7 The violation of the Nurse Practice Act or of an Order or Regulation of the Board of Nursing or the Board of Medical Practice Licensure and Discipline related to independent practice or prescriptive authority.
8.21.4 Complaints concerning the use or misuse of independent practice or prescriptive authority received by the Division of Professional Regulation or the Board of Nursing shall be investigated in accordance with the provisions of Title 29, Section 8807 governing investigations by the Division of Professional Regulation. As soon as convenience permits, the Board of Nursing shall assign an Investigating Board Member to assist with the investigation of the complaint. The Investigating Board Member shall, whenever practical, be a member of the Joint Practice Committee.
8.21.6 The hearing shall be conducted in accordance with the Administrative Procedures Act (29 Del.C. §101), and after the conclusion thereof, the Joint Practice Committee will promptly issue a written Decision and Order which shall be based upon the affirmative vote of a majority of the quorum hearing the case.
"Approved Method" means a planned educational experience, as described in 9.3.
"Approved Provider" means an entity that is one of the following:
An organization approved as a provider by a Board of Nursing of another U.S. jurisdiction or territory and which is a member of the National Council of State Boards of Nursing
"Audit" means
"Biennium" means the two year period of licensure beginning in an odd numbered year and ending in the next odd numbered year for the Registered Nurse and the two year period of licensure beginning in an even-numbered year and ending in the next even numbered year for the Licensed Practical Nurse.
"Contact Hour" means one contact hour equals a minimum of 60 minutes. One half contact hour equals a minimum of 30 minutes.
"Continuing Education" means those professional experiences designed to enrich the nurse's contribution to health care and for the purpose of protecting the public health, safety, and welfare.
"Orientation" means the means by which nurses are introduced to the philosophy, goals, policies, procedures, role expectations, physical facilities and special services in a specific work setting. Orientation programs do not meet the continuing education requirements of these rules.
9.2.1.1 The Board derives its authority under 24 Del.C. §1906(19), to create continuing education requirements as a prerequisite to obtaining a current license and to establish an audit system to assure compliance. This requirement is in addition to the practice requirement as stated in 6.6.
9.4.1.1 The Board derives its authority under 24 Del.C. Ch. 19, to create requirements for becoming an approved provider and maintaining that status. The Board also has the authority to develop an auditing mechanism to verify compliance with criteria for approved providers.
10.2.1 Any individual shall submit a written complaint of alleged violations of 24 Del.C. Ch. 19 to the Division of Professional Regulation. The Executive Director will retain a copy of the complaint.
10.2.3 Hearings on licensing matters and complaints filed with the Board that allege an applicant or a licensee has violated the Nurse Practice Act, 24 Del.C. Ch. 19, shall be heard and determined by the Board in accordance with the applicable provisions of the Nurse Practice Act and the Administrative Procedures Act, 29 Del.C. Ch. 101. When the applicant or licensee, prosecuting Deputy Attorney General, and appointed Board member consent, the complaint may be resolved through the Consent Agreement process in lieu of a formal disciplinary hearing before the Board.
12.3.1.1 Members are selected 24 Del.C., § 1906(19)
24 Del.C., Ch. 19A, Articles 6D and 8C of the Nurse Licensure Compact grant authority to the Compact Administrators to develop uniform rules to facilitate and coordinate implementation of the Compact.
14.1.1.1 “Board” means party state’s regulatory body responsible for issuing nurse licenses.
14.1.1.2 “Information System” means the coordinated licensure information system.
14.1.1.3 “Primary State Of Residence” means the state of a person’s declared fixed permanent and principal home for legal purposes; domicile.
14.1.1.4 “Public” means any individual or entity other than designated staff or representatives of party state Boards or the National Council of State Boards of Nursing, Inc.
(Statutory basis:24 Del.C., Ch. 19A, Articles 2E, 4C, and 4D)
(Statutory basis:24 Del.C., Ch. 19A, Article 5[B])
An individual who had a license which was surrendered, revoked, suspended, or an application denied for cause in a prior state of primary residence, may be issued a single state license in a new primary state of residence until such time as the individual would be eligible for an unrestricted license by the prior state(s) of adverse action. Once eligible for licensure in the prior state(s), a multistate license may be issued.
14.4.3.1 disciplinary action, agreement or order requiring participation in alternative programs or which limit practice or require monitoring (except agreements and orders relating to participation in alternative programs required to remain nonpublic by contributing state authority),
“Conviction” means a verdict of guilty by whether entered by a judge or jury, or a plea of guilty or a plea of nolo contendere or other similar plea such as a “Robinson” or “Alford” plea unless the individual has been discharged under §4218 of Title 11 of the Delaware Code (probation before judgment) or under §1024 of Title 10 (domestic violence diversion program) or by §4764 of Title 16 (first offenders controlled substances diversion program).
“Jurisdiction” means substantially similar crimes in another state or jurisdiction includes all crimes prohibited by or punishable under Title 18 of the United States Code Annotated (U.S.C.A.) such as, but not limited to, Federal Health Care offenses.
15.2.42 §771 Rape in the third degree;
15.3.41 §903 A Re-encoder and scanning devices;
15.3.44 §907A Criminal impersonation, accident related;
15.6 Any crime which involves offenses against a public health order and decency which may tend to bring discredit upon the profession, specifically including the below listed crimes from Title 11 of the Delaware Code Annotated which evidence a lack of appropriate concern for the safety and well being of another person or persons in general or sufficiently flawed judgment to call into question the individuals ability to make health care decisions or advise upon health care related matters for other individuals.
15.8.52 §8715 felony fraud or distribution or attempted distribution of adulterated article.
15.8.75 §2410 Breaking and Entering, Etc. to Place or Remove Equipment (class F felony)
15.8.97 §3913 Violations [knowing or reckless abuse of an infirm adult] (class A misdemeanor, class G felony for exploitation of infirm adult’s resources valued at $500 to $5000, class E felony if resources are valued from $5000 to $10,000, class D felony if resources are valued over $10,000 or if abuse or neglect results in bodily harm, class A felony if abuse or neglect results in death)
15.10 The Board reserves the jurisdiction and authority to modify this regulation as and if it becomes necessary to either add or delete crimes including such additions as may be required on an emergency basis under 29 Del.C. §10119 to address imminent peril to the public health, safety or welfare. The Board also specifically reserves the jurisdiction to review any crime committed by an applicant for licensure with regard to the temporal proximity of the crime or the conviction to the application and to determine whether the period of time involved has been so long as to negate any reasonable conclusion or determination that the crime for which the individual was convicted has a direct bearing on the individual’s fitness or ability to perform one or more of the duties and responsibilities necessarily related to nursing or to otherwise determine that sufficient restitution has been made for the offense committed.
Last Updated: December 31 1969 19:00:00.
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