Model Act and Rules Committee
Nathan Goldman, Chair
WHAT IS A MODEL ACT?
• According to the Michigan Law Revision
Commission and the Harvard Law School,
Model Acts are carefully drafted laws for
potential enactment by state legislatures in
whole or in part. Model Acts are experimental
efforts to assist states in developing effective
new approaches to a particular area of the
law.
Purpose of NCSBN’s Model Act and Rules
• Overall, the Model Act and Rules are intended
to serve as a guide for Member Boards.
• However, NCSBN encourages all boards to
adopt as much of the Model Act and Rules as
possible.
NCSBN MODEL NURSING PRACTICE ACT
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First adopted in 1982.
Revised in 1988, 1993, 1994, 1997, and 2004.
CBCs added in 2006.
APRN Consensus Model language added in
2008.
Model Act and Rules Committee
• Appointed in FY 2011
• Charge: Review and revise the NCSBN Model
Act & Rules as needed
Rose Kearney-Nunnelly, Chair (FY 2011)
Nathan Goldman, Chair (FY 2012)
Committee Members
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Betsy Houchen, RN, JD, Ohio, Board Liaison
Kathleen Beebout, RN, JD, Iowa
Dusty Johnston, JD, Texas
Fred Knight, JD, Arkansas
Sandra Priebe, RN, Arkansas
Pamela Randolph, RN, Arizona
Laura Rhodes, RN, West Virginia
Caron Robertson, RN, Massachusetts
Peg Sheaffer, RN, JD, Pennsylvania
Committee’s Goals for Revisions
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Streamline
Reduce redundancy
Clarify
Organize
Update/conform with other NCSBN initiatives
Move detail from Act to Rule
Use legislative language
Overview of Major Changes
• Reformatted the Act and Rule into two separate
documents
• Reordered and renumbered Articles and Chapters
• Revised language in all Articles and Chapters,
except Nurse Licensure Compact and APRN
Compact
• Removed all explanatory notes
• Replaced the term “client” with “patient”
New Organization
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Title and Purpose
Definitions
Scope of RN and LPN/VN Practice
Board of Nursing
RN and LPN/VN Licensure and Exemptions
Prelicensure Nursing Education
Discipline and Proceedings
Violations and Penalties
Implementation
Unlicensed Assistive Personnel
APRN
Nursing Licensure Compact
APRN Compact
Highlighted Changes
Title
• This Act shall be known and may be cited as
<the JURISDICTION> Nurse Practice Act (NPA),
which creates and empowers the board of
nursing (BON) to regulate nursing and to
enforce the provisions of this Act.
Purpose
• The purpose of this Act is to protect the
health, safety and welfare of the residents* of
this state.
• *The term “residents” was used instead of
“citizens” based upon comments received at
MYM
Definitions
• Deleted definitions that are commonly
understood
• Deleted definitions that are defined beyond
nursing law (ex. legal definitions)
• Deleted definitions for words not used in the
text of the Act or Rules
• Removed NLC definitions for inclusion in that
Article/Chapter
Revised/Maintained Act Definitions
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Advanced assessment
Clinical learning experiences
Competence
Comprehensive nursing assessment
Delegating
• Eligible for graduation*
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Encumbered
Focused nursing assessment
Inactive license
Internationally educated applicants
Act Definitions, cont.
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License
Nursing
Patient
Patient-centered health care plan
Reactivation
Reinstatement
Supervision
Unlicensed assistive personnel
Revised/Maintained Rule Definitions
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Dual relationship
NCLEX-PN®
NCLEX-RN®
Nursing faculty
Preceptor
Professional boundaries
Professional-boundary crossing
Professional-boundary violation
Sexualized body part
Board of Nursing
• Deleted requirement that BON members must be eligible
to vote
• Added authority to:
– Share current significant investigative information with other
regulatory bodies and law enforcement entities
– Withdraw a license issued in error
– Conduct criminal background checks for nurse licensure in
accordance with state and federal law
– Issue a cease and desist order for any violation of the Act and
– Adopt criteria for recognizing national certifying bodies for
APRN roles and population foci
Executive Officer
• Deleted specific requirements related to EOs:
– RN license
– Masters degree or higher
– Certain years experience
• Kept language that requires EO to be
“qualified”
• Added power to hire and fire
RN and LPN/VN Licensure and Exemptions
• Revised Model Act and Rules to conform with
the approved Uniform Licensure
Requirements (ULRs) that were passed at
Delegate Assembly in 2011.
• Removed all reference to a modified license
per ULRs.
Licensure by Examination
• Revised graduation language:
Graduate from or be eligible for graduation
from a <your jurisdiction> BON-approved
prelicensure program or a program that meets
criteria comparable to those established by
the <your jurisdiction> BON in its rules
Licensure by Examination
• Added the following requirements per the
ULRs:
– Report any substance use disorder in the last five
years
– Report any action taken or initiated against a
professional or occupational license, registration
or certification
– Graduates from an RN prelicensure program who
take the LPN/VN exam must complete a role
delineation course.
Internationally Educated Applicants
• Graduation from a nursing program comparable to a BON approved
prelicensure RN or LPN/VN program, whichever is applicable
• Applicant must submit to a credentials evaluation by a BON
approved/authorized organization for the level of licensure being
sought
• Successful passage of an English proficiency exam that includes the
components of reading, speaking, writing and listening, except for
applicants from countries where English is the native language, and
the nursing program where the applicant attended was taught in
English, used English textbooks and clinical experiences were
conducted in English, and
• Disclosure of nursing licensure status in country of origin, if
applicable
Licensure by Endorsement
• Graduate from a <your jurisdiction> BONapproved prelicensure program or a program that
meets criteria comparable to those established
by the <your jurisdiction> BON in its rules
• Report current participation in an alternative to
discipline program in any jurisdiction
• Submit verification of licensure status directly
from the U.S. jurisdiction of licensure by
examination
Renewal and Reactivation
• Applicant must report:
– Criminal conviction, nolo contendere plea, Alford plea,
deferred judgment, or other plea arrangements in lieu
of conviction
– Status of all nursing licenses, including any BON
actions taken or any current or pending investigations
– Substance use disorder in the last five years
– Actions taken or initiated against a professional or
occupational license, registration or certification and
– Current participation in an alternative to discipline
program
Continued Competence
• Deleted specific practice hour requirements
and inserted the following note as a
placeholder:
***At the present time, evidence does not
support any one mechanism for continued
competence and further study is warranted.
Criminal Background Checks
• Act: Each applicant for licensure shall submit a full
set of fingerprints to the BON for the purpose of
obtaining a state and federal criminal records check
pursuant to <state statute> and Public Law 92-544.
The <state agency responsible for managing
fingerprint data> may exchange this fingerprint data
with the Federal Bureau of Investigation (FBI).
Criminal Background Checks
• Rule: All individuals convicted of a sexual offense
involving a minor or performing a sexual act against
the will of another person shall be subject to a BON
order for evaluation by a qualified expert approved
by the BON. If the evaluation identifies sexual
behaviors of a predatory nature the BON shall deny
licensure.
• Other criminal convictions may be reviewed by the
BON on a case by case basis to determine eligibility
for licensure
Discipline and Proceedings
• Expanded authority of the BON
• Modified grounds for discipline
• Added additional immunity/protection from
retaliation
• Revised portions of the Alternative to
Discipline Program requirements and criteria
Expanded Authority of BON
• Summarily issue emergency limitation or
restriction of a license
• Summarily issue an emergency suspension of a
license
• Reprimand or censure a license
• Accept a voluntary surrender of a license
• Accept other voluntary limitation or restriction of
a license
• Place other limitations or restrictions on a license
Grounds for Discipline
• Added:
– Non-Compliance with federal, jurisdictional or contractual
requirements
– Confidentiality, patient privacy, consent or disclosure
violations
– Misconduct or abuse
– Other violations of the Act or administrative rules
• Deleted requirement that the criminal conviction or
adjudication relate to the practice of nursing or to
the ability to practice nursing.
Immunity/Retaliation
• A person may not suspend, terminate, or
otherwise discipline, discriminate against, or
retaliate against anyone who reports, or
advises on reporting, in good faith under this
section.
• Cause of action for good faith reporter against
retaliator
Alternative to Discipline Monitoring
Programs
• Added detail to the functions and responsibilities of
programs
• Modified the eligibility criteria to add specificity
• Added screening and assessment requirements
• Expanded contracts section
• Added notification, monitoring and practice
requirements and limitations as well as standards for
returning to work
Unlicensed Assistive Personnel
• Deleted all reference to the CNA II role
• Added specificity to the roles, duties and requirements
of CNAs and MACs
• Expanded basic curriculum and training requirements
• Added section to the Rules for CNA and MAC discipline
• Limited what MACs can do to medication
administration and related tasks only
• Removed all references to long-term care facilities
APRNs
• Additional Practice language added:
– Delegating and assigning therapeutic measures to assistive
personnel
– Consulting with other disciplines and providing referrals to health
care agencies, health care providers and community resources
– Wearing identification which clearly identifies the nurse as an
APRN when providing direct patient care, unless wearing
identification creates a safety or health risk for either the nurse or
the patient and
– Other acts that require education and training consistent with
professional standards and commensurate with the APRN’s
education, certification, demonstrated competencies and
experience
APRN Prescribing
• Added the following terms to what an APRN is
authorized to prescribe, furnish, order,
administer and dispense:
– durable medical equipment
– blood and blood products
APRN Licensure
• Deleted the contact hours limitation related to
herbal and complementary therapies from the
endorsement and renewal rules
Questions?