SECTION
I
SCOPE OF PRACTICE
The advanced practice registered nurse shall practice in a
manner consistent with the definition of the practice of advanced practice
registered nursing set forth in Arkansas Code Annotated §
17-87-102(4)(5)(6)(7)(8), and in accordance with the scope of practice defined by the
appropriate national certifying body and the standards set forth in these
rules. The advanced practice registered nurse (APRN) may provide health care
for which the APRN is educationally prepared and for which competence has been
attained and maintained.
SECTION
II
QUALIFICATIONS FOR
LICENSURE
Advanced practice registered nurse (APRN) licensure shall be
designated in one of the four roles below and at least one population focus:
Family/Individual Across the Lifespan, Adult-Gerontology, Neonatal, Pediatrics,
Women's Health/Gender-Related, or Psychiatric/Mental Health (effective 2015). A
current, unencumbered registered nurse license to practice in Arkansas is
required for all categories of advanced practice licensure. Effective January
1, 2003, all applicants for advanced practice licensure by examination shall
have completed a graduate or post-graduate level advanced practice registered
nursing education program. Applicants for advanced practice licensure by
endorsement shall have met the educational and certification requirements set
forth in Arkansas State Board of Nursing Rules at the time of
their initial licensure as an advanced practice registered nurse in another
jurisdiction. APRN roles and their respective qualifications are:
A.
CERTIFIED NURSE PRACTITIONER
(CNP)
1. Successful completion of a
nationally accredited graduate or post-graduate APRN education program that
prepares nurses for the advanced practice role of nurse practitioner;
and
2. Hold current certification
by a national certifying body recognized by the Board of Nursing in the APRN
role and population foci appropriate for educational preparation.
B.
CERTIFIED REGISTERED
NURSE ANESTHETIST (CRNA)
1. Successful
completion of a nationally accredited graduate or post-graduate APRN education
program that prepares nurses to perform as nurse anesthetists; and
2. Hold current certification by a national
certifying body recognized by the Board of Nursing in the APRN role and
population foci appropriate for educational preparation.
C.
CERTIFIED NURSE MIDWIFE (CNM)
1. Successful completion of a nationally
accredited graduate or post-graduate APRN education program that prepares
nurses for the advanced practice role of nurse midwife; and
2. Hold current certification by a national
certifying body recognized by the Board of Nursing in the APRN role and
population foci appropriate for educational preparation.
D.
CLINICAL NURSE SPECIALIST
(CNS)
1. Successful completion of a
nationally accredited graduate or post-graduate APRN education program that
prepares nurses for the advanced practice role of clinical nurse specialist
which shall include supervised clinical practice and classroom instruction in a
nursing clinical practice specialty; and
2. Hold current certification by a national
certifying body recognized by the Board of Nursing in the APRN role and
population foci appropriate for educational preparation.
SECTION III
LICENSURE
A.
ELIGIBILITY
The applicant shall meet the licensure requirements of the
Board including a valid United States Social Security Number (SSN) or has been
issued a Federal Form I-766 U.S. Citizenship and Immigration Services-issued
Employment Authorization Document.
B.
APPLICATION FOR LICENSURE BY
EXAMINATION
In addition to a current registered nurse license to practice
in Arkansas, the information submitted to the Board shall include:
1. A completed Board application
form;
2. Verification of active
practice of nursing as a registered nurse for a minimum of two-thousand (2,000)
hours, effective July 1, 2019;
3.
An official transcript or document from a nursing education program accredited
by a nursing accrediting body that is recognized by the U.S. Secretary of
Education and/or Council for Higher Education Accreditation (CHEA), as
acceptable by the Board and meets the qualifications of Section II of this
Chapter in the category of advanced practice nursing for which the applicant is
seeking licensure. The transcript or document shall verify the date of
graduation, the degree or certificate conferred, clinical hours completed, and
the role and population focus of the education program;
4. Evidence of state and federal criminal
background checks conducted by the Arkansas State Police and the Federal Bureau
of Investigation completed no earlier than twelve (12) months prior to the
application for advanced practice licensure;
5. Verification of certification directly
from the Board-approved national certifying body evidencing current
certification in good standing; and
6. Payment of the nonrefundable
fee.
C.
APPLICATION FOR LICENSURE BY ENDORSEMENT
1. The Board may issue a license by
endorsement to an APRN licensed under the laws of another state if, in the
opinion of the Board, the applicant meets the qualifications for licensure in
this state.
2. In addition to the
requirements set forth in Section II and III. A. and B. of this Chapter, the
information submitted to the Board shall include documentation of current
unencumbered advanced practice licensure/authority to practice in another
jurisdiction.
3. An individual
applying for licensure by endorsement who has been out of practice for more
than two (2) years shall provide evidence of passing an APRN nursing refresher
course approved by the Board or an extensive orientation, which shall include a
minimum of 200 hours, in the appropriate advanced practice role and population
focus which includes a supervised clinical component by a qualified preceptor
who meets the following requirements:
a. Holds
an active unencumbered APRN or physician license,
b. Is in current practice in the advanced
role and population focus and
c.
Functions as a supervisor and teacher and evaluates the individual's
performance in the clinical setting.
D.
APPLICATION FOR AN INTERNATIONALLY
EDUCATED APRN (educated outside the United States)
An internationally educated applicant for licensure in this
state as an APRN shall:
1. Graduate
from a graduate level APRN program equivalent to an APRN educational program in
the United States accepted by the Board.
2. Submit an official transcript directly
from the international nursing education program and verified through a
qualified credentials evaluation process for the license being
sought.
3. Meet all other licensure
criteria required of applicants educated in the United States, including
English proficiency.
E.
TEMPORARY PERMITS
1. Upon
application and payment of the required fee, the Board shall issue a
nonrenewable temporary permit to practice in an advanced practice nursing
category to a qualified applicant who has no violations as listed in ACA
§ 17-3-102 on the Arkansas State Police criminal background check and:
a. Meets the educational requirements set
forth in Section II of this Chapter and has been accepted by the appropriate
certification body to sit for the national certification exam he or she is
eligible to take; or
b. Has a
current advanced practice registered nurse license or the equivalent from
another jurisdiction and has current Board-approved certification in the
appropriate advanced practice nursing education category.
2. The temporary permit shall immediately
become invalid upon receipt of information obtained from the federal criminal
background check indicating any offense listed in ACA § 17-3-102 or upon
notification to the applicant or ASBN of failure of the certification
examination.
3. The temporary
permit is not renewable and does not apply to prescriptive authority.
4. In no event shall the permit be valid in
excess of six (6) months.
F.
RENEWALS
1. The date for renewal of licensure to
practice as an advanced practice registered nurse shall coincide with renewal
of the applicant's registered nurse license.
2. An applicant for renewal of an advanced
practice registered nurse license shall submit to the Board:
a. A completed Board renewal application
form;
b. Documentation of current
national certification in the appropriate APRN specialty through a maintenance
program of a Board approved certifying body;
c. Documentation of current compact state RN
licensure if primary state of residence has enacted the Interstate Nurse
Licensure Compact; and
d. Payment
of the nonrefundable renewal fee.
3. Advanced practice registered nurses with
prescriptive authority, who do not have full practice authority, shall submit
evidence of a current collaborative practice agreement as a prerequisite to
license renewal.
4. A certified
nurse practitioner who has been granted full independent practice authority
shall apply for renewal of the full independent practice authority certificate
every three (3) years.
5. If
disciplinary proceedings have been initiated against an individual with a
lapsed, inactive, or retired license, the license shall not be renewed until
the proceedings have been completed.
6. Continuing education submitted to the
certifying body to meet the qualifications for recertification shall be
accepted as meeting the statutory requirement for continuing
education.
7. Upon request, an APRN
shall submit documentation to the Board of continuing education.
8. APRNs with prescriptive authority shall
complete five (5) contact hours of pharmacotherapeutics continuing education in
the APRN's area of certification each biennium prior to license renewal.
Effective January 1, 2017, two (2) of the five (5) hours must contain
information related to maintaining professional boundaries and the prescribing
rules and laws that apply to APRNs in the State of Arkansas.
9. Pursuant to Act 204 of 2017, upon
notification of active duty status and submission of appropriate documentation,
the license renewal fee will be waived for members of the military.
HISTORY: Amended January 1, 2018
Amended: July 1, 2020; June 4, 2021
G.
LAPSED APRN
LICENSE
The license is lapsed if not renewed or placed on inactive
status by the expiration date.
1. The
license is lapsed if the RN license or privilege to practice in Arkansas is not
current.
2. The license is lapsed
when the national certification upon which licensure was granted
expires.
3. Failure to receive the
renewal notice at the last address of record in the Board office shall not
relieve the licensee of the responsibility for renewing the license by the
expiration date.
4. Any licensee
whose license has lapsed shall submit to the Board:
a. A completed Board renewal application
form;
b. Documentation of current
national certification; and
c. The
renewal fee and the reinstatement fee/late penalty.
5. Fees submitted to the Board are
nonrefundable.
6. Any person
engaged in advanced practice nursing during the time his or her license has
lapsed shall be considered an illegal practitioner and shall be subject to the
penalties provided for violation of the Nurse Practice
Act.
H.
REINSTATEMENT OF APRN LICENSE
1. An
individual who applies for licensure reinstatement who has been out of practice
for more than two (2) years shall provide evidence of passing an APRN refresher
course approved by the Board or an extensive orientation, which shall include a
minimum of 200 hours, in the appropriate advanced practice role and population
focus which includes a supervised clinical component by a qualified preceptor
who meets the following requirements:
a.
Holds an active unencumbered APRN or physician license
b. Is in current practice in the advanced
role and population focus; and
c.
Functions as a supervisor and teacher and evaluates the individual's
performance in the clinical setting.
2. For those licensees applying for licensure
reinstatement following disciplinary action, compliance with all Board
licensure requirements as well as any specified requirements set forth in the
Board's discipline order is required.
I.
INACTIVE STATUS
1. Any licensee who desires to temporarily
inactivate their advanced practice registered nurse license in this state shall
submit a request to the Board.
2.
The APRN license may immediately be placed on inactive status when the
registered nurse license is placed on inactive status.
3. While the license is inactive, the
licensee shall not engage in advanced practice nursing nor be subject to the
payment of renewal fees.
4. If the
APRN desires to resume practice in this state, he or she shall submit a
reinstatement application and meet the continuing education
requirements.
J.
RETIRED ADVANCED PRACTICE REGISTERED NURSE
1. Any advanced practice registered nurse in
good standing, who desires to retire for any length of time from the practice
of nursing in this state shall submit a request and their APRN license shall be
placed on retired status.
2. While
retired, the APRN shall not practice advanced practice nursing; however, an
APRN with a retired license may use the title "Advanced Practice Registered
Nurse" or the abbreviation "APRN." Retired APRNs that maintain an active RN or
RNP license may practice in the role of a Registered Nurse or Registered Nurse
Practitioner.
3. When the licensee
desires to resume practice, he or she shall submit a reinstatement application
with a reinstatement fee and the active renewal fee. The licensee must also
meet those requirements outlined in Section III, F.
4. When disciplinary proceedings have been
initiated against a retired licensee, the license shall not be reinstated until
the proceedings have been completed.
K.
ADDITIONAL CERTIFICATIONS
1. An APRN who has completed post-masters
education for an additional nursing specialty shall:
a. Submit a request for permission to
practice in the new certification area;
b. Submit evidence of eligibility to sit for
the new certification exam from the Board-approved certifying body;
c. Immediately cease practicing in the
specialty upon notification of failure of the exam;
d. Submit results of the certification in the
additional specialty directly from the certifying body;
e. Submit an official transcript or document
from a nursing education program that meets the qualifications in Section II of
this Chapter verifying the date and degree or certificate conferred.
2. An APRN who has
prescriptive authority shall:
a. Prescribe
only for patients covered by the original specialty while waiting additional
specialty results.
b. Submit a
collaborative practice agreement which includes the additional certification.
HISTORY: Amended: October 1, 2017
Amended: December 29, 2018
SECTION IV
CRIMINAL BACKGROUND CHECK
A. No application for issuance of an initial
license will be considered without state and federal criminal background checks
by the Arkansas State Police and the Federal Bureau of Investigation.
B. Federal background checks originating
within the State of Arkansas shall be submitted electronically.
C. Each applicant shall sign a release of
information on the criminal background check application and licensure
applications and shall be solely responsible for the payment of any fees
associated with the state and federal criminal background checks.
D. Upon completion of the state and federal
criminal background checks, the Identification Bureau of the Arkansas State
Police shall forward all information obtained concerning the applicant in the
commission of any offense listed in ACA § 17-3-102.
E. The state and federal criminal background
checks conducted by the Arkansas State Police and the Federal Bureau of
Investigation shall have been completed no earlier than twelve (12) months
prior to the application for an initial license issued by the ASBN and at any
other time thereafter that the Board deems necessary.
F. The ASBN shall not issue a permanent
license until the state and federal criminal background checks conducted by the
Arkansas State Police and the Federal Bureau of Investigation have been
completed.
G. Pursuant to Act 990
of 2019, an individual may petition for a pre-licensure determination of
whether the individual's criminal record will disqualify the individual from
licensure and whether a waiver may be obtained.
1. A request for a waiver shall be in writing
and accompany the completed application and fees.
2. All decisions of the Board in response to
the petition will be determined by the information provided by the
individual.
3. The Board's response
shall state the reason(s) for the decision.
4. Any decision made by the Board in response
to a pre-licensure criminal background waiver petition is not subject to
appeal.
H. A waiver of
the denial of licensure pursuant to the provisions of ACA § 17-3-102 is not
required for individuals who held a valid license on July 24, 2019, an
individual who held a valid license on or before July 24, 2019, but failed to
renew his or her license for any reason; or, an individual who was a student on
or before July 24, 2019, in a nursing school or program.
I. A request to seek waiver of the denial of
licensure pursuant to the provisions of ACA §
17-87-312 may be made to the
ASBN by:
1. The affected applicant for
licensure; or
2. The person holding
a license subject to revocation.
J. The request for a waiver shall be made in
writing to the Director or designee within thirty (30) calendar days after
notification of denial of a license. The request for waiver shall include, but
not be limited to the following:
1. Certified
copy of court records indicating grounds for conviction; and
2. Any other pertinent documentation to
indicate surrounding circumstances.
K. If an individual notifies ASBN in writing
that he or she desires a hearing regarding their request for a waiver, the ASBN
will schedule the individual for a hearing pursuant to the Arkansas
Administrative Procedures Act.
L.
In compliance with ACA §
17-87-312, whenever a criminal background check is
performed on a person under the provisions of the criminal background check
requirement contained in the Arkansas Code for licensure, the person may be
disqualified for licensure if it is determined that the person committed a
violation of any sexual offense formerly proscribed under ACA
§§
5-14-101 through
5-14-127 that is substantially equivalent to any
sexual offense presently listed in ACA §§
5-14-101 through
5-14-127
and is an offense screened for in a criminal background check.
HISTORY: Adopted: May 15, 2022
SECTION V
NAME OR ADDRESS
CHANGE
A. A
licensee, whose name is legally changed, shall submit a name change request,
copy of marriage license, or court action, and the required fee.
B. A licensee whose address changes from the
address on file with the Board shall immediately notify the Board in writing of
the change.
HISTORY: Amended: June 4, 2021
SECTION VI
STANDARDS OF NURSING
PRACTICE
A.
PURPOSE
1. To establish standards
essential for safe practice by the advanced practice registered
nurse.
2. To serve as a guide for
evaluation of advanced nursing practice.
B.
STANDARDS FOR ALL CATEGORIES OF
ADVANCED PRACTICE REGISTERED NURSING
1.
The advanced practice registered nurse shall assess clients at an advanced
level, identify health status including abnormal conditions, establish a
diagnosis, develop and implement treatment plans and evaluate client
outcomes.
2. The advanced practice
registered nurse shall use advanced knowledge and skills in teaching and
guiding clients and other health team members.
3. The advanced practice registered nurse
shall use critical thinking and decision making at an advanced level,
commensurate with the autonomy, authority, and responsibility of his/her
practice category.
4. The advanced
practice registered nurse shall have knowledge of the statutes and rules
governing advanced nursing practice, and function within the legal boundaries
of the appropriate advanced practice registered nursing category.
5. The advanced practice registered nurse is
authorized to sign the following official documents:
a. Certification of disability for patients
to receive disabled parking permits or placards from the Office of Motor
Vehicle;
b. Sports physicals to
authorize student athletes to participate in athletic activities;
c. Physicals for bus drivers;
d. Forms relating to do-not-resuscitate
orders;
e. Forms excusing a
potential jury member due to an illness;
f. Death certificate;
g. Workers' compensation forms;
h. Forms relating to absenteeism for
employment or school purposes; and
i. Authorizations for durable medical
equipment.
6. The
advanced practice registered nurse shall recognize the APRN's limits of
knowledge and experience, planning for situations beyond expertise, and
collaborating with or referring clients to other health care providers as
appropriate.
7. The advanced
practice registered nurse shall retain professional accountability for advanced
practice nursing care when delegating interventions.
8. The advanced practice registered nurse
shall maintain current knowledge and skills in the advanced practice nursing
category.
9. Rules which apply to
registered nurses are hereby incorporated by reference.
10. The APRN shall comply with the standards
for registered nurses as specified in Chapter 1. Standards for a specific role
and population focus of APRN supersede standards for registered nurses where
conflict between the standards, if any, exists.
C. In addition to the standards, the advanced
practice registered nurse shall practice in accordance with the standards
established by the national certifying body from which the APRN holds his or
her certification required for licensure.
These standards shall have been reviewed and accepted by the
Board.
D.
ADDITIONAL
STANDARDS FOR CRNAs
1. The CRNA, acting
in the normal course of his/her professional practice, may be authorized by a
hospital or institution to act as their agent or employee to order the
administration of controlled substances under the DEA registration of the
hospital or institution.
2. The
CRNA may order nurses to administer drugs preoperatively and/or postoperatively
in connection with an anesthetic and/or other operative or invasive procedure
that will be or has been provided.
3. The CRNA may select, obtain, and
administer Schedule II drugs only during the perioperative, peri-obstetrical
and medical procedure period.
4.
The CRNA's order shall be directly related to the administration of drugs
preoperatively and/or postoperatively in connection with an anesthetic and/or
other operative or invasive procedure that will be or has been
provided.
5. A CRNA who has not
been granted authority by a DEA registrant as described in Title 21 CFR
1301.22, or its successor to order the administration of controlled substances
shall give all orders as verbal orders from the supervising physician, dentist,
podiatrist, or other person lawfully entitled to order anesthesia.
6. The CRNA shall be responsible for
complying with all applicable state and federal laws and rules related to
medications.
7. The consulting
individual shall remain immediately available for consultation during the
delivery of anesthesia for diagnosis, consultation, and treatment of medical
conditions. The hospital's administrative staff, medical staff, and governing
body shall determine the guidelines on immediately available for consultation.
HISTORY: Amended January 1, 2018
Amended July 1, 2020; May 15, 2022
SECTION VII
PROFESSIONAL CERTIFICATION
PROGRAMS
A. A
national certification program which meets the following criteria shall be
recognized by the Board to satisfy Section II of these rules.
B. The national certification program:
1. Is national in the scope of its
credentialing;
2. Is accredited by
a national accreditation body as acceptable by the Board;
3. Has no requirement for an applicant to be
a member of any organization;
4.
Has an application process and credential review which includes documentation
that the applicant's education is in the advanced practice nursing category
being certified, and that the applicant's clinical practice is in the
certification category;
5.
Education requirements are consistent with the requirements of the advanced
practice role and population foci.
6. Uses an examination as a basis for
certification in the advanced practice nursing category which meets the
following criteria:
a. The examination is
based upon job analysis studies conducted using standard methodologies
acceptable to the testing community;
b. The examination represents entry-level
practice in the APRN role and population focus;
c. The examination represents the knowledge,
skills, and abilities essential for the delivery of safe and effective advanced
nursing care to clients;
d. The
examination content and its distribution are specified in a test plan
(blueprint), based on the job analysis study, that is available to
examinees;
e. Examination items are
reviewed for content validity and correct scoring using an established
mechanism, both before use and periodically;
f. Examinations are evaluated for
psychometric performance;
g. The
passing standard is established using acceptable psychometric methods, and is
re-evaluated at least every five (5) years;
h. Examination security is maintained through
established procedures; and
i. A
retake policy is in place.
7. Issues certification based upon passing
the examination and meeting all other certification requirements;
8. Provides for periodic recertification
which includes review of continued education, qualifications, and continued
competence;
9. Has mechanisms in
place for communication to the Board for timely verification of an individual's
certification status, changes in certification status, and changes in the
certification program, including qualifications, test plan, and scope of
practice;
10. Has an evaluation
process to provide quality assurance in its certification program.
C. The Board will notify the
appropriate certifying body when an APRN has disciplinary action taken on their
license or privilege to practice which restricts the APRN's ability to practice
(eg. suspension or revocation).
Amended: July 1, 2020
HISTORY: Amended December 29, 2018
SECTION VIII
PRESCRIPTIVE
AUTHORITY
A.
INITIAL APPLICANT
An applicant for an initial certificate of prescriptive
authority shall:
1. Be currently
licensed as an advanced practice registered nurse in Arkansas.
2. Provide evidence from the national
certifying body that differential diagnosis and prescribing practices are
recognized as being within the scope of practice for the applicant's
certification category.
3. Provide
documentation of successful completion of pharmacology coursework which shall
include pharmacokinetics principles and their clinical application and the
prescription of pharmacological agents in the prevention and treatment of
illness, and the restoration and maintenance of health. The coursework shall
contain a minimum of:
a. Three (3) graduate
credit hour pharmacology course offered by an accredited college or university
within two years immediately prior to the date of application to the Board; or
b. Forty-five (45) contact hours
[a contact hour is fifty (50) to sixty (60) minutes] in a pharmacology course
which includes a competency component, offered by an accredited college or
university, within two (2) years immediately prior to the date of application
to the Board; or
c. Three (3)
graduate credit hours pharmacology course, included as part of an advanced
practice nursing education program, within five (5) years immediately prior to
the date of application to the Board.
4. Provide documentation of a minimum of
three hundred (300) clock hours preceptorial experience in the prescription of
drugs, medicines and therapeutic devices with a qualified preceptor, to be
initiated with the pharmacology course and to be completed within one year of
the beginning of the course. Preceptorial experience completed as a part of the
formal educational program in which the pharmacology course is taught will meet
the three hundred (300) clock hour requirement.
5. Submit a collaborative practice agreement,
unless exempt by Section IX, with a practicing physician who is licensed under
the Arkansas Medical Practices Act, §
17-95-201 et seq., or a podiatrist
licensed by the Arkansas Board of Podiatric Medicine under Arkansas Code
Annotated §
17-96-101, et. seq., if employed by the podiatrist, and who has
training within the scope, specialty or expertise of the advanced practice
registered nurse. APRNs who will prescribe controlled substances shall seek a
collaborative practice with a physician or podiatrist who has an unrestricted
DEA registration number. The collaborative practice agreement shall include,
but not be limited to:
a. Availability of the
collaborating physician(s) or podiatrist for consultation or referral or
both;
b. Methods of management of
the collaborative practice, which shall include the use of protocols for
prescriptive authority;
c. Plans
for coverage of the health care needs of a client in the emergency absence of
the advanced practice registered nurse, podiatrist, or physician;
d. Provision for quality assurance;
e. Authorization for the APRN to prescribe
hydrocodone combination products which were reclassified from Schedule III to
Schedule II as of October 6, 2014 if expressly authorized by the collaborating
physician; and
f. Authorization
for the APRN to prescribe drugs listed in Schedule II subject to the provisions
in Section VIII(D) if expressly authorized by the collaborating physician or
podiatrist.
g. Signatures of the
advanced practice registered nurse and collaborating physician(s) or
podiatrist, signifying mutual agreement to the terms of the collaborative
practice.
6. Submit the
nonrefundable processing fee with the application for a certificate of
prescriptive authority.
7. APRNs
issued a certificate of prescriptive authority after December 31, 2015 shall
obtain a minimum of three (3) hours of prescribing education which includes
information on maintaining professional boundaries and the prescribing rules
and laws that apply to APRNs in the state of Arkansas within two (2) years of
issuance of the prescriptive authority certificate.
B.
ENDORSEMENT APPLICANT
1. An applicant for endorsement of
prescriptive authority shall:
a. Provide
documentation of a three (3) graduate credit hour pharmacology course offered
by an accredited college or university or a forty-five (45) contact hour [a
contact hour is fifty (50) to sixty (60) minutes] pharmacology course which
includes a competency component offered by an accredited college or
university;
b. Provide evidence
that prescriptive authority is current and unencumbered in the jurisdiction
from which the applicant is moving;
c. Provide evidence of prescribing in a
clinical setting for at least 500 hours in the year prior to application for a
certificate of prescriptive authority;
d. Have an unencumbered advanced practice
registered nurse license to practice or the equivalent in the jurisdiction from
which the applicant is moving;
e.
Provide a copy of current DEA registration (if prescriber has DEA number) and
history of registration status; and
f. Meet requirements in Section VIII.A.1, 2,
5, 6, 7.
2. Endorsement
applicants who do not meet all requirements established herein shall be
required to submit documentation acceptable to the Board according to Section
VIII.A.
C.
PROTOCOLS FOR PRESCRIPTIVE AUTHORITY
1. Protocols are required for all APRNs
practicing under a collaborative practice agreement.
2. Protocols shall be made available upon
request of the Board. Such protocols shall, at a minimum, include:
a. Indications for and classifications of
legend drugs, controlled substances (if prescriber holds a DEA registration
number), and therapeutic devices which will be prescribed or administered by
the APRN;
b. Date the protocol was
adopted or last reviewed, which shall be at least annually.
D.
PRESCRIBING PRIVILEGES
1. The
APRN, applying for a certificate of prescriptive authority, shall acknowledge
in the application that he or she is familiar with all state and federal laws
and rules regarding prescribing, and shall agree to comply with these laws and
rules.
2. An advanced practice
registered nurse with a certificate of prescriptive authority may receive and
prescribe legend drugs, medicines or therapeutic devices appropriate to the
APRN 's area of practice. The prescriptive authority for controlled drugs shall
extend to drugs listed in Schedules II through V and hydrocodone combination
products which were reclassified from Schedule III to Schedule II as of October
6, 2014.
3. Prescribing
stipulations are as follows:
a. Legend drugs,
therapeutic devices, and controlled substances (Schedules II-V), and
hydrocodone combination products, which were reclassified from Schedule III to
Schedule II as of October 6, 2014, will be prescribed, administered, or ordered
as established in protocols provided that the APRN has an assigned DEA
registration number which is entered on each written prescription for a
controlled substance.
b. Except as
provided below, the APRN shall provide a prescription for an opioid antagonist
when prescribing or dispensing an opioid when:
(1) the patient doesn't have an existing
prescription for an opioid antagonist; and
(2) the opioid dosage prescribed is equal to
or in excess of fifty morphine milligram equivalents (50 MME) per day;
or
(3) a benzodiazepine has been
prescribed for the patient in the past or will be prescribed at the same time
as the opioid; or
(4) the patient
has a history of opioid use disorder or drug overdose.
c. The APRN shall provide patient counseling
that addresses the use of an opioid antagonist for overdose
prevention.
d. Prescribing an
opioid antagonist does not apply to a patient receiving hospice or other
end-of-life care.
e. If a
healthcare professional does not believe that it is in the best interest of a
patient to coprescribe an opioid antagonist, the APRN shall document in the
medical record the reasons for not coprescribing the opioid
antagonist.
f. Except for
hydrocodone combination products, the APRN shall not prescribe Schedule II
opioids for more than a five (5) day period. If additional Schedule II opioids
are needed for management of pain, the patient shall be referred to
a physician.
g. The APRN is authorized to prescribe
Schedule II drugs that are classified as stimulants once the following criteria
are met:
(1) The prescription was originally
initiated by a physician;
(2) The
physician has evaluated the patient within six (6) months before the APRN
issues a prescription;
(3) The
prescription by the APRN is to treat the same condition as the original
prescription.
h. The
APRN shall not prescribe Schedule II controlled substances for his/her own use
or for the use of his/her immediate family.
i. The APRN shall file his/her DEA
registration number with the Board upon receipt.
j. Advanced practice registered nurses shall
not delegate to unlicensed ancillary staff the calling in of prescriptions to
the pharmacy.
k. The APRN who does
not have full practice authority shall notify the Board in writing within seven
(7) days following termination of the collaborative practice agreement. A new
collaborative practice agreement is required to be on file prior to
reactivating prescriptive authority.
4. The APRN who does not have full practice
authority may prescribe a legend drug, medicine or therapeutic devices not
included in the written protocols only as follows:
a. Upon a specific written or verbal order
obtained from a physician or podiatrist before the prescription or order is
issued by the APRN; and
b. Include
documentation of consultation as described above in the client's medical record
to be signed by the APRN;
c.
Schedule I controlled substances shall not be prescribed under the APRN's
certificate of prescriptive authority.
5. The APRN shall note prescriptions on the
client's medical record and include the following information:
a. Medication and strength;
b. Dose;
c. Amount prescribed;
d. Directions for use;
e. Number of refills; and
f. Initials or signature of APRN.
6. The APRN will keep
accurate records to include the medical history, physical examination, other
evaluations and consultations, treatment plan objective, informed consent noted
in the patient record, treatment, medications given, agreements with the
patient and periodic reviews.
7.
The APRN will periodically review the course of scheduled drug treatment of the
patient and any new information about etiology of the pain. If the patient has
not improved, the APRN may assess the appropriateness of continued prescribing
of scheduled medications or dangerous drugs, or trial of other
modalities.
8. The APRN will obtain
written informed consent from those patients he or she is concerned may abuse
controlled substances and discuss the risks and benefits of the use of
controlled substances with the patient, his or her guardian, or authorized
representatives.
9. Advanced
practice registered nurses in the category of certified registered nurse
anesthetists shall not be required to have prescriptive authority to provide
anesthesia care, including the administration of drugs or medicines necessary
for such care.
10. Advanced
practice registered nurses who prescribe prior to obtaining a certificate of
prescriptive shall be considered illegal practitioners and shall be subject to
the penalties provided for violation of the Nurse Practice
Act.
E.
PRESCRIPTION FORMAT
1. All
prescriptions issued by the APRN shall contain the name of the client, and the
APRN's name, title, address, telephone number, signature with the initials
"APRN" and shall include information contained in Subsection D.5.a-f of this
Section.
2. All prescriptions for
controlled substances shall be in accordance with federal rules. The APRN's
assigned DEA registration number shall be included on the prescription when a
controlled substance is prescribed.
F.
RECEIVING PREPACKAGED DRUG
SAMPLES
1. APRNs who have an active
prescriptive authority certificate may receive legend drug samples and
therapeutic devices appropriate to their area of practice, including controlled
substances contained in Schedules III through V and only hydrocodone
combination products, which were reclassified from Schedule III to Schedule II
as of October 6, 2014, which have been prepared, packaged, or fabricated by a
pharmaceutical manufacturer in accordance with the Arkansas pharmacy laws and
rules.
2. Records must comply with
all applicable federal and state laws and rules.
G.
TERMINATION OF PRESCRIPTIVE
AUTHORITY
1. Prescriptive authority may
be terminated by the Board when the prescriber:
a. Fails to maintain current active licensure
as an advanced practice registered nurse;
b. Violates provisions of this
Act and/or Rules established by the Arkansas
Department of Health, Nursing or Pharmacy Boards;
c. Violates any state or federal law or rules
applicable to prescriptions; or
d.
Fails to follow any conditions imposed.
2. To reinstate prescriptive authority, the
APRN must meet requirements of the Board at the time of reinstatement.
H.
LAPSED
CERTIFICATE OF PRESCRIPTIVE AUTHORITY
1. The certificate of prescriptive authority
is lapsed if:
a. The licensee's active
advanced practice registered nurse license is not renewed by the expiration
date;
b. The national certification
upon which licensure is based expires;
c. The advanced practice license is placed on
inactive or retired status or
d.
There is not a current collaborative practice agreement, if required, on file
with the board
2. Any
person engaged in prescribing during the time his or her certificate of
prescriptive authority has lapsed shall be considered an illegal practitioner
and shall be subject to the penalties provided for violation of the
Nurse Practice Act.
I.
INACTIVE STATUS
1. A certificate of prescriptive authority
will automatically be considered lapsed and subject to the requirements of
these rules when a licensee places his or her advanced practice registered
nurse license on inactive status.
2. While the certificate of prescriptive
authority or advanced practice registered nurse license is inactive, the
licensee shall not engage in any practice within the scope of the certificate
of prescriptive authority.
3. If
the nurse desires to resume practice in this state, he or she shall request a
renewal application which shall be completed and submitted with a renewal fee
and the reinstatement fee. Fees are nonrefundable.
4. All certification requirements for renewal
shall apply.
5. If disciplinary
proceedings on an inactive licensee have been initiated, the license shall not
be reinstated until the proceedings have been completed.
J.
REACTIVATION OF PRESCRIPTIVE
AUTHORITY
APRNs whose prescriptive authority is inactive shall
complete:
1. Five (5) contact hours of
pharmacotherapeutics continuing education in the APRN's area of certification
for each 12 months of non-prescribing activity in addition to the five (5)
contact hours required for APRN license renewal, as noted in Chapter 4,
III(F)(7), prior to reactivation of prescriptive authority.
2. Two (2) contact hours shall include
information on maintaining professional boundaries and the prescribing rules
and laws that apply to the APRNs in the state of Arkansas
K.
PRESCRIPTION DRUG MONITORING
PROGRAM
1. APRNs may delegate access to
the Prescription Drug Monitoring Program (PDMP) for running requested reports
to no more than two licensed nurses under his or her supervision or employment
at each practice location.
2. APRNs
with prescriptive authority shall review PDMP report from the Prescription Drug
Monitoring Program prior to prescribing:
a. An
opioid from Schedule II or Schedule III every time prescribing the medication
to a patient; and
b. A
benzodiazepine medication for the first time and every six (6) months
thereafter prescribing for a patient.
3. Review of the PDMP report shall be
documented in the patient's medical record.
4. Mandatory checking of the PDMP does not
apply when prescribing a controlled substance to a patient;
a. Immediately before or during surgery;
or
b. During recovery from surgery
while in a healthcare facility; or
c. In a healthcare facility; or
d. When necessary to treat a patient in an
emergency situation at the scene of an emergency, in a licensed ground
ambulance or air ambulance, or in the intensive care unit of a licensed
hospital; or
e. In palliative care
or hospice; or
f. In a licensed
nursing home facility; or
g. In
situations in which the PDMP is not accessible due to technological or
electrical failure.
HISTORY: Amended January 1, 2018
Amended July 1, 2020
SECTION
IX
FULL PRACTICE
AUTHORITY
A.
Certified Nurse Midwife
1. A collaborative
practice agreement is not required unless the Certified Nurse Midwife
prescribes Schedule II controlled substances.
2. If delivering infants outside an
accredited facility the Certified Nurse Midwife shall have an agreement with a
licensed physician or facility, or both, which identifies an arrangement for
referral and consultation in the event of a medical complication. The agreement
shall be made available to the Board upon request.
3. A certificate of prescriptive authority
shall be issued prior to prescribing any legend drug, medicine or therapeutic
device.
B. Certified
Nurse Practitioner
1. Qualifications
a. Currently be licensed as a Certified Nurse
Practitioner in Arkansas,
b. Have
no encumbrance on any nursing license in any jurisdiction,
c. Completed a minimum of six thousand two
hundred (6,240) hours of practice under a collaborative practice agreement, and
d. Hold an active prescriptive
authority certificate.
2. Scope of Practice
a. Receive and prescribe drugs, medications
or therapeutic devices appropriate for area(s) of approved population
foci.
b. Prescribing legend drugs
and controlled substances shall follow the provisions in ASBN
Rules, Chapter 4, Section VIII(D).
3. An applicant for initial full independent
practice authority shall submit:
a. An
application and applicable fees;
b.
An affidavit of successful completion of six thousand two hundred (6,240) hours
of practice under a collaborative practice agreement; and
c. Any other relevant information requested
by the Board or Full Independent Practice Credentialing Committee.
4. Certificates of full
independent practice authority shall be renewed every three (3) years. The
applicant shall:
a. Submit an application and
applicable fees, and
b. Any other
relevant information requested by the Board or Full Independent Practice
Credentialing Committee
5. Lapsed full independent practice authority
certificate
a. The certificate of full
independent practice authority is lapsed if:
i. The licensee's certificate of prescriptive
authority is lapsed; or
ii. The
renewal application for full independent practice authority has not been
approved.
b. The
Certified Nurse Practitioner may practice under a collaborative practice
agreement until the full independent practice certificate is renewed.
6. Complaints against a
Certified Nurse Practitioner with full independent practice authority shall be
referred to the Full Independent Practice Credentialing Committee for review
and action on the certificate of full independent practice authority.
7. In the office of practice, the Certified
Nurse Practitioner shall conspicuously display the current certificate of full
independent practice authority with notation the practitioner is not required
to have a collaborative practice agreement with a physician.
HISTORY: Adopted May 15, 2022
SECTION X
PRESCRIBING GUIDELINES FOR ANOREXIANT
DRUGS
An Advanced Practice Registered Nurse (APRN) must maintain
prescribing medication practices that are within the APRN's educational
preparation and certification. An APRN will be in violation of the Arkansas
Nurse Practice Act if he/she prescribes Schedule III and/or
Schedule IV drugs under the Uniform Controlled Substance Act for short-term
treatment of obesity, except in conformity with the requirements as set
below.
A.
PRESCRIBING
GUIDELINES
1. An established
APRN/patient relationship shall exist. The patient shall be age 18 or older, or
have written consent from a parent or guardian. The medication shall only be an
adjunct to a comprehensive weight loss program focused on appropriate nutrition
education, a change in lifestyle, counseling, and an individualized exercise
program. The APRN shall determine whether or not the patient has made a
substantial good faith effort to lose weight through diet and alteration of
lifestyle prior to beginning drug therapy.
2. The treating APRN shall take a complete
history of the patient, including a detailed family history, dietary history,
and shall perform a complete physical examination. The physical examination
shall include a minimum of checking the blood pressure and pulse, examining the
heart and lungs, recording height and weight, and administering any other
appropriate diagnostic tests to evaluate for a metabolic disorder. The history
and examination shall be sufficient to determine if the patient has previously
been drug dependent, to determine if there is a metabolic cause of the obesity
which would make anorexiant drugs inappropriate, and to determine if there are
other contraindications to use of anorexiant drugs exists.
3. The APRN shall discuss with the patient
different approaches to the treatment of obesity, and the risks and benefits
associated with each approach. Risks shall include potential side effects, such
as cardiovascular and pulmonary complications, as well as the potential for
lack of success with weight loss. The APRN shall be aware of potential drug
interactions between anorexiants, and other centrally acting drugs. The
treating APRN shall prescribe a diet for weight loss and appropriate counseling
regarding lifestyle change, and record these changes on the patient's medical
record. Consideration on the use of anorexiant medications shall take into
account the degree of overweight and associated medical conditions. The body
mass index (BMI) shall be used as a guide to determine the degree of overweight
status. In general, anorexiant medications shall only be used if the BMI is
more than 27. In the case of associated obesity-related medical conditions,
anorexiant medications may be considered with a BMI above 25. Obesity-related
medical conditions include, but are not limited to, diabetes, hypertension,
dyslipidemia, cardiovascular disease, sleep apnea, psychological conditions,
disc disease, and severe arthritis of the lower extremities.
4. The treating APRN shall prescribe a daily
dosage that does not exceed the dosage recommended in the manufacturer's
prescribing information for the drug prescribed.
5. The APRN shall not prescribe more than a
30-day supply for a patient at each visit and regular follow-up visits shall
not exceed 30 days. The patient shall be weighed at each visit prior to the
prescribing of an additional supply of the drug.
6. At the time of each return patient visit,
the treating APRN shall monitor progress of the patient. The patient's weight,
blood pressure, pulse, heart, and lungs shall be assessed. In addition to any
side effects of the medications, the APRN shall perform appropriate exams and
tests to monitor the safety of any weight loss. This may include a detailed
dietary questionnaire, serum electrolytes, blood glucose, and other tests
deemed appropriate. The APRN shall discontinue the anorexiant medications when
the patient reaches weight loss goals. These goals may be defined as a body
weight that is no longer considered "obese" (e.g. BMI of less than or equal to
27), or an improvement in medical conditions (e.g. normalization of blood
glucose). After the goal is reached, the APRN may continue to prescribe
anorexiant drugs for up to an additional sixty (60) days.
7. Except as otherwise provided by this
regulation, Schedule III and/or Schedule IV anorexiant drugs are only
recommended for short-term use (e.g. 90 days). In addition, anorexiant drugs
shall not be prescribed to a patient with a BMI of less than 27, unless
prescribing for obesity-related conditions with a BMI of above 25. The treating
APRN may extend therapy beyond 90 days under the following conditions:
a. When the anorexiant drugs are indicated
for treatment of diseases other than obesity; and
b. When, in the APRN's professional judgment,
the treating APRN is assessing and recording significant progress or benefit
from the drugs and no adverse effects occur that are related to the treatment.
SECTION
XI
PRESCRIPTIVE AUTHORITY ADVISORY
COMMITTEE
A.
PURPOSE
The purpose of this committee shall include functioning in an
advisory capacity to assist the Board with oversight and implementation of the
provisions regarding prescriptive authority.
B.
COMPOSITION
The Advisory Committee shall be composed of six (6) members
appointed by the Board and approved by the Governor. Four (4) members shall be
advanced practice registered nurses with at least three (3) of whom hold
certificates of prescriptive authority and an active Drug Enforcement
Administration (DEA) number. One (1) committee member shall be a licensed
physician who has been involved in a collaborative practice with an advanced
practice registered nurse for at least five (5) years. One member shall be a
licensed pharmacist who has been licensed for at least five (5) years.
C.
TERMS OF OFFICE
Members shall serve three (3) year terms and may be
reappointed. The Board may remove any advisory committee member, after notice
and hearing, for incapacity, incompetence, neglect of duty, or malfeasance in
office.
D.
COMPENSATION
Advisory committee members shall serve without compensation;
but may be reimbursed to the extent special monies are appropriated therefore
for actual and necessary expenses incurred in the performance of their official
Board duties.
SECTION
XII
NURSING EDUCATION
PROGRAMS
A.
NEW APRN PROGRAM LEADING TO LICENSURE
1. Prerequisite Approval
a. An institution, seeking to establish a new
APRN nursing education program leading to licensure, shall submit a letter of
intent to the Board.
(1) An applicant for an
Advanced Practice Registered Nursing (APRN) program shall comply with the
"Criteria and Procedures for Preparing Proposals for New Programs," established
by the Arkansas Department of Higher Education.
(2) Appropriate professional accreditation
(nursing accrediting organizations recognized by the U.S. Department of
Education and/or the Council for Higher Education Accreditation) of the new
APRN program is considered to be deemed status as approved by the
Board.
b. The
institution shall submit:
(1) A copy of the
curricula plan and course descriptions for Board review within thirty (30) days
of sending the information to the accrediting body;
(2) Other accreditation materials as
requested by the Board; and
(3)
Documentation of accreditation within thirty (30) days of receipt of the report
from the accrediting body.
B.
ESTABLISHED PROGRAM THAT PREPARES
GRADUATES FOR LICENSURE
1. Continued
Full Approval - an established graduate program in advanced practice registered
nursing shall submit to the Board documentation of the program's continued
national nursing accreditation status within thirty (30) days of receipt from
the accrediting body. Receipt of the documentation shall serve as deemed status
for approval by the ASBN.
C.
EDUCATION PROGRAM
1. The education program for advanced
practice nursing shall meet the nursing accrediting body standards for advanced
practice registered nursing.
2. The
curriculum plan for advanced practice registered nursing shall include:
a. Preparation in one of the four identified
APRN roles (CRNA, CERTIFIED NURSE MIDWIFE, CNS, and CNP); and
b. Preparation in at least one of the
approved population foci:
(1)
Family/Individual Across the Lifespan
(2) Adult-Gerontology
(3) Neonatal
(4) Pediatrics
(5) Women's Health/Gender-Related
(6) Psychiatric/Mental Health; and
c. Three separate graduate level
courses (the APRN Core):
(1) Advanced
physiology and pathophysiology
(2)
Advanced health assessment
(3)
Advanced pharmacology
3. Clinical Experiences
a. All graduate or post-graduate programs
leading to advanced practice licensure shall have a minimum of 500 supervised
clinical hours in direct clinical practice during the program.
b. APRN programs preparing for two population
foci shall have a minimum of 500 supervised clinical hours for each population
focus.
c. Clinical supervision must
be congruent with current national professional organizations and nursing
accrediting body standards applicable to the APRN role and population
focus.
d. Student clinical
experiences shall be congruent with the population focus of the role.
SECTION
XIII
PRESCRIBING FOR CHRONIC NONMALIGNANT
PAIN
A. Chronic
nonmalignant pain is defined as pain requiring more than three consecutive
months of prescriptions for:
1. An opioid
that is written for more than the equivalent of ninety (90) tablets, each
containing five (5) milligrams of hydrocodone; or
2. A morphine equivalent dose of more than
fifteen mg (15 mg) per day: or
3.
Tramadol - an average dose of two hundred milligrams (200 mg) or greater per
day.
B. When opioids are
started, the lowest effective dosage should be prescribed. APRNs should use
caution when prescribing opioids at any dosage and carefully reassess evidence
of individual benefits and risks when considering increasing dosage to >50
morphine milligram equivalents (MME) per day. APRNs should avoid increasing
dosage to >90 MME/day or carefully justify a decision to titrate dosage to
>90 MME/day.
C. If opioids are
prescribed at a level defined by the Centers for Disease Control and Prevention
(CDC) as excessive (>50 MME/day) the following shall be documented in the
patient's medical record:
1. Objective
findings, which include, but are not limited to, imaging studies, lab testing
and results, nerve conduction testing, biopsy, and any other test that would
establish pain generating pathology.
2. Specific reasons for the need to prescribe
> 50 MME/day.
3. Documented
alternative treatment plans as well as alternative therapies tried and failed
prior to considering chronic opioid therapy.
4. Documented risk factor assessment
detailing that the patient was informed of the risk and addictive nature of the
prescribed drug.
5. Documented
assessment of the potential for abuse and/or diversion of the prescribed
drug.
6. Documented review of the
Prescription Drug Monitoring report prior to issuing the
prescription.
7. A detailed
clinical rational for the prescribing
D. Patient Treatment and Evaluation
1. The patient shall be evaluated through an
in-person examination at least every three (3) months by the APRN and at least
one (1) time every six (6) months by a physician who is licensed by the
Arkansas State Medical Board.
2. A
current Prescription Drug Monitoring Program report shall be reviewed at least
every six (6) months. The review shall be documented in the patient's medical
record.
3. A current pain contract
with the patient shall be maintained and include, at a minimum, requirements
for:
a. Random urine drug screens and
b. Random pill counts
E. The
requirements of this section shall not apply to a patient:
1. Whose pain medications are being
prescribed for a malignant condition:
2. With a terminal condition;
3. Who is a resident of a licensed healthcare
facility;
4. Who is enrolled in a
hospice program; or
5. Who is in an
inpatient or outpatient palliative care program.
HISTORY: Adopted: March 26, 2017
Amended: January 1, 2018; December 29, 2018
SECTION XIV
MINIMUM STANDARDS FOR ESTABLISHING A PATIENT
RELATIONSHIP
A. The
APRN shall establish a proper APRN/patient relationship prior to providing any
patient care.
B. A proper
APRN/patient relationship, at a minimum requires that:
1. The APRN perform a history and an "in
person" physical examination of the patient adequate to establish a diagnosis
and identify underlying conditions and/or contraindications to the treatment
recommended/provided; OR
2. The
APRN perform a face-to-face examination using real-time audio or visual
telemedicine technology that provides information at least equal to such
information as would have been obtained by an in-person examination;
AND
3. Appropriate follow-up be
provided or arranged, when necessary, at medically necessary
intervals.
C. A proper
APRN/patient relationship is also deemed to exist in the following situations:
1. When treatment is provided in consultation
with, or upon referral by another health care provider who has an ongoing
relationship with the patient, and who has agreed to supervise the patient's
treatment, including follow-up care and the use of any prescribed
medications.
2. On-call or
cross-coverage situations arranged by the patient's health care
provider.
3. Has access to a
patient's personal health record maintained by a healthcare professional and
uses any technology deemed appropriate by the healthcare professional,
including the telephone, with a patient located in Arkansas to diagnose, treat
and, if clinically appropriate, prescribe a noncontrolled drug to the
patient.
D. Recognizing
a Providers duty to adhere to the applicable standard of care, the following
situations are hereby excluded from the requirement of this regulation:
1. Emergency situations where the life or
health of the patient is in danger or imminent danger.
2. Providing information of a generic nature
not meant to be specific to an individual.
3. Providing prescriptions written or
medications issued for use in expedited heterosexual partner therapy for the
sexually transmitted diseases of gonorrhea and/or chlamydia.
4. Administration of vaccines containing
tetanus toxoid (e.g., DTaP, DTP, DT, Tdap, TD, or TT) or inactive influenza
vaccines.
HISTORY: Adopted: January 1, 2018
Amended July 1, 2020
SECTION XV
TELEMEDICINE
Requirement for all services provided by APRNs providing care
via telemedicine:
A. An APRN/patient
relationship shall be established in accordance with Chapter 4, Section XIII
before the delivery of services via telemedicine. A patient completing a
medical history online and forwarding it to an APRN is not sufficient to
establish the relationship, nor does it qualify as store-and-forward
technology.
B. The following
requirements apply to all services provided by APRNs using telemedicine:
1. The practice of nursing via telemedicine
shall be held to the same standards of care as traditional in-person
encounters.
2. The APRN shall
obtain a detailed explanation of the patient's complaint from the patient or
the patient's health care provider.
3. If a decision is made to provide
treatment, the APRN shall agree to accept responsibility for the care of the
patient.
4. If follow-up care is
indicated, the APRN shall agree to provide or arrange for such follow-up
care.
5. An APRN using telemedicine
may NOT issue a prescription for any controlled substances defined as any
scheduled medication under schedules III through V and only hydrocodone
combination products which were reclassified from Schedule III to Schedule II
as of October 6, 2014 unless the APRN has seen the patient for an in-person
exam or unless a relationship exists through consultation or referral; or
on-call or cross-coverage situations.
6. The APRN shall keep a documented medical
record, including medical history.
7. At the patient's request, the APRN shall
make available to the patient an electronic or hardcopy version of the
patient's medical record documenting the encounter. Additionally, unless the
patient declines to consent, the APRN shall forward a copy of the record of the
encounter to the patient's regular treating health care provider if that health
care provider is not the same one delivering the service via
telemedicine.
8. Services shall be
delivered in a transparent manner, including providing access to information
identifying the APRN in advance of the encounter, with licensure and board
certifications, as well as patient financial responsibilities.
9. If the patient, at the recommendation of
the APRN, needs to be seen in person for the current medical issue, the APRN
shall arrange to see the patient in person or direct the patient to their
regular treating health care provider. Such recommendation shall be documented
in the patient's medical record.
10. APRNs who deliver services through
telemedicine shall establish protocols for referrals for emergency
services.
11. APRNs providing care
via telemedicine to a patient located within the State of Arkansas shall be
licensed to practice nursing in the State of Arkansas.
12. Telemedicine may be utilized for group
therapy for adults (over the age of 18) who are participants in a program or
plan authorized and funded under 42 U.S.C. §
1396a, if permitted by the
Centers for Medicare and Medicaid Services.
HISTORY: Adopted: January 1, 2018 Amended: May 15, 2022
SECTION XV I
LICENSURE FOR UNIFORMED SERVICE MEMBERS,
VETERANS AND SPOUSES
A. EXPEDITED LICENSURE
1. Temporary permits for individuals listed
in Section XVI(A)(2) shall be issued within twenty-four (24) hours of receipt
of all required documents.
2. The
Board will give preference in the order of processing to applications for full
licensure filed by the following individuals:
a. A uniformed service member stationed in
the State of Arkansas;
b. A
uniformed service veteran who resides in or establishes residency in the State
of Arkansas; or
c. The spouse of a:
1. Person under (a) or (b) above;
or
2. Uniformed service member who
is assigned a tour of duty that excludes the uniformed service member's spouse
from accompanying the uniformed service member and the spouse relocates to
Arkansas; or
3. Uniformed service
member who is killed or succumbs to his or her injuries or illness in the line
of duty if the spouse establishes residency in Arkansas.
B.
EXTENSION OF LICENSURE EXPIRATION DATE
Upon written request and submission of appropriate
documentation, deployed uniformed service member or spouse shall be allowed an
extension of the expiration date without penalty or assessment of a late fee
for renewing the nursing license. The extension shall be effective for one
hundred eighty (180) days after the service member or spouse returns from
active deployment.
C.
CONSIDERATION OF MILITARY TRAINING AND EXPERIENCE
When considering an application for licensure from a uniformed
service member or a uniformed service veteran applying within one (1) year of
his or her discharge from uniformed service, the Board shall:
1. Consider whether or not the applicant's
military training and experience in the practice of nursing is substantially
similar to the experience or education required for licensure.
2. Accept the applicant's military training
and experience in the practice of nursing in lieu of experience or education
required for licensure, if the Board determines that the military training and
experience is a satisfactory substitute for the experience or education
required for licensure.
D.
WAIVER OF CONTINUING
EDUCATION
1. Upon written request and
submission of appropriate documentation the continuing education requirements
for license renewal shall be waived for:
a. A
uniformed service member deployed; or
b. The spouse of a deployed uniformed service
member.
2. This waiver
shall be extended until one hundred eighty (180) days following the date of the
uniformed service member's return from deployment.
History: Adopted December 29, 2018
Amended: May 15, 2022
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