SECTION II
QUALIFICATIONS FOR LICENSURE
Advanced practice registered nurse (APRN) licensure shall be
designated in one of the four roles below and at least one population focus:
Family/Individual Across the Lifespan, Adult-Gerontology, Neonatal, Pediatrics,
Women's Health/Gender-Related, or Psychiatric/Mental Health (effective 2015). A
current, unencumbered registered nurse license to practice in Arkansas is
required for all categories of advanced practice licensure. Effective January
1, 2003, all applicants for advanced practice licensure by examination shall
have completed a graduate or post-graduate level advanced practice registered
nursing education program. Applicants for advanced practice licensure by
endorsement shall have met the educational and certification requirements set
forth in Arkansas State Board of Nursing Rules at the time of
their initial licensure as an advanced practice registered nurse in another
jurisdiction. APRN roles and their respective qualifications are:
A.
CERTIFIED NURSE PRACTITIONER
(CNP)
1. Successful completion of a
nationally accredited graduate or post-graduate APRN education program that
prepares nurses for the advanced practice role of nurse practitioner;
and
2. Hold current certification
by a national certifying body recognized by the Board of Nursing in the APRN
role and population foci appropriate for educational preparation.
B.
CERTIFIED REGISTERED
NURSE ANESTHETIST (CRNA)
1. Successful
completion of a nationally accredited graduate or post-graduate APRN education
program that prepares nurses to perform as nurse anesthetists; and
2. Hold current certification by a national
certifying body recognized by the Board of Nursing in the APRN role and
population foci appropriate for educational preparation.
C.
CERTIFIED NURSE MIDWIFE (CNM)
1. Successful completion of a nationally
accredited graduate or post-graduate APRN education program that prepares
nurses for the advanced practice role of nurse midwife; and
2. Hold current certification by a national
certifying body recognized by the Board of Nursing in the APRN role and
population foci appropriate for educational preparation; and
3. Written agreement with a consulting
physician if providing intrapartum care.
D.
CLINICAL NURSE SPECIALIST
(CNS)
1. Successful completion of a
nationally accredited graduate or post-graduate APRN education program that
prepares nurses for the advanced practice role of clinical nurse specialist
which shall include supervised clinical practice and classroom instruction in a
nursing clinical practice specialty; and
2. Hold current certification by a national
certifying body recognized by the Board of Nursing in the APRN role and
population foci appropriate for educational preparation.
SECTION III
LICENSURE
A.
ELIGIBILITY
The applicant shall meet the licensure requirements of the
Board.
B.
APPLICATION
FOR LICENSURE BY EXAMINATION
In addition to a current registered nurse license to practice in
Arkansas, the information submitted to the Board shall include:
1. A completed Board application
form;
2. Verification of active
practice of nursing as a registered nurse for a minimum of two-thousand (2,000)
hours, effective July 1,2019;
3. An
official transcript or document from a nursing education program accredited by
a nursing accrediting body that is recognized by the U.S. Secretary of
Education and/or Council for Higher Education Accreditation (CHEA), as
acceptable by the Board and meets the qualifications of Section
II of
this Chapter in the category of advanced practice nursing for which the
applicant is seeking licensure. The transcript or document shall verify the
date of graduation, the degree or certificate conferred, clinical hours
completed, and the role and population focus of the education
program;
4. Evidence of state and
federal criminal background checks conducted by the Arkansas State Police and
the Federal Bureau of Investigation completed no earlier than twelve (12)
months prior to the application for advanced practice licensure;
5. Verification of certification directly
from the Board-approved national certifying body evidencing current
certification in good standing; and
6. Payment of the nonrefundable
fee.
C.
APPLICATION FOR LICENSURE BY ENDORSEMENT
1. The Board may issue a license by
endorsement to an APRN licensed under the laws of another state if, in the
opinion of the Board, the applicant meets the qualifications for licensure in
this state.
2. In addition to the
requirements set forth in Section
II and
III.
A. and
B. of this Chapter, the information submitted
to the Board shall include documentation of current unencumbered advanced
practice licensure/authority to practice in another jurisdiction.
3. An individual applying for
licensure by endorsement who has been out of practice for more than two (2)
years shall provide evidence of passing an APRN nursing refresher course
approved by the Board or an extensive orientation, which shall include a
minimum of 200 hours, in the appropriate advanced practice role and population
focus which includes a supervised clinical component by a qualified preceptor
who meets the following requirements:
a. Holds
an active unencumbered APRN or physician license,
b. Is in current practice in the advanced
role and population focus and
c.
Functions as a supervisor and teacher and evaluates the individual's
performance in the clinical setting.
D.
APPLICATION FOR AN INTERNATIONALLY
EDUCATED APRN (educated outside the United States)
An internationally educated applicant for licensure in this state
as an APRN shall:
1. Graduate from a
graduate level APRN program equivalent to an APRN educational program in the
United States accepted by the Board.
2. Submit an official transcript directly
from the international nursing education program and verified through a
qualified credentials evaluation process for the license being
sought.
3. Meet all other licensure
criteria required of applicants educated in the United States, including
English proficiency.
E.
TEMPORARY PERMITS
1. Upon
application and payment of the required fee, the Board shall issue a temporary
permit to practice in an advanced practice nursing category to a qualified
applicant who has no violations as listed in ACA §
17-87-312
on the Arkansas State Police criminal background check and:
a. Meets the educational requirements set
forth in Section
II of
this Chapter and has been accepted by the appropriate certification body to sit
for the national certification exam he or she is eligible to take; or
b. Has a current advanced practice registered
nurse license or the equivalent from another jurisdiction and has current
Board-approved certification in the appropriate advanced practice nursing
education category.
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 failure of the certification
examination.
3. The temporary
permit is not renewable and does not apply to prescriptive authority.
4. In no event shall the permit be valid in
excess of six (6) months.
F.
RENEWALS
1. The date for renewal of licensure to
practice as an advanced practice registered nurse shall coincide with renewal
of the applicant's registered nurse license.
2. An applicant for renewal of an advanced
practice registered nurse license shall submit to the Board:
a. A completed Board renewal application
form;
b. Documentation of current
national certification in the appropriate APRN specialty through a maintenance
program of a Board approved certifying body;
c. Documentation of current compact state RN
licensure if primary state of residence has enacted the Interstate Nurse
Licensure Compact; and
d. Payment
of the nonrefundable renewal fee.
3. Advanced practice registered nurses with
prescriptive authority shall submit evidence of a current collaborative
practice agreement as a prerequisite to license renewal.
4. If disciplinary proceedings have been
initiated against an individual with a lapsed, inactive, or retired license,
the license shall not be renewed until the proceedings have been
completed.
5. Continuing education
submitted to the certifying body to meet the qualifications for recertification
shall be accepted as meeting the statutory requirement for continuing
education.
6. Upon request, an APRN
shall submit documentation to the Board of continuing education.
7. APRNs with prescriptive authority shall
complete five (5) contact hours of pharmacotherapeutics continuing education in
the APRN's area of certification each biennium prior to license renewal.
Effective January 1, 2017, two (2) of the five (5) hours must contain
information related to maintaining professional boundaries and the prescribing
rules, regulations and laws that apply to APRNs in the State of
Arkansas.
8. Pursuant to Act 204 of
2017, upon notification of active duty status and submission of appropriate
documentation, the license renewal fee will be waived for members of the
military.
G.
LAPSED APRN LICENSE
The license is lapsed if not renewed or placed on inactive status
by the expiration date.
1. The license
is lapsed if the RN license or privilege to practice in Arkansas is not
current.
2. The license is lapsed
when the national certification upon which licensure was granted
expires.
3. 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.
4. Any licensee
whose license has lapsed shall submit to the Board:
a. A completed Board renewal application
form;
b. Documentation of current
national certification; and
c. The
renewal fee and the reinstatement fee/late penalty.
5. Fees submitted to the Board are
nonrefundable.
6. Any person
engaged in advanced practice 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.
H.
REINSTATEMENT OF APRN LICENSE
1. An
individual who applies for licensure reinstatement who has been out of practice
for more than two (2) years shall provide evidence of passing an APRN refresher
course approved by the Board or an extensive orientation, which shall include a
minimum of 200 hours, in the appropriate advanced practice role and population
focus which includes a supervised clinical component by a qualified preceptor
who meets the following requirements:
a. Holds
an active unencumbered APRN or physician license
b. Is in current practice in the advanced
role and population focus; and
c.
Functions as a supervisor and teacher and evaluates the individual's
performance in the clinical setting.
2. For those licensees applying for licensure
reinstatement following disciplinary action, compliance with all Board
licensure requirements as well as any specified requirements set forth in the
Board's discipline order is required.
I.
INACTIVE STATUS
1. Any licensee who desires to temporarily
inactivate their advanced practice registered nurse license in this state shall
submit a request to the Board.
2.
The APRN license may immediately be placed on inactive status when the
registered nurse license is placed on inactive status.
3. While the license is inactive, the
licensee shall not engage in advanced practice nursing nor be subject to the
payment of renewal fees.
4. If the
APRN desires to resume practice in this state, he or she shall submit a
reinstatement application and meet the continuing education
requirements.
J.
RETIRED ADVANCED PRACTICE REGISTERED NURSE
1. Any advanced practice registered nurse in
good standing, who desires to retire for any length of time from the practice
of nursing in this state, shall submit a request and their APRN license shall
be placed on retired status.
2.
While retired, the APRN shall not practice advanced practice nursing; however,
an APRN with a retired license may use the title "Advanced Practice Registered
Nurse" or the abbreviation "APRN." Retired APRNs that maintain an active RN or
RNP license may practice in the role of a Registered Nurse or Registered Nurse
Practitioner.
3. When the licensee
desires to resume practice, he or she shall submit a reinstatement application
with a reinstatement fee and the active renewal fee. The licensee must also
meet those requirements outlined in Section
III,
F.
4. When disciplinary proceedings
have been initiated against a retired licensee, the license shall not be
reinstated until the proceedings have been completed.
K.
ADDITIONAL CERTIFICATIONS
1. An APRN who has completed post-masters
education for an additional nursing specialty shall:
a. Submit a request for permission to
practice in the new certification area;
b. Submit evidence of eligibility to sit for
the new certification exam from the Board-approved certifying body;
c. Immediately cease practicing in the
specialty upon notification of failure of the exam;
d. Submit results of the certification in the
additional specialty directly from the certifying body;
e. Submit an official transcript or document
from a nursing education program that meets the qualifications in Section
II of
this Chapter verifying the date and degree or certificate conferred.
2. An APRN who has prescriptive
authority shall:
a. Prescribe only for
patients covered by the original specialty while waiting additional specialty
results.
b. Submit a collaborative
practice agreement which includes the additional certification.
SECTION VI
STANDARDS OF
NURSING PRACTICE
A.
PURPOSE
1. To establish standards
essential for safe practice by the advanced practice registered
nurse.
2. To serve as a guide for
evaluation of advanced nursing practice.
B.
STANDARDS FOR ALL CATEGORIES OF
ADVANCED PRACTICE REGISTERED NURSING
1.
The advanced practice registered nurse shall assess clients at an advanced
level, identify health status including abnormal conditions, establish a
diagnosis, develop and implement treatment plans and evaluate client
outcomes.
2. The advanced practice
registered nurse shall use advanced knowledge and skills in teaching and
guiding clients and other health team members.
3. The advanced practice registered nurse
shall use critical thinking and decision making at an advanced level,
commensurate with the autonomy, authority, and responsibility of his/her
practice category.
4. The advanced
practice registered nurse shall have knowledge of the statutes and rules
governing advanced nursing practice, and function within the legal boundaries
of the appropriate advanced practice registered nursing category.
5. The advanced practice registered nurse is
authorized to sign the following official documents:
a. Certification of disability for patients
to receive disabled parking permits or placards from the Office of Motor
Vehicle;
b. Sports physicals to
authorize student athletes to participate in athletic activities;
c. Physicals for bus drivers;
d. Forms relating to do-not-resuscitate
orders;
e. Forms excusing a
potential jury member due to an illness;
f. Death certificate;
g. Workers' compensation forms;
h. Forms relating to absenteeism for
employment or school purposes; and
i. Authorizations for durable medical
equipment.
6. The
advanced practice registered nurse shall recognize the APRN's limits of
knowledge and experience, planning for situations beyond expertise, and
collaborating with or referring clients to other health care providers as
appropriate.
7. The advanced
practice registered nurse shall retain professional accountability for advanced
practice nursing care when delegating interventions.
8. The advanced practice registered nurse
shall maintain current knowledge and skills in the advanced practice nursing
category.
9. Rules which apply to
registered nurses are hereby incorporated by reference.
10. The APRN shall comply with the standards
for registered nurses as specified in Chapter 1. Standards for a specific role
and population focus of APRN supersede standards for registered nurses where
conflict between the standards, if any, exists.
C. In addition to the standards, the advanced
practice registered nurse shall practice in accordance with the standards
established by the national certifying body from which the APRN holds his or
her certification required for licensure. These standards shall have been
reviewed and accepted by the Board.
D.
ADDITIONAL STANDARDS FOR
CRNAs
1. The CRNA, acting in the normal
course of his/her professional practice, may be authorized by a hospital or
institution to act as their agent or employee to order the administration of
controlled substances under the DEA registration of the hospital or
institution.
2. The CRNA may order
nurses to administer drugs preoperatively and/or postoperatively in connection
with an anesthetic and/or other operative or invasive procedure that will be or
has been provided.
3. The CRNA's
order shall be directly related to the administration of drugs preoperatively
and/or postoperatively in connection with an anesthetic and/or other operative
or invasive procedure that will be or has been provided.
4. A CRNA who has not been granted authority
by a DEA registrant as described in Title
21 CFR
1301.22, or its successor to order the
administration of controlled substances shall give all orders as verbal orders
from the supervising physician, dentist, or other person lawfully entitled to
order anesthesia.
5. The CRNA shall
be responsible for complying with all applicable state and federal laws and
rules related to medications.
SECTION VII
PROFESSIONAL
CERTIFICATION PROGRAMS
A.
A national certification program which meets the following criteria shall be
recognized by the Board to satisfy Section
II of
these rules.
B. The national
certification program:
1. Is national in the
scope of its credentialing;
2. Is
accredited by a national accreditation body as acceptable by the
Board;
3. Has no requirement for an
applicant to be a member of any organization;
4. Has an application process and credential
review which includes documentation that the applicant's education is in the
advanced practice nursing category being certified, and that the applicant's
clinical practice is in the certification category;
5. Education requirements are consistent with
the requirements of the advanced practice role and population foci.
6. Uses an examination as a basis for
certification in the advanced practice nursing category which meets the
following criteria:
a. The examination is
based upon job analysis studies conducted using standard methodologies
acceptable to the testing community;
b. The examination represents entry-level
practice in the APRN role and population focus;
c. The examination represents the knowledge,
skills, and abilities essential for the delivery of safe and effective advanced
nursing care to clients;
d. The
examination content and its distribution are specified in a test plan
(blueprint), based on the job analysis study, that is available to
examinees;
e. Examination items are
reviewed for content validity and correct scoring using an established
mechanism, both before use and periodically;
f. Examinations are evaluated for
psychometric performance;
g. The
passing standard is established using acceptable psychometric methods, and is
re-evaluated at least every five (5) years;
h. Examination security is maintained through
established procedures; and
i. A
retake policy is in place.
7. Issues certification based upon passing
the examination and meeting all other certification requirements;
8. Provides for periodic recertification
which includes review of continued education, qualifications, and continued
competence;
9. Has mechanisms in
place for communication to the Board for timely verification of an individual's
certification status, changes in certification status, and changes in the
certification program, including qualifications, test plan, and scope of
practice;
10. Has an evaluation
process to provide quality assurance in its certification program.
C. The Board will notify the
appropriate certifying body when an APRN has any disciplinary action taken on
their license or privilege to practice.
SECTION VIII
PRESCRIPTIVE
AUTHORITY
A.
INITIAL APPLICANT
An applicant for an initial certificate of prescriptive authority
shall:
1. Be currently licensed as an
advanced practice registered nurse in Arkansas.
2. Provide evidence from the national
certifying body that differential diagnosis and prescribing practices are
recognized as being within the scope of practice for the applicant's
certification category.
3. Provide
documentation of successful completion of pharmacology coursework which shall
include pharmacokinetics principles and their clinical application and the
prescription of pharmacological agents in the prevention and treatment of
illness, and the restoration and maintenance of health. The coursework shall
contain a minimum of:
a. Three (3) graduate
credit hour pharmacology course offered by an accredited college or university
within two years immediately prior to the date of application to the Board;
or
b. Forty-five (45) contact hours
[a contact hour is fifty (50) to sixty (60) minutes] in a pharmacology course
which includes a competency component, offered by an accredited college or
university, within two (2) years immediately prior to the date of application
to the Board; or
c. Three (3)
graduate credit hours pharmacology course, included as part of an advanced
practice nursing education program, within five (5) years immediately prior to
the date of application to the Board.
4. Provide documentation of a minimum of
three hundred (300) clock hours preceptorial experience in the prescription of
drugs, medicines and therapeutic devices with a qualified preceptor, to be
initiated with the pharmacology course and to be completed within one year of
the beginning of the course. Preceptorial experience completed as a part of the
formal educational program in which the pharmacology course is taught will meet
the three hundred (300) clock hour requirement.
5. Submit a collaborative practice agreement
with a practicing physician who is licensed under the Arkansas Medical
Practices Act, §
17-95-201
et seq., and who has training within the scope, specialty or expertise of the
advanced practice registered nurse. APRNs who will prescribe controlled
substances shall seek a collaborative practice with a physician who has an
unrestricted DEA registration number. The collaborative practice agreement
shall include, but not be limited to:
a.
Availability of the collaborating physician(s) for consultation or referral or
both;
b. Methods of management of
the collaborative practice, which shall include the use of protocols for
prescriptive authority;
c. Plans
for coverage of the health care needs of a client in the emergency absence of
the advanced practice registered nurse or physician;
d. Provision for quality assurance;
e. Authorization for the APRN to prescribe
hydrocodone combination products which were reclassified from Schedule III to
Schedule II as of October 6, 2014 if expressly authorized by the collaborating
physician; and
f. Signatures of the
advanced practice registered nurse and collaborating physician(s), signifying
mutual agreement to the terms of the collaborative practice.
6. Submit the nonrefundable
processing fee with the application for a certificate of prescriptive
authority.
7. APRNs issued a
certificate of prescriptive authority after December 31,2015 shall obtain a
minimum of three (3) hours of prescribing education which includes information
on maintaining professional boundaries and the prescribing rules, regulations
and laws that apply to APRNs in the state of Arkansas within two (2) years of
issuance of the prescriptive authority certificate.
B.
ENDORSEMENT APPLICANT
1. An applicant for endorsement of
prescriptive authority shall:
a. Provide
documentation of a three (3) graduate credit hour pharmacology course offered
by an accredited college or university or a forty-five (45) contact hour [a
contact hour is fifty (50) to sixty (60) minutes] pharmacology course which
includes a competency component offered by an accredited college or
university;
b. Provide evidence
that prescriptive authority is current and unencumbered in the jurisdiction
from which the applicant is moving;
c. Provide evidence of prescribing in a
clinical setting for at least 500 hours in the year prior to application for a
certificate of prescriptive authority;
d. Have an unencumbered advanced practice
registered nurse license to practice or the equivalent in the jurisdiction from
which the applicant is moving;
e.
Provide a copy of current DEA registration (if prescriber has DEA number) and
history of registration status; and
f. Meet requirements in Section
VIII.A.1, 2, 5, 6, 7.
2. Endorsement applicants who do
not meet all requirements established herein shall be required to submit
documentation acceptable to the Board according to Section VIII. A.
C.
PROTOCOLS FOR
PRESCRIPTIVE AUTHORITY
Protocols shall be made available upon request of the Board. Such
protocols shall, at a minimum, include:
1. Indications for and classifications of
legend drugs, controlled substances (if prescriber holds a DEA registration
number), and therapeutic devices which will be prescribed or administered by
the APRN;
2. Date the protocol was
adopted or last reviewed, which shall be at least annually.
D.
PRESCRIBING
PRIVILEGES
1. The APRN, applying for a
certificate of prescriptive authority, shall acknowledge in the application
that he or she is familiar with all state and federal laws and rules regarding
prescribing, and shall agree to comply with these laws and rules.
2. An advanced practice registered nurse with
a certificate of prescriptive authority may receive and prescribe legend drugs,
medicines or therapeutic devices appropriate to the APRN's area of practice.
The prescriptive authority for controlled drugs shall extend to drugs listed in
Schedules III through V and only hydrocodone combination products which were
reclassified from Schedule III to Schedule II as of October 6, 2014.
3. Prescribing stipulations are as follows:
a. Legend drugs, therapeutic devices, and
controlled substances (Schedules III-V), and only hydrocodone combination
products, which were reclassified from Schedule III to Schedule II as of
October 6, 2014, will
be prescribed, administered, or ordered as established in protocols provided
that the APRN has an assigned DEA registration number which is entered on each
written prescription for a controlled substance.
b. The APRN shall not prescribe hydrocodone
combination products for acute pain in excess of seven (7) days.
c. The APRN shall not prescribe Schedule II
controlled substances for his/her own use or for the use of his/her immediate
family.
d. The APRN shall file
his/her DEA registration number with the Board upon receipt.
e. Advanced practice registered nurses shall
not delegate to unlicensed ancillary staff the calling in of prescriptions to
the pharmacy.
f. The APRN shall
notify the Board in writing within seven (7) days following termination of the
collaborative practice agreement. A new collaborative practice agreement is
required to be on file prior to reactivating prescriptive authority.
4. The APRN may prescribe a legend
drug, medicine or therapeutic devices not included in the written protocols
only as follows:
a. Upon a specific written or
verbal order obtained from the collaborating physician before the prescription
or order is issued by the APRN; and
b. Include documentation of consultation as
described above in the client's medical record to be signed by the
APRN;
c. Schedules I and II
controlled substances shall not be prescribed under the APRN's certificate of
prescriptive authority with the exception of hydrocodone combination products
which were reclassified from Schedule III to Schedule II as of October 6,
2014.
5. The APRN shall
note prescriptions on the client's medical record and include the following
information:
a. Medication and
strength;
b. Dose;
c. Amount prescribed;
d. Directions for use;
e. Number of refills; and
f. Initials or signature of APRN.
6. The APRN will keep accurate
records to include the medical history, physical examination, other evaluations
and consultations, treatment plan objective, informed consent noted in the
patient record, treatment, medications given, agreements with the patient and
periodic reviews.
7. The APRN will
periodically review the course of scheduled drug treatment of the patient and
any new information about etiology of the pain. If the patient has not
improved, the APRN may assess the appropriateness of continued prescribing of
scheduled medications or dangerous drugs, or trial of other
modalities.
8. The APRN will obtain
written informed consent from those patients he or she is concerned may abuse
controlled substances and discuss the risks and benefits of the use of
controlled substances with the patient, his or her guardian, or authorized
representatives.
9. Advanced
practice registered nurses in the category of certified registered nurse
anesthetists shall not be required to have prescriptive authority to provide
anesthesia care, including the administration of drugs or medicines necessary
for such care.
10. Advanced
practice registered nurses who prescribe prior to obtaining a certificate of
prescriptive shall be considered illegal practitioners and shall be subject to
the penalties provided for violation of the Nurse Practice
Act.
E.
PRESCRIPTION FORMAT
1. All
prescriptions issued by the APRN shall contain the name of the client, and the
APRN's name, title, address, telephone number, signature with the initials
"APRN" and shall include information contained in Subsection D.5.a-f of this
Section.
2. All prescriptions for
controlled substances shall be in accordance with federal rules. The APRN's
assigned DEA registration number shall be included on the prescription when a
controlled substance is prescribed.
F.
RECEIVING PREPACKAGED DRUG
SAMPLES
1. APRNs who have an active
prescriptive authority certificate may receive legend drug samples and
therapeutic devices appropriate to their area of practice, including controlled
substances contained in Schedules III through V and only hydrocodone
combination products, which were reclassified from Schedule III to Schedule II
as of October 6, 2014, which have been prepared, packaged, or fabricated by a
pharmaceutical manufacturer in accordance with the Arkansas pharmacy laws and
rules.
2. Records must comply with
all applicable federal and state laws and rules.
G.
TERMINATION OF PRESCRIPTIVE
AUTHORITY
1. Prescriptive authority
may be terminated by the Board when the prescriber:
a. Fails to maintain current active licensure
as an advanced practice registered nurse;
b. Violates provisions of this
Act and/or Rules established by the Arkansas
Department of Health, Nursing or Pharmacy Boards;
c. Violates any state or federal law or rules
applicable to prescriptions; or
d.
Fails to follow any conditions imposed.
2. To reinstate prescriptive authority, the
APRN must meet requirements of the Board at the time of
reinstatement.
H.
LAPSED CERTIFICATE OF PRESCRIPTIVE AUTHORITY
1. The certificate of prescriptive authority
is lapsed if:
a. The licensee's active
advanced practice registered nurse license is not renewed by the expiration
date;
b. The national certification
upon which licensure is based expires;
c. There is not a current collaborative
practice agreement on file with the board; or
d. The advanced practice license is placed on
inactive or retired status.
2. After reinstating a lapsed advanced
practice registered nurse license, the licensee shall submit to the Board a
current collaborative practice agreement to reactivate the certificate of
prescriptive authority.
3. Any
person engaged in prescribing during the time his or her certificate of
prescriptive authority has lapsed shall be considered an illegal practitioner
and shall be subject to the penalties provided for violation of the
Nurse Practice Act.
I.
INACTIVE STATUS
1. A certificate of prescriptive authority
will automatically be considered lapsed and subject to the requirements of
these rules when a licensee places his or her advanced practice registered
nurse license on inactive status.
2. While the certificate of prescriptive
authority or advanced practice registered nurse license is inactive, the
licensee shall not engage in any practice within the scope of the certificate
of prescriptive authority.
3. If
the nurse desires to resume practice in this state, he or she shall request a
renewal application which shall be completed and submitted with a renewal fee
and the reinstatement fee. Fees are nonrefundable.
4. All certification requirements for renewal
shall apply.
5. If disciplinary
proceedings on an inactive licensee have been initiated, the license shall not
be reinstated until the proceedings have been completed.
J.
REACTIVATION OF PRESCRIPTIVE
AUTHORITY
APRNs whose prescriptive authority is inactive shall
complete:
1. Five (5) contact hours of
pharmacotherapeutics continuing education in the APRN's area of certification
for each 12 months of non-prescribing activity in addition to the five (5)
contact hours required for APRN license renewal, as noted in Chapter
4,111(F)(7), prior to reactivation of prescriptive authority.
2. Two (2) contact hours shall include
information on maintaining professional boundaries and the prescribing rules,
regulations and laws that apply to the APRNs in the state of Arkansas
K.
PRESCRIPTION DRUG
MONITORING PROGRAM
1. APRNs may
delegate access to the Prescription Drug Monitoring Program (PDMP) for running
requested reports to no more than two licensed nurses under his or her
supervision or employment at each practice location.
2. APRNs with prescriptive authority shall
review PDMP report from the Prescription Drug Monitoring Program prior to
prescribing:
a. An opioid from Schedule II or
Schedule III every time prescribing the medication to a patient; and
b. A benzodiazepine medication for the first
time and every six (6) months thereafter prescribing for a patient.
3. Review of the PDMP report shall
be documented in the patient's medical record.
4. Mandatory checking of the PDMP does not
apply when prescribing a controlled substance to a patient;
a. Immediately before or during surgery;
or
b. During recovery from surgery
while in a healthcare facility; or
c. In a healthcare facility; or
d. When necessary to treat a patient in an
emergency situation at the scene of an emergency, in a licensed ground
ambulance or air ambulance, or in the intensive care unit of a licensed
hospital; or
e. In palliative care
or hospice; or
f. In a licensed
nursing home facility; or
g. In
situations in which the PDMP is not accessible due to technological or
electrical failure.
SECTION IX
PRESCRIBING
GUIDELINES FOR ANOREXIANT DRUGS
An Advanced Practice Registered Nurse (APRN) must maintain
prescribing medication practices that are within the APRN's educational
preparation and certification. An APRN will be in violation of the Arkansas
Nurse Practice Act if he/she prescribes Schedule III and/or
Schedule IV drugs under the Uniform Controlled Substance Act for short-term
treatment of obesity, except in conformity with the requirements as set
below.
A.
PRESCRIBING
GUIDELINES
1. An established
APRN/patient relationship shall exist. The patient shall be age 18 or older, or
have written consent from a parent or guardian. The medication shall only be an
adjunct to a comprehensive weight loss program focused on appropriate nutrition
education, a change in lifestyle, counseling, and an individualized exercise
program. The APRN shall determine whether or not the patient has made a
substantial good faith effort to lose weight through diet and alteration of
lifestyle prior to beginning drug therapy.
2. The treating APRN shall take a complete
history of the patient, including a detailed family history, dietary history,
and shall perform a complete physical examination. The physical examination
shall include a minimum of checking the blood pressure and pulse, examining the
heart and lungs, recording height and weight, and administering any other
appropriate diagnostic tests to evaluate for a metabolic disorder. The history
and examination shall be sufficient to determine if the patient has previously
been drug dependent, to determine if there is a metabolic cause of the obesity
which would make anorexiant drugs inappropriate, and to determine if there are
other contraindications to use of anorexiant drugs exists.
3. The APRN shall discuss with the patient
different approaches to the treatment of obesity, and the risks and benefits
associated with each approach. Risks shall include potential side effects, such
as cardiovascular and pulmonary complications, as well as the potential for
lack of success with weight loss. The APRN shall be aware of potential drug
interactions between anorexiants, and other centrally acting drugs. The
treating APRN shall prescribe a diet for weight loss and appropriate counseling
regarding lifestyle change, and record these changes on the patient's medical
record. Consideration on the use of anorexiant medications shall take into
account the degree of overweight and associated medical conditions. The body
mass index (BMI) shall be used as a guide to determine the degree of overweight
status. In general, anorexiant medications shall only be used if the BMI is
more than 27. In the case of associated obesity-related medical conditions,
anorexiant medications may be considered with a BMI above 25. Obesity-related
medical conditions include, but are not limited to, diabetes, hypertension,
dyslipidemia, cardiovascular disease, sleep apnea, psychological conditions,
disc disease, and severe arthritis of the lower extremities.
4. The treating APRN shall prescribe a daily
dosage that does not exceed the dosage recommended in the manufacturer's
prescribing information for the drug prescribed.
5. The APRN shall not prescribe more than a
30-day supply for a patient at each visit and regular follow-up visits shall
not exceed 30 days. The patient shall be weighed at each visit prior to the
prescribing of an additional supply of the drug.
6. At the time of each return patient visit,
the treating APRN shall monitor progress of the patient. The patient's weight,
blood pressure, pulse, heart, and lungs shall be assessed. In addition to any
side effects of the medications, the APRN shall perform appropriate exams and
tests to monitor the safety of any weight loss. This may include a detailed
dietary questionnaire, serum electrolytes, blood glucose, and other tests
deemed appropriate. The APRN shall discontinue the anorexiant medications when
the patient reaches weight loss goals. These goals may be defined as a body
weight that is no longer considered "obese" (e.g. BMI of less than or equal to
27), or an improvement in medical conditions (e.g. normalization of blood
glucose). After the goal is reached, the APRN may continue to prescribe
anorexiant drugs for up to an additional sixty (60) days.
7. Except as otherwise provided by this
regulation, Schedule III and/or Schedule IV anorexiant drugs are only
recommended for short-term use (e.g. 90 days). In addition, anorexiant drugs
shall not be prescribed to a patient with a BMI of less than 27, unless
prescribing for obesity-related conditions with a BMI of above 25. The treating
APRN may extend therapy beyond 90 days under the following conditions:
a. When the anorexiant drugs are indicated
for treatment of diseases other than obesity; and
b. When, in the APRN's professional judgment,
the treating APRN is assessing and recording significant progress or benefit
from the drugs and no adverse effects occur that are related to the
treatment.
SECTION XII
PRESCRIBING FOR CHRONIC NONMALIGNANT PAIN
A. Chronic nonmalignant pain is defined as
pain requiring more than three consecutive months of prescriptions for:
1. An opioid that is written for more than
the equivalent of ninety (90) tablets, each containing five (5) milligrams of
hydrocodone; or
2. A morphine
equivalent dose of more than fifteen mg (15 mg) per day: or
3. Tramadol - an average dose of two hundred
milligrams (200 mg) or greater per day.
B. When opioids are started, the lowest
effective dosage should be prescribed. APRNs should use caution when
prescribing opioids at any dosage and carefully reassess evidence of individual
benefits and risks when considering increasing dosage to >50 morphine
milligram equivalents (MME) per day. APRNs should avoid increasing dosage to
>90 MME/day or carefully justify a decision to titrate dosage to >90
MME/day.
C. If opioids are
prescribed at a level defined by the Centers for Disease Control and Prevention
(CDC) as excessive (>50 MME/day) the following shall be documented in the
patient's medical record:
a. Objective
findings, which include, but are not limited to, imaging studies, lab testing
and results, nerve conduction testing, biopsy, and any other test that would
establish pain generating pathology.
b. Specific reasons for the need to prescribe
> 50 MME/day.
c. Documented
alternative treatment plans as well as alternative therapies tried and failed
prior to considering chronic opioid therapy.
d. Documented risk factor assessment
detailing that the patient was informed of the risk and addictive nature of the
prescribed drug.
e. Documented
assessment of the potential for abuse and/or diversion of the prescribed
drug.
f. Documented review of the
Prescription Drug Monitoring report prior to issuing the
prescription.
g. A detailed
clinical rational for the prescribing
D. Patient Treatment and Evaluation
1. The patient shall be evaluated through an
in-person examination at least every three (3) months by the APRN and at least
one (1) time every six (6) months by a physician who is licensed by the
Arkansas State Medical Board.
2. A
current Prescription Drug Monitoring Program report shall be reviewed at least
every six (6) months. The review shall be documented in the patient's medical
record.
3. A current pain contract
with the patient shall be maintained and include, at a minimum, requirements
for:
a. Random urine drug screens
and
b. Random pill counts
E. The requirements of
this section shall not apply to a patient:
1.
Whose pain medications are being prescribed for a malignant
condition:
2. With a terminal
condition;
3. Who is a resident of
a licensed healthcare facility;
4.
Who is enrolled in a hospice program; or
5. Who is in an inpatient or outpatient
palliative care program.
SECTION XIII
MINIMUM
STANDARDS FOR ESTABLISHING A PATIENT RELATIONSHIP
A. The APRN shall establish a proper
APRN/patient relationship prior to providing any patient care.
B. A proper APRN/patient relationship, at a
minimum requires that:
1. The APRN perform a
history and an "in person" physical examination of the patient adequate to
establish a diagnosis and identify underlying conditions and/or
contraindications to the treatment recommended/provided; OR
2. The APRN perform a face-to-face
examination using real-time audio and visual telemedicine technology that
provides information at least equal to such information as would have been
obtained by an in-person examination; AND
3. Appropriate follow-up be provided or
arranged, when necessary, at medically necessary intervals.
C. A proper APRN/patient
relationship is also deemed to exist in the following situations:
1. When treatment is provided in consultation
with, or upon referral by another health care provider who has an ongoing
relationship with the patient, and who has agreed to supervise the patient's
treatment, including follow-up care and the use of any prescribed
medications.
2. On-call or
cross-coverage situations arranged by the patient's health care
provider.
SECTION
XIV
TELEMEDICINE
Requirement for all services provided by APRNs providing care via
telemedicine:
A. An APRN/patient
relationship shall be established in accordance with Chapter 4, Section
XIII
before the delivery of services via telemedicine. A patient completing a
medical history online and forwarding it to an APRN is not sufficient to
establish the relationship, nor does it qualify as store-and-forward
technology.
B. The following
requirements apply to all services provided by APRNs using telemedicine:
1. The practice of nursing via telemedicine
shall be held to the same standards of care as traditional in-person
encounters.
2. The APRN shall
obtain a detailed explanation of the patient's complaint from the patient or
the patient's health care provider.
3. If a decision is made to provide
treatment, the APRN shall agree to accept responsibility for the care of the
patient.
4. If follow-up care is
indicated, the APRN shall agree to provide or arrange for such follow-up
care.
5. An APRN using telemedicine
may NOT issue a prescription for any controlled substances defined as any
scheduled medication under schedules III through V and only hydrocodone
combination products which were reclassified from Schedule III to Schedule II
as of October 6, 2014 unless the APRN has seen the patient for an in-person
exam or unless a relationship exists through consultation or referral; or
on-call or cross-coverage situations.
6. The APRN shall keep a documented medical
record, including medical history.
7. At the patient's request, the APRN shall
make available to the patient an electronic or hardcopy version of the
patient's medical record documenting the encounter. Additionally, unless the
patient declines to consent, the APRN shall forward a copy of the record of the
encounter to the patient's regular treating health care provider if that health
care provider is not the same one delivering the service via
telemedicine.
8. Services shall be
delivered in a transparent manner, including providing access to information
identifying the APRN in advance of the encounter, with licensure and board
certifications, as well as patient financial responsibilities.
9. If the patient, at the recommendation of
the APRN, needs to be seen in person for the current medical issue, the APRN
shall arrange to see the patient in person or direct the patient to their
regular treating health care provider. Such recommendation shall be documented
in the patient's medical record.
10. APRNs who deliver services through
telemedicine shall establish protocols for referrals for emergency
services.
11. APRNs providing care
via telemedicine to a patient located within the State of Arkansas shall be
licensed to practice nursing in the State of Arkansas.
SECTION XV
LICENSURE FOR CERTAIN MILITARY NURSES AND
SPOUSES
A.
EXPEDITED
LICENSURE
1. Temporary permits for an
active duty military service member or their spouse stationed in the State of
Arkansas or a returning military veteran or their spouse applying within one
(1) year of his/her discharge from active duty shall be issued within
twenty-four (24) hours of receipt of all required documents.
2. The Board will give preference in the
order of processing to applications for full licensure filed by the following
individuals:
a. An active duty military
service member stationed in the State of Arkansas;
b. A returning military veteran applying
within one (1) year of his or her discharge from active duty; or
c. The spouse of a person under (a) or (b)
above
B.
EXTENSION OF LICENSURE EXPIRATION DATE
Upon written request and submission of appropriate documentation,
members of the Armed Forces of the United States who are ordered to active duty
outside of this state shall be allowed an extension of the expiration date
without penalty or assessment of a late fee for renewing the service member's
nursing license. The extension shall be effective for one hundred eighty (180)
days after the service member or spouse returns from active deployment.
C.
CONSIDERATION OF MILITARY
TRAINING AND EXPERIENCE
When considering an application for licensure from an active duty
military service member stationed in the State of Arkansas or a returning
military veteran applying within one (1) year of his or her discharge from
active duty, the Board shall:
1.
Consider whether or not the applicant's military training and experience in the
practice of nursing is substantially similar to the experience or education
required for licensure.
2. Accept
the applicant's military training and experience in the practice of nursing in
lieu of experience or education required for licensure, if the Board determines
that the military training and experience is a satisfactory substitute for the
experience or education required for licensure.
D.
WAIVER OF CONTINUING
EDUCATION
Upon written request and submission of appropriate documentation
the continuing education requirements for license renewal shall be waived
for:
1. An active duty military
service member deployed outside the State of Arkansas;
2. A returning military veteran renewing
within one (1) year of his/her discharge from active duty; or
3. The spouse of a person under (1) or (2)
above.