Proposed
Regulation |
July 1999 Version |
June 2000 Version |
Recommend. |
2:00
Standards of
Conduct |
|
|
|
| *Purpose |
"244 CMR
2.00 defines the standards of conduct for all persons holding
a nursing license issued by the Board of Registration in Nursing,
whether the license is current, expired, suspended, surrendered
or revoked. 244 CMR 2.00 also governs the conduct of applicants
for a nursing license and licensed Registered Nurses seeking
or holding advanced practice nursing authorization issued by
the Board." |
"244 CMR 2.00 defines the standards
of conduct for all nurses licensed by the Board of Registration
in Nursing." |
Okay |
| Definitions |
|
|
|
| +Abandon |
Did Not Exist |
Newly proposed –capturing intentional
termination without notice
"Abandon means to intentionally terminate any nurse-patient
relationship without reasonable notice to the patient or appropriate
other person(s), or both, so that arrangements can be made
for necessary continuation of care." |
Newly proposed. Must be clear that
Refusal of Mandatory overtime shall not constitute "abandon".
Adopt California language:
"For patient abandonment to occur, the nurse must:
a) have first accepted the patient assignment, thus establising
a nurse-patient relationship, and then
b) Severed that nurse-patient relationship without giving
reasonable notice to the appropriate person (e.g. supervisor,
patient) so that arrangements can be made for continuation of
nursing care by others.
Refusal to accept an assignment or a nurse-patient relationship
is not considered patient abandonment by the Board. Failure
to notify the employing agency that the nurse will not appear
to work an assigned shift, and refusal to work additional hours
or shifts would also not be considered patient abandonment by
the Board. |
| Abuse |
"Abuse means any impermissible
or unjustifiable contact or communication with a patient or
resident which in any way harms or intimidates, or is likely
to harm
or intimidate, a patient or resident. Abuse may be verbal or
non-verbal, and
may cause physical, sexual, mental or emotional harm." |
Same |
Unchanged. Should be using existing
statutory definition. |
| *Address
of Record |
Was listed under 7.0 Disciplinary
Action Section before as;
"Address of record means the licensed nurse's address as it
appears on the Board's licensed nurse database." |
New – nurse provided; not per residence
"Address of record means the address of a nurse licensed by
the Board as provided by the nurse and maintained by the Board
on its database. |
Allows nurse
to decide and provide "address of record" for license as its
listed on web |
| Advanced
Practice Nurse |
"Advanced Practice Nurse (APN)
means a Registered Nurse to whom the Board has granted written
authorization, under authority of M.G.L. c. 112, s. 80B, to
engage in advanced practice nursing as defined in 244 CMR 4.00." |
Same |
Okay |
| *Advanced
practice Nursing |
|
Newly proposed –
"Advanced practice nursing means professional nursing activity
engaged in by a Registered Nurse in accordance with 244 CMR
4.00." |
Clearly defines scope as according
to appropriate section of regulations on advanced practice. |
| APN Authorization |
"APN authorization means the written
authorization granted by the Board to a Registered Nurse in
accordance with 244 CMR 4.00 to engage in advanced practice
nursing." |
Same |
|
| *Agreement |
"Agreement means a legally binding
document signed by a licensed nurse and the Board containing
the terms and conditions of the resolution of a complaint agreed
upon by the nurse and the Board." |
"Agreement means a legally binding
document reflecting the agreement, including specified terms
and conditions, entered into by a nurse licensed by the Board
and the Board in resolution of any complaint against such nurse." |
Must include
"signature" of licensee to show a meeting of the minds was reached!!!
Otherwise this allows Board to just document what terms were
discussed. verbally. |
| Authorized
prescriber |
"Authorized prescriber means a
person who holds current and valid controlled substances registrations
issued by the United States Drug Enforcement Administration
and the Division of Food and Drugs of the Massachusetts
Department of Public Health." |
Same |
? Shouldn't it reflect "and/or"
for those who may choose to only prescribe schedule VI drugs.
This is true for many APNs. |
| Board |
"Board means the Massachusetts
Board of Registration in Nursing" |
Same |
|
| *CMR |
"CMR means the Code of Massachusetts
Regulations published by the
Regulations Division of the Massachusetts Office of the Secretary
of State.
Copies of the Board's regulations at 244 CMR governing the
practice of nursing may be obtained from the State House Book
Store or on the Internet." |
"CMR means the Code of Massachusetts
Regulations published by the Regulations Division of the Massachusetts
Office of the Secretary of State." |
Shorter: less helpful |
| *Competency |
"Competency means the application
of knowledge and the use of affective, cognitive, and psychomotor
skills required for the licensed nurse's role and the delivery
of safe nursing care." |
"Competency means the application
of knowledge and the use of affective, cognitive, and psychomotor
skills required for the role of a nurse licensed by the Board
and the delivery of safe and effective nursing care."
Required for the role of the nurse…licensed by the Board". |
Ambiguous and BORN lacks authority
to measure whether nursing care was "effective". Are they trying
to measure competence to practice by proposing a standard of
care that all nursing care must be effective? Does a
nurse fall below this standard if a patient does not have a
positive clinical response to a nursing intervention? |
| *Complaint |
"Complaint means a communication
to, or other information obtained by, the
Board alleging that a licensed nurse has engaged in conduct
in violation of Board law(s) or regulation(s), or both." |
"Complaint means a communication
to, or other information obtained by, the Board alleging that
a nurse has engaged in conduct related to the practice of
nursing that violates any law or regulation, or both, related
to such practice." |
Complaint now is limited to conduct
related to the practice of nursing which violates law or regulation.
Document still needs to be in writing to afford authenticity
protection for licensee. |
| Controlled
Substance |
"Controlled substance means a drug,
substance or immediate precursor in any schedule or class referred
to in M.G.L. c. 94C. Any drug or medication requiring a prescription
in Massachusetts is a controlled substance." |
Same |
|
| Drug |
"Drug means a substance recognized
as a drug in the official United States
Pharmacopoeia, official Homeopathic Pharmacopoeia of the United
States, or official National Formulary, and all revisions and
supplements thereto." |
Same |
|
| *Homeopathic
drug |
"Homeopathic drug means a substance
recognized as a homeopathic drug in
the Official Homeopathic Pharmacopoeia of the United States." |
Omitted |
Does the BORN consider these substances
"drugs" requiring a prescription before a nurse can administer?
Will the BORN discipline nurses for the administration of these
over the counter substances, anyway? |
| *Homeopathic
Pharmacopoeia |
"Homeopathic Pharmacopoeia of the
United States means the official Compendium of drugs which are
sold and prescribed according to homeopathic principles, and
all revisions and supplements thereto." |
Omitted |
|
| *Impaired |
"Impaired means the inability to
practice nursing with reasonable judgment, skill and safety
to patients by reason of physical or mental illness, alcohol
or drug use, use of other substance(s), loss of skill, or by
any combination of the foregoing." |
"Impaired means the inability to
practice nursing with reasonable judgment, skill and safety
by reason of alcohol or drug abuse, use of other substances,
a physical or mental illness or condition, or by any combination
of the foregoing." |
Eliminates "loss of skill" as requested,
but limits to alcohol or drug use while redefining "physical
and mental" in terms of illness or condition – assuming a need
for diagnosis.
Place period after "safety" and take out all of the reasons
listed. |
| *Licensed
Nurse |
"Licensed nurse means a nurse to
whom the Board has issued a valid
Registered Nurse (RN) or Licensed Practical Nurse (LPN) license,
or both." |
New title: Nurse Licensed by
the Board
"Nurse licensed by the Board means a nurse to whom the Board
has at any time issued a Registered Nurse or Licensed Practical
Nurse license, or both, whether or not such license is expired,
surrendered, suspended or revoked." |
Looks like Board wants to maintain
jurisdiction over you whether your license is valid or invalid. |
| *Licensed
Practical Nurse |
"Licensed Practical Nurse (LPN)
means a nurse who meets the criteria for licensure under M.G.L.
c. 112, s. 74A and 244 CMR 8.00 and has been issued a valid
LPN license by the Board." |
"Licensed Practical Nurse (LPN)
means a nurse who meets the criteria for licensure under M.G.L.
c. 112, s. 74A and 244 CMR 8.00 and who holds a valid to
engage in the practice of nursing as a Licensed Practical
Nurse." |
Grammatical errors here? |
| MGL |
"M.G.L. means Massachusetts General
Laws." |
Same |
|
| *Mistreatment |
"Mistreatment means the improper
use of any drug(s), physical or chemical restraint(s), confinement,
or any combination thereof." |
"Mistreatment means the improper
use of any drug, physical or chemical restraint, confinement,
or any combination thereof." |
Same – except for elimination of
plurality |
| *Neglect |
"Neglect means the failure to provide
treatment or services, or both, necessary to maintain the health
or safety of a patient or resident." |
"Neglect means the unjustified
failure to provide treatment or services, or both, necessary
to maintain the health or safety, or both, of a patient or resident." |
Includes "unjustified failure"
– and combines health and safety. Should use the statutory definition
of "neglect". |
| *Nurse licensed by the Board |
|
New – defines licensure as present,
past, expired or disciplined |
See "Licensed Nurse" above |
| *Practice
of Nursing |
"Practice of nursing means the
practice of nursing as defined in M.G.L. c.112, s. 80B and 244
CMR 3.00. The practice of nursing includes, but is not limited
to, seeking and accepting a paid or voluntary position requiring
that the
individual hold a current and valid nursing license." |
Defines in relation to the provision
of actual services and geographic boundaries of the state –
telecommunications and still in voluntary and paid practice |
Old definition characterizes voluntary
positon as practice of nursing even though Nurse Practice Act
clearly defines "practice of nursing" as that for compension.
New definition still speaks to "voluntary" employment. This
is poorly written. Voluntary language must be omitted.
Nothing in nurse practice act is defined as conduct constituting
"telenursing". Discussing it in regulation is premature. State
statute must change before this regulation can be adopted. A
reg cannot dictate the law. Insurers contract to provide coverage
where the practitioner is located not the patient. Practice
of nursing should be defined as where the nurse is. Remove
telenursing part of definition. |
| *Prescription
drug |
"Prescription drug means any and
all drugs upon which the manufacturer or distributor has, in
compliance with federal law and regulations, placed the following:
"Caution, Federal law prohibits dispensing without prescription." |
"Prescription drug means any and
all drugs determined to be prescription drugs under M.G.L. c.
94C." |
Old: Uses self defined labeling
New: Uses MGL 94C as descriptor |
| Prescriptive
Practice |
"Prescriptive practice means the
written and oral issuance of prescriptions and
medication orders for prescription and non-prescription drugs." |
Same |
|
| * Professional
Boundaries |
"Professional boundaries mean the
limits of the professional relationship that allow for a safe
therapeutic connection between the professional and the patient.
Boundaries protect the space between the professional's power
and the patient's vulnerability." |
"Professional boundaries mean the
limits of the professional relationship that allow for a safe
and therapeutic interface between the professional and the
patient." |
Old: Explanatory editorial for
the reason for boundaries
New: Editorial eliminated |
| *Registered
Nurse |
"Registered Nurse (RN) means a
nurse who meets the criteria for licensure under M.G.L. c. 112,
s. 74 and 244 CMR 8.00 and has been issued a valid RN license
by the Board." |
"Registered Nurse (RN) means a
nurse who meets the criteria for licensure under M.G.L. c. 112,
s. 74 and 244 CMR 8.00 and who holds a valid license to engage
in the practice of nursing in Massachusetts as a Registered
Nurse." |
Old: RN must be issued a
license
New: "holds license to engage in practice of nursing
in Massachusetts – if you have surrendered your license, you
don't qualify as RN any longer… |
| Standards
of Nursing Practice |
"Standards of nursing practice
means authoritative statements that describe a level of care
or performance common to the profession of nursing by which
the
quality of nursing practice can be judged." |
Same |
No mention of standards publication/promulgation
by the profession! Critical omission!! |
| Substance
Abuse |
"Substance abuse means a dysfunctional
pattern of human response characterized by excessive, inappropriate
or unhealthy use of chemical substances, including alcohol or
drugs, or both." |
Same |
We want this out. Board should
not be deciding what is or is not appropriate or healthy use….this
is a diagnosis outlined by DSM – 4. That definition of substance
abuse ought to be used. |
| *Telecommunications
technology |
"Telecommunications technology
means those modalities used in the practice of telenursing.
Such modalities include, but are not limited to: telephones,facsimile,
cellular phones, video phones, computers, e-mail, voice mail,
CD-ROM, electronic bulletin boards, audio tapes, audio-visual
tapes, teleconferencing, video conferencing, on-line services,
World Wide Web, Internet, interactive television, real-time
camera, and still-imaging." |
"Telecommunications technology
means those modalities used in the practice of nursing over
distance, whether intrastate or interstate. Such modalities
include, but are not limited to: telephones, facsimile, cellular
phones, video phones, computers, e-mail, voice mail, CD-ROM,
electronic bulletin boards, audio tapes, audio-visual tapes,
teleconferencing, video conferencing, on-line services, World
Wide Web, Internet, interactive television, real-time camera,
and still-imaging." |
Attempts to define nursing as including
those acts that utilize technology to service some long distance
need whether intrastate or interstate. This is for the state
legislature to decide. Must amend the Nurse Practice Act before
Board can make this interpretation. |
| *Telenursing |
"Telenursing means the practice
of nursing as defined in M.G.L. c. 112, s.80B, and 244 CMR 3.00
over distance, whether intrastate or interstate, using telecommunications
technology modalities." |
Omitted here but see "practice
of nursing" above |
|
| *Unlicensed Practice of Nursing |
"Unlicensed practice of nursing
means providing, or attempting to provide, nursing care as defined
in M.G.L. c. 112, s. 80B and 244 CMR 3.00 without holding a
current and valid nursing license issued by the Board.
Unlicensed
practice of nursing also means using any word(s) or designation(s)
indicating licensure as a Registered Nurse or Licensed Practical
Nurse without the requisite current and valid nursing license
issued by the Board." |
"Unlicensed practice of nursing
means engaging, or attempting to engage, in the practice of
nursing in Massachusetts without holding a valid license. Unlicensed
practice of nursing also means using any title or other designation
indicating licensure as a Registered Nurse or Licensed Practical
Nurse, or
authorization to engage in advanced practice nursing, without
the requisite valid license or APN authorization." |
Practicing Nursing without a
license is a better title. The law at MGL 112, s. 80B imposes
fines and up to one year in prison… shouldn't this be referenced
here? |
| *Valid license |
"Valid license means a license
properly issued to an individual by the Board on the basis of
truthful information provided the Board, and which license is
not expired surrendered, suspended or revoked." |
"Valid license means any license
to practice nursing in Massachusetts properly issued to a nurse
by the Board on the basis of truthful information related to
the qualifications for licensure as a Registered Nurse or Licensed
Practical Nurse, and which license is not expired, surrendered,
suspended or revoked." |
Looks to be grammatical changes
– not content |
| 2.03 Standards of Conduct |
|
|
|
| *Introduction |
"Each licensed nurse shall have
knowledge and understanding of the Standards of Conduct for
Nurses set forth in 244 CMR 2.00, state laws and Board regulations
governing nursing practice, and all other state and federal
laws and regulations relating to nursing practice.
A licensed nurse's failure to comply
with the Standards of Conduct for Nurses and all other laws
and regulations pertaining to the practice of nursing may
serve as the basis for disciplinary action against the nurse's
license." |
"Each nurse licensed by the Board
and engaged in the practice of nursing shall have knowledge
and understanding of the Standards of Conduct for Nurses set
forth in 244 CMR 2.00, all state laws and Board regulations
governing the practice of nursing, and any other state and federal
law(s) and regulation(s) related to such practice.
The Board may take disciplinary action against the license
of any nurse licensed by the Board or APN authorization, or
both, or against the nurse's right to
renew such license, upon the nurse's failure to comply with
the Standards of Conduct for Nurses or with any other law(s)
and regulation(s) related to the practice of nursing." |
Grammatical changes from "nursing
practice" to "engaged in the practice of nursing"
Again, failure to comply with these standards may serve as basis
for disciplinary action against nurses' license and right
to renew (added) |
| Practice Under Current and Valid
License |
"Except as provided by M.G.L. c.
112, s. 81, a nurse shall practice nursing in Massachusetts
only with a current and valid nursing license issued by the
Board." |
Now Practice Under Valid License
"Except as provided by M.G.L. c. 112,ss. 80, 80A, and 81, a
nurse shall only engage in the practice of nursing in Massachusetts
with a valid license." |
Grammatical changes |
| Practice as Advanced practice Nurse
(APN) |
"A Registered Nurse may engage
in advanced practice nursing in Massachusetts only after receiving
written authorization from the Board in accordance with 244
CMR 4.00." |
"A Registered Nurse may only engage
in advanced practice nursing in Massachusetts after receiving
written authorization from the Board in accordance with 244
CMR 4.00." |
Grammatical changes |
| Practice Following Loss of License |
"A nurse shall not
practice nursing in Massachusetts, or in any way represent himself
or herself as a Registered Nurse or Licensed Practical Nurse,
after the effective date of:
(a) license expiration;
(b) the surrender of his or her nursing license
under the terms of a written agreement entered into with the
Board;
(c) a Board order of license suspension or
license revocation contained in a final decision and order
issued by the Board;
(d) an order of summary license suspension
issued
by the Board in accordance with 244 CMR 7.05." |
" A nurse licensed by the Board
shall not engage in the practice of nursing in Massachusetts,
or in any way represent
himself or herself as a Registered Nurse or Licensed Practical
Nurse, after the effective date of:
(a) license expiration;
(b) the surrender of his or her nursing license
under the terms and conditions of a written agreement entered
into with the Board;
(c) a Board order of license suspension or
license revocation
contained in a final decision and order issued by the Board;
(d) an order of summary suspension issued
by the Board inaccordance with 244 CMR 7.05.
The practice of nursing in Massachusetts after
the occurrence of any of the events set forth in 244 CMR 2.03(3)
(a) - (d) shall constitute the unlicensedpractice of nursing." |
Grammatical changes
Change to "shall constitute practicing nursing without
a license"
|
| * Practice of Telenursing in Another
Jurisdiction |
" A nurse licensed by the Board
who, while physically located in Massachusetts, practices nursing
in
another state or jurisdiction using telecommunications technology
modalities, shall also be governed by the licensure and practice
laws and regulations of the state or jurisdiction in which he
or she practices nursing using such modalities." |
New title: Practice of Nursing
in Another Jurisdiction Using Telecommunications Technology
"A nurse licensed by the Board who, while physically located
within Massachusetts, provides a nursing service using telecommunications
technology to a person physically located outside Massachusetts,
shall also be governed by the licensure and practice laws and
regulations of the state or jurisdiction in which the recipient
of such a service is
located." |
Clear attempt to define nursing
as taking place where the patient is physically located, not
where the nurse is physically located. Board has no authority
to define "nursing" in another state but, is attempting to put
a nurse physically located in MA and interacting with patient
located in another state "on notice" that some states may have
deemed this "telenursing" with rules governing this conduct.
This "notice" to nurses in MA is inappropriate as a regulation.
It should be placed into a policy advisory. |
| * Standards of Nursing Practice |
" A licensed nurse shall practice
nursing in each setting in accordance with the accepted standards
of nursing practice." |
" A nurse licensed by the Board
shall
engage in the practice of nursing in accordance with accepted
standards of nursing practice." |
There is a Definiton term
called "Standards of Nursing Practice" and a Standard of Conduct
called "Standards of Nursing Practice" This is inconsistent.
Standard should be titled: "Adherence to Standards of Nursing
Practice". |
| * Compliance with laws and Regulations
Related to Nursing |
" A licensed nurse shall comply
with M.G.L. c. 112 governing nurse licensure and nursing practice,
as well as the following laws and attendant regulations related
to such licensure and practice:
(a) M.G.L. c. 19A, s. 15 (obligation to report
elder abuse);
(b) M.G.L. c. 19C, s. 4 (obligation to report
abuse of disabled person);
(c) M.G.L. c. 38, s. 3 (report of death to
medical examiner);
(d) M.G.L. c. 46, s. 9 (death pronouncement);
(e) M.G.L. c. 62C, s. 47A(d) (obligation to
pay state taxes);
(f) M.G.L. c. 71, s. 55A (obligation to sick
school child);
(g) M.G.L. c. 71, s. 55B (obligation to file
report certifying
freedom from tuberculosis in communicable form);
(h) M.G.L. c. 111, s. 70E (Patients' or Residents'
Rights);
(i) M.G.L. c. 111, s. 70F (HTLV-III Tests);
(j) M.G.L. c. 111, s. 72G (obligation to report
abuse of patient or Resident);
(k) M.G.L. c. 111, s. 110 (obligation to report
infant with
swollen, red or inflamed eye(s) or with unnatural discharge
within two weeks after birth);
(l) M.G.L. c. 111, s. 110B (obligation to
report examination or treatment of child with Reyes syndrome);
(n) M.G.L. c. 111, s. 191 (obligation to report
lead poisoning);
(o) M.G.L. c. 111, s. 200 (obligation to report
burn injury
affecting 5% or more of body surface);
(p) M.G.L. c. 112, s. 12CC (obligation to
provide patient
records);
(q) M.G.L. c. 112, s. 61 (obligation to pay
student loans);
(r) M.G.L. c. 119, s. 16 (obligation to pay
child support);
(s) M.G.L. c. 119, s. 51A (obligation to report
child abuse);
(t) M.G.L. c. 123, s. 12 (requirements for
commitment of
mentally ill person);
(u) M.G.L. c. 123, s. 21 (requirements for
use of restraint and seclusion of mentally ill person); and
(v) M.G.L. c. 123B, s. 8 (requirements for
use of restraint and seclusion of mentally retarded person)." |
" (a) A nurse who holds a valid
license shall comply with M.G.L. c. 112, ss. 74 - 81C, as well
as any other law(s) and regulation(s) related to nurse licensure
and practice. Examples of such laws include, but are not limited
to, the following:
1. M.G.L. c. 19A, s. 15 (obligation to report
elder abuse);
2. M.G.L. c. 19C, s. 4 (obligation to report
abuse of disabled person);
3. M.G.L. c. 38, s. 3 (report of death to
medical examiner);
4. M.G.L. c. 46, s. 9 (death pronouncement);
5. M.G.L. c. 62C, s. 47A(d) (obligation to
pay state taxes);
6. M.G.L. c. 71, s. 55A (obligation to sick
school child);
7. M.G.L. c. 71, s. 55B (obligation to file
report certifying
freedom from tuberculosis in communicable form);
8. M.G.L. 94C (Controlled Substances Act—requirements
for possessing, dispensing, administering, and prescribing
controlled substances);
9. M.G.L. c. 111, s. 70E (Patients' or Residents'
Rights);
10. M.G.L. c. 111, s. 70F (HTLV-III Tests);
11. M.G.L. c. 111, s. 72G (obligation to report
abuse of patient or resident);
12. M.G.L. c. 111, s. 110 (obligation to report
infant with
swollen, red or inflamed eye(s) or with unnatural discharge
within
two weeks after birth);
13. M.G.L. c. 111, s. 110B (obligation to
report examination or treatment of child with Reyes syndrome);
14. M.G.L. c. 111, s. 191 (obligation to report
lead poisoning);
15. M.G.L. c. 111, s. 200 (obligation to report
burn injury
affecting 5% or more of body surface);
16. M.G.L. c. 112, s. 12CC (obligation to
provide patient
records);
17. M.G.L. c. 112, s. 61 (obligation to pay
student loans);
18. M.G.L. c. 119, s. 16 (obligation to pay
child support);
19. M.G.L. c. 119, s. 51A (obligation to report
child abuse);
20. M.G.L. c. 123, s. 12 (requirements for
commitment of
mentally ill person);
21. M.G.L. c. 123, s. 21 (requirements for
use of restraint and seclusion of mentally ill person); and
22. M.G.L. c. 123B, s. 8 (requirements for
use of restraint and seclusion of mentally retarded person).
(b) Any nurse licensed by the Board who no
longer holds a valid license shall comply with 244 CMR 2.03(6)(a)5.,
17. and 18., as well as any other law(s)
and regulation(s) related to the qualifications for nurse
licensure." |
Grammatically numbered instead
of lettered. Now includes the Controlled Substances Act, M.G.L.
94C in list.
(b) even nurses who no longer hold valid licenses must comply?
What is this? What action does the Board propose to take against
a nurse who no longer holds a valid license and fails to comply
with this section? |
| * Compliance with Massachusetts
Law |
" A licensed nurse shall comply
with the laws of the commonwealth of Massachusetts." |
Omitted |
|
| Aiding Unlawful Activity |
" A licensed nurse shall not aid
any person in performing any act(s) prohibited by law or regulation." |
Same |
Must delete for same reasons "Compliance
with Massachusetts Law" was deleted. |
| * Identification badge |
" A licensed nurse who examines,
observes or treats a patient or resident in any practice setting
shall wear an identification badge which visibly discloses his
or her name, licensure status and, if applicable, advanced practice
authorization." |
" A nurse who holds a valid license
and who examines, observes or treats a patient or resident in
any practice setting shall wear an identification badge which
visibly discloses at a minimum his or her first name, licensure
status and, if applicable, advanced practice authorization." |
Now reflects the legal requirement
of providing first name only. |
| Responsibility and Accountability |
" A licensed nurse shall be responsible
and accountable for his or her nursing judgments, actions and
competence." |
Same |
|
| * Acts within Scope of Practice |
" A licensed nurse shall only perform
acts within the scope of nursing practice as defined in M.G.L.
c. 112, s. 80B and 244 CMR 3.00, and within the level of nursing
for which she is educated and competent, and for which she is
licensed or authorized, or both." |
" A nurse who holds a valid license
and is engaged in the practice of nursing in Massachusetts shall
only perform acts within the scope of nursing practice as defined
in M.G.L. c. 112, s. 80B and 244 CMR 3.00." |
Grammatical changes |
| * Performance of New Techniques
and Procedures |
"A licensed nurse
shall only perform new, approved nursing techniques and procedures
only after appropriate education and demonstrated clinical competence." |
" A nurse licensed by theBoard
shall perform nursing techniques and procedures only after appropriate
education and demonstrated clinical competency." |
Old: Includes provision for "approved
techniques"
New: "Approved" removed . Is the decision as to what is "appropriate"
education made in hindsight. How does a nurse know what is
"appropriate" education? This standard should be eliminated
and the recommendation below under "competency" adopted instead. |
| * Competency |
"A licensed nurse shall only assume
those duties and
responsibilities within the practice of nursing for which he
or she has acquired and maintained competency." |
"A nurse who holds a valid license
shall only assume those duties and responsibilities within his
or her scope of practice and for which he or she has acquired
and maintained necessary knowledge, skills and abilities." |
Defines competency as "necessary
knowledge, skills and abilities". Add "demonstrated clinical
competency to perform" to the end of this sentence. |
| * Nursing Assessment |
"A licensed nurse with responsibility
for direct patient care shall systematically collect, verify
and organize information about a patient, evaluate the significance
of the findings, accurately and adequately
record the information, communicate significant information
to the appropriate
person(s), and take appropriate nursing interventions as necessary
or the patient's well-being." |
Omitted altogether |
Nursing assessment is the essence
of the practice of nursing. The Board is misguided to not include
this as a standard of conduct. The standard should be included
and read:
"A licensed nurse with responsibility for direct patient
care shall directly observe and systematically collect, verify
and organize information about a patient, evaluate the significance
of the findings, accurately and adequately record the information,
communicate significant information to the appropriate person(s),
and take appropriate nursing interventions as necessary or the
patient's well-being." |
| * Discrimination |
" A licensed nurse shall provide
nursing care without regard to age, marital status, sex, sexual
orientation, race, religion, national origin, diagnosis, or
mental or physical disability." |
"A nurse licensed by the Board
shall not withhold or deny nursing care based on age, ancestry,
marital status, sex, sexual orientation, race, color, religious
creed, national origin, diagnosis, or mental or physical
disability." |
Concerned about abortions and licensee's
religious beliefs and caring for "homicidal patients" in relation
to workplace violence. Not appropriate for regulation. Please
Put in a Board Advisory not a standard of conduct. Otherwise,
please define "discrimination" according to statute(s). |
| * Asepsis and Infection control |
" A licensed nurse shall adhere
to
standard precautions and to principles of asepsis and infection
control, and shall not place a patient, himself or herself,
or others at risk for the transmission
of infectious diseases." |
" A nurse licensed by the Board
shall adhere to standard precautions and to principles of asepsis
and infection control, and shall not place a patient, himself
or herself, or others at risk for the
transmission of infectious diseases." |
Knowingly or intentionally should
be included before "place a patient…"
Grammatical changes made. |
| * Patient
Abuse, Neglect, Mistreatment or Other Harm |
" A licensed nurse shall not abuse,
neglect, mistreat or otherwise harm a patient under his or her
nursing care." |
New Title: Patient Abuse, Neglect,
Mistreatment, Abandonment or Other Harm.
" A nurse licensed by the Board shall not abuse, neglect, mistreat,
abandon or otherwise harm a patient." |
Includes "patient abandonment"
language Reference to statutory reference in definition. Remove
"or otherwise harm here." |
| *Leaving
an Nursing Assignment |
"When continued care is required,
a
licensed nurse who has accepted responsibility for a nursing
assignment or other patient care shall leave such assignment
only after properly reporting all
essential information to a designated individual. Further, when
continued care is required for the patient's condition, the
nurse shall transfer responsibilities to an appropriate caregiver." |
Omitted |
|
| Patient Confidential
Information |
"A licensed nurse shall safeguard
patient information from individuals not entitled to such information.
A licensed nurse shall share appropriate information as required
by law or for the protection of the patient." |
Same |
Include "entities" after the word
"individuals" to protect sensitive information from corporation(s)
as well as individual(s). Reword the second sentence so a licensed
nurse understands they have must use discretion and protect
patient information to the extent allowed by the law. Take out
the word "or". Their judgment in protecting the patient cannot
supersede the law. To read: A licensed nurse shall safeguard
patient information from individual(s) and entities not entitled
to such information. A licensed nurse shall only share appropriate
information for the protection of the patient and when required
by law. |
| Patient Dignity
and Privacy |
"A licensed nurse shall safeguard
a
patient's dignity and right to privacy." |
Same |
|
| Participation
in Research |
"A licensed nurse who enrolls or
cares for patients in a research study shall ensure that a body
appropriate to ensure the protection of human subjects
has approved the study." |
"A nurse licensed by the Board
who enrolls subjects in a research study or conducts such a
study, or both, shall verify that a body appropriate
to ensure the protection of human subjects has approved the
study." |
By changing "ensure" to "verify"
it's limited to nurse who enrolls or conducts study, no longer
includes nurse who "cares for patient in research study" |
| Exercise
of Undue Influence |
"A licensed nurse shall not exercise
undue influence on a patient, including the promotion or sale
of services, goods, appliances or drugs, in such a manner as
to exploit the patient for financial gain
of the nurse or a third party." |
Same |
|
| Duty to Safeguard
a patient |
"A licensed nurse shall to the
best of his or her ability safeguard a patient from the incompetent,
abusive or illegal practice of any health care provider, ancillary
personnel or other person involved in a patient's care." |
Omitted |
This speaks to the nurse's advocacy
role. Why was it omitted? We'd like it included as it was. |
| Solicitation
from Patients |
"A licensed nurse shall not solicit
services, or solicit or borrow money, materials or other property,
from patients." |
New Title: Borrowing from Patients
"A nurse licensed by the Board shall not borrow money, materials,
or other property from patients." |
Cleaner definition that will not
prohibit nurse entrepreneurs from advertising/soliciting their
products or services. |
| Undue Benefits
or Gain |
"A licensed nurse shall care for,
and refer, a patient without undue benefit or gain to the nurse
or a third party." |
"A nurse licensed by the Board
shall care for, and refer, a patient without undue benefit or
gain to the nurse or a third party." |
Confusing language – A nurse
licensed by the Board shall not receive undue benefit or gain
from the care or referral of a patient. |
| Advertisement |
"A licensed nurse shall not publish
or cause to be published any advertisement that is false, deceptive
or misleading." |
"A nurse licensed by the Board
shall not engage in false, deceptive or misleading advertising
related to the practice of nursing." |
Omit. This conduct falls
under consumer protection statute, M.G.L. 93A and not the BORN.
It is regulated by the Attorney General. |
| Sexual Contact |
"A licensed nurse shall not have
sexual contact with any patient with whom he or she has a nurse/patient
relationship or with his or her former patient who may be vulnerable
by virtue of emotional status, age, illness or cognitive ability." |
"A nurse licensed by the Board
shall not have sexual contact with any patient with whom he
or she has a nurse/patient relationship or
with any former patient who may be vulnerable by virtue of emotional
status, age, illness or cognitive ability." |
Omit. This is already prohibited
by the "professional boundaries" standard. It is repetitive. |
| Professional
boundaries |
"A licensed nurse shall establish
and observe professional boundaries with respect to any patient
with whom he or she has a nurse/patient relationship. A licensed
nurse shall continue to observe professional boundaries with
his or her former patients who may be vulnerable by virtue of
emotional status, age, illness or cognitive ability." |
Same |
|
| Relationship
Affecting Professional Judgment |
"A licensed nurse shall not initiate
or maintain a nurse-patient relationship that is likely to adversely
affect the nurse's professional judgment." |
Same |
Omit. This conduct is prohibited
by "professional boundaries" standard above. It is repetitive. |
| Mandatory
Reporting |
"A licensed nurse who has firsthand
knowledge of another nurse's:
(a) abuse of a patient;
(b) practice of nursing while impaired by
substance abuse;
(c) diversion of controlled substances shall
report that nurse to the Board in accordance with Board policy." |
"A nurse who holds avalid license
and who directly observes another nurse's:
(a) abuse of a patient;
(b) practice of nursing while impaired by
substance abuse;
(c) diversion of controlled substances shall
report that nurse to the Board in accordance with Board policy.
" |
"Directly observes" now instead
of "first hand knowledge" Still needs to be entirely removed.
No immunity to one reporting. -substance abuse singled out,
who makes the definition of impaired? Abuse and Neglect are
already reportable to other state agencies. Put this language
in the "Duty to Safeguard a Patient" instead as it relates to
incompetent practice including, but not limited to, making a
report to the appropriate agencies. |
| Change of
Personal Data |
"A licensed nurse shall inform
the Board in writing within 15 days of any change of
his or her name, address or Social Security number." |
"A nurse who holds a valid license
shall inform the Board in writing within 30 days of any
change of his or her name,
address of record, or Social Security number." |
Time lengthened. |
| Action Against
Certificate |
"A licensed nurse shall report
to the Board in writing within 30 days any action against, or
surrender of, his or her certificate issued by a certifying
body related to the practice of nursing in connection with any
investigation by such certifying body." |
Same |
|
| Examinations |
"In connection with any examination
related to the practice of nursing, an applicant for a nursing
license or a licensed nurse shall not:
(a) impersonate an applicant for a nursing
license, authorization,
or certification, or act as proxy for the applicant;
(b) disclose the contents of any examination
related to the practice of nursing, or solicit, accept or
compile information regarding the contents of any such examination
before, during or
after its administration, or in any other way compromise or
attempt to compromise the integrity of any such examination;
(c) in any other way cheat on any examination
related to the practice of nursing." |
Same |
|
| Practice
Under a False or Different Name |
"A licensed nurse shall practice
nursing only under the name in which his or her current nursing
license(s) has/have been issued by the Board." |
"A nurse who holds a valid license
shall practice nursing only under the name in which such license
has been issued." |
Grammatical changes |
| Falsification
of Information |
"A licensed nurse shall not falsify,
or attempt to falsify, any documentation or information related
to any aspect of licensure as a nurse, the practice of nursing
and the delivery of nursing services." |
"A nurse licensed by the Board
shall not knowingly falsify, or attempt to falsify, any
documentation or information
related to any aspect of licensure as a nurse, the practice
of nursing and the delivery of nursing services." |
|
| Fraudulent
Practices |
"A licensed nurse shall not engage
in any fraudulent practice including, but not limited to, billing
for services not rendered or submitting false claims for reimbursement." |
Same |
|
| Impersonation |
"A licensed nurse shall not impersonate
another licensed
nurse or health care provider, or knowingly allow or enable
another person to impersonate him or her." |
Same |
|
| Misrepresentation
of Credentials |
"A licensed nurse shall not
misrepresent his or her nursing credentials including, but not
limited to, those indicating education, type of nursing licensure,
advanced practice nursing authorization or other certification
related to the practice of nursing." |
Same |
|
| Security
of Controlled Substances |
"A licensed nurse shall maintain
the security of controlled substances, and of supplies and
equipment used in the administration of controlled substances,
which are under his or her responsibility and control." |
"A nurse licensed by the Board
and engaged in the practice of nursing shall maintain the
security of controlled substances that are under his or
her responsibility and control." |
|
| Practice
While Impaired |
"A licensed nurse shall not practice
nursing while impaired." |
Same |
|
| Unlawful
Acquisition and Possession of Controlled Substances |
"A licensed nurse shall not unlawfully
obtain or possess controlled substances." |
Same |
|
| Administration
of Drugs |
"In the course of practice as a
licensed nurse, a nurse shall not provide or administer any
prescription drug or non-prescription drug to any person except
as directed by an authorized prescriber." |
"A nurse licensed by the Board
shall not administer any prescription drug or non-prescription
drug to any person in the course of nursing practice except
as directed by an authorized prescriber. 244 CMR 2.03(38) shall
not apply where any Registered Nurse authorized by the Board
to practice as a nurse anesthetist administers anesthesia or
peri-operative medications, or both, under guidelines required
by 244 CMR 4.25(4)." |
Change was to reflect lawful nurse
anesthetist practice. |
| Documentation
of Controlled Substances |
"A licensed nurse shall document
the handling and administration of controlled substances in
accordance with all applicable federal and state laws and regulations
and in a manner consistent with safe and proper nursing
practice." |
"A nurse licensed by the
Board shall document the handling and administration of controlled
substances in accordance with all applicable federal and state
laws and regulations and in a manner consistent with safe and
effective nursing practice." |
Is the board getting at competence
by using the word "effective" or at legibility of documentation?
This is ambiguous and vague. What is "effective nursing practice"
when it comes to documentation? Remove this term. |
| Circumvention
of Law |
"A licensed nurse shall not receive
from, or offer, give or promise anything of value or benefit
to, any official to circumvent federal, state, or local law(s),
regulations or ordinance(s) governing the practice of nursing." |
"A nurse licensed by the Board
shall not receive from, or offer, give or promise anything of
value or benefit to, any official to
circumvent any federal, state, or local law(s), regulation(s)
or ordinance(s) related to the practice of nursing." |
Grammatical changes. |
| Compliance
with Board Order |
"A licensed nurse shall comply
with an order for disciplinary action issued against him or
her by the Board except as otherwise may be determined by the
appropriate court in the course of an appeal of a Board final
decision and order." |
"A nurse licensed by the Board
shall comply with any order for disciplinary action issued by
the Board against his or her license to practice nursing or
right to renew such license except as otherwise may be determined
by the appropriate court in the course of an appeal of a Board
final decision and order." |
Grammatical changes. |
| Compliance
with Agreements |
"A licensed nurse shall comply
with all provisions contained in any written agreement he or
she has entered into with the Board." |
Same |
See definition of "Agreement" recommendation |
| Delegation |
"A licensed nurse, in accordance
with 244 CMR 3.05, shall only delegate nursing activities to
persons who are competent and qualified to undertake and perform
the delegated nursing activities. A licensed nurse shall not
delegate to non-licensed persons nursing activities which require
nursing
assessment and judgment during implementation." |
Omitted |
Re-insert this important standard
of conduct to read: A licensed nurse shall only delegate
nursing activities in accordance with 244 CMR 3.05.
|
| Supervision
Following Delegation |
"A licensed nurse who delegates
activities shall appropriately supervise the person(s) to whom
the activities have been delegated in accordance with 244 CMR
3.05." |
Omitted |
Re-insert this important standard
of conduct. Language should read: Monitoring Following Delegation |
| Violence |
"A licensed nurse shall not endanger
the safety of the public, patients or coworkers by making actual
or implied threats of violence, or carrying out an act of violence." |
"A nurse licensed by the Board
shall not endanger the safety of the public, patients or coworkers
by making actual or implied threats of violence, or carrying
out an act of violence." |
Grammatical Changes |
| Making and
Maintaining Records |
"A licensed nurse shall make and
maintain adequate, accurate, legible and self-explanatory entries
in all records
required by law and the customary practice of nursing." |
New title: Documentation
"A nurse licensed by the Board shall make complete, accurate,
and legible entries in all records required by law, regulation
and the customary practice of nursing. On all documentation
requiring a nurse's signature, the nurse must sign his or her
name as it appears on his or her license." |
Looks like
Board expects nurse to sign full name on all documents despite
lack of available space. There will be "systems problems" preventing
compliance. This is unreasonable expectation. Remove second
sentence. |
| Alteration
or Destruction of Records |
"A licensed nurse shall not destroy
or inappropriately alter any record(s) related to the practice
of nursing." |
"A nurse licensed by the Board
shall not inappropriately destroy or alter any record related
to the practice of nursing." |
Grammatical Changes. Insert: "knowingly
after word "not". |
| *Responsibilities
of Nurse in Management Role |
"A licensed nurse functioning in
a management role in any health care setting, or in any nursing
education program, shall ensure that:
(a) . acceptable standards of nursing practice
are established and
carried out so that safe and effective nursing care is provided
to
patients;
(b) written nursing policies are readily available
to nursing staff;
(c) organizational policies and position descriptions
are not
inconsistent with M.G.L. c. 112, ss. 74-81B, Board regulations
at 244 CMR 2.00-7.00, and to all federal and other state laws
and
regulations related to the practice of nursing;
(d) assigned nursing care staff is determined
to be competent to
carry out the requirements of their jobs;
(e) reliable documentation of nursing licensure
and advanced practice authorization, where appropriate, is
acquired before the
time of hire and is maintained throughout the course of employment
by:
1. requiring the nurse to present his or her
currentnursing license issued by the Board; or
2. verifying the validity of the license with
the Board
either in writing, by telephone, or by Internet website
check;
(f) the name and any other identifying information
of a nurse is immediately reported to the Board when the nurse:
1. has a license that shows evidence of tampering
or alteration;
2. has engaged in nursing practice with an
expired nursing license;
3. is unable to produce official and credible
documentation of current and valid licensure" |
"A nurse licensed by the Board
and employed in a nursing management role shall make all
reasonable efforts to ensure the safe and effective practice
of nursing in all practice settings within the nurse's management
authority." |
Dramatically Different and Dramatically
Worse. Reduces accountability for nurse manager.
Re-insert specifics with previous MNA recommendations
for clean and unambiguous language. |
| Other Prohibited
Conduct |
"A licensed nurse shall not engage
in any other conduct that fails to conform to accepted standards
of nursing practice or behavior that has, or may have, an adverse
effect upon the health, safety and
welfare of the public." |
"A nurse licensed by the Board
shall not engage in any other conduct that fails to conform
to accepted standards of nursing practice or behavior that is
likely to have an adverse effect upon the
health, safety or welfare of the public." |
Grammatical Changes. Still Problematic.
Remove this broad sweeping provision. It is too subjective to
measure. |
| Standards
of Conduct for Advanced Practice Nurses (APNs) |
"In addition to the Standards of
Conduct set forth in 244 CMR 2.03(1)-(53),
the standards set forth in 244 CMR 2.04(1)-(6) shall govern
nurses engaged in
advanced practice nursing.
An APN's failure to comply with the Standards of Conduct
for Advanced
Practice Nurses may serve as the basis for disciplinary action
against the
APN's authorization to engage in advanced practice nursing
in accordance with
M.G.L. c. 112, ss. 61 and 74. Such failure may also serve
as the basis for a disciplinary action against the APN's Registered
Nurse license." |
Same |
|
| Preparation
and Competency |
"An APN authorized by the Board
shall practice only in the category of advanced practice
nursing for which the Board has authorized him or her. The
APN's clinical practice shall include only those areas of practice
for which the APN has formal advanced nursing education and
documented competency. Such formal advanced nursing education
shall meet the criteria for continuing education in nursing
as specified in 244 CMR 4.00." |
Same |
|
| Practice
Following Loss of Authorization |
"An APN shall not engage in advanced
practice nursing, or in any way represent that he or she is
authorized to engage in such practice, after the effective date
of the surrender, suspension or revocation of such authorization
by the Board." |
"An APN shall not engage in advanced
practice nursing, or in any way represent that he or she is
authorized to engage in such practice, after the effective date
of the surrender, suspension or revocation of such authorization
by the Board, or after the voluntary relinquishment of such
authorization to the Board." |
Expanded |
| Controlled
Substance Registration |
"An APN who is an
authorized prescriber shall:
(a) comply with Board regulations at 244 CMR
4.00 governing prescriptive practice by an APN and with all
federal and state laws and regulations governing prescriptive
practice and the handling of controlled substances; and
(b) notify the Board in writing of any surrender,
suspension, revocation or other action affecting the APN's
federal or state controlled substances registrations, or both.
In the case of the surrender, suspension or revocation of
either such registration, the APN shall immediately cease
all prescriptive practice." |
Same |
|
| Advanced
Practice Certification |
"In order to practice advanced
practice nursing, an APN shall maintain current professional
advanced practice certification and shall submit evidence satisfactory
to the Board of such recertification with each application for
license renewal." |
"In order to maintain APN authorization
and to engage in advanced practice nursing, an APN shall hold
current professional advanced practice certification and shall
submit evidence satisfactory to the Board of current certification
with each application for Registered Nurse license renewal." |
Grammatical Changes |
| *Full Disclosure |
"An APN shall fully disclose to
a patient or the patient's representative the risks and benefits
of, and alternatives to, any proposed diagnostic or therapeutic
intervention and shall document such disclosure in the patient's
records." |
"When proposing any diagnostic
or therapeutic intervention which is beyond the scope of generic
nursing practice, an APN shall fully disclose to the patient
or the patient's representative the risks and benefits of, and
|
