PART 1 DEFINITIONS
Section 1 Definitions.
As used in these Rules:
"Advanced Practice Registered Nurse" or "APRN" is defined at
26 V.S.A.
§
1572(4).
"Board" or "the Board" means the Vermont Board of
Nursing.
"Board website" means the primary Office website assigned to
the Vermont Board of Nursing, found at sos.vermont.gov/nursing/ or a designated
successor location.
"Compact" means the Nurse Licensure Compact adopted pursuant
to 26
V.S.A. §
1647 et seq. The Compact
facilitates interstate practice among RNs and LPNs from party states; it is not
applicable to APRN or LNA practice.
"Compact State" means a jurisdiction that is a member of the
Compact.
"Convert" means to change a multistate license to a
single-state license, secondary either to a disqualifying event or to
relocation from a Compact State to a non-Compact State; or to change a
single-state license to a multistate license when a disqualifying event is
eliminated.
"Current Practice Competence" means ongoing competence to
practice registered nursing or licensed practical nursing, which may be
established by documenting any one of the following:
(1) active practice of the licensed
profession totaling at least 50 days (400 hours) in the previous 2 years or 120
days (960 hours) in the previous 5 years, verified by appropriately certified
employment records;
(2) satisfactory
completion of 20 hours of qualifying continuing education in the two years
immediately preceding application; or
(3) current, nationally recognized
certification.
"Deactivate" means to change the status of a multistate
license or privilege to practice from active to inactive.
"Director" means the Director of Professional
Regulation.
"Direct Supervision" means supervision of a licensee's
practice by a nurse physically present on the unit.
"Disqualifying Event" means an incident, which results in a
person becoming disqualified or ineligible to retain or renew a multistate
license. These include but are not limited to the following: any adverse action
resulting in an encumbrance, current participation in an alternative program, a
misdemeanor offense related to the practice of nursing (which includes, but is
not limited to, an agreed disposition), or a felony offense (which includes,
but is not limited to, an agreed disposition).
"Executive Director" means the Executive Director of the
Board, employed by the Office pursuant to
26 V.S.A.
§
1574(b) to carry out
the work of the Board.
"Governing Organization" means the agency or institution that
has the authority and responsibility for financing a nursing education program,
employing the administrator and faculty, graduating students, and granting the
nursing diploma, certificate, or degree.
"High-fidelity" refers to simulation experiences that are
extremely realistic and provide a high level of interactivity and realism for
the learner (International Nursing Association for Clinical Simulation and
Learning, 2013). It can apply to any mode or method of simulation; for example:
human, manikin, task trainer, or virtual reality
"Licensed Practical Nurse" or "LPN" means licensed practical
nurse.
"Licensed Practical Nursing" is defined at
26 V.S.A.
§
1572(3).
"Medium-Fidelity Simulation Learning " means the use of
low-technology mannequins or actors to demonstrate a condition within a
simulated learning environment without automatic or programmed clues.
"Nationally Recognized Certification" means a specialty
certification by a national nursing certification board or agency issued based
upon a nurse's successful passing of an exam designed to validate a mastery of
knowledge and skill within a specific area of nursing practice and/or patient
population focus.
"Nursing Assistant" or "LNA" means licensed nursing
assistant.
"NCLEX" means National Council Licensure Examination.
"Office" means the Office of Professional Regulation
"Office website" means the primary website of the Office of
Professional Regulation, found at https://sos.vermont.gov/opr/ or a
designated successor location.
"On-Site Supervision" means active oversight and monitoring
of a licensee's practice by a specifically assigned nurse who is present on the
premises of a facility at all times the supervised licensee is
practicing.
"Practice of nursing" is defined at
26 V.S.A.
§
1572 and includes using in connection
with one's name, words, letters, signs or figures which imply that a person is
an RN, LPN, or APRN. See
26 V.S.A.
§
1584(a).
"Preceptor" means an Advanced Practice Registered Nurse or
Registered Nurse who serves as a facilitator and supervisor of student learning
experiences in a practice setting.
"Program" or "Nursing Education Program" means a formal
education program, based on a structured curriculum and clinical experience,
designed to prepare students to qualify for licensure and to practice as APRNs,
RNs, or LPNs.
"Qualifying continuing education" means continuing education
that has been approved and assigned a credit value by an organization approved
by the American Nurses Credentialing Center's Commission on Accreditation, or
by another verifying authority approved by the Board, or directly by the
Board.
"Registered Nurse" or "RN" means licensed registered
nurse.
"Registered Nursing" is defined at
26 V.S.A.
§
1572(2).
"Unencumbered license" means a license that authorizes a
nurse to engage in the full and unrestricted practice of nursing without
special conditions, limitations, or supervision.
PART 2 ADMINISTRATION
Section 2.1 Applicable Law.
The practice of nursing and "nursing related functions" is
regulated pursuant to
26 V.S.A.
§
1571 et seq. Copies of these and other
statutes are available online at www.legislature.vermont.gov/statutes/. The
Office administers licensure in conformity with these and other Vermont laws,
to include the Administrative Procedure Act,
3 V.S.A.
§
800 et seq.; the Public Records Act,
1 V.S.A.
§
315 et seq.; and the Laws of
Professional Regulation,
3 V.S.A.
§
121 et seq.
Section 2.2 Resources for Applicants and
Licensees.
The Office website offers information of general application
to Vermont licensed professionals, including policies of the Office, license
lookup services, and disciplinary orders. The Board website, available at
http://sos.vermont.gov/nursing,
offers information specific to the practice of nursing, including policies and
minutes of the Board, membership information, and practice guidance.
Section 2.3 U.S. Armed Forces.
The Director may accept toward the requirements of these
rules relevant military education, training, or service completed by a member
of the U.S. Armed Forces and may expedite licensure of a person who left
licensed employment in another state secondary to a spouse's military transfer
to Vermont.
3 V.S.A.
§
123(g). Service
members and the spouses of service members should visit the Office website for
details.
Section 2.4
Executive Director.
The Office employs an Executive Director of the Board.
26 V.S.A.
§
1574(b). The powers
and duties of the Executive Director include those appropriate to carry out the
work of the Board and to execute State policy respecting the regulation of
nursing practice, including without limitation:
(a) guiding Office staff in the conduct of
the Board's affairs, the execution of Board directives, and the administration
of applicable laws and policies;
(b) appointing members of committees created
by statute, these rules, or directive of the Board;
(c) interpreting policies, making
administrative decisions, and providing consultation regarding Board affairs
such as nursing education, examination, registration, licensure, renewal, and
practice questions;
(d) surveying
and monitoring nursing education programs;
(e) preparing agendas, reports, and
recommendations to the Board, and attending to official correspondence on the
Board's behalf;
(f) orienting new
Board members and nursing staff;
(g) monitoring evolving policy and practice
issues that may call for Board action;
(h) referring instances of misconduct and
hazards to the public health, safety, and welfare to the Office's Enforcement
Division and providing expert support to prosecutors as appropriate;
(i) representing the Board at meetings,
symposia, conferences, and the like; and
(j) such other lawful duties as may be
delegated by the Board or the Director in furtherance of the Board's mission
and policies.
Section 2.5
Committees.
(a) The Board shall maintain the
following committees:
(1) a Practice
Committee, to monitor evolving issues in nursing practice;
(2) an APRN Subcommittee, to study and report
to the Board on matters relating to advanced practice registered nurse practice
in conformity with
26 V.S.A.
§
1615a;
(3) a Disciplinary Alternative Program
Committee, to advise the Executive Director and Board on appropriate standards
for admission to and administration of a program to serve as an alternative to
the disciplinary process for nurses and nursing assistants with substance use
disorder or other professional practice issues; and
(4) an Education Committee, to assist the
Board with oversight of Vermont nurse education programs.
(b) Committee authority is advisory. In the
main, committees study issues, report to the Board, and recommend appropriate
courses of action. A committee may exercise binding administrative discretion
only if authorized in respect to a specific question or responsibility put to
the committee by vote of the Board duly recorded in the Board's
minutes.
(c) At least biennially,
each committee shall propose a charter to be reviewed and approved by the
Board.
PART 3
PROCEDURES
Section 3.1 Applications.
Online license applications must be completed through the
Office website.
(a) Incomplete
applications will not be processed. Applications are complete only when all
required questions have been answered fully, all attestations made, all
required documentation and materials provided, and all fees paid.
(b) When the Board, or the Office on the
Board's behalf, intends to deny an application, notice stating the reasons for
the action shall be given to the applicant by certified mail, whereupon the
applicant shall have 30 days to petition for a hearing before the Board. 3
V.S.A. 129(e)(1).
(c) The Board may
refuse to accept any application found to be redundant with a denied or in-
process application.
(d) The Board
may deem expired any application that is left incomplete for six
months.
(e) For good cause, the
Board may require that any applicant for licensure or relicensure obtain, from
an approved, qualified professional, an independent assessment of the
applicant's current mental, physical, and professional fitness to practice.
Section 3.2 Complaints.
Complaints against licensees, applicants for licensure, or
persons practicing without a license may be submitted through the Office
website.
Section 3.3
Contested Cases.
Procedures in contested cases relating to licensure or
discipline are governed by the Office of Professional Regulation Administrative
Rules of Practice, CVR 04-030- 005, as those rules may from time to time be
modified.
Section 3.4
Declaratory Rulings.
Petitions for declaratory rulings as to the applicability of
any statutory provision or of any rule or order of the Board or Office may be
made pursuant to
3 V.S.A.
§
808 and Office
procedure.
Section 3.5
Reasonable Accommodation.
The Board complies with applicable provisions of the
Americans with Disabilities Act. See the Office website for policies and
procedures.
Section 3.6
Conflict of Standards.
Where a standard of unprofessional conduct set forth in
statute conflicts with a standard set forth in rule, the standard that is most
protective of the public shall govern. See
3 V.S.A.
§
129a(e).
Section 3.7 Determination of
Equivalency.
Where the Board or Director is permitted by law or rule to
accept certain training or experience on the basis of equivalence to a fixed
standard, it is the burden of the applicant or licensee to establish
equivalence to the Board or Director's satisfaction, by producing credible,
clear, and convincing evidence of the same. The Board and the Office have no
obligation to research the bona fides of any institution, program, course,
degree, certification, practicum, fellowship, or examination.
Section 3.8 Waiver or Variance.
The Board will not grant routine waivers or variances from
any provisions of these rules without amending the rules. See
3 V.S.A.
§
845. Where, in extraordinary
circumstances, application of a rule would result in manifest unfairness, an
absurd result, unjustifiable inefficiency, or an outcome otherwise inimical to
the public health, safety, and welfare, the Board may, upon written request of
an interested party, so find, grant a waiver with or without particular
conditions and limitations, and record the action and justification in a
written memorandum. This rule shall not be construed as creating any
administrative hearing right or cause of action.
PART 4 LICENSURE GENERALLY
Section 4.1 Applicants from Other States:
Fast Track Endorsement.
An applicant with three or more years of full-time licensed
practice, as an LNA, LPN, RN, or APRN, in good standing, in a U.S. jurisdiction
outside Vermont, may qualify for expedited licensure in Vermont. See
3 V.S.A.
§
136a. An RN or LPN who holds an active
multistate license from another Compact State is not required to obtain a
Vermont license unless changing primary state of residence to
Vermont.
Section 4.2
Applicants Educated Outside the United States.
(a) Canadian Nursing Education. An applicant
whose nursing education and initial license to practice was in Canada, who has
been duly licensed by a provincial licensing authority, who has passed an
acceptable examination and maintained provincial licensure in good standing,
may apply for licensure by endorsement. Acceptable examinations are the NCLEX
and, for a person licensed prior to December 31, 2015, the Canadian Nurses'
Association Testing Service Examination. Applicants who have not completed an
acceptable examination must take the NCLEX and should apply by examination as
set out in Rule
6-1, for LPNs, or Rule
7-1, for RNs. Endorsement applications must
include:
(1) if the nursing education program
or licensing exam was not conducted in English, acceptable evidence of oral and
written English-language proficiency;
(2) documentation of:
(a) 50 days (400 hours) of practice as a
nurse in the two years immediately preceding the application;
(b) 120 days (960 hours) practice as a nurse
within five years of the application;
(c) 20 hours of qualifying continuing
education in the two years immediately preceding license application;
or
(d) a current nationally
recognized certification, and
(3) A completed federal criminal background
check.
(b) Other Non-U.S.
Nursing Education. An applicant whose nursing education and initial license to
practice was in a country other than the United States or Canada shall be
authorized to take a licensing examination once the Board has received
English-language documentation including:
(1)
a completed application for licensure;
(2) a completed federal criminal background
check;
(3) a credentials review by
an external agency that specializes in international academic credentials
review which verifies that the applicant's nursing education meets the
requirements of these rules;
(4)
satisfactory evidence of eligibility to work lawfully in the United States, to
include a social security number or taxpayer identification number;
(5) proof of oral and written English
proficiency, if the nursing education program was not conducted in English;
and
(6) documentation of a minimum
of:
(a) 50 days (400 hours) of practice as a
nurse in the two years immediately preceding the application;
(b) 120 days (960 hours) practice as a nurse
within five years of the application;
(c) 20 hours of qualifying continuing
education in the two years immediately preceding license application;
or
(d) active, nationally
recognized certification.
Section 4.3 Biennial Licensing Period.
Licenses are valid for fixed, two-year periods. Expiration
dates are printed on licenses. A license expires if not renewed by midnight on
the date of expiry. Practice under an expired license is prohibited. A search
tool on the Office website may be considered a primary source verification as
to license status and expiration.
Section
4.4 Initial License Issuance.
An applicant issued an initial license within 90 days of the
end of a licensing period will not be required to renew or pay the renewal fee.
The license will be issued through the next full licensure period.
Section 4.5 Provisional Licensure.
The Board is authorized to issue provisional licenses to
certain applicants who have met other licensure requirements but whose
eligibility for licensure is contingent upon acceptable verification of
licensure from another jurisdiction or the results of a required criminal
background check. See
3 V.S.A.
§
130.
Section 4.6 Telehealth Registration and
Licensure.
Effective July 1, 2023, a licensee who is not otherwise
licensed in Vermont but is licensed in another US jurisdiction and wishes to
provide telehealth care services to a patient or client located in Vermont
shall obtain a telehealth registration or license in accordance with 26 V.S.A.
chapter 56. RNs and LPNs who hold an active multistate license from a Compact
state are not required to obtain Vermont licensure to provide telehealth
services.
Section 4.7
License Renewal.
Online license renewal applications must be completed through
the Office website. The Office transmits email reminders to licensees at the
end of each biennial licensing period; however, non-receipt of such reminders
shall not excuse a licensee from the obligation to maintain continuous
licensure or the consequences of failing to do so. Practicing while a license
is lapsed is a violation of
3 V.S.A.
§
127.
Section 4.8 Requirements of Renewal.
(a) RNs & LPNs shall:
(1) Have practiced for a minimum of 50 days
(400 hours) in the two years preceding application or 120 days (960 hours) in
the five years preceding application; or
(2) Have completed 20 hours of qualifying
continuing education in the two years immediately preceding the application;
or
(3) Hold a current nationally
recognized certification.
(b) LNAs shall demonstrate, via job
description or other appropriate employer verification, at least 50 days (400
hours), in the two years preceding application, of employment as a nurse
assistant or in a role, regardless of title or obligation to hold a license,
that would reasonably tend to reinforce the training and skills of a licensed
nurse assistant. See
26 V.S.A.
§
1645.
(1) A licensee who does not meet the active
practice requirement shall repeat the nursing assistant education program and
competency examination.
(c) MNAs shall:
(1) Have satisfied LNA renewal
requirements;
(2) Have completed 4
hours qualifying continuing education specific to medication administration;
and
(3) Have dedicated at least 25%
of the qualifying LNA experience (100 hours) to MNA functions.
(d) APRNs shall:
(1) Have satisfied RN renewal requirements;
(2) Have practiced in an APRN role
for a minimum of 50 days (400 hours) in the two years preceding application or
120 days (960 hours) in the five years preceding application;
(3) Present current certification by a
national APRN certifying organization; and
(4) If required, have a current collaborating
provider agreement.
Section
4.9 Late Renewal Penalties.
Late renewal applications are subject to penalty fees, which
may be waived in certain circumstances, for example, if the applicant did not
practice in Vermont during the period of lapse. See
3 V.S.A.
§
127(d). Reinstatement
waivers may be requested through the online licensing system.
Section 4.10 Requirements of Reinstatement;
Extended License Lapse.
A license expired for more than two years requires
reinstatement, including a federal criminal background check.
(a) Two to five years. A license expired for
two to five years may be reinstated upon proof of continuous practice
elsewhere, or if practice ceased, upon satisfaction of the requirements of
renewal set out in Rule
4-8.
(b) More than five years. A license expired
for five or more years may be reinstated upon proof of continuous practice
elsewhere, or if practice ceased, a licensee's preparation to return to
practice will be assessed on a case-by-case basis. After consultation with the
Board, the Director may require re-training, testing, or re-application. See
3 V.S.A.
§
135. In most circumstances, completion
of an approved nursing re-entry program is a minimum prerequisite to
reinstatement.
(c) Enhanced APRN
requirements. This rule, 4-10, will yield to enhanced requirements for APRN
practice refreshment and license reinstatement set out in Part 9,
infra.
PART 5
VERMONT NURSING EDUCATION PROGRAMS
Section
5.1 Approval Required.
No person, including a corporation, association, or
individual may conduct a nursing education program in Vermont, other than an
online-only program approved by the Vermont Agency of Education, unless the
program has been approved by the Board. See
26 V.S.A.
§
1584.
Section 5.2 Accreditation Required.
Nursing education programs shall be accredited by the
Commission on Collegiate Nursing Education (CCNE), the National League for
Nursing's (NLN) Commission on Nursing Education Accreditation (CNEA), the
Accreditation Commission for Education in Nursing (ACEN), or a national nursing
accreditation organization otherwise specifically approved by the Board.
Section 5.3 Nursing Faculty.
Vermont nursing education programs shall be compliant with
their accrediting agency's faculty standards regarding educational and
experiential requirements for full- time and part-time nursing faculty.
Section 5.4 Operational Oversight;
Site Visits.
The Board may at any time request information appropriate to
confirm that a Vermont nursing education program is operating in conformity
with applicable rules and accrediting standards. The Board may conduct a site
visit to any proposed or existing nursing education program during the
application review, during any review for extension of approval, or at any time
deemed necessary to assess compliance with these rules. A nursing education
program shall reimburse the Board for actual and necessary costs incurred for a
site visit.
Section 5.5 Duty
to Report Site, Administrative, and Curricular Changes.
A program shall copy to the Board any required report made to
accrediting authorities concerning significant changes to program curriculum or
structure.
Section 5.6
Program Application.
At least nine months before a program proposes to admit its
first students, or within 30 days of a request from the Executive Director to
an operating program, an authorized representative of the governing
organization shall submit the following information or copies of submissions to
or from an approved accreditor reflecting the same:
(a) accreditation status of the governing
organization;
(b) a statement of
mission and purpose;
(c) an
initiation plan for the program including curricula, policies, outcome
measurements;
(d) the identity and
qualifications of the Program Administrator;
(e) a description of faculty, including
numbers and qualifications;
(f) a
chart illustrating the program's administrative and supervisory
hierarchy;
(g) evidence of the
feasibility of the program and community readiness to accept and support the
program;
(h) the certificate(s) or
degree(s) to be offered;
(i) a
statement of clinical and academic facilities and resources, including
classroom, conference room, library, office space, and skills
laboratory;
(j) evidence of
financial resources sufficient for the planning, implementation and operation
of the program;
(k) a description
of the anticipated student population; and
(l) any other information showing that the
proposed program will meet the requirements of these rules.
Section 5.7 Preliminary Program
Approval.
When the Board determines that an application to commence a
new program is satisfactory, as indicated by substantial progress toward
compliance with prevailing accrediting standards and demonstrated ability to
attain full compliance, it will issue a preliminary approval authorizing the
applicant to hire faculty, enroll students, develop and implement the program,
commence the use of all assigned facilities and resources, and otherwise begin
operation of the program.
Section
5.8 Full Program Approval and Reapproval.
A program granted preliminary approval shall notify the Board
when it graduates its first class and shall apply for full program approval by
submitting such information as the Executive Director or Board may request
demonstrating progress toward full accreditation. The Board may condition full
program approval upon accreditation.
Section 5.9 Application Denial.
If a program's preliminary application, full-program
application, or application for re-approval is found to be deficient, the Board
will offer a reasonable opportunity, not to exceed two years, for the program
to cure the deficiency before acting on the application. The process for denial
of an application is set out at
3 V.S.A.
§
129(e).
Section 5.10 Annual Reports.
Approved programs shall submit annual reports on forms
available from the Board. Each annual report shall be submitted no later than
October 1 and cover the period between August 1 of the preceding year and July
31 of the year the report is submitted. Annual reports to include any new sites
or site changes, administrative changes affecting the program, and significant
curricular changes, to include changes in, duration, structure, graduation
requirements, or core curricular content. Programs shall cooperate with
reasonable requests for supplemental information.
Section 5.11 Forms of Approval.
An operating program shall apply for reapproval as determined
by the duration of its prior approval, which may be set by the Board but will
not in any event exceed the duration of the program's national accreditation.
Approvals may be conditioned as appropriate to protect the public health,
safety, and welfare, or to ensure ongoing ability to conform to prevailing
accrediting standards.
Section
5.12 Intervention for Cause.
If the Board or Executive Director reasonably suspects a
program is at risk of falling out of substantial compliance with prevailing
accrediting standards, either may require that a program undergo a site visit,
apply for reapproval early, or otherwise show cause why its approval should not
be conditioned or withdrawn. The Board will give written notice to any program
considered for withdrawal of approval and will afford program administrators a
reasonable opportunity to be heard before acting upon a motion to terminate or
condition a program's approval.
Section
5.13 Voluntary Program Closure.
The governing organization shall advise the Board of a
decision to close its program. All Board approval requirements shall be
maintained until the last student has transferred or graduated. The governing
organization shall notify the Board where permanent program and student records
are stored and how they may be retrieved. The program shall:
(a) discontinue student admissions;
(b) assist accepted applicants and current
students to transfer to other approved programs; and
(c) officially close when the last student
has graduated.
Section
5.14 Practical Nurse Program: Duration.
An acceptable practical nurse curriculum shall require no
less than one academic year to complete.
Section 5.15 Practical Nurse Program:
Curriculum.
In accordance with the standards of a program's accrediting
agency, practical nursing programs shall include clinical and theory hours
sufficient to establish competency in Adult Nursing, Maternal/Infant Nursing,
Pediatric Nursing, and Psychiatric/Mental Health Nursing.
(a) Didactic content will include Anatomy and
Physiology, Social/Behavioral Science, Pharmacology and Nutrition
(b) Nursing education programs shall include
clinical experience in state approved facilities. Clinical experiences must
provide an opportunity for direct care in the promotion, prevention,
restoration and maintenance of health in clients across the life span in a
variety of settings. No more than 25% of clinical experience may be obtained in
a medium- or high- fidelity simulation learning laboratory without prior Board
approval or the approval of the program accrediting agency.
Section 5.16 Practical Nurse
Re-Entry Programs.
The Board will approve, for a presumptive period of five
years, a re-entry program that:
(a)
has a written purpose, program and unit objectives, and measurable
outcomes;
(b) includes at least 80
hours of theory and 80 hours of clinical experience;
(c) provides direct RN supervision for
re-entry program clinical experience; and
(d) is located within, or if individually
designed, is under the direction of, a program providing nursing
education.
Section 5.17
Registered Nurse Program Curriculum.
In accordance with a program's accreditation agency
standards, a registered nursing program will provide a sound foundation in
biological, physical, social and behavioral sciences and include:
(a) Didactic content including prevention of
illness and the promotion, restoration and maintenance of health in patients
across the lifespan and from diverse cultural, ethnic, social and economic
backgrounds.
(b) Didactic and
clinical experiences shall include clinical and theory hours sufficient to
establish competency in Medical/ Surgical, Obstetrics, Pediatrics, Psychiatric/
Mental Health and Community Health.
(c) No more than 25% of clinical experience
may be obtained in a medium- or high-fidelity simulation learning laboratory
without prior Board approval or the approval of the program's accrediting
agency.
(d) Clinical experiences
shall be supervised and occur directly with patients. Clinical experiences and
simulation shall include a variety of clinical settings sufficient for meeting
program outcomes.
Section
5.18 RN Re-entry Program Design.
(a) Re-entry programs may be individually
designed or established by a nursing education program or a nursing service
facility. Re-entry programs must be approved by the Board. Program approval is
valid for five years unless otherwise specified.
(b) The Board will approve a re-entry program
which meets the following requirements:
(1)
The re-entry program has a written purpose, program and unit objectives, and
measurable outcomes;
(2) consists
of a minimum of 120 hours of theory and a minimum of 120 hours of clinical
experience;
(3) provides direct RN
supervision for re-entry program clinical experience; and
(4) is located within, or if individually
designed, is under the direction of a program providing nursing
education.
Section
5.19 APRN Refresher Course.
(a)
Individuals who have been out of practice for less than five years and who do
not meet the practice requirement for initial licensure, or renewal, or
reinstatement of an APRN license must take a refresher course as set forth in
parts 9-16 through 9-18 of these Rules. Once commenced, the course must be
completed within 18 months.
(b)
Individuals who have been out of practice for more than five and fewer than ten
years may be assigned a case-specific refresher assignment approved by the
Board.
(c) Individuals who have
been out of practice for more than ten years must complete a new post-masters
APRN program that includes a minimum of 500 clinical practice
hours.
Section 5.20
Refresher Course Clinical Practice Permit.
The Board may grant a refresher course clinical practice
permit, valid in six month increments and renewable not more than twice, to an
applicant who:
(a) holds a Vermont RN
license; and
(b) holds a national
APRN certification.
A person practicing under a permit shall be conspicuously
identified as an "APRN Applicant" on name badges, signature blocks, medical
record entries, and other locations calling for a professional
designation.
Section
5.21 APRN Refresher Course Design.
(a) Refresher programs may be individually
designed or established by a nursing education program or a non-accredited
nursing service facility. Each must be approved by the Board.
(b) The Board may accept a Nationally
Accredited Refresher Program in Vermont or elsewhere which meets the
requirements of Parts 9-17 and 9-18 of these rules.
(c) Refresher programs are available to
APRN's who have been out of practice for ten years or less.
Section 5.22 APRN Refresher Course
Approval Criteria
The Board may approve a refresher program that provides
on-site supervision by an APRN collaborating provider qualified under Part 9 of
these rules who holds an unencumbered Vermont license, or a physician
collaborating provider who holds an unencumbered Vermont license. A supervising
provider must practice in the same role and population focus. Minimum course
hours are:
(a) for a licensee who has
been out of practice for less than five years consists of a minimum of:
(1) 150 hours of theory; and
(2) 200 hours of clinical experience;
or
(b) for a licensee who
has been out of practice for more than five years, but less than ten years
consists of a minimum of:
(1) 150 hours of
theory and
(2) 400 hours of clinical
experience.
Section
5.23 APRN Refresher Program Curricula.
Curricula must include a review and update of:
(a) advanced pharmacotherapeutics;
(b) advanced assessment;
(c) role and population specific theory and
practice standards;
(d) role and
population specific clinical practicum; and
(e) advanced practice nursing skills.
PART 6
LICENSED PRACTICAL NURSES
Section 6.1
Licensure by Examination.
To qualify for licensure by examination, an applicant
shall:
(a) be a graduate of an
approved LPN education program, as verified by an official
transcript;
(b) complete a federal
criminal background check;
(c)
receive Board approval to sit for the NCLEX-PN examination; and
(d) pass the NCLEX-PN examination within five
years of nursing program graduation.
Section 6.2 Licensure by Endorsement.
To qualify for licensure by endorsement, based on licensure
and experience outside Vermont, an applicant who is not eligible for expedited
endorsement under Rule
4-1 shall:
(a) be licensed in a United States
jurisdiction with licensing requirements substantially equivalent to those of
Vermont, on the basis of a U.S. nursing education program;
(b) complete a federal criminal background
check; and
(c) demonstrate ongoing
competency to practice in the form of:
(1)
active practice in the jurisdiction of origin totaling at least 50 days (400
hours) in the previous 2 years or 120 days (960 hours) in the previous 5 years,
verified by appropriately certified employment records; or
(2) satisfactory completion of 20 hours of
qualifying continuing education in the two years immediately preceding
application; or
(3) current,
nationally recognized certification.
Section 6.3 Scope of Practice.
Refer to Part 11-1. Consistent with
26 V.S.A.
§
1572, an LPN's scope of practice is
directed by a licensed RN, APRN, MD, DO, physician assistant, or dentist acting
within his or her own scope of practice. Direction may occur via direct
supervision or through provider orders, forms, guidelines, policies or
procedures, protocols, algorithms, or clearly established plans of care.
(a) The LPN, practicing to the extent of
their education and training under the supervision of an RN, advanced practice
registered nurse (APRN), physician or other authorized licensed health care
provider:
(1) Participates in nursing care,
health maintenance, patient teaching, counseling, collaborative planning and
rehabilitation.
(2) Plans for
patient care, including:
(i) Planning nursing
care for a patient whose condition is stable or predictable.
(ii) Assisting the RN, APRN, or physician in
identification of patient needs and goals.
(iii) Determining priorities of care together
with the RN, APRN or physician.
(3) Provides patient surveillance and
monitoring, participating with other health care providers and contributing to
the development, modification, and implementation of the patient centered
healthcare plan.
(4) Implements
nursing interventions and prescribed medical regimens in a timely and safe
manner.
(5) Documents nursing care
provided accurately and timely.
(6)
Collaborates and communicates relevant and timely patient information with
patients and other health team members to ensure quality and continuity of
care, including:
(i) Patient status and
progress.
(ii) Patient response or
lack of response to therapies.
(iii) Changes in patient condition.
(iv) Patient needs and special
requests.
(7) Takes
preventive measures to promote an environment that is conducive to safety and
health for patients, others and self.
(8) Respects patient diversity and advocates
for the patient's rights, concerns, decisions and dignity.
(9) Maintains appropriate professional
boundaries.
(10) Participates in
systems, clinical practice and patient care performance improvement efforts to
improve patient outcomes.
(11)
Assigns and delegates nursing activities to assistive personnel. The LPN shall
delegate only those nursing measures the delegate has the training, education,
and experience to accomplish safely.
Section 6.4 Individual Scope.
The individual scope of practice for each LPN is determined
by the individual's education, training, experience, and certification. Each
LPN has a responsibility to practice in a manner that protects and promotes the
health, safety and rights of the patient. Each nursing activity must be
consistent with reasonable and prudent practice. Refer to Part 11-1 of these
Rules.
PART 8
INTERSTATE PRACTICE PRIVILEGES FOR RNS AND LPNS: THE NURSE LICENSURE COMPACT
Section 8.1 Applicant Responsibilities.
(a) An applicant for a multistate license
shall declare Vermont as primary state of residence.
(b) A nurse who changes primary state of
residence to another party state shall apply for a license in the new party
state when the nurse declares to be a resident of the state and obtains
multistate privileges not ordinarily extended to nonresidents of the
state.
(c) A nurse shall not apply
for a Vermont single state license while the nurse holds a multistate license
in another party state.
(d) An
applicant must provide evidence of residence in Vermont. This evidence may
include, but is not limited to, a current:
(1)
driver's license with a home address;
(2) voter registration card with a home
address;
(3) federal income tax
return with a primary state of residence declaration;
(4) military form no. 2058 (state of legal
residence certificate); or
(5) W2
form from the United States government or any bureau, division, or agency
thereof, indicating residence.
(e) An applicant who is a citizen of a
foreign country, and who is lawfully present in the United States and is
applying for multistate licensure in Vermont may declare either the applicant's
country of origin or Vermont as the primary state of residence.
(f) If the applicant declares the foreign
country as the primary state of residence, they are not eligible for a
multistate license, but may apply for a single state license if the applicant
meets licensure requirements.
(g)
An applicant shall disclose current participation in an alternative program to
any party state, whether upon initial application or within ten (10) calendar
days of enrollment in the program.
Section 8.2 Change in Primary State of
Residence.
(a) A nurse who changes his or her
primary state of residence from one party state to another party state may
continue to practice under the existing multistate license while the nurse's
application is processed, and a multistate license is issued in the new primary
state of residence.
(b) Upon
issuance of a new multistate license in another party state, the Vermont
multistate license will be deactivated/expired.
(c) If a party state verifies that a licensee
who holds a multistate license changes primary state of residence to a
non-party state, the party state shall convert the multistate license to a
single state license within fifteen (15) calendar days and report this
conversion to the Coordinated Licensure Information System.
Section 8.3 Temporary Permits and
Licenses.
A temporary permit, license, or similar temporary
authorization to practice issued by a party state to an applicant for licensure
shall not grant multistate licensure privileges.
Section 8.4 Identification of Licenses.
A license issued by a party state shall be clearly identified
as either a single state license or a multistate license.
Section 8.5 Credentialing and English
Proficiency for Foreign Nurse Graduates.
(a) A
party state shall verify that an independent credentials review agency
evaluated the credentials of graduates.
(b) The party state shall verify successful
completion of an English proficiency examination for graduates.
Section 8.6 Deactivation,
Discipline, and Revocation.
(a) The Board of
Nursing shall determine whether a disqualifying event will result in adverse
action or deactivation of a multistate license or privilege.
(b) Upon deactivation due to a disqualifying
event, the Board may issue a single state license.
Section 8.7 Federal Criminal Records.
Communication between Vermont and the Nurse Licensure Compact
Commission and communication between party states regarding verification of the
nurse's eligibility for licensure pursuant to the Compact shall not include any
Criminal History Record Information (CHRI) received from the Federal Bureau of
Investigation relating to a federal criminal records check performed by a
member board under Public
Law 92-544.
Section 8.8 Active-duty Military Personnel
and Spouses.
(a) An active-duty service
member, or the member's spouse, shall designate a home state where the service
member or spouse has a current license in good standing.
(b) The service member may retain the home
state designation during the period the service member or spouse is on active
duty.
(c) After designating a home
state, the service member or spouse shall only change home state through
application for licensure in the new state.
PART 9 ADVANCED PRACTICE REGISTERED NURSES
Section 9.1 APRN License Requirements.
To be eligible for licensure as an APRN the applicant
must:
(a) hold an unencumbered Vermont
registered nursing license or an unencumbered multistate registered nursing
license from another Compact state;
(b) meet the education requirements set forth
below;
(c) hold certification from
a national board;
(d) complete a
federal criminal background check; and
(e) meet the practice
requirements.
Section 9.2
Roles.
The Board may license an individual to practice as an APRN in
the following roles:
(a) Certified
Nurse Practitioner;
(b) Certified
Nurse Midwife;
(c) Certified
Registered Nurse Anesthetist; and
(d) Clinical Nurse Specialist.
Section 9.3 Identification.
APRNs shall use, at a minimum, the license designation "APRN"
for purposes of identification and documentation.
Section 9.4 Population Focus.
Population Focus means that segment of the population,
defined by age group or health status to which an APRN provides professional
services. Each licensee is assigned a population focus area based on the
licensee's certification. Refer to the Board Website for recognized population
focus areas.
Section 9.5
Education
To be eligible for an APRN license, an applicant
shall:
(a) have a degree or
certificate as shown by the official transcripts from the applicant's graduate
nursing program in one of the four recognized APRN roles from:
(1) a Vermont graduate nursing program
approved by the Board; or
(2) a
United States graduate nursing program approved by a state or a national
accrediting agency approved by the Board; and
(b) have successfully completed graduate
level courses in:
(1) advanced
pharmacotherapeutics;
(2) advanced
patient assessment; and
(3) advanced
pathophysiology.
Section
9.6 APRN Certification Organizations
The Board may accept certification by a certifying
organization which:
(a) follows
established certification testing and psychometrically sound, legally
defensible standards for APRN certification exams;
(b) assesses APRN core and role competencies
across a minimum of one population focus of practice;
(c) assesses specialty competencies, when
applicable, separately from the APRN core role and population-focused
competencies; and
(d) is accredited
by a national U.S. or Canadian certification accreditation body.
Section 9.7 Education and Practice
Requirement.
To be eligible for initial licensure or to renew or reinstate
an APRN license, an applicant must have
(a) For initial licensure and renewals,
(1) Graduated from an APRN program within two
years of making the application; or
(2) Practiced as a licensed APRN for a
minimum of:
i. 50 days (400 hours) in the
previous two years; or
ii. 120 days
(960 hours) in the previous five years; and
(3) Maintained certification by a national
certification accreditation body; or
(b) For reinstatement, completed a Board
approved APRN Refresher Course as set forth in 9-14 through 9-17 of these Rules
within two (2) years of making the application.
Section 9.8 Transition to Practice:
Collaborative Provider Agreement.
An APRN with fewer than 24 months and 2,400 hours of licensed
active advanced nursing practice in an initial role and population focus or
fewer than 12 months and 1,600 hours for any additional role and population
focus shall have a formal agreement with a collaborating provider as required
by 26 VSA
§
1613 and these Rules:
(a) An APRN shall maintain signed and dated
copies of all collaborative provider agreements, and when the transition to
practice is complete, shall retain a copy of the Board form attesting to
completion of the transition to practice.
(b) An APRN required to practice under a
collaborative provider agreement may not practice in a setting where there are
no additional APRNs or licensed physicians to provide mentoring, consultation
or advisement.
Section
9.9 Collaborating Providers.
A collaborating provider may be a Vermont APRN, a medical
doctor licensed under 26 V.S.A. Ch. 23, or an osteopathic physician licensed
under 26 V.S.A. § Ch. 33. An APRN may have more than one collaborating
provider. A collaborating provider must be actively licensed in good standing
and possess at least four years of practice experience in the same role and
population focus or specialty as the APRN.
Section 9.10 Collaborating Provider
Responsibilities
A collaborating provider shall establish a written agreement
with an APRN to serve as an advisor, mentor, and consultant. A collaborating
provider shall participate in quality assurance activities.
Section 9.11 APRN Group Practice.
An APRN group practice must include one or more APRNs who are
not required to practice under a collaborative provider agreement.
Section 9.12 APRN Refresher Course
(a) Individuals who have been out of practice
for less than five years and who do not meet the practice requirement for
initial licensure, or renewal, or reinstatement of an APRN license must take a
refresher course as set forth in parts 9-16 through 9-18 of these Rules. Once
commenced, the course must be completed within 18 months.
(b) Individuals who have been out of practice
for more than five and fewer than ten years may be assigned a case-specific
refresher assignment approved by the Board;
(c) Individuals who have been out of practice
for more than ten years must complete a new post-masters APRN program that
includes a minimum of 500 clinical practice hours.
Section 9.13 Refresher Course Clinical
Practice Permit.
The Board may grant a refresher course clinical practice
permit, valid in six month increments and renewable not more than twice, to an
applicant who:
(a) holds a Vermont RN
license;
(b) holds a national APRN
certification.
A person practicing under a permit shall be conspicuously
identified as an "APRN Applicant" on name badges, signature blocks, medical
record entries, and other locations calling for a professional
designation.
Section
9.14 APRN Refresher Course Design.
(a) Refresher programs may be individually
designed or established by a nursing education program or a non-accredited
nursing service facility. Each must be approved by the Board.
(b) The Board may accept a Nationally
Accredited Refresher Program in Vermont or elsewhere which meets the
requirements of Parts 9-17 and 9-18 of these rules.
(c) Refresher programs are available to APRNs
who have been out of practice for ten years or less.
Section 9.15 APRN Refresher Course Approval
Criteria.
The Board will approve a refresher program which:
(a) for a licensee who has been out of
practice for less than five years consists of a minimum of:
(1) 150 hours of theory; and
(2) 200 hours of clinical experience;
or
(b) for a licensee who
has been out of practice for more than five years, but less than ten years
consists of a minimum of:
(1) 150 hours of
theory and
(2) 400 hours of clinical
experience; and
(c) which
provides on-site supervision:
(1) by an APRN
collaborating provider qualified under Part 9 of these rules holding a Vermont
unencumbered APRN license, or a physician collaborating provider with a Vermont
unencumbered license; and
(2) who
practices in the same role and population focus.
Section 9.16 APRN Refresher Program
Curricula.
Curricula must include a review and update of:
(a) advanced pharmacotherapeutics;
(b) advanced assessment;
(c) role and population specific theory and
practice standards;
(d) role and
population specific clinical practicum; and
(e) advanced practice nursing
skills.
Section 9.17
Scope of Practice
(a) The individual scope of
practice for each APRN is determined by the APRN's education, training,
experience, role, population focus, and national certification, consistent with
Rule 11-1.
(b) Nurse practitioners providing primary
care may be primary care providers of record.
(c) The scope of an APRN includes:
(1) registered nurse scope of
practice;
(2) acts of medical
diagnosis including, ordering, and interpreting diagnostic tests and
procedures;
(3) prescribing
medications;
(4) prescribing
medical, therapeutic, or corrective measures;
(5) initiating written or verbal orders to
other health care providers; and
(6) managing and evaluating care.
Section 9.18 Eligible
Colleges or Universities
The Board will approve a Vermont APRN education program
which:
(a) is offered by a college or
university;
(b) confers a graduate
degree with a major in nursing or a graduate degree that prepares nurses to
practice advanced practice nursing; and
(c) meets the educational standards set by a
national accrediting body and national certifying board approved by the
Board.
Section 9.19
Approval Process.
To obtain and maintain Board approval, an APRN education
program must follow the processes outlined in Part 5 of these Rules.
PART 10 LICENSED NURSE
ASSISTANTS
Section 10.1 Licensure by
Examination.
To qualify for licensure by examination, an applicant
shall:
(a) have completed, within two
years of application, a nursing assistant education program approved by the
Department of Disabilities, Aging, and Independent Living or its equivalent in
another U.S. jurisdiction, or be a student in an RN or LPN education program
who has completed studies equivalent thereto;
(b) complete a federal criminal background
check; and
(c) pass a competency
examination approved by the Department of Disabilities, Aging, and Independent
Living or an equivalent exam acceptable to the Board.
Section 10.2 Examination Attempts.
A candidate who has not passed LNA exams after three attempts
must repeat an approved nursing assistant education program.
Section 10.3 Licensure by Endorsement.
To qualify for licensure by endorsement, based on licensure
and experience outside Vermont, an applicant who is not eligible for expedited
endorsement under Rule
4-1 shall:
(a) be licensed or certified as nursing
assistant by another state;
(b)
complete a federal criminal background check; and
(c) demonstrate, via job description or other
appropriate employer verification, at least 50 days (400 hours), in the two
years preceding application, of employment as a nurse assistant or in a role,
regardless of title or obligation to hold a license, that would reasonably tend
to reinforce the training and skills of a licensed nurse
assistant.
Section 10.4
Scope of Practice.
(a) An LNA's scope of
practice includes:
(1) Basic Nursing
Care;
(2) Personal Care;
(3) Basic Restorative Care;
(4) Psychosocial Support;
(5) Care of the Cognitively
Impaired;
(6) Communication;
and
(7) Patient
Safety.
(b) Additional
tasks and skills may be performed by LNAs through the delegation process by
APRNs, RNs and LPNs as described in section
11.2
(c) An LNA may not perform activities which
exceed the scope defined by the level of licensure. This means that LNAs may
not perform, even if directed to do so, an activity not appropriate to their
level of licensure or otherwise prohibited by law. Examples of activities not
within the LNA scope of practice include nursing assessments, nursing
judgments, and development of the plan of care.
Section 10.5 Definition.
A medication nursing assistant (MNA) is a licensed nursing
assistant authorized by a specialty designation to administer medications in
limited settings set out by
26 V.S.A.
§
1641.
Section 10.6 Eligibility for MNA Specialty
Designation.
To be eligible for the MNA specialty designation, an
applicant must:
(a) hold an
unencumbered Vermont LNA license;
(b) be at least 18 years of age;
(c) have a high school diploma or
G.E.D.;
(d) have two years'
experience consisting of no fewer than 4,000 hours of LNA experience, of which
at least one year and 2,000 hours were acquired in a long-term care nursing
facility;
(e) complete, within the
year preceding application, an MNA training program approved by the Board;
and
(f) successfully complete MNA
competency and math proficiency examinations approved by the Board.
Section 10.7 Nursing Student
Eligibility.
The experience and training requirements set out in subparts
10-6(d) & (e) may be waived for a student enrolled in a Board-approved RN
or LPN program that has covered MNA training content.
Section 10.8 Training from Other
Jurisdictions.
(a) If the Board determines
that the program has complied with the requirements of statutes and these
rules, it will grant approval to continue the program. Approval will be for a
period of time determined by the Board. Approval may not exceed the duration of
the national accrediting agency's accreditation, and in no event exceed ten
years.
(b) Once approved, a program
is considered to be an "existing program" subject to the requirements of
Subsection B of this Part.
Section
10.9 Scope of Practice.
(a) An
MNA is supervised on-site, on the unit, by an LPN, RN, or APRN.
(b) A medication nursing assistant upon
delegation by an LPN, RN, or APRN may:
a.
administer medications to individual residents; and
b. administer medication via oral,
sublingual, buccal, inhalation, spray (on oral mucosa), topical, nasal, ocular,
optic, and suppository (vaginal or rectal) route.
Section 10.10 Limitations.
An MNA may:
(a)
administer medications to a newly admitted resident only after the delegating
nurse determines that the resident is stable, and then only according to
facility policy; and
(b) administer
prn medication only after an RN assessment confirms the need for the
medication.
Section 10.11
Exclusions.
An MNA may not:
(a)
administer injectable medications.
(b) administer medications new to the
patient;
(c) make adjustments to
dosage;
(d) take or transcribe
orders;
(e) apply medicated
dressings;
(f) administer
insulin;
(g) administer bladder
instillations;
(h) calculate
conversions;
(i) dispose of
medications; or
(j) administer
enteral feedings or medications.
SUBPART B MNA TRAINING PROGRAMS
Section 10.12 Board Approval Required.
Before providing MNA training, an MNA program must receive
Board approval. The process for receiving Board approval is set forth in Part 5
of these rules. The Board will approve a program which assures that
participants are trained in:
(a)
communication and documentation;
(b) ethical and legal responsibilities
regarding medication administration;
(c) medication use, side effects,
abbreviations, look alike drugs, drug interactions, proper storage, and the
need for reporting side effects;
(d) apothecary and metric
measurements;
(e) patient safety
principles regarding proper medication administration; and
(f) facility policies regarding medication
errors.
Section 10.13 MNA
Training Program Requirements.
To receive Board approval each MNA training program
must:
(a) employ a standardized
textbook approved by the Board;
(b)
require no fewer than 60 hours of class instruction including lab/simulation
instruction; and 40 hours of supervised clinical instruction;
(c) have instructors who:
(1) possess unencumbered Vermont RN
licenses;
(2) have at least 2 years'
full-time practice experience, of which one year was in clinical practice;
and
(3) hold a baccalaureate or
higher degree in nursing; and
(d) have a program administrator who holds a
baccalaureate or higher degree in nursing.
Section 10.14 MNA Program Review.
An annual report shall be submitted to the Board by each MNA
program as per Rule
5-9 of these rules and site visits to MNA
programs may be conducted by the Board in accordance with Rule
5-3 of these rules.
PART 11 STANDARDS OF
NURSING PRACTICE
Section 11.1 Determination
of Scope of Practice.
An activity not prohibited by Vermont Administrative Rules or
Statues and that is consistent with current national professional nursing
organizational standards, accreditation standards and or credible nursing
research may be considered within an individual nurse's scope of practice if
the following conditions are met:
(a)
the nurse has completed the necessary education and possesses adequate
knowledge to perform the activity;
(b) there is evidence of the nurse's current
competency and skill;
(c) a
reasonable and prudent nurse with similar training and experience would perform
the activity;
(d) there are
institutional policies and /or procedures in place governing the activity, and
the activity is consistent with those;
(e) There are adequate resources, equipment
and supports in the care setting to ensure patient safety; and
(f) The nurse is prepared to accept and
manage the consequences of performing the activity.
In the absence of any of the above, the activity would be
considered out of scope for an individual nurse and should not be performed. A
nurse may not perform, even if directed to do so, an activity not recognized by
the profession as appropriate for that level of licensure or otherwise
prohibited by law.
Section
11.2 Delegation.
A licensee shall not delegate tasks to a person the licensee
knows, or has reason to know, is not qualified by training, experience,
education, or licensing credentials to perform them. See
3 V.S.A.
§
129a(a)(6).
Decision-making regarding the delegation of nursing care must be focused on the
protection of the health, safety, and well-being of the patient/client.
(a) Non-delegable functions. An APRN or RN
may never delegate the exercise of nursing judgment, including patient
assessment, care planning, and evaluation of care, to a licensee whose scope of
practice does not include those functions.
(b) Factors. A nurse delegating tasks shall
consider the Five Rights set out in the National Guidelines for Nursing
Delegation:
(1) Right task: the activity must
be within the delegate's job description and consistent with written policies
and procedures;
(2) Right
circumstance: the patient's condition must be appropriately stable, and the
delegating nurse must be situated to be aware of changes;
(3) Right person: the delegate must have the
skills and knowledge to perform the activity;
(4) Right direction and communication: the
delegate must be appropriately educated, and understanding must be confirmed by
two-way communication and clear understanding and acceptance of the delegated
activity; and
(5) Right supervision
and evaluation: the delegating nurse must monitor the delegated activity,
remain ready and available to intervene, and follow up to evaluate performance,
outcomes, and accurate documentation.
Section 11.3 Evidence-based Practice;
Competent and Credible Evidence.
(a) Duty of
competence. A licensee shall maintain awareness of evolving evidence-based
practice guidelines and standards; shall implement these in nursing practice;
and shall exercise the critical thinking required to meet the statutory
obligation to refrain from "promoting or recommending a therapy or treatment in
a manner tending to deceive the public or to suggest a degree of reliability or
efficacy unsupported by competent evidence and professional
judgment."3 V.S.A. §
129a(a)(17).
(b) Credibility of sources. An APRN
considering a therapeutic intervention shall consider whether the therapy is
reasonably indicated for the relevant diagnosis, as indicated by FDA approval
or support by credible literature, meaning literature upon which a reasonable
clinician competent in the prevailing practice would rely.
Section 11.4 Fitness.
A licensee shall practice as a nurse or nurse assistant only
when fit to work. Fitness includes the ability to collect data, notice detail,
analyze information, solve problems, and respond rapidly to hazards to patient
safety or wellbeing. Fitness may be impaired by fatigue, stress, alcohol,
drugs, physical impairment, medical condition, or emotional state. Nurse peers,
nurse supervisors, and nursing employers share a responsibility to ensure
fitness and to intervene if a licensee appears unfit.
(a) A nurse or nurse assistant shall:
(1) Assure his or her ongoing wellness and
fitness for work, by such means as such as getting adequate rest, seeking
treatment for medical conditions, seeking counseling for emotional problems,
managing stress, and avoiding substances and activities that may impair fitness
for work;
(2) Notify the manager,
supervisor, or responsible person of any concerns regarding his or her fitness
for work and request appropriate accommodations, as needed;
(3) Refuse an assignment, if not fit to
competently and safely perform the assignment; and
(4) Notify the individual and the manager,
supervisor, or responsible person of any concerns regarding another person's
fitness for work.
(b) A
nurse supervising others shall:
(1) Develop
or enforce workplace policies and procedures regarding fitness for
work;
(2) Schedule responsibly,
allowing adequate time for rest breaks during and between shifts;
(3) Manage the work environment to promote
safety and avoid fatigue and hazards;
(4) Educate employees regarding fitness for
work concepts and available supports;
(5) Be available to observe and assess the
fitness for work of employees on duty, and
(6) if a nurse or nurse assistant appears to be unfit for work,
remove the employee from the work environment until the situation has been
assessed, appropriate action taken, and the employee is determined to be fit to
perform their assigned work.
Section 11.5 Patient Abandonment.
A licensee shall not abandon a patient. Abandonment occurs
when a licensee who has accepted a patient assignment or accepted
responsibility for care of a patient jeopardizes the safety of that or other
patients by improperly disengaging from the assignment or
responsibility.
(a) Examples of
abandonment include, without limitation:
(1)
Leaving the patient care area without transferring responsibility
appropriately;
(2) Remaining
unavailable for patient care for a duration that compromises patient
care;
(3) Inattention or
insufficient observation or contact with a patient;
(4) Sleeping while on duty outside
supervisor-approved rest consistent with written facility policy;
(5) Failing to timely notify a supervisor or
employer if unable to initiate or complete an assignment where the licensee is
the sole care provider; or
(6) For
an APRN, terminating the nurse-patient relationship without providing
reasonable notification to the patient and resources for continuity of
care.
(b) The following
employment acts generally do not constitute patient abandonment:
(1) Failing to report to work when an
assignment has not been assumed or accepted;
(2) Refusing to accept an assignment to a
unit when there has been no orientation and no educational preparation or an
assignment outside the licensee's scope of practice;
(3) Leaving an assignment after notifying the
appropriate personnel and transferring responsibility for patient care;
(4) Leaving an assignment due to
circumstances reasonably perceived by the licensee as placing the licensee in
imminent danger of serious harm;
(5) Refusing to work beyond a scheduled
shift; or
(6) Resigning without
giving specific notice.
Section 11.6 Informed Consent.
Each person has a right to determine what shall be done with
his or her body and a right to accept or refuse medical treatment. For those
determinations to be informed, the person, as patient, must be capable of
making relevant decisions, based not only on personal capacity, but also upon
the provision of accurate and adequate information by providers of care. If a
patient lacks capacity, informed consent is to be obtained from a parent or
legal guardian.
(a) An APRN or RN may
obtain a patient's informed consent for a treatment or procedure if:
(1) The APRN or RN will perform the treatment
or procedure;
(2) The treatment or
procedure is within the APRN or RN's scope of practice;
(3) The APRN or RN is able accurately to
convey to the patient:
i. A description of
the treatment or procedure;
ii. The
indications for the treatment or procedure;
iii. Risks and benefits of the treatment or
procedure;
iv. Alternatives and
their risks and benefits;
v. The
probable consequences of declining the recommended treatment or procedure; and
vi. Roles of others who may be
involved in executing the treatment or procedure.
Section 11.7 Duty to
Update and Self-report.
Applicants and licensees owe a duty of candor to the Board
and shall disclose circumstances that may call for further investigation to
protect the public. That a matter is reportable does not imply that the matter
necessarily is a basis for discipline. A licensee, including an applicant for
licensure, shall report to the Office, in writing, within 30 days:
(a) any change of name, e-mail, or mailing
address;
(b) any material
inaccuracy or change in circumstance relative to any application question,
where the changed circumstance arises between submission of a license
application and issuance of the license sought;
(c) any arrest or charge for conduct
occurring in the course of, or in direct relation to, the practice of
nursing;
(d) any conviction for any
criminal act;
(e) any injunction or
other order of a court or regulatory authority, including any order to cease
& desist and any assurance of discontinuance, limiting the licensee's
ability to practice;
(f) any legal
claim, settlement, or judgment arising from alleged professional negligence,
misconduct, or malpractice; and
(g)
any adverse action against a professional license in another jurisdiction,
where the adverse action relates to an allegation of misconduct, substandard
practice, or unethical conduct.
PART 12 ALTERNATIVE TO DISCIPLINE PROGRAM
Section 12.1 Alternative Program.
As authorized by
26 V.S.A.
§
1574(a)(10), the
Board administers an Alternative Program to serve as an alternative to the
disciplinary process for nurses and nursing assistants with substance use
disorders or other professional practice issues as designated by the Board. The
purpose of the Program is to protect the public safety while encouraging
licensees to seek help when necessary and without fear of adverse licensing
consequences or undue publicity. The Program reflects the Board's belief that
nurse wellness is foundational to safe practice.
Section 12.2 Eligibility.
A person eligible to participate in the Alternative Program
shall:
(a) hold a license issued by
the Board or be an eligible applicant for one;
(b) voluntarily request to
participate;
(c) not be the subject
of any unresolved complaint, investigation, or charge, unless specifically
approved for participation by the State Prosecuting Attorney authorized to
bring disciplinary charges;
(d)
acknowledge that a deficiency in some aspect of nursing practice, or a
substance use disorder, if not appropriately addressed, may impact the
licensee's ability to practice safely and competently;
(e) illustrate that the condition or
circumstance is of a type susceptible to successful treatment or remedial
training; and
(f) if requested,
agree to undergo a comprehensive assessment, at the applicant's expense, from a
pre-approved qualified provider based on criteria determined by the
Committee.
Section 12.3
Disqualification.
Notwithstanding Rule
12-2, supra., no person shall be eligible
to participate in the Program who:
(a)
has harmed or endangered a patient through willful, knowing, or reckless or
inexcusably negligent conduct, or has exhibited abusive or cruel behavior
toward a patient;
(b) presents a
danger to the public;
(c) has a
history of non-compliance with treatment or remediation programs;
(d) has attempted to conceal a practice error
or falsify records; or
(e) in the
judgment of the Committee, is not an appropriate candidate for any
reason.
Section 12.4
Confidentiality.
Records pertaining to an individual's participation in the
Program are not available to the public and shall not be publicized,
except:
(a) by order of a court of
competent jurisdiction;
(b) when
necessary and appropriate to monitor compliance with Program requirements, such
as by confirming conditions are followed at a place of employment or that a
participant has remained in treatment;
(c) when the Board is required by the terms
of the Nurse Licensure Compact to report Program participation to the
coordinated licensure information system, pursuant to
26 V.S.A.
§
1647f; or
(d) when participation in the Program is
considered in a future disciplinary matter.
Section 12.5 Administration and Selection.
The Alternative Program is administered by the Executive
Director. The investigative team assigned to a matter may refer a potential
participant if the team believes participation would be in the interest of the
public health, safety, and welfare; consistent with these Rules and applicable
policies of the Alternative Program Committee; and likely to benefit the
eligible person's fitness to practice.
Section 12.6 Agreement.
When a participant is approved, the Executive Director or
case manager shall propose an Alternative Program Agreement suited to address
the underlying conduct or circumstance. The Agreement must be jointly approved
by the participant and the Executive Director. The Agreement shall at a minimum
specify:
(a) the conduct,
circumstance, or condition acknowledged to require treatment or
remediation;
(b) that such conduct,
circumstance, or condition shall not be the subject of Board discipline if the
participant successfully completes the Alternative Program as set out in the
Agreement;
(c) the conditions of
participation, to include without limitation any supervision, restriction,
testing, coursework, treatment or other requirements calculated to aid the
participant while appropriately protecting the public;
(d) that the Agreement is voluntary and that
the participant agrees to forgo due process rights associated with a contested
disciplinary case before the Board;
(e) that the participant shall grant the
Program releases as may be reasonably requested to confirm treatment compliance
and progress and agrees not to assert patient-provider privilege to frustrate
Program oversight; and
(f) that
violation of the Agreement shall constitute unprofessional conduct and may
result in public disciplinary charges.
Section 12.7 Effect on Multistate Licensure
Privilege.
The Board is obligated by the Nurse Licensure Compact to
deactivate the multistate licensure privilege of any nurse licensed by the
Board, for the duration of the nurse's participation in an alternative program.
See 26
V.S.A. §
1647(e)(c).
