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RULES AND REGULATIONS

STATE BOARD OF NURSING

[49 PA. CODE CH. 21]

Continuing Education for Certified Registered Nurse Practitioners

[34 Pa.B. 6409]

   The State Board of Nursing (Board) adopts §§ 21.332--21.337 to read as set forth in Annex A.

   Notice of proposed rulemaking was published at 32 Pa.B. 5666 (November 16, 2002). Publication was followed by a 30-day public comment period during which the Board did not receive any comments from the public. On February 6, 2003, the House Professional Licensure Committee (HPLC) submitted two comments. The Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) made no comments. The Independent Regulatory Review Commission (IRRC) submitted comments to the proposed rulemaking on February 28, 2003.

   Section 3(c) of the act of December 9, 2002 (P. L. 1567, No. 206) (Act 206) amended the Professional Nursing Law (act) (63 P. S. §§ 211--226) by adding section 8.1 to the Professional Nursing Act (63 P. S. § 218.1) that requires all certified registered nurse practitioners (CRNPs) to complete 30 hours of Board-approved continuing education prior to biennial renewal of certification. Act 206 also requires that CRNPs with prescriptive authority complete at least 16 of the 30 hours in pharmacology. The proposed rulemaking cited section 2.1(k) of the act (63 P. S. § 212.1(k)) as the statutory authority for the rulemaking. Upon inquiry from the Office of Attorney General, the Board explained that its authority arose also from section 6.1 of the act (63 P. S. § 216.1), which authorizes the Board to establish and approve programs for the preparation of registered professional nurses. These sections of the act authorized the Board, jointly with the State Board of Medicine, to promulgate § 21.283(3) (relating to prescribing and dispensing drugs) effective November 18, 2000, which mandated 16 hours of continuing education in pharmacology for CRNPs with prescriptive authority. With the enactment of Act 206, this final-form rulemaking is authorized by section 8.1 of the act. This final-form rulemaking incorporates the new statutory requirement of continuing education for all CRNPs. The final-form rulemaking was delivered on January 6, 2004.

   On January 21, 2004, IRRC requested additional information on § 21.332(b)(4) (relating to requirement of continuing education). IRRC requested that § 21.332(b)(3) and § 21.337(c) (relating to CRNP responsibilities) refer specifically to the disciplinary provisions of the act. These changes were made. Finally, IRRC asked many questions about § 21.332a (relating to inactive status and reactivation). Upon review of this section, the Board determined that the section was confusing as written. The Board elected to withdraw the rulemaking on January 23, 2004, and resubmit after making appropriate revisions.

Summary of Comments and Responses to Proposed Rulemaking

   HPLC Comments

   The HPLC submitted two comments to the proposed rulemaking. First, the HPLC requested an explanation as to why 50 minutes constituted a continuing education hour instead of 60 minutes. (See § 21.334(f) (relating to sources of continuing education).) The Board decided to use the 50-minute hour because it anticipates that colleges and universities that house CRNP education programs will offer most of the continuing education courses that will be offered to CRNPs and 50 minutes is the standard hour in academia.

   Second, the HPLC questioned whether a limit should be placed on the number of credit hours a CRNP could obtain through correspondence courses, taped study courses and other independent study courses. In developing the proposed rulemaking, the Board considered whether it would be appropriate to place a limit on the number of continuing education credits that could be earned in these manners, and decided not to limit the number of distance learning credits that could be earned to satisfy the biennial requirement. The Board determined that it would not limit the number of credits that could be taken in distance learning for the following reasons: first, the Board is aware of only a very few distance learning courses being offered in the area of advanced pharmacology or CRNP practice areas as most of these courses are offered through CRNP programs; second, the nature of the practice of a CRNP in this Commonwealth often places the CRNP in less developed regions of the Commonwealth where the CRNP has difficulty accessing traditional continuing education programs and would greatly benefit by being permitted to meet the biennial requirement with distance learning.

IRRC Comments

   When proposed rulemaking was published, Act 206 had not been enacted and the proposed rulemaking governed only CRNPs with prescriptive authority. IRRC commented that the regulation's heading should reflect the regulation's limited application. This change is obviated by the changes made in this final-form rulemaking to conform to Act 206.

   IRRC suggested that § 21.334(a), relating to the provision of certificates of completion, would be more appropriate under § 21.335 (relating to requirements for courses). The Board concurs that § 21.334(a) is misplaced and has moved § 21.334(a) to § 21.336 (relating to continuing education course approval). IRRC also advised that the phrase ''the Board finds that'' in § 21.334 is unnecessary and it has been deleted.

   IRRC made numerous comments regarding the proposed rulemaking, including two similar to the HPLC comments. IRRC asked whether an Internet-based course would be included under the terminology ''correspondence courses and other independent study courses.'' The Board considers Internet-based courses to be correspondence courses, when the correspondence occurs through the computer rather than through the United States Postal Service. IRRC also inquired whether the Board should limit the number of credits obtainable through correspondence courses. As explained previously, the Board did not wish to limit credits that could be earned through correspondence courses. Finally, IRRC asked what kind of documentation would be submitted to obtain approval of the course from the Board. Correspondence courses would be approved in the same manner as other continuing education courses, in accordance with § 21.334(b), which provides that CRNPs may obtain Board approval for courses under § 21.336. The Board anticipates that preapproved providers listed in § 21.334(a) will offer the vast majority of continuing education courses, including correspondence courses.

   IRRC requested that the Board add to the final-form rulemaking some description of the type of documentation that would be acceptable evidence that the CRNP had been employed in another jurisdiction as a CRNP with prescriptive authority to reactivate a license placed on inactive status under § 21.332(a)(2)(ii). Generally, nurses who have placed their Pennsylvania licenses on inactive status to practice in another state and then seek to reactivate their Pennsylvania licenses submit a letter from their employer describing the nurse's duties. The Board declines to add this explanation to this subsection, as the Board does not believe the provision as written will cause any confusion. In addition, the Board notes that the requirement that the CRNP demonstrate that he has completed continuing education that is substantially equivalent to the requirements of § 21.283(3) could be met by submitting certificates of attendance and course outlines or verification from the other state's nursing board that the requirements are equivalent.

   IRRC commented that it believes that the Board lacks statutory authority for § 21.332(b)(4), which provides that the Board may waive the continuing education requirement in cases of illness or undue hardship. Section 8.1 of the act authorizes the Board to certify registered nurse practitioners. With this authority comes the authority to pass on the qualifications of applicants for renewal of registered nurse practitioner certification. The Board understands and respects the Legislature's determination that continuing education contributes to continued competency and ensures the safety of the public. However, the Board is also aware that circumstances may dictate a case-by-case approach. For example, CRNPs serving overseas may be unable to complete required continuing education. The Board does not believe that these nurses should be denied the opportunity to resume their profession when they return to this Commonwealth. The Board intends to use the waiver provision thoughtfully and sparingly, in cases of extreme hardship or prolonged illness. An applicant would apply for a waiver by writing to the Board and explaining the special circumstances the applicant believes warrants the grant of a waiver. IRRC also asked, on January 21, 2004, how many requests for waiver the Board has received. The Board has not received any requests for waiver because nurses have not previously been required to complete continuing education.

   Finally, IRRC questioned the reasonableness of § 21.336, noting that the Board had not provided any time limit for submitting applications for the approval of continuing education courses. In the final-form rulemaking, the Board has added a requirement that applications for course approval be submitted at least 60 days prior to the date the course is to be offered.

Amendments to Conform the Rulemaking to the Act and for Clarity

   By Act 206, the General Assembly instituted a 30-hour biennial continuing education requirement for all CRNPs, and codified the prior regulatory requirement of 16 hours of biennial continuing education in pharmacology for CRNPs with prescriptive authority. To avoid the confusion that may be caused by different statutory and regulatory provisions relating to continuing education, and to conform this rulemaking to Act 206, the Board has added provisions to the final version of the final-form rulemaking.

   Section 21.332 has been amended to make the continuing education provisions apply to all CRNPs. Section 21.332 restates the continuing education requirement and references section 8.1(c) of the act. References in former § 21.332(b)(1) to reactivation have been eliminated and that section has become § 21.332(b)(2). Paragraph (1) has been added to § 21.332(b) to set forth the general 30-hour biennial continuing education requirement for all CRNPs.

   For clarity, § 21.332(a)(1) and (2) have been moved to new § 21.332a (relating to inactive status). The inactive status and reactivation section has been split into three subsections instead of the two paragraphs published in the proposed rulemaking. The three new subsections of § 21.332a on inactive status and reactivation are divided as follows: § 21.332a(a) relates to a CRNP placing his certificate on inactive status; § 21.332a(b) relates to a CRNP placing his prescriptive authority approval on inactive status for less than 3 years; and § 21.332a(c) relates to the CRNP placing his prescriptive authority approval on inactive status for more than 3 years. A more stringent continuing education requirement must be met where the prescriptive authority has been inactive for more than 3 years to ensure competency and currency in handling prescription drugs.

   Section 21.332(b)(3) was amended to indicate that failure to meet continuing education requirements will subject a CRNP to formal disciplinary action. This amendment conforms the rulemaking to section 15 of the act (63 P. S. § 225). CRNPs, like other professional licens- ees who are required to complete biennial continuing education, will verify their continuing education compliance and the Bureau of Professional and Occupational Affairs will randomly audit 5% of the licensees by requiring submission of documentation for 30 hours of continuing education. At IRRC's request, the Board specified the reference to the disciplinary section of the act.

   A new subsection (a) was added to § 21.333 (relating to continuing education subject matter) to provide for general continuing education courses and the provision relating to pharmacology continuing education was designated as subsection (b). Section 21.334 was similarly amended. Now that all CRNPs in this Commonwealth are required to complete continuing education, it is anticipated that the broad list of preapproved providers will offer courses in both general and pharmacology subjects.

Statutory Authority

   This final-form rulemaking is authorized under section 8.1(c) of the act which mandates continuing education for all CRNPs and authorizes the Board to approve continuing education courses for CRNPs. In addition, section 2.1(k) of the act authorizes the Board to promulgate regulations for the administration of the act.

Fiscal Impact and Paperwork Requirements

   This final-form rulemaking will have no adverse fiscal impact on the Commonwealth or its political subdivisions. The Board is self-supporting and the cost to the Board of reviewing applications for continuing education course approval will be satisfied by the fee charged for approval of continuing education courses. This fee is being promulgated in a separate rulemaking package related to fees. The final-form rulemaking will impose only minimal additional paperwork requirements upon the Board, and none upon any political subdivisions. The private sector, to the extent that it seeks to provide continuing education programs for CRNPs with prescriptive authority, will incur nominal costs in submitting information to the Board.

Regulatory Review

   Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on November 16, 2002, the Board submitted a copy of the notice of proposed rulemaking, published at 32 Pa.B. 5666, to IRRC and the Chairpersons of the HPLC and the SCP/PLC for review and comment.

   Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Board has considered all comments from IRRC, the HPLC, the SCP/PLC and the public.

   Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on October 19, 2004, the final-form rulemaking was approved by the HPLC. On November 3, 2004, the final-form rulemaking was deemed approved by the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on November 4, 2004, and approved the final-form rulemaking.

Additional Information

   Additional information may be obtained by writing to Ann Steffanic, Board Administrator, State Board of Nursing, P. O. Box 2649, Harrisburg, PA 17105-2649.

Findings

   The Board finds that:

   (1)  Public notice of intention to adopt these regulations was given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) (CDL) and the regulations promulgated under at 1 Pa. Code §§ 7.1 and 7.2.

   (2)  These regulations are necessary and appropriate for the regulation of the practice of CRNPs in this Commonwealth.

   (3)  The amendments made to the final-form rulemaking do not enlarge the original purpose of the proposed rulemaking as published under section 201 of the CDL.

Order

   The Board orders that:

   (a)  The regulations of the Board, 49 Pa. Code Chapter 21, are amended by adding §§ 21.332, 21.332a and 21.333--21.337 to read as set forth in Annex A. (Editor's Note: The addition of § 21.332a was not included in the proposal which appeared at 32 Pa.B. 5666.)

   (b)  The Board shall submit a copy of Annex A to the Office of Attorney General and the Office of General Counsel for approval as required by law.

   (c)  The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.

   (d)  The regulations shall take effect immediately upon publication in the Pennsylvania Bulletin.

JANET HUNTER SHIELDS, MSN, CRNP, CS,   
Chairperson

   (Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 34 Pa.B. 6292 (November 20, 2004).)

   Fiscal Note: Fiscal Note 16A-5117 remains valid for the final adoption of the subject regulations.

Annex A

TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS

PART I. DEPARTMENT OF STATE

Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS

CHAPTER 21. STATE BOARD OF NURSING

Subchapter C. CERTIFIED REGISTERED NURSE PRACTITIONERS

CONTINUING EDUCATION

§ 21.332. Requirement of continuing education.

   (a)  A CRNP shall comply with this section and §§ 21.332a--21.337.

   (b)  Continuing education requirements shall be completed each biennial cycle.

   (1)  An applicant for biennial renewal of certification is required to complete, during the 2 years preceding renewal, a minimum of 30 hours of Board-approved continuing education, as set forth in section 8.1(c) of the act (63 P. S. § 218.1(c)). Completion of a course described in § 21.283(2) (relating to prescribing and dispensing drugs) satisfies the continuing education requirement for the biennial renewal period in which it is completed.

   (2)  An applicant for biennial renewal of prescriptive authority approval is required to complete, during the 2 years preceding renewal, a minimum of 16 of the 30 hours of continuing education in pharmacology. Completion of a course described in § 21.283(2) shall satisfy the continuing education requirement for the biennial renewal period in which it is completed.

   (3)  A person failing to meet the continuing education requirements for a biennial renewal period will be subject to formal disciplinary action under section 14(a)(3) of the act (63 P. S. § 224(a)(3)).

   (4)  The Board may waive the requirements of continuing education in cases of illness or undue hardship. It is the duty of each licensee who seeks a waiver to notify the Board in writing and request the waiver prior to the end of the renewal period. The Board will grant, deny or grant in part the request for waiver. An individual who requests a waiver may not prescribe or dispense drugs after the expiration of his current prescriptive authority and until the Board grants the waiver request.

§ 21.332a. Inactive status and reactivation.

   (a)  A CRNP who places his certification on inactive status is not required to meet the continuing education requirements in § 21.332(b)(1) (relating to requirement of continuing education) during the period the certification is on inactive status. Upon application for reactivation of certification, the CRNP shall show proof of meeting the continuing education requirements for the biennial period immediately preceding the request for reactivation.

   (b)  A CRNP who places his prescriptive authority approval on inactive status for less than 3 years is not required to meet the continuing education requirements in § 21.332(b)(2) during the period the prescriptive authority approval is on inactive status. Upon application for reactivation of prescriptive authority approval, the CRNP shall show proof of meeting the continuing education requirements for the biennial period immediately preceding the request for reactivation.

   (c)  A CRNP who places his prescriptive authority approval on inactive status for 3 years or longer may reactivate the prescriptive authority approval by meeting one of the following conditions:

   (1)  Complete the requirement in § 21.283(2) (relating to prescribing and dispensing drugs) by taking at least 45 hours of course work in advanced pharmacology.

   (2)  Provide evidence to the Board that:

   (i)  The CRNP has practiced, for at least 1 of the last 3 years, as a CRNP with prescriptive authority in another jurisdiction.

   (ii)  The scope of the prescriptive authority in the other jurisdiction is equivalent to prescriptive authority in this Commonwealth.

   (iii)  The CRNP was required, as a condition for continued practice in the other jurisdiction, to complete continuing education that is substantially equivalent to the requirements of § 21.283(3).

   (iv)  The CRNP met the continuing education requirements of the other jurisdiction within 1 year of the request for reactivation of prescriptive authority.

§ 21.333. Continuing education subject matter.

   (a)  Continuing education courses shall address the CRNP's area of practice and meet the requirements of § 21.332(b)(1) (relating to requirement of continuing education).

   (b)  Pharmacology continuing education courses shall meet the requirements of section 8.1(c) of the act (63 P. S. § 218.1(c)) and § 21.332(b)(2) and must provide the knowledge and skills to understand the pharmacokinetics and pharmacodynamics of broad categories of drugs and to analyze the relationship between pharmacologic agents and physiologic/pathologic responses.

§ 21.334. Sources of continuing education.

   (a)  The following providers of continuing education and credentialing organizations have currently met the standards for course approval for continuing education.

   (1)  Accordingly, provided that these providers agree to abide by § 21.336(a) (relating to continuing education course approval), the courses offered or approved by the following providers or credentialing organizations are approved:

   (i)  Board-approved CRNP programs.

   (ii)  The American Nurses Credentialing Center's Commission on Accreditation (ANCC).

   (iii)  The American Academy of Nurse Practitioners (AANP).

   (iv)  The National Association of Pediatric Nurse Practitioners (NAPNP).

   (v)  The American Medical Association (AMA).

   (2)  The approval given to the providers and credentialing organizations in paragraph (1) is subject to reevaluation. A rescission of provider or credentialing organization approval will be made only in accordance with 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure) or by amendment of this section.

   (b)  CRNPs may obtain credit for courses offered by providers not indicated in subsection (a)(1) if the provider receives approval of the course under § 21.336 prior to its implementation.

   (c)  CRNPs may obtain credit for continuing education hours on an individual basis if the CRNP, prior to attendance at the course, obtains Board approval by submitting a request for course approval and supporting documentation listed in § 21.336(b).

   (d)  CRNPs may obtain credit for correspondence courses, taped study courses and other independent study courses if the course is Board approved.

   (e)  Up to 4 hours will be credited for service as a teacher, preceptor, lecturer or speaker and for publication in a refereed journal or other scholarly publication relating to pharmacology or the CRNP's area of practice. Application shall be made prior to the service or within 90 days of the publication to assure that the Board will approve the service or publication and to allow the Board to determine the number of contact hours that will be granted.

   (f)  An hour for purposes of nurse practitioner continuing education is 50 minutes.

§ 21.335. Requirements for courses.

   Each course shall have:

   (1)  An established mechanism to measure its quality, established criteria for selecting and evaluating faculty, and established criteria for the evaluation of each participant who completes the course.

   (2)  Adequate facilities with appropriate instructional materials to carry out continuing education programs.

   (3)  Instructors who have suitable qualifications as detailed in § 21.336(d) (relating to continuing education course approval).

§ 21.336. Continuing education course approval.

   (a)  As a condition of approval, providers and credentialing organizations are required to provide CRNPs who complete continuing education courses with a certificate of completion which contains the information listed in § 21.337(a) (relating to CRNP responsiblities). Providers and credentialing organizations shall maintain records of course attendance for at least 5 years.

   (b)  Providers referenced in § 21.334(b) (relating to sources of continuing education) or CRNPs applying for individual approval in § 21.334(c), when seeking Board approval of a continuing education course shall pay the required fee (see § 21.253 (relating to fees)) and complete and submit an application for course approval at least 60 days prior to the date the course is to be offered, which shall include the following information:

   (1)  The full name and address of the provider.

   (2)  The title of the program.

   (3)  The dates and location of the program.

   (4)  The faculty names, titles, affiliations, degrees and areas of expertise.

   (5)  The schedule of program--title of subject, lecturer and time allocated.

   (6)  The total number of hours requested.

   (7)  The method of certifying and assuring attendance, and draft of certificate of attendance to be provided to course participants.

   (8)  The course objectives.

   (9)  The target audience.

   (10)  The core subjects.

   (11)  The program coordinator.

   (12)  The instruction and evaluation methods.

   (13)  Other information requested by the Board.

   (c)  Upon approval of a course, the Board will assign a course number and determine the number of hours awarded. The provider shall place the course number on the certificate of attendance and shall provide CRNPs who successfully complete a course with a certificate of attendance.

   (d)  Courses will be approved only in the instructor's demonstrated areas of expertise. Expertise may be demonstrated by the instructor's certification in the specialty area to be presented.

   (e)  A separate application shall be submitted whenever a change is made to any information submitted under subsection (b), except for information related to a change in date or location, or both, of the program submitted under subsection (b)(3).

§ 21.337. CRNP responsibilities.

   (a)  A CRNP is required to maintain documentation of completion of continuing education, including:

   (1)  CRNP name.

   (2)  Dates attended.

   (3)  Continuing education hours.

   (4)  Title of course.

   (5)  Course provider.

   (6)  Location of course.

   (7)  Course number.

   (b)  Primary responsibility for documenting completion of the continuing education requirements rests with the CRNP. A CRNP seeking to renew certification or prescriptive authority shall verify compliance with continuing education requirements. Documentation of completion of continuing education requirements must be maintained for 5 years. The certificate issued by the course provider must be acceptable documentation. Acceptable documentation of hours obtained through § 21.334(c) or (e) (relating to sources of continuing education) must be the Board approval letter sent to the applicant.

   (c)  Falsification of information required under this section or failure to complete continuing education requirements by those who continue to practice as a CRNP or to prescribe, may result in the institution of formal disciplinary action under section 14(a)(3) of the act (63 P. S. § 224(a)(3)).

[Pa.B. Doc. No. 04-2140. Filed for public inspection December 3, 2004, 9:00 a.m.]



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