3 CCR 716-1.14 - RULES AND REGULATIONS TO REGISTER PROFESSIONAL NURSES QUALIFIED TO ENGAGE IN ADVANCED PRACTICE REGISTERED NURSING
A.
BASIS: The authority for the promulgation of these rules and
regulations by the State Board of Nursing ("Board") is set forth in sections
12-20-202(3),
12-20-204(1),
12-255-107(1)(e) and
(j),
12-255-111, and
12-255-113, C.R.S.
B.
PURPOSE: These Rules are
adopted to implement the Board's authority to register professional nurses
qualified to engage in Advanced Practice Registered Nursing and are further
adopted to set forth the requirements and procedures for being so
registered.
C.
DEFINITIONS
1. Accrediting Body:
Any organization that establishes and maintains standards for professional
nursing programs and recognizes those programs that meet these standards and is
a National Nursing Accreditation Agency that is recognized by the U.S.
Department of Education (USDE) and/or the Council for Higher Education
Accreditation (CHEA).
2. Advanced
Practice Registered Nurse (APRN): A master's prepared nurse holding a graduate
degree in advanced practice registered nursing who has completed a graduate or
post-graduate program of study in an advanced practice Role and/or Population
Focus, in an accredited advanced practice registered nursing program and has
been recognized and included on the Advanced Practice Registry (APR) by the
Board. APRN Roles recognized by the Board are nurse practitioner (NP),
certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM)
and clinical nurse specialist (CNS). A nurse seeking recognition as an APRN
must be academically prepared for the expanded scope of practice described as
Advanced Practice Registered Nursing.
3. Advanced Practice Registered Nursing: The
expanded scope of nursing practice in an advanced Role and/or Population Focus
approved by the Board.
4. Advanced
Practice Registry (APR): The Board's registry of those professional nurses who
apply for, and meet the criteria for inclusion as established in accordance
with section
12-255-111, C.R.S., and Rule
1.14.
5. Applicant: A professional
nurse seeking inclusion on the APR as an APRN.
6. Board: The State Board of
Nursing.
7. Certifying Body: A
non-governmental agency approved by the Board that validates by examination,
based on pre-determined standards, an individual nurse's qualifications and
knowledge for practice in a defined functional or clinical area of
nursing.
8. Client: A person
receiving nursing care.
9.
Independent Practice: The practice of advanced practice registered nursing as
defined in section
12-255-104(8),
C.R.S. for which the APRN is solely responsible and performs on his/her own
initiative, and which occurs in a setting for which no exception as set forth
in Section (E)(2) of Rule 1.14 applies.
10. Population Focus: A broad,
population-based focus of study encompassing the common problems of that group
of patients and the likely co-morbidities, interventions and response to those
problems. Examples include, but are not limited to: Neonatal, Pediatric,
Women's Health, Adult, Family, Mental Health, etc. A Population Focus is not
defined as a specific disease/health problem or specific
intervention.
11. Role: The
advanced practice area or position for which the professional nurse has been
prepared; Nurse Practitioner (NP) Certified Registered Nurse Anesthetist
(CRNA), Certified Nurse Midwife (CNM) and Clinical Nurse Specialist
(CNS).
D.
REQUIREMENTS FOR INCLUSION ON THE ADVANCED PRACTICE REGISTRY
1. A professional nurse may request inclusion
on the APR by original registration or by endorsement.
2. Applicants must possess an active,
Colorado or multi-state compact professional nurse license.
3. Submit an APR application in a manner
approved by the Board.
4. Original
registration
a. Educational Requirements: The
successful completion of a graduate or postgraduate nursing degree in the Role
and, where applicable, the Population Focus, or equivalent as determined by the
Board, for which the Applicant seeks inclusion on the APR. Verification of
educational requirements shall be evidenced by receipt of either an official
transcript from a graduate or post-graduate APRN program accredited by a
nursing Accrediting Body, or by proof of a current national certification from
a nationally recognized accrediting agency, as approved by the Board, in the
appropriate role and population focus the applicant intends to practice. The
transcript shall verify date of graduation, credential conferred, and
Population Focus of the program.
b.
Certification Requirements
(1) Certification
requirements for Certified Registered Nurse Anesthetist (CRNA): A CRNA must
pass the national certification examination as administered by the Council on
Certification of Nurse Anesthetists. Verification of current certification or
recertification from the Council on Certification of Nurse Anesthetists or the
Council on Recertification of Nurse Anesthetists, as may be appropriate, shall
be submitted by the applicant as part of the application process, or in another
manner approved by the Board.
(2)
Certification Requirements for Certified Nurse-Midwife (CNM): A CNM must meet
the standards for education and certification established by the American
College of Nurse-Midwives American Midwifery Certification Board (AMCB)
formerly known as ACNM Certification Council (ACC, Inc.). Verification of
current AMCB certification shall be submitted by the applicant as part of the
application process, or in another manner approved by the Board.
(3) Certification requirements for Nurse
Practitioner (NP): A NP must meet the standards for education and certification
established by a national certifying body approved by the Board. Verification
of current certification or recertification, as may be appropriate, shall be
submitted by the applicant as part of the application process, or in another
manner approved by the Board.
(4)
Certification requirements for Clinical Nurse Specialist (CNS): A CNS must meet
the standards for education and certification established by a national
certifying body approved by the Board. Verification of current certification or
recertification, as may be appropriate, shall be submitted by the applicant as
part of the application process, or in another manner approved by the
Board.
5.
Registration by Endorsement
a. Pursuant to
the Occupational Credential Portability Program under section
12-20-202(3),
C.R.S., a professional nurse is entitled to be included on the advanced
practice registry by endorsement if:
(1) The
professional is currently in the advanced practice registry or is recognized as
an advanced practice nurse in good standing in another state or US territory or
through the federal government, or holds a military occupational specialty, as
defined in section
24-4-201, C.R.S., and has
submitted satisfactory proof under penalty of perjury that:
(a) The professional nurse
(i) Has substantially equivalent experience
or credentials that are required by Article 255 of Title 12 C.R.S.;
or
(ii) Has held for at least one
year a current and valid registration or recognition as an advanced practice
nurse in another jurisdiction with a scope of practice that is substantially
similar to the scope of practice for advanced practice nurses as specified in
Article 255 of Title 12, C.R.S., and these Rules
(b) The professional nurse has not committed
an act that would be grounds for disciplinary action under Article 255 of Title
12, C.R.S.
(2) The Board
may deny inclusion in the registry if:
(a)
The Board demonstrates by a preponderance of evidence, after notice and
opportunity for a hearing that the professional nurse:
(i) Lacks the requisite substantially
equivalent education, experience, or credentials for a inclusion in the
registry; or
(ii) Has committed an
act that would be grounds for disciplinary action under Article 255 of Title
12, C.R.S.;
b. A professional nurse may be included on
the advanced practice registry by endorsement if:
(1) The professional nurse holds active
national certification, as described in Section (D)(4)(d) above, in the Role
and, where applicable, the Population Focus for which the Applicant seeks
inclusion on the APR and possesses an appropriate graduate degree as determined
by the board. Verification of current certification or recertification, as may
be appropriate, shall be submitted by the applicant as part of the application
process or in another manner approved by the Board.
(2) For purposes of Section (D)(5)(a)(2) of
Rule 1.14, an appropriate graduate degree requires verification evidenced by
either receipt of an official transcript from a graduate or post-graduate
Advanced Practice Registered Nursing program accredited by a nursing
Accrediting body. Upon petition by the applicant, and with due consideration of
the need to protect the public, the Board may accept an alternative graduate
degree in support of endorsement under Section (D)(5)(a)(2) of Rule 1.14. It is
anticipated that such alternative graduate degree will rarely be used. The
decision to accept an alternative graduate degree is at the sole discretion of
the Board.
(3) Advanced practice
credentials issued by the United States Military are deemed to be substantially
equivalent to advanced practice authority in another state or
jurisdiction.
6. Registration of Additional Population
Focuses for Advanced Practice Registration
a.
Submit an APR application on the current Board approved form and submit
required fees.
b. Successful
completion of a graduate or post-graduate nursing degree in the Role and, where
applicable, the Population Focus, or equivalent as determined by the Board, for
which the Applicant seeks inclusion on the APR. Verification of educational
requirements shall be evidenced by either receipt of an official transcript
from a graduate or post-graduate Advanced Practice Registered Nursing program
accredited by a nursing Accrediting Body, or by proof of a current national
certification from a nationally recognized accrediting agency, as approved by
the Board, in the appropriate role and population focus the applicant intends
to practice. The transcript shall verify date of graduation, credential
conferred, and Population Focus of the program.
c. Verification of active certification in
the Role and, where applicable, the Population Focus, or equivalent as
determined by the Board, for which the Applicant seeks inclusion on the APR
shall be submitted by the applicant as part of the application process, or in
another manner approved by the Board.
E.
REQUIREMENTS FOR PROFESSIONAL
LIABILITY INSURANCE
1. Pursuant to the
requirements of section
12-255-113(1),
C.R.S., it is unlawful for any APRN engaged in an Independent Practice of
professional nursing to practice within the state of Colorado unless the APRN
purchases and maintains or is covered by professional liability insurance in an
amount not less than five hundred thousand dollars per claim with an aggregate
liability for all claims during the year of one million five hundred thousand
dollars.
2. Pursuant to these
rules, an APRN whose Independent Practice falls entirely within one or more of
the following categories is exempt from the professional liability insurance
requirements set forth in section
12-255-113, C.R.S.:
a. A federal civilian or military APRN whose
practice is limited solely to that required by his or her federal/military
agency.
b. An APRN who is covered
by individual professional liability coverage (or an alternative which complies
with section
12-255-113(1),
C.R.S.) or liability insurance that is maintained by an employer/contracting
agency in the amounts set forth in section
12-255-113(1),
C.R.S.
c. An APRN who provides
uncompensated health care; or
d. An
APRN who practices as a public employee under the "Colorado Governmental
Immunity Act, sections
24-10-101 to 118,
C.R.S."
3. In order to
establish eligibility for an exemption from the statutory financial
responsibility requirements, an APRN must provide such information as may be
requested by the Board.
4. Failure
to maintain professional liability insurance pursuant to section
12-255-113, C.R.S. may be grounds
for discipline pursuant to section
12-255-120(1)(aa),
C.R.S.
F.
SCOPE OF
ADVANCED PRACTICE REGISTERED NURSING
1. An APRN shall practice in accordance with
the standards of the appropriate national professional nursing organization and
have a safe mechanism for consultation or collaboration with a physician or,
when appropriate, referral to a physician. Advanced practice registered nursing
also includes, when appropriate, referral to other health care
providers.
2. The scope of Advanced
Practice Registered Nursing is based on:
a.
The professional nurse's scope of practice within the APRN's Role and
Population Focus;
b. Graduate or
post-graduate nursing education in the Role and/or Population Focus for which
the APRN has been recognized by the Board for inclusion on the APR.
3. The scope of Advanced Practice
Registered Nursing may include, but is not limited to: performing acts of
advanced assessment, diagnosing, treating, prescribing, ordering, selecting,
administering, and dispensing diagnostic and therapeutic measures.
4. Prescribing medication is not within the
scope of practice of an APRN unless the APRN has applied for and been granted
Prescriptive Authority by the Board.
G.
WITHDRAWAL OF ADVANCED PRACTICE
REGISTRATION
1. An APRN may request to
voluntarily withdraw the nurse's registration as an APRN in each Role and/or
Population Focus in which the nurse was granted inclusion on the APR by the
Board.
2. The Board may withdraw an
APRN's registration from the APR in one or more of the Roles/Specialties or
Population Foci in which the APRN was granted recognition, if the APRN no
longer meets the requirements for inclusion on the APR or the APRN is subject
to discipline under section
12-255-120, C.R.S., in accordance
with the procedures set forth in section
12-255-119, C.R.S.
H.
RENEWAL AND REINSTATEMENT
OF ADVANCED PRACTICE REGISTRATION
1.
Renewal of an APRN's registration on the APR is required at the time of the
APRN's Colorado professional nurse license renewal. Multi-state compact
licensed professional nurses granted inclusion on the APR shall be required to
renew their registration every two years and the registration shall be issued
with a specific expiration date.
2.
An APRN who has failed to timely renew the APRN registration may apply to
reinstate such registration. The nurse shall submit an application on the
current Board approved application forms, pay the current application fee, and
submit required documentation as set forth in Section (D) of Rule 1.14 for each
Role and/or Population Focus in which the applicant wishes to practice Advanced
Practice Registered Nursing.
3. The
Applicant may be required to demonstrate continued competency by:
a. Meeting the requirements to maintain
certification by a Certifying Body, or
b. Petitioning the Board with an alternative
method of establishing competency.
4. Reinstatement of an APRN's registration
following disciplinary action requires compliance with all requirements set
forth in Section (D) of Rule 1.14 and any requirements set forth by the
Board.
5. An APN who was included
in the APR as of June 30, 2008, but had not successfully completed the
educational requirements as set forth in section
12-255-111(3)(a),
C.R.S., will meet the education requirements set forth in (D)(4)(a) or
(D)(5)(b) of Rule 1.14.
6. An APN
who was included in the APR as of June 30, 2010, has not obtained national
certification as set forth in section
12-255-111(4)(b),
C.R.S., will meet the certification requirements set forth in Section (D)(2) of
Rule 1.14.
I.
DISCIPLINE OF ADVANCED PRACTICE REGISTERED NURSES
1. APRN disciplinary procedures shall be the
same as set forth in sections
12-255-119 and
12-255-120, C.R.S.
Adopted: April 28, 2010 5
Effective: July 1, 2010
Revised: July 26, 2017
Effective: September 14, 2017
Revised: October 27, 2021
Effective: December 30, 2021
Revised: October 25, 2023
Effective: December 15, 2023
Notes
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No prior version found.