Arkansas Administrative Code › Agency 067 - Board of Nursing › Rule 067.00.18-004 - Rules, Chapter 4

Current through Register Vol. 49, No. 6, June, 2024
CHAPTER FOUR
ADVANCED PRACTICE REGISTERED NURSE
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; and
3. Written agreement with a consulting
		  physician if providing intrapartum care.
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.
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 temporary
		  permit to practice in an advanced practice nursing category to a qualified
		  applicant who has no violations as listed in ACA §
										17-87-312
		  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 §
										17-87-312
		  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 shall submit evidence of a current collaborative
		  practice agreement as a prerequisite to license renewal.
4. 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.
5. Continuing education
		  submitted to the certifying body to meet the qualifications for recertification
		  shall be accepted as meeting the statutory requirement for continuing
		  education.
6. Upon request, an APRN
		  shall submit documentation to the Board of continuing education.
7. 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, regulations and laws that apply to APRNs in the State of
		  Arkansas.
8. 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.
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.
SECTION IV
DUPLICATE LICENSE
A duplicate license or certificate shall be issued when the
			 licensee submits a notarized statement to the Board that the document is lost,
			 stolen, or destroyed, and pays the required fee.
SECTION V
NAME OR ADDRESS
		  CHANGE
A. A licensee
		  whose name is legally changed shall be issued a replacement license following
		  submission of a name change form, a 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.
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'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.
4. 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, or other person lawfully entitled to
		  order anesthesia.
5. The CRNA shall
		  be responsible for complying with all applicable state and federal laws and
		  rules related to medications.
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 any disciplinary action taken on
		  their license or privilege to practice.
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
		  with a practicing physician who is licensed under the Arkansas Medical
		  Practices Act, §
										17-95-201
		  et seq., 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 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) 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 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. Signatures of the
		  advanced practice registered nurse and collaborating physician(s), 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, regulations
		  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
Protocols shall be made available upon request of the Board. Such
			 protocols shall, at a minimum, include:
1. 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;
2. 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 III through V and only 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 III-V), and only 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. The APRN shall not prescribe hydrocodone
		  combination products for acute pain in excess of seven (7) days.
c. The APRN shall not prescribe Schedule II
		  controlled substances for his/her own use or for the use of his/her immediate
		  family.
d. The APRN shall file
		  his/her DEA registration number with the Board upon receipt.
e. Advanced practice registered nurses shall
		  not delegate to unlicensed ancillary staff the calling in of prescriptions to
		  the pharmacy.
f. The APRN 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 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 the collaborating physician 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. Schedules I and II
		  controlled substances shall not be prescribed under the APRN's certificate of
		  prescriptive authority with the exception of hydrocodone combination products
		  which were reclassified from Schedule III to Schedule II as of October 6,
		  2014.
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. There is not a current collaborative
		  practice agreement on file with the board; or
d. The advanced practice license is placed on
		  inactive or retired status.
2. After reinstating a lapsed advanced
		  practice registered nurse license, the licensee shall submit to the Board a
		  current collaborative practice agreement to reactivate the certificate of
		  prescriptive authority.
3. 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
		  4,111(F)(7), prior to reactivation of prescriptive authority.
2. Two (2) contact hours shall include
		  information on maintaining professional boundaries and the prescribing rules,
		  regulations 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.
SECTION IX
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 X
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
		  XI
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, CNM, 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 XII
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:
a. 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.
b. Specific reasons for the need to prescribe
		  > 50 MME/day.
c. Documented
		  alternative treatment plans as well as alternative therapies tried and failed
		  prior to considering chronic opioid therapy.
d. Documented risk factor assessment
		  detailing that the patient was informed of the risk and addictive nature of the
		  prescribed drug.
e. Documented
		  assessment of the potential for abuse and/or diversion of the prescribed
		  drug.
f. Documented review of the
		  Prescription Drug Monitoring report prior to issuing the
		  prescription.
g. 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.
SECTION XIII
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 and 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.
SECTION
		  XIV
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.
SECTION XV
LICENSURE FOR CERTAIN MILITARY NURSES AND
		  SPOUSES
A.
EXPEDITED
		  LICENSURE
1. Temporary permits for an
		  active duty military service member or their spouse stationed in the State of
		  Arkansas or a returning military veteran or their spouse applying within one
		  (1) year of his/her discharge from active duty 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. An active duty military
		  service member stationed in the State of Arkansas;
b. A returning military veteran applying
		  within one (1) year of his or her discharge from active duty; or
c. The spouse of a person under (a) or (b)
		  above
B.
EXTENSION OF LICENSURE EXPIRATION DATE
Upon written request and submission of appropriate documentation,
			 members of the Armed Forces of the United States who are ordered to active duty
			 outside of this state shall be allowed an extension of the expiration date
			 without penalty or assessment of a late fee for renewing the service member's
			 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 an active duty
			 military service member stationed in the State of Arkansas or a returning
			 military veteran applying within one (1) year of his or her discharge from
			 active duty, 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
Upon written request and submission of appropriate documentation
			 the continuing education requirements for license renewal shall be waived
			 for:
1. An active duty military
		  service member deployed outside the State of Arkansas;
2. A returning military veteran renewing
		  within one (1) year of his/her discharge from active duty; or
3. The spouse of a person under (1) or (2)
		  above.