DEPARTMENT OF REGULATORY AGENCIES

Division of Professions and Occupations - Board of Nursing NURSING
3 CCR 716-1

[Editor’s Notes follow the text of the rules at the end of this CCR Document.]

 		_	_	_	_ CHAPTER 5 – RULES AND REGULATIONS FOR LICENSURE OF PSYCHIATRIC TECHNICIANS  1.	STATEMENT OF BASIS AND PURPOSE
The rules in Chapter 5 are adopted pursuant to authority granted the State Board of Nursing pursuant to Section 12-38-108(1)(k), C.R.S., in order to specify procedures used in obtaining and maintaining psychiatric technician licensure. The Division name changed pursuant to Section 24-34-102, C.R.S.

LICENSURE BY EXAMINATION INFORMATION

The State Board of Nursing (herein after referred to as the “Board”) determines the licensing examination for psychiatric technicians.

Any needed contract for the use of the examination will be approved by the Executive Officer or designee in the absence of the Executive Officer.

The examination will be administered by the Board at least annually at such times and places determined by the Board. and notification of the examination and filing procedures are sent to all state accredited programs preparing psychiatric technicians.

2.4	In the event that candidate examination answer sheets are lost or destroyed through circumstances beyond the control of the Board, the candidate will be required to rewrite the examination in order to meet requirements for licensure.

2.51.4  Candidates will be informed in writing regarding examination performance.

The Board releases examination performance reports only upon written authorization from the candidate or licensee.

Candidates who have completed Board accredited psychiatric technician programs are eligible to take the examination.

Applicants for licensure by examination must pass the written examination in three or fewer attempts within one (1) year of receipt of a complete psychiatric technician application.

Candidates who have completed Board approved or accredited programs outside Colorado are eligible to take the Colorado examination provided:

The psychiatric technician program meets substantially the same educational requirements as Colorado programs.

CODE OF COLORADO REGULATIONS	3 CCR 716-1
Division of Professions and Occupations – Board of Nursing

Sections 2.10 (A), (B), (C), (E), and (F) of these Chapter 5 Rules and Regulations have been met.

Candidates from the United States military who have education and training documented on an official transcript and determined to be substantially equivalent to the psychiatric technician training program curriculum requirements in the Chapter 6 Rules and Regulations for Accreditation of Psychiatric Technician Programs will be eligible to take the Colorado licensing exam for psychiatric technicians as provided for in Section 24-34-102(8.5), C.R.S. and are subject to requirements of Section 2.10 (A), (B), (C), (D), (E) and (F) of these Chapter 5 Rules and Regulations.

Requirements to be completed for licensure by examination:APPLICATION REQUIREMENTS FOR LICENSURE

A2.1.	Submission of application on current Board approved formMust apply in a manner approved by the Board.

B2.2.	Payment of application fee.

C2.3.	Verification Submit proof of successful completion of an approved psychiatric technician program as described in Section 3 of these Chapter 5 Rules.

D2.4.	Successful completion of a state approved psychiatric technician licensure or registration examination.Successful completion of the licensing examination.

E2.5.	Verification of high school graduation or equivalent.Applications for licensure by examination must also include:

 	2.5.1	Verification of high school graduation or the equivalent.

2.6.	Applicants for licensure by endorsement must also include:

 	2.6.1.   Verification of active licensure in another state or territory of the United States,
 	provided the requirements in the other jurisdiction are substantially equivalent to
 	those in Colorado at the time of application.

F.	Statutory requirements otherwise met.

Examination failures:

Candidates may repeat the test when a regularly scheduled examination is administered.

To repeat the test, an application for re-examination must be filed prior to the deadline date established for any scheduled examination.

LICENSURE BY ENDORSEMENTEDUCATION REQUIREMENTS FOR LICENSURE

Only applicants licensed or otherwise registered in another state or territory of the United States are eligible for licensure by endorsement in Colorado, providing the requirements in the other jurisdiction are substantially equal to those in Colorado at the time of the applicant's graduation, but in no event will the applicant be required to meet qualifications higher than those in force in Colorado at the time of his or her application for licensure in Colorado.Candidates for licensure must have successfully completed:

 	3.1.1.   A psychiatric technician program approved by the Colorado Board of Nursing; or

CODE OF COLORADO REGULATIONS	3 CCR 716-1
Division of Professions and Occupations – Board of Nursing

 	3.1.2	A Board approved or accredited program outside Colorado that meets substantially the
 	same educational requires as Colorado programs; or

 	3.1.3.   United States military personnel who have education and training documented on an
 	official transcript and determined to be substantially equivalent to the psychiatric
 	technician training program curriculum requirements in the Chapter 6 Rules and
 	Regulations for Accreditation of Psychiatric Technician Programs will be eligible to take
 	the Colorado licensing exam for psychiatric technicians as provided for in Section 24-34-
 	102(8.5), C.R.S. and are subject to requirements of Section 2 of these Chapter 5 Rules and Regulations.

Requirements to be completed for licensure by endorsement:

Submission of application on current Board approved form.

Payment of application fee.

Holds current licensure or registration in a state or territory of the United States.

Successful completion of a state approved psychiatric technician licensure or registration examination.

Statutory requirements otherwise met.

GENERAL RULES RELATING TO LICENSES

The Executive Officer of the Board has been delegated authority to administer examinations, issue licenses by endorsement and examination, renew licenses, and issue temporary licenses and permits to qualified applicants during the period between meetings.

Certificates are subject to renewal as set forth in Section 24-34-102, C.R.S.

The license may be renewed when the psychiatric technician maintains continued licensure prior to the expiration date of the license.

Psychiatric technician license renewal applications postmarked received after the license expiration date and prior to the end of the grace period, may be assessed a late fee.

The licensee’s online renewal confirmation or a receipt from the Board will be considered as proof of renewal until the renewed license is issued.

Separate payments are required for each renewal application.

A psychiatric technician license not renewed within the renewal period including the 60- day grace period will be subject to reinstatement requirements.

Change of name and address:

The licensee must supply to the Board legal evidence of name change within 30 days of the effective date of the name change.

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The licensee must notify the Board within 30 days of any change of address. This notification may be submitted in writing or via the Board’s on-line system.

Any application not completed within one (1) year of the date of the original application expires and will be purged.

5.	REINSTATEMENT

Inactive status:

Licensees may apply for inactive status if not practicing as a psychiatric technician.

After a two (2) year period in inactive status, the license may be renewed only by complying with provisions of licensure by examination as found in Section 2 of these Chapter 5 Rules and Regulations.

4.65.1 A licensee who does not renew his or her license with the 60 day grace period, as set forth in Section 24-34-102(8)(c), C.R.S., will have an expired license and is ineligible to practice until such licnese is reinstated.

The licensee must apply for reinstatement in a manner approved by the Board.

The licensee applying for reinstatement must pay an application fee.

A licensee who has practiced on an expired license may be subject to disciplinary action.

A licensee whose license has been expired less than two (2) years must comply with requirements of Sections 5.2 and 5.3 of these Chapter 5 Rules.

To reinstate a psychiatric technician license that has been expired for less than two (2) years the licensee must:

Submit an application in a manner approved by the Board.

Pay an application fee for reinstatement.

A licensee who has practiced on an expired license may be subject to disciplinary action.

An individual whose license To reinstate a psychiatric technician license that has been expired for more than 2 years and less than 5 years the applicant must comply with Sections 5.2 and 5.3 of these Chapter 5 Rules and demonstrate competency to practice. Competency to practice for the purposes of this Section 4.75.6 of these Chapter 5 Rules and Regulations may be demonstrated by:

Attesting to having an active psychiatric technician license in good standing in another state or territory of the Unites States and to having actively practiced as a psychiatric technician in that state or territory of the United States during the two (2) years immediately preceding the application receipt date; or

Retaking and passing the licensing examination for psychiatric technicians.

An individual whose license To reinstate a psychiatric technician license that has been expired for more than five (5) years the applicant must comply with Sections 5.2 and 5.3 of these Chapter 5 Rules and demonstrate competency to practice. Competency to practice for the purposes of this Section 4.85.7 of these Chapter 5 Rules and Regulations may be demonstrated by:

CODE OF COLORADO REGULATIONS	3 CCR 716-1
Division of Professions and Occupations – Board of Nursing

Attesting to having an active psychiatric technician license in good standing in another state or territory of the United States and to having actively practiced as a psychiatric technician in that stat or territory of the United State during the two (2) years immediately preceding the application receipt date; or

Provide evidence of having reentered and successfully completed an accredited psychiatric technician education program and retaking and passing the licensing examination for psychiatric technicians.

LICENSURE AS MILITARY SPOUSE

A military spouse as defined in Section 12-71-101(3), C.R.S. may practice in this state as a psychiatric technician for not more than one (1) year, as set forth in Section 12-71-102(1), C.R.S., before obtaining a license to practice in this state.

Adopted: January 9, 1997
Revised: October 24, 2012
Effective: December 15, 2012
Revised: January 22, 2013
Effective: March 18, 2013

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DEPARTMENT OF REGULATORY AGENCIES

Division of Professions and Occupations - Board of Nursing NURSING
3 CCR 716-1
[Editor’s Notes follow the text of the rules at the end of this CCR Document.]

 	_	_	_	_

CHAPTER VI 6 – RULES AND REGULATIONS FOR ACCREDITATION OF PSYCHIATRIC TECHNICIAN PROGRAMS

General authority C.R.S. 12-38-108 (1)(k)

Specific Authority C.R.S. 12-38-108(1)(k)(II, III, and IV)

Purpose: To specify procedures and criteria relating to the approval of psychiatric technician training programs.

DEFINITIONS

Accreditation: Recognition that a psychiatric technician program (hereinafter referred to as program) is meeting the standards as established by the Board.

PURPOSE OF ACCREDITATION

To establish eligibility of graduates of approved programs to apply for licensure.

INITIAL PROCEDURES FOR ACCREDITATION

Phase I, Application Approval

The governing body establishing a new psychiatric technician program shall inform the Board in writing before initiation and such program shall have the approval of the Board.

An application shall be submitted on forms provided by the Board with the following information:

Description of the program to be established and an operational plan of how the body will develop a program which meets the standards for approval set forth in this these Chapter 6 Rules,

Organizational structure,

Financial resources,

Ability of the geographic community to support adequately the program in relation to:

Potential students

Student support services,

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Faculty,

Written commitment of clinical resources and,

Physical facilities.

Number of patient populations with a variety of nursing needs.

Accreditation of the university, college, vocational technical school or institution by the appropriate national or regional accrediting agency.

Philosophy and purposes of the university, college, vocational technical school or institution.

Tentative time table for initiating the program.

Signatures of appropriate administrative officers.

The Board shall review the application within 90 days and may direct that a site visit occur before approval of the application. Such visit shall occur within a reasonable period of time after the Board directs a site visit.

A written report of the site visit shall be submitted to the Board and the appropriate administrative officers within a reasonable amount of time, not to exceed 60 days unless extended by the Board.

The Board shall advise the governing body concerning approval or disapproval of the application within 30 days of the Board's review. The Board shall specify the grounds for disapproval.

In the event of disapproval of the application, the Board shall grant a hearing, if requested, pursuant to the Nurse Practice Act and the Administrative Procedures Act.

Phase II, Interim Accreditation

The governing body shall secure a Director, with qualifications set forth in section 4.4 b (3) of this section, for the psychiatric technician program. The Director shall be responsible for providing compliance with this Chapter.

The Director shall prepare a written report for the Board showing evidence of meeting the requirements of 4.2.

The Board shall determine whether the program is prepared to admit students and if so, grant interim accreditation. If not, the Board shall specify the grounds for disapproval and the program can request a hearing pursuant to the Nurse Practice Act and the Administrative Procedures Act.

Phase III, Full Accreditation

The Director shall:

Insure the program is developed according to the rules and regulations for accreditation of this chapter.

Provide written progress reports as requested by the Board.

Prior to graduation of the first class, a report by the program shall be submitted to the Board addressing criteria as outlined in section 4 and a survey visit shall be made by site visitor(s)

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designated by the Board on a time frame established by the Board for consideration of accreditation of the program.

Notice of the Board's action to approve or disapprove shall be sent in writing to the administrative officer and the Director of the program within fourteen days of the Board's decision. If a program is disapproved, the Board shall provide with specificity the grounds for such.

In the event of disapproval of the application, the Board shall grant a hearing, if requested, pursuant to the Nurse Practice Act and the Administrative Procedures Act.

STANDARDS FOR ACCREDITING A PSYCHIATRIC TECHNICIAN PROGRAM

All psychiatric technician education programs must conform with generally accepted psychiatric technician nursing education standards.

Philosophy, purposes and objectives:

The faculty develops, approves, and periodically evaluates the philosophy, purposes and objectives of the psychiatric technician program. Such statements shall express the educational principles of the program and include a description of the graduate.

The statements of philosophy, purposes and objectives shall be utilized in planning, implementing and evaluating the total program.

Organization and administration:

There shall be a governing body which has the legal authority to conduct the psychiatric technician program, determine general policy and provide financial support for such program.

The governing body shall have in place policies regarding refunds of fees and tuition, and ethical standards for recruitment and advertising.

There shall be an organizational plan which demonstrates and describes the relationship of the psychiatric technician program to the governing body and the internal organization of the program.

There shall be a qualified Director with the authority, in accordance with the policies of the governing body, to:

Prepare and administer a financial plan.

Develop, implement and evaluate the psychiatric technician program.

Arrange for educational facilities, clinical resources, and student services.

Arrange for qualified faculty.

Plan for learning experiences with a variety of patient needs and obtain written agreements with the providers of clinical resources.

Develop policies relating to admission, retention, progression, reentry and graduation of students.

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Division of Professions and Occupations – Board of Nursing

Provide for a system of permanent records and reports essential to the operation of the psychiatric technician program which shall include:

Current and final official records for students.

Current records of program activities such as minutes and reports.

Faculty records which demonstrate compliance with faculty requirements as delineated in section 4.4.

Annual report due on a schedule determined by the Board to be submitted to the Board (form furnished by the Board office) shall include, at a minimum:

Developments in the psychiatric technician program;

Student policies, including student health;

Current problems and recommendations;

Curriculum plan;

Clinical resources including confirmation of adequate patient populations;

Faculty list for the year including qualifications and area of responsibility;

Listing of hours of instruction;

School catalog;

Audited financial report of the governing institution including statement of income and expenditures. This needs to be submitted only every two years on a schedule determined by the Board; and

Proposals and plans for future development including either increases or decreases of 25% or greater in student numbers admitted, types of students, admission times and progression options.

Biannual report including, but not limited to numbers of student admissions, graduations and faculty list.

The amount of time allocated the Director for psychiatric technician administrative duties for one campus shall be related to the number of students enrolled in the psychiatric technician program at that campus. The Director may delegate administrative duties and reflect appropriate release time for the delegated activities.

In a program with no more than 50 students, there shall be allotted a minimum of 25% of an FTE for administration.

In a program with at least 51 students but no more than 110 students, there shall be allotted a minimum of 50% of an FTE to administration.

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In a program with at least 111 students but no more than 180 students, there shall be allotted a minimum of 75% of an FTE to administration.

In a program with at least 181 students, there shall be at least the equivalent of a full FTE position devoted to administration.

Personnel policies for the faculty of the psychiatric technician program shall be consistent with the faculty policies for the controlling body.

There shall be a plan for an ongoing systematic evaluation of all aspects of the psychiatric technician program with evidence of implementation which includes student and community input.

Written student policies shall be developed and made available to all students including, but not limited to, admission, progression and graduation requirements. These policies shall be consistent with those of the governing body. The school shall have a written policy regarding the dismissal of students for scholastic or other reasons and potential reentry. The program shall adhere to its set policies or have a rationale for exceptions.

Curriculum

The curriculum shall be developed, implemented, controlled and evaluated by the faculty within the framework of the philosophy, purposes and objectives of the psychiatric technician program and policies of the governing body.

The program outcomes shall identify the expectations for the students who complete the program and are used to:

Develop, organize, implement, evaluate and revise the curriculum.

Identify objectives for courses.

Select content related to the care of individuals experiencing mental and/or developmental disabilities. Program outcomes shall reflect the current scope of practice and, at a minimum, shall include 200 clock hours of theory and 200 clock hours of clinical practice. A psychiatric technician curriculum shall include, but not be limited to:

Nursing principles, which shall include, but not be limited to, learning experiences to develop:

An understanding of the principles of mental and physical health and the maintenance of health;

A knowledge of health services, community resources and the role of the psychiatric technician in these health services. The ability to perform the following functions as required:

Activities concerned with daily hygiene;

Activities concerned with prescribed therapeutic measures with an understanding of basic principles; and

Observing the appearance and behavior of patients and reporting to appropriate persons.

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Division of Professions and Occupations – Board of Nursing

Ability to work with licensed physicians, professional nurses, dentists, and other treatment personnel in assisting with nursing situations;

For psychiatric technicians working with the mentally ill, the curriculum shall include, but not be limited to, fundamentals of psychiatric and mental health nursing with learning experiences planned to develop the following:

The knowledge, skills and attitudes necessary to function adequately as a contributing member of the psychiatric team;

Understanding of self and patient relationship;

Principles of psychiatric nursing including social and cultural studies, rehabilitation and special therapies.

For psychiatric technicians working with the developmentally disabled, the curriculum shall include, but not be limited to:

Mental retardation theory and practice;

Human development; and

Behavior management.

The number of faculty shall be determined by size of enrollment, number of classes admitted per year, number of agencies utilized for clinical instruction and methods of instruction.

Faculty-student ratio for clinical instruction should not exceed a 1:10 ratio.

The implementation of the curriculum shall include:

Development of outlines that identify essential aspects of each course.

Utilization of a variety of teaching methods.

Development and maintenance of an environment consistent with the philosophy and purposes of the program.

Facility and resource coordination.

The organizational plan of the curriculum shall provide for time periods (terms, semesters, quarters) and identified sequencing of courses.

Evaluation of the curriculum shall include a plan for ongoing systematic assessment of student achievement.

Faculty

Only qualified nurse faculty shall teach basic nursing concepts.

All nursing faculty shall:

CODE OF COLORADO REGULATIONS	3 CCR 716-1
Division of Professions and Occupations – Board of Nursing

Hold a current license in good standing to practice as a Registered Nurse in Colorado.

Have a minimum of one year of experience as a Registered Nurse in psychiatric nursing if teaching in a program preparing technicians to care for the mentally ill or in nursing care of the developmentally disabled if teaching in a program preparing technicians to care for the developmentally disabled.

The Director of the psychiatric technician program, in addition to 4.4, shall have:

A minimum of a baccalaureate degree in nursing.

One years' teaching experience in a health related program.

Non-nurse faculty shall have appropriate academic and professional preparation and experience in their field of teaching.

Resources and facilities:

The Director shall be responsible for recommending and/or obtaining resources and facilities in accord with the program's philosophy and objectives as well as the policies of the governing body.

1	Including:

Classrooms, laboratories, conference rooms, and equipment for utilizing a variety of teaching methods.

Library resources.

Health care facilities sufficient to achieve the objectives of the program, with consideration given to:

Quality of nursing service, including organization and nursing care.

Administrative support.

Number of programs and students using the facility.

Daily average census.

Licensure or accreditation by the appropriate authorities.

A program must demonstrate that no more than three successive classes have a passage rate of below 75% on the state licensure examination.maintain an acceptable average psychiatric technician examination pass rate for first time test takers.

 	4.6.1.   All approved psychiatric technician programs shall have an average minimum pass rate
 	for first-time test takers of at least sixty-five (65) percent during any eight (8) quarter
 	period.

 	4.6.2	First-time test takers are those individuals that test for the first time within two (2) years of
 	completion from a Board approved psychiatric technician program.

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CONTINUED ACCREDITATION

Regular periodic surveys for continued accreditation may be conducted by the Board on a date mutually acceptable to the Board and the program.

Accreditation of a program shall be continued by the Board provided the standards of the Board are met as set forth in this Chapter.

The Board's action regarding program review shall be sent to the governing body and the Director of the program with recommendations, if indicated.

The school may be visited at times other than the regularly scheduled survey visit, if deemed necessary by the Board.

Major program revisions shall be reported to the Board for approval Major program revision shall be defined to include, but not be limited to:

Major changes in program goals,

The number of hours required for successful completion of the program,

Change in required clinical practice hours.

Either an increase or decrease of 25% or greater in student numbers admitted, types of students, admission times and progression options.

WITHDRAWAL OF ACCREDITATION

The governing body and the Director of the program shall be notified in writing if the requirements of the statute and the standards set forth in this chapter are not fulfilled. Deficiencies shall be specified in the written communication.

The program shall have 30 days from the date of the letter to respond to deficiencies. Such response would be reviewed by the Board and a determination made to continue accreditation or withdraw accreditation.

The governing body and the Director shall be advised that requirements must be met within a year from the date of service of the notice of deficiencies at which time another survey visit shall be made to confirm the corrections or remaining deficiencies.

Conditional accreditation shall be given for the year to allow the identified deficiencies to be corrected.

Status reports regarding progress in meeting the identified deficiencies shall be submitted to the Board at each regularly scheduled Board meeting during the year of conditional accreditation.

At any time during the year, the program Director may request restoration to full accreditation if the program demonstrates correction of the deficiencies. The decision to restore full accreditation rests solely with the Board. If full accreditation is not restored, the original time period for conditional approval is still retained.

At any time during conditional approval, the Board staff shall be available for consultation with the program.

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All students enrolled during the conditional accreditation must be informed in writing by the school that they shall not be eligible to take the licensure examination if the program loses its accreditation.

Accreditation of the program shall be withdrawn by the Board if the identified deficiencies are not corrected as confirmed on a survey visit within the one year period.

The program may appeal the decision to withdraw accreditation by requesting a hearing within 60 days of service of the notice to withdraw.

Such a hearing shall be heard before the Board subject to the provisions of the Administrative Procedures Act and the Nurse Practice Act regarding the conducting of hearings.

CLOSING OF PROGRAMS

Programs desiring to close shall notify the Board of such intention.

If the program is closed, the controlling agency shall be responsible for the permanent safekeeping of the student transcripts.

CHANGE OF CONTROL

When a program changes administrative control, the new authority shall notify the Board.

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DEPARTMENT OF REGULATORY AGENCIES
Division of Registrations Professions and Occupations

3 CCR 716-1 CHAPTER XIV 14
RULES AND REGULATIONS TO REGISTER PROFESSIONAL NURSES QUALIFIED TO ENGAGE IN ADVANCED PRACTICE NURSING

BASIS: The authority for the promulgation of these rules and regulations by the State Board of Nursing (“Board”) is set forth in sections 12-38-108(1)(d) and (j), 12-38-111.5, and 12-38-111.8, C.R.S.

PURPOSE: These rules are adopted to implement the Board’s authority to register professional nurses qualified to engage in Advanced Practice Nursing and are further adopted to set forth the requirements and procedures for being so registered.

DEFINITIONS

Accrediting Body: Any organization that establishes and maintains standards for professional nursing programs and recognizes those programs that meet these standards and is recognized by the U.S. Department of Education (USDE) and/or the Council for Higher Education Accreditation (CHEA), including the Commission on Collegiate Nursing Education (CCNE), National League for Nursing Accrediting Commission (NLNAC), Council on Accreditation of Nurse Anesthesia Education Programs (COA), Accreditation Council for Midwifery Education (formerly the Division of Accreditation) of the American College of Nurse Midwives, and the National Association of Nurse Practitioners in Women’s Health Council on Accreditation.

Advanced Practice Nurse (APN): A master’s prepared nurse holding a graduate degree  in advanced practice nursing who has completed a graduate or post-graduate program of study in an advanced practice Role and/or Population Focus, in an accredited advanced practice nursing program and has been recognized and included on the Advanced Practice Registry (APR) by the Board. APN Roles recognized by the Board are nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM) and clinical nurse specialist (CNS). A nurse seeking recognition as an APN must be academically prepared for the expanded scope of practice described as Advanced Practice Nursing.

Advanced Practice Nursing: The expanded scope of nursing practice in an advanced Role and/or Population Focus approved by the Board.

Advanced Practice Registry (APR): The Board’s registry of those professional nurses who apply for, and meet the criteria for inclusion as established in accordance with section 12-38-111.5, C.R.S. and these Chapter XIV 14 Rules.

Applicant: A professional nurse seeking inclusion on the APR as an APN.

Board: The State Board of Nursing.

Certifying Body: A non-governmental agency approved by the Board that validates by examination, based on pre-determined standards, an individual nurse’s qualifications and knowledge for practice in a defined functional or clinical area of nursing.

Client: A person receiving nursing care.

Independent Practice: The practice of advanced practice nursing as defined in section 12-38-103(8.5), C.R.S. for which the APN is solely responsible and performs on his/her own initiative, and which occurs in a setting for which no exception as set forth in section
3.2 of these rules applies.

Population Focus: A broad, population-based focus of study encompassing the common problems of that group of patients and the likely co-morbidities, interventions and response to those problems. Examples include, but are not limited to: Neonatal, Pediatric, Womens’ Health, Adult, Family, Mental Health, etc. A Population Focus is not defined as a specific disease/health problem or specific intervention.

Role: The advanced practice area or position for which the professional nurse has been prepared; Nurse Practitioner (NP) Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM) and Clinical Nurse Specialist (CNS).

Unencumbered: No pending disciplinary action or current restriction to practice in the state of Colorado.

REQUIREMENTS FOR INCLUSION ON THE ADVANCED PRACTICE REGISTRY

A professional nurse may request inclusion on the APR by original registration or by endorsement:

Applicants must possess an active, Unencumbered Colorado or multi-state compact professional nurse license.

Submit an APR application in a manner approved by the Board.

For Ooriginal Rregistration: by education and certification the applicant must show proof of:

2.41.1  Educational Requirements: The successful completion of a graduate or post- graduate nursing degree in the Role and, where applicable, the Population Focus for which the Applicant seeks inclusion on the APR. Verification of educational requirements shall be evidenced by receipt of a sealed,an official transcript from  a graduate or post-graduate APN program accredited by a nursing Accrediting Body. The transcript shall verify date of graduation, credential conferred, and Population Focus of the program.

2.1.2	Endorsement: Active licensure/recognition as an APN in another state or territory of the United States in the Role and, where applicable, the Population Focus for which the Applicant seeks inclusion on the APR and verification, submitted in a manner approved by the Board, of active practice for at least two of the last five years immediately preceding the date of application.

Certification Requirements

Certification requirements for Certified Registered Nurse Anesthetist (CRNA): A CRNA must pass the national certification examination as administered by the Council on Certification of Nurse Anesthetists.
Verification of current certification or recertification from the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists as may be appropriate, shall be required and submitted in a manner approved by the Board.

B.	Certification Requirements for Certified Nurse-Midwife (CNM): A CNM must meet the standards for education and certification established by the American College of Nurse-Midwives American Midwifery Certification Board (AMCB) formerly known as ACNM Certification Council (ACC, Inc.). Verification of current AMCB certification shall be required and submitted in a manner approved by the Board.

Applicants must possess an active, Unencumbered Colorado or multi- state compact professional nurse license.

C.	Certification requirements for Nurse Practitioner (NP): A NP must meet the standards for education and certification established by a national certifying body approved by the Board. Verification of current certification or recertification, as may be appropriate, shall be required and submitted in a manner approved by the Board.

D.	Certification requirements for Clinical Nurse Specialist (CNS): A CNS must meet the standards for education and certification established by a national certifying body approved by the Board. Verification of current certification or recertification, as may be appropriate, shall be required and submitted in a manner approved by the Board.

Registration by Endorsement

 	2.5.1	Endorsement by Active PracticeRegistration by Endorsement requires:

Active licensure/recognition as an APN in another state or territory of the United States in the Role and, where applicable, the Population Focus for which the Applicant seeks inclusion on the APR. Verification of such licensure/recognition must be submitted in a manner approved by the Board.

Advanced Practice Nurse credentials issued by the United States Military are deemed to be substantially equivalent to advanced practice prescriptive authority in another state or jurisdiction.

Active practice for at least two of the last five years in another state or territory immediately preceding the date of application. Verification must be submitted in a manner approved by the Board.

 	2.5.2	Endorsement by Education and CertificationEducation requirements for Endorsement requires:

The successful completion of a graduate or post-graduate nursing degree in the Role and, where applicable, the Population Focus for

which the Applicant seeks inclusion on the APR. Verification of educational requirements shall be evidenced by receipt of an official transcript from a graduate or post-graduate Advanced Practice Nursing program accredited by a nursing Accrediting Body. The transcript shall verify date of graduation, credential conferred, and Population Focus of the program.

Active Certification in the Role and, where applicable, the Population Focus for which the Applicant seeks inclusion on the APR. Verification of current certification or recertification, as may be appropriate, shall be required and submitted in a manner approved by the Board.

For eachRegistration of Additional Population Focuses for which the Applicant applies for inclusion on the APR, the Applicant shall be required toAdvanced Practice Registration:

Submit an APR application on the current Board approved form and submit required fees;

SThe successful completion of a graduate or post-graduate nursing degree in the Role and, where applicable, the Population Focus for which the Applicant seeks inclusion on the APR. Verification of educational requirements shall be  evidenced by receipt of an official transcript from a graduate or post-graduate Advanced Practice Nursing program accredited by a nursing Accrediting Body. The transcript shall verify date of graduation, credential conferred, and  Population Focus of the program.Provide a sealed, official transcript from the graduate or post graduate APN program; and

Active Certification in the Role and, where applicable, the Population Focus for which the Applicant seeks inclusion on the APR. Verification of current certification or recertification, as may be appropriate, shall be required and submitted in a manner approved by the Board.Pay the current application fee.

2.8	Any APN who was included in the APR as of June 30, 2008, but had not successfully completed the educational requirements as set forth in section 12-38-111.5(4)(c), C.R.S., may continue to be included in the APR and to use the appropriate title and abbreviation as long as that APN maintains current licensure as stated in section 2.4 of these rules.

REQUIREMENTS FOR PROFESSIONAL LIABILITY INSURANCE

Pursuant to the requirements of section 12-38-111.8 (1), C.R.S., it is unlawful for any APN engaged in an Independent Practice of professional nursing to practice within the state of Colorado unless the APN purchases and maintains or is covered by professional liability insurance in an amount not less than five hundred thousand dollars per claim with an aggregate liability for all claims during the year of one million five hundred thousand dollars.

Pursuant to these rules, an APN whose Independent Practice falls entirely within one or more of the following categories is exempt from the professional liability insurance requirements set forth in section 12-38-111.8, C.R.S.:

A federal civilian or military APN whose practice is limited solely to that required by his or her federal/military agency.

An APN who is covered by individual professional liability coverage (or an alternative which complies with section 12-38-111.8(1), C.R.S.) or liability insurance that is maintained by an employer/contracting agency in the amounts set forth in section 12-38-111.8(1), C.R.S.

An APN who provides uncompensated health care; or

An APN who practices as a public employee under the “Colorado Governmental Immunity Act, sections 24-10-101 thru – 118, C.R.S.”

In order to establish eligibility for an exemption from the statutory financial responsibility requirements, an APN must provide such information as may be requested by the Board.

SCOPE OF ADVANCED PRACTICE NURSING

An APN shall practice in accordance with the standards of the appropriate national professional nursing organization and have a safe mechanism for consultation or collaboration with a physician or, when appropriate, referral to a physician. Advanced practice nursing also includes, when appropriate, referral to other health care providers.

The scope of Advanced Practice Nursing is based on:

The professional nurse’s scope of practice within the APN’s Role and Population Focus;

Graduate or post-graduate nursing education in the Role and/or Population Focus for which the APN has been recognized by the Board for inclusion on the APR.

The scope of Advanced Practice Nursing may include, but is not limited to: performing acts of advanced assessment, diagnosing, treating, prescribing, ordering, selecting, administering, and dispensing diagnostic and therapeutic measures.

Prescribing medication is not within the scope of practice of an APN unless the APN has applied for and been granted Prescriptive Authority by the Board.

WITHDRAWAL OF ADVANCED PRACTICE REGISTRATION

An APN may request to voluntarily withdraw the nurse’s registration as an APN in each Role and/or Population Focus in which the nurse was granted inclusion on the APR by the Board.

An APN who was included in the APR as of June 30, 2008, but had not successfully completed the educational requirements as set forth in section 12-38-111.5(4)(c), C.R.S., will meet the requirement the education requirements set forth in 2.5.2.1 of these rules.

An APN who was included in the APR as of June 30, 2010, has not obtained national certification as set forth in section 12-38-111.5(4)(d), C.R.S., will meet the certification requirements set forth in 2.5.2.2 of these rules.

5.42	The Board may withdraw an APN’s registration from the APR in one or more of the Roles/Specialties or Population Foci in which the APN was granted recognition, if the  APN no longer meets the requirements for inclusion on the APR or the APN is subject to discipline under section 12-38-117, C.R.S., in accordance with the procedures set forth in section 12-38-116.5, C.R.S.

RENEWAL AND REINSTATEMENT OF ADVANCED PRACTICE REGISTRATION

Renewal of an APN’s registration on the APR is required at the time of the APN’s Colorado professional nurse license renewal. Multi-state compact licensed professional nurses granted inclusion on the APR shall be required to renew their registration every two years and the registration shall be issued with a specific expiration date.

An APN who has failed to timely renew the APN registration may apply to reinstate such registration. The nurse shall submit an application on the current Board approved application forms, pay the current application fee, and submit required documentation as set forth in section 2 of these rules for each Role and/or Population Focus in which the Applicant wishes to practice Advanced Practice Nursing.

The Applicant may be required to demonstrate continued competency by:
Meeting the requirements to maintain certification by a Certifying Body, or
Petitioning the Board with an alternative method of establishing competency.

Reinstatement of an APN’s registration following disciplinary action requires compliance with all requirements set forth in section 2 of these Chapter XIV Rules and any requirements set forth by the Board.

DISCIPLINE OF ADVANCED PRACTICE NURSES

7.1		APN disciplinary procedures shall be the same as set forth in sections 12-38-116.5 and 12-38-117, C.R.S.

Adopted: April 28, 2010 5
Effective: July 1, 2010 Revised: July 26, 2017 Effective:

CHAPTER 15 – RULES AND REGULATIONS FOR PRESCRIPTIVE AUTHORITY FOR ADVANCED PRACTICE REGISTERED NURSES

BASIS: The authority for the promulgation of these rules and regulations by the State Board of Nursing (“Board”) is set forth in Sections 12-38-108(1)(j) and 12-38-111.6 of the Colorado Revised Statutes (C.R.S.).

PURPOSE: Section 12-38-111.6(4.5), C.R.S. sets forth the legal requirements for an Advanced Practice Registered Nurse (APRN) to obtain prescriptive authority in Colorado. First, the APRN must obtain Provisional Prescriptive Authority. Generally, those requirements are:

Completion of a the appropriate graduate degree or post-graduate degree orcertificate, as determined by the Board in an the advanced practice Role and, if applicable, Population Focus;

Satisfactory completion of educational requirements as determined by the Board in the use of controlled substances and prescription drugs;

National certification by a nationally recognized certifying body as determined by the Board in the Role and, if applicable, Population Focus of the APRN, unless the Board grants an exception; and

Professional liability insurance if required by Chapter XXI of the Board’s Rules and Regulations; and

Completion of at least three (3) years of combined clinical work experience as a professional nurse or as an APRN.

Upon receiving Provisional Prescriptive Authority, the APRN is legally authorized to prescribe medications and controlled substances schedules II-V to patients appropriate to the APRN’s Role and, if applicable, Population Focus. Within three (3) years of receiving Provisional Prescriptive Authority the APRN with Provisional Prescriptive Authority (hereinafter referred to as RXN-P) must:

Complete a 1000 hour Mentorship with a Physician or an Advanced Practice Nurse with Full Prescriptive Authority and experience in prescribing medications; and

Develop an Articulated Plan for safe prescribing.

If the RXN-P does not complete these additional requirements within three (3) years of receiving Provisional Prescriptive Authority such authority will expire for failure to comply with statutory requirements.

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The purpose of these rules is to further clarify each of the statutory requirements, with the exception of professional liability insurance, which can be found in Chapter XXI 14 of the Board’s Rules and Regulations. These rules apply only to the prescribing relationship authority and should not be construed to govern other relationships between APRNs and health care providers in other situations.

DEFINITIONS

Accrediting Agency: An organization that establishes and maintains standards for professional nursing programs and recognizes those programs that meet these standards and is recognized by US Department of Education (USDE) and/or the Council for Higher Education Accreditation (CHEA), including the Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), Council on Accreditation of Nurse Anesthesia Educational Programs (COA), and Accreditation Council for Midwifery Education.

Advanced Practice Registered Nurse (APRN): A professional nurse who meets the requirements of Section 12-38-111.5, C.R.S., who obtained specialized education or training and is included on the Advanced Practice Registry.

Advanced Practice Registry (APR): The Board’s record of those professional nurses who are granted APRN status by the Board in accordance with Section 12-38-111.5, C.R.S. and Chapter XIV of the Board’s Rules and Regulations.

Applicant: An APRN seeking Provisional Prescriptive Authority in the same Role and, if applicable, Population Focus for which the APRN was recognized on the APR.

Articulated Plan (Plan): A documented plan for safe prescribing, setting forth the RXN’s plans to maintain ongoing collaboration with physicians and other health care professionals in connection with the RXN’s practice of prescribing medications within their Role and, if applicable, Population Focus, as set forth in Section 6 of these Chapter 15 Rules. The Articulated Plan includes: mechanism for consultation or collaboration and referral; quality assurance mechanisms employed by the RXN to assure safe prescribing; decision support tools for safe prescribing; and ongoing continuing education in pharmacology and safe prescribing within the RXN’s Role and, if applicable, Population Focus.

Original Articulated Plan (Original): The initial Articulated Plan developed to obtain Full Prescriptive Authority. The development of the Original Articulated Plan will be documented by the signature of the Mentor, or when applying under Section 8.2 of these Chapter 15 Rules the Physician meeting the requirements of Section 1.12, or RXN meeting the requirements of Section 1.13, verifying such development pursuant to Section 6 of these Chapter 15 Rules.

Updated Articulated Plan (Updated): Changes to the Original Plan, as needed pursuant to Section 6.4.1 of these Chapter 15 Rules. An Updated Plan may replace and may be a re- write of the Original Plan and must address all of the elements included in the Original Plan. The Updated Plan does not require signatures of Mentors, Physicians or other RXNs.

Board: The State Board of Nursing.

Certifying Body: A non-governmental agency approved by the Board that validates by examination, based on pre-determined standards, an individual nurse’s qualifications and knowledge for practice in a defined APRN Role and, if applicable, Population Focus.

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Clinical Work Experience: Any relevant experience accumulated as a professional nurse or an advanced practice registered nurse, including paid or unpaid work experience, volunteer work, or student work. The gratuitous care of friends or members of the family is not included in Clinical Work Experience.

DEA: Drug Enforcement Administration.

Disciplinary Sanction: Any current restriction, limitation, encumbrance or condition on a Physician Mentor’s medical license or on a RXN Mentor’s nursing licenses, including confidential participation in a peer health assistance or an alternative to discipline program authorized by the Mentor’s licensing board.

Full Prescriptive Authority: The authority granted to the RXN to prescribe medications upon completion of the requirements set forth in Section 4.2 of these Chapter 15 Rules.

Mentor: Physician Mentor: A person who holds a license to practice medicine in Colorado or a physician who is otherwise exempted from licensure pursuant to Section 12-36-106(3)(i), C.R.S. The physician’s license must be in good standing without Disciplinary Sanction as defined in Section 1.10 above. The Physician Mentor must be actively practicing medicine in the State of Colorado and shall have education, training, experience and a practice that corresponds with but need not be identical to the Role and, if applicable, Population Focus of the RXN-P. The Physician Mentor must also have an unrestricted DEA registration.

Mentor: RXN Mentor: A professional nurse who has met the qualifications for an APRN, is included on Colorado’s APR, has Full Prescriptive Authority in Colorado, and has experience prescribing medications with full prescriptive authority preceding the beginning of the Mentorship. The RXN Mentor’s nursing license must be without Disciplinary Sanction as defined in Section
1.10 above. The RXN Mentor shall have an active practice in Colorado and shall have education, training, experience and a practice that corresponds with, but need not be identical to, the Role and, if applicable, Population Focus of the RXN-P. The RXN Mentor must have an unrestricted DEA registration.

Mentorship: A formal, Mutually Structured relationship between an RXN-P, as defined in Section
1.24 below, and a Physician Mentor or RXN Mentor to further the RXN-P’s knowledge, skill, and experience in prescribing.

Mentorship Agreement: A mutually structured agreement documented in writing and signed by the RXN-P and the Mentor(s) which outlines a process and frequency for ongoing interaction and discussion of prescriptive practice throughout the Mentorship between the Mentor(s) and the
RXN-P to assure safe prescribing practice.

Mutually Structured: Developed, implemented, and agreed upon by the RXN-P and the Mentor(s).

Pathophysiology: A minimum of three (3) semester hours or four (4) quarter hours completed   either as part of degree program or in addition to a degree program at  the graduate or post-graduate  level in an accredited nursing program for which graduate credit  has been awarded with an emphasis appropriate to the Role and, if applicable, Population Focus of the APRN, including but not limited to pathophysiologic processes of all body systems.

Pharmacology: A minimum of three (3) semester credit hours or four (4) quarter hours completed either as part of a degree program or in addition to a degree program    at the graduate or post- graduate level in an accredited nursing program for which graduate credit  has been awarded with an emphasis appropriate to, but need not be identical to the Role and, if  applicable, Population Focus of the APRN, including but not limited to the study of pharmacotherapeutics and pharmacokinetics of broad categories of pharmacological agents.

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Physical Assessment: A minimum of three (3) semester hours or four (4) quarter hours completed either as part of a degree program or in addition to a degree program  at the graduate or post- graduate level in an accredited nursing program for which graduate credit  has been awarded with an emphasis appropriate to the Role and, if applicable, Population Focus of the APRN including, but not limited to comprehensive history taking; physical and   psychological assessment; pathophysiologic and psychopathologic status of the patient; and development of a clinical diagnosis and management plan.

Population Focus: A broad area of study encompassing the common problems of a specific group of patients and the likely co-morbidities, interventions and responses to those problems including, but not limited to, the following areas of practice: primary care across the life span, adults/geriatrics, pediatrics, neonates, women; acute care adults/geriatrics or pediatrics;  psychiatry and mental health across the life span. A Population Focus is not defined as a specialty, specific disease, health problem or intervention.

Provisional Prescriptive Authority: The authority granted to the Applicant to prescribe medications within the Role and, if applicable, Population Focus of the APRN pursuant to Section 4.1 and Section 8.2 of these Chapter 15 Rules.

Role: The advanced practice area for which the Applicant has been prepared including nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and/or clinical nurse specialist (CNS).

RXN: An APRN who is listed on the APR and who has been granted Full Prescriptive Authority by the Board.

RXN Provisional (RXN-P): An APRN who is listed on the APR and who has been granted Provisional Prescriptive Authority by the Board.

Synchronous Communication: Real-time communication; existing or happening at the same time; occurring at the same moment of time; simultaneous. Synchronous Communication will be conducted in a secure manner to safeguard protected information. Synchronous Communication may include the use of electronic communication tools such as audio, web or video conferencing. Synchronous Communication does not include email communications.

Unencumbered: No current restriction to practice in the state of Colorado.

EDUCATIONAL REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY

An Applicant for prescriptive authority must have successfully completed a the appropriate graduate degree or  post-graduate degree or certification as determined by the Boardnursing certificate in the Role and, if applicable, Population Focus for which the Applicant seeks prescriptive authority. Such coursework shall include a minimum of three (3)  graduate semester hours or four (4) quarter hours, or the equivalent thereof, as determined by the Board, in each of the following: Pathophysiology, Pharmacology and Physical Assessment. The coursework in Pharmacology shall include  education on prescribing drugs and controlled substances.

The transcript shall verify date of course completion, grade and credits awarded. Applicants must provide copies of course descriptions or course syllabi when the required coursework in Physical Assessment, Pathophysiology, and Pharmacology is integrated into broad categories of
advanced practice courses or when course titles do not accurately reflect course content.

Letters of verification are generally not accepted documentation for the educational requirements of Physical Assessment, Pathophysiology, and Pharmacology; however, the Applicant may petition the Board on a case-by-case basis for a waiver. The decision to grant or deny such waiver shall be at the sole discretion of the Board.

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NATIONAL   CERTIFICATIONREQUIREMENT

Pursuant to Section 12-38-111.6 (4.5)(a)(III) C.R.S., an APRN applying for prescriptive authority must obtain and maintain national certification from a recognized Certifying Body.

Certification requirements for Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS): A Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) must pass the national certification examination as administered by a Certifying Body in the Role and Population Focus for which the APRN is applying for prescriptive authority. Documentation required shall be verification of   current certification or recertification from the Certifying Body, as approved by the Board.

If the Applicant cannot meet the requirements above, the Applicant may petition the 	  board for an exception. Exceptions will be reviewed on a case-by-case basis. The 	  decision to grant or deny such exception shall be at the sole discretion of the Board.

Certification requirements for Certified Registered Nurse Anesthetist (CRNA): Certified Registered Nurse Anesthetist (CRNA) must pass the national certification examination as administered by the Council on Certification of Nurse Anesthetists. Documentation required shall be verification of current certification or recertification from the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists, as approved by the Board.

Certification Requirements for Certified Nurse-Midwife (CNM): A Certified Nurse-Midwife must meet the standards for education and certification established by the American Midwifery Certification Board (AMCB). Documentation required shall be verification of status as a current holder of an AMCB certificate.

3.43.5  If the Applicant cannot meet the requirements above, the Applicant may petition the Board  for an exception. Exceptions will be reviewed on a case-by-case basis. The decision to  grant or deny such exception shall be at the sole discretion of the Board.

REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY

Requirements for Provisional Prescriptive Authority.

Must apply in a manner approved by the Board;

Pay application fee;

Submit proof of an appropriate degree and satisfactory completion of education requirements as described in Section 2 of these Chapter 15 Rules;

Submit verification of National Certification as described in Section 3 of these Chapter 15 Rules, unless the Board grants an exception;

An attestation of having professional liability insurance pursuant to Section 12-38-111.8,
C.R.S. and Chapter XXI 14 Rules and Regulations;

Submit verification of inclusion on the Advanced Practice Registry pursuant to Section 12-38-111.5, C.R.S.;

An attestation stating the Applicant has completed at least three (3) years of Clinical Work Experience, as defined in Section 1.8 of these Chapter 15 Rules;

An attestation stating that the Applicant’s Mentor(s) meets requirements in Section 1.12 or 1.13 of these Chapter 15 Rules;

4.1.8.1 The Applicant under Section 8.2 of these Chapter 15 Rules with prescriptive 	  authority and at least 1000 hours of prescribing experience in another state is not
 	required to have a mentorship and must apply for Full Prescriptive Authority 	
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within one (1) year of obtaining Provisional Prescriptive Authority or the 	  Provisional Prescriptive Authority will be expired.

Has an active professional nurse and APRN license that is in good standing and without disciplinary sanctions or significant adverse prescribing as determined by the Board.

Requirements for Original Full Prescriptive Authority.

Submit an application in a manner approved by the Board which includes:

An attestation of successful completion of 1000 hours experience in a Mentorship or if applying under Section 8.2 of these Chapter 15 Rules an attestation of prescriptive authority and 1000 hours of prescribing experience in another state;

An attestation of development of an Articulated Plan as described in Section 6 of these Chapter 15 Rules; and

An attestation, signature, and license number of the Mentor verifying the development of the Articulated Plan for safe prescribing in accordance with these Chapter 15 Rules; or

For those applying under Section 8.2 of these Chapter 15 Rules with prescriptive 	     authority and at least 1000 hours of prescribing experience in another state the 	  development of the Articulated Plan must be attested to by a Physician or RXN 	   who meets the requirements set forth in Sections 1.12 and 1.13 of these Chapter  15 Rules.

The application for Full Prescriptive Authority must be submitted within three (3) years of being granted Provisional Prescriptive Authority or if applying under Section 8.2 of these Chapter 15 Rules within one (1) year of being granted Provisional Prescriptive Authority.

D.A. If the RXN-P cannot meet the requirements in Section 4.2.2, the RXN-P may petition the Board for an exception to demonstrate competence. Exceptions will be reviewed on a case-by-case basis. The decision to grant or deny such exception will be at the sole discretion of the Board.

4.2.2.1 If the RXN-P cannot meet the requirements in Section 4.2.2, the RXN-P may 	  petition the Board for an exception to demonstrate competence. Exceptions will 	  be reviewed on a case-by-case basis. The decision to grant or deny such 	  exception will be at the sole discretion of the Board.

Any application not completed within one (1) year of the date of receipt of the application expires and will be purged.

MENTORSHIP  REQUIREMENTS

To obtain Full Prescriptive Authority, the RXN-P must complete1000 hours of documented experience in a Mentorship. The Mentorship shall be conducted with either a Physician Mentor or RXN Mentor [hereinafter referred to as Mentor(s)] as defined in Sections 1.12 and 1.13, respectively. The Mentorship must be completed within three (3) years after Provisional Prescriptive Authority is granted.

This Section 5 does not apply to the RXN-P with prescriptive authority and at least 1000 hours of prescribing experience in another state or jurisdiction applying for Full Prescriptive Authority as set forth in Section 8.2 of these Chapter 15 Rules.

The Mentorship Agreement shall contain the following elements:

 	5.2.1    Is documented in writing and signed by the RXN-P and the Mentor(s). 	
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5.2.2	Outlines a process, documentation, and frequency for ongoing Synchronous Communication, interaction and discussion of prescriptive practice throughout the Mentorship between the Mentor(s) and the RXN-P to provide for safe prescribing practice.

The Mentorship Agreement shall be retained for a period of three (3) years by the RXN and the Mentor(s) following completion of the Mentorship and shall be available to the Board upon request.

The RXN-P and the Mentor(s) shall provide documentation of the successful completion of the Mentorship as requested by the RXN-P to complete an application to obtain Full Prescriptive Authority. The Mentor(s) shall not, without good cause, withhold his/her signature or otherwise fail to attest to the completion of the Mentorship. Upon submission of the application and development of the Articulated Plan as set forth in Section 6 of these Chapter 15 Rules, the RXN- P                 may be granted Full Prescriptive Authority.

If a circumstance such as retirement, illness, relocation or other event precludes any Mentor from continuing in the Mentorship, the RXN-P shall secure a replacement Mentor and enter into a new, Mutually Structured Mentorship. Any hours accrued during the period of time in which the RXN-P does not have a Mentor will not be credited toward completion of the 1000 hour Mentorship.

The Mentor(s) shall not require payment or employment as a condition of entering into the mentor relationship. The Mentorship relationship should not be financially burdensome to either party. In recognition of the Mentor(s) time and expertise, reasonable expenses may be paid. Compensation by the RXN-P to the Mentor(s) should be agreed upon as part of the Mutually
Structured Mentorship, shall comply with standards of fair market value, and shall not be onerous or otherwise present a barrier to completion of the Mentorship.

ARTICULATED PLAN

To obtain Full Prescriptive Authority, the RXN-P must develop an Articulated Plan for safe prescribing within three (3) years after Provisional Prescriptive Authority is granted. The RXN-P’s Mentors are required to provide a one-time signature on the Articulated Plan to verify that the RXN-P has developed the plan for safe prescribing in accordance with these Rules.

To obtain Full Prescriptive Authority when applying as an APRN with prescriptive authority in another state, under Section 8.2 of these Chapter 15 Rules, the RXN-P must develop an Articulated Plan for safe prescribing within one (1) year after Provisional Prescriptive Authority is granted. The RXN-P will obtain a one-time signature of a Physician or RXN who meets the requirements set forth in Sections 1.12 and 1.13 of these Rules. Such signature verifies that the RXN-P has developed an Articulated Plan for safe prescribing in accordance with these Rules.

The Articulated Plan shall contain the following elements:

General information about the RXN-P and the Articulated Plan including:

Name of the RXN-P;

Role and, if applicable, Population Focus of the RXN-P;

Practice Setting of the RXN-P;

Signature of the Mentor(s), or Physician or RXN meeting the requirements of Sections 1.12 and 1.13 of these Rules, verifying development of the Articulated Plan; and

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Date the Articulated Plan was developed.

Documents a mechanism for consultation or collaboration with physicians and other appropriate health care providers and a mechanism for referral, when appropriate, to physicians and other appropriate health care providers for issues regarding prescribing.

Such documentation shall include a written statement or plan that delineates the resources or contacts available to assist the RXN with regard to issues relating to safe prescribing and prescriptive authority.

Such documentation shall also include a written statement or plan for the maintenance of ongoing collaboration with other health care professionals with regard to issues relating to safe prescribing and prescriptive authority.

Sets forth a quality assurance plan for safe prescribing.

A quality assurance plan is an individualized process by which an RXN seeks to evaluate the efficacy and quality of his or her prescribing practices. Such measures may include, but are not limited to, peer review, periodic chart audits, prescription audits on the Colorado Prescription Drug Monitoring Program, use of an electronic decision support system and utilization review. The quality assurance plan shall address and be relevant to the RXN’s Role and, if applicable, Population Focus.

Identifies decision support tools the RXN may utilize for prescribing medications.

A decision support tool is an assistive tool commonly recognized by healthcare professionals as a valid resource for information on pharmaceutical agents or to aid the RXN in making appropriate judgments regarding safe prescribing. Such tools may include, but are not limited to, electronic prescribing databases, evidenced-based guidelines, antimicrobial reference guides, professional journals and textbooks.

Documents the RXN’s ongoing continuing education in pharmacology and safe prescribing.

Such documentation shall include a personal record of the RXN’s participation in programs with content in pharmacology and safe prescribing within the RXN’s Role and, if applicable, Population Focus for which continuing education credits or certificates of completion are awarded. The RXN must maintain up to five (5) years, if applicable, of documentation of continuing education in the Articulated Plan.

The RXN must review the Articulated Plan at least annually after Full Prescriptive Authority has been granted by the Board and for so long as the RXN holds Full Prescriptive Authority in Colorado. Each annual review must be signed and dated by the RXN on the Articulated Plan.

The RXN must Update the Articulated Plan when the RXN has a change to any of the following:

Practice setting;

Mechanism or resources for consultation, collaboration, and referral;

Quality assurance plan (frequency or method);

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Decision support tools; or

Continuing education in pharmacology and safe prescribing.

Updates to the RXN’s Articulated Plan must be signed and dated by the RXN.

The Original Articulated Plan will be retained by the RXN.

The Articulated Plan must be reviewed and Updated as described in Section 6.4 of these Chapter 15 Rules.

The Articulated Plan documenting annual reviews will be available to the Board upon request for so long as the RXN has prescriptive authority.

The RXN-P and the Mentor(s), or when applying under Section 8.2 of these Chapter 15 Rules,  the Physician or RXN meeting the requirements of Sections 1.12 and 1.13 of these Chapter 15 Rules, will attest to the development of the Original Articulated Plan as requested by the RXN-P  to complete the application for obtaining Full Prescriptive Authority. The Mentor(s), or when applying under Section 8.2 of these Chapter 15 Rules, the Physician or RXN shall not, without good cause, withhold signature or otherwise fail to provide timely verification of completion of the Original Articulated Plan. Upon development of the Articulated Plan, successful completion of the Mentorship as set forth in Section 5 of these Rules, and application, the RXN-P may be granted Full Prescriptive Authority by the Board.

OTHER  REQUIREMENTS

An RXN-P or RXN must hold a valid DEA registration to prescribe controlled substances,  Schedule II through V, and must adhere to all DEA requirements.

Pursuant to Section 12-38-111.6 (8)(c)(II), C.R.S., nothing in these Chapter 15 Rules shall be construed to require a registered nurse to obtain prescriptive authority to deliver anesthesia care.

Pursuant to Section 12-38-111.6(10), C.R.S., nothing in these Chapter 15 Rules shall be construed to permit dispensing or distribution, as defined in Section 12-22-102, C.R.S., by an  RXN, except for receiving and distributing a therapeutic regimen of prepackaged drugs prepared by a licensed pharmacist or drug manufacturer registered with the FDA and appropriately labeled, free samples supplied by a drug manufacturer, and distributing drugs for administration and use  by other individuals as authorized by law.

REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY BY ENDORSMENT - AN ADVANCED PRACTICE NURSE WITH PRESCRIPTIVE AUTHORITY IN ANOTHER STATE TO OBTAIN FULL PRESCRIPTIVE AUTHORITY IN COLORADO

Submit an application in a manner approved by the Board.

Applicants must be actively listed on the Advanced Practice Registry in the Role and, where  applicable, the Population Focus for which the Applicant seeks Prescriptive Authority.

Applicants must have Active Prescriptive Authority in another state or jurisdiction of the United State in the Role and, where applicable, the Population Focus for which the Applicant seeks  Prescriptive Authority.All applicants for Full Prescriptive Authority must first obtain Provisional Prescriptive Authority in Colorado pursuant to 12-38-111.6, C.R.S. and these Chapter 15 Rules.

8.1.18.3.1	Prescriptive Authority credentials issued by the United States Military are  deemed to be substantially equivalent to prescriptive authority in another state or  jurisdiction.

Requirements to apply for Full Prescriptive Authority for applicants with prescriptive authority and at least 1000 hours of documented experience prescribing medications in another state or

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jurisdiction:

Verification of prescriptive authority and 1000 hours of documented experience 	  prescribing medications, in another state, jurisdiction, or the U.S. MilityarMilitary, in a manner approved by the Board. The acceptance of the documented hours of experience prescribing medications is at the sole discretion of the Board; and 

Development of an Articulated Plan as set forth in Section 6 of these Chapter 15 Rules  within one year of being granted Prescriptive Authority by endorsement, failure to do so  will result in cancellation of Prescriptive Authority.

The development of the Articulated Plan must be attested to by a physician licensed (or otherwise legally exempt) and practicing in Colorado or an Advanced Practice Nurse with Full Prescriptive Authority licensed and practicing in Colorado. Licenses must be active and unencumbered with active DEA registration.

Active Provisional Prescriptive Authority granted pursuant to Section 4.1 of these
Chapter 15 Rules; and

Submission of an application for Full Prescriptive Authority within one (1) year of obtaining Provisional Prescriptive Authority, providing evidence
of the following:

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Formatted: Indent: Left: 1.61"

Verification of prescriptive authority and 1000 hours of documented experience prescribing medications, in another state, in a manner approved by the Board. 	  The acceptance of the documented hours of experience prescribing medications  is at the sole discretion of the Board; and

Development of an Articulated Plan as set forth in Section 6 of these Chapter 15 Rules.

8.28.5  Requirements to apply for Full Prescriptive Authority for applicants with prescriptive authority and less than 1000 hours of documented experience prescribing medications in another state:

8.2.18.5.1	Active Provisional Prescriptive Authority granted pursuant to Section 4.1 of these Chapter  15 Rules;

8.2.28.5.2	Completion of the additional hours, up to at least 1000 hours, of experience prescribing medications within a Mentorship as set forth in Section 5 of these Chapter 15 Rules; and

Submission of an application for Full Prescriptive Authority within three (3) years of obtaining Provisional Prescriptive Authority, providing evidence of the following:

Verification of prescriptive authority and hours of documented experience prescribing medications, in another state, in a manner approved by the Board. The acceptance of the documented hours of experience prescribing medication is at the sole discretion of the Board;

Additional mentored prescribing hours, up to at least 1000 hours, completed within a Mentorship in Colorado; and

Development of an Articulated Plan as set forth in Section 6 of these Chapter 15 Rules.

REINSTATEMENT OF PRESCRIPTIVE AUTHORITY

To apply for reinstatement of prescriptive authority the APRN must possess an active, Colorado   or multi-state compact professional nurse license that is in good standing and without Disciplinary Sanction as defined in Section 1.10, and have reinstated the Role and, if applicable, Population Focus on the APR for which the APRN wishes to reinstate Full Prescriptive Authority.

An APRN applying to reinstate Full Prescriptive Authority must complete the reinstatement application for Full Prescriptive Authority and meet the requirements as set forth in Sections 2, 3, 4 and 6 of these Chapter 15 Rules.

If an APRN fails to meet the requirements as set forth in Section 12-38-111.6, C.R.S., and the Provisional Prescriptive Authority expires by operation of law, the APRN must complete a new application for Provisional Prescriptive Authority and meet the current requirements as set forth in Sections 2, 3 and 4 of these Chapter 15 Rules.

An APRN whose Provisional or Full Prescriptive Authority is withdrawn as the result of a disciplinary action under Section 12-38-116.5, C.R.S., as set forth in Section 11.2.1 below, shall not be eligible to apply for Prescriptive Authority for two (2) years after the date of the withdrawal of such Prescriptive Authority. After the end of the two (2) year waiting period an APRN must complete a new application and meet all requirements as set forth in these Chapter 15 Rules.

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RENEWAL OF PRESCRIPTIVE AUTHORITY

Renewal of Provisional or Full Prescriptive Authority is required at the time of the RXN’s professional nurse license renewal in Colorado. Multi-state compact licensed professional nurses  granted Provisional or Full Prescriptive Authority by the Board shall be required to renew the Provisional or Full Prescriptive Authority every two (2) years and shall be issued a specific expiration date for the Prescriptive Authority.

WITHDRAWAL OF PROVISIONAL OR FULL PRESCRIPTIVE AUTHORITY

An RXN may request that the Provisional or Full Prescriptive Authority be voluntarily withdrawn.

The Board may withdraw Provisional or Full Prescriptive Authority if the APRN no longer meets the requirements for Provisional or Full Prescriptive Authority or the APRN is subject to discipline  under Section 12-38-117, C.R.S., in accordance with the procedures set forth in Section 12-38- 116.5, C.R.S.

The APRN whose Provisional or Full Prescriptive Authority has been withdrawn as a result of disciplinary action under Section 12-38-116.5, C.R.S., shall not be eligible to apply for Prescriptive Authority for two (2) years after the date of the Board’s withdrawal of such Prescriptive Authority. For the purpose of this Section 11.2.1, withdrawal of Provisional or Full Prescriptive Authority shall include surrender or revocation of same.

If Provisional or Full Prescriptive Authority has been withdrawn, and the APRN wishes to apply for  Provisional or Full Prescriptive Authority, the APRN must file a new application and meet all requirements as set forth in these Chapter 15 Rules at the time of application.

DISCIPLINE OF ADVANCED PRACTICE NURSES WITH PRESCRIPTIVE AUTHORITY

RXN and RXN-P disciplinary proceedings shall be the same as set forth in Section 12-38- 116.5, C.R.S., and the grounds for discipline are as set forth in Section 12-38-117, C.R.S.

Approved: January 27, 2010
Effective: July 1, 2010
Revised: July 25, 2012
Effective: September 14, 2012
Revised: September 18, 2015
Effective: November 14, 2015
     Revised: July 26, 2017
     Effective:

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