SB 170 – FINAL VERSION
SENATE BILL 170
This bill revises the law governing the occupational regulation of nurses by the board of nursing.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [
in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Five
AN ACT revising the nurse practice act.
Be it Enacted by the Senate and House of Representatives in General Court convened:
293:1 Nurse Practice Act. RSA 326-B is repealed and reenacted to read as follows:
NURSE PRACTICE ACT
326-B:1 Purpose. In order to safeguard the life, health, and public welfare of the people of New Hampshire and in order to protect the people of the state from the unauthorized, unqualified, and improper application of services by individuals in the practice of nursing, it is necessary that a regulatory authority be established and adequately funded. To further this policy, the practice of nursing shall be regulated through the New Hampshire board of nursing, and such board shall have the power to enforce the provisions of this chapter. Licensees under this chapter are accountable to clients, the nursing profession, and the board for complying with the requirements of this act and the quality of nursing care rendered, and for recognizing limits of knowledge and experience and planning for management of situations beyond the licensee’s experience.
326-B:2 Definitions. In this chapter:
I. “Advanced registered nurse practitioner” or “ARNP” means a registered nurse currently licensed by the board under RSA 326-B:18.
II. “Board” means the New Hampshire board of nursing established in RSA 326-B:3.
III. “Continuing competence” means integrated learning by which a licensee gains, maintains, or refines practice knowledge, skills, and abilities. This development may occur through a formal education program, continuing education, and clinical practice, and is expected to continue throughout the practitioners’ career.
IV. “Licensed nursing assistant” or “LNA” means an individual who holds a current license to provide client care under the direction of a registered nurse or licensed practical nurse.
V. “Licensed practical nurse” or “LPN” means an individual who holds a current license to practice practical nursing as defined in paragraph IX.
VI. “Medication nursing assistant” means a licensed nursing assistant holding a currently valid certificate authorizing the delegation to the nursing assistant of tasks of medication administration.
VII. “Nursing” means assisting clients or groups of clients to attain or maintain optimal health by implementing a strategy of care to accomplish defined goals and by evaluating responses to nursing care and medical treatment. Nursing includes basic health care that helps both clients and groups of clients cope with difficulties in daily living associated with their actual or potential health or illness status and also those nursing activities that require a substantial amount of scientific knowledge or technical skill.
VIII. “Nursing-related activities” means client care provided by a licensed nursing assistant directed by an ARNP, an RN, or an LPN.
IX. “Practical nursing” means the practice of nursing as defined in paragraph VII by a person who:
(a) Uses sound nursing judgment based on preparation, knowledge, skills, understanding, and past nursing experience.
(b) Works under the direction of a registered nurse, advanced registered nurse practitioner, dentist, or physician.
(c) Functions as a member of a health care team and contributes to the assessment, planning, implementation, and evaluation of client care.
X. “Registered nurse” or “RN” means an individual who holds a current license to practice registered nursing as defined in paragraph XI.
XI. “Registered nursing” means the application of nursing knowledge, judgment, and skill drawn from broad in-depth education in the biological, psychological, social, and physical sciences in assessing and diagnosing the health status of a client, and in planning, implementing, and evaluating client care which promotes the optimum health, wellness, and independence of the individual, the family, and the community.
326-B:3 Board of Nursing.
I. The board of nursing shall comprise 11 members to be appointed by the governor with the consent of the council. Any interested individual, association, or entity may make recommendation to the governor. The members of the board shall include 5 registered nurses, one of whom shall be an advanced registered nurse practitioner, 2 licensed practical nurses, 2 licensed nursing assistants, one of whom shall be a medication licensed nursing assistant if possible, and 2 representative members of the public. The terms of members shall be staggered as determined by the governor and council. All terms shall be for 3 years, and no member of the board shall be appointed to more than 3 consecutive terms.
II. Each RN member shall be a resident of this state, licensed in good standing under the provisions of this chapter, and currently engaged in the practice of nursing as an RN and shall have no fewer than 5 years of experience as an RN, at least 3 of which shall have immediately preceded appointment. RN members of the board shall represent the various areas of nursing practice including education, administration, and clinical practice.
III. The LPN members of the board shall be residents of this state, licensed in good standing under the provisions of this chapter, and currently engaged in the practice of nursing and shall have had no fewer than 5 years of experience as an LPN, at least 3 of which shall have immediately preceded the date of appointment.
IV. The LNA members of the board shall be residents of this state, licensed in good standing under the provisions of this chapter, and currently engaged in nursing-related activities. These members shall have a minimum of 5 years of experience as an LNA, at least 3 of which shall have immediately preceded the date of their appointment.
V. The public members shall be residents of the state of New Hampshire who are not, and never have been, members of the nursing profession or the spouse of any such person. The public members shall not have, and shall never have had, a material financial interest in either the provision of nursing services or an activity directly related to nursing, including the representation of the board or its predecessor or the profession for a fee at any time during the 5 years preceding the date of appointment.
VI. No more than one board member shall be associated with a particular agency, corporation, or other enterprise or subsidiary at one time.
VII. Each member of the board shall be compensated at the rate of $100 for attendance at a regular board meeting and $50 for each other day actually engaged in official duties of the board, and shall be reimbursed for actual and necessary expenses incurred in the discharge of official duties, including travel at the state employee mileage rate.
VIII. An appointee to a full term on the board shall be appointed by the governor with the consent of the council before the expiration of the term of the member being succeeded and shall become a member of the board on the first day following the appointment expiration date of the previous appointee. Appointees to unexpired portions of full terms shall become members of the board on the day following such appointment, and shall serve the unexpired term and then be eligible to serve 3 full 3-year terms.
IX. The governor may remove any member from the board for neglect of any duty under RSA 326-B:4 or for incompetence or unprofessional or dishonorable conduct. Any person may file a complaint against a board member with the department of health and human services. The provisions of RSA 4:1 controlling the removal of public officials from office shall be followed in dismissing board members.
X. All members of the board and its agents or employees shall enjoy immunity from individual civil liability while acting within the scope of their duties as board members, agents, or employees, as long as they are not acting in a wanton or reckless manner.
XI. Board meetings shall be open to the public. In accordance with RSA 91-A:3, the board may conduct part of a meeting in nonpublic session.
XII. The board shall be administratively attached, under RSA 21-G:10, to the department of health and human services.
326-B:4 Powers and Duties of the Board. The board may:
I. Establish reasonable and uniform standards for nursing practice consistent with the criteria identified by the National Council of State Boards of Nursing.
II. Provide consultation regarding nursing practice for institutions and agencies and investigate reports of illegal practice.
III. Examine, license, and renew the licenses of duly qualified individuals. The board shall select an appropriate nationally approved licensing examination.
IV. Gather and report to the public statistical information regarding, but not limited to, the education and licensure of registered and practical nurses.
V. Conduct investigations, hearings, and proceedings concerning alleged violations of this chapter or of rules adopted under this chapter.
VI. Subpoena witnesses, records, and documents, as needed, and administer oaths to those testifying at hearings.
VII. Determine and enforce appropriate disciplinary action against all individuals found guilty of violating this chapter or the rules adopted under this chapter.
VIII. Deny or withdraw approval of nursing educational programs that do not meet the minimum requirements of this chapter.
IX. Maintain records of proceedings as required by the laws of New Hampshire.
X. Conduct conferences, forums, studies, and research on nursing practice and education.
XI. Obtain legal counsel, hearing officers, accountants and such other employees, assistants, and agents as may be necessary, in the opinion of the board to administer and enforce the provisions of this chapter.
XII. Prescribe the duties of a qualified registered nurse to serve as executive director and request such additional staff positions as may be necessary to administer and enforce the provisions of this chapter.
XIII. Establish and collect fees, under rules adopted by the board under RSA 541-A, relative to applicants seeking any type of license issued by the board under this chapter, including fees for applications for temporary licenses, reinstatement of inactive licenses, license by examinations, and renewal of licenses, as well as fees for verifying license status, program graduation, or computerized lists.
XIV. In accordance with state due process laws, limit the multistate licensure privilege of any registered nurse or licensed practical nurse to practice in New Hampshire and may take any other actions under applicable state laws necessary to protect the health and safety of New Hampshire citizens. If the board does take such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such action taken by the state of New Hampshire.
326-B:5 Administration By Executive Director.
I. The executive director shall have at least the following qualifications:
(a) Be eligible for licensure to practice as an RN in this state; and
(b) Hold a master’s degree in nursing or hold a master’s degree in a related field and a baccalaureate degree in nursing.
II. The executive director shall be responsible for:
(a) The performance of the administrative responsibilities of the board.
(b) Employment of personnel needed to carry out the functions of the board.
(c) The performance of any other duties the board may direct.
326-B:6 Collection and Expenditure of Funds. The board shall receive and expend funds provided such funds are received and expended for the pursuit of the objectives authorized by this chapter. Fees, fines, and administrative charges other than those collected pursuant to RSA 326-B:8 shall be deposited in the general fund.
326-B:7 Nursing Assistant Fees and Fines; Continual Appropriation.
I. The nursing assistant fund is established in the state treasury and continually appropriated to the board which shall administer the fund. The fund shall be used only for administration of the nursing assistant component and expenses relating to that component.
II. All fees, charges, and fines relating to nursing assistants shall be credited to the fund.
326-B:8 Fees; Charges.
I. The board shall charge fees for the issuance, renewal, and reinstatement of all licenses, specialty licenses, and certificates authorized by this chapter. The board shall recover at least 125 percent of its direct expenses through licensee fees, fines, and administrative charges.
II. The board may provide the following services and make administrative charges for:
(a) The administration of examinations required by this chapter.
(b) Verification of licensure status.
(c) The sale of lists of licensees who have given their written authorization to have their names included on such lists.
(d) The actual costs of a criminal conviction record check required pursuant RSA 326-B:15.
(e) The actual cost of collection of statistical data provided to private entities.
326-B:9 Rulemaking Authority. The board shall adopt rules, in accordance with RSA 541-A, relative to the following:
I. Application procedures and eligibility requirements for the issuance of all initial, temporary, and renewal licenses, specialty licenses, and certificates issued by the board, including the issuance of such licenses to applicants holding a currently valid license or other authorization to practice in another jurisdiction.
II. Application procedures and eligibility requirements for the reinstatement of licenses after lapse and after disciplinary action.
III. Recognition of national certifying bodies issuing specialty certifications required for licensure as an ARNP which shall also be recognized by the National Council of State Boards of Nursing.
IV. The standards to be met by, and the process for approval of, education programs designed to prepare applicants to qualify for licensure or certification in any of the disciplines regulated by the board, including the time period within which noncompliance must be corrected before such approval is withdrawn.
V. The standards to be met by, and the process for approval of, education programs designed to prepare LPNs in intravenous therapy and by programs designed to prepare LNAs to perform tasks not addressed in the basic curriculum required for licensure.
VI. The determination of disciplinary sanctions authorized by this chapter, including the determination of administrative fines.
VII. The administration of examinations authorized by this chapter, and the manner in which information regarding the contents of any licensing examinations may be disclosed, solicited, or compiled.
VIII. Ethical standards for the practice of nursing and nursing-related activities.
IX. Continuing competence requirements.
X. Designations that may be used by persons regulated by the board and retired persons regulated by the board.
XI. The implementation and coordination of the nurse licensure compact adopted in RSA 326-B:46. The board shall use model rules developed for the nurse licensure compact by the National Council of State Boards of Nursing as the basis for adopting rules which shall be modified as necessary to comply with state statutes.
326-B:10 Joint Health Council.
I.(a) The joint health council shall consist of 9 members as follows: 3 licensed, practicing ARNPs, appointed by the board of nursing; 3 licensed, practicing physicians who work with ARNPs, appointed by the board of medicine; and 3 licensed clinical pharmacists who are practicing clinical pharmacists, appointed by the board of pharmacy. In no case shall a member of the joint health council be a member of the member’s appointing board.
(b) The chairmanship of the council shall rotate annually among the appointees of the 3 respective boards. Administrative expenses shall be assumed, and administrative support services provided, by the board of nursing.
(c) Members of the council shall be appointed for 3-year terms and shall serve no more than 2 terms.
II. The council shall meet not less than once every 3 months to discuss matters pertinent to the ARNP formulary and matters of mutual concern to the board of medicine, the board of nursing, and the board of pharmacy, unless there are no agenda items. Any council member may submit items to be considered by the council. Any council member may request that an item submitted for consideration by the council include relevant scientific information from recognized professional publications. A denial of a request to include a drug in the formulary or a decision to further restrict a drug already approved by the council shall be issued in writing and shall include relevant scientific information from recognized professional publications.
III. The duties of the joint health council shall include, but not be limited to, determining the type of ARNP formulary, exclusionary, inclusionary, or other, and adding to or altering the list of controlled and non-controlled molecular entities in the ARNP formulary. The council shall render decisions on such additions or alterations within 3 months of initial consideration unless there is a request for additional scientific information. Appeals of decisions shall be submitted to the council in writing for further deliberation by the council. The ARNP formulary shall be updated at least annually and shall be available in paper and electronic format from the board of nursing, the board of medicine, and the board of pharmacy.
IV. Meetings of the joint health council shall be open to the public and conducted in accordance with the provisions of RSA 91-A. Meetings shall be conducted in a building owned or leased by the state and situated in Concord. Notice of the time and place of each meeting shall be posted in the house and senate calendars at least 30 days prior to the meeting date.
326-B:11 Scope of Practice and Authority; Advanced Registered Nurse Practitioner.
I. Advanced registered nursing practice by nurse practitioners shall consist of a combination of knowledge and skills acquired in basic nursing education. The ARNP scope of practice, with or without compensation or personal profit, shall be limited to:
(a) Performing acts of advanced assessment, diagnosing, prescribing, selecting, administering, and providing therapeutic measures and treatment regimes;
(b) Obtaining consultation, planning, and implementing collaborative management, referral, or transferring the care of the client as appropriate; and
(c) Providing such functions common to a nurse practitioner for which the ARNP is educationally and experientially prepared and which are consistent with standards established by a national credentialing or certification body recognized by the National Council of State Boards of Nursing and approved by the board in the appropriate ARNP role and specialty.
II. An ARNP shall practice within standards consistent with standards established by a national credentialing or certification body recognized by the National Council of State Boards of Nursing and approved by the board in the appropriate ARNP role and specialty. The board shall not approve a new advanced practice specialty category that has not been developed by a national credentialing or certifying body recognized by the National Council of State Board of Nursing without approval of the legislature under RSA 332-G:6. Each ARNP shall be accountable to clients and the board:
(a) For complying with this chapter and the quality of advanced nursing care rendered;
(b) For recognizing limits of knowledge and experience and planning for the management of situations beyond the ARNP’s expertise; and
(c) For consulting with or referring clients to other health care providers as appropriate.
III. An ARNP shall have plenary authority to possess, compound, prescribe, administer, and dispense and distribute to clients controlled and non-controlled drugs in accordance with the formulary established by the joint health council and within the scope of the ARNP’s practice as defined by this chapter. Such authority may be denied, suspended, or revoked by the board after notice and the opportunity for hearing, upon proof that the authority has been abused.
IV. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.
326-B:12 Scope of Practice; Registered Nurse.
I. An RN shall, with or without compensation or personal profit, practice nursing that incorporates caring for all clients in all settings, is guided by nursing standards consistent with standards established by the National Council of State Boards of Nursing and approved by the board, and shall be limited to:
(a) Providing comprehensive nursing assessment of the health status of clients, families, groups, and communities.
(b) Collaborating with a health care team to develop an integrated client-centered plan of health care.
(c) Developing a plan of nursing strategies to be integrated within the client-centered health care plan that establishes nursing diagnoses, setting goals to meet identified health care needs, prescribing nursing interventions, and implementing nursing care through the execution of independent nursing strategies and prescribed medical regimen.
(d) Delegating and assigning nursing interventions to implement the plan of care.
(e) Providing for the maintenance of safe and effective nursing care rendered directly or indirectly.
(f) Promoting a safe and therapeutic environment.
(g) Providing health teaching and counseling to promote, attain, and maintain the optimum health level of clients, families, groups, and communities.
(h) Advocating for clients, families, groups, and communities by attaining and maintaining what is in the best interest of the client or group.
(i) Evaluating responses to interventions and the effectiveness of the plan of care.
(j) Communicating and collaborating with other health care professionals in the management of health care and the implementation of the total health care regimen within and across care settings.
(k) Acquiring and applying critical new knowledge and technologies to the practice of nursing.
(l) Managing, supervising, and evaluating the practice of nursing.
(m) Teaching the theory and practice of nursing.
(n) Participating in the development of policies, procedures, and systems to support the client.
(o) Other nursing services that require education and training prescribed by the board and in conformance with national nursing standards. Additional nursing services shall be commensurate with the RN’s experience, continuing education, and demonstrated competencies.
II. Each RN is accountable to clients, the nursing profession, and the board for complying with the requirements of this act and the quality of nursing care rendered, and for recognizing limits of knowledge and experience and planning for management of situations beyond the nurse’s experience.
III. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.
326-B:13 Scope of Practice; Licensed Practical Nurse.
I. An LPN shall, with or without compensation or personal profit, practice under the supervision of an RN, ARNP, licensed physician, or dentist. Such practice is guided by nursing standards established by the National Council of State Boards of Nursing and approved by the board, and shall be limited to:
(a) Collecting data and conducting focused nursing assessments of the health status of clients.
(b) Planning nursing care for clients with stable conditions.
(c) Participating in the development and modification of the comprehensive plan of care for all types of clients.
(d) Implementing appropriate aspects of the strategy of care within the LPN scope of practice.
(e) Participating in nursing care management through delegating, assigning, and directing nursing interventions that may be performed by others, including other LPNs, that do not conflict with this chapter.
(f) Maintaining safe and effective nursing care rendered directly or indirectly.
(g) Promoting a safe and therapeutic environment.
(h) Participating in health teaching and counseling to promote, attain, and maintain the optimum health level of clients.
(i) Serving as an advocate for the client by communicating and collaborating with other health service personnel.
(j) Participating in the evaluation of client responses to interventions.
(k) Communicating and collaborating with other health care professionals.
(l) Providing input into the development of policies and procedures.
(m) Other nursing services that require education and training prescribed by the board and in conformance with national nursing standards. Additional nursing services shall be commensurate with the LPN’s experience, continuing education, and demonstrated LPN competencies.
II. Each nurse is accountable to clients, the nursing profession, and the board for complying with the requirements of this chapter and the quality of nursing care rendered and for recognizing limits of knowledge and experience and planning for management of situations beyond the nurse’s expertise.
III. LPNs who have successfully completed the curriculum of a board-approved LPN intravenous therapy course may administer intravenous solutions under the direction of a physician or dentist, or as delegated by an RN.
IV. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.
326-B:14 Scope of Practice; Licensed Nursing Assistant.
I. An LNA shall, with or without compensation or personal profit, practice under the supervision of an RN, ARNP, or LPN.
II. An LNA is responsible for competency in the nursing assistant curriculum approved by the board. LNAs are authorized to administer medication when they hold a currently valid certificate of medication administration and under the circumstances established by the board through rules adopted pursuant to RSA 541-A.
III. Following successful completion of the curriculum, a nursing assistant shall be able to:
(a) Form a relationship, communicate, and interact effectively with individuals and groups.
(b) Demonstrate comprehension related to individuals’ emotional, mental, physical, and social health needs through skillful, direct nursing-related activities.
(c) Assist individuals to attain and maintain functional independence in a home or health care facility.
(d) Exhibit behaviors supporting and promoting care recipients’ rights.
(e) Demonstrate observational and documenting skills required for reporting of people’s health, safety, welfare, physical and mental condition, and general well-being.
(f) Provide safe nursing-related activities under the supervision of an RN or an LPN.
IV. LNAs may perform tasks not addressed in the basic curriculum required for licensure if they obtain additional training in the performance of such tasks through programs approved by the board. Additional tasks may be delegated provided:
(a) The task has been properly delegated to the nursing assistant by the supervising licensed nurse pursuant to RSA 326-B:28.
(b) The task has not been made exempt from nursing assistant practice.
(c) The policies of the employing health care facility allow the delegation of the task to an LNA.
V. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.
326-B:15 Criminal Record Checks.
I. Every applicant for initial licensure or license renewal or reinstatement shall submit to the board a notarized criminal conviction record release authorization form, as provided by the division of state police, which authorizes the release of his or her criminal conviction record to the board pursuant to RSA 106-B:14.
II. Upon receipt of a notarized criminal conviction record release authorization form from the board or from an applicant for licensure or license renewal or reinstatement, the division of state police shall conduct a criminal conviction record check pursuant to RSA 106-B:14 and provide the results to the board.
III. The board shall review the criminal record information prior to making a licensing decision and shall maintain the confidentiality of all criminal conviction records received pursuant to this section.
326-B:16 Licensure; All Applicants. All applicants shall:
I. Submit a completed application and fees as established by the board.
II. Have the ability to read and write in the English language.
III. Report any pending criminal charges, criminal convictions, or plea arrangement in lieu of convictions.
IV. Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made.
V. Meet continuing competence requirements as defined in rules adopted under RSA 541-A.
VI. Meet other criteria as established by the board.
326-B:17 Registered Nurse and Licensed Practical Nurse; Initial License by Examination.
I. The board shall administer the examination to applicants for licensure as RN’s or LPN’s.
II. The board may employ, contract, and cooperate with any entity in the preparation and process for determining results of a valid, reliable, legally defensible and uniform licensure examination. When such an examination is utilized, the board shall restrict access to questions and answers.
III. The board shall determine whether a license examination may be repeated, the frequency of reexamination, and any requisite education prior to reexamination.
IV. An applicant for licensure by examination to practice as an RN or LPN who successfully meets the requirements of this section shall be entitled to licensure as an RN or LPN, whichever is applicable.
V. Applicants for licensure by exam as an RN or LPN shall graduate from or verify successful completion and eligibility for graduation from a board approved nursing education program or a program that meets criteria comparable to those established by the board.
VI. An internationally educated applicant for RN or LPN licensure by examination shall meet the requirements as established by the board.
326-B:18 Advanced Registered Nurse Practitioner; Licensure.
I. An applicant for initial ARNP licensure shall:
(a) Hold a current license as a registered nurse;
(b) Have graduated with a graduate degree earned in an accredited advanced registered nurse practitioner education program or have graduated before July 1, 2004 from an ARNP education program accredited by a national accrediting body;
(c) Be currently certified by a board-recognized national certifying body in the specialty for which the applicant was educated; and
(d) Meet other criteria as established by the board.
II. The board may issue one or more licenses to applicants meeting the qualifications established in paragraph I.
326-B:19 Licensed Nursing Assistant; Licensure by Examination. Applicants for an initial LNA license shall:
I. Submit documentation of successful completion and certification from a board approved nursing assistant education program.
II. Pass an examination approved by the board.
III. Meet other criteria as established by the board.
326-B:20 Registered Nurse and Licensed Practical Nurse; Licensure by Endorsement. An applicant for licensure by endorsement to practice as an RN or LPN who is currently licensed or certified in any other state or jurisdiction shall:
I. Hold an active unencumbered license as an RN or LPN.
II. Have committed no acts or omissions which are grounds for disciplinary action in another jurisdiction, or, if such acts have been committed and would be grounds for disciplinary action as set forth in this chapter, the board has found, after investigation, that sufficient restitution has been made.
III. Pass an examination approved by the board.
IV. Submit verification of licensure status directly from the jurisdiction of licensure by examination.
V. Meet other criteria established by the board.
326-B:21 Licensed Nursing Assistant; Licensure by Endorsement. An applicant for licensure by endorsement as a licensed nursing assistant who is currently licensed or certified in any other state or jurisdiction shall:
I. Provide proof of current and original licensing, certification, or nursing assistant registry status;
II. Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made; and
III. Meet other criteria as established by the board.
326-B:22 License Renewal; All Licensees.
I. All license renewals shall be issued biennially.
II. Any person licensed who intends to continue practicing as a nurse or nursing assistant shall:
(a) By midnight on his or her date of birth in the renewal year submit a completed application and fees as established by the board;
(b) Report any pending criminal charges, criminal convictions, or plea arrangements in lieu of convictions;
(c) Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made;
(d) Meet continuing competence requirements as defined in rules adopted under RSA 541-A;
(e) For those licensees applying for renewal following disciplinary action, comply with all board licensure requirements as well as any specific requirements set forth in the board’s discipline order; and
(f) Meet other criteria as established by the board.
III. Failure to renew the license shall result in forfeiture of the ability to practice nursing or nursing activities in the state of New Hampshire.
326-B:23 License Reinstatement; All Licensees. An individual whose license has lapsed by failure to renew may apply for reinstatement by meeting all requirements for renewal, or satisfying the following conditions:
I. An individual who applies for license reinstatement who does not meet the continuing competence requirements shall demonstrate current nursing or nursing assistant knowledge and skill, as defined in rules adopted by the board under RSA 541-A.
II. For those licensees applying for reinstatement following disciplinary action, compliance with all board licensure requirements as well as any specific requirements set forth in the board’s discipline order.
III. Application for reinstatement of a license which has lapsed under this section shall include payment of a reinstatement fee and be made, and granted or denied, in accordance with rules adopted by the board pursuant to RSA 541-A.
326-B:24 Temporary Licenses; All Licensees.
I. The board may issue temporary licenses, as provided in paragraph II, to applicants who meet entry level licensing requirements in the license category. A temporary license shall expire on the date the board approves or denies the permanent license sought by the holder of the temporary license, or in 120 days, whichever is less.
II. The following applicants for licensure as RNs or LPNs may be issued temporary licenses:
(a) Unlicensed applicants for licensure under paragraph I and applicants for licensure under RSA 326-B who have met all requirements for licensure except that they have not yet taken the required examination or the results of the examination are not yet available to the board.
(b) If they can demonstrate proficiency in English, currently foreign-licensed applicants for licensure under RSA 326-B who have met all requirements for licensure except that they have not yet taken the required examination or the results of the examination are not yet available to the board.
(c) Applicants for licensure under RSA 326-B who have met all of the requirements of that paragraph and are awaiting the board’s decision on their application for permanent licensure.
III. Applicants described in paragraph II who have received temporary licenses shall practice only under the supervision of an RN currently licensed in New Hampshire.
326-B:25 Modified License; Registered Nurse or Licensed Practical Nurse. The board may issue a modified license to an individual who has met licensure requirements and who is able to practice without compromising public safety within a modified scope of practice or with accommodations or both as specified by the board.
326-B:26 Licensed Nursing Assistant Registry. The board shall maintain a registry of nursing assistants licensed who qualify pursuant to 42 C.F.R. section 483.156. Nursing assistants who are registered or licensed shall comply with all provisions of the Omnibus Reconciliation Act (OBRA) of 1987, sections 1819 and 1919 of the Social Security Act, and all provisions of this chapter.
326-B:27 Certificate of Medication Administration for Licensed Nursing Assistants.
I. The board may issue a certificate of medication administration to a current LNA who:
(a) Has participated in and completed a board-approved medication administration education program;
(b) Has passed an examination approved by the board; and
(c) Has paid the certification fee.
II. Certification may be renewed on a biennial basis.
326-B:28 Delegation of Nursing Activities and Tasks. A nurse holding a currently valid license as an RN or an LPN may delegate specific nursing activities and tasks under the circumstances, and in accordance with the constraints, set forth in rules of the board adopted under RSA 541-A.
326-B:29 Delegation; Circumstances Not Subject to Disciplinary Action by the Board of Nursing.
I. A licensee who delegates or has delegated a specific nursing activity or task in compliance with this chapter shall not be subject to disciplinary action because of the performance of the person to whom the nursing activity or task is or was delegated.
II. No person may coerce an RN or an LPN into compromising client safety by requiring the nurse to delegate a nursing activity or task when the nurse determines that it is inappropriate to do so. A licensee shall not be subject to disciplinary action for refusing to delegate or refusing to provide training related to such delegation when the licensee has determined that such delegation may compromise client safety except as provided in RSA 326-B:37, II(h)(2).
326-B:30 Obligations of Licensees.
I. In response to board inquiries relevant to a licensee’s status or practice of nursing or nursing-related activities, each licensee shall provide complete and truthful information.
II. Each licensee shall notify the board if a license is lost or stolen.
III. Each licensee shall notify the board of a change of name or address within 10 days.
IV. Each licensee shall report to the board those acts or omissions which are violations of this chapter or grounds for disciplinary action.
326-B:31 Continuing Education. Applicants for license renewal and license reinstatement after lapse shall complete continuing education as follows:
I. An LNA shall complete 12 hours of continuing education in programs approved by the board each year, provided that licensees who hold a certificate of medication administration shall complete at least 4 hours of those 12 hours in medication administration.
II. An LPN or an RN shall complete 30 hours of continuing education every 2 years.
III. An ARNP, in addition to the continuing education requirements to renew or reinstate a license as an RN, shall complete 30 hours of continuing education every 2 years, 20 hours of which shall be specific to the specialty for which renewal or reinstatement is sought, and 5 hours of which shall be training in pharmacology appropriate to the specialty for which license renewal or reinstatement is sought.
326-B:32 Education Programs.
I. The board shall establish standards for the establishment and outcomes for nursing and nursing assistant education programs intended to prepare students for licensure or for certification, including clinical learning experiences. The board shall approve, disapprove, or withdraw approval for such programs that meet or fail to meet the requirements of this chapter. An educational institution or other entity conducting such an education program shall comply with paragraphs II and III and rules adopted by the board pursuant to RSA 541-A.
II. The board shall establish the process for determining nursing and nursing assistant education program compliance.
III. The board:
(a) Shall set requirements for establishment of new nursing and nursing assistant programs.
(b) Shall periodically review nursing and nursing assistant education programs and require such programs to submit evidence of compliance with standards.
(c) Shall grant continuing approval if, upon review of evidence, the board determines that the program meets the established standards. The board shall publish a list of approved programs.
(d) May deny or withdraw approval or take such action as deemed necessary when nursing or nursing assistant education programs fail to meet the standards established by the board.
(e) Shall reinstate approval of a nursing or nursing assistant education program upon submission of satisfactory evidence that its program meets the standards established by the board.
(f) Shall establish the process for nursing and nursing assistant programs that cease operation.
IV. Any education program conducted in another state shall be deemed to be an education program approved by the board if that program meets the requirements for approval established by this section and the program has been approved by the regulatory authority of its state.
326-B:33 Duty to Warn of Violent Acts of Client; Civil Liability.
I. Any licensee, or person working under the supervision of a licensee to provide services that are customary and necessary for diagnosis or treatment, has a duty to warn of, or to take reasonable precautions to provide protection from, a client’s violent behavior when the client has communicated to the ARNP or the person working under an ARNP licensee, or person working under the supervision of a licensee, a serious threat of physical violence against a clearly identified or reasonably identifiable victim or victims, or a serious threat of substantial damage to real property.
II. The duty may be discharged by the licensee, or a person working under the supervision of a licensee to provide services that are customary and necessary for diagnosis or treatment by making reasonable efforts to communicate the threat to the victim or victims, notifying the police department closest to the client’s or potential victim’s residence, or obtaining civil commitment of the client to the state mental health system.
III. No monetary liability or cause of action based on breach of client privacy, confidentiality, or any other ground shall arise from an act or communication done in a good faith effort to discharge a duty in accordance with paragraph II.
326-B:34 Duties of Licensees Relating to Reports of Sexual Relations.
I. If, during the course of diagnosis or treatment by a licensee, a client alleges that another mental health counselor or health care practitioner licensed by the board of nursing or another state licensing or certifying agency has engaged with the client in sexual relations, the licensee shall have a duty to inform the client that the act reported by the client may be unprofessional or unethical and may subject the actor to disciplinary action by the actor’s licensing or certifying agency.
II. No liability for breach of client confidentiality, slander, or defamation, or other civil or criminal liability, shall arise from the disclosure by a licensee of information related to reported sexual relations between a client and any mental health counselor or health care licensee of a state licensing or certifying agency when the disclosure is made in good faith and made to the board or any other state licensing or certifying agency.
326-B:35 Privileged Communications Between Licensees and Their Clients.
I. Confidential communications between licensees and their clients are privileged in the same manner as those provided by law between physician and patient, and, except as otherwise provided by law, no licensee shall be required to disclose such privileged communications. Confidential communications between a client of a licensee and any person working under the supervision of such licensee to provide services that are customary and necessary for diagnosis and treatment are privileged to the same extent as would be the same communications between the supervising licensee and the client.
II. This section shall not apply to disciplinary proceedings conducted by:
(a) The board;
(b) The board of examiners of nursing home administrators under RSA 151-A:11; or
(c) Any other statutorily-created health care occupational licensing board conducting disciplinary proceedings.
III. This section shall not apply to hearings conducted pursuant to RSA 135-C or RSA 464-A.
IV. This section shall also not apply to the release of blood samples and the results of laboratory tests for blood alcohol content taken from a person who is under investigation for driving a motor vehicle while such person was under the influence of intoxicating liquors or controlled drugs. The use and disclosure of such information shall be limited to the official criminal proceedings.
326-B:36 Emergency Treatment; Assisting the Board; Immunity From Civil Liability.
I. No person licensed to practice under this chapter or under the laws of any other state who, in good faith, renders emergency care at the scene of an emergency, which occurs outside both the place and the course of employment, shall be liable for any civil damages as a result of acts or omissions in rendering such emergency care, or as a result of any act or failure to act to provide or arrange for further medical treatment or care.
II. Any person acting in good faith shall be immune from civil liability to a licensee or an applicant for licensure for making any report or other information available to the board or assisting the board in carrying out any of its duties.
III. Nurses licensed in other states who respond to emergencies in New Hampshire during a civil disaster event shall be immune from civil liability and board action for acts or omissions in rendering such emergency care, or as a result of any act or failure to act to provide or arrange for further medical treatment or care.
326-B:37 Disciplinary Action; Misconduct.
I. The board may undertake investigations and disciplinary proceedings:
(a) Upon its own initiative.
(b) Upon written complaint of any person which charges that a licensee has committed any acts of misconduct under this section and which specifies the grounds for such complaint.
II. The board may discipline a licensee or applicant for any one or a combination of the following grounds:
(a) Failing to demonstrate the qualifications or satisfy the requirements.
(b) Conduct that violates the security of the examination, including, but not limited to:
(1) Copying, disseminating, or receiving any portion of an examination.
(2) Having unauthorized possession of any portion of a future, current, or previously administered examination.
(3) Violating test administration.
(4) Permitting an impersonator to take the examination on one’s behalf or impersonating an examinee.
(c) Convictions by a court or any plea to a crime in any jurisdiction that relates adversely to the practice of nursing or to the ability to practice nursing.
(d) Employing fraud or deceit in procuring or attempting to procure a license to practice nursing, in filing any reports or completing client records, in representation of oneself to the board or public, in authenticating any report or records in the nurse’s capacity as an ARNP, RN, LPN, or LNA, or in submitting any information or record to the board.
(e) Unethical conduct including but not limited to conduct likely to deceive, defraud, or harm the pubic or demonstrating a willful or careless disregard for the health or safety of a client. Actual injury need not be established.
(f) If a nurse’s license to practice nursing or a multi-state privilege or another health care related license or other credential has been denied, revoked, suspended, or restricted, or the licensee has been otherwise disciplined in this or any other state.
(g) Conduct including but not limited to failure or inability to perform nursing or nursing assistant practice as defined in this chapter, with reasonable skill and safety.
(h) Unprofessional conduct including but not limited to:
(1) A departure from or failure to conform to nursing standards, including improper management of client records.
(2) Delegating or accepting the delegation of a nursing function or a prescribed health function when the delegation or acceptance could reasonably be expected to result in unsafe or ineffective client care.
(3) Failure to supervise the performance of acts by any individual working at the nurse’s delegation or assignment.
(4) Failure of a clinical nursing instructor to supervise student experiences.
(i) Failure of a chief administrative nurse to follow appropriate and recognized standards and guidelines in providing oversight of the nursing organization and nursing services of a health care delivery system.
(j) Failure to practice within a modified scope of practice or with the required accommodations, as specified by the board in granting a modified license under this act.
(k) Any nursing practice that may create unnecessary danger to a client’s life, health, or safety. Actual injury to a client need not be established.
(l) Inability to practice safely, including demonstration of actual or potential inability to practice nursing with reasonable skill and safety to clients by reason of illness or as a result of any mental or physical condition.
(m) Actions or conduct that include, but are not limited to, falsifying reports, client documentation, agency records, or other essential health documents, failure to cooperate with a lawful investigation conducted by the board, failure to maintain professional boundaries with clients or family members, use of excessive force upon or mistreatment or abuse of any client, engaging in sexual conduct with a client, touching a client in a sexual manner, requesting or offering sexual favors or language or behaviors suggestive of same, or threatening or violent behavior in the workplace.
(n) Diversion or attempts to divert drugs or controlled substances.
(o) Failure of a licensee to comply with terms of any alternative program agreement made with the board.
(p) Other drug-related actions or conduct that include but are not limited to:
(1) Use of any controlled substance or any drug or device or alcoholic beverages to an extent or in a manner dangerous or injurious to himself or herself, any other person, or the public, or to the extent that such use may impair his or her ability to conduct with safety to the public the practice of nursing.
(2) Falsification or making incorrect, inconsistent, or unintelligible entries in any agency, client, or other record pertaining to drugs or controlled substances.
(3) A positive drug screen for which there is no lawful prescription.
(q) Actions or conduct that include but are not limited to:
(1) Knowingly aiding, assisting, advising, or allowing an unlicensed person to engage in the practice of nursing.
(2) Violating a rule adopted by the board under RSA 541-A, an order of the board, a state or federal law relating to the practice of nursing, or a state or federal narcotics or controlled substance law.
(3) Practicing beyond the scope of practice as stated in this chapter, and failing to report violations of this chapter.
(r) Upon notification by the licensing authority of another jurisdiction that a licensee has been disciplined.
III. The board may refuse to renew or reinstate a license on disciplinary grounds, or take disciplinary action in any one or more of the following ways:
(a) By reprimand or by suspension, limitation, conditions, or probation of a licensee for a period of time as determined reasonable by the board.
(b) By revocation of a license.
(c) By requiring licensees to participate in educational or rehabilitative programs in the area or areas in which they have been found deficient or incompetent.
(d) By requiring the licensee to submit to the care, counseling, or treatment of a physician, counseling service, health care facility, professional assistance program, or any comparable person or facility approved by the board.
(e) By requiring the person to practice under the direct supervision of an RN for a period of time specified by the board.
(f) By imposition, after notice and the opportunity for hearing, of fines not to exceed $1,000 for each violation or, in the case of a continuing violation, $100 for each day the violation continues.
IV. In cases involving imminent danger to public health, safety, or welfare, the board may order the immediate suspension of a license pending an adjudicative proceeding. The board shall commence this adjudicative proceeding not later than 10 working days after the date of the board order suspending the license. The licensee may waive the 10-day commencement requirement to allow for additional time to prepare for a hearing. If the licensee waives the requirement, the license shall remain suspended until the completion of the hearing. A record of the proceeding shall be made by a certified court reporter provided by the board. Unless expressly waived by the licensee, board failure to commence an adjudicative proceeding within 10 working days shall mean that the suspension order is automatically vacated. The board shall not again suspend the license for the same conduct which formed the basis of the vacated suspension without granting the licensee prior notice and an opportunity for an adjudicative proceeding.
V. Every individual, agency, facility, institution, or organization that employs licensed nursing personnel within the state shall report to the board within 30 days any action by a licensee that willfully violates any provision of paragraph II. The board shall have authority, after notice and the opportunity for hearing, to impose civil penalties of up to $1,000 per violation upon persons found to have willfully violated the reporting requirements of this paragraph.
326-B:38 Investigations and Hearings.
I. The board shall investigate possible misconduct by licensees and other matters governed by the provisions of this chapter. Investigations shall be conducted with or without the issuance of a board order setting forth the general scope of the investigation. Board investigations and any information obtained by the board pursuant to such investigations shall be exempt from the public disclosure provisions of RSA 91-A, unless such information subsequently becomes part of a public disciplinary hearing. However, the board may disclose information acquired in an investigation to law enforcement or health licensing agencies in this state or any other jurisdiction, or in accordance with specific statutory requirements or court orders.
II. The board may appoint legal counsel, health care advisors, or other investigators to assist with any investigation and with adjudicative hearings.
III. The form taken by an investigation is a matter within the discretion of the board. The board may conduct investigations on an ex parte basis.
IV.(a) The board may administer oaths or affirmations, preserve testimony, and issue subpoenas for witnesses, documents, and things, relative to investigations or adjudicative hearings, except that subpoenas for records issued pursuant to paragraph V may be issued at any time.
(b) The board may serve a subpoena on any licensee by certified mail, but shall serve a subpoena on any other person in accordance with the procedures and the fee schedules established by the superior court.
(c) A person licensed by the board shall not be entitled to a witness fee or mileage expenses for travel within the state related to his or her appearance at a hearing or investigatory proceeding.
(d) In order to be valid, any subpoena issued by the board, except one issued to a licensee, shall be annotated “Fees guaranteed by the New Hampshire board of nursing.”
(e) A minimum of 48 hours’ notice shall be given for compliance with a subpoena issued under this paragraph.
V. The board may at any time subpoena a licensee’s health care records, employment records, and nursing education academic records in the possession of its licensees, nursing education programs licensed by the board, or hospitals, and other health care providers and facilities regulated in this state, except that it may not subpoena quality assurance records of health facilities licensed under RSA 151. Subpoenas shall be served by certified mail or personal delivery to the address currently on file with the board in the case of delivery to a licensee. No witness or other fee shall be required. A minimum of 15 days’ advance notice shall be allowed for complying with a subpoena issued under this paragraph.
VI. Complaints of licensee misconduct shall be in writing and shall be treated as petitions for the commencement of a disciplinary hearing. The board shall determine whether a complaint alleges misconduct sufficient to support disciplinary proceedings. If the board determines that it does, the board shall forward a copy of the complaint to the licensee complained against within 5 business days of its determination. If the board determines that it does not, the board shall send the complainant a written notice of dismissal of the complaint. Some or all of the allegations in a complaint may be consolidated with another complaint or with issues the board wishes to investigate or hear on its own motion. If an investigation of a complaint results in an offer of settlement by the licensee, the board may settle the allegations against the licensee without the consent of a complainant, provided that material facts are not in dispute.
VII. At any time during an investigation of a complaint, and without issuing a subpoena, the board may mail a copy of a complaint to the licensee named in the complaint, and may require in a written request that the licensee and the licensee’s employer provide detailed and good faith written responses to allegations identified by the board and also provide copies of all records concerning any client identified in the complaint. The licensee and others receiving inquiries from the board shall respond within a reasonable time period of not less than 15 days as the board may specify. This procedure may also be used in connection with matters the board has undertaken to investigate on its own motion.
VIII. The board may hold adjudicative hearings concerning allegations of misconduct or other matters within the scope of this chapter. Such hearings shall be public proceedings. Any member of the board other than the public members, or any other qualified person appointed by the board, shall have authority to preside at such a hearing and to issue oaths or affirmations to witnesses.
IX. The board shall give the respondent and the complainant, if any, at least 15 days’ written notice of the date, time, and place of a hearing, except as otherwise provided in this chapter. Such notice shall comply with RSA 541-A and include an itemization of the issues to be heard, and, in the case of a disciplinary hearing, a statement as to whether the action has been initiated by a written complaint or upon the board’s own motion, or both. If a written complaint is involved, the notice shall provide the complainant with a reasonable opportunity to intervene as a party. Such notice shall be sent by certified mail, return receipt requested, to the complainant and to the respondent at the address provided by the respondent currently on file at the board offices. Notice mailed in compliance with this section shall be deemed served.
X. The board may at any time dispose of allegations in a complaint, investigation, or disciplinary hearing by settlement, default, or consent order, by issuing an order of dismissal for failing to state a proper basis for disciplinary action, or by summary judgment order based upon undisputed material facts. In disciplinary hearings, the board may hold prehearing conferences which shall be exempt from the provisions of RSA 91-A, but any final disciplinary action or decision which occurs without holding a public hearing shall be publicly released at the time it is served upon the parties.
XI. Final disciplinary actions and other adjudicative decisions made by the board shall be in writing and served upon the parties. Such decisions shall not be released to the public until they are served upon the parties.
XII. Any person appearing at a board hearing or investigation may be represented by legal counsel or other representative, but the board shall have no obligation or authority to appoint or provide such representation.
XIII. The board shall hear any complaint not resolved at or prior to a preliminary hearing.
XIV. In the case of sanctions for discipline in another jurisdiction, the decision of the other jurisdiction’s disciplinary authority may not be collaterally attacked and the board may impose any of the sanctions set forth in this chapter, but shall provide notice and an opportunity to be heard if it intends to impose sanctions above those imposed by the other jurisdiction.
326-B:39 Rehearing; Appeals.
I. Any person who has been refused a license by the board or has been disciplined by the board shall have the right to petition for a rehearing within 30 days after the original decision.
II. Appeals from a decision on rehearing shall be by appeal pursuant to RSA 541.
III. No sanction shall be stayed by the board during an appeal.
326-B:40 Injunctive Relief. The attorney general, the board of nursing, any citizen, or the prosecuting attorney of any county or municipality where the act occurs may maintain an action to enjoin a person not currently licensed to do so from practicing, or purporting to practice, nursing or nursing-related activities. The action to enjoin shall not replace any other civil, criminal, or regulatory remedy. An injunction without bond is available to the board.
326-B:41 Unlawful Acts. It shall be unlawful for any person or entity to:
I. Sell or fraudulently obtain or furnish any nursing diploma, license, or record, or to aid and abet in such an act.
II. Practice as a licensee when the license to do so has been revoked or suspended or when the license to do so has lapsed.
III. Use, in connection with the individual’s name, any designation tending to imply licensure as an RN, an LPN, or an LNA unless so licensed.
IV. Represent or imply that the person or entity is conducting a nursing education program or a program for the education of nursing assistants which has been approved by the board when the program has not been so approved.
V. Disclose, solicit, or compile information regarding the contents of any licensing examinations relative to this chapter, except as authorized by the board.
326-B:42 Persons Licensed Under Previous Laws. Any person authorized to practice nursing by authority of this state as of the effective date of this section shall continue to be licensed under the provisions of this chapter and shall be eligible for license renewal pursuant to this chapter.
326-B:43 Exemptions. The provisions of this chapter shall not prohibit or limit:
I. The employment in federal government institutions and agencies of nurses who are members of federal agencies and are currently licensed in some state of the United States.
II. The practice of nursing by persons enrolled in nursing programs approved by the board when such practice is part of their program of study.
III. The furnishing of nursing assistance in an emergency.
IV. Nursing services by anyone when done in accordance with the practice of the religious principles or tenets of any well-recognized church or denomination which relies upon prayer or spiritual means alone for healing.
V. The practice of nursing in this state by any nurse currently licensed by another state engaged to accompany and care for a person passing through or temporarily residing in this state, during the period of one visit not to exceed 2 months.
VI. The administration of medications, by any person employed or under contract, to provide direct care to clients receiving community-based services pursuant to RSA 135-C or RSA 171-A, provided that persons delivering such care who administer medications shall have successfully completed a medication administration educational program conducted by an RN and approved by the board under rules adopted pursuant to RSA 541-A. The commissioner of health and human services, in consultation with the board, shall adopt rules under RSA 541-A establishing criteria for the administration of medications, and for the process of approving an RN to conduct the medication administration educational program.
VII. The practice of any nurse currently licensed in another state who is in this state on a non-routine basis to provide nursing consulting services.
326-B:44 Certified Midwifery Not the Practice of Nursing. Midwives certified under RSA 326-D, and practicing midwifery as defined by RSA 326-D:2, V, shall not be construed as practicing nursing.
326-B:45 Direct Care in Community-Based Services. The administration of medications by non-licensees to individuals receiving community-based services pursuant to RSA 135-C or RSA 171-A shall not be construed as practicing nursing.
326-B:46 Nurse Licensure Compact. The nurse licensure compact is adopted and entered into with all other jurisdictions that legally join the compact, which is substantially as follows:
Findings and Declaration of Purpose
(a) The party states find that:
(1) The health and safety of the public are affected by the degree of compliance with and the effectiveness of enforcement activities related to state nurse licensure laws;
(2) Violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public;
(3) The expanded mobility of nurses and the use of advanced communication technologies as part of our nation’s health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation;
(4) New practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex; and
(5) The current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant to both nurses and states.
(b) The general purposes of this compact are to:
(1) Facilitate the states’ responsibility to protect the public’s health and safety;
(2) Ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation;
(3) Facilitate the exchange of information between party states in the areas of nurse regulation, investigation, and adverse actions;
(4) Promote compliance with the laws governing the practice of nursing in each jurisdiction; and
(5) Invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses.
In this compact:
(a) “Adverse action” means a home or remote state action.
(b) “Alternative program” means a voluntary, nondisciplinary monitoring program approved by a nurse licensing board.
(c) “Coordinated licensure information system” means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws, which is administered by a nonprofit organization composed of and controlled by state nurse licensing boards.
(d) “Current significant investigative information” means:
(1) Investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction; or
(2) Investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.
(e) “Home state” means the party state which is the nurse’s primary state of residence.
(f) “Home state action” means any administrative, civil, equitable, or criminal action permitted by the home state’s laws which are imposed on a nurse by the home state’s licensing board or other authority including actions against an individual’s license such as: revocation, suspension, probation, or any other action which affects a nurse’s authorization to practice.
(g) “Licensing board” means a party state’s regulatory body responsible for issuing nurse licenses.
(h) “Multistate licensure privilege” means current, official authority from a remote state permitting the practice of nursing as either a registered nurse or a licensed practical/vocational nurse in such party state. All party states have the authority, in accordance with existing state due process law, to take actions against the nurse’s privilege such as: revocation, suspension, probation, or any other action which affects a nurse’s authorization to practice.
(i) “Nurse” means a registered nurse or licensed practical/vocational nurse, as those terms are defined by each party’s state practice laws.
(j) “Party state” means any state that has adopted this compact.
(k) “Remote state” means a party state, other than the home state:
(1) Where the patient is located at the time nursing care is provided; or
(2) In the case of the practice of nursing not involving a patient, in such party state where the recipient of nursing practice is located.
(l) “Remote state action” means:
(1) Any administrative, civil, equitable, or criminal action permitted by a remote state’s laws which are imposed on a nurse by the remote state’s licensing board or other authority including actions against an individual’s multistate licensure privilege to practice in the remote state; and
(2) Cease and desist and other injunctive or equitable orders issued by remote states or the licensing boards thereof.
(m) “State” means a state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of Puerto Rico.
(n) “State practice laws” means those individual party’s state laws and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline. The term state practice laws does not include the initial qualifications for licensure or requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state.
General Provisions and Jurisdiction
(a) A license to practice registered nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a multistate licensure privilege to practice as a registered nurse in such party state. A license to practice licensed practical/vocational nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a multistate licensure privilege to practice as a licensed practical/vocational nurse in such party state. In order to obtain or retain a license, an applicant must meet the home state’s qualifications for licensure and license renewal as well as all other applicable state laws.
(b) Party states may, in accordance with state due process laws, limit or revoke the multistate licensure privilege of any nurse to practice in their states and may take any other actions under their applicable state laws necessary to protect the health and safety of their citizens. If a party state takes such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such actions by remote states.
(c) Every nurse practicing in a party state must comply with the state practice laws of the state in which the patient is located at the time care is rendered. In addition, the practice of nursing is not limited to patient care, but shall include all nursing practice as defined by the state practice laws of a party state. The practice of nursing will subject a nurse to the jurisdiction of the nurse licensing board and the courts, as well as the laws, in that party state.
(d) This compact does not affect additional requirements imposed by states for advanced practice registered nursing. However, a multistate licensure privilege to practice registered nursing granted by a party state shall be recognized by other party states as a license to practice registered nursing if one is required by state law as a precondition for qualifying for advanced practice registered nurse authorization.
(e) Individuals not residing in a party state shall continue to be able to apply for nurse licensure as provided for under the laws of each party state. However, the license granted to these individuals will not be recognized as granting the privilege to practice nursing in any other party state unless explicitly agreed to by that party state.
Applications for Licensure in a Party State
(a) Upon application for a license, the licensing board in a party state shall ascertain, through the coordinated licensure information system, whether the applicant has ever held, or is the holder of, a license issued by any other state, whether there are any restrictions on the multistate licensure privilege, and whether any other adverse action by any state has been taken against the license.
(b) A nurse in a party state shall hold licensure in only one party state at a time, issued by the home state.
(c) A nurse who intends to change primary state of residence may apply for licensure in the new home state in advance of such change. However, new licenses will not be issued by a party state until after a nurse provides evidence of change in primary state of residence satisfactory to the new home state’s licensing board.
(d) When a nurse changes primary state of residence by:
(1) Moving between 2 party states, and obtains a license from the new home state, the license from the former home state is no longer valid;
(2) Moving from a nonparty state to a party state, and obtains a license from the new home state, the individual state license issued by the nonparty state is not affected and will remain in full force if so provided by the laws of the nonparty state;
(3) Moving from a party state to a nonparty state, the license issued by the prior home state converts to an individual state license, valid only in the former home state, without the multistate licensure privilege to practice in other party states.
In addition to the general provisions described in Article III, the following provisions apply:
(a) The licensing board of a remote state shall promptly report to the administrator of the coordinated licensure information system any remote state actions including the factual and legal basis for such action, if known. The licensing board of a remote state shall also promptly report any significant current investigative information yet to result in a remote state action. The administrator of the coordinated licensure information system shall promptly notify the home state of any such reports.
(b) The licensing board of a party state shall have the authority to complete any pending investigations for a nurse who changes primary state of residence during the course of such investigations. It shall also have the authority to take appropriate action, and shall promptly report the conclusions of such investigations to the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the new home state of any such actions.
(c) A remote state may take adverse action affecting the multistate licensure privilege to practice within that party state. However, only the home state shall have the power to impose adverse action against the license issued by the home state.
(d) For purposes of imposing adverse action, the licensing board of the home state shall give the same priority and effect to reported conduct received from a remote state as it would if such conduct had occurred within the home state. In so doing, it shall apply its own state laws to determine appropriate action.
(e) The home state may take adverse action based on the factual findings of the remote state, so long as each state follows its own procedures for imposing such adverse action.
(f) Nothing in this compact shall override a party state’s decision that participation in an alternative program may be used in lieu of licensure action and that such participation shall remain nonpublic if required by the party state’s laws. Party states must require nurses who enter any alternative programs to agree not to practice in any other party state during the term of the alternative program without prior authorization from such other party state.
Additional Authorities Invested in Party State Nurse Licensing Boards
Notwithstanding any other powers, party state nurse licensing boards shall have the authority to:
(a) If otherwise permitted by state law, recover from the affected nurse the costs of investigations and disposition of cases resulting from any adverse action taken against that nurse;
(b) Issue subpoenas for both hearings and investigations which require the attendance and testimony of witnesses, and the production of evidence. Subpoenas issued by a nurse licensing board in a party state for the attendance and testimony of witnesses, and/or the production of evidence from another party state, shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the state where the witnesses and/or evidence are located;
(c) Issue cease and desist orders to limit or revoke a nurse’s authority to practice in their states;
(d) Promulgate uniform rules and regulations as provided for in Article VIII(c).
Coordinated Licensure Information System
(a) All party states shall participate in a cooperative effort to create a coordinated data base of all licensed registered nurses and licensed practical/vocational nurses. This system will include information on the licensure and disciplinary history of each nurse, as contributed by party states, to assist in the coordination of nurse licensure and enforcement efforts.
(b) Notwithstanding any other provision of law, all party states’ licensing boards shall promptly report adverse actions, actions against multistate licensure privileges, any current significant investigative information yet to result in adverse action, denials of applications, and the reasons for such denials, to the coordinated licensure information system.
(c) Current significant investigative information shall be transmitted through the coordinated licensure information system only to party state licensing boards.
(d) Notwithstanding any other provision of law, all party states’ licensing boards contributing information to the coordinated licensure information system may designate information that may not be shared with nonparty states or disclosed to other entities or individuals without the express permission of the contributing state.
(e) Any personally identifiable information obtained by a party states’ licensing board from the coordinated licensure information system may not be shared with nonparty states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information.
(f) Any information contributed to the coordinated licensure information system that is subsequently required to be expunged by the laws of the party state contributing that information, shall also be expunged from the coordinated licensure information system.
(g) The compact administrators, acting jointly with each other and in consultation with the administrator of the coordinated licensure information system, shall formulate necessary and proper procedures for the identification, collection, and exchange of information under this compact.
Compact Administration and Interchange of Information
(a) The head of the nurse licensing board, or his or her designee, of each party state shall be the administrator of this compact for his or her state.
(b) The compact administrator of each party state shall furnish to the compact administrator of each other party state any information and documents including, but not limited to, a uniform data set of investigations, identifying information, licensure data, and disclosable alternative program participation information to facilitate the administration of this compact.
(c) Compact administrators shall have the authority to develop uniform rules to facilitate and coordinate implementation of this compact. These uniform rules shall be adopted by party states, under the authority invested under Article VI (d).
No party state or the officers or employees or agents of a party state’s nurse licensing board who act in accordance with the provisions of this compact are liable on account of any act or omission in good faith while engaged in the performance of their duties under this compact. Good faith in this article does not include willful misconduct, gross negligence, or recklessness.
Entry into Force, Withdrawal, and Amendment
(a) This compact shall enter into force and become effective as to any state when it has been enacted into the laws of that state. Any party state may withdraw from this compact by enacting a statute repealing the same, but no such withdrawal shall take effect until 6 months after the withdrawing state has given notice of the withdrawal to the executive heads of all other party states.
(b) No withdrawal affects the validity or applicability by the licensing boards of states remaining party to the compact of any report of adverse action occurring prior to the withdrawal.
(c) Nothing contained in this compact may be construed to invalidate or prevent any nurse licensure agreement or other cooperative arrangement between a party state and a nonparty state that is made in accordance with the other provisions of this compact.
(d) This compact may be amended by the party states. No amendment to this compact becomes effective and binding upon the party states unless and until it is enacted into the laws of all party states.
Construction and Severability
(a) This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact shall be severable and if any phrase, clause, sentence, or provision of this compact is declared to be contrary to the constitution of any party state or of the United States or the applicability thereof to any government, agency, person, or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person, or circumstance may not be affected thereby. If this compact is held contrary to the constitution of any state party thereto, the compact remains in full force and effect as to the remaining party states and in full force and effect as to the party state affected as to all severable matters.
(b) In the event party states find a need for settling disputes arising under this compact:
(1) The party states may submit the issues in dispute to an arbitration panel which will be comprised of an individual appointed by the compact administrator in the home state; an individual appointed by the compact administrator in the remote state or states involved; and an individual mutually agreed upon by the compact administrators of all the party states involved in the dispute; and
(2) The decision of a majority of the arbitrators shall be final and binding.
293:2 Nursing Assistant Fund. Amend RSA 6:12, I(b)(24), to read as follows:
(24) Money received under RSA [
326-B:29] 326-B:7, which shall be credited to the board of nursing’s nursing assistant fund.
293:3 Residential Care and Facility Licensing; Disciplinary Actions; Report to Board of Nursing Added. Amend RSA 151:6-b to read as follows:
151:6-b Report of Disciplinary Action. Every facility administrator, or designee, for any health care facility licensed under this chapter shall report to the board of medicine or the board of nursing any disciplinary or adverse action[
,] taken against a licensee of the board. Such report shall be made within 30 days after such action is taken[ , including]. Actions reported shall only involve misconduct sufficient to support disciplinary proceedings by the board and shall include all situations in which allegations of misconduct are settled by voluntary resignation without adverse action[ , against a person licensed by the board].
293:4 Residential Care and Facility Licensing; Rules. Amend RSA 151:9, I(k) to read as follows:
(k) Procedures for reviewing documentation of the mandatory completion of a state approved program under RSA [
326-B:4-a] 326-B for assistants to nurses in facilities licensed under RSA 151:2, who may not assume the responsibility of the position of an assistant to nurses prior to completion of the appropriate course required by this chapter.
293:5 Privileged Communication. Amend RSA 316-A:27 to read as follows:
316-A:27 Privileged Communications. The confidential relations and communications between any person licensed under provisions of this chapter and such licensed person’s patient are placed on the same basis as those provided by law between attorney and client, and, except as otherwise provided by law, no such doctor of chiropractic shall be required to disclose such privileged communications. Confidential relations and communications between a patient and any person working under the supervision of a doctor of chiropractic that are customary and necessary for diagnosis and treatment are privileged to the same extent as though those relations or communications were with such supervising doctor of chiropractic. This section shall not apply to disciplinary hearings or actions conducted under RSA 316-A:22, relative to the board of chiropractic examiners, RSA [
326-B:12] 326-B, relative to the board of nursing, RSA 151-A:11, relative to the board of examiners of nursing home administrators, or any other statutorily created medical occupational licensing board conducting disciplinary proceedings. This section shall not apply to hearings conducted pursuant to RSA 135-C:27-54.
293:6 Pharmacies; Definitions. Amend RSA 318:1, I-a to read as follows:
I-a. “Advanced registered nurse practitioner” means a person licensed to practice as an advanced registered nurse practitioner in this state pursuant to RSA [
293:7 Pharmacies; Possessing Prescription Drugs. Amend RSA 318:42, VII(b) to read as follows:
(b) The drugs appear on the current formulary approved pursuant to RSA [
326-B:10, II] 326-B.
293:8 Controlled Drug Act; Definitions. Amend RSA 318-B:1, I-b to read as follows:
I-b. “Advanced registered nurse practitioner” means a person licensed to practice as an advanced registered nurse practitioner in this state pursuant to RSA [
293:9 Respiratory Care Practice Act; Definitions. Amend RSA 326-E:1, V to read as follows:
V. “Nurse practitioner” means a person licensed to practice as an advanced registered nurse practitioner in this state pursuant to RSA [
293:10 Mental Health Practice; Definitions. Amend RSA 330-A:2, VIII to read as follows:
VIII. “Psychotherapist” means a psychologist, clinical social worker, pastoral psychotherapist, clinical mental health counselor, or marriage and family therapist licensed under this chapter who performs or purports to perform psychotherapy. This definition shall include psychiatrists licensed as physicians under RSA 329 and advanced registered nurse practitioners licensed under RSA [
326-B:10] 326-B:18 as psychiatric nurse practitioners.
293:11 Mental Health Practice; Penalties. Amend RSA 330-A:23, I to read as follows:
I. Except as provided in RSA 330-A:34, it shall be unlawful for any person to be engaged in mental health practice unless that person is licensed by the board, working as a candidate under the direct supervision of a person licensed by the board, or engaged in the practice of other mental health services as an alternative provider as defined in RSA 330-A:2, I. The license or the registration of such person shall be current and valid. It shall be unlawful for any person to practice as or to refer to oneself as a psychologist, a pastoral psychotherapist, a clinical social worker, a clinical mental health counselor, or a marriage and family therapist, or use the word “psychotherapist,” or any variation thereof, in such person’s title unless that person is licensed by the board or working as a candidate under the direct supervision of a person licensed by the board. Psychiatrists licensed under RSA 329 and psychiatric nurse practitioners licensed under RSA [
326-B:10] 326-B:18 may refer to themselves as psychotherapists.
293:12 Mental Health Practice; Persons Exempted. Amend RSA 330-A:34, I(e) to read as follows:
(e) The psychotherapy activities and services of physicians licensed under RSA 329, and advanced registered nurse practitioners, licensed under RSA [
293:13 Insurance; Coverage for Mental or Nervous Conditions. Amend RSA 415:18-a, V(d) to read as follows:
(d) “Psychiatric/mental health advanced registered nurse practitioner” means an individual who is licensed as an advanced registered nurse practitioner in psychiatric mental health nursing under RSA [
326-B:10] 326-B:18, who is defined by and whose scope of practice is described under the rules adopted pursuant to RSA 326-B, and who is a licensed registered nurse, educationally prepared in nursing at a minimum of the master’s level, and certified in the specialty by a recognized national certifying agency, such as the American Nurses Credentialing Center.
293:14 Effective Date. This act shall take effect July 1, 2005 at 12:01 a.m.
(Approved: July 25, 2005)
(Effective Date: July 1, 2005 at 12:01 a.m.)