An Overview of The Kentucky Board of Nursing and APRN Statutes and Regulations

1. An Overview of The Kentucky Board of Nursing and APRN Statutes and Regulations Myra K. Goldman MSN, APRN, FNP-BC Developed in collaboration with: Pamela C. Hagan, MSN, RN Acting Executive Director 2019

2. Objectives • Understand the Mission of the Board of Nursing. • Identify the role of the Board of Nursing in relation to APRN prelicensure programs of nursing across the Commonwealth. • Discuss the roles and responsibilities of the chief nurse administrator/APRN program coordinator in a Board Approved APRN nursing education program. • Discuss the provisions in the Statutes and Administrative regulations that relate to APRN nursing education. • Explain the process for ongoing program compliance and reporting to the Board. • Understand the licensure and credentialing process.

3. KBN Roles: Myth or Fact…The Board of Nursing: • Advocates for nurses • Is charged with regulating nurses and nursing practice • Intercedes with employers on behalf of nurses • Monitors initial and continued competence of nurses • Protects the public

4. Mission Statement The Kentucky Board of Nursing protects the well-being of the public by development and enforcement of state law governing the safe practice of nursing, nursing education and credentialing.

5. 2019 Licensure Statistics • *March 24, 2019

6. Professional Organization vs Regulatory Agency Society PROFESSIONAL REGULATORY Defines nature and scope of nursing practice Statutorydefinition of nursing practice Standards of Practice Laws and Regulations Licensure Quality Assurance PublicProtection To protect the public through safe nursing practice To define nature and scope of nursing practice

7. Who is “The Board”? • State government agency • 16 members appointed by the Governor Members serve four (4) year terms, may be reappt.’d • Ten (10) Registered Nurse Members • One (1) APRN Member • Three (3) Licensed Practical Nurse members • Two (2) Citizens-at-Large KRS 314.121

8. Nominating Organizations • Kentucky Nurses Association • Kentucky License Practical Nurses Organization • Kentucky Organization of Nurse Leaders • Kentucky Association of Health Care Facilities • Kentucky Association of Homes and Services for the Aging, Inc., (LeadingAge) • KRS 314.121 (3)

9. Open Meetings Most meetings of the Board and its advisory councils or committees are open to the public. Board Meetings April, June, August, October, December (even months) Education & Practice Committee/Council Meetings January, March, May, September, November (odd months)

10. KBN Committees • Education Committee • Practice Committee • APRN Council • Controlled Substances Formulary Development Committee • Collaborative Prescribing Agreement Joint Advisory Committee (CAPA-COM) • Consumer Protection Committee • Governance Committee • Dialysis Tech Council

11. KBN Branches Credentials • Licensure • APRNs • DT/SANE Credentials • Exams • Nurse Licensure Compact • SRNA Registry Investigation Compliance • KARE Program Information Management Administrative Services Executive Office • Executive Director • General Council Professional Support • Nursing Education Consultant • APRN Education & Practice Consultant • Practice Consultant • CE/Competency • NISF

12. Kentucky Board of Nursing Activities • Implement Kentucky Nursing Law through creation of Regulations • Issue Advisory Opinions about safe practice • Approve PONs: Pre-licensure, APRN/MSN, APRN/DNP • Issue APRN, RN and LPN licenses • Issue DT and SANE Credentials • Maintain SRNA registry • Approve Continuing Education Providers • Administer special programs as directed by legislature • Investigate Complaints/Disciplinary Action • Nursing Incentive Scholarship Fund

13. Licensure Renewal – CE Requirements • Renewal period begins September 15 and closes on October 31 of each • CE/Competency requirements – Earning period begins November 1– conclude October 31 of each year • 14 nursing contact hours (7 ways to obtain)

14. Nursing Incentive Scholarship Fund • $5 of licensure renewal fee • KY residents attending approved pre-licensure or graduate programs • Programs of Nursing do not have to be located in KY • Typical award is $3000 per academic year • May be used for cost of living expenses as well as school expenses.

15. Nursing Incentive Scholarship Fund • Students in prelicensure (LPN & RN) and BSN completion nursing programs must complete a minimum of 15 credit hours of published requirements for the nursing program per academic year for each $3,000 NISF scholarship awarded.   • Graduate nursing programs require completion of 9 credit hours per academic year. • Students must maintain a minimum grade point average that will allow continuation in a nursing program. 

16. Nursing Incentive Scholarship Fund • The scholarship requires that a recipient must work full-time as a nurse in Kentucky for one year for each academic year funded.  • The work obligation begins after graduation from the program which you are funded. 

17. Questions?

18. APRN Consensus Model & APRN Practicein Kentucky

19. Background to APRN Consensus Model • Concerns about regulatory sufficiency were voiced upon learning that some nurse practitioner certification programs were not designed for entry-level use. • Concern that there was uneven enforcement of admission requirements • Boards were concerned about their reliance on national specialty certification programs for regulatory purposes. Due to expressed concerns, boards of nursing, via their 1995 Delegate Assembly, directed the NCSBN to collaborate with nurse practitioner specialty certification organizations to make significant progress toward legally defensible, psychometrically sound nurse practitioner examinations that are sufficient for regulatory purposes. History of APRN retrieved from the ncsbn.org website 4/3/2019 https://www.ncsbn.org/737.htm

20. APRN Consensus Model Framework that allows for a consistent definition of advanced nursing practice for quality and safety across jurisdictions, employers, and settings…..towards uniformity

21. Consensus Model for APRN Regulation • 1993 NCSBN Position Paper on APRN Licensure • 1995 NCSBN worked to ensure certification exams legally defensible and psychometrically sound for regulatory purposes • 1997-2004 Simultaneous Groups working on topic • 2004-2007 Joint Dialogue Group (national nursing groups and NCSBN) • 2006 NCSBN APRN Vision Paper • 2008 Consensus Document Published

22. Consensus Model for APRN Regulation:Licensure, Accreditation, Certification & EducationJuly 7, 2008FINAL APRN Consensus Document APRN Consensus Document

23. KBN Implementation of Consensus Model • 2009 NCSBN developed Model Legislative Language • 2010 KBN Adopted Model • 2011 KY Law – KRS Chapter 314 [KRS 314.011 (8)]

24. Regulatory Components • Licensure • Accreditation • Certification • Education LACE

25. Elements of APRN Regulation in Consensus Model • Title -- APRN • Roles -- CNP, CNS, CRNA, CNM • Licensure -- RN + APRN • Education -- Graduate Degree • Certification – Advanced Certification

26. APRN Roles • CNP – certified nurse practitioner • CRNA –certified registered nurse anesthetist • CNM – certified nurse midwife • CNS – clinical nurse specialist (certified)

27. Elements of APRN Regulation in Consensus Model • Independent Practice –without MD oversight or written collaborative agreement • Full Prescriptive Authority –without MD oversight or written collaborative agreement

28. APRN Educational Preparation • Clinical and didactic coursework must be comprehensive and sufficient to prepare the graduate to obtain certification for licensure and to practice in the APRN role and population focus.

29. Population Foci for APRN In addition to the role, each APRN is educated in one of 6 population foci. Foci are: • Family/individual across the lifespan • Adult-gerontology • Neonatal • Pediatrics • Women’s health/gender related • Psychiatric/Mental Health

30. Population Foci for APRN • Family/individual across the lifespan • Adult-Gerontology • Acute • Primary • Neonatal • Pediatrics • Acute • Primary • Women’s Health/gender related • Psychiatric/Mental Health

31. Specialty Education and Practice • Specialty focus is on practice beyond role and population focus & linked to healthcare needs • Preparation in a specialty area of practice is optional in the graduate program, but if included, must build on the APRN role/population-focus competencies. • Example: palliative care, oncology, diabetes, new AANP ENP

32. Core Educational Goals • Ensure3P’s – advancedPhysical/health assessment, advanced Pathophysiology, advancedPharmacology –separate, unique courses • Ensure APRN role and population focused competencies attained • Integrate adult and older adult • Psychiatric-mental health across the lifespan

33. Relationship Between Education, Competencies, Licensure and Certification Competencies Measures of Competencies Identified by Professional Organizations (e.g. oncology, palliative care, CV) Specialty Certification* Specialty CNP, CRNA, CNM, CNS in Population context Population Foci Licensure: Based on Education and Certification** Role APRN Core Courses: Pathophysiology, Pharmacology, Physical/health assess. APRN

34. APRN Regulatory Model APRN Specialties Focus of Practice beyond role and population focus Linked to health care needs Examples include but are not limited to: Oncology, Diabetes, Orthopedics, Nephrology, Palliative care POPULATION FOCI Neonatal Adult-++ Gerontology* Family/Individual Across Lifespan Women’s Health/ Gender Related Pediatrics ++ Psych/Mental Health** Licensure at levels of role and population foci APRN ROLES Nurse Anesthetist Nurse Midwife Clinical Nurse Specialist+ Nurse Practitioner ++ Primary care Acute care

35. Principle of Population Focus • * Adult-gerontology, encompasses the young adult to the older adult, including the frail elderly. APRNs educated and certified in the adult-gerontology population are educated and certified across both areas of practice and are titled Adult-Gerontology CNP or CNS. • All APRNs in any of the four roles providing care to the adult population, e.g., family or gender specific, must be prepared to meet the growing needs of the older adult population. Therefore, the education program should include didactic and clinical education experiences necessary to prepare APRNs with these enhanced skills and knowledge. • **Psychiatric/mental health, encompasses education and practice across the lifespan. • + Clinical Nurse Specialist (CNS) is educated and assessed through national certification processes across the continuum from wellness through acute care.

36. Acute vs. Primary • ++The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP competencies. • As of 2008 Consensus Document, the acute care and primary care CNPdelineationapplies only to the pediatric and adult-gerontology CNP population foci. • Programs may prepare individuals across both theprimary care andacute care CNP competencies, but will need to write two exams.

37. Acute vs. Primary • If programs prepare graduates across both primary and acute care roles, the graduate must be prepared with the consensus-based competencies for both roles and must successfully obtain certification in both the acute and the primary care CNP roles. • CNP certification in the acute care or primary care roles must match the educational preparation for CNPs in these roles. • Scope of practiceof the primary care or acute care CNP is not setting specific but is based on patient care needs.

38. KY APRN Scope of Practice • Performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program thatpreparesthe registered nurse for one (1) of the four (4) APRN roles [designations] • Limited to certified population foci, and as described in applicable national scope and standards of practice… KRS 314.011(8)

39. Kentucky’s Scorecard on Meeting Elements of Consensus

40. NCSBN Scoring Grid

42. Kentucky Nursing Laws • Kentucky Revised Statutes (KRS) • Body of laws that govern the Commonwealth of Kentucky • Provides the structure (framework) for Administrative Regulations • Chapter 314 • Location of Nursing Laws for the Commonwealth of Kentucky http://www.lrc.ky.gov/Statutes/chapter.aspx?id=38813

43. Kentucky Administrative Regulations Kentucky Administrative Regulations (KAR) • Detailed directions developed by KBN to operationalize and implement statutes • Carry the force and effect of law • Specific in language and construction • Divided into sections (title, chapter, number) • Title: 201KAR=Kentucky Administrative Regulation • Chapter 20 = Nursing Regulations • Number 056-065 http://www.lrc.state.ky.us/kar/TITLE201.htm#chp020

44. Overview: Regulations on the LRC Regulations are color-coded on the LRC website: • Blue = current version of the regulation • Green = Regulation in process of being amended; takes approximately 3 months • Red = emergency regulation that goes into effect immediately

45. Kentucky Nursing Laws & Regulations for APRN Nursing Education

47. KRS 314.111 Nursing school approval -- Standards -- Administrative regulations -- Administrative hearing. • (1) An institution desiring to conduct a school of nursing shall apply to the board and submit evidence that it is prepared to carry out the minimum approved basic curriculum in nursing and that it is prepared to fulfill other requirements of standards which are established by KRS 314.011 to 314.161 and KRS 314.991 and the administrative regulations promulgated by the board. No person shall operate a nursing education program or school of nursing without complying with the provisions of this section

48. KRS 314.111 Nursing school approval -- Standards -- Administrative regulations -- Administrative hearing. • (2) A survey of the institution and its proposed education program shall be made by the executive director or an authorized employee of the board who shall submit a written report of the survey to the board. If in the opinion of the board the requirements for an approved nursing education program or school of nursing are met it shall approve the school.

49. Authority of the Board to Approve Programs of Nursing • KRS 314.131 Board meetings -- Officers -- Quorum -- Duties -- Executive director -- Compensation of members -- Liability insurance -- Expunging of disciplinary action records. …(2) The board shall approve programs of nursing and shall monitor compliance with standards for nurse competency under this chapter. It shall examine, license, and renew the license of duly-qualified applicants; … issue advisory opinions or declaratory rulings dealing with the practice of nursing; register and designate those persons qualified to engage in advanced nursing practice; and it shall conduct administrative hearings in accordance with KRS Chapter 13B upon charges calling for discipline of a licensee and cause the prosecution of all persons violating any provisions of this chapter. It shall keep a record of all its proceedings and make an annual report to the Governor.

50. KRS 314.011(8) "Advanced practice registered nursing" means • the performance of additional acts by registered nurses • who have gained advanced clinical knowledge and skills through an accredited education program that prepares the registered nurse for one (1) of the four (4) APRN roles. • who arecertifiedby the American Nurses' Association or other nationally established organizations or agencies recognized by the board to certify registered nurses for advanced practice registered nursing as a certified nurse practitioner, certified nurse anesthetist, certified nurse midwife, or clinical nurse specialist; and • who certified in at least one (1) population focus.