Program Branch State Board of Nursing
Section 10 – Licensing
State Board of Nursing Nursing Board Policies
Policy 10-01 Exit program requirements ........................................................................................................... 3 Policy 10-02 Exemptions for former nurse lay midwives returning to the practice of nursing ................ 4 Policy 10-03 Continued competency requirements for practical and professional nurses ........................ 5 Policy 10-04 Minimum recommended documentation for applicants for licensure by examination following revocation or surrender of license due to substance abuse issues ........................ 7 Policy 10-05 English competency requirements for licensure as a professional or practical nurse ......... 8 Policy 10-06 Continuing competency requirements for psychiatric technicians ........................................ 9 Policy 10-07 (Formerly 60-01) Clarification of the 4 month statutory certification exemption and the term “denied” pertaining to CNAs ...........................................................................................11 Policy 10-08 Delegated authority related to licensing ................................................................................ 12 Policy 10-09 Streamlining Certified Nurse Aide (CNA) credentials for veterans............................................ 14 Policy 10-10 Streamlining Licensed Practical Nurse (LPN) credentials for veterans .............................. 15 Policy 10-11 License employment designations ............................................................................................ 17 Policy 10-12 Streamlining Registered Nurse (RN) credentials for veterans .............................. 18 Policy 10-13 Streamlining Certified Nurse Aide-Medication Aide Authority (CAN-MA) credential for veterans ............................................................................ 20 Policy 10-14 Streamlining Licensed Psychiatric Technician (LPT) credentials for veterans ............22 Section 20 – Enforcement Policy 20-01 Patient abandonment ................................................................................................................. 24 Policy 20-02 Delegated authority to expand an investigation.................................................................... 25 Policy 20-03 Complaints against individuals practicing with RXW a license ............................................... 26 Policy 20-04 Definition of diverting controlled substances ......................................................................... 27 Policy 20-05 Extensions of time to respond to a complaint ....................................................................... 28 Policy 20-06 Delegated authority in relation to enforcement ................................................................... 29 Policy 20-07 Practicing on an expired license or certificate ...................................................................... 31 Policy 20-10 Anonymous complaints ............................................................................................................... 32 Policy 20-11 Enforcement of injunctive actions ........................................................................................... 33 Policy 20-13 Authorization to accept a surrender of a license or certificate .......................................... 34 Policy 20-14 Minimum qualifications for nurses performing oversight of probationary licensees ........ 35 Policy 20-15 Delegation of authority regarding monitoring of licensees .................................................. 36 Policy 20-16 Urine drug and alcohol testing policy ....................................................................................... 37 Policy 20-17 Compliance with probationary reporting requirements ........................................................ 40 Policy 20-18 Selection of evaluators .............................................................................................................. 41 Policy 20-19 Public disciplinary documents .................................................................................................... 43 Policy 20-20 Reporting requirements .............................................................................................................. 44 Policy 20-21 Non-public participation – peer health assistance or alternative to discipline program.................................................................................................46
1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800
F 303.894.7693 www.dora.colorado.gov/professions
Policy 20-22 Delegation of authority to PD for violations involving expiration ......................................... 47 Policy 20-23 Cases dismissed with letters of concern ................................................................................... 48 Policy 20-24 Process for handling complaints involving board or advisory committee members ........... 49 Policy 20-25 Requirements for evaluation reports ......................................................................................... 50 Policy 20-26 Impairment while on duty ............................................................................................................ 51 Policy 20-27 Board actions to protect the public from drug diversion by a licensed nurse ................ 52 Section 30 – Authorities/Scope of Practice Policy 30-01 IV certification by endorsement for LPN or LVN ................................................ 53 Policy 30-04 Orders from other healthcare practitioners (conduit theory) ............................... 54 Policy 30-05 Prescriptive authority articulated plan compliance and audit process .............................. 55 Policy 30-06 Determination of death .............................................................................................................. 56 Policy 30-07 Voluntary withdrawal of advanced practice registry, prescriptive, and IV authorities ...57 Policy 30-09 Telenursing ................................................................................................................................... 58 Policy 30-10 Policy for prescribing and dispensing opioids ......................................................................... 59 Section 40 – Administration Policy 40-01 Delegated authority to order summary suspension, interim cessation, mental physical examination ........................................................................................................................................................ 72 Policy 40-03 Consideration of ALJ initial decisions ...................................................................................... 73 Policy 40-04 Subpoena enforcement............................................................................................................... 74 Policy 40-05 Personal appearances before the full board, panels, or advisory committee .................. 75 Policy 40-06 Nurse aide advisory committee authority and purpose ........................................................ 76 Policy 40-07 Applicants who wish to serve on the nurse aide advisory committee........................77 Policy 40-08 Composition and terms for the nurse aide advisory committee members ........................ 78 Policy 40-09 Mediation ...................................................................................................................................... 79 Policy 40-10 Designation of complementary rules and regulations ........................................................... 80 Policy 40-11 Release of active complaint and investigatory information ................................................ 81 Policy 40-12 Release of investigatory information to governmental and law enforcement agencies ..82 Policy 40-13 Guidelines regarding practice coverage outside of normal office hours ............................ 83 Section 50 – Multi-State Licensure (Nurse Compact) Policy 50-03 Clarification of establishment of residency in Colorado ....................................................... 85 Section 60 - Miscellaneous Policy 60-02 Nursing student extern ............................................................................................................... 86 Policy 60-03 Nurse aide training program pass rates............................................................87 Policy 60-04 Calculation of full time to part time faculty for nursing education programs .................. 89 Policy 60-05 Further clarification of the definition of nursing education program ................................ 90 Policy 60-06 Faculty waiver submission for nursing education programs ................................................. 91 Policy 60-07 Ratio of faculty to student in professional and practice nursing education programs ....93 Policy 60-08 Clinical simulation laboratory experience evaluation and faculty competency ................ 94 Policy 60-09 Submission of educational material for board consideration .............................................. 95
1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800
F 303.894.7693 www.dora.colorado.gov/professions
Nursing Board Policy POLICY NUMBER:
10-01
Title:
Exit Program Requirements
Date Issued:
November 1993
Date(s) Reviewed
March 1998, May 2002, October 2006, January 2007, July 2011 (revised)
References:
Sections 12-38-108(1)(a) and 12-38-112(1)(b), C.R.S.
Purpose:
Define exit program requirements to qualify for NCLEX-PN.
POLICY: An exit program is a course of study in an approved professional nursing education program approved by the State Board of Nursing leading to a diploma or certificate of completion in practical nursing. A graduate is an individual who has successfully completed all requirements of an approved nursing program. All graduates must submit an official transcript documenting the date the diploma or certificate was conferred. It is noted that individuals who have not officially completed an approved program appropriate to their level of licensure may not be accepted by other state boards of nursing for license endorsement.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
10-02 Exemptions for former nurse lay midwives returning to the practice of nursing November 2002 January 2007 (revised); October 2007 (revised) C.R.S. 12-37-101(1); 12-38-108(1)(b)(I) To facilitate the review and approval of applications from lay midwives who seek licensure.
POLICY: The Board of Nursing has determined that applicants for licensure who relinquished their professional or practical nursing license solely in order to practice as lay midwives, as required by C.R.S. 12-37-101(1), shall not be required to retake the licensure examination if the applicant:
Has not engaged in any conduct or behavior that would constitute a violation of 12-38117 or 12-37-107(3). Meets all qualifications for licensure. Has established competency in accordance with Board of Nursing Policy 10-03.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
10-03 Continued Competency Requirements for Practical and Professional Nurses August 23, 2006 January 2007 (revised); October 2007 (revised); July 2008 (revised); January 2009 (revised); October 2009; April 2012 (revised); October 2013 (revised) Sections12-38-108(b),12-38-118.5 and 24-34-102(8)(d)(II)(A),(C) and (D),C.R.S. To provide a procedure for applicants for reinstatement, reactivation or endorsement whose license has been expired or inactive for more than two years to demonstrate competency prior to reinstatement or issuance of an active license.
POLICY: An individual whose professional or practical nursing license has been inactive or expired for more than two years or who has not demonstrated use of nursing skills and knowledge for the two year period preceding application for reactivation, reinstatement or endorsement, must demonstrate competency. The Program Director or designee may accept proof of competency in one of the following ways, or may refer any case to an Inquiry Panel: 1. Demonstration of the active practice of nursing in another state, federal facility, or U.S. territory during the two years immediately preceding the filing of the reinstatement, reactivation or endorsement application. If the applicant has practiced nursing only for a portion of the two year period immediately preceding the filing of the application, the Board may determine on a case by case basis, in its discretion, whether the applicant has adequately demonstrated continued competency to practice professional or practical nursing; or 2. Successful completion of remedial or refresher courses under a restricted license as defined in A, B and C below. "Successfully complete" means achieving a grade of "C" or better or the equivalent in each course. A. The refresher courses must have medical/surgical focus, must clearly differentiate knowledge and skill level for RNs and LPNs, and have the following minimum content: 1. Physical Assessment, history-taking, documentation and health information technologies; 2. Pharmacology, Medication Administration and IV Therapy; 3. Nursing knowledge and skills update based on best evidence; and 4. Legal, ethical and professional issues. B. The number of successfully completed contact hours required of each individual to demonstrate competency prior to reinstatement, reactivation or licensure by endorsement will be determined by the number of years that his or her license has been inactive or expired, as follows:
2-5 years
Contact Hours:
80 Theory (including lab) and 80 Clinical
6-10 years
Contact Hours:
120 Theory (including lab) and 120 Clinical
More than 10 yrs.
Contact Hours:
120 Theory (including lab) and 120 Clinical; and possible additional hours as determined by the Board on a case-by-case basis.
C. If an applicant for reinstatement, reactivation or endorsement enrolls in a remedial or refresher course that is nontraditional, i.e., a course that does not include a facultysupervised teaching/learning component in clinical settings taught concurrently with theoretical content, the required clinical hours must occur in acute care or sub-acute care settings, skilled nursing facilities, or other site(s) as approved by the Board. 3.
Upon a petition by the licensee, and with due consideration of the need to protect the public, the Board may accept an alternative method for establishing competency. It is anticipated that such alternative methods for establishing competency would be rarely used. The decision to accept an alternative method for establishing competency shall be at the sole discretion of the Board.
Nursing Board Policy POLICY NUMBER: 10-04 Title: Minimum recommended documentation for applicants for licensure by examination following revocation or surrender of license due to substance abuse issues. Date Issued: January, 2007 Date(s) Reviewed: April 22, 2009 References: C.R.S 12-38-111, 112 & 113(1) Purpose:
To provide clear direction for recommended documentation for application submission following revocation or surrender of nursing license due to substance abuse issues.
POLICY: Prior to the processing of any application for licensure of an individual whose license was previously revoked or surrendered due to drug or alcohol usage, it is the policy of the Board of Nursing that the Program Director or designee may request the following items: Written confirmation from the individual detailing o the individual’s willingness to participate in the Nurse Peer Health Assistance or Alternative to Discipline program; o a description of any current recovery program, o a current relapse prevention plan, and o information about the current use of any controlled substances prescribed for any physical or mental condition.
Copies of all police/court documents pertaining to any criminal convictions/guilty pleas or pending matters, including, if applicable, the individual’s current status with the courts; a letter from the individual’s probation/parole officer regarding her/his compliance with court requirements; and a statement from the individual explaining the behavior that resulted in the courts’ involvement.
Evidence of enrollment in, participation in and/or completion of any residential, inpatient or outpatient treatment for chemical dependency.
Evidence of continuing competency in the practice of nursing.
If applicable, a Health Care Provider Form, completed by the individual’s health care provider, explaining the need for the current use of any prescribed controlled substances and the plan for discontinuing the use of controlled substances.
Within twelve (12) consecutive months immediately preceding application, the applicant must show evidence of sobriety as follows:: o Results of weekly, random negative urine drug screens, to include ETG testing collected and tested pursuant to the Board’s Urine Drug and Alcohol Screening Policy (20-16) o Results of weekly, random negative breathalyzers, when ETG testing is not available; o Written confirmation of completion of twelve (12) consecutive months of weekly attendance at 12 step meetings immediately preceding application. o Written confirmation of regularly scheduled treatment for substance abuse issues by a qualified licensed health care professional. (See Board Policy 20-18)
Any application submitted without the above listed minimum recommended documentation will be considered incomplete and will be placed on the Board’s agenda only after all documents are received. The Board may require additional documentation in its consideration of an application. Submission of all of the requested documentation does not assure licensure. Link to Template forms
Nursing Board Policy POLICY NUMBER: Title:
10-05
English Competency Requirements for Licensure as a Professional or Practical Nurse Date Issued: October 2007 Date(s) Reviewed: April 23, 2008 (revised); July 30, 2008 (revised) References: §§12-38-111 and 12-38-112, C.R.S. Purpose: To provide nationally accepted guidelines for English proficiency prior to licensure in Colorado as a professional or practical nurse
POLICY: A foreign educated applicant from a non-English speaking country or a non-English speaking institution or not educated in English must submit proof of English competency requirements as established by the U.S. Department of Education and health and Human Services and required by the Department of Homeland Security. All non-exempt applicants are required to have the Commission on Graduates of Foreign Nursing Schools (CGFNS) English Language Proficiency Report to accompany their CES Healthcare Profession and Science Report. The passing score per profession and definition of exempt applicants can be accessed through the CGFNS website: http://www.cgfns.org under the VisaScreen link in the VisaScreen requirements link.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
10-06 Continuing Competency Requirements for Psychiatric Technicians April 23, 2008
12-38-108(b), C.R.S; 24-34-102(8)(d)(II)(A),(C) and (D), C.R.S.; 12-42112(3), C.R.S. To provide a procedure for applicants for reinstatement whose license has been expired for more than two years to demonstrate competency prior to reinstatement of an active license and to clarify the requirements to reactivate a license that has been inactive for more than five years.
POLICY: The policy of the Board of Nursing is as follows: A. An individual whose psychiatric technician license has been expired for more than two years must demonstrate competency prior to reactivation of the license. 1. If the license has been expired for more than two years and less than five years, the Program Director or designee may accept proof of competency in one of the following ways, or may refer any case to the Board: a. Demonstration of active practice as a licensed psychiatric technician in another state, federal facility, or U.S. territory during the two years immediately preceding the filing of the reinstatement application. If the applicant has practiced nursing only for a portion of the two year period immediately preceding the filing of the application, the Board may determine on a case by case basis, in its discretion, whether the applicant has adequately demonstrated continued competency to practice as a psychiatric technician; or b. Evidence that the applicant has retaken and passed the Colorado state licensing examination for psychiatric technicians. 2. If the license has been expired for more than five years, the Program Director or designee may accept proof of competency in one of the following ways, or may refer any case to the Board. a. Demonstration of active practice as a licensed psychiatric technician in another state, federal facility, or U.S. territory during the two years immediately preceding the filing of the reinstatement application. If the applicant has practiced nursing only for a portion of the two year period immediately preceding the filing of the application, the Board may determine on a case by case basis, in its discretion, whether the applicant has adequately demonstrated continued competency to practice as a psychiatric technician; or b. Evidence that the applicant has reentered and successfully completed an accredited psychiatric technician educational program and has retaken and passed the Colorado state licensing examination for psychiatric technicians.
B. Upon a petition by the licensee, and with due consideration of the need to protect the public, the Board may accept an alternative method for establishing competency. It is anticipated that such alternative methods for establishing competency would be rarely used. The decision to accept an alternative method for establishing competency shall be at the sole discretion of the Board. C. If an applicant is applying to reactivate an inactive psychiatric technician license and the license has been inactive for more than five years, the applicant must comply with the requirements of section 12-42-112(3), C.R.S. Specifically, the applicant must comply with all of the statutory provisions related to the issuance of an original license including but not limited to, reentering and successfully completing an accredited psychiatric technician educational program and retaking and passing the Colorado state licensing examination for psychiatric technicians. The applicant must also comply with all other statutory provisions required of a new applicant for licensure.
Nursing Board Policy POLICY NUMBER: Title:
10-07 (Formerly 60-01)
Clarification of the four (4) month statutory certification exemption and the term “denied” as used in section 12-38.1-117(1)(d), C.R.S. pertaining to Certified Nurse Aides Date Issued: January 2007 Date(s) Reviewed: July 2008 (revised) References: §12-38.1-117(1)(d), C.R.S.; 42 C.F.R. §483.75(2) 2006 Purpose: To provide guidance to employers and nurse aide students
POLICY: As used in section 12-38.1-117(1)(d), C.R.S. “A person who is directly employed by a medical facility while acting within the scope and course of such employment for the first four months of such person’s employment at such medical facility if such person is pursuing initial certification as a nurse aide. A person may utilize this exclusion only once in any twelve-month period. This exclusion shall not apply to any person who has allowed his or her certification to lapse, had his or her certification as a nurse aide suspended or revoked, or had his or her application for such certification denied.” The State Board of Nursing (“Board”) hereby clarifies that the definition of a “denied” applicant for nurse aide certification as anyone who has either applied for certification but not successfully passed all testing requirements or has otherwise not completed the requirements for certification as a nurse aide. Therefore, a denied applicant may not work as a nurse aide longer than the initial four consecutive months of employment following graduation from his or her approved nurse aide training program. As further clarification, the Board specifies the following: 1. The four (4) month employment period begins on the date of first hire after graduation from an approved nurse aide training program and is consecutive and may not be divided. This four (4) month employment period must occur within the first twelve (12) months following successful completion of an approved nurse aide training program. 2. Applicants applying for original certification in Colorado who hold or have ever held certification as a nurse aide in any other U.S. state or territory, may not utilize the four (4) month exemption period as set forth in §12-38.1-117(1)(d), C.R.S., and may only begin practicing as set forth in the application for original license by endorsement. 3. An applicant for certification as a nurse aide is considered “denied” if the applicant does not apply for or pass all testing requirements or has otherwise been denied.
POLICY NUMBER: Title: Date Issued: Date(s) Reviewed:
10-08 Delegated Authority Related to Licensing October 2012 January 2015; July 2017 (revised)
References: Purpose:
To clarify the authority delegated to the Program Director to assist the Board in carrying out its duties with regard to licensing.
POLICY: The Board of Nursing delegates to the Program Director, or designee, the authority to: 1. Review applications and applicant responses to screening questions and approve applications whose answers or additional information meet the internal staff guidelines as determined by the Board. Internal guidelines are subject to change. 2. Approve initial, endorsement, and reinstatement applications for Certified Nurse Aide (CNA) that meet the requirements of Sections 12-38.1-104 through 12-38.1-108, C.R.S. and Chapter 10 of the Board Rules. 3. Approve initial, endorsement, retired volunteer, reinstatement, and reactivation applications for Licensed Practical Nurse (LPN) that meet the requirements of Section 12-38-112, C.R.S. and Chapter 1 of the Board Rules. 4. Approve initial, endorsement, retired volunteer, reinstatement, and reactivation applications for Registered or Professional Nurse (RN) that meet the requirements of Section 12-38-111, C.R.S. and Chapter 1 of the Board Rules. 5. Approve initial, endorsement, and reinstatement applications for the Advanced Practice Registry (APN) that meet the requirements of Section 12-38-111.5, C.R.S. and Chapter 14 of the Board Rules. 6. Approve initial, endorsement, and reinstatement applications for prescriptive authority (RXN) that meet the requirements of Section 12-38-111.6, C.R.S and Chapter 15 of the Board Rules. 7. Approve initial, endorsement, and reinstatement applications for Licensed Psychiatric Technicians (LPT) that meet the requirements of Sections 12-42-105 through 12-42111, C.R.S. and Chapter 5 of the Board Rules. 8. Approve applications for temporary licenses and permits for practical or professional nurse (LPN) or (RN) that meet the requirements of Section 12-38-115, C.R.S. and Chapter 1 of the Board Rules. 9. Approve requests for inactive license status in those instances wherein there is no probable cause to believe that the nurse making the request has committed any of the acts set forth in Section 12-38-117, C.R.S. 10. Sign Suspension Orders as required by the Child Support Enforcement Program. 11. Terminate Orders of Suspension when the licensee has provided evidence of compliance with the Child Support Enforcement Program. 12. Utilize services of the Office of Investigations as warranted to carry out duties of the Board. 13. Perform additional delegated duties as set forth in other Board policies. Adopted: October 24, 2012 Effective: December 1, 2012 Revised: January 27, 2015 Revised Effective: July 26, 2017
Colorado Board of Nursing Policy POLICY NUMBER: 10-09 Title: Streamlining Certified Nurse Aide (CNA) credentials for veterans. Date Issued: January 22, 2013; Revised April 26, 2017 Date(s) Reviewed: April 26, 2017 References: Colorado HB 16-1197; State Board of Nursing Rules and Regulations, Chapter 1; CRS 24-34-102 (8.5). Purpose: To determine substantial equivalence for nurse aide training gained in military service and provide direction on certification, so as to fulfill HB 16-1197. ______________________________________________________________________ POLICY: Veterans with military training and education equivalent to nurse aide training may request the State Board of Nursing (Board) or its delegated appointee to evaluate submitted transcripts for educational equivalency. To qualify for CNA the applicant must meet the requirements outlined in Chapter 10 of the State Board of Nursing Rules and Regulations. Items 1-6 outline process requirements for this policy. 1. The Board delegates evaluation of veteran applications to the Program Director for the Board of Nursing, or the Deputy Division Director. The Board maintains final ratifying authority on all licensees. 2. Evaluate the extent to which veteran applicants meet CNA requirements listed below. i • Successful completion of a minimum 75 clock hours or 5 semester hours of coursework in basic nursing skills, to include safety and emergency procedures as well as 16 clock hours of clinical practicum. 3. Veteran applicants found to meet the CNA requirements must apply to the Board for Certified Nurse Aide-Certification by Examination ii and may mark eligibility as by military equivalence. 4. Veteran applicants found not to meet CNA requirements may be directed toward missing content found as listed below. iii • Colorado State Board of Nursing approved CNA training programs. • Colorado Community College System courses. • Independent and facility-based training programs. • Any other education programs found to have relevant courses. • Other areas if prescribed by the Board. 5. For reciprocity consideration, veteran applicants certified as CNA in other states are required to follow certification by endorsement, Board of Nursing, Chapter 10, Rules and Regulations for Certification of a Nurse Aide, Section 3. iv
6. A national exam is not utilized for competency evaluation at this time. v i
Fulfills Colorado HB 16-1197 requirement to “evaluate the extent to which military training meets all or part of the state requirements to be authorized to practice an occupation.” ii Fulfills Colorado HB 16-1197 requirement to “determine if an occupational exam is available to authorize a veteran to practice an occupation.” iii Fulfills Colorado HB 16-1197 requirement to “consult with Community Colleges and other postsecondary educational institutions with regard to a) courses or programs to cover the gap between military occupational specialty training and the training required to be authorized to practice an occupation, and b) refresher courses for the reinstatement of lapsed civilian credentials.” iv Fulfills Colorado HB 16-1197 requirement to “identify reciprocity mechanisms with other states.” v Fulfills Colorado HB 16-1197 requirement to “consider adopting a national credentialing exam.”
Colorado Board of Nursing Policy POLICY NUMBER: 10-10 Title: Streamlining Licensed Practical Nurse (LPN) credentials for veterans. Date Issued: January 22, 2013; Revised April 26, 2017 Date(s) Reviewed: April 26, 2017 References: Colorado HB 16-1197; State Board of Nursing Rules and Regulations, Chapter 1; CRS 24-34-102 (8.5). Purpose: To determine substantial equivalence for practical nursing education gained in military service and provide direction on licensure, so as to fulfill HB 16-1197. ______________________________________________________________________ POLICY: Veterans with military training and education equivalent to practical nursing education, as outlined in Chapter 2 of the State Board of Nursing Rules and Regulations, may request the State Board of Nursing (Board) or its designated appointee evaluate submitted transcripts for educational equivalency. To qualify for a LPN license, applicants must meet the requirements outlined in Chapter 1 of the State Board of Nursing Rules and Regulations. Items 1-6 outline process requirements for this policy. 1. The Board delegates evaluation of veteran applications to the Program Director for the Board of Nursing, or the Deputy Division Director. The Board maintains final ratifying authority on all licensees. 2. Evaluate the extent to which veteran applicants meet LPN requirements listed below. i • 300 clock hours of theory to include IV therapy, medical surgical nursing, pediatric nursing, obstetric nursing and psychiatric nursing in caring for stable patients with predictable outcomes. • 400 clock hours of supervised clinical to include IV therapy, medical surgical nursing, pediatric nursing, obstetric nursing and psychiatric nursing in caring for stable patients with predictable outcomes. • Apply standard equivalence of: • 1 semester hour of theory = 15 clock hours. • 1 semester hour of clinical = 45 clock hours. • Military job experience in clinical preforming the above tasks = 40 clock hours per week. 3. Veteran applicants found to meet the LPN requirements must apply to the Board for Licensed Practical Nurse-Original License by Examination. ii 4. Veteran applicants found not to meet LPN requirements may be directed toward missing content found as listed below. iii
• Course(s) from Colorado State Board of Nursing approved nursing education programs, particularly those programs within the Colorado Community College System; or any other education programs found to have relevant courses. • References from professional nurse supervisors detailing type, duration, and level of performance in clinical practice submitted as verification for missing clinical specialty practice and/or hours. • Completion of the Licensed Practical Nurse Competency to Practice Form under the Student Permit application to allow verification of practical nurse competency by a professional nurse supervisor/preceptor. • Other areas if prescribed by the Board. 5. For reciprocity consideration, veteran applicants licensed as LPN/LVN in other states or territories of the United States are required to follow original licensure by endorsement, Board of Nursing, Chapter 1, Rules and Regulations for Licensure of Practical and Professional Nurses. iv 6. The National Council State Boards of Nursing NCLEX-PN exam is available to all qualified applicants. v i
Fulfills Colorado HB 16-1197 requirement to “evaluate the extent to which military training meets all or part of the state requirements to be authorized to practice an occupation.” ii Fulfills Colorado HB 16-1197 requirement to “determine if an occupational exam is available to authorize a veteran to practice an occupation.” iii Fulfills Colorado HB 16-1197 requirement to “consult with Community Colleges and other postsecondary educational institutions with regard to a) courses or programs to cover the gap between military occupational specialty training and the training required to be authorized to practice an occupation, and b) refresher courses for the reinstatement of lapsed civilian credentials.” iv Fulfills Colorado HB 16-1197 requirement to “identify reciprocity mechanisms with other states.” v Fulfills Colorado HB 16-1197 requirement to “consider adopting a national credentialing exam.”
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
10-11 License/Employment Designations January 22, 2013 Sections 12-38-103(8) & (11); 12-38.1-102(3); and 12-38-117(w)(I) & (II), C.R.S. To clarify licensing requirements while employed in positions designated for alternate licensure types.
POLICY: Professional Nurses (RN) may be employed in a position designated for a practical nurse or nurse aide and Licensed Practical Nurses (LPN) may be employed in a position designated for a Nurse Aide. The Colorado Nurse Practice Act (NPA) and the State Board of Nursing Rules and Regulations do not preclude an RN from seeking employment in a position designated for a practical nurse or nurse aide, and do not preclude an LPN from seeking employment in a position designated for a nurse aide. An RN working in a position designated for a practical nurse or nurse aide is responsible and accountable to the higher level of education, skills, and abilities of their RN license. An LPN working in a position designated for a nurse aide is responsible and accountable to the higher level of education, skills, and abilities of their Practical Nurse license. The RN and/or LPN is responsible for limiting his or her practice to that of the designated position in which they are employed. If the individual is performing designated duties within their employment, separate licenses are not required. Under no circumstance should a licensed professional use a title of RN, LPN, or CNA unless the person is licensed or certified by the Board. The use of the title RN, LPN, or CNA is limited to those individuals appropriately licensed, certified or registered by the State Board of Nursing pursuant to Sections 12-38-103(8) & (11), 12-38.1-102(3), and 12-38-117(w)(I) & (II), C.R.S. The licensee or certificate holder is not required to inactivate or otherwise change their licensure status to be employed in a designated position that includes duties within the education, skills, and abilities of his or her license, registration, or certificate. An RN may not use or submit duties performed in a position designated for a practical nurse or nurse aide as hours toward continued competency as an RN. Similarly, an LPN may not use or submit duties performed in a position designated for a nurse aide as hours toward continued competency as an LPN. Any adverse actions that occur during the employment of the alternate designation may result in discipline on the professional license held by the RN and/or LPN. For an individual seeking additional license types, this policy does not negate the education, application, and examination requirements of any license, certification, or registration issued by the State Board of Nursing.
Colorado Board of Nursing Policy POLICY NUMBER: 10-12 Title: Streamlining Registered Nurse (RN) credentials for veterans. Date Issued: April 26, 2017 Date(s) Reviewed: References: Colorado HB 16-1197; State Board of Nursing Rules and Regulations, Chapter 1; CRS 24-34-102 (8.5). Purpose: To determine substantial equivalence for professional nursing education gained in military service and provide direction on licensure, so as to fulfill HB 16-1197. ______________________________________________________________________ POLICY: Veterans with military education equivalent to professional nurse education, as outlined in Chapter 2 of the State Board of Nursing Rules and Regulations, may request the State Board of Nursing (Board) evaluate submitted transcripts for educational equivalency. To qualify for a RN license, applicants must meet the requirements outlined in Chapter 1 of the State Board of Nursing Rules and Regulations. Items 1-6 outline process requirements for this policy. 1. The Board delegates evaluation of veteran applications to the Program Director for the Board of Nursing, or the Deputy Division Director. The Board maintains final ratifying authority on all licensees. 2. Evaluate the extent to which veteran applicants meet RN requirements listed below. i • 450 clock hours of theory in IV therapy, medical surgical nursing, pediatric nursing, obstetric nursing and psychiatric nursing in caring for multiple patients with predictable and unpredictable outcomes and evidence of advanced level (beyond LPN) coursework. • 750 clock hours of supervised clinical in IV therapy, medical surgical nursing, pediatric nursing, obstetric nursing and psychiatric nursing in caring for multiple patients with predictable and unpredictable outcomes and evidence of advanced level (beyond LPN) clinical supervision. • Apply standard equivalence of: • 1 semester hour of theory = 15 clock hours. • 1 semester hour of clinical = 45 clock hours. • Military job experience in clinical preforming the above tasks = 40 clock hours per week. 3. Veteran applicants found to meet RN requirements must apply to the Board for Registered Nurse-Original License by Examination. ii 4. Veteran applicants found not to meet RN requirements may be directed toward missing content found as listed below. iii
• Course(s) from Colorado State Board of Nursing approved nursing education programs, particularly those programs within the Colorado Community College System; or any other education programs found to have relevant courses. • References from professional nurse supervisors detailing type, duration, and level of performance in clinical practice submitted as verification for missing clinical specialty practice and/or hours. • Completion of the Registered Nurse Competency to Practice Form under the Student Permit application to allow verification of professional nurse competency by a nurse supervisor/preceptor. • Other areas if prescribed by the Board. 5. For reciprocity consideration, veteran applicants licensed as RN in other states or territories of the United States are required to follow original licensure by endorsement, Board of Nursing, Chapter 1, Rules and Regulations for Licensure of Practical and Professional Nurses. iv 6. The National Council State Boards of Nursing NCLEX-RN exam is available to all qualified applicants. v i
Fulfills Colorado HB 16-1197 requirement to “evaluate the extent to which military training meets all or part of the state requirements to be authorized to practice an occupation.” ii Fulfills Colorado HB 16-1197 requirement to “determine if an occupational exam is available to authorize a veteran to practice an occupation.” iii Fulfills Colorado HB 16-1197 requirement to “consult with Community Colleges and other postsecondary educational institutions with regard to a) courses or programs to cover the gap between military occupational specialty training and the training required to be authorized to practice an occupation, and b) refresher courses for the reinstatement of lapsed civilian credentials.” iv Fulfills Colorado HB 16-1197 requirement to “identify reciprocity mechanisms with other states.” v Fulfills Colorado HB 16-1197 requirement to “consider adopting a national credentialing exam.”
Colorado Board of Nursing Board Policy POLICY NUMBER: 10-13 Title: Streamlining Certified Nurse Aide-Medication Aide Authority (CNAMA) credential for veterans. Date Issued: April 26, 2017 Date(s) Reviewed: References: Colorado HB 16-1197; State Board of Nursing Rules and Regulations, Chapter 1; CRS 24-34-102 (8.5). Purpose: To determine substantial equivalence for medication aide training gained in military service and provide direction on CNA authorities, so as to fulfill HB 16-1197. ______________________________________________________________________ POLICY: Veterans with an unencumbered Colorado CNA certification, 1000 hours of military experience administering medications, and military training and education equivalent to the medication aide training may request the State Board of Nursing (Board) to evaluate submitted transcripts for educational equivalency. To qualify for CNA-MA the applicant must meet the requirements outlined in Chapter 19 of the State Board of Nursing Rules and Regulations. Items 1-7 outline process requirements for this policy. 1. The Board delegates evaluation of veteran applications to the Program Director for the Board of Nursing, or the Deputy Division Director. The Board maintains final ratifying authority on all licensees. 2. Evaluate the extent to which veteran applicants meet CNA-MA requirements listed below. i • 100 clock hours of training (40 theory; 60 clinical) that includes curriculum content in Chapter XII, Rules and Regulations for Approval of Medication Aide Training Programs, Section 6. • Apply standard equivalence of: • 1 semester hour of theory = 15 clock hours. • 1 semester hour of clinical = 45 clock hours. • Military job experience in clinical preforming the above tasks = 40 clock hours per week. 3. In addition to the requirements listed above, veteran applicants must also provide a written recommendation to become a medication aide from a current supervising nurse, director of nursing, or nursing home administrator. 4. Veteran applicants found to meet the CNA-MA requirements will be authorized to take the Colorado Medication Aide Authority Exam. ii 5. Veteran applicants found not to meet CNA-MA requirements may be directed toward missing content found as listed below. iii
• Colorado State Board of Nursing approved CNA-MA training programs. • Colorado Community College System courses. • Any other education programs found to have relevant courses. • Other areas if prescribed by the Board. 6. A provision for reciprocity or endorsement from another state is currently not available for the CNA-MA authority. iv 7. A national credentialing exam is not applicable, as this state authorized program has curriculum and scope of practice unique to Colorado. v i
Fulfills Colorado HB 16-1197 requirement to “evaluate the extent to which military training meets all or part of the state requirements to be authorized to practice an occupation.” ii Fulfills Colorado HB 16-1197 requirement to “determine if an occupational exam is available to authorize a veteran to practice an occupation.” iii Fulfills Colorado HB 16-1197 requirement to “consult with Community Colleges and other postsecondary educational institutions with regard to a) courses or programs to cover the gap between military occupational specialty training and the training required to be authorized to practice an occupation, and b) refresher courses for the reinstatement of lapsed civilian credentials.” iv Fulfills Colorado HB 16-1197 requirement to “identify reciprocity mechanisms with other states.” v Fulfills Colorado HB 16-1197 requirement to “consider adopting a national credentialing exam.”
Colorado Board of Nursing Policy POLICY NUMBER: 10-14 Title: Streamlining Licensed Psychiatric Technician (LPT) credentials for veterans. Date Issued: April 26, 2017 Date(s) Reviewed: References: Colorado HB 16-1197; State Board of Nursing Rules and Regulations, Chapter 1; CRS 24-34-102 (8.5). Purpose: To determine substantial equivalence for psychiatric technician education gained in military service and provide direction on licensure, so as to fulfill HB 16-1197. ______________________________________________________________________ POLICY: Veterans with military training and education equivalent to psychiatric technician as outlined in Chapter VI of the State Board of Nursing Rules and Regulations, may request the State Board of Nursing (Board) or its designated appointee evaluate submitted transcripts for educational equivalency. To qualify for the LPT license, applicants must meet the requirements outlined in Chapter 5 of the State Board of Nursing Rules and Regulations. Items 1-7 outline process requirements for this policy. 1. The Board delegates evaluation of veteran applications to the Program Director for the Board of Nursing, or the Deputy Division Director. The Board maintains final ratifying authority on all licensees. 2. Evaluate the extent to which veteran applicants meet the following LPT with a focus on developmental disabilities requirements listed below. i • 200 clock hours of theory and 200 clock hours of supervised clinical that includes curriculum content from the Chapter VI, Rules and Regulations for Accreditation of Psychiatric Technician Programs, Section 4.3 B 3 (a) and (c). The 200 hour supervised clinical must be with the developmental disability population and must include basic principles of prescribed therapeutic measures and practice in medication administration and common treatment procedures. • Apply standard equivalence of: • 1 semester hour of theory = 15 clock hours. • 1 semester hour of clinical = 45 clock hours. • Military job experience in clinical preforming the above tasks = 40 clock hours per week. 3. Evaluate the extent to which veteran applicants meet the following LPT with a focus on mental illness requirements listed below. • 200 clock hours of theory and 200 clock hours of supervised clinical that includes curriculum content from the Chapter VI, Rules and Regulations for Accreditation of
Psychiatric Technician Programs, Section 4.3 B 3 (a) and (b). The 200 hour supervised clinical must be with the mentally ill population and must include basic principles of prescribed therapeutic measures and practice in medication administration and common treatment procedures. • Apply standard equivalence of: • 1 semester hour of theory = 15 clock hours. • 1 semester hour of clinical = 45 clock hours. • Military job experience in clinical preforming the above tasks = 40 clock hours a week. 4. Veteran applicants found to meet the LPT requirements must apply to the Board for Licensed Psychiatric Technician-Original License by Examination and specify the population focus. ii 5. Veteran applicants found not to meet LPT requirements may be directed toward missing content found as listed below. iii • Colorado State Board of Nursing approved LPT training programs. • Colorado Community College System courses. • Any other education programs found to have relevant courses. • Other areas if prescribed by the Board. 6. For reciprocity consideration, veteran applicants licensed as LPT in other states are required to follow original licensure by endorsement, Board of Nursing, Chapter V, Rules and Regulations for Licensure of Psychiatric Technicians, Section 3. iv 7. A national credentialing exam is not applicable, as this state authorized program has curriculum and scope of practice unique to Colorado. v i
Fulfills Colorado HB 16-1197 requirement to “evaluate the extent to which military training meets all or part of the state requirements to be authorized to practice an occupation.” ii Fulfills Colorado HB 16-1197 requirement to “determine if an occupational exam is available to authorize a veteran to practice an occupation.” iii Fulfills Colorado HB 16-1197 requirement to “consult with Community Colleges and other postsecondary educational institutions with regard to a) courses or programs to cover the gap between military occupational specialty training and the training required to be authorized to practice an occupation, and b) refresher courses for the reinstatement of lapsed civilian credentials.” iv Fulfills Colorado HB 16-1197 requirement to “identify reciprocity mechanisms with other states.” v Fulfills Colorado HB 16-1197 requirement to “consider adopting a national credentialing exam.”
Nursing Board Policy POLICY NUMBER:
20-01
Title:
Patient abandonment
Date Issued:
November 1995
Date(s) Reviewed:
January 1997 [reaffirmed], May 2002, November 2002, January 2007 (revised), January 2015 (revised)
References:
Sections 12-38-117(1)(c) & (f); 12-42-113(1)(c) & (f); 12-38.1111(1)(o), C.R.S.
Purpose:
To clarify the kinds of conduct that constitute abandonment.
POLICY: The State Board of Nursing has found it appropriate to establish a policy defining patient abandonment for all licensees under its jurisdiction. Thus, the following policy relates to relationships established between a nurse and a patient, a nurse aide and a patient, and a psychiatric technician and a patient. The Board declares that for patient abandonment to occur, the licensee must: •
First, accept the patient assignment. This establishes the relationship with the patient.
•
Second, sever the relationship without giving reasonable notice to the appropriate person (such as the supervisor or patient), so that arrangements can be made for continuation of nursing care by others.
A relationship is established between a licensee and a patient when responsibility for nursing care of the patient is accepted by the licensee. Refusal to accept an assignment or a relationship may not be considered patient abandonment. Failure to notify the employing agency that the nurse will not appear to work an assigned shift or and refusal to work additional hours or shifts would also not be considered patient abandonment unless a licensee engaged in home health care has previously accepted the assignment. Once the licensee has accepted responsibility for nursing care of a patient, severing of the relationship without proper notice may lead to disciplinary action.
Nursing Board Policy POLICY NUMBER:
20-02
Title:
The Office of Investigations may expand an investigation
Date Issued:
March 1994
Date(s) Reviewed:
May 1999, May 2002, January 2007
References: Purpose:
To delegate the authority to expand an investigation to the Program Director or designee
POLICY: It is the policy of the Board of Nursing to allow an investigator to expand the scope of an investigation when warranted. Expansion may include, but not be limited to, investigation of the care provided to patients other than those originally referred for investigation or the investigation of other possible statutory violations which were not known to the Inquiry Panel at the time the case was referred for investigation. When the investigator feels that expansion of the scope of an investigation is warranted, the investigator must notify the Board's Program Director or designee. Should the Program Director or designee have any concerns regarding the expansion of the investigation, the matter will be brought to the appropriate inquiry panel for consideration.
Nursing Board Policy POLICY NUMBER:
20-03
Title:
Complaints against individuals practicing without a license
Date Issued:
February 2000; June 2005 (revised)
Date(s) Reviewed:
May 2002, January 2007 (revised)
References:
C.R.S. 12-38-124
Purpose:
To expedite remedies for the unlawful practice of nursing
POLICY: When the Board of Nursing receives a complaint relating to unlicensed practice, the Program Director or designee is delegated the authority to transmit the case directly to the Office of Investigations. If warranted by the information in the Report of Investigation, the Board President has the authority to act on behalf of the Full Board and may refer the case directly to the Office of the Attorney General for legal action. Any action taken by the Board President will be presented at the next regularly scheduled Full Board meeting for review/ratification.
Nursing Board Policy POLICY NUMBER:
20-04
Title:
Definition of "diverting controlled substances"
Date Issued:
January 2007
Date(s) Reviewed: References:
C.R.S. 12-42-113(1)(i); 12-38-117(1)(i)
Purpose:
To clarify to licensees the meaning of the statutory grounds for discipline related to "diverting controlled substances."
POLICY: Diversion occurs when a controlled substance or a drug having a similar effect is dispensed other than to the person for whom it is prescribed or is not wasted in accordance with generally accepted nursing standards. Additionally, drug diversion occurs when a controlled substance or a drug having similar effects is obtained without proper authorization from supplies, samples or wastage.
Nursing Board Policy POLICY NUMBER:
20-05
Title:
Extensions of time to respond to a complaint
Date Issued:
April 27, 2005
Date(s) Reviewed:
January 2007
References: Purpose:
To allow the Program Director or designee to grant one extension of time to licensees and certificate holders to respond to a 30-day letter
POLICY: The Board of Nursing authorizes the Program Director or designee to grant one extension of time to licensees and certificate holders in which to respond to a complaint. The Program Director or designee has the discretion to deny the request or to bring the request to the Inquiry Panel or Nurse Aide Advisory Committee for consideration.
Nursing Board Policy POLICY NUMBER: Title:
20-06
Date Issued:
May 25, 2005
Date(s) Reviewed: References:
January 2007 (revised);October 2012 (revised); July 2014 (revised); July 2017 (revised)
Purpose:
To clarify the authority delegated to the Program Director to assist the Board in carrying out its duties.
Delegated Authority in Relation to Enforcement
POLICY: The Board of Nursing delegates to the Program Director, or designee, the authority to: 1. Sign Stipulations, Final Agency Orders, and other orders authorized by the Board. 2. Sign Suspension Orders as required by the Child Support Enforcement Program. 3. Issue and sign Orders of Suspension authorized pursuant to sections 12-38-116.5(8)(a), 12-38116.5(4)(c)(IV), 12-38-131(4) and 12-38.1-113(2)(b), C.R.S. 4. Terminate Orders of Suspension when the licensee has provided evidence of compliance with the original order or agreement. 5. Perform the initial review of complaints relating to the practice of persons under the Board’s and/or Nurse Aide Advisory Committee’s jurisdiction and to issue 30-day letters relating to the complaints. 6. Sign and issue subpoenas and otherwise gather information in order to assist the Board in carrying out its duties. 7. Initiate complaints and issue 30-day letters to licensees currently under Stipulation or other Final Board Order if, in the opinion of the Program Director or designee, the licensee has failed to comply with any of the terms of the Stipulation or other Final Board Order. 8. Initiate complaints and issue 30-day letters where otherwise authorized by the Board. 9. Utilize services of the Office of Investigations as warranted to carry out duties of the Board. 10. Grant extensions to due dates set forth in board rules related to Initial Decisions and respond to other procedural matters that may arise prior to or in between the Hearings Panel meetings. 11. Approve requests for inactive license status in those instances wherein there is no probable cause to believe that the nurse making the request has committed any of the acts set forth in section 12-38-117, C.R.S. 12. Terminate probation when Peer Assistance Services notifies Board staff that a licensee has been successfully discharged from the program. 13. Process complaints for arrests and convictions due to impaired driving as follows: a. For first time arrests or convictions within the last five years, the Program Director or designee is delegated authority to resolve the complaint by issuance of a Board approved Letter of Concern. b. For second or subsequent arrests within a five year period that occurs during the last ten years, the Program Director or designee will offer the licensee the opportunity to confidentially participate in the Board’s diversion program. The refusal to participate in the diversion program will result in a referral to the Board for review. c. For second or subsequent convictions within a five year period that occurs during the last ten years, the case will be referred to the Board for review. 14. Directly refer a case to the Office of Investigations when a lack of information exists for the Panel or Nurse Aide Advisory Committee to consider discipline options. A list of cases referred in the previous month under this delegated authority would be ratified by the Inquiry Panel or Nurse Aide Advisory Committee at their monthly meeting. 15. Directly refer a case to the Office of Investigations when an existing case for the same Respondent, or a companion case, is already open in the Office of Investigations for the same or similar allegations. 16. Administratively dismiss a case that lacks jurisdiction and/or is duplicative or repetitive in nature
from the same complainant. 17. Perform additional delegated duties as set forth in other Board policies. Adopted: October 24, 2012 Effective: December 1, 2012 Revised Effective: July 22, 2014 Revised Effective: July 26, 2017
Nursing Board Policy POLICY NUMBER:
20-07
Title:
Practicing on an expired license or certificate
Date Issued:
April 2004
Date(s) Reviewed: References:
January 2007 (revised), July 2011 (revised)
Purpose:
Section 24-34-102(8), C.R.S. To provide guidance to licensees, certificate holders, and staff regarding the Board’s position on reinstatement of an expired license or certificate when the individual has been practicing with an expired license or certificate.
POLICY: It is the position of the State Board of Nursing that a nurse, nurse aide, or psychiatric technician must immediately cease practicing upon learning that his or her license or certificate has expired. Further, the nurse, nurse aide, or psychiatric technician shall not return to practice until the license has been reinstated. An individual who has not timely renewed and wishes to resume practice must file an application to reinstate the license or certificate. The Board may conduct an investigation and take disciplinary action for practicing on an expired license or certificate.
Nursing Board Policy POLICY NUMBER:
20-10
Title:
Anonymous Complaints
Date Issued:
January 2007
Date(s) Reviewed: References: Purpose:
To clarify the Board’s position regarding consideration of anonymous complaints.
POLICY: It is the policy of the Board of Nursing not to encourage anonymous complaints. The Board will not automatically investigate anonymous complaints. Rather, they will be subject to review on a case-by-case basis.
Nursing Board Policy POLICY NUMBER:
20-11
Title:
Enforcement of Injunctive Actions
Date Issued:
January 2007
Date(s) Reviewed: References: Purpose:
To authorize referral of cases for contempt proceedings.
POLICY: When a court has issued an Order of Injunction against an individual or entity pursuant to section 12-38-124 or 12-38.1-119, C.R.S., and the Program Director or designee for the Board of Nursing has reasonable cause to believe that the individual or entity has violated the injunction, the Board authorizes the Program Director or designee to refer such matter directly to the Office of the Attorney General for initiation of contempt proceedings. Any action taken by the Program Director or designee will be presented at the next regularly scheduled Full Board meeting for review/ratification.
Nursing Board Policy POLICY NUMBER:
20-13
Title:
Authorization to accept a surrender of a license or certificate after the initiation of an investigation or hearing
Date Issued:
October 25, 2006
Date(s) Reviewed:
January 2007 (revised)
References:
Sections 12-38-122(2), 12-38.1-115(2) and 12-42-115.7(2), C.R.S.
Purpose:
To authorize acceptance of a license or certificate surrender after an investigation or hearing has been initiated.
POLICY: Sections 12-38-122(2), 12-38.1-115(2) and 12-42-115.7(2), C.R.S. provide that following the initiation of an investigation or hearing, the Board of Nursing must make a finding that it is in the public interest to allow a licensee, a temporary license holder or a certified nurse aide to surrender the license or certificate in lieu of proceeding with further investigation and/or disciplinary proceedings. It is the policy of the Board that the surrender of a license or certificate is most often in the public interest as it provides for more timely and effective public protection. Therefore, the Board authorizes the Program Director or designee to accept a surrender of a license or certificate by means of stipulation in lieu of pursuing disciplinary proceedings. Said Stipulation will be a public disciplinary document. The Stipulation will either contain substantial admissions of grounds for discipline or must be a permanent surrender.
The Board and Nurse Aide Advisory Committee reserve the right to make a finding that acceptance of the surrender of a license or certificate would not be in the public interest in a particular case, to so advise its legal counsel and Program Director, and to instruct them to proceed with investigation and/or disciplinary proceedings as deemed appropriate.
Nursing Board Policy POLICY NUMBER:
20-14
Title:
Minimum Qualifications for nurses performing oversight of probationary licensees
Date Issued:
January 25, 2007
Date(s) Reviewed:
March 1998; March 1991; May 1999; May 2002; June 2005; January 2007(revised)
References: Purpose:
To describe the qualifications necessary for a nurse to perform oversight of a probationary licensee
POLICY: Licensees on probationary status requiring monitoring shall only work under the oversight responsibility of a registered nurse. The nurse accepting oversight responsibility must: 1. Have an active Colorado license in good standing; and 2. Be in good standing on all licenses held in any other state; and 3. Have no formal disciplinary action taken against the nurse’s license in any state within the last two (2) years. The Board retains the authority to permit or deny, in its discretion, the assumption of oversight responsibility by any nurse in the interest of public safety.
Nursing Board Policy POLICY NUMBER:
20-15
Title:
Delegation of authority regarding the monitoring of licensees who are subject to the terms of disciplinary actions
Date Issued:
March 1996
Date(s) Reviewed:
May 2002; June 2005 (revised), January 2007 (revised)
References: Purpose:
To clarify the authority the Board of Nursing has delegated to the Program Director or designee regarding the monitoring of licensees who are subject to the terms of disciplinary actions.
POLICY: The Board of Nursing has delegated to the Program Director or designee the authority to: 1. Review and approve supervision plans and reports submitted to the Board. The Inquiry Panels shall review unfavorable reports. 2. Approve the continuing education coursework required by a Board Order. 3. Grant an extension of time to allow a licensee to complete continuing education requirements upon a showing that the licensee has made reasonable efforts to complete the continuing education requirement within the probationary time period. 4. Review and approve treatment monitor plans and reports submitted to the Board. 5. Review and approve favorable urines screen reports submitted to the Board.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
20-16 Urine Drug and Alcohol Testing Policy March 1992 May 1996; May 1998; May 2002; August 2002; August 2007; October 2012 To provide consistent, accurate, standardized procedures for urine sample collection and testing for drugs and alcohol. This policy pertains to a licensee who is suspended or to an applicant who surrendered his/her license or who has had his/her license revoked (“licensee”) based on substance abuse.
POLICY: Responsibilities of the Licensee COLLECTION SITE: 1. The licensee must submit urine samples for drug and alcohol testing to include ethyl glucuronide (“EtG”) and ethylsulfate (“EtS”) at a collection site and laboratory that meet industry standards for urine sample collection and testing. The urine samples must be submitted on a random basis for the 12 months immediately preceding application for a license or a request to lift a suspension. a. A same gender collection site staff member, who has no relationship to the licensee/applicant, must physically observe licensee’s urine stream at the time the specimen is provided. b. Documentation of the urine specimen must be maintained by the collection site from the time it is collected until it is disposed of after analysis. c.
The collection site must request that the licensee’s urine sample be tested for drugs listed on an expanded professional drug test panel.
2. In the case of alcohol testing: a. The licensee must not use or inhale any external substance containing alcohol that could result in a positive EtG/EtS test result, such as hand disinfectant, hair spray, lotions or mouthwash. b. If EtG/EtS testing is not available within a ten (10) mile distance from the licensee’s place of residence or employment, breathalyzers may be substituted for EtG/EtS testing. c.
If breathalyzers are substituted for EtG/EtS testing, the licensee must complete breathalyzer testing within two (2) hours of calling the collection site’s reporting (color) line.
d. If the licensee cannot provide a urine sample for alcohol testing, a blood sample may be substituted. 3. The licensee must disclose all ingested substances, to include prescribed medications, over the counter medications or herbs, at the time the urine sample is provided. It is the licensee’s responsibility to research a substance’s ability to affect the results of a drug and alcohol test prior to ingesting such substance. The licensee should not ingest the substance during the entire period that the licensee is submitting urine samples for drug/alcohol testing. The State Board of Nursing (“Board”) will not accept positive urine drug and alcohol screens based on the licensee’s explanation that the licensee did not know that the substance ingested would cause a positive test result.
4. The Board will not excuse failure to provide urine samples or test results based upon the licensee’s inability to pay the collection site and/or laboratory fees. 5. The licensee must provide thirty (30) to sixty (60) random urine samples per year for drug and alcohol testing, unless otherwise required by the Board. 6. A urine sample must contain at least 20 mg/dl of creatinine. The specific gravity of the sample must be within the normal limits, i.e. 1.002 to 1.030. If the licensee, after observing the urine sample, believes that the urine may be dilute, the licensee may wait at the collection site and submit a second urine sample. Both samples must be tested. The licensee may substitute a blood sample for a urine sample in this situation. 7. The licensee must provide an adequate sample (minimum 30 ccs) of urine. If the licensee is unable to provide a sufficient sample, the licensee may either wait at the collection site until able to do so, return to the collection site prior to its closing for the day to provide the sample, or have a blood sample taken. 8. The Board may require the licensee to submit to random testing of body fluids or other matrix including, but not limited to, hair, nails or other body tissue. 9. Licensees are expected to comply with all requirements of the policy while traveling or on vacation. MEDICAL TREATMENT 1. If the licensee receives or has previously received prescriptions for controlled substances, other habit-forming drugs, or drugs that have a similar effect, for the treatment of an acute or chronic condition, the licensee must: a. Submit a copy of each such prescription to the Board; or b. If the prescription was called into a pharmacy, request that the health care provider prescribing the drug provide a document to the Board verifying the prescription. c.
Submit on a Health Care Provider form the following information from any health care provider that prescribes controlled substances, other habit forming drugs, or drugs that have a similar effect to the licensee/applicant: (1)
an acknowledgement of the health care provider’s awareness of the licensee’s drug and alcohol problem and a statement from the health care provider regarding the rationale for prescribing controlled substances, other habit forming drugs, or drugs which have similar effect in light of that knowledge; and
(2)
a rationale for the continued prescribing of controlled substances, other habit forming drugs or drugs which have similar effect for a chronic medical condition; provide parameters for their use.
d. The above referenced documentation is to be submitted with the licensee’s request to lift a suspension or for licensure after waiting the required period of time after a surrender or revocation of their license.
ADDITIONAL INFORMATION 1. Failing to submit urine sample(s) for drug and alcohol testing, failing to submit a sufficient quantity of urine for drug and alcohol testing, providing a dilute urine sample or providing a urine sample that
2
tests positive for controlled/illegal substances may result in denial of licensure or denial of the licensee’s request to lift the suspension of a license. 2. If a licensee fails to provide a urine sample(s) for drug and alcohol testing, provides a dilute urine sample, provides a urine sample that tests positive for controlled substances and/or alcohol, submits a urine sample that cannot be tested because of insufficient quantity, or if the applicant is noncompliant with the urine drug screen policy or the terms of the licensee’s stipulation, the licensee may submit a letter to the Board describing the circumstances of the licensee’s non-compliance. If the Board does not accept the licensee’s explanation for the non-compliance, the licensee must begin a new compliance period. 3. The testing of urine samples submitted for drug and alcohol testing by standard laboratory procedures is the only testing method approved by the Board. The Board specifically does not approve the use of pharmaceutical sweat patches, instantaneous methods of urine drug screen testing, or any other method of testing urine samples for drugs other than by standard laboratory procedures. Adopted: October 24, 2012 Effective: December 1, 2012
3
Nursing Board Policy POLICY NUMBER:
20-17
Title:
Compliance with probationary reporting requirements
Date Issued:
May 1999
Date(s) Reviewed:
May 2002; June 2005 (revised), January 2007 (revised)
References:
Section 12-38-116.5(4)(c)(IV), CRS
Purpose:
To provide guidance to the Program Director or designee and to licensees practicing pursuant to a Stipulation or Final Board Order requiring the submission of supervisory plans and/or reports as to how those reporting requirements are enforced.
POLICY: It is the policy of the Board of Nursing that the Program Director or designee is to promptly notify a licensee whose supervisory plan or practice report is late that the licensee must come into compliance with the terms of the Stipulation or Final Board Order within 14 days. If the licensee does not come into compliance, the Inquiry Panel will determine whether imposition of a suspension pursuant to section 12-38-116.5(4)(c)(IV),C.R.S., is warranted. The Panel may also determine that additional disciplinary proceedings are warranted due to a licensee’s noncompliance with a Stipulation or Final Board Order. Nurses providing such oversight whose plans and/or reports are not timely submitted and complete may be deemed to have failed to perform their duties as required by the Stipulation or Final Board Order and may be terminated as the nurse providing oversight at the discretion of Program Director or designee. If the nurse is discharged from providing oversight of a licensee practicing pursuant to a Stipulation or Final Board Order, the licensee shall be instructed to nominate a new overseeing nurse within thirty days of the date of notification to the licensee. A licensee’s probationary period shall be tolled pursuant to the terms of the licensee’s Stipulation or Final Board Order until a new oversight nurse has been approved.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
20-18 Selection of evaluators November 1999 May 2002; June 2005 (revised); January 2007 (revised); July 2014 (Revised) C.R.S. 12-38-116.5(8); 12-38.1-113 To set forth criteria for the selection of healthcare professionals to examine licensees and certificate holders for investigatory or disciplinary purposes
POLICY: The Board of Nursing authorizes the Program Director or designee to identify, approve and contract with licensed healthcare professionals to perform Board ordered mental and/or physical examinations, using the following guidelines: Evaluator services (“Contractor”) personnel utilized in the assessment process include intake staff; administrative staff; and case managers. Contractor may also use external resources for additional assessment including specialists in psychiatry, addiction medicine, psychology, pain management, neuropsychiatry, and neurology. Case managers will be responsible for conducting bio-psycho-social assessments and completing evaluations of Recipients. Contractor will ensure that case managers have one or more of the following credentials: •
Licensed Psychologist,
• Licensed Clinical Social Worker with Certified Addiction Counselor (CAC) II or Ill and at least 2 years of experience in completing assessments, • Licensed Marriage and Family Therapist with CAC II or Ill and at least 2 years of experience in completing assessments, • Licensed Professional Counselor with CAC II or Ill and at least 2 years of experience in completing assessments, •
Certified Addictions Registered Nurse-Advanced Practice (CARN-AP),
• Advance Practice Psychiatric Nurse who is Board Certified as a clinical nurse specialist or nurse practitioner in psychiatric mental health nursing, performing assessments related to their scope of practice. • Registered Nurse with both a Master's degree in Counseling Psychology and CAC II or Ill with two years of experience in completing assessments, • Physicians who are board certified in a relevant specialty related to the type of assessment they are performing (e.g. mental health, substance use disorder, physical examination) and have identified their specific certifications,
• Licensed Addiction Counselor and at least 2 years of experience in completing assessments. Case managers without the credentials listed above may be used by the Contractor to conduct assessments only upon approval by the Board of Nursing. Contractor shall ensure that persons who conduct assessments and evaluations of sex offenders are approved by the Colorado Sex Offender Management Board. Any potential evaluator who has received disciplinary action from his/her licensing board or certifying authority will not be considered to be a qualified evaluator.
Nursing Board Policy POLICY NUMBER: 20-19 Title:
Public Disciplinary Documents
Date Issued:
October 26, 2005
Date(s) Reviewed: January 2007 (revised); August 2007 References:
C.R.S 12-38-116.5(9)
Purpose:
To put licensees, certificate holders, Board of Nursing staff and the public on notice as to the Board's interpretation of C.R.S 12-38-116.5(9)and specifically concerning those documents the Board considers to be a matter of public record.
POLICY: It is the policy of the Board of Nursing that the following documents pertaining to the disciplinary process shall be considered matters of public record: 1. Letters of Admonition; 2. Stipulations between the Board and a licensee or certificate holder including but not limited to final disciplinary stipulations, temporary stipulations, and cease practice agreements. 3. Orders of Summary Suspension; 4. Final Board Orders; 5. Following service of a Notice of Charges or Formal Complaint upon the licensee or certificate holder in a particular case, all Board documents related to that particular case, unless those documents are otherwise confidential, privileged, or exempt from public inspection pursuant to the Colorado Open Records Act. This paragraph 5 does not apply to any documents in the Board's file relating to a case where a Notice of Charges or Formal Complaint has not been filed with the Office of Administrative Courts; 6. All pleadings, initial decisions or orders, including any attachments, filed or created in relation to a hearing held pursuant to the Nurse Practice Act, Nurse Aide Practice Act, Psychiatric Technicians Act or the Administrative Procedure Act. This paragraph 6 does not apply to documents, exhibits or testimony sealed by order of the Administrative Law Judge or the Hearings Panel; and 7. All material contained in the record of an appellate proceeding following a hearing held pursuant to the Nurse Practice Act or the Administrative Procedure Act, unless sealed by order of the Administrative Law Judge or the Hearings Panel.
Nursing Board Policy POLICY NUMBER:
20-20
Title:
Reporting Requirements
Date Issued:
August 1, 2007
Date(s) Reviewed:
January 25, 2012 (revised); October 22, 2013 (revised)
References:
Sections 12-38-108(1)(j) and (k), 12-38.1-103(3), 12-38-116.5(3)(b)(I), 12-38117(1), 12-38.1-111(1), 12-38.1-114(12), 12-42-113(1), and 18-18-102(5), C.R.S. To offer to the public guidance for reporting violations of the Nurse Practice Act, Nurse Aide Practice Act, or Psychiatric Technicians Practice Act.
Purpose:
POLICY: It is the intent of the State Board of Nursing (“Board”) that licensees or certificate holders whose continued practice may pose a risk of harm to persons under the care of the licensee or certificate holder be reported to the Board. Anyone may report a licensee or certificate holder whose practice appears to be in violation of the Nurse Practice Act or generally accepted standards of practice. Information that should be reported: 1. Failure to meet generally accepted standards of practice by the licensee or certificate holder that creates or results in serious harm or risk to the persons under the licensee or certificate holder's care, or a demonstrated pattern of practice which fails to meet generally accepted standards. 2. Reasonable cause to believe the licensee or certificate holder is unable to practice with reasonable skill and safety to patients as the result of a physical or mental disability or substance abuse. 3. Events that result in a disciplinary action (i.e. suspension or termination of employment by an employer after an internal investigation), when such disciplinary action is due to substandard practice, conduct which poses a risk to the health and safety of the public, chemical dependency or drug diversion. 4. Failure by a licensee or certificate holder to comply with the terms of Board orders, including suspensions, stipulations, and final agency orders. 5. A person who practices or offers to practice as a nurse, advanced practice nurse, authority holder, nurse aide, or psychiatric technician when such person has not been licensed, registered, or certified, or who uses any title, abbreviation, card, or device to indicate that such person is licensed, registered, or certified to practice in Colorado while not so licensed, registered, or certified. 6. Patient abuse including, but not limited to, physical, emotional, psychological, verbal, sexual, or financial abuse. 7. Conviction of a felony.
8. Conduct by a licensee or certificate holder which constitutes a crime and is relevant to such licensee or certificate holder's ability to practice safely. Such conduct includes, but is not limited to, felonies, fraud, theft, or assaults, including sexual assaults. Such conduct need not have resulted in a conviction. 9. Signs or symptoms of excessive use or abuse of alcohol, habit-forming drugs, or controlled substances, as defined in C.R.S. 18-18-102(5) or other drugs having similar effect that negatively impact the licensee or certificate holder's practice. 10. Actions, behavior, or information that suggest or substantiates the licensee’s or certificate holder’s diversion of controlled substances as defined in C.R.S. 18-18-102(5) or other drugs having similar effects.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
20-21 Non-public Participation in the Nursing Peer Health Assistance or Nurse Alternative to Discipline Program April 23, 2008, January 2011, July 21, 2015 (revised) July 21, 2015 C.R.S. 12-38-131 To delegate authority in order to resolve complaints alleging physical, emotional, psychiatric, psychological, drug abuse, or alcohol abuse problems to the Program Director or designee, excepting allegations of diversion from this delegated authority.
POLICY: The State Board of Nursing (“Board”) authorizes the Program Director or designee the ability to offer a licensee participation in the Nursing Peer Health Assistance or Nurse Alternative to Discipline Program (“Program”) via a non-public agreement to participate (“agreement”) when a first time complaint alleges a non-diversion violation of 12-38-117(1)(i) and/or a violation of (j), including when a complaint also alleges a practice non-diversion problem that is related to (i) and/or (j). Upon verification that the licensee has entered into a signed contract with the Program, the complaint will be administratively closed without further Board review. Nothing in this policy of delegated authority will be construed to require the Program Director or designee to offer such participation to a licensee in the Nursing Peer Health Assistance or Nurse Alternative to Discipline Program (“Program”), even if the licensee meets the criteria identified herein for eligibility of such an offer. A complaint submitted against a licensee with previous disciplinary action will be reviewed by the Board. At its discretion, the Board may allow a previously disciplined person to participate via an agreement if the facts considered at the time of application to the Program warrant such action.
Nursing Board Policy POLICY NUMBER: Title:
Date Issued: Date(s) Reviewed: References: Purpose:
20-22 Delegation of authority to the Program Director or designee to process and resolve violations involving practice on expired licenses, authorities or certificates for Nurses, Nurse Aides and Psychiatric Technicians July 30, 2008 April 22, 2009, January 25, 2012 (revised); October 22, 2013 (revised) Section 24-34-102(8), C.R.S., and State Board of Nursing Policy 20-07 To expedite the resolution of routine violations for practicing on an expired license or certificate.
POLICY: The State Board of Nursing (“Board”) authorizes the Program Director, or designee to initiate disciplinary action upon completion of the complaint process or administratively close the case regarding active practice on an expired license, authority or certificate: 1.
If the licensee or certificate holder has submitted evidence that there was no active practice on an expired license, authority or certificate, then the case can be administratively closed by Board staff.
2.
If a Letter of Concern (LOC) or Letter of Admonition (LOA) has been issued prior to the submission of evidence substantiating that there was no active practice on an expired license, authority or certificate, the LOC or LOA may be vacated and case administratively closed by Board staff.
3.
If a license, authority or certificate has been expired for six (6) months or less, including the sixty (60) day grace period, Board staff will draft a letter of concern to the licensee or certificate holder.
4.
If a license, authority or certificate has been expired for greater than six (6) months, but less than two (2) years, Board staff will draft a letter of admonition to the licensee or certificate holder.
5.
If a licensee or certificate holder fails to respond to the Board’s complaint, Board staff will draft a letter of admonition to the licensee or certificate holder that includes the applicable statute violations for practicing on an expired license, authority or certificate and failing to respond in a materially factual and timely manner to a complaint.
6.
If a license, authority or certificate has been expired for greater than two (2) years, Board staff will initiate the complaint process. The licensee or certificate holder may be subject to disciplinary action, which may include a fine and/or withdrawal of an authority.
Nursing Board Policy POLICY NUMBER: Title:
20-23 Cases Dismissed with Letters of Concern: clarification of basis for dismissal, reopening of such cases and case retention period April 22, 2009
Date Issued: Date(s) Reviewed: References: Purpose: To clarify the basis for this type of dismissal, when the Board of Nursing may reopen such a case and designation of a specific retention period for these types of cases.
POLICY: It is the policy of the State Board of Nursing that complaints that are dismissed with letters of concern are not dismissed as being without merit but rather are dismissed due to no reasonable cause to warrant further action at that time. Cases that are dismissed with a confidential letter of concern will be retained in the Board’s files for a period of five (5) years. The Board may reopen a case that was dismissed with a letter of concern in the face of a change in circumstances. Such a change in circumstances would include but not be limited to: discovery of new evidence supporting the underlying charges evidence that the licensee has engaged in further unprofessional conduct/grounds for discipline following issuance of the letter of concern in which there is a nexus between the new conduct and that which was addressed in the case that was dismissed with the letter of concern. After five (5) years from the date of the letter of concern, the file will be disposed of in accordance with the Division’s records management procedures. If the licensee has other active cases pending at the end of the five (5) year retention period, the letter of concern may be kept for a longer period of time at the discretion of the Board staff.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
20-24 Process for Handling Complaints Involving State Board of Nursing (“Board”) Members or Nurse Aide Advisory Committee (“NAAC”) Members August 26, 2009 April 27, 2011 (revised) Sections 12-38-116.5 and 12-38-117, C.R.S. To provide written notice regarding the process by which specific types of complaints against current Board members or NAAC members, licensees/certificate holders who have served on the Board or NAAC within the past five years, or licensees/certificate holders who have an ongoing formal relationship with the Board will be handled. The purpose of this policy is to assure the integrity of the disciplinary process and prevent any appearance of bias or preferential treatment.
POLICY: It is the policy of the Board that any signed complaint alleging a violation of the Nurse Practice Act, Title 12, Article 38 or the Nurse Aide statute, Title 12, Article 38.1 of the Colorado Revised Statutes received by the Board against a current licensee/certificate holder who is a member of the Board or NAAC or one who has served on the Board or NAAC within the past five years, or a licensee who has an ongoing formal relationship with the Board or NAAC will be handled as follows:
The complaint will be sent to the Office of Investigations within the Division of Registrations for a formal investigation.
If the complaint alleges substandard practice, the Office of Investigations will also have the case reviewed by an independent consultant selected by the Office of Investigations.
If the complaint alleges sexual boundary violations, allegations of substance abuse or allegations of a physical or mental impairment, the licensee will be required to undergo evaluation by the designated peer assistance provider to the Board or by a qualified healthcare provider selected by the Office of Investigations.
Upon completion of the investigation and/or evaluation, the report will be referred to the Inquiry Panel for appropriate action. If the complaint is against a current board member, the complaint will be assigned to the Inquiry Panel on which the Board member does not serve. If the complaint is against a NAAC member, it will be assigned to an Inquiry Panel of the Board. If the complaint is against a current Board member, the President shall recuse from all discussions regarding the complaint and physically leave the meeting room during these discussions. All other customary procedures for the handling of a complaint by the Board will apply. These include but are not limited to issuance of a 30-day letter, notification to the licensee and complainant of Board decisions, and the confidentiality of the complaint and investigation as provided by the appropriate practice act. Anonymous complaints filed against a current licensee/certificate holder who is a member of the Board or NAAC or one who has served on the Board or NAAC within the past five years, or a licensee who has an ongoing formal relationship with the Board or NAAC will be evaluated by the Panel or NAAC in accordance with the Board’s policy regarding anonymous complaints.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
20-25 Requirements for Evaluation Reports January 22, 2013 Sections 12-38-116.5(8) and 12-38-113, C.R.S. To set forth criteria and requirements of reports of examination by approved healthcare providers, as described in Board Policy 20-18.
POLICY: The State Board of Nursing (“Board”) requires healthcare professionals performing mental health and/or substance use disorder examinations pursuant to Board Policy 20-18 to provide the report to the Board within 10 days of completion of the examination. The written report must include the following elements:
Applicant, licensee or certificate holder (“Client”) history: o Including but not limited to legal, licensure, employment/education, family, living situation, medical health, mental health, substance use, and treatment. Presenting problem, if applicable. Diagnostic tests performed or assessment tools used in the examination process. Interpretation of diagnostic tests or assessment findings used in the examination process. Sources of information for the examination or assessment of the Client. Prognosis of the Client. Recommendations, if any, for treatment or monitoring of Client for mental health and/or substance abuse disorders. Any supporting information which, in the healthcare professional’s opinion, may assist the Board in its determination of the Client’s status as it relates to his/her ability to practice with reasonable skill and safety to patients. An opinion as to the Client’s ability to practice with reasonable skill and safety to patients. The credentials of the healthcare professional performing the examination and preparing the written report must be included in the signature block of the examiner.
The report from the healthcare professional should be a comprehensive examination and assessment of the Client for mental health and/or substance abuse disorders.
Nursing Board Policy POLICY NUMBER: 20-26 Title:
Impairment While on Duty for RNs, LPNs, LPTs and CNAs
Date Issued:
January 22, 2013
Date(s) Reviewed: References:
Sections 12-38-117(1)(c), (f) & (i); 12-42-113(1)(c), (f) & (i); 12-38.1-111(1)(p) & (i), C.R.S.
Purpose:
To provide guidelines regarding impairment while on duty while practicing as an RN, LPN, LPT or CNA.
POLICY: The State Board of Nursing has found it appropriate to establish a policy providing guidelines regarding impairment while on duty for all licensees under its jurisdiction. Thus, the following policy relates to RNs, LPNs, LPTs and CNAs. The Board will consider impairment while on duty when a complaint is received indicating a licensee was impaired while on duty and when the totality of the circumstances leads to a reasonable conclusion that the licensee was impaired while on duty. The impairment may be evidenced from any substance including legal, illegal and prescription substances. The submission of a positive urinalysis, drug screen or breathalyzer will be considered proof of impairment. Any licensee that is determined to be impaired while on duty may be subject to disciplinary action.
Board of Nursing Policy Policy Number:
20-27
Title:
Board actions to protect the public from drug diversion by a licensed nurse
Date Issued:
July 26, 2016
Purpose:
To provide guidelines for Colorado nurses who may be subject to expedient action for drug diversion.
Policy: This policy provides guidance to nurses and notice to the public that, consistent with the Nurse Practice Act, the board will take expedient action to protect the public by suspending a license or seeking a cessation of practice agreement in instances where suspected drug diversion, or working while impaired by a licensee, causes the potential for public harm. Such instances include but are not limited to the following:
Licensee is terminated for diversion. For the purposes of this policy, the Board will consider resignation in lieu of termination to be a termination Licensee fails to submit to a drug test ordered by their employer Licensee is found to be working while impaired Self-disclosure of drug diversion by a licensee Notification to the board from law enforcement of suspected drug diversion by licensee Pharmacy monitoring or surveillance that identifies suspicious activity for diversion of a controlled substance by a licensee Witnessed incident by a credible source of drug diversion by a licensee
Other instances of drug diversion may warrant expedient action as well. The board retains the discretion, as well as the responsibility, to consider the specific facts and circumstances of each case. It shall be the policy of the board to ensure a timely response and to take expedient action when warranted pursuant to its authority if objective and reasonable grounds exist. The board delegates to the Program Director the authority to take expedient action, in consultation with the Board President, Board Vice-President, or Panel Chairs in instances of suspected diversion of controlled substances that cause the potential for public harm. Expedient action includes summary suspension and cessation of practice agreements and is subject to ratification by the board.
Nursing Board Policy POLICY NUMBER: 30-01 Title: Date Issued: Date(s) Reviewed: References: Purpose:
IV Certification by endorsement for Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) July 1998 May 2002, January 2007, January 22, 2013 (revised) Section 12-38-108(1)(d) & (f), C.R.S. To permit LPNs who are IV certified, have an IV authority or are IV competent to obtain Colorado IV certification by endorsement.
POLICY: It is the policy of the Board of Nursing that LPNs or LVNs, endorsing from any state, may be granted Colorado IV Certification. They will not be required to take the IV Certification course in Colorado if they hold IV Certification, have an IV authority or are IV competent according to any other state. 1. Any active LPN IV certification or authority granted by another state’s Board of Nursing that includes the requirements of Colorado’s LPN IV Certification shall be endorsed and not required to complete an IV Certification course in Colorado. 2. If an LPN can submit a completed Board-approved competency checklist as required by Chapter 10 State Board of Nursing Rules and Regulations from a current Colorado employer that indicates competency, the applicant may be endorsed without completion of an IV certification course in Colorado.
Nursing Board Policy POLICY NUMBER:
30-04
Title:
Orders from other healthcare practitioners (conduit theory)
Date Issued:
March 1983, May 2002
Date(s) Reviewed:
January 2007 (revised)
References: Purpose:
To clarify individuals who may convey lawful orders to nurses performing delegated medical functions.
POLICY: The practice of professional nursing includes executing delegated medical functions by implementing orders of a licensed physician, dentist, podiatrist or, where appropriately delegated by a supervising physician, a physician assistant. Prior to implementing such an order, the nurse has an independent obligation to assure himself or herself that the order is consistent with the health and safety of the patient.
Further, when such orders are communicated to the nurse by someone other than the prescribing physician, dentist, podiatrist or physician assistant, the nurse may implement the order only where the nurse has taken reasonable steps to assure himself or herself that: (1) the order is, indeed, that of a physician, dentist, podiatrist or physician assistant, and (2) the other person is merely communicating the order and acting as a conduit. Please note that rules regarding the delegating of nursing functions are found in Chapter XIII of the Nursing Board Rules.
Nursing Board Policy
POLICY NUMBER:
30-05
Title:
Prescriptive Authority Articulated Plan Compliance and Audit Process
Date Issued:
May 2002
Date(s) Reviewed:
January 2007, January 22, 2013 (revised)
References:
Section 12-38-111.6(4.5), C.R.S.
Purpose:
To outline the requirements for an Advanced Practice Nurse with Prescriptive Authority (RXN includes provisional and full authorities), Articulated Plan Compliance and the Audit Process.
Articulated Plan Compliance An RXN must develop, retain and maintain an Articulated Plan (Plan) that satisfies the requirements of Section 12-38-111.6(4.5), C.R.S. and Section 6, Chapter XV State Board of Nursing Rules and Regulations. RXNs are not required to develop a new Plan when changing places of employment or employers so long as the population foci does not change. The Board requires the RXN to update and retain the Articulated Plan. Updates and reviews do not require a physician’s signature; the signature is required for the Attestation of Development of Articulated Plan only. The Articulated Plan must include at least the following elements: 1. A mechanism for consultation and referral for issues regarding prescriptive authority; 2. A quality assurance plan; 3. Decision support tools; and 4. Documentation of ongoing continuing education in pharmacology and safe prescribing. Audits of Articulated Plans The Board is required to perform random audits of Articulated Plans pursuant to Section 12-38111.6(4.5), C.R.S. The Audit is to confirm existence of the Articulated Plan and review of compliance with the required elements to be included in the plan pursuant to Section 12-38111.6, C.R.S. Failure to comply with the Audit may result in discipline of the professional nurse (RN) license. Audit Schedule An Audit will be coordinated every two (2) years in conjunction with renewal beginning 2014. The APRN Subcommittee, if so appointed, will review and determine compliance as delegated by the State Board of Nursing.
Nursing Board Policy POLICY NUMBER:
30-06
Title:
Determination of death
Date Issued:
January 1994
Date(s) Reviewed:
May 2002, January 2007 (revised)
References: Purpose:
To clarify a nurse’s role in the pronouncement of death
POLICY: Determination of death is outside the scope of practice of a practical nurse. Under appropriate circumstances as set forth below, determination of death is within the scope of practice of a professional nurse. Death is statutorily defined as the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain including the brain stem. § 12-36-136, C.R.S. The practice of professional nursing includes diagnosis, which, in a nursing context, means the use of professional nursing knowledge and skills in the identification of, and discrimination between, physical and psychological signs or symptoms to arrive at a conclusion that a condition exists for which nursing care is indicated or for which referral to appropriate medical or community resources is required. Nursing care is indicated throughout the process of death and past the moment of death. Referral to appropriate medical or community resources is required following a patient’s death. If a professional nurse has the knowledge, skill and training to assess the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain including the brain stem, then it is within the scope of practice for that professional nurse to determine whether a patient is dead. The Department of Health requires physician signature on a death certificate. § 25-2-110(4), C.R.S.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
30-07 Voluntary Withdrawal of Advanced Practice Registry, Prescriptive and IV Authorities October 25, 2006 January 22, 2013 (revised) Sections 12-38-111.5(2); 12-38-111.6(1); and 12-38-112(1)(b), C.R.S. To allow the Program Director or designee, on behalf of the Board of Nursing, to acknowledge a licensee's request to voluntarily withdraw a Board-granted authority from their license.
POLICY: The Board of Nursing authorizes the Program Director or designee to acknowledge, in writing, a licensee's written request to voluntarily withdraw a Board-granted authority and that the licensee will no longer be practicing within the scope of practice of withdrawn authority. The staff will maintain a record of the withdrawn authority. In addition, the licensee must reapply to the Board of Nursing and meet all criteria to regain and practice within the scope of the voluntarily withdrawn authority. The Board of Nursing through designated staff will notify the DEA of any Advanced Practice Nurse with Prescriptive Authority who voluntarily withdraws his or her Prescriptive Authority.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
30-09 Telenursing August 26, 2009
To define telenursing as within the scope of nursing practice in the State of Colorado
POLICY: Telenursing is the practice of nursing using telecommunications technology which may cross state lines. Telenursing includes, but is not limited to, electronically receiving and sending patient’s health status data; initiating and transmitting therapeutic interventions and regimens; and monitoring and recording the patient’s response and nursing care outcomes. Engaging in any of the activities defined as the practice of professional or practical nursing in section 12-38-103, C.R.S., via telecommunications technology constitutes the practice of nursing in the State of Colorado. An individual engaging in such activities must be licensed to practice nursing in Colorado or be authorized to practice nursing in Colorado pursuant to the Nurse Licensure Compact, sections 24-60-3201 and -3202, C.R.S. Nursing practice occurs at the location of the recipient of nursing services. Regardless of the physical location of the individual providing the service, any one who provides any of the services listed above to a resident of the State of Colorado via telecommunications technology is engaged in the practice of nursing in Colorado. A person engaged in telenursing who is not licensed or authorized to practice nursing in the State of Colorado is subject to both administrative and criminal penalties.
This policy is in accord with the positions of the American Nurses Association, the Association of Telehealth Service Providers, the Case Management Society of America, and the National Council of State Boards of Nursing.
Policy for Prescribing and Dispensing Opioids Colorado Dental Board, Colorado Medical Board, State Board of Nursing, and State Board of Pharmacy In collaboration with the Nurse-Physician Advisory Task Force for Colorado Healthcare
Policy for Prescribing and Dispensing Opioids
PREAMBLE Prescribing and dispensing medication for the appropriate treatment of pain is a priority for Colorado healthcare providers. However, in 2013 the misuse and abuse of prescription opioids became a public health epidemic in the United States in general, and Colorado in particular, leading to drug addiction, death from overdose, and increased costs to society. In order to address this crisis, the Colorado Dental Board, Colorado Medical Board, State Board of Nursing, State Board of Pharmacy, and the Nurse-Physician Advisory Task Force for Colorado Healthcare collaborated to identify opportunities and provide meaningful guidance to prescribers and dispensers in Colorado. The Boards recognize that reversing the trend of opioid misuse and abuse requires coordinated efforts to increase public awareness, take-back events for safe disposal, addiction treatment and recovery options, and enforcement, among others. The Boards and the practitioners they license are one part of a multi-pronged solution. The Boards recognize the complexities faced by prescribers in the appropriate management of pain.1 The demands on practitioners considering opioid prescribing differ depending on patient diagnosis, practice settings, and/or conditions. Importantly, long-term therapies addressing cancer-related treatment, palliative and/or hospice care involve different considerations from short-term therapies appropriate for acute or chronic non-cancer pain. Pain and addiction specialists play an important role in healthcare and the communities they serve to compassionately and safely care for patients. Many of the tools and practices referenced in this policy were developed by such specialists. The need for therapeutic care of pain in Colorado patients exceeds the supply of specialists in the state. However, other types of providers can successfully treat many painful conditions and achieve the function and relief the patient seeks. Accordingly, this policy is intended to educate prescribers and dispensers broadly by providing useful tools that may be utilized at the point-of-care to support clinical decision making. The Boards further recognize that decreasing opioid misuse and abuse in Colorado should be addressed by collaborative and constructive policies aimed at improving prescriber education and practice, decreasing diversion, and establishing the same guidelines for all opioid prescribers and dispensers. This includes opioid therapies for both acute and chronic non-cancer pain, 2 because the Boards find that treatment for pain often does not fall clearly into one category or another.
1
“Boards” as used in this policy means the Boards overseeing prescribing and dispensing of opioids and involved in the drafting of this policy: the Colorado Medical Board, State Board of Nursing, Colorado Dental Board, and the State Board of Pharmacy. 2 Pain is categorized by a number of descriptors ranging from duration, impact, or physiological response, among others. For the purpose of this policy, the term "chronic, non-cancer pain" is utilized to refer to pain that lasts longer than 90 days and is non-terminal. It does not include conditions such as cancer, scleroderma, multiple sclerosis, muscular dystrophy, or rheumatoid arthritis.
i
Policy for Prescribing and Dispensing Opioids
Diversion and “doctor shopping” accounts for 40% of drug overdose deaths.3 To address the dual issues of access to appropriate pain management and opioid-related adverse outcomes, prescribers have dual obligations: to manage pain and improve function while reducing problems resulting from misuse and abuse of prescription opioids in the patient and community. Pharmacists share a corresponding responsibility with the prescriber to assure that a prescription order is valid in all respects and is appropriate for the patient and condition being treated. Therefore, the Boards have agreed to the following guidelines regarding opioid prescriptions in Colorado. Providers prescribing and/or dispensing opioids should: ● Follow the same guidelines ● Use the Colorado Prescription Drug Monitoring Program (PDMP) ● Be informed about evidence-based practices for opioid use in healthcare and risk mitigation ● Educate patients on appropriate use, storage and disposal of opioids, risks and the potential for diversion ● Collaborate within the integrated healthcare team to decrease over-prescribing, misuse and abuse of opioids. Opioid prescribers and dispensers must conform to the regulations set forth by the respective licensing board and other laws. To this end, we, the Boards regulating the prescribers and dispensers in Colorado, have developed this joint policy incorporating the guidelines above. This policy provides guidelines, and does not set a standard of care for prescribers and dispensers. This policy represents the Boards’ current thinking on this topic. It does not create or confer any rights for or on any person and does not operate to bind Boards or the public. Prescribers may use an alternative approach if the approach satisfies the requirements of the applicable statutes, regulations, and standard of care. The Boards will refer to current clinical practice guidelines and expert review in approaching cases involving the management of pain. 4
3
Paulozzi, L., Baldwin, G., Franklin, G., Ghiya, N., & Popovic, T. (2012). CDC Grand Rounds: Prescription drug overdoses — a U.S. epidemic. Center for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR), 61(01), 10-13. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm 4 A “policy” is adopted by a board to provide guidance to licensees regarding the board’s position on various subjects. Policies are unlike statutes or rules in that they are not law. Conversely, “board rules” have the force of law and set forth requirements to which licensees must adhere.
ii
Policy for Prescribing and Dispensing Opioids
Table of Contents BEFORE PRESCRIBING OR DISPENSING....................................................................................................... 1 WHEN PRESCRIBING OR DISPENSING ........................................................................................................ 2 PRESCRIBING AND DISPENSING FOR ADVANCED DOSAGE, FORMULATION OR DURATION ..................................... 4 PATIENT EDUCATION ............................................................................................................................. 5 DISCONTINUING OPIOID THERAPY ........................................................................................................... 5
iii
Policy for Prescribing and Dispensing Opioids
BEFORE PRESCRIBING OR DISPENSING Develop and maintain competence Prescribers, including prescribers who dispense, must maintain competence to assess and treat pain to improve function. This includes understanding current, evidencedbased practices and using other resources and tools related to opioid prescribing and dispensing. In some clinical situations consultation with a specialist is appropriate. Pharmacists must maintain competence in the appropriateness of therapy. See the Appendix for a list of resources and tools for developing and maintaining competence.
Utilize safeguards for the initiation of pain management The decision to prescribe or dispense opioid medication for outpatient use may be made only after a proper diagnosis and complete evaluation which should include a risk assessment, pain assessment, and review of relevant PDMP data. These safeguards apply to acute and chronic, non-cancer pain but not to palliative end-of-life care. Not all pain requires opioid treatment. Prescribers should not prescribe opioids when non-opioid medication is both effective and appropriate for the level of pain.
1. Diagnose Prescribers should establish a diagnosis and legitimate medical purpose appropriate for opioid therapy through a history, physical exam, and/or laboratory, imaging or other studies. A bona fide provider-patient relationship must exist.
2. Assess Risk Prescribers should conduct a risk assessment prior to prescribing opioids for outpatient use and again before increasing dosage or duration. Risk assessment is defined as identification of factors that may lead to adverse outcomes and may include: ● Patient and family history of substance use (drugs including alcohol and marijuana) ● Patient medication history (among other reasons, this is taken to avoid unsafe combinations of opioids with sedative-hypnotics, benzodiazepines, barbiturates, muscle relaxants or to determine other drug-drug interactions) ● Mental health/psychological conditions and history ● Abuse history including physical, emotional or sexual ● Health conditions that could aggravate adverse reactions (including COPD, CHF, sleep apnea, elderly, or history of renal or hepatic dysfunction) ● Prescribers and dispensers should observe the patient for any aberrant drugrelated behavior and follow-up appropriately when aberrant drug-related behavior is presented. See the Appendix for a description of such behaviors. 1
Policy for Prescribing and Dispensing Opioids
See the Appendix for additional resources related to assessment, including resources for alcohol and substance use screening and guidelines for treating patients with risk factors. If the assessment identifies risk factors, prescribers should exercise greater caution before prescribing opioids as detailed in subsequent sections, consider conducting a drug test or consulting a specialist and put in place additional safeguards as part of the treatment plan.
3. Assess Pain An appropriate pain assessment should include an evaluation of the patient’s pain for the: ● Nature and intensity ● Type ● Pattern/frequency ● Duration ● Past and current treatments ● Underlying or co-morbid disorders or conditions ● Impact on physical and psychological functioning
4. Review PDMP Prescribers and dispensers should utilize the Prescription Drug Monitoring Program (PDMP) prior to prescribing or dispensing opioids.
Collaborate with the healthcare team Prescribers and dispensers should collaborate within the healthcare team to prevent under-prescribing, over-prescribing, misuse and abuse of opioids. See the Appendix for additional resources.
WHEN PRESCRIBING OR DISPENSING Verify a provider-patient relationship A bona fide provider-patient relationship must exist. The prescriber or dispenser should verify the patient’s identification prior to prescribing or dispensing opioids to a new or unknown patient. For pharmacists, this includes exercising judgment and conducting research if appropriate (such as use of the PDMP or communication with the prescriber or relevant pharmacies) when the prescription order is: ● For a new or unknown patient 2
Policy for Prescribing and Dispensing Opioids
● ● ●
For a weekend or late day prescription Issued far from the location of the pharmacy or patient’s residential address Denied by another pharmacist.
Additional Safeguards Ensure the dose, quantity, and refills for prescription opioids are appropriate to improve the function and condition of the patient, at the lowest effective dose and quantity, in order to avoid over-prescribing opioids. Factors that have been associated with adverse outcomes include: 1) opioid doses greater than 120 mg morphine equivalents per day 2) certain formulations and 3) treatment exceeding 90 days. Additional safeguards have been found to reduce these risks.
Dosage Opioid doses >120 mg morphine equivalents per day is a dosage that the Boards agree is more likely dangerous for the average adult (chances for unintended death are higher) over which prescribers should use clinical judgment, put in place additional safeguards for the treatment plan (such as utilizing a treatment agreement), consult a specialist or refer the patient; and dispensers should be more cautious.5 Benzodiazepines are known to potentiate the effects of opioids and may increase the risk of adverse outcomes. See the Appendix for additional resources on dose calculators
Formulation In addition to noting and responding to this dosage marker, prescribers and dispensers must use clinical judgment regardless of dose, especially when: The prescription is considered an outlier to what is normally prescribed, or Transdermal, extended relief or long-acting preparation is prescribed.
Duration Treatment exceeding 90 days should be re-evaluated as opioids may no longer be as effective. One way to distinguish pain is as either acute (that lasting less than 90 days) or chronic (that lasting 90 days or greater). Management of each presents its own unique challenges. The overwhelming majority of prescribers treat patients with acute pain; in fact the pain for these patients lasts considerably less than 90 days.
5
Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med 2010;152(2):85-92.
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Policy for Prescribing and Dispensing Opioids
If a prescriber extends short-term treatment, and results in exceeding 90 days, prescribers should re-conduct the risk and pain assessments, review the PDMP and undertake the additional safeguards.
PRESCRIBING AND DISPENSING FOR ADVANCED DOSAGE, FORMULATION OR DURATION Tools and Trials Prior to issuing prescriptions that are outliers to the dosage, formulation and duration guidelines described above (for chronic, non-cancer pain), prescribers should determine whether the patient improves functionally on opioids, which could include an opioid trial, and whether the pain relief improves his/her ability to comply with the overall pain management program.
Monitoring The prescribing and dispensing of opioids for chronic pain must be monitored on an ongoing basis, such as: assessing for improved function rechecking the PDMP, and random drug screening according to the prescriber’s clinical assessment. These monitoring tools and others should be documented in a treatment agreement signed by the patient, described more below. Prescribers should not increase an initial opioid dosage without rechecking the PDMP.
Treatment Agreements Prescribers should utilize treatment agreements (also commonly referred to as a plan or contract) and should ensure the patient understands the terms of the agreement. This may be accomplished by having the patient review and sign the treatment agreement. A treatment agreement often includes information about proper: ● Goals of treatment ● Patient education (proper use, risks of addiction, alternatives) ● Controls (single prescriber, single pharmacy for refills) ● Random drug testing and restrictions on alcohol use ● Storage, disposal, and diversion precautions (including detailed precautions related to adolescents and/or children and visitors to the home). ● Process and reasons for changing/discontinuing the treatment plan; communicating reduction or increase of symptoms; and referring to a specialist. See the Appendix for resources on sample agreements.
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Policy for Prescribing and Dispensing Opioids
PATIENT EDUCATION Prescribers should educate patients regardless of the dosage, formulation and duration of opioid therapy on proper use, risks of addiction, alternatives, storage, and disposal of opioids and the potential for diversion (see the Appendix for resources on disposal). Risks may include but are not limited to: overdose, misuse, diversion, addiction, physical dependence and tolerance, interactions with other medications or substances, and death. Pharmacists should offer to review information with the patient about risks, disposal, and other applicable topics. Providers should educate patients about the risks and benefits of medications that exceed the dosage, formulation and duration guidelines indicated above which may place them at increased risk for long-term dependence and unintended adverse drug effects. Patients who have a previous history of substance use disorder (including alcohol) are at elevated risk. When alerted to these risk factors, patients can make more informed decisions about their healthcare treatment. For example, some patients have reduced or forgone opioids when alerted to the risk factors. If a decision is made to continue with opioid therapy, a satisfactory response to treatment would be indicated by a reduced level of pain, increased level of function and/or improved quality of life. The use of an interdisciplinary team and family members may be considered as a part of the treatment plan and ongoing monitoring.
DISCONTINUING OPIOID THERAPY The prescriber should consider discontinuing opioid therapy when: ● The underlying painful condition is resolved; ● Intolerable side effects emerge; ● The analgesic effect is inadequate; ● The patient’s quality of life fails to improve; ● Functioning deteriorates; or ● There is aberrant medication use. The prescriber discontinuing opioid therapy should employ a safe, structured tapering regimen through the prescriber or an addiction or pain specialist. There is a risk of patients turning to street drugs or alcohol abuse if tapering is not done with appropriate supports. Prescribers of opioids should be familiar with treatment options for opioid addiction. See the Appendix for tips on tapering.
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Policy for Prescribing and Dispensing Opioids
APPENDIX PDMP Colorado Prescription Drug Monitoring Program (PDMP): http://www.hidinc.com/copdmp
Preventing diversion through appropriate disposal In order to prevent diversion, providers should provide information regarding appropriate disposal, including the following: ● Secure unused prescription opioids until such time they can be safely disposed. Specifically, ensure that prescription opioids are not readily accessible to other family members (including adolescents and/or children) or visitors to the home. ● Take-back events are preferable to flushing prescriptions down the toilet or throwing them in the trash. Only some medications may be flushed down the toilet. See the FDA’s guidelines for a list of medications that may be flushed: www.fda.gov ● Utilize take-back events and permanent drop box locations ● Utilize DEA disposal guidelines if take-back or drop boxes are unavailable. Those guidelines include: ● Take the drugs out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter; then put them in a sealable bag, empty can, or other container to prevent the medication from leaking out of a garbage bag; ● Before throwing out a medicine container, tell the patient to scratch out all identifying information on the prescription label to protect their identity and personal health information; and ● Educate patients that prescriptions are patient specific. Patients may not share prescription opioids with friends, family or others and may pose serious health risks, including death. ● Use activated charcoal absorption technologies to inactivate unused medications or used fentanyl patches.
Record keeping Prescribers who treat patients with opioids should maintain accurate and complete medical records according to the requirements set forth by their licensing board.
Discontinuing/tapering opioid therapy Weaning from opioids can be done safely by slowly tapering the opioid dose and taking into account several factors related to risk, symptom, and alternatives. Opioid Taper Plan and Calculator: “Interagency Guidelines on Opioid Dosing for Chronic Non-Cancer Pain” State of Appendix Page 1
Policy for Prescribing and Dispensing Opioids
Washington Agency Medical Directors Group. 2010 Online: www.agencymeddirectors.wa.gov Withdrawal Symptoms Assessment: “Clinical Opiate Withdrawal Scale” The National Alliance for Advocates for Buprenorphine Treatment. Online at: www.naabt.org
Aberrant drug-related behavior Prescribers and dispensers should use clinical judgment when aberrant drug-related behaviors are observed. Such behavior should be reported to the proper authorities and/or healthcare team as appropriate. Aberrant drug-related behaviors broadly range from mildly problematic (such as hoarding medications to have an extra dose during times of more severe pain) to felonious acts (such as selling medication). These are any medication-related behaviors that depart from strict adherence to a prescribed therapeutic plan of care. Prescribers and dispensers should observe, monitor and take precautionary measures when a patient presents aberrant drug-related behaviors such as: ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Requesting early and/or repeated refills Presents at or from an emergency department seeking high quantities of a prescription Denied by other prescribers or dispensers Presents what is suspected to be a forged, altered or counterfeit prescription. Forging prescriptions Stealing or borrowing drugs Frequently losing prescriptions Aggressive demand for opioids Injecting oral/topical opioids Unsanctioned use of opioids Unsanctioned dose escalation Concurrent use of illicit drugs Failing a drug screen Getting opioids from multiple prescribers Recurring emergency department visits for chronic pain management*
Prescribers and dispensers should be alert for subjective behaviors such as being nervous, overly talkative, agitated, emotionally volatile, and evasive, as these may be signs of a psychological condition that may be considered in a treatment plan or could suggest drug misuse.** *“Interagency Guidelines on Opioid Dosing for Chronic Non-Cancer Pain” State of Washington Agency Medical Directors Group. 2010 Online: http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf **Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain. Sunrise River Press, North Branch, MN 2007.
Appendix Page 2
Policy for Prescribing and Dispensing Opioids
Practitioner Considerations Healthcare team: Consider that the patient may be receiving opioids from another prescriber. Contact the patient’s healthcare team when appropriate which may include the following: ● Physician ● Specialist (pain, addiction, etc.) ● Dentist ● Advanced Practice Nurse (APN) ● Physician assistant ● Pharmacists ● Area emergency rooms ● Surrounding (within 5 miles) or historical pharmacies Authorities: ● If the prescriber or dispenser suspects illegal activity, the matter should be referred to the Drug Enforcement Agency (DEA) and local law enforcement. ● If a prescriber or dispenser suspect illegal activity on behalf of another prescriber or dispenser, at a minimum, the matter should be reported to the appropriate licensing board. Prescribers and dispensers should be aware that: ● There is no legal obligation to prescribe or dispense a prescription; and, ● Colorado law strongly encourages prescribers and dispensers of opiate antagonists “to educate persons receiving the opiate antagonist on the use of an opiate antagonist for overdose, including but not limited to instructions concerning risk factors for overdose, recognition of overdose, calling emergency medical services, rescue breathing and administration of an opiate antagonist.” (Section 18-1-712(3)(b), C.R.S.)
Additional Resources and Tools Establishing and maintaining competence: Tenney, Lili and Lee Newman. “The Opioid Crisis: Guidelines and Tools for Improving Pain Management” Center for Worker Health and Environment, Colorado School of Public Health. Functional and pain assessment: “Functional Assessment” Colorado Division of Workers Compensation Patient agreements: “Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP - R)” PainEDU.org Online at: www.painedu.org Pain tool kit: Various resources for assessing and managing pain including risk assessments, patient Appendix Page 3
Policy for Prescribing and Dispensing Opioids
agreements, dose and conversion calculators among others. Center for Worker Health and Environment, Colorado School of Public Health. Online at: http://www.ucdenver.edu/academics/colleges/PublicHealth/research/centers/maperc/ online/Pages/Pain-Management-CME.aspx Substance use screening and brief counseling: SBIRT Colorado www.ImprovingHealthColorado.org Drug abuse resources: Substance Abuse and Mental Health Services Administration: www.samhsa.gov NIH National Institute on Drug Abuse: www.drugabuse.gov or www.nida.nih.gov
Appendix Page 4
Board of Nursing Policy
Policy Number:
40-01
Title:
Delegated authority to order a summary suspension, execute an interim cessation of practice agreement and/or order a mental/physical examination July 1986 May 1999, May 2002, June 2005 (revised), January 2007 (revised; April 2013 (revised); July 2016 (revised); July 2017 (revised) C.R.S. 24-4-104(4); 12-38-116.5; 12-38-116.5(8); 12-38.1-113; 12-38.1-114 To expedite the issuance of summary suspensions, interim agreements to cease practice; and orders for mental or physical examinations.
Date Issued: Dates(s) Reviewed: References: Purpose:
POLICY: The Board of Nursing has delegated to the Program Director, or designee, with the approval of the Board President, Vice-President, or Panel Chairs, the authority to: 1. Order a summary suspension pursuant to C.R.S. 24-4-104(4) or alternatively to execute a nondisciplinary Interim Cessation of Practice Agreement pursuant to C.R.S. 12-38-116.5 or C.R.S. 12-38.1-114. 2. Order a mental or physical examination of a licensee or certificate holder pursuant to C.R.S. 12-38-116.5(8) or C.R.S. 12-38.1-113 Any action taken pursuant to this policy will be presented at the next regularly scheduled meeting of the Inquiry Panel or Nurse Aide Advisory Committee for review/ratification. The Program Director, or designee, may cancel or vacate Interim Cessation of Practice Agreements, Summary Suspensions, and/or mental or physical exam orders issued under this policy if he or she receives additional information that warrants a lower priority of action before being ratified by the Inquiry Panel or Nurse Aide Advisory Committee
Revised Effective: July 26, 2017
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
40-03 Consideration of ALJ Initial Decisions May 1986 May 2002; January 2007 (revised); January 2011 (revised); April 2013 (revised); July 2015 (revised) To clarify the Board’s process for consideration of Initial Decisions
POLICY: It is the policy of the State Board of Nursing (“Board”) that the Initial Decision will be mailed to the respondent and the Office of the Attorney General accompanied by a Board Procedural Order (“Order”), that sets forth procedural standards for the filing of exceptions and review of Initial Decisions, upon receipt from the Administrative Law Judge. The Board delegates the authority to the Program Director to issue this Order. The Board determines that every Hearings Panel shall be deemed to have preserved its option to initiate review of an Initial Decision on its own motion pursuant to section 24-4-105(14)(a)(II), C.R.S., without requiring a vote for each case. However, in the event that no timely exceptions are filed to an Initial Decision that has occurred by default because the Respondent has failed to appear for hearing, the Board delegates authority to the Program Director, or designee, to sign and issue a Final Board Order (also known as a Final Agency Order) affirming and adopting the Initial Decision in its entirety. The Board also authorizes a Hearings Panel that performs a review of an Initial Decision to delegate to the Program Director, or designee, on a case by case basis the authority to sign and issue a Final Board Order that incorporates the Hearings Panel’s findings. The Board delegates to the Deputy Director, or designee, the authority to act on behalf of the Board to rule upon motions, including but not limited to requests for extension of time for good cause and issue procedural orders for the Board. The Deputy Director may delegate this authority to an individual within the Division of Professions and Occupations staff, but may not delegate this authority to the Program Director or any individual supervised by the Program Director.
Nursing Board Policy POLICY NUMBER:
40-04
Title:
Subpoena enforcement
Date Issued:
September 1994
Date(s) Reviewed:
May 2002, January 2007 (revised)
References: Purpose:
Delegation to staff to enforce Board subpoenas
POLICY: When in the course of an investigation of a complaint or other matter, a person or entity fails to comply with a lawfully issued subpoena, the Board of Nursing specifically authorizes the Program Director, or designee, to refer such matter directly to the Office of the Attorney General for enforcement.
Nursing Board Policy POLICY NUMBER:
40-05
Title: Date Issued:
Personal appearances before the Full Board, the Panels or the Nurse Aide Advisory Committee (NAAC) April 2004
Date(s) Reviewed:
June 2005 (revised), January 2007 (revised), January 25, 2012 (revised)
References: Purpose:
Appearances Before an Inquiry or Licensing Panel or the NAAC: Any individual may attend open sessions of Panel or NAAC meetings. Persons may not initiate dialogue with Panel or NAAC members during an open session. Board or NAAC members have the discretion to ask an applicant or licensee questions. The Panel or NAAC may, where consistent with statutory requirements, discuss the matter outside the presence of the applicant or licensee and other members of the public. Closed sessions are not open to the public. Appearances Before the Full Board on Education Cases: Any individual may attend the Full Board meetings. During the Nursing Education Program cases, the person representing the Education Facility may approach and present to the Board. The designated person will have 3 minutes to inform the Board of any updates related to their facility. At the conclusion of such summary, the Education Manager will address the Board, outline the case and formulate the options available to the Board. At the conclusion of the Education Manager’s presentation, the Board may inquire of the Education Manager or Facility Representative as necessary to facilitate a decision by the Board. Appearances Before the Full Board for Informing the Board or Requesting an Opinion of the Board: Persons who wish to advise the Full Board of Nursing on a health care issue or matters of general professional interest, may do so by submitting their request in writing to the Program Director or Administrative Manager. The submission must include the name and contact information of presenter, topic or question posed, amount of time needed for the presentation and any handouts to be used in the presentation. Once received, the Program Director or Administrative Manager will contact the presenter to confirm receipt and inform presenter of the date of the next full Board meeting and the anticipated time of the presentation. The Board members may inquire of the presenter for clarification or further questions raised by the presentation. If the Board gives an opinion, it will be in writing and submitted in writing within 10 days of the date of the presentation.
Nursing Board Policy POLICY NUMBER:
40-06
Title:
Nurse Aide Advisory Committee (NAAC), authority and purpose
Date Issued:
March 1990
Date(s) Reviewed:
March 1998; May 2002, January 2007 (revised); August 2007
References:
12.38.1-110 (1) C.R.S.
Purpose:
To describe the authority and responsibilities of the NAAC
POLICY: It is the policy of the Board of Nursing that the NAAC is authorized to review applications for nurse aide certification in which "yes" answers are given to application questions. The NAAC is also authorized to review and act on complaints and Reports of Investigations in accordance with sections 12-38.1-111 and 114, C.R.S. The NAAC may provide documentation to the Board on any issue for which it requests guidance from the Board. The Board shall request reports from the NAAC as deemed necessary. The Board reserves the right to review and approve or deny any application for certification and to act on any complaint or Report of Investigation presented to, but not acted upon by, the NAAC.
Nursing Board Policy POLICY NUMBER:
40-07
Title:
Applicants who wish to serve on the Nurse Aide Advisory Committee (NAAC)
Date Issued:
March 1990
Date(s) Reviewed:
March 1998; May 2002, January 2007 (revised)
References: Purpose:
POLICY: Applicants who wish to serve on the NAAC shall submit an application on a form approved by the Board of Nursing. The Board will review such applications and make appointments to the NAAC.
Nursing Board Policy POLICY NUMBER:
40-08
Title:
Composition and Terms for the Nurse Aide Advisory Committee (NAAC) Members
Date Issued:
March 1992
Date(s) Reviewed:
March 1995; May 2002, January 2007 (revised)
References: Purpose:
POLICY: It is the policy of the Board of Nursing that NAAC members are eligible to serve for one three year term and may be reappointed for one additional three year term. The terms of the NAAC members shall be staggered.
Nursing Board Policy POLICY NUMBER:
40-09
Title:
Mediation
Date Issued:
May 1999
Date(s) Reviewed:
May 2000; May 2002, January 2007 (revised)
References: Purpose:
To provide guidance to the Office of the Assistant Attorney General to mediate settlements.
POLICY: The Board of Nursing authorizes the Office of the Assistant Attorney General to take a case to mediation unless directed otherwise by the Panel or the Nurse Aide Advisory Committee (NAAC). The Board delegates to the Board or NAAC member participating in the mediation the authority to enter into a settlement on behalf of the Board within the parameters established by the Panel or NAAC. The Board reserves the right to retain settlement authority on a case-bycase basis.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
40-10 Designation of Complementary Rules and Regulations Effective date July 1. 2010 Chapter XV Rules and Regulations for Prescriptive Authority for Advanced Practice Nurses To identify those sections and subsections of Chapter XV Rules and Regulations that are complementary to the Colorado Board of Medical Examiners Rule 950
POLICY: It is the policy of the Board to identify those portions of the Chapter XV Rules and Regulations that are to remain complementary with the Colorado Board of Medical Examiners Rule 950. The Director of the Division of Registrations shall be informed of any proposed changes to these rules. For clarification purposes the following Sections and/or Subsections are considered Complementary: Section 1: 1.2; 1.3; 1.4; 1.5; 1.8; 1.9; 1.10; 1.11; 1.12; 1.14; 1.16; 1.17; 1.18; 1.19 1.20; 1.21; 1.22; 1.23; 1.24; 1.25; and, 1.26. Section 4: All Section 5: All Section 6: All Section 7: 7.1 only
Nursing Board Policy POLICY NUMBER: 40-11 Title: Release of Active Complaint and Investigatory Information to Other State, Canadian or U.S. Territorial Licensing Boards Date Issued: August 25, 2010 Date(s) Reviewed: References: Purpose:
To authorize staff to release active complaint information and to transmit confidential investigatory materials to other licensing boards upon request.
POLICY: It is the policy of the State Board of Nursing that staff may advise other state, Canadian or U.S. Territorial nursing boards regarding a licensee's complaint history and complaints currently under investigation. Upon receipt of a request for verification of licensure status, the Colorado Board will notify the other state nursing Board if there is a case currently under investigation and also provide the licensee's complaint history. It shall be the responsibility of the inquiring board to request further documentation of the nature of any active complaint, if that information is desired. Upon request from another licensing board, staff may transmit information from the investigatory and/or hearing file which is normally considered to be confidential pursuant to Section 12-38-116.5(9)(a), C.R.S. Prior to transmittal of this information, Board staff may consult with the Attorney General's Office to ensure that no information is being released which must be kept confidential by law, such as documents subject to the attorney-client and letters of concern.
Nursing Board Policy POLICY NUMBER: 40-12 Title: Release of Investigatory File Information to Governmental and Law Enforcement Agencies Date Issued: August 25, 2010 Date(s) Reviewed: References: Purpose:
To provide notice to licensees and the public regarding the Board’s process for reviewing requests for release of investigatory file information.
POLICY: It is the policy of the State Board of Nursing (“Board”) that requests from governmental agencies, law enforcement entities or other parties involved in the criminal justice system for release of information that is normally considered to be confidential pursuant to Section 12-38-116.5(9)(a), C.R.S. will be evaluated on a case-by-case basis. When determining what information, if any, to release following such requests, the Board will consider several factors including, but not limited to, whether it believes that the Board's primary mission of public protection and legal obligations warrant the release of such information. Prior to transmittal of this information, the Board staff may consult with the Office of the Attorney General to prevent the release of information that the Board is prohibited from disclosing or that is otherwise confidential by law, such as documents subject to the attorney-client privilege and confidential letters of concern.
Nursing Board Policy POLICY NUMBER: 40-13 Title: Guidelines Regarding Practice Coverage Outside of Normal Office Hours Date Issued: August 25, 2010 Date(s) Reviewed: References: Purpose:
To provide guidance to advanced practice nurses (APN) concerning the Board's expectations with respect to practice coverage and the communication of coverage arrangements to patients.
POLICY: The State Board of Nursing (the Board) has adopted this policy to provide guidance to advanced practice nurses (APN) regarding its expectations with respect to practice coverage and the communication of the APN’s coverage arrangements to patients with whom a physician/patient relationship has been established. The Board determined that this policy was necessary because of the numerous inquiries from both the public and APNs regarding an APN’s responsibility to provide continued care for patients outside normal office hours. The Board is particularly concerned about APNs who do not have a well-defined protocol for the provision of after-hours care and about APNs who merely leave a telephone message directing patients to go to the emergency department if after-hours care is needed. The Board finds that in any practice setting, including rural settings, patients need to know where to go for necessary after-hours care. The Board urges APNs to provide patients with specific, understandable and available directions toward a viable point of coverage. This policy is not meant to address those unanticipated situations that require the patient to go immediately to the emergency department. Applicability: This policy applies to APNs who provide care to patients on an ongoing basis. This policy also applies to APNs who provide discrete medical services that have an identifiable beginning and end. For APNs providing such discrete services, this policy applies until such time as follow-up care is no longer expected and is no longer required under generally accepted standards of medical practice. This policy is in addition to any coverage requirements of an institution or facility. Guidelines: 1. It is the duty of the APN to provide care whenever it is needed or to assure that proper medical coverage is available to take care of the patient at all times. However, the Board recognizes that an APN cannot practically provide personal coverage for patients at all times. Consequently, it is expected that the APN will have an explicit coverage arrangement to assure continued care for patients outside of normal office hours or when otherwise unavailable. 2. Ideally, the APN will have well codified coverage arrangements with physicians or APNs within the same practice or specialty or within an institution or facility. 3. In the event that the arrangements described in paragraph 2 cannot be made, the APN may choose to enter into an agreement with an established triage center, facility or institution qualified to handle the needs of the APN's patients. The agreement should be explicit, preferably in writing. However, when using this coverage arrangement, there must still be a mechanism for the triage center, facility or institution staff to know whom to call for questions or dispositions regarding those patients who are seen in the triage center, facility or institution or counseled on the telephone.
4. At a minimum, an emergency department ("ED") may provide after-hours coverage for urgent care so long as the ED understands and agrees in advance to provide this service for the APN and the APN's patients. The agreement should be explicit, preferably in writing. However, when using this coverage arrangement, there must still be a mechanism for the ED physicians to know whom to call for questions or dispositions regarding those patients who are seen in the ED or counseled on the phone. This would include, but may not be limited to, designating which APN, physician or group of APNs or physicians should treat any potential admissions and assuring a mechanism exists to receive information regarding the patient's ED course and scheduled follow-up, as deemed appropriate by the ED physician. 5. Generic communications to patients by answering machine (i.e., simply to go to an ED for after-hours care) do not replace an APN's obligation to provide coverage as stated above. 6. It is the APN's responsibility to assure that the practice coverage policy is communicated to patients in a clear and understandable way. It is preferable that the policy be communicated to patients verbally and in writing (i.e. a patient brochure) at the time the APN/patient relationship is initially established. Subsequent changes to the practice coverage policy also need to be communicated to patients. The Board also suggests that APNs consider posting their coverage policy in the office reception area as a reminder to patients. 7. Failure of an APN to adhere to these guidelines may be considered patient abandonment by the Board, which fails to meet the accepted standards for nursing practice pursuant to Section 12-38-117, C.R.S.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
50-03 Clarification of establishment of residency in Colorado when changing residency from another compact state April 28, 2010 April 26, 2012 (revised); July 23, 2013 (revised) Section 24-60-3201, C.R.S; Chapter 20 Rules and Regulations To establish guidelines for applicants and employers regarding the establishment of primary residency when moving from another compact state to Colorado.
POLICY: It is the policy of the Board that a professional nurse (RN) or licensed practical nurse (LPN) may work in Colorado with a multi-state license issued by a compact state other than Colorado for a maximum of ninety (90) days after the date that primary residency is established. Primary Residence is a person’s declared, fixed, permanent and principal home for legal purposes. Documentation of Primary Residence may be requested and includes: A. Driver’s license with a home address; B. Voter registration card displaying a home address; C. Federal income tax return declaring the state of Primary Residence; D. Military Form No. 2058 – state of legal residence certificate; or E. Form W-2 from U. S. Government or any bureau, division or agency thereof, indicating the declared state of residence. PROCEDURE: Responsibility of the Applicant/Licensee: 1. Upon relocation to the state of Colorado and establishment of residency, submit an application for licensure to the Division of Registrations. 2. Notify potential or current employer(s) of the date of residence in Colorado. Responsibility of Employer(s): 1. On the first day of employment of a RN or LPN, who is/will be relocating from another compact state, the employer will verify the nurse’s active, multi-state licensure in the previous compact state. 2. Ninety (90) days following the date the nurse establishes Colorado residency, the employer will verify the nurse’s active Colorado license. 3. If the Colorado license has not been issued by the end of the ninety (90) day period, the nurse is not eligible to practice in Colorado until a Colorado nursing license is issued, even if the multi-state license from the prior state of issuance is still active.
Please note that this policy does not apply to a nurse working in Colorado on a privilege from another compact state and declaring another compact state as his/her state of primary residency.
Nursing Board Policy POLICY NUMBER: 60-02 Title: Nursing Student Extern Date Issued:
April 25, 2007
Date(s) Reviewed: References: Purpose:
C.R.S. 12-38-123(1)(b)(I)(II) Many healthcare institutions employ nursing students to provide enhanced education and experience as they transition through school and into the professional, licensed role of Registered Nurse. The Colorado State Board of Nursing supports these experiences but recognizes that such roles should be clearly identified in order to avoid any misunderstanding by the student, the employer, and the public.
POLICY:
Nursing students who are pursuing the education of a licensed professional nurse but remain an unlicensed assistive person in their employed position are to be identified, with the title and a name tag identifying the student as a “nursing student extern.” Nursing student externs must be students in good academic standing, enrolled in a Board of Nursing approved program to prepare candidates for licensure as a licensed professional nurse, and have successfully completed sufficient clinical nursing courses to have obtained competency in performing basic health care tasks. Nursing student externs may not wear school identification. Nursing student externs are, at all times, under the direct supervision of a licensed Registered Nurse. The Registered Nurse may not delegate tasks to the nursing student extern which are solely within the scope of practice of the licensed Registered Nurse. Nursing student externs may perform those tasks that are routine, repetitive and require no nursing judgment. Prohibited tasks include but are not limited to: Administration of intravenous fluids, blood products, performing venopuncture or assuming responsibility for the delivery of intravascular therapy. Assuming primary responsibility for patient care. Directing or supervising any other healthcare personnel. Making independent decisions regarding patient care. Administration of medications.
Nursing Board Policy
POLICY NUMBER:
60-03
Title:
Nurse Aide Training Program Pass Rates
Date Issued:
October 2007
Date(s) Reviewed:
April 23, 2013, effective January 1, 2014; January 27, 2015 (revised)
References:
Chapter 11 – Rules and Regulations for the Approval of Nurse Aide Training Programs Section 9.2(C)
Purpose:
To establish and clarify a minimum standard of achievement for first time competency evaluation test takers.
POLICY: The State Board of Nursing (“Board”) requires minimum achievement levels for all nurse aide training program first- time competency evaluation test takers. First- time test takers are those individuals that test for the first time within two (2) years of completion from a Board approved nurse aide training program. The date candidate completed training is reported by the program on the Proof of Training Affidavit, which is identified by its unique Program Code issued by the Board. All approved nurse aide training programs shall have an average minimum pass rate for first time competency evaluation test takers of at least sixty (60) percent during any one consecutive four (4) quarter period within an eight (8) quarter period, as long as 10 or more students have tested within the 4 consecutive quarter test period. Programs with fewer than ten (10) first time test takers during a consecutive four (4) quarter period shall be exempt from this policy. First time competency evaluation test taker pass rates for all programs with sufficient numbers (more than ten (10)) will be posted for public viewing on the Board’s website. First time test takers submitting application for original license by exam after two (2) years from the completion date reported on the Proof of Training Affidavit will be issued a testing code that is different from that of their training program. The pass rates of candidates testing after two (2) years, under the new testing code, will not impact the nurse aide training program overall pass rates for first- time test takers.
Program meets minimum achievement level
# of Candidates
# Passing
% Passing
Q1
1
0
0%
Q2
4
3
75%
Q3
3
3
100%
Q4
7
5
71%
62%
Q1-Q4
Q5
5
3
60%
77%
Q2-Q5
Q6
2
1
50%
70%
Q3-Q6
Q7
1
1
100%
70%
Q4-Q7
Q8
8
4
50%
65%
Q5-Q8
Program meets minimum achievement level
# of Candidates
# Passing
% Passing
Q1
1
0
0%
Q2
4
2
50%
Q3
3
3
100%
Q4
7
5
71%
55%
Q1-Q4
Q5
5
3
60%
70%
Q2-Q5
Q6
2
1
50%
70%
Q3-Q6
Q7
1
1
100%
70%
Q4-Q7
Q8
8
2
25%
59%
Q5-Q8
Program Referred to Board for Consideration
# of Candidates
# Passing
% Passing
Q1
1
0
0%
Q2
4
2
50%
Q3
3
2
67%
Q4
7
5
71%
47%
Q1-Q4
Q5
5
2
40%
57%
Q2-Q5
Q6
2
1
50%
57%
Q3-Q6
Q7
1
0
0%
40%
Q4-Q7
Q8
8
8
100%
48%
Q5-Q8
Nursing Board Policy POLICY NUMBER: Title:
60-04 Calculation of full-time to part-time faculty for professional and practical nursing education programs. January 23, 2008
Date Issued: Date(s) Reviewed: References: C.R.S. 12-38-108 Purpose: To set forth procedures for the calculation of full-time to part-time faculty ratios as outlined in Chapter II Rules, paragraph 3.4 (C)
POLICY: It is the policy of the Board of Nursing to define the ratio calculation method of full-time to parttime faculty as set forth in Chapter II Rules 3.4 (C) as follows: The calculation shall be based on the number of full-time faculty teaching nursing courses in a program (RN-ADN; RN-BSN; or PN stand alone) in an academic term (semester, quarter, module, etc.) to the number of part-time nursing faculty and/or ANIP teaching courses in that same program during that same defined academic term. It is the Board’s position that this ratio calculation promotes and maintains adequate faculty consistency and measures programs accurately. Moreover, the calculation does not combine various programs into one overall pool of instructors and, thereby, create an unnecessary hardship for the educational institutions.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
60-05 Further Clarification of the Definition of Nursing Education Program January 23, 2008 C.R.S. 12-38-108 To further clarify the meaning of the term “Nursing Education Program” as defined in Chapter II Rules, paragraph 1.14.
POLICY: It is the policy of the Board of Nursing to further clarify the definition of “Nursing Education Program” by the basis of admission into the nursing education program. Nursing students must first meet the requirements of admission into an associate or baccalaureate degree program leading to licensure as a professional nurse. In cases where a nursing student wishes to interrupt pursuing his or her current degree program as a professional nurse, the school may have defined additional course work for the student to complete in order to meet the requirements for examination as a practical nurse. If the program has such coursework and requirements, it shall be monitored by the Board in conjunction with the Chapter II Rules for Education Programs. If a student elects to interrupt or exit the educational program to obtain licensure as a practical nurse, the board will view this as a continuation of the program for which the student was originally admitted and as a certificate program whose coursework can be applied to the degree granting program. Such certificate requirements shall be defined and published in the school catalog.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Revised: References: Purpose:
60-06 Faculty Waiver Submissions for Nursing Education Programs January 21, 2009 April 28, 2010 Section12-38-116 C.R.S.; Chapter II Rules & Regulations To clarify the expected documentation for nursing education programs to submit for consideration of waivers of faculty requirements
POLICY: It is the policy of the State Board of Nursing (“Board”) to request the Director of the Nursing Education Program (DNEP) with written verification (signature) from the University/College President or designee to submit the following minimum documentation when requesting a waiver of the faculty requirements: 1. 2. 3. 4. 5.
6. 7.
8. 9. 10. 11.
What section of the Board of Nursing’s Chapter II Rules are you asking to be waived? Why should the waiver be granted? What steps have been taken to attempt to comply with the Rules prior to this waiver request? What would be the impact on the program if the waiver was not granted? Does the program or individual faculty member plan to ultimately meet the requirements of the Chapter II Rules? In other words, is this a request for a permanent waiver or a request for a waiver for a specific time period? If the latter, what is the time period of the request? How many waivers of the Board’s Chapter II Rules does the school/program currently have? Please list all previously granted waivers and the reasons for the waivers. What are the teaching responsibilities (theory courses to be taught/ clinical instruction/ lab instruction; advising; faculty supervision, etc.) of the person seeking the waiver? What education, skills, prior experience or other qualifications does this person possess that prepares him or her to take on these responsibilities? (provide documentation of transcripts, resume, certificates, etc) What is the impact of this waiver on maintaining institutional accreditation? (please verify with senior administration of your institution and submit verification) What is the impact of this waiver on gaining or maintaining nursing programmatic accreditation? (please verify the information with the accrediting agency and submit verification) How does the salary that you are offering for this faculty position compare with salaries for individuals with commensurate qualifications in the community? How is the integrity of the program affected if the waiver is granted? Hiring standards at the institution- e.g. Will this person be able to fill the faculty position based on institutional standards? a. For DNEP’s, will the person for whom the waiver is being requested be able to meet all of the responsibilities of that position? b. For faculty positions, will the person for whom the waiver is being requested meet the promotion and tenure track requirements? Will the institution have a sufficient number of full time faculty for each specialty area to provide adequate supervision of clinical faculty, ANIPs and preceptors? Will the program meet the following Board rule for faculty? Will the institution have a sufficient number of full time faculty for each specialty area to provide adequate supervision of clinical faculty, ANIPs and preceptors? Will this waiver affect the institution’s willingness to seek adequate resources to hire qualified faculty? Does the institution have an understanding of appropriate faculty workload and the effects on workload if a waiver is granted to a faculty member that does not meet all of the qualifications? If so, how does the institution plan to address this issue?
Other 12. What is the impact on student learning if a waiver is granted to this faculty member? Please address the following in relation to the person for whom the waiver is being requested: Ability to adequately evaluate and prepare students for safe practice Ability to provide quality instruction—please submit copies of faculty and peer evaluations and reviews for the person who would be granted the waiver Ability to develop, evaluate, and implement curriculum developed from nursing conceptual frameworks Ability to provide quality advising to students
Nursing Board Policy POLICY NUMBER: Title:
60-07 Ratio of Faculty to Student in Professional and Practical Nursing Education Programs August 26, 2009
Date Issued: Date(s) Reviewed: References: Purpose: To provide guidance to Nursing Education Programs for determining safe faculty to student ratios
POLICY: The State Board of Nursing provides the following guidance and direction to Nursing Education Programs for the purpose of ensuring a safe clinical environment. This policy provides guidance regarding the ratio of faculty to students as set forth in Chapter II Rules and Regulation for Nursing Education Programs, Section 1.12 A as follows: The calculation shall be based on: 1) course objectives/competencies; 2) the patient acuity in the direct care clinical environment; 3) limits on faculty to student ratio in the clinical agency contract, and; 4) competency level of the student. A. A lower faculty to student ratio would be permissible in the following context: a. Course syllabus has clinical competencies for a preceptor- student experience or for complex unstable patients with highly unpredictable outcomes. b. Patient is complex with high acuity needs c. Novelty of the situation for the student is higher. d. Student level of independent functioning (competency) in the given patient care context is lower B. A higher faculty to student ratio would be permissible in the following context: a. Course syllabus has clinical competencies that promote care to more stable and predictable patients b. Patient is more predictable with low to moderate acuity needs. c. Novelty of the situation for the student is lower d. Student level of independent functioning (competency) given the patient care context is greater C. The maximum faculty to student ratio when students are providing direct patient care should not be greater than one (1) faculty to ten (10) students. Nothing in this policy is intended to override the contractual agreement between the Nursing Education Program and the clinical agency.
Nursing Board Policy POLICY NUMBER: Title:
60-08 Clinical Simulation Laboratory Experience Evaluation and Faculty Competency in the Clinical Simulation Experience August 26, 2009
Date Issued: Date(s) Reviewed: References: Chapter II Rules Purpose: To provide guidelines for faculty competency in incorporating Clinical Simulation Laboratory and measuring the outcomes of the simulation experiences
POLICY: It is the policy of the Board of Nursing to provide guidelines to nursing education programs when incorporating Clinical Simulation Laboratory (CSL) experiences into the nursing clinical course curriculum. The Board offers further guidance for the responsibilities and qualifications for faculty utilizing CSL within the structure of a clinical nursing course.
Faculty incorporating CSL experiences should use current and specific peer reviewed, clinical objective based scenarios (based upon evidenced based practice and evidence based education) that provide the student with appropriate cognitive, affective and psychomotor development. The scenarios should encompass debriefing and a peer reviewed post evaluation completed by both the students and the simulation faculty. Faculty instructors in the CSL environment should have documented simulation training and or mentorship from qualified vendor training, formal education in an approved education program, or other qualified training programs. Faculty is responsible for assuring adequate oversight and evaluation of students and facilitators in the CSL experience.
Nursing Board Policy POLICY NUMBER: Title: Date Issued: Date(s) Reviewed: References: Purpose:
60-09 Submission of Educational Material for Board Consideration April 28, 2010 Chapter II Rules and Regulations To set forth the procedure by which the Board will review material submitted for nursing education approval
POLICY: It is the policy of the Board that submissions of material to be reviewed by the Board for the approval of nursing education programs must be submitted in a comprehensive and timely manner in order to assure that the Board staff has sufficient time to review and prepare the material for Board approval or decision. Therefore, the Board will adhere to the following guidelines for submission of such material: 1. Board staff is to adhere to the submission deadlines posted on the Board’s website. Any submissions received past the deadline will be reviewed by the Board at the next scheduled full board meeting. 2. A submission of material to correct identified areas of non-compliance must address all areas of non-compliance. Incomplete or partial submissions will be returned to the nursing education program to be resubmitted at such time as all areas of non-compliance are able to be addressed.
