Nur 600-700

CHAPTER Nur 100 ORGANIZATIONAL RULES

Statutory Authority: RSA 326-B:2, RSA 326-B:3

REVISION NOTE #1:

Document #5887, effective 8-26-94, made extensive changes to the wording, format, structure, and the sections in these chapters. The prior filings for former rules included the following documents:

#2848, eff 9-21-84	#4944, eff 9-28-90
#4277, eff 6-30-87	#5031, eff 12-24-90
#4346, eff 12-22-87	#5032, eff 12-24-90
#4731, eff 1-19-90

REVISION NOTE #2:

Document #13003, effective 3-16-20, adopted Nur 101.04 as an emergency rule defining “clinical experience.” The adoption necessitated the renumbering of the existing definitions in Nur 101.04 through Nur 101.22 as Nur 101.05 through Nur 101.23. However, the emergency rules expired 9-14-20. Pursuant to RSA 541-A:18, V, the rules numbered Nur 101.05 though Nur 101.23 reverted to their original numbering as Nur 101.04 through Nur 101.22.

Exhibit U of the Governor’s Emergency Order #29, effective October 15, 2020, adopted again Nur 101.04 defining “clinical experience”, and renumbered the existing definitions in Nur 101.04 through Nur 101.22 as Nur 101.05 through Nur 101.23, pursuant to the State of Emergency declared in Executive Order 2020-04, which was effective 3-13-20. Nur 101.04 remained in effect during the duration of the State of Emergency until the State of Emergency terminated at midnight on 6-11-21. The rules numbered Nur 101.05 through Nur 101.23 also reverted to their original numbering as Nur 101.04 through Nur 101.22.

PART Nur 101 DEFINITIONS

Nur 101.01 “Advanced Practice Registered Nurse (APRN)” means a registered nurse currently licensed by the board under RSA 326-B:18.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.01); renumbered by #13672 (formerly Nur 101.02)

Nur 101.02 “Board” means “board” as defined in RSA 326-B:2, II, namely “the New Hampshire board of nursing established in RSA 326-B:3.”

Source. (See Revision Note at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.02); renumbered by #13672 (formerly Nur 101.03)

Nur 101.03 “Competency” means having the integration of knowledge, judgment and skills necessary to provide safe nursing care or safely to perform nursing related activities.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.03) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.04)

Nur 101.04 “Contact hour” means a minimum of 60 minutes of organized learning.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.04) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.05)

Nur 101.05 “Continuing competence” means “continuing competency” as defined by RSA 326-B:2, III, namely, “integrated learning by which a licensee gains, maintains, or refines practice knowledge, skills, and abilities through a formal education program, continuing education, or clinical practice. This development may occur through a formal education program, continuing education, and clinical practice, and is expected to continue throughout the practitioners’ career.”

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.05) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.06)

Nur 101.06 “Delegatee” means the person to whom a licensed nurse delegates a task of client care.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.06) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.07)

Nur 101.07 “Delegation” means the transfer, at the discretion of the nurse, of authority for the performance of a task of client care from the licensed nurse with authority to perform the task to someone who does not otherwise have such authority.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.07) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.08)

Nur 101.08 “Executive director” means the person given authority by the board to perform administrative functions for the board.

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.08) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.09)

Nur 101.09 “Licensed nursing assistant (LNA)” means “licensed nursing assistant” as defined in RSA 326-B:2, IV, namely, “an individual who holds a current license to provide client care under the direction of a registered nurse or licensed practical nurse.”

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.09) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.10)

Nur 101.10 “Licensed practical nurse (LPN)” means “licensed practical nurse” as defined in RSA 326-B:2, V, namely, “an individual who holds a current license to practice practical nursing as defined in RSA 326-B:2, IX.”

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.10) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.11)

Nur 101.11 “Medication nursing assistant” means a licensed nursing assistant who holds a currently valid certificate authorizing the delegation to the nursing assistant of tasks of medication administration.

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.11); ss by #10569, eff 4-17-14 (from Nur 101.11) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.12)

Nur 101.12 “Medication nurse-reviewer” means a registered nurse approved by the board to administer a medication administration education program meeting the requirements of Nur 800.

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.12); ss by #10569, eff 4-17-14 (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.13)

Nur101.13 “Medication skills instructor” means a registered nurse approved by the board to teach in a medication administration education program meeting the requirements of Nur 900.

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.13); #ss by 10569, eff 4-17-14 (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.14)

Nur 101.14 “National Council Licensure Examination (NCLEX)” means the assessment instrument developed by the National Council of State Boards of Nursing to determine the professional competency of a candidate for licensure.

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.14); ss by #10569, eff 4-17-14 (from Nur 101.12) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.15)

Nur 101.15 “Nursing-related activities” means “nursing-related activities” as defined by RSA 326-B:2, VIII, namely, “client care provided by a licensed nursing assistant directed by an APRN, an RN, or an LPN.”

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.15); ss by #10569, eff 4-17-14 (from Nur 101.15) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.16)

Nur 101.16 “Practical nursing” means “practical nursing” as defined in RSA 326-B:2, IX, namely, “the practice of nursing as defined in RSA 326-B:2, VII by a person who:

(a) Uses sound nursing judgment based on preparation, knowledge, skills, understanding, and past nursing experience.

(b) Works under the direction of a registered nurse, advanced registered nurse practitioner, dentist, or physician.

(c) Functions as a member of a health care team and contributes to the assessment, planning, implementation, and evaluation of client care.”

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.16); ss by #10569, eff 4-17-14 (from Nur 101.16) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.17)

Nur 101.17 “Registered nurse (RN)” means “registered nurse” as defined in RSA 326-B:2, X, namely, “an individual who holds a current license to practice registered nursing as defined in XI.”

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.17); ss by #10569, eff 4-17-14 (from Nur 101.17) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.18)

Nur 101.18 “Registered nursing” means “registered nursing” as defined in RSA 326-B:2, XI, namely, “the application of nursing knowledge, judgment, and skill drawn from broad in-depth education in the biological, psychological, social, and physical sciences in assessing and diagnosing the health status of a client, and in planning, implementing, and evaluating client care which promotes the optimum health, wellness, and independence of the individual, the family, and the community.”

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.18); ss by #10569, eff 4-17-14 (from Nur 101.18) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.19)

Nur 101.19 “Sponsoring institution” means an educational institution, public agency, non-profit organization or for-profit business offering a board-approved program in medication administration education.

Source. #8777, eff 12-23-06; ss by #10296, eff 3-22-13 (from Nur 101.19); ss by #10569, eff 4-17-14 (from Nur 101.19) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.20)

Nur 101.20 “Stable client” means a client whose overall health status, as assessed by a licensed nurse, is at the expected baseline or with predictable or expected responses that can occur with known chronic or long term medical conditions.

Source. #10296, eff 3-22-13 (from Nur 101.20); ss by #10569, eff 4-17-14 (from Nur 101.20) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.21)

Nur 101.21 “Unlicensed assistive personnel” means an unlicensed individual who functions in a complementary role to the licensed RN or LPN in providing patient care.

Source. #10296, eff 3-22-13; ss by #10569, eff 4-17-14 (from Nur 101.21) (see Revision Note #2 at chapter heading for Nur 100); renumbered by #13672 (formerly Nur 101.22)

PART Nur 102 DESCRIPTION OF THE BOARD

Nur 102.01 Composition and Functions.

(a) The board of nursing shall consist of 13 members appointed by the governor and council, pursuant to RSA 326-B:3.

(b) The board shall adopt rules relative to:

(1) Standards for nursing practice;

(2) Criteria for nursing education programs;

(3) Criteria for initial licensure, license renewal, and the reinstatement of licenses for registered and practical nurses, advanced registered nurse practitioners, and nursing assistants;

(4) Criteria for certifying licensed nursing assistants to administer medication;

(5) Ethical and professional standards for the practice of licensees;

(6) The determination and enforcement of disciplinary action against all individuals found in violation of RSA 326-B or the rules adopted by the board;

(7) The implementation of the nurse licensure compact set forth in RSA 326-B:46; and

(8) Any other matters necessary for the proper administration of RSA 326-B.

Nur 102.02 Organization.

(a) The board shall be comprised of 13 members who meet the applicable eligibility requirements of RSA 326-B:3, II to VI, and are appointed pursuant to RSA 326-B:3, VIII.

(b) As required by RSA 326-B:3, I, membership of the board shall include:

(1) Six registered nurses, 2 of which are advanced practice registered nurses;

(2) Two licensed practical nurses;

(3) Three licensed nursing assistants, one of which is a medication licensed nursing assistant, if possible; and

(4) Two public members.

(d) In December every 2 years, the board shall elect one member to serve as chair and one member to serve as vice chair and shall serve as follows:

(1) The chair shall preside over the board’s meetings, establish the order of its business, and approve the actions of the administrator, consistent with the policies of the OPLC; and

(2) The vice-chair shall assume the duties of the chair in their absence.

(e) No member of the board shall serve as chair or vice-chair of the board more than one consecutive 2 year term. The vice-chair shall be authorized to move to the chair position for an additional 2 year term if the board chooses to elect that individual as chair.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14; amd by #11144, eff 7-28-16; ss by #14294, eff 6-27-25

Nur 102.03 Meetings. The board meets each month, if a quorum is present, or at such additional times as called for by the chairperson or by majority vote of the board.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14; ss by #12567, eff 6-29-18

Nur 102.04 Quorum. Pursuant to RSA 91-A:2, I and RSA 21:15, II, a quorum for a meeting or hearing shall consist of a majority of members approved by the governor and council.

Nur 102.05 Committees.

(a) The liaison committee and the practice and education committee shall be permanent subcommittees of the board.

(b) These committees shall meet as directed by the board and in compliance with RSA 91-A and RSA 310:5, VI through VII.

(1) The liaison committee shall:

a. Make recommendations to the board related to practice and education issues concerning APRN practice; and

b. Offer consultation to the board regarding standards of practice in relation to a complaint or investigation into an APRN licensee’s practice; and

(2) The practice and education committee shall make recommendations to the board related to practice and education issues.

(d) Committees additional to the liaison committee and the practice and education committee, if any, shall consist of one or more board members who have been directed by the board to investigate and make recommendations on matters to be decided by the full board.

(e) When expressly authorized by the board, the authority of a committee described in (d) above shall include:

(1) The retention of voluntary assistance from qualified persons to serve as

advisors to the committee; or

(2) The retention of paid advisors or consultants.

(f) A member of the board shall act as liaison to each committee described in (d) above.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14; amd by #12567, eff 6-29-18; ss by #14294, eff 6-27-25

Nur 102.06 Attendance at Meetings By Members of the Public. Pursuant to RSA 91-A:2, II, members of the public may attend and record board meetings except for those parts of the meetings which are nonpublic sessions pursuant to RSA 91-A:3.

Source. (See Revision Note at #1 chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14

PART Nur 103 PUBLIC REQUESTS FOR INFORMATION

Nur 103.01 Office Location, Mailing Address, Telephone Numbers and TTY/TDD Number.

(a) The board’s office and mailing address is:

New Hampshire Board of Nursing

121 S. Fruit St.

Concord, New Hampshire 03301

(b) The telephone number for the office is 603-271-2323.

(d) The board’s website is at www.state.nh.us/nursing.

(e) The board’s email address is boardquestions@nursing.state.nh.us.

Source. #6778, eff 6-26-98; ss by #7099, eff 9-20-99; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14

Nur 103.02 Communication with the Board.

(a) Persons wishing to make submissions to or requests of the board may mail a letter to the address stated in Nur 103.01(a), call the number stated in Nur 103.01(b), send an email to the address in Nur 103.01(e), or communicate by TTY/TDD using the number stated in Nur 103.01 (c).

(b) Persons seeking information from the board may do so by mail, email, by telephone using the numbers stated in paragraph Nur 103.01(b) or by TTY/TDD using the number stated in Nur 103.01

(c) Inquiries regarding clinical practice may be submitted via mail or email by completing and submitting Form Clinical Practice Inquiry, amended 11-2013.

Source. #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14

Nur 103.03 Custodian of Records. The Office of Professional Licensure and Certification is the custodian of the board’s records and responds to requests to examine those portions of the board’s records which are public records.

Source. #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14; amd by #11144, eff 7-28-16

Nur 103.04 Inspection and Copies of Records.

(a) Pursuant to RSA 91-A:4 members of the public may inspect and copy those records of the board, including meeting minutes, which are public records and not exempt from disclosure under RSA 91-A:5 or other applicable law.

(b) Persons desiring copies of board records shall describe as particularly as possible the information being sought and pay a copying fee of $.25 per page.

(c) If records are requested that contain both public information and information exempt from disclosure pursuant to RSA 91-A or other law, the board shall redact the exempt information and provide the remaining information.

Source. #6778, eff 6-26-98; ss by #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14

Nur 103.05 Access to Board Administrative Rules. The public may:

(a) Inspect and copy the official version of the board’s administrative rules at the board’s office;

(b) Receive a copy of the rules by calling or writing the board; and

Source. #7736, eff 8-6-02; ss by #8777, eff 12-23-06; ss by #10296, eff 3-22-13; ss by #10569, eff 4-17-14

Nur 103.06 Computerized Lists Distribution.

A computerized list of licensees who have agreed to share their name, email and physical address shall be furnished upon request. The fee shall be $100.00.

Source. #11144, eff 7-28-16

CHAPTER Nur 200 RULES OF PRACTICE AND PROCEDURE

Statutory Authority: RSA 326-B:12, RSA 326-B:13, RSA 326-B:14

REVISION NOTE:

Document #13917, effective 3-29-24, repealed Part Nur 201 through Part Nur 214 in Chapter Nur 200, titled “Practice and Procedure”, and renamed the chapter as “Rules of Practice and Procedure”. Document #13917 also adopted a new Part Nur 201 titled “Practice and Procedure and Waiver of Rules”, containing Nur 201.01 titled “Rules of Practice and Procedure” and Nur 201.02 titled “Waiver of Administrative Rules.”

Document #13917 replaces all prior filings affecting the rules in the former Chapter Nur 200. The prior filings included the following documents. Italics indicate the rules were subject to expiration only pursuant to RSA 541-A:17, II:

#5887, eff 8-26-94 (See Revision Note #1 at chapter heading for Nur 100)

#6778, eff 6-26-98

#7100, eff 9-20-99 (Nur 217.01 only)

#8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

#8778, eff 12-23-06 (Nur 201-Nur 210, Nur 211.01, Nur 212, and Nur 214 only)

#8779, eff 12-23-06 (Nur 206.02, Nur 211.01-Nur 211.03, and Nur 213 only)

#10297, eff 3-22-13

As practice and procedure rules, the rules in Document #13917 will not expire except pursuant to RSA 541-A:17, II.

PART Nur 201 PRACTICE AND PROCEDURE AND WAIVER OF RULES

Nur 201.01 Rules of Practice and Procedure. The Plc 200 rules shall govern with regards to all procedures for:

(a) Adjudicatory proceedings;

(b) Rulemaking submissions, considerations, and dispositions of rule making;

(d) Declaratory rulings;

(e) All statements of policy and interpretation;

(f) Explanation of adopted rules; and

(g) Voluntary surrender of licenses.

Source. (See Revision Note at chapter heading for Nur 200) #13917, eff 3-29-24

Nur 201.02 Waiver of Administrative Rules.

(a) The board shall initiate a waiver of a substantive rule upon its own motion by providing affected parties with notice and opportunity to be heard and issuing an order which finds that a waiver would be necessary to advance the purpose of the rules of the board.

(b) Individuals who wish to request a waiver of a rule shall submit a written request to the board, which includes:

(1) The rule for which a waiver is requested;

(2) The anticipated length of time the requested waiver will be needed;

(3) The reason for requesting the waiver;

(4) Evidence of how the waiver will provide for the health and safety of the consumer or licensee;

(5) A time-limited written compliance plan which sets forth plans to achieve compliance including an estimated date of compliance; and

(6) The signature of the applicant.

(1) If adherence to the rule would cause the petitioner unnecessary or undue hardship;

(2) If the requested waiver is necessary because of any neglect or misfeasance on the part of the practitioner;

(3) If enforcement of the rule would injure a third person(s); and

(4) If waiver of the rule would injure a third person(s).

(d) The board shall approve a waiver of an administrative rule request only if:

(1) Granting a waiver does not have the effect of waiving or modifying a provision of RSA 326-B;

(2) The petitioner has shown good cause exists pursuant to (c) above to waive the rule; and

(3) The board determines that the individual’s plans for compliance with the rule includes an estimated date of compliance and eventual compliance.

(e) If the board, after receiving and reviewing a request for a waiver, requires further information or documentation to grant or deny the waiver, the board shall:

(1) Notify the applicant in writing within 30 days; and

(2) Specify the information or documentation the board requires.

(f) The board shall issue a written approval or denial of the waiver within 60 days of the date the request is received, unless additional information or documentation is required. If additional information and documentation is required, then the board shall issue a written approval or denial within 60 days of receiving the requested information or documentation.

Source. (See Revision Note at chapter heading for Nur 200) #13917, eff 3-29-24

CHAPTER Nur 300 LICENSING REQUIREMENTS

Statutory Authority: RSA 326-B:4, III

REVISION NOTE #1:

The Governor declared a State of Emergency in Executive Order 2020-04, which was effective 3-13-20. The declaration and subsequent Emergency Orders issued pursuant to Executive Order 2020-04 affected various rules and statutes governing licensing under Chapter Nur 300, such as Exhibit H to Emergency Order #29, effective 5-19-20, which modified Nur 303.05 titled “RN and LPN Licensure through Comparable Education” and RSA 326-B:24. The State of Emergency terminated at midnight on 6-11-21, and rules or statutes amended during the State of Emergency were restored. To determine what rules in Nur 300 were applicable during the State of Emergency, the user should check not only the source notes of the rules but also the Emergency Orders in effect at the time in question.

Document #13012, effective 3-16-20, amended paragraph (d) in Nur 303.02 titled “Registered and Practical Nurse Examinations” as an emergency rule. Pursuant to RSA 541-A:18, V, the emergency rule expired 9-23-20, and Nur 303.02(d) was effective again in its original form in Document #12753, effective 4-4-19.

Document #13219, effective 6-25-21, readopted with amendment Nur 301.02 titled “Temporary Registered and Practical Nurse Licensure” as an emergency rule. Pursuant to RSA 541-A:18, V, the emergency rule expired 12-22-21, and Nur 301.02 was effective again in its original form in Document #12753, effective 4-4-19.

Document #13300, effective 12-3-21, readopted with amendment Nur 301.05 titled “Licensed Nursing Assistant” as an emergency rule. Pursuant to RSA 541-A:18, V, the emergency rule expired 6-1-22, and Nur 301.05 was effective again in its original form.

Document #13301, effective 12-3-21, adopted Nur 302.015 titled “Restricted Licensure Pending Criminal Records Check” as an emergency rule. Pursuant to RSA 541-A:18, V, the emergency rule expired 6-1-22.

Document #13424, effective 8-2-22, readopted with amendment Nur 301.05 titled “Licensed Nursing Assistant” as a regular rule and adopted Nur 302.07 titled “Restricted Licensure Pending Criminal Records Check” as a regular rule.

REVISION NOTE #2:

Nur 301.07 titled “Fees” expired 3-22-23. The rule had specified the methods for paying fees set by the Board of Nursing. The prior filings affecting Nur 301.07 included the following documents:

#8873, effective 4-24-07

#10298, effective 3-23-13, EXPIRED: 3-22-23

The Executive Director of the Office of Professional Licensure and Certification (OPLC) subsequently adopted Document #13703, effective 8-1-23, containing Plc 1002.33 titled “Application Processing, Initial Inspection, and Licensing Fees for the Professions and Programs Regulated by the Board of Nursing”. Plc 1002.33 specifies the amounts for various fees that apply to the professions and programs regulated by the Board of Nursing under RSA 326-B. Plc 1002.33 is located in Part Plc 1002 titled “Application Processing, Examination, Initial Inspection, and Licensing Fees Specific to Each Profession” in Chapter Plc 1000 titled “Fees, Per Diems, and Reimbursable Expenses”. See Chapter Plc 1000 for all subsequent rules on payment of fees for the Board of Nursing.

PART Nur 301 APPLICATION PROCEDURE

Nur 301.01 Registered Nurse and Licensed Practical Nurse Licensure by Examination.

(a) This section shall apply to those who seek licensure by examination as a registered nurse or practical nurse in New Hampshire under RSA 326-B:17.

(b) Each person seeking licensure as a registered nurse or practical nurse by examination who was educated in the United States or Canada, except for Quebec Province shall:

(1) Complete and submit to the board a forms packet containing the following forms listed below, including all required explanations as attachments:

a. “Application Process for Licensing by Examination (NCLEX),” as amended 12/2018, including verification that the individual has pre-registered with Pearson VUE and paid the required fee;

b. “NH Board of Nursing License by Examination (NCLEX) Application,” as amended 12/2018;

c. “Declaration of Primary State of Residency Form,” as amended 12/2018;

d. “LPN Comparable Education Verification Form,” as amended 12/2018;

e. “RN Comparable Education Verification Form,” as amended 12/2018;

f. “NH Board of Nursing Temporary License Application,” as amended 12/2018; and

g. “Optional Information Question Regarding Military Experience and/or Relationship to Military Personnel Transferred to New Hampshire,” as amended 12/2018; and

(2) Have the following documents submitted to the board:

a. “New Hampshire Board of Nursing Record Information Authorization” form, also known as form DSSP from the department of safety, available at https://www.oplc.nh.gov/nursing/documents/criminal-background.pdf;

b. A completed fingerprint card or submission of Live Scan documentation. A fingerprint card may be obtained by contacting the board offices. Livescan site locations are listed on the department of safety’s website at https://www.nh.gov/safety/divisions/nhsp/ssb/crimrecords/index.html;

c. The fee, as required by the department of safety;

d. Final official transcript showing completion of the nursing educational program requirements, the type of degree conferred, and the date of graduation; and

e. If requesting American with Disabilities Act (ADA) Accommodations when taking the NCLEX, a “Request for NCLEX Accommodations under the Americans with Disabilities Act” form, as amended 2/28/18.

(c) Each person seeking licensure as a registered nurse or practical nurse by examination who was educated outside of the United States or educated in Quebec Province shall:

(1) Complete and submit to the board a forms packet containing the following forms listed below, including all required explanations as attachments:

a. “Application Process for Licensing by Examination (NCLEX),” as amended 12/2018, including verification that the individual has pre-registered with Pearson VUE and paid the required fee;

b. “License by Examination (NCLEX) Application,” as amended 12/2018;

c. “Declaration of Primary State of Residency Form,” as amended 12/2018; and

d. A notarized Criminal Record Release Authorization, available at https://www.oplc.nh.gov/nursing/criminal-background- check.htm/, and completed fingerprint card along with any required fee, with the New Hampshire board of nursing identified as the recipient of the record or records; and

(2) Have the following documents submitted to the board:

a. All foreign educated nurses shall provide evidence of educational evaluations by an organization recognized by National Council State Board of Nursing, which includes a certificate of a passing grade from an examination pursuant to Nur 302.(c);

b. For applicants whose program was not in English or English is not the applicant’s native language, the credentialing shall also include an English proficiency exam that includes the components of reading, speaking, writing and listening as required by RSA 326-B:46, Article III(c)(3); and

c. If requesting American with Disabilities Act (ADA) Accommodations when taking the NCLEX, a “Request for NCLEX Accommodations under the Americans with Disabilities Act” form, as amended 2/28/18.

(d) New Hampshire school of nursing students and military personnel applying pursuant to Nur 303.05 shall submit evidence, by means of an official stamped transcript, of educational experiences comparable to Nur 602.12 and Nur 602.13.

(e) All applicants for initial licensure shall submit the application fee of $120.

(f) All applicants for initial licensing shall comply with the Nurse Licensure Compact (NLC) Model Rules and Regulations developed by the Nurse Licensure Compact Administrators (NLCA) as amended January 19, 2018 and as referenced in Appendix 2.

(g) An applicant who has satisfactorily met the requirements of this section shall:

(1) Receive a registered nurse license or a practical nurse license, as appropriate; and

(2) Be authorized to use the title RN or LPN, as appropriate.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; amd by #7101, eff 9-20-99; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15; ss by #12753, eff 4-4-19

Nur 301.02 Temporary Registered and Practical Nurse Licensure.

(a) This section shall apply to each registered or practical nurse applicant who has met the requirements for licensure except passage of the required examination and seeks a once-per-lifetime temporary registered or practical nurse license pursuant to RSA 326-B:24 while awaiting a decision on full licensure pursuant to Nur 301.01.

(b) Each applicant for a temporary registered or practical nurse license shall:

(1) Submit a completed “Application for New Hampshire Temporary Nurse Licensure”, as amended 7-2015;

(2) Demonstrate proficiency in English as outlined in Nur 302.01(a), if currently foreign educated; and

(3) Pay the application fee of $20.

(1) A final licensure determination is made after receipt of initial examination results; or

(2) The passage of 120 days from the date of issuance.

(d) A temporary licensee shall, pursuant to RSA 326-B:24, III, practice only under the supervision of an RN currently licensed in New Hampshire or working under a compact license, pursuant to RSA 326-B:46.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15; ss by #12753, eff 4-4-19; ss by #13219, EMERGENCY RULE, eff 6-25-21, EXPIRED: 12-22-21 (see Revision Note #1 at chapter heading for Nur 300)

Nur 301.03 Advance Practice Registered Nurse (APRN) Licensure.

(a) This section shall apply to each registered nurse licensed in New Hampshire and to each nurse who holds a current, unencumbered registered nurse license from a compact state pursuant to RSA 326-B:46, who seeks licensure in New Hampshire as an APRN.

(b) Each applicant seeking licensure as an APRN under this section shall submit:

(1) Evidence of completion of an accredited advanced nursing education program that includes:

a. At least 225 hours of theoretical nursing content; and

b. At least 480 hours of clinical nursing practice, including precepted experience and pharmacological interventions;

(2) A final, official transcript from a nurse practitioner program, accredited by a national accrediting body, that demonstrates that the applicant earned a:

a. Graduate or post-masters graduate degree; or

b. Certificate prior to July 1, 2004;

(3) Documentation from the director of the program identified pursuant to (2) above for each pharmacology course taken but not reflected on the transcript, verifying integration of pharmacological interventions;

(4) Evidence of competence to practice, as a result of participation in and completion of the nurse practitioner program.

(5) The following, if the applicant graduated from an APRN program 2 or more years prior to the submission of the application:

a. A copy of current national certification pursuant to Nur 302.04(a)(6);

b. Documentation of meeting the advanced practice requirements set forth in Nur 302.04(a)(6); and

c. Documentation of completion of the continuing education required pursuant to Nur 302.04(a)(7) including at least 5 hour in pharmacology, within the 2 years immediately preceding the application;

(6) The following forms:

a. A separate Form “Application Process for APRN License”, as amended 4-2015; and

b. Declaration of Primary State of Residence, as amended 1-2015; and

(7) To the department of safety, division of state police, a notarized Criminal Record Release Authorization along with any required fee, with the board identified as the recipient of the record or records;

(1) Receive an Advanced Practice Registered Nurse license; and

(2) Be authorized to use the title, APRN.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15

Nur 301.04 Advanced Practice Registered Nurse (APRN) Temporary Licensure.

(a) Pursuant to RSA 326-B:24, a new graduate of an advanced nursing practice educational program may seek a once-per-lifetime temporary licensure to practice in the advanced role following verification of authorization from the certifying agency to sit for the first national certifying examination in the applicant’s specialty area.

(b) Each temporary APRN license shall expire at the earlier of:

(1) The passage of 120 days; or

(2) The date on which the applicant receives either:

a. A permanent APRN license, after having made timely application; or

b. Notice that the applicant failed the national certifying examination.

(c) An applicant seeking temporary APRN licensure shall, along with, or at any time after, the submission of an “Application for License: Advanced Practice Registered Nurse” submit:

(1) A Form “Directions for Temporary APRN Licensure”, as amended 1-2015; and

(2) The application fee of $20.

(d) Notwithstanding (c) above, no applicant shall seek a temporary APRN license after sitting for the national certifying examination.

(e) As part of the application, the applicant shall provide a statement of agreement from an APRN holding a currently unencumbered APRN license issued by the board who agrees to oversee the applicant during the period of temporary licensure.

(f) Temporary APRN licensees shall use the designation “TAPRN” during the period of temporary licensure.

(g) Upon notification of the examination results by the national certifying agency the licensee shall:

(1) Complete the APRN licensing process within 15 business days if successful in the examination specified above; or

(2) Immediately cease APRN practice and notify the board within 15 business days.

(h) Failure to comply with (g) above, shall result in disciplinary action by the board as specified in RSA 326-B: 37.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15

Nur 301.05 Licensed Nursing Assistant.

(a) This section shall apply to those who seek licensure as a licensed nursing assistant (LNA) by competency examination, alternate experience, or by endorsement in accordance with Plc 313.

(b) Each person seeking licensure as a LNA, regardless of method of qualification, shall:

(1) Complete and submit a required “Universal Application for Initial Licensure” providing the information described in Plc 304.03(a), (c), (d), and (f) and signing the form in accordance with Plc 304.05;

(2) In addition to the application required in (a) above, the applicant shall complete and submit the “Nursing Assistant Addendum to the Universal Application for Initial Licensure” by providing the following:

a. All names the applicant has ever been known by;

b. Answer yes or no to the question “Were any special arrangements made for you during the nursing assistant program or competency testing because of a physical or mental conditions?”;

c. Answer yes or no to the question “Do you have a mental or physical condition that makes you incompetent to practice as a nursing assistant?;

d. Answer yes or no to the question “Have you previously been or are you currently impaired by any chemical substances that affects your ability to practice as a nursing assistant?”;

e. Answer yes or no to the question “Have you ever diverted any chemical substance(s)?”;

(3) If the applicant answers yes to any of the questions on the application a detailed description of the yes answer and any relevant supporting documents;

(4) Submit to the department of safety, division of state police, a notarized Criminal Record Release Authorization along with any required fee, with OPLC identified as the recipient of the record or records; and

(5) Pay any fees required by Plc 1002.33 and Plc 1001.08.

(c) Subject to (d), below, each applicant seeking licensure as a LNA by competency examination shall, in addition to complying with (b) above:

(1) Submit a copy of their LNA Education Program Certificate to demonstrate successful completion of such program; and

(2) Submit a copy of the final report for the Written and Clinical Competency Testing results showing the applicant to be competent in all areas tested.

(d) An applicant shall not be required to submit the copies required by (c), above, if the program from which the applicant graduated has already provided information to the OPLC that the applicant has successfully completed the program and passed the competency test.

(e) Each applicant seeking licensure as a LNA by alternate experience shall, in addition to complying with (b) above, submit to the OPLC the following:

(1) Proof that the applicant has been assigned an enlisted occupation code consistent with RSA 326-B:21-a, I(a); and

(2) Proof that the applicant has used those skills as part of their service in the last 3 years.

(f) An applicant who has satisfactorily met the requirements of this section shall:

(1) Receive a licensed nursing assistant license; and

(2) Be authorized to use the title LNA.

Source. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15; ss by #13300, EMERGENCY RULE, eff 12-3-21, EXPIRED: 6-1-22; ss by #13424, eff 8-2-22 (see Revision Note #1 at chapter heading for Nur 300); ss by #13886, eff 4-22-24; ss by #13941, EMERGENCY RULE, eff 4-25-24, EXPIRES: 10-22-24; rpld by #13985, eff 5-24-24 @ 8:56 a.m.

Nur 301.06 Licensed Medication Nursing Assistant.

(a) This section shall apply to licensed nursing assistants who seek certification in New Hampshire as a medication nursing assistant (MNA).

(b) Each LNA seeking certification as a MNA shall:

(1) Submit a completed Form “Medication Nursing Assistant Certification”, as amended 3-2014;

(2) Submit a copy of the completion certificate from the MNA education program approved by the board;

(3) Submit a copy of the applicant’s current, unrestricted LNA license issued by the board; and

(4) Pay the application fee of $10.

Source. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15

PART Nur 302 QUALIFICATIONS

Nur 302.01 General Qualifications for All Applicants. Each applicant for any license or certificate issued by the OPLC shall, pursuant to RSA 326-B:16, meet the following general requirements:

(a) The applicant shall have the ability to read and write the English language, and demonstrate such proficiency through either:

(1) Graduating from a school of nursing in which:

a. All classroom instruction was in English;

b. All nursing textbooks were in English; and

c. The majority of all clinical experience was in English; or

(2) Passing the English proficiency evaluation of a nationally accepted accredited examination;

(b) The applicant shall have committed no acts or omissions which are grounds for disciplinary actions as set forth in RSA 326-B, unless the board determines that restitution has been made for such acts or omissions;

(c) The applicant shall not have been convicted of a crime constituting any of the following unless such conviction was annulled by a court of competent jurisdiction:

(1) Murder or manslaughter;

(2) Robbery;

(3) Felonious theft;

(4) Felonious assault;

(5) Sexual crime involving a child;

(6) Kidnapping; or

(7) Endangering the welfare of a child or incompetent person.

(d) The applicant shall not have committed any act or engaged in any course of conduct involving intentional deception by the applicant, whether in the course of employment or as private conduct, that indicates the applicant cannot be entrusted with the care of patients; and

(e) The applicant shall submit a complete application for the specific license or certificate sought, including the payment of all fees required by Plc 1002.33 and Plc 1001.08.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9395, eff 2-25-09; ss by #10298, eff 3-22-13, EXPIRED: 3-22-23

New. #13886, eff 4-22-24

Nur 302.02 Qualifications for Initial Registered and Practical Nurses Licensure by Examination. Each applicant for an initial registered or practical nurse license by examination shall:

(a) Meet the general requirements of Nur 302.01; and

(b) Meet either education requirement:

(1) Graduated from a board approved nursing education program in the United States or Canada that meets the requirements set forth in Nur 600, including the NCLEX-RN or NCLEX-PN course requirements; or

(2) Graduated from a nursing program outside the United States or Canada;

(1) NCLEX exam if a graduate of a board approved nursing education program in the United States or Canada; or

(2) A nationally accepted accrediting agency examination endorsed by the National Council of State Boards of Nursing examination and NCLEX if a graduate of a board approved nursing education program outside the United States or Canada.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13, EXPIRED: 3-22-23

New. #13886, eff 4-22-24

Nur 302.03 Qualifications for Initial Registered and Practical Nurses Licensure by Endorsement.

(a) Each applicant for an initial registered or practical nurse license by endorsement shall:

(1) Meet the general requirements of Nur 302.01;

(2) Hold a current, unencumbered license in any other jurisdiction; and

(3) Submit verification of licensure status from the jurisdiction of licensure by examination.

(b) Graduates of a nursing program in the United States or Canada, except Quebec, who have passed the NCLEX examination, shall also meet all of the requirements of Nur 304.01.

(c) Graduates of a nursing program in Canada who have not taken the NCLEX examination shall also meet all of the requirements of Nur 304.02.

(d) Graduates of a non-Canadian foreign nursing program who have taken the NCLEX examination shall also meet all of the requirements of Nur 304.03.

(e) Graduates of a non-Canadian foreign nursing program shall present verification pursuant to Nur 301.01(b)(2)a.2 that the nursing educational program required theoretical and clinical content that meets the minimum requirements of Nur 601.15 and Nur 601.16.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; amd by #7101, eff 9-20-99; ss by #7740, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15; ss by #12753, eff 4-4-19

Nur 302.04 Qualifications for an Initial Advanced Practice Registered Nurse (APRN) License.

(a) Each applicant for an initial advanced registered nurse practitioner license shall:

(1) Meet the general requirements of Nur 302.01;

(2) Hold a current and unencumbered RN license issued by the OPLC or a multi-state license issued by another compact state;

(3) Have either:

a. Earned a graduate degree in an accredited advanced registered nurse practitioner education program; or

b. Graduated before July 1, 2004 from a APRN education program or its equivalent accredited by a national accrediting body that meets the requirements of Nur 600;

(4) Be competent to practice as a result of graduation from an educational program that complies with (3) above that has been recognized by the National Council of State Boards of Nursing in the specialty area of practice;

(5) Hold current certification from a national certifying body, recognized by the by National Council of State Boards of Nursing, that specializes in the APRN area of practice;

(6) Have used advanced practice nursing knowledge, judgment, and skills for at least 400 hours within the 4 years immediately preceding the application; and

(7) If the applicant graduated from an advanced nurse practitioner program 2 or more years prior to the date of application, taken:

a. At least 30 educational contact hours to satisfy the requirements of RN continuing competence; and

b. An additional 30 hours, at least 5 of which shall be training in pharmacology appropriate to the specialty, within 2 years immediately prior to date of application.

(b) Current certification as described in (a)(5) above may be counted for 30 of the 60 contact hour requirement of (a)(7).

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9395, eff 2-25-09; ss by #10298, eff 3-22-13, EXPIRED: 3-22-23

New. #13886, eff 4-22-24

Nur 302.05 Qualifications for an Initial Nursing Assistant License. Each applicant for an initial nursing assistant license shall:

(a) Meet the general requirements of Nur 302.01; and

(b) If seeking licensure by examination:

(1) Successfully complete a board-approved nursing assistant education program pursuant to Nur 700; and

(2) Pass the examination required pursuant to Nur 700; or

(1) Have used nursing assistant knowledge and skills for a minimum of 200 hours in the 2 years immediately preceding the application; and

(2) Either:

a. Provide documentation of at least 24 educational contact hours within 2 years immediately preceding the application to satisfy the requirements of LNA continuing competence; or

b. Have taken and passed a competency evaluation within the 2 years immediately preceding the application.

Source. #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; amd by #11146, eff 7-28-16

Nur 302.06 Qualifications for a Medication Nursing Assistant Certificate. Each applicant for an initial medication nursing assistant certificate shall:

(a) Possess a current unencumbered LNA license issued by the OPLC;

(b) Successfully complete a board-approved medication administration education program described in Nur 800; and

Source. #8873, eff 4-24-07; ss by #10298, eff 3-22-13, EXPIRED: 3-22-23

New. #13886, eff 4-22-24

Nur 302.07 Restricted Licensure Pending Criminal Records Check.

(a) Notwithstanding Nur 302.01(c), an applicant who meets all other qualifications shall be issued a restricted, single-state license pending receipt of the results of the criminal records check.

(b) Upon receipt of the results of the criminal records check demonstrating that the requirement of Nur 302.01(c) has been met, the restricted license shall be converted to a regular license without further action by the holder of the restricted license, provided that for RNs and LPNs, the regular license shall be multi-state license.

(c) Upon receipt of the results of the criminal records check demonstrating that the requirements of Nur 302.01(c) are not met, then:

(1) The restricted license shall be immediately suspended under RSA 541-A:30, III; and

(2) The board shall commence an adjudicative proceeding to determine whether to revoke the restricted license

Source. #13424, eff 8-3-22

PART Nur 303 EXAMINATION

Nur 303.01 Applicant Responsibility for Examination. Each applicant for licensure shall:

(a) Contact the appropriate examining entity;

(b) Submit all required application materials, including any required fees, to the OPLC;

(d) Pass all portions of the required examination.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13, EXPIRED: 3-22-23

New. #13886, eff 4-22-24; ss by #14295, eff 8-25-25, EXPIRES: 8-25-35

Nur 303.02 Registered and Practical Nurse Examinations.

(a) Each person seeking licensure as an LPN and who graduated from a nursing education program in the United States or Canada shall take and pass the NCLEX-PN examination.

(b) Each person seeking licensure as an RN and who graduated from a nursing education program in the United States or Canada, except Quebec, shall take and pass the NCLEX-RN examination, unless the applicant meets the requirement for endorsement under Nur 304.02.

(c) Each person seeking licensure as an RN or LPN and who graduated from a nursing education program outside the United States or Canada or has graduated from a nursing program in Quebec shall:

(1) Provide a certificate of a passing grade from an examination endorsed by the National Council of State Boards of Nursing, issued within the 2 years prior to the date of the application;

(2) Provide evidence the applicant has received educational credentials review from an institution accredited by the National Council State Boards of Nursing, and meets English language requirements pursuant to Nur 302.01(a); and

(3) Provide verification of any existing nursing license from the issuing jurisdiction.

(d) For graduates of programs within the US or Canadian Provinces where the NCLEX is required, the NCLEX shall be taken within 6 months of graduation from an approved school of nursing.

(e) Notwithstanding (d) above, the following individuals who graduate from programs where the NCLEX is required may take the NCLEX examination at any time following graduation from an approved school of nursing:

(1) Graduates of foreign nursing schools that have:

a. Practiced in the licensed role for a minimum of 400 hours within the past 4 years before filing the application; and

b. Have met the requirements of Nur 303.02(c); and

(2) Graduates of Canadian nursing schools that have:

a. Practiced in the licensed role for a minimum of 400 hours within the past 4 years before filing the application; and

b. Are taking NCLEX for licensure.

(f) An applicant required by this part to obtain a passing grade on the NCLEX examination shall have a lifetime total of 5 opportunities within a consecutive 3 year period to obtain a passing grade on the examination.

(g) An applicant may take the examination 3 times without intervention by the board.

(h) Prior to a fourth attempt the applicant and the board shall do the following:

(1) The applicant shall submit to the board through the OPLC a written plan of remediation and propose measures the applicant intends to implement in order to pass the exam;

(2) Once the board receives a plan of remediation, it shall review the proposed remediation plan, and:

a. Approve the plan if it addresses the applicant’s barriers to passing the examination; or

b. Deny the plan if it fails to adequately address such barriers, and return it to the applicant with written findings of the reason(s) for denial; and

(3) Once the applicant’s remediation plan is approved, the applicant shall:

a. Complete the remediation plan no more than one year prior to taking the examination; and

b. Submit evidence of completion of the remediation plan to the board prior to again sitting for the examination.

(i) If the board denies the remediation plan described in (h) above the applicant may submit a revised plan of remediation for reconsideration by the board.

(j) Following a fourth failure to obtain a passing grade on the required NCLEX examination, an applicant shall not be permitted to retake the examination for the fifth and final time unless the following occurs:

(1) The applicant submits to the board through the OPLC a second and updated written plan of remediation and proposes measures the applicant intends to implement in order to pass the exam;

(2) Once the board receives a plan of remediation, it shall review the proposed remediation plan, and either:

a. Approve the plan if it addresses the applicant’s barriers to passing the examination; or

b. Deny the plan if it fails to adequately address such barriers. If the board does so, it shall return the plan to the applicant with written findings of the reason(s) for denial; and

(3) The remediation plan shall:

a. Be completed no more than one year prior to taking the examination; and

b. The applicant shall submit evidence of completion of the remediation plan prior to again sitting for the examination.

Source. #5925, INTERIM, eff 11-21-94; ss by #6010, eff 3-25-95; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9395, eff 2-25-09; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15; ss by #12753, eff 4-4-19; amd by #13012, EMERGENCY RULE, eff 3-27-20, EXPIRED: 9-23-20 (see Revision Note #1 at chapter heading for Nur 300); ss by #14295, eff 8-25-25, EXPIRES: 8-25-35

Nur 303.03 Licensed Nursing Assistant Competency Examinations.

(a) Each person seeking licensure as a LNA who graduated from a nursing assistant education program in the United States shall take and pass a competency evaluation approved by the board and administered by an organization approved by the board. Approval of such examinations and organizations shall be determined by applying the criteria for each as set forth in Nur 700.

(b) The following individuals may take the examination:

(1) Graduates from an approved nursing assistant program in New Hampshire;

(2) Graduates of nursing assistant schools in other jurisdictions; and

(3) Students in board approved nursing programs who have successfully completed the fundamentals of nursing curriculum.

Source. #8873, eff 4-24-07; ss by #10298, eff 3-22-13, EXPIRED: 3-22-33

New. #13886, eff 4-22-24

Nur 303.04 Medication Nursing Assistant Examinations.

(a) Each person seeking licensure as a MNA and who graduated from a medication nursing assistant education program in New Hampshire or its equivalent shall take and pass a competency evaluation approved by the board and administered by an organization approved by the board. Approval of such examinations and organizations shall be determined by applying the criteria for each as set forth in Nur 800.

(b) Only those who have completed a medication nursing assistant education program in New Hampshire or it’s equivalent shall take the examination.

Source. #8873, eff 4-24-07; ss by #10298, eff 3-22-13, EXPIRED: 3-22-33

New. #13886, eff 4-22-24; ss by #14295, eff 8-25-25, EXPIRES: 8-25-35

Nur 303.05 RN and LPN Licensure through Comparable Education.

(a) Licensure as an LPN through comparable education shall be limited to:

(1) Pre-licensure students attending approved state of New Hampshire nursing programs; or

(2) Military personnel who meet New Hampshire’s minimum educational practical nursing requirements pursuant to Nur. 602.13 and Nur 602.12.

(b) Applicants for licensure as an LPN through comparable education shall submit:

(1) Form “LPN Comparable Education Verification Form,” as amended 12/2018, referenced in Nur 301.01(b)(1)(d); and

(2) Evidence of completion of a minimum of 600 course work hours of instruction that meet the requirements of Nur 602.12 in:

a. Fundamentals of Nursing;

b. Medical/Surgical Nursing;

c. Mental Health Nursing;

d. Parent and Child Health; and

e. Any other applicable nursing courses required under Nur.602.13.

(c) In order to license as an LPN, a passing grade shall be obtained on the NCLEX-PN examination, provided that no applicant for licensure by comparable education shall be permitted to take the examination more than 2 times.

(d) The NCLEX PN exam shall be taken within 6 months of leaving an RN program or at any point during matriculation through an RN program. An applicant for licensure may take the NCLEX-PN up to 2 times within a 2 year period.

(e) Applicants for licensure as an RN through comparable education shall submit:

(1) Form “RN Comparable Education Verification Form,” as amended 12/2018, referenced in Nur 301.01(b)(1)(e);

(2) Evidence of completion of a minimum of 1080 course work hours of instruction that meet the requirements of Nur 602.13; and

(3) A stamped official transcript that verifies completion of general education requirements as required by Nur 302.02;

(f) In order to license as an RN, a passing grade shall be obtained on the NCLEX-RN examination, provided that no applicant for licensure by comparable education shall be permitted to take the examination more than 5 times pursuant to Nur 303.02(f).

Source. #10996, eff 12-19-15; ss by #12753, eff 4-4-19

PART Nur 304 ENDORSEMENT

Nur 304.01 Registered Nurse and Licensed Practical Nurse Licensure by Endorsement with NCLEX.

(a) This section shall apply to nurses who seek licensure in New Hampshire and who:

(1) Graduated from a nursing school in the United States or Canada, except Quebec, and took the NCLEX in the United States; or

(2) Have taken the NCLEX –RN examination in Canada, except Quebec.

(b) Each person seeking licensure as a registered nurse or practical nurse by endorsement shall:

(1) Complete and submit to the board a forms packet containing the following forms listed below:

a. “Application Process for LPN/RN License by Endorsement,” as amended 12/2018;

b. “LPN/RN License by Endorsement Application,”, as amended 12/2018;

c. “Declaration of Primary State of Residence Form,” as amended 12/2018;

d. “Request for LPN/RN Verification of Original License,” as amended 12/2018; and

e. “Optional Information Question Regarding Military Experience and/or Relationship to Military Personnel Transferred to New Hampshire,” as amended 12/2018;

(2) Have the following documents submitted to the board:

a. A completed “New Hampshire Board of Nursing Record Information Authorization” form, also known as form DSSP 387 from the department of safety, available at http://www.oplc.nh.gov/nursing/documents/criminal-background.pdf;

b. A completed fingerprint card or submission of Live Scan documentation. A fingerprint card may be obtained by contacting the board offices. Live Scan site locations shall be as listed on the department of safety’s website at https://www.nh.gov/safety/divisions/nhsp/ssb/crimrecords/index.html;

c. The fee, as required by the department of safety;

d. Final official transcript showing completion of the nursing educational program requirements, the type of degree conferred, and the date of graduation; and

e. If requesting American with Disabilities Act (ADA) accommodations when taking the NCLEX, a “Request for NCLEX Accommodations under the Americans with Disabilities Act” form, as amended 2/28/18;

(3) Submit evidence of either having:

a. Used nursing knowledge, judgment, and skills for at least 400 hours in the 4 years immediately preceding the application; or

b. Successfully completed the NCLEX examination within the 2 years immediately preceding the application;

(4) Submit evidence of either having:

a. Completed 30 contact hours of continuing education within the 2 years immediately preceding the application; or

b. Successfully completed the NCLEX examination within the 2 years immediately preceding the application;

(5) If a graduate of a nursing program in Canada who took the NCLEX in the United States or in a Canadian Province that requires the NCLEX, submit one of the following:

a. A copy of the nursing school transcript and course descriptions submitted to the original licensing body; or

b. Verification of having worked in the United States or Canada as a nurse for at least 200 hours within the 2 years immediately preceding the application; and

(6) Pay the application fee of $120.

(1) Receive a registered nurse license or a practical nurse license, as appropriate; and

(2) Be authorized to use the title RN or LPN, as appropriate.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by 10996, eff 12-19-15; ss by #12924, eff 11-26-19

Nur 304.02 Canadian Registered Nurse Licensure by Endorsement without NCLEX.

(a) This section shall apply to registered nurses who graduated from a nursing school in Canada and have not taken the NCLEX in the United States or Canada and who seek licensure in New Hampshire.

(b) Each applicant seeking licensure as a registered nurse by endorsement under this section shall:

(1) Submit evidence of graduation from nursing education program in Canada that has been approved by the regulatory body of the province or territory where the program is located;

(2) Submit evidence of successful completion of one of the following examinations with at least the scores indicated as follows:

a. The English version of the Canadian Nurses’ Association Testing Service 5-part examination between the years 1970 and 1980, achieving a score of at least 350 in each of the following areas:

1. Medical nursing;

2. Maternal-child nursing;

3. Surgical nursing;

4. Mental health nursing; and

5. Pediatric nursing; and

b. The English version of the Canadian Nurses’ Association Testing Service Comprehensive Examination between 1980 and July 31, 1995, achieving a score of at least 400;

(3) Submit additional evidence that the applicant has:

a. An educational credentials review from an institution accredited by a nationally recognized accrediting body that is endorsed by the National Council of State Boards of Nursing;

b. Proficiency with the English language; and

c. Nurse licensure in the country of origin;

(4) Submit evidence of having been licensed by the province in which the examination in (2) above was taken;

(5) Submit evidence of use of nursing knowledge, judgment, and skills for at least 400 hours in the 4 years immediately preceding the application;

(6) Submit evidence of completion of at least 30 contact hours of continuing education within the 2 years immediately preceding the application;

(7) Complete and submit to the board a forms packet containing the following forms listed below:

a. “Application Process for LPN/RN License by Endorsement,” as amended 12/2018;

b.. “LPN/RN License by Endorsement Application,” as amended 12/2018;

c. “Declaration of Primary State of Residence Form,” as amended 12/2018;

d. “Request for LPN/RN Verification of Original License,” as amended 12/2018; and

e. “Optional Information Question Regarding Military Experience and/or Relationship to Military Personnel Transferred to New Hampshire,” as amended 12/2018;

(8) Have the following documents submitted to the board:

b. A completed fingerprint card or submission of Live Scan documentation. A fingerprint card may be obtained by contacting the board offices. Live Scan site locations are listed on the department of safety’s website at https://www.nh.gov/safety/divisions/nhsp/ssb/crimrecords/index.html;

c. The fee, as required by the department of safety;

d. Final official transcript showing completion of the nursing educational program requirements, the type of degree conferred, and the date of graduation; and

(9) Pay an application fee of $120.

(1) Receive a registered nurse license; and

(2) Be authorized to use the title RN.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; amd by #7101, eff 9-20-99; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by 10996, eff 12-19-15; ss by #12924, eff 11-26-19

Nur 304.03 Quebec and Non-Canadian Foreign Registered Nurse and Licensed Practical Nurse Licensure by Endorsement.

(a) This section shall apply to nurses who seek licensure in New Hampshire and who have:

(1) Graduated from a nursing school outside the United States and Canada; or

(2) Graduated from a non-English speaking nursing program in Quebec, Canada and are already licensed in another state.

(b) Each person seeking licensure as a registered nurse or practical nurse by endorsement and who does not qualify under Nur 302.01 or Nur 302.02 shall complete and submit, including all required explanations as attachments:

(1) The following forms packet “Endorsement (Reciprocity) Application for LPN/RN, Quebec and non-Canadian Foreign Educated Nurses,” as amended 12/2018, including the following forms;

a. “LPN/RN License by Endorsement Application,” as amended 12/2018;

b. “Declaration of Primary State of Residency Form,” as amended 12/2018; and

c. “Request for LPN/RN Verification of Original License,” as amended 12/2018;

(2) To the department of safety, division of state police, a notarized Criminal Record Release Authorization along with any required fee, with the board identified as the recipient of the record or records;

(3) Evidence that the applicant has received educational credentials from an institution recognized by a nationally recognized accrediting body that is endorsed by the National Council of State Boards of Nursing, and verification of English language proficiency pursuant to Nur 302.01(a) including:

a. Official transcript(s), translated into English, from the applicant’s school of nursing; or

b. Certified copies of applicant’s school of nursing curriculum as provided to the state board of nursing that originally licensed the applicant;

(4) Evidence of a minimum of 400 hours of active practice in the 4 years immediately prior to this application; and

(5) Payment of the application fee of $120.

(1) Receive a registered nurse license or a practical nurse license, as appropriate; and

(2) Be authorized to use the title RN or LPN, as appropriate.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7740, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by 10996, eff 12-19-15; ss by #12753, eff 4-4-19

Nur 304.04 Licensed Nursing Assistant.

(a) This section shall apply to those who seek licensure as a nursing assistant by endorsement.

(b) Each person seeking licensure as a nursing assistant shall complete and submit:

(1) Form “Application for Initial Endorsement Nursing Assistant License” packet as amended 4-28-2016;

(2) Evidence of having taken 24 contact hours of continuing education in the last 2 years immediately preceding the application; and

(3) Evidence of having worked as a licensed nursing assistant for at least 200 hours within the 2 years immediately preceding the application;

(4) Payment of the application fee of $35.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10298, eff 3-22-13; ss by #10996, eff 12-19-15; amd by #11146, eff 7-28-16

CHAPTER Nur 400 CONTINUED STATUS

REVISION NOTE:

The Governor declared a State of Emergency in Executive Order 2020-04, which was effective 3-13-20. The declaration and subsequent Emergency Orders issued pursuant to Executive Order 2020-04 affected various rules and statutes governing continued status of licensees under Chapter Nur 400, including continuing education. The State of Emergency terminated at midnight on 6-11-21, and rules or statutes which had been amended during the State of Emergency were restored. To determine what rules in Nur 400 were applicable during the State of Emergency, the user should check not only the source notes of the rules but also the Emergency Orders in effect at the time in question.

Document #13347, effective 2-28-22, adopted and readopted with amendment various rules in Chapter Nur 400 as emergency rules. The rule adopted was Nur 401.015 defining “re-entry”, “reinstatement”, and “renewal.” The rules Nur 401.02 through Nur 401.07 were readopted with amendment. Pursuant to RSA 541-A:18, V, the emergency rules expired 8-27-22, including Nur 401.015, and the rules Nur 401.02 through Nur 401.07 were effective again in their original form as indicated in the source notes.

PART Nur 401 RENEWAL AND REINSTATEMENT

Nur 401.01 Licensure Renewal for All Licensees.

(a) Each applicant seeking renewal of licensure shall, pursuant to RSA 326-B:22 and Nur 403:

(1) By midnight on the applicant’s date of birth in the renewal year submit a completed renewal application applicable to the type of license renewal sought, as follows:

a. An applicant for a license renewal to practice as a RN or LPN under RSA 326-B:22 shall complete and submit the “Application for License Renewal: Registered (RN) and Practical Nurse (LPN)”, revised 6/2023;

b. An applicant for license renewal to practice as an Advanced Practice Registered Nurse under RSA 326-B:22 shall complete and submit the “Application for License Renewal: Advanced Practice Registered Nurse (A.P.R.N.)”, revised 6-2023; and

c. An applicant for license renewal to practice as an LNA under RSA-B: 22 shall complete and submit the “Application for License Renewal: Nursing Assistant (LNA)”, revised 6-2023.

(2) Pay the applicable renewal fee as set forth in (b), below;

(3) Meet the applicable continuing competence requirements described in Nur 401;

(4) Report any pending criminal charges, criminal convictions, or plea arrangements in lieu of convictions;

(5) Have committed no acts or omissions constituting grounds for disciplinary actions as set forth in RSA 326-B or the rules adopted pursuant thereto, unless the board has found, after investigation that sufficient restitution has been made;

(6) Meet the continuing competence requirements for the specific type of license for which the applicant seeks renewal; and

(7) Have complied with all special requirements ordered by the board as part of disciplinary action against the applicant.

(b) Pursuant to RSA 326-B 9, all applicants for renewal of license as an RN or LPN shall comply with the Nurse Licensure Compact (NLC) Model Rules and Regulations developed by the Nurse Licensure Compact Administrators (NLCA) as amended January 19, 2018 and as referenced in Appendix 2;

(d) The license for which renewal is sought shall be renewed when the completed application has been reviewed and approved. The application shall be approved if it complies with the specific procedural and substantive provisions of this part and all applicable requirements of RSA 326-B.

(e) Each license renewal shall be valid for the biennium commencing the day after the license being renewed expired, except that reinstatement of a license that has lapsed, was obtained after completion of a reentry program, or was the subject of discipline shall be effective as of the date that the renewal application was approved and shall expire at the end of the biennium.

(f) Failure to renew the license shall result in forfeiture of the ability to practice nursing or engage in nursing activities in New Hampshire. Failure to receive and complete the license renewal application shall not relieve the licensee of the obligation to renew the license prior to midnight on the licensee’s birthday of the renewal year.

(g) Each person who practices as a nurse or as a nursing assistant after their license or certification has lapsed, after notice and opportunity for a hearing pursuant to Nur 402.04(a), shall be fined up to $50.00 for every calendar month, or any part thereof, during which the individual so practices. The Board shall apply the factors described in Nur 402.04(g) when determining the amount of the fine to be imposed.

(h) Each nurse or as a nursing assistant who fails to notify the board of a change of address shall, after notice and opportunity for a hearing pursuant to Nur 402.04(a), be fined $10.00.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #9395, eff 2-25-09; ss by #9573, eff 10-21-09; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; amd by #10953, eff 10-22-15; amd by #12789, eff 5-25-19; ss by #13706, eff 9-27-23

Nur 401.02 Re-entry Requirement and Process for Re-entry for RN and LPN.

(a) Each nurse who has not held an active RN or LPN license in any U.S. jurisdiction for 5 or more years prior to their application for renewal or reinstatement shall successfully complete a reentry program prior to being issued a license.

(b) An applicant for a license renewal to practice as a RN or LPN under RSA 326-B:23 shall complete and submit Form “Registered and Practical Nurse License Reinstatement”, 3-2014.

(c) An applicant for a license renewal to practice as a registered and practical nurse under RSA 326-B:23 shall complete and submit the “Declaration of Primary State of Residency Form”, revised 6/2023.

(d) Each re-entry applicant shall also:

(1) Obtain temporary licensure prior to the start of the re-entry program;

(2) Be supervised by an RN; and

(3) After completion of the reentry program, document successful completion of the program.

(e) Each re-entry applicant shall select and complete one of the following within 120 days of application:

(1) A structured refresher course as described in (g) below; and

(2) An individualized program of study as described in (h) and (i) below.

(f) The board shall extend the time in (e) above for 90 days when the reentry applicant:

(1) Cannot meet the time requirement of (e) above; and

(2) Requests that the board extend the time in a letter setting forth the reason(s) for requesting extension.

(g) Each applicant seeking re-entry through successful completion of a structured refresher course shall complete a course of at least 120 hours that includes theoretical and clinical experiences which:

(1) Are pertinent to those activities set forth in RSA 326-B:12 for practical nurses or RSA 326-B:13 for registered nurses; and

(2) Comply with Nur 605.03.

(h) Each applicant seeking re-entry through successful completion of an individualized program of study shall submit the proposed program of study to the board for approval.

(i) The board shall approve the proposed individualized program of study if:

(1) It includes theoretical and clinical components which:

a. Include content described in Nur 602.13; and

b. Are consistent with RSA 326-B:12 for practical nursing and RSA 326-B:13 for registered nursing; and

(2) The clinical component of the individualized program shall be supervised by an RN.

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; ss by #13347, EMERGENCY RULE, eff 2-28-22, EXPIRED: 8-27-22 (see Revision Note at chapter heading for Nur 400); ss by #13706, eff 9-27-23

Nur 401.03 Specific Renewal Requirements for APRN.

(a) In addition to meeting the requirements of Nur 401.01, each applicant for renewal or reinstatement of an APRN license shall:

(1) Document at least 30 educational contact hours to satisfy the requirements of RN continuing competence and an additional 30 hours, 5 of which shall be education in pharmacology within 2 years immediately prior to date of application;

(2) Document current national certification if licensed after September 1984;

(3) If holding lifetime certification, document continuing participation in the certification process; and

(4) Verify current licensure as an RN in NH or another compact state.

(b) The national certification required by (a)(3) above may be counted as 30 of the 60 contact hours required by (a)(2) above.

(d) APRN applicants for license renewal unable to comply with (a)(1) above shall complete a board approved reentry program as described in Nur 401.05.

(e) Pursuant to RSA 126-A:5, XVIII-a (a) and RSA 326-B:9-a, licensees may complete and submit, as part of their renewal application, the New Hampshire Division of Public Health Service’s “New Hampshire APRN Licensure Survey” issued by the State Office of Rural Health and Primary Care, Department of Health and Human Services.

(f) The board shall provide licensees with the opportunity to opt out of the survey. Written notice of the opt-out opportunity shall be provided with the renewal application. The opt out form shall be available on the NH State Office of Rural Health and Primary Care website, https://www.dhhs.nh.gov/programs-services/health-care/rural-health-primary-care/health-professions-data-center.

(g) Licensees choosing to opt-out of the survey shall submit a completed NH Department of Health and Human Services form, “New Hampshire Health Professions Survey Opt-Out Form” pursuant to HB 322, Laws of 2017, Ch. 131, to the State Office of Rural Health and Primary Care, Department of Health and Human Services, via one of the following as specified on the form:

(1) Mail;

(2) Email; or

(3) Fax.

(h) Information contained in the opt-out forms shall be kept confidential in the same accord with the survey form results, pursuant to RSA 126-A:5, XVIII-a (c).

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; amd by #10953, eff 10-22-15; ss by #13347, EMERGENCY RULE, eff 2-28-22, EXPIRED: 8-27-22 (see Revision Note at chapter heading for Nur 400); ss by #13706, eff 9-27-23

Nur 401.04 Re-entry Requirement and Process for Re-entry for APRN.

(a) Each APRN who has not held an active APRN license in any U.S. jurisdiction for 5 years or more prior to their application for renewal or reinstatement shall successfully complete a re-entry program prior to being issued a license.

(b) An applicant for license reinstatement to practice as an APRN under RSA 326-B:23 shall complete and submit Form “Application for Reinstatement: Advanced Practice Nurse (A.P.R.N.)”, revised 6/2023.

(c) An applicant for license reinstatement to practice as an APRN under RSA 326-B:23 shall complete and submit the “Declaration of Primary State of Residency Form”, revised 6/2023.

(d) APRN re-entry applicants shall hold a current registered nurse license issued by the New Hampshire board of nursing or hold a multi-state registered nurse license issued by a state that is a member of the nurse licensure compact.

(e) Re-entry applicants shall, after completion of the re-entry program, document successful completion of the program.

(f) Re-entry applicants shall complete one of the following:

(1) An established reentry program approved by the board pursuant to Nur 603 and designed and implemented by a New Hampshire, regional, or national nursing specialty professional organization; or

(2) A supervised re-entry program as described in (g) below and then comply with (h) below.

(g) Each applicant seeking re-entry through successful completion of a supervised reentry program shall complete the following under the supervision of an education program that prepares APRN’s:

(1) A minimum of 3 credit hours or minimum of 30 class hours in pharmacology at the advanced nurse practitioner level; and

(2) A minimum of 200 hours clinical practice supervised by an advanced registered nurse practitioner practicing in the applicant’s specialty practice area.

(h) After completion of the re-entry program pursuant to (g) above, each applicant shall provide documentation from the program director or designee that the applicant possesses competencies equal to or greater than current program graduates.

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; amd by #12577, eff 7-21-18; ss by #13347, EMERGENCY RULE, eff 2-28-22, EXPIRED: 8-27-22 (see Revision Note at chapter heading for Nur 400); ss by #13706, eff 9-27-23

Nur 401.05 Specific Renewal and Reinstatement Requirements for LNA.

(a) An applicant seeking licensure renewal as an LNA shall complete and submit Form “Nursing Assistant License Renewal”, as amended, 5-2016.

(b) An applicant seeking licensure reinstatement as an LNA shall complete and submit the “Application for License Reinstatement: Nursing Assistant”, revised 6/2023.

(c) Each re-entry nursing assistant applicant shall complete and submit an application form for renewal or reinstatement, as applicable, and pay the appropriate application fee.

(d) In addition to meeting the requirements of Nur 401.01, each applicant for renewal or reinstatement of an LNA license shall either:

(1) Affirm use of nursing assistant knowledge, judgment, and skills within their practice category for a minimum of 200 hours within 2 years immediately prior to the date of application;

(2) Affirm completion of at least 24 contact hours of continuing education in the last 2 years immediately preceding the application; or

(3) Present evidence of completion of a board-approved nursing assistant education program pursuant to Nur 702 within 2 years immediately prior to the date of application.

(e) Applicants shall have the option to fulfill the requirements of (d) (1) above through:

(1) Paid or unpaid work; or

(2) Providing care to a family member if:

a. Licensed expertise is required for such care;

b. A nursing plan of care is implemented; and

c. Care is provided under the supervision of a licensed nurse.

Nur 401.06 Specific Renewal Requirements for Medication Nursing Assistant (MNA).

(a) In addition to meeting the requirements of Nur 401.01, each applicant for renewal or reinstatement of a Medication Nursing Assistant (MNA) certificate shall either:

(1) Affirm use of medication nursing assistant knowledge, judgment and skills within the applicant’s practice category for a minimum of 50 hours within 2 years immediately prior to the date of application;

(2) Affirm completion of at least 8 contact hours of continuing education in each of the last 2 years immediately preceding the application for a minimum total of 8 hours for the 2-year period; or

(3) Present evidence of completion of a board-approved medication nursing assistant education program pursuant to Nur 806.03 within 2 years immediately prior to the date of application.

(b) An applicant for license renewal as a MNA shall complete and submit Form “MNA Renewal Application”, as amended, 5-2016.

(c) Applicants for renewal or reinstatement who fail to meet the requirements of (a) shall have the option to take a board-approved medication nursing assistant competency evaluation to meet the active in practice, continuing education requirement, or both.

(d) An applicant who fails the medication nursing assistant competency evaluation shall not retake the competency evaluation and may reestablish eligibility only by meeting the requirements for and receiving another initial certificate pursuant to Nur 801.01.

(e) A licensed nursing assistant whose medication administration certification has expired and has not been renewed within one year from the certification expiration date shall be:

(1) Ineligible to administer medication; and

(2) Able to reestablish eligibility only by meeting the requirements for and receiving another initial certificate pursuant to Nur 801.01.

(f) An applicant seeking reinstatement of MNA Certification shall complete and submit Form “Medication Nursing Assistant Certification Reinstatement”, as amended, 5-2016.

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; amd by #11132, eff 7-1-16; ss by #13347, EMERGENCY RULE, eff 2-28-22, EXPIRED: 8-27-22 (see Revision Note at chapter heading for Nur 400); renumbered by #13706, (formerly Nur 401.06)

Nur 401.07 Retired Status Designation.

(a) A retired RN may use the title, “R.N. (Ret.).”

(b) A retired LPN may use the title, “L.P.N. (Ret.).”

(d) A retired LNA may use the title, “L.N.A. (Ret.).”

Source. #9096, eff 2-23-08; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #13706 (formerly Nur 401.06)

PART Nur 402 REVOCATION, SUSPENSION AND OTHER SANCTIONS

Nur 402.01 Initiation of Disciplinary Action. The board shall undertake misconduct investigations, settlements of misconduct allegations, or disciplinary hearings, when warranted, in response to any information which reasonably suggests that a licensee has engaged in professional misconduct.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14

Nur 402.02 License Surrender When Misconduct Allegations Pending.

(a) A licensee may surrender the license at any time.

(b) Surrender or nonrenewal of license shall not preclude the board from investigating or completing a disciplinary proceeding based upon the licensee’s conduct while the license was still in effect. Such investigations and proceedings shall be handled in the same manner as other disciplinary investigations and proceedings.

(c) A licensee who surrenders a license shall have no right or privilege to practice in New Hampshire except as shall be specifically set forth in a board order or settlement agreement. A licensee who reapplies for a license in New Hampshire after surrender shall meet all the requirements in effect for new applicants as set forth in statute or rules at that time.

(d) A licensee who surrenders the license as part of a settlement of pending misconduct allegations shall make a written settlement offer to the board before the close of the record in a disciplinary hearing.

(e) Any settlement agreement reached under (d), above, shall include the following concessions:

(1) That license surrender has occurred in settlement of pending disciplinary allegations;

(2) That all or some specifically identified part of the material facts pertaining to the allegations are true; and

(3) That the pending allegations shall be issues to be resolved in any future application the licensee submits to the board.

(f) The fact of license surrender pending disciplinary action and the terms of any settlement agreement pertaining thereto shall be distributed to all relevant licensing authorities and data bank in the same manner as a final decision containing specific findings of dishonesty or misconduct.

Nur 402.03 Immediate Suspension.

(a) When the board receives information indicating that a licensee has engaged misconduct that poses an immediate danger to public health, safety, or welfare, the board shall, pursuant to RSA 326-B:37, IV, immediately suspend such person’s license and commence an adjudicative proceeding not later than 10 working days after the date of the board order suspending the license.

(b) Suspension orders under this section shall include a notice of hearing that sets forth all the information required by RSA 326-B: 38, IX, and RSA 541-A: 31, III.

(c) No hearing date established in a proceeding conducted under this section shall be postponed at the request of the licensee unless the licensee agrees in writing to waive the 10-working day requirement. If the licensee waives the 10-working day requirement, the suspension shall remain in effect until the completion of the hearing, pursuant to RSA 326-B: 37, IV.

(d) Pursuant to RSA 541-A: 31, III, a record of the proceeding shall be made by a certified shorthand court reporter provided by the board.

Nur 402.04 Disciplinary Sanctions.

(a) Other than immediate license suspensions authorized by RSA 541-A: 30, III, and RSA 326-B: 37, IV, the board shall impose disciplinary sanctions only:

(1) After prior notice and an opportunity for a hearing; or

(2) Pursuant to a mutually agreed upon settlement or consent decree.

(b) In addition to the acts described in RSA 326-B: 37, II, the following shall also be considered acts of misconduct or dishonesty for any person licensed under RSA 326-B:

(1) Accepting a nursing or nursing-related assignment when the licensee knows or has reason to know he or she is unqualified to perform the assignment;

(2) Leaving an assignment from the acute care, long term care, home care or community setting, without notifying the appropriate authority, whereby such departure endangers the health, safety, and welfare of those individuals entrusted to the licensee's care;

(3) Violating care recipients' rights, confidentiality, privacy, or records;

(4) Practicing in a manner that discriminates on the basis of age, race, sex, handicap, national origin, sexual orientation, nature of illness or health status, physical or mental infirmity;

(5) Misappropriating human or material resources;

(6) Physical, mental and/or verbal abuse, battery, exploitation, harassment, or neglect of individuals;

(7) Receiving, or agreeing to receive, fees or other considerations for influencing the care, activities or records of individuals;

(8) Failure to maintain standards of practice or education pursuant to RSA 326-B: 2;

(9) Claiming as their own another's license, or allowing others to use a license not their own;

(10) Administering therapeutic agents, treatments, or activities, or recording of same, in an inaccurate or negligent manner;

(11) Failure to record or report in an accurate manner without omission, falsification, or alteration any patient care data, or health care, employment or board records;

(12) Failure to take appropriate action to safeguard individuals from incompetent health-care, nursing practices, nursing-providers, ancillary personnel or others involved with care-recipients;

(13) Performing nursing activities or interventions, or providing nursing-related activities beyond the authorized scope of practice;

(14) Practicing without a current license, or altering a license pocket-card by changing dates, numbers, or any information appearing on a license pocket-card;

(15) Falsifying or not providing information requested by the board;

(16) Being the subject of 3 different medical injury actions reported under RSA 326-B: 37; and

(17) Any pattern of behavior consisting of more than one incident of professional misconduct that is incompatible with the standards of practice.

(1) Delegating or directing activities or tasks to individuals when the licensee knows or has reason to know that the individual(s) is not qualified to perform the activity or task;

(2) Failure of licensee to supervise individuals or groups required to practice nursing or provide nursing-related activities under supervision;

(3) Requiring a licensee to perform specific nursing interventions or nursing related activities when the licensee clearly and cogently states their inability, either through lack of education, practice or knowledge and skills, to perform the delegated activity; and

(4) Permitting the use or disclosure of program information under control of the APRN’s by a person not authorized to receive it in violation of RSA 318 or administrative rules of the board of pharmacy.

(d) When the board receives notice that a licensee has been disciplined for acts related to professional conduct by the licensing authority of another jurisdiction, the board shall issue an order providing the opportunity for a hearing and directing the licensee to demonstrate why reciprocal discipline should not be imposed in New Hampshire.

(e) In a disciplinary proceeding brought on the basis of discipline imposed in another jurisdiction, a licensee shall not be subject to disciplinary sanctions which exceed those imposed by the other jurisdiction unless the board first provides specific notice of an intention to consider other sanctions. When such notice is provided, the licensee shall be subject to any disciplinary sanction authorized by RSA 326-B: 37, III.

(f) Following opportunity for a hearing and after a finding that misconduct or dishonesty has occurred by a licensee, the board shall impose disciplinary sanctions, to the extent authorized by RSA 326-B: 37, III, and the Omnibus Budget Reconciliation Act (OBRA) of 1987; Section 1819 and 1919 of the Social Security Act (42 U.S.C. 1395 & 1396).

(g) In imposing sanctions, the board shall apply the following factors in determining the level or kind of disciplinary sanction imposed:

(1) The seriousness of the offense;

(2) The licensee’s prior disciplinary record;

(3) The licensee’s state of mind at the time of the offense;

(4) The licensee’s acknowledgment of his or her wrongdoing;

(5) The licensee’s willingness to cooperate with the board;

(6) The purpose of the rule or statute violated;

(7) The potential harm to public health and safety; and

(8) The nature and extent of the enforcement activities required of the board as a result of the offense.

(h) Discipline imposed upon a licensee under (b) above shall be intended to be the minimum sanction or sanctions, both in type and extent, that the board believes will, based upon the unique facts and circumstances of each act of misconduct:

(1) Protect the public; and

(2) Deter both the licensee charged and any other licensee from engaging in such misconduct in the future.

(i) The type of disciplinary sanctions available to the board shall include the following, listed in ascending order of severity:

(1) Issuance of a public reprimand pursuant to RSA 326-B: 37, III(a);

(2) Imposing conditions on the licensee’s scope of practice pursuant to RSA 326-B: 37, III(a);

(3) Imposing one or more limitations on the licensee’s scope of practice pursuant to RSA 326-B:37, III(a);

(4) Placing the licensee on probation for a specific period of time pursuant to RSA 326-B: 37, III(a);

(5) Requiring the licensee to practice under the direct supervision of an RN pursuant to RSA 326-B: 37, III(e);

(6) Imposition of an administrative fine pursuant to RSA 326-B: 37, III(f);

(7) Requiring the licensee to submit to the care, counseling, or treatment of a physician, counseling service, health care facility, professional assistance program, or any comparable person or facility pursuant to RSA 326-B:37, III(d);

(8) Requiring continuing nursing education in the area or areas in which they have been found deficient or incompetent pursuant to RSA 326-B:37, III(c);

(9) Requiring participation in a rehabilitative program in the area or areas in which they have been found deficient or incompetent pursuant to RSA 326-B: 37, III(c);

(10) Imposition of a period of license suspension pursuant to RSA 326-B: 37, III(a);

(11) Declining to renew or reinstate a license pursuant to RSA 326-B: 37, III; and

(12) Revocation of a license pursuant to RSA 326-B: 37, III(b).

(j) Copies of board orders imposing disciplinary sanctions and copies of all settlement agreements or consent decrees shall be sent to the licensing body of each state in which the licensee is licensed and to such other entities, organizations, associations, or boards as are required to be notified under applicable state or federal law.

PART Nur 403 CONTINUING EDUCATION

Nur 403.01 Continuing Education Requirements for LPN, RN, and APRN.

(a) Each applicant for licensure by endorsement, renewal or reinstatement for an RN or LPN license shall complete at least 30 contact hours of workshops, conferences, lectures or in-service educational offerings that are designed to enhance nursing knowledge, judgment, and skills. Current national certification may be used to fulfill such continuing education requirement.

(b) Educational courses offering content in the following shall fulfill the requirements of (a) above:

(1) Nursing art and science;

(2) Nursing education, practice, or research;

(3) Research in health care;

(4) Biological, physical, or behavioral sciences;

(5) Management, administration or supervision of health-care delivery;

(6) Teaching or learning principles;

(7) Ethical or legal aspects of health-care;

(8) Content offered in basic nursing educational programs appropriate to the licensure category; or

(9) Health-care trends, issues or policies.

(1) Authorship of a published professional nursing article or book;

(2) Preparation and initial delivery of a professional nursing paper;

(3) Preparation and initial participation on a professional nursing panel;

(4) Participation in quality assessment or risk management studies;

(5) Nursing or nursing-related grant-writing or research; or

(6) Completion of 2 or more credits in a school, college, or university that enhances nursing knowledge, judgment and skills.

(d) Each APRN applicant for APRN license renewal or reinstatement shall complete at least 30 contact hours of continuing education in addition to the continuing education requirements to renew or reinstate a RN license within the 2 years immediately preceding date of application. At least 20 of the 30 hours shall be specific to the specialty practice area, and 5 hours shall be education in pharmacology appropriate to the specialty practice area.

Source. #6778, eff 6-26-98; ss by #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14

Nur 403.02 Continuing Education Requirements for LNA. Each applicant for renewal, reinstatement, or endorsement of an LNA license shall complete at least 12 contact hours per year of workshops, conferences, lectures, or in-service educational offerings that are designed to enhance nursing assistant knowledge, judgment, and skills. Successful completion of a state nursing assistant examination may be used to fulfill such continuing education requirements.

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14

Nur 403.03 Continuing Education Requirements for MNA. Each applicant for renewal of an MNA license shall complete at least 4 contact hours per year of workshops, conferences, lectures, or in-service educational offerings that are designed to enhance nursing assistant knowledge, judgment, and skills related to medications and/or medication administration.

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14

Nur 403.04 Method of Calculation of Contact Hours for Individualized Learning.

(a) Academic credit for courses shall be converted to contact hours, with one credit being the equivalent of 15 contact hours.

(b) Individualized learning activities shall count on an hour-for-hour basis towards fulfilling the requirements of continuing education.

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14

Nur 403.05 Continuing Education Validation.

(a) Licensees shall be responsible for maintaining accurate records and upon request shall submit documentation demonstrating compliance with all applicable continuing education requirements.

(b) All nurse licensees audited for continuing education shall complete and submit Form “Continuing Education Contact Hour Audit”, 1-2014.

(c) All nursing assistant licensees audited for continuing education shall complete and submit “Form Licensed Nursing Assistant Continuing Education Audit”, 11-2013.

(d) At least 45 days prior to the renewal date, every 100th license application shall be selected for a continuing education audit and the licensee shall submit a list of educational offerings, sponsor and hours documenting compliance with continuing education requirements.

(e) A renewal under Nur 401 shall not be issued if:

(1) The licensee fails to submit documentation upon request before midnight of the renewal date; or

(2) Submitted documents fail to meet continuing education requirements.

(f) Licensees may request inactive status in lieu of complying with the specific continuing education requirements of Nur 403 applicable to their license.

Source. #8873, eff 4-24-07 (formerly Nur 402.05); ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14

PART Nur 404 ONGOING REQUIREMENTS

Nur 404.01 Purpose.

(a) The purpose of Nur 404.01 to Nur 404.07 is to regulate the delegation of tasks of client care by licensed nurses to licensed and unlicensed persons, pursuant to RSA 326-B:28 and RSA 326-B:29.

(b) The purpose of Nur 404.08 to Nur 404.11 is to regulate the delegation of tasks of administration of medication tasks by licensed nurses to MNA, pursuant to RSA 326-B:28 and RSA 326-B:29.

Source. #6778, eff 6-26-98; ss by #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #9395, eff 2-25-09; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; amd by #11082, eff 4-26-16

Nur 404.02 Scope. This part shall apply to the delegation of nursing tasks by all licensees except for those persons exempted by RSA 326-B:43.

Source. #6778, eff 6-26-98; ss by #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; amd by #11082, eff 4-26-16

Nur 404.03 Definitions

(a) “Administration of medication” means an action taken by a licensee or authorized delegate whereby a single does of the prescribed medication is instilled into or applied to the body of a person for immediate consumption or use.

(b) “Assistance with administration of medication” means an action taken by a licensee or authorized delegate whereby a client with stable medical condition(s) and who is fully able to recognize and accept prescribed medications is assisted with one or more of the following steps in the process of instilling or applying a single dose of prescribed medication:

(1) Providing assistance, observation, and documentation to a a client;

(2) Taking the medication to the client when the client is present to receive medication;

(3) Opening the medication container for the client when the client is present;

(4) Reminding or prompting the client to take the medication at the proper time;

(5) Reading a medication label to the client;

(6) Physically assisting the client to self-administer medication utilizing hand or hand technique; and

(7) Providing food or liquids if the medication label instructs the client to take the medication with food or liquids.

(c) “Nursing task” means a procedure that requires nursing education and a license as a registered nurse or licensed practical nurse to perform.

Source. #10953, eff 10-22-15; amd by #11082, eff 4-26-16

Nur 404.04 Licensees with the Authority to Delegate Nursing Related Activities.

(a) The following licensees shall have the authority pursuant to RSA 326-B to delegate nursing related activities:

(1) Any currently licensed RN or APRN when practicing registered nursing; and

(2) Any currently licensed LPN when practicing practical nursing directed by a licensed APRN, RN, dentist or physician.

(b) For nursing related tasks involving assistance with or the administration of medication, the following persons shall be eligible to be delegatees:

(1) Any currently licensed RN and APRN;

(2) Any currently licensed LPN, only when:

a. The method of medication administration is not intravenous; or

b. The method of medication administration is intravenous and the LPN is in compliance with Nur 604.01 (b) and (c);

(3) Unlicensed assistive personnel who have competency to perform the specific task to be delegated; and

(4) Any currently licensed LNA only when:

a. The task is assistance with medication administration; or

b. The task is administration of medication in a setting that involves administration of medication to stable clients, as defined in Nur 101.21, and the LNA holds a certificate of medication administration issued in accordance with the provisions of Nur 801; or

c. The LNA that does not hold a certificate of medication administration is employed in the home care, residential care, adult day care, or hospice care setting, where the number of delegations is limited to the number of clients assigned to the LNA, and in accordance with Nur 404.07(h).

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; amd by #10953, eff 10-22-15 (from Nur 404.03); amd by #11082, eff 4-26-16; amd by #12439, eff 12-22-17

Nur 404.05 Eligibility to be a Delegatee.

(a) Any individual shall be eligible to receive the delegation of a task of client care not involving the administration of medication only if such individual has competency to perform the specific task.

(b) For nursing related activities involving the administration of medication, the following persons shall be eligible to be delegatees:

(1) Any currently licensed RN and APRN;

(2) Any currently licensed LPN only when:

a. The method of medication administration is not intravenous; or

b. The method of medication administration is intravenous and the LPN is in compliance with Nur 604.01 (b) and (c);

(3) Unlicensed assistive personnel who have competency to perform the specific task to be delegated; and

(4) Currently licensed LNA when:

a. The LNA holds a certificate of medication administration issued in accordance with the provisions of Nur 801 and in compliance with this part; or

b. The LNA is in compliance with Nur 404.07(h).

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.04); amd by #12439, eff 12-22-17

Nur 404.06 Delegation of Nursing Tasks.

(a) To delegate a nursing task, the delegating nurse shall:

(1) Assess the client to ensure the client’s condition is stable and predictable pursuant to Nur 101.21;

(2) Ensure the task does not require nursing assessment and consider:

a. The nature of the task, the complexity, and the risks involved;

b. The delegate skills necessary to safely perform the task within the care setting and without the direct supervision of the delegating nurse; and

c. The willingness of the delegate to perform the task;

(3) Teach the task to the prospective delegate;

(4) Observe the prospective delegate performing the task to ensure that the task is performed safely and accurately;

(5) Upon finding the delegate competent at the task, delegate the task and instruct the delegate that the delegation is specific to the specified client only and not transferable to another client;

(6) Document the delegation and the delegation process and leave written instructions with the delegate, as appropriate;

(7) Supervise the delegate and provide ongoing evaluation at a frequency determined by consideration of the following:

a. The complexity of the delegated task of client care;

b. The condition of the client;

c. The skill level of the delegate; and

d. The familiarity of the delegate with the environment in which the task is to be performed; and

(8) Rescind the delegation if:

a. The client’s condition changes in a way that renders the delegation no longer safe or appropriate;

b. The delegate proves unwilling or incompetent to perform the delegated task;

c. The client objects to the delegation ; or

d. The delegating nurse is no longer able to supervise the performance of the delegated task. The delegating nurse shall notify the delegate and the delegatee’s supervisor of a rescission.

(b) A licensed nurse shall report to the board an attempt to coerce the delegation of a task of client”care in violation of RSA 326-B: 29, II.

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.05); ss by #11082, eff 4-26-16

Nur 404.07 Delegation of Medication Administration.

(a) In addition to the requirements of Nur 404.05, when delegating medication administration, the delegating nurse shall specify:

(1) The medication to be administered;

(2) The dosage, route and time of the medication to be administered;

(3) The proper method for administration;

(4) Required documentation; and

(5) The duty to report immediately to the delegating nurse any error in the administration.

(b) In addition to the requirements in paragraph (a), and when relevant to the care of the client by the delegate, the delegating nurse shall instruct the delegate on:

(1) The reasons for the medication;

(2) The potential side effects of the medication;

(3) Observation of the client’s response; and

(4) Expected actions if side effects are observed.

(1) Topical;

(2) Oral;

(3) Nasal;

(4) Ocular;

(5) Auricular;

(6) Vaginal;

(7) Rectal;

(8) Enteral tube; and

(9) Injection of insulin or epinephrine in accordance with paragraph (f) and (g).

(d) A nurse shall not delegate the following:

(1) Medication administered via a parenteral route, if not listed in paragraph (c);

(2) Medication administered via a nasogastric tube;

(3) The initial dose of a new medication or a previously prescribed medication with a dosage change; or

(4) Medication administration requiring a dosage calculation by the LNA.

(e) A nurse may delegate PRN medications subject to the following:

(1) The delegating nurse provides written instructions; and

(2) The administration is authorized by the supervising nurse on duty or on call.

(f) A nurse may delegate the administration of insulin from a labeled and pre-set or pre-drawn Insulin delivery device.

(g) A nurse may delegate the administration of epinephrine from a labeled and pre-set or pre-drawn delivery device.

(h) In addition to the requirements of this part, when delegating medication administration to a currently licensed LNA that does not hold a certificate of medication administration, the delegating nurse shall:

(1) Ensure the administration of medication is to stable clients, as defined in Nur 101.21 and pursuant to Nur 404.06(a)(1);

(2) Identify a routine medication regime with a clear process for the LNA to follow, such as the use of:

a. A medication planner or box that is prefilled by a licensed nurse;

b. Clearly marked medication bottles or containers that provide direction for administration; or

c. Written instructions on administration provided by the delegating nurse;

(3) Ensure the LNA has, pursuant to Nur 404.06(a)(3), received instruction on requirements of the task delegated and understands a client medication administration record; and

(4) Ensure delegation of medication administration does not, pursuant to Nur 404.06(a)(2), require independent decision-making by the LNA and shall only be appropriate when the client is unable to safely self-administer.

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.06); ss by #11082, eff 4-26-16; amd by #12439, eff 12-22-17

Nur 404.08 Obligations of Licensees as Delegatees.

(a) A licensee to whom a specific task of client care has been delegated shall perform that task in accordance with RSA 326-B and these rules.

(b) A delegatee who is a licensee shall wear a badge showing the delegatee’s name and title when performing the delegated task of client care.

(c) A delegatee who is a licensee shall report to the board the fact of any delegation which the delegatee believes to be beyond his or her competency.

Source. #7741, eff 8-13-02; ss by #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.07)

Nur 404.09 Circumstances Permitting the Performance by a MNA of Tasks Involving the Administration of Medication. A MNA shall perform a task involving the administration of medication only if:

(a) The task has been delegated to the MNA by a licensed nurse in accordance with the provisions of Nur 404; and

(b) The delegation is not prohibited by Nur 404.04.

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.08)

Nur 404.10 Circumstances Prohibiting the Performance by an LNA of Tasks Involving Medication Administration. An MNA shall not perform a task involving the administration of medication if:

(a) The task requires the determination of the client's need for the medication, the calculation of the dosage of the medication or the conversion of dosage;

(b) The delegating nurse is unavailable to monitor the progress of the client and the effect on the client of the medication; or

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.09)

Nur 404.11 Obligations of Delegating Licensee in Connection with the Delegation to a LNA of a Task Involving Medication Administration.

(a) A licensee intending to delegate, or having delegated, a task involving medication administration to a MNA shall comply with the requirements of Nur 404.05 and Nur 404.06.

(b) A licensee who, having delegated a task involving medication administration to a MNA, has any reason to believe that the delegatee may have made an error in the administration of medication shall:

(1) Immediately ascertain whether the error occurred; and

(2) If the error occurred or its occurrence cannot be ascertained immediately, take the following steps:

a. Inform the administrator of the facility, institution or agency in which the error occurred;

b. Document the error in the client's clinical record;

c. Complete any report required by the policies or rules of the facility, institution or agency within the required time period;

d. Determine whether immediate action is required to be taken with respect to the delegation of tasks to the MNA who made the error; and

e. Maintain a record of errors in medication administration and actions taken by the delegating licensee for medication nursing assistant program site review.

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.10)

Nur 404.12 Obligation of MNA to Report Possible or Known Error in the Administration of Medication. An MNA who has any reason to believe that he or she has made an error in the administration of medication shall:

(a) Immediately report to the following people a possible or known error in the administration of medication:

(1) The licensee who delegated the task involving the administration of medication; and

(2) The MNA’s immediate supervisor in the facility, institution or agency in which the possible or known error occurred, if such supervisor is someone other than the delegating licensee; and

(b) Assist the delegating licensee and the immediate supervisor in the setting in which the possible or known error occurred in the completion of any document for reporting error which required to be completed.

Source. #8873, eff 4-24-07; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.11)

PART Nur 405 ONGOING REQUIREMENTS

Nur 405.01 Competence to Practice. All licensees shall, through education and experience, maintain the ability to practice nursing or nursing related activities competently.

Source. #9096, eff 2-23-08; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.12); ss by #11082, eff 4-26-16 (formerly Nur 404.13)

Nur 405.02 Change of Address.

(a) Each licensee shall notify the board, in writing or electronically, within 30 days of a change of residential or business address by completing and submitting Form “Address Name Change Form”, 11-2013.

(b) The notification required by (a) above shall include the licensee’s:

(1) Full name, license type and number;

(2) Complete current residential mailing and physical address, even if unchanged; and

(3) Current business mailing and physical address, even if unchanged.

(c) As part of the notice required pursuant to (a) above, the licensee may also provide his or her email address, even if unchanged.

(d) Each person who fails to notify the board as required pursuant to (a) above shall, after notice and opportunity for a hearing pursuant to Nur 402.04(a), be fined $10.00.

Source. #9395, eff 2-25-09; ss by #10299, eff 3-22-13; ss by #10571, eff 4-17-14; renumbered by #10953 (from Nur 404.13); renumbered by #11082 (formerly Nur 404.14)

CHAPTER Nur 500 ETHICAL STANDARDS

PART Nur 501 ETHICAL CONDUCT STANDARDS AND GENERAL ETHICAL STANDARDS

Nur 501.01 Obligation to Obey.

(a) The ethical requirements set forth in this part shall bind all licensees and certificate holders and, as applicable, applicants for a license.

(b) Violations of any of the rules in this part shall be included within the scope of the term "unprofessional conduct" as used in RSA 326-B:37, II(h) and shall result in disciplinary action by the board.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7769, eff 10-1-02; ss by #8873, eff 4-24-07; ss by #10300, eff 3-22-13; ss by #13673, eff 6-23-23; ss by #14297, eff 8-25-25, EXPIRES: 8-25-35

Nur 501.02 Ethical Conduct Requirements. A licensee, certificate holder, or, as applicable, an applicant for licensing shall:

(a) Perform during nursing care or nursing-related activities only those acts which are within the licensee's competency;

(b) Submit only truthful and correct information in any application or other document filed with or statement made to the board;

(d) Promptly, and in any case within 10 business days, inform the board of any disciplinary action taken by a state, regional, or national regulatory board or agency;

(e) Promptly, and in all cases within 10 business days, inform the board of any civil action or insurance claim filed against the licensee that alleges malpractice, and inform the board of any decisions made in such civil action(s) or any claim(s) paid on such insurance claims within 10 days of the action(s) or the claim(s) being paid;

(f) Obey in good faith and within any time period specified any disciplinary orders issued by the board, including orders requiring the payment of fees or fines;

(g) Hold the health and safety of clients to be of first consideration and render to each client the full measure of their ability as an essential health care provider;

(h) Always strive to perfect, enlarge, and utilize their knowledge in conjunction with their professional judgment;

(i) Observe the law and uphold the nursing profession;

(j) Be truthful and respectful of information received and rendered;

(k) Hold confidential the information received from clients and their caregivers;

(l) Not agree to practice under terms or conditions which through interference with professional judgment and skill would cause deterioration in the licensee's ability to render safe care at all times; and

(m) Fulfill all professional obligations conscientiously.

Nur 501.03 Professional Duties.

(a) An Advanced Practice Registered Nurse (APRN) shall, pursuant to RSA 326-B:11, III. and RSA 326-B:37, II.(h) be under a professional duty to comply with the requirements of the controlled drug prescription health and safety program (PDMP), RSA 318-B:31-38, and all administrative rules of the board of pharmacy adopted thereunder.

(b) Pursuant to RSA 318-B:36, the following actions shall result in a disciplinary proceeding and the imposition of sanctions upon an APRN by the board in accordance with its rules:

(1) Prescribing or dispensing of controlled substances in schedule II-IV without having registered with the PDMP;

(2) The knowing disclosure of PDMP information by a person authorized to receive it, in a manner that violates RSA 318-B or administrative rules of the board of pharmacy;

(3) The use of information from the PDMP by a person authorized to receive it, for a purpose that violates RSA 318-B or administrative rules of the board of pharmacy; or

(4) Permitting the use or disclosure of information from the PDMP under control of the nurse by a person not authorized to receive it, in violation of RSA 381-B or administrative rules of the board of pharmacy.

Source. #7769, eff 10-1-02; ss by #8873, eff 4-24-07; ss by #10300, eff 3-22-13; ss by #13673, eff 6-23-23; ss by #14297, eff 8-25-25, EXPIRES: 8-25-35 (formerly Nur 501.04)

Nur 501.04 Prescription of an Opioid Antagonist by an APRN.

(a) An Advanced Practice Registered Nurse (APRN) shall be under a professional duty to comply with the requirements of the Controlled Drug Act, RSA 318-B, and administrative rules of the board of pharmacy adopted thereunder, and shall be afforded the benefit of the exemption for actions taken with an opioid antagonist provided in RSA 318-B:15, IV.

Source. #11056, eff 3-19-16

PART Nur 502 OPIOID PRESCRIBING

Nur 502.01 Applicability. This part shall apply to the prescribing of opioids for the treatment of non-cancer and non-terminal pain, and shall not apply to the supervised administration of opioids in a health care setting.

Source. #11117, eff 6-9-16; ss by #12070, eff 1-1-17

Nur 502.02 Noncompliance with Ethical Requirements as Unprofessional Conduct. The ethical requirements set forth in this part shall bind all licensees, and noncompliance with these requirements shall constitute unprofessional conduct as used in NH RSA 326-B:37, II.(h).

Source. #11117, eff 6-9-16; ss by #12070, eff 1-1-17; ss by #14297, eff 8-25-25, EXPIRES: 8-25-35

Nur 502.03 Definitions. Except where the context makes another meaning manifest, the following words have the meanings indicated when used in this chapter:

(a) “Acute pain” means the normal, predicted physiological response to a noxious chemical, thermal, or mechanical stimulus and typically is associated with invasive procedures, trauma, and disease. It can be generally time-limited, often less than 3 months in duration;

(b) “Administer” means an act whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use;

(c) “Addiction” means a primary, chronic, neuro-biologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include impaired control over drug use, craving, compulsive use, or continued use despite harm. The term does not include physical dependence and tolerance, which are normal physiological consequences of extended opioid therapy for pain;

(d) “Chronic pain” means a state in which non-cancer pain persists beyond the usual course of an acute disease or healing of an injury, or that may or might not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years. It also includes intermittent episodic pain that may require periodic treatment. For the purposes of these rules, chronic pain does not include pain from cancer or terminal disease;

(e) “Clinical coverage” means specified and prearranged coverage that is available 24 hours a day, 7 days a week, to assist in the management of patients with chronic pain;

(f) “Dose unit” means one pill, one capsule, one patch, or one liquid dose;

(g) “Medication-assisted treatment” means any treatment of opioid addiction that includes a medication, such as methadone, buprenorphine, or naltrexone, that is approved by the FDA for opioid detoxification or maintenance treatment;

(h) “Morphine equivalent dose (MED)” means a conversion of various opioids to a morphine equivalent dose by the use of board-approved conversion tables;

(i) “Prescription” means a verbal, written, facsimile, or electronically transmitted order for medications for self-administration by an individual patient;

(j) “Risk assessment” means a process for predicting a patient’s likelihood of misusing or abusing opioids in order to develop and document a level of monitoring for that patient;

(k) “ Treatment agreement” means a written agreement that outlines the joint responsibilities of Advanced Practice Registered Nurse (APRN) and patient; and

(l) “Treatment plan” means a written plan that reflects the particular benefits and risks of opioid use for each individual patient and establishes goals, expectations, methods, and time course for treatment.

Source. #11117, eff 6-9-16; ss by #12070, eff 1-1-17 (from Nur 502.02)

Nur 502.04 Acute Pain. If opioids are indicated and clinically appropriate for prescription for acute pain, prescribing licensees shall:

(a) Conduct and document a physical examination and history;

(b) Prescribe the lowest effective dose for a limited duration;

(d) Ensure that the patient has been provided information that contains the following:

(1) Risk of side effects, including addiction and overdose resulting in death;

(2) Risks of keeping unused medication;

(3) Options for safely securing and disposing of unused medication; and

(4) Danger in operating motor vehicle or heavy machinery;

(e) Comply with all federal and state controlled substance laws, rules and regulations;

(f) Conduct and document a risk assessment, such as the evidence-based screening tool Screener and Opioid Assessment for Patients with Pain (SOAPP);

(g) Document an appropriate treatment plan and consideration of non-pharmacological modalities and non-opioid therapy;

(h) Utilize a written informed consent that explains the following risks associated with opioids:

(1) Addiction;

(2) Overdose and death;

(3) Physical dependence;

(4) Physical side effects;

(5) Hyperalgesia;

(5) Tolerance; and

(6) Crime victimization;

(i) In an emergency department, urgent care setting, or walk-in clinic:

(1) Not prescribe more than the minimum amount of opioids medically necessary to treat the patient’s medical condition. In most cases, an opioid prescription of 3 or fewer days is sufficient, but a licensee shall not prescribe for more than 7 days; and

(2) If prescribing an opioid for acute pain that exceeds a board-approved limit, document the medical condition and appropriate clinical rationale in the patient’s medical record; and

(j) Not be obligated to prescribe opioids for more than 30 days, but if opioids are indicated and appropriate for persistent, unresolved acute pain that extends beyond a period of 30 days, the licensee shall conduct an in-office follow-up with the patient prior to issuing a new opioid prescription.

Source. #11117, eff 6-9-16; ss by #12070, eff 1-1-17 (from Nur 502.03)

Nur 502.05 Chronic Pain. If opioids are indicated and clinically appropriate for prescription for chronic pain, prescribing licensees shall:

(a) Conduct and document a history and physical examination;

(b) Conduct and document a risk assessment, including, but not limited to, the use of an evidence- based screening tool such as the Screener and Opioid Assessment for Patients with Pain (SOAPP);

(d) Prescribe for the lowest effective dose for a limited duration;

(e) Comply with all federal and state controlled substances laws, rules, and regulations;

(f) Utilize a written informed consent that explains the following risks associated with opioids:

(1) Addiction;

(2) Overdose and death;

(3) Physical dependence;

(4) Physical side effects;

(5) Hyperalgesia;

(6) Tolerance; and

(7) Crime victimization;

(g) Create and discuss a treatment plan with the patient. This shall include, but not be limited to the goals of treatment, in terms of pain management, restoration of function, safety, time course for treatment, and consideration of non-pharmacological modalities and non-opioid therapy. Informed consent documents and treatment agreements may be part of one document and for the sake of convenience;

(h) Utilize a written treatment agreement that is included in the medical record and specifies conduct that triggers the discontinuation or tapering of opioids;

(i) The treatment agreement shall also address, at a minimum, the following:

(1) The requirement of safe medication use and storage;

(2) The requirement of obtaining opioids from only one prescriber or practice;

(3) The consent to periodic and random drug testing; and

(4) The prescriber’s responsibility to be available or to have clinical coverage available;

(j) Document the consideration of a consultation with an appropriate specialist in the following circumstances:

(1) When the patient receives a 100 mg morphine equivalent dose daily for longer than 90 days;

(2) When a patient is at high risk for abuse or addiction; or

(3) When a patient has a co-morbid psychiatric disorder;

(k) Reevaluate treatment plan and use of opioids at least twice a year;

(l) Require random and periodic urine drug testing at least annually for all patients using opioids for longer than 90 days. Unanticipated findings shall be addressed in a manner that supports the health of the patient; and

(m) Have clinical coverage available for 24 hours per day, 7 days per week, to assist in the management of patients; and

(n) The prescriber may forego the requirements for a written treatment agreement and for periodic drug testing for patients:

(1) Who are residents in a long term, non-rehabilitative nursing home facility where medications are administered by licensed staff; or

(2) Who are being treated for episodic, intermittent pain and receiving no more than 50 dose units of opioids in a 3 month period.

Source. #11117, eff 6-9-16; ss by #12070, eff 1-1-17 (from Nur 502.04)

Nur 502.06 Prescription Drug Monitoring Program.

(a) Prescribers required to register with the controlled drug prescription health and safety program under RSA 126-A:91, or their delegate, shall query the PDMP to obtain a history of schedule II-IV controlled substances dispensed to a patient, prior to prescribing an initial schedule II, III, and IV opioids for the management or treatment of this patient’s pain and then periodically and at least twice per year, except when:

(1) Controlled medications are to be administered to patients in a health care setting;

(2) The PDMP is inaccessible or not functioning properly, due to an internal or external electronic issue; or

(3) An emergency department is experiencing a higher than normal patient volume such that querying the PDMP database would materially delay care.

(b) A licensee shall document the exceptions described in (a)(2) and (3) above in the patient’s medical record.

Source. #11117, eff 6-9-16; ss by #12070, eff 1-1-17 (from Nur 502.05); ss by #14297, eff 8-25-25, EXPIRES: 8-25-35

Nur 502.07 Medication Assisted Treatment. Licensees who prescribe medication assisted treatment shall adhere to the principles outlined in the “American Society of Addiction Medicine’s National Practice Guideline For the Treatment of Opioid Use Disorders 2020 focused update” found at https://sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/docs/default-source/guidelines/npg-jam-supplement.pdf?sfvrsn=a00a52c2_2 as cited in Appendix II.

Source. #12070, eff 1-1-17 (from Nur 502.06); ss by #14297, eff 8-25-25, EXPIRES: 8-25-35

Chapter Nur 600 NURSING EDUCATION PROGRAM APPROVAL

PART Nur 601 PURPOSE AND DEFINITIONS

Statutory Authority: RSA 326-B: 4-a, XV, RSA 326-B: 27.

Nur 601.01 Purpose.

(a) The purpose of this chapter is to set minimum standards that must be met by programs that educate those who seek to enter, or who are in and seek to advance in, the nursing profession.

(b) These standards are intended to safeguard the life, health, and public welfare of the people of New Hampshire by:

(1) Providing for safe nursing practices by setting legal standards for the educational preparation of nurses;

(2) Promoting self-evaluation of educational programs;

(3) Providing for interested persons a list of educational programs meeting legal standards; and

(4) Providing an educated, safe workforce.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 601.02 Definitions.

(a) “Clinical preceptor” means a registered nurse who:

(1) Holds either a current unencumbered New Hampshire registered nurse license or a current and unencumbered multi-state registered nurse license issued by a compact state pursuant to RSA 326-B: 46;

(2) Is employed by a cooperating agency, who assists a nursing student participating in a clinical practicum with acclimating to the role of the nurse; and

(3) Evaluates student progress in meeting the goals and objectives of the program.

(b) “Clinical teacher” means a registered nurse who holds either a current unencumbered New Hampshire registered nurse license or a current and unencumbered multi-state registered nurse license issued by a compact state pursuant to RSA 326-B:46, and who will be responsible for the supervision and guidance of no more than 2 nursing students during a clinical experience.

(d) “Distance education” means instruction offered by any means, whether synchronous or asynchronous, where the student and faculty are in separate physical locations.

(e) “First level nurse” means a nurse who provides and coordinates patient care after graduating from an approved program of at least 2 years in length. Regionally, he or she might be referred to as a professional nurse or registered nurse.

(f) “Full approval” means the status granted to a nursing education program that has graduated its first class and is determined by the board to have complied with Section 326- B: 32 and these rules.

(g) “Good academic standing” means the nursing student is in compliance with his or her institution’s degree program’s definition of good standing and is making satisfactory progress toward the completion of degree requirements within the time limits of the degree program, including approved extensions.

(h) “Home state/jurisdiction” means the National Council of State Boards of Nursing (NCSBN) member state/jurisdiction where the nursing education program has legal domicile.

(i) “Host state/jurisdiction” means the NCSBN member state/jurisdiction, outside of the home state/jurisdiction where students participate in didactic coursework through distance learning and/or clinical experiences.

(j) “Initial approval” means the status granted to a new nursing education program that has been approved by the board to admit students.

(k) “Institutional accreditation” means the formal recognition or acceptance of the governing institution by an accrediting agency recognized by the United States Department of Education.

(l) “NCLEX- PN” means an examination offered through the NCSBN entitled the National Council Licensure Examinations by Practical Nurses.

(m) “NCLEX- RN” means an examination offered through the NCSBN entitled the National Council Licensure Examinations by Registered Nurses.

(n) “Nurse educator” means a person who holds either a current unencumbered New Hampshire registered nurse license or a current and unencumbered multi-state registered nurse license issued by a compact state pursuant to RSA 326-B:46, and who provides instruction in core theoretical or clinical nursing courses.

(o) “Program accreditation” means the formal recognition or acceptance of the nursing education program by a specialized professional nursing accrediting agency recognized as such by the United States Department of Education.

(p) “Probation” means the status granted to a nursing education program when there is evidence at any time of non-compliance with RSA 326- B: 32 or these rules.

(q) “Second level nurse” means a nurse who provides basic nursing care under the direction of a first level nurse. Regionally, he or she might be referred to as a practical nurse or vocational nurse.

(r) “Sponsoring institution official” means the person with authority to bind the educational institution in all matters related to nursing program approval and ongoing oversight of the nursing program.

(s) “Withdrawal of approval” means an action taken by the board when it has been determined that the program fails substantially to meet the standards set forth in RSA 326-B: 32 or these rules and fails to correct the deficiencies within the time specified by the board.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

PART Nur 602 NURSE EDUCATION PROGRAM ORGANIZATIONAL, STAFF AND FACULTY, AND CURRICULAR REQUIREMENTS

Nur 602.01 Program Organization.

(a) Institutions seeking approval to offer either an RN or LPN nursing educational program shall:

(1) Have the legal authority to conduct an educational program;

(2) Establish academic policies, ensure financial support and maintain adequate human and material resources;

(3) Establish policies that comply with all ethical requirements adopted by the New Hampshire department of education, division of higher education-higher education commission;

(4) Satisfy one or both of the following:

a. Be part of an existing educational institution accredited by the U.S. Department of Education; or

b. Have approval by the New Hampshire department of education, division of higher education higher education commission to operate in the state of New Hampshire;

(5) Present an organizational chart depicting the authoritative, communicative, collaborative and cooperative lines within the institution and between groups and cooperating agencies contributing to the program’s educational goals;

(6) Appoint a nursing program director who:

a. Holds a current and unencumbered New Hampshire license or a current and unencumbered multi-state license issued by another compact state;

b. Meets criteria required by Nur 602.06;

c. Reports to the sponsoring official; and

d. Has the authority and responsibility for the program’s administration;

(7) Authorize the director to prepare and administer the program’s budget, and make recommendations to the sponsoring institution’s officials regarding the program’s fiscal needs; and

(8) For programs located within the state of New Hampshire require that the full time director’s primary duty location be in New Hampshire

(b) The director shall initiate and maintain current contractual agreements with cooperating agencies providing student-learning experiences which shall:

(1) Indicate instructional responsibilities, instructional activities, nurse-educator and staff orientations, and patient-care responsibilities;

(2) Be developed with the cooperating agency providing the learning resources;

(3) Require periodic review according to program policies and provide notice for contract termination sufficient to prevent interruption of the program;

(4) Require full control of learning activities by the sponsoring institution including selection, instruction and evaluation of learning activities; and

(5) Establish times for nurse-educators and agency members to meet jointly to review the program’s philosophy, objectives, learning experiences, expected outcomes and future directions.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 601.03); ss by #9395, eff 2-25-09; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.02 Program Policies. Each sponsoring institution shall adopt and make publicly available clearly written student and institutional policies and procedures, including but not limited to:

(a) Admission;

(b) Transfer;

(d) Dismissal and termination;

(e) Withdrawal;

(f) Grading;

(g) Successful completion and graduation;

(h) Grievance and due process;

(i) Illness;

(j) Personal leave;

(k) Confidentiality and access to student records housed within the nursing department;

(l) Tuition and refund.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 601.04); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.03 Program Fiscal, Human and Physical Resources.

(a) The program shall provide sufficient learning resources for students and staff, including print and non-print materials, to accommodate the needs of all students and nurse educators.

(b) The program shall develop and make available for review policies that address acquisition and deletion of library materials, including both print and non-print materials.

(c) The program shall provide and make available to nursing students and nurse-educators sufficient hardware, software, related equipment and electronic resources to support current educational practices.

(d) The sponsoring institution shall provide to nurse-educators classroom and office space comparable to that of other sponsoring institution faculty that provides:

(1) Privacy for individual conferences;

(2) Sufficient work area to accomplish assigned tasks;

(3) Sufficient office equipment and teaching tools to meet faculty needs;

(4) Clean, safe environmental conditions with comfortable temperatures;

(5) Adequate lighting; and

(6) Audio-visual or simulator equipment necessary for care demonstrations.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from 601.05); ss by #9395, eff 2-5-09; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.04 Program Documents.

(a) Program documents pertaining to students shall be accurate, complete, confidential, and secure, and contain the following data:

(1) Admission and re-admission;

(2) Dismissal and termination;

(3) Grading;

(4) Graduation;

(5) Evaluation;

(6) Failure;

(7) Withdrawal;

(8) Health; and

(9) Personal leave.

(b) The institution shall provide for permanent preservation, security and retrievability of student documents including a transcript indicating dates of entrance, progression, completion and courses.

(1) Current and unencumbered New Hampshire registered nurse licensure or multi-state license issued by a compact state; and

(2) Performance evaluations.

(d) Sponsoring institutions shall retain and make available records regarding administration and nurse-educator evaluative procedures.

(e) The sponsoring institution shall prepare and file with the board no later than January 1 of the following calendar year an annual report that includes:

(1) State and regional and professional accrediting agency findings;

(2) Current catalogue and program policies that accurately depict the nursing programs actually offered during the program year;

(3) The name and address of the sponsoring institution official, and the director of the nursing program;

(4) The name, nursing specialty and academic preparation of each nurse-educator;

(5) Each nurse-educator’s work load in terms of hours and weeks and the program director’s responsibilities in terms of teaching, administration and student guidance;

(6) A list of cooperating agencies;

(7) Current curricular plan and anticipated curricular or program changes;

(8) The number of applications, enrollments, transfers, dismissals, failures, and graduates, by year for the previous 5 years;

(9) A 3-year summary of the NCLEX-PN or NCLEX-RN scores received by program graduates;

(10) Program budget data along with a copy of:

a. The sponsoring institution’s most recent fiscal audit of receipts and expenditures relating to the program,

b. Opinion letters of the auditors; and

c. Management’s response to audit findings; and

(11) The dated signature of the program director.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 601.06); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.05 Nurse Educator Approval.

(a) Each sponsoring institution shall submit for each proposed nurse educator Form “Application for Faculty Approval Board Approved Education Programs”, as amended 04-06-2015.

(b) No nurse-educator shall assume responsibilities for which approval under this section is requested until such approval has been granted by the board.

(c) Each faculty member, preceptor, employee or agent of a distance education pre-licensure education program who is in contact with patients and students shall hold a current and active license to practice in the place where the patients are located that is not encumbered and meets all licensing requirements of the state of NH.

(d) Faculty of distance education pre-licensure programs who teach clinical experiences in NH shall seek and obtain nurse-educator approval pursuant to Nur 602.07.

(e) Faculty who teach distance education didactic nursing courses, or who have oversight of students or preceptors but do not provide care for patients, shall hold a current and active license to practice that is not encumbered and meets the requirements of the home state or jurisdiction where the nursing program is approved.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-09 (from Nur 601.08); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.06 Director’s Qualifications.

(a) The program shall complete and submit Form “Application for Faculty Approval Board, Approved Education Programs”, as amended 04-06-2014.

(b) The director of a nursing program offering a degree leading to a registered nurse license shall possess and document the following minimum qualifications:

(1) For a program that offers a doctoral level nursing degree, the following criteria are required:

a. A nursing master’s degree, and a doctoral degree with a focus in nursing; and

b. At least 5 years of administrative/educational experience in nursing;

(2) For a program that offers a masters level nursing degree, following criteria are required:

a. A master’s degree in nursing and a doctorate with a focus in nursing; and

b. At least 5 years of administrative/educational experience in nursing; and

(3) For a program that offers a baccalaureate level degree, the following criteria are required:

a. A master’s degree in nursing; and

b. At least 5 years of administrative/educational experience in nursing.

(c) The director of a nursing program offering an associate degree leading to a registered nurse license shall possess and document the following minimum qualifications:

(1) A master’s degree in nursing; and

(2) At least 5 years of administrative/educational experience in nursing.

(d) The director of a nursing program offering a diploma or associate degree leading to a practical nurse license shall possess and document the following minimum qualifications:

(1) A master’s degree in nursing; and

(2) At least 5 years of administrative/educational experience in nursing.

(e) For programs located within the state of New Hampshire, the program shall require that the full time director’s primary duty location be in New Hampshire.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 601.09); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.07 Nurse-Educator Qualifications.

(a) Nurse-educators in programs offering the baccalaureate, masters, or doctorate degree leading to a registered nurse license shall possess the following minimum qualifications including:

(1) A master’s degree in nursing or a baccalaureate in nursing with a master’s degree or doctorate in:

a. Public health;

b. Health care administration/leadership;

c. Health promotion; or

d. Another field related to health care or education;

(2) At least 2 years of relevant nursing experience in their specific area of educational responsibility; and

(3) Comply with Nur 602.05.

(b) Nurse-educators in programs offering the associate degree or the diploma leading to a registered nurse license shall possess and document the following minimum qualifications:

(1) A master’s degree in nursing or a baccalaureate in nursing with a master’s degree in:

a. Public health;

b. Health care administration/leadership;

c. Health promotion; or

d. Another field related to health care or education;

(2) Have and document at least 2 years of relevant nursing experience in their specific area of educational responsibility; and

(3) Comply with Nur 602.05.

(c) Nurse-educators in educational programs offering the diploma leading to a practical nurse license shall possess and document the following minimum qualifications including:

(1) Both of the following:

a. A master’s degree in nursing or a baccalaureate in nursing with a master’s degree in:

1. Public health;

2. Health care administration/ leadership;

3. Health promotion; or

4. Another field related to health care or education;

b. At least 2 years of relevant nursing experience in their specific area of educational responsibility; or

(2) A bachelor’s degree in nursing and at least 4 years of relevant nursing experience in their specific area of educational responsibility.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 601.10); ss by #9395, eff 2-25-09; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16; ss by #12824, eff 7-6-19

Nur 602.08 Temporary Nurse-Educator Approval.

(a) Each sponsoring institution and program director may seek a temporary nurse-educator approval for an individual who fails to meet criteria as required by Nur 602.07.

(b) The sponsoring institution shall submit a request that provides the following information:

(1) The nurse-educator’s name, address, teaching and practice experience, educational qualifications;

(2) The nurse-educator’s anticipated instructional assignment and supervision of that assignment; and

(3) The details of an academic study plan and timeframe designed to bring the nurse-educator into compliance with Nur 602.07.

(1) The nurse-educator has successfully completed a baccalaureate degree nursing program, or can document:

a. Successful matriculation in a graduate or doctorate program having met generalist requirements for a BSN or MS degree and with a program focus as listed in Nur 602.07(a); and

b. That he or she holds a current and unencumbered New Hampshire registered nurse license or a current and unencumbered multi-state RN license issued by a compact state;

(2) The nurse-educator has and documents at least 2 years of clinical experience in the area of the anticipated teaching assignment to prepare the nurse-educator to instruct students in that area;

(3) The anticipated assignment is congruent with educational and experiential preparation;

(4) Supervision is adequate for the anticipated assignment; and

(5) The academic study-plan meets the requirements of (b) above.

(d) Temporary nurse-educator approval shall be extended if the applicant has matriculated and demonstrated progress in master’s degree education program with a program focus as listed in Nur 602.07(a) as evidenced by taking at least one full course per semester. Each such extension shall remain in effect for 12 months and the total time allotted for master’s degree completion, including any extensions, shall not exceed 48 months.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 601.11); ss by #9395, eff 2-25-09; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.09 Nurse-Educator Responsibilities.

(a) A nurse-educator shall be responsible for the instruction and supervision of no more than 8 students during clinical learning activities at cooperating agencies.

(b) A nurse educator shall be responsible for the instruction of no more than 12 students when:

(1) The student is directly supervised by a registered nurse, who is serving as either a clinical teacher or preceptor, in a health care setting; and

(2) A method of access to program faculty for purposes of communication of student progress and evaluation is identified for each student at the onset of the clinical experience.

(1) Level of student’s educational preparation;

(2) Quality of nursing care required;

(3) Number of care-recipients assigned;

(4) Faculty expertise;

(5) Cooperating agency policies; and

(6) The limitations imposed pursuant to (a) and (b) above.

(d) During a clinical learning experience, nurse-educators may seek expertise of other health-care providers for specific learning activities based on written objectives, but the nurse-educator shall be readily available and shall meet with students to assist with integration of learning activities.

(e) Nurse-educators shall meet periodically, but at least annually, according to sponsoring institution and program policies, to recommend educational and policy revisions based on program review and evaluation.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 601.12); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.10 Substitute Nurse-Educator.

(a) In programs leading to registered or practical nurse licensure a substitute nurse-educator for a specific clinical site shall be designated by the program director when a nurse-educator is absent due to illness, education or other unexpected circumstances.

(b) Appointment of substitute nurse educators for longer than one semester shall require approval by the board using the same criteria as set forth in Nur 602.07.

(1) Is appropriate to the clinical content;

(2) Is of limited duration; and

(3) Maintains the program integrity.

(d) Substitute nurse-educators shall be selected on the basis of:

(1) The level of the students’ educational preparation;

(2) The substitute nurse-educator’s education and demonstrated clinical expertise; and

(3) Institutional and cooperating agency policies.

(e) A substitute nurse-educator shall:

(1) Hold a current and unencumbered New Hampshire registered nurse license or a current and unencumbered multi-state RN license issued by a compact state;

(2) Be employed at the clinical site at the time of approval as a substitute nurse-educator;

(3) Have been employed at such site for at least 3 months;

(4) Have been approved by the program director on the director’s evaluation of the factors in (c) above; and

(5) Have been oriented by the program director, or designee, to the curriculum and student performance expectations.

(f) The substitute nurse-educator shall not:

(1) Maintain his or her own clients or patients during the time that he or she acts as a substitute nurse-educator; or

(2) Be responsible for the instruction of more than 8 students, except as provided under Nur 602.09 (b).

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.11 Program Philosophy and Outcomes.

(a) Each nursing program shall develop and maintain a clearly written statement of the nursing program’s philosophy, reflecting the mission statement of the sponsoring institution, that defines the nurse-educators’ beliefs regarding the concepts identified as foundational to the program.

(b) The nursing program’s anticipated outcomes shall be grounded in the philosophy and the organizing framework and shall serve to evaluate student performance as well as criteria for selecting learning activities.

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.12 Curricular Requirements.

(a) The curriculum shall be derived from the program’s written philosophy and organizing framework and shall demonstrate logical sequencing and internal consistency.

(b) To promote health and prevent disease, registered nurse programs shall provide a minimum of 1080 hours of nursing classroom instruction and concurrent clinical practice offering students the opportunity to care for individuals, families, groups and communities during various developmental stages who are experiencing physiological, or psychosocial, or environmental disruptions.

(c) To promote health and prevent disease practical nurse programs shall provide a minimum of 600 hours of nursing classroom instruction and concurrent clinical practice offering students the opportunity to care for individual, families, groups and communities during various developmental stages that shall be considered to be in physiologically or psychosocially, noncomplex, stable situations.

(d) Curricular content related to nursing courses shall include concurrent theoretical and clinical components designed to provide instructional activities benefiting individuals, families, and groups across the life span.

(e) Curriculum components shall include:

(1) Experiences that promote clinical judgment, clinical management, and commitment to improving quality and safety of the health care system; and

(2) Evidence-based learning experiences and methods of instruction, including distance education methods, which are consistent with the curriculum, provided that:

a. Faculty supervised clinical practice shall provide clinical hours consistent with Nur 602.12 (b), (c) and (d);

b. Simulation may be utilized as a teaching strategy in laboratory and clinical settings to meet objectives for purpose of calculating the hours in the curriculum;

c. Simulation will not be in lieu of an entire clinical experience; and

d. Clinical experiences, including those with preceptors, shall be directed by readily available nurse-educator faculty members; and

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.13 Course Content, Registered Nursing.

(a) Nursing as an applied science, shall, at a minimum, include choices from the natural, physical and behavioral sciences and the humanities including but not limited to the following:

(1) Anatomy & physiology

(2) Genetics;

(3) Microbiology;

(4) Nutrition;

(5) Pathophysiology;

(6) Physics;

(7) Chemistry;

(8) Pharmacology;

(9) Mathematics;

(10) Communications;

(11) Anthropology;

(12) Sociology;

(13) Psychology;

(14) Human development throughout the life span;

(15) Literature;

(16) Philosophy;

(17) Ethics and Bioethics;

(18) History.

(b) The curriculum of the nursing education program shall include knowledge, skills, and abilities necessary for the scope and guidelines of competent nursing practice expected at the level of licensure with coursework in:

(1) Biological, physical, social and behavioral sciences to promote safe and effective nursing practice;

(2) Professional responsibilities, legal and ethical issues, history and trends in nursing and health care;

(3) Didactic content and supervised clinical experiences in the prevention of illness, the promotion, restoration and maintenance of health in patients across the lifespan, including end of life, and from diverse backgrounds; and

(4) Didactic content and supervised clinical experience which integrates the Quality and Safety Education for Nurses (QSEN) (2012), as referenced in Appendix II, to include patient safety, patient-centered care, evidence-based practice, teamwork and collaboration, quality improvement and informatics, reflect contemporary practice and nationally established patient health & safety goals.

(1) A contractual arrangement between the program and cooperating agency;

(2) Evidence of organized student orientation to the cooperating agency;

(3) Orientation of program faculty and nursing staff serving in the roles of nurse clinical educator, clinical teacher, or preceptor/practicum facilitator to the educational program’s philosophy, objectives and purposes;

(4) Regularly scheduled discussion regarding learning experiences that include, but are not limited to, clinical conferences, formal meetings, and phone conferences;

(5) Awareness of and adherence to policies that address role and responsibilities of student, clinical teacher, and preceptor/practicum facilitator; and

(6) An evaluation process of the learning experience that addresses student learning at the conclusion of each experience;

(d) Additional requirements for clinical experiences and assignments shall include:

(1) No more than 2 students shall be assigned to a registered nurse preceptor;

(2) Regular communication regarding student progress shall occur between an assigned registered nurse preceptor, student and program faculty member responsible for oversight of the clinical experience;

(3) Clinical preceptors shall have an unencumbered license to practice as a nurse at or above the level for which the student is being prepared, in the jurisdiction where the clinical experience is being conducted; and

(4) Clinical teachers shall have access to program faculty for purposes of communicating student progress with learning outcomes, inquiries and evaluation of student.

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.14 Course Content, Practical Nursing.

(a) Nursing as an applied science, shall, at a minimum, include choices from the natural, physical and behavioral sciences and the humanities including but not limited to the following:

(1) Anatomy & physiology

(2) Microbiology;

(3) Nutrition;

(4) Pathophysiology;

(5) Chemistry;

(6) Pharmacology;

(7) Mathematics;

(8) Communications;

(9) Sociology;

(10) Psychology;

(11) Human development throughout the life span;

(12) Literature; and

(13) Ethics, or Bioethics.

(b) The curriculum of the nursing education program shall coursework that addresses knowledge, skills, and abilities necessary for the scope and guidelines of competent nursing practice expected at the level of licensure with coursework in:

(1) Biological, physical, social and behavioral sciences to promote safe and effective nursing practice;

(2) Professional responsibilities, legal and ethical issues, history and trends in nursing and health care;

(4) Faculty supervised clinical practice, which shall provide clinical hours consistent with Nur 602.12 (b), (c) and (d);

(5) Didactic content and supervised clinical experience which integrates the Quality and Safety Education for Nurses (QSEN), (2012), as referenced in Appendix II, to include patient safety, patient-centered care, evidence-based practice, teamwork and collaboration, quality improvement and informatics, reflect contemporary practice, and nationally established patient health & safety goals.

(1) A contractual arrangement between the program and cooperating agency;

(2) Evidence of organized student orientation to the cooperating agency;

(3) Orientation of program faculty and / nursing staff to the educational program’s philosophy, objectives and purposes;

(4) Regularly scheduled discussion regarding learning experiences that include, but are not limited to, clinical conferences, formal meetings, and phone conferences;

(5) Awareness of and adherence to policies that address role and responsibilities of student and faculty; and

(6) An evaluation process of the learning experience that addresses student learning at the conclusion of each experience.

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.15 Distance Education-Pre-Licensure.

(a) The curriculum of the distance nursing education program shall include knowledge, skills and abilities necessary for the scope and standards of competent nursing practice expected at the level of licensure.

(b) Distance education provided by nursing faculty shall meet the same requirements, rigor and quality as an on-campus program and shall comply with Nur 602.11 and Nur 602.09.

(c) A distance learning pre-licensure nursing education program shall be approved by the board of nursing in its home state or jurisdiction.

(d) If the board as host state receives a complaint against a distance learning pre-licensure program that is approved in another state/jurisdiction, it shall file that complaint with the home state/jurisdiction for investigation and action.

(e) Distance learning pre-licensure nursing education programs in the home state shall provide oversight to the students in the host states and shall be responsible for the student’s supervision.

(f) Each distance learning pre-licensure nursing education program shall have accreditation from a regional or national accreditation entity approved as such by the U.S. Department of Education for programs of nursing education.

(g) A distance learning pre-licensure education program seeking to serve students in New Hampshire shall submit proof of its accreditation to the board.

(h) No provisions of this rule shall be construed to prohibit the practice of nursing by a student currently enrolled in and actively pursuing completion of a pre-licensure nursing education program, if all the following are met:

(1) The student is participating in a program located in New Hampshire and approved by the board;

(2) The student is participating in this jurisdiction in a component of a program located in another jurisdiction that is approved by a board of nursing that is a member of NCSBN.

(3) The student’s practice is under the auspices of an approved program; and

(4) The student acts under the supervision of a licensed RN serving for the program as a faculty member or teaching assistant.

(i) The distance education program shall establish:

(1) A systematic plan of evaluation for assessment of student learning and program outcomes; and

(2) A systematic plan to intervene effectively should untoward clinical or professional issues arise.

(j) Approved pre-licensure nursing education programs located in jurisdictions other than New Hampshire that contract with health care facilities or agencies in New Hampshire to provide clinical experience for nursing students shall register their intent with the board prior to providing the experience. Notification of intended placement of students in NH shall occur 6 weeks in advance of the clinical experience. Schools seeking clinical placement in NH shall complete and submit, “Form New Hampshire Petition for Non-New Hampshire Based Pre-Licensure Programs Offering Clinical Experience in New Hampshire, Part B- Student Clinical Placement, 10-29-2014; and Form Clinical Preceptor Agreement for Non New Hampshire Based Pre-Licensure Programs Offering Clinical Experience in New Hampshire, 01-07-2015”.

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.16 Program Changes.

(a) The director of a nursing education program shall provide written notice to the board at least 3 months prior to implementation of any curricular design changes.

(b) The following changes to curricular or program design shall require board approval:

(1) Revisions to the philosophy, organizing framework, and student learning and program outcomes;

(2) A significant increase or decrease in planned enrollment that may affect the overall faculty-student ratio or the capacity of institutional facilities or regional practice sites;

(3) Departure from the current educational methods or practices;

(4) Anticipated timeframe for implementing and evaluating changes;

(5) Revision of curriculum; to include changes in more than 10% of credit hours;

(6) Length of program;

(7) Implementation of a pilot program or project;

(8) Implementation of any relocation, satellite, off campus program or distance education component;

(9) Changes in availability of adequate practice sites for the program that result in reduction in student enrollment or faculty positions; or

(10) Changes in nursing program leadership.

(1) Description of the proposed change with cumulative, data evidence- based, criteria for change;

(2) Rationale for the change;

(3) Human, financial, and physical resources required;

(4) Integration with the current philosophy, purposes, organizing framework and curriculum; and

(5) Evaluative process for assessing change.

(d) The board shall apply the criteria set forth in Nur 602.12 when considering approval of changes in curricular or program design pursuant to (a) above.

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 602.17 Accreditation Required.

(a) Each nursing program that has not been approved by the board prior to October 1, 2007, shall obtain accreditation from a regional or national nursing accreditation entity approved as such by the U. S. Department of Education for programs of nursing education and submit proof of such accreditation as part of its application for full approval by the board.

(b) Unaccredited nursing programs that do not show student outcomes that meet or exceed minimum state or national NCLEX scores for licensure shall not be recognized in New Hampshire prior to completion of the full accreditation process.

Source. #11024, eff 1-23-16 (from Nur 602.16)

Nur 602.18 Comparable Education.

(a) Comparable education for practical nursing shall include the following requirements:

(1) Licensing by comparable education for practical nursing shall only be available to pre-licensure students within the state of New Hampshire;

(2) An applicant seeking licensure as an LPN shall complete and submit Form “Licensing by Examination Comparable Education” 2-2015; and

(3) Each person seeking licensure as an LPN by comparable education shall provide, prior to sitting for the NCLEX- PN, evidence of completion of courses in:

a. Fundamentals of Nursing;

b. Medical/Surgical Nursing;

c. Mental Health Nursing;

d. Maternal and Child Health;

e. Pediatric Nursing; and

f. All other applicable nursing courses required by Nur 602.14; and

(4) Course work hours shall total a minimum of 600 hours of instruction.

(b) Military personnel who meet New Hampshire’s minimum educational practical nursing requirements pursuant to Nur.602.14 shall be allowed to take the examination.

(d) Each person seeking licensure as an RN by comparable education for registered nursing, prior to sitting for the NCLEX RN, shall provide the following:

(1) An official transcript or other evidence of completion of courses that verifies completion of generalist requirements for a nursing degree pursuant to Nur 602.13; and

(2) An official transcript or other evidence of completion of course work hours that total a minimum of 1,080 hours of instruction pursuant to Nur 602.12.

Source. #11024, eff 1-23-16

PART Nur 603 NURSE EDUCATION PROGRAM APPROVAL

Nur 603.01 Approval Process.

(a) Upon receipt of an application for a nurse education program approval and payment of all applicable fees under Nur 607.01, the board shall:

(1) Confer initial approval pursuant to Nur 603.01;

(2) Extend initial approval for up to2 years;

(3) Confer full approval pursuant to Nur 603.05; or

(4) Deny approval pursuant to Nur 603.06.

(b) The board shall provide written notification to the sponsoring institution official and director within 10 working days of its decision, including all findings of program deficiencies and actions needed for compliance with these rules and RSA 326-B: 32.

(c) The sponsoring institution may appeal the board’s decision by requesting a hearing within 30 days of the date of the notification.

(d) The sponsoring institution’s official and director shall be given notice of the hearing as required by RSA 541-A:31, III, and Nur 207.02.

(e) The board shall, following a hearing held pursuant to Nur 200, notify in writing within 10 working days the sponsoring institution’s official and director of the board’s decision.

(f) Based upon the application for approval and the evidence adduced at the hearing, the board shall:

(1) Confer full approval;

(2) Confer initial approval;

(3) Affirm its previous decision; or

(4) Deny approval.

(g) Failure of the sponsoring institution to respond to the board’s order resulting from the hearing under (e), above, shall result in denial or withdrawal of approval pursuant to Nur 603.09.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 602.02); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 603.02 Application and Initial Approval.

(a) The board shall confer initial approval to sponsoring institutions seeking to establish a nursing program following review and compliance with:

(1) The provisions of (b) and (c) below; and

(2) RSA 326-B: 32.

(b) The sponsoring institution shall file an application with the board, at least 12 months before anticipated enrollment of students, providing the following:

(1) The name of the sponsoring institution and the sponsoring institution official;

(2) Documentation, in the form of applicable statutes, the institution’s charter, or articles of incorporation, that the sponsoring institution is authorized to conduct such a program;

(3) An indication of whether the application proposes RN educational preparation or LPN educational preparation;

(4) The sponsoring institution’s rationale for establishing the program, which shall include:

a. The details of the program planned;

b. The length of the program;

c. The expected program opening date; and

d. Anticipated enrollment;

(5) A comprehensive feasibility study that shall address at least the following:

a. Documentation of the need and demand for such a program in New Hampshire;

b. The projected impact the program would have on existing programs in the region where the program is being proposed;

c. A hiring plan for qualified program administrators, faculty, and staff;

d. The sources and number of potential students; and

e. The names of proposed cooperating agencies and contact information, including evidence of their intent to contribute to the achievement of the clinical objectives of the program;

(6) The name of a qualified registered nurse director who meets board criteria as required by Nur 602.06;

(7) Documentation of human, fiscal, and material resources, including the number of nurse-educators representing specialty areas, to meet educational needs;

(8) Documentation of meeting the surety indemnification requirements of RSA 188-G:3 and Hedc 304.11, including requiring the company that issues the bond to notify the board directly in the event of non-renewal or cancellation;

(9) Anticipated nurse-educator to student ratio;

(10) Proof of institutional accreditation from a regional or national accreditation entity approved as such by the U. S. Department of Education and proof of application for accreditation for programs of nursing, as required by Nursing 602.17; and

(11) A proposed time line for initiating and expanding the program.

(c) The sponsoring institution shall submit to the board, at least 6 months prior to anticipated student attendance, the following:

(1) An overview of the proposed total curriculum that includes:

a. A statement of its philosophy, organizing framework and student learning and program outcomes.

b. A master plan of curriculum, indicating the sequence for both nursing and non-nursing courses, as well as pre- and co-requisites for such courses;

c. A description of each course and its objectives;

d. Course syllabi for all first-year nursing courses;

e. A plan for total program evaluation, addressing at least the following:

1. Student progress;

2. Curriculum and course content;

3. Proposed nurse educators and instructional methods;

4. Cooperating agencies;

5. Physical, human and fiscal resources required to achieve student success;

6. Attrition, recruitment, and retention;

7. Total program integration;

8. Clinical opportunities and availability of resources; and

9. Contracts for clinical sites; and

f. Documentation to demonstrate that the program has:

1. Adequate support resources including:

(i) A library;

(ii) Learning resources and technology designed to enhance learning that is comprehensive, state of the art, and sufficient to meet faculty and student needs;

(iii) Classroom space;

(iv) At least one laboratory;

(v) Office equipment and supplies;

(vi) Office space;

(vii) Secretarial support; and

(viii) Academic counseling staff and resources for the projected enrollment;

2. Adequate financial resources for planning, implementing, and continuing the program; and

(2) Clearly written student and institutional policies and procedures that address at least the following:

1. Admission criteria and decision making authority;

2. Transfer;

3. Evaluation;

4. Dismissal and termination;

5. Withdrawal;

6. Grading;

7. Program completion and graduation;

8. Grievances and due process;

9. Illness;

10. Personal leave;

11. Confidentiality of and access to student records maintained by the program; and

12. Tuition, other costs, and refunds.

(d) The board shall conduct an on-site survey of the proposed program and agencies to determine compliance with all applicable requirements for the establishment of the nursing education program.

(e) The board shall afford the sponsoring institution the opportunity to comment on the survey in writing.

(f) If the board finds that the resources and plans meet all the applicable rules for establishing the new nursing education program, the board shall grant initial approval conditioned upon:

(1) The maximum enrollment for the first class of students correlates with the required program resources;

(2) Enrollment of the first class of students within one year of such initial approval;

(3) Receipt of program approval from the higher education commission; and

(4) Acknowledgement that if the above conditions of initial approval are not met, the board’s approval shall expire.

(g) Sponsoring institutions shall notify the board immediately in the event that the surety indemnification required pursuant to RSA 188-G: 3 and Hedc 304.11 is not renewed or is cancelled.

(h) Notification to the board by the surety company that issued the bond shall not relieve the sponsoring institution from providing notification of the non-renewal or cancellation of such required surety indemnification.

(i) Sponsoring institutions shall seek full program approval within 6 months following the issuance of its first diplomas and issuance of NCLEX results.

(j) If the board finds that the resources and plans do not meet all the rules for establishing a new nursing program, the program may submit a new plan no sooner than 6 months after being informed that the original plans were not satisfactory.

(k) A program that received initial approval that expired due to failure to enroll students within one year shall not submit a new application for initial approval until at least 12 months have passed since the rescission.

(l) A sponsoring institution that seeks to establish another nurse education program at a different level shall not apply before receiving full approval of the previous program.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 602.04); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 603.03 Program Annual Report and Self-Study.

(a) The sponsoring institution shall annually complete and submit form, “New Hampshire Board of Nursing Program Annual Report”; as amended 2015.

(b) Approved programs that have received national nursing accreditation shall submit a self- study report that correlates with the required timeframe for the national accreditation report. For approved programs not accredited, a self -study report shall be required every 5 years.

(1) A systematic evaluation of:

a. Student learning outcomes;

b. Graduate competencies;

c. Program outcomes; and

d. Results of trended and aggregated data used for program improvement; and

(2) Sources of evidence used to measure achievement of program outcomes, to include, but not be limited to:

a. Student retention, attrition, and on-time program completion rates;

b. Type and number of faculty, faculty competence and faculty retention/turnover;

c. Laboratory and clinical learning experiences;

d. NCLEX examination pass rates for graduates taking the examination for the first time;

e. Proposed future curriculum adjustments related to NCLEX performance;

f. Proposed future curriculum adjustments related to employer and graduate satisfaction;

g. Proposed performance improvement initiatives related to program outcomes; and

h. Review and resolution of program complaints and review of grievances.

(d) The board’s review of the program’s evaluation shall include a site visit by board representatives which:

(1) Shall be conducted in conjunction with the national nursing accreditation body survey visit;

(2) Is intended to assess, clarify, verify and evaluate the material submitted in the self-study; and

(3) Shall provide the basis for determining compliance with these rules and RSA 326-B: 32.

(e) Programs accredited by a national nursing organization authorized by the federal agency authorized to accredit nursing programs may submit that organization’s accreditation report to the board if it is:

(1) Within 3 years of the board’s date of review; and

(2) Cross referenced and revised to demonstrate compliance with these rules.

(f) Following review of the institution’s self-study, the board representatives’ site visit, and other materials submitted by the sponsoring institution, the board shall take action as noted in Nur 603.01(f) based upon the degree of compliance with these rules and RSA 326-B: 32.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 602.06); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16 (from Nur 603.04)

Nur 603.04 Full Approval.

(a) Following initial approval, the sponsoring institution may request the board to confer full approval if the program:

(1) Is in compliance with all of the conditions imposed by the board under Nur 603.02;

(2) Has filed all annual reports required by Nur 603.03;

(3) Has filed all self-study materials required by Nur 603.03;

(4) Is determined to be in compliance with all board rules and RSA 326-B: 32 based upon the self-study, as validated by the site visit;

(5) Meets the nationally determined NCLEX pass rates average of the current year for first time test takers when the annual pass rates for the three most recent calendar years are averaged; and

(6) Has received, subsequent to the receipt of the initial approval from the board, all necessary approvals from the higher education commission.

(b) The board shall deny full approval for failure to comply with RSA 326-B: 32 or these rules, and:

(1) Commence the process to place the program on probation pursuant to Nur 603.05; or

(2) Commence the process to withdraw approval pursuant to Nur 603.06.

(c) The board shall provide written notification to the sponsoring institution official and director within 10 working days of its decision. The notification shall indicate any program deficiencies and actions needed for compliance with these rules and RSA 326-B: 32.

(d) The sponsoring institution may appeal the board’s decision by requesting a hearing within 30 days of the date of the notification.

(e) The sponsoring institution’s official and director shall be given notice of the hearing as required by RSA 541-A: 31, III, and Nur 207.02.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16 (from Nur 603.05)

Nur 603.05 Program Probation.

(a) If the board denies a request of a sponsoring institution to grant full approval to a nursing education program under Nur 603.04, the board shall enter a written order that:

(1) Changes the status of the program from “initially approved” to “approved on probation”;

(2) Identifies all deficiencies required to be corrected for the program to come into compliance with these rules and RSA 326-B: 32;

(3) Provides a reasonable period of time of not less than 90 days to submit an action plan to correct the identified program deficiencies; and

(4) Provides notice of the right of the sponsoring institution to seek a hearing pursuant to Nur 200 to address the findings of the board.

(b) The appeal of an order hereunder shall not stay the change in the status of the program, but shall stay the obligation of the program to comply with the remainder of this section pending:

(1) Full resolution of the issues in the hearing conducted pursuant to Nur 200;

(2) Further order of the board; or

(3) Receipt of an order from a court of competent jurisdiction directing the board or the program to initiate additional action.

(1) Within 90 days of the order, provide the board with a report that discusses factors contributing to the program deficiencies noted by the board, including:

a. Program graduation rates for the last 3 years;

b. Number of nursing faculty teaching on full-time and part-time basis, including adjunct clinical faculty;

c. National Council Licensure Examination for Registered Nurses (NCLEX-RN®) pass rates for the last 3 years; or

d. National Council Licensure Examination for Practical Nurses (NCLEX-PN®) pass rates for the last 3 years; and

e. How program evaluation data is collected and used for program planning and improvement; and

(2) Provide the board with a written plan of correction covering the next 12 month period, to include but not be limited to:

a. Timelines for improvement;

b. Adjustment to the mission, philosophy and organizing framework of the nursing program;

c. Changes in faculty resources and workload;

d. Changes in student support services;

e. Receipt of additional fiscal resources;

f. Changes to program admission, progression, and graduation policies; and

g. How student, graduate, and employer data is collected to measure program satisfaction among these key stakeholders.

(d) No later than one calendar year after notification of a change to probation status, the sponsoring institution shall either:

(1) Correct the deficiencies identified pursuant to (a) above and come into compliance with board requirements; or

(2) Request an extension of time, in which it shall:

a. Explain why the identified deficiencies have not been corrected within the allotted time;

b. Provide a summary of the program’s good faith efforts to come into compliance within the allotted time; and

c. Present a plan of action to come into compliance within the extension.

(e) The board shall extend the one year time frame up to 6-months if:

(1) The efforts made to come into compliance demonstrate good faith; and

(2) The plan of action to come into compliance is realistic and complete.

(f) After 18 months of probation, the program administrator shall be required to appear before and present to the board a current analysis of program effectiveness, problems identified, outcomes of correction plan and timeline for improvement if the nursing program has not:

(1) Demonstrated consistent measurable progress toward implementation of the correction plan; or

(2) Maintained NCLEX scores for first time test takers above the national benchmark for its graduates.

(g) While on probationary status, a nursing program shall as ordered by the board:

(1) Limit or suspend admissions and enrollment;

(2) Not add new sites or expand the program;

(3) Submit to additional site visits; and

(4) Submit interim data, including but not limited to:

a. Progress reports;

b. Syllabi of courses, and evaluations of faculty performance;

c. Reviews of textbooks, and electronic resources used to promote student learning outcomes;

d. National nursing accreditation findings; and

e. Financial and student records when necessary to verify the accuracy of the institution’s self-study.

(h) The board shall reinstate initial or full approval status if:

(1) The program submits evidence of compliance with nursing education standards within the specified time frame; and

(2) NCLEX scores for first time test takers are maintained for a minimum of two years at or above the national pass rate averages.

(i) If the program does not meet the criteria for reinstatement of its approval status, it shall be summoned by the board to show cause why approval of the program should not be withdrawn.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 602.05); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16; amd by #11145, eff 7-28-16

Nur 603.06 Withdrawal of Approval.

(a) When a program previously placed on probation fails to demonstrate compliance with RSA 326-B: 32 or these rules as set forth in the board’s probation order(s), the board shall enter an order:

(1) Directing the sponsoring institution’s official and the director to appear at a hearing;

(2) Directing the sponsoring institution to present evidence why the program’s approval should not be withdrawn; and

(3) Describing the areas of continued deficiency.

(b) The sponsoring institution shall, at least 10 days prior to the hearing, present documentation that it believes fully describes its efforts to come into compliance in the areas identified in the order as being of continued deficiency.

(c) The board shall review the documentation submitted pursuant to (b) above and all other evidence presented at the hearing and make a decision regarding compliance with these rules and the program’s approval status within 90 days.

(d) The board shall provide written notification to the sponsoring institution official and director within 10 working days of its decision.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 602.07); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16 (from Nur 603.09)

Nur 603.07 Program Approval Status Re-Evaluation. An approved nurse education program shall have its approval status re-evaluated:

(a) If the ownership or organizational structure changes;

(b) If an institution is discovered by the board to have offered false information regarding a program;

(d) If there is a change in the program’s accreditation status by a regional or national accrediting body approved by the U.S. Department of Education for programs of nursing;

(e) If the board receives complaints from students, consumers, instructors, employers, other interested parties;

(f) If the board receives information that indicates that the program is or was out of compliance with any provision in this chapter;

(g) If the approval of the higher education commission is withdrawn;

(h) Pursuant to Nur 603.04 (b) (c) and as directed by the board;

(i) If a nursing education program’s first-time test taker NCLEX pass rate falls below the NCLEX standard for the examination given as determined by the National Council of State Boards of Nursing; or

(j) If the board is notified by complaint or report of student attrition, faculty turnover, or inability of students to obtain clinical learning opportunities in numbers that are elevated for the program under consideration or for all programs in New Hampshire.

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16; ss by #11024, eff 1-23-16

Nur 603.08 Approved Program Accreditation Requirement.

(a) A program that has been approved prior to October 1, 2007, shall be required to obtain accreditation from a regional or national accrediting body approved by the U.S. Department of Education for programs of nursing if the status of the program is required to be reviewed pursuant to Nur 603.07(g) or (i).

(b) Following any visit by the accrediting agency, a nursing program shall submit a complete copy of all site visit reports to the board within 15 days of receipt by the program and notify the board within 15 days of any change or pending changes in program accreditation status or reporting requirements.

(c) The administrator of a nursing program that loses accreditation status or allows its accreditation status to lapse shall file an application for renewal of accreditation pursuant to Nur 603.07 within 30 days of loss or lapse in accreditation status.

Source. #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 603.09 Termination.

(a) No program shall be voluntarily terminated by the sponsoring institution prior to the earlier of:

(1) The passage of one full academic year; or

(2) The graduation of the last admitted class.

(b) When a sponsoring institution decides to terminate a nursing program, it shall notify the board within 30 days of that decision.

(c) Upon notification pursuant to (b) above, the institution shall suspend admissions and continue the program as required pursuant to (a) above.

(d) The institution shall provide the board with a plan to phase out the program including, but not limited to:

(1) The timeline for ending the program;

(2) Plans for student program completion, including details of assistance to be provided in arranging transfer to other approved programs;

(3) Arrangements for the secure storage and appropriate permanent access to academic records and transcripts by students and faculty; and

(4) Plans to notify all students, at their last known address, who attended the program within the last 5 years, but failed to complete the program, of the plan to terminate the program and how such students may obtain assistance with program completion.

(e) A program whose approval is withdrawn involuntarily pursuant to Nur 603.06 shall be ordered by the board to provide a plan of termination that complies with the criteria in (d) above.

Source. #9096, eff 2-23-08 (from Nur 602.08); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16 (from Nur 603.10)

PART Nur 604 CERTIFICATE OF LICENSED PRACTICAL NURSE INTRAVENOUS THERAPY COURSE

Nur 604.01 Overview.

(a) To promote the health, safety and welfare of individuals receiving specific intravenous fluids and drugs, and pursuant to RSA 326-B, LPNs may be instructed in the performance of intravenous therapy.

(b) An LPN who has successfully completed a board approved intravenous therapy course shall provide IV therapy under the direction of a physician or dentist, or as delegated by a registered nurse.

(c) LPNs shall be instructed that they are accountable and responsible for their delegated activities and shall only perform intravenous therapy for clients weighing greater than 32 kilograms.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 604.02 Application Process for Course Approval.

(a) Any institution planning to sponsor a course designed to prepare LPNs to provide intravenous therapy shall submit the documentation required by (b) below to the board for initial approval 6 months prior to course implementation. Board approval shall be required prior to course implementation.

(b) Initial course approval by the board shall be granted if there is compliance with these rules, as well as documentation of the following:

(1) That the purposes of the program are consistent with Nur 601.01(b), (1) – (4);

(2) That the curricular organization of the program, including the number of classroom and clinical hours as well as the number hours of theoretical and clinical instruction meet the requirements of Nur 602.12;

(3) That the course content and course objectives meet the requirements of Nur 602.12;

(4) Program policies for admission criteria and educational policies;

(5) Each course offered as part of the program shall provide one or more mechanisms for:

a. The evaluation of the academic performance of the student by the instructor; and

b. The evaluation of the proficiency of the instructor by his or her students; and

c. Each cooperating agency’s ability to provide the quality and quantity of learning opportunities necessary to meet instructional needs.

(c) The board shall initially, and every 3 years following full approval, review the documents required pursuant to (b) above for compliance with these rules;

(d) Following review of documents as required by (c) above, the board shall:

(1) Grant initial approval;

(2) Grant full approval after one year of initial approval and every 3 years thereafter, if the course continues to meet criteria as required by these rules;

(3) Impose probation after notice and opportunity for hearing, on a course at any time the course is not in compliance with RSA 326-B or these rules; or

(4) Withdraw approval, after notice and opportunity for hearing, if a course on probation fails to correct deficiencies within the timeframe established by the board.

(e) In addition to determining program status pursuant to (d) above, the board shall offer recommendations for compliance or course enhancement;

(f) The board shall notify the sponsoring institution within 10 working days of the board’s decision. The decision shall be tentative but shall become final if no appeal is received within 30 days;

(g) If the sponsoring institution fails to meet criteria and the board withdraws approval, the board shall notify the sponsoring institution within 10 working days of the board’s decision;

(h) Pursuant to RSA 326-B, the sponsoring institution may appeal within 30 working days the board’s decision by requesting a hearing to present evidence supporting course approval;

(i) The board shall provide notice of the hearing sponsoring institution pursuant to Nur 207.02;

(j) The board shall contact the sponsoring institution to determine compliance with RSA 326-B and these rules if complaints are received regarding the course, the instruction, course policies or graduates’ performance;

(k) Course changes shall be presented to the board for determination of compliance with this part.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 604.03 Intravenous Therapy Course Content.

(a) The purpose of the course shall be clearly written and reflect the sponsoring institution’s beliefs regarding:

(1) Care-recipients;

(2) Care-providers;

(3) Characteristics of that care;

(4) The environments within which that care is provided; and

(5) The education needed to provide intravenous therapy as a nursing intervention.

(b) The expected outcomes of the course and participants’ behaviors shall be clearly stated in the course outline.

(c) An organizational chart shall demonstrate the authoritative and cooperative relationships between the sponsoring institution and cooperating agency(s).

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 604.04 Intravenous Therapy Course Evaluation. The course coordinator and instructors shall evaluate each course based on standardized or instructor evaluative tools designed to obtain information regarding:

(a) Theoretical content and clinical experience;

(b) Instruction and educational policies; and

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 604.05 Intravenous Therapy Course Provider Qualifications.

(a) The course shall only be offered by a sponsoring institution licensed under RSA 151, or a New Hampshire educational institution, or board approved distance education program that has the financial resources and personnel to conduct such a course.

(b) The sponsoring institution shall retain a course coordinator who shall have the responsibility for the course’s administration.

(1) Hold a current and unencumbered registered nurse license in New Hampshire, a current and unencumbered multi-state RN license issued by a compact state, or shall hold a current active RN license to practice that is not encumbered and meet requirements in the jurisdiction where the program is approved;

(2) Meet the requirements of Nur 602.07(c) (1);

(3) Document at least 3 years of registered nurse experience in a management or supervisory position, including experience in the education role;

(4) Assist with developing, implementing and oversight of the budget;

(5) Plan, implement, and evaluate the course;

(6) Hire, supervise and evaluate qualified instructors;

(7) Secure adequate facilities and material resources to support the course; and

(8) Determine course policies related to:

a. Student admission;

b. Retention;

c. Testing and grading;

d. Student dismissal from the course; and;

e. Successful completion criteria.

(d) The course coordinator shall complete and submit annually the NH Board of Nursing Form “LPN IV Therapy Program Annual Report” as amended 12- 2014.

(e) The student LPN shall submit to the board within 30 days of course completion a certification of completion from the sponsoring program.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 604.06 Instruction.

(a) Instructors shall participate in:

(1) Classroom and clinical teaching;

(2) Student evaluation;

(3) Course implementation and evaluation; and

(4) Development of course policies and other course activities as assigned.

(b) Instructors shall meet the following criteria:

(1) Faculty, preceptors, or others employed by, or who are agents of the LPN intravenous course program and who are in contact with patients shall hold a current and active license to practice nursing that is not encumbered and meets requirements in New Hampshire where the students and patients are located;

(2) Faculty who teach didactic courses, or who have oversight of students or preceptors but do not provide care for patients, shall hold a current and active license to practice nursing that is not encumbered and meet requirements in the home state/jurisdiction where the LPN intravenous course is approved; and

(3) All faculty, regardless of function in the program shall document at least 3 years of clinical registered nurse experience, at least one year of which shall be providing intravenous therapy.

(d) Guest lecturers with specialized knowledge, experience, or both, in content areas required by Nur 604.07 may participate in student instruction for specific learning activities under the supervision of the course coordinator.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 604.07 Curriculum.

(a) The curriculum of the LPN IV therapy course shall include knowledge, skills and abilities necessary for the scope and standards of competent nursing practice expected at the level of licensure. The LPN IV therapy course provided by nursing faculty shall meet the same requirements, rigor and quality of the board approved pre-licensure nursing programs.

(b) The curriculum shall prepare the LPN to:

(1) Initiate intravenous therapy and administer crystalloid intravenous fluids;

(2) Initiate, monitor and regulate the prescribed flow rate of solutions required by (1) above;

(3) Maintain the intravenous site;

(4) Replace solutions required by (1) above;

(5) Discontinue intravenous devices in accordance with institutional policy;

(6) Add medications and nutrients to intravenous fluids in accordance with (1) above and institutional policy;

(7) Add medications and nutrients to fluids previously mixed by a registered pharmacist or the pharmaceutical manufacturer in accordance with institutional policy;

(8) Flush intermittent devices with physiological saline or a heparin solution; and

(9) Administer medications by concentration, manual administration or intermittent infusion; and

(10) Access CVAD per institutional policy.

(1) Fluids used in research, or oncology therapy;

(2) Blood or blood products;

(3) Hyperalimentation solutions, colloids and lipids; and

(4) Intravenous therapy to clients who weigh less than 32 kilograms.

(d) Intravenous therapy course content shall include:

(1) A minimum of 30 hours of theoretical content and laboratory practice pertinent to intravenous therapy;

(2) Review of the law and rules pertinent to nursing in New Hampshire, and the policies and procedures of the cooperating agency where clinical instruction occurs;

(3) Review of anatomy and physiology particularly as it relates to the transport system, fluid replacement and intravenous therapy;

(4) Information pertinent to the relationship between intravenous therapy and human regulatory functions, as well as the clinical manifestations resulting from fluid and electrolyte imbalance and pathological disturbances;

(5) Principles of infection control and aseptic procedures;

(6) Use of equipment and methods for assessing and correcting equipment malfunctions;

(7) Review of principles related to the compatibility and incompatibility of drugs and solutions;

(8) Calculations pertinent to the administration of intravenous fluids and drugs;

(9) Maintenance, monitoring, and discontinuance of intravenous treatment systems;

(10) Care of the patient experiencing local or systemic adverse complications resulting from intravenous therapy; and

(11) Care of the high risk patient.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 604.08 Participants.

(a) Applicants for the course shall:

(1) Demonstrate the ability to read and write common terminology used in intravenous therapy;

(2) Have the ability to perform the physical activities related to intravenous therapy;

(3) Hold a current and unencumbered practical nurse license in New Hampshire or a current and unencumbered multi-state LPN license issued by a compact state; and

(4) Maintain competence to safely perform intravenous therapy using principles of pharmaco-kinetics.

(b) To practice intravenous therapy in New Hampshire, graduates of intravenous therapy courses, other than a New Hampshire course, shall submit their documents and credentials to the board who shall evaluate their education and practice and if comparable with current course graduates shall designate them as having completed an approved LPN IV therapy program.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

PART Nur 605 NURSING REFRESHER COURSE

Nur 605.01 Course Availability.

(a)Sponsoring institutions seeking approval for a refresher course shall comply with Nur 605.02 – Nur 605.05.

(b) One year following initial approval, the board’s representatives shall review the course to determine compliance with this chapter.

(c) The course coordinator of an approved Refresher Program shall complete and submit annually to the board Form “Refresher Course Annual Report”, as amended 12-20-2014.

(d) Continuing approval shall be granted every3 years based on compliance.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 605.02 Refresher Course Application.

(a) A sponsoring institution submitting an application to offer a structured nursing refresher course shall submit an application and supporting documents pursuant to (b) below for board approval 3 months prior to course initiation.

(b) The applicant shall provide a complete application that:

(1) Demonstrate that the projected budget will support the course;

(2) Includes a statement of philosophy and purpose consistent with fully educating and providing necessary skills for the workforce;

(3) Includes a course calendar describing all content, learning activities, and objectives stated in behavioral terms;

(4) Describes the methods of instruction and evaluation;

(5) Includes a complete reference of current literature and resources pertinent to content that will be available to those taking the course;

(6) Describes its expected student outcome; and

(7) Specifies its criteria for measurement of successful completion.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 603.02); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 605.03 Refresher Course Criteria.

(a) A refresher course shall last no longer than 6 months and consists of:

(1) A minimum of 80 hours of clinical practice directly supervised by a registered nurse;

(2) A minimum of 40 hours of theoretical instruction;

(3) A calendar of current readings and activities pertinent to nursing education and practice;

(4) A description of the expected educational outcomes based on content required by Nur 602.13; and

(5) A method for evaluating the course.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 605.04 Refresher Course Coordinator.

(a) Prior to assuming responsibility and accountability for the course, the course coordinator shall be approved by the board. The board shall grant such approval if the course coordinator meets the criteria specified in (b) below.

(b) The course coordinator located within New Hampshire shall:

(1) Possess a current and unencumbered registered nurse license in New Hampshire or a current and unencumbered multi-state RN license issued by a compact state;

(2) All course coordinators, shall document at least 3 years’ experience as a nurse educator or education coordinator within 5 years of request for approval and meet Nur 602.06 (a) and (b) (3) a.; and

(3) Document at least 5 years of nursing practice.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 603.04); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 605.05 Refresher Course Instructors.

(a) Each refresher course instructor shall:

(1) Possess a current and unencumbered registered nurse license in New Hampshire or a current and unencumbered multi-state RN license issued by a compact state;

(2) Document at least 3 years of active nursing practice, to include clinical nursing faculty within the 5 years immediately prior to request for approval; and

(3) Meet Nur 602.07 (a) (1) b.

(b) The sponsoring institution shall ensure that there are sufficient instructors to:

(1) Meet the instructor to student ratio of 1:8;

(2) Meet the educational goals of the course; and

(3) Ensure that the safety and welfare of care-recipients, care-providers and instructors is not compromised.

(1) Determine successful completion of the theoretical and clinical content;

(2) Evaluate effectiveness of instructional methods and instructors; and

(3) Assess suitability of cooperating agencies.

(d) Upon successful completion of the refresher course, the course coordinator shall provide to the reentry nurse and the board a written statement that includes the following:

(1) The name of the course graduate;

(2) The number of theoretical and clinical hours;

(3) The date of successful completion; and

(4) The instructor’s signature and date validating the nurse’s ability to safely meet standards as required by RSA 326-B:12 or RSA 326-B13.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #9096, eff 2-23-08 (from Nur 603.06); ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16

Nur 605.06 Refresher Course Offered through Distance Education Programs.

(a) Faculty, preceptors, course coordinator and instructors and others employed by, or who are agents of, the refresher course program and who are in contact with patients shall hold a current and active license or privilege to practice that is not encumbered and meets requirements in the state/ jurisdiction where the students/ patients are located.

(b) Coordinator and faculty who teach didactic nursing, or faculty who have oversight of students or preceptors but do not provide care for patients, shall hold a current and active license or privilege to practice that is not encumbered and meet requirements in the home state/jurisdiction where the refresher course program is approved.

Source. #11024, eff 1-23-16

PART Nur 606 NURSING PROGRAM APPROVAL FEES

Nur 606.01 Fees.

(a) The fees set forth in Table 6.1 “Fees” shall be applicable for all applications for initial approval under this chapter and ongoing approval as deemed necessary by the board:

Table 6.1 “Fees”

Action

Fee

Application for Initial Approval

$1000.00 for first site visit;

$500.00 per subsequent site visit

Application for Additional Program Approval (as part of Initial Approval)

$250.00

Complications with Accreditation or Continuing Approval Requiring Site Visit

$1000.00 for each resulting site visit

Stipends for Program Approval Evaluation Team Members

$750.00 for Team Chair

$500.00 per Non-Chair Team Member

(b) In addition to the fixed fees listed in Table 6.1 “Fees”, applicants shall pay the actual cost, as calculated and shown on an invoice sent by the board to the applicant following completion of the site visit, of the following for board members only:

(1) Transportation to and from the site visit for evaluation team members;

(2) Transportation of the team members during the site visit;

(3) Lodging required for the site visit for evaluation team members;

(4) Meals during the site visit for evaluation team members, taken after the evaluation team members depart for the site and before their return from the site;

(5) All expenses of the team members or board incurred in preparation for, during, or after the site visit, as necessitated by the site visit, including but not limited to:

a. Copying or reproduction of documents; and

b. Office consumables such as paper, computer disks, and postage.

(c) All fees except for stipends shall be paid by the sponsoring institution directly to the board within 30 days of submission of an invoice or invoices by the board. If paying by check, such check shall be made payable to “Treasurer, State of New Hampshire.”

(d) Stipends shall be payable to the individual evaluation team members but shall be sent to the board for distribution to the team members. Payment of stipends shall be made within 30 days of submission of an invoice or invoices by the board.

Source. #9302, INTERIM, eff 10-24-08, EXPIRES: 4-22-09; ss by #9395, eff 2-25-09; ss by #10301, eff 3-22-13; ss by #11024, eff 1-23-16; amd by #11145, eff 7-28-16

PART Nur 607 INNOVATIVE APPROACHES

Nur 607.01 Pilot Program for Innovative Approaches for Teaching and Learning.

(a) The purpose of a pilot program is to:

(1) Foster innovative models of nursing education to address the changing needs in health care delivery systems;

(2) Ensure that innovative approaches are conducted in a manner consistent with the board’s role of protecting the public; and

(3) Ensure that innovative approaches conform to the quality outcome standards and core education criteria established by the board.

(b) A program applying for a pilot program shall:

(1) Hold full approval by the board of nursing;

(2) Have no substantiated complaint, discipline or deficiencies in the past 2 years, and

(3) Have been compliant with all board rules during the past 2 years.

(1) Identifying information including name of program, address, responsible party and contact information;

(2) A brief description of the current program, including accreditation and Board approval status;

(3) Identification of the regulation or regulations that the proposed innovative approach would alter;

(4) Length of time for which the innovative approach is requested;

(5) Description of the innovative approach, including objectives;

(6) Brief explanation of the rationale for the innovative approach at this time;

(7) Explanation of how the proposed innovation differs from approaches in the current program;

(8) Available evidence supporting the innovative approach;

(9) Identification of faculty, program, and sponsoring institution resources that support the proposed innovative approach;

(10) Expected impact the innovative approach will have on the program, including administration, students, faculty, and other program resources;

(11) Plan for implementation, including timeline;

(12) Plan for evaluation of the proposed innovation, including measurable outcomes, method of evaluation, and frequency of evaluation; and

(13) Additional application information as requested by the board.

(d) The board shall approve an application for innovation that meets the following criteria or approve the application with modifications as agreed between the board and the nursing education program:

(1) Eligibility criteria in (b) and application criteria in (c) are met;

(2) The innovative approach will not compromise the quality of education or safe practice of students;

(3) Resources are sufficient to support the innovative approach;

(4) Rationale with available evidence supports the implementation of the innovative approach;

(5) The implementation plan is reasonable to achieve the desired outcomes of the innovative approach;

(6) The timeline provides for a sufficient period to implement and evaluate the innovative approach; and

(7) The plan for periodic evaluation is comprehensive and supported by appropriate methodology.

(e) The board shall:

(1) Deny the application or request additional information if the program does not meet the criteria in (b) and(c); or

(2) Rescind the approval of the innovation or require the program to make modifications if:

a. The board receives substantiated evidence indicating adverse impact ;

b. The program fails to implement or evaluate the innovative approach as presented and approved; or

c. The program fails to maintain the eligibility criteria in (b).

(f) An education program that is granted approval for an innovation shall maintain eligibility criteria in (b) and submit:

(1) Progress reports conforming to the evaluation plan annually; and

(2) A final evaluation report that conforms to the evaluation plan, detailing and analyzing the outcomes data.

(g) If the innovative approach has achieved the desired outcomes and the final evaluation has been submitted, the program may request that the innovative approach be continued.

(h) The board shall grant the request to continue approval if the innovative approach has achieved desired outcomes, has not compromised public protection and is consistent with core nursing education criteria.

Source. #11024, eff 1-23-16

PART Nur 608 NURSE EXTERNS

Nur 608.01 Definitions.

(a) “Nurse externship” means a clinical learning program pursuant to RSA 326-B:32(I)(a), whether paid, for course credit, or uncompensated, that supplements an RN student’s education and training through placement in a health care facility at which the nurse extern performs nursing tasks or activities under supervision.

(b) “Nurse extern preceptor” means a board licensed RN or APRN working at a New Hampshire health care facility that meets the qualifications outlined in Nur 608.05.

(c) “Nurse extern” means a student enrolled in board approved RN education program who practices in a non-licensed capacity in a New Hampshire health care facility.

(d) “Supervision” means direction by a qualified nurse extern preceptor for the accomplishment of a nursing task or activity, including initial direction and periodic inspection of the actual accomplishment of the task or activity.

Source. #13707, 9-27-23

Nur 608.02 Nurse Extern Programs.

(a) Nurse education programs with approval pursuant to Nur 603.04 may seek to add nurse externship programs to its clinical learning program.

(b) Nurse education programs shall submit written notice of the addition of a nurse externship program pursuant to Nur 602.16.

(c) The board may, upon notice and an opportunity to be heard, revoke the approval of the nurse extern program if any nurse extern or nurse extern preceptor commits any act that would be subject to discipline under RSA 326-B:37 or Nur 402.04(b). The nurse extern preceptor shall be responsible for the nurse extern’s conduct during the duration of the approved nurse externship agreement as it pertains to the scope of the externship agreement.

Source. #13707, 9-27-23

Nur 608.03 Nurse Extern Qualifications.

(a) In order to qualify as a nurse extern, the individual shall:

(1) Be enrolled and in good standing in a board approved RN education program;

(2) Have successfully completed a clinical or simulation course in their current RN education program;

(3) Have successfully completed a pharmacology course or its equivalent if their nurse externship is to involve assistance with medication administration; and

(4) Be assigned a nurse extern preceptor to act as a nurse extern for a designated time period not to extend more than 3 months beyond the person’s expected graduation date from their RN training program.

(b) The board shall approve the nurse extern application of any person satisfying the requirements of Nur 608.03(a).

(c) If a nurse extern ceases to meet any of the requirements of Nur 608.03(a), the nurse extern shall inform the educational program and nurse extern preceptor of the change and shall no longer serve as a nurse extern.

(d) A nurse extern preceptor shall inform the approved education program immediately of any violations of state laws, board’s administrative rules, or any complaints made which would be a violation of any state law or administrative rule regarding its nurse extern. The approved education program shall thereafter immediately notify the board,

Source. #13707, 9-27-23

Nur 608.04 Nurse Extern Practice. As part of a nurse externship program, a nurse extern may, under the supervision of the nurse extern preceptor, perform any nursing task for which they have, through education or experience, demonstrated competency.

Source. #13707, 9-27-23

Nur 608.05 Nurse Extern Preceptor Qualifications.

(a) Each nurse extern preceptor seeking approval to supervise a nurse extern shall:

(1) Be employed at a health care facility licensed, certified, or accredited by the appropriate New Hampshire authority;

(2) Be in good standing; and

(3) Not have been subject to any current or pending discipline by the board.

(b) After receiving notification under Nur 608.05(b), or on its own initiative, the board may, upon notice and an opportunity to be heard, revoke the approval of any nurse extern preceptor that:

(1) No longer meets the requirements of Nur 608.03;

(2) Has failed to provide supervision of a nurse extern; or

(3) Has otherwise demonstrated an inability to provide safe, effective training opportunities for nurse externs.

Source. #13707, 9-27-23

CHAPTER Nur 700 NURSING ASSISTANTS

Statutory Authority: RSA 326-B:4-a, XIII

PART Nur 701 NURSING ASSISTANT REGISTRY

Nur 701.01 Purpose. These rules set forth requirements pursuant to RSA 326-B:9 and RSA 326-B:32 requiring nursing assistant training and competency testing. The Omnibus Budget Reconciliation Act (OBRA) of 1987; Section 1819 and 1919 of the Social Security Act (42 U.S.C. 1395 & 1396) and RSA 326-B authorize a registry that lists all nursing assistants who qualify through education and testing to provide nursing-related activities.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

PART Nur 702 COMPETENCY EVALUATION

Nur 702.01 Frequency and Place.

(a) The board shall arrange with other boards, agencies, associations or organizations for the purchase, administration, use and scoring of competency evaluations consisting of a written/oral, and skills evaluation.

(b) Competency evaluations shall be administered to applicants at a time and place determined by the number of applicants, security requirements and cost.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; amd by #7101, eff 9-20-99; ss by #7738, eff 8-6-02; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07 (formerly Nur 703.01); ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 702.02 Subject Matter.

(a) The skills part of the competency evaluation shall consist of a minimum of 5 nursing-related activities at varying levels of difficulty commonly performed by nursing assistants and based on content noted in Nur 704.

(b) A New Hampshire registered nurse skilled in testing methods and using previously determined criteria based on content noted in Nur 704 shall evaluate the nursing assistant's ability to demonstrate mastery of nursing-related activities including any 5 of the following:

(1) Use of communication techniques;

(2) Noting observations of a care-recipient's environment;

(3) Identifying hazardous conditions in the environment;

(4) Demonstrating emergency measures;

(5) Manipulating adaptive devices or special equipment;

(6) Recording stages of the developmental process;

(7) Ambulating, positioning, supporting or transferring a care-recipient;

(8) Providing personal care;

(9) Determining temperature, pulse, respirations or blood pressure;

(10) Providing nutrition or hydration;

(11) Recording intake or output;

(12) Noting abnormalities in behavior or bodily functions;

(13) Identifying violations of confidentiality or human rights;

(14) Noting and recording results of simple laboratory tests;

(15) Identifying infection control techniques;

(16) Identifying religious symbols and artifacts;

(17) Identifying nursing and medical equipment;

(18) Describing and reporting abuse;

(19) Recognizing, applying, monitoring restraints and restraint alternatives; and

(20) Manipulating, and utilizing adaptive devices to promote rest, comfort and independence.

(c) The integrated written or oral part of the competency evaluation shall include testing for knowledge and comprehension of commonly performed nursing-related activities as follows:

(1) Role functions;

(2) Holistic care through the lifespan;

(3) Communication skills;

(4) Safety and emergency procedures;

(5) Care-recipient's rights, dignity, and confidentiality;

(6) Personal hygiene;

(7) Ambulation and movement;

(8) Nutrition and bodily waste;

(9) Environmental and personal safety;

(10) Emotional support;

(11) The developmental process;

(12) Utilization of resources;

(13) Comfort, rest, and activity;

(14) Physical and occupational skills; and

(15) Observing, reporting and documenting.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07 (formerly Nur 703.02); ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 702.03 Scores.

(a) A candidate shall successfully complete the written part and the skills demonstration part of the competency evaluation, noted in Nur 702.01(a), as set forth in Nur 702.02(b) and Nur 702.02(c), to be eligible to apply for licensing.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #7738, eff 8-6-02

New. #8873, eff 4-24-07 (formerly Nur 703.03); ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 702.04 Procedure.

(a) The board shall review any testing service's policies to ensure that:

(1) The test reliability and valid;

(2) The reading level is consistent with practice as a licensed nursing assistant (LNA) and RSA 326-B:16, II;

(3) Test items are grounded in common nursing-related activities based on a national or regional job analysis;

(4) It employs security measures to ensure freedom from tampering and breech of confidentiality;

(5) The test is legally defensible;

(6) The administration and evaluation of skills demonstrations will be monitored by registered nurses with 2 years of experience with the elderly, or chronically ill of any age;

(7) Tests are graded on a pass or fail basis; and

(8) There will be accurate, concise and prompt reporting of scores.

(b) In the event any part of the competency evaluation is lost, destroyed, damaged or security violated, the applicant shall retake and pass that particular part of the competency evaluation prior to application for licensing.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; amd by 7101, eff 9-20-99; ss by #7738, eff 8-6-02

New. #8873, eff 4-24-07 (formerly Nur 703.04); ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

PART Nur 703 RECORDS

Nur 703.01 Registry Reporting.

(a) The board shall keep on file the name, address, telephone number, date of certification, date license was issued, and license number of every individual providing nursing-related activities.

(b) The registry file shall contain any legally proven acts of neglect, abuse, or misappropriation of personal or public property, and disciplinary actions taken by the board pursuant to OBRA 1987, RSA 326-B, and these rules.

(c) The board shall disclose the date of registry entry of any nursing assistant and upon request shall disclose proven acts of abuse, neglect, or misappropriation of personal or public property or other actions taken by the board.

#5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07 (formerly Nur 704.03); ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

PART Nur 704 EDUCATIONAL PROGRAMS FOR NURSING ASSISTANTS

Nur 704.01 Purpose.

(a) Pursuant to RSA 326-B:9, and RSA 326-B:32 and to ensure the health, safety and welfare of individuals and groups for whom nursing care shall be delegated, these rules set forth requirements for programs providing education for persons who wish to become nursing assistants and provide nursing-related activities.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07 (formerly Nur 706.01); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 704.02 Approval.

(a) Individuals or sponsoring institutions who wish to implement a nursing assistant educational program shall seek board approval at least 12 months before implementation.

(b) One year following initial approval, the board’s representatives shall review the program on site to determine compliance with this chapter.

(c) Form “Nursing Assistant Educational Program Self Assessment Report”, 11-2013 noting activities pertinent to this chapter shall be completed and submitted to the board by the sponsoring individuals or sponsoring institutions who wish to implement a nursing assistant educational program on the non-site review years.

(d) Every 2 years following the first on-site review, the program’s sponsoring institution shall complete and submit a review summary of the program in accordance with Nur 704.04-Nur 704.10. Every 4 years, after the first on -site review, the program’ sponsoring institution shall submit a written request for an onsite visit as a requirement for continued program approval.

(e) The board shall notify in writing the program’s sponsoring institution of its action indicating any program deficiencies and actions required for compliance with the rules or law.

(f) The board shall provide for a hearing when a program fails to demonstrate compliance with rules or the law, or fails to provide an acceptable plan for correcting identified deficiencies.

(g) A sponsoring institution may appeal the board’s decision within 30 days of notification of the board’s decision by requesting a hearing with the board.

(h) A sponsoring institution shall be notified of the date, time and place of the appeals hearing.

(i) The board shall, upon review of the evidence pursuant to Nur 704.04 through Nur 704.13, approve a program based on compliance with requirements of this chapter.

(j) The board shall take one of the following actions if an educational program for nursing assistants does not comply with the requirements of this chapter.

(1) Offer recommendations for compliance or program enhancement without changing the approval status of the program where the violations are minor and do not impair the effectiveness of the program;

(2) After opportunity for a hearing pursuant to Nur 200, approve the program with conditions for compliance within a specified period of time where the violations are more significant than in (1) above, but are still capable of being quickly remedied; or

(3) After opportunity for a hearing pursuant to Nur 200, withdraw approval of the program where the seriousness or extent of the violations is such that the board determines that the violations cannot be remedied while the program is in operation.

(k) The board shall notify the sponsoring institution within 10 working days following the appeals hearing of the board’s decision. Failure to take appropriate action as required in the board’s decision shall result in denial or withdrawal of approval.

(l) The board shall review a program, if it receives complaints from students, consumers, instructors, employers or others concerned with students or graduates of the program.

(m) Programs proposed or implemented by sponsoring institutions determined to be in noncompliance with federal or state rules/laws shall not be granted approval, or shall have their program approval withdrawn until requirements are met.

(n) Program proposals not approved by the board may be revised and submitted for reconsideration but the program shall not be implemented during the revision period.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07 (formerly Nur 706.02); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14; amd by #11177, eff 9-17-16

Nur 704.03 Initial Approval.

(a) Any sponsoring institution planning to offer a program designed to educate nursing assistants shall initially submit documents to the board for approval at least 12 months prior to the implementation of the program.

(b) Board approval shall be received by the sponsoring institution prior to initiating a program and shall be based upon compliance with Nur 704.04 through Nur 704.10.

(1) A comprehensive feasibility study that shall address at least the following:

a. Documentation of the need and demand for such a program in New Hampshire;

b. The projected impact the program would have on existing programs in the region where the program is being proposed;

c. A hiring plan for qualified program administrators, faculty, and staff;

d. The sources and number of potential students; and

e. The names of proposed cooperating agencies, including evidence of their intent to contribute to the achievement of the clinical objectives of the program;

(2) Credentials of the program coordinator;

(3) Credentials of the instructor(s);

(4) Philosophy of the educational program with expected student outcomes;

(5) Curricular organization;

(6) Course and unit objectives;

(7) Course outlines describing content;

(8) Schedule of instruction indicating classroom and clinical hours, examinations;

(9) Methods of instruction and evaluation;

(10) Clinical experiences and list of cooperating agencies;

(11) Program policies; and

(12) Written narrative describing items noted in Nur 704.03(c)(1) through (11).

(d) Directors of board-approved registered or practical nurse educational programs noted in Nur 600 may issue nursing assistant certificates to students who have successfully completed course content noted in Nur 704.09.

Source. (See Revision Note #1 at chapter heading for Nur 100) #5887, eff 8-26-94; ss by #6778, eff 6-26-98; ss by #8664, INTERIM, eff 6-24-06, EXPIRED: 12-21-06

New. #8873, eff 4-24-07 (formerly Nur 706.03); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 704.04 Program Coordinator Qualifications.

(a) The sponsoring institution shall appoint the program coordinator who shall have the responsibility and accountability for program administration. The sponsoring institution shall complete and submit Form “Application for Faculty Approval, Board Approved Education Programs,” 11-14-2013 for approval of the appointed program coordinator. Additionally, the sponsoring institution shall cause to be submitted a current resume including employment experience and length of employment documenting compliance with Nur 704.04 for program coordinator qualifications, Nur 704.06 for instructor qualifications, Nur 805.03 for medication nurse reviewer qualifications, and Nur 805.04 for medication skills instructor qualifications.

(b) If in compliance with the following criteria, the coordinator shall receive board approval:

(1) Possesses a current New Hampshire unencumbered registered nurse license or a multi-state RN license from another compact state;

(2) Validates 2 years experience with the elderly or chronically ill of any age with 1 year experience in the provision of long term care (LTC) facility services; and

(3) Demonstrates competence to teach adult learners through one of the following:

a. Baccalaureate educational preparation; or

b. Successful completion of a board-approved Train-the-Trainer course:

1. Taught by a registered nurse with 3 years of clinical experience;

2. Reviewed by the board every 2 years for compliance with Nur 704; and

3. Offering a curriculum related to:

(i) Learning styles;

(ii) Written and clinical performance;

(iii) Evaluations;

(iv) Teaching strategies;

(v) Textbook selection; and

(vi) Classroom management.

Source. #8873, eff 4-24-07 (formerly Nur 706.04); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14; ss by #12835, eff 7-26-19

Nur 704.05 Coordinator Responsibilities.

(a) The coordinator shall:

(1) Be responsible for planning, implementing and evaluating the program;

(2) Maintain:

a. Course documents, including descriptions of each course’s content;

b. A list of nursing-related activities;

c. A list of individuals who successfully complete the program; and

d. A list of the as dates of all programs;

(3) Maintain a physical presence in New Hampshire during all hours of instruction in the nursing assistant program;

(4) Provide a certificate to the student upon successful program completion; and

(5) Submit to the board names, address, telephone number and employer, if known, of those persons successfully completing a nursing assistant program within 30 days of program completion.

Source. #8873, eff 4-24-07 (formerly Nur 706.05); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 704.06 Instructor Qualifications.

(a) The sponsoring institution shall submit for faculty approval for program instructors. The sponsoring institution shall complete and submit Form “Approval for Board Approved Education Programs,” 11-14-13;

(b) The instructor shall:

(1) Comply with Nur 704.04(b) (1) and Nur 704.04(b)(3); or

(2) Comply with Nur 704.04(b)(2 and (3) and possess a current New Hampshire unencumbered licensed practical nurse license (LPN) or a multi-state LPN license issued by a compact state.

Source. #8873, eff 4-24-07 (formerly Nur 706.06); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14; ss by #13141, EMERGENCY RULE, eff 12-4-20, EXPIRED: 6-2-21

Nur 704.07 Instruction.

(a) The instructor shall be responsible for classroom and clinical teaching.

(b) Instructors shall implement and give to each student written policies regarding:

(1) Class attendance;

(2) Academic achievement;

(3) Theoretical and clinical competence; and

(4) Other program policies affecting students.

(d) The instructor shall have no other work responsibilities while instructing clinical and classroom learning experiences.

(e) Qualified resource people from the health-care field appointed by the course coordinator may participate in instructing students.

(f) The instructor assigning learning activities to students shall determine whether they are qualified, through classroom and laboratory experience, to perform nursing-related activity(s).

(g) Students shall be responsible and accountable for the activities assigned and shall not perform nursing-related activities for which they have not been theoretically and clinically prepared.

(h) At all times, students shall be clearly identified as acting in the student role.

Source. #8873, eff 4-24-07 (formerly Nur 706.07); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 704.08 Admission Standards. Each applicant for admission to a nursing assistant program shall:

(a) Document the ability to read, comprehend, write, and communicate in English, relative to job-related assignments;

(b) Not have been convicted of a crime constituting any of the following unless such conviction was annulled by a court of competent jurisdiction:

(1) Murder or manslaughter;

(2) Robbery;

(3) Felonious theft;

(4) Felonious assault;

(5) Sexual crime involving a child;

(6) Kidnapping; and

(7) Endangering the welfare of a child or incompetent person.

Source. #8873, eff 4-24-07 (formerly Nur 706.08); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 704.09 Curriculum.

(a) The philosophy of the program shall be written and clearly reflect the sponsoring institution’s beliefs regarding care-recipients, care-providers, care-characteristics, environment within which care shall be provided, and educational preparation for providing nursing-related activities.

(b) The course objectives shall identify expected student outcomes.

(1) Form a relationship, communicate and interact effectively with individuals and groups;

(2) Demonstrate comprehension related to individuals’ emotional, mental, physical and social health needs through skillful, direct nursing-related activities;

(3) Assist individuals to attain and maintain functional independence in a home or health-care facility;

(4) Exhibit behaviors supporting and promoting care-recipients’ rights;

(5) Demonstrate observational and documenting skills required for reporting of people’s health, safety, welfare, physical and mental condition, and general well-being; and

(6) Provide safe nursing-related activities under the supervision of a registered or licensed practical nurse.

(d) Content shall include the following information:

(1) Pathological, physical, psychological, social, cultural and religious influences related to the life cycle and the aging process;

(2) End of life issues; and

(3) Legal, ethical and moral issues involved when providing nursing-related activities.

(e) Prior to direct care with care-recipients, students shall receive 16 hours of instruction including the following:

(1) Orientation to the role;

(2) Holistic approach to care throughout the lifespan;

(3) Communication skills;

(4) Safety and emergency procedures including the Heimlich Maneuver; and

(5) Protection of care-recipients’ rights, dignity and their confidentiality.

(f) Theoretical and clinical experiences shall include assisting care-recipients with nursing-related activities in the following areas:

(1) Personal hygiene including bathing, grooming, dressing;

(2) Ambulation, and movement including range of motion, turning, positioning, transferring;

(3) Nutrition and elimination including feeding and hydration, toileting, bowel and bladder training;

(4) Environmental and personal safety involving housekeeping concerns, adaptive devices, special clothing;

(5) Emotional support including appropriate responses and techniques used with the cognitively impaired and demented, the aging process, identification of resources, preservation of dignity, assuring freedom from fear and reprisal;

(6) Comfort, rest, and activities including privacy, physical and occupational skills; and

(7) Emergency situations including appropriateness of action or non-action, fire drills, security of the environment, resources available.

(g) The course content, learning activities, and objectives shall be offered at the educational level appropriate to the applicants.

(h) Students shall be prepared to observe and report activities appropriately.

(i) The program shall consist of a minimum of 100 hours of instruction. Of this time, there shall be 40 hours of theory and 60 hours of concurrent clinical experience.

(j) Instructors shall prepare and administer written/oral and skills tests formulated from program objectives and expected outcomes.

(k) Instructors shall require the following:

(1) A grade of 70, or greater, in examinations testing for theoretical content; and

(2) A grade of “pass” on skills test.

(l) Instructors shall prepare and give to each student at the successful completion of the program a performance record of nursing-related activities that includes but is not limited to:

(1) Skill(s) performed;

(2) Date(s) of skill performance;

(3) Satisfactory or unsatisfactory performance; and

(4) Instructor signature and date of performance evaluation.

(m) Upon successful completion of the program, the coordinator shall provide to the successful candidate a certificate indicating the following:

(1) Student name;

(2) Name of sponsoring agency;

(3) Hours of clinical and theoretical instruction;

(4) Date of program initiation and successful completion; and

(5) Signature of program coordinator.

Source. #8873, eff 4-24-07 (formerly Nur 706.09); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 704.10 Program Facilities and Resources.

(a) The physical facilities and educational materials shall meet the needs of the program, the number of students, and the instructional staff.

(b) Sponsoring agencies shall provide for:

(1) Clean, safe environmental conditions with comfortable temperatures;

(2) Adequate lighting; and

(3) Audio-visual or simulated equipment necessary for care demonstrations.

(c) Sponsoring institutions that fail to have the appropriate educational facilities may contract with cooperating agencies to provide clinical and classroom facilities prior to student placement. Said contract shall delineate roles, responsibilities and time-frames pertinent to the program.

(d) The sponsoring institution shall submit Form “Application For Board Approval of a Cooperating Agency for LNA/MNA Education,” 11-2013, 3 months prior to placement of students within the cooperating agency.

(e) The application, noted in (d) above, shall include the following:

(1) Instructor and staff responsibilities, and orientations;

(2) Annual meetings addressing the program philosophy, objectives, learning activities and future plans;

(3) The student faculty ratio, which shall not exceed 8:1, for each unit;

(4) Copy of contract or agreement providing for adequate time for termination;

(5) A description of the planned physical, material and human resources intended to support learning activities; and

(6) Cooperative plans with other programs using the agency.

(f) Cooperating agencies shall have sufficient care-recipients, and material resources to provide for learning activities identified by the coordinator/instructor.

(g) Sponsoring institutions and cooperating agencies/institutions shall be licensed by the department of health and human services or the appropriate state agency.

Source. #8873, eff 4-24-07 (formerly Nur 706.10); ss by #9395, eff 2-25-09; ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

Nur 704.11 Comparable Experience.

(a) Individuals may apply for a license as a nursing assistant by documenting comparable or greater nursing educational experience and successfully completing one of the following:

(1) A registered or practical nursing educational course that contains content noted in Nur 704.09 within 5 years immediately prior to date of application;

(2) A nursing assistant program that meets the requirements of Nur 704.09(i) within 5 years immediately prior to date of application and a board-approved competency evaluation that measures the content noted in Nur 704.09 within 2 years immediately prior to date of application;

(3) A challenge examination offered by an approved nursing assistant program and board-approved competency evaluation as described in Nur 702 within 2 years immediately prior to date of application, provided the qualifying applicant possesses an official transcript of structured education that contains curriculum noted in Nur 704.09 taken within 5 years immediately prior to date of application; or

(4) Have provided 200 hours of nursing or nursing assistant care within 2 years immediately prior to application and appropriate state registry verification of a practice in good standing.

(b) Programs that provide a challenge option for individuals seeking licensure through comparable education shall provide the board with a self assessment report. Any program that provides a challenge option to individuals seeking licensure through comparable education shall complete and submit, on an annual basis, Form “Nursing Assistant Challenge Program Self Assessment Report,” 11/2013.

Source. #9395, eff 2-25-09 (from Nur 704.10); ss by #10302, eff 3-22-13; ss by #10570, eff 4-17-14

CHAPTER Nur 800 CERTIFICATE OF MEDICATION ADMINISTRATION FOR LICENSED NURSING ASSISTANTS AND MEDICATION ADMINISTRATION EDUCATION PROGRAM

PART Nur 801 CERTIFICATE OF MEDICATION ADMINISTRATION

Nur 801.01 Licensed Nursing Assistant’s Certificate of Medication Administration.

(a) A licensed nursing assistant shall not be eligible to administer medication unless:

(1) Such nursing assistant holds a valid certificate of medication administration issued by the board of nursing; or

(2) Pursuant to Nur 404.04(b).

(b) A licensed nursing assistant shall receive an initial certificate of medication administration when such assistant has:

(1) Participated and completed a board-approved medication administration education program;

(2) Passed with the required score the examination described in Nur 806.03; and

(3) Paid the fee specified in Nur 301.06(b)(4).

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 902.01); ss by #9395, eff 2-25-09; ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14; ss by #12439, eff 12-22-17

Nur 801.02 - REPEALED

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 902.02); rpld by #10303, eff 3-22-13

PART Nur 802 ELIGIBILITY FOR AND APPLICATION TO APPROVED MEDICATION ADMINISTRATION EDUCATION PROGRAMS

Nur 802.01 Eligibility To Be a Student in A Board Approved Medication Administration Education Program. A person shall be eligible to be a student in board-approved medication administration education program if such person:

(a) Holds a valid and unencumbered nursing assistant license issued by the board;

(b) Has been employed as a licensed nursing assistant within the past 5 years for the hours-equivalent of 2 years of full time employment;

(d) Has not been convicted of a felony; and

(e) Meets the requirements for enrollment set forth in Nur 802.02.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 903.01); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 802.02 Student Enrollment Requirements. A person eligible under Nur 802.01 who seeks to enroll in a board-approved medication administration education program shall:

(a) Comply with the application procedures specified by the sponsoring institution;

(b) Comply with the tuition requirements of the sponsoring institution;

(d) Submit to the sponsoring institution 2 character references from nurse managers or directors on behalf of the employer affirming the applicant's honesty, integrity, compassion and enthusiasm for nursing-related activities.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 903.02); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 802.03 Duty of Students. While receiving education through a board-approved medication administration education program, a student shall comply with all of the regulations and requirements of the sponsoring institution and of the program.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 903.03); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

PART Nur 803 BOARD APPROVAL OF MEDICATION ADMINISTRATION EDUCATION PROGRAMS

Nur 803.01 Eligibility for Board Approval of Medication Administration Education Program. A medication administration education program shall be approved by the board if it meets the requirements of this chapter.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 904.01); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 803.02 Board Approval Process.

(a) An educational institution, public agency, non-profit organization or for-profit business planning to sponsor and seek initial, full or renewed approval for a medication administration education program shall submit documents to the board 12 months prior to program implementation.

(b) No medication administration education program sought to be approved by the board shall be implemented before it has received approval by the board.

(1) Initial approval valid for one year; and

(2) Full approval after one year of initial approval renewable every 2 years thereafter as long as the program continues to comply with the requirements of this chapter.

(d) After issuing full approval to a medication administration education program, the board’s representative shall review the program onsite to determine compliance with this chapter.

(e) The board shall take one or more of the following actions if a medication administration education program pursuant to Nur 804 through Nur 806 does not comply with the requirements of this chapter:

(1) Offer recommendations for compliance or program enhancement without changing the approval status of the program where the violations are minor and do not impair the effectiveness of the program;

(f) The board shall give written notice to the program and its sponsoring institution within 10 working days of its decision to withdraw approval of the program.

(g) A program for which the approval of the board has been withdrawn shall have the right to request reconsideration of the decision to withdraw approval within 30 working days of the date of such decision.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 904.02); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14; amd by #12028, eff 10-28-16

Nur 803.03 Documents to be Submitted By A Medication Administration Education Program Seeking Board Approval. A medication administration education program seeking any of the approvals listed in Nur 803.02(c) shall submit to the board:

(a) A statement describing:

(1) How the program curriculum reflects current practice standards;

(2) The organization of the curriculum including:

a. The content of each of the courses; and

b. The goals and objectives of each of the courses;

(3) The total number of theoretical and clinical hours; and

(4) The processes used, in addition to the examination described in Nur 806.03, to evaluate the progress of the students;

(b) If applicable, a copy of the written contract between the program or its sponsoring institution and the entity which has agreed to provide the setting required by Nur 806.02(c);

(c) Written permission for the board to visit the program site for the purpose of assessing the program's compliance with the requirements for board approval; and

(d) If necessary to make effective the permission described in (c) above, written permission from the program's sponsoring institution for the board to visit the program site for the purpose of assessing the program's compliance with the requirements for board approval.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 904.03); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

PART Nur 804 GENERAL ADMINISTRATIVE REQUIREMENTS

Nur 804.01 Annual Report.

(a) A board-approved medication administration education program shall complete and submit Form “Request for Onsite Visit and Continued Approval”, 11-2013 to the board annually the following information:

(1) The number of students admitted to the program during the year reported;

(2) The number of students completing the program during the year reported;

(3) The name or names of the medication skills instructors; and

(4) The number of times during the year reported that the entire program was offered by the sponsoring institution.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 905.01); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 804.02 Written Verification of Program Completion.

(a) When each student has completed the curriculum of the medication administration education program and passed the examination described in Nur 806.03, the medication administration education program attended by the student shall issue the student a written verification of completion showing:

(1) The name and residential address of the student;

(2) The name of the sponsoring institution;

(3) The name of the issuing medication administration education program;

(4) The date of issuance of the written verification;

(5) The number of hours of theoretical instruction and the number of hours of clinical instruction received by the student;

(6) A statement that the student has attained proficiency in the following methods of medication administration:

a. Topical;

b. Oral;

c. Nasal;

d. Ocular;

e. Auricular;

f. Vaginal;

g. Rectal;

h. Enteral tubes;

i. Parenteral route, limited to insulin from a labeled and pre-set or pre-drawn insulin delivery device; and

j. Parenteral route, limited to epinephrine from a labeled and pre-set or pre-drawn delivery device; and

(7) The signature of the medication nurse-reviewer.

(b) A medication administration education program shall report to the board the names, addresses, telephone numbers and employers, if known of students who have passed the examination described in Nur 806.03 within 5 working days of the students' passing the examination.

(c) A medication administration education program shall report to the board the names of the students to whom it has issued the written verification described in (a) above.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 905.02); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14; amd by #12692, eff 12-22-18

PART Nur 805 PROGRAM PERSONNEL

Nur 805.01 Program Staff.

(a) The staff of a medication administration education program shall consist of:

(1) A program administrator who shall be a medication nurse-reviewer approved by the board pursuant to Nur 805.03; and

(2) As many medication skills instructors approved pursuant to Nur 805.04 as are required by the size of the student body.

(b) The medication nurse-reviewer who administers the program may simultaneously be a medication skills instructor if such double role is practicable.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 906.01); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 805.02 Ancillary Instructors. Both the medication nurse-reviewer and a medication skills instructor shall have the authority to appoint a person with expertise in one or more of the program's curriculum topics to teach one or more courses or hours of the theoretical component of the curriculum if such expert's instruction is:

(a) Within the area of expertise; and

(b) Under the supervision of a medication skills instructor.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 906.02); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 805.03 Medication Nurse-Reviewer.

(a) A medication nurse-reviewer seeking to be hired to administer a medication administration education program shall complete and submit Form “Application for Faculty Approval Board Approved Education Programs,” 11-14-2013, and be approved by the board in accordance with (b) below.

(b) The board shall approve a medication nurse-reviewer who:

(1) Holds an unencumbered RN license issued by the board or another compact state;

(2) Has successfully completed a baccalaureate nursing program or has met the requirements of Nur 704.04(b)(3); and

(3) Has had 3 years of experience in a management or supervisory position in a healthcare facility.

(c) A medication nurse-reviewer hired to administer a medication administration education program shall perform the following functions:

(1) Assist the sponsoring institution with developing and implementing the budget for the program;

(2) Plan, implement and evaluate the program;

(3) Hire, supervise and evaluate the program's medication skills instructors;

(4) Secure facilities and material resources adequate to support the program;

(5) Ensure that the program continues to meet the requirements of the board;

(6) Submit to the board the documents required to be submitted by Nur 803.03, Nur 804.01 and Nur 804.02(b) and (c); and

(7) With respect to a quality assurance committee designed to ensure safe and effective medication administration by program students, either:

a. Establish such a committee; or

b. Approve a committee previously established by the sponsoring institution if such committee has the same purpose as would a newly established committee.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 906.03); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 805.04 Medication Skills Instructor.

(a) Medication skills instructors seeking to be hired to teach in a medication administration education program shall complete and submit Form “Application for Faculty Approval Board Approved Education Programs,” 11-14-2013, and be approved by the board in accordance with (b) below.

(b) The board shall approve a medication skills instructor who:

(1) Holds an unencumbered RN license issued by the board or another compact state; and

(2) Has successfully completed a baccalaureate nursing program or has met the requirements of Nur 704.04(b)(3).

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 906.04); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

PART Nur 806 PROGRAM CURRICULUM AND EXAMINATION

Nur 806.01 Theoretical Component of the Program Curriculum. There shall be a theoretical component of the medication administration education program consisting of a minimum of 30 hours covering the following topics:

(a) Information related to individual rights regarding accepting or denying medications;

(b) Review of the law and rules pertinent to nursing and nursing-related activities in New Hampshire;

(c) Review of the policies, protocols and procedures of the entity offering the setting for the clinical component of the curriculum if the medication administration education program does not itself offer the setting;

(d) Review of anatomy and physiology as it relates to medication administration;

(e) Principles of infection control and aseptic procedures as they relate to medication administration;

(f) Use of equipment, and methods for assessing, monitoring and reporting equipment malfunctions;

(g) The 5 principles of medication administration as follows:

(1) Administration of the correct medication;

(2) Administration of the correct dosage of the medication;

(3) Administration of the medication to the correct client;

(4) Administration of the medication to the client at the correct time; and

(5) Administration of the medication to the client by the correct method of administration;

(h) Methods of administration of medication to stable clients;

(i) Common reactions to medications;

(j) Quality management related to storage, disposal, security, recording and error control pertinent to medications;

(k) Methods of documenting:

(1) The administration of medications;

(2) The storage and disposal of medications;

(3) Security for supplies of medications; and

(4) Errors in the administration of medications;

(l) Effective communications with clients about their medications; and

(m) Behaviors and performance expected of a licensed nursing assistant administering medications.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 907.01); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

Nur 806.02 Clinical Component of the Program Curriculum.

(a) There shall be a clinical component of the medication administration education program consisting of a minimum of 30 hours.

(b) The content of the clinical component shall be designed to teach the accurate and safe administration of medications by the following methods:

(1) Topical;

(2) Oral;

(3) Nasal;

(4) Ocular;

(5) Auricular;

(6) Vaginal;

(7) Rectal;

(8) Enteral tubes; and

(9) Parenteral route, limited to:

a. Insulin from a labeled and pre-set or pre-drawn insulin delivery device; and

b. Epinephrine from a labeled and pre-set or pre-drawn delivery device.

(1) There are one or more nursing clients who are in-patients;

(2) A nursing care plan has been established for such clients by a registered nurse;

(3) The care of such clients is managed by a healthcare team;

(4) The student is permitted to participate in the care of the clients; and

(5) There is a quality assurance committee which reviews the administration of medication by licensed nursing assistants and advises the healthcare team on the matter.

(d) The quality assurance committee required by (c)(5) above shall be the committee established or approved pursuant to Nur 805.03(c)(7) if the jurisdiction of such committee reaches to the setting or settings of the clinical component of the curriculum.

(e) In the clinical component of the curriculum, the medication skills instructor to student ratio shall not exceed 1:4 during any hour of instruction.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 907.02); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14; amd by #12692, eff 12-22-18

Nur 806.03 Competency Evaluation Requirement. After completion of the theoretical and clinical components of the medication administration education program a student shall pass with a minimum score of 90% correct answers a written examination which:

(a) Has been designed and is administered by the medication administration education program or organization approved by the board pursuant to Nur 803;

(b) Fairly tests knowledge of the content of the curriculum of the medication administration education program.

Source. #7742, eff 8-13-02; ss by #8873, eff 4-24-07 (formerly Nur 907.03); ss by #10303, eff 3-22-13; ss by #10572, eff 4-17-14

APPENDIX I

Rule	Specific State Statute the Rule Implements
Nur 101	RSA 326-B:9, I; RSA 326-B:19
Nur 102.01	RSA 326-B:3, I; RSA 326-B:4
Nur 102.01(a)	RSA 326-B:3, I
Nur 102.01(b)(1) – (6)	RSA 326-B:4, I
Nur 102.01(b)(7)	RSA 326-B:9, XI
Nur 102.02	RSA 326-B:3; RSA 326-B:4, VI
Nur 102.02 (c)	RSA 326-B:3, I
Nur 102.03 – Nur 102.04	RSA 541-A:16, I(a)
Nur 102.05	RSA 541-A:16, I(a); RSA 326-B:4, VI
Nur 102.06	RSA 91-A:2, II
Nur 103.01 – Nur 103.03	RSA 541-A:16, I(a)
Nur 103.04 – Nur 103.05	RSA 91-A:4; RSA 541-A:16, I(a)
Nur 103.04(b) and (c)	RSA 541-A:16, I(a)
Nur 103.06	RSA 326-B: 8

Nur 201.01	RSA 328-B:9, VI
Nur 201.02	RSA 541-A:16, I (b)

Nur 301	RSA 326-B:9, I and X; RSA 326-B:15
Nur 303.01	RSA 326-B:9, I
Nur 303.02	RSA 326-B:9, VII; RSA 326-B:17
Nur 301.03	RSA 326-B:9, I, III; RSA 326-B:15; RSA 326-B:16; RSA 326-B:18
Nur 301.04	RSA 326-B:9, I; RSA 326-B:24
Nur 301.05	RSA 326-B:9, I; RSA 326-B:19
Nur 301.06	RSA 326-B:9, I;

Nur 302.01	RSA 326-B:9, I; RSA 326-B:16, VI
Nur 302.02	RSA 326-B:9, I, VII; RSA 326-B:17
Nur 302.03	RSA 326-B:9, I, X; RSA 326-B:20
Nur 302.04	RSA 326-B:9, I; RSA 326-B:18
Nur 302.05	RSA 326-B:9, I; RSA 326-B:19; RSA 326-B:21
Nur 302.06	RSA 326-B:9, I; RSA 326-B:27
Nur 302.07	RSA 326-B:9, I; RSA 326-B:16, VI;
Nur 303.01	RSA 326-B:9, I
Nur 303.02	RSA 326-B:9, VII; RSA 326-B:17
Nur 303.03	RSA 326-B:9, VII; RSA 326-B:19
Nur 303.04	RSA 326-B:9, VII; RSA 326-B:27
Nur 303.05	RSA 326-B:9, I, IX, X; RSA 326-B:15
Nur 304.01	RSA 326-B:9, I; RSA 326-B:20
Nur 304.02	RSA 326-B:9, I; RSA 326-B:20
Nur 304.03	RSA 326-B:9, I, X; RSA 326-B:20
Nur 304.04	RSA 326-B:9, I; RSA 326-B:21

Nur 401.01	RSA 326-B:8, I; RSA 326-B:22; RSA 326-B:46
Nur 401.01(a)(1)b.	RSA 326-B:22
Nur 401.01(b)	RSA 326-B:8, I; RSA 326-B:9, XI; RSA 326-B:22; RSA 326-B:46
Nur 401.02	RSA 326-B:23
Nur 401.03	RSA 326-B:22
Nur 401.03(e)-(h)	RSA 326-B:9-a, I
Nur 401.04	RSA 326-B:23
Nur 401.05	RSA 326-B:22
Nur 401.06 and Nur 401.07	RSA 326-B:22
Nur 401.07 (a) intro. and (a) (2)(b) &(f)	RSA 326-B: 27
Nur 401.08	RSA 326-B:9, X
Nur 402.01	RSA 326-B:37
Nur 402.02	RSA 541-A:16, I(b); RSA 326-B:46, VII(a)
Nur 402.03	RSA 326-B:37, IV
Nur 402.04	RSA 541-A:16, I(b); RSA 326-B:37, I – III
Nur 403.01	RSA 326-B:31, II and III
Nur 403.02 and Nur 403.03	RSA 326-B:31
Nur 403.04 and Nur 403.05	RSA 326-B:31
Nur 404.01 and Nur 404.02	RSA 541-A:8
Nur 404.03(a)(b)	RSA 326-B:2; RSA 326-B:14
Nur 404.03 (c)	RSA 541-A:8
Nur 404.04	RSA 541-A:16, I (b); RSA 326-B:28
Nur 404.05	RSA 541-A:16,I (b); RSA 326-B:28
Nur 404.06	RSA 541-A:16, I (b); RSA 326-B:28
Nur 404.07	RSA 541-A:16, I (b); RSA 326-B:28
Nur 404.09	RSA 326-B:9, VI
Nur 404.10 and Nur 404.11	RSA 541-A:16, I(b); RSA 326-B:28
Nur 404.12	RSA 326-B:9, IX
Nur 404.13	RSA 326-B:30
Nur 405.01	RSA 326-B:30
Nur 405.02
Nur 406.01	RSA 326-B:4-a, XVI
Nur 406.02	RSA 326-B:4, I;

Nur 501.01	RSA 326-B:9, VIII; RSA 326-B:4, I and V
Nur 501.02	RSA 326-B:9, VIII
Nur 501.03 (formerly Nur 501.04)	RSA 326-B:11
Nur 501.05(a)	RSA 326-B:11; RSA 318-B:15, IV
Nur 502	RSA 326-B:9, VIII; RSA 326-B:11,III; RSA 326-B:37, II (h); RSA 318-B:10, I
Nur 502.02	RSA 326-B:37, II(h); RSA 326-B:37, II(q) (2); RSA 318-A:31-38
Nur 502.06	RSA 326-B:9, VIII; RSA 326-B:11,III; RSA 326-B:37, II(h); RSA 318-B:10, I
Nur 502.07	RSA 326-B:9, XVI; RSA 326-B:14, II-a, RSA-B:14-a; RSA-B:27; RSA 326-B:27-a
Nur 601.01	RSA 541-A:7; RSA 541-A:8
Nur 601.02	RSA 541-A:7; RSA 541-A:8
Nur 602.01	RSA326-B:9, IV; RSA 326-B:32, I
Nur 602.02	RSA 326-B:9; RSA 326-B; 32, I
Nur 602.03	RSA 326-B:9; RSA 326-B:32, I
Nur 602.04 - Nur 602.06	RSA 326-B:9, IV; RSA 326-B:32, I (b); RSA 326-B:16, IV, V
Nur 602.07	RSA 326-B:9, IV; RSA 326-B:32, I (b); RSA 326-B:16, IV, V
Nur 602.08 - Nur 602.18	RSA 326-B:9, IV; RSA 326-B:32, I (b); RSA 326-B:16, IV, V

Nur 603	RSA 326-B:9. IV; RSA 326-B:32
Nur 603.05(c)(1)c.	RSA 326-4,XIII
Nur 604	RSA 326-B:9, V; RSA 326-B:13, III
Nur 605	RSA 326-B:9, II; RSA 326-B:31
Nur 606	RSA 326-B:4, XIII
Nur 607	RSA 326-B:9, IV; RSA 326-B:32, I (a)
Nur 608	RSA 326-B:32

Nur 701 - Nur 702	RSA 326-B:14, II-IV; RSA 326-B:9, I
Nur 703	RSA 541-A:16(b)
Nur 703.01	RSA 541-A:16, I(b); RSA 326-B:4, IV
Nur 704.01 - Nur 704.10	RSA 326-B:9, IV
Nur 704.11	RSA 326-B:9, I

Nur 801	RSA 326-B:14, II
Nur 802	RSA 326-B:14, II
Nur 803	RSA 326-B:9, IV and V; RSA 326-B:32
Nur 804	RSA 326-B:9, IV and V; RSA 326-B:32
Nur 805	RSA 326-B:9, IV and V; RSA 326-B:32
Nur 806.01	RSA 326-B:9, IV and V; RSA 326-B:32
Nur 806.02	RSA 326-B:9, IV and V; RSA 326-B:32
Nur 806.03	RSA 326-B:9, VII

APPENDIX II

RULE	Title	Obtain at:
Nur 301.01	Nurse Licensure Compact Model Rules and Regulations (as amended November 13, 2012)	https://www.ncsbn.org/2539.htm
Nur 301.01(f)	Enhanced Nurse Licensure Compact (eNLC) Model Rules and Regulations (as amended January 19, 2018)	https://www.NCSBN.org/nlcrule s
Nur 401.01	Nurse Licensure Compact Model Rules and Regulations (as amended November 13, 2013)	https://www.ncsbn.org/2539.htm
Nur 401.01(b)	Enhanced Nurse Licensure Compact (eNLC) Model Rules and Regulations (as amended January 19, 2018)	https://www.NCSBN.org/nlcrules
Nur 502	RSA 326-B:9, VIII; XII RSA 326-B:11,III; RSA 326-B:37, II (h); RSA 318-B:10, I
Nur 502.06	American Society of Addiction Medicine’s National Practice Guideline For the Treatment of Opioid Use Disorders, 2020 focused update	https://sitefinitystorage.blob.core.windows.net/sitefinity-production-blobs/docs/default-source/guidelines/npg-jam-supplement.pdf?sfvrsn=a00a52c2_2
Nur 502.07	American Society of Addiction Medicine’s National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use (2015)	http://www.asam.org/quality-practice/guidelines-and-consensus-documents/npg/complete-guideline
Nur 603.02	White Paper On The State Of The Art Of Approval/Accreditation Process In Boards of Nursing, August 2004	Available free of charge from NCSBN website at www.ncsbn.org/2919.htm
Nur 602.13(b)(4)	Quality and Safety Education for Nurses (QSEN), (2012)	http://qsen.org/.