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NEW JERSEY REGISTER
VOLUME 39, ISSUE 10
ISSUE DATE: MAY 21, 2007
RULE PROPOSALS
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
NEW JERSEY BOARD OF NURSING

Proposed Amendments: N.J.A.C. 13:37-5.5, 7.1, 7.3, 7.10, 13.1 and 13.2
Proposed New Rules: N.J.A.C. 13:37-7.3, 7.10 and 7.12
Proposed Repeals and New Rules: N.J.A.C. 13:37-7.2 and 7.5 through 7.9
Proposed Repeals: N.J.A.C. 13:37-7.4 and 7.11

Click here to view Interested Persons Statement

Certification of Advanced Practice Nurses

Authorized By: State Board of Nursing, George Hebert, Executive Director.
Authority: N.J.S.A. 45:11-24 and 45:11-50.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2007-154.
Submit written comments by July 20, 2007 to:

George Hebert, Executive Director
State Board of Nursing
PO Box 45010
Newark, New Jersey 07101

The agency proposal follows:

Summary

The Board of Nursing (the Board) proposes repeals, new rules and amendments to N.J.A.C. 13:37-7 concerning certification of advanced practice nurses (APN) to effectuate P.L. 1999, c. 85 and P.L. 2004, c. 122, and to clarify certification and practice standards for APNs.

On April 9, 2003 the Board of Nursing (the Board) received a petition from Alma L. Saravia, Esq., on behalf of the New Jersey Association of Nurse Anesthetists (NJANA) requesting that the Board amend Subchapter 7 of N.J.A.C. 13:37 to authorize the certification of certified registered nurse anesthetists (CRNAs) as advanced practice nurses. The petitioner suggested that CRNAs who do not hold a masters degree be "grandfathered" by the Board as APNs. The petitioner also suggested that joint protocols for a CRNA who is certified as an APN should identify that his or her primary task is the administering of drugs and not the ordering or prescribing of drugs. The petitioner requested that CRNAs who are certified as APNs be allowed to use the term CRNA if possible and that language be drafted to allow students and new graduates to practice prior to certification. A notice of receipt of petition for rulemaking was published in the New Jersey Register on May 19, 2003 at 35 N.J.R. 2374(a), a notice of action, which referred discussion of the petition to the Board's Regulatory Committee was published in the New Jersey Register on June 16, 2003 at 35 N.J.R. 2754(a) and a notice of final action on petition for rulemaking was published in the New Jersey Register on November 3, 2003 at 35 N.J.R. 5169(a). The Board partially granted the petitioner's request to allow for some CRNAs to obtain certification as an APN and proposes to amend N.J.A.C. 13:37-7 and N.J.A.C. 13:37-13 to set forth a mechanism for obtaining certification. In N.J.A.C. 13:37-5.5 and throughout Subchapter 7 the term "nurse practitioner/clinical nurse specialist" has been changed to "advanced practice nurse" to conform with statutory changes in P.L. 1999, c. 85.

N.J.S.A. 45:1-7.3 requires the Board to permit advanced practice nurses to renew certification as inactive practitioners. The Board proposes to amend N.J.A.C. 13:37-5.5 to impose an inactive renewal fee of $ 80.00 on advanced practice nurses who choose to renew as inactive. This fee is half of the active renewal fee of $ 160.00. The Board also proposes to delete N.J.A.C. 13:37-5.5(c)5, which imposes a $ 75.00 fee for late renewal of advanced practice nurse certification. The Board has organized renewals of advanced practice nurse certification to coincide with the renewal of an individual's registered professional nurse licensure. N.J.A.C. 13:37-5.5(a)7, imposes a fee for the late renewal of registered professional nurse licensure. Since this license and the advanced practice nurse certification must be renewed together, if one is renewed late, the other would be late as well. The Board has decided to charge only one late fee, found at N.J.A.C. 13:37-5.5(a)7, so as to not impose two fees for the same late renewal. N.J.A.C. 13:37-7.1 sets forth the application process for certification as an advanced practice nurse. Amendments to this rule clarify that "advanced practice nurse" refers to nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. Applicants for certification are required to complete a course of study and an examination in an advanced practice nursing specialty. The amendments to the rule further require nurses who seek to practice as advanced practice nurses to hold current New Jersey licensure as a registered professional nurse and certification from the Board as an advanced practice nurse. Applicants for certification are required to complete the certification examination within the past year, except for applicants who seek to specialize in anesthesia. Applicants must submit proof that they are certified in an area of advanced practice nursing specialization that is accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies.

N.J.A.C. 13:37-7.2 sets forth the educational requirements for certification. The existing requirements are proposed for repeal and new requirements are proposed in their place. The proposed new rule requires applicants to complete either a masters degree in nursing in a school accredited by a nursing accrediting association or a masters degree in nursing and a postmasters program that focuses on an advanced practice nursing specialty from a school accredited by a nursing accrediting association. Applicants must complete this education within the last two years, except for applicants specializing in anesthesia. Applicants are also required to complete 39 hours of pharmacology and six contact hours in pharmacology related to controlled dangerous substances. Existing N.J.A.C. 13:37-7.3 requires that every applicant for certification take the first examination for which they are eligible. This rule ensures that there is little lag between an applicant completing his or her education and obtaining certification, so that there is currency to an individual's education when he or she first starts to practice. The Board believes that this goal is better served by requiring that applicant apply within two years of completing his or her education. The proposed new rule also requires that every applicant complete at least 39 hours of pharmacology during their education. In order to effectuate P.L. 2004, c. 122, the proposed new rule requires applicants to complete six contact hours in pharmacology related to controlled dangerous substances.

Proposed new rule N.J.A.C. 13:37-7.3 allows individuals who have not yet passed the certification examination to apply to the Board for a work permit letter to work as an applicant advanced practice nurse. An applicant advanced practice nurse is not permitted to engage in prescriptive practice and must identify himself or herself as an "applicant advanced practice nurse." An applicant advanced practice nurse must take the first available certification examination.

If an applicant advanced practice nurse fails the certification examination twice, he or she must relinquish the work permit letter to the Board and may not practice as an advanced practice nurse until he or she passes the examination. Amendments to this rule require an applicant to pass an advanced practice examination offered by a national certifying agency accredited by the American Board of Nurse Specialties or the National Commission for Certifying Agencies.

N.J.A.C. 13:37-7.3, which sets forth the examination requirements for certification, is proposed for recodification as N.J.A.C. 13:37-7.4. The Board proposes to delete provisions in this rule that allow an applicant to engage in advanced practice nursing pending the results of the examination. These provisions have been moved to proposed new N.J.A.C. 13:37-7.3.

Existing N.J.A.C. 13:37-7.4 is proposed for repeal. This rule deals with applications for certification in the obstetrics/gynecology specialty submitted prior to May 2, 2002. Since that date has passed, the rule is no longer needed.

The Board is proposing new rule N.J.A.C. 13:37-7.5 to impose standards for an individual seeking certification as an advanced practice nurse specializing in anesthesia. These standards apply to any individual who does not possess a masters degree and who is seeking certification prior to one year from the effective date of this rule. Such an applicant must be licensed as a registered professional nurse, have successfully completed an education program accredited by the American Association of Nurse Anesthetists (AANA), be currently certified by the Council on Recertification of Nurse Anesthetists of the AANA, have completed at least 1600 hours as a nurse anaesthetist over the previous 24 months and have completed pharmacology requirements.

N.J.A.C. 13:37-7.6 is a proposed new rule that allows advanced practice nurses who are certified in another state to obtain certification in New Jersey without examination. Existing N.J.A.C. 13:37-7.5, which deals with renewal of certification, is proposed for repeal. The Board proposes new N.J.A.C. 13:37-7.7 to introduce new requirements for renewal. Existing N.J.A.C. 13:37-7.5 required certificants to renew certification biennially. The rule also imposed continuing education requirements. The proposed new rule also requires biennial renewal of certification, but requires certificants to show that they are currently certified by a national certifying agency. The proposed new rule also imposes consequences for failure to renew certification, permits certificants to renew on inactive status and imposes requirements for reinstatement of lapsed certification and reactivation of inactive certificates.

Existing N.J.A.C. 13:37-7.5(a) requires advanced practice nurses to complete 30 contact hours of continuing education every biennial period. The Board proposes to repeal this requirement and is proposing new N.J.A.C. 13:37-7.8 to set forth new standards for continuing education. This proposed new rule requires advanced practice nurses to complete, every biennial period, the continuing education required for renewal of registered professional nurse licensure and the continuing education requirements of their national certifying agency. In order to effectuate P.L. 2004, c. 122, every advanced practice nurse will also be required to complete six contact hours in pharmacology related to controlled dangerous substances, including pharmacologic therapy and addiction prevention and management, within six months from the effective date of this rule. Upon completing these hours, an advanced practice nurse is required to submit to the Board documentation indicating that he or she has completed the hours. Existing N.J.A.C. 13:37-7.6 deals with prescriptive practice. The Board proposes to repeal this rule. Existing N.J.A.C. 13:37-7.7, which deals with issuing prescriptions, is proposed for repeal and new rule N.J.A.C. 13:37-7.9 is proposed in its place. The proposed new rule incorporates provisions from existing N.J.A.C. 13:37-7.6 and 7.7 and imposes new requirements for prescriptions for controlled dangerous substances and the generic drug substitution.

Existing N.J.A.C. 13:37-7.8 deals with standards for certification by endorsement. The Board has proposed new rule N.J.A.C. 13:37-7.6 to set forth new requirements for certification by endorsement. The Board proposes to repeal existing N.J.A.C. 13:37-7.8. Existing N.J.A.C. 13:37-7.9 sets forth standards for individuals who apply for certification as an advanced practice nurse in the obstetrics/gynecology specialty prior to October 29, 1994. Since this date has passed, the Board proposes to repeal this rule.

N.J.A.C. 13:37-7.10 is a proposed new rule that sets forth standards and procedures to be followed by advanced practice nurses who dispense prescription medications. Existing N.J.A.C. 13:37-7.10, proposed for recodification as N.J.A.C. 13:37-7.11, clarifies that none of the statutes or rules regarding advanced practice nurses prevent an individual licensed as a registered professional nurse from practicing nursing. The proposed amendments to the rule delete the requirement that any duty performed by the registered professional nurse be consistent with accepted standards of nursing. Registered professional nurses are always required to comply with these accepted standards of nursing and this phrase is redundant.

Existing N.J.A.C. 13:37-7.11 sets forth areas of specialization for advanced practice nurses. As the Board has proposed new methods for recognizing specialties in N.J.A.C. 13:37-7.1, the Board proposes to repeal N.J.A.C. 13:37-7.11. N.J.A.C. 13:37-7.12 is a proposed new rule that requires an advanced practice nurse to practice only in the area of specialization in which he or she received his or her education.

N.J.A.C. 13:37-13.1 and 13.2 set forth standards for certified registered nurse anesthetists. The Board is recognizing anesthesia as an area of specialization for advanced practice nurses and is proposing procedures by which individuals currently practicing as certified registered nurse anesthetists may obtain certification as an advanced practice nurse. The Board proposes to amend N.J.A.C. 13:37-13.1 and 13.2 so that these rules will expire one year from the effective date of the proposed amendments. Once these rules expire, no certified registered nurse anesthetist shall practice unless he or she has obtained certification as an advanced practice nurse. As the Board has provided a 60-day comment period on this notice of proposal, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.

Social Impact

The Board believes that the proposed amendments, new rules and repeals will have a positive impact on nurses and the general public. The proposed amendments, repeals and new rules set forth standards by which professional registered nurses will be certified as advanced practice nurses. This protects the public by ensuring that advanced practice nurses have the necessary skills and knowledge to perform their duties.

The proposed amendments and new rules to N.J.A.C. 13:37-7.1, 7.2 and 7.4 ensure that advanced practice nurses are qualified to practice in their area of specialization. N.J.A.C. 13:37-7.2 also requires every advanced practice nurse to complete pharmacy courses, including six contact hours in pharmacology related to controlled dangerous substances. This ensures that all advanced practice nurses are adequately prepared to prescribe medications, including controlled dangerous substances.

N.J.A.C. 13:37-7.5 sets forth requirements for the certification of an applicant who is working in the area of anesthesia but who does not have a masters degree. This ensures that individuals who are currently providing anesthesia services as a certified registered nurse anesthetist will be able to obtain certification as an advanced practice nurse and continue to provide such services. It also ensures that these individuals are adequately prepared to provide these services at an advanced practice level.

N.J.A.C. 13:37-7.6 sets forth standards for certification by endorsement. This allows advanced practice nurses certified in other states to obtain certification in New Jersey more easily, while ensuring that such individuals are adequately prepared to practice as advanced practice nurses in New Jersey.

N.J.A.C. 13:37-7.7 requires that advanced practice nurses who were automatically suspended for failure to renew certification or who were on inactive status demonstrate that they have maintained competency. This ensures that advanced practice nurses who return to active status are still proficient in advanced practice nursing. N.J.A.C. 13:37-7.8 requires advanced practice nurses to complete the continuing education required of registered professional nurses and their national certifying organizations every biennial period. This will ensure that advanced practice nurses maintain the knowledge and skills of the evolving standards and practices of advanced practice nursing. The rule also requires every advanced practice nurse to complete six contact hours in pharmacology related to controlled dangerous substances. This ensures that all advanced practice nurses are adequately prepared to prescribe controlled dangerous substances.

Proposed new N.J.A.C. 13:37-7.9 protects the public by ensuring that advanced practice nurses are appropriately prescribing medication and devices. The rule also sets forth the standards for issuing written prescriptions, which ensure that the patient, the advanced practice nurse and a pharmacist are fully aware of the specifications of the prescription.

N.J.A.C. 13:37-7.10 sets forth standards that advanced practice nurses must follow when they dispense medications. This ensures that patients receive medications that are properly maintained and labeled when dispensed to them by an advanced practice nurse. N.J.A.C. 13:37-7.12 requires an advanced practice nurse to work only in the area of practice in which he or she has received an education. This ensures that the advanced practice nurse is only working in areas in which he or she can safely and effectively provide advance practice services.

Economic Impact

The Board believes that the proposed amendments, new rules and repeals will have an economic impact on nurses who wish to be certified in advanced practice. The education prerequisite found in N.J.A.C. 13:37-7.2 will require the payment of tuition fees to educational institutions attended by advanced practice nurse candidates.

N.J.A.C. 13:37-7.1 requires payment of a fee when a nurse applies for certification as an advanced practice nurse. This fee is used by the Board to cover the costs of processing the application. N.J.A.C. 13:37-7.4 requires an applicant to take an examination offered by a certifying agency, which charges a fee to take the examination. Although the Board requires applicants to take the examination, the Board does not determine the cost assessed for the examination. N.J.A.C. 13:37-7.6 requires payment of a fee when an advanced practice nurse certified in another state applies for certification by endorsement.

N.J.A.C. 13:37-7.7 requires advanced practice nurses to submit the renewal fee along with the certification renewal. N.J.A.C. 13:37-7.8 requires advanced practice nurses to complete the continuing education required of registered professional nurses and those required by national certifying agencies. These courses are sponsored by organizations that may charge a fee for attendance.

Proposed amendments to N.J.A.C. 13:37-5.5 will have an economic impact on advanced practice nurses who renew as inactive. These individuals will pay a reduced fee for their inactive renewal.

Federal Standards Statement

A Federal standards analysis is not required because there are no applicable Federal laws or standards.

Jobs Impact

The Board believes that the proposed amendments, new rules and repeals may impact jobs in the State. By clarifying certification and practice standards for advanced practice nurses, the changes may increase the number of individuals who obtain certification as advanced practice nurses and may lead to more employment opportunities for advanced practice nurses.

N.J.A.C. 13:37-7.6 permits advanced practice nurses certified to practice in other states to be endorsed to practice in New Jersey, which will increase the number of advanced practice nurses available to work in this State.

Agriculture Industry Impact

The Board does not believe that the proposed amendments, new rules and repeals will have any impact on the agriculture industry of this State.

Regulatory Flexibility Analysis

Since the approximately 3,500 advanced practice nurses certified by the Board are individually certified by the Board, under the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., they may be considered "small businesses" for the purposes of the Act.

The costs imposed by the proposed amendments, repeals and new rules are the same for all advanced practice nurses as set forth above in the Economic Impact statement. The Board does not believe that advanced practice nurses will need to employ any professional services to comply with the requirements of the proposed amendments, new rules and repeals. The proposed amendments, new rules and repeals impose reporting, compliance and recordkeeping requirements upon advanced practice nurses, as discussed in the Summary above.

The Board believes that because the proposed amendments, new rules, and repeals further the welfare and safety of the public in its dealings with advanced practice nurses, the provisions must be applied uniformly to all certificants regardless of the size of the business.

Smart Growth Impact

The Board does not anticipate that the proposed amendments, new rules and repeals will have any impact on the achievement of smart growth and implementation of the State Development and Redevelopment Plan, otherwise known as the State Plan.

Full text of the rules proposed for repeal may be found in the New Jersey Administrative Code at N.J.A.C. 13:37-7.2, 7.4 through 7.9 and 7.11.

Full text of the proposed amendments and new rules follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):

13:37-5.5 Fee schedule

(a)-(b) (No change.)

(c) The following fees shall be charged by the Board in connection with certification of [nurse practitioners/clinical nurse specialists] advanced practice nurses:

1.-2. (No change.)
3. Renewal of certification (biennial)[.............. 160.00]
i. Active............................................ 160.00
ii. Inactive......................................... 80.00
4. (No change.)
[5. Late renewal of certificate (one to 30 days)..... 75.00 plus the certification renewal fee set forth in (c)3 above]

Recodify existing 6. and 7. as 5. and 6. (No change in text.)

(d)-(f) (No change.)

SUBCHAPTER 7. CERTIFICATION OF [NURSE PRACTITIONERS/CLiNICAL NURSE SPECIALISTS] ADVANCED PRACTICE NURSES

13:37-7.1 Application for certification

(a) Advanced practice nurses shall include those individuals who have been educated as nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists.

(b) An applicant for certification as an advanced practice nurse shall complete a course of study and successfully complete an examination in an advanced practice nursing specialty certified by a national certifying agency, that is accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies.

[(a)] (c) [Any] A registered professional nurse who wishes to practice as [a nurse practitioner/clinical nurse specialist, or present, call or represent himself or herself as a nurse practitioner/clinical nurse specialist must be certified by the Board.] an advanced practice nurse shall:

1. Possess a current New Jersey registered professional nurse license; and

2. Be certified by the Board as an advanced practice nurse.

[(b)] (d) Each applicant for certification as an advanced practice nurse shall submit the following [materials] to the Board:

[1. Proof of a current New Jersey registered professional nurse license in good standing;]

[2.] 1. A completed application form [and the application fee set forth in N.J.A.C. 13:37-5.8(c)1. The application form solicits information including: general biographical, educational and experiential data];

[3.] 2. Proof that the applicant has successfully completed the educational requirements of an advanced practice nurse as set forth in N.J.A.C. 13:37-7.2 or, [where applicable,] when the advanced practice nurse specializes in anesthesia and does not hold a masters degree, the certification requirements ofN.J.A.C. 13:37-[7.4]7.5. The applicant shall [obtain verification of] submit to the Board a transcript showing successful completion [from the school(s) where the applicant completed the educational requirements] of an advanced practice nurse program that meets the requirements of N.J.A.C. 13:37-7.2(a); [and]

[4.] 3. Proof that the applicant has successfully completed the examination requirements set forth in N.J.A.C. 13:37-[7.3]7.4 within the last year prior to the date of application or, [where applicable] for applicants specializing in anesthesia who do not hold a masters degree, the certification requirements of N.J.A.C. 13:37-[7.4]7.5. Applicants specializing in anesthesia who have successfully completed the examination requirements of N.J.A.C. 13:37-7.4 need not show that they have completed that examination within the last year if they apply between (the effective date of this amendment) and (one year from the effective date of this amendment);

4. Proof that the applicant is currently certified by a national certifying agency that is accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies; and

5. The application fee set forth in N.J.A.C. 13:37-5.5(c).

13:37-7.2 Educational requirements for certification

(a) An applicant for certification as an advanced practice nurse shall possess;

1. A masters degree in nursing from a school accredited by a nursing accrediting association recognized by the U.S. Department of Education; or

2. A masters degree in nursing and shall have completed a post-masters program that focuses on an advanced practice nursing specialty from a school accredited by a nursing accrediting association recognized by the U.S. Department of Education.

(b) An applicant shall have completed the education required by (a) above no more than two years prior to submitting an application for certification to the Board. An education program completed more than two years prior to submission shall not qualify an applicant for certification. Applicants specializing in anesthesia who have successfully completed the education required by (a) above need not show that they have completed that education within the last two years if they apply between (the effective date of this new rule) and (one year from the effective date of this new rule).

(c) Each applicant shall have successfully completed at least 39 hours in pharmacology during the education program referred to in (a) above.

(d) In addition to the requirements of (a) and (c) above, an applicant shall have completed six contact hours in pharmacology related to controlled dangerous substances, including pharmacologic therapy and addiction prevention and management, presented by:

1. An organization that has been approved by a credentialing agency accredited by the National Commission for Certifying Agencies; or

2. A college or university licensed by either the New Jersey Commission on Higher Education or an agency of another state with requirements substantially similar to the requirements of the New Jersey Commission on Higher Education.

13:37-7.3 Practice prior to passing the examination for certification

(a) Prior to passing the examination for certification as an advanced practice nurse, an individual who has submitted an advanced practice nurse application to the Board may apply to the Board for a work permit letter authorizing the applicant to practice pursuant to this subchapter, except that no holder of a work permit letter shall engage in prescriptive practice. An applicant seeking a work permit letter shall submit to the Board proof that:

1. The applicant has completed the educational requirements of N.J.A.C. 13:37-7.2 or 7.5; and

2. The applicant has applied to take the examination required by N.J.A.C. 13:37-7.4.

(b) An applicant who engages in advanced practice nursing pursuant to a work permit letter shall indicate that he or she is an "applicant advanced practice nurse" whenever the applicant identifies himself or herself either in person, on a chart, on a report or on any other document.

(c) An applicant who engages in advanced practice nursing pursuant to a work permit letter shall take the first examination for which the applicant is eligible. If the applicant fails the first examination, the applicant shall take the next examination for which he or she is eligible. If the applicant fails the second examination, the applicant shall surrender the work permit letter to the Board and shall not practice as an applicant advanced practice nurse until he or she passes the examination.

13:37-[7.3]7.4 Examination requirements for certification

[(a) Each] An applicant for certification shall [be required to successfully] pass [the highest level] an advanced practice examination in [the] his or her area of specialization [approved by the Board] offered by a national certifying agency that is accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies.

[(b) Each applicant who meets the educational requirements of N.J.A.C. 13:37-7.2 shall apply to take the first available examination for which the applicant is eligible. The applicant may engage in advanced nursing practice pending the results of the first available examination, provided that the applicant clearly delineates the word, "applicant" each time said applicant assumes the title or designation of a "nurse practitioner/clinical nurse specialist" or any of its abbreviations. If the applicant is unsuccessful in passing two consecutive examinations, he or she shall not be eligible to engage in advanced nursing practice but shall not be denied the right to continue to take any examination for certification for which he or she qualifies. Said examination requirements must be completed within two years of the date of initial application.]

13:37-7.5 Educational and examination certification requirements in the area of anesthesia on or before (one year after the effective date of this new rule)

(a) An applicant who does not possess a masters degree who is seeking certification as an advanced practice nurse in the specialty area of anesthesia on or before (one year from the effective date of this new rule) shall be certified, provided the applicant is licensed as a registered nurse in New Jersey and submits the following to the Board:

1. Proof of successful completion of an education program accredited and/or approved by the Council on Accreditation of Nurse Anesthesia Educational Programs;

2. Proof of current re-certification by the Council on Recertification of Nurse Anesthetists of the AANA;

3. Proof that the applicant has worked for a minimum of 1600 hours as a nurse anesthetist over the previous 24 months; and

4. Proof that the applicant has completed:

i. At least 39 hours in pharmacology during the program referred to in (a)1 above or at least three credits of graduate level course work in pharmacology from a school accredited by a nursing accrediting association recognized by the U.S. Department of Education; and

ii. Six contact hours in pharmacology related to controlled dangerous substances, including pharmacologic therapy and addiction prevention and management, offered by either an organization that has been approved by a credentialing agency accredited by the National Commission for Certifying Agencies or a college or university licensed by either the New Jersey Commission on Higher Education or an agency of another state with requirements substantially similar to the requirements of the New Jersey Commission on Higher Education.

13:37-7.6 Certification by endorsement

(a) An advanced practice nurse certified in another state shall be eligible for certification in this State without meeting the examination requirements of N.J.A.C. 13:37-7.4 if the educational requirements of the state in which he or she is certified are substantially similar to the educational requirements of this State.

(b) An applicant for advanced practice nurse certification who is certified in another state shall submit to the Board:

1. A completed application form, which contains biographical, educational and experiential data concerning the applicant;

2. Verification of certification as an advanced practice nurse in good standing in another state;

3. Proof that the applicant has successfully completed the educational requirements of an advanced practice nurse as set forth in N.J.A.C. 13:37-7.2. The applicant shall submit to the Board a transcript showing successful completion of an advanced practice nurse program from the school(s) where the applicant completed the educational requirements. An applicant applying for certification through endorsement shall not be required to meet the requirements of N.J.A.C. 13:37-7.2(b);

4. Proof that the applicant is currently certified by a national certifying agency that is accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies; and

5. The application fee set forth in N.J.A.C. 13:37-5.5(e).

13:37-7.7 Biennial certificate renewal; certificate suspension; reinstatement of suspended certificate; inactive status; return from inactive status

(a) All certificates for advanced practice nurses shall be issued for a two-year certification period, which coincides with the advanced practice nurse's registered professional nurse licensure renewal period. An advanced practice nurse who seeks renewal of the certificate shall submit a renewal application, proof that the applicant is currently certified by a national certifying agency that is accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies and the renewal fee set forth in N.J.A.C. 13:37-5.5 prior to the expiration date of the certificate. An advanced practice nurse who is certified prior to (the effective date of this new rule) shall not have to show that he or she is certified by a national certifying agency until the biennial period (two years from the effective date of this new rule).

(b) The Board shall send a notice of renewal to each advanced practice nurse, at least 60 days prior to the expiration of his or her certificate. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew.

(c) If an advanced practice nurse does not renew the certificate prior to its expiration date, the advanced practice nurse may renew the certificate within 30 days of its expiration by submitting a renewal application, proof that the applicant is currently certified by a national certifying agency that is accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies, a renewal fee and a late fee, as set forth in N.J.A.C. 13:37-5.5.

(d) A certificate that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended certificate shall be deemed to be engaged in unlicensed practice.

(e) An advanced practice nurse whose certificate has been automatically suspended for five years or less for nonpayment of a biennial renewal fee pursuant to (c) above may be reinstated by the Board upon completion of the following:

1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:37-5.5;

2. Completion of the continuing education units required under N.J.A.C. 13:37-7.8 for each biennial registration period for which the advanced practice nurse was suspended; and

3. Submission of an affidavit of employment listing each job held during the period the certificate was suspended, including the name, address, and telephone number of each employer.

(f) An advanced practice nurse whose certificate has been automatically suspended for failure to renew for more than five years who wishes to have his or her certificate reinstated shall reapply for certification pursuant to N.J.A.C. 13:37-7.1. The applicant shall fulfill all of the initial licensure requirements, including retaking the examination required by N.J.A.C. 13:37-7.1(d)3. An applicant reapplying for certification shall not be required to meet the requirements of N.J.A.C. 13:37-7.2(b).

(g) Renewal applications shall provide the advanced practice nurse with the option of either active or inactive status. An advanced practice nurse electing inactive status shall pay the inactive certificate fee set forth in N.J.A.C. 13:37-5.5 and shall not practice as an advanced practice nurse.

(h) An advanced practice nurse who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board upon completion of the following:

1. Payment of the active status fee set forth in N.J.A.C. 13:37-5.5;

2. The completion of the continuing education units required for each biennial registration period for which the advanced practice nurse was on inactive status; and

3. Submission of an affidavit of employment listing each job held during the period the advanced practice nurse was on inactive status, including the name, address, and telephone number of each employer.

(i) An advanced practice nurse who has been on inactive status for more than five years who wishes to return to practice shall reapply for certification pursuant to N.J.A.C. 13:37-7.1. The applicant shall fulfill all of the initial licensure requirements, including retaking the examination required by N.J.A.C. 13:37-7.1(d)3. An applicant reapplying for certification shall not be required to meet the requirements of N.J.A.C. 13:37-7.2(b).

(j) An advanced practice nurse who was initially certified by the Board in an area of practice that was approved by the Board prior to (the effective date of this new rule) shall be permitted to renew certification for that practice.

13:37-7.8 Continuing education

(a) Every biennial period, an advanced practice nurse shall complete the continuing education required for the renewal of a registered professional nurse license pursuant to N.J.A.C. 13:37-5.3 and the continuing education requirements of the national certifying agency whose examination the advanced practice nurse successfully passed pursuant to N.J.A.C. 13:37-7.4 or 7.5.

(b) By (six months from effective date of this new rule), every advanced practice nurse shall have completed six contact hours in pharmacology related to controlled dangerous substances, including pharmacologic therapy and addiction prevention and management, presented by:

1. An organization that has been approved by a credentialing agency accredited by the National Commission for Certifying Agencies; or

2. A college or university licensed by either the New Jersey Commission on Higher Education or an agency of another state with requirements substantially similar to the requirements of the New Jersey Commission on Higher Education.

(c) Upon completing the six contact hours in pharmacology related to controlled dangerous substances as required by (b) above, an advanced practice nurse shall submit to the Board a certificate of completion issued by the organization, college or university that provided the contact hours indicating that he or she has completed the hours.

13:37-7.9 Prescriptive practice

(a) An advanced practice nurse may prescribe or order medications, devices and treatments, including referrals, and shall do so in conformity with the provisions of this subchapter, N.J.S.A. 45:11-45 et seq., and written protocols for the prescription of medications and devices jointly developed by the advanced practice nurse and the collaborating physician in accordance with the standards of N.J.S.A. 45:11-51 and N.J.A.C. 13:37-6.3.

(b) An advanced practice nurse who issues prescriptions in any setting other than in a licensed acute care or long-term care facility may issue written prescriptions for medications to patients only on New Jersey Prescription Blanks in accordance with N.J.S.A. 45:14-55.

(c) An advanced practice nurse shall include the following information on each prescription blank issued:

1. The prescribing advanced practice nurse's full name, designation, that is, APN, address, telephone number, and certification number;

2. The full name, date of birth and address of the patient;

3. The date of issuance;

4. The name, strength, route and quantity of the medication prescribed;

5. The number of refills permitted or time limit for refills, or both;

6. A handwritten, original signature;

7. An explicit indication, by initials placed next to "do not substitute," if a specified brand name drug is to be dispensed;

8. The full name, title, address, telephone number, and license number of the collaborating physician;

9. Words, in addition to numbers, to indicate the drug quantity authorized if the prescription is for a controlled dangerous substance, for example: "ten (10) Percodan" or "five (5) Ritalin 5 mg"; and

10. If the prescription is for a controlled dangerous substance, the advanced practice nurse's DEA number and instructions as to the frequency of use.

(d) An advanced practice nurse who prescribes medication or devices shall advise patients by a sign or pamphlets in the waiting room of the office, that a patient may request a generic drug as a substitute for a brand name drug prescribed.

(e) An advanced practice nurse may use only prescription blanks that are imprinted with the words "substitution permissible" and "do not substitute," with a space for the prescribing advanced practice nurse's initials next to the chosen option. The prescription blanks shall not include preprinted information designed to discourage or prohibit substitution.

(f) When using health care facility or multi-prescriber prescription blanks, the full name and certificate number of the advanced practice nurse shall be legibly printed at the top of the prescription blank or the identity of the advanced practice nurse shall be designated by a checkmark or other legible means.

(g) Each prescription for a controlled dangerous substance shall be written on a separate New Jersey Prescription Blank.

13:37-7.10 Requirements for dispensing medications

(a) An advanced practice nurse may dispense a medication directly to a patient pursuant to a joint protocol. An advanced practice nurse who dispenses medications shall assure that follow-up care is provided and that the effects of the medication are properly evaluated and integrated into the treatment plan of the patient.

(b) An advanced practice nurse who dispenses medications in the office shall maintain those medications in accordance with pharmaceutical standards and manufacturer recommendations concerning storage conditions. An advanced practice nurse shall not maintain in inventory any medications, which are outdated, misbranded, deteriorated, adulterated, recalled, unlabeled, damaged, discontinued or which were previously dispensed to a patient.

(c) When an advanced practice nurse dispenses a medication to a patient, he or she shall record the dispensing in the patient's record.

(d) All medications dispensed, except for those dispensed as pharmaceutical samples shall be recorded in a permanent, contemporaneous dispensing log, which shall contain the following:

1. The full name of the patient;

2. The complete name of each medication dispensed;

3. The strength and quantity of the medication dispensed;

4. Instructions as to the frequency of use;

5. The date of dispensing; and

6. The identity of the dispensing advanced practice nurse, if more than one individual dispenses in the office.

(e) Every medication dispensed, in whatever dosage form, shall be placed in a separate container with a safety closure cap, unless the patient requests otherwise or the drug is a pharmaceutical sample, which has been packaged and labeled by the manufacturer.

(f) Every medication dispensed, except for pharmaceutical samples, shall bear a legible label, which includes:

1. The full name of the patient;

2. The complete name of the medication dispensed;

3. The strength and quantity of the medication dispensed;

4. Instructions as to the frequency of use;

5. Special precautions, if appropriate;

6. The date of dispensing;

7. The expiration date of the medication;

8. A list of the ingredients if the medication was compounded, not manufactured; and

9. The identity of the dispensing advanced practice nurse.

(g) Medications dispensed as a pharmaceutical sample shall bear a legible label, which includes;

1. The complete name of the medication dispensed;

2. The strength and quantity of the medication dispensed;

3. Instructions as to the frequency of use;

4. Special precautions, if appropriate; and

5. The expiration date of the medication.

(h) An advanced practice nurse shall not charge a fee for a medication packaged and labeled by a manufacturer as a sample.

(i) An advanced practice nurse may charge a fee for dispensing any medication that is not packaged and labeled by a manufacturer as a sample. This fee shall not exceed the actual acquisition cost for the medication plus an administrative amount which shall not exceed 10 percent of the actual acquisition cost.

(j) Except as exempted by (k) below, an advanced practice nurse who dispenses a medication for a fee shall:

1. Not dispense the medication or a substantially equivalent medication in a quantity or in dosages greater than that which would allow the patient a seven-day supply;

2. Not dispense the medication or a substantially equivalent medication more than once every 30 days:

3. Assure that information is given to the patient regarding the availability of the medication outside of the advanced practice nurse's office; and

4. Disclose to the patient in advance of purchase and again on the bill the actual acquisition cost of the medication.

(k) An advanced practice nurse need not comply with (j) above if:

1. The office at which the dispensing occurs is situated 10 or more miles from the nearest licensed pharmacy;

2. The medication is dispensed pursuant to an oncological or AIDS protocol;

3. The medication dispensed is a salve, ointment or drops; or

4. The medication is dispensed in, and directly related to, the services rendered to the patient at:

i. A hospital emergency room;

ii. A student health center at an institution of higher education; or

iii. A publicly subsidized community health center, family planning clinic or prenatal clinic.

(l) The requirements set forth in (d) through (g) above shall not apply to the dispensing of nonprescription substances.

13:37-[7.10]7.11 Practice as a registered professional nurse

Nothing in N.J.S.A. 45:11-45 et seq. or this subchapter shall be construed to limit, preclude or otherwise interfere with the practice of nursing as defined by N.J.S.A. 45:11-23 by [persons duly] a person licensed as a registered professional nurse in this State, provided that [such duties are consistent with the accepted standards of nursing and said registered professional nurse is] the licensee does not [represented] represent himself or herself as [a nurse practitioner/clinical nurse specialist] an advanced practice nurse.

13:37-7.12 Scope of practice

An advanced practice nurse shall only practice in the area of specialization in which the advanced practice nurse received his or her education and hold certification from an agency accredited by the American Board of Nursing Specialties and/or the National Commission for Certifying Agencies.

13:37-13.1 Nurse anesthetist practice

(a)-(b) (No change.)

(c) This section shall expire (one year from the effective date of this amendment). A nurse anesthetist who has not obtained certification as an advanced practice nurse shall cease to administer anesthesia on (one year from the effective date of this amendment).

13:37-13.2 Practice pending the results of the examination

(a)-(b) (No change.)

(c) This section shall expire (one year from the effective date of this amendment).



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