HB256 (2006) Detail

Revising the nurse practice act.


HB 256 – AS INTRODUCED

2005 SESSION

05-0444

08/09

HOUSE BILL 256

AN ACT revising the nurse practice act.

SPONSORS: Rep. O'Neil, Rock 15

COMMITTEE: Executive Departments and Administration

ANALYSIS

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

05-0444

08/09

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:

1 Nurse Practice Act. RSA 326-B is repealed and reenacted to read as follows:

CHAPTER 326-B

NURSE PRACTICE ACT

326-B:1 Purpose. In order to safeguard 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.

326-B:2 Definitions. In this chapter:

I. “Advanced registered nurse practitioner” or “ARNP” means a registered nurse currently licensed in New Hampshire who is additionally licensed by the board in one or more practice specialties pursuant to RSA 326-B:13.

II. “Board” means the New Hampshire board of nursing established in RSA 326-B:3.

III. “Certified graduate nurse” or “CGN” means those graduate nurses exempted by chapter 265, laws of 1959 and certified prior to January 1, 1975.

IV. “Contact hour” means a minimum of 50 minutes of organized learning.

V. “Continuing competence” means integrated learning designed to enhance nursing knowledge, judgment and skills beyond those achieved during the education or other preparation required to qualify for initial licensing.

VI. “Delegation” means the transfer of authority for the performance of a specific task from a licensed nurse authorized to perform the task to someone who does not have that authority when such transfer is authorized by this chapter or the rules adopted by the board.

VII. “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.

VIII. “Licensed practical nurse” or “LPN” means an individual who holds a current license to practice practical nursing as defined in paragraph XII.

IX. “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.

X. “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. Nursing also includes, but is not limited to:

(a) Promoting an environment conducive to well-being.

(b) Planning and implementing independent nursing strategies and prescribed treatment in the prevention and management of illness, injury, disability, and achievement of a dignified death.

(c) Providing health counseling and teaching.

(d) Collaborating on aspects of the health regimen.

(e) Advocating for the client.

XI. “Nursing-related activities” means client care provided by a licensed nursing assistant directed by an ARNP, an RN, or an LPN.

XII. “Practical nursing” means the practice of nursing as defined in paragraph X by a nurse 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 contributing to the assessment, planning, implementation and evaluation of client care.

XIII. “Registered nurse” or “RN” means an individual who holds a current license to practice registered nursing as defined in paragraph XIV.

XIV. “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 2 consecutive terms.

II. Each RN member shall be a resident of this state, licensed in good standing under the provisions of this chapter, 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, 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, and licensed in good standing in, New Hampshire, 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 2 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 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 New Hampshire board of nursing 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.

I. The board shall have the power to:

(a) Regulate the practice of nursing and take disciplinary action authorized by this chapter.

(b) Adopt, amend, and repeal administrative rules as authorized by this chapter.

(c) Appoint and employ a qualified RN to serve as executive director.

(d) Delegate to the executive director those activities which expedite the functions of the board, including the employment of professional and support staff, investigators, legal counsel, and other personnel necessary for the board to carry out its functions.

(e) Employ or contract with any entity for the purpose of administering examinations authorized by this chapter.

(f) Gather and report to the public statistical information regarding, but not limited to, the education and licensure of nurses and nursing assistants.

(g) Maintain membership in national organizations advancing the practice of nursing.

(h) Provide consultation and conduct conferences, forums, studies, and research on nursing education and practice.

II. The board shall have the duty to:

(a) Interpret and enforce the provisions of this chapter and of the rules implementing it.

(b) Maintain a record of all persons and education programs regulated by the board.

(c) Determine and collect reasonable fees authorized by this chapter.

(d) Administer the state registry for nursing assistants in compliance with the Omnibus Budget Reconciliation Act of 1987, sections 1819 and 1919 of the Social Security Act.

326-B:5 Criminal Record Checks.

I. Every applicant for initial licensure or license renewal or reinstatement under this chapter 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 under this chapter, 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:6 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:7 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:8 Nursing Assistant Fees and Fines; Continual Appropriation.

I. The nursing assistant fund is established in the state treasury and continually appropriated to the board of nursing 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:9 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 them:

(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:5.

326-B:10 Public Hearings on Fees.

I. The board shall be exempt from the requirements, procedures, and provisions of RSA 541-A with respect to the establishment of fees.

II. The board shall review all fees established under this chapter on a biannual basis. The board shall hold at least one public hearing on all proposed changes to such fees. All interested parties shall be afforded reasonable opportunity to testify and to submit data, views or arguments in writing or in electronic format, relative to proposed fee changes. All materials submitted in writing shall be signed by the person who submits them. The board shall post the date, time and location of the public hearing and the cut-off date for the submission of written testimony at least 20 days prior to the hearing date. Such posting shall be on the board’s website and in the newsletter published by the board. Copies of the proposed fee changes shall be available to the public at least 5 days prior to the hearing. A period of at least 10 days after the hearing shall be provided for the submission of materials in writing or electronic format.

III. Each hearing shall be attended by a quorum of the board. A public comment hearing on fees may be postponed in the event of inclement weather or a lack of a quorum of the board. If such hearing is postponed, the board shall provide at least 5 days’ notice of the rescheduled hearing.

IV. The board shall consider all public input that has been submitted under the provisions of this section when voting on any changes to fees established under this chapter.

326-B:11 Rulemaking Authority. The board shall adopt rules in accordance with RSA 541-A on the following topics:

I. Application procedures and eligibility requirements, in addition to those set forth in this chapter, 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, in addition to those set forth in this chapter, for the reinstatement of licenses after lapse and after disciplinary action.

III. Approval of national certifying bodies issuing specialty certifications required for licensure as an ARNP.

IV. The standards to be met by 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 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.

326-B:12 Scope of Practice; Advanced Registered Nurse Practitioner.

I. Only those licensees duly authorized under RSA 326-B:13 shall perform those common customary advanced nursing practices noted in this section. ARNPs are authorized to prescribe medications in the ARNP formulary established by the joint health council. The ARNP shall be competent as set forth below to practice independently in accordance with a scope of practice established by national standards in the following specialty areas:

(a) Certified nurse midwife.

(b) Pediatric nurse practitioner.

(c) Family nurse practitioner.

(d) Women’s health nurse practitioner.

(e) Adult nurse practitioner.

(f) Geriatric nurse practitioner.

(g) School nurse practitioner.

(h) Psychiatric/mental health nurse practitioner.

(i) Emergency/trauma nurse practitioner.

(j) Neo-natal nurse practitioner.

(k) Certified registered nurse anesthetist.

(l) Acute care nurse practitioner.

(m) Community health nurse practitioner.

(n) Reproductive health nurse practitioner.

(o) Oncology nurse practitioner.

(p) Palliative care nurse practitioner.

(q) Wound care nurse practitioner.

II. The ARNP shall have the ability to:

(a) Elicit and record physical and mental health status, psychosocial history, including review of bodily systems.

(b) Perform physical examination.

(c) Initiate appropriate diagnostic tests to screen or evaluate the care recipient’s current health status.

(d) Assess findings of history, review of systems, physical examination and diagnostic tests, and formulate a diagnosis prior to implementing a treatment regimen.

(e) Identify health problems and learning needs of the care recipient.

(f) Plan, teach, promote, and manage physical and mental health care in a continuous program.

(g) Implement and manage treatment regimens and administer, prescribe, dispense, and procure pharmacological agents.

(h) Arrange appropriate referrals.

(i) Initiate appropriate emergency treatment in life-threatening or unusual situations in order to stabilize the care recipient.

(j) Provide other functions within the ARNPs scope of practice for which the ARNP is educationally and experientially prepared, provided that any functions not specifically authorized by this section shall be performed only under the direct supervision of a physician.

326-B:13 Advanced Registered Nurse Practitioner; Specialty License.

I. The board may issue one or more specialty licenses to applicants meeting the qualifications stated in paragraph III. Holding one or more currently valid specialty licenses qualifies the holder as an ARNP.

II. An applicant for licensure in a specialty shall:

(a) Hold a currently valid license as an RN;

(b) Submit a completed application for specialty licensure and pay the specialty license fee;

(c) Have graduated after July 1, 2004 with a master’s degree earned in an ARNP education program accredited by a national accrediting body or have graduated before July 1, 2004 from an ARNP education program accredited by a national accrediting body; and

(d) Be currently certified by a board-approved national certifying body in the specialty for which the applicant was educated.

III. An applicant for renewal of a specialty license issued after September 30, 1984 shall:

(a) Submit a completed application for renewal and pay the renewal fee;

(b) Hold, and have since first specialty licensure maintained, a currently valid license as an RN;

(c) Be, and have since first specialty licensure continued to be, certified by a board-approved national certifying body;

(d) Meet any continuing competence requirements set by the board; and

(e) Meet any continuing education requirements established under this chapter.

IV. An applicant for renewal of a specialty license issued before September 30, 1984 shall meet the requirements of paragraph III except that the applicant shall not be required to be and continue to have been certified by a board-approved national certifying body.

V.(a) 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.

(b) Such plenary 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.

326-B:14 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:15 Scope of Practice; Registered Nurse.

I. Practice as an RN means the full scope of nursing, with or without compensation or personal profit, that incorporates caring for all clients in all settings; is guided by nursing standards and evidence-based practice guidelines developed by a nationally-recognized authority 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 practice domain.

(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.

326-B:16 Scope of Practice; Licensed Practical Nurse.

I. Practice as an LPN means a directed scope of nursing practice, with or without compensation or personal profit, under the supervision of an RN, ARNP, licensed physician, or other health care provider authorized by the state to delegate health care activities and functions. Such practice is guided by nursing standards developed by a nationally-recognized authority 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 episode 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. LPNs shall be instructed that they are accountable and responsible for activities delegated to them. LPNs shall only perform intravenous therapy for clients that are 13 years of age or older.

326-B:17 Qualifications for Licensure to Practice as a Registered Nurse or a Licensed Practical Nurse.

I. An applicant for licensure to practice as an RN or an LPN who has never been licensed or who holds a currently valid license issued by a foreign jurisdiction other than a Canadian jurisdiction shall:

(a) Submit a completed application and pay the license fee.

(b) Be a graduate of a board-approved nursing education program or a program that is determined by the board to be comparable to a board-approved nursing education program.

(c) Pass a national examination approved by the board.

(d) Be of a good character as character relates to the practice of nursing.

(e) Have complied with continuing competence requirements, if applicable.

II. An applicant for licensure to practice as an RN or an LPN who holds or has held a license issued by another state shall meet the requirements of paragraph I, except that an applicant who has passed a national examination approved by the board shall not be required to take the examination again.

III. An applicant for licensure to practice as an RN or an LPN who received nursing education in Canada and was never licensed by any state shall:

(a) Meet the requirements of paragraph I; or

(b) Meet the requirements of paragraphs I (a), (d) and (e), have graduated from a Canadian nursing education program, and demonstrate that:

(1) Between the years 1939 and 1970 the applicant passed the English version of the National League for Nursing Board Test Pool Examination;

(2) Between the years 1970 and 1980 the applicant took the English version of the Canadian Nurses’ Association testing service 5-part examination and received a minimum passing score of 350 in each of the following topics: medical nursing, surgical nursing, pediatric nursing, maternity nursing, and psychiatric nursing; or

(3) Since the year 1980 the applicant took the English version of the Canadian Nurses’ Association testing service comprehensive examination and received a minimum passing score of 400.

326-B:18 Scope of Practice; Licensed Nursing Assistant.

I. Practice as an LNA means a scope of nursing assistant practice, with or without compensation or personal profit, under the supervision of the RN, ARNP, or LPN, as defined in RSA 326-B:2.

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 can be delegated provided:

(a) The task has been properly delegated to the nursing assistant by the supervising licensed nurse pursuant to RSA 326-B:22.

(b) The task has not been made exempt from nursing assistant practice under this chapter.

(c) The policies of the employing health care facility allow the delegation of the task to a LNA.

326-B:19 Qualifications for Licensure to Practice as a Licensed Nursing Assistant.

I. An applicant for licensure to practice as an LNA who is not licensed in any other state shall:

(a) Submit a completed application and pay the license fee established by the board;

(b) Be a graduate of a board-approved nursing assistant education program or a program that is determined by the board to be comparable to a board-approved nursing assistant education program;

(c) Pass a national or regional examination approved by the board;

(d) Be of a good character as character relates to the practice of nursing-related activities; and

(e) Have complied with continuing competence requirements, if applicable.

II. An applicant for licensure to practice as an LNA who holds a current and valid license or other authorization to practice nursing-related activities in another state shall meet the requirements of paragraph I, except that the applicant shall either have passed a national or regional examination approved by the board or passed the last examination taken for licensure or other authorization to practice in any other state. The applicant shall submit verification of current and valid licensure or other authorization to practice issued by another state. The applicant shall not have committed in any other state acts or omissions which are grounds for disciplinary action under this chapter and for which the board determines that insufficient restitution was made or insufficient disciplinary action taken by the disciplining state.

326-B:20 Qualifications; Medication Nursing Assistant.

I. Practice as a medication nursing assistant means a scope of nursing assistant practice, with or without compensation or personal profit, as an LNA who holds a currently valid certification authorizing the delegation of medication administration under the supervision of the RN, ARNP or LPN as defined in RSA 326-B:2.

II. A medication nursing assistant shall be proficient in the following methods of medication administration:

(a) Topical.

(b) Oral.

(c) Nasal.

(d) Ocular.

(e) Auricular.

(f) Vaginal.

(g) Rectal.

(h) Gastrostomy or jejunostomy tube.

326-B:21 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 in accordance with RSA 326-B:26.

326-B:22 Delegation of Nursing Activities and Tasks.

I. 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 this section. The following licensees shall have the authority to delegate tasks of client care:

(a) Any current RN or ARNP when practicing registered nursing; and

(b) Any current LPN when practicing practical nursing directed by an ARNP, RN, dentist, or physician.

II. LNAs shall not delegate tasks of client care.

III. This section applies to the delegation of tasks of client care by all licensees except for licensees exempted by RSA 326-B:43.

IV. Any individual shall be eligible to receive the delegation of a task of client care not involving the administration of medication only if such individual has competence to perform the specific task. For tasks of client care involving the administration of medication, the following persons shall be eligible to be delegates:

(a) Currently RNs and ARNPs;

(b) Currently LPNs when:

(1) The method of medication administration is not intravenous; or

(2) The method of medication administration is intravenous, only in compliance with RSA 326-B:16, III;

(c) Unlicensed assistive personnel who have competence to perform the specific task to be delegated;

(d) Currently LNAs when they hold a certificate of medication administration issued in accordance with the provisions of this chapter.

V. The following limitations on the delegation of tasks of client care shall apply:

(a) No delegation shall be made of any task of client care which is not within the competence of the delegating licensee.

(b) An RN or an LPN shall not delegate any task of client care for which the delegate does not have competence.

(c) A delegation of a task of client care involving the administration of medication shall specify:

(1) The medication to be administered.

(2) The dosage, route, and time of the medication to be administered.

(3) The client to whom the medication is to be administered.

VI. Before delegating a task of client care, a delegating licensee shall determine:

(a) The intended delegate’s competence to perform the task; and

(b) In the case of an intended delegation to an LNA of a task involving the administration of medication, the status of the nursing assistant’s license and certificate of medication administration.

VII. In exercising such discretion in delegation as is permitted by this chapter, a licensee intending to delegate a task of client care shall take into account:

(a) The degree of the intended delegate’s competence to perform the task;

(b) Whether the client is stable; and

(c) Whether the client’s nursing needs are currently changing.

VIII. A delegating licensee shall introduce the delegate to the client.

IX. A delegating licensee shall supervise the delegate’s performance of the delegated task. Such supervision shall be continual or intermittent as warranted by the following:

(a) The complexity of the delegated task of client care.

(b) The condition of the client.

(c) The degree of the competence of the delegate.

(d) The familiarity of the delegate with the environment in which the task is to be performed.

X. A delegating licensee shall reevaluate the nature of the supervision as often as the condition of the client changes.

XI. A delegating licensee shall rescind a delegation if:

(a) An evaluation shows that the client’s condition has changed in a way that renders the delegation no longer safe or appropriate;

(b) The delegate proves unwilling or incompetent to perform the delegated task;

(c) The client objects to the delegation; or

(d) The delegating licensee is no longer able to supervise the performance of the delegated task.

XII. When rescinding a delegation, the licensee shall communicate the rescission clearly to the delegate to whom the task was originally delegated and to the administrative supervisor of the delegate, if any.

XIII. A licensee shall report to the board the fact of anyone’s attempting to coerce the delegation of a task of client care in violation of RSA 326-B:24, II.

XIV. A licensee to whom a specific task of client care has been delegated shall:

(a) Perform that task in accordance with this chapter and its implementing rules.

(b) Wear a badge showing the delegate’s name and title when performing the delegated task of client care; and

(c) Report to the board the fact of any delegation which the delegate believes to be beyond the competence of the delegate.

326-B:23 Delegation; Administration of Medication.

I. A nurse holding a currently valid license as an RN or an LPN may delegate tasks involving the administration of medication to an LNA holding a currently valid certificate as a medication nursing assistant under the circumstances, and in accordance with the constraints, set forth in this section.

II. An LNA shall perform a task involving the administration of medication if:

(a) The task has been delegated to the LNA by a licensed nurse in accordance with the provisions of this chapter; and

(b) The delegation is not prohibited by this section.

III. An LNA shall not perform a task involving the administration of medication if:

(a) The task requires the determination of the client’s need for the medication, the calculation of the dosage of the medication, or the conversion of dosage;

(b) The delegating nurse is unavailable to monitor the progress of the client and the effect on the client of the medication; or

(c) The client is not stable or has changing nursing needs.

IV. A licensee intending to delegate, or having delegated, a task involving medication administration to an LNA shall comply with the requirements of this chapter.

V. A licensee who, having delegated a task involving medication administration to an LNA, has any reason to believe that the delegate may have made an error in the administration of medication shall:

(a) Immediately ascertain whether the error occurred; and

(b) If the error occurred or its occurrence can not be immediately ascertained, take the following steps:

(1) Inform the administrator of the facility, institution, or agency in which the error occurred;

(2) Document the error in the client’s clinical record;

(3) Complete any report required by the policies or rules of the facility, institution, or agency within the required time period;

(4) Determine whether immediate action is required to be taken with respect to the delegation of tasks to the LNA who made the error; and

(5) Maintain a record of errors in medication administration and actions taken by the delegating licensee for medication nursing assistant program site review.

VI. An LNA who has any reason to believe that he or she has made an error in the administration of medication shall:

(a) Immediately report to the following people a possible or known error in the administration of medication:

(1) The licensee who delegated the task involving the administration of medication; and

(2) The LNA’s immediate supervisor in the facility, institution or agency in which the error occurred, if such supervisor is someone other than the delegating licensee; and

(b) Assist the delegating licensee and the immediate supervisor in the setting in which the error occurred in the completion of any document for reporting error which may be required to be completed.

326-B:24 Delegation; Circumstances Not Subject to Disciplinary Action.

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 nursing activities or tasks or refusing to provide training related to such delegation when the licensee has determined that such delegation may compromise client safety.

326-B:25 Duration of Initial Licenses. All initial licenses, other than temporary licenses, are valid from the date of issuance until midnight of the date of birth of the licensee in the year following the year in which the license was issued unless their validity has been continued in accordance with RSA 326-B:26, III.

326-B:26 Biennial Renewal of Licenses; Lapsed Licenses.

I. All license renewals shall be on a biennial basis.

II. Any person licensed under this chapter who intends to continue practicing nursing or nursing-related activities shall, by midnight on his or her date of birth in the renewal year, complete continuing education requirements, complete continuing competence requirements, pay the renewal fee and submit a completed application for license renewal. The payment of the renewal fee and the completed application must be at the board’s office no later than midnight on the applicant’s date of birth in the renewal year. The board shall mail a renewal application form with instructions to each licensee at the address on file with the board at least 30 days before the licensee’s application deadline. However, failure by the licensee to receive the application form with instructions shall not relieve the licensee of the obligation to meet the deadline. The board shall not renew any license issued under this chapter unless it is satisfied that the applicant for renewal is of good character, as character relates to nursing or nursing-related activities.

III. If an applicant for license renewal has met the requirements of paragraph II, a license previously issued to the applicant under this or a predecessor chapter shall continue valid and in effect pending the decision by the board on the application for renewal.

IV. If an applicant for license renewal has not met the requirements of paragraph II, any license previously issued to the applicant under this or a predecessor chapter shall lapse at midnight of the applicant’s date of birth in the renewal year. A holder of a lapsed license shall not practice nursing or nursing-related activities until the license has been reinstated.

V. Application for reinstatement of a license 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:27 Temporary Licensure.

I. The board may issue temporary licenses valid for no more than 180 days to applicants described in paragraph II, and may renew such temporary licenses in accordance with rules adopted pursuant to RSA 541-A. A temporary license shall become void on the date the board denies the permanent license sought by the holder of the temporary license.

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:17, III 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:17, I 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:17, II who have met all of the requirements of that paragraph and are awaiting the board’s decision on their application for permanent licensure.

(d) Applicants for licensure under RSA 326-B:17, II who have met all requirements except for any continuing competence requirements applicable to them.

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:28 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 as soon as such change occurs.

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:29 Continuing Education. Applicants for license renewal and license reinstatement after lapse shall complete continuing education as follows:

I. An LNA shall complete 12 contact 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 contact hours in medication administration.

II. An LPN or an RN shall complete 30 contact 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 contact hours of continuing education every 2 years; 20 contact hours of which shall be specific to the specialty for which renewal or reinstatement is sought, and 5 contact hours of which shall be training in pharmacology appropriate to the specialty for which license renewal or reinstatement is sought.

326-B:30 Continuing Competence.

I. Applicants for first licensure, license renewal, or license reinstatement after lapse shall have or maintain continuing competence in their area of licensure and may be required to achieve and demonstrate such competence as a condition of licensure, license renewal, or license reinstatement.

II. In addition, individuals seeking reinstatement of their licenses after disciplinary denial of license renewal, disciplinary suspension or disciplinary revocation, or seeking the removal of disciplinary limitations placed on their licenses, may be required to achieve and demonstrate continuing competence as a condition of license reinstatement or the removal of limitations.

326-B:31 Education Programs.

I. The board shall approve, disapprove, and withdraw approval for education programs intended to prepare students for licensure or for certification. An educational institution or other entity conducting such an education program shall comply with rules consistent with paragraphs II and III and adopted by the board pursuant to RSA 541-A.

II. With respect to the education programs named in paragraph I, the board is authorized to establish:

(a) Minimum qualification of faculty and administrators.

(b) The content of the curriculum.

(c) The minimum number of hours of instruction and clinical work.

(d) Any standards to be met for successful completion of the programs which may be additional to any required by the entities conducting the programs.

(e) Procedures for initial, full, and conditional approval of the programs by the board.

(f) Qualifications for entrance into education programs intended to prepare LNAs to become medication nursing assistants, which qualifications may be additional to any required by the entities conducting the programs.

(g) Application procedures for entrance into education programs intended to prepare LNAs to become medication nursing assistants, which procedures may be additional to any required by the entities conducting the programs.

(h) Administrative organization of education programs intended to prepare LNAs to become medication nursing assistants.

(i) The content of, and standards for passing, examinations administered by education programs intended to prepare LNAs to become medication nursing assistants.

III. Education programs shall include:

(a) Curricular topics consistent with the knowledge and skills required for the licensure or certification and for the practice for which they are designed to prepare.

(b) Instruction administered and organized in accordance with established educational principles.

(c) Content relating to the biological, physical, social, behavioral and nursing and medical sciences.

IV. The board shall periodically survey all education programs intended to prepare students for licensure or certification under this chapter to determine compliance with this section and the rules adopted by the board. If an education program is in overall compliance, the board shall grant initial, full, or conditional approval.

V. If the board determines that an education program does not comply with the requirements of this section and the rules adopted by the board, the board shall notify the education program of the specific areas of noncompliance.

VI. The board shall withdraw approval from any education program failing to correct specified areas of noncompliance within a time period established by rules adopted by the board, provided that such action shall be taken only after consultation with representatives of the program.

VII. 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 board’s rules and the program has been approved by the regulatory authority of its state.

326-B:32 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:33 Duties of Licensees Relating to Reports of Sexual Relations.

I. In this section:

(a) “Former client” means a person who was diagnosed or treated by a licensee of the board within the 2 years prior to the sexual relations in question.

(b) “Sexual relations” means the intentional touching of any part of the client’s body, or any verbal or non-verbal communication, for the purpose of sexual arousal or gratification of either party.

II. If, during the course of diagnosis or treatment by a licensee, a client alleges that another counselor or health care practitioner licensed by the board of nursing or any other 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.

III. 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 licensee of a state licensing or certifying agency when the disclosure is made in good faith and made to the board of nursing or any other state licensing or certifying agency

IV. If the client of a licensee on the client’s own initiative reports to the board of nursing sexual relations with a licensee of another state agency, the licensee shall provide support and advocacy to the client, either directly or indirectly through referral.

326-B:34 Privileged Communications Between Licensees and Their Clients.

I. Confidential communications between licensees and their clients are placed on the same basis 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 under this chapter;

(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:35 Confidentiality of Information. Any reports, information or records provided to the board by an individual, agency, facility, institution, or organization pursuant to this chapter shall be confidential insofar as the reports, information or records identify or permit identification of any client. However, the board may disclose confidential information:

I. When required to do so by this chapter or any other law.

II. When the information is relevant, during an adjudicative hearing or informal conference before the board.

III. In an agreement to settle a matter subject to adjudicative hearing, when the information constitutes or pertains to the basis of board action.

326-B:36 Emergency Treatment; Assisting the Board; Immunity From Civil Liability.

I. No person authorized 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 both outside 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.

326-B:37 Disciplinary Action; Misconduct.

I. In order to assure the citizens of New Hampshire a reasonable standard of nursing care 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 paragraph III of this section and which specifies the grounds for such complaint.

(c) Upon notification by the licensing authority of another jurisdiction that a licensee’s license has been disciplined in that jurisdiction.

II. The board shall conduct an investigation of any person licensed by the board who has had brought against him or her 3 reservable claims, written complaints, or actions for medical injury, or any combination thereof, which pertain to 3 different acts or events within any consecutive 5-year period. For the purpose of this paragraph, “medical injury” means any adverse, untoward or undesired consequences arising out of or sustained in the course of professional services rendered by a licensee, whether resulting from negligence, error, or omission in the performance of such services; from rendition of such services without informed consent or in breach of warranty or in violation of contract; from failure to diagnose; from premature abandonment of a patient or of a course of treatment; from failure properly to maintain equipment or appliances necessary to the rendition of such services; or otherwise arising out of or sustained in the course of such services.

III. Misconduct sufficient to support disciplinary proceedings under this section shall include:

(a) Knowingly or negligently, whether or not intentionally, providing inaccurate material information to the board or failing to provide complete and truthful material information upon inquiry by the board, including during the process of license application.

(b) Conviction of a felony or any criminal act, not including traffic offenses, or failure to report such conviction within 30 days.

(c) Unethical or unprofessional conduct, including sexual relations with a client as defined in RSA 326-B:33.

(d) Failure to provide care with reasonable skill, safety and regard for patient rights, with or without actual patient injury.

(e) Actual or potential inability to render care with reasonable skill and safety by reason of illness, use of alcohol, drugs, chemicals, or any other material, or as a result of mental or physical conditions.

(f) Disciplinary action by a licensing authority in another jurisdiction.

(g) Failure to take appropriate action to safeguard individuals from incompetent counselors and health care practitioners, whether or not they are licensed in this state.

(h) Violations of any provision of this chapter, any substantive rule adopted by the board pursuant to RSA 541-A, or any other state or federal statute or substantive rule reasonably related to the licensee’s ability to safely practice nursing or nursing-related activities.

IV. 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 license 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.

V. 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 shorthand 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.

VI. 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 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 subpoenas 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 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 reduced to 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 under this chapter 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 under this chapter.

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, including a CGN, 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 acceptable to 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 any certified unlicensed graduate nurse who has been engaged in this state in nursing the sick for hire without assuming in any way to be an RN, as a bona fide occupation previous to July 1, 1959 and who was certified prior to January 1, 1975.

V. 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.

VI. 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 engagement not to exceed 2 months.

VII. 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 establishing criteria for the administration of medications, and for the process of approving an RN to conduct the medication administration educational program.

326-B:44 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 under this chapter.

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.

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:8, which shall be credited to the board of nursing’s nursing assistant fund.

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].

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.

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.

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 [326-B:10] 326-B:13.

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.

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 [326-B:10] 326-B:13.

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 [326:B] 326-B:13.

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:13 as psychiatric nurse practitioners.

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:13 may refer to themselves as psychotherapists.

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 [326-B:10] 326-B:13.

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:13, 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.

14 Effective Date. This act shall take effect July 1, 2006.