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RULE PROPOSALS
VOLUME 42, ISSUE 14
ISSUE DATE: JULY 19, 2010
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF NURSING

Proposed Readoption with Amendments: N.J.A.C. 13:37
Proposed Repeals: N.J.A.C. 13:37-7.5 and 13

Rules

Authorized By: State Board of Nursing, George Hebert, Executive Director with the approval of Paula T. Dow, Attorney General as to N.J.A.C. 13:37-9.
Authority: N.J.S.A. 45:11-24, 45:11-67 and 52:14B-5.1.

Calendar Reference: See Summary below for explanation of exception to calendar requirement.

Proposal Number: PRN 2010-144.

Submit comments by September 17, 2010 to:
George Hebert, Executive Director
State Board of Nursing
Post Office 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 and repeals. These rules are scheduled to expire on January 2, 2011 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. 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 that 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 the standards and the process for obtaining accreditation of programs in nursing education. N.J.A.C. 13:37-1.1 sets forth what schools, divisions or departments of nursing are eligible to obtain accreditation as a nursing program. 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 and provides that the Board has the option to grant permission to pursue the development of the program, require revisions to the program or deny permission to establish the program. N.J.A.C. 13:37-1.3 outlines the requirements a program on provisional accreditation must meet in order to be fully accredited. 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. N.J.A.C. 13:37-1.5 sets forth standards for developing and communicating the philosophy, organizing framework, objectives and outcomes of a nursing program. 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.

N.J.A.C. 13:37-1.7 sets forth qualifications for the faculty of nursing programs. N.J.A.C. 13:37-1.8 outlines curriculum content and requires that nursing program curriculums enable students to develop the knowledge, skills and competencies necessary for nursing practice. 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. N.J.A.C. 13:37-1.10 requires every nursing program to provide clinical experiences through an affiliation with a clinical agency and to have a written agreement with the clinical agency that outlines the terms of their relationship. Pursuant to N.J.A.C. 13:37-1.11, programs must have admission policies, criteria for granting course credit to students with advanced standing, policies governing payment of tuition, 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 the review or surveying of 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. 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 and sets forth the procedures for renewal, which differ if the on-site visit is waived. N.J.A.C. 13:37-1.14 permits a program to submit a request for a waiver of the on-site visit.

N.J.A.C. 13:37-1.15 sets forth standards for program recordkeeping and reporting and requires that program records be made available to the Board upon request. N.J.A.C. 13:37-1.16 requires a program to notify the Board of changes in ownership or of the Dean, Director, Chair or administrator of the program. The rule also requires a program to apply to the Board for approval to make a major curriculum change. N.J.A.C. 13:37-1.17 states that a program will be placed on conditional accreditation if less than 75 percent of its graduates, for three successive years, pass the licensing examination. N.J.A.C. 13:37-1.18 states that a program may be placed on conditional accreditation if the program fails to meet or maintain the requirements of Subchapter 1.

[page=1482] N.J.A.C. 13:37-1.19 provides that a program on conditional accreditation, which fails to achieve the goals of its action plan will be placed on probation. A program on probation may not admit new students. N.J.A.C. 13:37-1.20 requires a program that voluntarily ceases operations to notify the Board that the program is closing.

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.

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 Board proposes to amend this rule to recognize that a program may be accredited by a board of nursing in another state. N.J.A.C. 13:37-2.3 sets forth application requirements for graduates of foreign nursing programs.

Subchapter 3 is reserved.

Subchapter 4 deals with licensure by endorsement for professional and practical nurses. N.J.A.C. 13:37-4.1 sets forth eligibility requirements for licensure by endorsement. N.J.A.C. 13:37-4.2 sets forth the items that an applicant for licensure by endorsement must submit with a completed application form. N.J.A.C. 13:37-4.3 is a reserved section.

Subchapter 5 contains general requirements for licensure. N.J.A.C. 13:37-5.1 requires that a person engaging in the practice of nursing hold a current license. N.J.A.C. 13:37-5.2 requires licensees to renew licenses biennially and describes renewal options and the renewal process.

N.J.A.C. 13:37-5.3 requires licensees to complete 30 hours of continuing education every biennial renewal period. The rule sets forth the various methods by which licensees may complete continuing education hours and how licensees are required to document completion of hours. The Board may waive continuing education requirements for reasons of hardship. Subsection (j) provides a time frame for implementing continuing education requirements. Full implementation of this requirement began with the 2009 renewal. As this implementation date has passed, the Board proposes to delete subsection (j).

N.J.A.C. 13:37-5.4 is a reserved section. N.J.A.C. 13:37-5.5 sets forth the fees the Board charges. N.J.A.C. 13:37-5.6 states that licensees will be held to the standards required of 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 constitutes effective notice.

N.J.A.C. 13:37-5.8 requires licensees and certificants to report to the Board any incident or series of incidents that violates N.J.S.A. 45:11-23 et seq., N.J.A.C. 13:37 or N.J.A.C. 13:45C. N.J.A.C. 13:37-5.9 requires a licensee or certificant to self-report to the Board if the licensee is incapable of discharging the functions of a licensee or if certain events occur calling the licensee's competence into question. 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 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, including nursing tasks delegated to licensed practical nurses or ancillary nursing personnel. 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. N.J.A.C. 13:37-6.4 requires licensees and certificants to wear an identification tag while practicing unless a licensee or certificant can show a risk to his or her safety or a substantial invasion of privacy and requests a waiver of this requirement from the Board.

Subchapter 7 deals with the certification and practice of advanced practice nurses. N.J.A.C. 13:37-7.1 sets forth the application process for certification as an advanced practice nurse. N.J.A.C. 13:37-7.2 sets forth the educational requirements for certification.

N.J.A.C. 13:37-7.3 allows individuals who have not yet passed the certification examination to apply to the Board for a work permit letter, which allows an applicant to work as an applicant advanced practice nurse. An applicant advanced practice nurse is not permitted to engage in prescriptive practice. N.J.A.C. 13:37-7.4 requires applicants to pass an advance practice examination in his or her area of specialization.

N.J.A.C. 13:37-7.5 imposes standards for an individual seeking certification as an advanced practice nurse specializing in anesthesia. These standards apply to any individual who does not possess a master's degree and who is seeking certification prior to June 16, 2009. As the deadline for complying with this rule has passed, the Board is proposing to repeal this rule. N.J.A.C. 13:37-7.6 allows advanced practice nurses who are certified in another state to obtain certification in New Jersey without examination.

N.J.A.C. 13:37-7.7 requires advanced practice nurses to renew certification biennially and to show that they are currently certified by a national certifying agency; it also describes renewal options and the renewal process. N.J.A.C. 13:37-7.8 requires advanced practice nurses to complete, every biennial period, the continuing education required for renewal of registered professional nurse licensure and the continuing education requirements of their national certifying agency. Subsections (b) and (c) require every advanced practice nurse to complete six contact hours in pharmacology related to controlled dangerous substances by June 16, 2009. As this deadline has passed, the Board proposes to delete subsections (b) and (c).

N.J.A.C. 13:37-7.9 sets forth standards for advanced practice nurse prescriptive practice. N.J.A.C. 13:37-7.10 sets forth standards and procedures to be followed by advanced practice nurses who dispense prescription medications.

N.J.A.C. 13:37-7.11 clarifies that none of the statutes or rules regarding advanced practice nurses prevent an individual licensed as a registered professional nurse from practicing nursing. 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.

Subchapter 9 deals with the forensic nurse-certified sexual assault program. 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, which are reviewed by the Board and the Director of the Division of Criminal Justice. Subsection (b) refers to individuals who completed an education program prior to July 13, 2004. Since any applicant who completed the program prior to this date would have already obtained certification, this provision is not necessary and the Board proposes to delete subsection (b).

N.J.A.C. 13:37-9.4 is reserved. N.J.A.C. 13:37-9.5 provides for applications for FN-CSA education programs, which will be reviewed by the Board and the Director.

N.J.A.C. 13:37-9.6 sets forth the clinical education requirements for applicants for a FN-CSA. Subsection (d) refers to individuals who attended to five victims of sexual assault as part of a county program prior to July 13, 2004. Since any applicant who was part of a county program prior to this date would have already obtained certification, this provision is not necessary and the Board proposes to delete subsection (d). N.J.A.C. 13:37-9.7 sets forth requirements for clinical education facilities.

N.J.A.C. 13:37-9.8 requires certificants to renew certification every two years. N.J.A.C. 13:37-9.9 sets forth the circumstances under which the Board and the Director of the Division of Criminal Justice may revoke or suspend certification. N.J.A.C. 13:37-9.10 provides for certification by endorsement for an FN-CSA who is certified in another state.

Subchapters 10, 11 and 12 are reserved.

Subchapter 13 deals with nurse anesthetists. N.J.A.C. 13:37-13.1 sets forth standards for nurse anesthetist practice. N.J.A.C. 13:37-13.2 permits [page=1483] a nurse anesthetist to practice prior to receiving the results of the certifying examination. Both of these rules expired on June 16, 2009 and the practice of nurses specializing in anesthesia is now governed by the rules regarding advanced practice nurses in Subchapter 7. The Board proposes to repeal Subchapter 13. The Board points out that repealing this subchapter does not affect the standards that advanced practice nurses specializing in anesthesia are currently required to comply with.

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. 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. 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 minimum of a bachelor's degree in nursing and at least 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. 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. 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 authorizes 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.

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. P.L. 2007, c. 37 created a new Massage and Bodywork Therapy Board. This act will become effective once this Massage and Bodywork Therapy Board has adopted rules. Once those rules are adopted, and the new act is effective, the Board will no longer have authority over massage, bodywork and somatic therapists and the rules in Subchapter 16 will be repealed.

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 is reserved. 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 other 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. A certificant who does not renew within 30 days of the expiration of the certificate shall be suspended without a hearing. Renewal applications provide certificants with the option of renewing as inactive. 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. The rule also sets forth practices that are prohibited for certificants.

N.J.A.C. 13:37-16.8 sets forth infection control precautions with which certificants must comply. 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 requires certificants to complete 20 credit hours of continuing education related to the practice of massage, bodywork and somatic therapy every biennial renewal period. N.J.A.C. 13:37-16.12 prohibits certificants 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 may not engage in sexual harassment or 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.

N.J.A.C. 13:37-16.13 allows certificants to provide information to the public by advertising in print or electronic media. N.J.A.C. 13:37-16.14 requires certificants to maintain client records, which reflect the services rendered to the client. 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 notice of proposal shall be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this notice 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 impose specific requirements on graduates of foreign nursing programs; these requirements ensure 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 licensing nurses by endorsement. 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. Licensees must report any incident that they believe violates the Nurse Practice Act or Board rules. Such reporting will advise the Board of inappropriate [page=1484] 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 also sets forth standards for joint protocols between advanced practice nurses and collaborating physicians, ensuring that these nurses are prescribing medications in a safe and effective manner. The subchapter also requires licensees to wear identification tags so that patients can identify the individuals who are providing nursing services.

Subchapter 7 sets out the standards for the practice and education of advanced practice nurses. Generally these rules benefit the public as they ensure that practitioners have the knowledge and skills necessary to perform advanced nursing tasks. The rules require that advanced practice nurses prescribe medications in accordance with the Nurse Practice Act, Board rules and the written protocols developed by the nurse and the collaborating physician. This ensures that, when an advanced practice nurse 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. The rules provide for the proper preparation of nurses who provide forensic sexual assault examinations. 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. These rules allow consumers 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 the Board. The rules require certificants to adhere to 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. Institutions are 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. The costs imposed by these various requirements are not easily identified. They depend mainly on the fees paid to faculty and staff, or outside consultants, who develop the required documents and policies. While the Board is not able to identify the cost imposed, it believes that these costs are significant. Whatever the costs may be, they are outweighed by the benefit of ensuring that nurse education programs are sufficiently prepared to educate students to safely and effectively practice nursing, protecting the safety of patients.

Subchapter 2 imposes costs on applicants for licensure. An applicant is required to complete a nursing education and to take either the NCLEX-RN or NCLEX-PN. The cost of completing an education varies greatly, depending on the tuition charged by the school an applicant attends and the length of the program. An examination costs $ 200.00. These costs are outweighed by the benefit of ensuring that licensees are adequately prepared to safely and effectively practice nursing.

An applicant must take a remediation course before retaking the NCLEX if he or she has failed the NCLEX three times. Remediation courses can be expensive, up to $ 1,500. The cost of these courses is outweighed by the benefit an applicant receives from being adequately prepared to pass the licensing examination. This preparation will help to avoid the costs involved with continuously retaking the examination because he or she is not adequately prepared.

N.J.A.C. 13:37-2.3 imposes costs on applicants from foreign nursing programs. These applicants must submit a transcript review performed by the Commission on Graduates of Foreign Nursing Schools (CGFNS) 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. The cost of a CGFNS review is $ 385.00. The cost of taking courses that cover areas of insufficient education can vary greatly, depending on the school at which they are taken, but can be as high as $ 1,500. These costs are outweighed by the benefit of ensuring that applicants who are educated in another country have received an education that is equivalent to one received in this country.

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 obtaining verification from another state is low, ranging from $ 10.00 to $ 25.00. This cost is outweighed by the benefit of the Board being aware of the licensure status of a nurse who is applying for licensure in New Jersey.

N.J.A.C. 13:37-5.2 imposes costs, consisting of past due license renewal fees and a reinstatement fee, on licensees who let their licenses lapse. If such licensees have lapsed licenses for more than five years, they are also required to retake the licensing examinations. These costs are imposed pursuant to N.J.S.A. 45:1-7.2.

N.J.A.C. 13:37-5.3 requires licensees to take continuing education courses. The costs of these courses are set by the sponsors who offer them. The Board believes that the costs licensees incur in completing these courses are outweighed by the benefits licensees, and patients who receive nursing services from these licensees, receive from continuously updating their competency through education.

N.J.A.C. 13:37-5.5 sets forth the fees that 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 nominal, mainly the cost of mailing, and is outweighed by the benefit of the Board knowing how to contact licensees.

N.J.A.C. 13:37-6.3 has an economic impact in that the rule requires advanced practice nurses to draft a joint protocol. The costs of drafting this protocol are borne by advanced practice nurses and their collaborating physicians. These costs are an opportunity cost associated with time spent drafting joint protocols that could be spent in other endeavors. It is difficult to specifically identify the dollar amount of these costs as they depend on the salaries of the respective practitioners and the other tasks that they may be foregoing to draft the protocol. The benefit of ensuring that an advanced practice nurse is engaged in safe and effective prescriptive practice outweighs this cost.

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 Board does not know exactly what it costs to obtain such an identification tag, but believes that this cost is less than $ 10.00 per identification tag. The low costs imposed by this requirement are outweighed by the benefit patients receive from being able to identify the name and licensure status of the individuals providing nursing services.

Subchapter 7 imposes costs on applicants for certification as advanced practice nurses. An applicant must graduate from a master's level program in advanced practice nursing, complete a pharmacology course, pass an examination offered by a certification agency and hold current certification from a certification agency. The costs of these courses vary greatly depending on the school, some can be as high as $ 60,000 or more. Examination and certification costs also vary depending on the entity providing the examination and certification; examination costs can be $ 725.00 or higher and certification costs can be $ 500.00 or higher. These costs are outweighed by the benefits of ensuring that advanced practice nurses are adequately prepared to safely and effectively practice in New Jersey.

[page=1485] The Subchapter also imposes costs on nurses who have been certified as advanced practice nurses. N.J.A.C. 13:37-7.7 imposes costs on advance practice nurses who let their certification lapse in that such advanced practice nurses are required to pay past due certification renewal fees and a reinstatement fee. If such advanced practice nurses have allowed their certifications to lapse for more than five years, they are also required to retake the certification examination. These costs are imposed pursuant to N.J.S.A. 45:1-7.2. N.J.A.C. 13:37-7.8 requires advanced practice nurses to complete the continuing education required by national certifying agencies. The costs of these courses are set by the sponsors who offer them. The Board believes that the costs advanced practice nurses incur in completing these courses is outweighed by the benefits advanced practice nurses, and patients who receive nursing services from these advanced practice nurses, receive from continuously updating their competency through education.

Subchapter 9 imposes costs on applicants for certification as forensic nurse-certified sexual assault. Applicants for certification are required to take an education course and complete clinical hours. The cost of completing these courses and the clinical hours vary depending on the entity that is providing the course, some can be as high as $ 16,000. The costs of the course and clinical hours are outweighed by the benefit of ensuring that nurses who are performing sexual assault examinations and testifying in court as to their findings are adequately prepared.

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 costs of equipping classrooms and laboratories vary greatly depending on the quality of the equipment and whether it is purchased new or used. These costs are outweighed by the benefit of ensuring that homemaker-home health aides are adequately prepared to provide services to clients. The cost of submitting documents to the Board is nominal and mostly constitutes mailing costs and opportunity costs associated with time spent preparing documents that could be spent in other endeavors. These costs are outweighed by the benefit of the Board having accurate information as to the programs that are educating homemaker-home health aides. The cost of hiring faculty depends on prevailing rates for teachers and registered professional nurses and what the program sponsors determine the program is able to pay staff. These costs are outweighed by the benefit of homemaker-home health aide education programs having adequate staff to provide students with the education they need to safely and effectively practice as homemaker-home health aides.

The subchapter also imposes costs on certificants who must recertify biennially with the Board and pay the fee set out in N.J.A.C. 13:37-5.5. These fees are charged in order for the Board to be self-funding and in compliance with N.J.S.A. 45:1-3.2.

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 be imposed only 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 an education can range from $ 5,000 to over $ 15,000. There are two examinations for certification; they cost either $ 225.00 or $ 400.00. The education and examination costs are outweighed by the benefits of ensuring that applicants are adequately prepared to safely and effectively practice massage, bodywork and somatic therapy. N.J.A.C. 13:37-16.6 requires certificants to recertify biennially with the Board and pay the fee set out in N.J.A.C. 13:37-5.5. These fees are charged 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. 13:37-16.8 sets forth infection control precaution requirements. The cost of complying with these requirements will be borne by certificants. The costs of complying with these requirements consist mainly of buying cleaning and disinfecting products. These costs are nominal and are outweighed by the benefit of ensuring that the equipment used by certificants is properly cleaned and disinfected. N.J.A.C. 13:37-16.11 requires certificants to complete continuing education courses every biennial renewal period. The costs of these courses are set by the sponsors who offer them. The Board believes that the costs certificants incur in completing these courses is outweighed by the benefits certificants, and the consumers who receive massage, bodywork and somatic therapy services from these certificants, receive from continuously updating their competency through education.

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 does not believe that the rules proposed for readoption with amendments will increase or decrease the number of jobs in New Jersey.

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

Since the registered professional nurses, licensed practical nurses, advanced practice nurses, forensic nurses-certified sexual assault, homemaker-home health aides and massage, bodywork and somatic therapists licensed or certified by the Board are individually licensed or certified by the Board, under the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., they may be considered "small businesses" for the purposes of the Act.

The costs imposed by the rules proposed for readoption with amendments are the same for all licensees and certificants as set forth above in the Economic Impact statement. The Board does not believe that licensees and certificants 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 imposes compliance, reporting and recordkeeping requirements as detailed in the Summary above.

As the compliance, reporting and recordkeeping requirements contained in the rules proposed for readoption with amendments 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 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.

Housing Affordability Impact

The rules proposed for readoption with amendments will have an insignificant impact on affordable housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the rules concern the regulation of registered professional nurses, licensed practical nurses, advanced practice nurses, forensic nurses-certified sexual assault, homemaker-home health aides and massage, bodywork and somatic therapists.

Smart Growth Development Impact

The rules proposed for readoption with amendments will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules would evoke a change in housing production in Planning Areas 1 or 2 or within designated centers under the State Development and Redevelopment Plan in New Jersey because the rules concern the regulation of registered professional nurses, licensed practical nurses, advanced practice nurses, forensic nurses-certified sexual assault, homemaker-home health aides and massage, bodywork and somatic therapists.

[page=1486] Full text of the rules proposed for readoption may be found in the New Jersey Administrative Code N.J.A.C. 13:37.

Full text of the rules proposed for repeal may be found in the New Jersey Administrative Code at N.J.A.C. 13:37-7.5 and 13.

Full text of the proposed amendments follows (additions indicated in boldface thus ; deletions indicated in brackets [thus]):

SUBCHAPTER 2. LICENSURE BY EXAMINATION; REGISTERED PROFESSIONAL AND LICENSED PRACTICAL NURSES

13:37-2.2 Application requirements; professional and practical nurses

(a) Each applicant for licensure shall file with the Board:

1.-2. (No change.)

3. A written certification from the registrar, or program administrator authorized by the registrar, attesting that the applicant has successfully completed all requirements for graduation from a [Board-accredited] registered professional nursing program accredited by the Board or a board of nursing in another state or a [Board-accredited] licensed practical nursing program accredited by the Board or by a board of nursing in another state . The certification shall indicate the date of graduation or the date the degree or diploma was conferred.

SUBCHAPTER 5. GENERAL REQUIREMENTS OF LICENSURE; LICENSE RENEWAL; FEE SCHEDULE

13:37-5.3 Continuing education

(a)-(i) (No change.)

[(j) Registered professional nurses and licensed practical nurses whose licenses expire on May 31, 2006 shall comply with the requirements of (a) through (e) above commencing with the 2008 renewal of licensure. Registered professional nurses and licensed practical nurses whose licenses expire on May 31, 2007 shall comply with the requirements of (a) through (i) above commencing with the 2009 renewal of licensure.]

SUBCHAPTER 7. CERTIFICATION OF ADVANCED PRACTICE NURSES

13:37-7.5 (Reserved)

13:37-7.8 Continuing education

[(a)] Every biennial period, an advanced practice nurse shall complete the continuing education required for the renewal of a registered professional nurse license pursuant to N.J.A.C. 13:37-5.3 and the continuing education requirements of the national certifying agency whose examination the advanced practice nurse successfully passed pursuant to N.J.A.C. 13:37-7.4 or 7.5.

[(b) By June 16, 2009, every advanced practice nurse shall have completed six contact hours in pharmacology related to controlled dangerous substances, including pharmacologic therapy and addiction prevention and management, presented by:

1. An organization that has been approved by a credentialing agency accredited by the National Commission for Certifying Agencies; or

2. A college or university licensed by either the New Jersey Commission on Higher Education or an agency of another state with requirements substantially similar to the requirements of the New Jersey Commission on Higher Education.

(c) Upon completing the six contact hours in pharmacology related to controlled dangerous substances as required by (b) above, an advanced practice nurse shall submit to the Board a certificate of completion issued by the organization, college or university that provided the contact hours indicating that he or she has completed the hours.]

SUBCHAPTER 9. FORENSIC NURSE - CERTIFIED SEXUAL ASSAULT PROGRAM

13:37-9.3 Application for certification

(a) (No change.)

[(b) An applicant who attended a 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 FN-CSA education course he or she completed would have met the requirements of N.J.A.C. 13:37-9.5.]

Recodify existing (c) and (d) as (b) and (c) (No change in text.)

13:37-9.6 Clinical education

(a)-(c) (No change.)

[(d) An individual who attended to five victims of sexual assault as part of a county 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.]

   
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