Arizona Secretary of State - Ken Bennett


 
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Supp. 13-2
RULE INTERPRETATION:
The Office of the Secretary of State does not interpret or enforce rules in the Administrative Code. Questions should be directed to the state agency responsible for the promulgation of the rule as provided:
Name: Pamela K. Randolph RN, MS
Associate Director of Education and Evidence-based Regulation
Address: 4747 N. 7th St., Suite 200
Phoenix, AZ 85014
Telephone: 602-771-7803

TITLE 4. PROFESSIONS AND OCCUPATIONS

CHAPTER 19. BOARD OF NURSING

(Authority: A.R.S. § 32-1602 et seq.)

ARTICLE 1. DEFINITIONS AND TIME-FRAMES

New Article 1, consisting of R4-19-101, adopted effective July 19, 1995 (Supp. 95-3).

Article 1, consisting of R4-19-101 through R4-19-102, repealed effective July 19, 1995 (Supp. 95-3).

Section

R4-19-101. Definitions

R4-19-102. Time-frames for Licensure, Certification, or Approval

Table 1. Time-frames

ARTICLE 2. ARIZONA REGISTERED AND PRACTICAL NURSING PROGRAMS; REFRESHER PROGRAMS

Article 2, consisting of R4-19-201 through R4-19-214, adopted effective July 19, 1995 (Supp. 95-3).

Section

R4-19-201. Organization and Administration

R4-19-202. Resources, Facilities, Services, and Records

R4-19-203. Administrator; Qualifications and Duties

R4-19-204. Faculty; Personnel Policies; Qualifications and Duties

R4-19-205. Students; Policies and Admissions

R4-19-206. Curriculum

R4-19-207. New Programs; Proposal Approval; Provisional Approval

R4-19-208. Full Approval of a New Nursing Program

R4-19-209. Nursing Program Change

R4-19-210. Renewal of Approval of Nursing Programs Not Accredited by a National Nursing Accrediting Agency

R4-19-211. Unprofessional Conduct in a Nursing Program

R4-19-212. Notice of Deficiency

R4-19-213. Nursing Programs Holding National Program Accreditation

R4-19-214. Pilot Programs for Innovative Approaches in Nursing Education

R4-19-215. Voluntary Termination of a Nursing Program or a Refresher Program

R4-19-216. Approval of a Refresher Program

R4-19-217. Distance Learning Nursing Programs; Out-of-State Nursing Programs

ARTICLE 3. LICENSURE

Article 3, consisting of R4-19-301 through R4-19-308, adopted effective July 19, 1995 (Supp. 95-3).

Section

R4-19-301. Licensure by Examination

R4-19-302. Licensure by Endorsement

R4-19-303. Requirements for Credential Evaluation Service (CES)

R4-19-304. Temporary License

R4-19-305. License Renewal

R4-19-306. Inactive License

R4-19-307. Application for a Duplicate License

R4-19-308. Change of Name or Address

R4-19-309. School Nurse Certification Requirements

R4-19-310. Certified Registered Nurse

R4-19-311. Nurse Licensure Compact

R4-19-312. Practice Requirement

R4-19-313. Background

ARTICLE 4. REGULATION

Article 4, consisting of R4-19-401 through R4-19-404, adopted effective July 19, 1995 (Supp. 95-3).

Section

R4-19-401. Standards Related to Licensed Practical Nurse Scope of Practice

R4-19-402. Standards Related to Registered Nurse Scope of Practice

R4-19-403. Unprofessional Conduct

R4-19-404. Re-issuance or Subsequent Issuance of License

R4-19-405. Board-ordered Evaluations

ARTICLE 5. ADVANCED PRACTICE REGISTERED NURSING

Section

R4-19-501. Roles and Population Foci of Advanced Practice Registered Nursing (APRN); Certification Programs

R4-19-502. Requirements for APRN Programs

R4-19-503. Application for Approval of an Advanced Practice Registered Nursing Program; Approval by Board

R4-19-504. Notice of Deficiency; Unprofessional Program Conduct

R4-19-505. Requirements for Initial APRN Certification

R4-19-506. Expiration of APRN Certificate; Practice Requirement; Renewal

R4-19-507. Temporary Advanced Practice Certificate; Temporary Prescribing and Dispensing Authority

R4-19-508. Standards Related to Registered Nurse Practitioner Scope of Practice

R4-19-509. Delegation to Medical Assistants

R4-19-510. Expired

R4-19-511. Prescribing and Dispensing Authority; Prohibited Acts

R4-19-512. Prescribing Drugs and Devices

R4-19-513. Dispensing Drugs and Devices

R4-19-514. Standards Related to Clinical Nurse Specialist Scope of Practice

R4-19-515. Repealed

R4-19-516. Repealed

ARTICLE 6. RULES OF PRACTICE AND PROCEDURE

Article 6, consisting of R4-19-601 through R4-19-615, adopted effective October 10, 1996 (Supp. 96-4).

Section

R4-19-601. Expired

R4-19-602. Letter of Concern

R4-19-603. Representation

R4-19-604. Notice of Hearing; Response

R4-19-605. Expired

R4-19-606. Expired

R4-19-607. Recommended Decision

R4-19-608. Rehearing or Review of Decision

R4-19-609. Effectiveness of Orders

R4-19-610. Expired

R4-19-611. Expired

R4-19-612. Renumbered

R4-19-613. Expired

R4-19-614. Renumbered

R4-19-615. Renumbered

ARTICLE 7. PUBLIC PARTICIPATION PROCEDURES

Article 7, consisting of R4-19-701 through R4-19-706, adopted effective October 10, 1996 (Supp. 96-4).

Section

R4-19-701. Expired

R4-19-702. Petition for Rulemaking; Review of Agency Practice or Substantive Policy Statement; Objection to Rule Based Upon Economic, Small Business, or Consumer Impact

R4-19-703. Oral Proceedings

R4-19-704. Petition for Altered Effective Date

R4-19-705. Written Criticism of an Existing Rule

R4-19-706. Renumbered

 

ARTICLE 8. CERTIFIED NURSING ASSISTANTS

Article 8, consisting of Sections R4-19-801 through R4-19-815, adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1).

Section

R4-19-801. Standards for Nursing Assistant Training Programs

R4-19-802. Curriculum

R4-19-803. Initial Approval of Nursing Assistant Training Programs

R4-19-804. Renewal of Approval of Nursing Assistant Training Programs

R4-19-805. Deficiencies and Rescission of Program Approval, Voluntary Termination, Disciplinary Action, and Reinstatement

R4-19-806. Nursing Assistant Certification by Examination

R4-19-807. Nursing Assistant Certification by Endorsement

R4-19-808. Temporary Certificate

R4-19-809. Certified Nursing Assistant Certificate Renewal

R4-19-810. Certified Nursing Assistant Register

R4-19-811. Application for Duplicate Certificate

R4-19-812. Change of Name or Address

R4-19-813. Performance of Nursing Assistant Tasks

R4-19-814. Standards of Conduct for Certified Nursing Assistants

R4-19-815. Reinstatement or Issuance of a Nursing Assistant Certificate

ARTICLE 1. DEFINITIONS AND TIME-FRAMES

R4-19-101. Definitions

In addition to the definitions in A.R.S. § 32-1601, in this Chapter:

“Abuse” means a misuse of power or betrayal of trust, respect, or intimacy by a nurse, nursing assistant, or applicant that causes or is likely to cause physical, mental, emotional, or financial harm to a client.

“Administer” means the direct application of a medication to the body of a patient by a nurse, whether by injection, inhalation, ingestion, or any other means.

“Admission cohort’ means a group of students admitted at the same time to the same curriculum in a regulated nursing, nursing assistant, or advanced practice nursing program or the first clinical course in a regulated program.

“Applicant” means a person seeking licensure, certification, prescribing, or prescribing and dispensing privileges, or an entity seeking approval or re-approval, if applicable, of a:

CNS or RNP nursing program,

Credential evaluation service,

Nursing assistant training program,

Nursing program,

Nursing program change, or

Refresher program.

“Approved national nursing accrediting agency” means an organization recognized by the United States Department of Education as an accrediting agency for a nursing program.

“Assign” means a nurse designates nursing activities to be performed by another nurse that are consistent with the other nurse's scope of practice.

“Certificate or diploma in practical nursing” means the document awarded to a graduate of an educational program in practical nursing.

“Client” means a recipient of care and may be an individual, family, group, or community.

“CES” means credential evaluation service.

“Clinical instruction” means the guidance and supervision provided by a nursing program faculty member or NATCEP instructor while a student is providing client care.

“CMA” means certified medication assistant.

“CNA” means a certified nursing assistant, as defined in A.R.S § 32-1601(14).

“CNS” means clinical nurse specialist, as defined in A.R.S. § 32-1601(6).

“Collaborate” means to establish a relationship for consultation or referral with one or more licensed physicians on an as-needed basis. Supervision of the activities of a registered nurse practitioner by the collaborating physician is not re-quired.

“Contact hour” means a unit of organized learning, which may be either clinical or didactic and is either 60 minutes in length or is otherwise defined by an accrediting agency recognized by the Board.

“Continuing education activity” means a course of study related to nursing practice that is awarded contact hours by an accrediting agency recognized by the Board, or academic credits in nursing or medicine by a regionally or nationally ac-credited college or university.

“CRNA” means a certified registered nurse anesthetist as defined in A.R.S. § 32-1601(5).

“DEA” means the federal Drug Enforcement Administration.

“Dispense” means to package, label, and deliver one or more doses of a prescription-only medication in a suitable container for subsequent use by a patient.

“Dual relationship” means a nurse or CNA simultaneously engages in both a professional and nonprofessional relation-ship with a patient or resident that is avoidable, non-incidental, and results in the patient being exploited financially, emotionally, or sexually.

“Eligibility for graduation” means that the applicant has successfully completed all program and institutional requirements for receiving a degree or diploma but is delayed in receiving the degree or diploma due to the graduation schedule of the institution.

“Endorsement” means the procedure for granting an Arizona nursing license to an applicant who is already licensed as a nurse in another state or territory of the United States and has passed an exam as required by A.R.S. §§ 32-1633 or 32-1638 or an Arizona nursing assistant certificate to an applicant who is already listed on a nurse aide register in another state or territory of the United States.

“Episodic nursing care” means nursing care at nonspecific intervals that is focused on the current needs of the individual.

“Failure to maintain professional boundaries” means any conduct or behavior of a nurse or CNA that, regardless of the nurse's or CNA’s intention, is likely to lessen the benefit of care to a patient or resident or a patient's or resident's family or places the patient, resident or the patient's or resident's family at risk of being exploited financially, emotionally, or sexually.

“Full approval” means the status granted by the Board when a nursing program, after graduation of its first class, demonstrates the ability to provide and maintain a program in accordance with the standards provided by A.R.S. Title 32, Chapter 15 and this Chapter.

“Good standing” means the license of a nurse, or the certificate of a nursing assistant, is current, and the nurse or nursing assistant is not presently subject to any disciplinary action, consent order, or settlement agreement.

“Independent nursing activities” means nursing care within an RN's scope of practice that does not require authorization from another health professional.

“Initial approval” means the permission, granted by the Board, to an entity to establish a nursing assistant training pro-gram, after the Board determines that the program meets the standards provided by A.R.S. Title 32, Chapter 15 and this Chapter.

“Licensure by examination” means the granting of permission to practice nursing based on an individual's passing of a prescribed examination and meeting all other licensure requirements.

“LPN” means licensed practical nurse.

“NATCEP” means Nurse Aide Training and Competency Evaluation Program and includes both the nursing assistant training program and the required certification exam.

“NCLEX” means the National Council Licensure Examination.

“Nurse” means a licensed practical or registered nurse.

“Nursing diagnosis” means a clinical judgment, based on analysis of comprehensive assessment data, about a client's response to actual and potential health problems or life processes. Nursing diagnosis statements include the actual or potential problem, etiology or risk factors, and defining characteristics, if any.

“Nursing practice” means assisting individuals or groups to maintain or attain optimal health, implementing a strategy of care to accomplish defined health goals, and evaluating responses to care and treatment.

“Nursing process” means applying problem-solving techniques that require technical and scientific knowledge, good judgment, and decision-making skills to assess, plan, implement, and evaluate a plan of care.

“Nursing program” means a formal course of instruction designed to prepare its graduates for licensure as registered or practical nurses.

“Nursing program administrator” means a nurse educator who meets the requirements of A.R.S. Title 32, Chapter 15 and this Chapter and has the administrative responsibility and authority for the direction of a nursing program.

“Nursing program faculty member” means an individual working full or part time within a nursing program who is responsible for either developing, implementing, teaching, evaluating, or updating nursing knowledge, clinical skills, or curricula.

“Nursing-related activities or duties” means client care tasks for which education is provided by a basic nursing assistant training program.

“P & D” means prescribing and dispensing.

“Parent institution” means the educational institution in which a nursing program or nursing assistant training program is conducted.

“Patient” means an individual recipient of care.

“Pharmacology” means the science that deals with the study of drugs.

“Physician” means a person licensed under A.R.S. Title 32, Chapters 7, 8, 11, 13, 14, 17, or 29, or by a state medical board in the United States.

“Preceptor” means a registered nurse or other health professional who meets the requirements of A.R.S. Title 32, Chapter 15 and this Chapter who instructs, supervises and evaluates a licensee, clinical nurse specialist, nurse practitioner or pre-licensure nursing student, for a defined period.

“Preceptorship” means a clinical learning experience by which a learner enrolled in a registered nursing program, nurse refresher program, clinical nurse specialist, or registered nurse practitioner program or as part of a Board order provides nursing care while assigned to a health professional who holds a license or certificate equivalent to or higher than the level of the learner's program or in the case of a nurse under Board order, meets the qualifications in the Board order.

“Prescribe” means to order a medication, medical device, or appliance for use by a patient.

“Proposal approval” means that an institution has met the standards provided by A.R.S. Title 32, Chapter 15 and this Chapter to proceed with an application for provisional approval to establish a pre-licensure nursing program in Arizona.

“Provisional approval” means that an institution has met the standards provided by A.R.S. Title 32, Chapter 15 and this Chapter to implement a pre-licensure nursing program in Arizona.

“Refresher program” means a formal course of instruction designed to provide a review and update of nursing theory and practice.

“Regionally accredited” means an educational institution meets the standards and holds a current, valid certificate of accreditation from a regional accrediting organization recognized by the Council for Higher Education Accreditation (CHEA) or a subsequent equivalent organization.

“Register” means a listing of Arizona certified nursing assistants maintained by the Board that includes the following about each nursing assistant:

Identifying demographic information;

Date placed on the register;

Date of initial and most recent certification, if applicable; and

Status of the nursing assistant certificate, including findings of abuse, neglect, or misappropriation of property made by the Arizona Department of Health Services, sanctions imposed by the United States Department of Health and Human Services, and disciplinary actions by the Board.

“Resident” means a patient who receives care in a long term care facility or other residential setting.

“RN” means registered nurse.

“RNP” means a registered nurse practitioner as defined in A.R.S. § 32-1601(19).

“SBTPE” means the State Board Test Pool Examination.

“School nurse” means a registered nurse who is certified under R4-19-309.

“Self-study” means a written self-evaluation conducted by a nursing program to assess the compliance of the program with the standards listed in Article 2.

“Standards related to scope of practice” means the expected actions of any nurse who holds the identified level of licensure.

“Substance use disorder” means misuse, dependence or addiction to alcohol, illegal drugs or other substances.

“Supervision” means the direction and periodic consultation provided to an individual to whom a nursing task or patient care activity is delegated.

“Traineeship” means a clinical learning experience where a student enrolled in an approved nursing assistant training program provides care for residents in a long term care facility while working with a CNA employed by the facility under the supervision of an RN or LPN.

“Unlicensed assistive personnel” or “UAP” means a CNA or any other unlicensed person, regardless of title, to whom nursing tasks are delegated.

“Verified application” means an affidavit signed by the applicant attesting to the truthfulness and completeness of the application and includes an oath that applicant will conform to ethical professional standards and obey the laws and rules of the Board.

Historical Note

Former Glossary of Terms; Amended effective Nov. 17, 1978 (Supp. 78-6). Former Section R4-19-01 repealed, new Section R4-19-01 adopted effective February 20, 1980 (Supp. 80-1). Amended paragraphs (1) and (7), added paragraphs (9) through (25) effective July 16, 1984 (Supp. 84-4). Former Section R4-19-01 renumbered as Section R4-19-101 (Supp. 86-1). Amended effective November 18, 1994 (Supp. 94-4). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended effective December 22, 1995 (Supp. 95-4). Amended effective November 25, 1996 (Supp. 96-4). Amended by final rulemaking at 7 A.A.R. 1712, effective April 4, 2001 (Supp. 01-2). Amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citations in the definitions of “CNA” “CNS” and “RNP” have been updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1308 effective July 6, 2013 (Supp. 13-2).

R4-19-102. Time-frames for Licensure, Certification, or Approval

A. In this Section:

1. “Administrative completeness” or “administratively complete” means Board receipt of all application components required by statute or rule and necessary to begin the substantive review time-frame.

2. “Application packet” means an application form provided by the Board and the documentation necessary to establish an applicant’s qualifications for licensure, certification, or approval.

3. “Comprehensive written request for additional information” means written communication after the administrative completeness time-frame by the Board to an applicant in person or at the mailing or electronic address identified on the application notifying the applicant that additional information, including missing documents is needed before the Board can grant the license. The written communication shall:

a. Contain a list of information required by statute or rule and necessary to complete the application or grant the license, and

b. Inform the applicant that the request suspends the running of days within the time-frame, and

c. Be effective on the date of issuance which is:

i. The date of its postmark, if mailed;

ii. The date of delivery, if delivered in person by a Board employee or agent; or

iii. The date of delivery to the electronic address if delivered electronically.

4. “Deficiency notice” means written communication by the Board to an applicant in person or at the mailing or electronic address identified on the application notifying the applicant that additional information, including missing documents, is needed to complete the application. The written communication shall:

a. Contain a list of information required by statute or rule and necessary to complete the application or grant the license;

b. Inform the applicant that the request suspends the running of days within the time-frame; and

c. Be effective on the date of issuance which is:

i. The date of its postmark, if mailed;

ii. The date of delivery, if delivered in person by a Board employee or agent; or

iii. The date of delivery to the electronic address if delivered electronically.

5. “Notice of administrative completeness” means written communication by the Board to an applicant in person or at the mailing or electronic address identified on the application notifying the applicant the application contains all information required by statute or rule to complete the application.

6. “Overall time-frame” has the same meaning as A.R.S. § 41-1072(2).

7. “Substantive review time-frame” has the same meaning as A.R.S. § 41-1072(3).

B. In computing the time-frames in this Section, the day of the act or event from which the designated period begins to run is not included. The last day of the period is included unless it is a Saturday, Sunday, or official state holiday, in which event the period runs until the end of the next day that is not a Saturday, Sunday, or official state holiday.

C. For each type of licensure, certification, or approval issued by the Board, the overall time-frame described in A.R.S. § 41-1072(2) is listed in Table 1. An applicant may submit a written request to the Board for an extension of time in which to provide a complete application. The request for an extension of time shall be submitted to the Board office before the deadline for submission of a complete application and shall state the reason that the applicant is unable to comply with the time-frame requirements in Table 1 and the amount of additional time requested. The Board may grant an extension of time based on whether the Executive Director of the Board finds that the applicant is unable to comply within the time-frame due to circumstances beyond the applicant’s control and that the additional information can reasonably be supplied during the extension of time.

D. For each type of licensure, certification, or approval issued by the Board, the administrative completeness review time-frame described in A.R.S. § 41-1072(1) is listed in Table 1 and begins to run when the Board receives an application packet.

1. If the application packet is not administratively complete, the Board shall send a deficiency notice to the applicant. The time for the applicant to respond to a deficiency notice begins to run on the date the deficiency notice is issued.

a. The deficiency notice shall list each deficiency.

b. The applicant shall submit to the Board the missing information listed in the deficiency notice within the period specified in Table 1 for responding to a deficiency notice. The time-frame for the Board to complete the administrative review is suspended until the Board receives the missing information.

c. If an applicant fails to provide the missing information listed in the deficiency notice within the period specified in Table 1, the Board shall close the applicant’s file and send a notice to the applicant by U.S. mail and electronically, if an electronic address is included in the application.

d. If the applicant is the subject of an investigation, the Board may continue to process the application. Failure of the applicant to supply the requested information may result in denial of the license or certificate based on information gathered during the investigation.

2. If the application packet is administratively complete, the Board shall send a written notice of administrative completeness to the applicant.

3. If the Board issues a license, certificate, or approval during the administrative completeness review time-frame, the Board shall not send a separate written notice of administrative completeness.

E. For each type of licensure, certification, or approval issued by the Board, the substantive review time-frame described in A.R.S. § 41-1072(3) is listed in Table 1 and begins to run on the date the notice of administrative completeness is issued.

1. During the substantive review time-frame, an applicant may make a request to withdraw an application packet. The Board may deny the request to withdraw an application packet if the applicant is the subject of an investigation, based on information gathered during the investigation.

2. If an applicant discloses or the Board receives allegations of unprofessional conduct as described in A.R.S. § 32-1601 or this Chapter, the Board shall review the allegations and may investigate the applicant. The Board may require the applicant to provide additional information as prescribed in subsection (E)(3) based on its assessment of whether the conduct is or might be harmful or dangerous to the health of a client or the public.

3. During the substantive review time-frame, the Board may make one comprehensive written request for additional information. The applicant shall submit the additional information within the period specified in Table 1. The time-frame for the Board to complete the substantive review of the application packet is suspended from the date the comprehensive written request for additional information is issued until the Board receives the additional information.

4. If the applicant fails to provide the additional information identified in the comprehensive written request for additional information within the time specified in Table 1, the Board shall close the applicant’s file and send a notice to the applicant by U.S. mail and electronically, if an electronic address is included in the application. The Board may continue to process the application if the applicant is the subject of an investigation. Failure of the applicant to supply the requested information may result in denial of the license or certificate based on information gathered during the investigation.

5. The Board shall grant licensure, conditional licensure, limited licensure, certification, or approval to an applicant:

a. Who meets the substantive criteria for licensure, certification, or approval required by A.R.S. Title 32, Chapter 15 and this Chapter; and

b. Whose licensure, certification, or approval is in the best interest of the public.

6. The Board shall deny licensure, certification, or approval to an applicant:

a. Who fails to meet the substantive criteria for licensure, certification, or approval required by A.R.S. Title 32, Chapter 15 and this Chapter; or

b. Who has engaged in unprofessional conduct as described in A.R.S. § 32-1601 or this Chapter; and

c. Whose licensure, certification, or approval is not in the best interest of the public.

7. The Board’s written order of denial shall meet the requirements of A.R.S. § 41-1076. The applicant may request a hearing by filing a written request with the Board within 30 days of receipt of the Board’s order of denial. The Board shall conduct hearings in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-02 renumbered and amended as Section R4-19-102 effective February 21, 1986 (Supp. 86-1). Section repealed effective July 19, 1995 (Supp. 95-3). New Section adopted April 20, 1998 (Supp. 98-2). Amended by final rulemaking at 7 A.A.R. 1712, effective April 4, 2001 (Supp. 01-2). Amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4).

Table 1. Time-frames

Time-frames (in days)

Type of License,
Certificate, or Approval

Applicable

Statute

and Section

Board Overall Time-frame

Without
Investigation

Board Overall Time-frame

With Investigation

Board Administrative

Completeness

Review

Time-frame

Applicant Time to Respond to Deficiency Notice

Board Substantive Review

Time-frame Without Investigation

Board Substantive Review

Time-frame With Investigation

Applicant

Time to

Respond to

Comprehensive
Written Request

Nursing Program Proposal Approval

A.R.S. §§ 32-1606(B)(2), 32-1644; R4-19-207

150

Not

applicable

60

180

90

Not

applicable

120

Nursing Program

Provisional Approval

A.R.S. §§ 32-1606(B)(2), 32-1644; R4-19-207

150

Not

applicable

60

180

90

Not

applicable

120

Nursing Program Full Approval or

Re-approval

A.R.S. §§ 32-1606(B)(2), 32-1644; R4-19-208, R4-19-210

150

Not

applicable

60

180

90

Not

applicable

120

Nursing Program Change

A.R.S. § 32-1606(B)(1);

R4-19-209

150

Not

applicable

60

180

90

Not

applicable

120

Refresher Program

Approval or

Re-approval

A.R.S. § 32-1606(B)(21);

R4-19-216

150

Not

applicable

60

180

90

No

applicable

120

CNS or RNP

Nursing Program Approval or

Re-approval

A.R.S. §§ 32 1606(B)(18),

32-1644; R4-19-503

150

Not

applicable

60

180

90

Not

applicable

120

Credential

Evaluation Service Approval or

Re-approval

A.R.S. §§ 32-1634.01(A)(1),

32-1634.02(A)(1), 32-1639.01(1),

32-1639.02(1); R4-19-303

150

Not

applicable

60

180

90

Not

applicable

120

Licensure by Exam

A.R.S. §§ 32-1606(B)(5), 32-1633, 32-1638, and R4-19-301

150

270

30

270

120

240

150

Licensure by Endorsement

A.R.S. §§ 32-1606(B)(5), 32-1634, 32-1639, and R4-19-302

150

270

30

270

120

240

150

Temporary License or Renewal

A.R.S. §§ 32-1605.01(B)(3),

32-1635, 32-1640; R4-19-304

60

90

30

60

30

60

90

License Renewal

A.R.S. §§ 32-1606(B)(5), 32-1642; R4-19-305

120

270

30

270

90

240

150

School Nurse Certification or Renewal

A.R.S. §§ 32-1606(B)(13), 32-1643(A)(8); R4-19-309

150

270

30

270

120

240

150

Re-issuance or Subsequent

Issuance of License

A.R.S. § 32-1664(O);

R4-19-404

150

270

30

270

120

240

150

Registered Nurse Practitioner Certification or Renewal

A.R.S. §§ 32-1601(19), 32-1606(B)(21);

R4-19-505, R4-19-506

150

270

30

270

120

240

150

RNP Prescribing and Dispensing

Privilege

A.R.S. § 32-1601(19); R4-19-511

150

270

30

270

120

240

150

CNS Certification or Renewal

A.R.S. §§ 32-1601(6), 32-1606(B)(21); R4-19-505, R4-19-506

150

270

30

270

120

240

150

CRNA Certification or Renewal

A.R.S. § 32-1634.03; R4-19-505, R4-19-506

150

270

30

270

120

240

150

Temporary RNP, CRNA or CNS Certificate or Renewal

A.R.S. §§ 32-1635.01, 1634.03; R4-19-507

60

Not

applicable

30

60

30

Not

applicable

60

Nursing Assistant and Medication Assistant Training Programs Approval or

Re-approval

A.R.S. §§ 32-1606(B)(11), 32-1650.01; R4-19-803, R4-19-804

120

Not

applicable

30

180

90

Not

applicable

120

Nursing Assistant and Medication Assistant Certification by Examination

A.R.S. §§ 32-1606(B)(11), 32-1647, 32-1650.02, 32-1650.03; R4-19-806

150

270

30

270

120

240

150

Nursing Assistant and Medication

Assistant
Certification by Endorsement

A.R.S §§ 32-1606(B)(11), 32-1648, 32-1650.04; R4-19-807

150

270

30

270

120

240

150

Temporary CNA or CMA Certificate or Renewal

A.R.S. §§ 1646(A)(5), 32-1650;

R4-19-808

60

Not

applicable

30

60

30

Not

applicable

60

Nursing and Medication Assistant
Certificate Renewal

A.R.S. § 32-1606(B)(11);

R4-19-809

120

270

30

270

90

240

150

Re-issuance or Subsequent Issuance of a Nursing Assistant Certificate

A.R.S. § 32-1664(O); R4-19-815

150

270

30

270

120

240

150

 

Historical Note

Table 1 adopted effective April 20, 1998 (Supp. 98-2). Amended by final rulemaking at 7 A.A.R. 1712, effective April 4, 2001 (Supp. 01-2). Table 1 amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citations in column two of “Registered Nurse Practitioner Certification or Renewal,” “RNP Prescribing and Dispensing Privilege,” and “CNS Certification or Renewal” have been updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1308 effective July 6, 2013 (Supp. 13-2).

 

ARTICLE 2. ARIZONA REGISTERED AND PRACTICAL NURSING PROGRAMS; REFRESHER PROGRAMS

R4-19-201. Organization and Administration

A. The parent institution of a nursing program shall be accredited as a post-secondary institution, college, or university, by an accrediting body that is recognized as an accrediting body by the U.S. Department of Education, and shall hold Arizona private post-secondary approval status if applicable. The parent institution shall submit evidence to the board of continuing accreditation after each reaccreditation review or action. If the parent institution holds both secondary and post-secondary accreditation, it shall operate any RN or PN program under its post-secondary accreditation.

B. A nursing program shall have a written statement of mission and goals consistent with those of the parent institution and compatible with current concepts in nursing education and practice appropriate for the type of nursing program offered.

C. A nursing program shall be an integral part of the parent institution and shall have at a minimum equivalent status with other academic units of the parent institution.

D. The parent institution shall center the administrative control of the nursing program in the nursing program administrator and shall provide the support and resources necessary to meet the requirements of R4-19-203 and R4-19-204.

E. A nursing program shall provide an organizational chart that identifies the actual relationships, lines of authority, and channels of communication within the program, and between the program and the parent institution.

F. A nursing program shall have a written agreement between the program and each clinical agency where clinical experience is provided to the program's students that:

1. Defines the rights and responsibilities of both the clinical agency and the nursing program,

2. Lists the role and authority of the governing bodies of both the clinical agency and the nursing program,

3. Allows faculty members of the program the right to participate in selecting learning experiences for students, and

4. Contains a termination clause that provides sufficient time for enrolled students to complete the clinical experience upon termination of the agreement.

G. A nursing program shall implement written policies and procedures that provide a mechanism for student input into the development of academic policies and procedures and allow students to anonymously evaluate faculty, nursing courses, clinical experiences, resources and the overall program.

H. The parent institution shall appoint a sole individual to the full-time position of nursing program administrator. The parent institution shall ensure that the individual appointed meets or exceeds the requirements of, and fulfills the duties specified in, R4-19-203, whether on an interim or permanent basis.

I. A nursing program shall develop and implement a written plan for the systematic evaluation of the total program that is based on program and student learning outcomes and that incorporates continuous improvement based on the evaluative data. The plan shall include measurable outcome criteria, logical methodology, frequency of evaluation, assignment of responsibility, actual outcomes and actions taken. The following areas shall be evaluated:

1. Internal structure of the program, its relationship to the parent institution, and compatibility of program policies and procedures with those of the parent institution;

2. Mission and goals;

3. Curriculum;

4. Education facilities, resources, and student support services;

5. Clinical resources;

6. Student achievement of program educational outcomes;

7. Graduation and attrition for each admission cohort including at a minimum:

a. Number and percent of students who left the program;

b. Number and percent of students who are out of sequence in the program; and

c. Number and percent of students who graduated within 100%, 150% or greater than 150% of time allotted in the curriculum plan.

8. Graduate performance on the licensing examination;

9. Faculty performance; and

10. Protection of patient safety including but not limited to:

a. Student and faculty policies regarding supervision of students, practicing within scope and student safe practice;

b. The integration of safety concepts within the curriculum;

c. The application of safety concepts in the clinical setting; and

d. Policies made under R4-19-203(C)(6).

J. The parent institution shall provide adequate fiscal, human, physical, and learning resources to support program processes and outcomes necessary for compliance with this Article.

K. The parent institution shall provide adequate resources to recruit, employ, and retain sufficient numbers of qualified faculty members to meet program and student learning outcomes and the requirements of this Article.

L. The parent institution shall notify the Board of a vacancy, pending vacancy, or leave of absence greater than 30 days in the position of nursing program administrator within 15 days of the program's awareness of the vacancy, pending vacancy, or leave of absence and do the following:

1. Appoint an interim or permanent administrator who meets the requirements of R4-19-203(A) within 15 days of the effective date of the vacancy or absence, and

2. Notify the Board of the appointment of an interim or permanent administrator within 15 days of appointment and provide a copy of the administrator's credentials to the Board.

M. A parent institution shall notify the Board within 15 days of any change or pending change in institutional accreditation status or reporting requirements.

N. Prior to final approval for new nursing programs and by July 31, 2015 for existing programs, all RN nursing programs offering less than a bachelor’s degree in nursing shall have a minimum of one articulation agreement with a Board approved and nationally accredited baccalaureate or higher nursing program that includes recognition of prior learning in nursing and recognition of foundational courses.

Historical Note

Former Section I, Part I; Amended effective January 20, 1975 (Supp. 75-1). Former Section R4-19-11 repealed, new Section R4-19-11 adopted effective February 20, 1980 (Supp. 80-1). Amended effective July 16, 1984 (Supp. 84-4). Former Section R4-19-11 renumbered as Section R4-19-201 (Supp. 86-1). Section repealed; new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-202. Resources, Facilities, Services, and Records

A. The parent institution of a nursing program shall consider the size of the program including number of program faculty and number of program students and shall provide and maintain resources, services and facilities for the effective development and implementation of the program that are at a minimum:

1. Equivalent to those provided by approved programs of equivalent size and type, or in the case of no equivalent program, scaled relative to an approved program;

2. Comparable to those provided to other academic units of the parent institution; and

3. Include the following:

a. A private office for the nursing program administrator;

b. Faculty offices that are conveniently located to program classrooms and secretarial support staff;

c. If faculty offices are not private, the parent institution shall provide dedicated space for private faculty-student conferences that is:

i. Conveniently located to faculty offices, and

ii. Available whenever confidential student information is discussed.

d. Space for secretarial support and a secure area for records and files, convenient to the nursing program faculty and administrator;

e. Classrooms, laboratories, and conference rooms of the size and type needed with furnishings and equipment consistent with the educational purposes for which the facilities are used;

f. Acoustics, lighting, ventilation, plumbing, heating and cooling in working order;

g. Dedicated secretarial, laboratory and other support personnel available to meet the needs of the program;

h. Access to a comprehensive, current, and relevant collection of educational materials and learning resources for faculty members and students;

i. Access to supplies and equipment to simulate patient care that are:

i. In working order,

ii. Organized in a manner so that they are readily available to faculty,

iii. Consistent with current clinical practices, and

iv. Of sufficient quantity for the number of students enrolled,

j. Current technology in working order to support teaching and learning. Institutions offering web-enhanced and distance education shall provide ongoing and effective technical, design and production support for faculty members and technical support services for students.

B. A nursing program shall maintain current and accurate records of the following:

1. Student records, including admission materials, courses taken, grades received, scores in any standardized tests taken, health and performance records, and health information submitted to meet program or clinical requirements for a minimum of three years after the fiscal year of program completion for academic records and one year after program completion for health records;

2. Faculty records, including Arizona professional nursing license number, evidence of fulfilling the requirements in R4-19-204, and performance evaluations for faculty employed by the parent institution for one or more years. Records shall be kept current during the period of employment and retained for a minimum of three years after termination of employment;

3. Minutes of faculty and committee meetings for a minimum of three years;

4. Reports from accrediting agencies and the Board for a minimum of 10 years;

5. The statement of mission and goals, and curricular materials consistent with the requirements of R4-19-206 for the current curriculum and, if the current curriculum is less than three years old, the previous curriculum; and

6. Formal program complaints and grievances since the last site review with evidence of due process and resolution.

Historical Note

Former Section I, Part II; Former Section R4-19-12 repealed, new Section R4-19-12 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-12 repealed, new Section R4-19-12 adopted effective July 16, 1984 (Supp. 84-4). Former Section R4-19-12 renumbered as Section R4-19-202 (Supp. 86-1). Section repealed; new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-203. Administrator; Qualifications and Duties

A. The nursing program administrator shall hold a current Arizona registered nurse license in good standing or multi-state privilege to practice in Arizona under A.R.S., Title 32, Chapter 15 and:

1. For registered nursing programs:

a. A graduate degree with a major in nursing;

b. A minimum of three years work experience as a registered nurse providing direct patient care; and

c. If appointed to the position of nursing program administrator on or after the effective date of these rules, have a minimum of one academic year full-time experience teaching in or administering a nursing education program leading to licensure; or

d. If lacking the requirements of subsection (A)(1)(c), the parent institution may appoint an individual to the position of “Interim Program Administrator” under the following conditions:

i. The individual is subject to termination based on performance and any factors determined by the institution;

ii. A direct supervisor evaluates performance periodically over the next 12 months to ensure institutional and program goals are being addressed; and

iii. If evaluations are satisfactory, the individual may be appointed to permanent status after 12 months in the interim position.

2. For practical nursing programs:

a. If appointed prior to the effective date of these rules, a baccalaureate degree with a major in nursing; and

b. If appointed on or after the effective date of these rules, the requirements of subsection (A)(1).

B. The administrator shall have comparable status with other program administrators in the parent institution and shall report directly to an academic officer of the institution.

C. The administrator shall have the authority to direct the program in all its phases, including:

1. Administering the nursing education program;

2. Directing activities related to academic policies, personnel policies, curriculum, resources, facilities, services, and program evaluation;

3. Preparing and administering the budget;

4. Recommending candidates for faculty appointment, retention, and promotion;

5. In addition to any other evaluation used by the parent institution, ensuring that nursing program faculty members are evaluated at a minimum:

a. Annually in the first year of employment and every three years thereafter;

b. Upon receipt of information that a faculty member, in conjunction with performance of their duties, may be engaged in intentional, negligent or other behavior that either is or might be:

i. Below the standards of the program or the parent institution,

ii. Inconsistent with nursing professional standards, or

iii. Potentially or actually harmful to a patient.

c. By the nurse administrator or a nurse educator designated by the nurse administrator, and

d. In the areas of teaching ability and application of nursing knowledge and skills relative to the teaching assignment.

6. Together with faculty develop, enforce and evaluate equivalent student and faculty policies necessary for safe patient care and to meet clinical agency requirements regarding:

a. Physical and mental health,

b. Criminal background checks,

c. Substance use screens,

d. Functional abilities, and

e. Supervision of clinical activities.

7. Participating in activities that contribute to the governance of the parent institution;

8. Together with faculty develop, enforce and evaluate both student and faculty policies regarding minimal requisite nursing skills and knowledge necessary to provide safe patient care for the type of unit and patient assignment; and

9. Enforcing consistent application of all nursing program policies.

D. The administrator of the nursing program shall not carry a teaching load of more than three clock hours per week if required to teach.

E. The administrator may have administrative responsibilities other than the nursing program, provided that a nursing program faculty member is designated to assist with program management and the administrator is able to fulfill the duties of this Article.

Historical Note

Former Section I, Part III; Former Section R4-19-13 repealed, new Section R4-19-13 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-13 repealed, new Section R4-19-13 adopted effective July 16, 1984 (Supp. 84-4). Former Section R4-19-13 renumbered as Section R4-19-203 (Supp. 86-1). Section repealed; new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-204. Faculty; Personnel Policies; Qualifications and Duties

A. A nursing program shall implement written personnel policies for didactic and clinical nursing faculty members including workload policies that at minimum conform to those for other faculty members of the parent institution and that are in accordance with accepted nursing educational standards or provide a written explanation of any differences not related to the requirements of this Article.

B. A nursing program shall provide at a minimum the number of qualified faculty members necessary for compliance with the provisions of this Article and comparable to that provided by approved programs of equivalent size and program type, or, in the case of no equivalent program, a number scaled relative to an approved program.

C. The parent institution of a nursing program shall ensure that at least one nursing faculty member is assigned to no more than ten students while students are directly or indirectly involved in the care of patients including precepted experiences.

D. The faculty shall supervise all students in clinical areas in accordance with the acuity of the patient population, clinical objectives, demonstrated competencies of the student, and requirements established by the clinical agency.

E. The parent institution of a nursing program shall ensure that every registered nursing program faculty member holds a current Arizona registered nurse license in good standing or multi-state privilege to practice in Arizona under A.R.S., Title 32, Chapter 15 and that every faculty member meets one of the following:

1. If providing didactic instruction:

a. At least two years of experience as a registered nurse providing direct patient care; and

b. A graduate degree. The majority of the faculty members of a registered nursing program shall hold a graduate degree with a major in nursing. If the graduate degree is not in nursing, the faculty member shall hold a minimum of a baccalaureate degree in nursing; or

2. If providing clinical instruction, as defined in R4-19-101, only:

a. The requirements for didactic faculty, or

b. A baccalaureate degree with a major in nursing and at least three years of experience as a registered nurse providing direct patient care.

F. The parent institution of a nursing program shall ensure that each practical nursing program faculty member holds a current Arizona registered nurse license in good standing or multi-state privilege to practice in Arizona under A.R.S., Title 32, Chapter 15 and that every faculty member meets the following:

1. At least two years of experience as a registered nurse providing direct patient care, and

2. A minimum of a baccalaureate degree with a major in nursing.

G. Under the leadership of the nursing program administrator, nursing program faculty members shall:

1. Develop, implement, evaluate, and revise the program of learning including the curriculum and learning outcomes of the program;

2. Develop, implement, evaluate and revise standards for the admission, progression, and graduation of students;

3. Participate in advisement and guidance of students.

H. Together with the nursing program administrator, develop, implement and evaluate written policies for faculty orientation, continuous learning and evaluation.

Historical Note

Former Section I, Part IV; Former Section R4-19-14 repealed, new Section R4-19-14 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-14 repealed, new Section R4-19-14 adopted effective July 16, 1984 (Supp. 84-4). Former Section R4-19-14 renumbered as Section R4-19-204 (Supp. 86-1). Section repealed; new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-205. Students; Policies and Admissions

A. The number of students admitted to a nursing program shall be determined by the number of qualified faculty, the size, number and availability of educational facilities and resources, and the availability of the appropriate clinical learning experiences for students. The number of students admitted shall not exceed the number for which the program was approved plus minor increases allowed under R4-19-209 without Board approval.

B. A nursing program shall implement written student admission and progression requirements that are evidence-based, allow for a variety of clinical experiences and satisfy the licensure criteria of A.R.S. Title 32, Chapter 15 and A.A.C. Title 4 Chapter 19.

C. A nursing program shall have and enforce written policies available to students and the public regarding admission, readmission, transfer, advanced placement, progression, graduation, withdrawal, and dismissal.

D. A nursing program and parent institution shall have and enforce written policies that are readily available to students in either the college catalogue or nursing student handbook that address student rights, responsibilities, grievances, health, and safety.

E. A nursing program and parent institution shall provide accurate and complete written information that is readily available to all students and the general public about the program including

1. The nature of the program, including course sequence, prerequisites, co-requisites and academic standards;

2. The length of the program;

3. Total program costs including tuition, fees and all program related expenses;

4. The transferability of credits to other public and private educational institutions in Arizona; and

5. A clear statement regarding any technology based instruction and the technical support provided to students.

F. A nursing program shall communicate changes in policies, procedures and program information clearly to all students, prospective students and the public and provide advance notice similar to the advance notice provided by an approved program of similar size and type.

Historical Note

Adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-15 repealed, new Section R4-19-15 adopted effective July 16, 1984 (Supp. 84-4). Former Section R4-19-15 renumbered as Section R4-19-205 (Supp. 86-1). Section repealed; new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-206. Curriculum

A. A nursing program shall assign students only to those clinical agencies that provide the experience necessary to meet the established clinical objectives of the course.

B. A nursing program shall provide a written program curriculum to students that includes;

1. Student centered outcomes for the program;

2. A curriculum plan that identifies the prescribed course sequencing and time required;

3. Specific course information that includes:

a. A course description;

b. Student centered and measurable didactic objectives;

c. Student centered and measurable clinical objectives, if applicable;

d. Student centered and measurable simulation objectives, if applicable;

e. A course content outline that relates to the course objectives;

f. Student centered and measurable objectives and a content outline for each unit of instruction.

g. Graded activities to demonstrate that course objectives have been met.

C. A nursing program administrator and faculty members shall ensure that the curriculum:

1. Reflects the nursing program’s mission and goals;

2. Is designed so that the student is able to achieve program objectives within the curriculum plan;

3. Is logically consistent between and within courses and structured in a manner whereby each course builds on previous learning.

4. Incorporates established professional standards, guidelines or competencies; and

5. Is designed so that a student who completes the program will have the knowledge and skills necessary to function in accordance with the definition and scope of practice specified in A.R.S. § 32-1601(16) and R4-19-401 for a practical nurse or A.R.S. § 32-1601(20) and R4-19-402 for a registered nurse.

D. A nursing program shall provide for progressive sequencing of classroom and clinical instruction sufficient to meet the goals of the program and be organized in such a manner to allow the student to form necessary links of theoretical knowledge, clinical reasoning, and practice.

1. A nursing program curriculum shall provide coursework that includes, but is not limited to:

a. Content in the biological, physical, social, psychological and behavioral sciences to provide a foundation for safe and effective nursing practice consistent with the level of the nursing program;

b. Content regarding professional responsibilities, legal and ethical issues, history and trends in nursing and health care;

c. Didactic content and supervised clinical experience in the prevention of illness and the promotion, restoration and maintenance of health in patients across the life span and from diverse cultural, ethnic, social and economic backgrounds to include:

i. Patient centered care,

ii. Teamwork and collaboration,

iii. Evidence-based practice,

iv. Quality improvement,

v. Safety, and

vi. Informatics,

2. A registered nursing program shall provide clinical instruction that includes, at a minimum, selected and guided experiences that develop a student's ability to apply core principles of registered nursing in varied settings when caring for:

a. Adult and geriatric patients with acute, chronic, and complex, life-threatening, medical and surgical conditions;

b. Peri-natal patients and families;

c. Neonates, infants, and children;

d. Patients with mental, psychological, or psychiatric conditions; and

e. Patients with wellness needs.

2. A practical nursing program shall provide clinical instruction that includes, at minimum, selected and guided experiences that develop a student’s ability to apply core principles of practical nursing when caring for:

a. Patients with medical and surgical conditions throughout the life span,

b. Peri-natal patients, and

c. Neonates, infants, and children in varied settings.

E. A nursing program may provide precepted clinical instruction. Programs offering precepted clinical experiences shall:

1. Develop and adhere to policies that require preceptors to:

a. Be licensed nurses at or above the level of the program either by holding an Arizona license in good standing, holding multi-state privilege to practice in Arizona under A.R.S. Title 32, Chapter 15, or if practicing in a federal facility, meet requirements of A.R.S. § 32-1631(5);

b. For LPN preceptors, practice under the general supervision of an RN or physician according to A.R.S. § 32-1601(16).

2. Develop and implement policies that require a faculty member of the program to:

a. Together with facility personnel, select preceptors that possess clinical expertise sufficient to accomplish the goals of the preceptorship;

b. Supervise the clinical instruction according to the provisions of R4-19-204(C) and (D), and

c. Maintain accountability for student education and evaluation.

F. A nursing program may utilize simulation in accordance with the clinical objectives of the course. Unless approved under R4-19-214, a nursing program shall not utilize simulation for an entire clinical experience with any patient population identified in subsection (D) of this Section.

G. A nursing program shall maintain at least a 80% NCLEX® passing rate for graduates taking the NCLEX-PN® or NCLEX-RN® for the first time within 12 months of graduation. The Board shall issue a notice of deficiency to any program that has a NCLEX® passing rate less than 80% for two consecutive calendar years or less than 75% for one calendar year.

H. At least 45% of students enrolled in the first nursing clinical course shall graduate within 100% of the prescribed period. “Prescribed period” means the time required to complete all courses and to graduate on time according to the nursing program’s curriculum plan excluding the time to complete program pre-requisite or pre-clinical courses.

Historical Note

Adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-16 repealed, former Section R4-19-17 renumbered and amended as Section R4-19-16 effective July 16, 1984 (Supp. 84-4). Former Section R4-19-16 renumbered as R4-19-206 (Supp. 86-1). Section repealed; new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citations in subsection (B)(3) were updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-207. New Programs; Proposal Approval; Provisional Approval

A. At a minimum of one year before establishing a nursing program, a parent institution shall submit to the Board one electronic copy and one paper copy of an application for proposal approval. The parent institution shall ensure that the proposal application was written by or under the direction of a registered nurse who meets the requirements of R4-19-203(A) and includes the following information and documentation:

1. Name and address of the parent institution;

2. Statement of intent to establish a nursing program, including the academic and licensure level of the program; and

3. Proposal that includes, but is not limited to, the following information:

a. Documentation of the present and future need for the type and level of program in the state including availability of potential students, need for entry level nurses at the educational level of the program and availability of clinical placements that meet the requirements of R4-19-206;

b. Evidence that written notification of intent to establish a new nursing education program has been provided to the nursing program administrators of all existing Arizona-approved programs a minimum of 30 days prior to submission of the proposal application, including projected student enrollment and clinical sites;

c. Organizational structure of the educational institution documenting the relationship of the nursing program within the institution and the role of the nursing program administrator consistent with R4-19-201 and R4-19-203;

d. Evidence of institutional accreditation consistent with R4-19-201 and post-secondary approval, if applicable. The institution shall provide the most recent full reports including findings and recommendations of the applicable accrediting organization or approval agency. The Board may request additional accreditation or approval evidence.

e. Purpose and mission of the nursing program,

f. Curriculum development documentation to include:

i. Student-centered outcomes for the program;

ii. A plan that identifies the prescribed course sequencing and time required; and

iii. Identification of established professional standards, guidelines or competencies upon which the curriculum will be based;

g. Name, qualifications, and job description of a nursing program administrator who meets the requirements of R4-19-203 and availability and job description of faculty who meet qualifications of R4-19-204;

h. Number of budgeted clinical and didactic faculty positions from the time of the first admission to graduation of the first class;

i. Evidence that the program has secured clinical sites for its projected enrollment that meet the requirements of R4-19-206;

j. Anticipated student enrollment per session and annually;

k. Documentation of planning for adequate academic facilities and secretarial and support staff to support the nursing program consistent with the requirements of R4-19-202;

l. Evidence of program financial resources comparable to an approved program of similar size and type or, if there is no comparable program, scaled relative to an approved program adequate for the planning, implementation, and continuation of the nursing program; and

m. Tentative time schedule for planning and initiating the nursing program including faculty hiring, entry date and size of student cohorts, and obtaining and utilizing clinical placements from the expected date of proposal approval to graduation of the first cohort.

n. A parent institution or owner corporation that has multiple nursing programs in one or more U.S. jurisdictions including Arizona, shall provide the following evidence for each nursing program:

i. Program approval in good standing with no conditions, restrictions, ongoing investigations or deficiencies;

ii. An NCLEX pass rate of at least 80% for the past two years or since inception; and

iii. An on-time graduation rate consistent with the requirements of R4-19-206(H).

B. The Board shall grant proposal approval to any parent institution that meets the requirements of subsection (A) if the Board deems that such approval is in the best interests of the public. Proposal approval expires one year from the date of Board issuance.

C. A parent institution that is denied proposal approval may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for proposal approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

D. At a minimum of 180 days before planned enrollment of students, a parent institution that received proposal approval within the previous year may submit to the Board one electronic copy and one paper copy of an application for provisional approval. The parent institution shall ensure that the provisional approval application was written by or under the direction of a registered nurse who meets the requirements of R4-19-203(A) and includes the following information and documentation:

1. Name and address of parent institution;

2. A self-study that provides evidence supporting compliance with R4-19-201 through R4-19-206, and

3. Names and qualifications of:

a. The nursing program administrator;

b. Didactic nursing faculty or one or more nurse consultants who are responsible for developing the curriculum and determining nursing program admission, progression and graduation criteria;

4. Plan for recruiting and hiring additional didactic faculty for the first semester or session of operation at least 60 days before classes begin;

5. Plan for recruiting and hiring additional clinical nursing faculty at least 30 days before the clinical rotation begins;

6. Final program implementation plan including dates and number of planned student admissions not to exceed 60 per calendar year, recruitment and hire dates for didactic and clinical faculty for the period of provisional approval. An increase in student admissions may be sought under subsection (H) of this Section;

7. Descriptions of available and proposed physical facilities with dates of availability; and

8. Detailed written plan for clinical placements for all planned enrollments until graduation of the first class that is:

a. Based on current clinical availability and curriculum needs;

b. Accompanied by documentation of commitment from proposed clinical agencies for the times and units specified, in addition to a signed clinical contract that meets the requirements of R4-19-201(F) from each agency; and

c. Lists any nursing programs who are currently using the planned clinical units for the times proposed and will be displaced.

E. Following an onsite evaluation conducted according to A.R.S. § 41-1009, the Board shall grant provisional approval to a parent institution that meets the requirements of R4-19-201 through R4-19-206 if approval is in the best interest of the public. A parent institution that is denied provisional approval may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for provisional approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

F. The provisional approval of a nursing program expires 12 months from the date of the grant of provisional approval if a class of nursing students is not admitted by the nursing program within that time. The Board may rescind the provisional approval of a nursing program for a violation of any provision of this Article according to R4-19-211.

G. One year after admission of the first nursing class into nursing courses, the program shall provide a report to the Board containing information on:

1. Implementation of the program including any differences from the plans submitted in the applications for proposal and provisional approval and an explanation of those differences; and

2. The outcomes of the evaluation of the program according to the program’s evaluation plan under R4-19-201(I);

H. Following receipt of the report, a representative of the Board shall conduct a site survey visit under A.R.S. § 41-1009 to determine compliance with this Article. A report of the site visit shall be provided to the Board. After reviewing the consultant report and at the request of the program under R4-19-209, the Board may grant permission to increase admissions.

I. If a nursing program fails to apply for full approval within two years of graduating its first class of students, the Board shall rescind its provisional approval. A nursing program whose provisional approval is rescinded may request a hearing by filing a written request with the Board within 30 days of service of the Board's order rescinding the provisional approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

J. A nursing program or the parent institution or governing body of a nursing program under provisional approval may not admit additional students other than those specifically provided for in the application or subsequently approved by the Board under subsection (H) of this Section and R4-19-209 and may not expand to another geographical location.

K. A nursing program whose provisional approval is rescinded may request a hearing by filing a written request with the Board within 30 days of service of the Board's order rescinding the provisional approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-17 renumbered and amended as Section R4-19-16 effective July 16, 1984 (Supp. 84-4). Former Section R4-19-17 renumbered as R4-19-207 (Supp. 86-1). New Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-208. Full Approval of a New Nursing Program

A. A nursing program seeking full approval shall submit an electronic and one paper copy of an application that includes the following information and documentation:

1. Name and address of the parent institution,

2. Date the nursing program graduated its first class of students, and

3. A self-study report that contains evidence the program is in compliance with R4-19-201 through R4-19-206.

B. Following an onsite evaluation conducted according to A.R.S § 41-1009, the Board shall grant full approval for a maximum of five years or the accreditation period for nationally accredited programs governed by R4-19-213, to a nursing program that meets the requirements of this Article and if approval is in the best interest of the public. A nursing program that is denied full approval may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for full approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-209. Nursing Program Change

A. The program administrator shall ensure that the following changes to a nursing education program are evidence-based and supported by rationale. A nursing program administrator shall receive approval from the Board before implementing any of the following nursing program changes:

1. Substantive change in the mission or goals of the program that requires revision of curriculum or program delivery method;

2. Increasing or decreasing the academic credits or units of the program excluding pre-requisite credits;

3. Adding a geographical location of the program;

4. Increasing the student admission capacity annually by more than 30 students;

5. Changing the level of educational preparation provided;

6. Transferring the nursing program from one institution to another; or

7. Establishing different admission, progression or graduation requirements for specific cohorts of the program.

B. The administrator shall submit one electronic and one paper copy of the following materials with the request for nursing program changes:

1. The rationale for the proposed change and the anticipated effect on the program administrator, faculty, students, resources, and facilities;

2. A summary of the differences between the current practice and proposed change;

3. A timetable for implementation of the change; and

4. The methods of evaluation to be used to determine the effect of the change.

C. The Board shall approve a request for a nursing program change if the program demonstrates that it has the resources to implement the change and the change is evidence-based and consistent with R4-19-201through R4-19-206. A nursing program that is denied approval of program changes may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for full approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-210. Renewal of Approval of Nursing Programs Not Accredited by a National Nursing Accrediting Agency

A. An approved nursing program that is not accredited by an approved national nursing accrediting agency shall submit an application packet to the Board at least four months before the expiration of the current approval that includes the following:

1. Name and address of the parent institution,

2. Evidence of current institutional accreditation status under R4-19-201,

3. Copy or on-line access to:

a. A current catalog of the parent institution,

b. Current nursing program and institutional student and academic policies, and

c. Institutional and nursing program faculty policies and job descriptions for nursing program faculty, and

4. One electronic copy and one paper copy of a self-study report that contains evidence of compliance with R4-19-201 through R4-19-206.

B. Following an onsite evaluation conducted according to A.R.S. § 41-1009, the Board shall renew program approval for a maximum of five years if the nursing program meets the criteria in R4-19-201 through R4-19-206 and if renewal is in the best interest of the public. The Board shall determine the term of approval that is in the best interest of the public.

C. If the Board denies renewal of approval, the nursing program may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for renewal of approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-211. Unprofessional Conduct

A disciplinary action, denial of approval, or notice of deficiency may be issued against a nursing or refresher program for any of the following acts of unprofessional conduct in a nursing program:

1. Failure to maintain minimum standards of acceptable and prevailing educational or nursing practice;

2. Deficiencies in compliance with the provisions of this Article;

3. Utilization of students to meet staffing needs in health care facilities;

4. Non-compliance with the program’s or parent institution’s mission or goals, program design, objectives, or policies;

5. Failure to provide the variety and number of clinical learning opportunities necessary for students to achieve program outcomes or minimal competence;

6. Student enrollments without necessary faculty, facilities, or clinical experiences;

7. Ongoing or repetitive employment of unqualified faculty or program administrator;

8. Failure to comply with Board requirements within designated time-frames;

9. Fraud or deceit in advertising, promoting or implementing the program;

10. Material misrepresentation of fact by a nursing or refresher program in any advertisement, application or information submitted to the Board;

11. Failure to allow Board staff to visit the program or conduct an investigation including failure to supply requested documents; or

12. Any other evidence that gives the Board reasonable cause to believe the program’s conduct may be a threat to the safety and well-being of students, faculty, patients or potential patients.

Historical Note

Adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). R4-19-211 renumbered to R4-19-212; New Section R4-19-211 made by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-212. Notice of Deficiency

A. Under A.R.S. § 32-1644(D), when surveying or re-surveying a nursing program, the Board shall, upon initially determining that a nursing program is not in compliance with applicable provisions of this Article provide to the nursing program administrator a written notice of deficiencies that establishes a reasonable time, based upon the number and severity of deficiencies, to correct the deficiencies not to exceed 18 months.

1. The administrator shall, within 30 days from the date of service of the notice of deficiencies, file a plan to correct each of the identified deficiencies after consultation with the Board or designated Board representative.

2. The administrator may, within 30 days from the date of service of the notice of deficiencies, submit a written request for a hearing before the Board to appeal the Board's determination of deficiencies. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

3. If the Board's determination is not appealed or is upheld upon appeal, the Board shall conduct periodic evaluations of the program during the time of correction to determine whether the deficiencies have been corrected.

B. The Board shall, following a determination of continued non-compliance, rescind the approval of, or restrict admissions to a nursing program if the program fails to comply with Article 2 within the time set by the Board in the notice of deficiencies served upon the program.

1. The Board shall serve the administrator with a written notice of proposed rescission of approval or restriction of admissions that states the grounds for the proposed action. The administrator shall have 30 days to submit a written request for a hearing to appeal the Board’s proposed action. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

2. Upon the effective date of a decision to rescind program approval, the nursing program shall immediately cease operation and be removed from the official approved-status listing. A nursing program that has been ordered to cease operations shall assist currently enrolled students to transfer to an approved nursing program.

C. In addition to the cause in subsection (B), the Board may, depending on the severity and pattern of violations, issue discipline, rescind approval of or restrict admissions to a nursing program for any of the following causes:

1. For a program that was served with a notice of deficiencies within the preceding three years and timely corrected the noticed deficiencies, subsequent noncompliance with the standards in this Article;

2. Failure to comply with orders of or stipulations with the Board within the time determined by the Board; or

3. Unprofessional program conduct under R4-19-211.

D. A parent institution that voluntarily terminates a nursing education program while under a Board action, including a Notice of Deficiency, shall not apply to open a new nursing education program for a period of two years and shall provide evidence in any future application that the basis for the Board action has been rectified.

Historical Note

Adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). R4-19-212 renumbered to R4-19-213; New Section R4-19-212 renumbered from R4-19-211 and amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-213. Nursing Programs Holding National Program Accreditation

A. An approved nursing program that is accredited by an approved national nursing accrediting agency shall submit to the Board evidence of initial accreditation including a copy of the site visit report and the official notice of accreditation.

B. A nationally accredited nursing program or a program seeking national accreditation or re-accreditation shall inform the Board at least 30 days in advance of any pending visit by a nursing program accrediting agency and allow Board staff to attend all portions of the visit.

C. 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 change in program accreditation status or reporting requirements.

D. The administrator of a nursing program that loses its accreditation status or allows its accreditation status to lapse shall file an application for renewal of approval under R4-19-210 within 30 days of loss of or lapse in accreditation status.

E. Under A.R.S. § 32-1644(D) the Board may periodically re-survey a nationally accredited program to determine compliance with this Article and require a self study report. Board site visits may be conducted in conjunction with the national accrediting team.

F. Unless otherwise notified by the Board following receipt and review of the documents required by subsections (A), (B) and (C), a nationally accredited nursing program continues to have full-approval status. The administrator of a nursing program that has its continuing approval-status rescinded by the Board may request a hearing by filing a written request with the Board within 30 days of service of the Board's order rescinding continuing full-approval status. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). R4-19-213 renumbered to R4-19-215; New Section R4-19-213 renumbered from R4-19-212 and amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-214. Pilot Programs for Innovative Approaches in Nursing Education

A. Under A.R.S. § 32-1606(A)(9) a nursing education program, refresher program or a certified nursing assistant program may implement a pilot program for an innovative approach by complying with the provisions of this Section. Education programs approved to implement innovative approaches shall comply with all other applicable provisions of A.R.S. Title 32, Chapter 15 and A.A.C. Title 4, Chapter 19.

B. A program applying for a pilot program shall:

1. Hold full approval;

2. Have no substantiated complaints, discipline or deficiencies in the past two years; and

3. Have been compliant with all Board regulations during the past two years.

C. The following written information shall be provided to the Board at least 90 days prior to a Board meeting:

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 violate;

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 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:

1. Eligibility criteria in subsection (B) and application criteria in subsection (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. Implementation plan is reasonable to achieve the desired outcomes of the innovative approach;

6. Timeline provides for a sufficient period to implement and evaluate the innovative approach; and

7. Plan for periodic evaluation is comprehensive and supported by appropriate methodology.

E. The Board may:

1. Deny the application or request additional information if the program does not meet the criteria in subsections (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 eligibility criteria in subsection (B).

F. An education program that is granted approval for an innovation shall maintain eligibility criteria in subsection (B) and submit:

1. Progress reports conforming to the evaluation plan annually or as requested by the Board; 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 may grant the request to continue approval if the innovative approach has achieved desired outcomes and has not compromised public protection.

Historical Note

Adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 7 A.A.R. 5349, effective November 8, 2001 (Supp. 01-4). Amended by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (05-1). R4-19-214 renumbered to R4-19-216; New Section R4-19-214 made by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-215. Voluntary Termination of a Nursing Program or a Refresher Program

A. The administrator of a nursing program or a refresher program shall notify the Board within 15 days of a decision to voluntarily terminate the program. The administrator shall, at the same time, submit a written plan for terminating the nursing program or refresher program. A program is considered voluntarily terminated when it no longer admits or plans to admit students after current students graduate.

B. The administrator shall ensure that the nursing program or refresher program is maintained, including the nursing faculty, until the last student is transferred or completes the program. At that time the Board shall remove the program from the current list of approved programs.

C. Within 15 days after the termination of a nursing program or refresher program, the administrator shall notify the Board of the permanent location and availability of all program records.

Historical Note

New Section made by final rulemaking at 11 A.A.R. 451, effective March 7, 2005 (Supp. 05-1). Amended by final rulemaking at 13 A.A.R. 1483, effective June 2, 2007 (Supp. 07-2). R4-19-215 renumbered to R4-19-217; New Section R4-19-215 renumbered from R4-19-213 and amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-216. Approval of a Refresher Program

A. An applicant for approval of a refresher program for nurses whose licenses have been inactive or expired for five or more years, nurses under Board order to enroll in a refresher program, or nurses who have not met the requirements of R4-19-312 shall submit one electronic and one paper copy of a completed application that provides all of the following information and documentation:

1. Applicant's name, address, e-mail address, telephone number, web site address, if applicable, and fax number;

2. Proposed starting date for the program;

3. Name and qualifications of all instructors that meet the requirements of subsection (C);

4. Statement describing the facilities, staff, and resources that the applicant will use to conduct the refresher program;

5. A program and participant evaluation plan that includes student evaluation of the course, instructor, and clinical experience;

6. Evidence of a curriculum that meets the requirements of subsection (B);

B. A refresher program shall provide:

1. A minimum of 40 hours of didactic instruction for a licensed practical nurse program and 80 hours of didactic instruction for a registered nurse program. Didactic instruction shall include, at a minimum:

a. Nursing process and patient centered care;

b. Pharmacology, medication calculation, and medication administration;

c. Communication;

d. Critical thinking, clinical decision making and evidence-based practice;

e. Delegation, management, and leadership;

f. Working with interdisciplinary teams;

g. Meeting psychosocial and physiological needs of adult clients with medical-surgical conditions;

h. Ethics;

i. Documentation including electronic health records;

j. Informatics;

k. Quality Improvement; and

l. At the program’s discretion, additional content hours in other populations of care for students who will be engaged in clinical experiences with these populations.

2. A clinical experience of a type and duration to meet course objectives for each student which consists of a minimum of 112 hours for a practical nurse program and 160 hours for a registered nurse program. Relative to the clinical portion of the program, the program shall:

a. Ensure that each qualified student has a verified clinical placement within 12 months of course enrollment;

b. Provide program policies for clinical placement in advance of enrollment that specify both the obligations of the school and the student regarding placement;

c. Validate that a student has the necessary theoretical knowledge to function safely in the specific clinical setting before starting a clinical experience;

d. Ensure that clinical placements provide an opportunity to demonstrate safe and competent application of program didactic content through either direct or indirect client care; and

e. Include, at its discretion, up to 32 hours of scheduled clinical time in laboratory experiences including simulation.

3. Curriculum and other materials to students and prospective students that, include:

a. An overall program description including goals;

b. Objectives, content, and hours allotted for each area of instruction;

c. Implemented course policies that include but are not limited to admission requirements, passing criteria, cause for dismissal, clinical requirements, grievance process and student responsibilities; and

d. Program costs and length of the program.

C. Refresher program personnel qualifications and responsibilities:

1. An administrator of a refresher program shall:

a. Hold a graduate degree in nursing or a bachelor of science in nursing degree and a graduate degree in either education or a health-related field, and

b. Be responsible for administering and evaluating the program.

2. A faculty member of a refresher program shall:

a. Hold a minimum of a bachelor of science in nursing degree,

b. Be responsible for implementing the curriculum and supervising clinical experiences either directly or indirectly through the use of clinical preceptors.

3. Licensure requirements for program administrator and faculty:

a. If the program is located in Arizona, the administrator and faculty members shall hold a current Arizona RN license in good standing or a multi-state privilege under A.R.S., Title 32, Chapter 15;

b. If the program is located in another state, the administrator and didactic faculty members shall either hold a current RN license in good standing in the state of the program location or meet the requirements of subsection (a).

4. If preceptors are used for clinical experiences, the program shall adhere to the preceptorship requirements of R4-19-206(E).

5. Other licensed health care professionals may participate in course instruction consistent with their licensure and scope of practice and under the direction of the program administrator or faculty.

D. Program types; bonding

1. A refresher program may be offered by:

a. A private educational institution that is accredited by the private post-secondary board,

b. A public post-secondary educational institution,

c. A licensed health care institution, or

d. A private individual, partnership or corporation.

2. If the refresher program is offered by a private individual, partnership or corporation, the program shall:

a. Submit proof of insurance covering any potential or future claims for damages resulting from any aspect of the program or provide evidence of a surety bond from a surety company with a rating of “A” or better by either Best’s Credit Ratings, Moody’s Investor Service, or Standard and Poor’s rating service in the amount of a minimum of $15,000. The program shall ensure that:

i. Bond or insurance distributions are limited to students or former students with a valid claim for instructional or program deficiencies;

ii. The amount of the bond or insurance coverage is sufficient to reimburse the full amount of collected tuition and fees for all students during all enrollment periods of the program; and

iii. The bond or insurance is maintained for an additional 24 months after program closure.

b. For programs offering on-ground instruction, provide a fire inspection report of the classroom and building by the Arizona State Fire Marshall or an entity approved by the Arizona State Fire Marshall for each program location.

c. Subsection (D) is effective immediately for new programs and within one year of the effective date for approved programs.

E. The Board shall approve a refresher program that meets the requirements of this Section, if approval is in the best interest of the public, for a maximum term of five years. An applicant who is denied refresher program approval may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

F. The refresher program sponsor shall apply for renewal of approval in accordance with subsection (A) not later than 90 days before expiration of the current approval. The sponsor of a refresher program that is denied renewal of approval may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for renewal of approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, and 4 A.A.C. 19, Article 6.

G. The sponsor of an approved refresher program shall provide written notification to the Board within 15 days of a participant's completion of the program of the following:

1. Name of the participant and whether the participant successfully completed or failed the program,

2. Participant's license, and

3. Date of participant's completion of the program.

H. The Board may accept a refresher program from another U.S. jurisdiction for an individual applicant on a case-by-case basis if the applicant provides verifiable evidence that the refresher program substantially meets the requirements of this Section. The acceptance of the program for an individual applicant does not confer approval status upon the program.

I. Within 30 days, a refresher program shall report to the Board changes in:

1. Name, address, electronic address, web site address or phone number of the program;

2. Clinical or didactic hours of the program;

3. Program delivery method; or

4. Ownership including adding or deleting an owner.

J. The Board may take action against the approval of a refresher program under A.R.S § 32-1606(C) and the provisions of this Article. The administrator of a refresher program whose approval is disciplined or subject to a notice of deficiency may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for renewal of approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, and 4 A.A.C. 19, Article 6.

Historical Note

New Section R4-19-216 renumbered from R4-19-214 and amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-217. Distance Learning Nursing Programs; Out-of-State Nursing Programs

A. An out-of-state nursing program that is in good standing in another state and plans to provide distance based didactic instruction and on-ground clinical instruction in Arizona shall comply with the application requirements of R4-19-207 and R4-19-208. The program shall employ at least one faculty member who is physically present in this state to coordinate the education and clinical experience.

B. Any nursing program that delivers didactic instruction by distance learning methods, whether in this state or another, shall ensure that the methods of instruction are compatible with the program curriculum plan and enable a student to meet the goals, competencies, and objectives of the educational program and standards of the Board.

1. A distance learning nursing program shall establish a means for assessing individual student outcomes, and program outcomes including, at minimum, student learning outcomes, student retention, student satisfaction, and faculty satisfaction.

2. For out-of-state nursing programs, the program shall be within the jurisdiction of and regulated by an equivalent United States nursing regulatory authority in the state from which the program originates, unless also providing clinical experience in Arizona.

3. Didactic faculty members shall be licensed in the state of origination of a distance learning nursing program. Clinical supervising faculty shall be licensed in the location of the clinical activity.

4. A distance learning nursing program shall provide students with supervised clinical and laboratory experiences so that program objectives are met and didactic learning is validated by supervised, land-based clinical and laboratory experiences.

5. A distance-learning nursing program shall provide students with access to technology, resources, technical support, and the ability to interact with peers, preceptors, and faculty.

C. A nursing program, located in another state or territory of the United States, that wishes to provide clinical experiences in Arizona under A.R.S. § 32-1631(3), shall obtain Board approval before offering or conducting a clinical session. To obtain approval, the program shall submit a proposal package that contains:

1. A self study, describing the program's compliance with R4-19-201 through R4-19-206; and

2. A statement regarding, the number and type of student placements planned, a copy of signed clinical contracts and written commitment by the clinical facilities to provide the necessary clinical experiences, the name and qualifications of faculty licensed in Arizona and physically present in the facility who will supervise the experience and verification of good standing of the program in the jurisdiction of origin.

D. The Board may require a nursing program approved under this Section to file periodic reports for the purpose of data collection or to determine compliance with the provisions of this Article. A program shall submit a report to the Board within 30 days of the date on a written request from the Board or by the due date stated in the request if the due date is after the normal 30-day period.

E. The Board shall approve an application to conduct clinical instruction in Arizona that meets the requirements in A.R.S. Title 32, Chapter 15 and this Chapter, and is in the best interest of the public. An applicant who is denied approval to conduct clinical instruction in Arizona may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the application for approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

F. The Board may rescind an approval held by an out-of-state nursing program to conduct clinical instruction in Arizona, in accordance with R4-19-212.

G. If the Board finds that a nursing program located and approved in another state or territory of the United States does not meet requirements for nursing programs prescribed in this Article the Board shall either provide a notice of deficiency to the program as prescribed in R4-19-212(A), (A)(1) and (A)(2) or take other disciplinary action depending on the severity of the offense under R4-19-211.

1. If the Board issues a notice of deficiency and the program fails to correct the deficiency before the expiration of the period of correction, the Board shall rescind approval of the program as prescribed in R4-19-212(B)(1).

2. If the period of rescission, from the date of rescission to the date of reinstatement, is at any time concurrent with an applicant's education from the date of admission to the date of graduation, the Board shall withhold licensure unless the applicant meets all licensure requirements and completes any remedial education prescribed by the Board under R4-19-301(H). The Board shall ensure that the applicant has completed a curriculum that is equivalent to that of an approved nursing program.

3. If a nursing program provides evidence of compliance with this Article after the rescission of approval, the Board shall review the evidence, determine whether or not the nursing program complies with these standards, and reinstate approval of the program if the program complies with these standards and reinstatement is in the best interest of the public.

Historical Note

New Section R4-19-217 renumbered from R4-19-215 and amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

ARTICLE 3. LICENSURE

R4-19-301. Licensure by Examination

A. An applicant for licensure by examination shall:

1. Submit a verified application to the Board on a form furnished by the Board that provides the following information about the applicant:

a. Full legal name and all former names used by the applicant;

b. Mailing address, including declared primary state of residence, and telephone number;

c. Place and date of birth;

d. Ethnic category, marital status and e-mail address, at the applicant's discretion;

e. Social Security number for an applicant who lives or works in the United States;

f. Post-secondary education, including the names and locations of all schools attended, graduation dates, and degrees received, if applicable;

g. Current employer or practice setting, including address, position, and dates of service, if employed or practicing in nursing or health care;

h. Information regarding the applicant’s compliance with the practice or education requirements in R4-19-312;

i. Any state, territory, or country in which the applicant holds or has held a registered or practical nursing license and the license number and status of the license, including original state of licensure, if applicable;

j. The date the applicant previously filed an application for licensure in Arizona, if applicable;

k. Responses to questions regarding the applicant's background on the following subjects:

i. Current investigation or pending disciplinary action by a nursing regulatory agency in the United States or its territories;

ii. Action taken on a nursing license by any other state;

iii. Undesignated offenses, felony charges, convictions and plea agreements, including deferred prosecution;

iv. Misdemeanor charges, convictions and plea agreements, including deferred prosecution, that are required to be reported under A.R. S. § 32-3208;

v. Unprofessional conduct as defined in A.R.S. § 32-1601;

vi. Substance use disorder within the last 5 years;

vii. Current participation in an alternative to discipline program in any other state;

l. Explanation and supporting documentation for each affirmative answer to questions regarding the applicant's background; and.

m. Certification in nursing including category, specialty, name of certifying body, date of certification, and expiration date.

2. Submit proof of United States citizenship or alien status as specified in A.R.S. § 41-1080;

3. Submit a completed fingerprint card on a form provided by the Board or prints for the purpose of obtaining a criminal history report under A.R.S. § 32-1606 if the applicant has not submitted a fingerprint card or prints to the Board within the last two years; and

4. Pay the applicable fees.

B. If an applicant is a graduate of a pre-licensure nursing program in the United States that has been assigned a program code by the National Council of State Boards of Nursing during the period of the applicant’s attendance, the applicant shall submit one of the following:

1. If the program is an Arizona-approved program, the transcript required in subsection (B)(2) or a statement signed by a nursing program administrator or designee verifying that:

a. The applicant graduated from or is eligible to graduate from a registered nursing program for a registered nurse applicant; or

b. The applicant graduated from or is eligible to graduate from a practical nursing program or graduated from a registered nursing program and completed Board-prescribed role delineation education for a practical nurse applicant; or

2. If the program is located either in Arizona or in another state or territory and meets educational standards that are substantially comparable to Board standards for educational programs under Article 2 when the applicant completed the program, an official transcript sent directly from one of the following as:

a. Evidence of graduation or eligibility for graduation from a diploma registered nursing program, associate degree registered nursing program, or baccalaureate or higher degree registered nursing program for a registered nurse applicant.

b. Evidence of graduation or eligibility for graduation of a practical nursing program, associate degree registered nursing program, or baccalaureate or higher degree registered nursing program for a practical nurse applicant.

C. If an applicant is a graduate of a pre-licensure international nursing program and lacks items required in subsection (B), the applicant shall comply with subsection (A), submit a self report on the status of any international nursing license, and submit the following:

1. To demonstrate nursing program equivalency, one of the following:

a. If the applicant graduated from a Canadian nursing program, evidence of a passing score on the English language version of either the Canadian Nurses' Association Testing Service, the Canadian Registered Nurse Examination, NCLEX or an equivalent examination;

b. A Certificate or Visa Screen Certificate issued by the Commission on Graduates of Foreign Nursing Schools (CGFNS), or a report from CGFNS that indicates an applicant's program is substantially comparable to a U.S. program; or

c. A report from any other credential evaluation service (CES) approved by the Board.

2. If a graduate of an international pre-licensure nursing program subsequently obtains a degree in nursing from an accredited U.S. nursing program, the requirement for a CES equivalency report may be waived by the Board, however the applicant is not eligible for a multi-state compact license.

3. If an applicant's pre-licensure nursing program provided classroom instruction, textbooks, or clinical experiences in a language other than English, a test of written, oral, and spoken English is required. Clinical experiences are deemed to have been provided in a language other than English if the principal or official language of the country or region where the clinical experience occurred is a language other than English, according to the United States Department of State.

4. An applicant who is required to demonstrate English language proficiency shall ensure that one of the following is submitted to the Board directly from the testing or certifying agency:

a. Evidence of a minimum score of 84 with a minimum speaking score of 26 on the Internet-based Test of English as a Foreign Language (TOEFL),

b. Evidence of a minimum score of 6.5 overall with minimum of 6.0 on each module of the Academic Exam of the International English Language Test Service (IELTS) Examination,

c. Evidence of a minimum score of 55 overall with a minimum score of 50 on each section of the Pearson Test of English Academic exam.

d. A Visa Screen Certificate from CGFNS,

e. A CGFNS Certificate,

f. Evidence of a similar minimum score on another written and spoken English proficiency exam determined by the Board to be equivalent to the other exams in this subsection, or

g. Evidence of employment for a minimum of 960 hours within the past five years as a nurse in a country or territory where the principal language is English, according to the United States Department of State.

D. An applicant for a registered nurse license shall attain one of the following:

1. A passing score on the NCLEX-RN;

2. A score of 1600 on the NCLEX-RN, if the examination was taken before July 1988; or

3. A score of not less than 350 on each part of the SBTPE for registered nurses.

E. An applicant for a practical nurse license shall attain:

1. A passing score on the NCLEX-PN;

2. A score of not less than 350 on the NCLEX-PN, if the examination was taken before October 1988; or

3. A score of not less than 350 on the SBTPE for practical nurses.

F. The Board shall grant a license to practice as a registered or practical nurse to any applicant who meets the criteria established in statute and this Article. An applicant who is denied a license by examination may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the license. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10.

G. If the Board receives an application from a graduate of a nursing program and the program's approval was rescinded under R4-19-212 at any time during the applicant's nursing education, the Board shall ensure that the applicant has completed a basic curriculum that is equivalent to that of a Board-approved nursing program and may do any of the following:

1. Grant licensure, if the program's approval was reinstated during the applicant's period of enrollment and the program provides evidence that the applicant completed a curriculum equivalent to that of a Board-approved nursing program;

2. By order, require successful completion of remedial education while enrolled in a Board approved nursing program which may include clinical experiences, before granting licensure; or

3. Return or deny the application if the education was not equivalent and no remediation is possible.

Historical Note

Former Section II, Part I; Amended effective January 20, 1975 (Supp. 75-1). Amended effective December 7, 1976 (Supp. 76-5). Former Section R4-19-24 repealed, new Section R4-19-24 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-24 repealed, new Section R4-19-24 adopted effective May 9, 1984 (Supp. 84-3). Former Section R4-19-24 renumbered as Section R4-19-301 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 13 A.A.R. 1483, effective June 2, 2007 (Supp. 07-2). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-302. Licensure by Endorsement

A. An applicant for a license by endorsement shall submit all of the information required in R4-19-301(A).

B. In addition to the information required in subsection (A), an applicant for a license by endorsement shall:

1. Submit evidence of a passing examination score in accordance with:

a. R4-19-301(E) for a registered nurse applicant, or

b. R4-19-301(F) for a practical nurse applicant.

2. Submit the following:

a. Evidence of previous or current license in another state or territory of the United States,

b. Information related to the nurse’s practice for the purpose of collecting nursing workforce data, and

c. One of the following:

i. Completion of a pre-licensure nursing program that has been assigned a nursing program code by the National Council of State Boards of Nursing (NCSBN) at the time of program completion and the program meets educational standards substantially comparable to Board standards for educational programs in Article 2;

ii. If the applicant completed a pre-licensure nursing program that has been assigned a program code by the NCSBN but the program's approval was rescinded under A.R.S. § 32-1606(B)(8) or removed from the list of approved programs under A.R.S. § 32-1644(D) or R4-19-212 during the applicant's enrollment in the program, proof of completion of the program and completion of any remedial education required by the Board to mitigate the deficiencies in the applicant's initial nursing program;

iii. If the applicant graduated from a U.S. nursing program before 1986 and the applicant was issued an initial license in another state or territory of the United States without being required to obtain additional education or experience, proof both of program completion and initial licensure without additional educational or experiential requirements;

iv. If the applicant graduated from an international nursing program, proof of meeting the requirements in R4-19-301.

v. If the Board finds that the documentation submitted by the applicant does not fulfill one of the requirements in (B)(2)(b)(i) through (iv), but the applicant has submitted verified employer evaluations demonstrating applicant’s safe practice as a registered or practical nurse in another state for a minimum of two years full-time during the past three years and applicant otherwise meets licensure requirements, the Board may grant a single-state only license if the Board determines that licensure is in the best interest of the public.

C. The Board shall grant a license to practice as a registered or practical nurse to any applicant who meets the criteria established in statute and this Article. An applicant who is denied a license by endorsement may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the license. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10.

Historical Note

Former Section II, Part II; Amended effective December 7, 1976 (Supp. 76-5). Former Section R4-19-25 repealed, new Section R4-19-25 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-25 repealed, new Section R4-19-25 adopted effective May 9, 1984 (Supp. 84-3). Former Section R4-19-25 renumbered and amended as Section R4-19-302 effective February 21, 1986 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 13 A.A.R. 1483, effective June 2, 2007 (Supp. 07-2). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-303. Requirements for Credential Evaluation Service

A. A CES seeking Board approval shall submit documentation to the Board demonstrating that it:

1. Provides a credential evaluation to determine comparability of registered nurse or practical nurse programs in other countries to nursing education in the United States;

2. Evaluates original source documents;

3. Has five or more years of experience in evaluating nursing educational programs or employs personnel that have this experience;

4. Employs staff with expertise in evaluating nursing programs;

5. Has access to resources pertinent to the field of nursing education and the evaluation of nursing programs;

6. Issues a report on each applicant, and supplies the Board with a sample of such a report, regarding the comparability of the applicant’s nursing educational program to nursing education in the United States that includes:

a. The current name of the applicant including any names formerly used by the applicant;

b. Source and description of the documents evaluated;

c. Name and nature of the nursing education program, including status of the parent institution;

d. Dates applicant attended;

e. References consulted;

f. A seal or some other security measure;

g. Notification of any falsification or misrepresentation of documents by the applicant;

h. A report on licensure examination results for the applicant, if an exam was required for licensure in the international jurisdiction; and

i. The status of any international nursing licenses held by the applicant.

7. Has a quality control program that includes at a minimum:

a. Standards regarding the use of original documents;

b. Verification of authenticity of documents and translations;

c. Processes and procedures to prevent and detect fraud;

d. Policies for maintaining confidentiality of applicant educational records;

e. Responsiveness to applicants, including ensuring that reports are issued no later than eight weeks from the receipt of an applicant’s documents; and

f. Tracking of and notification to the Board of any trends in falsification or misrepresentation of documents;

8. Follows or exceeds the standards of the National Association of Credentialing Services (NACES) or an equivalent organization;

9. Responds to Board requests for information in a timely and thorough manner; and

10. Agrees to notify the Board before any changes in any of the above criteria.

B. If a CES fails to comply with the provisions of subsection (A), the Board may rescind its approval of the CES.

C. The Board shall approve a credential evaluation service that meets the criteria established in this Section. A CES applicant who is denied approval or whose approval is revoked may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying the approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10.

Historical Note

Former Section II, Part III; Former Section R4-19-26 repealed, new Section R4-19-26 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-26 renumbered and amended as Section R4-19-27, new Section R4-19-26 adopted effective May 9, 1984 (Supp. 84-3). Former Section R4-19-27 renumbered as Section R4-19-303 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 5 A.A.R. 1802, effective May 18, 1999 (Supp. 99-2). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Former Section R4-19-303 renumbered to R4-19-304; new Section R4-19-303 made by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-304. Temporary License

A. Subject to subsection (B), the Board shall issue a temporary license if:

1. An applicant:

a. Is qualified under:

i. A.R.S. § 32-1635 and applies for a temporary registered nursing license, or is qualified under A.R.S. § 32-1640 and applies for a temporary practical nursing license; and

ii. R4-19-301 for applicants for licensure by examination, or is qualified under R4-19-302 for applicants for licensure by endorsement; and

b. Submits an application for a temporary license with the applicable fee required under A.R.S. § 32-1643(A)(9); and

c. Submits an application for a license by endorsement or examination with the applicable fee required under A.R.S. § 32-1643(A).

2. An applicant is seeking a license by examination, meets the requirements of R4-19-312(C), and the Board receives a report from the Arizona Department of Public Safety (DPS), verifying that DPS has no criminal history record information, as defined in A.R.S. § 41-1701, relating to the applicant or that any criminal history reported has been reviewed by the executive director or the director’s designee and determined not to pose a threat to public health, safety, or welfare; or

3. An applicant is seeking a license by endorsement, meets the requirements in R4-19-312(B), and the applicant submits evidence that the applicant has a current license in good standing in another state or territory of the United States or, if no current license, a previous license in good standing that was not the subject of an investigation or pending discipline; or

4. An applicant who does not meet the practice requirements in R4-19-312(B) or (C), but provides evidence that the applicant has applied for enrollment in a refresher or other competency program approved by the Board, may practice nursing under a temporary license during the clinical portion of the program only.

B. An applicant who has a criminal history, a history of disciplinary action by a regulatory agency, a pending complaint before the Board, or answers affirmatively to any criminal background or disciplinary question in the application is not eligible for a temporary license or extension of a temporary license without Board approval.

C. A temporary license is valid for a maximum of 12 months unless extended for good cause under subsection (D) of this Section.

D. An applicant with a temporary license may apply for and the Board, the Executive Director or the Executive Director’s designee may grant an extension of the temporary license period for good cause. Good cause means reasons beyond the control of the temporary licensee, such as unavoidable delays in obtaining information required for licensure.

E. An applicant who receives a temporary license but does not meet the criteria for a regular license within the established period under subsections (C) and (D) is no longer eligible for a temporary license except for the purpose of completing a refresher or other competency program under subsection (A)(4) of this Section.

Historical Note

Former Section II, Part IV; Amended effective January 20, 1975 (Supp. 75-1). Former Section R4-19-27 repealed, new Section R4-19-27 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-27 renumbered and amended as Section R4-19-28. Former Section R4-19-26 renumbered and amended as Section R4-19-27 effective May 9, 1984 (Supp. 84-3). Former Section R4-19-27 renumbered and amended as Section R4-19-304 effective February 21, 1986 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Former Section R4-19-304 renumbered to R4-19-305; new Section R4-19-304 renumbered from R4-19-303 and amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-305. License Renewal

A. An applicant for renewal of a registered or practical nursing license shall:

1. Submit a verified application to the Board on a form furnished by the Board that provides all of the following information about the applicant:

a. Full legal name, mailing address, telephone number and declared primary state of residence;

b. A listing of all states in which the applicant is currently licensed, or, since the last renewal, was previously licensed or has been denied licensure;

c. Marital status, ethnic category and e-mail address, at the applicant’s discretion;

d. Information regarding qualifications, including:

i. Educational background;

ii. Employment status;

iii. Practice setting; and

iv. Other information related to the nurse’s practice for the purpose of collecting nursing workforce data.

e. Responses to questions regarding the applicant’s background on the following subjects:

i. Criminal convictions for offenses involving drugs or alcohol since the time of last renewal;

ii. Undesignated offenses and felony charges, convictions and plea agreements including deferred prosecution;

iii. Misdemeanor charges, convictions and plea agreements, including deferred prosecution, that are required to be reported under A.R.S. § 32-3208;

iv. Unprofessional conduct as defined in A.R.S. § 32-1601 since the time of last renewal;

v. Substance use disorder within the last five years;

vi. Current participation in an alternative to discipline program in any other state; and

vii. Disciplinary action or investigation related to the applicant’s nursing license by any other state nursing regulatory agency since the last renewal.

f. Explanation and supporting documentation for each affirmative answer to questions regarding the applicant’s background;

g. Information related to the applicant’s current or most recent nursing practice setting, including position, address, telephone number, and dates of practice;

h. Information regarding the applicant’s compliance with the practice or education requirements in R4-19-312;

i. National certification in nursing including specialty, name of certifying body, date of certification, certification number, and expiration date, if applicable; and for an applicant certified as a registered nurse practitioner or clinical nurse specialist the patient population of the certification; and

2. Pay fees for renewal authorized by A.R.S. § 32-1643 (A)(6); and

3. Pay an additional fee for late renewal authorized by A.R.S. § 32-1643(A)(7) if the application for renewal is submitted after May 1 of the year of renewal.

B. A license expires on August 1 of the year of renewal indicated on the license.

C. A licensee who fails to submit a renewal application before expiration of a license shall not practice nursing until the Board issues a renewal license.

D. If the applicant holds a license or certificate that has been or is currently revoked, surrendered, denied, suspended or placed on probation in another jurisdiction, the applicant is not eligible to renew or reactivate a license until a review or investigation has been completed and a decision regarding eligibility for renewal or reactivation is made by the Board.

E. The Board shall renew the license of any registered or practical nurse applicant who meets the criteria established in statute and this Article. An applicant who is denied renewal of a license may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying renewal of the license. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10.

Historical Note

Former Section II, Part V; Repealed effective January 20, 1975 (Supp. 75-1). New Section R4-19-28 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-28 renumbered and amended as Section R4-19-29. Former Section R4-19-27 renumbered and amended as Section R4-19-28 effective May 9, 1984 (Supp. 84-3). Former Section R4-19-28 renumbered and repealed as Section R4-19-305 effective February 21, 1986 (Supp. 86-1). New Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Former Section R4-19-305 renumbered to R4-19-306; new Section R4-19-305 renumbered from R4-19-304 and amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-306. Inactive License

A. A licensee in good standing may submit to the Board either as a separate written document or as part of the renewal application, a request to transfer to inactive status, or retirement status under A.R.S. §§ 32-1606(A)(10) and 32-1636(E).

B. The Board shall send a written notice to the licensee granting inactive or retirement status or denying the request. A licensee denied a request for transfer to inactive or retirement status may request a hearing by filing a written request with the Board within 30 days of service of the denial of the request. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10.

Historical Note

Former Section II, Part VI; Amended effective January 20, 1975 (Supp. 75-1). Amended effective December 7, 1976 (Supp. 76-5). Former Section R4-19-29 repealed, new Section R4-19-29 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-29 renumbered and amended as Section R4-19-30 effective May 9, 1984 (Supp. 84-3). Former Section R4-19-28 renumbered and amended as Section R4-19-29 effective May 9, 1984 (Supp. 84-3). Former Section R4-19-29 renumbered as Section R4-19-306 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Former Section R4-19-306 renumbered to R4-19-307; new Section R4-19-306 renumbered from R4-19-305 and amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-307. Application for a Duplicate License

A. A licensee shall report a lost or stolen license to the Board, in writing or electronically through the Board website, within 30 days of the loss.

B. A licensee requesting a duplicate license shall file an application on a form provided by the Board for a duplicate license and pay the applicable fee under A.R.S. § 32-1643(A)(14).

Historical Note

Former Section II, Part VII; Former Section R4-19-30 renumbered and amended as Section R4-19-45, new Section R4-19-30 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-30 renumbered and amended as Section R4-19-31. Former Section R4-19-29 renumbered and amended as R4-19-30 effective May 9, 1984 (Supp. 84-3). Former Section R4-19-29 renumbered and amended as Section R4-19-307 effective February 21, 1986 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Former Section R4-19-307 renumbered to R4-19-308; new Section R4-19-307 renumbered from R4-19-306 and amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-308. Change of Name or Address

A. A licensee or applicant shall notify the Board, in writing or electronically through the Board website, of any legal change in name within 30 days of the change, and submit a copy of the official document verifying the name change.

B. A licensee or applicant shall notify the Board in writing or electronically through the Board website of any change in mailing address within 30 days.

Historical Note

Former Section II, Part VII; Former Section R4-19-31 repealed, new Section R4-19-31 adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-31 renumbered and amended as Section R4-19-32. Former Section R4-19-30 renumbered and amended as Section R4-19-31 effective May 9, 1984 (Supp. 84-3). Former Section R4-19-31 renumbered as Section R4-19-308 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended effective December 3, 1998 (Supp. 98-4). Amended by final rulemaking at 6 A.A.R. 4819, effective December 7, 2000 (Supp. 00-4). Former Section R4-19-308 renumbered to R4-19-309; new Section R4-19-308 renumbered from R4-19-307 and amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-309. School Nurse Certification Requirements

A. An applicant for initial school nurse certification shall:

1. Hold a current license in good standing or multistate privilege to practice as a registered nurse in Arizona.

2. Submit a verified application to the Board on a form furnished by the Board that provides the following information about the applicant:

a. Full legal name and any former names used by the applicant;

b. Mailing address and telephone number;

c. Registered nurse license number;

d. Social security number;

e. A description of the applicant’s educational background, including the number and location of schools attended, the number of years attended, the date of graduation, the type of degree or certificate awarded, and if applicable, evidence that the applicant has satisfied the requirements specified in subsection (B), (C) or (D);

f. Current employer, including address, telephone number, position type, dates of employment, and previous employer if the current employment is less than 12 months;

g. The name of any national certifying organization, specialty area, certification number and date of certification, if applicable; and for an applicant certified in as a nurse practitioner or clinical nurse specialist, the population of the certification;

h. Responses to questions regarding the applicant’s background on the following subjects:

i. Current investigation or pending disciplinary action by a nursing regulatory agency in the United States or its territories or current investigation in another state or territory of the United States;

ii. Action taken on a nursing license by any other state;

iii. Undesignated offenses, felony charges, convictions and plea agreements, including deferred prosecution;

iv. Misdemeanor charges, convictions and plea agreements, including deferred prosecution, that are required to be reported under A.R.S. § 32-3208:

v. Unprofessional conduct as defined in A.R.S. § 32-1601;

vi. Substance use disorder within the last five years; and

vii. Current participation in an alternative to discipline program in any other state;

i. Explanation and supporting documentation for each affirmative answer to questions regarding the applicant’s background; and

j. E-mail address, ethnic category and marital status at the applicant’s discretion.

3. Pay applicable fees.

B. National certification. In addition to the requirements of subsection (A), if an applicant provides evidence of current national certification as a school nurse or school nurse practitioner from an organization that meets the requirements of R4-19-310, the applicant qualifies for Arizona school nurse certification without meeting the requirements in subsection (C) for as long as the national certification remains current. The nurse shall provide evidence of continuing certification upon each renewal under subsection (D).

C. Initial certification

1. In addition to the requirements in subsection (A), the registered nurse applicant shall provide evidence of completion of all the following:

a. Three semester hours in school nurse practice course work;

b. Three semester hours in physical assessment of the school-aged child course work unless the applicant provides evidence of current national certification from an organization that meets the requirements of R4-19-310 as a pediatric nurse practitioner, family nurse practitioner, or pediatric clinical nurse specialist; and

c. Three semester hours in nursing care of the child with special needs.

2. An initial certificate expires six years after the issue date on the certificate.

D. Renewal of certification.

1. If the initial certificate of a school nurse has expired and the applicant, has met the requirements in subsections (B) or (C)(1) of this Section, the applicant is eligible to apply for re-certification. Within the application, the applicant shall provide evidence of completion of one of the following for renewal of certification:

a. Current national certification as a school nurse as specified in subsection (B),

b. A bachelor of science or graduate degree in nursing earned from an accredited institution as specified in R4-19-201(A) within the last six years, or

c. Evidence of completion of a minimum of 90 contact hours of continuing education activity, as defined in R4-19-101, related to school nursing practice and completed within the last six years.

2. Renewal of certification expires six years after the issue date on the certificate.

E. The Board shall grant a school nurse certificate to any applicant who meets the criteria established in statute and this Article. An applicant who is denied a school nurse certificate may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying the certificate. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10.

Historical Note

Former Section II, Part IX; Repealed effective February 20, 1980 (Supp. 80-1). Former Section R4-19-31 renumbered and amended as Section R4-19-32 effective May 9, 1984 (Supp. 84-3). Former Section R4-19-32 renumbered as Section R4-19-309 (Supp. 86-1). Repealed effective July 19, 1995 (Supp. 95-3). New Section made by final rulemaking at 8 A.A.R. 1813, effective March 20, 2002 (Supp. 02-1). Former Section R4-19-309 renumbered to R4-19-311; new Section R4-19-309 renumbered from R4-19-308 and amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-310. Certified Registered Nurse

A registered nurse who has been certified by a nursing certification organization accredited by the Accreditation Board for Specialty Nursing Certification, the National Commission for Certifying Agencies, or an equivalent accrediting agency as determined by the Board is deemed certified for the purposes of A.R.S. § 32-1601(4).

Historical Note

New Section made by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-311. Nurse Licensure Compact

The Board shall implement A.R.S. §§ 32-1668 and 32-1669 according to the provisions of the Nurse Licensure Compact Model Rules and Regulations, published by the National Council of State Boards of Nursing, Inc., 111 E. Wacker Dr., Suite 2900, Chicago, IL, 60601, www.ncsbn.org, August 4, 2008, and no later amendments or editions, which is incorporated by reference and on file with the Board.

Historical Note

New Section renumbered from R4-19-309 and amended by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Amended by final rulemaking at 18 A.A.R. 2485, effective September 11, 2012 (Supp. 12-3).

R4-19-312. Practice Requirement

A. The Board shall not issue a license or renew the license of an applicant who does not meet the applicable requirements in subsections (B), (C), and (D).

B. An applicant for licensure by endorsement or renewal shall either have completed a post-licensure nursing program or practice nursing at the applicable level of licensure for a minimum of 960 hours in the five years before the date on which the application is received. This requirement is satisfied if the applicant verifies that the applicant has:

1. Completed a post-licensure nursing education program at a school that is accredited under R4-19-201(A) and obtained a degree, or an advanced practice certificate in nursing within the past five years; or

2. Practiced for a minimum of 960 hours within the past five years where the nurse:

a. Worked for compensation or as a volunteer, as a licensed nurse in the United States or an international jurisdiction, and performed one or more acts under A.R.S. § 32-1601(20) as an RN if applying for RN renewal or licensure or A.R.S. § 32-1601(16) as an LPN if applying for LPN renewal or licensure; or

b. Held a position for compensation or as a volunteer in the United States or an international jurisdiction that required or recommended, in the job description, the level of licensure being sought or renewed; or

c. Engaged in clinical practice as part of an RN-to-Bachelor of Science in Nursing, Masters, Doctoral or Nurse Practitioner program.

C. Care of family members does not meet the requirements of subsection (B)(2) unless the applicant submits evidence:

1. That the applicant is providing care as part of a medical foster home; or

2. That the specific care provided by the applicant was:

a. Ordered by another health care provider who is authorized to prescribe and was responsible for the care of the patient,

b. The type of care would typically be authorized by a third-party payer, and

c. The care was documented and reviewed by the health care provider.

D. An applicant for licensure by either examination or endorsement, who is a graduate of a nursing program located in the U.S. or its territories and does not meet the requirements of subsection (B), shall have completed the clinical portion of a pre-licensure nursing program within two years of the date of licensure. Examination applicants who were previously licensed in an international jurisdiction shall meet the applicable requirements of subsection (B) or (E).

E. A licensee or applicant who fails to satisfy the requirements of subsection (B) or (D), shall submit evidence of satisfactory completion of a Board-approved refresher or competency program. The Board may issue a temporary license stamped “for refresher course only” to any applicant who meets all requirements of this Article except subsection (B) or (D) and provides evidence of applying for enrollment in a Board-approved refresher or competency program.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citations in subsection (B)(2)(a) were updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

R4-19-313. Background

A. All applicants convicted of a sexual offense involving a minor or performing a sexual act against the will of another person shall be subject to a Board order under A.R.S. § 32-1664(F) and R4-19-405 unless the individual is precluded from licensure under A.R.S. § 32-1606(B)(17). If the evaluation identifies sexual behaviors of a predatory nature, the Board shall deny licensure or renewal of licensure.

B. All individuals reporting a substance use disorder in the last five years may be subject to a Board order for an evaluation under A.R.S. § 32-1664(F) and R4-19-405 to determine safety to practice.

C. The Board may order the evaluation of other individuals on a case-by-case basis under A.R.S. § 32-1664(F) and R4-19-405.

Historical Note

New Section made by final rulemaking at 19 A.A.R. 1308, effective July 6, 2013 (Supp. 13-2).

ARTICLE 4. REGULATION

R4-19-401. Standards Related to Licensed Practical Nurse Scope of Practice

A. A licensed practical nurse shall engage in practical nursing as defined in A.R.S. § 32-1601 only under the supervision of a registered nurse or licensed physician.

B. A LPN’s nursing practice is limited to those activities for which the LPN has been prepared through basic practical nursing education in accordance with A.R.S. § 32-1637(1) and those additional skills that are obtained through subsequent nursing education and within the scope of practice of a LPN as determined by the Board.

C. A LPN shall:

1. Practice within the legal boundaries of practical nursing within the scope of practice authorized by A.R.S. Title 32, Chapter 15 and 4 A.A.C.19;

2. Demonstrate honesty and integrity;

3. Base nursing decisions on nursing knowledge and skills, the needs of clients, and licensed practical nursing standards;

4. Accept responsibility for individual nursing actions, decisions, and behavior in the course of practical nursing practice.

5. Maintain competence through ongoing learning and application of knowledge in practical nursing practice.

6. Protect confidential information unless obligated by law to disclose the information;

7. Report unprofessional conduct, as defined in A.R.S. § 32-1601(22) and further specified in R4-19-403 and R4-19-814, to the Board;

8. Respect a client’s rights, concerns, decisions, and dignity;

9. Maintain professional boundaries; and

10. Respect a client’s property and the property of others.

D. In participating in the nursing process and implementing client care across the lifespan, a LPN shall:

1. Contribute to the assessment of the health status of clients by:

a. Recognizing client characteristics that may affect the client’s health status;

b. Gathering and recording assessment data;

c. Demonstrating attentiveness by observing, monitoring, and reporting signs, symptoms, and changes in client condition in an ongoing manner to the supervising registered nurse or physician;

2. Contribute to the development and modification of the plan of care by:

a. Planning episodic nursing care for a client whose condition is stable or predictable;

b. Assisting the registered nurse or supervising physician in identification of client needs and goals; and

c. Determining priorities of care together with the supervising registered nurse or physician;

3. Implement aspects of a client’s care consistent with the LPN scope of practice in a timely and accurate manner including:

a. Following nurse and physician orders and seeking clarification of orders when needed;

b. Administering treatments, medications, and procedures;

c. Attending to client and family concerns or requests;

d. Providing health information to clients as directed by the supervising RN or physician or according to an established educational plan;

e. Promoting a safe client environment;

f. Communicating relevant and timely client information with other health team members regarding:

i. Client status and progress,

ii. Client response or lack of response to therapies,

iii. Significant changes in client condition, and

iv. Client needs and special requests, and

g. Documenting the nursing care the LPN provided;

4. Contribute to evaluation of the plan of care by:

a. Gathering, observing, recording, and communicating client responses to nursing interventions; and

b. Modifying the plan of care in collaboration with a registered nurse based on an analysis of client responses.

E. A LPN assigns and delegates nursing activities. The LPN shall:

1. Assign nursing care within the LPN scope of practice to other LPNs;

2. Delegate nursing tasks to unlicensed assistive personnel (UAPs). In maintaining accountability for the delegation, the LPN shall ensure that the:

a. UAP has the education, legal authority, and demonstrated competency to perform the delegated task;

b. Tasks delegated are consistent with the UAP’s job description and can be safely performed according to clear, exact, and unchanging directions;

c. Results of the task are reasonably predictable;

d. Task does not require assessment, interpretation, or independent decision making during its performance or at completion;

e. Selected client and circumstances of the delegation are such that delegation of the task poses minimal risk to the client and the consequences of performing the task improperly are not life-threatening;

f. LPN provides clear directions and guidelines regarding the delegated task or, for routine tasks on stable clients, verifies that the UAP follows each written facility policy or procedure when performing the delegated task;

g. LPN provides supervision and feedback to the UAP; and

h. LPN observes and communicates the outcomes of the delegated task.

Historical Note

Former Section III, Part II; Amended effective February 20, 1980 (Supp. 80-1). Former Section R4-19-42 renumbered as Section R4-19-401 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4). Subsection (C)(7) amended at request of Board, Office File No. M11-423, filed November 18, 2011 (Supp. 11-4). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citation in subsection (C)(7) was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3).

R4-19-402. Standards Related to Registered Nurse Scope of Practice

A. A registered nurse (RN) shall perform only those nursing activities for which the RN has been prepared through basic registered nursing education and those additional skills which are obtained through subsequent nursing education and within the scope of practice of an RN as determined by the Board.

B. A RN shall:

1. Practice within the legal boundaries of registered nursing within the scope of practice authorized by A.R.S. Title 32, Chapter 15 and 4 A.A.C. 19;

2. Demonstrate honesty and integrity;

3. Base nursing decisions on nursing knowledge and skills, the needs of clients, and registered nursing standards;

4. Accept responsibility for individual nursing actions, decisions, and behavior in the course of registered nursing practice;

5. Maintain competence through ongoing learning and application of knowledge in registered nursing practice;

6. Protect confidential information unless obligated by law to disclose the information;

7. Report unprofessional conduct, as defined in A.R.S. § 32-1601(22) and further specified in R4-19-403 and R4-19-814, to the Board;

8. Respect a client’s rights, concerns, decisions, and dignity;

9. Maintain professional boundaries;

10. Respect a client’s property and the property of others; and

11. Advocate on behalf of a client to promote the client’s best interest.

C. In utilizing the nursing process to plan and implement nursing care for clients across the life-span, a RN shall:

1. Conduct a nursing assessment of a client in which the nurse:

a. Recognizes client characteristics that may affect the client’s health status;

b. Gathers or reviews comprehensive subjective and objective data and detects changes or missing information;

c. Applies nursing knowledge in the integration of the biological, psychological, and social aspects of the client’s condition; and

d. Demonstrates attentiveness by providing ongoing client surveillance and monitoring;

2. Use critical thinking and nursing judgment to analyze client assessment data to:

a. Make independent nursing decisions and formulate nursing diagnoses; and

b. Determine the clinical implications of client signs, symptoms, and changes, as either expected, unexpected, or emergent situations;

3. Based on assessment and analysis of client data, plan strategies of nursing care and nursing interventions in which the nurse;

a. Identifies client needs and goals;

b. Formulates strategies to meet identified client needs and goals;

c. Modifies defined strategies to be consistent with the client’s overall health care plan; and

d. Prioritizes strategies based on client needs and goals;

4. Provide nursing care within the RN scope of practice in which the nurse:

a. Administers prescribed aspects of care including treatments, therapies, and medications;

b. Clarifies health care provider orders when needed;

c. Implements independent nursing activities consistent with the RN scope of practice;

d. Institutes preventive measures to protect client, others, and self;

e. Intervenes on behalf of a client when problems are identified;

f. Promotes a safe client environment;

g. Attends to client concerns or requests;

h. Communicates client information to health team members including:

i. Client concerns and special needs;

ii. Client status and progress;

iii. Client response or lack of response to interventions; and

iv. Significant changes in client condition; and

i. Documents the nursing care the RN has provided;

5. Evaluate the impact of nursing care including the:

a. Client’s response to interventions;

b. Need for alternative interventions;

c. Need to communicate and consult with other health team members; and

d. Need to revise the plan of care;

6. Provide comprehensive nursing and health care education in which the RN:

a. Assesses and analyzes educational needs of learners;

b. Plans educational programs based on learning needs and teaching-learning principles;

c. Ensures implementation of an educational plan either directly or by delegating selected aspects of the education to other qualified persons; and

d. Evaluates the education to meet the identified goals;

D. A RN assigns and delegates nursing activities. The RN shall:

1. Assign nursing care within the RN scope of practice to other RNs;

2. Assign nursing care to a LPN within the LPN scope of practice based on the RN’s assessment of the client and the LPN’s ability;

3. Supervise, monitor, and evaluate the care assigned to a LPN; and

4. Delegate nursing tasks to UAPs. In maintaining accountability for the delegation, an RN shall ensure that the:

a. UAP has the education, legal authority, and demonstrated competency to perform the delegated task;

b. Tasks delegated are consistent with the UAP’s job description and can be safely performed according to clear, exact, and unchanging directions;

c. Results of the task are reasonably predictable;

d. Task does not require assessment, interpretation, or independent decision making during its performance or at completion;

e. Selected client and circumstances of the delegation are such that delegation of the task poses minimal risk to the client and the consequences of performing the task improperly are not life-threatening;

f. RN provides clear directions and guidelines regarding the delegated task or, for routine tasks on stable clients, verifies that the UAP follows each written facility policy or procedure when performing the delegated task;

g. RN provides supervision and feedback to the UAP; and

h. RN observes and communicates the outcomes of the delegated task.

Historical Note

Former Section III, Part I; Amended effective February 20, 1980 (Supp. 80-1). Former Section R4-19-43 renumbered as Section R4-19-402 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Section repealed, new Section made by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4). Subsection (B)(7) amended at request of Board, Office File No. M11-423, filed November 18, 2011 (Supp. 11-4). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citation in subsection (B)(7) was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3).

R4-19-403. Unprofessional Conduct

For purposes of A.R.S. § 32-1601(22)(d), any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public includes one or more of the following:

1. A pattern of failure to maintain minimum standards of acceptable and prevailing nursing practice;

2. Intentionally or negligently causing physical or emotional injury;

3. Failing to maintain professional boundaries or engaging in a dual relationship with a patient, resident, or any family member of a patient or resident;

4. Engaging in sexual conduct with a patient, resident, or any family member of a patient or resident who does not have a pre-existing relationship with the nurse, or any conduct in the work place that a reasonable person would interpret as sexual;

5. Abandoning or neglecting a patient who requires immediate nursing care without making reasonable arrangement for continuation of care;

6. Removing a patient’s life support system without appropriate medical or legal authorization;

7. Failing to maintain for a patient record that accurately reflects the nursing assessment, care, treatment, and other nursing services provided to the patient;

8. Falsifying or making a materially incorrect, inconsistent, or unintelligible entry in any record:

a. Regarding a patient, health care facility, school, institution, or other work place location; or

b. Pertaining to obtaining, possessing, or administering any controlled substance as defined in the federal Uniform Controlled Substances Act, 21 U.S.C. 801 et seq., or Arizona’s Uniform Controlled Substances Act, A.R.S. Title 36, Chapter 27;

9. Failing to take appropriate action to safeguard a patient’s welfare or follow policies and procedures of the nurse’s employer designed to safeguard the patient;

10. Failing to take action in a health care setting to protect a patient whose safety or welfare is at risk from incompetent health care practice, or to report the incompetent health care practice to employment or licensing authorities;

11. Failing to report to the Board a licensed nurse whose work history includes conduct, or a pattern of conduct, that leads to or may lead to an adverse patient outcome;

12. Assuming patient care responsibilities that the nurse lacks the education to perform, for which the nurse has failed to maintain nursing competence, or that are outside the scope of practice of the nurse;

13. Failing to supervise a person to whom nursing functions are delegated;

14. Delegating services that require nursing judgment to an unauthorized person;

15. Removing, without authorization, any money, property, or personal possessions, or requesting payment for services not performed from a patient, employer, co-worker, or member of the public.

16. Removing, without authorization, a narcotic, drug, controlled substance, supply, equipment, or medical record from any health care facility, school, institution, or other work place location;

17. A pattern of using or being under the influence of alcohol, drugs, or a similar substance to the extent that judgment may be impaired and nursing practice detrimentally affected, or while on duty in any health care facility, school, institution, or other work location;

18. Obtaining, possessing, administering, or using any narcotic, controlled substance, or illegal drug in violation of any federal or state criminal law, or in violation of the policy of any health care facility, school, institution, or other work location at which the nurse practices;

19. Providing or administering any controlled substance or prescription-only drug for other than accepted therapeutic or research purposes;

20. Engaging in fraud, misrepresentation, or deceit in taking a licensing examination or on an initial or renewal application for a license or certificate;

21. Impersonating a nurse licensed or certified under this Chapter;

22. Permitting or allowing another person to use the nurse’s license for any purpose;

23. Advertising the practice of nursing with untruthful or misleading statements;

24. Practicing nursing without a current license or while the license is suspended;

25. Failing to:

a. Furnish in writing a full and complete explanation of a matter reported pursuant to A.R.S. § 32-1664, or

b. Respond to a subpoena issued by the Board;

26. Making a written false or inaccurate statement to the Board or the Board’s designee in the course of an investigation;

27. Making a false or misleading statement on a nursing or health care related employment or credential application concerning previous employment, employment experience, education, or credentials;

28. If a licensee or applicant is charged with a felony or a misdemeanor involving conduct that may affect patient safety, failing to notify the Board in writing, as required under A.R.S. § 32-3208, within 10 days of being charged. The licensee or applicant shall include the following in the notification:

a. Name, address, telephone number, social security number, and license number, if applicable;

b. Date of the charge; and

c. Nature of the offense;

29. Failing to notify the Board, in writing, of a conviction for a felony or an undesignated offense within 10 days of the conviction. The nurse or applicant shall include the following in the notification:

a. Name, address, telephone number, social security number, and license number, if applicable;

b. Date of the conviction; and

c. Nature of the offense;

30. For a registered nurse granted prescribing privileges, any act prohibited under R4-19-511(D); or

31. Practicing in any other manner that gives the Board reasonable cause to believe the health of a patient or the public may be harmed.

Historical Note

Adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-44 repealed, new Section R4-19-44 adopted effective May 9, 1984 (Supp. 84-3). Amended by adding Paragraphs 18 through 22 effective July 16, 1984 (Supp. 84-4). Former Section R4-19-44 renumbered and amended as Section R4-19-403 effective February 21, 1986 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4). Antiquated statute reference in opening subsection revised at the request of Board under A.R.S. § 41-1011(C), Office File No. M11-189, filed May 16, 2011 (Supp. 11-2). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citation in the opening subsection was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3).

R4-19-404. Re-issuance or Subsequent Issuance of License

A. The Board may restore a license to a nurse whose license has been suspended after the period of suspension if the licensee provides written evidence that all requirements or conditions prescribed or ordered in the consent agreement or Board order for suspension have been met to the satisfaction of the Board. The Board may place conditions or limitations on the restored license. The license of a nurse who fails to provide such evidence of fulfilling the requirements or conditions prescribed by the Board shall remain on suspended status until such submission and acceptance by the Board.

B. A person whose nursing license is denied, revoked, or voluntarily surrendered under A.R.S. § 32-1663 may apply to the Board to issue or re-issue the license:

1. Five years from the date of denial or revocation, or

2. In accordance with the terms of a voluntary surrender agreement.

C. A person who applies for issuance or re-issuance of a license under the conditions of subsection (B) is subject to the following terms and conditions:

1. The person shall submit a written application for issuance or re-issuance of the license that contains substantial evidence that the basis for surrendering, denying, or revoking the license has been removed and that the issuance or re-issuance of the license will not be a threat to public health or safety.

2. Safe practice.

a. Under A.R.S. § 32-1664(F), the Board for reasonable cause may require a combination of mental, physical, nursing competency, psychological, or psychiatric evaluations, or any combination of evaluations, reports, and affidavits that the Board considers necessary to determine the person’s competence and conduct to safely practice nursing.

b. Under A.R.S. 32-1664(K) the Board may issue subpoenas and compel the attendance of witnesses and the production of records and documentary evidence relevant to the person’s ability to safely practice nursing.

3. After receipt of the application, the information required under subsection (C)(2), and the completion of an investigation, the Board shall place the application on the agenda of a regularly scheduled Board meeting.

4. After consideration of the application and any information required under subsection (C)(2),the Board may:

a. Grant the license with or without conditions or limitations;

b. If other licensure requirements have been met, grant, with or without conditions, a temporary license for the sole purpose of allowing the applicant to successfully complete an approved nurse refresher course; or

c. Deny the license if the Board determines that licensure might be harmful or dangerous to the health of a patient or the public.

5. If the Board orders a refresher course described in subsection (C)(4)(b) the Board shall consider the applicant’s performance in the approved refresher course and any other evidence, if available, of the applicant’s safety to practice, and either deny the license under subsection (C)(4)(c) or grant the license with or without conditions or limitations.

6. An applicant who is denied issuance or re-issuance of a license shall have 30 days from the date of issuance of the notice of denial from the Board to file a written request for hearing with the Board. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Former Section R4-19-30 renumbered and amended as Section R4-19-45 effective February 20, 1980 (Supp. 80-1). Former Section R4-19-45 renumbered as Section R4-19-404 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4).

R4-19-405. Board-ordered Evaluations

A. Under A.R.S. § 32-1664(F), the Board may order a licensee or CNA certificate-holder to undergo an evaluation by an independent qualified evaluator for the purposes of determining the licensee’s or certificate holder’s safety and competence to practice. Evaluations may be in the areas of:

1. Nursing knowledge or skills or both;

2. Mental functioning, including but not limited to neuropsychological evaluation, and other cognition evaluations;

3. Medical status including but not limited to medical review of drug screen results, chronic pain evaluation, physical examination, and biological testing;

4. Psychiatric or psychological status including but not limited to substance abuse evaluation, boundary or sexual misconduct evaluations, and psychological testing; or

5. Other similar evaluations that the Board determines are necessary to evaluate a licensee or certificate holder’s ability to safely practice.

B. Before making the decision to order the evaluation, the Board shall review the allegations and investigative findings.

C. The Board retains the discretion to use an evaluator based on the evaluator’s licensure history, the Board’s past experience with the evaluator, and the quality of the evaluation provided. Before conducting a Board-ordered evaluation, a potential evaluator shall submit documentation that the evaluator:

1. Possesses expertise and educational credentials in the area that the Board has ordered an evaluation;

2. Holds a license or certificate in good standing with a licensing or certifying board located in the United States and discloses any past licensure disciplinary actions and criminal history;

3. Will provide equipment and environmental conditions necessary to conduct a valid evaluation;

4. Has no current or past treatment, collegial, or social relationship with the licensee or certificate holder, any family member of the licensee or certificate holder, or the licensee’s or certificate holder’s legal counsel;

5. Will not enter into a treatment relationship with the licensee or certificate holder unless the relationship is unavoidable due to geographical location or the specific expertise of the evaluator; and

6. Agrees to keep information provided by the Board under subsection (D) confidential as evidenced by a signed confidentiality agreement provided by the Board.

D. Upon receipt of the evaluator’s signed confidentiality agreement, the Board may provide confidential investigative information and documents to the evaluator for the purpose of disclosing the reason for the evaluation, the focus of the evaluation, and the conduct causing the Board to order the evaluation including:

1. The complaint and all information that has been received during the investigation of the complaint. Documents may include but are not limited to employment records, medical records, arrest records, conviction and sentencing records, excluding FBI fingerprint results, drug screen results, pharmacy profiles, witness statements, past licensure history, and a summary of information obtained during investigative interviews; and

2. The specific questions for which the Board is seeking answers; and

E. The evaluator shall provide the following information to the Board:

1. A professional report that is objective, thorough, timely, accurate, and defensible;

2. Evaluation findings including diagnosis if appropriate and assessment of ability to practice safely;

3. Recommendations for further evaluation, treatment, and remediation; and

4. Suggestions for assuring safe practice and compliance with treatment and remediation recommendations, if any.

Historical Note

Adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-46 renumbered and amended as Section R4-19-405 effective February 21, 1986 (Supp. 86-1). Repealed effective July 19, 1995 (Supp. 95-3). New Section made by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4).

ARTICLE 5. ADVANCED PRACTICE REGISTERED NURSING

R4-19-501. Roles and Population Foci of Advanced Practice Registered Nursing (APRN); Certification Programs

A. The Board recognizes the following APRN roles;

1. Registered nurse practitioner (RNP) in a population focus including Certified Nurse Midwife as a population focus of RNP;

2. Clinical Nurse Specialist (CNS) in a population focus; and

3. Certified Registered Nurse Anesthetist (CRNA).

B. RNPs and CNSs shall practice within one or more population foci, consistent with their education and certification. Population foci include:

1. Family-individual across the life span;

2. Adult-gerontology primary or acute care;

3. Neonatal;

4. Pediatric primary or acute care;

5. Women’s health-gender related;

6. Psychiatric-mental health;

7. For Certified Nurse Midwives, women’s health gender related including childbirth and neonatal care;

8. Other foci that have been recognized by the Board previously and new foci that meet the following conditions:

a. There is an accredited educational program and a national certifying process that meets the requirements of subsection (C); and

b. The focus is broad enough for an educational program to be developed that prepares a registered nurse to function both within the scope of practice of the role and population focus.

C. The Board shall accept advanced practice certifications from programs that meet the following qualifications:

1. The certification program:

a. Is accredited by the National Commission for Certifying Agencies, the Accreditation Board for Specialty Nursing Certification, or an equivalent organization as determined by the Board;

b. Establishes educational requirements for certification that are consistent with the requirements in R4-19-505;

c. Has an application process and credential review that requires an applicant to submit original source documentation of the applicant's education and clinical practice in the advanced practice role and population focus, if applicable, for which certification is granted; and

d. Is national in the scope of its credentialing.

2. The certification program uses an examination as a basis for certification in the advanced practice role and population focus, as applicable that meets all of the following criteria:

a. The examination is based upon job analysis studies conducted using standard methodologies acceptable to the testing community both initially and every five years;

b. The examination assesses entry-level practice in the advanced practice role and population focus, if applicable;

c. The examination assesses the knowledge, skills, and abilities essential for the delivery of safe and effective advanced nursing care to clients;

d. Examination items are reviewed for content validity, cultural sensitivity, and correct scoring using an established mechanism, both before first use and periodically; items are reviewed for currency at least every three years;

e. The examination is evaluated for psychometric performance and conforms to psychometric standards that are routinely utilized for other types of high-stakes testing;

f. The passing standard is established using accepted psychometric methods and is re-evaluated periodically;

g. Examination security is maintained through established procedures;

h. A re-take policy is in place; and

i. Conditions for taking the certification examination are consistent with standards of the testing community;

3. Certification is issued upon passing the examination and meeting all other certification requirements;

4. The certification program periodically provides for re-certification that includes review of qualifications and continued competence;

5. The certification program provides timely communication to the Board regarding licensee or applicant certification status, changes in an individual’s certification status, exam results and changes in the certification program, including qualifications, test plan, and scope of practice; and

6. The certification program has an evaluation process to provide quality assurance in its certificate program.

D. The Board shall determine whether a certification program meets the requirements of this Section. The following certification programs meet the requirements of this Section as of the effective date of this rulemaking:

1. For RNP:

a. American Academy of Nurse Practitioner certification programs;

i. Adult nurse practitioner,

ii. Family nurse practitioner,

iii. Gerontologic nurse practitioner,

iv. Adult health-gerontological nurse practitioner.

b. American Nurses Credentialing Center certification programs:

i. Acute care nurse practitioner (adult/gerontology),

ii. Adult nurse practitioner,

iii. Family nurse practitioner,

iv. Gerontological nurse practitioner,

v. Pediatric nurse practitioner,

vi. Adult psychiatric and mental health nurse practitioner,

vii. Family psychiatric and mental health nurse practitioner,

viii. Adult health-gerontological nurse practitioner,

c. Pediatric Nursing Certification Board certification programs:

i. Pediatric nurse practitioner primary care,

ii. Pediatric nurse practitioner acute care,

d. National Certification Corporation for Obstetric, Gynecological, and Neonatal Nursing Specialties certification programs;

i. Women's health nurse practitioner,

ii. Neonatal nurse practitioner,

e. For a nurse-midwife, the American Midwifery Certification Board certification program in nurse midwifery,

f. AACN Certification Corporation certification programs:

i. Adult acute care nurse practitioner,

ii. Adult-gerontology acute care nurse practitioner,

2. For CNS:

a. AACN Certification Corporation certification programs:

i. Adult acute and critical care CNS,

ii. Pediatric acute and critical care CNS,

iii. Neonatal acute and critical care CNS,

b. American Nurses Credentialing Center certification:

i. Adult psychiatric-mental health CNS,

ii. Family psychiatric-mental health CNS,

iii. Gerontological CNS,

iv. Adult health CNS,

v. Pediatric CNS.

3. For CRNA, National Board of Certification and Recertification for Nurse Anesthetists.

E. The Board shall approve a certification program that meets the criteria established in this Section. An entity that seeks approval of a certification program and is denied approval may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10.

Historical Note

Former Section IV, Part I. Former Section R4-19-53 renumbered as Section R4-19-501 (Supp. 86-1). Former Section R4-19-501 renumbered to R4-19-502, new Section R4-19-501 adopted effective November 18, 1994 (Supp. 94-4). Amended effective November 25, 1996 (Supp. 96-4). Amended by final rulemaking at 7 A.A.R. 3213, effective July 12, 2001 (Supp. 01-3). Amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (05-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-502. Requirements for APRN Programs

A. An educational institution or other entity that offers an APRN program in this state for RNP or CNS roles shall ensure that the program:

1. Is offered by or affiliated with a college or university that is accredited under A.R.S. § 32-1644;

2. For new programs, the college or university offering the program has at least one additional nationally accredited nursing program as defined in R4-19-101 or otherwise provides substantial evidence of the ability to attain national APRN program accreditation for all graduating cohorts;

3. Is a formal educational program, that is part of a masters or doctoral program or a post-masters program in nursing with a concentration in an advanced practice registered nursing role and population focus under R4-19-501;

4. Is nationally accredited, or has achieved candidacy status for national accreditation by an approved national nursing accrediting agency as defined in R4-19-101;

5. Offers a curriculum that covers the scope of practice for both the role of advanced practice as specified in A.R.S. § 32-1601 and the population focus including;

a. Three separate graduate level courses in:

i. Advanced physiology and pathophysiology, including general principles across the lifespan;

ii. Advanced health assessment, which includes assessment of all human systems, advanced assessment techniques, concepts and approaches;

iii. Advanced pharmacology, which includes pharmacodynamics, pharmacokinetics and pharmacotherapeutics of all broad category agents;

b. Diagnosis and management of diseases across practice settings including diseases representative of all systems;

c. Preparation that provides a basic understanding of the principles for decision making in the identified role;

d. Preparation in the core competencies for the identified APRN role including legal, ethical and professional responsibilities; and

e. Role preparation in an identified population focus under R4-19-501.

6. Verifies that each student has an unencumbered license to practice as an RN in the state of clinical practice;

7. Includes a minimum of 500 hours of faculty supervised clinical practice (programs that prepare students for more than one role or population focus shall have 500 hours of clinical practice in each role and population focus);

8. Notifies the Board of any changes in hours of clinical practice, accreditation status, denial or deferral of accreditation or program administrator and responds to Board requests for information;

9. Has financial resources sufficient to support accreditation standards and the educational goals of the program;

10. Establishes academic, professional, and conduct standards that determine admission to the program, progression in the program, and graduation from the program that are consistent with sound educational practices and recognized standards of professional conduct;

11. Establishes provisions for advanced placement for individuals holding a graduate degree in nursing who are seeking education in an APRN role and population focus, provided that advanced placement students master the same APRN competencies as students in the graduate-level APRN program; and

12. Provides the Board an application for approval under the provisions of R4-19-209(B) before making changes to the:

a. Scope of the program, or

b. Level of educational preparation provided.

B. A CNS or RNP program shall appoint the following personnel:

1. An APRN program administrator who:

a. Holds a current unencumbered RN license or multi-state privilege to practice in Arizona and a current unencumbered APRN certificate issued by the Board;

b. Holds an earned doctorate in nursing or health-related field if appointed after the effective date of this Section;

c. Has at least two years clinical experience as an APRN; and

d. Holds current national certification as an APRN.

2. A lead faculty member who is educated and certified both nationally and by the Board in the same role and population focus to coordinate the educational component for the role and population focus in the advanced practice registered nursing program.

3. Nursing faculty to teach any APRN course that includes a clinical learning experience who have the following qualifications:

a. A current unencumbered RN license or multi-state privilege to practice registered nursing in Arizona;

b. A current unencumbered Arizona APRN certificate,

c. A graduate degree in nursing or a health related field in the population focus,

d. Two years of APRN clinical experience, and

e. Current knowledge, competence and certification as an APRN in the role and population focus consistent with teaching responsibilities.

4. Adjunct or part-time clinical faculty employed solely to supervise clinical nursing experiences shall meet all of the faculty qualifications for the APRN program they are teaching.

5. Interdisciplinary faculty who teach non-clinical courses shall have advanced preparation in the areas of course content.

6. Clinical preceptors may be used to enhance faculty-directed clinical learning experiences, but not to replace faculty. A clinical preceptor shall be approved by program administration or faculty and:

a. Hold a current unencumbered license or multistate privilege to practice as a registered nurse or physician in the state in which the preceptor practices or, if employed by the federal government, holds a current unencumbered RN or physician license in the United States;

b. Have at least one year clinical experience as a physician or an advanced practice nurse

c. Practice in a population focus comparable to that of the APRN program;

d. For nurse preceptors, have at least one of the following:

i. Current national certification in the advanced practice role and population focus of the course or program in which the student is enrolled;

ii. Current Board certification in the advanced practice role and population focus of the course or program in which the student is enrolled; or

iii. If an advanced practice preceptor cannot be found who meets the requirements of subsection (B)(6)(d)(i) or (ii), educational and experiential qualifications that will enable the preceptor to precept students in the program, as determined by the nursing program and approved by the Board.

C. An entity that offers a CRNA program in Arizona shall maintain full national program accreditation with no limitations from the Council on Accreditation of Nurse Anesthesia Educational Programs or an equivalent agency approved by the Board. The program shall notify the Board of all program accreditation actions within 30 days of official notification by the accrediting agency.

Historical Note

Former Section IV, Part II; Amended effective February 20, 1980 (Supp. 80-1). Former Section R4-19-54 repealed, new Section R4-19-54 adopted effective July 20, 1981 (Supp. 81-4). Former Section R4-19-54 renumbered as Section R4-19-502 (Supp. 86-1). Section repealed, new Section R4-19-502 renumbered from R4-19-501 and Section heading amended effective November 18, 1994 (Supp. 94-4). Section repealed, new Section R4-19-502 adopted effective November 25, 1996 (Supp. 96-4). Amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (05-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-503. Application for Approval of an Advanced Practice Registered Nursing Program; Approval by Board

A. An administrator of an educational institution that proposes to offer a CNS or RNP program shall submit an application that includes all of the following information to the Board:

1. Role, population focus that meets the criteria in R4-19-501 program administrator and lead faculty member as required in R4-19-502(B);

2. Name, address, and evidence verifying institutional accreditation status of the affiliated educational institution and program accreditation status of current nursing programs offered by the educational institution;

3. The mission, goals, and objectives of the program consistent with generally accepted standards for advanced practice education in the role and population focus of the program;

4. List of the required courses, and a description, measurable objectives, and content outline for each required course consistent with curricular requirements in R4-19-502;

5. A proposed time schedule for implementation of the program and attaining national accreditation;

6. The total hours allotted for both didactic instruction and supervised clinical practicum in the program;

7. A program proposal that provides evidence of sufficient financial resources, clinical opportunities and available faculty and preceptors for the proposed enrollment and planned expansion;

8. A self-study that provides evidence of compliance with R4-19-502;

B. An entity that wishes to offer a CRNA program shall submit evidence of current accreditation by the Council on Accreditation of Nurse Anesthesia Education Programs or an equivalent organization.

C. The Board shall approve an advanced practice registered nursing program if approval is in the best interest of the public and the program meets the requirements of this Article. The Board may grant approval for a period of two years or less to an advanced practice nursing program where the program meets all the requirements of this Article except for accreditation by a national nursing accrediting agency, based on the program's presentation of evidence that it has applied for accreditation and meets accreditation standards.

D. An educational institution or entity that is denied approval of an advanced practice registered nursing program may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying its application for approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

E. Approval of an advanced practice registered nursing program expires 12 months from the date of approval if a class of students is not admitted within that time.

Historical Note

Former Section IV, Part III; Amended effective Nov. 17, 1978 (Supp. 78-6). Amended effective February 20, 1980 (Supp. 80-1). Amended by adding subsection (F) effective July 20, 1981 (Supp. 81-4). Amended by adding subsection (G) effective September 15, 1982 (Supp. 82-5). Former Section R4-19-55 renumbered as Section R4-19-503 (Supp. 86-1). Former Section R4-19-503 repealed, new Section adopted effective November 18, 1994 (Supp. 94-4). Former Section R4-19-503 renumbered to Section R4-19-504; new Section R4-19-503 adopted effective November 25, 1996 (Supp. 86-1). Amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (05-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-504. Notice of Deficiency; Unprofessional Program Conduct

A. The Board may periodically survey an advanced practice registered nursing program under its jurisdiction to determine whether criteria for approval are being met.

B. The Board shall, upon determining that an advanced practice registered nursing program is not in compliance with this Article, provide to the program administrator a written notice of deficiencies that establishes a reasonable time, based upon the number and severity of deficiencies, to correct the deficiencies. The time for correction may not exceed 18 months.

1. The program administrator shall, within 30 days from the date of service of the notice of deficiencies, consult with the Board or designated Board representative and, after consultation, file a plan to correct each of the identified deficiencies.

2. The program administrator may, within 30 days from the date of service of the notice of deficiencies, submit a written request for a hearing before the Board to appeal the Board's determination of deficiencies. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

3. If the Board's determination is not appealed or is upheld upon appeal, the Board may conduct periodic evaluations of the program during the time of correction to determine whether the deficiencies have been corrected.

C. The Board shall, following a Board-conducted survey and report, rescind the approval or limit the ability of a program to admit students if the program fails to comply with R4-19-502 within the time set by the Board in the notice of deficiencies provided to the program administrator.

1. The Board shall serve the program administrator with a written notice of proposed rescission of approval or limitation of admission of students that states the grounds for the rescission or limitation. The program administrator has 30 days to submit a written request for a hearing to show cause why approval should not be rescinded or admissions limited. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

2. Upon the effective date of a decision to rescind program approval, the affected advanced practice registered nursing program shall immediately cease operation and be removed from the official approved-status listing. An advanced practice registered nursing program that is ordered to cease operations shall assist currently enrolled students to transfer to an approved nursing program.

D. A disciplinary action, denial of approval, or notice of deficiency may be issued against an RNP or CNS nursing program for any of the following acts of unprofessional conduct:

1. Failure to maintain minimum standards of acceptable and prevailing educational practice;

2. For a program that was served with a notice of deficiencies within the preceding three years and timely corrected the noticed deficiencies, subsequent noncompliance with the standards in this Article;

3. Utilization of students to meet staffing needs in health care facilities;

4. Non-compliance with the program or parent institution mission or goals, program design, objectives, or policies;

5. Failure to provide the variety and number of clinical learning opportunities necessary for students to achieve program outcomes or minimal competence;

6. Student enrollments without adequate faculty, facilities, or clinical experiences;

7. Ongoing or repetitive employment of unqualified faculty;

8. Failure to comply with Board requirements within designated time-frames;

9. Fraud or deceit in advertising, promoting or implementing a nursing program;

10. Material misrepresentation of fact by the program in any advertisement, application or information submitted to the Board;

11. Failure to allow Board staff to visit the program or conduct an investigation;

12. Any other evidence that gives the Board reasonable cause to believe the program’s conduct may be a threat to the safety and well-being of students, faculty or potential patients.

Historical Note

Former R4-19-504 renumbered to R4-19-505; new R4-19-504 made by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (05-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-505. Requirements for Initial APRN Certification

A. An applicant for certification as an advanced practice registered nurse, shall:

1. Hold a current Arizona registered nurse (RN) license in good standing or an RN license in good standing from a compact party state with multistate privileges; and

2. Submit a verified application to the Board on a form provided by the Board that provides all of the following:

a. Full legal name and all former names used by the applicant;

b. Current mailing address, including primary state of residence and telephone number;

c. Place and date of birth:

d. RN license number, application for RN license, or copy of a multistate compact RN license;

e. Social security number for an applicant who lives or works in the United States;

f. Current e-mail address;

g. Educational background, including the name and location of basic nursing program, the institution that awarded the highest degree held and any and all advanced practice registered nursing education programs or schools attended including the number of years attended, the length of each program, the date of graduation or completion, and the type of degree or certificate awarded;

h. Role and population focus, as applicable for which the applicant is applying;

i. Current employer or practice setting, including address, position, and dates of service, if employed or practicing in nursing or health care;

j. Evidence of national certification or recertification as an advanced practice registered nurse in the role and population focus, if applicable, of the application and by a certification program that meets the requirements of R4-19-501(C). The applicant shall include the name of the certifying organization, population focus, certification number, date of certification, and expiration date;

k. For applicants holding a multistate compact RN license in a state other than Arizona:

i. State of original licensure and license number;

ii. State of current compact RN license, license number and expiration date;

iii. Date of taking RN licensure exam and name of exam;

iv. Whether the applicant ever submitted an application for and was granted an Arizona license and, if applicable, the date of Arizona licensure;

v. Other information related to the nurse’s practice for the purpose of collecting nursing workforce data; and

vi. State of licensure and license number of all RN licenses held,

l. Responses regarding the applicant’s background on the following subjects:

i. Current investigation or pending disciplinary action by a nursing regulatory agency in the United States or its territories;

ii. Undesignated offense and felony charges, convictions and plea agreements including deferred prosecution;

iii. Misdemeanor charges, convictions, and plea agreements, including deferred prosecution, that are required to be reported under A.R.S. § 32-3208;

iv. Actions taken on a nursing license by any other state;

v. Unprofessional conduct as defined in A.R.S. § 32-1601;

vi. Substance use disorder within the last five years;

vii. Current participation in an alternative to discipline program in any other state; and

m. Information that the applicant meets the criteria in R4-19-506(A) or (C).

3. Submit a fingerprint card on a form provided by the Board or prints if the applicant has not submitted fingerprints to the Board within the last two years.

4. Submit an official transcript from an institution accredited under A.R.S. § 32-1644 either sent directly from the institution or obtained from a Board-approved database that provides evidence of:

a. A graduate degree with a major in nursing for RNP and CNS Applicants, or

b. A graduate degree associated with a CRNA program for a CRNA applicant.

5. The applicant shall cause the program to provide the Board with evidence of completion of an APRN program in the role and population focus of the application through submission of an official letter or other official program document sent either directly from the program, or from a Board-approved data base. The APRN program shall meet one of the following criteria during the period of the applicant’s attendance in the program:

a. The program was part of a graduate degree, or post-masters program at an institution accredited under A.R.S. § 32-1644; or

b. The program was approved or recognized in the U.S jurisdiction of program location for the purpose granting APRN licensure or certification.

6. For an applicant who completed an advanced practice or graduate program in a foreign jurisdiction, submit an evaluation from the Commission on Graduates of Foreign Nursing Schools or a Board-approved credential evaluation service that indicates the applicant's program is comparable to a U.S. graduate nursing or APRN program.

7. Submit the required fee.

B. If the applicant satisfies all other requirements, the Board shall continue to certify:

1. An RNP without a graduate degree with a major in nursing if the applicant:

a. Meets all other requirements for certification; and

b. Ensures that the U.S. jurisdiction of an applicant’s previous RNP licensure or certification submits evidence of the applicant’s certification or licensure in the nurse practitioner role and population focus that either is current or was current at least six months before the application was received by the Board, and was originally issued:

i. Before January 1, 2001, if the RNP applicant lacks a graduate degree; or

ii. Before November 13, 2005 if the RNP's graduate degree is in a health-related area other than nursing.

2. An RNP or CNS applicant without evidence of national certification who received initial advanced practice certification or licensure in another state not later than July 1, 2004 and provides evidence, directly from the jurisdiction, that the certification or licensure is current.

3. A CNS applicant without evidence of completion of a CNS program who received initial certification or advanced practice licensure in this or another state not later than November 13, 2005 and provides evidence, directly from the jurisdiction, that the certificate or license is current.

4. A CRNA who completed a CRNA program before the effective date of this Section without evidence of a graduate degree.

5. A CNS applicant who completed a women’s health clinical nurse specialist program that was part of a graduate degree in nursing program under subsection (A), without evidence of national certification upon submission of the following:

a. A description of the applicant's scope of practice that is consistent with A.R.S. § 32-1601(6);

b. One of the following:

i. A letter from a faculty member who supervised the applicant during the graduate program attesting to the applicant's competence to practice within the defined scope of practice;

ii. A letter from a current supervisor verifying the applicant's competence in the defined scope of practice; or

iii. A letter from a physician, RNP, or CNS who has worked with the applicant within the past two years attesting to the applicant's competence in the defined scope of practice; and

c. A form verifying that the applicant has practiced a minimum of 500 hours in the population focus within the past two years, which may include clinical practice time in a CNS program.

C. The Board shall issue a certificate to practice as an RNP in a population focus, a CNS in a population focus, or a registered nurse anesthetist to a registered nurse who meets the criteria in this Section. An applicant who is denied a certificate may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying certification. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective February 20, 1980 (Supp. 80-1). Former Section R4-19-56 repealed, new Section R4-19-56 adopted effective July 16, 1984 (Supp. 84-4). Former Section R4-19-56 renumbered as Section R4-19-504 (Supp. 86-1). Former Section R4-19-504 renumbered to R4-19-505, new Section R4-19-504 adopted effective November 18, 1994 (Supp. 94-4). Former Section R4-19-504 renumbered to Section R4-10-505; new Section R4-19-504 renumbered from R4-19-503 and amended effective November 25, 1996 (Supp. 96-4). Amended effective January 10, 1997 (Supp. 97-1). Amended by final rulemaking at 5 A.A.R. 3911, effective September 28, 1999 (Supp. 99-3). Former R4-19-505 renumbered to R4-19-508; new R4-19-505 renumbered from R4-19-504 and amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 13 A.A.R. 1483, effective June 2, 2007 (Supp. 07-2). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citation in subsection (A)(7)(a) was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-506. Expiration of APRN Certificate; Practice Requirement; Renewal

A. An advanced practice certificate issued after July 1, 2004, expires when the certificate holder's RN license expires. Certificates issued on or before July 1, 2004, or those issued without proof of national certification under R4-19-505(B)(5) and (B)(2) do not expire unless the RN license expires under A.R.S. § 32-1642 or the nurse has not practiced advanced practice nursing at the applicable level of certification for a minimum of 960 hours in the five years before the date the application is received. This requirement is satisfied if the applicant verifies that the applicant has:

1. Completed an advanced practice nursing education program within the past five years; or

2. Practiced for a minimum of 960 hours within the past five years where the nurse:

a. Worked for compensation or as a volunteer, as an APRN and performed one or more acts under A.R.S. § 32-1601(6) for a CNS, A.R.S. § 32-1601(19) for an RNP or A.R.S. § 32-1634.04 for a CRNA; or

b. Held a position for compensation or as a volunteer that required, preferred or recommended, in the job description, the level of advanced practice certification being sought or renewed.

B. A registered nurse requesting renewal of an advanced practice certificate or an RNP certificate issued after July 1, 2004 shall provide evidence of current national certification or recertification under R4-19-505(A)(2)(j). This provision does not apply to a CNS granted a waiver of certification.

C. An advanced practice nurse who does not satisfy the practice requirement of subsection (A) shall complete coursework or continuing education activities at the graduate or advanced practice level that include, at minimum, 45 contact hours of advanced pharmacology and 45 contact hours in a subject or subjects related to the role and population focus of certification. Upon completion of the coursework, the nurse shall engage in a period of precepted clinical practice as specified in this subsection;

1. Precepted clinical practice shall be directly supervised by an advanced practice nurse in the same role and population focus as the certification being renewed or a physician who engages in practice with the same population focus as the certification being renewed.

2. Practice hours completed during the time-frame specified below may be applied to reduce the number of precepted clinical practice hours, except that in no case shall the hours be reduced by more than half the requirement. The nurse shall complete hours according to the following schedule:

a. 300 hours if the applicant has practiced less than 960 hours in only the last five years;

b. 600 hours if the applicant has not practiced 960 hours in the last five years, but has practiced at least 960 hours in the last six years;

c. 1000 hours if the applicant has not practiced at least 960 hours in the last six years, but has practiced 960 hours in the last seven to 10 years; or

d. If the nurse has not practiced 960 hours of advanced practice nursing in the role and population focus being renewed in more than 10 years, complete a program of study as recommended by an approved advanced practice nursing program that includes, at minimum, 500 hours of faculty supervised clinical practice in the role and population focus of certification. An applicant who qualifies for any option in subsection (C)(2)(a) through (c) may complete the requirements of this subsection to satisfy the practice requirement.

D. An applicant who, in addition to not meeting the requirements for continued APRN certification, does not meet the requirements for RN renewal, shall fulfill all RN renewal requirements before satisfying the requirements of this Section.

E. The Board shall renew a certificate to practice as a registered nurse practitioner in a population focus, a clinical nurse specialist in a population focus, or a registered nurse anesthetist for a registered nurse who meets the criteria in this Section. An applicant who is denied renewal of a certificate may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying renewal of certification. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Section R4-19-506 renumbered from R4-19-505 effective November 18, 1994 (Supp. 94-4). Former Section R4-19-506 renumbered to R4-19-510, new Section R4-19-506 adopted effective November 25, 1996 (Supp. 96-4). Former R4-19-506 renumbered to R4-19-510; new Section R4-19-506 made by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 13 A.A.R. 1483, effective June 2, 2007 (Supp. 07-2). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citations in subsection (A)(2)(a) were updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-507. Temporary Advanced Practice Certificate; Temporary Prescribing and Dispensing Authority

A. Based on the registered nurse's qualifications, the Board may issue a temporary certificate to practice as a registered nurse practitioner or a clinical nurse specialist in a population focus or a registered nurse anesthetist. A registered nurse who is applying for a temporary certificate shall:

1. Apply for certification as an advanced practice nurse;

2. Submit an application for a temporary certificate;

3. Demonstrate authorization to practice as a registered nurse in Arizona on either a permanent or temporary Arizona license in good standing or a multistate compact privilege;

4. Meet all requirements of R4-19-505 or meet the requirements of R4-19-505 with the exception of national certification for RNP and CNS applicants unless exempt under R4-19-505(B); and

5. Submit evidence that the applicant:

a. Has applied for and is eligible to take an approved national advanced practice certification exam in the role and population focus of the application;

b. Has requested that the certification program transmit all exam results directly to the Board; or

c. For a CRNA, holds national certification according to R4-19-501.

B. If an applicant fails to meet criteria for national advanced practice certification or has failed a certification exam, the applicant is not eligible for a temporary certificate.

C. The Board may issue temporary prescribing and dispensing authority for RNP applicants, if the applicant:

1. Meets all application requirements for temporary certification in this Section,

2. Applies for and meets all requirements for prescribing and dispensing authority under R4-19-511,

3. Has been certified or licensed as a nurse practitioner or nurse midwife with prescribing and dispensing authority in the same role and population focus in another state or territory of the United States,

4. Either holds current national certification as a registered nurse practitioner or nurse midwife in the population focus of the application or is exempt from national certification under R4-19-505(B), and

5. Meets the practice requirement of R4-19-506(A)(2).

D. Temporary certification as an advanced practice nurse and temporary prescribing and dispensing authority expire in six months and may be renewed for an additional six months for good cause. Good cause means reasons beyond the control of the temporary certificate holder such as unavoidable delays in obtaining information required for certification.

E. Notwithstanding subsection (D), the Board shall withdraw a temporary advanced practice certificate and temporary prescribing and dispensing authority under any one of the following conditions. The temporary certificate holder:

1. Does not meet requirements for RN licensure in this state or the RN license is suspended or revoked,

2. Fails to renew the RN license upon expiration,

3. Loses the multistate compact privilege,

4. Fails the national certifying examination, or

5. Violates a statute or rule of the Board.

F. An applicant who is denied a temporary certificate or temporary prescribing and dispensing authority may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the temporary certification or authority. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

Adopted effective November 25, 1996 (Supp. 96-4). Amended by final rulemaking at 5 A.A.R. 4300, effective October 18, 1999 (Supp. 99-4). Section repealed; new Section made by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 13 A.A.R. 1483, effective June 2, 2007 (Supp. 07-2). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-508. Standards Related to Registered Nurse Practitioner Scope of Practice

A. An RNP shall refer a patient to a physician or another health care provider if the referral will protect the health and welfare of the patient and consult with a physician and other health care providers if a situation or condition occurs in a patient that is beyond the RNP's knowledge and experience.

B. In addition to the scope of practice permitted a registered nurse, a registered nurse practitioner, under A.R.S. §§ 32-1601 (19) and 32-1606(B)(12), may perform the following acts within the limits of the population focus of certification:

1. Examine a patient and establish a medical diagnosis by client history, physical examination, and other criteria.

2. For a patient who requires the services of a health care facility:

a. Admit the patient to the facility,

b. Manage the care the patient receives in the facility, and

c. Discharge the patient from the facility.

3. Order and interpret laboratory, radiographic, and other diagnostic tests, and perform those tests that the RNP is qualified to perform.

4. Prescribe, order, administer and dispense therapeutic measures including pharmacologic agents and devices if authorized under R4-19-511, and non-pharmacological interventions including, but not limited to, durable medical equipment, nutrition, home health care, hospice, physical therapy and occupational therapy.

5. Identify, develop, implement, and evaluate a plan of care for a patient to promote, maintain, and restore health.

6. Perform therapeutic procedures that the RNP is qualified to perform.

7. Delegate therapeutic measures to qualified assistive personnel including medical assistants under R4-19-509.

8. Perform additional acts that the RNP is qualified to perform and that are generally recognized as being within the role and population focus of certification.

C. An RNP shall only provide health care services including prescribing and dispensing within the RNP’s population focus and role and for which the RNP is educationally prepared and for which competency has been established and maintained. Educational preparation means academic coursework or continuing education activities that include both theory and supervised clinical practice.

Historical Note

Adopted effective February 25, 1987 (Supp. 87-1). Former Section R4-19-505 renumbered to R4-19-506, new Section R4-19-505 renumbered from R4-19-504 effective November 18, 1994 (Supp. 94-4). Former Section R4-19-505 repealed, new Section R4-19-505 renumbered from R4-19-504 and amended effective November 25, 1996 (Supp. 96-4). Amended by final rulemaking at 5 A.A.R. 4300, effective October 18, 1999 (Supp. 99-4). Former R4-19-508 renumbered to R4-19-513; new R4-19-508 renumbered from R4-19-505 and amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 13 A.A.R. 1483, effective June 2, 2007 (Supp. 07-2). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore one of the A.R.S. citations in subsection (B) was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-509. Delegation to Medical Assistants

A. Under A.R.S. §§ 32-1456 and 32-1601(19)(d)(vii), an RNP may delegate patient care to a medical assistant in an office or outpatient setting. The RNP shall verify that a medical assistant to whom the RNP delegates meets at least one of the following qualifications:

1. Completed an approved medical assistant training program as defined in A.A.C. R4-16-101(3);

2. If a graduate of an unapproved medical assistant training program, passed the medical assistant examination administered by either the American Association of Medical Assistants or the American Medical Technologists;

3. Completed an unapproved medical assistant training program and was employed as a medical assistant on a continuous basis since completion of the program before February 2, 2000;

4. Was directly supervised by the same registered nurse practitioner for at least 2000 hours before February 2, 2000; or

5. Completed a medical services training program of the Armed Forces of the United States.

B. An RNP may delegate the following acts to a medical assistant who is under the direct supervision of the RNP and demonstrates competency in the performance of the act:

1. Obtain vital signs;

2. Perform venipuncture and draw blood;

3. Perform capillary puncture;

4. Perform pulmonary function testing;

5. Perform electrocardiography;

6. Perform patient screening using established protocols;

7. Perform dosage calculations as applicable to written orders;

8. Apply pharmacology principles to prepare and administer oral, inhalant, topical, otic, optic, rectal, vaginal and parenteral medications (excluding intravenous medications);

9. Maintain medication and immunization records;

10. Assist provider with patient care;

11. Perform Clinical Laboratory Improvement Amendments (CLIA) waived hematology, chemistry, urinalysis, microbiological and immunology testing;

12. Screen test results;

13. Obtain specimens for microbiological testing;

14. Obtain patient history;

15. Instruct patients according to their needs to promote health maintenance and disease prevention;

16. Prepare a patient for procedures or treatments;

17. Document patient care and education;

18. Perform first aid procedures;

19. Perform whirlpool treatments;

20. Perform diathermy treatments;

21. Perform electronic galvation stimulation treatments;

22. Perform ultrasound therapy;

23. Perform massage therapy (subject to regulation by massage therapy board);

24. Apply traction treatments;

25. Apply Transcutaneous Nerve Stimulation unit treatments;

26. Apply hot and cold pack treatments; and

27. Administer small volume nebulizer treatments.

Historical Note

Adopted effective November 25, 1996 (Supp. 96-4). Section repealed by final rulemaking at 5 A.A.R. 4300, effective October 18, 1999 (Supp. 99-4). New Section made by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009
(Supp. 08-4). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore one of the A.R.S. citations in subsection (A) was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-510. Expired

Historical Note

Section renumbered from R4-19-506 and amended effective November 25, 1996 (Supp. 96-4). Section repealed made by final rulemaking at 10 A.A.R. 792, effective April 3, 2004 (Supp. 04-1). Section R4-19-510 renumbered from R4-19-506 and amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005
(Supp. 05-3). Section expired under A.R.S. § 41-1056(E) at 17 A.A.R. 1093, effective March 24, 2011 (Supp. 11-2).

R4-19-511. Prescribing and Dispensing Authority; Prohibited Acts

A. The Board shall authorize an RNP to prescribe and dispense (P&D) drugs and devices within the RNP's population focus only if the RNP does all of the following:

1. Obtains authorization by the Board to practice as a registered nurse practitioner;

2. Applies for prescribing and dispensing privileges on the application for registered nurse practitioner certification;

3. Submits a completed verified application on a form provided by the Board that contains all of the following information:

a. Name, address, e-mail address and home telephone number;

b. Arizona registered nurse license number, or copy of compact license;

c. Nurse practitioner population focus;

d. Nurse practitioner certification number issued by the Board; and

e. Business address and telephone number;

4. Submits evidence of a minimum of 45 contact hours of education within the three years immediately preceding the application, covering one or both of the following topics consistent with the population focus of education and certification:

a. Pharmacology, or

b. Clinical management of drug therapy, and

5. Submits the required fee.

B. An applicant who is denied P & D authority may request a hearing by filing a written request with the Board within 30 days of service of the Board's order denying the P & D authority. Board hearings shall comply with A.R.S. Title 41, Chapter 6, Article 10, and 4 A.A.C. 19, Article 6.

C. An RNP shall not prescribe or dispense drugs or devices without Board authority or in a manner inconsistent with law. The Board may impose an administrative or civil penalty for each violation, suspend the RNP's P & D authority, or impose other sanctions under A.R.S. § 32-1606(C). In determining the appropriate sanction, the Board shall consider factors such as the number of violations, the severity of each violation, and the potential for or existence of patient harm.

D. In addition to acts listed under R4-19-403, for a nurse who prescribes or dispenses a drug or device, a practice that is or might be harmful to the health of a patient or the public, includes one or more of the following:

1. Prescribing a controlled substance to oneself or a member of the nurse's family;

2. Providing any controlled substance or prescription-only drug or device for other than accepted therapeutic purposes;

3. Delegating the prescribing and dispensing of drugs or devices to any other person;

4. Prescribing for a patient that is not in the registered nurse practitioner’s population focus of education and certification except as authorized in subsection (D)(5)(d); and

5. Prescribing, dispensing, or furnishing a prescription drug or a prescription-only device to a person unless the nurse has examined the person and established a professional relationship, except when the nurse is engaging in one or more of the following:

a. Providing temporary patient care on behalf of the patient's regular treating and licensed health care professional;

b. Providing care in an emergency medical situation where immediate medical care or hospitalization is required by a person for the preservation or health, life, or limb;

c. Furnishing a prescription drug to prepare a patient for a medical examination; or

d. Prescribing antimicrobials to a person who is believed to be at substantial risk as a contact of a patient who has been examined and diagnosed with a communicable disease by the prescribing RNP even if the contact is not in the population focus of the registered nurse practitioner’s certification.

Historical Note

Adopted effective November 25, 1996 (Supp. 96-4). Section repealed; new Section made by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005
(Supp. 05-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-512. Prescribing Drugs and Devices

A. An RNP granted P & D authority by the Board may:

1. Prescribe drugs and devices;

2. Provide for refill of prescription-only drugs and devices for one year from the date of the prescription.

B. An RNP with P & D authority who wishes to prescribe a controlled substance shall obtain a DEA registration number before prescribing a controlled substance. The RNP shall file the DEA registration number with the Board.

C. An RNP with a DEA registration number may prescribe:

1. A Schedule II controlled substance as defined in the federal Controlled Substances Act, 21 U.S.C. § 801 et seq., or Arizona's Uniform Controlled Substances Act, A.R.S. Title 36, Chapter 27, but shall not prescribe refills of the prescription;

2. A Schedule III or IV controlled substance, as defined in the federal Controlled Substances Act or Arizona's Uniform Controlled Substances Act, and may prescribe a maximum of five refills in six months; and

3. A Schedule V controlled substance, as defined in the federal Controlled Substances Act or Arizona's Uniform Controlled Substances Act, and may prescribe refills for a maximum of one year.

D. An RNP whose DEA registration is revoked or expires shall not prescribe controlled substances. An RNP whose DEA registration is revoked or limited shall report the action to the Board.

E. In all outpatient settings or at the time of hospital discharge, an RNP with P & D authority shall personally provide a patient or the patient's representative with the name of the drug, directions for use, and any special instructions, precautions, or storage requirements necessary for safe and effective use of the drug if any of the following occurs:

1. A new drug is prescribed or there is a change in the dose, form, or direction for use in a previously prescribed drug;

2. In the RNP's professional judgment, these instructions are warranted; or

3. The patient or patient's representative requests instruction.

F. An RNP with P & D authority shall ensure that all prescription orders contain the following:

1. The RNP's name, address, telephone number, and population focus;

2. The prescription date;

3. The name of the patient and either the address of the patient or a blank for the address if the prescription is not being dispensed by the RNP;

4. The full name of the drug, strength, dosage form, and directions for use;

5. The letters “DAW”, “dispense as written”, “do not substitute”, “medically necessary” or any similar statement on the face of the prescription form if intending to prevent substitution of the drug;

6. The RNP's DEA registration number, if applicable; and

7. The RNP's signature.

Historical Note

Former R4-19-512 renumbered to R4-19-514; new R4-19-512 made by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (05-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-513. Dispensing Drugs and Devices

A. A registered nurse practitioner (RNP) granted prescribing and dispensing authority by the Board may:

1. Dispense drugs and devices to patients;

2. Dispense samples of drugs packaged for individual use without a prescription order or additional labeling;

3. Only dispense drugs and devices obtained directly from a pharmacy, manufacturer, wholesaler, or distributor; and

4. Allow other personnel to assist in the delivery of medications provided that the RNP retains responsibility and accountability for the dispensing process.

B. If dispensing a drug or device, an RNP with dispensing authority shall:

1. Ensure that the patient has a written prescription that complies with R4-19-512(F) and contains the address of the patient and inform the patient that the prescription may be filled by the prescribing RNP or by a pharmacy of the patient's choice;

2. Affix a prescription number to each prescription that is dispensed;

3. Ensure that all original prescriptions are preserved for a minimum of seven years and make the original prescriptions available at all times for inspection by the Board of Nursing, Board of Pharmacy, and law enforcement officers in performance of their duties; and

4. Report the dispensing of controlled substances to the Board of Pharmacy’s Controlled Substance Prescription Monitoring Program as required in A.R.S. § 36-2608.

C. An RNP practicing in a public health facility operated by this state or a county or in a qualifying community health center under A.R.S. § 32-1921(D) and (F) may dispense drugs or devices to patients without a written prescription if the public health facility or the qualifying community health center adheres to all storage, labeling, safety, and recordkeeping rules of the Board of Pharmacy.

D. An RNP who dispenses a drug shall ensure that a label is affixed that contains all of the following information:

1. Dispensing RNP's name and population focus;

2. Address and telephone number of the location from which the drug is dispensed;

3. Date dispensed;

4. Patient's name and address;

5. Name and strength of the drug, quantity in the container, directions for use, and any cautionary statements necessary for the safe and effective use of the drug;

6. Manufacturer and lot number; and

7. Prescription order number.

E. An RNP who dispenses a drug or device shall ensure that the following information about the drug or device is entered into the patient's medical record:

1. Name of the drug, strength, quantity, directions for use, and number of refills;

2. Date dispensed;

3. Therapeutic reason;

4. Manufacturer and lot number; and

5. Prescription order number.

F. An RNP with dispensing authority shall:

1. Keep all drugs in a locked cabinet or room in an area that is not accessible to patients;

2. If dispensing a controlled substance:

a. Control access by a written policy that specifies:

i. Those persons allowed access, and

ii. Procedures to report immediately the discovery of a shortage or illegal removal of drugs to a local law enforcement agency and provide that agency and the DEA with a written report within seven days of the discovery.

b. Maintain and make available to the Board upon request an ongoing inventory and record of:

i. A Schedule II controlled substance, as defined in the federal Controlled Substances Act or Arizona's Uniform Controlled Substances Act, separately from all other records, and a prescription for a Schedule II controlled substance in a separate prescription file; and

ii. A Schedule III, IV, or V controlled substance, as defined in the federal Controlled Substances Act or Arizona's Uniform Controlled Substances Act, in a form that is readily retrievable from other records.

G. If a prescription order is refilled, an RNP with P & D authority shall record the following information on the back of the prescription order or in the patient's medical record:

1. Date refilled,

2. Quantity dispensed if different from the full amount of the original prescription,

3. RNP's name or identifiable initials, and

4. Manufacturer and lot number.

H. Under the supervision of an RNP with P & D authority, other personnel may:

1. Receive and record a prescription refill request from a patient or a patient's representative;

2. Receive and record a verbal refill authorization from the RNP including:

a. The RNP's name;

b. Date of refill;

c. Name, directions for use, and quantity of drug; and

d. Manufacturer and lot number;

3. Prepare and affix a prescription label; and

4. Prepare a drug or device for delivery, provided that the dispensing RNP:

a. Inspects the drug or device and initials the label before issuing to the patient to ensure compliance with the prescription; and

b. Ensures that the patient is informed of the name of the drug or device, directions for use, precautions, and storage requirements.

Historical Note

Adopted effective November 25, 1996 (Supp. 96-4). Amended by final rulemaking at 5 A.A.R. 4300, effective October 18, 1999 (Supp. 99-4). Former R4-19-513 renumbered to R4-19-515; new R4-19-513 renumbered from R4-19-508 and amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-514. Standards Related to Clinical Nurse Specialist Scope of Practice

In addition to the functions of a registered nurse, a CNS, under A.R.S. § 32-1601(6), may perform one or more of the following for an individual, family, or group within the population focus of certification and for which competency has been maintained:

1. Conduct an advanced assessment, analysis, and evaluation of a patient's complex health needs;

2. Establish primary and differential health status diagnoses;

3. Direct health care as an advanced clinician;

4. Develop, implement, and evaluate a treatment plan according to a patient's need for specialized nursing care;

5. Establish nursing standing orders, algorithms, and practice guidelines related to interventions and specific plans of care;

6. Manage health care according to written protocols;

7. Facilitate system changes on a multidisciplinary level to assist a health care facility and improve patient outcomes cost-effectively;

8. Consult with the public and professionals in health care, business, and industry in the areas of research, case management, education, and administration;

9. Perform psychotherapy if certified as a clinical nurse specialist in psychiatric and mental health nursing;

10. Prescribe and dispense durable medical equipment; or

11. Perform additional acts that the clinical nurse specialist is qualified to perform.

Historical Note

Adopted effective November 25, 1996 (Supp. 96-4). Section R4-19-514 renumbered from R4-19-512 and amended by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citation in the opening subsection was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3). Amended by final rulemaking at 19 A.A.R. 1438, effective July 6, 2013 (Supp. 13-2).

R4-19-515. Repealed

Historical Note

Section adopted by final rulemaking at 6 A.A.R. 335, effective December 20, 1999 (Supp. 99-4). Section R4-19-515 renumbered from R4-19-513 by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Repealed by final rulemaking at 18 A.A.R. 2140, effective August 8, 2012 (Supp. 12-3).

R4-19-516. Repealed

Historical Note

New Section made by final rulemaking at 11 A.A.R. 3804, effective November 12, 2005 (Supp. 05-3). Repealed by final rulemaking at 18 A.A.R. 2140, effective August 8, 2012 (Supp. 12-3).

ARTICLE 6. RULES OF PRACTICE AND PROCEDURE

R4-19-601. Expired

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 618, effective December 31, 2001 (Supp. 02-1). Section R4-19-601 renumbered from R4-19-602 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2). Section expired under A.R.S. § 41-1056(E) at 17 A.A.R. 2692, effective August 31, 2011 (Supp. 11-4).

R4-19-602. Letter of Concern

A letter of concern issued by the Board is not an appealable agency action as defined in A.R.S. § 41-1092.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-602 renumbered to R4-19-601; new Section R4-19-602 made by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-603. Representation

Any person subject to a hearing may participate in the hearing and may be represented by legal counsel. The Board shall not pay for the person’s legal counsel.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-603 repealed; new Section R4-19-603 renumbered from R4-19-604 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-604. Notice of Hearing; Response

A. The Board, in consultation with the Office of Administrative Hearings, as necessary shall prepare and serve a written notice of hearing on all parties under A.R.S. § 41-1092.05.

B. In addition to the notice requirements in A.R.S. § 41-1092.05(D), the Board shall include the following in the notice:

1. The full name, address, and license number, if any, of the licensee, certificate holder, program, or applicant;

2. The name, mailing address, and telephone number of the Board’s executive director or Board designee if the hearing is to be conducted by the Board;

3. A statement that a hearing will proceed without a party’s presence if a party fails to attend or participate in the hearing;

4. The names and mailing addresses of persons to whom notice is being given, including the Attorney General representing the state at the hearing; and

5. Any other matters relevant to the proceedings.

C. The party named in the notice of hearing shall file a written response under A.R.S. § 32-1664 within 30 days after service of the notice of hearing. The response shall contain:

1. The party’s name, address, and telephone number;

2. Whether the party has legal representation and, if so, the name and address of the attorney;

3. A response to the allegations contained in the notice of hearing; and

4. Any other matters relevant to the proceedings.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-604 renumbered to R4-19-603; new Section R4-19-604 renumbered from R4-19-605 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-605. Expired

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-605 renumbered to R4-19-604; new Section R4-19-605 renumbered from R4-19-606 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2). Section expired under A.R.S. § 41-1056(E) at 17 A.A.R. 2692, effective August 31, 2011 (Supp. 11-4).

R4-19-606. Expired

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-606 renumbered to R4-19-605; new Section R4-19-606 renumbered from R4-19-607 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2). Section expired under A.R.S. § 41-1056(E) at 17 A.A.R. 2692, effective August 31, 2011 (Supp. 11-4).

R4-19-607. Recommended Decision

The Administrative Law Judge who conducts the hearing shall make a recommended decision under A.R.S. § 41-1092.08. The Board shall immediately transmit a copy of the recommended decision to each party. Each party may file a memorandum of objections for consideration at the next Board meeting that contains the reasons why the recommended decision is in error or requires correction, and includes appropriate citations to the record, statutes, or rules in support of each objection.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-607 renumbered to R4-19-606; new Section R4-19-607 renumbered from R4-19-612 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-608. Rehearing or Review of Decision

A. A party may file a motion for rehearing or review of a decision under A.R.S. §§ 41-1092.09 and 32-1665.

B. The Board may grant a rehearing or review of the decision for any of the following causes materially affecting the moving party’s rights:

1. Irregularity in the administrative proceedings of the Board or the administrative law judge, or any order, or abuse of discretion, which deprived the moving party of a fair hearing;

2. Misconduct of the Board, the administrative law judge, or the prevailing party;

3. Accident or surprise that could not have been prevented by ordinary prudence;

4. Newly discovered material evidence that could not, with reasonable diligence, have been discovered and produced at the original hearing;

5. Excessive or insufficient penalties;

6. Error in the admission or exclusion of evidence or other errors of law occurring during the pendency of the proceeding or at the administrative hearing; or

7. The decision is not justified by the evidence or is contrary to law.

C. Upon the Board’s receipt of a motion for rehearing or review, the Board may affirm or modify the decision or grant a rehearing to all or any of the parties on all or part of the issues for any of the reasons in subsection (B). An order granting a rehearing shall specify with particularity the grounds for the order. Any rehearing shall cover only those specified matters.

D. Within the time limits of A.R.S. § 41-1092.09, the Board may order a rehearing or review on its own initiative for any of the reasons in subsection (B). The Board shall specify the grounds for the rehearing or review in the order.

E. When a motion for rehearing is based upon affidavits, they shall be served with the motion. An opposing party may, within 15 days of such service, serve opposing affidavits.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 491, effective December 31, 2001 (Supp. 02-1). Section R4-19-608 renumbered from R4-19-614 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-609. Effectiveness of Orders

A. Except as provided in subsection (B), a decision is final upon expiration of the time for filing a request for rehearing or review or upon denial of such a request, whichever is later. If the Board grants a rehearing or review, the decision is stayed until another order is issued.

B. If it finds that the public health, safety, or welfare imperatively requires emergency action, the Board may proceed under A.R.S. § 41-1092.11(B), ordering summary suspension of a license while other proceedings are pending. If the Board orders a summary suspension, a party shall exhaust the party’s administrative remedies by filing a motion for rehearing or review under A.R.S. § 41-1092.09(B) before seeking judicial review of the decision.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 491, effective December 31, 2001 (Supp. 02-1). Section R4-19-609 renumbered from R4-19-615 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-610. Expired

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 491, effective December 31, 2001 (Supp. 02-1).

R4-19-611. Expired

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 491, effective December 31, 2001 (Supp. 02-1).

R4-19-612. Renumbered

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section renumbered to R4-19-607 by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-613. Expired

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 491, effective December 31, 2001 (Supp. 02-1).

R4-19-614. Renumbered

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section renumbered to R4-19-608 by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-615. Renumbered

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Section renumbered to R4-19-609 by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

ARTICLE 7. PUBLIC PARTICIPATION PROCEDURES

R4-19-701. Expired

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2). Section expired under A.R.S. § 41-1056(E) at 17 A.A.R. 2692, effective August 31, 2011 (Supp. 11-4).

R4-19-702. Petition for Rulemaking; Review of Agency Practice or Substantive Policy Statement; Objection to Rule Based Upon Economic, Small Business, or Consumer Impact

A person may petition the Board, requesting the making of a final rule, or a review of an existing agency practice or substantive policy statement that the petitioner alleges to constitute a rule under A.R.S. § 41-1033, or objecting to a rule under A.R.S. § 41-1056.01, by filing a petition which contains the following:

1. The name, current address, and telephone number of the person submitting the petition.

2. For the making of a new rule, the specific language of the proposed rule.

3. For amendment of a current rule, the Arizona Administrative Code (A.A.C.) Section number, the Section heading, and the specific language of the current rule, with any language to be deleted stricken through but legible, and any new language underlined.

4. For repeal of a current rule, the A.A.C. Section number and Section heading proposed for repeal.

5. The reasons the rule should be made, specifically stating in reference to an existing rule, why the rule is inadequate, unreasonable, unduly burdensome, or otherwise not acceptable. The petitioner may provide additional supporting information including:

a. Any statistical data or other justification, with clear references to attached exhibits;

b. An identification of any person or segment of the public that would be affected and how they would be affected; and

c. If the petitioner is a public agency, a summary of relevant issues raised in any public hearing, or written comments offered by the public.

6. For a review of an existing agency practice or substantive policy statement alleged to constitute a rule, the reasons the existing agency practice or substantive policy statement constitutes a rule and the proposed action requested of the Board.

7. For an objection to a rule based upon the economic, small business, or consumer impact, evidence of any of the following grounds:

a. The actual economic, small business, or consumer impact significantly exceeded the impact estimated in the economic, small business, and consumer impact statement submitted during the making of the rule.

b. The actual economic, small business, or consumer impact was not estimated in the economic, small business, and consumer impact statement submitted during the making of the rule and that actual impact imposes a significant burden on persons subject to the rule.

c. The Board did not select the alternative that imposes the least burden and costs to persons regulated by the rule, including paperwork and other compliance costs, necessary to achieve the underlying regulatory objective.

8. The signature of the person submitting the petition.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2). Amended by final rulemaking at 19 A.A.R. 1419, effective July 6, 2013 (Supp. 13-2).

R4-19-703. Oral Proceedings

A. The Board shall schedule an oral proceeding on all rulemakings and publish the notice as prescribed in A.R.S. § 41-1023. A Board member, the executive director, or a Board staff member shall serve as presiding officer at an oral proceeding.

B. The Board shall record all oral proceedings either by an electronic recording device or stenographically, and any resulting cassette tapes or transcripts, registers, and all written comments received shall become part of the official record.

C. The presiding officer shall conduct an oral proceeding according to A.R.S. § 41-1023; and

1. Request each person in attendance register;

2. Obtain the following information from any person who intends to speak:

a. Name and whether the person represents another;

b. Position with regard to the proposed rule; and

c. Approximate length of time needed to speak;

3. Open the proceeding by identifying the subject matter of the rules under consideration and the purpose of the proceeding;

4. Present the agenda;

5. Ensure that a Board representative explains the background and general content of the proposed rules;

6. Limit comments to a reasonable period, and prevent undue repetition of comments;

7. Announce the address for written public comments and the date and time for the close of record; and

8. Close the proceeding if there are no persons in attendance within 15 minutes after the posted meeting time.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-703 repealed; new Section R4-19-703 renumbered from R4-19-704 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-704. Petition for Altered Effective Date

A. A person wishing to alter the effective date of a rule shall file a written petition that contains:

1. The name, current address, and telephone number of the person submitting the petition;

2. Identification of the proposed rule;

3. If the person is petitioning for an immediate effective date, a demonstration that the immediate date is necessary for one or more of the reasons in A.R.S. § 41-1032(A);

4. If the person is petitioning for a later effective date, more than 60 days after filing of the rule, a demonstration under A.R.S. § 41-1032(B) that good cause exists for, and the public interest will not be harmed by, the later effective date; and

5. The signature of the person submitting the petition.

B. The Board shall make a decision and notify the petitioner of the decision within 60 days of receipt of the petition.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-704 renumbered to R4-19-703; new Section R4-19-704 renumbered from R4-19-705 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-705. Written Criticism of an Existing Rule

A. Any person may file with the Board a written criticism of an existing rule that contains:

1. The rule addressed, and

2. The reason the existing rule is inadequate, unduly burdensome, unreasonable, or improper.

B. The Board shall acknowledge receipt of any criticism within 10 working days and shall place the criticism in the official record for review by the Board under A.R.S. § 41-1056.

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-705 renumbered to R4-19-704; new Section R4-19-705 renumbered from R4-19-706 and amended by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

R4-19-706. Renumbered

Historical Note

Adopted effective October 10, 1996 (Supp. 96-4). Renumbered to R4-19-705 by final rulemaking at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).

ARTICLE 8. CERTIFIED NURSING ASSISTANTS

R4-19-801. Standards for Nursing Assistant Training Programs

A. For the purposes of this Article “traineeship” means a clinical experience in which a nursing assistant student works with a facility staff member under the supervision of a licensed nurse to provide care for residents without an instructor onsite.

B. Organization and administration

1. A nursing assistant training program shall provide a description of the program that includes the length of the program, number of hours of clinical and classroom instruction, and program goals consistent with federal, state, and if applicable, private postsecondary requirements. The program shall provide a description that is consistent with the purpose, goals, and objectives of a parent institution, if any.

2. A nursing assistant training program that uses external clinical facilities shall execute a written agreement with each external clinical facility that:

a. Defines the rights and responsibilities of both the clinical facility and the program,

b. Defines the role and authority of the governing bodies of both the clinical facility and the program,

c. Allows the program instructor the right to select learning experiences for students, and

d. Contains a termination clause that provides sufficient time for enrolled students to complete the clinical experience upon termination of the agreement.

3. A nursing assistant training program shall promulgate written policies and procedures that are consistent with the policies and procedures of the parent institution, if any, and contain an effective and review date for each policy or procedure. The program shall provide a copy of its policies and procedures to each student on or before the first day the student participates in the program. The program shall develop and adhere to policies and procedures in the following areas:

a. Student attendance ensuring that a student receives 120 hours of instruction or the equivalent of 120 hours;

b. Student grading, requiring that a student either attain at least 75% on each theoretical exam, or 75% on a comprehensive theoretical exam;

c. Test retake, if retake tests are allowed, informing students that a retake test:

i. Addresses the competencies tested in the original test,

ii. Contains different items from the original test, and

iii. Is documented in the student’s record;

d. Student record maintenance including information regarding records retention, retention period, records location, and documents required under subsections (D)(5) and (6);

e. Instructor supervision of students in the clinical area, providing for:

i. A method to contact the instructor that ensures the instructor is available as needed;

ii. Instructor rounds for each student according to patient or resident need and student ability;

iii. Direct observation and documentation of student performance, consistent with course and clinical objectives; and

iv. Only activities related to the direct supervision of students during the clinical session.

f. Student fees and financial aid, if any;

g. Dismissal, advanced placement consistent with subsection (B)(4), and withdrawal policies;

h. Student grievance policy, including a chain of command for grade disputes;

i. Admission requirements, including any criminal background or drug testing required;

j. Program completion criteria; and

k. Notification of Board requirements for certification, including the criminal background check requirement, before enrolling a student.

4. In lieu of requiring completion of all course hours specified in R4-19-802, a nursing assistant training program may develop a policy that allows a student with at least one year full-time nursing assistant experience to demonstrate attainment of course objectives and clinical competencies consistent with curriculum requirements in R4-19-802(C). The program shall evaluate competency through a written comprehensive examination, skills testing, and at least 16 hours of clinical practice in a long-term care facility directly supervised by the registered nurse instructor. A program that develops a policy under this subsection shall submit a copy of the policy to the Board.

5. Within 15 days of program completion, a nursing assistant training program shall provide a certificate of completion document, which contains the following, to each student who has completed the program:

a. The name and classroom location of the program;

b. The number of classroom and clinical hours in the program;

c. The number of traineeship hours, if any;

d. The end date of the program;

e. The program number, if known; and

f. The signature of the program coordinator, instructor, or the supervisor of the program coordinator or instructor.

6. A nursing assistant training program shall execute and maintain under subsection (D)(5) and (6) the following documents for each student:

a. A skills check-off list, containing documentation of competency of the nursing assistant skills in R4-19-802(C), and

b. A program evaluation form, containing the student’s responses to questions about the quality of the classroom and clinical experiences during the training program.

C. Program coordinator and instructor qualifications and responsibilities

1. A program coordinator shall:

a. Hold a current, registered nurse license that is active and in good standing under A.R.S. Title 32, Chapter 15; and

b. Possess at least two years of nursing experience at least one year of which is in the provision of long-term care facility services.

2. A director of nursing in a health care facility may assume the role of a program coordinator for a nursing assistant training program based in the facility but shall not function as a program instructor.

3. A program coordinator shall:

a. Supervise and evaluate the program;

b. Ensure that instructors meet Board qualifications; and;

c. Ensure that the written policies in subsection (B) are available to students on or before the first day of the program;

4. A program instructor shall:

a. Hold a current, registered nurse license that is active and in good standing under A.R.S. Title 32, Chapter 15; and

b. Possess one or more of the following:

i. Credit for a course on teaching adults,

ii. One year of experience teaching adults, or

iii. One year of experience supervising nursing assistants.

5. For classroom and clinical, excluding hours spent in a traineeship, a program instructor shall:

a. Plan each learning experience;

b. Accomplish course goals and lesson objectives;

c. Enforce a grading policy that meets or exceeds the requirements of subsection (B)(3)(b);

d. Require satisfactory performance of all critical elements of each nursing assistant skill under R4-19-802(C);

e. Prevent a student from performing an activity unless the student has received instruction and been found to competently perform the activity;

f. Supervise any student who provides care to clients in clinical areas, consistent with the requirements of subsection (B)(3)(e);

g. Be present in the classroom during all instruction; and

h. Supervise health care professionals and clinical instructors who assist in providing program instruction.

6. A certified or licensed health care professional shall not assist the program instructor unless the health care professional has at least one year of experience in the field of licensure or certification and the learning activity is within the scope of practice of the licensee or certificate holder. A certified nursing assistant shall not provide classroom or clinical instruction in a nursing assistant training program.

D. Clinical requirements, resources, and records

1. A nursing assistant training program shall provide a minimum of one clinical instructor for every 10 students if students perform one or more nursing assistant activities for a patient or resident. The program shall ensure that the instructor is physically present in the health care setting during each performance of a nursing assistant activity for a patient or resident.

2. A nursing assistant training program shall provide an instructor-supervised clinical experience for each nursing assistant student, which consists of at least 40 hours of direct patient or resident care, and includes at least 20 hours caring for long-term care facility residents. If there is no long-term care facility available within a 50-mile radius of the program, the program may conduct clinical sessions in a healthcare institution that provides experiences with patients or residents who have nursing care needs similar to those of long-term care facility residents.

3. A nursing assistant training program shall ensure that each nursing assistant student is identified as a student by a name badge or another means readily observable to staff, patients, or residents and not utilize students as staff during clinical and traineeship experiences.

4. A nursing assistant training program shall provide or have access to instructional and educational resources for implementing the program, for the planned number of students and instructional staff, including:

a. Current reference materials, related to the level of the curriculum;

b. Equipment in functional condition for simulating patient care, including:

i. A patient bed, overbed table, and nightstand;

ii. Privacy curtains and call bell;

iii. Thermometers, stethoscopes, including a teaching stethoscope, blood pressure cuffs, and a balance-type scale;

iv. Hygiene supplies, elimination equipment, drainage devices, and linens;

v. Hand washing equipment and clean gloves; and

vi. Wheelchair, gait belt, walker, anti-embolic hose, and cane;

c. Audio-visual equipment and media; and

d. Designated space for didactic teaching and skill practice that provides a clean, distraction-free learning environment for accomplishing the educational goals of the program and is comparable to the space provided by a previously approved program of similar size and type, if any;

5. A nursing assistant training program shall maintain the following program records for three years:

a. Curriculum and course schedule for each cohort group;

b. Results of state-approved written and manual skills testing;

c. Completed student program evaluation forms, a summary of the evaluations for each cohort group, and measures taken by the program, if any, to improve the program based on student and instructor evaluation; and

d. A copy of any Board reports, applications, or correspondence, related to the program.

6. A nursing assistant training program shall maintain the following student records for three years:

a. A record of the student’s name, date of birth, and Social Security number, if available;

b. A completed skill checklist;

c. Attendance record, which describes any make-up class sessions;

d. Scores on each test, quiz, or exam and, if applicable, whether such test quiz or exam was retaken; and

e. For programs with traineeships, documentation from the registered nurse supervising the traineeship that indicates the number of hours completed and the performance of the student during the traineeship; and

f. A copy of the certificate of completion issued to the student upon successful completion of the training program.

E. Periodic evaluation

1. A nursing assistant training program shall permit the Board, or a state agency designated by the Board, to conduct an onsite scheduled evaluation for initial Board approval, in accordance with R4-19-803, and renewal of approval, in accordance with R4-19-804.

2. For reasonable cause, as determined by the Board, a nursing assistant training program shall permit the Board, or a state agency designated by the Board, to conduct an onsite unannounced evaluation of the program.

F. A nursing assistant training program shall submit written documentation and information regarding the following changes within 30 days of instituting the change:

1. For a change or addition of an instructor or coordinator, the name, license number, and documentation of meeting coordinator or instructor requirements of this Section, as applicable;

2. For a decrease in the number of program hours, a description of the change, the reason for the change, a revised curriculum outline, and a revised course schedule;

3. For a change in classroom location, the address of the new location, if applicable, and a description of the new classroom;

4. For a change in a clinical facility, the name of the new facility and a copy of the clinical contract; and

5. For a change in the name or ownership of the facility, the former, present and new name of the facility.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-802. Curriculum

A. A nursing assistant training program shall provide at least 120 hours of instruction which can be met by the student completing either of the following:

1. A 120 hour curriculum consisting of at least 60 hours of classroom instruction with clinical instruction that satisfies the requirements of R4-19-801(D)(2); or

2. A curriculum of at least 60 hours of classroom instruction and 40 hours of supervised, clinical instruction that satisfies the requirements R4-19-801(D)(2), followed by a long-term care facility-based traineeship. The program coordinator shall ensure that the traineeship experience:

a. Consists of no more than 20 hours of the total 120 hours, and

b. Is verified by the supervising nurse in a written document that contains the number of hours provided through the traineeship and confirmation that the student has demonstrated required skills and abilities, competently performed nursing assistant functions, and met course objectives.

B. A nursing assistant training program shall provide a written curriculum plan to each student that includes overall course goals and for each required subject:

1. Measurable learner-centered objectives,

2. An outline of the material to be taught,

3. The time allotted for each unit of instruction, and

4. The learning activities or reading assignments.

C. A nursing assistant training program shall provide classroom and clinical instruction regarding each of the following subjects:

1. Communication, interpersonal skills, and documentation;

2. Infection control;

3. Safety and emergency procedures, including the Heimlich© maneuver and cardiopulmonary resuscitation instruction;

4. Patient or resident independence;

5. Patient or resident rights, including:

a. The right to confidentiality;

b. The right to privacy;

c. The right to be free from abuse, mistreatment, and neglect;

d. The right to make personal choices;

e. The right to obtain assistance in resolving grievances and disputes;

f. The right to care and security of a patient’s or resident’s personal property; and

g. The right to be free from restraints;

6. Recognizing and reporting abuse, mistreatment or neglect to a supervisor;

7. Basic nursing assistant skills, including:

a. Taking vital signs, height, and weight;

b. Maintaining a patient’s or resident’s environment;

c. Observing and reporting pain;

d. Assisting with diagnostic tests;

e. Providing care for patients or residents with drains and tubes;

f. Recognizing and reporting abnormal changes to a supervisor;

g. Applying clean bandages;

h. Providing peri-operative care; and

i. Assisting in admitting, transferring, or discharging patients or residents.

8. Personal care skills, including:

a. Bathing, skin care, and dressing;

b. Oral and denture care;

c. Shampoo and hair care;

d. Fingernail care;

e. Toileting, perineal, and ostomy care; and

f. Feeding and hydration, including proper feeding techniques and use of assistive devices in feeding;

9. Age specific, mental health, and social service needs, including:

a. Modifying the nursing assistant’s behavior in response to patient or resident behavior,

b. Demonstrating an awareness of the developmental tasks associated with the aging process,

c. Responding to patient or resident behavior,

d. Promoting patient or resident dignity,

e. Providing culturally sensitive care,

f. Caring for the dying patient or resident, and

g. Interacting with the patient’s or resident’s family;

10. Care of the cognitively impaired patient or resident including;

a. Addressing the unique needs and behaviors of patients or residents with dementia,

b. Communicating with cognitively impaired patients or residents,

c. Understanding the behavior of cognitively impaired patients or residents, and

d. Reducing the effects of cognitive impairment;

11. Skills for basic restorative services, including:

a. Body mechanics;

b. Resident self-care;

c. Assistive devices used in transferring, ambulating, eating, and dressing;

d. Range of motion exercises;

e. Bowel and bladder training;

f. Care and use of prosthetic and orthotic devices; and

g. Family and group activities;

12. Health care team member skills including time management and prioritizing work; and

13. Legal aspects of nursing assistant practice, including:

a. Board-prescribed requirements for certification and re-certification;

b. Delegation,

c. Ethics,

d. Advance directives and do-not-resuscitate orders, and

e. Standards of conduct under R4-19-814.

14. Body structure and function, together with common diseases and conditions of the elderly.

D. A nursing assistant training program shall provide a student with a minimum of 16 hours instruction in the subjects identified in subsections (C)(1) through (C)(6) before allowing a student to care for patients or residents.

E. A nursing assistant training program shall utilize a nursing assistant textbook that has been published within the previous five years.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-803. Initial Approval of Nursing Assistant Training Programs

A. An applicant for initial nursing assistant training program approval shall submit an application packet to the Board at least 90 days before the expected starting date of the program. An applicant shall submit application documents that are unbound, typed or word processed, single-sided, and on white, letter-size paper. The Board does not accept notebooks, spiral bound documents, manuals, books, or tabulations.

B. The application packet for initial program approval shall include all of the following:

1. Name, address, telephone number, and fax number of program;

2. Identity of the program as a long-term care facility-based or other program;

3. Name, license number, telephone number and qualifications of the program coordinator required in R4-19-801;

4. Name, license number, telephone number and qualifications of each program instructor required in R4-19-801;

5. Name and telephone number of the person with administrative oversight of the nursing assistant training program;

6. Accreditation status of the applicant, if any, including the name of the accrediting body and date of last review;

7. Name, address, telephone number, contact person, Department of Health Services (DHS) status, and most recent DHS review for all health care institutions where program classroom or clinical instruction will take place;

8. Medicare certification status, if any;

9. Evidence of compliance with R4-19-801 and R4-19-802, including all of the following:

a. Program description, consistent with R4-19-801(B) (1) and an implementation plan, including timelines;

b. Classroom facilities, equipment, and instructional tools available, consistent with R4-19-801(D)(4); and

c. Written curriculum, consistent with R4-19-802;

d. A copy of the documentation that the program will use to verify nurse assistant skills for each student, consistent R4-19-801(B)(6)(a);

e. A copy of the document issued to the student upon completion of the program, consistent with R4-19-801(B)(5);

f. Textbook author, name, year of publication, and publisher; and

g. A copy of course policies, consistent with R4-19-801(B)(3) and, if applicable, R4-19-801(B)(4);

10. For a Medicare or Medicaid certified long-term care facility-based program, a signed, sworn, and notarized document, executed by a program coordinator, affirming that the program does not require a nursing assistant student to pay a fee for any portion of the program including the state competency exam.

11. For a Medicare or Medicaid long-term care facility-based program, the actual price of a textbook and other loaned equipment, if the program charges a student who does not return these items upon course completion, and any commercially available standard uniform, watch, pen, paper, duty shoes, and other commonly available personal items that are required for the course, for which a student may incur an expense.

C. Following receipt and review of a complete application packet, the Board shall take one of the following actions:

1. Schedule an onsite evaluation of the program and, if requirements are met, approve the program for a period not to exceed two years,

2. Approve the program for a period that does not exceed one year if requirements are met, without an onsite visit, or

3. Deny approval of the program if the applicant does not meet the requirements.

D. A program shall not conduct classes before receiving program approval.

E. If approval is in the best interest of the public, the Board shall grant initial approval to any applicant who meets requirements in A.R.S. Title 32, Chapter 15, and in this Article. If the Board denies approval, an applicant may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying the application for approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-804. Renewal of Approval of Nursing Assistant Training Programs

A. A nursing assistant training program applying for renewal of approval shall submit an application packet to the Board before expiration of the current approval. An applicant shall submit application documents that are unbound, typed or word processed, single-sided, and on white, letter-size paper. The Board does not accept notebooks, spiral bound documents, manuals, books, or tabulations.

1. The application packet shall include the following:

a. A program description and course goals;

b. Name, license number, and qualifications under R4-19-801 of the current program coordinator and instructors, required in R4-19-801;

c. A copy of the current curriculum plan, which meets the requirements in R4-19-802;

d. Number of classes held, number of students who have completed the program, and the results of the state-approved written and manual skills tests, including first-time pass rate since the last program review;

e. A copy of course policies, consistent with R4-19-801;

f. Any change in resources, contracts, or clinical facilities since the previous approval;

g. A copy of current student program evaluation forms, a summary of the evaluations for each cohort group, and measures taken by the program, if any, to improve the program based on student and instructor evaluation;

h. A sample of the certificate of completion issued to a graduate of the program containing the information required by R4-19-801(B)(5); and

i. Textbook author, name, year of publication, and publisher.

2. Following receipt of the application packet, a Board representative shall review the application packet for completeness under subsection (A)(1). In addition to the other requirements in this Section, an applicant shall provide evidence of at least one of the following to provide a complete application packet:

a. That at least one person has completed the program and the state-approved written and manual skills exam within the previous approval period;

b. If no graduates of the program completed the state-approved written and manual skills exam in the previous approval period, an explanation why Board approval is necessary for public protection, and a comprehensive plan to assist students to apply for testing and certification; or

c. If the program did not graduate any students in the previous approval period, a detailed plan including dates, marketing tools, and instructor name, which indicates that the program will be offered within the next six months.

3. Upon receipt and review of a complete application packet the Board, through its authorized representative, shall evaluate the entity offering the program either in-person or by conference call. If a program is to be evaluated by means of a conference call, the Board shall issue a comprehensive request for information to the program for all of the following:

4. A program that is evaluated by means of a conference call shall ensure that both the coordinator and all instructors are available to participate in the call.

a. A description of the classroom, supplies, and recordkeeping;

b. A copy of the records of three students; and

c. A copy of the course schedule for each cohort group.

5. A Board representative shall evaluate each program and program site in-person at least once every four years. If a program or program site has received an in-person evaluation for the previous approval, no concerns are identified in the site-visit report, and there have been no complaints filed with the Board for two years following the approval, the program is eligible for a conference call evaluation.

B. Following a conference call or onsite evaluation, the Board shall renew program approval for two years if a program complies with R4-19-801 and R4-19-802 and renewal is in the best interest of the public. If the program does not comply, the Board shall issue a notice of deficiency under R4-19-805.

C. If the Board denies renewal of approval, a program may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying the application for renewal of approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

D. A program that is denied renewal of approval shall not apply for reinstatement of approval for two years from the date of the denial.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-805. Deficiencies and Rescission of Program Approval, Voluntary Termination, Disciplinary Action, and Reinstatement

A. Deficiencies and rescission of approval

1. Upon determining that a nursing assistant training program does not comply with this Article, the Board shall provide the program coordinator or an administrator who supervises the program with a written notice of deficiency. The Board shall establish a reasonable period of time, based upon the number and severity of deficiencies, for correction of the deficiencies. Under no circumstances, however, shall the period for correction of deficiencies exceed three months from the date of graduation of the next training class.

a. Within 10 days from the date that the notice of deficiency is served, the program shall file a plan of correction with the Board.

b. The Board may conduct periodic evaluations during the period of correction to ascertain progress in correcting the deficiencies.

c. The Board shall conduct at least one evaluation immediately following the period of correction to determine whether the program has corrected the deficiencies.

2. The Board may rescind the approval of a nursing assistant training program or take other disciplinary action under A.R.S. § 32-1663 based on the number and severity of violations for any of the following reasons:

a. Failure to file a plan of correction with the Board within 10 days of service of a notice of deficiency.

b. Failure to comply with R4-19-801 or R4-19-802 within the period set by the Board in the notice of deficiency;

c. Noncompliance with federal, state, or if applicable, private postsecondary requirements;

d. Failure to permit a scheduled or unannounced onsite evaluation, authorized by subsection R4-19-801(E);

e. Loaning or transferring program approval to another entity or facility, including a facility with the same ownership;

f. Conducting a nursing assistant training program before approval is granted;

g. Conducting a nursing assistant training program after expiration of approval without filing an application for renewal of approval before the expiration date; or

h. If the program is conducted by a long-term care facility, charging for any portion of the program.

3. If the Board rescinds approval of a nursing assistant training program, the program may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order rescinding approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10, and 4 A.A.C. 19, Article 6.

4. If the Board rescinds approval of a nursing assistant training program, the program shall not seek reinstatement for two years from the date of the rescission.

B. Voluntary termination

1. If a nursing assistant training program is being voluntarily terminated, the program coordinator or an administrator who supervises the program shall submit notice of termination to the Board.

2. The program coordinator shall maintain the nursing assistant training program, including the instructors, until the last student is transferred or has completed the nursing assistant training program.

C. Reinstatement

1. If the Board rescinds approval of a nursing assistant training program, the program may apply for reinstatement after a period of two years by complying with the requirements of this Article.

2. The applicant shall submit a complete application packet in writing that contains all of the information and documentation required by R4-19-803(B). The applicant shall provide substantial evidence that the basis for rescission no longer exists and that reinstatement of the program is in the best interest of the public.

3. Unless the basis for rescission still exists, the Board shall reinstate a nursing assistant training program that otherwise meets the requirements of this Article. A program that is denied reinstatement may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying reinstatement. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-806. Nursing Assistant Certification by Examination

A. An applicant for certification by examination shall submit the following information and documentation to the Board:

1. An application that contains all of the following information:

a. Full legal name;

b. Current address, including county of residence, and telephone number;

c. Date of birth;

d. Social Security number;

e. Educational background, including the name of the training program attended, and date of graduation;

f. Current employer, including address and telephone number, type of position, and dates of employment;

g. A list of all states in which the applicant is or has been registered as a nursing assistant and the certificate number, if any;

h. Responses to questions that address each of the following subjects:

i. Any pending disciplinary action by a nursing regulatory agency or nursing assistant regulatory agency in the United States or its territories or current investigation regarding the applicant’s nursing license, nursing assistant license, or nursing assistant certificate in another state or territory of the United States;

ii. Felony conviction or conviction of an undesignated or other similar offense and the date of absolute discharge of sentence; and

iii. Unprofessional conduct as defined in A.R.S. § 32-1601;

iv. A written or electronic signature by the applicant on a statement attesting to the truthfulness of the information provided by the applicant.

2. Proof of satisfactory completion of a nursing assistant training program that meets the requirements in subsection (B);

3. One or more fingerprint cards, if required by A.R.S. § 32-1606; and

4. Applicable fees.

B. An applicant for certification as a nursing assistant shall submit a passing score on a Board-approved nursing assistant examination and provide one of the following criteria:

1. Proof that the applicant has completed a Board-approved nursing assistant training program;

2. Proof that the applicant has completed a nursing assistant training program approved in another state or territory of the United States consisting of at least 120 hours;

3. Proof that the applicant has completed a nursing assistant program approved in another state or territory of the United States of at least 75 hours of instruction and proof of working as a nursing assistant for an additional number of hours that together with the hours of instruction, equal at least 120 hours; or

4. Proof that the applicant either holds a valid nursing license in the U.S. or territories, has graduated from an approved nursing program, or otherwise meets educational requirements for a registered or practical nursing license in Arizona.

C. An applicant who fails either the written or manual skills portion of the nursing assistant examination may retake the failed portion of the examination until a passing score is achieved. An applicant shall pass both portions of the nursing assistant examination within two years from the date of completion of the nursing assistant training program or meet the requirements in subsection (D).

D. An applicant who does not pass an examination within the time period specified in subsection (C) shall repeat and complete a training program before being permitted to retake an examination.

E. An applicant who has never taken the examination and provides proof of at least 160 hours of employment as a nursing assistant for every two-year period since completing a state-approved nursing assistant training program meets federal requirements to take the written and manual skills nursing assistant examination.

F. The Board shall certify an applicant who meets the applicable criteria in this Article if certification is in the best interest of the public.

G. An applicant who is denied nursing assistant certification may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying the application for certification. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-807. Nursing Assistant Certification by Endorsement

A. An applicant for nursing assistant certification by endorsement shall submit all of the information, documentation, and fees required in R4-19-806.

B. An applicant whose current employment is less than one year shall list all employers during the past two years.

C. An applicant for nursing assistant certification by endorsement shall meet the training program criteria in R4-19-806(B).

D. In addition to the other requirements of this Section, an applicant for certification by endorsement shall provide evidence that the applicant:

1. Is listed as active on a nursing assistant register or a substantially equivalent register by another state or territory of the United States; and

2. Meets one or more of the following criteria:

a. Currently is working in nursing, performing nursing assistant activities, whether the job description or job title includes the term certified nursing assistant;

b. Has worked in nursing, performing nursing assistant activities, whether the job description or job title included the term “certified nursing assistant” for at least 160 hours within the past two years; or

c. Has completed a nursing assistant training program and passed the required examination within the past two years.

E. The Board shall certify an applicant who meets the applicable criteria in this Article if certification is in the best interest of the public.

F. An applicant who is denied nursing assistant certification may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying the application for certification. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-808. Temporary Certificate

A. Subject to subsection (B), the Board may issue a temporary nursing assistant certificate to an applicant who desires to work as a certified nursing assistant based on receipt or consideration of the following:

1. A report from the Arizona Department of Public Safety, verifying that the Department has no criminal history record information, as that term is defined in A.R.S. § 41-1701, regarding the applicant; and

2. An application for temporary nursing assistant certificate, furnished by the Board and completed by the applicant;

3. The fee required under A.R.S. § 32-1643(A)(9); and

4. Evidence that the applicant is qualified for:

a. Certification by endorsement under A.R.S. § 32-1648 and R4-19-807, through submission of documentation or an official statement from another state or territory of the United States, verifying that the applicant has a current certificate or an equivalent document from that state or territory; or

b. Certification by examination under A.R.S. § 32-1645 and R4-19-806.

B. An applicant who discloses a disciplinary charge, substantiated complaint, criminal conviction, substance abuse, pending disciplinary charge, or a substantiated complaint by a regulatory agency, is not eligible for a temporary certificate without prior Board approval.

C. Unless extended for good cause under subsection (D), a temporary certificate is valid for three months.

D. A temporary certificate holder may apply and the Board or the Executive Director may grant an extension for good cause. Good cause means reasons beyond the control of the temporary certificate holder, such as unanticipated delays in obtaining information required for nursing assistant certification.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 8 A.A.R. 5004, effective November 15, 2002 (Supp. 02-4). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005
(Supp. 05-4).

R4-19-809. Certified Nursing Assistant Certificate Renewal

A. A certified nursing assistant may apply for renewal of a certificate by submitting an application to the Board on or before the expiration date of the certificate.

1. The application packet shall include all of the following:

a. Full legal name;

b. Current address, including county of residence, and telephone number;

c. Date of birth;

d. Current employer;

e. If the applicant has not been employed as a nursing assistant, or performed nursing assistant activities, whether the job description or the job title included the term certified nursing assistant, as specified in subsection (A)(2), documentation that the applicant has completed a Board-approved nursing assistant training program and passed both the written and manual skills portions of the competency examination within the past two years;

f. Responses to questions that address the following subjects:

i. Pending disciplinary action by a nursing regulatory agency or nursing assistant regulatory agency in the United States or its territories or current investigation of the applicant’s nursing license, nursing assistant license, or nursing assistant certificate in another state or territory of the United States,

ii. Felony conviction or conviction of undesignated offense and date of absolute discharge of sentence since certified or last renewed, and

iii. Unprofessional conduct as defined in A.R.S. § 32-1601;

g. A written or electronic signature by the applicant on a statement attesting to the truthfulness of the information provided.

2. Documentation of proof of employment, such as a pay stub, W-2 form, or letter from an employer that verifies the applicant’s employment as a nursing assistant or the applicant’s performance of nursing assistant activities for a minimum of 160 hours within the past two years, and

3. Applicable fees.

B. The certificate of a nursing assistant who fails to renew expires on the last day of the month of a certificate holder’s birthdate.

1. A nursing assistant’s responsibility to renew is not relieved by the nursing assistant’s failure to obtain an application.

2. A nursing assistant who fails to renew shall not work as a certified nursing assistant.

3. Based on consideration of a nursing assistant’s record regarding timely renewal, the Board may impose a late fee on a nursing assistant who fails to renew certification in a timely manner.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-810. Certified Nursing Assistant Register

A. The Executive Director shall include the following information in the Register for each individual who receives Board certification:

1. Full legal name and any other names used;

2. Address of record;

3. County of residence;

4. The date of initial placement on the register;

5. Dates and results of both the written and manual skills portions of the nursing assistant competency examination;

6. Date of expiration of current certificate, if applicable;

7. Existence of pending investigation, if applicable; and

8. Status of certificate, such as active, denied, expired, or revoked, as applicable.

B. The Executive Director shall include the following information in the Register for an individual if the Board, or the United States Department of Health and Human Services (HHS), or the Arizona Department of Health Services finds that the individual has violated relevant law:

1. For a finding by the Board or HHS, the Executive Director shall include:

a. The finding, including the date of the decision, and a reference to each statute, rule, or regulation violated; and

b. The sanction, if any, including the date of action and the duration of action, if time-limited.

2. For a finding by the Arizona Department of Health Services, the Executive Director shall include:

a. The allegation;

b. Documentation of the investigation, including:

i. Nature of allegation, and

ii. Evidence supporting the finding;

c. Date of hearing, if any, or the date that the complaint was substantiated;

d. Statement disputing the allegation, if any;

e. The finding, including the date of the decision and a reference to each statute or rule violated; and

f. The sanction, including the dates of action and the duration of the sanction, if time-limited.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-811. Application for Duplicate Certificate

A. A certified nursing assistant shall report a lost or stolen certificate to the Board within 30 days of discovery of the loss.

B. A certified nursing assistant shall make a written request for a duplicate certificate to the Board, provide a notarized signature or proof of identification, and pay the applicable fee.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1).

R4-19-812. Change of Name or Address

A. An applicant or a certified nursing assistant, who legally changes names, shall notify the Board in writing within 30 days of any name change. The applicant or certified nursing assistant shall submit a copy of any official document evidencing the name change.

B. An applicant or a certified nursing assistant shall notify the Board in writing within 30 days of any address change.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-813. Performance of Nursing Assistant Tasks

A. A certified nursing assistant may perform the following:

1. Tasks for which the nursing assistant has been trained through the curriculum identified in R4-19-802, and

2. Tasks learned through inservice or educational training if the task meets the following criteria and the nursing assistant has demonstrated competence performing the task:

a. The task can be safely performed according to clear, exact, and unchanging directions;

b. The task poses minimal risk to the patient or resident and the consequences of performing the task improperly are not life-threatening or irreversible;

c. The results of the task are reasonably predictable; and

d. Assessment, interpretation, or decision-making is not required during the performance or at the completion of the task.

B. A nursing assistant may not perform any task that requires a judgment based on nursing knowledge, such as the administration of medications.

C. A nursing assistant shall:

1. Recognize the limits of the nursing assistant’s personal knowledge, skills, and abilities;

2. Comply with laws relevant to nursing assistant practice;

3. Inform the registered nurse, licensed practical nurse, or another person authorized to delegate the task about the nursing assistant’s ability to perform the task before accepting the assignment;

4. Accept delegation, instruction, and supervision from a professional or practical nurse or another person authorized to delegate a task;

5. Acknowledge responsibility for personal actions necessary to complete an accepted assigned task;

6. Follow the plan of care, if available;

7. Observe, report, and record signs, symptoms, and changes in the patient or resident’s condition in an ongoing and timely manner; and

8. Retain responsibility for the assigned task without delegating it to another person.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4).

R4-19-814. Standards of Conduct for Certified Nursing Assistants

For purposes of A.R.S. § 32-1601(22)(d), a practice or conduct that is or might be harmful or dangerous to the health of a patient or the public and constitutes a basis for disciplinary action on a certificate includes the following:

1. Failing to maintain professional boundaries or engaging in a dual relationship with a patient, resident, or any member of the patient’s or resident’s family;

2. Engaging in sexual conduct with a patient, resident, or any member of the patient’s or resident’s family who does not have a pre-existing relationship with the nursing assistant, or any conduct in the work place that a reasonable person would interpret as sexual;

3. Leaving an assignment or abandoning a patient or resident who requires care without properly notifying the immediate supervisor;

4. Failing to accurately document care and treatment provided to a patient or resident;

5. Falsifying or making a materially incorrect entry in a health care record;

6. Failing to follow an employer’s policies and procedures, designed to safeguard the patient or resident;

7. Failing to take action to protect a patient or resident whose safety or welfare is at risk from potential or actual incompetent health care practice, or to report the practice to the immediate supervisor or a facility administrator;

8. Failing to report signs, symptoms, and changes in patient or resident conditions to the immediate supervisor in an ongoing and timely manner;

9. Violating the rights or dignity of a patient or resident;

10. Violating a patient or resident’s right of privacy by disclosing confidential information or knowledge concerning the patient or resident, unless disclosure is otherwise required by law;

11. Neglecting or abusing a patient or resident physically, verbally, emotionally, or financially;

12. Soliciting, or borrowing, property or money from a patient or resident, or any member of the patient’s or resident’s family;

13. Removing, without authorization, any money, property, or personal possessions, or requesting payment for services not performed from a patient, resident, employer, co-worker, or member of the public.

14. Repeated use or being under the influence of alcohol, medication, or any other substance to the extent that judgment may be impaired and practice detrimentally affected or while on duty in any work setting;

15. Accepting patient or resident care tasks that the nursing assistant lacks the education or competence to perform;

16. Removing, without authorization, narcotics, drugs, supplies, equipment, or medical records from any work setting;

17. Obtaining, possessing, using, or selling any narcotic, controlled substance, or illegal drug in violation of any employer policy or any federal or state law;

18. Permitting or assisting another person to use the nursing assistant’s certificate or identity for any purpose;

19. Making untruthful or misleading statements in advertisements of the individual’s practice as a certified nursing assistant;

20. Offering or providing certified nursing assistant services for compensation without a designated registered nurse supervisor;

21. Threatening, harassing, or exploiting an individual;

22. Using violent or abusive behavior in any work setting;

23. Failing to cooperate with the Board during an investigation by:

a. Not furnishing in writing a complete explanation of a matter reported under A.R.S. § 32-1664;

b. Not responding to a subpoena issued by the Board;

c. Not completing and returning a Board-issued questionnaire within 30 days; or

d. Not informing the Board of a change of address or phone number within 10 days of each change;

24. Engaging in fraud or deceit regarding the certification exam or an initial or renewal application for certification;

25. Making a written false or inaccurate statement to the Board or the Board’s designee during the course of an investigation;

26. Making a false or misleading statement on a nursing assistant or health care related employment or credential application concerning previous employment, employment experience, education, or credentials;

27. If an applicant or certified nursing assistant is charged with a felony or a misdemeanor, involving conduct that may affect patient safety, failing to notify the Board, in writing, within 10 days of being charged under A.R.S. § 32-3208. The applicant or certified nursing assistant shall include the following in the notification:

a. Name, current address, telephone number, Social Security number, and license number, if applicable;

b. Date of the charge; and

c. Nature of the offense;

28. Failing to notify the Board, in writing, of a conviction for a felony or an undesignated offense within 10 days of the conviction. The nursing assistant or applicant shall include the following in the notification:

a. Name, current address, telephone number, Social Security number, and license number, if applicable;

b. Date of the conviction;

c. Nature of the offense; and

29. Practicing in any other manner that gives the Board reasonable cause to believe that the health of a patient, resident, or the public may be harmed.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1). Amended by final rulemaking at 11 A.A.R. 4254, effective December 5, 2005 (Supp. 05-4). Amended by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4). Antiquated statute reference in opening subsection revised at the request of Board under A.R.S. § 41-1011(C), Office File No. M11-189, filed May 16, 2011 (Supp. 11-2). Pursuant to authority of A.R.S. § 41-1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citation in the opening subsection was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3).

R4-19-815. Reinstatement or Issuance of a Nursing Assistant Certificate

An applicant whose application is denied or a nursing assistant whose certificate is revoked in accordance with A.R.S. § 32-1663, may reapply to the Board after a period of five years from the date the certificate or application is revoked or denied. A nursing assistant who voluntarily surrenders a nursing assistant certificate may reapply to the Board after no less than three years from the date the certificate is surrendered. The Board shall issue or reinstate a nursing assistant certificate under the following terms and conditions:

1. An applicant shall submit documentation showing that the basis for denial, revocation or voluntary surrender has been removed and that the issuance or reinstatement of nursing assistant certification will no longer constitute a threat to the public health or safety. The Board may require an applicant to be tested for competency, or retake and successfully complete a Board approved training program and pass the required examination.

2. The Board shall consider the application and may designate a time for the applicant to address the Board at a regularly scheduled meeting.

3. After considering the application, the Board may:

a. Grant nursing assistant certification, or

b. Deny the application.

4. An applicant who is denied issuance or reinstatement of nursing assistant certification may request a hearing by filing a written request with the Board within 30 days of service of the Board’s order denying issuance or reinstatement of nursing assistant certification. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, Article 6.

Historical Note

New Section adopted by final rulemaking at 6 A.A.R. 757, effective February 4, 2000 (Supp. 00-1).

 


Scott Cancelosi
Director
Public Services Division

A.A.C. Table of Contents

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Editor
Arizona Administrative Code