Session Laws

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 13 of the General Laws is hereby amended by striking out section 13, as appearing in the 1992 Official Edition, and inserting in place the following section:-

Section 13. (a) The governor shall appoint thirteen members to a board of registration in nursing hereinafter called the board. When making such appointments the governor shall consider persons suggested by nursing organizations in the commonwealth. Members shall be residents of the commonwealth. The composition of the board shall be as follows: nine registered nurses; three licensed practical nurses; one consumer.

(b) At the time of appointment or reappointment, nurse members shall:

(1) be currently licensed as nurses in the commonwealth;

(2) have at least eight years of experience in nursing practice in the ten years immediately preceding the appointment; and

(3) be currently employed in nursing in the commonwealth at the time of appointment or reappointment.

(c) Registered nurse board members shall include representatives from long-term care, acute care, and community health settings in the following manner:

(1) one representative from each level of nursing education whose graduates are eligible to write nursing licensure examinations; provided, however that baccalaureate and higher degree programs shall be considered one level;

(2) two registered nurses in advanced practice, both of whom must meet requirements for authorization as a registered nurse in advanced practice as established by the board, at least one of whom is employed providing direct patient care at the time of appointment;

(3) one registered nurse who is currently employed as a nursing service administrator and who is responsible in that role for agency or service wide policy development and implementation;

(4) two registered nurses not authorized in advanced nursing practice and who provide direct patient care.

(d) Licensed practical nurse board members shall include representatives from long-term care, acute care, and community health settings.

(e) The consumer board member shall be knowledgeable in consumer health concerns and shall neither be, nor ever have been, associated directly or indirectly with the provision of health care.

(f) Board members shall serve for a term of three years and until the governor appoints a successor, no member may serve more than two consecutive full terms in any category. Completion of an unexpired term does not constitute a full term. No fewer than four members of the board shall be appointed each year.

(g) The governor shall fill any vacancy on the board within ninety days of the date that position becomes vacant.

(h) The present members of the board holding office upon the effective date of this act shall serve as members for the duration of their respective terms.

SECTION 2. Said chapter 13 is hereby further amended by striking out section 14, as so appearing, and inserting in place thereof the following section:-

Section 14. The board shall:

(a) meet at least four times per year and shall elect a chairperson and officers annually;

(b) appoint, employ and prescribe the duties of a qualified registered nurse to serve as executive director of the board, who shall not be subject to chapter thirty-one and who shall employ persons, as necessary, to administer section thirteen and this section and sections seventy-four to eighty-one C, inclusive, of chapter one hundred and twelve, and who shall receive such salary as may be fixed in accordance with chapter thirty;

(c) have responsibility and power to administer, coordinate, and enforce the provisions of section thirteen and this section and sections seventy-four to eighty-one C, inclusive, of chapter one hundred and twelve, without limitation to such other powers, duties, and authorities as it may be granted by its status;

(d) be authorized to make, adopt, amend, repeal, and enforce such rules and regulations consistent with law as it deems necessary for the protection of the public health, safety and welfare and for proper administration and enforcement of its responsibilities;

(e) conduct such hearings and keep records and minutes as are necessary to carry out its duties;

(f) collect reasonable fees established pursuant to the provisions of section three B of chapter seven; provided, however, that in setting the level of said fees, the secretary of administration shall take into consideration the projected costs of assuring sufficient funding to meet the purposes of this section, including, but not limited to, clauses (g) to (k), inclusive;

(g) conduct studies of the supply of nurses in the commonwealth and, in conjunction with other agencies of the commonwealth, evaluate the demand for nursing services;

(h) provide consultation, conduct conferences, forms, studies and research on nursing practice, nursing education and related matters;

(i) prepare and publish materials the board determines integral to the delivery of safe and effective nursing care;

(j) notify all licensees annually about all changes in law and rules and regulations regarding nursing licensure and nursing practice; and

(k) participate in, including attending at meetings of, and paying fees to, national organizations of state boards of nursing.

SECTION 3. Said chapter 13 is hereby further amended by striking out section 14A, as so appearing, and inserting in place thereof the following section:-

Section 14A. There shall be an assistant to the executive director of the board, who shall have been a registered nurse for at least five years prior to appointment, who shall be appointed by the director, with the approval of the board.

SECTION 4. Chapter 112 of the General Laws is hereby amended by striking out section 74, as so appearing, and inserting in place thereof the following section:-

Section 74. The board of registration in nursing in this section and in sections seventy-four A to eighty-one C, inclusive, called the board, shall hold examinations for the registration of nurses at such times and places as it shall determine. Applications for registration, signed and sworn to by the applicant, shall be made on blanks approved by the board. An applicant who furnishes satisfactory proof that he is of good moral character and a graduate of a school for nurses approved by the board shall, upon payment of a fee as determined by the secretary of administration pursuant to chapter seven of the General Laws, be examined by the board, and if found qualified, shall be registered, with the right to use the title registered nurse and to practice as such, and shall receive a certificate thereof from the board.

An applicant failing to pass an examination satisfactory to the board shall be entitled to additional examinations under the rules of the board, but shall file a new application and pay a fee as determined under the aforementioned provision for each such examination.

Every person registered hereunder who continues to hold himself out as a registered nurse shall, on or before his birthday in each even-numbered year, renew his registration for the ensuing two year period by payment of a fee as determined by the aforementioned provision to the board, and thereupon, the board shall issue a certificate showing that the holder thereof, is entitled to practice as a registered nurse for the period covered by said payment; provided, however, that if a birthday of any person who shall be registered hereunder shall occur within three months after such original registration, such person need not renew his registration until his birthday in the even-numbered year next following the birthday aforesaid; provided, further, that every person seeking renewal of registration hereunder shall provide evidence of such continuing education as the board shall require by regulation unless the board accepts the training and experience of any such person in lieu of said continuing education requirement.

The board shall promulgate rules and regulations as to the type and amount of continuing education required for such nurse as a qualification for licensing or relicensing; criteria for approved programs, which shall not exclude programs offered by health care facilities licensed by the department of public health or institutions chartered by the commonwealth; procedure for the approval of such programs; mechanism for the verifications of compliance by each person seeking renewal or registration and provision for inactive status.

The board shall have the authority from time to time to make, amend and rescind such rules and regulations as may be necessary to carry out the provisions of the continuing education requirements. Said regulations shall provide that the minimum number of hours required shall not be less than fifteen hours. For the purposes of this section and of section seventy-four A, the birthday of a person born on February twenty-ninth shall be deemed to be February twenty-eighth. In default of such renewal, a person registered hereunder shall forfeit the right to practice as a registered nurse or to hold himself out as such until such fee shall have been paid.

The board, after a hearing, by vote of a majority of its members, may annul the registration and cancel the certificate of any nurse who has been found guilty of a felony.

SECTION 5. Said chapter 112 is hereby further amended by striking out section 74A, as so appearing, and inserting in place thereof the following section:-

Section 74A. The board shall hold examinations for the licensing of practical nurses at such times and places as it shall determine. Applications for licenses as practical nurses, signed and sworn to by the applicants, shall be made on blanks approved by the board. An applicant who furnishes satisfactory proof that he is of good moral character and that he is a graduate of a school for practical nurses approved by the board or is a graduate of an accredited school of professional nursing or was a student in good standing at an accredited school of professional nursing before completing the program of studies and, at the time of withdrawal, had completed a program of study, theory and clinical practice equivalent to that required for graduation from an approved school of practical nursing, shall, upon payment of a fee as determined by the secretary of administration pursuant to chapter seven shall be examined by the board and, if found qualified, shall be licensed, with a right to use the title licensed practical nurse and to practice as such, and shall receive a certificate thereof from the board. An applicant failing to pass an examination satisfactory to the board shall be entitled to additional examinations under the rules of the board but shall file a new application and pay a fee as determined under the aforementioned provision for each such examination. Every person licensed hereunder who continues to hold himself out as a licensed practical nurse shall, on or before his birthday in each odd numbered year, renew his license for the ensuing two-year period by payment of a fee as determined under the aforementioned provision to the board, and thereupon the board shall issue a certificate showing that the holder is entitled to practice as a licensed practical nurse for the period covered by said payment; provided, however, that if a birthday of any person who shall be licensed hereunder shall occur within three months after such original licensing, such person need not renew his license until the birthday in the odd-numbered year next following the birthday aforesaid; provided, further, that every person seeking renewal or licensing hereunder shall provide evidence of such continuing education as the board shall require by regulation, unless the board accepts the training and experience of any such person in lieu of said continuing education requirements. The board shall promulgate rules and regulations as to the type and amount of continuing education required for such nurse as a qualification for licensing or relicensing; criteria for approved programs, which shall not exclude programs offered by health care facilities licensed by the department of public health or educational institutions chartered by the commonwealth; procedure for the approval of programs; mechanism for the verification of compliance by each person seeking renewal or registration and provision for inactive status. The board shall have the authority from time to time to make, amend, and rescind such rules and regulations as may be necessary to carry out the provisions of continuing education requirements. Said regulations shall provide that the minimum number of hours required shall not be less than fifteen hours in the registration periods. In default of such renewal, a person licensed hereunder shall forfeit the right to practice as a licensed practical nurse or to hold himself out as such until such fee shall have been paid. The board, after a hearing, by vote of a majority of its members, may annul the license and cancel the certificate of any practical nurse who has been found guilty of a felony.

SECTION 6. Said chapter 112 is hereby further amended by striking out section 77, as so appearing, and inserting in place thereof the following section:-

Section 77. The board shall investigate all complaints of violation of sections seventy-four to eighty-one C, inclusive, and report same to the proper prosecuting officers. The board shall participate in national data reporting systems which provide information on individual nurses.

SECTION 7. Said chapter 112 is hereby further amended by striking out section 80B, as so appearing, and inserting in place thereof the following section:-

Section 80B. The practice of nursing shall mean the performance for compensation of those services which assist individuals or groups to maintain or attain optimal health. Nursing practice requires substantial specialized knowledge of nursing theory and related scientific, behavioral and humanistic disciplines such as are taught and acquired under the established curriculum in a school for nurses duly approved in accordance with this chapter.

Nursing practice involves clinical decision making leading to the development and implementation of a strategy of care to accomplish defined goals, the administration of medication, therapeutics and treatment prescribed by duly authorized nurses in advanced roles, including certified nurse midwives, nurse practitioners and psychiatric nurse mental health clinical specialists; dentists; physicians; and physician assistants' and the evaluation of responses to care and treatment. It shall include, but not be limited to the performance of services which promote and support optimal functioning across the life span; the collaboration with other members of the health team to achieve defined goals; health counseling and teaching; the provision of comfort measures; teaching and supervising others; and participation in research which contributes to the expansion of nursing knowledge.

Each individual licensed to practice nursing in the commonwealth shall be directly accountable for safety of nursing care he delivers.

The practice of registered nurses shall include, but not be limited to:

(1) the application of nursing theory to the development, implementation, evaluation and modification of plans of nursing care for individuals, families and communities;

(2) coordination and management of resources for care delivery;

(3) management, direction and supervision of the practice of nursing, including the delegation of selected activities to unlicensed assistive personnel.

Registered nurses who apply for initial authorization in advanced nursing practice shall furnish to the board documentation that they have received either a degree for preparation in advanced nursing practice from a graduate school approved by a national accrediting body acceptable to the board, or have received a certificate of completion of an educational program in advanced nursing practice approved by a national accrediting body acceptable to the board. The applicant shall also submit to the board documentation of current certification in advanced nursing practice from a national professional or specialty certifying organization acceptable to the board.

Those registered nurses whose applications include the above-described documentation may be authorized by the board to practice in advanced practice nursing roles as defined in regulations promulgated by the board.

Advanced practice nursing regulations which govern the ordering of tests, therapeutics and prescribing of medications shall be promulgated by the board in conjunction with the board of registration in medicine. Said promulgation shall occur only after the two boards have met, consulted and concurred on the content of such regulations.

The standards of care in the ordering of tests, therapeutics and the prescribing of medications, to which nurses in advanced practice shall be held, shall be those standards which protect consumers, and provide them with safe and comprehensive care, and shall be standards comparable to other professionals, including physicians, providing the same services.

The board is authorized to promulgate regulations requiring advanced practice nurses to have professional malpractice liability insurance or a suitable bond or other indemnity against liability for professional malpractice in such amounts as may be determined by the board.

The practice of licensed practical nurses shall include, but not be limited to:

(1) participation in the development, implementation, evaluation and modification of the plans of nursing care for individuals, families and communities through the application of nursing theory;

(2) participation in the coordination and management of resources for the delivery of patient care;

(3) managing, directing and supervising safe and effective nursing care, including the delegation of selected activities to unlicensed assistive personnel.

Neither "professional nursing" nor "practical nursing" shall mean or be construed to prevent: (1) the gratuitous care of any ill, injured or infirm person by any member of his family or any friend, or his care by any person employed primarily as a companion, housekeeper, domestic servant or nursemaid; (2) the performance of any nursing service in an emergency; (3) the performance, of any student enrolled in a school for nurses or practical nurses duly approved in accordance with this chapter, of any nursing service incidental to any prescribed course in such school; (4) the performance of services incidental to the practice of the religious tenets of any church by any member thereof; (5) the performance of nursing service by a person authorized to practice nursing under section seventy-six A, subject to the provisions of said section; or (6) the performance of services by physicians, dentists, pharmacists, teachers, health educators, social workers, dieticians, therapists, technicians, and medical students which are commonly recognized to be functions of their respective callings; or (7) the performance of any nursing service for any patient in a convalescent or nursing home or rest home, by any person employed in such home, provided that such nursing service is performed under the supervision of a registered nurse or licensed practical nurse.