HAR §16-89-81. Practice specialties

(a) The four areas of advanced practice registered nurses recognized by the board from which the practice specialties are derived are: (1) Nurse practitioner ("NP"); (2) Certified registered nurse anesthetist ("CRNA"); (3) Certified nurse-midwife ("CNM"); and §16-89-81 89-37 (4) Clinical nurse specialist ("CNS"). (b) In addition to those functions specified for the registered nurse, and in accordance with appropriate nationally recognized standards of practice, the advanced practice registered nurse may perform the following generic acts which include, but are not limited to: (1) Provide direct care by utilizing advanced scientific knowledge, skills, nursing and related theories to assess, plan, and implement appropriate health and nursing care to patients; (2) Provide indirect care. Plan, guide, evaluate and direct the nursing care given by other personnel associated with the health care team; (3) Teach, counsel, or plan care for individuals or group, utilizing a synthesis of advanced skills, theories, and knowledge of biologic, pharmacologic, physical, sociocultural and psychological aspects of care to accomplish desired objectives; (4) Serve as a consultant and resource of advanced clinical knowledge and skills to those involved directly or indirectly in patient care; (5) Participate in joint and periodic evaluation of services rendered including, but not limited to, chart reviews, case reviews, patient evaluations, and outcome of case statistics; (6) Establish collaborative, consultative, and referral networks as appropriate with other health care professionals. Patients who require care beyond the scope of practice of an APRN shall be referred to an appropriate health care provider; (7) Manage the plan of care prescribed for the patient; (8) Initiate and maintain accurate records and authorize appropriate regulatory and other legal documents; (9) Recognize, develop, and implement professional and community educational programs related to health care; (10) Conduct research and analyze the health needs of individuals and populations and design programs which target at-risk groups and cultural and environmental factors which foster health and prevent illness; (11) Participate in policy analysis and development of new policy initiative in the area of practice specialty; and (12) Contribute to the development, maintenance, and change of health care delivery systems to improve quality of health care services and consumer access to services. (c) The scope of practice for each of the four areas of clinical practice specialties shall be in accordance with nationally recognized standards of practice which are consistent with the following: §16-89-81 89-38 (1) Nurse practitioner scope of practice, depending on area of specialty, may include, but is not limited to: (A) Evaluate the physical and psychosocial health status of patients through a comprehensive health history and physical examination, or mental status examination, using skills of observation, inspection, palpation, percussion, and auscultation, and using diagnostic instruments or procedures that are basic to the clinical evaluation of physical, developmental, and psychological signs and symptoms; (B) Order, interpret, or perform diagnostic, screening, and therapeutic examinations, tests and procedures; (C) Formulate a diagnosis; (D) Plan, implement, and evaluate care; (E) Order or utilize medical, therapeutic, or corrective measures including, but not limited to, rehabilitation therapies, medical nutritional therapy, social services and psychological and other medical services; (F) Monitor the effectiveness of therapeutic interventions; (G) Assist in surgery; and (H) Admit and discharge clients for inpatient care at facilities licensed as hospitals, long term care facilities or hospice. (2) Certified registered nurse anesthetist scope of practice: (A) Be responsible for performing and documenting total anesthesia care of patient including, but not limited to, pre- anesthetic preparation and evaluation, requesting consultations and diagnostic studies, obtaining informed consent for anesthesia, and selection and administration of anesthetic agents or other agents administered in the management of anesthetic care, anesthesia induction, maintenance, emergence, and post anesthesia care; (B) Develop and implement an anesthetic care plan; (C) Select and initiate the planned anesthesia technique which may include: general, regional, and local anesthesia and sedation; (D) Select, apply, or insert appropriate non-invasive and invasive monitoring modalities for collecting and interpreting patient physiological data; (E) Support life functions during the peri-operative period; 16-89-81 89-39 (F) Select, obtain, and administer the anesthetics, adjuvant drugs, accessory drugs, and fluids, necessary to manage the anesthetic to maintain the patient's physiologic homeostasis, and to correct abnormal responses to the anesthesia or surgery; (G) Recognize and be able to take appropriate action for untoward patient responses during anesthesia; (H) Observe and manage the patient's emergence from anesthesia by selecting, obtaining, ordering, or administering medications, fluids, or ventilatory support in order to maintain homeostasis; (I) Discharge patients from a post-anesthesia care area; (J) Participate in the life support of the patient including, but not limited to, peri-anesthetic and clinical support functions; (K) Implement acute and chronic pain management modalities; and (L) Respond to emergency situations by providing airway management, administration of emergency fluids or drugs, or using basic or advanced cardiac life support techniques. (3) Certified nurse-midwife scope of practice: (A) Provide independent management of women's health care, focusing particularly on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of women; (B) Practice in accordance with the standards for the practice of nurse-midwifery of the American College of Nurse- Midwives, unless otherwise indicated by the board. The standards include but do not limit the nurse midwife to: (i) Provide primary care services for women and newborns; (ii) Take histories and perform physical exams; (iii) Order and interpret diagnostic tests; (iv) Operate within a health care system that provides for consultation, collaborative management, or referral as indicated by the status of the client; and (v) Admit clients for inpatient care at facilities licensed as hospitals or birth centers in the State; and (C) Includes all of the functions listed in paragraph (1) relating to nurse practitioner scope of practice. §16-89-81 89-40 (4) Clinical nurse specialist scope of practice, depending on area of specialty, may include, but is not limited to: (A) Evaluate the physical, developmental, and psychosocial health status of patients through a comprehensive health history, physical examination, or mental status examination, using skills of observation, inspection, palpation, percussion, and auscultation, and using diagnostic instruments or procedures that are basic to clinical evaluation of physical, developmental, and psychological signs and symptoms; (B) Order, interpret, or perform diagnostic and therapeutic examinations, tests and procedures, if CNS educational preparation included pathophysiology, pharmacology, advanced health promotion and disease prevention, differential diagnosis, and disease management; formulate a diagnosis; (C) Assess the normal and abnormal findings from the history, physical, and mental status examinations, and diagnostic reports; (D) Plan, implement, and evaluate the care of patients and groups of patients (including individuals, couples, groups, families, and communities) with complex needs in the area of practice specialty; (E) Provide advanced management of health care for selected client populations; (F) Consult, as needed, with members of health care teams concerning physiological, psychological, social, educational, and ethical issues in area of expertise; and (G) Initiate and maintain accurate records, appropriate legal documents, and other health and nursing care reports. (d) Nothing in this section shall allow an APRN to prescribe any substance included in the current Exclusionary Formulary. It shall be unlawful for any nurse not granted prescriptive authority under this chapter to prescribe, offer to prescribe, or to use any sign, card, or device to indicate that the nurse is so authorized. (e) Nothing in this section shall preclude a licensed nurse from carrying out prescribed medical orders of a licensed dentist, physician, osteopath, or podiatrist licensed in accordance with chapter 448, 453, or 463E, HRS, or the orders of a recognized advanced practice registered nurse. (f) Nothing in this section shall limit a certified registered nurse anesthetist from providing total anesthesia care as designated in subsection (c)(2). §16-89-83 89-41 [Eff and comp 9/5/97; am and comp 8/9/01; comp 5/5/05; am and comp 12/27/10; am and comp 3/28/13; am and comp 10/27/18] (Auth: HRS §457-5) (Imp: HRS §457-8.5) §16-89-83 Requirements for license as an advanced practice registered nurse. In addition to submitting an application prescribed by the board and having a current, unencumbered license as a registered nurse in this State the applicant for license as an advanced practice registered nurse shall provide proof of: (1) Documentation relating to any disciplinary action ordered by or pending before any board of nursing in any state or jurisdiction of the United States; (2) Documentation from the appropriate agencies or parties regarding any criminal conviction, of which the applicant is the subject, that has not been annulled or expunged. This includes, but is not limited to, certified copies of any court records, orders, or other documents that state the facts and statutes upon which the applicant was convicted, the judgment of the court with regard to the conviction, the sentence imposed, the actual terms of the sentence, and whether sentence was completed; and (3) A self-query report from the NPDB. The board may require additional background checks of nurse applicants from an independent background check service as approved by the board, provided that the applicant shall pay the cost of the background check. The board may also require that the applicant submit a signed explanation of the events that led to the disciplinary action or prior conviction. [Eff and comp 9/5/97; comp 8/9/01; comp 5/5/05; am and comp 12/27/10; comp 3/28/13; am and comp 10/27/18] (Auth: HRS §457-5) (Imp: HRS §457-8.5)