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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, 9.2 and 9.5
Proposed Repeal: N.J.A.C. 13:37-9.4

Click here to view Interested Persons Statement

Fee Schedule; Definitions; Pediatric Sexual Assault Forensic Examinations; FN-CSA Education Programs

Authorized By: State Board of Nursing, George Hebert, Executive Director.
Authority: N.J.S.A. 45:11-24.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2007-155.
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

On March 3, 2003, at 35 N.J.R. 1195(a), the Board of Nursing (Board) and the Attorney General proposed new rules N.J.A.C. 13:37-9.1 through 9.10 to allow for the certification of forensic nurses-certified sexual assault (FN-CSA). A portion of this proposal, N.J.A.C. 13:37-9.4, prohibited an FN-CSA from performing a sexual assault forensic examination on a child unless he or she had completed a clinical preceptorship supervised by a regional diagnostic center physician. One of the comments that the Board received on the proposal contended that the clinical preceptorship required by N.J.A.C. 13:37-9.4 would not prepare an FN-CSA to safely perform pediatric examinations. In its response to this comment, the Board noted that there were no clinical preceptorships available for FN-CSAs and that the requirements of N.J.A.C. 13:37-9.4 could never be met. The Board changed N.J.A.C. 13:37-9.4 upon adoption to prohibit any FN-CSA from performing a sexual assault forensic examination on a child. The Board intended to address FN-CSAs and sexual assault forensic examination on children after it had time to investigate the nature of pediatric sexual assault forensic examinations and the practice of FN-CSAs once they became certified. Soon after N.J.A.C. 13:37-9.1 through 9.10 was adopted, the Board received correspondence from the New Jersey State Nurses Association asking the Board to address pediatric sexual assault forensic examinations and FN-CSAs. The Board has completed its investigation and has determined that FN-CSAs are sufficiently prepared by their education, and by the nature of their scope of practice as registered professional nurses, to perform pediatric sexual assault forensic examinations. The Board proposes to repeal N.J.A.C. 13:37-9.4 and to reserve this section. The Board also proposes to delete the definitions of "adult" and "child" in N.J.A.C. 13:37-9.2, as these terms are no longer used in Subchapter 9. The Board proposes to amend N.J.A.C. 13:37-5.5 to reflect that the title "sexual assault nurse examiner" has been changed to "forensic nurse - certified sexual assault." The FN-CSA State program is organized and administered by the Division of Criminal Justice (Division). As part of its administration of the FN-CSA State program, the Division has reviewed the curriculum that applicants for certification as FN-CSAs are required to complete pursuant to N.J.A.C. 13:37-9.5(c). The Division has recommended that the Board reorganize this curriculum so that similar topics are grouped together, as opposed to being separately taught. The Board proposes to reorganize the curriculum in N.J.A.C. 13:37-9.5(c) as recommended by the Division. This reorganization does not delete any of the topics that are currently required by existing N.J.A.C. 13:37-9.5(c), it merely groups existing topics within the similar categories. The Board has determined that the comment period for this proposal will be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this proposal is excepted from the rulemaking calendar requirement.

Social Impact

Permitting forensic nurses-certified sexual assault to perform sexual assault forensic examinations on children will benefit society by ensuring that children can receive the same care provided by forensic nurses-certified sexual assault during these examinations as adults. The prosecution of individuals suspected of committing sexual assaults will be facilitated by allowing forensic nurses-certified sexual assault, who are educated to act as expert witnesses at sexual assault trials, the ability to provide testimony at the trials of individuals who are accused of sexually assaulting children. The proposed amendments and repeal will not have any other impact on society.

Economic Impact

The reorganization of N.J.A.C. 13:37-9.5(c) may have an economic impact on educational institutions that provide forensic nurse-certified sexual assault education programs. These institutions may incur a cost in revising their curricula to conform to the proposed amendments. The Board does not believe that the proposed amendments and repeal will have any other economic impact.

Federal Standards Statement

A Federal standards analysis is not required because there are no Federal laws or standards applicable to the proposed amendments and repeal.

Jobs Impact

The Board believes that the proposed amendments and repeal will not increase or decrease the number of jobs in New Jersey.

Agriculture Industry Impact

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

Regulatory Flexibility Analysis

Since forensic nurse-certified sexual assault are individually certified by the Board, they may be considered "small businesses" under the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq. Some of the institutions that provide forensic nurse-certified sexual assault education programs may also be considered small businesses under the Act.

The costs imposed by the proposed amendments are the same for all programs as outlined above in the Economic Impact statement. The Board does not believe that licensees will need to employ any professional services to comply with the requirements of the proposed amendments. The proposed amendments impose no reporting or recordkeeping requirements, but impose compliance requirements upon institutions that provide forensic nurse-certified sexual assault education programs. The proposed amendments and repeal reorganize forensic nurse-certified sexual assault curricula so that similar topics are grouped together. This will improve the education that forensic nurse-certified sexual assault receive by emphasizing the similarities between topics. Since the proposed amendments will improve the education that forensic nurses-certified sexual assault receive, no differing standards are provided based upon the size of the business.

Smart Growth Impact

The Board does not anticipate that the proposed amendments and repeal 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 proposal follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):

13:37-5.5 Fee schedule

(a)-(d) (No change.)

(e) The following fees shall be charged by the Board in connection with certification of [sexual assault nurse examiners] forensic nurses-certified sexual assault:

1.-4. (No change.)

(f) (No change.)

13:37-9.2 Definitions

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:

["Adult' means a person who is at least 13 years old.]

["Child" means a person who is under 13 years.]

13:37-9.4 [Pediatric sexual assault forensic examinations] (Reserved)

[No FN-CSA shall perform a sexual assault forensic examination on a child.]

13:37-9.5 FN-CSA education programs

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

(c) A course in FN-CSA education shall be completed within a six-month period. A course shall contain a minimum of 40 hours of didactic instruction in the following:

[1. Historical perspectives of sexual assault and forensic nurses-certified sexual assault, for a minimum of one-half hour;

2. Definitions and facts of sexual assault, for a minimum of one hour;

3. Role and responsibility of the forensic nurse-certified sexual assault, for a minimum of one and one-half hours;

4. Orientation to the biopsychosocial aspects of sexual assault issues and cultural needs of the sexual assault victim, for a minimum of one hour;

5. Symptomology of survivors and crisis intervention skills, for a minimum of one hour;

6. Rape trauma syndrome and post-traumatic stress disorder, for a minimum of one hour;

7. Needs of special populations, such as persons with physical or mental disabilities or older adults, for a minimum of one and one-half hours;

8. Vicarious victimization, for a minimum of one-half hour;

9. Identification of the practice skills necessary to complete the sexual assault forensic examination, for a minimum of one hour;

10. History-taking skills, for a minimum of two hours;

11. Components of a thorough forensic physical assessment, for a minimum of two hours;

12. Orientation to the female and male genital anatomy and development stages, for a minimum of one and one-half hours;

13. Detailed genital examination for injury identification, for a minimum of three hours;

14. Familiarization with fact based documentation, for a minimum of one and one-half hours;

15. Laws specific to sexual assault, for a minimum of one hour;

16. Laws and procedures for evidence collection, for a minimum of two hours;

17. Medical and nursing treatment for the adult sexual assault survivor, for a minimum of one hour;

18. Review of the Nurse Practice Act, N.J.S.A. 45:11-24 et seq., and its application to FN-CSA practice, for a minimum of one-half hour;

19. Various stages of genital healing, for a minimum of one hour;

20. Medical treatment/forensic implications of sexually transmitted diseases, for a minimum of one hour;

21. County multi-disciplinary team system approach, review of Sexual Assault Response Team policies and procedures for a minimum of two hours;

22. Examinations of sexual assault victims, utilizing specialized adjunct equipment including a colposcope, for a minimum of two hours;

23. Laws specific to the reporting of sexual abuse of special populations, for a minimum of one hour;

24. Fact and expert witness testimony, for a minimum of two hours;

25. Criminal trial procedure, for a minimum of one hour;

26. Testimony techniques, for a minimum of one hour;

27. Medical screening examinations, as required by 42 CFR 489.24 and N.J.A.C. 8:43G, for a minimum of one-half hour;

28. Ethics of nursing and ethical considerations pertaining to evidence collection, for a minimum of one hour;

29. Issues relating to drug facilitated sexual assault, for a minimum of one hour; and

30. Discharge planning for the sexual assault victim, for a minimum of one hour.]

1. History and role of forensic nursing, for a minimum of two hours, including:

i. History of forensic nursing;

ii. Forensic roles and practice settings;

iii. Professional organizations; and

iv. Ethical issues of forensic practice;

2. Role and responsibility of the FN-CSA, for a minimum of two hours, including:

i. Board statutes and rules, N.J.S.A. 45:11-24 et seq. and N.J.A.C. 13:37;

ii. Job description; and

iii. Role within the Sexual Assault Response Team;

3. Sexual Assault Response Teams, for a minimum of two hours, including:

i. Role of the rape care advocate;

ii. Role of law enforcement; and

iii. Sexual Assault Response Team activation;

4. Secondary responding/interacting agencies, for a minimum of two hours, including:

i. Division of Youth and Family Services;

ii. Regional Diagnostic and Treatment Centers;

iii. Division of Developmental Disabilities; and

iv. Office of the Ombudsman for the Institutionalized Elderly;

5. Psychosocial issues of sexual assault, for a minimum of two hours, including:

i. Definition and dynamics of sexual assault;

ii. Cultural awareness;

iii. Rape Trauma Syndrome/Post Traumatic Stress Disorder; and

iv. Vicarious trauma;

6. Needs of special victim populations, for a minimum of two hours, including:

i. Pediatrics;

ii. Elders:

iii. Disabled; and

iv. Male victims;

7. Sexual assault offenders, for a minimum of two hours, including:

i. Offender characteristics; and

ii. Drug-facilitated sexual assault;

8. Anatomy and physiology, for a minimum of six hours, including:

i. Male and female genital anatomy-normal growth and development;

ii. Genital injury and healing; and

iii. Injury versus disease process;

9. Nursing management issues, for a minimum of two hours, including:

i. Emergency Medical Treatment and Labor Act (EMTALA) regulations and medical screening exams, as required by 43 CFR 489.24 and N.J.A.C. 8:43G;

ii. Sexually transmitted disease and pregnancy prevention;

iii. Managing/referring medical problems; and

iv. Patient discharge and referral;

10. Evidence in sexual assault cases, for a minimum of four hours, including:

i. Specialized equipment and Sexual Assault Forensic Evidence (SAFE) kits; and

ii. Lab procedures and DNA Evidence;

11. Documentation skills, for a minimum of four hours, including:

i. Forensic history taking skills;

ii. Communication skills; and

iii. Fact-based documentation;

12. Documenting injuries and evidence, for a minimum of four hours, including:

i. Body map diagrams (pediatric and adult);

ii. Physical assessment;

iii. Forensic photography; and

iv. Colposcopy;

13. Genital exams, for a minimum of two hours;

14. Criminal justice system, for a minimum of two hours, including:

i. New Jersey sexual assault laws;

ii. Rules of evidence; and

iii. Investigation and prosecution; and

15. Trial testimony, for a minimum of two hours, including:

i. Preparing to testify; and

ii. Mock trial demonstration.

(d)-(g) (No change.)



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