January 2003 Bulletin

• NCLEX "First Time" Test Takers Pass Rates
• Discipline
• The Role of the Board of Nursing
• Frequently Asked Questions

NCLEX "FIRST TIME" TEST TAKERS PASS RATES

Practical Nurses

For the year October 1, 2001 through September 30, 2002, 20 first time candidates educated in Maine wrote the NCLEX examination for practical nurses and
17 passed, an 85 % pass rate. The national pass rate for the same time period was 86.00%.
(The total number of P.N. candidates was 37, 491 and 32, 244 passed first time, an 86% pass rate)

Registered Nurses

For the year October 1, 2001 through September 30, 2002, 419 first time candidates educated in Maine wrote the NCLEX examination for registered nurses and 356 passed, an 84.96 % pass rate. The national pass rate for the same time period was 86.34%.
(The total number and percent passing of first time candidates educated in U.S. jurisdictions:
71, 380 R.N. candidates; 61,633 passed first time for 86.34% pass rate

NCLEX-RN "FIRST TIME" TEST TAKERS PASS RATES
For the year October 1, 2001 through September 30, 2002

When reviewing statistics, keep in mind absolute numbers as well as percentages. (Percentages for smaller absolute numbers can vary widely.)

Discipline

The purpose of this article is to remind and educate nurses about the role of the Maine State Board of Nursing. Confusion often arises as to what the role and function of the Board and its staff are. Comments often received in the Board office include: " I thought you were advocates for nurses"; "Why don't you fight for nurses' rights?"; "I thought you were supposed to give legal advice when a nurse is reported to the Board"; "I thought you were on my side" and the like.

What the Board Does
The Board is an administrative agency of the State of Maine, a governmental, regulatory body responsible for enforcing the LAW REGULATING THE PRACTICE OF NURSING which states that the purpose of the Board is to safeguard the life and health of the people of this State by requiring evidence that those who practice professional or practical nursing are qualified and competent to do so. (You may access the law at the Board's web site: http://www.maine.gov/boardofnursing )

Under our Constitution there are three branches of government: the legislative branch which makes the laws; the judicial branch which interprets the laws; and the executive branch which executes or carries out (enforces) the laws. The Board of Nursing as an administrative agency of the state, enforces the LAW REGULATING THE PRACTICE OF NURSING (usually referred to as the Nurse Practice Act) which was passed by the Legislature. As a matter of interest, the first law passed to regulate nursing was in 1915. Thus, the Legislature delegated to the Board of Nursing the responsibility of regulating the practice of nursing under the guidelines provided in the Nurse Practice Act (32 MRSA Chapter 31). The following discussion will highlight how the Board is designed to regulate nursing practice on behalf of the public and how the Board ensures that nurses licensed in Maine are providing competent care.

The Board is made up of nine members who serve four year terms and are appointed by the Governor. Six members must be registered professional nurses ( 2 must be nursing educators who prepare persons for initial licensure; 2 must be in nursing service; 1 must be in long term care nursing ; 1 must be in advanced practice nursing). One member must be a licensed practical nurse; two members must be consumers who provide valuable input about the practice of nursing from the layman's perspective. The Board meets every two months to make decisions that enable it to function effectively. For the daily activities the Board has a staff of seven who carry out the operations of the Board. The staff of the Board are state employees.

The Board is responsible for adopting rules and regulations which establish minimum legal standards and clarify or explain parts of the law. The Board does not make or change regulations in secret. Rulemaking is a public process that invites comment by the public. Notices of rulemaking proposals are always published in the state's five major newspapers.

The Board regulates the scope of nursing practice as defined in law of all registered professional nurses, licensed practical nurses, and advanced practice nurses. There are no "lists" of tasks provided in the law or the rules but rather broad guidelines.

The Board make take disciplinary action against a nurse's license in response to violations of the law. Nurses must keep in mind that investigations, informal conferences, hearings, and disciplinary actions are conducted from the perspective of protecting the public. The Board does not take any disciplinary action against a nurse's license without due process, which includes the opportunity for an adjudicatory hearing and the right to be represented by counsel.
The only time the Board may suspend a license is if there is enough evidence to believe that there is a threat to the safety of the public in accordance with 5 MRSA Sec 10004. Should this happen, the nurse is automatically scheduled for an adjudicatory hearing within 30 days of the suspension.

The Board regulates nursing education programs that lead to initial RN or LPN licensure.

The Board regulates the practice of individual licensed nurses in all practice settings.

What the Board Does Not Do

The Board does not regulate the conditions of employment such as staffing ratios, mandatory overtime, float policy, assignments, hiring and firing, or discipline imposed by an employer.

The Board does not regulate hospitals, nursing homes, home care organizations nor any other health care facility that may employ nurses. Complaints about facilities should be made to the Division of Licensing and Certification, 11 State House Station, Augusta, ME 04333.

The Board is not a professional association for nurses. Professional membership organizations are responsible for representing rather than regulating the profession of nursing.

The Board cannot independently change the law. Only the Maine State legislature (your state representatives and state senators) can make statutory changes.

The Board does not regulate RN to BSN or graduate nursing education programs.

The Board does not regulate reimbursement for nursing services and does not determine which services are reimbursable. The nurse seeking third party reimbursement should negotiate with the payor.

The Board does not certify nurses for specialties.

The Board is not a substitute for a citizen's private remedies.

Frequently Asked Questions on Prescriptive Authority for Certified Nurse-Midwives and Nurse Practitioners

Q: When may I start prescribing and dispensing medications?
A: A nurse practitioner or nurse-midwife must be approved to practice by the Maine State
Board of Nursing and receive either a temporary approval to practice or full approval to
practice to prescribe and dispense medications.

Q: Do I need a DEA number to prescribe and dispense medications?
A: A nurse practitioner or nurse-midwife who prescribes and dispenses controlled substances is
required to register with the U.S. Department of Justice Drug Enforcement Administration
(DEA) as a mid-level practitioner and obtain a DEA number. You may contact the DEA at
(617) 557-2200. You cannot register with the DEA until you have received full approval to
practice from the Board.

Q: What must a written prescription include?
A: In addition to the required client and drug information, a written prescription shall
include the date, printed name, legal signature, specialty category, business address,
and telephone number of the prescribing nurse practitioner or nurse-midwife.

Q: What documentation may be requested from the prescribing nurse practitioner or
nurse-midwife in order to fill a prescription?
A: A prescribing nurse practitioner or nurse-midwife should be prepared to provide a
copy of his/her approval to practice letter and DEA certificate.

Q: Do I have to obtain continuing education in pharmacology for renewal approval to
practice as a nurse practitioner or nurse-miwife?
A: If a nurse practitioner or nurse-midwife has not prescribed drugs within the past 2 years he/she shall provide evidence of satisfactory completion of 15 contact hours of pharmacology within
the 2 years prior to applying for approval to practice.
________________________________________________________________________ Frequently Asked Questions Regarding Physician Supervision of the Nurse Practitioner

Q: Does the physician who supervises a nurse practitioner have to be in the same practice
category as that nurse practitioner?
A: Yes. A physician's practice category must include the nurse practitioner's scope of
practice approved by the Board.

Q: Does the physician need to countersign the nurse practitioner's orders/patient
notations?
A: The Board does not require that the nurse practitioner's orders/ patient notations be
countersigned. However, facilities/organizations may require this per their policy.

Q: Does the physician have to be on-site to supervise the nurse practitioner?
A: The physician does not have to be on-site to supervise the nurse practitioner. However,
the nurse practitioner must have a continuous mechanism to contact the physician as
needed.

Q: Does the nurse practitioner have to contact the Board prior to changing an employment setting during the 24 month supervision period?
A: The nurse practitioner must have the physician send the Board a letter indicating he/she will
be the supervising physician, hours per week, start date, and a brief synopsis of what the
nurse practitioner will be providing for services, prior to changing an employment setting.

Q: Does the nurse practitioner need to notify the Board when he/she has completed the 24
month physician supervision requirement?
A: The nurse practitioner must have his/her supervising physician send the Board a letter
stating that the nurse practitioner has been supervised for 24 months (include dates of
supervision) based on a full time (40 hour per week) schedule.
______________________________________________________________________________
Frequently Asked Nursing Practice Questions

Q: May a student nurse be employed as a certified Nursing Assistant-Medications
(CNA-M) ?
A: No. A student nurse may not be employed as a CNA-M unless he/she has completed the
Standardized Medication Course for Certified Nursing Assistants approved by The Maine
State Board of Nursing.

Q: May a student nurse be employed as such in a health care facility during the summer?
A: These individuals are unlicensed assistive personnel. They may not be employed as student
nurses. They may be employed as certified nursing assistants if they are listed as active on the Certified Nursing Assistant (CNA) registry.

Q: May a new graduate from a nursing program be employed to work as such in a health
care facility prior to the person's licensure?
A: Technically, these individuals are unlicensed assistive personnel since they are not
eligible to be classified as a registered professional nurse (RN) applicant or licensed
practical nurse (LPN) applicant. The new graduate should not be part of the facility's
staffing pattern, i.e. does not carry a patient assignment. The new graduate may begin
an orientation program (didactic and clinical) in a structured setting with a defined
educational program for the orientation of new graduates under the continous, on-site
supervision of a registered professional nurse. The new graduate must provide the
facility with an Authorization to Test (ATT) letter by the test service. The new
graduate must pass the NCLEX examination within three months of starting
orientation. If the individual is not licensed by the end of three month period or has
failed the first attempt at the NCLEX examination, the new graduate may function only as an unlicensed assistive personnel (UAP).

Q: May a LPN perform phlebotomy without on-site supervision of a registered
professional nurse?
A: The Board determined that the performance of phlebotomy is not considered the
practice of nursing; therefore, it is not necessary for the registered nurse to be
physically present in the facility when the LPN performs phlebotomy.

Q. May a registered professional nurse delegate nursing tasks to a medical assistant?
A: A registered professional nurse may only delegate selected nursing tasks to a licensed
practical nurse or certified nursing assistant. Medical Assistants perform tasks under the
on-site delegation of the physician.

Q: May a registered professional nurse administer flu vaccines, Hepatitis B and C
injections, TB tests utilizing standing orders signed by a physician or medical director?
A: A registered professional nurse may execute the medical regime as prescribed by a
licensed physician, podiatrist or dentist or otherwise legally authorized individual acting
under the delegation of a physician, podiatrist or dentist.

Q: Does the Board need to be notified when a registered professional nurse successfully
completes the certification process in a specialty?
A: No. Registered professional nurses who specialize sometimes receive certification from a
national nursing organization or national certification organization in a specialized
field of professional nursing (but not advanced practice registered nursing). The
certification recognizes the nurse who has a strong knowledge base in that specialty.
This certification does not provide a credential that allows the registered professional
nurse to apply to the Board to practice as an advanced practice registered nurse. The
Board does not need to be notified when the nurse has obtained this credential.