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NEW JERSEY REGISTER
VOLUME 37, NUMBER 2
TUESDAY, JANUARY 18, 2005
RULE PROPOSAL

LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF NURSING
RULES OF THE STATE BOARD OF NURSING

Proposed Readoption with Amendments: N.J.A.C. 13:37

Authorized By: State Board of Nursing, George Hebert, Executive Director with the approval of Peter Harvey, Attorney General as to N.J.A.C. 13:37-9.

Authority: N.J.S.A. 45:11-24.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2005-30.

Submit comments by March 19, 2005 to:

George Hebert, Acting Executive Director

State Board of Nursing

PO Box 45010

Newark, New Jersey 07101

The agency proposal follows:

Summary

The State Board of Nursing (the Board) proposes to readopt N.J.A.C. 13:37 with amendments. These rules are scheduled to expire on July 12, 2005 pursuant to N.J.S.A. 52:14B-5.1c.

In compliance with N.J.S.A. 52:14B-5.1, the Board undertook a thorough review of the existing provisions of N.J.A.C. 13:37 in order to delete unnecessary or unreasonable rules and to propose new rules that the Board believes are needed to clarify and assist the practice of nursing. The Board believes that the rules proposed for readoption, as amended, are necessary, reasonable, understandable and responsive to the purposes for which they were originally promulgated. These rules have had a beneficial impact on the regulation and conduct of the nursing profession by enabling the Board to have in place procedures which serve and protect the public's best interests. The following summarizes each subchapter in N.J.A.C. 13:37 and any amendments proposed to the existing rules.

Subchapter 1 sets forth standards for programs in nursing education. N.J.A.C. 13:37-1.1 states that a school, division or department of nursing may be eligible to receive accreditation as a nursing program. Generic doctoral degree programs, generic master degree programs, baccalaureate degree programs, associate degree programs, diploma programs and practical nursing degree programs given by such institutions are eligible for nursing program accreditation. The rule is proposed for amendment to change the term "baccalaureate degree programs" to "generic baccalaureate degree programs," which is the term used in the academic community to describe such programs. The rule is also proposed for amendment to clarify that only those generic doctoral degree programs, generic master degree programs, generic baccalaureate degree programs and associate degree programs that make a student eligible for licensure as a registered professional nurse are eligible for accreditation.

N.J.A.C. 13:37-1.2 sets forth the information a new program in nursing must submit to the Board when applying for accreditation. After it receives an application, the Board has the option of either granting permission to pursue the development of the program, requiring revisions to the program or denying permission to establish the program. The rule requires an applicant who has been permitted to pursue the development of a program to submit more information to the Board. The Board, after reviewing this information may grant provisional accreditation to the program, require revisions to the program or deny permission to establish a program.

N.J.A.C. 13:37-1.3 outlines the requirements a program must meet once it has been granted provisional accreditation in order to be fully accredited. If a program does not meet the requirements set forth in N.J.A.C. 13:37-1.3, a program shall remain on provisional accreditation status. A program may only be on provisional accreditation status for two years from the date it graduates its first class, after that time a program that has not met the requirements of this rule shall cease to admit students and will be placed on probation until the last student enrolled in the program leaves.

N.J.A.C. 13:37-1.4 details the requirements for the organization and administration of a nursing program in order to maintain accreditation. A program must have a written organizational and administrative plan, adequate financial resources, a program administrator, written criteria for faculty promotion and retention, written criteria for student admission, promotion, retention and completion and written policies on grading and graduation.

N.J.A.C. 13:37-1.5 sets forth standards for the philosophy, organizing framework, objectives and outcomes of a nursing program in order to maintain accreditation. The rule requires that the faculty of a nursing program develop the program philosophy, organizing framework, program objectives and program outcomes. Faculty are also required to develop the Systematic Plan for Program Evaluation and to show that the philosophy, organizing framework, program objectives and program outcomes are integrated into the total program of learning. A nursing program is required to communicate the philosophy, organizing framework, program objectives and program outcomes to students, cooperating facilities, advisory committees and the communities of interests outlined in the Systematic Plan for Program Evaluation. Faculty are required to develop additional requirements for admission to a nursing program, grading policies and requirements for graduation. The rule requires the faculty and the program administrator to construct, implement, teach and evaluate the curriculum and requires the program administrator to maintain records that indicate the curriculum has been evaluated pursuant to the Systematic Plan for Program Evaluation.

N.J.A.C. 13:37-1.6 requires every nursing program to have an administrator and requires that the administrator meet the requirements of N.J.A.C. 13:37- 1.7. An administrator for a doctoral degree program, masters degree program or baccalaureate degree program is required to hold a doctoral degree in nursing or a masters degree in nursing with an earned doctoral degree. An administrator for an associate degree program, diploma program or licensed practical nursing program is required to hold a masters degree in nursing. The rule requires that, if an administrator is replaced, the Board be notified in writing within 30 days.

N.J.A.C. 13:37-1.7 sets forth qualifications for the faculty of nursing programs. All faculty members must be licensed in New Jersey as registered professional nurses and have taken a course, or have professional experience, in the area of teaching responsibility. The rule further requires that faculty in baccalaureate degree programs, associate degree programs and diploma degree programs, who began their employment after September 1, 1981, have a masters degree in nursing. Faculty in a licensed practical nursing program who began their employment after September 1, 1981 must have a bachelors degree with a major in nursing. An institution must maintain a record of the professional preparation and experience of all faculty. Faculty members must develop a plan to maintain competency in their area of teaching responsibility and are prohibited from supervising more than 10 students in a clinical setting.

N.J.A.C. 13:37-1.8 requires that nursing program curriculums enable students to develop the knowledge, skills and competencies necessary for nursing practice. All nursing courses must be taught by nursing faculty, except for nutrition courses, which may be taught by a dietician with a masters in nutrition, and pharmacology, which may be taught by a licensed pharmacist with a masters degree in pharmacology. The curriculum of professional nursing programs must include courses in the sciences, social sciences, humanities and clinical experiences. The curriculum of a practical nursing program must contain courses in the sciences, social sciences and clinical experiences.

N.J.A.C. 13:37-1.9 requires that every program provide classrooms and laboratories for students, and office space, conference rooms and equipment for faculty. Furnishings, supplies and equipment to achieve the program's objectives and outcomes and access to current reference resources also must be provided. N.J.A.C. 13:37-1.10 sets forth requirements for clinical agencies. Every nursing program is required to provide clinical experiences through an affiliation with a clinical agency and to have a written agreement with the clinical agency which outlines the terms of their relationship. N.J.A.C. 13:37-1.11 requires programs to have admission policies, criteria for granting course credit to students with advanced standing, policies governing payment of tuition, set dates for the beginning and ending of each term, an appeals process for students, individual liability insurance for each student and policies regarding health and guidance services.

N.J.A.C. 13:37-1.12 sets forth standards for surveying nursing programs. The Board may conduct a survey of any nursing program to ensure that it is in compliance with the requirements of Subchapter 1. Such survey will consist of an on-site visit to the program and a review of all documents maintained by the program pursuant to the rules of Subchapter 1. If the Board finds that a program is not in compliance with Subchapter 1, it will place the program on conditional accreditation. The rule also requires the Board to conduct a survey and an on-site visit of programs every eight years, unless the on-site visit has been waived pursuant to N.J.A.C. 13:37-1.14.

N.J.A.C. 13:37-1.13 states that accreditation of a nursing program is valid for eight years. Prior to expiration of the accreditation, the Board will send an accreditation renewal form to the program, along with a notification as to when the on-site visit will occur. The Board may waive the on-site visit if the program requests a waiver and meets the requirements of N.J.A.C. 13:37-1.14. If the on-site visit is waived, the program shall submit the completed accreditation renewal form and the accreditation renewal fee required by N.J.A.C. 13:37-5.5(d)3. If a program does not apply, or qualify, for the waiver of the on-site visit, the program administrator must submit 30 days prior to the on-site visit: the completed accreditation renewal form; the most recent institutional regional accreditation report; the nursing student handbook; course outlines for all nursing courses; description and location of clinical facilities; the Systematic Plan of Evaluation; the program's bylaws; the program's organizational chart; the program's insurance policy; a list of the nursing journals subscribed to by the program's library; and the renewal fee required by N.J.A.C. 13:37-5.5(d)2. After the Board has reviewed the renewal form and the results of the on-site survey, if it has not been waived, it shall decide whether the program conforms to the rules of Subchapter 1 and whether its accreditation should be renewed. After making its decision, the Board shall send notification to the program.

N.J.A.C. 13:37-1.14 requires a program that wishes the on-site visit waived to submit a waiver request. If the on-site visit is waived, the program must notify the Board if its National League for Nursing Accrediting Commission (NLNAC) or Commission on Collegiate Nursing Education (CCNE) accreditation status changes. If a program's NLNAC or CCNE accreditation changes, the Board will conduct a survey, including an on-site visit, of the program to verify that it conforms to the dictates of Subchapter 1. If a program does not conform to those standards, the program will be placed on conditional accreditation.

N.J.A.C. 13:37-1.15 sets forth standards for program recordkeeping and reporting. Any records that a program maintains must be made available to the Board upon request. Every nursing program must maintain a record of nursing department committee meetings and records of student academic data. Every program must maintain a copy of all contracts with clinical agencies and must submit an annual report to the Board.

N.J.A.C. 13:37-1.16 requires a program to notify the Board of changes in ownership or the Dean, Director, Chair or administrator of the program. A program is required to apply to the Board, in writing, for approval to make a major curriculum change. After reviewing the request, the Board shall either grant approval for the change, require revisions to the request or deny approval for the curriculum change. If the Board denies a curriculum change, the program may not resubmit a request for the same curriculum change for six months.

N.J.A.C. 13:37-1.17 states that a program will be placed on conditional accreditation if the program fails to meet or maintain the requirements of Subchapter 1 or if less than 80 percent of its graduates pass the licensing examination. A program placed on conditional accreditation shall be notified by letter. The Board is permitted to remove a program from conditional accreditation if the standards of Subchapter 1 have been met. N.J.A.C. 13:37-1.18 states that a program may be placed on probation if, for two consecutive years, less than 80 percent of its graduates have passed the licensing examination. A program on probation may not admit new students.

N.J.A.C. 13:37-1.19 requires that a program that voluntarily ceases operations provide for its enrolled students by either phasing students out or by transferring students to other programs. The person responsible for the institution shall inform the Board of the intent to terminate the program. The report must include the reasons for terminating the program and the plan for accommodating enrolled students. A program that closes is required to provide for the safekeeping of its records and to inform the Board, at least 10 days prior to the official date of closure, where the records are to be stored.

Subchapter 2 sets forth licensing examination requirements for registered professional and licensed practical nurses. N.J.A.C. 13:37-2.1 states that applicants for licensure must meet the requirements set forth in N.J.S.A. 45:11-26 and 45:11-27 and must take either the National Council Licensure Examination for Registered Nurses (NCLEX-RN) or the National Council Licensure Examination for Practical Nurses (NCLEX-PN). If an applicant fails three licensing examinations, he or she must take 30 hours of remediation courses. The rule is proposed for amendment to correctly reflect that the qualifications for faculty is codified at N.J.A.C. 13:37-1.7 and not N.J.A.C. 13:37- 1.10.

N.J.A.C. 13:37-2.2 requires applicants to submit a completed application form, an application fee and a written certification from the registrar or a program administrator attesting that the applicant has completed the requirements for graduation. The rule also states that professional nursing programs shall not serve as an equivalent for a practical nursing education.

N.J.A.C. 13:37-2.3 sets forth application requirements for graduates of foreign nursing programs. Such graduates must submit an application form, the application fee and a Commission on Graduates of Foreign Nursing Schools (CGFNS) certificate that indicates that the applicant graduated from a nursing program or was licensed as a registered nurse in a foreign country. Registered professional nurse applicants must also submit a certification from CGFNS. Licensed practical nurse applicants must submit a certification from a foreign transcript evaluating service and proof of a passing score on the Test of English as a Foreign Language (TOEFL). A graduate of a foreign licensed practical nursing program who has not taken courses in medical, surgical, pediatric, obstetric or psychiatric nursing is required to take a course in a licensed practical nursing program that covers the courses that the applicant missed.

N.J.A.C. 13:37-2.4 and 2.5 are reserved sections which the Board proposes to delete.

Subchapter 3 is reserved.

Subchapter 4 deals with licensure by endorsement. N.J.A.C. 13:37-4.1 sets forth eligibility requirements for licensure by endorsement. A registered professional nurse or licensed practical nurse who is licensed in another state, territory or possession of the United States, or the District of Columbia, will be eligible for licensure by endorsement if he or she meets the requirements of N.J.S.A. 45:1-14 et seq., 45:11-26 and 45:11-27. The rule states that attendance in, or successful completion of, a professional nursing program is not a substitute for a licensed practical nursing program and will not qualify an applicant for licensure as a licensed practical nurse. N.J.A.C. 13:37-4.2 requires an applicant for licensure by endorsement to submit a completed application form, the initial license fee, the application for licensure by endorsement fee and verification of licensure from every state, territory or possession of the United States, or the District of Columbia, in which the applicant was ever licensed. N.J.A.C. 13:37-4.3 is reserved.

Subchapter 5 contains general requirements of licensure. N.J.A.C. 13:37-5.1 specifies that to engage in the practice of nursing an individual must possess a current license. N.J.A.C. 13:37-5.2 states that licenses are valid for two years. N.J.A.C. 13:37-5.3 is a reserved section. N.J.A.C. 13:37-5.4 states that licenses are either active or inactive. Any licensee who is practicing is required to have an active license. Any licensee who is not engaged in any type of nursing practice may request an inactive license.

N.J.A.C. 13:37-5.5 sets forth the fees the Board may charge. N.J.A.C. 13:37-5.6 states that licensees will be held to their level of licensure, regardless of their employment status. N.J.A.C. 13:37-5.7 requires licensees who change their address to notify the Board of such change within 30 days. The rule additionally states that mailing to the address registered with the Board shall constitute effective notice. The Board proposes to amend this rule to clarify that the address registered with the Board cannot be a post office box unless there is another address on file with the Board that includes a street, city, state and zip code.

N.J.A.C. 13:37-5.8 requires licensees and certificants to report any incident or series of incidents that violates N.J.S.A. 45:11-23 et seq., N.J.A.C. 13:37 or 13:45C. N.J.A.C. 13:37-5.9 requires a licensee or certificant to notify the Board if: he or she is incapable of discharging the functions of a licensee; is indicted or convicted of a crime involving moral turpitude or a crime adversely relating to practice; is named as a defendant in an investigation, complaint or judgment involving alleged malpractice, negligence or misconduct; is the subject of a voluntary license or certification surrender or disciplinary action by any state or Federal agency; or fails to maintain or renew any certification which is required by law as a condition of practice. The rule also states that licensees and certificants who violate N.J.S.A. 45:11-23 et seq. or 45:1-14 et seq. may be subject to disciplinary action.

Subchapter 6 deals with nursing procedures and the delegation of nursing tasks. N.J.A.C. 13:37-6.1 states that nursing procedures are determined by the dictates of the Nursing Practice Act. N.J.A.C. 13:37-6.2 states that a registered professional nurse is responsible for nursing care delivered to patients. A registered professional nurse may delegate nursing tasks to licensed practical nurses or ancillary nursing personnel. Registered professional nurses are responsible for the supervision of individuals to whom tasks have been delegated. The level of supervision required is based upon the condition of the patient, the nature of the tasks and the education, skill and training of the individual to whom tasks have been delegated.

N.J.A.C. 13:37-6.3 sets forth standards for joint protocols between advanced practice nurses and collaborating physicians. A joint protocol must be: in writing; signed by the advanced practice nurse and the physician; kept in every office where the advanced practice nurse works; updated to reflect any changes in the office or working relationship; and reviewed at least annually. The rule also sets forth the specific information that must be addressed in a joint protocol. N.J.A.C. 13:37-6.4 requires licensees and certificants to wear an identification tag while practicing. If a licensee or certificant can show a risk to their safety or a substantial invasion of their privacy because they wear an identification tag, they may request a waiver of this requirement from the Board.

Subchapter 7 deals with the certification and practice of nurse practitioners/clinical nurse specialists. N.J.A.C. 13:37-7.1 sets forth how a nurse may apply for certification as a nurse practitioner/clinical nurse specialist. Applicants must submit proof of licensure as a registered professional nurse in New Jersey, a completed application form, the application fee, proof that the applicant has completed the educational requirements of N.J.A.C. 13:37-7.2 or 7.4 and proof that the applicant has passed the examination required by N.J.A.C. 13:37-7.3 or certification requirements of N.J.A.C. 13:37-7.4.

N.J.A.C. 13:37-7.2 sets out the educational requirements for practice as nurse practitioner/clinical nurse specialist. Applicants must graduate from a masters degree program that has been accredited by an agency approved by the Board and complete a graduate level course in pharmacology. An applicant who has completed the pharmacology requirement more than five years prior to filing the application must complete an additional graduate level course in pharmacology or thirty contact hours of continuing education.

N.J.A.C. 13:37-7.3 sets forth the examination requirements for certification. An applicant must pass the highest level examination in his or her area of specialization. An applicant may practice as a nurse practitioner/clinical nurse specialist prior to passing the examination as long as the applicant clearly identifies him-or herself as an applicant. An applicant who fails two examinations shall no longer engage in advanced practice nursing until he or she passes the examination.

N.J.A.C. 13:37-7.4 requires an individual who applies for certification as a nurse practitioner/clinical nurse specialist in OB/GYN or women's health on or before May 2, 2002 to submit proof that he or she has completed a post basic nursing certificate program, holds certification from a OB/GYN or women's health certifying agency, has completed a preceptor program and has completed a pharmacology course. N.J.A.C. 13:37-7.5 requires nurse practitioners/clinical nurse specialists to renew certification biennially. The rule also requires that nurse practitioners/clinical nurse specialists complete 30 hours of continuing education every biennial period.

N.J.A.C. 13:37-7.6 permits a nurse practitioner/clinical nurse specialist to prescribe medications and devices. The rule requires nurse practitioners/ clinical nurse specialists to have written joint protocols that are reviewed, updated and signed annually by the nurse practitioner/clinical nurse specialist and the collaborating physician.

N.J.A.C. 13:37-7.7 sets forth specific information that nurse practitioners/ clinical nurse specialists must include on prescriptions and orders. N.J.A.C. 13:37-7.8 permits nurse practitioners/clinical nurse specialists who are certified in another state to obtain certification in this State. Such nurse practitioners/clinical nurse specialists must meet the requirements of N.J.A.C. 13:37-7.1. The Board may waive the examination requirement for such an applicant if the applicant is certified in a state that has standards equivalent to New Jersey's requirements.

N.J.A.C. 13:37-7.9 addresses nurse practitioners/clinical nurse specialists who were certified pursuant to N.J.S.A. 45:11-48. Such applicants may qualify for certification without meeting the educational and examination requirements of N.J.A.C. 13:37-7.2 and 7.3. The applicants are required to submit: proof of licensure as a registered professional nurse in New Jersey; the application form; the application fee; and proof that the applicant is certified by a national accrediting agency approved by the Board. N.J.A.C. 13:37-7.10 states that nothing in Subchapter 7 limits the practice of a registered professional nurse. N.J.A.C. 13:37-7.11 sets forth the categories of advanced practice in which nurse practitioners/clinical nurse specialists may engage. N.J.A.C. 13:37-7.12 is reserved.

Subchapter 8 sets forth standards for nursing practice. N.J.A.C. 13:37-8.1 and 8.2 are reserved sections. N.J.A.C. 13:37-8.3 deals with sexual misconduct. Licensees are prohibited from engaging in sexual contact with a client or patient, from seeking or soliciting sexual contact with any person in exchange for professional services or from engaging in an unnecessary sexual discussion with a client or patient. A licensee is required to provide examination conditions which prevent the exposure of the unclothed body of a client or patient. A licensee may not engage in sexual harassment. Neither may a licensee engage in any activity with a patient or client that could be construed as serving the licensee's prurient interests or which constitutes sexual abuse. A licensee is allowed to render services to his or her spouse as long as those services are not rendered to exploit the spouse. The fact that a client or patient solicited or consented to the sexual contact or that the licensee was in love with the client or patient is not a defense to a sexual misconduct charge.

Subchapter 9 deals with the sexual assault nurse examiner program. Throughout this subchapter, the Board proposes to change the term "sexual assault nurse examiner" to "forensic nurse-certified sexual assault" and the term "SANE" to "FN-CSA." The Board proposes to make this change to differentiate between individuals certified by the Board and those who hold national certification. The Board believes it is necessary to create such a differentiation because the national certification does not provide New Jersey specific information on laws and procedures that are necessary to effectively provide sexual assault forensic examinations in New Jersey or to act as an expert witness in a New Jersey court. N.J.A.C. 13:37-9.1 sets forth the purpose and scope of the subchapter and N.J.A.C. 13:37 9.2 defines the terms used in the subchapter.

N.J.A.C. 13:37-9.3 sets forth eligibility and application requirements for certification. An applicant must be licensed as a registered professional nurse, have worked full time for at least two years as a registered professional nurse and have completed an FN-CSA education course and clinical requirements. An applicant who attended an FN-CSA education course prior to July 13, 2004 shall be eligible for certification as long as the applicant can show that the course would have met the requirements of N.J.A.C. 13:37-9.5. The Board and the Director of the Division of Criminal Justice will review applications to ensure that an applicant qualifies for certification. N.J.A.C. 13:37-9.4 prohibits any FN-CSA from performing sexual assault forensic examinations on a child.

N.J.A.C. 13:37-9.5 sets forth standards for FN-CSA education programs. Individuals, agencies or institutions which wish to present an FN-CSA course must submit an application to the Board. The Board and the Director will review the application and, if both approve the course, the Board will send a letter indicating such approval to the individual, agency or institution presenting the course. A course in clinical forensics is required to consist of at least 40 hours of didactic instruction, these 40 hours must be allocated between 32 topics which are outlined in the rule. The course must be taught by an instructor who either has a masters degree in nursing or who is an FN-CSA. Every program must have an administrator who has a masters degree in nursing.

N.J.A.C. 13:37-9.6 sets forth requirements for clinical education. Applicants are required to complete at least 10 routine gynecological genital inspections and at least five sexual assault examinations. An individual who attended to five victims of sexual assault as part of a county FN-CSA program prior to July 13, 2004 need not complete the five simulated sexual assault examinations.

N.J.A.C. 13:37-9.7 sets forth requirements for clinical education facilities. A Board accredited school of nursing is permitted to apply for approval as a clinical education facility. The Board and the Director of the Division of Criminal Justice will review the application for approval and send a letter to an approved laboratory indicating such approval. An approved laboratory is required to provide an opportunity for applicants to complete the five sexual assault examinations required by N.J.A.C. 13:37-9.6.

N.J.A.C. 13:37-9.8 requires certificants to renew certification every two years by sending a completed renewal application and the biennial renewal fee to the Board. N.J.A.C. 13:37-9.9 allows the Board and the Director of the Division of Criminal Justice to revoke or suspend certification if a certificant falsified documentation, violated patient confidentiality, violated the provisions of N.J.S.A. 45:1-21 or was convicted of a crime or an offense involving perjury or sex.

N.J.A.C. 13:37-9.10 provides for certification by endorsement for an FN-CSA who is certified in another state. Such an FN-CSA may apply for certification in New Jersey if he or she is licensed in New Jersey as a registered professional nurse. The applicant must have completed an education course and clinical hours substantially similar to the requirements of N.J.A.C. 13:37- 9.5 and 9.6, completed a course which covers New Jersey specific information required by N.J.A.C. 13:37-9.5 and passed a clinical competency examination pursuant to N.J.A.C. 13:37-9.7. An applicant for certification by endorsement must submit to the Board a completed application form and the endorsement application fee. The Board will forward the application to the Director of the Division of Criminal Justice and both the Board and the Director will review the application for approval. The rule is proposed for amendment to recognize that other states may not use the designation FN-CSA to describe nurses who are certified to perform sexual assault forensic examinations.

Subchapters 10, 11 and 12 are reserved.

Subchapter 13 deals with nurse anesthetists. N.J.A.C. 13:37-13.1 requires a licensee who wishes to practice as a nurse anesthetist to be licensed as a registered professional nurse in New Jersey, have graduated from a program in nurse anesthesia accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs of the American Association of Nurse Anesthetists, pass the certifying examination administered by the Council on Certification of Nurse Anesthesia of the American Association of Nurse Anesthetists and recertify biennially with the Council on Recertification of Nurse Anesthesia of the American Association of Nurse Anesthetists. A nurse anesthetist may only practice in a location that has written policies that meet accepted standards of nurse anesthetist practice and the standards of the American Association of Nurse Anesthetists.

N.J.A.C. 13:37-13.2 allows an applicant who has met the educational requirements of N.J.A.C. 13:37-13.1 and has applied to take the certifying examination to engage in nurse anesthetist practice pending the results of the certifying examination. The applicant must be supervised by a physician or certified nurse anesthetist. If the applicant fails the examination, he or she shall no longer practice as an applicant nurse anesthetist but shall remain eligible to take the certifying examination.

Subchapter 14 deals with homemaker-home health aides. N.J.A.C. 13:37-14.1 sets out the purpose and scope of the subchapter. N.J.A.C. 13:37-14.2 contains definitions of words and terms used in the subchapter. N.J.A.C. 13:37-14.3 sets forth the duties of a homemaker-home health aide and prohibits a homemaker-home health aide from administering medications.

N.J.A.C. 13:37-14.4 contains requirements for homemaker-home health aide training programs. Training programs must consist of a minimum of 76 hours, of which 60 must be in the classroom and 16 must be clinical instruction. The student to instructor ratio shall not exceed 30 students to one instructor. Clinical instruction must be supervised by a registered professional nurse and the ratio in a clinical setting should not exceed 10 students to one supervisor. Program approval is valid for 12 months. The rule also specifically sets forth the curriculum for training programs.

N.J.A.C. 13:37-14.5 sets forth the information that must be included in a home care or hospice care training program. N.J.A.C. 13:37-14.6 sets forth the requirements of a program sponsor. The program sponsor must provide a classroom laboratory and must receive program approval from the Board before the commencement of a training program. The program sponsor may not make any changes to a training program without the Board's approval and the sponsor must notify the Board of the location of, and starting and ending dates of, the training program at least two weeks before the commencement of the program.

N.J.A.C. 13:37-14.7 requires a training program to be coordinated by a registered professional nurse licensed in New Jersey. The program coordinator must have a bachelor's degree in nursing and two years of experience as a registered professional nurse, one year of which shall be in community health, public health or home care. N.J.A.C. 13:37-14.8 requires that instructors be registered professional nurses licensed in New Jersey who have worked for two years, one year of which shall have been in community health, public health or home care. Registered dieticians, licensed social workers, licensed psychologists, licensed physical therapists, mental health consultants, licensed speech-language pathologists, public health nurses, home economists, occupational therapists, and members of the clergy may work with a registered professional nurse in providing instruction. Clinical experience must be provided by a registered professional nurse who has two years of experience as a nurse, one year of which shall have been in community health, public health or home care. Clinical instructors also must have six months of experience in the supervision of homemaker-home health aides.

N.J.A.C. 13:37-14.9 requires an applicant for certification as a homemaker- home health aide to complete a training program within four months. N.J.A.C. 13:37-14.10 requires an applicant to submit evidence that he or she has completed a training program, evidence that he or she is of good moral character and the application fee.

N.J.A.C. 13:37-14.11 requires that an applicant register for a competency examination upon completing a training program. An applicant may work for a home health care agency under the supervision of a registered professional nurse while waiting to take the competency examination. An applicant who fails the competency examination may take the examination again provided he or she registers for the next available examination. An applicant who has failed the competency examination may continue working for a home health care agency under the supervision of a registered professional nurse provided that he or she is registered to take the next available examination. An applicant who fails the second competency examination must retake the homemaker-home health aide training program and may not work for a home health care agency until he or she passes the competency examination. An applicant may take an oral examination in either English or Spanish in lieu of the written competency examination. N.J.A.C. 13:37-14.12 allows nursing students who have completed a course in basic nursing to take the competency examination without completing an approved training program.

N.J.A.C. 13:37-14.13 states that a person who has passed the competency examination may be eligible for certification as a homemaker-home health aide. A certified homemaker-home health aide must renew certification biennially. N.J.A.C. 13:37-14.14 permits certification by endorsement, by which a person certified as a homemaker-home health aide in another state may be certified in this State.

N.J.A.C. 13:37-14.15 allows the Board to deny or revoke approval of a training program if the program sponsor fails to comply with N.J.S.A. 45:11- 24(d)20 through 24 or Subchapter 14. The Board may investigate program sponsors and homemaker-home health aides based upon complaints and the Board may suspend or revoke certification of a homemaker-home health aide who has violated N.J.S.A. 45:11-24(d)20 through 24 or Subchapter 14.

Subchapter 15 is reserved.

Subchapter 16 deals with the Massage, Bodywork and Somatic Therapy Examining Committee (the Committee) and sets forth certification and practice standards for massage, bodywork and somatic therapists. N.J.A.C. 13:37-16.1 identifies the purpose and scope of the subchapter. N.J.A.C. 13:37-16.2 contains definitions of words and terms used throughout the subchapter. N.J.A.C. 13:37-16.3 sets forth requirements for individuals who are currently practicing massage, bodywork and somatic therapy and who are seeking certification as a massage, bodywork and somatic therapist. Applicants who apply prior to November 5, 2006 need not meet the educational requirements of N.J.A.C. 13:37-16.4 if the applicant has completed at least 200 hours of education and training and has practiced either full-time as a massage, bodywork and somatic therapist over the last two years or part-time for the last five years.

N.J.A.C. 13:37-16.4 sets forth requirements for certification as a massage, bodywork and somatic therapist. An applicant may qualify for certification by either completing a course of study or passing the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) or National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) examination. N.J.A.C. 13:37-16.5 allows an applicant who is licensed or certified in another state to qualify for certification in New Jersey if the educational requirements of the certifying state are substantially similar to those required in this State.

N.J.A.C. 13:37-16.6 requires certificants to renew certification every two years. Certificants must attest that they have completed the continuing education requirements for the prior biennial period when renewing certification. A certificant is required to renew certification by the expiration date by paying the renewal fee and submitting a renewal application. A certificant who fails to renew by the expiration date may renew certification within 30 days of the expiration date by paying the renewal and late fee and submitting the renewal application. A certificant who does not renew within this 30-day period date shall be suspended without a hearing. A person who has been suspended may seek reinstatement within five years of the expiration date of the certification by submitting to the Committee a reinstatement application, all past delinquent renewal fees, the reinstatement fee, a certification verifying completion of all continuing education credits and an affidavit listing all jobs held during the period of suspension. A person seeking reinstatement after more than five years following a suspension must submit the same items required of a person who has been suspended for less than five years and must also successfully complete the examination required by N.J.A.C. 13:37-16.4. Renewal applications will provide a certificant with the option of renewing as inactive. The Committee may permit a certificant on inactive status to return to active status if the certificant completes the continuing education credits that are required for each biennial period the certificant has been on inactive status and the certificant holds a current certification in basic life support.

N.J.A.C. 13:37-16.7 addresses a certificant's scope of practice. Certificants are allowed to practice only those methods of massage, bodywork and somatic therapy for which they have received training or which they have developed. Regardless of the training a certificant receives, no certificant will be permitted to perform: colonic irrigations; prostate massages; vaginal or penis massages; decongestive therapy; manual lymph drainage used as part of decongestive therapy; animal therapies prohibited by N.J.S.A. 45:16-1 et seq.; any application of electrical current to the body; ultrasound therapy; or the treatment or diagnosis of illness, disease, impairment or disability.

N.J.A.C. 13:37-16.8 sets forth infection control precautions with which certificants must comply. Certificants are required to wash their hands with liquid disinfectant soap before and after each client session. Certificants must dispose of soiled disposable items and must disinfectant any equipment that comes in contact with a client, as well as exposed surfaces, implements or tools used during a client session, face cradles, arm rests and all ice and heat pack equipment. Single service materials and linens must be stored off of the floor. Soiled linens and draping materials must be either commercially laundered or washed in a washing machine in hot water and dried on the high heat setting in a clothes dryer. Clean linens must be stored separately from dirty linens and trash. Certificants must maintain a clean environment in the massage, bodywork and somatic therapy establishment and ensure that the establishment is well-lit, ventilated and free of animals, except as provided by law.

N.J.A.C. 13:37-16.9 allows a certificant to use certain titles and prohibits uncertified individuals from using these titles. Any person who holds a certification from a school or an agency, but who is not certified by the Committee pursuant to these rules, may not identify themselves as certified. The rule also states that uncertified individuals are not precluded from rendering massage, bodywork and somatic therapy, provided these individual do not hold themselves out as State certified. N.J.A.C. 13:37-16.10 requires certificants to display their certificates in view of clients when providing massage, bodywork and somatic services.

N.J.A.C. 13:37-16.11 sets forth continuing education requirements. Certificants are required to complete 20 credit hours of continuing education related to the practice of massage, bodywork and somatic therapy every biennial period. Certificants may complete this requirement by: attending a continuing education course related to massage, bodywork and somatic therapy; teaching a new continuing education course; presenting a new seminar or lecture to professional peers; writing a chapter of a textbook; or writing a published article related to massage, bodywork and somatic therapy.

N.J.A.C. 13:37-16.12 deals with sexual misconduct. Certificants are prohibited from engaging in sexual contact with a client, from seeking or soliciting sexual contact with any person in exchange for professional services or from engaging in a sexual discussion with a client. A certificant is required to provide privacy for clients in order to prevent the exposure of the unclothed body of a client. A certificant may not engage in sexual harassment. Neither may a certificant engage in any activity with a client that could be construed as serving the certificant's prurient interests or which constitutes sexual abuse. A certificant is allowed to render services to his or her spouse as long as those services are not rendered to exploit the spouse. The fact that a client solicited or consented to the sexual contact or that the certificant was in love with the client is not a defense to a sexual misconduct charge.

N.J.A.C. 13:37-16.13 allows certificants to provide information to the public by advertising in print or electronic media. A certificant who uses any false claim, promotes services for which the certificant did not receive training or provides identifying information of a client without obtaining the client's prior written consent is engaged in professional misconduct. All advertisements must include the certificant's name, address or telephone number, and the term "N.J. Cert. #." followed by the certificant's certificate number. Certificants are required to keep video or audio tapes of every advertisement made in electronic media, or a copy of any print advertisement, for three years from the date of the last publication or dissemination of the advertisement.

N.J.A.C. 13:37-16.14 requires certificants to maintain client records which reflect the services rendered for the client. These records must be maintained for seven years from the most recent service. Certificants are required to provide clients access to the client's records within 30 days of receiving a written request for the records. N.J.A.C. 13:37-16.15 requires a certificant to notify the Committee in writing within 30 days of a change in the certificant's address of record or legal name. N.J.A.C. 13:37-16.16 requires all certificants to have each client read and sign an informed consent form prior to providing initial services to a client.

The Board has determined that the comment period for this proposal shall be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this proposal is excepted from the rulemaking calendar requirement.

Social Impact

The rules proposed for readoption will continue to ensure proper care of patients. The rules establish practice standards and ensure that licensees and certificants remain accountable to the public and the Board. The proposed readoption of the current rules and amendments also benefit the Board, licensees and certificants by providing procedures for the orderly administration of the Board and by establishing clear practice guidelines.

Subchapter 1 regulates the institutions that educate nurses. Generally these rules benefit society by ensuring that these schools and programs are prepared to effectively and properly educate nurses.

Subchapter 2 delineates the eligibility of applicants for licensure. The rules require applicants to have passed either the NCLEX-RN or NCLEX-PN which ensures that applicants have the knowledge and ability required for safe practice. Applicants who fail the licensing examination three times must take a remediation course before taking the examination a fourth time. This benefits the applicant by identifying and correcting areas of deficiency and enhances the applicant's chances of passing the examination. The rules also require graduates of foreign nursing programs to submit a Commission on Graduates of Foreign Nursing Schools (CGFNS) certificate, for registered nurses, or proof of a passing score on the Test of English as a Foreign Language (TOEFL) examination, for licensed practical nurses. This ensures that graduates of foreign nursing programs meet the same standards as nurses who graduate from schools in the United States.

Subchapter 4 sets forth standards for the endorsement of nurses. This subchapter allows nurses, licensed in other states, to obtain licensure in this State if they meet New Jersey standards for licensure. This subchapter increases the number of nurses available to work in the State while ensuring that all nurses meet the same high standards for licensure.

Subchapter 5 sets forth general requirements of licensure. The rules set out categories of active and inactive licenses. An inactive license may be requested by a licensee who is eligible for practice but does not actually practice. This allows nurses who are not practicing to maintain a license without having to pay the higher fee paid by a licensee who practices. A licensee is held to the standard of practice of the highest license held, which ensures that a registered nurse who is also licensed as a licensed practical nurse will be held to the standard of a registered professional nurse when it comes to caring for patients. Licensees must report any incident that he or she believes violates the Nurse Practice Act or this subchapter. Such reporting will advise the Board of inappropriate conduct and provide the opportunity to take measures to ensure the safety of the public.

Subchapter 6 sets forth responsibilities of delegation and ensures that the registered professional nurse will remain responsible for all nursing tasks delegated. A nurse who delegates must verify that the person to whom tasks have been delegated has the requisite knowledge and skill to perform the task. This ensures that all nursing tasks are performed safely and effectively when they are delegated. The subchapter sets forth standards for joint protocols between nurse practitioners/clinical nurse specialists and collaborating physicians, ensuring that these nurses safely and effectively perform advanced nursing tasks. The subchapter also requires licensees to wear identification tags which ensures that patients can identify the individuals who are providing nursing services.

Subchapter 7 sets out the standards for the practice and training of nurse practitioners/clinical nurse specialists. Generally these rules benefit the public as they ensure that these practitioners have the knowledge and skills necessary to perform advanced nursing tasks. The rules ensure that nurse practitioners/clinical nurse specialists will only prescribe medications in accordance with the rules, the Nurse Practice Act and the written protocols developed by the nurse and the collaborating physician. This ensures that, when a nurse practitioner/clinical nurse specialist prescribes medications, the prescription is made with the appropriate skill and knowledge to protect both certificants and patients.

Subchapter 8 protects patients by prohibiting licensees from engaging in sexual misconduct.

Subchapter 9 sets certification standards for forensic nurse-certified sexual assault. This ensures that the nurses who provide forensic sexual assault examinations are properly prepared to perform these examinations. The amendments to this subchapter, which changes the designation of certificants from "sexual assault nurse examiner (SANE)" to "forensic nurse-certified sexual assault (FN-CSA)," ensures that individuals certified by the State are easily identified and differentiated from those who only hold national certification.

Subchapter 13 sets practice and education standards for nurse anesthetists which ensure that nurse anesthetists will have the requisite skills and knowledge to safely administer anesthesia.

Subchapter 14 sets certification standards for homemaker-home health aides which ensure the safety of those who use the services of homemaker-home health aides.

Subchapter 16 sets certification standards for massage, bodywork and somatic therapists. This subchapter ensures that consumers will be able to identify and choose massage, bodywork and somatic therapists who have met the certification standards and who will practice pursuant to the standards imposed by Subchapter 16. The rules also require certificants to adhere to certain sanitary standards and universal precautions that will assure clients that they are receiving massage, bodywork and somatic services in a safe environment.

Economic Impact

Some of the rules proposed for readoption or amendment will have an economic impact on applicants for licensure, institutions that have nursing programs, licensees and certificants.

Subchapter 1 imposes costs on institutions that have programs in nursing. These institutions must bear the costs of preparing an application for Board approval, an organizational chart, a projected budget, a written organizational plan for the program, and written policies regarding admission, course credits, payment of tuition, grievance procedures and health services. The program is also required to draft and distribute a written statement of philosophy and objectives, provide for adequate classroom, office and library space, draft a written agreement regarding the relationship between the program and its clinical affiliate, provide individual liability insurance for every student, maintain records for students, and notify the Board before making a major curriculum change. These requirements all impose costs on the program.

Subchapter 2 imposes costs on applicants for licensure. An applicant is required to take either the NCLEX-RN or NCLEX-PN. While the Board does not charge for these examinations, the applicant must pay a fee for the examination. An applicant must take a remediation course before retaking the NCLEX if he or she has failed the NCLEX three times. N.J.A.C. 13:37-2.3 imposes costs on applicants from foreign nursing programs. These applicants must submit documents that show that the applicant has the necessary skills and knowledge to practice as a nurse in this State and must, if they are applying for a license as a licensed practical nurse, take courses that cover any areas in which they have insufficient education.

N.J.A.C. 13:37-4.2 requires an applicant for licensure by endorsement to submit an application and a written verification from every state in which he or she was ever licensed. The cost of preparing these documents is borne by the applicant.

N.J.A.C. 13:37-5.3 requires a licensee to register as either active or inactive. The licensee must pay a fee for whichever category they are registered. N.J.A.C. 13:37-5.4 sets forth the fees which the Board assesses for services rendered to its licensees. The fee schedule has an economic impact on licensees and applicants for licensure by establishing fees that they have to pay in order for the Board to be self-funding and in compliance with N.J.S.A. 45:1-3.2. N.J.A.C. 13:37-5.6 requires licensees to notify the Board of any change in address. The cost of this notification is borne by the licensee.

N.J.A.C. 13:37-6.3 imposes an economic impact in that the rule requires nurse practitioners/clinical nurse specialists to draft a joint protocol. The costs of drafting this protocol are borne by the nurse practitioner/clinical nurse specialist and the collaborating physician who works with the nurse. N.J.A.C. 13:37-6.4 requires all licensees to wear an identification tag, unless they have obtained a waiver from the Board. The cost of obtaining this tag or applying to the Board for a waiver are borne by the licensee.

Subchapter 7 imposes costs on applicants for certification as nurse practitioners/clinical nurse specialists. An applicant must graduate from a masters level program in advanced practice nursing, complete a pharmacology course and take an examination offered by a certification agency. The costs of these courses and the examination is borne by the applicant. An applicant who specializes in OB/GYN and women's health must submit proof that he or she has completed a post basic nursing certificate program, been certified by a nationally recognized OB/GYN certifying agency and completed a course in pharmacology. The costs of submitting this proof, and completing the educational and certifying requirements implicit in the rule, are borne by the applicant. The subchapter also imposes costs on nurses who have been certified as nurse practitioners/clinical nurse specialists. N.J.A.C. 13:37-7.5 requires nurse practitioners/clinical nurse specialists to renew the certification biennially. The fee for this renewal is set forth in N.J.A.C. 13:37-5.5 and is borne by the applicant. A nurse practitioner/clinical nurse specialist may only prescribe medication where there is a written protocol between the nurse practitioner/clinical nurse specialist and a collaborating physician. The nurse and the collaborating physician bear the cost of drafting and maintaining the protocol. N.J.A.C. 13:37-7.9 requires applicants for certification made prior to October 29, 1994 to submit proof that the applicant was certified in a specialty by an accrediting agency approved by the Board. The cost of obtaining this proof is borne by such applicants.

Subchapter 9 imposes costs on applicants for certification as forensic nurse- certified sexual assault, certificants and organizations that wish to conduct education programs. Applicants for certification are required to take an education course and complete clinical hours. The cost of completing these courses and the clinical hours will be borne by applicants. The Board will charge applicants a fee to apply for certification. The Board will also charge certificants a fee for initial certification and renewal of certification. Organizations may incur costs in ensuring that their education courses or clinical examination facilities comply with the requirements of the rules.

N.J.A.C. 13:37-13.1 requires an applicant for a nurse anesthetist certification to graduate from a program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs of the American Association of Nurse Anesthetists, to pass an examination offered by the Council on Certification of Nurse Anesthetists of the American Association of Nurse Anesthetists and to recertify with the Council on Recertification of Nurse Anesthetists of the American Association of Nurse Anesthetists. The costs of the course, examination and recertification are borne by the applicant.

Subchapter 14 imposes costs on programs that prepare homemaker-home health aides for certification. A sponsor of a homemaker-home health aide training program is required to properly equip classrooms and laboratories, submit an application and the resumes of all instructors to the Board, submit the annual program approval fee, maintain a file on the curriculum, hire a registered professional nurse to act as the program coordinator and hire program instructors. The subchapter also imposes costs on applicants for certification and certificants. Applicants must complete a training program and take the competency examination. If an applicant fails two competency examinations he or she must re-take the homemaker-home health aide training program. Certificants must recertify biennially with the Board and pay the fee set out in N.J.A.C. 13:37-5.5.

Subchapter 16 imposes costs on those who apply for massage, bodywork and somatic therapist certification, certificants and sponsors of continuing education programs. The Board points out that, pursuant to N.J.S.A. 45:11- 65, no one is required to obtain certification and these costs will only be imposed on those individuals who choose to obtain certification. N.J.A.C. 13:37-16.3, 16.4 and 16.5 set forth requirements for applicants for certification. These rules require applicants to either obtain an education in massage, bodywork and somatic therapy or successfully pass a certifying examination. The cost of completing either the educational or examination requirements is borne by the applicant for certification. These rules also require applicants to submit applications to the Committee. The cost of preparing and submitting these applications is borne by applicants. N.J.A.C. 13:37-16.6 requires certificants to renew their certification biennially. The cost of renewal is borne by certificants. N.J.A.C. 13:37-16.8 sets forth infection control precaution requirements. The cost of complying with these requirements will be borne by certificants, as will the cost of complying with the continuing education requirements of N.J.A.C. 13:37-16.11. Certificants will also incur costs due to the recordkeeping requirements of N.J.A.C. 13:37-16.14. Sponsors of massage, bodywork and somatic therapy continuing education courses who seek Committee approval will bear the cost of preparing applications.

Federal Standards Statement

A Federal standards analysis is not required because there are no Federal laws or standards applicable to the rules proposed for readoption with amendments.

Jobs Impact

The Board believes that some of the rules proposed for readoption and amendments may impact jobs. N.J.A.C. 13:37-2.1 requires every applicant for licensure to pass either the NCLEX-RN or NCLEX-PN. If an applicant does not pass the examination, he or she cannot be licensed or work as a nurse.

N.J.A.C. 13:37-13.2, which allows a nurse who has completed the educational requirements of a nurse anesthetist to practice prior to passing the certifying examination, will increase the number of available nurse anesthetists in the State.

N.J.A.C. 13:37-14.11 requires an applicant for certification as a homemaker-home health aide to take a competency examination for certification. If the applicant fails the examination twice he or she must retake the homemaker-home health aide training program, as a homemaker-home health aide cannot work without certification. The rule does allow applicants to work under the supervision of a registered professional nurse prior to passing the competency examination.

N.J.A.C. 13:37-16.11 may create more jobs for continuing education instructors who teach courses that are applicable to the practice of massage, bodywork and somatic therapy.

Agriculture Industry Impact

The Board does not believe that the rules proposed for readoption with amendments will have any impact on the agriculture industry of this State.

Regulatory Flexibility Analysis

If, for the purposes of the Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq., the approximately 182,000 practitioners licensed or certified by the Board are deemed "small businesses," then the following analysis applies.

The Act requires the Board to set forth the reporting, recordkeeping and other compliance requirements of the rules proposed for readoption with amendments including the kinds of professional services likely to be needed to comply with the requirements. The Act further requires the Board to estimate the initial and annual compliance costs of the rules proposed for readoption with amendments with an indication of the varying impact on small businesses of differing types and sizes and to outline the manner in which it has designed the rules to minimize any adverse economic impact upon small businesses.

The costs imposed on small businesses by the rules proposed for readoption with amendments are the same costs that are imposed on all businesses as outlined in the Economic Impact statement above.

The Board does not believe that licensees will need to employ any professional services to comply with the requirements of the rules proposed for readoption with amendments.

The rules proposed for readoption with amendments at N.J.A.C. 13:37 imposes compliance, recordkeeping and reporting requirements on licensees, certificants and education programs.

The rules impose several compliance requirements. N.J.A.C. 13:37-1.2 requires a nursing program that wishes to be accredited to apply to the Board. N.J.A.C. 13:37-1.5 requires faculty to develop a written model of the organizing framework, program objectives, outcomes and philosophy. The rule also requires faculty to identify competencies for entry into nursing practice, to develop the Systematic Plan for Program Evaluation and to integrate the framework, philosophy, program objectives and program outcomes into the total program of learning. The faculty is required to communicate to students and communities of interest the organizing framework, philosophy, program objectives and outcomes and develop any additional policies on admissions, grading or graduation as needed. The faculty is also required to develop the curriculum. N.J.A.C. 13:37-1.6 requires every program to have an administrator who meets the requirements of N.J.A.C. 13:37-1.7 and holds either a doctoral degree or masters degree, depending on the program. N.J.A.C. 13:37-1.7 requires that each faculty member be licensed as a registered professional nurse in this State, have experience in the area taught and hold a degree in nursing. The rule also requires faculty to develop a plan to maintain competency and requires that the faculty to student ratio in the clinical setting not exceed 10 students to every faculty member. N.J.A.C. 13:37-1.8 requires that nursing courses be taught by nursing faculty, that the curriculum be based on the organizing framework, program objectives, outcomes and philosophy, that the faculty select clinical experiences that correlate to course objectives and that courses reflect input from the community of interest. The rule also outlines what information the curriculum must cover and dictates the length of a practical nursing program. N.J.A.C. 13:37-1.9 sets forth what a nursing program must provide students and faculty by way of physical accommodations. N.J.A.C. 13:37-1.10 requires nursing programs to provide clinical experiences for students and to memorialize agreements with clinical agencies in writing. N.J.A.C. 13:37-1.11 outlines what policies a nursing program must develop to deal with student admissions and promotion. N.J.A.C. 13:37-1.13 dictates what information a program must submit to the Board when renewing accreditation. N.J.A.C. 13:37-1.14 sets forth what a program must submit if it wishes to have the on-site accreditation renewal visit waived. N.J.A.C. 13:37-1.16 requires a program to apply to the Board if it wishes to make a major curriculum change. N.J.A.C. 13:37-1.18 prohibits a program on probation from admitting new students. N.J.A.C. 13:37-1.19 requires programs that cease operation to either phase out students or transfer them to other schools and to provide for the safekeeping of program records.

N.J.A.C. 13:37-5.1 requires a nurse to obtain a license before engaging in the practice of nursing. N.J.A.C. 13:37-5.2 requires any nurse who is registered as inactive to register with the Board as active prior to engaging in the practice of nursing. N.J.A.C. 13:37-5.6 requires that a licensee be held to the standards of his or her highest license. N.J.A.C. 13:37-6.2 requires a registered professional nurse who has delegated a task to another person to ensure that the other person has the requisite skill and knowledge to perform the task. The rule also requires the nurse to supervise the person to whom nursing tasks have been delegated. N.J.A.C. 13:37-6.3 requires nurse practitioner/clinical nurse specialists to draft joint protocols with collaborating physicians. N.J.A.C. 13:37-6.4 requires licensees to wear identification tags.

N.J.A.C. 13:37-7.1 requires a nurse who wishes to practice as a nurse practitioner/clinical nurse specialist to be certified by the Board and submit an application and fee to the Board. N.J.A.C. 13:37-7.5 requires nurse practitioner/clinical nurse specialists to renew certifications on a biennial basis and complete 30 hours of continuing education courses every two years. N.J.A.C. 13:37-7.6 requires a nurse practitioner/clinical nurse specialist to prescribe medication only if a protocol has been established with a collaborating physician. N.J.A.C. 13:37-7.7 requires nurse practitioner/ clinical nurse specialists to include specific information on every prescription. N.J.A.C. 13:37-8.3 prohibits licensees from engaging in sexual misconduct.

Subchapter 9 imposes several compliance requirements. A certificant is required to renew certification every two years and is prohibited from performing sexual assault forensic examinations on a child. An organization wishing to sponsor an education program must apply to the Board for approval and provide a course which contains at least 40 hours of didactic instruction covering information required by N.J.A.C. 13:37-9.5(c). Courses must have instructors who either have masters degrees in nursing or are FN-CSAs, and must have a program administrator. Courses also must meet the requirements of Educational Design I or II programs as set forth by the American Nurses Credentialing Center's Commission on Accreditation and administer an examination to students. Approved programs are required to provide students with a copy of the letter of approval. Clinical education facilities must apply for approval and must have equipment for a comprehensive sexual assault forensic examination, a person who will act as a surrogate sexual assault victim and an outline of what the surrogate sexual assault victim must say during the examination. Approved clinical education facilities also must provide an opportunity for applicants to complete their required clinical hours.

N.J.A.C. 13:37-13.1 requires a licensee who wishes to practice as a nurse anesthetist to be licensed as a registered professional nurse, graduate from a program in nurse anesthesia, pass the certifying examination and recertify biennially. N.J.A.C. 13:37-13.2 allows individuals to practice as a nurse anesthetist prior to passing the examination as long as they are supervised by a physician or certified nurse anesthetist.

N.J.A.C. 13:37-14.3 prohibits homemaker-home health aides from administering medications. N.J.A.C. 13:37-14.4 requires that a homemaker- home health aide training course consist of as minimum of 76 hours, 60 spent in the classroom and 16 spent in a clinical setting. The 16 hours of clinical instruction must be supervised by a registered professional nurse and the registered professional nurse cannot supervise more than 10 students. The training program must obtain Board approval prior to commencement. N.J.A.C. 13:37-14.4 and 14.5 set forth information that must be taught in homemaker- home health aide training programs and home care and hospice training programs. N.J.A.C. 13:37-14.6 requires that program sponsors provide appropriately equipped classrooms and laboratories and that sponsors submit an application, application fee and the resumes of all nursing instructors two months prior to the start of a program. The program must receive Board approval prior to making changes and the sponsor must notify the Board of the starting date of every program. N.J.A.C. 13:37-14.7 requires that a program have a coordinator who is a registered professional nurse. N.J.A.C. 13:37-14.8 requires that classroom instruction be provided by an individual who has two years experience as a registered professional nurse. Clinical experience must be supervised by an individual with two years experience as a registered professional nurse and six months of experience in supervising homemaker-home health aides. N.J.A.C. 13:37-14.9 requires applicants for certification as homemaker-home health aides to complete a training program approved by the Board. N.J.A.C. 13:37-14.13 requires certificants to renew certification biennially.

N.J.A.C. 13:37-16.6 requires certificants to renew their certification every two years and imposes requirements for the renewal of a lapsed certificate. N.J.A.C. 13:37-16.7 sets forth a scope of practice which certificants are required to follow. Certificants can only practice methods of massage, bodywork and somatic therapy for which they have received adequate training or which they developed. The rule also sets forth a list of procedures which a certificant is not allowed to perform. N.J.A.C. 13:37-16.8 sets forth infection control precaution standards that certificants are required to meet. N.J.A.C. 13:37-16.9 sets forth designations that certificants can use and prohibits individuals who do not hold certification from using certain designations. N.J.A.C. 13:37-16.10 requires certificants to display their certificates whenever providing services. N.J.A.C. 13:37-16.11 requires certificants to complete 20 credit hours of continuing education. The rule also sets forth requirements for continuing education sponsors who are seeking approval for their courses. N.J.A.C. 13:37-16.12 prohibits certificants from engaging in sexual misconduct. N.J.A.C. 13:37-16.13 imposes compliance requirements on certificants who choose to advertise their professional services. N.J.A.C. 13:37-16.14 sets forth compliance requirements certificants must meet if they maintain records on a computer. The rule also requires certificants to protect the privacy of client records and to make these records available to a client when requested. N.J.A.C. 13:37-16.16 requires certificants to provide to every client, prior to the initial provision of services, an informed consent form and have the client read and sign the form.

The proposed readoption with amendments also imposes several recordkeeping requirements. N.J.A.C. 13:37-1.4 requires a nursing program to maintain written plans regarding organization and administration, faculty promotion and retention, student admission and promotion and grading. N.J.A.C. 13:37-1.5 requires a program to maintain a record of the organizing framework, program objectives, outcomes and philosophy. The rule also requires programs to maintain a Systematic Plan for Program Evaluation and to keep records that indicate whether the curriculum has been evaluated pursuant to the Systematic Plan for Program Evaluation. N.J.A.C. 13:37-1.7 requires nursing faculty to maintain records that indicate whether they have experience in the area in which they teach and requires the program to keep a record of the professional preparation and experience of all faculty. N.J.A.C. 13:37-1.15 requires nursing programs to maintain records of their nursing department committee minutes, of student academic data and a copy of all contracts with clinical agencies. N.J.A.C. 13:44-14.6 requires program sponsors to maintain records for each student and a plan for evaluating the effectiveness of the program. N.J.A.C. 13:37-16.11 requires certificants to maintain documentation indicating that the certificant completed continuing education requirements. N.J.A.C. 13:37-16.13 requires certificants who advertise to maintain a copy of the advertisement as part of their records. N.J.A.C. 13:37-16.14 requires certificants to maintain client records.

The proposed readoption of the rules imposes reporting requirements. N.J.A.C. 13:37-1.3 requires a nursing program to submit a Self-Study Report to the Board if it wishes to be accredited. N.J.A.C. 13:37-1.5 requires nursing programs to communicate the organizing framework, philosophy, program objectives and program outcomes to students, affiliates, committees and communities of interest. N.J.A.C. 13:37-1.6 requires a program to notify the Board if the program administrator is replaced. N.J.A.C. 13:37-1.14 requires a nursing program that had on-site visits waived to notify the Board if its NLNAC or CCNE accreditation status changes. N.J.A.C. 13:37-1.15 requires a program to submit an annual report to the Board. N.J.A.C. 13:37-1.16 requires a nursing program to notify the Board if it changes ownership or replaces the Dean, Director or program administrator. N.J.A.C. 13:37-1.19 requires a program to notify the Board if it plans to cease operation and to tell the Board where it will keep program records after it ceases operations.

N.J.A.C. 13:37-5.7 requires a licensee to notify the Board when he or she changes his or her address. N.J.A.C. 13:37-5.8 requires licensees to report to the Board any incident that is in violation of the N.J.S.A. 45:11-23 et seq. or N.J.A.C. 13:37. N.J.A.C. 13:37-5.9 requires licensees to report to the Board if his or her practice is impacted by any incident which is in violation of the Nurse Practice Act or these regulations, health problem or a civil or criminal legal proceeding. N.J.A.C. 13:37-7.5 requires a nurse practitioner/clinical nurse specialist to submit proof to the Board that he or she has completed 30 hours of continuing education during the previous biennial period. N.J.A.C. 13:37-7.6 requires a nurse practitioner/clinical nurse specialist to maintain written joint protocols at any location where he or she prescribes medication or devices. N.J.A.C. 13:37-9.7 requires clinical education facilities to test FN-CSA applicants and to forward the results of this test to the Board. N.J.A.C. 13:37-14.6 requires sponsors of homemaker- home health aide training programs to notify the Board, two weeks before the commencement of a program, as to the beginning and ending dates of the program. Program sponsor are also required to notify the Board if there are changes to the program. N.J.A.C. 13:37-16.15 requires a certificant to report a change in his or her address of record or legal name.

As the compliance, recordkeeping and reporting requirements contained in the rules proposed for readoption and amendments as discussed above are necessary to adequately regulate licensees and certificants, and to protect consumers who use their services, the Board believes that the rules must be uniformly applied to all licensees and certificants and no exemptions are provided based on the size of the licensee's or certificant's business.

Smart Growth Impact

The Board does not anticipate that the rules proposed for readoption with amendments will have any impact on the achievement of smart growth and implementation of the State Development and Redevelopment Plan, otherwise known as the State Plan.

Full text of the rules proposed for readoption may be found in the New Jersey Administrative Code at N.J.A.C. 13:37.

Full text of the proposed amendments follows :

<< NJ ADC 13:37-1.1 >>

13:37-1.1 Eligibility for accreditation

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

(c) The following educational programs, when offered by an institution that meets the requirements of (b) above, shall be considered eligible for accreditation by the Board as nursing programs:

1. Generic doctoral degree programs: For purposes of this subchapter, a generic doctoral degree program means a program conducted by an educational institution with a program in nursing, which leads to a doctoral degree in nursing <<+and makes a student eligible for licensure as a registered professional nurse+>>. The educational institution shall be licensed by the New Jersey Commission on Higher Education for the purpose of granting doctoral degrees;

2. Generic masters degree programs: For purposes of this subchapter, a generic masters degree program means a program conducted by an educational institution with a program in nursing, which leads to a masters degree in nursing <<+and makes a student eligible for licensure as a registered professional nurse+>>. The educational institution shall be licensed by the New Jersey Commission on Higher Education for the purpose of granting masters degrees;

3. <<-Baccalaureate->> <<+Generic baccalaureate+>> degree programs: For purposes of this subchapter, a <<+generic+>> baccalaureate degree program is a program conducted by an educational institution with a program in nursing, which leads to a baccalaureate degree in nursing <<+and makes a student eligible for licensure as a registered professional nurse+>>. The educational institution shall be licensed by the New Jersey Commission on Higher Education for the purpose of granting baccalaureate degrees. Registered professional nurse completion programs, which are educational programs that provide licensed registered nurses who do not have a baccalaureate degree the opportunity to complete their baccalaureate degrees, shall be considered baccalaureate degree programs<<-.->><<+;+>>

4. Associate degree programs: For purposes of this subchapter, an associate degree program means a program conducted by an educational institution with a program which leads to an associate degree in nursing <<+and makes a student eligible for licensure as a registered professional nurse+>>. The educational institution shall be licensed by the New Jersey Commission on Higher Education for the purpose of granting associate degrees;

5.-6. (No change.)

<< NJ ADC 13:37-2.1 >>

13:37-2.1 Eligibility requirements

(a) (No change.)

(b) An applicant who fails to pass three consecutive licensing examinations shall submit to the Board, prior to the fourth licensing examination, proof of successful completion of a remediation course, consisting of 30 hours and conducted by a qualified instructor within the meaning of N.J.A.C. 13:37-<<-1.10->><<+1.7+>>. The remediation course shall be completed within one year prior to taking the fourth examination. An applicant who fails the fourth examination may retake the examination two more times before being required to take the remediation course again.

<< NJ ADC 13:37-5.4 >>

<<-13:37-2.4 (Reserved)->>

<< NJ ADC 13:37-5.5 >>

<<-13:37-2.5 (Reserved)->>

<< NJ ADC 13:37-5.7 >>

13:37-5.7 Notification of change of address

A licensee or certificant shall notify the Board in writing of any change of address from that registered with the Board and shown on the most recently issued license or certificate. <<+This address shall not be a post office box unless there is another address on file with the Board that includes a street, city, state and zip code.+>> Such notice shall be given no later than 30 days following the change of address. Service to the <<+street+>> address registered with the Board shall constitute effective notice pursuant to N.J.A.C. 13:45-3.2.

SUBCHAPTER 9. <<-SEXUAL ASSAULT NURSE EXAMINER->> <<+FORENSIC NURSE- CERTIFIED SEXUAL ASSAULT+>> PROGRAM

<< NJ ADC 13:37-9.1 >>

13:37-9.1 Purpose and scope

(a) (No change.)

(b) This subchapter sets forth standards for the education and certification of <<-sexual assault nurse examiners->> <<+forensic nurses certified in sexual assault+>>.

<< NJ ADC 13:37-9.2 >>

13:37-9.2 Definitions

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

... "Certification" means the formal process by which education is received and the clinical competency of the <<-SANE->> <<+FN-CSA+>> is demonstrated.

... <<+"Forensic nurse-certified sexual assault (FN-CSA)" means a registered professional nurse licensed in New Jersey, and specially trained to provide comprehensive care to sexual assault victims, who demonstrates competency in conducting a sexual assault forensic examination and who has successfully completed a course of education as set forth in this subchapter.+>>

... <<-"Sexual assault nurse examiner (SANE) means a registered professional nurse licensed in New Jersey, and specially trained to provide comprehensive care to sexual assault victims, who demonstrates competency in conducting a forensic examination and who has successfully completed a course of education as set forth in this subchapter.->>

<< NJ ADC 13:37-9.3 >>

13:37-9.3 Application for certification

(a) To be eligible for certification as a <<-SANE->> <<+FN-CSA+>>, an applicant must:

1.-2. (No change.)

3. Have successfully completed a <<-SANE->> <<+FN-CSA+>> education course approved by the Board and the Director of the Division of Criminal Justice, pursuant to N.J.A.C. 13:37-9.5; and

4. Have successfully completed the <<-SANE->> <<+FN-CSA+>> clinical requirement pursuant to N.J.A.C. 13:37-9.6 and passed a clinical examination given by an approved clinical examination facility pursuant to N.J.A.C. 13:37-9.7(d).

(b) An applicant who attended a <<-SANE->> <<+FN-CSA+>> education course prior to July 13, 2004 that has not been approved by the Board and the Director of the Division of Criminal Justice shall be eligible for certification if he or she has met the requirements of (a)1, 2 and 4 above and can show that the <<-SANE->> <<+FN-CSA+>> education course he or she completed would have met the requirements of N.J.A.C. 13:37-9.5.

(c) An applicant for certification as a <<-SANE->> <<+FN-CSA+>> shall submit, or arrange to have submitted, to the Board:

1. (No change.)

2. Proof that the applicant has successfully completed a <<-SANE->> <<+ FN-CSA+>> education program, as outlined in N.J.A.C. 13:37-9.5, and the clinical requirements of N.J.A.C. 13:37-9.6 and 9.7(d); and

3. (No change.)

(d) (No change.)

<< NJ ADC 13:37-9.4 >>

13:37-9.4 Pediatric sexual assault forensic examinations

No <<-SANE->> <<+FN-CSA+>> shall perform a sexual assault forensic examination on a child.

<< NJ ADC 13:37-9.5 >>

13:37-9.5 <<-SANE->> <<+FN-CSA+>> education programs

(a) An individual, agency or institution seeking approval for a course in clinical forensics for the purpose of providing education for <<-sexual assault nurse examiners->> <<+forensic nurses-certified sexual assault+>> shall submit to the Board an application which shall include:

1.-3. (No change.)

4. An affidavit which indicates that the curriculum is included in the <<- SANE->> <<+FN-CSA+>> education course;

5.-7. (No change.)

(b) (No change.)

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

1. Historical perspectives of sexual assault and <<-sexual assault nurse examiners->> <<+forensic nurses-certified sexual assault+>>, for a minimum of one-half hour;

2. (No change.)

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

4.-17. (No change.)

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

19.-30. (No change.)

(d) The didactic instruction required in (c) above shall be taught by an instructor who either has a masters degree in nursing from a school accredited by the New Jersey Department of Education, or another state's department of education, or who is a <<-SANE->> <<+FN-CSA+>>. Didactic instruction in topics required by (c)15, 23, 24, 25 and 26 above may be taught by an attorney. Didactic instruction in topics required by (c)16 above may be taught by an attorney or by an investigator or detective who is part of a New Jersey law enforcement agency. Didactic instruction in topics required by (c)1, 5, 6, 7 and 21 above may be taught by an individual who is recognized as a rape care advocate pursuant to N.J.S.A. 52:4B-52.

(e)-(g) (No change.)

<< NJ ADC 13:37-9.6 >>

13:37-9.6 Clinical education

(a) Applicants for certification as a <<-SANE->> <<+FN-CSA+>> shall complete classroom education, pursuant to N.J.A.C. 13:37-9.5, before beginning their clinical education.

(b)-(c) (No change.)

(d) An individual who attended to five victims of sexual assault as part of a county <<-SANE->> <<+FN-CSA+>> program prior to July 13, 2004 shall be deemed to have met the requirements of (b)2 above and need not complete the five simulated sexual assault examinations required by (b)2 above in order to obtain certification.

<< NJ ADC 13:37-9.7 >>

13:37-9.7 Clinical education facilities

(a) A Board accredited school of nursing may apply to the Board for approval as a clinical education facility. An applicant for approval shall submit to the Board:

1.-4. (No change.)

5. After July 13, 2005, evidence that the training facility has an instructor who is a <<-SANE->> <<+FN-CSA+>>.

(b)-(c) (No change.)

(d) An approved clinical education facility shall, upon completion of the clinical education required by N.J.A.C. 13:37-9.6(b)2, provide an examination which tests the ability of a <<-sexual assault nurse examiner->> <<+forensic nurse-certified sexual assault+>> applicant to perform sexual assault forensic examinations. The facility shall forward the results of this examination to the Board.

<< NJ ADC 13:37-9.8 >>

13:37-9.8 Renewal of certification

(a) Certification as a <<-SANE->> <<+FN-CSA+>> shall be valid for two years.

(b) Certified <<-SANEs->> <<+FN-CSAs+>> shall renew certification biennially by submitting to the Board:

1.-2. (No change.)

<< NJ ADC 13:37-9.9 >>

13:37-9.9 Revocation or suspension of certification

(a) The Board and the Director of the Division of Criminal Justice may revoke or suspend a certification, after affording an opportunity to be heard, if they find that a <<-SANE->> <<+FN-CSA+>> has:

1.-5. (No change.)

<< NJ ADC 13:37-9.10 >>

13:37-9.10 Endorsement

(a) A registered professional nurse, licensed in New Jersey, who is working as a <<-SANE->> <<+FN-CSA+>> in another state may apply for certification as a <<-SANE->> <<+FN-CSA+>> in New Jersey if the applicant is certified by another state as a <<-SANE->> <<+FN-CSA, or its equivalent,+>> and the applicant:

1.-3. (No change.)

(b) An applicant for certification by endorsement shall submit to the Board:

1.-2. (No change.)

3. Evidence that the applicant is certified in another state and has worked in the past year as a <<-SANE->> <<+FN-CSA, or its equivalent+>>;

4.-8. (No change.)

(c) The Board shall review the endorsement application and forward it to the Director of Criminal Justice for review and approval. Once both the Board and the Director have approved the applicant, the Board shall issue the applicant a certification as a <<-SANE->> <<+FN-CSA+>> in New Jersey.




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