Nursing
Regulations of the Commissioner of Education
Part 64, Nursing
Effective August 17, 2006
§64.1 Professional
study of nursing | §64.2 Licensing
examinations | §64.3 Limited
permits | §64.4 Nurse practitioner
certification | §64.5 Nurse
practitioner practice | §64.6
Prescription and direction of nursing services | §64.7 Immunizations and emergency treatment of
anaphylaxis, purified protein derivative (PPD) mantoux tuberculin
skin tests and human immunodeficiency virus (HIV) tests pursuant
to non-patient specific orders and protocols
§64.1 Professional study of nursing.
- Registered professional nursing. To meet the
professional education requirement, the applicant shall have
graduated from:
- a program in nursing registered by the department as
preparation for practice as a registered professional
nurse;
- a program in nursing approved by the licensing authority in
another state, territory or possession of the United States as
preparation for practice as a registered professional nurse;
or
- a general nursing course of at least two academic years in a country outside the United States and its territories or possessions that is satisfactory to the department and that the licensing authority or appropriate governmental agency of said country certifies to the department as being preparation for practice as a registered professional nurse. For issuance of a limited permit, an applicant shall obtain a score satisfactory to the department on a proficiency examination selected by the department as evidence of equivalent training, if the applicant's nursing education was obtained in a school of nursing outside the United States and its territories and has not been determined by the department to be equivalent in quality and scope to a program of nursing education registered by the department.
- a program in nursing registered by the department as
preparation for practice as a registered professional
nurse;
- Licensed practical nursing. To meet the education
requirements, the applicant shall have graduated from high school
or its equivalent, and shall have:
- graduated from a program in nursing registered by the
department or approved by the licensing authority in another
state, territory, or possession of the United States as
preparation for practice as a licensed practical nurse;
- completed preparation in a program determined by the
department to be equivalent to the programs described in
paragraph (1) of this subdivision;
- graduated from a program in practical nursing of at least
nine months in a country outside the United States and its
territories or possessions, which program is satisfactory to the
department and which program the licensing authority of said
country certifies to the department as being preparation for
practice as a licensed practical nurse; or
- graduated from a general nursing course in a country outside the United States and its territories that is satisfactory to the department and that the licensing authority of said country certifies to the department as being preparation for practice as a professional nurse.
- graduated from a program in nursing registered by the
department or approved by the licensing authority in another
state, territory, or possession of the United States as
preparation for practice as a licensed practical nurse;
§64.2 Licensing examinations.
- Registered professional nursing.
- All parts of the registered professional nurse licensing
examination shall be taken each time the candidate is
examined.
- Each candidate for licensure as a registered professional
nurse examined after November 22, 1961 shall have taken an
examination acceptable to the State Board for Nursing. Except as
provided in Section 64.3 of this Part, each candidate examined
after May 31,1974 shall have taken the same examination on the
same dates such examination was given in this State.
- The registered professional nurse licensing examination
results shall be reported as a single score. Applicants who have
passed a part or parts of the registered professional nurse
licensing examination prior to July 1,1982 may not retain credit
for such part or parts beyond that date.
- All parts of the registered professional nurse licensing
examination shall be taken each time the candidate is
examined.
- Licensed practical nursing.
- A candidate for licensure as a practical nurse shall pass an
examination acceptable to the State Board for Nursing. Each
candidate examined after September 11, 1974 shall have taken the
same examination on the same dates such examination was given in
this State.
- The passing score as determined by the State Board for
Nursing for the licensed practical nurse licensing examination
shall be reported as a single score.
- A candidate for licensure as a practical nurse shall pass an
examination acceptable to the State Board for Nursing. Each
candidate examined after September 11, 1974 shall have taken the
same examination on the same dates such examination was given in
this State.
§64.3 Limited permits.
A limited permit to practice as a registered professional nurse or licensed practical nurse may be issued after the applicant has met requirements of age, moral character, education and proficiency examination, if applicable, provided that the applicant has not failed the professional licensing examination. Failure on a registered professional nurse licensing examination shall not preclude issuance of a limited permit to practice as a licensed practical nurse.
§64.4 Nurse practitioner certification.
- Certificates.
- Nurse practitioner certificates issued to a registered
professional nurse will reflect the specialty area of nurse
practitioner academic preparation.
- The certificate will specify the specialty area of practice
and, when applicable, that prescriptive privileges have been
granted.
- A nurse practitioner may apply for certification in more than
one specialty area of practice. A complete application and fee
shall be required for each certificate.
- Nurse practitioner certificates issued to a registered
professional nurse will reflect the specialty area of nurse
practitioner academic preparation.
- Professional study. To meet the professional
education requirements for certification in this State, the
applicant shall present evidence of:
- i. completion of an educational program registered
by the department, or a program determined by the department to
be equivalent to a registered program, which is designed and
conducted to prepare graduates to practice as nurse
practitioners; or ii. certification as a nurse
practitioner by a national certifying body acceptable to the
department; and
- completion of not less than three semester hours or the
equivalent in pharmacology either in an acceptable nurse
practitioner program or after other educational requirements for
certification as nurse practitioner have been satisfied. An
acceptable course in pharmacology shall be equivalent in scope
and content to that required by Section 52.12 of this
Title.
- i. completion of an educational program registered
by the department, or a program determined by the department to
be equivalent to a registered program, which is designed and
conducted to prepare graduates to practice as nurse
practitioners; or ii. certification as a nurse
practitioner by a national certifying body acceptable to the
department; and
- Alternative criteria for certification.
- For applicants whose professional education as a nurse
practitioner was completed prior to April 1, 1989, the department
may accept as alternative educational criteria the following
qualifications:
- A program of education preparation for the provision of
primary health care services as nurse practitioner of at least
four weeks in duration, and completed prior to April 1,1989;
and
- a course of instruction in pharmacotherapeutics management as
required by this subdivision; and either:
- two years of experience prior to April 1, 1989, at least one
year of which shall be subsequent to April 1, 1986, in the
provision of primary health care services in a health care
facility licensed pursuant to Article 28 of the Public Health Law
or in a school health demonstration project; or
- satisfactory completion of a supplemental educational program
culminating in the successful completion of a comprehensive
examination or clinical evaluation.
- A program of education preparation for the provision of
primary health care services as nurse practitioner of at least
four weeks in duration, and completed prior to April 1,1989;
and
- the department may accept as alternative criteria for
satisfaction of the pharmacotherapeutics requirement set forth in
paragraph 2 of subdivision (b) of this section any of the
following:
- an educational program or a combination of courses which is
the substantial equivalent in content and scope to the
pharmacotherapeutics component of a registered program; or
- satisfactory completion of an examination in
pharmacotherapeutics satisfactory to the department; or
- satisfactory completion of a nationally recognized
examination acceptable for licensure in New York State as a
physician assistant or as a midwife.
- an educational program or a combination of courses which is
the substantial equivalent in content and scope to the
pharmacotherapeutics component of a registered program; or
- The department may issue a certificate upon the receipt of
satisfactory evidence that an applicant licensed or certified in
another state or country has met the substantial equivalent of
the New York requirements for certification. An applicant who
does not have the substantial equivalent of all of the New York
requirements may be required to make up specific deficiencies
and/or pass a proficiency examination.
- For applicants whose professional education as a nurse
practitioner was completed prior to April 1, 1989, the department
may accept as alternative educational criteria the following
qualifications:
- Alternative criteria for certification in additional
specialty areas of practice.
- The alternative requirements of this subdivision are only
available to applicants who apply to the department for
certification in the additional specialty area of practice on or
before September 15, 2006 and who meet all requirements for
certification under this subdivision by September 15, 2007. These
alternative requirements for certification shall not be available
to applicants who do not meet these conditions and shall not be
available to applicants who apply for certification after
September 15, 2006.
- An applicant who has been certified as a nurse practitioner
may be certified in an additional specialty or specialties upon
the submission of evidence satisfactory to the department that
the criteria for initial certification in the additional
specialty or specialties has been met, or in the alternative,
that the applicant has met the following alternative education
and experience requirements:
- Alternative education. The department may accept 60 hours of
continuing education obtained in the specialty area of practice
in which certification is sought. Such continuing education may
be obtained through the completion of any of the following:
- academic courses or continuing education programs approved by
the department or by a nursing or medical organization or
accrediting agency acceptable to the department; or
- evidence of preparation for the specialty by service as a
presenter or lecturer in an academic or continuing education
program, or by the publication in a professional journal of
clinical information related to the specialty. Credit for such
services or publication may not exceed 30 contact hours;
- independent study in an academic course or continuing
education program may be accepted but may not exceed 12 contact
hours;
- for the purposes of this paragraph one contact hour shall
include at least 50 minutes of study and one academic semester
hour shall equal 15 contact hours and one academic quarter hour
shall equal 12.5 contact hours.
- academic courses or continuing education programs approved by
the department or by a nursing or medical organization or
accrediting agency acceptable to the department; or
- Alternative experience. The department may accept
either:
- one thousand hours of clinical practice after April 1, 1986
in the specialty for which additional certification is sought.
Such practice shall be in a health care facility licensed
pursuant to article 28 of the Public Health Law or in a school
health demonstration project; or
- three hundred hours of clinical practice as part of a
clinical practicum affiliated with a nurse practitioner program
registered by the department, or accredited by an accrediting
agency acceptable to the department.
- one thousand hours of clinical practice after April 1, 1986
in the specialty for which additional certification is sought.
Such practice shall be in a health care facility licensed
pursuant to article 28 of the Public Health Law or in a school
health demonstration project; or
- Alternative education. The department may accept 60 hours of
continuing education obtained in the specialty area of practice
in which certification is sought. Such continuing education may
be obtained through the completion of any of the following:
- Evidence of completion of educational programs, experience
and examinations submitted to meet alternative criteria for
certification as a nurse practitioner must be satisfactory to the
department, and the overall preparation of the applicant must be
comparable by assessment and substantially equivalent to the
preparation provided by a registered or approved program. The
department may require verification of the content and completion
of the program or experience and of the satisfactory performance
of the applicant by the person or institution conducting the
program or in which the experience was acquired.
- The alternative requirements of this subdivision are only
available to applicants who apply to the department for
certification in the additional specialty area of practice on or
before September 15, 2006 and who meet all requirements for
certification under this subdivision by September 15, 2007. These
alternative requirements for certification shall not be available
to applicants who do not meet these conditions and shall not be
available to applicants who apply for certification after
September 15, 2006.
- Prescriptive privilege. An applicant who satisfies
all requirements for certification as a nurse practitioner may be
authorized to issue prescriptions pursuant to Section 6902(3)(b)
of the Education Law after completing instruction, satisfactory
to the department, in New York State and Federal laws and
regulations relating to prescriptions and recordkeeping.
§64.5 Nurse practitioner practice.
- Practice agreements and practice protocols shall be
maintained in the practice setting of the nurse practitioner and
collaborating physician and shall be available to the department
for inspection.
- Practice agreements shall include provisions for referral and
consultation, coverage for emergency absences of either the nurse
practitioner or collaborating physician, resolution of
disagreements between the nurse practitioner and collaborating
physician regarding matters of diagnosis and treatment, and the
review of patient records at least every three months by the
collaborating physician; and may include such other provisions as
determined by the nurse practitioner and collaborating physician
to be appropriate.
- Protocols shall identify the area of practice to be performed
by the nurse practitioner in collaboration with the physician and
shall reflect accepted standards of nursing and medical practice.
Protocols shall include provisions for case management, including
diagnosis, treatment, and appropriate recordkeeping by the nurse
practitioner; and may include such other provisions as are
determined by the nurse practitioner and collaborating physician
to be appropriate. Such protocols may be updated
periodically.
- The department in its discretion or upon request of a nurse
practitioner or collaborating physician may review practice
protocols for the purpose of insuring that they are in
conformance with accepted medical and nursing practice and with
the statutes and regulations governing the practice of medicine,
nursing, and the prescribing of drugs, and may render an opinion
which shall be binding upon the parties to the protocol. A
practice and protocol committee designated by the Deputy
Commissioner for the Professions shall review practice protocols
and shall recommend findings as to their adequacy and conformity
with current accepted medical and nursing practice. If the
department determines that a protocol is inadequate or contrary
to current accepted medical and nursing practice it shall
communicate that determination, and the reasons therefor, to the
nurse practitioner and to the collaborating physician in writing.
The nurse practitioner and collaborating physician shall conform
to accepted medical and nursing practice immediately, and shall
submit a revised protocol within 30 days of receipt of the
department's determination, unless an extension of time is
requested and granted by the department. Continuation of practice
in violation of the determination shall constitute unprofessional
conduct by either or both licensees.
- An appeal from a determination that a practice protocol is
inadequate or contrary to current accepted medical and nursing
practice may be taken within 30 days after receipt of the notice
of determination by a petition setting forth the reasons for the
appeal, and signed by both the nurse practitioner and the
collaborating physician. Such joint appeal shall be filed with
the Division of Professional Licensing Services and determined by
the Committee on the Professions whose determination shall be
final.
- In addition to the requirements of Section 6810 of the
Education Law, prescription forms used by nurse practitioners
shall be printed with the name, nurse practitioner certificate
number, office address, and office telephone number of the nurse
practitioner.
§64.6 Prescription and direction of nursing services.
- Health care providers authorized to prescribe medical
regimens to be executed by a registered professional nurse shall
include persons licensed or authorized to practice pursuant to a
limited permit or statutory exemption from the licensure
requirement in the following licensed professions: medicine,
including physician's assistant and specialist's
assistant; dentistry; podiatry; midwifery; and nurse
practitioner.
- Health care providers authorized to direct the performance of
professional services by licensed practical nurses shall include
persons licensed or authorized to practice pursuant to a limited
permit or statutory exemption from the licensure requirement in
the following licensed professions: medicine, including
physician's assistant and specialist's assistant;
dentistry; podiatry; midwifery; and registered professional
nursing, including but not limited to nurse practitioners.
§64.7 Immunizations and emergency treatment of anaphylaxis, purified protein derivative (PPD) mantoux tuberculin skin tests and human immunodeficiency virus (HIV) tests pursuant to non-patient specific orders and protocols.
- Immunizations.
- Pursuant to subdivision (5) of section 6909 of the Education
Law, a registered professional nurse shall be authorized to
administer immunization agents prescribed in paragraph (2) of
this subdivision to patients therein specified, pursuant to a
non-patient specific order and protocol prescribed and ordered by
a licensed physician or a certified nurse practitioner, provided
the registered nurse meets the prerequisite requirements
prescribed in paragraph (3) of this subdivision and the order and
protocol meets the requirements of paragraph (4) of this
subdivision.
- Authorized immunization agents.
- Adult immunizations. A registered professional nurse that
meets the requirements of paragraph (3) of this subdivision shall
be authorized to administer the following immunization agents to
patients 18 years of age or older, pursuant to a non-patient
specific order and protocol prescribed and ordered by a licensed
physician or a certified nurse practitioner that meets the
requirements of paragraph (4) of this subdivision: Hepatitis A,
Hepatitis B, Influenza, Pneumococcus, Meningococcus, Diphtheria,
Tetanus, Measles, Mumps, Rubella, Varicella, Inactivated Polio, Acellular Pertussis,
Human Papilloma Virus, Smallpox vaccine,
and additional immunizations
agents approved by resolution of the Board of Regents upon
recommendation by the commissioner that such additional
immunization agents are safe and effective immunization agents
for registered professional nurses to administer to patients who
are 18 years or older, pursuant to a nonpatient specific order
and protocol as prescribed in this section, after consideration
of the recommendations of State and/or nationwide authorities
that evaluate the effectiveness and safety of immunization
agents, including but not limited to the Centers for Disease
Control and Prevention of the U.S. Department of Health and Human
Services. Such additional immunization agents, which are not
specifically enumerated in this subparagraph, may be removed by
resolution of the Board of Regents, upon recommendation of the
commissioner that such immunization agents are not safe and
effective immunization agents for registered professional nurses
to administer to patients who are 18 years or older, pursuant to
a nonpatient specific order and protocol as prescribed in this
section, after consideration of the recommendations of State
and/or nationwide authorities that evaluate the effectiveness and
safety of immunization agents, including but not limited to the
Centers for Disease Control and Prevention of the U.S. Department
of Health and Human Services.
- Child immunizations. A registered professional nurse that
meets the requirements of paragraph (3) of this subdivision and
who is employed or is acting as an agent for the Visiting Nurses
Association or other equivalent organization as determined by the
department that is legally authorized to provide nursing
services, or for a State, county, municipal or other government
agency, shall be authorized to administer the following
immunization agents to patients under the age of 18, pursuant to
a non-patient specific order and protocol prescribed and ordered
by a licensed physician or a certified nurse practitioner that
meets the requirements of paragraph (4) of this subdivision:
Diphtheria, Tetanus, Acellular Pertussis, Measles, Mumps,
Rubella, Varicella, Haemophilus Influenzae Type b (Hib),
Inactivated Polio, Hepatitis B, Rotovirus, Human Papilloma Virus, and additional immunizations agents approved by resolution of the Board of Regents upon
recommendation by the commissioner that such additional
immunization agents are safe and effective immunization agents
for registered professional nurses to administer to patients who
are under the age of 18 years old, pursuant to a non-patient
specific order and protocol as prescribed in this section, after
consideration of the recommendations of State and/or nationwide
authorities that evaluate the safety and effectiveness of
immunization agents, including but not limited to the Centers for
Disease Control and Prevention of the U.S. Department of Health
and Human Services. Such additional immunization agents, which
are not specifically enumerated in this subparagraph, may be
removed by resolution of the Board of Regents, upon
recommendation of the commissioner that such immunization agents
are not safe and effective immunization agents for registered
professional nurses to administer to patients who are under the
age of 18 years old, pursuant to a non-patient specific order and
protocol prescribed in this section, after consideration of the
recommendations of State and/or nationwide authorities that
evaluate the effectiveness and safety of immunization agents,
including but not limited to the Centers for Disease Control and
Prevention of the U.S. Department of Health and Human
Services.
- Epidemics. Notwithstanding the requirements of subparagraphs
(i) and (ii) of this paragraph, a registered professional nurse
that meets the requirements of paragraph (3) of this subdivision
shall be authorized to administer to patients, pursuant to a
non-patient specific order and protocol prescribed and ordered by
a licensed physician or a nurse practitioner that meets the
requirements of paragraph (4) of this subdivision, any
immunization agents authorized under such order and protocol to
be administered as part of an immunization program maintained,
authorized, or under the auspices of the Commissioner of Health,
a county commissioner of health, or a county public health
director, when such an immunization program is instituted
pursuant to an epidemic declared by such official.
- Adult immunizations. A registered professional nurse that
meets the requirements of paragraph (3) of this subdivision shall
be authorized to administer the following immunization agents to
patients 18 years of age or older, pursuant to a non-patient
specific order and protocol prescribed and ordered by a licensed
physician or a certified nurse practitioner that meets the
requirements of paragraph (4) of this subdivision: Hepatitis A,
Hepatitis B, Influenza, Pneumococcus, Meningococcus, Diphtheria,
Tetanus, Measles, Mumps, Rubella, Varicella, Inactivated Polio, Acellular Pertussis,
Human Papilloma Virus, Smallpox vaccine,
and additional immunizations
agents approved by resolution of the Board of Regents upon
recommendation by the commissioner that such additional
immunization agents are safe and effective immunization agents
for registered professional nurses to administer to patients who
are 18 years or older, pursuant to a nonpatient specific order
and protocol as prescribed in this section, after consideration
of the recommendations of State and/or nationwide authorities
that evaluate the effectiveness and safety of immunization
agents, including but not limited to the Centers for Disease
Control and Prevention of the U.S. Department of Health and Human
Services. Such additional immunization agents, which are not
specifically enumerated in this subparagraph, may be removed by
resolution of the Board of Regents, upon recommendation of the
commissioner that such immunization agents are not safe and
effective immunization agents for registered professional nurses
to administer to patients who are 18 years or older, pursuant to
a nonpatient specific order and protocol as prescribed in this
section, after consideration of the recommendations of State
and/or nationwide authorities that evaluate the effectiveness and
safety of immunization agents, including but not limited to the
Centers for Disease Control and Prevention of the U.S. Department
of Health and Human Services.
- Prerequisite requirements. For a registered professional
nurse authorized to administer immunization agents prescribed in
paragraph (2) of this subdivision to recipients therein
specified, pursuant to a non-patient specific order and protocol
prescribed by a licensed physician or a certified nurse
practitioner, such registered professional nurse shall be
currently certified in cardio-pulmonary resuscitation by a
program of the American Red Cross or the American Heart
Association or an equivalent organization acceptable to the
department, which has an established record of providing programs
of cardio-pulmonary resuscitation training.
- Order and Protocol.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-patient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner which authorizes a registered
professional nurse to administer immunization agents, in
accordance with the requirements of paragraph (1) of this
subdivision. The order prescribed in subparagraph (ii) of this
paragraph shall incorporate a protocol that meets the
requirements of subparagraph (iii) of this paragraph. Such order
and protocol shall be considered a record of the patient who is
immunized and maintained as a record for the period of time
prescribed in paragraph 29.2(a)(3) of this Title.
- The order shall authorize one or more named registered
professional nurses, or registered professional nurses who are
not individually named but are identified as employed or under
contract with an entity that is legally authorized to employ or
contract with registered professional nurses to provide nursing
services, to administer specified immunization agents for a
prescribed period of time. In instances in which the registered
professional nurses are not individually named in the order, but
are identified as employed or under contract with an entity that
is legally authorized to employ or contract with registered
professional nurses to provide nursing services, such registered
professional nurses shall not be authorized by such order to
administer immunizations outside of such employment or contract.
The order shall contain but shall not be limited to the following
information:
- the specific immunization agents that the registered
professional nurse(s) is permitted to administer;
- the period of time that the order is effective, including the
beginning and ending dates;
- the name and license number of the registered professional
nurse(s) authorized to administer the immunization agent(s)
pursuant to the order; or the name of the entity that is legally
authorized to employ or contract with registered professional
nurses to provide nursing services with whom registered
professional nurses who are not individually named are employed
or under contract to administer the prescribed immunization
agent(s) pursuant to the order;
- in instances in which the registered professional nurses are
not individually named in the order, but are identified as
employed or under contract with an entity that is legally
authorized to employ or contract with registered professional
nurses to provide nursing services, the order shall contain a
statement limiting the registered professional nurses to
administering immunizations only in the course of such employment
or pursuant to such contract; and
- the name, license number, and signature of the licensed
physician or nurse practitioner who has issued the order.
- the specific immunization agents that the registered
professional nurse(s) is permitted to administer;
- The protocol, incorporated into the order prescribed in
subparagraph (ii) of this paragraph, shall require the registered
professional nurse to meet the following requirements:
- The registered professional nurse shall ensure that each
potential recipient is assessed for untoward conditions that
would preclude immunization(s) and each recipient's record of
immunization with manufacturer and lot number or a potential
recipient's refusal to be immunized shall be documented in
accordance with paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall be responsible for
having emergency anaphylaxis treatment agents, related syringes
and needles available at the immunization site.
- The registered professional nurse shall inform each recipient
of potential side effects and adverse reactions, orally and in
writing, prior to immunization. The registered professional nurse
shall provide written instructions to the recipient regarding the
appropriate course of action in the event of untoward or adverse
reactions, which statements are required to be developed by a
competent entity knowledgeable about the untoward or adverse
reactions of the immunization agent which shall be administered,
such as the Centers for Disease Control of the U.S. Department of
Health and Human Services, which issues vaccine information
statements. The registered professional nurse shall not
administer immunizations unless the recipient is adequately
informed as prescribed in this clause and the recipient consents
to the immunization; except for minors or other recipients
incapable of consenting to the administration of an immunization,
in which case a person legally responsible for the recipient
shall have given prior written consent to the immunization after
having been informed in writing as prescribed in this clause
before it may be administered; or shall be in attendance during
the immunization, informed as prescribed in this clause, and have
consented to the immunization before it may be
administered.
- The registered professional nurse shall provide to each
recipient or other person legally responsible when the recipient
is a minor or otherwise incapable of consenting to immunization,
a signed certificate of immunization with the recipient's
name, date of immunization, address of administration,
administering nurse, immunization agent, manufacturer and lot
number and recommendations for future immunizations recorded
thereon. With the consent of the recipient or a person legally
responsible when the recipient is a minor or otherwise incapable
of consenting, the registered professional nurse shall
communicate this information to the recipient's primary
health care provider, if one exists.
- Each registered professional nurse shall report any adverse
outcomes as may be required by Federal law on the Vaccine Adverse
Event Reporting System form of the Centers for Disease Control of
the U.S. Department of Health and Human Services, or on the
successor form.
- Each registered professional nurse shall ensure that a record
of all persons immunized including the recipient's name,
date, address of administration, administering nurse,
immunization agent, manufacturer, lot number and recommendations
for future immunizations is recorded and maintained in accordance
with paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall ensure that each
potential recipient is assessed for untoward conditions that
would preclude immunization(s) and each recipient's record of
immunization with manufacturer and lot number or a potential
recipient's refusal to be immunized shall be documented in
accordance with paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-patient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner which authorizes a registered
professional nurse to administer immunization agents, in
accordance with the requirements of paragraph (1) of this
subdivision. The order prescribed in subparagraph (ii) of this
paragraph shall incorporate a protocol that meets the
requirements of subparagraph (iii) of this paragraph. Such order
and protocol shall be considered a record of the patient who is
immunized and maintained as a record for the period of time
prescribed in paragraph 29.2(a)(3) of this Title.
- Pursuant to subdivision (5) of section 6909 of the Education
Law, a registered professional nurse shall be authorized to
administer immunization agents prescribed in paragraph (2) of
this subdivision to patients therein specified, pursuant to a
non-patient specific order and protocol prescribed and ordered by
a licensed physician or a certified nurse practitioner, provided
the registered nurse meets the prerequisite requirements
prescribed in paragraph (3) of this subdivision and the order and
protocol meets the requirements of paragraph (4) of this
subdivision.
- Anaphylaxis treatment agents.
- Pursuant to subdivision (5) of section 6909 of the Education
Law, a registered professional nurse shall be authorized to
administer anaphylaxis treatment agents, including but not
limited to epinephrine, for the emergency treatment of
anaphylaxis, pursuant to a non-patient specific order and
protocol prescribed and ordered by a licensed physician or a
certified nurse practitioner, provided the order and protocol
meets the requirements of paragraph (2) of this
subdivision.
- Order and Protocol.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-patient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner which authorizes a registered
professional nurse to administer anaphylaxis treatment agents,
including but not limited to epinephrine, for the emergency
treatment of anaphylaxis, in accordance with the requirements of
paragraph (1) of this subdivision. The order prescribed in
subparagraph (ii) of this paragraph shall incorporate a protocol
that meets the requirements of subparagraph (iii) of this
paragraph. Such order and protocol shall be considered a record
of the patient who receives the anaphylaxis treatment agent and
maintained as a record for the period of time prescribed in
paragraph 29.2(a)(3) of this Title.
- The order shall authorize one or more named registered
professional nurses, or registered professional nurses who are
not individually named but are identified as employed or under
contract with an entity that is legally authorized to employ or
contract with registered professional nurses to provide nursing
services, to administer specified anaphylaxis treatment agents
for a prescribed period of time. In instances in which the
registered professional nurses are not individually named in the
order, but are identified as employed or under contract with an
entity that is legally authorized to employ or contract with
registered professional nurses to provide nursing services, such
registered professional nurses shall not be authorized by such
order to administer anaphylaxis treatment agents outside of such
employment or contract. The order shall contain but shall not be
limited to the following information:
- the specific anaphylaxis treatment agents that the registered
professional nurse(s) is permitted to administer;
- the period of time that the order is effective, including the
beginning and end date; and
- the name and license number of the registered professional
nurse(s) authorized to administer the anaphylaxis treatment
agent(s) pursuant to the order; or the name of the entity that is
legally authorized to employ or contract with registered
professional nurses to provide nursing services with whom
registered professional nurses who are not individually named are
employed or under contract to administer the prescribed
anaphylaxis treatment agent(s) pursuant to the order;
- in instances in which the registered professional nurses are
not individually named in the order, but are identified as
employed or under contract with an entity that is legally
authorized to employ or contract with registered professional
nurses to provide nursing services, the order shall contain a
statement limiting the registered professional nurses to
administering anaphylaxis treatment agents only in the course of
such employment or pursuant to such contract; and
- the name, license number, and signature of the licensed
physician or certified nurse practitioner who has issued the
order.
- the specific anaphylaxis treatment agents that the registered
professional nurse(s) is permitted to administer;
- The protocol, incorporated into the order prescribed in
subparagraph (ii) of this paragraph, shall require the registered
professional nurse to meet the following requirements:
- Each registered professional nurse shall ensure that a record
of all persons to whom they have administered an anaphylaxis
treatment agent, including but not limited to: the
recipient's name, date, address of administration,
administering nurse, anaphylaxis treatment agent, manufacturer,
and lot number, is recorded and maintained in accordance with
paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall contact the local
emergency medical services system following the administration of
the anaphylaxis treatment agent, or shall ensure that equivalent
follow-up care is provided through other arrangements.
- The registered professional nurse shall report to the local
emergency medical system or other provider of equivalent
follow-up care information concerning the administration of the
anaphylaxis treatment agent, including but not limited to: when
it was administered, the dosage, strength, and route of
administration. The registered professional nurse shall also
report such information to the patient's primary care
provider if one exists, unless the patient is unable to
communicate the identity of his or her primary care
provider.
- Each registered professional nurse shall ensure that a record
of all persons to whom they have administered an anaphylaxis
treatment agent, including but not limited to: the
recipient's name, date, address of administration,
administering nurse, anaphylaxis treatment agent, manufacturer,
and lot number, is recorded and maintained in accordance with
paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-patient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner which authorizes a registered
professional nurse to administer anaphylaxis treatment agents,
including but not limited to epinephrine, for the emergency
treatment of anaphylaxis, in accordance with the requirements of
paragraph (1) of this subdivision. The order prescribed in
subparagraph (ii) of this paragraph shall incorporate a protocol
that meets the requirements of subparagraph (iii) of this
paragraph. Such order and protocol shall be considered a record
of the patient who receives the anaphylaxis treatment agent and
maintained as a record for the period of time prescribed in
paragraph 29.2(a)(3) of this Title.
- Pursuant to subdivision (5) of section 6909 of the Education
Law, a registered professional nurse shall be authorized to
administer anaphylaxis treatment agents, including but not
limited to epinephrine, for the emergency treatment of
anaphylaxis, pursuant to a non-patient specific order and
protocol prescribed and ordered by a licensed physician or a
certified nurse practitioner, provided the order and protocol
meets the requirements of paragraph (2) of this
subdivision.
- Purified protein derivative (PPD) mantoux tuberculin skin
tests.
- Pursuant to section 6909 (5) of the Education Law, a
registered professional nurse shall be authorized to execute the
order to administer purified protein derivative (PPD) mantoux
tuberculin skin tests, pursuant to a non-patient specific order
and protocol prescribed and ordered by a licensed physician or a
certified nurse practitioner, provided the order and protocol
meets the requirements of paragraph (2) of this
subdivision.
- Order and Protocol.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-patient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner, which authorizes a registered
professional nurse to execute the order to administer the
purified protein derivative (PPD) mantoux tuberculin skin test,
in accordance with the requirements of paragraph (1) of this
subdivision. The order prescribed in subparagraph (ii) of this
paragraph shall incorporate a protocol that meets the
requirements of subparagraph (iii) of this paragraph. Such order
and protocol shall be considered a record of the patient who has
received a purified protein derivative (PPD) mantoux tuberculin
skin test and maintained as a record for the period of time
prescribed in paragraph 29.2(a)(3) of this Title.
- The order shall authorize one or more named registered
professional nurses, or registered professional nurses who are
not individually named but are identified as employed or under
contract with an entity that is legally authorized to employ or
contract with registered professional nurses to provide nursing
services, to execute the order to administer purified protein
derivative (PPD) mantoux tuberculin skin tests for a prescribed
period of time. In instances in which the registered professional
nurses are not individually named in the order, but are
identified as employed or under contract with an entity that is
legally authorized to employ or contract with registered
professional nurses to provide nursing services, such registered
professional nurses shall not be authorized by such order to
execute the order to administer purified protein derivative (PPD)
mantoux tuberculin skin tests outside of such employment or
contract. The order shall contain but shall not be limited to the
following information:
- identification of the purified protein derivative (PPD)
mantoux tuberculin skin test;
- the period of time that the order is effective, including the
beginning and ending dates;
- the name and license number of the registered professional
nurse(s) authorized to execute the order to administer the
purified protein derivative (PPD) mantoux tuberculin skin test;
or the name of the entity that is legally authorized to employ or
contract with registered professional nurses to provide nursing
services with whom registered professional nurses who are not
individually named are employed or under contract to execute the
order to administer the prescribed purified protein derivative
(PPD) mantoux tuberculin skin test;
- in instances in which registered professional nurses are not
individually named in the order, but are identified as employed
or under contract with an entity that is legally authorized to
employ or contract with registered professional nurses to provide
nursing services, the order shall contain a statement limiting
registered professional nurses to execute the order to administer
purified protein derivative (PPD) mantoux tuberculin skin tests
only in the course of such employment or pursuant to such
contract; and
- the name, license number, and signature of the licensed
physician or certified nurse practitioner that has issued the
order.
- identification of the purified protein derivative (PPD)
mantoux tuberculin skin test;
- The protocol, incorporated into the order prescribed in
subparagraph (ii) of this paragraph, shall require the registered
professional nurse to meet the following requirements:
- The registered professional nurse shall ensure that each
potential recipient is assessed for untoward conditions that
would preclude purified protein derivative (PPD) mantoux
tuberculin skin testing and each recipient's record of the
purified protein derivative (PPD) mantoux tuberculin skin test
with manufacturer and lot number or a potential recipient's
refusal to be tested shall be documented in accordance with
paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall be responsible for
having emergency anaphylaxis treatment agents, related syringes
and needles available at the purified protein derivative (PPD)
mantoux tuberculin skin testing site, except in an emergency as
determined by the Commissioner of Health, a county commissioner
of health, or a county public health director.
- When the recipient of the test is legally capable of
consenting to the test, the registered professional nurse may
execute the order to administer the purified protein derivative
(PPD) mantoux tuberculin skin test only after the recipient is
adequately informed in writing as prescribed in this clause and
consents to the purified protein derivative (PPD) mantoux
tuberculin skin test. In the case of minors or other recipients
incapable of consenting to the test, the registered professional
nurse may execute the order to administer the purified protein
derivative (PPD) mantoux tuberculin skin test only after the
person legally responsible for the recipient of the test is
adequately informed in writing as prescribed in this clause and
consents to the purified protein derivative (PPD) mantoux
tuberculin skin test. Prior to the registered professional nurse
executing the order to administer the test, the recipient of the
test, or the person legally responsible for the recipient of the
test in the case of minors or other recipients incapable of
consenting to the test, shall be informed in writing about the
potential side effects of and adverse reactions to the test, the
appropriate course of action in the event of untoward or adverse
reactions to the test, and the need for test evaluation within 48
to 72 hours after the test is administered.
- The registered professional nurse shall ensure that the
recipient, or other person legally responsible for the recipient
when the recipient is a minor or otherwise incapable of
consenting to the test, is provided with a signed certificate of
purified protein derivative (PPD) mantoux tuberculin skin testing
and results, with the recipient's name, date of the test,
address where the test was administered, administering nurse,
manufacturer and lot number and recommendations for future tests
recorded thereon. With the consent of the recipient or a person
legally responsible for the recipient when the recipient is a
minor or otherwise incapable of consenting, the registered
professional nurse shall ensure that this information is
communicated to the recipient's primary health care provider
if one exists.
- Each registered professional nurse shall ensure that a record of all persons so tested including the recipient's name, date of the test, address where the test was administered, administering nurse, test results, manufacturer, lot number and recommendations for future tests is recorded and maintained in accordance with paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall ensure that each
potential recipient is assessed for untoward conditions that
would preclude purified protein derivative (PPD) mantoux
tuberculin skin testing and each recipient's record of the
purified protein derivative (PPD) mantoux tuberculin skin test
with manufacturer and lot number or a potential recipient's
refusal to be tested shall be documented in accordance with
paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-patient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner, which authorizes a registered
professional nurse to execute the order to administer the
purified protein derivative (PPD) mantoux tuberculin skin test,
in accordance with the requirements of paragraph (1) of this
subdivision. The order prescribed in subparagraph (ii) of this
paragraph shall incorporate a protocol that meets the
requirements of subparagraph (iii) of this paragraph. Such order
and protocol shall be considered a record of the patient who has
received a purified protein derivative (PPD) mantoux tuberculin
skin test and maintained as a record for the period of time
prescribed in paragraph 29.2(a)(3) of this Title.
- Pursuant to section 6909 (5) of the Education Law, a
registered professional nurse shall be authorized to execute the
order to administer purified protein derivative (PPD) mantoux
tuberculin skin tests, pursuant to a non-patient specific order
and protocol prescribed and ordered by a licensed physician or a
certified nurse practitioner, provided the order and protocol
meets the requirements of paragraph (2) of this
subdivision.
- Human Immunodeficiency Virus (HIV) tests.
- As used in this subdivision, human immunodeficiency virus
(HIV) test means HIV-related test as defined in Section 63.1 of
the Rules and Regulations of the New York State Department of
Health (10 NYCRR 63.1).
- Pursuant to section 6909(5) of the Education Law, a
registered professional nurse shall be authorized to execute an
order to administer HIV tests, pursuant to a non-patient specific
order and protocol prescribed and ordered by a licensed physician
or a certified nurse practitioner, provided the order and
protocol meet the requirements of paragraph (3) of this
subdivision.
- Order and Protocol.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-pat ient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner, which authorizes a registered
professional nurse to execute the order to administer an HIV
test, in accordance with the requirements of paragraph (2) of
this subdivision. The order prescribed in subparagraph (ii) of
this paragraph shall incorporate a protocol that meets the
requirements of subparagraph (iii) of this paragraph. Such order
and protocol shall be considered a record of the patient who has
received an HIV test and be maintained as a record for the period
of time prescribed in paragraph 29.2(a)(3) of this Title.
- The order shall authorize one or more named registered
professional nurses, or registered professional nurses who are
not individually named but are identified as employed or under
contract with an entity that is legally authorized to employ or
contract with registered professional nurses to provide nursing
services, to execute the order to administer HIV tests for a
prescribed period of time. In instances in which the registered
professional nurses are not individually named in the order, but
are identified as employed or under contract with an entity that
is legally authorized to employ or contract with registered
professional nurses to provide nursing services, such registered
professional nurses shall not be authorized by such order to
execute the order to administer HIV tests outside of such
employment or contract. The order shall contain but shall not be
limited to the following information:
- identification of the HIV test;
- the period of time that the order is effective, including the
beginning and ending dates;
- the name and license number of the registered professional
nurse(s) authorized to execute the order to adm inister the HIV
test; or the name of the entity that is legally authorized to
employ or contract with registered professional nurses to provide
nursing services with whom registered professional nurses who are
not individually named are employed or under contract to execute
the order to administer the HIV test;
- in instances in which registered professional nurses are not
individually named in the order, but are identified as employed
or under contract with an entity that is legally authorized to
employ or contract with registered professional nurses to provide
nursing services, the order shall contain a statement limiting
registered professional nurses to execute the order to administer
HIV tests only in the course of such employment or pursuant to
such contract; and
- the name, license number, and signature of the licensed
physician or certified nurse practitioner that has issued the
order.
- identification of the HIV test;
- The protocol, incorporated into the order prescribed in
subparagraph (ii) of this paragraph, shall require the registered
professional nurse to meet the following requirements:
- The registered professional nurse shall ensure that each
potential recipient is assessed for conditions that would
preclude HIV testing and ensure that each recipient's record
of the HIV test with manufacturer and lot number or a potential
recipient's refusal to be tested is documented in accordance
with paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall execute the order to
administer a HIV test in accordance with applicable state laws
and regulations, including, but not limited to Article 27-F of
the Public Health Law and Part 63 of the Rules and Regulations of
the New York State Department of Health.
- The registered professional nurse shall certify that he/she
obtained the written, informed consent of the recipient, or when
the recipient lacks capacity to consent, a person authorized
pursuant to law to consent to health care for such individual,
prior to ordering the performance of the HIV test. Informed
consent shall include pre-test counseling to the recipient, or if
the recipient lacks capacity to consent, a person authorized
pursuant to law to consent to health care for such individual.
The written informed consent and the pre-test counseling shall be
obtained and conducted in accordance with Article 27-F of the
Public Health Law and Part 63 of the Rules and Regulations of the
New York State Department of Health.
- A physician or nurse practitioner who issues a non-patient
specific order for HIV testing shall retain responsibility for
communication of a confirmatory, positive HIV test result to the
recipient, or when the recipient lacks capacity to consent, a
person authorized pursuant to law to consent to health care for
such individual. A registered professional nurse is not
authorized to deliver a final confirmatory HIV positive test
result through a non-patient specific order. A registered
professional nurse may only deliver a confirmatory, positive HIV
test result through a patient specific order as directed by the
treating physician or nurse practitioner.
- When a confirmatory, positive HIV test result is communicated
to a recipient, the registered professional nurse shall ensure
that the recipient, or when the recipient lacks capacity to
consent, a person authorized pursuant to law to consent to health
care for such individual, is provided with post-test counseling
in conformance with the requirements of Article 27-F of the
Public Health Law and Part 63 of the Rules and Regulations of the
New York State Department of Health.
- The registered professional nurse shall, upon request, ensure
that the recipient, or when the recipient lacks capacity to
consent, a person authorized pursuant to law to consent to health
care for such individual, is provided with a signed certificate
of HIV testing and results, with the recipient's name, date
of the test, address where the test was administered, the name of
the administering nurse, manufacturer and product lot number. If
the recipient has a confirmatory, positive HIV test result, the
registered nurse shall not provide a signed certificate of HIV
testing and results until after the physician or nurse
practitioner who issued the non-patient specific order for the
HIV test communicates the confirmatory, positive HIV test result
to the recipient, or when the recipient lacks capacity to
consent, a person authorized pursuant to law to consent to health
care for such individual.
- With the consent of the recipient or when the recipient lacks
capacity to consent, a person authorized pursuant to law to
consent to health care for such individual, and with an
appropriate authorization for the release of confidential HIV
information, the registered professional nurse shall ensure that
this information is communicated to the recipient's primary
health care provider if one exists in accordance with the
requirements of Article 27-F of the Public Health Law and Part 63
of the Rules and Regulations of the New York State Department of
Health.
- Each registered professional nurse shall ensure that a record of all persons so tested including the recipient's name, date of the test, address where the test was administered, administering nurse, test results, manufacturer, lot numbers and such other information as may be necessary pursuant to the protocol is recorded and maintained in accordance with section 29.2(a)(3) of this Title and Article 27-F of the Public Health Law and Part 63 of the Rules and Regulations of the New York State Department of Health.
- The registered professional nurse shall ensure that each
potential recipient is assessed for conditions that would
preclude HIV testing and ensure that each recipient's record
of the HIV test with manufacturer and lot number or a potential
recipient's refusal to be tested is documented in accordance
with paragraph 29.2(a)(3) of this Title.
- The registered professional nurse shall either maintain or
ensure the maintenance of a copy of the non-pat ient specific
order and protocol prescribed by a licensed physician or a
certified nurse practitioner, which authorizes a registered
professional nurse to execute the order to administer an HIV
test, in accordance with the requirements of paragraph (2) of
this subdivision. The order prescribed in subparagraph (ii) of
this paragraph shall incorporate a protocol that meets the
requirements of subparagraph (iii) of this paragraph. Such order
and protocol shall be considered a record of the patient who has
received an HIV test and be maintained as a record for the period
of time prescribed in paragraph 29.2(a)(3) of this Title.
- As used in this subdivision, human immunodeficiency virus
(HIV) test means HIV-related test as defined in Section 63.1 of
the Rules and Regulations of the New York State Department of
Health (10 NYCRR 63.1).
