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Board of Registration in Nursing

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Module 4: Module 4: Competence: A Legal Competence: A Legal

Requirement for Advanced Requirement for Advanced Registered Nursing Scope of Registered Nursing Scope of

PracticePractice

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CompetenceCompetence

244 CMR 9.02244 CMR 9.02 defines Competence as: defines Competence as:

““The application of knowledge and the The application of knowledge and the use of affective, cognitive, and use of affective, cognitive, and

psychomotor skills required for the psychomotor skills required for the role of a nurse licensed by the Board role of a nurse licensed by the Board and for the delivery of safe nursing and for the delivery of safe nursing care in accordance with accepted care in accordance with accepted

standards of practice.”standards of practice.”

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APRN CompetenceAPRN Competence

• Includes only those areas of practice for which Includes only those areas of practice for which the APRN has formal, advanced nursing the APRN has formal, advanced nursing education and documented competencyeducation and documented competency

• Certification is one measure of competenceCertification is one measure of competence

• Additional education obtained through Additional education obtained through experience and/or by principles of continuing experience and/or by principles of continuing education can be another measure of education can be another measure of competencecompetence

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CompetenceCompetence

Involves Responsibility:Involves Responsibility:ResponsibleResponsible to self, patient, employer, to self, patient, employer, profession (for example, following profession (for example, following policies and procedures)policies and procedures)

and Accountability:and Accountability:Accountable Accountable to the Board, employer, to the Board, employer, profession (i.e. adhering to the profession (i.e. adhering to the regulations)regulations)

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Continued CompetenceContinued Competence

The application of knowledge and the The application of knowledge and the

interpersonal, decision-making, and interpersonal, decision-making, and

psychomotor skill expected for nurse’s psychomotor skill expected for nurse’s

practice role, within the context of practice role, within the context of public public

health, welfare and safety.health, welfare and safety.

Ref: Ref: National Council of State Boards of Nursing, 1996National Council of State Boards of Nursing, 1996

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CertificationCertification

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

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Board Requirement for Board Requirement for Certification in Category of Certification in Category of

PracticePractice

• The Board recognizes five The Board recognizes five APRN categories: APRN categories:

• CNP (Nurse Practitioner)CNP (Nurse Practitioner)• CNM (Nurse Midwife)CNM (Nurse Midwife)• PCNS (Psychiatric Clinical Nurse PCNS (Psychiatric Clinical Nurse

Specialist)Specialist)• CRNA (Nurse Anesthetist) CRNA (Nurse Anesthetist) • CNS (Clinical Nurse Specialist)CNS (Clinical Nurse Specialist)

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Board Approved Professional Board Approved Professional Certifying Organizations CNPCertifying Organizations CNP

• American Academy of Nurse Practitioners (AANP) www.aanpcertification.org

• American Nurses Credentialing Center (ANCC) www.nursecredentialing.org

• National Certification Council (NCC) www.nccwebsite.org

• Pediatric Nursing Certification Board (PNCB) www.pncb.org

• American Association of Critical-Care Nurses (AACN) Certification Corporation www.aacn.org

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Professional Certifying Professional Certifying Organization PCNSOrganization PCNS

American Nurses Credentialing Center (ANCC)

www.nursecredentialing.org

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Professional Certifying Professional Certifying Organizations CRNAOrganizations CRNA

Council on Certification and Recertification of Nurse Anesthetists

(CCRNA) aka American Association of Nurse

Anesthetists (AANA)

www.aana.com

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Professional Certifying Professional Certifying Organizations CNMOrganizations CNM

American Midwifery Certification Board American Midwifery Certification Board (AMCB) (AMCB)

aka American College of Nurse aka American College of Nurse Midwives (ACNM) Midwives (ACNM)

www.amcbmidwife.orgwww.amcbmidwife.org

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Professional Certifying Professional Certifying Organizations CNSOrganizations CNS

• American Nurses Credentialing Center (ANCC) www.nursecredentialing.org

• American Association of Critical-Care Nurses (AACN) Certification Corporation www.aacn.org

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APRN PracticeAPRN Practice

• Employment of advanced skillsEmployment of advanced skills• EvaluationEvaluation• DiagnosisDiagnosis• TreatmentTreatment

• Responsible for own practice Responsible for own practice • Formal, advanced nursing education and Formal, advanced nursing education and

documented competency required for documented competency required for population servedpopulation served

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Category vs. Category vs. Specialization Specialization

• Board authorizes APRN practice by Board authorizes APRN practice by category, not by specialization within category, not by specialization within the categorythe category

• Category competency determines:Category competency determines:• Ages of population servedAges of population served• Characteristics of population servedCharacteristics of population served• Medical conditions of population servedMedical conditions of population served• Activities performedActivities performed

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Demonstration of Demonstration of CompetencyCompetency

• Certification (Mandated by Certification (Mandated by Regulation)Regulation)

• ExperienceExperience• On the job trainingOn the job training

• On-going educationOn-going education• Attendance at educational sessionAttendance at educational session• Formal course workFormal course work

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244 CMR 5.00: 244 CMR 5.00: Continuing EducationContinuing Education

• Consists of planned, organized Consists of planned, organized learning experiences designed to learning experiences designed to augment the knowledge, skills, and augment the knowledge, skills, and attitudes for the enhancement of attitudes for the enhancement of nursing practice, to the end of nursing practice, to the end of improving health care to the public.improving health care to the public.

• 15 Contact Hours per renewal 15 Contact Hours per renewal period to maintain RN Licenseperiod to maintain RN License

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Continuing Education to Continuing Education to maintain certificationmaintain certification

• Additional requirements for Additional requirements for continuing education through your continuing education through your professional certifying organizationprofessional certifying organization

• Your responsibility to keep track of Your responsibility to keep track of professional requirements professional requirements

• Review Review Module 3: preparing for Practice as an APRN: Board Module 3: preparing for Practice as an APRN: Board AuthorizationAuthorization for detailed certification information for detailed certification information

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Determining APRN Scope of Determining APRN Scope of PracticePractice

• Describe the practice or activity.Describe the practice or activity.• Is it supported by statute or regulation?Is it supported by statute or regulation?• Does entry into practice education Does entry into practice education

provide the necessary provide the necessary knowledge/skill/ability? Or Continuing knowledge/skill/ability? Or Continuing Education?Education?

• Is this a practice that is consistent with Is this a practice that is consistent with the nursing literature and/or research?the nursing literature and/or research?

• Does the APRN have a documented Does the APRN have a documented competence?competence?

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Scope of APRN Practice - Scope of APRN Practice - continuedcontinued

• Is this within a standard of care Is this within a standard of care that another reasonable & prudent that another reasonable & prudent APRN would do?APRN would do?

• Is the patient’s safety assured?Is the patient’s safety assured?• Is the APRN prepared to accept Is the APRN prepared to accept

accountability for performing the accountability for performing the activity?activity?

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Scope of APRN Practice - Scope of APRN Practice - continuedcontinued

• Apply the Board’s Apply the Board’s Decision-making Decision-making GuidelinesGuidelines to a clinical situation to to a clinical situation to determine if the selected activity is determine if the selected activity is within the APRN’s scope of within the APRN’s scope of practice. practice.

• http://www.mass.gov/eohhs/docs/http://www.mass.gov/eohhs/docs/dph/quality/boards/decision-dph/quality/boards/decision-making.pdfmaking.pdf

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GuidelinesGuidelines

• Except for CNM, required for prescriptive practice

• Mutually developed and agreed upon with the APRN and the physician supervising the APRN’s prescriptive practice.

• Review Review Module 6: Preparing for APRN Prescriptive Practice and Module 6: Preparing for APRN Prescriptive Practice and Guideline DevelopmentGuideline Development for detailed guideline information for detailed guideline information

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Content of GuidelinesContent of Guidelines• identify the supervising physician and APRN;identify the supervising physician and APRN;

• include a defined mechanism for the delegation of supervision to another physician include a defined mechanism for the delegation of supervision to another physician including, but not limited to, duration and scope of the delegation;including, but not limited to, duration and scope of the delegation;

• describe the nature and scope of the APRN's prescribing practice;describe the nature and scope of the APRN's prescribing practice;

• identify any limitations on medications or intravenous therapy to be prescribed;identify any limitations on medications or intravenous therapy to be prescribed;

• describe circumstances in which physician consultation or referral is required for the describe circumstances in which physician consultation or referral is required for the pharmacologic treatment of medical conditions;pharmacologic treatment of medical conditions;

• include a defined mechanism and time frame to monitor prescribing practices;include a defined mechanism and time frame to monitor prescribing practices;

• specify that the initial prescription of Schedule II drugs must be reviewed within 96 specify that the initial prescription of Schedule II drugs must be reviewed within 96 hours; hours;

• be kept on file in the workplace and be reviewed and re-executed every two years; andbe kept on file in the workplace and be reviewed and re-executed every two years; and

• conform to M.G.L. c. 94C, the regulations of the Department of Public Health at 105 conform to M.G.L. c. 94C, the regulations of the Department of Public Health at 105 CMR 700.000 CMR 700.000 et seq.et seq., 105 CMR 721.000 et seq., M.G.L. c. 112, §§ 80B, 80C, 80E, 80G, , 105 CMR 721.000 et seq., M.G.L. c. 112, §§ 80B, 80C, 80E, 80G, 80H, and 244 CMR 4.00.80H, and 244 CMR 4.00.

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Legal DocumentationLegal Documentation

• In all records required by federal and state In all records required by federal and state laws and regulations and accepted standards laws and regulations and accepted standards of nursing practiceof nursing practice• Must be accurate, complete, legibleMust be accurate, complete, legible• Sign name and initials as they appear on Sign name and initials as they appear on

your license (CNP, PCNS, CRNA, CNM, CNS)your license (CNP, PCNS, CRNA, CNM, CNS)

• May use certification credentials on business May use certification credentials on business cards, stationary, advertisements, and other cards, stationary, advertisements, and other similar correspondencesimilar correspondence

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Review 4.00 and 9.00Review 4.00 and 9.00

• Go to the Board’s website to review:Go to the Board’s website to review:• 244 CMR 4.00: Massachusetts 244 CMR 4.00: Massachusetts

Regulations Governing Advanced Regulations Governing Advanced Practice Registered NursingPractice Registered Nursing

• 244 CMR 9.00: Standards of Conduct244 CMR 9.00: Standards of Conduct

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Get into the habit of Get into the habit of Checking the Board’s WebsiteChecking the Board’s Website

www.mass.gov/dph/boards/rnwww.mass.gov/dph/boards/rn

• News and UpdatesNews and Updates• Practice IssuesPractice Issues• AlertsAlerts• Regulatory GuidanceRegulatory Guidance• Advisory RulingsAdvisory Rulings• NewslettersNewsletters

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Board of Registration in NursingBoard of Registration in Nursing239 Causeway Street239 Causeway Street22ndnd Floor, Suite 200 Floor, Suite 200Boston, MA 02114Boston, MA 02114

On-Line RenewalOn-Line Renewal

www.mass.gov/dph/boards/rnwww.mass.gov/dph/boards/rn(go to (go to On Line ServicesOn Line Services in right margin) in right margin)