CALL TO ORDER

The meeting of the Nevada State Board of Nursing Advanced Practice Advisory Committee was called to order by Debra Scott, MSN, RN, APN, Executive Director, at 3:05 p.m., via videoconference at the Board of Nursing, 5011 Meadowood Mall Way, #300, Reno, Nevada, 89502, and the Board of Nursing, 2500 W. Sahara, #207, Las Vegas, Nevada, 89102.

MEMBERS PRESENT

Debra Scott, MSN, RN, APN, Executive Director, Chair

Amy Booth, MSN, RN, APN

Tricia Brown, MSN, RN, APN

George Cox, MS, RN, CRNA

Phyllis Suiter, MA, RN, APN

Rhigel Jay Tan, MSN, RN, APN

Susan VanBeuge, MSN, RN, APN

MEMBERS ABSENT

Ronnie Wing, MSN, RN, CRNA

OTHERS PRESENT

Fred Olmstead, Board General Counsel

Jeanette Belz, Nevada State Society of Anesthesiologists (NSSA)

Gina Kronenberg, CRNA, Nevada Association of Nurse Anesthetists

Jonathan Zucker, MD, NSSA 

CALL TO ORDER: The meeting was called to order at 3:05 p.m. by  D. Scott, committee chair.

PUBLIC COMMENTS:  There were no public comments.

A. APPROVAL OF MINUTES: May 29, 2007: It was moved and seconded to approve the minutes of the May 29, 2007 meeting of the APN Advisory Committee as written.

B. OLD BUSINESS:

1.      Report from the July, September, and November 2007 Board meetings: D. Scott reported on the outcomes of the last three Board meetings as related to APN issues, including the Board’s approval of the Affidavit-APN policy and procedure which requires the applicant to submit an official transcript before being issued a permanent APN certificate of recognition.

2.      Discussion regarding APN protocols (specifically drug list):  D. Scott discussed the proposed regulation change regarding the necessity of APNs having a “drug list” as part of their protocols.  The proposed wording recommends that the regulation be changed to say that the APN must have a “drug class list” rather than what is now in regulation, “a drug list.”

3.   Review, discussion and action regarding regulation changes to clarify protocol language:  D. Scott reiterated the proposed changes and recommended that the committee members and any other interested persons attend the regulation workshop on November 30, 2007, at 10:00 am which will be videoconferenced between the NSBN’s Reno and Las Vegas office sites. She also suggested individuals submit written testimony to be read into the record if they are unable to attend the workshop or hearing. The hearing is scheduled during the January 16-18, 2008, Board meeting in Las Vegas.

C. NEW BUSINESS

1.      Review and discussion regarding scope of practice question regarding APNs doing colonoscopies:  D. Scott discussed the results of a survey done by NCSBN related to APN scope of practice related to colonoscopies. The committee members stated that had no knowledge of APNs performing colonoscopies in Nevada, but at least one committee member was aware of certification courses for APNs to learn to do them. The committee concluded that, in order for APNs in Nevada to perform this procedure, they would need to follow the scope of practice decision tree, be competent to do the procedure, and be certified to do so. D. Scott also recommended that an APN research nursing articles to determine if APNs across the country were doing this procedure, utilizing the CINAHL process.

2.      Review and discussion regarding anesthesiologist assistants: D. Scott introduced this agenda item, requesting that the committee utilize this time to discuss any information that they were aware of regarding anesthesiologist assistants (AAs). G. Kronenberg, CRNA, president of the Nevada Association of Nurse Anesthetists (NVANA), provided information from the literature about the role of AAs, comparing their scope of practice with that of CRNAs. J. Zucker, MD, president of the Nevada State Society of Anesthesiologists (NSSA), relayed further information about this type of practitioner. The intent of the discussion was to make the committee members more aware of AAs for further discussion at a later time.

3.      Discussion regarding having board certification be a requirement for APNs in Nevada to be certified: D. Scott and T. Brown gave a historical perspective of Nevada’s decision to not require all APNs to be certified in their specialties. A. Booth suggested that it is important to “raise the bar” as far as qualifications for certification. The committee discussed the use of “grandfathering” current APNs. D. Scott offered to bring information back to the committee about how many states require specialty certification for licensure/certification of advanced practice nurses. P. Suiter offered to bring further information about the requirements for certification in her specialty.

4.      Discussion regarding Changes in Healthcare Professions’ Scope of Practice: Legislative Considerations: D. Scott gave a quick overview of this publication, but since the committee members had not received this document, the committee suggested that it be put on the next committee agenda for further discussion.

5.      Discussion regarding CRNA/APN audits: D. Scott distributed the forms that the NSBN staff utilized for auditing advanced practice nurses. She described the process and answered questions that the committee members had regarding the audit process. She stated that audits were done on individuals on a purely random basis, a process devised by the Board’s information technology officer. She stated that noncompliance in responding to an audit letter may result in discipline, but that Board staff work closely with APNs to meet the audit criteria, allowing adequate time for individuals to produce the required documents.

6.      Discussion and action regarding 2008 committee meeting schedule: The committee decided on the following 2008 meeting dates:  February 12, May 20, August 26, and November 4, 2008.

7.      Suggestions for agenda items for next meeting: The committee recommended that the Changes in Healthcare Professions’ Scope of Practice: Legislative Considerations document and further information about requiring specialty certification for APNs be put on the next meeting’s agenda.

ADJOURNMENT: The meeting was adjourned at 4:45 p.m.

May 29, 2007

CALL TO ORDER 

The meeting of the Nevada State Board of Nursing Advanced Practice Advisory Committee was called to order by Debra Scott, MSN, RN, APN, Executive Director, at 3:10 p.m., via videoconference at the Board of Nursing, 5011 Meadowood Mall Way, #300, Reno, Nevada, 89502, and the Board of Nursing, 2500 W. Sahara, #207, Las Vegas, Nevada, 89102.

MEMBERS PRESENT

Debra Scott, MSN, RN, APN, Executive Director, Chair

David Burgio, MS, RN, APN, Board Liaison

Tricia Brown, MSN, RN, APN

George Cox, MS, RN, CRNA

Rhigel Jay Tan, MSN, RN, APN

Susan VanBeuge, MSN, RN, APN

MEMBERS ABSENT

Amy E. Booth, MSN, RN, APN

Phyllis Suiter, MA, RN, APN

Ron Wing, CRNA

OTHERS PRESENT

Fred Olmstead, Board General Counsel

CALL TO ORDER: The meeting was called to order at 3:10 p.m.

PUBLIC COMMENTS: The committee discussed the issue of Expedited Partner Therapy (EPT) related to sexually transmitted diseases based on a question submitted by the public health nurses.

A. APPROVALOF MINUTES— February 13, 2007:  The minutes of the February 13, 2007 meeting of the APN Advisory Committee were approved as written.

B. OLD BUSINESS:

1.      Report from the March and May 2007 Board meetings: D. Scott presented items from the Board meetings related to advanced practice nursing.

2.      Discussion regarding more accurate wording for the definition of “nurse midwife” in regulation: D. Scott described the testimony by Martha Drohobyzcer at the Board’s May meeting in support of the changes to NAC 632.0605 “Nurse midwife” defined. She reported that the Board accepted the concept and wording of the proposed regulation change. The proposed regulation change will proceed through the regulatory process of public workshops and hearings.

3.      Review, discussion and action regarding Guidelines for Protocols for APNs: D. Scott presented the finalized revision of the Record of Practice and Protocol Guidelines for APNs which Board staff provide to new APNs in Nevada as part of the application packet. This document is available on the Board’s website. It gives one example of how APNs may set up their protocols for practice in the advanced nursing role. There was some discussion about NAC 632.257 (2), which refers to “those drugs listed in his protocols.” The committee suggested bringing this regulation back to the committee for review of the possibly outdated language related to other changes that had been made in regulation during the last 12 months. The committee approved the final Record of Practice and Protocol and Guidelines unanimously.

C. NEW BUSINESS

1.      Legislative update: D. Scott reported on the bills which were being considered during the legislative session which impact the nursing board. F. Olmstead reported on AB235 and AB446, two bills which may affect APN practice in Nevada. D. Scott clarified a committee member’s question related to AB385 related to an APN’s scope of practice with the performance of intense pulsed light therapy, and the injection of cosmetic and chemotherapeutic substances. D. Scott explained that this bill does not impinge on an RN or an APN’s scope in providing these procedures.

2.      Suggestions for agenda items for next meeting: The committee suggested putting NAC 632. 257 on the next agenda for consideration of revision, and to include another legislative update.

ADJOURNMENT: The meeting was adjourned at 4:30 p.m.

February 13, 2007

CALL TO ORDER

MEMBERS PRESENT

                            Debra Scott, MSN, RN, APN, Executive Director, Chair

Tricia Brown, MSN, RN, APN                     Phyllis Suiter, MA, RN, APN  

Amy E. Booth, MSN, RN, APN                   Susan VanBeuge, MSN, RN, APN

George H. Cox, MS, RN, CRNA                 Ron Wing, CRNA

Jeanette DiChiro, MSN, RN, APN               

MEMBERS ABSENT

David Burgio, MS, RN, APN, Board Liaison   

OTHERS PRESENT

                              Fred Olmstead, Board General Counsel

                                                Martha Drohobyczer, MSN, RN, APN, CNM

CALL TO ORDER:  The meeting was called to order at 2:05 p.m.

PUBLIC COMMENTS:  D. Scott congratulated M. Drohobyczer on her appointment to the office of president-elect of Nevada Nurses Association, District 3.  The committee members introduced themselves to the newest member of the committee, R. Wing.

A.  APPROVAL OF MINUTES— November 7, 2006:  The minutes of the November 7, 2006 meeting of the APN Advisory Committee were approved as written.

B.  OLD BUSINESS:

1.      Report from the November 2006 and January 2007 Board meetings: D. Scott reviewed the minutes of the last two Board meetings.

2.      Review, discussion and action regarding Guidelines For Protocols For APNs: P. Suiter reviewed the six-page document, which was provided to the committee members for review.  The document is a synthesis of the previous “Guidelines for Protocols” document and the “Example of a Process Protocol” document previously reviewed by the committee. D. Scott also submitted a document, which could be used to guide new advanced practitioners of nursing in Nevada in the process of creating their protocols. After a careful review of all of the documents, the committee recommended that the updates be made to P. Suiter’s document and be utilized when nurses apply for a certificate of recognition as an advanced practitioner of nursing in Nevada.

3.      Review, discussion and action regarding more accurate wording for the definition of

“nurse midwife” in regulation to read, “nurse midwife means a registered professional nurse who has completed an organized formal program of training in the area of pregnancy, childbirth, the postpartum period, care of the newborn and the family planning, gynecological, and primary health needs of women”: M. Drohobyczer presented this agenda item. She reported that the majority of nurse midwifery programs today include training in all of the classic midwifery areas, but also include the primary health needs of women. She stated that the current definition in regulation would better define nurse midwife if this phrase were added. The proposed language for the regulation revision is:

NAC 632.0605  “Nurse midwife” defined.  “Nurse midwife” means a registered professional nurse who has completed an organized formal program of training in the area of pregnancy, childbirth, the postpartum period, care of the newborn and the family planning, and the gynecological needs of women, and the primary health needs of women.

After an enlightening discussion, the committee members voted to recommend the Board adopt this proposed regulatory change in concept and wording at its May 2007 meeting in Las Vegas. M. Drohobyczer stated that she intends to testify at that meeting in support of the proposed concept and wording.

4.      Review, discussion and action regarding guidelines for filling out FMLA forms and disabled placards: P. Suiter presented this agenda item, stating that the issue of FMLA forms is not a problem. She further reported her conversation with a representative from the Department of Motor Vehicles who stated that the DMV wants to remain neutral in the issue of who has the authority to sign documentation for disabled placards. It was stated that if APNs want authority to have this within their scope of practice, it would be up to the APNs to approach the legislature. The committee decided to go no further with this issue at this time.

C.  NEW BUSINESS

1.      Review, discussion and action regarding time of day of committee meetings: D. Scott informed the committee that some of the members were having difficulty attending the committee meetings due to the time of the meeting. The members agreed to start the meetings one hour later on the prescheduled days. In the future, the APN Advisory Committee meeting will begin at 3:00 p.m.

2.      Suggestions for agenda items for next meeting: The members recommended that the committee be given a legislative update at the next meeting.

ADJOURNMENT:  The meeting was adjourned at 3:35 p.m.

November 7, 2006

CALL TO ORDER

MEMBERS PRESENT

                        Debra Scott, MS, RN, APN, Board Executive Director, Chair

Tricia Brown, MSN, RN, APN                       Martha Drohobyczer, MSN, RN, APN, CNM

Amy E. Booth, MSN, RN, APN                     Phyllis Suiter, MA, RN, APN  

George H. Cox, MS, RN, CRNA                   Susan VanBeuge, MSN, RN, APN

Jeanette DiChiro, MSN, RN, APN   

MEMBERS ABSENT

David Burgio, MS, RN, APN, Board Liaison   

OTHERS PRESENT

Roseann Colosimo, PhD, MSN, RN, Board Education Consultant

Fred Olmstead, Board General Counsel

CALL TO ORDER:  The meeting was called to order at 2:15 p.m.

PUBLIC COMMENTS:  The committee set the dates for the Advanced Practice Advisory Committee meetings for 2007—February 13, May 29, August 28, and November 13. Meetings are at 2pm.

A.  APPROVAL OF MINUTES— August 16, 2006:  The minutes of the August 16, 2006 meeting were approved as written.

B.  OLD BUSINESS:

1.      Report from the September Board meeting: D. Scott gave an overview of the Board meeting outcomes from September, including appointments to committees and the Board’s action on the proposed concept and wording for the revision of NAC 632.675.

2.      Review, discussion and action regarding Guidelines For Protocols For APNs: P. Suiter presented this agenda item, describing the information distributed to the committee members.  She included the information under agenda item C.2 regarding “Suggestions For Record of Practice.” The committee agreed that all of the information in these documents would be helpful for new APNs or those who are endorsing from another state. P. Suiter offered to combine the documents into a handout that the Board could distribute in support of these individuals. She will bring the revised document to the next committee meeting in February 2007.

C.  NEW BUSINESS:

1.      Review, discussion and action regarding more accurate wording for the definition of “nurse midwife” in regulation to read, “nurse midwife means a registered professional nurse who has completed an organized formal program of training in the area of pregnancy, childbirth, the postpartum period, care of the newborn and the family planning, gynecological, and primary health needs of women": M. Drohobyczer and D. Scott presented the history behind this agenda item. M. Drohobyczer described the information from the American College of Nurse-Midwives, which describes the role of the nurse-midwife, which includes the more familiar scope of managing patients in pregnancy, during childbirth, during the postpartum period, the care of the newborn, and in family planning and gynecology. The addition of the scope of treating the primary health needs of women is more broad, but the committee agreed that this may be within the scope of a nurse-midwife, depending on her education, experience, and the practice setting. The committee accepted the concept of including primary health needs of women in the regulatory definition, but it seemed that how the regulation is worded in referring to the program of training, rather than the knowledge, skill, and abilities of the nurse-midwife may be limiting for practice in this role. D. Scott will work on the wording of the current regulation so that it reflects the opinion of the committee members and bring the proposed regulation change back to the committee at its next meeting in February 2007.

2.      Review, discussion and action regarding "Suggestions For Record of Practice": See description in the minutes under agenda item B.2.

3.      Review, discussion and action regarding guidelines for filling out FMLA forms and disabled placards: P. Suiter presented this agenda item describing the history and her interchange with Ginny Lewis, Director of the Department of Motor Vehicles. She explained to the committee that the existing law, NRS 482.384, states, a “licensed physician” can certify an applicant as a person with a disability, which limits or impairs the ability to walk.  In her correspondence, Ms. Suiter suggested changing the language to “medical examiner” which is already defined in law to include among others, APNs and PAs. Since the Department of Motors Vehicles has several bill draft requests in at this time, Ms. Suiter wondered if this change could be added to one of the existing BDRs. G. Lewis has acknowledged receiving Ms. Suiter’s request and will discuss the issue with the respective administrators.

4.      Suggestions for agenda items for next meeting: The members suggested putting the nurse-midwife regulatory definition, the DMV bill issue, and the revision of the documents for distribution to new APNs on the next meeting agenda.

ADJOURNMENT:  The meeting was adjourned at 3:15 p.m.

August 16, 2006

CALL TO ORDER

MEMBERS PRESENT

Debra Scott, MS, RN, APN, Committee Chair

David Burgio, MS, RN, APN, Board Liaison
Amy E. Booth, MSN, RN, APN

Tricia Brown, MSN, RN, APN

George H. Cox, MS, RN, CRNA

Martha Drohobyczer, MSN, RN, APN, CNM

Jeanette DiChiro, MSN, RN, APN

Phyllis Suiter, MA, RN, APN

MEMBERS ABSENT

None

OTHERS PRESENT

Fred Olmstead, General Counsel, NSBN

James Cooper, CRNA

Gina Kronenberg, President, Nevada Association of Nurse Anesthetists

Catherine Hadey, NSC Student

Betty Ann Peters, NSC Student

Dan Laird, MD, Anesthesiologist

Jon Zucker, MD

CALL TO ORDER:  The meeting was called to order at 2:03 p.m.

PUBLIC COMMENTS:  There were no public comments.

A.  APPROVAL OF MINUTES— May 9, 2006: The minutes of the May 9, 2006, meeting were approved as written.

B.  OLD BUSINESS:

1. Report from Board Annual Business meeting: D. Scott and D. Burgio discussed highlights of the annual meeting, including the legislative issues which may affect healthcare, and specifically, nursing and advanced practice. 

2. Review, discussion and action regarding Guidelines For Protocols For APNs: P. Suiter presented her recommended format for information that might be distributed to new APN applicants in Nevada. The proposed language is attached. The committee requested that Ms. Suiter submit an example of protocols which would clarify the format for new applicants. She stated that she would email the draft to D. Scott who would then distribute to the members of the committee for review (attached). This information is a tool for new applicants and will not need to be forwarded to the Board for approval.

C.  NEW BUSINESS

1.      Discussion regarding CRNA scope of practice: J. Cooper, CRNA, gave a short review of CRNA scope of practice in Nevada’s rural regions.  He stated that 65% of anesthesia nationwide is administered by CRNAs—nearly 100% of rural anesthesia is administered by CRNAs. He described the delivery of anesthesia services in Elko, Nevada. He stated that Nevada’s governor has not “opted out” of the federal CMS reimbursement requirement of supervision for CRNAs, but that an opt-out would be consistent with Nevada state law. D. Scott read a letter submitted by Christopher H. Ward, M.D., who supports the Nevada opt-out of the physician supervision requirement. D. Laird, past president of the state anesthesiologist association, disagreed with some of J. Cooper’s assumptions regarding the legality of the opt-out. He stated that his position is that an opt-out is inconsistent with state law.  Further input was given by G. Cox, CRNA, a committee member who clarified that requiring supervision of CRNAs was a reimbursement issue rather than a scope of practice issue. F. Olmstead reminded the attendees of the importance of keeping discussion within the agenda item. D. Scott thanked all parties for the lively discussion and reiterated that this was only a discussion and that the Nevada State Board of Nursing had no intention of initiating either legislation or enlisting the help of the governor in pursuing an opt-out for Nevada.

2.      Suggestions for agenda items for next meeting: M. Drohobyczer, committee member, suggested more accurate wording for the definition of “nurse midwife” in regulation to read “nurse midwife means a registered professional nurse who has completed an organized formal program of training in the area of pregnancy, childbirth, the postpartum period, care of the newborn and the family planning, gynecological, and primary health needs of women." This item will be on the committee’s next agenda.

ADJOURNMENT:  The meeting was adjourned at 3:45 p.m.

May 9, 2006

CALL TO ORDER

The meeting of the Nevada State Board of Nursing Advanced Practice Advisory Committee was called to order by Debra Scott, MSN, RN, APN, Executive Director, at 2:00 p.m., via videoconference at the Board of Nursing, 5011 Meadowood Mall Way, Ste. 201, Reno, Nevada, 89502, and the Board of Nursing, 2500 W. Sahara, #207, Las Vegas, Nevada 89102.

MEMBERS PRESENT

Debra Scott, MS, RN, APN, Committee Chair

Tricia Brown, MSN, RN, APN

Martha Drohobyczer, MSN, RN, APN, CNM

George H. Cox, MS, RN, CRNA

Phyllis Suiter, MA, RN, APN

Jeanette DiChiro, MSN, RN, APN

Amy E. Booth, MSN, RN, APN

MEMBERS ABSENT

David Burgio, MS, RN, APN, Board Liaison

OTHERS PRESENT

Diane M. McGinnis, MSN Nursing student

Dr. Jerry Matsumara, president of the Nevada State Society of Anesthesiologists

Fred Olmstead, General Counsel, NSBN

CALL TO ORDER:  The meeting was called to order at 2:00 p.m.

PUBLIC COMMENTS: D. McGinnis, MSN student from UNLV, introduced herself and gave a summary of her project regarding a specialty certificate program for emergency nurse practitioners.  Questions arose regarding the role of the student, who would already be certified as an APN, and the need for a collaborative physician. 

A. APPROVAL OF MINUTES— February 7, 2006:  The minutes were approved as written.

B.  OLD BUSINESS:

1. Review, discussion and action regarding proposed regulation changes:  D. Scott led the discussion regarding the proposed regulations regarding APN practice, highlighting the changes recommended since the last APNAC meeting.  Two regulations regarding CRNAs were deleted from the group of regulations being forwarded to the Board for public hearing at the May 2006 Board meeting.  Dr. J. Matsumura discussed the testimony he gave regarding NAC 632.500 and NRS 632.014 at the Board meeting when the regulations were scheduled for concept and wording consideration. 

C.  NEW BUSINESS

1. Review, discussion and action regarding CNM Privileging:  M. Drohobyczer presented the Certified Nurse Midwife Allied Health Professional Scope of Practice form, which was being utilized at University Medical Center.  Some of the language written in the form does not reflect what is in the Nurse Practice Act regarding the practice of APNs.  The committee commented that facilities may have more restrictive policies than the Nurse Practice Act outlines, but there was consensus that this may be confusing in practice. Ms. Drohobyczer stated that UMC is working on clarifying the language in the document and will keep the committee informed of the process.  CNM input will help to clarify the scope of practice for APNs.

2. Review, discussion and action regarding APNs doing spinal injections:  The question, “ Do you recognize spinal injections as within the scope of practice for advanced nurse practitioners, other than certified registered nurse anesthetists?  These injections, comprised of a corticosteroid and local anesthetic agents, would include selective nerve root blocks, fact blocks, and translaminar epidurals, administered in the cervical, thoracic or lumbar spine.”  After discussion including input from Dr. J. Matsumura, the committee concurred that this practice is outside the scope of practice for APNs.  In fact, this practice is limited even among anesthesiologists, being done only by those who have special competencies in this area.

3. ANCC certification exam—name change:  The American Nurses Credentialing Center continues to offer the Clinical Nurse Specialist in Medical-Surgical Nursing Certification exam, however in keeping with contemporary nursing practice, it is now called Clinical Nurse Specialist in Adult Health Nursing Certification.  There has been no change in the exam, just the name change.  This information was given to the committee for information only.

4. American Medical Association article regarding allied health professionals’ scope of practice:  D. Scott presented a summary of an article in the National Council of State Boards of Nursing Policy Perspectives entitled, Physician Task Force Confronts Scope-of-Practice Legislation which gave the AMA’s point of view regarding scope of practice battles.  This was given to the committee for information only.

5. NCSBN Vision Paper:  The Future Regulation of Advanced Practice Nursing: D. Scott gave an overview of this vision paper, highlighting that this paper is not intended to be enacted any time soon, but it is out for consideration to be applied in the next ten years.  She underscored the information in the April 13, 2006, letter from NCSBN, which included frequently asked questions and answers. Ms. Scott will keep the committee informed of any further action regarding the vision paper.

6. Review, discussion and action regarding Guidelines For Protocols For APNs: D. Scott opened the discussion about the guidelines provided for new APNs coming in to Nevada or those just graduating from their programs.  P. Suiter stated that she was instrumental in creating the guidelines in the past and offered to review the current document.  She will bring her recommendations for revision back to the committee at its next meeting.

7. APNA – ANCC press release on adult psych nursing:  D. Scott summarized the press release which reviewed a joint study conducted by the American Psychiatric Nurses Association and the American Nurses Credentialing Center which found commonalities in the roles of clinical nurse specialists and nurse practitioners practicing in the area of adult psychiatric and mental health nursing.   As a result, APNA and ANCC recommended that one exam be developed to be taken by both CNSs and NPs practicing in that area.  The press release states that they will convene meetings to consider this issue.  This item was given to the committee for information only.

8. Suggestions for agenda items for next meeting:  Items suggested for the next meeting agenda included discussion about the “licensed professional counselor” and follow up regarding P. Suiter’s suggestions for the guidelines for protocols.

ADJOURNMENT:  The meeting was adjourned at 3:45 p.m.

February 7, 2006

CALL TO ORDER

MEMBERS PRESENT    

Debra Scott, MS, RN, APN, Committee Chair    Tricia Brown, MSN, RN, APN

David Burgio, MS, RN, APN, Board Liaison       Martha Drohobyczer, MSN, RN, APN, CNM

George H. Cox, MS, RN, CRNA                        Phyllis Suiter, MA, RN, APN

Jeanette DiChiro, MSN, RN, APN                      Amy E. Booth, MSN, RN, APN

MEMBERS ABSENT 
                                None

OTHERS PRESENT

Fred Olmstead, General Counsel, NSBN

Robert Buck, Application Coordinator, NSBN

Jeanette Belz, Universal Health Services

Nicola Aaker, Orvis graduate student

Marena Works, Orvis graduate student

CALL TO ORDER:  The meeting was called to order at 2:00 p.m.

PUBLIC COMMENTS:  D. Scott read a letter from John A. Ellerton, MD, CM, FACP, Chief of Staff of University Medical Center of Southern Nevada, regarding the role of certified nurse midwives in the hospital setting.

A.  APPROVAL OF MINUTES— November 1, 2005:  The minutes were approved as written.

B.  OLD BUSINESS:

1. Review, discussion and action regarding proposed regulation changes:  D. Scott, D. Burgio, M. Drohobyczer, and J. DiChiro related the Nevada State Board of Nursing’s response to the proposed regulation changes related to advanced practitioners of nursing who are certified in Nevada.  In addition to the regulations that were presented at the January Board meeting, the committee discussed the definitions in statute and regulation related to advanced practitioners of nursing.  The committee agreed that the definitions were somewhat confusing and made the following suggestions.  NRS 632.014—Take this statute to the Board to discuss whether the Board would like to bring forward a bill to add “advanced practitioner of nursing and physician assistant” to the list of practitioners that a CRNA may administer anesthetic agents to a person under the care of.  This concept will be presented to the Board at its March, 2006 meeting.  NAC 632.020—The committee suggested deleting the last sentence of this regulation.  NAC 632.061—The committee suggested adding “and certified pursuant to NAC 632.255-295” to this regulation.  NAC 632.062—The committee suggested adding “at the minimum” between the words “has” and “a,” and adding “A nurse psychotherapist may seek recognition as an advanced practitioner of nursing if he meets the requirements to be certified pursuant to NAC 632.260.”  NAC 632.072—The committee suggested deleting the word “specified” in this regulation.  NAC 632.255—The committee suggested deleting the words “ordinary” and “medical” from this regulation.  The committee also recommended adding to the regulations a definition for nurse midwife and a regulation speaking to the authorized use of the title of advanced practitioner of nursing.  These recommendations will go to the March Board meeting for consideration of concept and wording by the Board.

The committee reviewed the suggestions by the Board at the January 2006 Board meeting with the following changes to the proposed regulations:  NAC 632. 500, 510, 515, 520, 530, 535, 540, 550—The committee decided that after the recommended changes to the definitions in regulation, that the regulations could go back to the Board as they were presented.  NAC 632.545—The committee recommended the following wording  “(1) A Nevada certificate of recognition as a certified registered nurse anesthetist expires automatically when the individual’s national certification lapses.”  In addition, it was recommended that subsections 2-5 be deleted because the concepts addressed in 2-5 are addressed with the changes recommended in subsection 1.  NAC 632.260 (1)(b)—The committee recommended the following wording.” Except as otherwise provided in this paragraph, if previously licensed or certified as an advanced practitioner of nursing in another state or jurisdiction, has maintained the licensure or certification in good standing and complied with the requirements of continuing education of that state or jurisdiction.”  1(b)(1) Within two years before the date of his application. . . .NAC 632.255—The Board suggested combining “NAC 632.255 and 259 by adding “An advanced practitioner of nursing may only prescribe controlled substances, poisons, dangerous drugs or devices which are currently within the standard of medical practice in his identified medical specialty.” NAC 632.2555—The Board suggested that ss 1(e) be added to state “Reflect the ongoing collaborative relationship between the advanced practitioner of nursing and the physician.”  NAC 632.290—The committee recommended deleting ss 2 and making ss 3, 2 to state: “To reinstate a certificate of recognition which has expired because the fee for renewal has not been paid, the applicant must meet the requirements pursuant to NAC 632.293. “ NAC 632.293—The committee suggested adding to ss 2: “for a period of 800 hours” to the end of that subsection.  D. Scott will make the listed changes to the regulations and forward to the Board at the March 2006 meeting.           

C.  NEW BUSINESS:

1.      Review, discussion and action regarding NAC 632.260 Qualifications for

      certificate of recognition; practice by student:  R. Buck presented the regulation which requires a graduate student in nursing to notify the Board that he is completing his clinical rotation for his advanced practitioner degree in Nevada.

2.      Discussion of “Ask the Doctor” video news clip:  D. Scott informed the committee of this video news clip, which is available at the Board office. She participated in Channel 2’s program “Ask the Doctor” during December 2005, answering questions regarding the APN’s role in Nevada.

3.      Review, discussion and action regarding whether NPs and CNMs are

            authorized to insert and remove a subdermal contraceptive: D. Scott read a letter from Arent Fox, attorneys at law asking if nurse practioners and certified nurse midwives “are authorized to insert and remove a subdermal contraceptive under Nevada laws and regulations.” The committee agreed that inserting and removing a subdermal contraceptive was within the scope of practice for NPs and CNMs as long as they are competent to do so and this procedure is listed in their practice protocols.

4.      Suggestions for agenda items for next meeting:  M. Drohobyczer submitted information regarding CNM, Allied Health Professional—Scope of Practice credentialing in the hospital to be put on the next meeting’s agenda.

ADJOURNMENT:  The meeting was adjourned at 4:30 p.m.

November 1, 2005

CALL TO ORDER

                                                       MEMBERS PRESENT
Debra Scott, MS, RN, APN, Committee Chair           Tricia Brown, MSN, RN, APN

David Burgio, MS, RN, APN, Board Liaison              Martha Drohobyczer, MSN, RN, APN, CNM

George H. Cox, MS, RN, CRNA                               Phyllis Suiter, MA, RN, APN

                                                     MEMBERS ABSENT

                                                Jeannette A. DiChiro, MSN, RN, APN

            Amy E. Booth, MSN, RN, APN         

  OTHERS PRESENT

Fred Olmstead, General Counsel, NSBN

Robert Buck, Application Coordinator, NSBN

Donna Cowling, Education Consultant, NSBN

Kathie Baldridge, Orvis School of Nursing Student

Jeanette Belz, Universal Health Services

CALL TO ORDER:  The meeting was called to order at 2:05 p.m.

PUBLIC COMMENTS:  There was no public comment.

A.  APPROVAL OF MINUTES— August 16. 2005:  The minutes were approved as written.

B.  OLD BUSINESS:

1. Review, discussion and action regarding APN instructor hours: meeting the hourly requirements for renewal of APN certification:  D. Scott presented this agenda item.  The committee discussed the difficulties related to APNs who are faculty in nursing programs being required to be certified as an APN to teach in an APN program, but still being required to do the 800 hours of clinical practice to renew their certificates with the NSBN. The committee agreed that APN instructor hours may be used to meet the Board’s hour renewal requirement.  Any Board forms which need to be revised to reflect this decision will be done by R. Buck, Application Coordinator.

2. Review, discussion, and action regarding the differences in the APN regulations concerning the hour requirements for continuous practice, renewal and prescribing privileges (NAC 632. 257, 260 and 291):  D. Scott presented this agenda item.  The committee supported the changes as outlined in the document attached which will be taken to the January 2006, Board meeting in Las Vegas for approval of concept and wording for the regulation changes.

3. Review, discussion, and action regarding all CRNA regulations (NAC 632.500-550):  G. Cox, committee member, presented this agenda item.  The committee agreed to recommend the following revisions:  (1). Add advanced practitioner of nursing as one of the practitioners who may decide if anesthesia is necessary for a procedure. (2). Add “consultations” to ss 1.c. (3). Add “monitored anesthesia care” to 500 ss 1.i. and 530.  (4). Delete 540 ss 4. (5). Change “at least one year” to the number of hours required by the CRNA national certifying body to maintain active practice.  (6). Add advanced practitioner of nursing to 550 ss 3. (For the actual recommended changes, see attached.)

4. Review, discussion, and action regarding the proposed regulation revisions to NAC 632.255, 2555, 256, 259, 290, 291, 293, and 305.  D. Scott presented this agenda item by referring the committee members to the handout, which outlines all previously recommended changes.  This handout is attached. This recommendation will be presented to the Board at its January 2006 meeting in Las Vegas for approval of concept and wording for the regulation changes.                                 

C.  NEW BUSINESS

1. Scheduling of 2006 Advanced Practice Advisory Committee meeting dates: The dates of the APN committee meetings are as follows:  February 7, May 9, August 16, and November 7, 2006.

2. Suggestions for agenda items for next meeting:  Suggested agenda items for upcoming meetings. The members requested that all addresses for the committee members be sent to all of the other APN Committee members.  D. Scott’s assistant will send this information out this week.  The committee discussed the direction for the next year—the consensus was that they are committed to continuing to remove barriers to APN practice in Nevada, and would like to move toward a more independent practice for APNs in Nevada to provide support for advanced nursing practice in Nevada to be at least equal to what’s happening in the nation and internationally.  They were interested in looking at how APNs can be part of the solution to Nevada’s limited access to medical care for its citizens.

ADJOURNMENT:  The meeting was adjourned at 3:45 p.m.

Attachments

DRAFT  

NAC 632.500  Authorized functions. (NRS 632.120)

     1.  A certified registered nurse anesthetist may, in addition to those functions authorized for the registered nurse, perform the following acts, when it has been determined by a patient’s physician, dentist, or podiatric physician, or advanced practitioner of nursing that an anesthetic is necessary for a procedure, test or other treatment, in accordance with the applicable policies and procedures regarding the administration of anesthetics:

     (a) Obtain a history of the patient’s health, as appropriate to the anticipated procedure, test or treatment;

     (b) Assess the client’s condition, as appropriate to the anticipated procedure, test or treatment;

     (c) Recommend, request, and order consultations and pertinent diagnostic studies and evaluate the results of those studies;

     (d) Prepare a written preanesthetic evaluation of the patient and obtain the patient’s informed consent for the anesthesia;

     (e) Select, order and administer preanesthetic medication;

     (f) Order, prepare and use any equipment and supplies necessary for the administration of anesthesia and perform or order any necessary safety checks on the equipment;

     (g) Order and prepare any drugs used for the administration of anesthesia;

     (h) Select and order anesthesia techniques, agents and adjunctive drugs;

     (i) Perform and manage general, regional, monitored anesthesia care,and local anesthesia and techniques of hypnosis;

     (j) Perform tracheal intubation and extubation and provide mechanical ventilation;

     (k) Provide perianesthetic invasive and noninvasive monitoring, as appropriate, and respond to any abnormal findings with corrective action;

     (l) Manage the patient’s fluid, blood and balance of electrolytes and acid base;

     (m) Recognize abnormal response by a patient during anesthesia, select and take corrective action;

     (n) Identify and manage any related medical emergency requiring such techniques as cardiopulmonary resuscitation, airway maintenance, ventilation, tracheal intubation, pharmacological cardiovascular support and fluid resuscitation;

     (o) Evaluate the patient’s response during emergence from anesthesia and institute pharmacological or supportive treatment to ensure adequate recovery from anesthesia;

     (p) Provide care consistent with the principles of infection control and anesthesia safety to prevent the spread of disease and prevent harm to the anesthetized patient and others in the anesthetizing environment;

     (q) Select, order and administer postanesthetic medication;

     (r) Report to the person providing postanesthetic care the patient’s physical and psychological condition, perioperative course and any anticipated problems;

     (s) Initiate, order and administer respiratory support to ensure adequate ventilation and oxygenation in the immediate postanesthetic period;

     (t) Release the patient from the postanesthetic care unit or discharge the patient from the ambulatory surgical setting;

     (u) Include in a timely manner as a part of the patient’s medical records a thorough report on all aspects of the patient’s anesthesia care; and

     (v) Assess the patient’s postanesthetic condition, evaluate the patient’s response to anesthesia and take corrective action.

     2.  In addition, the nurse anesthetist may accept additional responsibilities which are appropriate to the practice setting and within his expertise. Such responsibilities may include, but are not limited to, the selection and administration of drugs and techniques for the control of pain in the preoperative, intraoperative and postoperative setting.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86; A 5‑12‑93)

      NAC 632.510  Performance of duties in accordance with guidelines of facility. (NRS 632.120)  A certified registered nurse anesthetist practicing in a facility shall practice in accordance with written guidelines that are approved by that facility and conform to NAC 632.500 to 632.550, inclusive. A review of the guidelines may be conducted by the Board to determine if they conform to NAC 632.500 to 632.550, inclusive.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86; A 5‑12‑93)

      NAC 632.515  Qualifications for initial approval. (NRS 632.120)

     1.  An applicant for initial approval as a certified registered nurse anesthetist must:

     (a) Hold a current license in Nevada in good standing as a registered nurse;

     (b) Submit to the Board evidence of successful completion of a program for training as a nurse anesthetist that has been accredited by a national organization recognized by the Board;

     (c) Submit a notarized application, on forms supplied by the Board, which substantiates that the applicant meets the requirements of this section and chapter 632 of NRS;

     (d) Submit evidence that he has passed an examination for initial certification and evidence that he is currently certified by a nationally organized group recognized by the Board.

     2.  In addition to the requirements of subsection 1, any applicant who is a graduate of a program for training as a nurse anesthetist, after:

     (a) June 1, 1988, must submit evidence that he has received a baccalaureate degree in nursing; or

     (b) June 1, 2005, must submit evidence that he has received a master’s degree in nursing or anesthetic care.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86; A 5‑12‑93)

      NAC 632.520  Requirements if approved in another jurisdiction. (NRS 632.120)  Any person seeking to be approved as a certified registered nurse anesthetist in this State and who is approved as a certified registered nurse anesthetist, or its equivalent, in another jurisdiction must comply with all the requirements set forth in NAC 632.500 to 632.550, inclusive.

     (Added by NAC by Bd. of Nursing, eff. 8‑5‑86)

      NAC 632.530  Certificate of recognition: Issuance; restrictions. (NRS 632.120)  If the Board finds that the applicant has met all the appropriate requirements set forth in NAC 632.500 to 632.550, inclusive, he will be issued a certificate of recognition as a certified registered nurse anesthetist. The certificate may be restricted to administering certain types of anesthetics or to general, regional monitored anesthesia care, or local anesthesia, or any combination thereof.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86)

      NAC 632.535  Temporary approval to practice. (NRS 632.120)

     1.  A recent graduate of an accredited program for training as a nurse anesthetist may apply for temporary approval to practice as a nurse anesthetist. If temporary approval is granted, the applicant must take the first examination for certification available. During the period of the temporary approval, the applicant must practice under the direct supervision of a currently certified registered nurse anesthetist.

     2.  A temporary approval to practice may also be issued to an applicant who has practiced as a nurse anesthetist in another state, has a license in this State as a registered nurse, is in good standing and not under investigation in any state, and is currently certified as a nurse anesthetist by a nationally organized group recognized by the Board.

     3.  The temporary approval expires automatically:

     (a) On the date designated by the Board;

     (b) If the applicant fails the examination; or

     (c) If the applicant does not take the first examination available.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86; A 2‑6‑90)

      NAC 632.540  Certificate of recognition: Expiration; renewal. (NRS 632.120)

     1.  A certificate of recognition as a certified registered nurse anesthetist expires biennially upon expiration of the holder’s license as a registered nurse.

     2.  A certificate of recognition as a certified registered nurse anesthetist will be renewed upon:

     (a) Submission of evidence of the renewal of a current license as a registered nurse in Nevada;

     (b) Submission of evidence of current certification as a nurse anesthetist from the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists; and

     (c) Except as otherwise provided in subsection 3, documentation of 45 contact hours of continuing education related to practice as a nurse anesthetist, 15 hours of which must concern pharmacology in relation to the practice as an anesthetist.

     3.  If the national recertification occurs within 1 year before the nurse anesthetist’s birthday, the Board will consider it sufficient evidence of:

     (a) The successful completion of 40 contact hours of continuing education related to practice as a nurse anesthetist; and

     (b) Validation of his professional practice during the previous 2 years.

     4.  Each nurse anesthetist shall submit the application for renewal not later than 60 days after the expiration of the certificate.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86; A 5‑12‑93)

      NAC 632.545  Certificate of recognition: Expiration due to lapse in practice. (NRS 632.120)

     1.  A certificate of recognition as a certified registered nurse anesthetist expires automatically when a substantial engagement in his practice consists of less than 850 hours of practice over the two year recertification period whenever there is a lapse in practice of at least 1 year.

     2.  If the lapse of practice is for more than 1 year and less than 3 years, before recertification, the Board will require evidence of the successful completion of procedures identified in accordance with applicable policies and procedures regarding the administration of anesthetics while under the supervision of a certified registered nurse anesthetist approved by the Board.

     3.  If the lapse of practice is for 3 years, but less than 5 years, before recertification the Board will require, in addition to a program of supervision pursuant to subsection 2, evidence of additional education by the nurse anesthetist applying for certification, as it finds appropriate.

     4.  If the lapse of practice is more than 5 years, the nurse anesthetist must, before recertification, provide evidence to the Board of the completion of the requirements for initial certification set forth in NAC 632.515.

     5.  As used in this section, a lapse in practice occurs when a certified registered nurse anesthetist has not, within a certain period, administered any of the types of anesthetics approved by the Board.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86; A 2‑6‑90; 5‑12‑93)

      NAC 632.550  Certificate of recognition: Revocation, suspension or denial of issuance or renewal. (NRS 632.120)  The Board may revoke, suspend or deny issuance or renewal of a certificate of recognition of a certified registered nurse anesthetist if he:

     1.  Commits any acts constituting a ground for disciplinary action against a registered nurse;

     2.  Exceeds his authority or fails to adhere to practice as designated by NAC 632.500 to 632.545, inclusive;

     3.  Administers an anesthetic without the consent of a licensed physician, podiatric physician, or dentist, or an advanced practitioner of nursing;

     4.  Makes or causes to be made a false or a forged statement or representation in procuring or attempting to procure approval or renewed certification as a nurse anesthetist;

     5.  Violates any statute or regulation relating to prescribing, possessing, administering or dispensing drugs; or 

 6.  Practices below the accepted standard of practice.

     (Added to NAC by Bd. of Nursing, eff. 8‑5‑86; A 5‑12‑93)

NAC 632.260  Qualifications for certificate of recognition; practice by student.

     1.  An applicant for a certificate of recognition as an advanced practitioner of nursing must:

     (a) Have completed a program designed to prepare an advanced practitioner of nursing which must:

          (1) Be at least 1 academic year in length, including at least 4 months of instruction in the classroom and clinical experience with a qualified physician or advanced practitioner of nursing;

          (2) Be accredited or approved by an organization approved by the Board to accredit or approve those programs;

          (3) Include an advanced course in the following areas of study:

               (I) The assessment of the health of patients;

               (II) Pathophysiology; and

               (III) The preparation for practice as an advanced practitioner of nursing;

          (4) Include a concentration of courses in at least one medical specialty;

          (5) Include clinical experience that requires the student to integrate the knowledge and skills that are taught in the program and emphasizes the medical specialty chosen by the student; and

          (6) Include training in making clinical decisions, including, but not limited to, diagnosing medical conditions and providing appropriate medical care.

     (b) Except as otherwise provided in this paragraph, present to the Board evidence of active continuous practice in 3 of the 5 years immediately preceding the date of the application as an advanced practitioner of nursing in the specialty for which certification is requested. The continuous practice must include 400 hours of practice per year. An applicant is not required to comply with the provisions of this paragraph if:

          (1) Within a time before the date of his application which is specified by the Board, he completed a program to prepare an advanced practitioner of nursing; or

          (2) He presents evidence to the Board that he will complete 1,000 hours of practice, without the privilege of writing prescriptions, under the supervision of a qualified physician or certified advanced practitioner of nursing, within a time specified by the Board.

     (c) If previously licensed or certified as an advanced practitioner of nursing in another state or jurisdiction, have maintained the licensure or certification in good standing and complied with the requirements for continuing education of that state or jurisdiction.

     (d) If the applicant completes a program designed to prepare an advanced practitioner of nursing on or after July 1, 1992:

          (1) Be certified as an advanced practitioner of nursing by a nationally recognized certification agency; or

          (2) Hold a bachelor’s degree in nursing from an accredited school.

     (e) If the applicant completes a program designed to prepare an advanced practitioner of nursing on or after June 1, 2005, hold a master’s degree in nursing or in a related health field approved by the Board. and has completed a program designed to prepare an advanced practitioner of nursing.

     2.  A student enrolled in a formal educational program for an advanced practitioner of nursing may perform the functions of an advanced practitioner of nursing, except writing prescriptions, if he does so under the supervision of a licensed physician or a certified advanced practitioner of nursing. The student:

     (a) Must hold a license as a registered nurse in this State; and

     (b) Shall notify the Board in writing of the agreement concerning the practice between the student and the supervisor.

     [Bd. of Nursing, § III part subsec. C, eff. 7‑10‑75; A and renumbered as § III subsec. C par. 2, 5‑16‑79]—(NAC A 3‑28‑86, eff. 4‑3‑86; 9‑6‑88; 3‑26‑90;

NAC 632.255  Scope of practice. (NRS 632.120, 632.237)  An advanced practitioner of nursing may perform the following acts in addition to the ordinary functions of a registered nurse if he is properly prepared and the acts are currently within the standard of medical practice for his specialty and appear in his protocols:

     1.  Systematically assess the health status of persons and families by:

     (a) Taking, recording and interpreting medical histories and performing physical examinations; and

     (b) Performing or initiating selected diagnostic procedures.

     2.  Based on information obtained in the assessment of a person’s health, manage the care of selected persons and families with common, acute, recurrent or long-term health problems. Management may include:

     (a) Initiation of a program of treatment;

     (b) Evaluation of responses to health problems and programs of treatment;

     (c) Informing a person or family of the status of the patient’s health and alternatives for care;

     (d) Evaluation of compliance with a program of treatment agreed upon by the person or family and the advanced practitioner of nursing;

     (e) Modification of programs of treatment based on the response of the person or family to treatment;

     (f) Referral to appropriate providers of health care; and

     (g) Treatment of minor lacerations which do not involve damage to a nerve, tendon or major blood vessel; and

     (h)(g) Commencement of care required to stabilize a patient’s condition in an emergency until a physician can be consulted.

     3.  Any other act if:

     (a) The advanced practitioner of nursing is certified to perform that act by an organization recognized by the Board;

     (b) The performance of the act was taught in the program of education attended by the advanced practitioner of nursing;

     (c) The performance of the act was taught in a comprehensive program of instruction successfully completed by the advanced practitioner of nursing, which included clinical experience; or

     (d) The act is within the scope of practice of an advanced practitioner of nursing as determined by the Board.

      (e) The advanced practitioner of nursing is trained to perform that act by a physician or another advanced practitioner of nursing and the act is within the scope of practice for advanced practitioners of nursing as described in the Cumulative Index to Nursing and Allied Health Literature that was most recently approved by the Board.

     [Bd. of Nursing, § III subsec. C par. 4, eff. 5‑16‑79]—(NAC A 4‑27‑84; 3‑28‑86, eff. 4‑3‑86; 9‑6‑88)

      NAC 632.2555  Requirements for protocol. (NRS 632.120, 632.237)

     1.  A protocol must:

     (a) Reflect the current practice of the advanced practitioner of nursing;

     (b) Reflect established national or customary standards for his medical specialty;

     (c) Be maintained at the place of his practice; and

     (d) Be available for review by the Board.

     2.  A comprehensive review and revision of the protocols of an advanced practitioner of nursing must be conducted and documented by the advanced practitioner and the collaborating physician at the time of renewal. 

     (Added to NAC by Bd. of Nursing, 3‑28‑86, eff. 4‑3‑86; A 3‑26‑90)

      NAC 632.256  Records. (NRS 632.120, 632.237)

     1.  An advanced practitioner of nursing shall maintain accurate records documenting all physical findings concerning a patient, the diagnosis and treatment, and any prescriptions written for a patient for whom he provides care.

     2.  A representative sample of these records must be reviewed by the collaborating physician for compliance with the protocols of the advanced practitioner of nursing.  A system of quality assurance must be in place.

     3.  All the records must be available for review by the Board. Any review will be conducted in accordance with the laws relating to the confidentiality of medical records.

     (Added to NAC by Bd. of Nursing, 3‑28‑86, eff. 4‑3‑86; A 3‑26‑90)

NAC 632.259  Controlled substances, poisons, dangerous drugs or devices that may be prescribed; review and revision of list of drugs. (NRS 632.120, 632.237)

     1.  An advanced practitioner of nursing may only prescribe controlled substances, poisons, dangerous drugs or devices which are:

     (a) Currently within the standard of medical practice in his identified medical specialty; and

     (b) Listed in his protocols.

     2.  The collaborating physician must approve, in writing, any change in the list of controlled substances, poisons, dangerous drugs or devices in the protocol. He may approve the change only if the advanced practitioner of nursing is capable of safely prescribing the controlled substance, poison, dangerous drug or device.

     3.  A comprehensive review and revision of the list of drugs must be conducted and documented by the advanced practitioner of nursing and the collaborating physician at least once each year.

     (Added to NAC by Bd. of Nursing, 3‑28‑86, eff. 4‑3‑86; A 3‑26‑90; R122‑01, 12‑17‑2001)

NAC 632.260  Qualifications for certificate of recognition; practice by student. (NRS 632.120, 632.237)

     1.  An applicant for a certificate of recognition as an advanced practitioner of nursing must:

     (a) Have completed a program designed to prepare an advanced practitioner of nursing which must:

          (1) Be at least 1 academic year in length, including at least 4 months of instruction in the classroom and clinical experience with a qualified physician or advanced practitioner of nursing;

          (2) Be accredited or approved by an organization approved by the Board to accredit or approve those programs;

          (3) Include an advanced course in the following areas of study:

               (I) The assessment of the health of patients;

               (II) Pathophysiology; and

               (III) The preparation for practice as an advanced practitioner of nursing;

          (4) Include a concentration of courses in at least one medical specialty;

          (5) Include clinical experience that requires the student to integrate the knowledge and skills that are taught in the program and emphasizes the medical specialty chosen by the student; and

          (6) Include training in making clinical decisions, including, but not limited to, diagnosing medical conditions and providing appropriate medical care.

     (b) Except as otherwise provided in this paragraph, present to the Board evidence of continuous practice in 3 of the 5 years immediately preceding the date of the application as an advanced practitioner of nursing in the specialty for which certification is requested. The continuous practice must include 400 hours of practice per year. An applicant is not required to comply with the provisions of this paragraph if:

          (1) Within a time before the date of his application which is specified by the Board, he completed a program to prepare an advanced practitioner of nursing; or

          (2) He presents evidence to the Board that he will complete 1,000 hours of practice, without the privilege of writing prescriptions, under the supervision of a qualified physician or certified advanced practitioner of nursing, within a time specified by the Board.

     (c) If previously licensed or certified as an advanced practitioner of nursing in another state or jurisdiction, have maintained the licensure or certification in good standing and complied with the requirements for continuing education of that state or jurisdiction.

     (d) If the applicant completes a program designed to prepare an advanced practitioner of nursing on or after July 1, 1992:

          (1) Be certified as an advanced practitioner of nursing by a nationally recognized certification agency; or

          (2) Hold a bachelor’s degree in nursing from an accredited school.

     (e) If the applicant completes a program designed to prepare an advanced practitioner of nursing on or after June 1, 2005, hold a master’s degree in nursing or in a related health field approved by the Board.

     2.  A student enrolled in a formal educational program for an advanced practitioner of nursing may perform the functions of an advanced practitioner of nursing, except writing prescriptions, if he does so under the supervision of a licensed physician or a certified advanced practitioner of nursing. The student:

     (a) Must hold a license as a registered nurse in this State; and

     (b) Shall notify the Board in writing of the agreement concerning the practice between the student and the supervisor.

     [Bd. of Nursing, § III part subsec. C, eff. 7‑10‑75; A and renumbered as § III subsec. C par. 2, 5‑16‑79]—(NAC A 3‑28‑86, eff. 4‑3‑86; 9‑6‑88; 3‑26‑90; 8‑27‑91; 7‑7‑94; R141‑97, 1‑26‑98; R122‑01, 12‑17‑2001)

NAC 632.290  Certificate of recognition: Expiration; renewal; reinstatement. (NRS 632.120, 632.237)

     1.  The certificate issued to an advanced practitioner of nursing expires at the same time as a license for a registered nurse.

     2.  An advanced practitioner of nursing may renew his certificate by:

     (a) Renewing his license as a registered nurse; and

     (b) Submitting documentation of maintenance and improvement of his skills by a statement from the collaborating physician or by peer review.

     3.  To reinstate a certificate of recognition which has expired because the fee for renewal has not been paid, the applicant must submit:

     (a) The information required for an original application for a certificate on forms provided by the Board and submit the fee required;

     (b) The information required to renew a certificate; and

     (c) The fee for renewal.

     [Bd. of Nursing, § III subsec. C par. 5, eff. 5‑16‑79]—(NAC A 3‑28‑86, eff. 4‑3‑86; 3‑3‑92)

NAC 632.291  Certificate of recognition: Requirements for renewal; issuance of temporary certificate. (NRS 632.120, 632.237)  When he renews his certificate, an advanced practitioner of nursing must submit, on forms supplied by the Board:

     1.  Proof that he has reviewed the protocols with the collaborating physician.

     2.  Proof that he has practiced a minimum of 800 hours in his area of specialization.

     3. (1 ) A statement that:

     (a) He has not been named as a defendant in any malpractice suits; and

     (b) He has never had his clinical privileges limited, suspended or revoked.

Ê If an advanced practitioner of nursing answers yes to these questions, a temporary certificate may be issued until the next Board meeting.

     4.(2) Proof that he has completed satisfactorily 45 hours of continuing education directly related to his area of specialization which may include the requirements for continuing education for renewal of a license for a registered nurse.

     5. (3) Any other information required by the Board.

     (Added to NAC by Bd. of Nursing, 3‑28‑86, eff. 4‑3‑86; A 9‑6‑88; 3‑26‑90)

      NAC 632.292  Certificate of recognition: Placement on inactive status. (NRS 632.120, 632.237)  An advanced practitioner of nursing must submit to the Board a written notification that he wishes his certificate of recognition to be placed on inactive status.

     (Added to NAC by Bd. of Nursing, eff. 3‑26‑90; A by R211‑97, 9‑25‑98)

      NAC 632.293  Application to renew practice after period of inactivity or infrequent activity. (NRS 632.120, 632.237)  If an advanced practitioner of nursing has not engaged in at least 800 hours of active practice during the previous 2 5 years, or wishes to return from inactive to active status, he must submit to the Board an application to renew his practice which includes evidence that:

     1.  He has satisfactorily completed the continuing education required for that period; and

     2.  He has entered into an agreement with a collaborating physician or an advanced practitioner of nursing who is in the same medical specialty which provides that the practice of the applicant will be closely supervised by that physician or advanced practitioner of nursing.

     (Added to NAC by Bd. of Nursing, 3‑28‑86, eff. 4‑3‑86; A 3‑26‑90; 3‑3‑92)

NAC 632.305  Duties; scope of practice. (NRS 632.120)

     1.  A clinical nurse specialist must, in addition to other duties, demonstrate competence in the ability to:

     (a) Assess, conceptualize and diagnose nursing problems; and

     (b) Analyze complex problems related to health.

2.      A clinical nurse specialist may act directly in the care of patients as an expert clinician and indirectly as a consultant, leader of other nurses, educator, researcher and agent to ensure the quality of health care provided.

3.  A clinical nurse specialist may seek recognition as an advanced practitioner of nursing if he meets the requirements to be certified pursuant to NAC 632.260 and 632.300.

     (Added to NAC by Bd. of Nursing, eff. 8‑18‑88)

August 16, 2005

CALL TO ORDER

MEMBERS PRESENT

Debra Scott, MS, RN, APN, Committee Chair           Tricia Brown, MSN, RN, APN

      Martha Drohobyczer, MSN, RN, APN, CNM           Jeannette A. DiChiro, MSN, RN, APN

George H. Cox, MS, RN, CRNA                               Phyllis Suiter, MA, RN, APN

                                                     MEMBERS ABSENT

        Amy E. Booth, MSN, RN, APN

         Richard Null, MSN, RN, APN

                        David Burgio, MS, RN, APN, Board Member Liaison

  OTHERS PRESENT

 Fred Olmstead, General Counsel, NSBN

       Donna Cowling, Education Consultant, NSBN

       Robert Buck, Application Coordinator, NSBN

    Jaemee Wenthe, Student Nurse, NSC

      Nicole Evans, Student Nurse, NSC

CALL TO ORDER:  The meeting was called to order at 2:10 p.m.

PUBLIC COMMENTS:  M. Drohobyczer offered the question of what Board regulates the APN’s authority to prescribe.  Both the Board of Nursing and Board of Pharmacy have jurisdiction over the APN’s prescribing privileges.

A.  APPROVAL OF MINUTES— May 24, 2004:  The minutes were approved as written. The attachments to the minutes were revised and will be discussed at the next Advanced Practice Advisory Committee meeting. 

B.  OLD BUSINESS:

1. Review, discussion and action regarding APN instructor hours: meeting the hourly requirements for renewal of APN certification:  R. Buck presented the agenda item and the committee discussed the information.  The committee requested that Board staff do more research and bring this agenda item back for the next committee meeting in November, 2005.

2. Review, discussion and action regarding the differences in the APN regulations concerning the hour requirements for continuous practice, renewal and prescribing privileges (NAC 632. 257, 260 and 291):  R. Buck introduced this agenda item stating that items B.1.and 2. were brought before the committee because board staff had identified possible inconsistencies in how the law addresses requirements for nurses who are renewing their certificates in Nevada, the requirements for nurses who are endorsing into Nevada, and the requirements for nurses educated for APN certification and practice in Nevada.  The committee had the resulting concerns: 1)  The lack of an adequate definition of “active practice”, 2) The lack of the requirement for all APNs to be nationally certified in their role, and 3) The lack of consistency in requirements for practice across the United States.  D. Scott summarized the discussion by stating that the committee had identified some concerns that may need further research for the committee to come to a consensus on its recommendation for concept and wording for regulation change in the future.  This agenda item will be brought back to the next committee meeting with further information.           

C.  NEW BUSINESS

1. Suggestions for agenda items for next meeting.  The committee members identified the need to discuss the previous old business agenda items as identified above at the next meeting, the CRNA regulations, and the remainder of the previously discussed regulations regarding advanced practice which are currently under revision.

ADJOURNMENT:  The meeting was adjourned at 4 p.m.

May 24, 2005

CALL TO ORDER

MEMBERS PRESENT

Debra Scott, MS, RN, APN, Committee Chair                Tricia Brown, MSN, RN, APN

Martha Drohobyczer, MSN, RN, APN, CNM                 Jeannette A. DiChiro, MSN, RN, APN

David Burgio, MS, RN, APN, Board Member Liaison             Amy E. Booth, MSN, RN, APN        

Richard Null, MSN, RN, APN

MEMBERS ABSENT  

George H. Cox, MS, RN, CRNA

Phyllis Suiter, MA, RN, APN

Richard Null, MSN, RN, APN

OTHERS PRESENT

Patty Towler, Certification Specialist,  NSBN

Jeanette Belz, Universal Health Services

Elissa De Wolfe

Teri Kozik

CALL TO ORDER:  The meeting was called to order at 2:05 p.m.

PUBLIC COMMENTS:  There were no public comments.

A.  APPROVAL OF MINUTES— November 2, 2004: 

B.  OLD BUSINESS:

1.      Discussion of actions taken at the November 2004 through May 2005 meetings of the Nevada State Board of Nursing:  D. Scott gave an update of recent Board actions.

2.      Discussion, actions and recommendations related to defining NAC 632.260 (1.e.) “…or in a related health field approved by the board”:  The relevant section of the regulation as written is: NAC 632.260 (1). An applicant for a certificate of recognition as an advanced practitioner of nursing must: (e)  If the applicant completes a program designed to prepare an advanced practitioner of nursing on or after June 1, 2005, hold a master’s degree in nursing or in a related health field approved by the Board.  The members discussed the existing regulation in terms of what this actually means to individuals applying for certification in Nevada.  The members stated that this regulation may suggest to individuals who are not prepared to practice as an APN that they meet the requirements for certification.  The members suggested that the phrase, “and have completed a program designed to prepare an advanced practitioner of nursing which is a component of the masters or as a post-graduate certification program. ”

3.      Report from members concerning proposed regulation changes:

a.       NAC 632.020, NAC 632.255 through NAC 632.295 – Advanced Practitioner of Nursing: A. Booth, committee member, distributed the regulations regarding advanced practitioners of nursing which she had reviewed to update according to the actual APN practice environment in Nevada. The review included:  NAC 632.255, 2555, 256, 257, 258, 259, 2595, 2597, 260, 265, 285, 290, 291, 292, 293, and 295.

b.      NAC 632.037, NAC 632.300 through NAC 632.310 – Clinical Nurse Specialist:  M. Drohobyczer, committee member, presented the regulations regarding clinical nurse specialists which she had reviewed to update according to the actual CNS practice environment in Nevada.  The review included:  NAC 632.037, 300, 305, and 310.

c.       NAC 632.500 through NAC 632.550 – Certified Registered Nurse Anesthetists: This agenda item was continued to allow the presenter to be in attendance.

C.  NEW BUSINESS

1. Suggestions for agenda items for next meeting: There were no suggestions for upcoming agenda items.

2. Legislative update: D. Scott discussed recent legislative activities concerning bills that may potentially impact the Board.

3. Differences in the APN regulations concerning the hour requirements for continuous practice, renewal and prescribing privileges (NAC 632. 257, 260 and 291).  D. Scott presented information submitted by Robert Buck, Application Coordinator, the staff member who is now responsible for the certification process of APNs in Nevada.  Because of the difference in hour requirements, current regulations are causing confusion among applicants, APNs and employers regarding hours required for certification by endorsement and for certification renewal, and hours required for prescribing privileges. The question was whether or not a uniform number of hours should be required for all situations.  The three regulations involved are as follows:  NAC 632.257 (2) Authorization to issue written prescriptions: requires an APN who does not hold a master’s degree to submit documentation of 1,000 hours of practice in the immediately proceeding two years.—The committee suggested that this requirement stay in regulation.  NAC 632.260 (1)(b) Qualifications for certificate of recognition: requires evidence of continuous practice three of the five years immediately preceding the date of the application for certification.  The continuous practice must include 400 hours of practice per year. (The Board accepts a notarized copy of active APN status in another state as evidence of continuous practice.)—The committee suggested that this requirement be changed to redefine “continuous practice” and require that this practice be within the last five years to align this requirement with the practice requirement for renewal of an RN license. The committee recommended this regulation change be presented to the Board for approval in concept and wording. NAC 632.291 (2) Requirements for renewal: requires proof of a minimum of 800 hours of practice in area of specialty.  (This would be at the time of renewal, however, it does not indicate when the 800 hours has to be completed.)  NAC 632.293 does address a period of inactivity indicating that at least 800 hours of practice in the two previous years must be completed to renew without close supervision by a physician.—Again, the committee suggested that this requirement be changed to redefine “practice” and require that this practice be within the last five years to align this requirement with the practice requirement for renewal of an RN license. The committee recommended this regulation change be presented to the Board for approval in concept and wording.

4. APN instructor hours: meeting the hourly requirements for renewal of APN certification. R. Buck also submitted this discussion item.  The basis for the discussion was a call from an APN instructor requesting that the Board address instructional hours counting toward meeting the 800-hour requirement for renewal of an APN certificate.  The instructor indicated that APN certification is a requirement for employment as an instructor and that full-time employment as an instructor makes it difficult to work 800 hours in another APN setting.  She stated, “If the instruction hours don’t count, it may force full- time instructors out of a faculty position after two years.”  In keeping with the previously mentioned philosophy, the committee suggested that the 800-hour limit might be revised, but most importantly, they suggested that when redefining “practice,” it include a reference to the inclusion of faculty hours in an education program designed to prepare an advanced practitioner of nursing. The committee recommended this regulation change be presented to the Board for approval in concept and wording.

ADJOURNMENT:  The meeting was adjourned at 4:15 p.m.

November 2, 2004

The meeting of the Nevada State Board of Nursing Advanced Practice Advisory Committee was called to order on November 2, 2004 by Associate Executive Director, Donald Rennie, MSN, RN.  The meeting began at 2:00 p.m. via videoconference at the Community College of Southern Nevada, Cheyenne Campus, 3200 E. Cheyenne Avenue, Conference Room A, Las Vegas, Nevada and Truckee Meadows Community College, Meadowood Center, 5270 Neil Road, South Building, Room 104, Reno, Nevada.

MEMBERS PRESENT

Donald Rennie, MSN, RN, AED, Licensure and Certification

David Burgio, MSN, RN, APN, Board Liaison

Amy Booth, MSN, RN, APN

Tricia Brown, MSN, RN, APN

George Cox, MSN, RN, CRNA

Martha Drohobyczer, MSN, APN, CNM

Phyllis Suiter, MS, RN, APN

MEMBERS ABSENT

Jeannette DiChiro, MSN, RN, APN

Richard Null, MS, RN

OTHERS PRESENT

Debra Scott, MS, RN, APN, Executive Director

Fred Olmstead, Board Counsel

Jeanie Jenkins, Management Assistant

1. CALL TO ORDER:  The meeting was called to order at 2:00 p.m.

2. PUBLIC COMMENT:  D. Scott announced the appointment of Doreen Begley, RN to the Board and the reappointments of Mary Ann Lambert, RN and Helen Vos, RN to the Board.

C.  OLD BUSINESS

1.      Approval minutes of August 17, 2004:  The minutes were approved as presented. 

2.      Discussion of actions taken at September 2004 meeting of the Nevada State Board of Nursing:  An update was provided by D. Scott, D. Rennie, and F. Olmstead.

3.      Discussion, recommendations and actions related to defining NAC 623.260 (1.e) “…or in a related health field approved by the board”:  A brief history of this section of the NAC was presented.  It was noted this will apply only to APNs, who graduate on or after June 1, 2005.  Discussion ensued relative to various options for committee consideration.  The committee recommended a board policy be drafted that would include:  a list of acceptable non-nursing masters degrees, a process for the APN Committee to review APN applications with degrees not on the accepted list of degrees, and a process for the APN applicant, with a degree not on the accepted list of degrees to petition the Board for acceptance of that degree.  The petition would include the recommendations of the APN Committee.  The committee requested the draft policy be brought to the next committee meeting for further review and comment before submission to the Board.

D.  NEW BUSINESS

1.      Discussion, actions and recommendations related to NAC 632.020, NAC 632.255 thru NAC 632.295 – Advanced Practitioner of Nursing:  The committee began a review of the regulations related to the Advanced Practitioner of Nursing.  Committee member recommendations should be provided to A. Brown for compiling for the next committee meeting.  The committee did recommend a fifth subsection be added to NAC 632.255 (3) to allow for acts learned in the practice setting.  The committee recommended language such as “has acquired the additional knowledge and skills and is competent in the performance of the skills”.  The committee requested this be drafted for review and comment at the next meeting. 

2.      Discussion, actions and recommendations related NAC 632.037, NAC 632.300 thru NAC 632.310 – Clinical Nurse Specialist:  The committee began a review of the regulations related to the Clinical Nurse Specialist.  Committee member recommendations should be provided to M. Drohobyczer for compiling for the next committee meeting.

3.      Discussion, actions and recommendations related to NAC 632.500 thru NAC 632.550 Certified Registered Nurse Anesthetist:  The committee began a review of the regulations related to the Certified Registered Nurse Anesthetist.  Committee member recommendations should be provided to G. Cox for compiling for the next committee meeting. 

4.      Discussion related to collaboration and physician responsibility issues:  A brief history of the implications and differences of supervision and collaboration was presented.  Discussion ensued.  It was noted the advanced practitioner of nursing and physician relationship is one of collaboration.  The committee requested the Executive Director write to the Executive Director of the Board of Medical Examiners to seek consideration for the removal of the wording of supervision in MAC 630.490 (13) of the medical board’s regulations. 

5.      Discussion related to possible governor “opt-out” to set standards for anesthesia:  A brief overview of the Center of Medicare and Medicaid Services regulations related to anesthesia services was provided.  It was noted that each state governor has the ability to “opt” out of the supervisory requirements for Certified Registered Nurses Anesthetists.  Discussion ensued related to the “opt-out” status of various states including Nevada.

6.      Schedule meetings for 2005:  The committee approved the meeting dates of February 22, 2005; may 10, 2005; August 16, 2005; and November 1, 2005.

       E.  ITEMS FOR NEXT AGENDA:  No items were presented. 

       F.  ADJOURNMENT

The meeting was adjourned at 3:30 p.m.

August 17, 2004

The meeting of the Nevada State Board of Nursing Advanced Practice Advisory Committee was called to order on August 17, 2004 by Associate Executive Director, Donald Rennie, MSN, RN.  The meeting began at 2:05 p.m. via videoconference at the University of Nevada, Las Vegas, Classroom Building Complex, Building B, Room 117, 4505 Maryland Parkway, Las Vegas, Nevada, 89154 and TMCC Meadowood Center, 5270 Neil Road, South Building, Room 104, Reno, Nevada, 89502.

MEMBERS PRESENT

Donald Rennie, MSN, RN, AED, Licensure and Certification

Amy Booth, MSN, RN, APN

Tricia Brown, MSN, RN, APN

George Cox, MSN, RN, CRNA

Jeannette DiChiro, MSN, RN, APN

Martha Drohobyczer, MSN, APN, CNM

Richard Null, MS, RN

Phyllis Suiter, MS, RN, APN

MEMBERS ABSENT

None

OTHERS PRESENT

David Burgio, RN, MS, APN, Board Liaison

Debra Scott, MS, RN, APN, Board Executive Director

Fred Olmstead, Board Counsel

Neena Laxalt, Legislative Lobbyist, NNA

A.     CALL TO ORDER:  The meeting was called to order at 2:05 p.m.

B.    PUBLIC COMMENTS:  D. Scott and D. Burgio discussed the results of a recently published state-by-state advanced nursing practice survey that listed Nevada with a low ranking.  A review of the study indicated the most recent practice data, such as prescriptive authority for controlled substances, was not included.  Had this and other data been included, the ranking for Nevada would have been extremely high.  A copy of the full study will be provided to the committee members.

C.  OLD BUSINESS

1.      Discussion, recommendations and actions related to “Guidelines for Selection of APN Collaborating Physician”:  At the July, 2004 Board meeting, the Board approved the APN Committee’s recommended revisions to the guidelines.  It will be the APN’s professional responsibility to ensure competency within the legally authorized practice specialty.  Periodic APN practice audits will be conducted to include a review of whether the APN is practicing within his legally authorized area/scope of practice and a review of the specialty(ies) of the collaborating physician to ensure the physician has a like medical specialty, although it may not be the physician’s current area of practice.  It was noted the medical specialty of the collaborating physician is verified during the random audits of APN practice.

2.      Discussion, recommendations and actions regarding APNs writing prescriptions for disabled persons related to NRS 482.3831 through NRS 482.384:  F. Olmstead presented an overview of his discussions with the Deputy Attorney General representing Department of Motor Vehicles (DMV).  Statutes currently limit the issuance of disability statements to licensed physicians.  Authorization for other persons to issue disability statements would require a statutory change.  Discussion ensued.  It was recommended the APN specialty group should enter into discussions with DMV personnel to further explore a possibility and processes of obtaining authorization to issuance of disability statements.  It was further recommended the discussions should focus on the benefits to Nevada citizens of having APN authority available to issue disability statements.     

3.      Discussion, recommendations and actions taken at Nevada State Board of Nursing meetings of June and July 2004:  D. Rennie reviewed Board actions taken during the June Special Board Meeting in Reno and the Annual Business Meeting in Las Vegas.

4.      Discussion of requirement to submit a list of drugs to the board (NAC 632.257 (2.b.):  Historically APNs applying for prescribing privileges have been required to submit a drug list to the board.  The drug lists have been submitted either by categories of drugs or by lists of specific authorized drugs.  The NPA requires the list be maintained in protocol and that the collaborating physician review and approve the list at least yearly, or when significant changes are made.  Discussion ensued related to the submission of a drug list to the board versus retention of the drug list with the APN’s protocols.  The committee recommended the Board policy, per NAC 632.258, be revised to reflect the drug list be retained with the protocols and be available for submission to the board as part of the Board’s random practice audit process.

D.  NEW BUSINESS

1.      Discussion, actions and recommendations related to training for procedures pursuant to NAC 632.255 (3):  This regulation identifies the processes available for APNs to acquire additional skills related to their practice.  It does not specifically address skills learned through employment.  Discussion ensued with particular reference to (d) “The act is within the scope of practice of an advanced practitioner of nursing as determined by the board”.  The committee concluded the Board’s annual approval of the use of the Cumulative Index of Nursing and Allied Health Literature (CINAHL), commonly referred to as the “CINAHL Process”, would be appropriate for use by APNs to document the inclusion of additional skills into their practice.  The committee recommended the regulation be reviewed for specific inclusion of use of CINAHL as a means of determining APN scope of practice.  

2.      Discussion, actions and recommendations related to required collaborative relationships:  Information was provided related to states that have authorized independent practice for APNs.  The committee concluded the APN specialty groups should research the necessary legislative processes should the APN community desire to seek a change from collaboration to independent practice.

3.      Discussion, actions and recommendations related to the Committee Mission Statement:  It was moved and seconded to change the mission statement to read “The mission of the Advanced Practice Advisory Committee is to advise the Nevada State

  Board of Nursing on matters or issues related to advanced nursing practice”. MOTION CARRIED.

4.      Discussion, actions and recommendations related to defining NAC 632.260 (1.e.) “or in a related health field approved by the board”:  Beginning June 1, 2005, all applicants for certification who complete an APN program on that date or after will be required to have a “masters degree in nursing or in a related health field approved by the Board”.  Discussion ensued concerning the types of related health field degrees to recommend to the board for approval.  It was further discussed if the committee should recommend a list of degrees, degrees accepted by national certification organizations, or deletion of this statement in the regulation.  The committee concluded there was insufficient information available at this time to make a recommendation.  The committee further concluded additional information should be obtained through legal research, from other boards of nursing and certification organizations before a recommendation can be made. 

E.  ITEMS FOR NEXT AGENDA:  No items were presented. 

F.            ADJOURNMENT

The meeting was adjourned at 4:05 p.m.

May 11, 2004

The meeting of the Nevada State Board of Nursing Advanced Practice Advisory Committee was called to order on May 11, 2004 by Associate Executive Director, Donald Rennie, MSN, RN.  The meeting began at 2:00 p.m. via videoconference at CCSN, Cheyenne Campus, Conference Room A2638, 3200 E. Cheyenne Blvd, Las Vegas, Nevada and TMCC Meadowood Center, 5270 Neil Road, South Building, Room 104, Reno, Nevada

MEMBERS PRESENT

Donald Rennie, MSN, RN, AED, Licensure and Certification

David Burgio, MSN, RN, APN, Board Liaison

Amy Booth, MSN, RN, APN

Tricia Brown, MSN, RN, APN

Phyllis Suiter, MS, RN, APN

MEMBERS ABSENT

Martha Drohobyczer, MSN, APN, CNM

Richard Null, MS, RN

OTHERS PRESENT

Debra Scott, MS, RN, APN

Neena Laxalt. Legislative Lobbyist, NNA

A.     CALL TO ORDER:  The meeting was called to order at 2:00 p.m.

B.  PUBLIC COMMENTS:    No person appeared to offer comments.

C.  APPROVAL OF MINUTES:  The committee minutes of February 24, 2004 were approved as written.

D.  OLD BUSINESS

1.      Discussions of actions taken at Nevada State Board of Nursing meeting of March 2004:  The board approved the Education Advisory Committee’s proposed concept and wording changes to the education regulations related to faculty education requirements, accreditation, provisional approval, administrator duties and program composition.  The Board approved the Advanced Practice Advisory Committee’s proposed concept and wording changes to NAC 632.257 (2.b.) related to the 1000 hours requirement for prescriptive privileges.  Curriculum changes were approved for Community College of Southern Nevada RN and PN programs, Nevada State College and Truckee Meadows Community College nursing programs.  Practice decisions were approved related to Sexual Assault Nurse Examiners and activities not considered “providing patient care”.  Board members and staff reported on the National Council of State Boards of Nursing (NCSBN) Mid-Year meeting, which covered topics as the global issues of nursing and the federal visa screening requirement for certain Trade NAFTA nurses currently working in the United States.  The board approved the NCSBN proposed revisions to the NCLEX-PN test plan to be implemented in Spring 2005. 

E.  NEW BUSINESS

1.        Discussion, Recommendations and Actions regarding APNs writing prescriptions for disabled persons related to NRS 482.3831 – NRS 482.384:  In these statues, a licensed physician is identified as the practitioner authorized to complete applications for DMV permits for persons with permanent disabilities.  The committee discussed various avenues to pursue in obtaining DMV consideration as an authorized practitioner.  The committee recommended the Executive Director write a letter to the Director of the DMV requesting APNs also be considered as authorized practitioners based upon their ability to prescribe.  The committee further recommended the Board Counsel discuss this issue with the Deputy Attorney General for the DMV.

2.        Discussion, Recommendations and Actions related to the use of the title of APN when not employed:  Currently APNs are encouraged to place their certificate on inactive status when not employed or no collaborating physician agreement is in effect.  The committee discussed the continued use of the title APN when not actively employed.  The committee concluded it would be appropriate to continue to use the title APN when not employed.  The committee further concluded it would be a violation of the Nurse Practice Act to practice as an APN when not currently certified, not employed, or when a physician collaboration agreement was not in effect.  The committee also requested the Board Counsel further research this issue and report his findings at the next committee meeting   

3.       Discussion, Recommendations and Actions related to the “Guidelines for Selection of APN Collaborating Physician”:  APNs are required by NAC 632. 265 (1.b), to have a collaborating physician whose scope of practice includes the medical specialty of the APN.  Guidelines were developed by the committee in 2000 to assist the APN in the selection of the appropriate collaborating physician.  A potential collaborating physician may have multiple medical specialties, including that of the APN, although no longer be practicing in the particular specialty of the APN.  The committee reinforced the requirement that APNs must practice within the scope of their certified specialty.  The committee recommended the guidelines be revised to reflect appropriate APN practice with accountability being monitored through practice audits.  The committee further recommended the guidelines be developed into policy for Board approval.   

ADJOURNMENT

      The meeting was adjourned at 3:05 p.m.

February 24, 2004

The meeting of the Nevada State Board of Nursing Advanced Practice Advisory Committee was called to order on February 24, 2004 by Associate Executive Director, Donald Rennie.  The meeting began at 9:05 a.m. via videoconference at CCSN, Cheyenne Campus, Conference Room A2638, 3200 E. Cheyenne Blvd, Las Vegas, Nevada and TMCC Meadowood Center, 5270 Neil Road, South Building, Room 104, Reno, Nevada, and Great Basin College, 1500 College Parkway, GTA Building, Room 124, Elko, Nevada.

MEMBERS PRESENT

Donald Rennie, MSN, RN, AED, Licensure and Certification

Sheri Aikin, MS, RN, APN

Amy Booth, MSN, RN, APN

Tricia Brown, MSN, RN, APN

Martha Drohobyczer, MSN, APN, CNM

Richard Null, MS, RN

Phylllis Suiter, MS, RN, APN

MEMBERS ABSENT

None

OTHERS PRESENT

Debra Scott, MS, RN, APN

Fred Olmstead, JD, General Counsel

Neena Laxalt. Legislative Lobbyist, NNA

Stephanie Atwood, Nursing Student, UNLV

CALL TO ORDER:  The meeting was called to order at 9:05 a.m.

PUBLIC COMMENTS:  M. Drohobyczer requested, at a future meeting, the committee review the use of the APN certification title when an APN is not employed. 

1. APPROVAL OF MINUTES:  The minutes of August 4, 2003, were approved.

B.  OLD BUSINESS

1. Discussion concerning APNs using national certification credentials in lieu of “APN”:  A brief overview and history of the issue was presented and a review of discussions of the previous committee meeting was provided.  It was noted telephonic queries to other boards of nursing did not result in any additional information than previously reported.  Discussion ensued with a clarification that NAC 632.020 defines advanced practitioner of nursing.  It was moved and seconded an APN should be identified by the title as defined in regulation and the additional identification of professional and/or educational credentials could be used if deemed appropriate by the APN.  MOTION CARRIED.

2. Discussion of NAC 632.257 (3): documenting 1000 hours of active practice to meet the requirement for obtaining prescribing privileges:  A review of the issue was presented.  It was noted the Board tabled the draft concept and wording changes presented in September, 2003.  The board further requested additional information from the APN community and additional recommendations from the committee.  A survey of 100 APNs was conducted in fall 2003.  41 acceptable responses were received and the results were tabulated by Charles Bonney, senior nursing student at Orvis School of Nursing.  Survey results were discussed.  It was moved and seconded to recommend elimination of the 1000 hour requirement effective on June 1, 2005 to coincide with the master’s degree requirement as stipulated in NAC 632.515 (2.b.).  MOTION CARRIED.

3. Discussion of requirement to submit a list of drugs to the board (NAC 632.257 (2.b.):  A brief history and review of the issue was presented.  Current regulation requires a drug list to be submitted by APNs seeking certification by endorsement.  The list may be presented in a format of individual drugs or by drug categories.  Discussion ensued.  It was noted that many drugs have approval for multiple categories and it is the responsibility of the APN to posses the appropriate knowledge related to the drugs prescribed.  It was moved and seconded to recommend removal of this section of the regulation.  MOTION CARRIED.

4. Discussion of proposed Board of Pharmacy removal of 180 day prescribing limitation:  The Board of Pharmacy recently amended NAC 639.879 (2.b.)  “Scope of authority to dispense” to allow APNs (who have dispensing privileges) to dispense amounts not to exceed a 365-day supply if authorized by the collaboration physician.

5. Highlights of Board meetings from November 2003 and January 2004:  November 2003 board meeting:  •Election of officers was held with the following results:  President-Patty Shutt, LPN, Vice President-Mary Ann Lambert, MSN, RN, and Secretary-Helen Vos, MS, RN.  •Newly appointed board members were David Burgio, MSN, RN, APN, as RN Member and Joe Cortez, as Consumer Member.  •All CNA related fees were increased to the maximum allowed by statute.  •The Nursing Practice Advisory Committee presented a draft practice decision related to SANE which the board reviewed and requested the proposed decision be agendized for the March 2004 meeting so individuals from northern Nevada could give public testimony. January 2004 meeting:  •Board committee liaison appointments were made as follows:  D. Burgio - Advanced Practice Advisory Committee; D. Perkins – CNA Advisory Committee; C. Bible – Disability Advisory Committee; M.A. Lambert—Education Advisory Committee; and H. Vos – Nursing Practice Advisory Committee.   •A policy change was approved related to the auditing of CE for RN/LPN licensure renewal.  •A presentation by the Chancellor of the UCCSN system related to nursing faculty education requirements as identified in NAC 632.670.  •Discussion related to draft SANE practice decision continued.  

C.  NEW BUSINESS

1. NAC 632.265- Discussion of collaboration specialty:  Discussion ensued concerning issues related to the specialty of APNs and their collaborating physicians.  These issues included the requirements of the regulation and the crossover in specialties that is currently occurring in advanced nursing practice specialties.  The board’s Guidelines for Selection of APN Collaborating Physicians was presented and discussed.  It was moved and seconded to review these guidelines for possible revision and acceptance by the Board.  MOTION CARRIED.    

ADJOURNMENT

The meeting was adjourned at 11:20 a.m.

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