CHAPTER TWO
LICENSURE: R.N., L.P.N.,
AND L.P.T.N.
SECTION I
QUALIFICATIONS
A. Good moral
character.
B. Completion of an
approved high school course of study or the equivalent as determined by the
appropriate educational agency.
C.
Completion of the required approved nursing education program. (LPN and LPTN
requirements may be waived if applicant is determined to be otherwise
qualified.)
D. The Arkansas State
Board of Nursing (ASBN) may refuse to admit to the examination any candidate
and refuse to issue a license, certificate or registration to any applicant if
the license, practice privilege, certificate or registration of such person has
been revoked or suspended or placed on probation and not reinstated by the
jurisdiction which took such action.
E. Effective January 1, 2000, no person shall
be eligible to receive or hold a license issued by the board if that person has
pleaded guilty or nolo contendere to, or been found guilty by any court in the
State of Arkansas, or of any similar offense by a court in another state, or of
any similar offense by a federal court of any offense listed in ACA §
17-87-312.
SECTION II
EXAMINATION
A.
ELIGIBILITY
The applicant shall meet the licensure requirements of the
Board.
B.
APPLICATION
1. Applications for
examination shall be completed, certified and filed with the Board prior to the
examination.
2. One 2x3-inch
photograph, signed by the applicant, shall be filed with the
application.
3. Examination
applications shall be notarized. The application shall not be acceptable if the
director or chairman of an educational program has certified the applicant
prior to date of completion.
4.
Applicants for licensure by examination shall not be deemed eligible to take
the licensure examination until such time that the results of the state and
federal criminal background checks have been received.
C.
FEE
1. The examination fee shall accompany the
application.
2. The examination fee
(first time or retake) is not refundable.
3. The fees for the state and federal
criminal background checks are the responsibility of the applicant and shall be
submitted to the Arkansas State Police with the application for same.
4. The fees are determined by the Arkansas
State Police and the FBI and are not refundable.
D.
PASSING SCORE
The passing score on the licensure examination shall be
determined by the Board.
E.
FAILING SCORE AND ELIGIBILITY TO RETAKE THE EXAMINATION
1. Any applicant whose score falls below the
passing score shall fail the examination.
2. Persons failing the examination will be
responsible for preparing to retake the examination.
3. The frequency and number of retests by
unsuccessful candidates shall be determined by the Board.
4. Applicants retaking the examination shall
have state and federal criminal background checks within the past twelve months
on file with the Board.
F.
RESULTS
1. Examination results shall not be released
until a copy of the applicant's transcript is received from the
school.
2. Examination results
shall be mailed to all applicants and to their respective schools.
G.
FOREIGN EDUCATED
NURSES
1. The applicant must present
evidence of:
a. Graduation from an approved or
accredited school of nursing. The Board may waive this requirement for LPN and
LPTN applicants provided they are otherwise qualified.
b. Licensure or proof of eligibility for
licensure in the country of graduation.
c. Theory and practice in medical, surgical,
pediatric, obstetric and psychiatric nursing which is substantially similar in
length and content to that in equivalent Arkansas Board approved nursing
programs at the time of application as verified by a credentials review
agency.
d. State and federal
criminal background checks within the past twelve months on file with the
Board.
e. Credentials review that
includes verification of the candidate's education, training, experience and
licensure with respect to the statutory and regulatory requirements for the
nursing profession, as well as oral and written competence in
English.
2. L.P.N,
applicants must have evidence of all the foregoing with the exception of
psychiatric nursing, in which theory only is required.
3. Transcripts and certificates which are not
in English must be accompanied by a certified translation.
4. Applicants shall be required to take such
licensure examinations as required of Arkansas Board approved nursing
programs.
H.
EQUIVALENCIES
1. LPN to LPTN:
Candidates holding LPN licensure may, with the approval of the Board's
representative, take the requisite psychiatric nursing courses in a Board
approved LPTN program to meet the Board's requirements for LPTN licensure by
examination at the time of application.
2. LPTN to LPN: Candidates holding LPTN
licensure who completed Arkansas Board approved LPTN programs after March 18,
1980, may be admitted to the LPN licensure examination provided they are
otherwise qualified.
3. RN
examination failures: Graduates of Board approved R.N. programs, upon
submission of an official transcript directly from the school, and a copy of
their R.N. examination failure results, may be admitted to the LPN licensure
examination provided they are otherwise qualified.
4. Portion of RN Program: Candidates who have
completed equivalent courses in a state approved program of nursing may be
admitted to the LPN licensure examination provided they are otherwise
qualified. Evidence must be provided verifying successful completion of
classroom instruction and clinical practice substantially similar to the
minimum requirements for practical nursing programs.
SECTION III
INTERSTATE NURSE
LICENSURE COMPACT
A.
DEFINITIONS OF TERMS IN THE COMPACT
For the purpose of the Compact:
1. "Board" means party state's regulatory
body responsible for issuing nurse licenses.
2. "Information system" means the coordinated
licensure information system.
3.
"Primary state of residence" means the state of a person's declared fixed
permanent and principal home for legal purposes; domicile.
4. "Public" means any individual or entity
other than designated staff or representatives of party state Boards or the
National Council of State Boards of Nursing, Inc.
5. "Alternative program" means a voluntary,
non-disciplinary monitoring program approved by a nurse licensing
board.
6. "Coordinated Licensure
Information System" means an integrated process for collecting, storing, and
sharing information on nurse licensure and enforcement activities related to
nurse licensure laws, which is administered by a non-profit organization
composed of state nurse licensing boards.
7. "Home state" means the party state which
is the nurse's primary state of residence.
8. "Multistate licensure privilege" means
current, official authority from a remote state permitting the practice of
nursing as either a registered nurse or a licensed practical/vocational nurse
in such party state.
9. "Nurse"
means a registered nurse or licensed practical nurse, as those terms are
defined by each party's state practice laws.
10. "Party state" means any state that has
adopted this Compact.
11. "Remote
state" means a party state, other than the home state,
(a) where the patient is located at the time
nursing care is provided, or,
(b)
in the case of the practice of nursing not involving a patient, in such party
state where the recipient of nursing practice is located.
12. "Current significant investigative
information" means:
(a) investigative
information that a licensing board, after a preliminary inquiry that includes
notification and an opportunity for the nurse to respond if required by state
law, has reason to believe is not groundless and, if proved true, would
indicate more than a minor infraction; or
(b) investigative information that indicates
that the nurse represents an immediate threat to public health and safety
regardless of whether the nurse has been notified and had an opportunity to
respond.
13. Licensed
Practical Nurse or Licensed Vocational Nurse means a person who has been
licensed as an LPN or LVN by a party state licensing board.
Other terms used in these rules are to be defined as in the
Interstate Compact.
B.
ISSUANCE OF A LICENSE BY A COMPACT
PARTY STATE
For the purpose of this Compact:
1. A nurse applying for a license in a home
party state shall produce evidence of the nurses' primary state of residence.
Such evidence shall include a declaration signed by the licensee. Further
evidence that may be requested may include but is not limited to:
a. Driver's license with a home
address;
b. Voter registration card
displaying a home address; or
c.
Federal income tax return declaring the primary state of residence.
2. A nurse changing primary state
of residence, from one party state to another party state, may continue to
practice under the former home state license and multistate licensure privilege
during the processing of the nurse's licensure application in the new home
state for a period not to exceed thirty (30) days.
3. The licensure application in the new home
state of a nurse under pending investigation by the former home state shall be
held in abeyance and the thirty (30) day period in section B.2. shall be stayed
until resolution of the pending investigation.
4. The former home state license shall no
longer be valid upon the issuance of a new home state license.
5. If a decision is made by the new home
state denying licensure, the new home state shall notify the former home state
within ten (10) business days and the former home state may take action in
accordance with that state's laws and rules.
6. Party states shall recognize and honor
either the LPN or LVN title used for Licensed Practical Nurses and Licensed
Vocational Nurses, respectively.
C.
LIMITATIONS ON MULTISTATE LICENSURE
PRIVILEGE
Home state Boards shall include in all licensure disciplinary
orders and/or agreements that limit practice and/or require monitoring the
requirement that the licensee subject to said order and/or agreement will agree
to limit the licensee's practice to the home state during the pendency of the
disciplinary order and/or agreement. This requirement may, in the alternative,
allow the nurse to practice in other party states with prior written
authorization from both the home state and such other party state
Boards.
D.
INFORMATION SYSTEM
1. Levels of
access
a. The public shall have access to
nurse licensure information limited to:
(1)
the nurse's name,
(2)
jurisdiction(s) of licensure,
(3)
license expiration date(s),
(4)
licensure classification(s) and status(es),
(5) public emergency and final disciplinary
actions, as defined by contributing state authority, and (6) the status of
multistate licensure privileges.
b. Non-party state Boards shall have access
to all Information System data except current significant investigative
information and other information as limited by contributing party state
authority.
c. Party state Boards
shall have access to all Information System data contributed by the party
states and other information as limited by contributing non-party state
authority.
2. The
licensee may request in writing to the home state Board to review the data
relating to the licensee in the Information System. In the event a licensee
asserts that any data relating to him or her is inaccurate, the burden of proof
shall be upon the licensee to provide evidence that substantiates such claim.
The Board shall verify and within ten (10) business days correct inaccurate
data to the Information System.
3.
The Board shall report to the Information System within ten (10) business days:
a. Disciplinary action, agreement or order
requiring participation in alternative programs or which limit practice or
require monitoring (except agreements and orders relating to participation in
alternative programs required to remain nonpublic by contributing state
authority),
b. Dismissal of
complaint, and
c. Changes in status
of disciplinary action, or licensure encumbrance.
4. Current significant investigative
information shall be deleted from the Information System within ten (10)
business days upon report of disciplinary action, agreement or order requiring
participation in alternative programs or agreements which limit practice or
require monitoring or dismissal of a complaint.
5. Changes to licensure information in the
Information System shall be completed within ten (10) business days upon
notification by a Board.
SECTION IV
ENDORSEMENT
A.
ELIGIBILITY
1. An applicant for licensure by endorsement
must meet the requirements of the Board at the time of graduation.
2. An applicant licensed in another state
after January 1950 must have taken a state board licensing examination and
achieved a passing score.
3. LPTN
applicants will be accepted from California and Kansas only.
B.
EQUIVALENCIES
1. R.N. examination failures: Graduates of
Board approved RN programs, holding LPN licensure by examination in other
jurisdictions, may be endorsed provided they are otherwise qualified.
2. Canadian Registered Nurses licensed by NLN
State Board Test Pool Examination in the following provinces during the years
indicated: Alberta, 1952-1970; British Columbia, 1949-1970; Manitoba,
1955-1970; Newfoundland, 1961-1970; Nova Scotia, 1955-1970; Prince Edward
Island, 1956-1970; Quebec (English language), 1959-1970; and Saskatchewan,
1956-1970. These applicants may be endorsed provided they are otherwise
qualified.
3. Portion of RN
Program: Candidates who have completed equivalent courses in a state approved
program of nursing may be endorsed provided they are otherwise qualified.
Evidence must be provided verifying successful completion of classroom
instruction and clinical practice substantially similar to the minimum
requirements for practical nursing programs.
C.
APPLICATION
1. Applications must be completed, certified,
accompanied by a 2x3-inch photograph signed by the applicant, and filed with
the Board.
2. Endorsement
certification will be accepted from the state of original licensure
only.
3. Applicants for licensure
by endorsement shall not be issued a permanent license to practice until such
time that the results of the state and federal criminal background checks have
been received.
D.
FEE
1. The endorsement fee must
accompany the application.
2. The
fees for the state and federal criminal background checks are the
responsibility of the applicant and shall be submitted to the Arkansas State
Police with the application for same.
3. The fees are not refundable.
SECTION V
CRIMINAL BACKGROUND CHECK
A. No
application for issuance of an initial license will be considered without state
and federal criminal background checks by the Arkansas State Police and the
Federal Bureau of Investigation.
B.
Each applicant shall sign a release of information on the criminal background
check application and licensure applications and shall be solely responsible
for the payment of any fees associated with the state and federal criminal
background checks to the Arkansas State Police.
C. Upon completion of the state and federal
criminal background checks, the Identification Bureau of the Arkansas State
Police shall forward all information obtained concerning the applicant in the
commission of any offense listed in ACA §
17-87-312.
D. The state and federal criminal background
checks conducted by the Arkansas State Police and the Federal Bureau of
Investigation shall have been completed no earlier than twelve (12) months
prior to the application for an initial license issued by the ASBN and at any
other time thereafter that the Board deems necessary.
E. The ASBN shall not issue a permanent
license until the state and federal criminal background checks conducted by the
Arkansas State Police and the Federal Bureau of Investigation have been
completed.
F. A request to seek
waiver of the denial of licensure pursuant to the provisions of ACA §
17-87-312
may be made to the ASBN by:
(1) the affected
applicant for licensure, or
(2) the
person holding a license subject to revocation.
G. The request for a waiver shall be made in
writing to the Executive Director or the designee within thirty (30) calendar
days after notification of denial of a license. The request for waiver shall
include, but not be limited to the following:
(1) certified copy of court records
indicating grounds for conviction,
(2) any other pertinent documentation to
indicate surrounding circumstances.
H. If an individual notifies ASBN in writing
that he/she desires a hearing regarding their request for a waiver, the ASBN
will schedule the individual for a hearing pursuant to the Arkansas
Administrative Procedures Act.
I.
In compliance with Act 1393 of 2003, whenever a criminal background check is
performed on a person under the provisions of the criminal background check
requirement contained in the Arkansas Code for licensure, the person may be
disqualified for licensure if it is determined that the person committed a
violation of any sexual offense formerly proscribed under ACA §§
5-14-101 through
5-14-127
that is substantially equivalent to any sexual offense presently listed in
Arkansas Code §§
5-14-101 through
5-14-127
and is an offense screened for in a criminal background check.
SECTION VI
TEMPORARY
PERMITS
A.
ENDORSEMENT AND EXAM
APPLICANTS
1. ASBN shall be authorized
to issue a temporary permit for a period not exceeding six months. This
temporary permit shall be issued only to those applicants who meet all other
qualifications for licensure by the ASBN.
2. The temporary permit shall immediately
become invalid upon receipt of information obtained from the federal criminal
background check indicating any offense listed in ACA §
17-87-312
or upon notification to the applicant or ASBN of results on the first licensure
examination he or she is eligible to take after the permit is issued.
3. Falsification of the applicant's criminal
record history shall be grounds for disciplinary action by the Board.
B.
FEES AND
APPLICATIONS
1. The temporary permit
fee shall be submitted with the application.
2. The fee is not refundable.
SECTION VII
CONTINUING EDUCATION
Each person holding an active license or applying for
reinstatement of a license under the provisions of the Nurse Practice Act shall
be required to complete certain continuing education requirements prior to
licensure renewal or reinstatement.
A.
DECLARATION OF COMPLIANCE
Each nurse shall declare his/her compliance with the requirements
for continuing education at the time of license renewal or reinstatement. The
declaration shall be made on the form supplied by the Board.
B.
AUDITS OF LICENSEES
1. The Board shall perform random audits of
licensees for compliance with the continuing education requirement.
2. If audited, the licensee shall prove
participation in the required continuing education during the 24-months
immediately preceding the renewal date by presenting photocopies of original
certificates of completion to the Board.
3. The licensee shall provide evidence of
continuing education requirements within thirty (30) calendar days from the
mailing date of the audit notification letter sent from the Board to the last
known address of the licensee.
C.
CONTINUING EDUCATION REQUIREMENT
STANDARDS
1. Standards for Renewal of
Active Licensure Status
Licensees who hold an active nursing license shall document
completion of one of the following during each renewal period:
a. Fifteen (15) practice focused contact
hours from a nationally recognized or state continuing education approval body
recognized by the ASBN; or
b.
Certification or re-certification during the renewal period by a national
certifying body recognized by the ASBN; or
c. An academic course in nursing or related
field; and
d. Provide other
evidence as requested by the Board.
2. Standards for Nurses on Inactive Status
Nurses who have their license placed on inactive status have no
requirements for continuing education.
3. Standards for Reinstatement of Active
Licensure Status
a. Nurses reinstating a
nursing license to active status after five years or less shall document
completion of the following within the past two (2) years:
i) Twenty (20) practice focused contact hours
within the past two years from a nationally recognized or state continuing
education approval body recognized by the ASBN, or
ii) Certification or re-certification by a
national certifying body recognized by the ASBN; or
iii) An academic course in nursing or related
field; and/or
iv) Provide other
evidence as requested by the Board.
b. Nurses reinstating a nursing license to
active status after greater than five years shall document completion of the
following within the past two (2) years:
i)
Twenty (20) practice focused contact hours within the past two years from a
nationally recognized or state continuing education approval body recognized by
the Arkansas State Board of Nursing, or
ii) Certification or re-certification by a
national certifying body recognized by the ASBN; or
iii) An academic course in nursing or related
field; and
iv) A refresher course
approved by the ASBN; or
v) An
employer competency orientation program, and
vi) Provide other evidence as requested by
the Board.
4.
The Board may issue a temporary permit to a nurse during the time enrolled in a
Board-approved nursing refresher course or an employer competency orientation
program upon submission of an application, fees and verification of enrollment
in such program.
5. Continuing
education hours beyond the required contact hours shall not be "carried over"
to the next renewal period.
D.
RESPONSIBILITIES OF THE INDIVIDUAL
LICENSEE
1. It shall be the
responsibility of each licensee to select and participate in those continuing
activities that will meet the criteria for acceptable continuing education as
specified in A.C.A. §
17-87-207
and these regulations.
2. It shall
be the licensee's responsibility to maintain records of continuing education as
well as documented proof such as original certificates of attendance, contact
hour certificates, academic transcripts or grade slips and to submit copies of
this evidence when requested by the Board. 3. Records shall be maintained by
the licensee for a minimum of two consecutive renewal periods or four
years.
E.
RECOGNITION OF PROVIDERS
1. The Board
shall identify organizations, agencies, and groups that shall be recognized as
valid approval bodies/providers of nursing continuing education. The
recognition may include providers approved by national organizations and state
agencies with comparable standards.
2. The Board shall work with professional
organizations, approved nursing schools, and other providers of continuing
educational programs to ensure that continuing education activities are
available to nurses in Arkansas.
F.
ACTIVITIES ACCEPTABLE FOR
CONTINUING EDUCATION
1. Activities
presented by recognized providers which may be acceptable include: national/
regional educational conferences, classroom instruction, individualized
instruction (home study/programmed instruction), academic courses, and
institutional based instruction; and
2. The educational activity shall be at least
one contact hour in length.
3. The
content shall be relevant to nursing practice and provide for professional
growth of the licensee.
4. If
participation is in an academic course or other program in which grades are
given, a grade equivalent to "C" or better shall be required, or "pass" on a
pass/fail grading system. An academic course may also be taken as "audit",
provided that class attendance is verified by the instructor.
G.
ACTIVITIES WHICH ARE NOT
ACCEPTABLE AS CONTINUING EDUCATION
1.
Inservice programs. Activities intended to assist the nurse to acquire,
maintain, and/or increase the competence in fulfilling the assigned
responsibilities specific to the expectations of the employer.
2. Refresher courses. Programs designed to
update basic general knowledge and clinical practice, which consist of a
didactic and clinical component to ensure entry level competencies into nursing
practice.
3. Orientation programs.
A program by which new staff are introduced to the philosophy, goals, policies,
procedures, role expectations, physical facilities and special services in a
specific work setting. Orientation is provided at the time of employment and at
other times when changes in roles and responsibilities occur in a specific work
setting.
4. Courses designed for
lay people.
H.
INDIVIDUAL REVIEW OF A CONTINUING EDUCATION ACTIVITY PROVIDED BY A
NON-RECOGNIZED AGENCY/ORGANIZATION
1.
A licensee may request an individual review by:
a. Submitting an "Application for Individual
Review".
b. Paying a fee.
2. Approval of a non-recognized
continuing educational activity shall be limited to the specific event under
consideration.
I.
FAILURE TO COMPLY
1. Any licensee who
fails to complete continuing education or who falsely certifies completion of
continuing education shall be subject to disciplinary action, non-renewal of
the nurse's license, or both, pursuant to A.C.A. §
17-87-207
and A.C.A §
17-87-309(a)(1)
and (a)(6).
2. If the Board determines that a licensee
has failed to comply with continuing education requirements, the licensee will:
a. Be allowed to meet continuing education
requirements within ninety(90) days of notification of
non-compliance.
b. Be assessed a
late fee for each contact hour that requirements are not met after the ninety
(90) day grace period and be issued a Letter of Reprimand. Failure to pay the
fee may result in further disciplinary action.
SECTION VIII
RENEWALS
A.
Each person licensed under the provisions of the Nurse Practice Act shall renew
biennially.
1. Thirty (30) days prior to the
expiration date, the Board shall mail a renewal application to the last known
address of each nurse to whom a license was issued or renewed during the
current period.
2. The application
shall be completed before the license renewal is processed.
3. The fee for renewal shall accompany the
application.
4. The fee is not
refundable.
5. Pursuant to Act 996
of 2003 and upon written request and submission of appropriate documentation,
members of the Armed Forces of the United States who are Arkansas residents and
are ordered to active duty to a duty station located outside of this state
shall be allowed an extension without penalty or assessment of a late fee for
renewing the service members nursing license. The extension shall be effective
for the period that the service member is serving on active duty at a duty
station located outside of this state and for a period not to exceed six months
after the service member returns to the state.
B.
LAPSED LICENSE
1. The license is lapsed if not renewed or
placed in inactive status by the expiration date.
2. Failure to receive the renewal notice at
the last address of record in the Board office shall not relieve the licensee
of the responsibility for renewing the license by the expiration
date.
3. Any licensee whose license
has lapsed shall file a renewal application and pay the current renewal fee and
the reinstatement fee.
4. Any
person practicing nursing during the time his or her license has lapsed shall
be considered an illegal practitioner and shall be subject to the penalties
provided for violation of the Nurse Practice Act.
C.
INACTIVE STATUS
1. Any licensee in good standing, who desires
to retire temporarily from the practice of nursing in this state, shall submit
a request in writing and the current license shall be placed on inactive status
from the date of expiration.
2.
While inactive, the licensee shall not practice nursing nor be subject to the
payment of renewal fees.
3. When
the licensee desires to resume practice, he or she shall request a renewal
application, which shall be completed and submitted with a reinstatement fee
and the renewal fee and must meet those requirements outlined in Section
VII.
4. When disciplinary proceedings have been
initiated against an inactive licensee, the license shall not be reinstated
until the proceedings have been completed.
D.
RETIRED NURSE
1. Any licensee in good standing, who desires
to retire for any length of time from the practice of nursing in this state,
shall submit a request in writing, surrender the current license, and pay the
required fee and the current license shall be placed on inactive status and a
retired license issued.
2. A
retired license shall be renewed biennially following submission of a renewal
application and fee.
3. Fees are
non-refundable.
4. While retired,
the licensee shall not practice nursing, however:
a. A registered nurse with a retired license
may use the title "Registered Nurse", or the abbreviation "RN"; and
b. A practical nurse with a retired license
may use the title "Licensed Practice Nurse", or the abbreviation "LPN";
and
c. A psychiatric technician
nurse with a retired license may use the title "Licensed Psychiatric Technician
Nurse", or the abbreviation "LPTN".
5. When the licensee desires to resume
practice, he or she shall request a renewal application, which shall be
completed and submitted with a reinstatement fee and the active renewal fee.
The licensee must also meet those requirements outlined in Section
VII.
6. If the retired license is allowed to
lapse, the licensee shall not hold himself or herself out as an RN, LPN or LPTN
and shall pay a reinstatement fee in addition to the fee required for renewal
of the retired license.
7. When
disciplinary proceedings have been initiated against a retired licensee, the
license shall not be reinstated until the proceedings have been
completed.
E. The
licensee may be required to submit to a state and federal criminal background
check if the Board deems it necessary.
SECTION IX
DUPLICATE LICENSE
A. A duplicate license or certificate shall
be issued when the licensee submits a notarized statement to the Board that the
document is lost, stolen, or destroyed, and pays the required fee.
B. The license will be marked
"duplicate".
SECTION X
CERTIFICATION/VERIFICATION TO ANOTHER
JURISDICTION
Upon payment of a certification/verification fee, a nurse seeking
licensure in another state may have a certified statement of Arkansas licensure
issued to the Board of Nursing in that state.
SECTION XI
NAME OR ADDRESS
CHANGE
A. A licensee, whose name is
legally changed, shall be issued a replacement license following submission of
the current license, along with a notarized statement, copy of marriage license
or court action, and the required fee.
B. A licensee, whose address changes from the
address appearing on the current license, shall immediately notify the Board in
writing of the change.
Effective December 1,
2
005
CHAPTER
FIVE
DELEGATION
A.
PURPOSE
Registered nurses, licensed practical nurses and licensed
psychiatric technician nurses, within the parameters of their education and
experience, are responsible for all nursing care that a client receives under
their direction. Assessment of the nursing needs of a client, the plan of
nursing actions, implementation of the plan, and evaluation of the plan, under
the direction of a registered professional nurse, are essential components of
nursing practice. Unlicensed personnel may be used to complement the licensed
nurse in the performance of nursing functions; but such personnel cannot be
used as a substitute for the licensed nurse.
Delegation by registered nurses, licensed practical nurses, and
licensed psychiatric technician nurses must fall within the definitions of Ark.
Code Ann. 3
17-87-102.
Delegation must occur within the framework of the job description of the
delegatee and organizational policies and procedures, and must be in compliance
with the Arkansas Nurse Practice Act. The following sections govern the
licensed nurse in delegating and supervising nursing tasks to unlicensed
personnel in all settings.
B.
CRITERIA FOR DELEGATION
1. Delegation of nursing tasks to unlicensed
persons shall comply with the following requirements:
a. A licensed nurse delegating the task is
responsible for the nursing care given to the client and for the final decision
regarding which nursing tasks can be safely delegated.
b. A licensed nurse must make an assessment
of the client=s nursing care needs prior to delegating the nursing task. (Ref.
Section C. for exceptions.)
c. The
nursing task must be one that a reasonable and prudent licensed nurse would
assess to be appropriately delegated; would not require the unlicensed person
to exercise nursing assessment, judgment, evaluation or teaching skill; and
that can be properly and safely performed by the unlicensed person involved
without jeopardizing the client=s welfare.
d. A licensed nurse shall have written
procedures available for the proper performance of each task and shall have
documentation of the competency of the unlicensed person to whom the task is to
be delegated.
e. The delegating
licensed nurse shall be readily available either in person or by
telecommunication.
f. The licensed
nurse shall be responsible for documentation of delegated tasks.
g. Unlicensed nursing students may work only
as unlicensed nursing personnel. They may not represent themselves, or
practice, as nursing students except as part of a scheduled clinical learning
activity in the curriculum of a Board approved nursing program,
h. The licensed nurse shall adequately
supervise the performance of delegated nursing tasks in accordance with the
requirements of supervision which follow.
2. Supervision: The degree of supervision
required shall be determined by the licensed nurse after an evaluation of
appropriate factors involved, including, but not limited to, the following:
a. The stability of the condition of the
client;
b. The training and
capability of the unlicensed person to whom the nursing task is
delegated;
c. The nature of the
nursing task being delegated; and
d.
The proximity and availability of a licensed nurse to the
unlicensed person when performing the nursing task.
C.
SPECIFIC NURSING TASKS
WHICH MAY BE DELEGATED WITHOUT PRIOR NURSING ASSESSMENT
By way of example, and not in limitation, the following nursing
tasks are ones that are within the scope of sound nursing practice to be
delegated, provided the delegation is in compliance with Ark. Code Ann. 3
17-87-102 and the level of supervision required is determined by the
nurse.
1. Noninvasive and nonsterile
treatments unless otherwise prohibited by Section D. of this Chapter (relating
to nursing tasks that may not be routinely delegated);
2. The collecting, reporting and
documentation of data including, but not limited to:
a. Vital signs, height, weight, intake and
output, urine test, and hematest results;
b. Changes from baseline data established by
the nurse;
c. Environmental and
safety situations;
d. Client or
family comments relating to the client's care; and
e. Behaviors related to the plan of
care;
3. Ambulation,
positioning, and turning;
4.
Transportation of the client within a facility;
5. Personal hygiene;
6. Feeding, cutting up of food, or placing of
meal trays;
7. Socialization
activities;
8. Activities of daily
living; and
9. Reinforcement of
health teaching planned and/or provided by the registered nurse.
D.
NURSING TASKS THAT MAY
NOT BE ROUTINELY DELEGATED
1. Nursing
tasks not included in Section C. are not usually within the scope of sound
nursing judgment to delegate and may be delegated only in accordance with
subsection 2. of this section.
2.
The nursing tasks of this section may be delegated to an unlicensed person
only:
a. Under circumstances where a
reasonable and prudent licensed nurse would find that the delegation does not
jeopardize the client's safety and/or welfare;
b. If, in the judgment of the licensed nurse,
the unlicensed person has the appropriate knowledge and skills to perform the
nursing task(s) in a safe and effective manner;
c. If the licensed nurse delegating the task
is directly responsible for the nursing care given to the client;
d. If the agency, facility, or institution,
employing unlicensed personnel, follows a current protocol for the instruction
and training of unlicensed personnel performing nursing tasks under this
subsection; and that said protocol is developed by and taught under the
supervision of registered nurses currently employed in the facility, and
includes:
(1) The manner in which the
instruction addresses the complexity of the delegated task;
(2) The manner in which the unlicensed person
demonstrates competency of the delegated task;
(3) The mechanism for reevaluation of the
competency; and
(4) An established
mechanism for identifying those individuals to whom nursing tasks under this
subsection may be delegated; and
e. If the protocol recognizes that the final
decision as to what nursing tasks can be safely delegated in any specific
situation is within the specific scope of the nurse's professional
judgment.
E.
NURSING TASKS THAT SHALL NOT BE DELEGATED
By way of example, and not in limitation, the following are
nursing tasks that are not within the scope of sound nursing judgment to
delegate:
1. Physical, psychological,
and social assessment which requires nursing judgment, intervention, referral,
or follow-up;
2. Formulation of the
plan of nursing care and evaluation of the client's response to the care
rendered;
3. Specific tasks
involved in the implementation of the plan of care which require nursing
judgment or intervention;
4. The
responsibility and accountability for client health teaching and health
counseling which promotes client education and involves the client's
significant others in accomplishing health goals; and
5. Administration of any medications or
intravenous therapy, including blood or blood products.
6. Receiving or transmitting verbal or
telephone orders;
7. Registered
nurse practitioners and advanced practice nurses shall not delegate to
unlicensed ancillary staff the calling in of prescriptions to the
pharmacy.
F.
TRANSFERENCE OF DELEGATED NURSING TASKS
It is the responsibility of the licensed nurse to assess each
client prior to delegation of a nursing task and determine that the unlicensed
person has the competence to perform the nursing task in that clients
situation.
1. The licensed nurse shall
not transfer delegated tasks to other clients under the care of the unlicensed
person.
2. In delegating personal
care, a licensed nurse is not required to assess each client; but must
periodically assess the competence of the caregiver in those
activities.
G.
EXCLUSIONS
These sections shall not be construed to apply to:
1. The gratuitous nursing care of the sick by
family or friends;
2. The
furnishing of nursing care where treatment is by prayer or spiritual means
alone;
3. Acts done by persons
licensed by any board or agency of the State of Arkansas if such acts are
authorized by such licensing statutes;
4. Nursing tasks performed by nursing
students enrolled in Board approved nursing programs while practicing under the
direct supervision of qualified faculty or preceptors;
5. The instruction and/or supervision of
licensed nurses by registered professional nurses in the proper performance of
tasks as a part of a state approved training/education course designed to
prepare persons to obtain certification:
6. The performance in the school setting of
nursing procedures necessary for students to achieve activities of daily living
as cited in the Education of the Handicapped Act, 20 United States Code
1400-1485, and which are routinely performed by the student or the student=s
family in the home setting.
7. The
acts of unlicensed persons responding to an emergency. This exclusion shall not
be construed as permitting licensed nurses to delegate routinely to unlicensed
persons.
8. Health maintenance
activities performed by a designated care aide in the home as defined in the
Consumer Directed Care Act of 2005, A.C.A. §
17-87-103(11).
H.
CONSUMER DIRECTED
CARE
1. Health maintenance activities
may be provided by a designated care aide for a competent adult at the
direction of the adult or for a minor child or incompetent adult at the
direction of a caretaker.
2.
Caretaker means a person who is directly and personally involved in providing
care for a minor child or incompetent adult, and the parent, foster parent,
family member, friend, or legal guardian of the minor child or incompetent
adult receiving care.
3. Designated
care aide means the person hired by the competent adult or caretaker to provide
care for the competent adult, minor child, or incompetent adult.
4. Health maintenance activities mean
activities that the minor child or adult is unable to perform for himself or
herself.
5. The attending
physician, advanced practice nurse, or registered nurse must determine a
designated care aide under the direction of a competent adult or caretaker can
safely perform the activity in the minor child's or adult's home.
6. Home shall not include nursing home,
assisted living facility, residential care facility, an intermediate care
facility, or hospice care facility.
7. Health maintenance activities that are not
exempted by the Consumer Directed Care Act of 2005 include:
a. Physical, psychological, and social
assessment which requires nursing judgment, intervention, referral, or
follow-up;
b. Formulation of the
plan of nursing care and evaluation of the client's response to the care
rendered;
c. Tasks that require
nursing judgment or intervention;
d. Teaching and health counseling;
e. Administration of any injectable
medications intradermal, subcutaneous, intramuscular, intravenous,
intraosseous, or any other form of injection) or intravenous therapy.
f. Receiving or transmitting verbal or
telephone orders.
8. The
designated care aide must demonstrate the ability ot safely perform the health
maintenance activity.