1. 1 Board of Registration in Nursing

2. 2 Module 4: Competence: A Legal Requirement for Advanced Registered Nursing Scope of Practice

3. 3 Competence 244 CMR 9.02 defines Competence as: “The application of knowledge and the use of affective, cognitive, and psychomotor skills required for the role of a nurse licensed by the Board and for the delivery of safe nursing care in accordance with accepted standards of practice.”

4. 4 APRN Competence Includes only those areas of practice for which the APRN has formal, advanced nursing education and documented competencyIncludes only those areas of practice for which the APRN has formal, advanced nursing education and documented competency Certification is one measure of competenceCertification is one measure of competence Additional education obtained through experience and/or by principles of continuing education can be another measure of competenceAdditional education obtained through experience and/or by principles of continuing education can be another measure of competence

5. 5 Competence Involves Responsibility: Responsible to self, patient, employer, profession (for example, following policies and procedures) and Accountability: Accountable to the Board, employer, profession (i.e. adhering to the regulations)

6. 6 Continued Competence The application of knowledge and the interpersonal, decision-making, and psychomotor skill expected for nurse’s practice role, within the context of public health, welfare and safety. Ref: National Council of State Boards of Nursing, 1996

7. 7 Certification In order to maintain Board authorization and to engage in advanced practice nursing, an APRN must hold current professional advanced practice certification and must submit documentation satisfactory to the Board of current certification with each authorization for renewal.In order to maintain Board authorization and to engage in advanced practice nursing, an APRN must hold current professional advanced practice certification and must submit documentation satisfactory to the Board of current certification with each authorization for renewal.

8. 8 Board Requirement for Certification in Category of Practice The Board recognizes fiveThe Board recognizes five APRN categories: APRN categories: CNP (Nurse Practitioner)CNP (Nurse Practitioner) CNM (Nurse Midwife)CNM (Nurse Midwife) PCNS (Psychiatric Clinical Nurse Specialist)PCNS (Psychiatric Clinical Nurse Specialist) CRNA (Nurse Anesthetist)CRNA (Nurse Anesthetist) CNS (Clinical Nurse Specialist)CNS (Clinical Nurse Specialist)

9. 9 Board Approved Professional Certifying Organizations CNP American Academy of Nurse Practitioners (AANP) www.aanpcertification.org www.aanpcertification.org American Nurses Credentialing Center (ANCC) www.nursecredentialing.org www.nursecredentialing.org National Certification Council (NCC) www.nccwebsite.org www.nccwebsite.org Pediatric Nursing Certification Board (PNCB) www.pncb.org www.pncb.org American Association of Critical-Care Nurses (AACN) Certification Corporation www.aacn.org

10. 10 Professional Certifying Organization PCNS American Nurses Credentialing Center (ANCC) www.nursecredentialing.org

11. 11 Professional Certifying Organizations CRNA Council on Certification and Recertification of Nurse Anesthetists (CCRNA) aka American Association of Nurse Anesthetists (AANA) www.aana.com

12. 12 Professional Certifying Organizations CNM American Midwifery Certification Board (AMCB) aka American College of Nurse Midwives (ACNM) www.amcbmidwife.org

13. 13 Professional Certifying Organizations CNS American Nurses Credentialing Center (ANCC) www.nursecredentialing.org www.nursecredentialing.org American Association of Critical-Care Nurses (AACN) Certification Corporation www.aacn.org

14. 14 APRN Practice Employment of advanced skillsEmployment of advanced skills EvaluationEvaluation DiagnosisDiagnosis TreatmentTreatment Responsible for own practiceResponsible for own practice Formal, advanced nursing education and documented competency required for population servedFormal, advanced nursing education and documented competency required for population served

15. 15 Category vs. Specialization Board authorizes APRN practice by category, not by specialization within the categoryBoard authorizes APRN practice by category, not by specialization within the category Category competency determines:Category competency determines: Ages of population servedAges of population served Characteristics of population servedCharacteristics of population served Medical conditions of population servedMedical conditions of population served Activities performedActivities performed

16. 16 Demonstration of Competency Certification (Mandated by Regulation)Certification (Mandated by Regulation) ExperienceExperience On the job trainingOn the job training On-going educationOn-going education Attendance at educational sessionAttendance at educational session Formal course workFormal course work

17. 17 244 CMR 5.00: Continuing Education Consists of planned, organized learning experiences designed to augment the knowledge, skills, and attitudes for the enhancement of nursing practice, to the end of improving health care to the public.Consists of planned, organized learning experiences designed to augment the knowledge, skills, and attitudes for the enhancement of nursing practice, to the end of improving health care to the public. 15 Contact Hours per renewal period to maintain RN License15 Contact Hours per renewal period to maintain RN License

18. 18 Continuing Education to maintain certification Additional requirements for continuing education through your professional certifying organizationAdditional requirements for continuing education through your professional certifying organization Your responsibility to keep track of professional requirementsYour responsibility to keep track of professional requirements Review Module 3: preparing for Practice as an APRN: Board Authorization for detailed certification informationReview Module 3: preparing for Practice as an APRN: Board Authorization for detailed certification information

19. 19 Determining APRN Scope of Practice Describe the practice or activity.Describe the practice or activity. Is it supported by statute or regulation?Is it supported by statute or regulation? Does entry into practice education provide the necessary knowledge/skill/ability? Or Continuing Education?Does entry into practice education provide the necessary knowledge/skill/ability? Or Continuing Education? Is this a practice that is consistent with the nursing literature and/or research?Is this a practice that is consistent with the nursing literature and/or research? Does the APRN have a documented competence?Does the APRN have a documented competence?

20. 20 Scope of APRN Practice - continued Is this within a standard of care that another reasonable & prudent APRN would do?Is this within a standard of care that another reasonable & prudent APRN would do? Is the patient’s safety assured?Is the patient’s safety assured? Is the APRN prepared to accept accountability for performing the activity?Is the APRN prepared to accept accountability for performing the activity?

21. 21 Scope of APRN Practice - continued Apply the Board’s Decision-making Guidelines to a clinical situation to determine if the selected activity is within the APRN’s scope of practice.Apply the Board’s Decision-making Guidelines to a clinical situation to determine if the selected activity is within the APRN’s scope of practice. http://www.mass.gov/eohhs/docs/dph/ quality/boards/decision-making.pdfhttp://www.mass.gov/eohhs/docs/dph/ quality/boards/decision-making.pdf

22. 22 Guidelines Except for CNM, required for prescriptive practice Mutually developed and agreed upon with the APRN and the physician supervising the APRN’s prescriptive practice. Review Module 6: Preparing for APRN Prescriptive Practice and Guideline Development for detailed guideline informationReview Module 6: Preparing for APRN Prescriptive Practice and Guideline Development for detailed guideline information

23. 23 Content of Guidelines identify the supervising physician and APRN;identify the supervising physician and APRN; include a defined mechanism for the delegation of supervision to another physician including, but not limited to, duration and scope of the delegation;include a defined mechanism for the delegation of supervision to another physician including, but not limited to, duration and scope of the delegation; describe the nature and scope of the APRN's prescribing practice;describe the nature and scope of the APRN's prescribing practice; identify any limitations on medications or intravenous therapy to be prescribed;identify any limitations on medications or intravenous therapy to be prescribed; describe circumstances in which physician consultation or referral is required for the pharmacologic treatment of medical conditions;describe circumstances in which physician consultation or referral is required for the pharmacologic treatment of medical conditions; include a defined mechanism and time frame to monitor prescribing practices;include a defined mechanism and time frame to monitor prescribing practices; specify that the initial prescription of Schedule II drugs must be reviewed within 96 hours;specify that the initial prescription of Schedule II drugs must be reviewed within 96 hours; be kept on file in the workplace and be reviewed and re-executed every two years; andbe kept on file in the workplace and be reviewed and re-executed every two years; and conform to M.G.L. c. 94C, the regulations of the Department of Public Health at 105 CMR 700.000 et seq., 105 CMR 721.000 et seq., M.G.L. c. 112, §§ 80B, 80C, 80E, 80G, 80H, and 244 CMR 4.00.conform to M.G.L. c. 94C, the regulations of the Department of Public Health at 105 CMR 700.000 et seq., 105 CMR 721.000 et seq., M.G.L. c. 112, §§ 80B, 80C, 80E, 80G, 80H, and 244 CMR 4.00.

24. 24 Legal Documentation In all records required by federal and state laws and regulations and accepted standards of nursing practiceIn all records required by federal and state laws and regulations and accepted standards of nursing practice Must be accurate, complete, legibleMust be accurate, complete, legible Sign name and initials as they appear on your license (CNP, PCNS, CRNA, CNM, CNS)Sign name and initials as they appear on your license (CNP, PCNS, CRNA, CNM, CNS) May use certification credentials on business cards, stationary, advertisements, and other similar correspondenceMay use certification credentials on business cards, stationary, advertisements, and other similar correspondence

25. 25 Review 4.00 and 9.00 Go to the Board’s website to review:Go to the Board’s website to review: 244 CMR 4.00: Massachusetts Regulations Governing Advanced Practice Registered Nursing244 CMR 4.00: Massachusetts Regulations Governing Advanced Practice Registered Nursing 244 CMR 9.00: Standards of Conduct244 CMR 9.00: Standards of Conduct

26. 26 Get into the habit of Checking the Board’s Website www.mass.gov/dph/boards/rn News and UpdatesNews and Updates Practice IssuesPractice Issues AlertsAlerts Regulatory GuidanceRegulatory Guidance Advisory RulingsAdvisory Rulings NewslettersNewsletters

27. 27 Board of Registration in Nursing 239 Causeway Street 2 nd Floor, Suite 200 Boston, MA 02114 On-Line Renewal www.mass.gov/dph/boards/rn (go to On Line Services in right margin)