Nursingboard News 2016
Nursingboard News 2016
Nursingboard News 2016
Board News
Mission
The mission of the Board of Registration in Nursing is to protect the health, safety and welfare of the
citizens of the Commonwealth through the fair and consistent application of the statutes and regulations
governing nursing practice and nursing education.
Table of Contents
New Law in Fight Against Opioid Overdose Epidemic: Implications for APRN Prescribers 2
Nursing Board (BRN) and Division of Health Professions Licensure (DHPL) Staff 23
The data also indicates an alarming link between fentanyl and opioid-related deaths. Among the 1319
opioid-related deaths in 2015 in which a toxicology screen was also available, over 50% had a positive
screen for fentanyl3, the synthetic opioid prescription pain killer with effects similar to heroin.
In response to this growing epidemic, Governor Charlie Baker signed landmark legislation into law in
March 2016 to address the Commonwealths opioid crisis. Chapter 52 of the Acts of 2016 represents a
multi-pronged approach in the fight against this devastating epidemic by focusing on prevention,
education, treatment and recovery. The Board of Registration in Nursing takes this opportunity to highlight
three of the statutory requirements designed to curb opioid misuse.
Additionally, the law enables patients to direct pharmacies to dispense less than the fully prescribed
quantity of an opioid. Whenever a prescriber issues a Schedule II opioid, the prescriber must:
1. consult with the patient regarding the quantity of the opioid prescribed and the patients option to
request the prescription be filled in a reduced quantity; and
2. inform the patient of the risks associated with the opioid. If dispensed in a lesser amount, the
prescription is void as to the unfilled quantity.
1
MA Department of Public Health. Data Brief: Opioid-related Overdose Deaths among Massachusetts
Residents. Posted August 2016.
2
Ibid.
3
Ibid.
Page 3 begins.
The MassPAT will go live August 22, 2016. Online registration for MassPAT is now open (users will not be
able to conduct patient searches in MassPAT until August 22, 2016).
For more information, including how to access MassPAT, visit the Prescription Monitoring Program
website at http://www.mass.gov/dph/dcp/pmp.
counseling patients about the side effects, addictive nature and proper storage and disposal of
prescription medications;
appropriate prescription quantities for prescription medications that have an increased risk of
abuse; and
opioid antagonists, overdose prevention treatments and instances in which a patient may be
advised on both the use of and ways to access opioid antagonists and overdose prevention
treatments.
This new continuing education requirement must be fulfilled as a prerequisite to initial application for a MA
Controlled Substance Registration and subsequently during each APRN license renewal period, and it
must be consistent with 244 CMR 5.00: Continuing Education. The APRN prescriber will be required to
attest under the penalties of perjury to complying with M.G.L. c. 94C, 18(e) when signing the
Massachusetts Controlled Substance Registration form and the nursing license/APRN authorization
renewal form.
Page 4 begins.
An accomplished nurse executive and educator, Dr. Silva brings a national perspective to her new role
having served in leadership positions in Arizona, California and North Carolina. Most recently, she was
the Chief Operating Officer and Chief Nursing Officer at a large healthcare network.
As its Chief Executive Officer, Dr. Silva will oversee and direct the Boards daily operations related to:
the licensure of over 120,000 Licensed Practical Nurses, Registered Nurses and Advanced
Practice Registered Nurses;
the regulation of nursing practice and education including the approval of 75 Registered Nurse
and Licensed Practical Nurse education programs.
The Board has also appointed Claire MacDonald, MSN, DNP, RN, to the position of Deputy Executive
Director.
Dr. MacDonald has served in several leadership roles in academia and acute care in the Commonwealth.
Prior to her appointment, she was a Professional Development Specialist of a large academic medical
center.
Dr. MacDonald will assist the Executive Director in managing the Boards daily operations.
Both Drs. Silva and MacDonald began their positions in January 2016.
Page 5 begins.
Image: Lorena Silva, Executive Director (far right), congratulates Katherine Gehly (center right), on her re-
election as Board Chairperson as Deputy Executive Director, Claire MacDonald (far left) and newly
elected Vice-Chairperson, Barbara Levin (center left) look on.
For a list of the Fiscal Year 2017 meeting dates, visit the Boards website at
www.mass.gov/dph/boards/rn, click on About the Board of Registration in Nursing and then on the link to
the BORN calendar. Minutes of the Boards regularly scheduled monthly meetings are published on the
Minutes and Agendas of Previous Board Meetings webpage.
Page 6 begins.
one representative from each level of nursing education whose graduates are eligible to write
nursing licensure examinations (baccalaureate and higher degree programs are considered be
considered one level);
two Registered Nurses in advanced practice, at least one of whom is employed providing direct
patient care at the time of appointment;
one Registered Nurse who is currently employed as a nursing service administrator and who is
responsible for agency or service wide policy development and implementation; and
two Registered Nurses not authorized in advanced nursing practice and who provide direct
patient care.
The statute also specifies that the consumer board member must be knowledgeable in consumer health
concerns and have no current or prior association, directly or indirectly, with the provision of health care.
Page 7 begins.
Currently, there are three vacant seats on the Board: Licensed Practical Nurse; Educator representing
Hospital-Based Diploma Education; and Consumer. To be eligible for a Board appointment, potential
members must meet criteria established at M.G.L., Chapter 13, 13 which include residency in the
Commonwealth. Nurse members must:
possess at least eight years of nursing practice experience in the ten years immediately
preceding appointment; and
Appointments to the Board are made by the Governor for a three-year term; members may serve no more
than two consecutive terms or until a successor is appointed. All members are subject to the State
Conflict of Interest and Ethics Law in accordance with M.G.L. Part IV, Title I, c. 268A.
Individuals who are interested in an appointment to the Board should submit a letter of intent and current
resume to:
James Lavery, Director
Division of Health Professions Licensure
239 Causeway Street
Boston, MA 02114.
The resulting proposed revisions to 244 CMR were approved by the Board at its December 2015 meeting
when it also authorized the submission of the revisions for approval by the Executive Office of Health and
Human Services (EOHHS) and the Executive Office of Administration and Finance (ANF) in compliance
with Executive Order 562. The proposed revisions are intended to incorporate:
Extensive and substantive updates to the regulations proposed by Board-appointed task forces
including 244 CMR 3.00 with respect to delegation to unlicensed persons and 244 CMR 6.00
designed to modernize standards and streamline the process for the approval of Registered
Nurse and Practical Nurse education programs;
Page 8 begins.
Recent changes to statutes that impose conditions on nurse licensure such as St. 2010, c. 283,
An Act Adding Safeguards to the Prescription Monitoring Program and Furthering Substance
Abuse Education and Prevention which added M.L.G. C. 94C, 18(e) requiring Advanced
Practice Registered Nurses who prescribe to complete training in topics relating to pain
management, substance abuse and counseling and the new mandatory domestic violence
training requirement specified at M.G.L. c. 260, 9 of the Acts of 2014 (see following article);
Technical corrections to 244 CMR 4.00 concerning provisions applicable to the practice of
certified registered nurse anesthetists;
Codification of licensee and applicant responsibilities with respect to license renewal and the
information submitted to the Board in connection with any application;
A newly created chapter of definitions to promote internal consistency within 244 CMR; and
Greater efficiency and consistency in the initiation, investigation and handling of complaints
across all boards within the Division of Health Professions Licensure.
As of this writing, the Board has received EOHHS and ANF approval for the proposed revisions at 244
CMR 3.00, 6.00, 7.00 and 10.00 and a public hearing has been scheduled for October 4, 2016. Details
regarding the hearings time and location will be posted on the Boards website when available and will
also be published at least 21 days before the hearing in selected daily newspapers with broad distribution.
The Board will review all of the comments it receives at the hearing during a regularly scheduled open
meeting and based on the publics feedback, it may make further revisions to the regulations.
The Boards proposed regulations are currently progressing through the administrative review process.
Once this process is completed, the Board will convene a hearing at which the public may submit oral and
written comments on the proposed regulations. Information about the hearing will be posted on the
Boards website as soon as it is available. Nurses are encouraged to consult the Boards website
regularly to stay abreast of further developments.
Page 9 begins.
Image: Graph showing nursing practice inquiries. The largest areas are practice scope, APRN practice,
and regulations. The mid-size areas are licensing, continuing education, and other. The smallest areas
are complaint, duty to report, and employment.
As a result, APRNs are required to inform the Board of their current certification including the name of
their Board-recognized APRN certification agency (i.e. ANCC, AANP, NCC, PNCB, AACN, AMCB,
NBCRNA), certification number and expiration date (mm/dd/year) when renewing their APRN
authorization. To avoid delays in authorization renewal, be sure to provide the certification number only
(do not provide the Registered Nurse license number in lieu of the APRN certification number).
Should an APRNs certification lapse for any reason, the APRN must inform the Board by completing a
Request to remove APRN authorization form and cease APRN practice until such time that certification
becomes current (there is no grace period). Once the re-certification process is successfully completed,
the APRN can complete a Request to reinstate APRN authorization. Upon receipt of the form, the Board
will verify the certification as current and will update the Boards license verification website, and the
APRN may return to practice. It is an APRN professional responsibility to meet the initial and continued
certification requirements of the Board approved certifying organization. APRNs should contact their
certifying organization for additional certification information.
9401: The Role of the Licensed Nurse As Trainer or Consultant for the DPH MAP Program
In each of its advisories, the Board affirms that the licensed nurse is responsible and accountable for
acquiring and maintaining the knowledge, skills and abilities (i.e. competencies) necessary to practice in
accordance with accepted standards. The Boards Advisory Rulings on Nursing Practice can be found in
the Nursing Practice section of the Boards website.
Nursys E-Notify also automatically provides licensure, discipline and publicly available notifications to
enrolled institutions that employ nurses. The e-Notify system alerts subscribers when a modification is
made to a nurses record including changes to license status, license expiration, license renewal and
public disciplinary action/resolution and alerts. If a nurses license is about to expire, the system will notify
the institution of the expiration date. It will also inform the institution if a nurse is disciplined by a board of
nursing.
To learn more about the Nursys e-Notify and to enroll, visit www.nursys.com/e-notify.
Page 11 begins.
As of June 30, 2016, there were 75 Board-approved Registered Nurse and Practical Nurse education
programs:
20 Registered Nurse Associate Degree Programs (all programs hold Full Approval status)
7 RN Entry level Graduate Degree Programs all programs, Full Approval status
A list of all Board approved nursing education programs is available on the Boards website at
www.mass.gov/eohhs/docs/dph/quality/boards/rnnecpro.pdf.
Board actions related to individual nursing education programs during Fiscal Year 2016 is contained in the
Boards monthly meeting minutes available on the Minutes and Agendas of Previous Board Meetings
webpage.
The Boards action was based on its review of two Board-directed reports, one addressing the Programs
regulatory deficiencies including its ongoing annual NCLEX-PN pass rate less than 80% and the second
addressing its difficulty retaining a qualified nurse administrator.
Page 12 begins.
Image: Graph of Number of Graduates from BRN-approved Nursing Education Programs: 2011 to 2015,
showing an overall increase in Practical Nurses, an overall decrease in ADs, an overall increase in BSNs,
overall even Diplomas, and overall increase in Direct Entry Masters.
Source: MA BRN data compiled from 2015 Annual Reports submitted by BRN-approved nursing
education programs.
The pass rate for graduates of Board-approved Practical Nurse education programs who wrote the
National Council Licensure Examinations for Practical Nurses (NCLEX-PN) for the first time during 2015
was 84.84% compared to 81.89% for all U.S.-educated Practical Nurse program graduates.
Page 13 begins.
The NCLEX-RN and NCLEX-PN are valid and reliable assessments of the competencies needed to
perform safely and effectively as a newly licensed, entry-level Registered Nurse or Licensed Practical
Nurse. The NCLEX exams are administered daily Monday through Friday using computer adaptive testing
(CAT) which merges computer technology with the latest measurement theory to increase the efficiency
of the exam process. The NCLEX has been administered using CAT since 1994 when it replaced the
pencil-and-paper version of what many nurses refer to as Boards.
For information on the 2015 NCLEX pass rate for individual Board-approved nursing education programs,
visit the Boards 2015 Performance Summary for Massachusetts Nursing Education Programs webpage.
The NCLEX-RN passing standard is evaluated every three years to ensure the minimum competence of
entry-level Registered Nurses. The current passing standard was implemented on April 1, 2013.
employment performance evaluations of the nurse prior to and following the error;
whether there is a need, in the publics interest, for an official record of the nurses practice-
related error.
Based on its evaluation of the evidence, the Board may dismiss a complaint when it determines that:
the nurse has successfully completed the Boards Substance Abuse Rehabilitation Program
(SARP) as determined by the SARP and the Board.
The Board, under the terms of an agreement with a nurse, may impose discipline in the form of a
reprimand or probation. Probation consists of a period of time during which a nurse may continue to
practice nursing in Massachusetts under terms and conditions specified by the Board. The nurse whose
license is subject to probation must comply with the terms and conditions in order to continue to engage
in the practice of nursing in Massachusetts. The common terms include:
remedial education.
Less frequently, the Board may enter into an agreement with the nurse for a suspension, surrender or
revocation of the nurses license to practice nursing. For detailed information regarding the Boards
complaint resolution process, visit 244 CMR 7.00: Action on Complaints.
Page 15 begins.
During Fiscal Year 2016, the Board opened 251 complaints and closed 175. Of the 175 closed
complaints, 99 were resolved through a disciplinary action (i.e. reprimand, probation, suspension,
surrender or revocation of the nurses license).
The types of allegations presented in the 99 closed complaints are reported below:
Drug Violations 37
Criminal Activity 7
Substance Abuse 7
DOR Notice 5
Unethical Conduct 5
Inadequate/Fraudulent Documentation 2
Patient Abuse 2
Unlicensed Practice 2
Abuse 1
The NPDB is intended to combat fraud and abuse in health insurance and health care delivery, and can
be accessed by employers, federal and state governmental agencies, health insurance plans, medical
facilities, individual health care practitioners and the public.
The Board also reports disciplinary action against licensees on its website. It also provides licensee
information, including disciplinary actions, to the National Council of State Boards of Nursing NURSYS
database, the only national database for verification of nurse licensure.
Page 16 begins.
SARP is a five-year abstinence-based program designed to protect the public health, safety and welfare
by establishing adequate safeguards to maintain professional standards of nursing practice. It is
accomplished by monitoring and supporting participants ongoing recovery and their return to safe nursing
practice.
To ensure public safety, it is vital that these nurses are identified, removed from practice, and provided
with support and treatment options. Moreover, professional nurses have a legal responsibility to report a
nurses impaired practice or diversion of controlled substances as outlined in the Standards of Conduct
244 CMR 9.03 (26)(b) and (26)(c) Duty to Report.
4
National Council of State Boards of Nursing. Substance Use Disorder in Nursing: A Resource Manual
and Guidelines for Alternative and Disciplinary Monitoring Programs (2011).
Page 17 begins.
Well-informed nurses understand the complex nature of Substance Use Disorders, including the stigma
associated with it, internal workplace policies, and treatment options. It is often easy to identify
impairment, while diversion may be difficult to recognize.
While not an exhaustive list, the signs and symptoms of Substance Use Disorders in nurses include:
Nurses who recognize the behavioral changes, physical signs and indicators of drug diversion will help
not only a colleague with SUD but also protect patients.
5
National Council of State Boards of Nursing. What You Should Know About Substance Use Disorder in
Nursing (2014).
6
Ibid.
Page 18 begins.
The National Council of State Boards of Nursing offers helpful educational resources:
Substance Use Disorder in Nursing, a video available at ncsbn.org/sud, identifies the warning
signs of SUD and provides guidelines for prevention, education and intervention;
Understanding Substance Use Disorder in Nursing, a 4-contact hour online course (cost $30) is a
companion to the video;
Nurse Manager Guidelines for Substance Use Disorder is a 3-contact hour online course (cost
$30) designed for nurse managers.
The 2014 RN Data Series report will be available on the Boards Health Professions Data Series:
Registered Nurses and Licensed Practical Nurses webpage as soon as it is published.
Page 19 begins.
147,672 TOTAL
Among the changes resulting from this review are the development of new operational policies for license
application processing, which includes the implementation of new license verification requirements, the
addition of new standards for the verification of graduation from an approved nursing education program,
including requirements for transcript submission and strict adherence to chain of custody requirements,
as well as changes to the Certification of Graduation form completed by program administrators.
After the current renewal cycle, nurses will be expected to initiate renewal of their nursing license without
a paper reminder by logging on tohttps://onlineservices.hhs.state.ma.us/. Nurses who subscribe to Nursys
e-Notify will be able to receive renewal reminders.
The Board will use email to send updates to nurses who maintain a current email address in the Boards
database. Log onto the Mass Department of Public Health Online Licensing site to update email or
mailing addresses.
Please note that the mailing and email addresses for each license held must be updated individually. For
example,
Page 20 begins.
those with both a RN license and Advanced Practice Registered Nurse (APRN) authorization will be
required to maintain current addresses for both categories.
Licensure status can be verified by accessing the Board of Registration in Nursing (Board) Check a
License link that can be accessed at http://www.mass.gov/dph/boards/rn. The link is considered primary
source of verification and is available 24 hours a day, seven days a week at no cost. It is possible to print
information from the website or download licensing information into an excel spread sheet. Directions are
provided at the site. Details regarding the Boards process for Primary Source Verification are available on
the Boards website.
In addition, nurses and employers can automatically receive free, publicly available primary source
license and discipline status updates from boards of nursing in multiple jurisdictions after logging into
Nursys e-Notify.
Practice with an expired license is illegal and grounds for Board discipline. A civil administrative penalty
for unlicensed practice of up to $2,500 and or six months of imprisonment may be imposed [ref: M.G.L. c.
112, 65A].
During the renewal process, all nurses attest under penalties of perjury to compliance with:
In addition, the titles, Registered Nurse and Licensed Practical Nurse, reflect the conduct standards with
which the nurse must comply. Established at 244 CMR 9.03, these standards include, but are not limited
to, requirements that the nurse will:
only engage in the practice of nursing with a valid license issued by the Board on the basis of
truthful information related to the qualifications for licensure as a Registered Nurse or Licensed
Practical Nurse and which license is not expired, surrendered, suspended or revoked (Standard
1);
practice nursing in accordance with accepted standards of practice, the authoritative statements
that describe a level of care or performance common to the profession of nursing by which the
quality of nursing practice can be judged (Standard 5);
comply with M.G.L. c. 112, 74 through 81C as well as any other laws and regulations related to
licensure and practice (Standard 6);
wear an identification badge which visibly discloses at a minimum his or her first name, licensure
status, and if applicable, advanced practice authorization if the nurse examines, observes or
treats a patient in any practice setting (Standard 8);
assume only those duties and responsibilities within his or her scope of practice and for which he
or she has acquired and maintained the competencies (Standard 12);
in the event the nurse directly observes another nurse engaged in abuse of a patient; practice of
nursing while impaired by substances of abuse; or diversion of controlled substances, report that
nurse to the Board in accordance with Board guidelines (Standard 26);
inform the Board in writing within 30 days of any change of his or her name, address of records or
Social Security Number (Standards 26);
not endanger the safety of the public, patients or coworkers by making actual or implied threats of
violence, or carrying out an act of violence (Standard 43); and
make complete, accurate and legible entries in all records required by federal and state laws and
regulations, and accepted standards of nursing practice. On all documentation requiring a nurses
signature, the nurse must sign his or her name as it appears on his or her license (Standard 45).
The Standards of Conduct at 244 CMR 9.00 is available online on the Boards regulations webpage.
Page 22 begins.
Frequently asked questions and responses related to continuing education are detailed on the Boards
website at www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/nursing/faq/continuing-
education-.html.
In order to keep current, the Board recommends that all nurses subscribe to the Boards RSS feed icon
at www.mass.gov/dph/boards/rn to be automatically notified via email when the Board posts a news and
alert item.
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BRN Staff
Stewart Allen, Administrative Assistant
DHPL Director
James Lavery, JD
Hearing Officers
Jason Barshak, JD, Chief Hearings Officer
Email: nursing.admin@state.ma.us
Telephone: 617-973-0900
Toll-free: 800-414-0168