TITLE 3: HUMAN RESOURCES
DIVISION 2: HEALTH
§ 2304. Definitions and Scope. In this chapter, unless otherwise provided or the context requires a different construction or application, the following definitions shall apply: (a) "Advanced Practice Registered Nurse" means a nurse in the practice of Advanced Practice Registered Nursing by Certified Nurse Practitioners, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, and Clinical Nurse Specialists, which shall be based on knowledge and skills acquired in basic nursing education, licensure as a Registered Nurse and a certification training and/or a graduate degree with a major in nursing or graduate degree with a concentration in the Advanced Nursing Practice category, which includes both didactic and clinical components, advanced knowledge in nursing theory, physical and psycho-social assessment, appropriate interventions, and management of health care. The Advanced Practice Registered Nurse shall only provide health care services within the scope of practice for which he/she is educationally prepared and for which competency has been established and maintained as defined by the Board as defined in this section. The term "Advanced Practice Registered Nursing" shall include, but not limited to: (1) Assessing clients, synthesizing and analyzing data, and understanding and applying nursing principles at an advanced level; (2) Providing expert guidance and teaching; (3) Working effectively with clients, families, and other members of the health care team; (4) Managing clients' physical and psycho-social health-illness statute; (5) Utilizing research skills; (6) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem, and selecting appropriate treatment; (7) Making independent and/or collaborative decisions in solving client care problems within their Advanced Practice Category. (8) Performing acts of diagnosing and prescribing within scope of practice and as defined by the Board, administering and dispensing therapeutic measures appropriate to the Advanced Practice Registered Nurse's area of specialty as defined by the Board; and (9) Recognizing limits of knowledge and experience, planning for situations beyond expertise, and consulting with or referring clients to other health care providers as appropriate. (b) “Board” means the Commonwealth Board of Nurse Examiners. (c) “Certified Nursing Assistant” means a nursing assistant, at least sixteen years of age - certified under this chapter, to whom licensed Registered Nurses, licensed Practical/Vocational Nurses, or Advance Practice Registered Nurse delegate nursing or nursing related activities to meet the needs of the patient or client. (d) “Certified Technician” means a person who received training to provide patient care or certain nursing practices as set forth in regulations established by
TITLE 3: HUMAN RESOURCES
DIVISION 2: HEALTH
the Board, and the carrying out of medical orders under the direction of a Registered Professional Nurse, an Advanced Practice Nurse, a licensed Physician, or a licensed Dentist, where such activities do not require the substantial specialized skill, judgment, and knowledge required in professional nursing. (e) “Continuing Education” means an organized, systematic and evaluative educational program designed to promote the enrichment of knowledge, the improvement of skills, and the development of attitudes for enhancement of nursing practice. (f) “Graduate Nurse” means a person who has graduated from a nursing program approved by the Board, holds an interim permit that would expire one year from date of graduation, and works under the supervision of a Registered Nurse who is at the site where care is provided. (g) “License” means a current document permitting the practice of nursing as a Registered Nurse, Licensed Practical/Vocational Nurse, Graduate Nurse, Certified Technician, Certified Nursing Assistant, or Advanced Practice Registered Nurse. (h) “Licensed Practical/Vocational Nurse” means a person in the practice of nursing as a Licensed Practical/Vocational Nurse with a directed scope of nursing practice that shall include, but not limited to: (1) Contributing to the health status of individuals and groups; (2) Participating in the development and modification of strategy of care; (3) Implementing the appropriate aspects of strategy of care as defined by the Board; (4) Maintaining safe and effective nursing care rendered directly or indirectly; (5) Participating in the evaluation of responses to interventions; and (6) Delegating nursing interventions to qualified others as provided in this chapter. The Licensed Practical/Vocational Nurse practices under the direction of the Licensed Registered Nurse, Licensed Advanced Practiced Registered Nurse, Licensed Physician, or Licensed Dentist in the performance of activities delegated by that health care professional. (i) “Other board” means the comparable regulatory agency in any U.S. state, commonwealth, or territory as well as any comparable foreign regulatory agency recognized by the Commonwealth Board of Nurse Examiners. (j) The “Practice of Nursing” means assisting individuals or groups to maintain or attain optimal health, implementing a strategy of care to accomplish defined goals, and evaluating responses to care and treatment. This practice shall include, but not be limited to, initiating and maintaining comfort measures, promoting and supporting human functions and response, establishing an environment conducive to well-being, providing health counseling and teaching, and collaborating on certain aspects of the health regimen. This practice is based on understanding the human condition across the lifespan and the relationship of the individual within the environment.
TITLE 3: HUMAN RESOURCES
DIVISION 2: HEALTH
(k) “Prescriptive/Dispensing Authority” means an Advanced Practice Registered Nurse authorized to prescribe and dispense drugs and therapeutic measures defined by the Board. The authorization to prescribe and dispense drugs and therapeutic measures is for administration to and use by other persons (patients or clients) within the scope of practice of the Advanced Practice Registered Nurse. (l) “Professional Nurse” includes both Registered Nurses and Advanced Practice Registered Nurses. (m) The practice of nursing as a “Registered Nurse” means the practice of the full scope of nursing that includes but is not limited to: (1) Assessing the health status of individuals and groups; (2) Establishing a nursing diagnosis; (3) Establishing goals to meet identified health care needs; (4) Planning a strategy of care; (5) Prescribing nursing interventions to implement the strategy of care; (6) Implementing the strategy of care; (7) Delegating nursing interventions to qualified others as provided in this chapter; (8) Providing for the maintenance of safe and effective nursing care rendered directly or indirectly; (9) Evaluating responses to interventions; (10) Teaching the theory and practice of nursing; (11) Managing and supervising the practice of nursing; and collaborating with other health care professionals in the management of health cares. Source: PL 14-62, § 2 (2304), modified; (a) and (k) amended by 16-34 §§ 2 and 3, respectively. Commission Comment: Subsection (c) was modified by deleting figures that were a repetition of words pursuant to the authority granted by 1 CMC § 3806(e). Public Law 16-34, enacted on March 23, 2009, contained severability and savings clause provisions and the following: Section 1. Findings and Purposes. The Commonwealth Legislature hereby finds that due to the difficulty of recruiting physicians to serve in the Commonwealth hospital and clinics, patients' access to health care is greatly diminished. Because of the extensive training that nurse practitioners must undergo in order to be licensed in the United States and the Commonwealth, the increasing use of nurse practitioners as alternative health care providers in many rural areas on the United States, and the availability of professionally trained and educated local nurse practitioners who can provide quality healthcare services, increasing nurse practitioners' autonomy will improve access to quality health care in the Commonwealth. The Legislature finds and declares that this Act is necessary and a proper use of the legislative power granted by Article II of the Commonwealth Constitution.