24 Del. Admin. Code §§ 1900-8.0

Current through Register Vol. 27, No. 12, June 1, 2024

Section 1900-8.0 - Rules and Regulations Governing the Practice of Nursing as an Advanced Practice Registered Nurse

8.1 Authority

These rules and regulations are adopted by the Delaware Board of Nursing under the authority of the Delaware Nurse Practice Act, 24 Del.C. §§ 1902(d), 1906(1), 1906(7).

8.2 Purpose

8.2.1 The general purpose of these rules and regulations is to assist in protecting and safeguarding the public by regulating the practice of the Advanced Practice Registered Nurse.

8.3 Scope

8.3.1 These rules and regulations govern the educational and experience requirements and standards of practice for the Advanced Practice Registered Nurse. Prescribing medications and treatments independently is pursuant to the Rules and Regulations promulgated by the Board as defined in 24 Del.C. § 1906(20). The Advanced Practice Registered Nurse is responsible and accountable for her or his practice. Nothing herein is deemed to limit the scope of practice or prohibit a Registered Nurse from engaging in those activities that constitute the practice of professional nursing and/or professional nursing in a specialty area.

8.4 Definitions

"Advanced Practice Registered Nurse" as defined in 24 Del.C. § 1902(c)(1). Such a nurse will be given the title Advanced Practice Registered Nurse by state licensure, and may use the title Advanced Practice Registered Nurse within his/her specific specialty area.

"Advanced Practice Registered Nurse Role and Population Focus" Advanced practice roles include the C.R.N.A., C.N.M., C.N.S. and C.N.P. Population foci include: adult/gerontology, family/individual across the lifespan, neonatal, pediatric, psychiatric/mental health, or women's health/gender related.

"Board" The Delaware Board of Nursing

"Certified Nurse Midwife (C.N.M.)" A Registered Nurse who is a provider for normal maternity, newborn and well-woman gynecological care. The CNM designation is received after completing an accredited post-basic nursing program in midwifery at schools of medicine, nursing or public health, and passing a certification examination administered by the American Midwifery Certification Board (AMCB) or other nationally recognized, Board of Nursing approved certifying organization.

"Certified Nurse Practitioner (C.N.P.)" A Registered Nurse with advanced nursing educational preparation who is a provider of primary healthcare in a variety of settings with a focus on a specific area of practice. The C.N.P designation is received after graduation from a Master's program or from an accredited post-basic C.N.P certificate program of at least one academic year in length in a nurse practitioner specialty such as acute care, adult, family, geriatric, pediatric, or women's health, etc. The C.N.P must have national certification in the area of specialization at the advanced level by a certifying agency which meets the established criteria approved by the Delaware Board of Nursing.

"Certified Registered Nurse Anesthetist (C.R.N.A.)" A Registered Nurse who has graduated from a nurse anesthesia educational program accredited by the Council on Accreditation of Nurse Anesthesia Educational programs (COA), and who is certified by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) or other nationally recognized, Board of Nursing approved certifying organization.

"Clinical Nurse Specialist (C.N.S.)" A Registered Nurse with advanced nursing educational preparation who functions in primary, secondary, and tertiary settings with individuals, families, groups, or communities. The CNS designation is received after graduation from a Master's degree program in a clinical nurse specialty or post Master's certificate, such as gerontology, maternal-child, pediatrics, psych/mental health, etc. The CNS must have national certification in the area of specialization at the advanced level. The certifying agency must meet the established criteria approved by the Delaware Board of Nursing.

"Clinical Nursing Specialty" a delimited focus of advanced nursing practice. Specialty areas can be identified in terms of population, setting, disease/pathology, type of care or type of problem. Nursing administration does not qualify as a clinical nursing specialty.

"Consultation" means the communication and decision-making process among healthcare professionals related to the treatment and care of a patient, including the exchange of clinical observations and assessments; accessing an assessment of appropriate additional resources or expertise; arrangement of appropriate referrals, testing, or studies; and development of an appropriate plan of care that includes decisions regarding the health care provided.

"Full practice authority," as granted to an advanced practice registered nurse, means:

(1) Practicing within standards established or recognized by the Board of Nursing.

(2) Being accountable to patients, the nursing profession, and the Board of Nursing for complying with the requirements of this Act and the quality of advanced nursing care rendered.

(3) Recognizing the limits of knowledge and experience.

(4) Planning for the management of situations beyond the APRN's expertise.

(5) Consultation with or referring patients to other health care providers as appropriate.

(6) Practicing to the full scope of practice within the licensed role and population foci, without a collaborative agreement.

"Guidelines/Protocols" Suggested pathways to be followed by an Advanced Practice Registered Nurse for managing a particular medical problem. These guidelines/protocols may be developed collaboratively by an Advanced Practice Registered Nurse and a licensed physician, or a podiatrist, or licensed Delaware health care delivery system.

"National Certification" That credential earned by a nurse who has met requirements of a Board approved certifying agency.

The agencies so approved include but are not limited to:

American Association of Critical Care Nurses (AACN) Certification Corporation

American Academy of Nurse Practitioners Certification Board

American Midwifery Certification Board

American Nurses Credentialing Center

National Board of Certification and Recertification for Nurse Anesthetists

National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties

Pediatric Nursing Certification Board

"Pharmacology/Pharmacotherapeutics" Refers to any course, program, or offering that would include, but not be limited to, the identification of individual and classes of drugs, their indications and contraindications, their likelihood of success, their dosages, their side-effects and their interactions. It also encompasses clinical judgment skills and decision making. These skills may be based on thorough interviewing, history taking, physical assessment, test selection and interpretation, patho-physiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non-pharmacologic interventions.

"Post Basic Program" A combined didactic and clinical/preceptored program of at least one academic year of full time study in the area of advanced nursing practice with a minimum of 400 clinical/preceptored hours. The program must be one offered and administered by an approved health agency and/or institution of higher learning. Post basic means a program taken after licensure is achieved.

"Scope of Specialized Practice" That area of practice in which an Advanced Practice Registered Nurse has a Master's degree or a post-basic program certificate in a clinical nursing specialty with national certification.

"Supervision" Direction given by a licensed physician or Advanced Practice Registered Nurse to an Advanced Practice Registered Nurse practicing pursuant to a temporary permit. The supervising physician or Advanced Practice Registered Nurse must be periodically available at the site where care is provided, or available for immediate guidance.

8.5 Grandfathering Period

8.5.1 Any person holding a certificate of state licensure as an Advanced Practice Registered Nurse that is valid on July 31, 2014 shall be eligible for renewal of such licensure under the conditions and standards prescribed herein for renewal of licensure.

8.6 Standards for the Advanced Practice Registered Nurse:

8.6.1 APRNs shall comply with the standards for RNs as well as the standards of the national professional nursing associations recognized by the Board of Nursing. Standards for a specific role and population focus supersede standards for RNs where conflict between the standards exists. APRNs shall practice within standards established by the Board of Nursing and assure patient care is provided according to relevant patient care standards recognized by the Board of Nursing, including standards of national professional nursing associations. Advanced Practice Registered Nurses view clients and their health concerns from an integrated multi-system perspective.

8.6.2 Standards provide the practitioner with a framework within which to operate and with the means to evaluate practice. In meeting the standards of practice of nursing in the advanced role, each practitioner:

8.6.2.1 Performs comprehensive assessments using appropriate physical and psychosocial parameters;

8.6.2.2 Develops comprehensive nursing care plans based on current theories and advanced clinical knowledge and expertise;

8.6.2.3 Initiates and applies clinical treatments based on expert knowledge and technical competency to client populations with problems ranging from health promotion to complex illness and for whom the Advanced Practice Registered Nurse assumes primary care responsibilities. These treatments include, but are not limited to psychotherapy, administration of anesthesia, and vaginal deliveries;

8.6.2.4 Functions under established guidelines/protocols and/or accepted standards of care;

8.6.2.5 Uses the results of scientifically sound empirical research as a basis for nursing practice decisions;

8.6.2.6 Uses appropriate teaching/learning strategies to diagnose learning impediments;

8.6.2.7 Evaluates the quality of individual client care in accordance with quality assurance and other standards;

8.6.2.8 Reviews and revises guidelines/protocols, as necessary;

8.6.2.9 Maintains an accurate written account of the progress of clients for whom primary care responsibilities are assumed;

8.6.2.10 Collaborates with members of a multi-disciplinary team toward the accomplishment of mutually established goals;

8.6.2.11 Pursues strategies to enhance access to and use of adequate health care services;

8.6.2.12 Maintains optimal advanced practice based on a continual process of review and evaluation of scientific theory, research findings and current practice;

8.6.2.13 Performs consultative services for clients referred by other members of the multi-disciplinary team.

8.6.3 In addition to these standards, each nurse certified in an area of specialization and recognized by the Board to practice as an Advanced Practice Registered Nurse is responsible for practice at the level and scope defined for that specialty certification by the agency which certified the nurse.

8.7 Generic Functions of the Advanced Practice Registered Nurse within the Specialized Scope of Practice include but are not limited to:

8.7.1 Eliciting detailed health histories

8.7.2 Defining nursing problems

8.7.3 Performing physical examinations

8.7.4 Collecting and performing laboratory tests

8.7.5 Interpreting laboratory data

8.7.6 Initiating requests for essential laboratory procedures

8.7.7 Initiating requests for essential x-rays

8.7.8 Screening patients to identify abnormal problems

8.7.9 Initiating referrals to appropriate resources and services as necessary

8.7.10 Initiating or modifying treatment and medications within established guidelines

8.7.11 Assessing and reporting changes in the health of individuals, families and communities

8.7.12 Providing health education through teaching and counseling

8.7.13 Planning and instituting health care programs in the community with other health care professionals and the public

8.7.14 Delegating tasks appropriately

8.7.15 Prescribing medications and treatments independently pursuant to 24 Del.C. § 1935.

8.7.15.1 APRNs are authorized to assign and supervise medication administration to a medical assistant if the medical assistant has successfully completed a medical assistant training program and possesses current national medical assistant certification.

8.7.15.1.1 If a practice is solely operated by APRNs, the APRN must be present in the building when the medical assistant is administering medications and assumes liability for the actions of the medical assistant.

8.7.15.2 When a physician delegates to a medical assistant, and an organizational policy exists to allow the APRN to assign and supervise the medical assistant, the physician retains responsibility and accountability for the actions of the medical assistant and will be notified of unsafe or improper practices.

8.7.16 Inserting and removing epidural catheters by Certified Registered Nurse Anesthetists.

8.7.17 Removing epidural catheters by Nurse Practitioners, Clinical Nurse Specialists and Certified Nurse Midwives after specialized training in collaboration with the facility department of anesthesiology, including population specific advanced life support.

8.7.18 The certified nurse midwife (CNM) or certified nurse practitioner (CNP) may perform medication and manual vacuum aspiration (MVA) abortion to 12 weeks gestation.

8.7.18.1 Prior to performing MVA the CNM or CNP must:

8.7.18.1.1 Demonstrate knowledge and competence including the:

8.7.18.1.1.1 Knowledge of risks, benefits, alternatives, and client selection criteria.

8.7.18.1.1.2 Process for acquisition of required skills.

8.7.18.1.1.3 Identification and management of complications.

8.7.18.1.1.4 Process to evaluate outcomes and maintain competency.

8.7.18.1.1.5 Mechanism for obtaining medical consultation, collaboration, and referral related to these procedures.

8.7.18.1.1.6 Documentation of the process for obtaining the necessary knowledge, skills and ongoing competency which must be maintained by the nurse and employer.

8.7.18.2 Approved educational methods include successful completion of a training or a certificate of completion from:

8.7.18.2.1 The American College of Nurse-Midwives.

8.7.18.2.2 Planned Parenthood.

8.7.18.2.3 The Reproductive Health Access Project.

8.7.18.2.4 On the job training from an experienced provider with privileges to perform MVA.

8.8 Criteria for Approval of Certification Agencies

8.8.1 A national certifying body which meets the following criteria shall be recognized by the Board to satisfy 24 Del.C. § 1902(d)(1).

8.8.2 The national certifying body:

8.8.2.1 Is national in the scope of its credentialing.

8.8.2.2 Has no requirement for an applicant to be a member of any organization.

8.8.2.3 Has educational requirements which are consistent with the requirements of the advanced practice registered nurse role and population focus.

8.8.2.4 Has an application process and credential review which includes documentation that the applicant's education is in the advanced nursing practice role and population focus being certified, and that the applicant's clinical practice is in the same role and population focus.

8.8.2.5 Uses an examination as a basis for certification in the advanced nursing practice category which meets the following criteria:

8.8.2.5.1 The examination is based upon job analysis studies conducted using standard methodologies acceptable to the testing community;

8.8.2.5.2 The examination represents the knowledge, skills and abilities essential for the delivery of safe and effective advanced nursing care to the clients;

8.8.2.5.3 The examination content and its distribution are specified in a test plan (blueprint), based on the job analysis study, that is available to examinees;

8.8.2.5.4 Examination items are reviewed for content validity, cultural sensitivity and correct scoring using an established mechanism, both before use and periodically;

8.8.2.5.5 Examinations are evaluated for psychometric performance;

8.8.2.5.6 The passing standard is established using acceptable psychometric methods, and is reevaluated periodically; and

8.8.2.5.7 Examination security is maintained through established procedures

8.8.2.6 Issues certification based upon passing the examination and meeting all other certification requirements.

8.8.2.7 Provides for periodic recertification which includes review of qualifications and continued competency.

8.8.2.8 Has mechanisms in place for communication to Boards of Nursing for timely verification of an individual's certification status, changes in certification status, and changes in the certification program, including qualifications, test plan and scope of practice.

8.8.2.9 Has an evaluation process to provide quality assurance in its certification program.

8.9 Application for Initial Licensure to Practice as an Advanced Practice Registered Nurse

8.9.1 An applicant for initial licensure shall:

8.9.1.1 Hold an active RN license in Delaware or an active multistate RN license in another compact state.

8.9.1.2 Have completed an accredited graduate level APRN program in the role and at least one population focus congruent with licensure application.

8.9.1.3 Be currently certified by a national certifying body recognized by the Board in the APRN role and population foci congruent with educational preparation.

8.9.1.4 Have committed no acts or omissions, which are grounds for disciplinary action in any jurisdiction or, if such acts have been committed and would be grounds for disciplinary action as set forth in statute or regulation, the Board has found, after investigation, that sufficient restitution has been made.

8.9.2 An application for licensure to practice as an Advanced Practice Registered Nurse shall be submitted on forms supplied by the Board along with the required non-refundable fee. A completed application provides the following information: Graduation from an APRN graduate or post-graduate program accredited by a nursing accrediting body that is recognized by the U.S. Secretary of Education and/or the Council for Higher Education Accreditation (CHEA), or its successor organization; documentation shall verify date of graduation, credential conferred, number of clinical hours completed, completion of three separate graduate level courses in advanced physiology and pathophysiology, advanced health assessment, advanced pharmacokinetics and pharmacotherapeutics of all broad categories of agents, role and population focus of the education program, and evidence of meeting the standards of nursing education in this state.

8.9.3 In order to be licensed, all APRN applicants must be currently licensed as an RN or hold a privilege to practice as an RN in this state and take and pass the appropriate national certification examination in the role and population focus congruent with educational preparation.

8.9.4 A Registered Nurse meeting requirements set forth in these Rules and Regulations may be issued a license as an Advanced Practice Registered Nurse in the role and population focus in which the nurse has been nationally certified at the advanced level or has earned at a minimum a Master's degree in the same role and population.

8.9.5 The Board may refuse to issue or renew, revoke, suspend or otherwise discipline the license as an Advanced Practice Registered Nurse or otherwise discipline an applicant or a practitioner who fails to meet the requirements for licensure as an Advanced Practice Registered Nurse or as a registered nurse, or who commits any disciplinary offense under the Nurse Practice Act, 24 Del.C. Ch. 19, or the Rules and Regulations promulgated pursuant thereto.

8.9.6 A Registered Nurse who is duly enrolled as a bona fide student in an approved educational program for Advanced Practice Registered Nurses is not required to obtain an APRN license for the clinical requirements of the program, so long as the student is always under the direct supervision of a qualified instructor.

8.9.7 An internationally educated applicant for licensure as an APRN in this state must:

8.9.7.1 Have graduated from a graduate or post-graduate level APRN program equivalent to an APRN educational program in the U.S. acceptable to the Board.

8.9.7.2 Submit an official transcript directly from the international nursing education program and verified through a Board-approved credentials evaluation process.

8.9.7.3 Meet all other licensure criteria required of applicants educated in the U.S.

8.10 Temporary Permit for Advanced Practice Registered Nurse Licensure

8.10.1 A temporary permit to practice, pending Board approval for permanent licensure, may be issued provided that:

8.10.1.1 The applicant holds a current RN license in Delaware, or current multistate RN license in good standing from another state;

8.10.1.2 The applicant submits proof of graduation from a nationally accredited or Board approved master's or certificate advanced practice registered nursing program, and has passed the certification examination;

8.10.1.3 The applicant has undergone a criminal background check in accordance with 24 Del.C. § 1928, even if the applicant holds a current multistate RN license in good standing from another state, and the Board has received the results thereof; and

8.10.1.4 The applicant has submitted the applicable application and fee.

8.10.2 A temporary permit to practice, under supervision only, may be issued at the discretion of the Executive Director provided that:

8.10.2.1 The individual meets the requirements in subsections 8.10.1.1 - 8.10.1.4; and

8.10.2.2 The individual submits proof of graduation from a nationally accredited or Board approved Master's or certificate advanced practice registered nurse program, and;

8.10.2.3 The individual submits proof of admission into the approved certifying agency's examination or is seeking a temporary permit to practice under supervision to accrue the practice hours required to sit for the certifying examination or has accrued the required practice hours and is scheduled to take the first advanced certifying examination upon eligibility or is accruing the practice hours referred to in subsection 8.10.2.4; or,

8.10.2.4 The individual meets subsections 8.10.2.1 and 8.10.2.2 of this regulation and is awaiting review by the certifying agency for eligibility to sit for the certifying examination.

8.10.3 If the certifying examination has been passed, the appropriate form must accompany the application.

8.10.4 A temporary permit may be issued:

8.10.4.1 For up to two years in three month periods.

8.10.4.2 At the discretion of the Executive Director.

8.10.5 A temporary permit will be withdrawn:

8.10.5.1 Upon failure to pass the first certifying examination

8.10.5.1.1 The applicant may petition the Board of Nursing to extend a temporary permit under supervision until results of the next available certification exam are available by furnishing the following information:

8.10.5.1.1.1 Current employer reference;

8.10.5.1.1.2 Supervision available;

8.10.5.1.1.3 Job description;

8.10.5.1.1.4 Letter outlining any extenuating circumstances;

8.10.5.1.1.5 Any other information the Board of Nursing deems necessary.

8.10.5.2 For other reasons stipulated under temporary permits elsewhere in these Rules and Regulations.

8.10.6 A lapsed temporary permit for designation is equivalent to a lapsed license and the same rules apply.

8.10.7 Failure of the certifying examination does not impact on the retention of the basic professional Registered Nurse licensure.

8.10.8 Any person practicing or holding oneself out as an Advanced Practice Registered Nurse in any category without a Board authorized license in such category shall be considered an illegal practitioner and shall be subject to the penalties provided for violations of the Law regulating the Practice of Nursing in Delaware, (24 Del.C. Ch. 19).

8.11 Application for Licensure by Endorsement

8.11.1 The Board may, by endorsement, license as an Advanced Practice Registered Nurse an applicant who is duly licensed as an Advanced Practice Registered Nurse or is entitled to perform similar services under a different title under the laws of another state, territory or foreign country if, in the opinion of the Board, the applicant meets all qualifications specified by these regulations for Advanced Practice Registered Nurses in this State.

8.11.2 Applicants must submit documentation of graduation from a graduate or post-graduate level APRN program, as evidenced by an official transcript or other official documentation acceptable by the Board, verifying date of graduation and credential conferred; number of clinical hours completed; completion of three separate graduate level courses in advanced physiology and pathophysiology, advanced health assessment, advanced pharmacokinetics and pharmacotherapeutics of all broad categories of agents; and role and population focus of the education program.

8.11.3 Applicants must meet the practice requirement of 1500 hours in the past five years or no less than 600 hours in the past two years in the role and population focus consistent with certification and educational preparation.

8.11.3.1 APRNs who have never practiced and graduated more than two years prior to application must either complete a refresher program or complete 24 hours of continuing education with 12 hours in pharmacotherapeutics and 12 hours in the clinical management of patients, all taken within 1 year of submitting the application and complete 600 hours of supervised practice.

8.12 Maintenance of Licensure Status: Renewal; Reinstatement

8.12.1 To maintain licensure, the Advanced Practice Registered Nurse must meet the requirements for recertification as established by the certifying agency.

8.12.2 The Advanced Practice Registered Nurse must have practiced a minimum of 1500 hours in the past five years or no less than 600 hours in the past two years in the role and population focus in which licensure has been granted.

8.12.2.1 Faculty members teaching in graduate level clinical courses may count a maximum of 500 didactic course contact hours in the past five years or 200 in the past two years and all hours of direct on-site clinical supervision of students to meet the practice requirement.

8.12.2.2 An Advanced Practice Registered Nurse who does not meet the practice requirement may be issued a temporary permit to practice under the supervision of a person licensed to practice medicine, surgery, or advanced practice nursing, as determined on an individual basis by the Board.

8.12.3 Renewal of licensure shall be on a date consistent with the current Registered Nurse renewal period. A non-refundable renewal fee shall be paid.

8.12.3.1 An applicant for renewal of APRN licensure shall submit a detailed explanation and supporting documentation when the applicant's answers to questions regarding background and current certification/recertification by a national professional certification organization indicate that the applicant does not meet the requirements for renewal of licensure.

8.12.4 To reinstate licensure status as an Advanced Practice Registered Nurse, the requirements for recertification and 1500 hours of practice in the past five years or no less than 600 hours in the past two years in the role and population must be met.

8.12.5 To renew or reinstate an APRN license applicant must submit information related to the nurse's practice and demographics for the purpose of collecting nursing workforce data.

8.12.6 An application for reinstatement of licensure must be filed and the appropriate non-refundable fee paid.

8.12.7 An individual who applies for licensure reinstatement and who has been out of practice for more than five years shall provide evidence of successfully completing a Board-approved APRN refresher program within one year prior to application for reinstatement. If no refresher is available, the applicant must complete 600 hours of supervised clinical practice in the appropriate advanced practice role and population focus by a qualified preceptor within one year prior to reinstatement.

8.12.7.1 A preceptor must hold an active license to practice as an APRN or physician that is not encumbered and practices in a comparable practice focus. Evidence of satisfactory completion of the supervised practice must be submitted in writing to the Board of Nursing; likewise, unsatisfactory performance must be reported to the Board in a timely manner.

8.12.7.2 APRNs who have been out of practice more than two years but less than five must submit 24 hours of CE with 12 hours in pharmacotherapeutics and 12 hours in the clinical management of patients taken within one year prior to application.

8.12.7.3 APRNs who have been out of practice more than five years must submit 45 hours of pharmacotherapeutics CE taken within one year prior to application in addition to the advanced practice refresher program.

8.13 Audit of Licensees

8.13.1 The Board shall notify the licensees that they are to be audited for compliance with the requisite practice hours.

8.13.1.1 Upon receipt of such notice, the licensee must submit verification of compliance with APRN practice hours on a form supplied by the Board office that includes employer's name, title, address, telephone number, job title, and dates of employment. Upon receipt of such notice, the licensee must submit the form to the employer and the employer will submit the completed form directly to the Board office.

8.13.1.2 The Board shall notify the licensee of the results of the audit.

8.13.1.3 An unsatisfactory audit shall result in Board action.

8.13.1.4 Failure to notify the Board of a change in mailing address will not absolve the licensee from audit requirements.

8.14 Prescriptive Authority

8.14.1 The Board of Nursing grants APRNs prescriptive authority when granting an initial license by direct application or endorsement. APRNs who have not practiced a minimum of 1500 hours in the past five years or 600 hours in the past two years must comply with 24 Del.C. § 1918.

8.14.2 Prescription Order - includes the prescription date, the name of the patient; the name, title, address, area of specialization and business telephone number of the advanced practice registered nurse prescriber; the full name, strength, dosage, route, quantity, amount to be dispensed; directions for use; and number of refills of the drug product or device prescribed; and must bear the name and prescriber ID number and signature of the advanced practice registered nurse prescriber, and when applicable, prescriber's D.E.A. number and signature. There must be lines provided to show whether the prescription must be dispensed as written or substitution is permitted.

8.14.3 APRNs are authorized to prescribe, procure, administer, store, dispense, and furnish over the counter, legend, and controlled substances pursuant to applicable state and federal laws and within the APRN's role and population focus.

8.14.4 APRNs may prescribe, administer, and dispense legend medications including Schedule II - V controlled substances, (as defined in the Controlled Substance Act and labeled in compliance with 24 Del.C. § 2522, parenteral medications, medical therapeutics, devices and diagnostics.

8.14.4.1 Controlled Substances registration will be as follows:

8.14.4.2 APRNs must register with the Drug Enforcement Agency and use such DEA number for controlled substance prescriptions.

8.14.4.3 APRNs must register biennially with the Office of Narcotics and Dangerous Drugs in accordance with 16 Del.C. § 4732(a).

8.14.4.4 APRNs may request and issue professional samples of legend, including schedule II-V controlled substances, and over-the-counter medications that must be labeled in compliance with 24 Del.C. § 2522.

8.14.4.5 APRNs may give verbal prescription orders.

8.14.5 APRNs may order and prescribe non-pharmacological interventions including: medical devices and durable medical equipment, nutrition, blood, and blood products; diagnostic and supportive services including home health care, hospice, and physical and occupational therapy.

8.14.6 APRNs may: diagnose, prescribe and institute therapy or referrals of patients within the APRN's role and population foci to health care agencies, health care providers, and community resources; pronounce death and sign death certificates; seek consultation regarding treatment and care of patients; and be designated as the primary care provider by an insurer or health services corporation.

8.14.7 APRNs licensed in Delaware prior to September 1, 2015 who were not previously granted prescriptive authority must meet the following qualifications in order to be granted prescriptive authority:

8.14.7.1 Hold a current national certification. For APRNs that do not have current national certification, eligibility will be determined on a case by case basis; and

8.14.8 An APRN who has prescriptive authority in another jurisdiction who is applying for prescriptive authority in Delaware must show evidence of having current prescriptive authority in another jurisdiction and have no encumbered APRN designation or designations in any jurisdiction.

8.14.9 Renewal of Prescriptive Authority

8.14.9.1 Maintain current APRN licensure.

8.14.9.2 Prescriptive authority will renew with APRN licensure renewal.

8.14.10 Electronic Prescribing: [Authority: 24 Del.C. § 1927(4)]

8.14.10.1 A "temporary technological or electrical failure" as that term is used in 24 Del.C. § 1927(4)b. shall mean a technological or electrical failure that occurred through no fault of the licensee and lasts no more than one week.

8.14.10.2 Electronic prescriptions are not required for prescriptions that will be dispensed by a pharmacy not under the jurisdiction of the State of Delaware that does not have an electronic prescribing requirement in place via statute or regulation at the time the prescription is issued.

8.14.10.3 A licensee may petition the Board for a waiver of the e-prescribing requirement under 24 Del.C. § 1927(4)(i). Waiver petitions must be made in writing to the Board and will only be issued for one of the following reasons:

8.14.10.3.1 The licensee does not issue more than 50 prescriptions in one calendar year;

8.14.10.3.2 The licensee will experience a financial hardship if required to issue prescriptions electronically; or

8.14.10.3.3 The licensee is unable to issue electronic prescriptions as a result of technological limitations that are not reasonably within the control of the practitioner, such as limited internet coverage in geographic region of practice.

8.14.10.4 If the Board grants a waiver, such waiver shall be valid for a specified period of time not to exceed one year and may be renewed upon a demonstration that the basis for the initial waiver still exists. Renewal requests must be made in writing to the Board.

8.15 Unprofessional Conduct

8.15.1 Practice or prescriptive authority may be restricted, suspended or revoked where the advanced practice registered nurse has been found to have committed unprofessional conduct in his or her practice or prescriptive authority or if his or her mental or physical faculties have changed or deteriorated in such a manner as to create an inability to practice or prescribe with reasonable skill or safety to patients.

8.15.2 Unprofessional conduct, for purposes of restriction, suspension or revocation of practice or prescriptive authority shall include but not be limited to:

8.15.2.1 The use or attempted use of any false, fraudulent or forged statement or document or use of any fraudulent, deceitful, dishonest or immoral practice in connection with any acquisition or use of prescriptive authority or practice;

8.15.2.2 Conviction of a felony;

8.15.2.3 Any dishonorable or unethical conduct likely to deceive, defraud or harm the public;

8.15.2.4 Use, distribution, administration or prescription of any drugs or medical devices other than for therapeutic, prophylactic, or diagnostic purposes;

8.15.2.5 Misconduct, incompetence, or gross negligence in connection with practice or prescriptive authority;

8.15.2.6 Unjustified failure upon request to divulge information relevant to authorization or competence to practice or exercise prescriptive authority to the Executive Director of the Board of Nursing or to anyone designated by him or her to request such information.

8.15.2.7 The violation of the Nurse Practice Act or of an Order or Regulation of the Board of Nursing related to practice or prescriptive authority.

8.15.2.8 Restriction, suspension, or revocation of independent practice or prescriptive authority granted by another licensing authority in any state, territory or federal agency.

8.15.2.9 Prescribing, dispensing, administering, or distributing drugs in an unsafe manner or without adequate instructions to patients according to acceptable and prevailing standards.

8.15.2.10 Selling, purchasing, trading, or offering to sell, purchase or trade drug samples.

8.15.2.11 Prescribing or distributing drugs to individuals who are not within that nurse's role and population focus.

8.15.2.12 Violating any of the unprofessional conduct provisions in Section 10.0.

8.15.3 Members of the APRN Committee may review and provide consultation for investigation of disciplinary complaints.

8.16 Required Criteria for APRN Education Programs:

8.16.1 An APRN program administrator's qualifications must include:

8.16.1.1 A current, active APRN license or privilege to practice that is not encumbered in the state where the program is approved or accredited;

8.16.1.2 A graduate degree in nursing or other healthcare-related fields;

8.16.1.3 Educational or experiential preparation as an APRN with experience in providing nursing education; and

8.16.1.4 Current national APRN certification. Current program administrator without national certification as of October 11, 2020 are grandfathered.

8.16.2 A lead faculty member or assistant program administrator who is educated and nationally certified in the same role and population focus as the education program and licensed as an APRN may coordinate the educational component, including curriculum development for the role and population focus in the APRN program;

8.16.3 Nursing faculty who teach any APRN nursing course that includes a clinical learning experience shall meet the following qualifications:

8.16.3.1 Possess a current, active APRN license or privilege to practice that is not encumbered in the state where the program is approved or accredited;

8.16.3.2 Hold a minimum of a master's degree in nursing or healthcare related field in the clinical specialty;

8.16.3.3 Have sufficient APRN clinical experience to demonstrate clinical competency; and

8.16.3.4 Possess current knowledge, competence and certification as an APRN in the role and population focus consistent with teaching responsibilities.

8.16.4 Adjunct clinical faculty employed solely to supervise clinical nursing experiences of students shall meet the faculty qualifications consistent with the national nursing accrediting body;

8.16.5 Interdisciplinary faculty who teach non-clinical nursing courses shall have advanced preparation appropriate to these areas of content;

8.16.6 Clinical preceptors shall have demonstrated competencies related to the area of assigned clinical teaching responsibilities and will serve as a role model and educator to the student. Clinical preceptors may be used to enhance faculty-directed clinical learning experiences, but not to replace them. Faculty are not expected to be in the clinical setting with precepted students;

8.16.7 Clinical preceptors will be approved by faculty and meet the following requirements:

8.16.7.1 Hold an active license that is not encumbered as an APRN, or a physician assistant, pharmacist, or physician, and practices in a comparable practice focus; and

8.16.7.2 Function as a supervisor and teacher and evaluate the individual's performance in the clinical setting. Faculty retain responsibility for evaluating clinical performance and the quality of clinical experiences.

8.16.8 Preceptors who supervise students in the clinical setting must be oriented to the curriculum requirements, practice course objectives, and expectations regarding student supervision and evaluation;

8.16.9 The curriculum of the APRN nursing education program must prepare the graduate to practice in one of the four identified APRN roles, i.e., CRNA, CNM, CNS, and CNP, and at least one of the six population foci, i.e., family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women's health/gender-related or psychiatric/mental health. The curriculum shall include:

8.16.9.1 Three separate graduate-level courses (the APRN core) in: advanced physiology and pathophysiology, including general principles that apply across the lifespan; advanced health assessment, which includes assessment of all human systems, advanced assessment techniques, concepts and approaches; and advanced pharmacology, which includes pharmacodynamics, pharmacokinetics and pharmacotherapeutics of all broad categories of agents;

8.16.9.2 Diagnosis and management of diseases across practice settings including diseases representative of all systems;

8.16.9.3 Preparation that provides a basic understanding of the principles for decision making in the identified role;

8.16.9.4 Preparation in the core competencies for the identified APRN role; and

8.16.9.5 Role preparation in one of the six population foci of practice.

8.16.10 Additional required components of graduate or post-graduate education programs preparing APRNs shall ensure that all enrolled students shall have an active RN license or privilege to practice prior to and throughout enrollment in APRN clinical courses;

8.16.11 Graduates of an APRN education program must be licensed for each role and population focus;

8.16.12 Education programs offered by an accredited college or university that offers a graduate degree with a concentration in the advanced nursing practice role and at least one population focus or post-masters certificate programs offered by an accredited college or university shall include the following components:

8.16.12.1 Clinical supervision congruent with current national professional organizations and nursing accrediting body standards applicable to the APRN role and population focus;

8.16.12.2 Curriculum that is congruent with national standards for graduate level and advanced practice nursing education, is consistent with nationally recognized APRN roles and population foci, and includes, but is not limited to graduate APRN program core courses; and an advanced practice nursing core, including legal, ethical and professional responsibilities of the APRN;

8.16.12.3 Curriculum consistent with competencies of the specific areas of practice;

8.16.12.4 APRN programs preparing for two population foci or combined nurse practitioner/clinical nurse specialist shall include content and clinical experience in both functional roles and population foci;

8.16.12.5 Each instructional track/major shall have a minimum of 500 supervised clinical hours or the equivalent. The supervised experience is directly related to the role and population focus, including pharmacotherapeutic management of patients; and

8.16.12.6 There shall be provisions for the recognition of prior learning and advanced placements in the curriculum for individuals who hold a master's in nursing and are seeking preparation in a different role and population focus. Post-masters nursing students shall complete the requirements of the master's APRN program through a formal graduate-level certificate in the desired role and population focus. Post-masters students must meet the same APRN outcome competencies as the master-level students.

24 Del. Admin. Code §§ 1900-8.0

4 DE Reg. 296 (08/01/00)
5 DE Reg. 1606 (02/01/02)
8 DE Reg. 1683 (06/01/05)
17 DE Reg. 1095 (5/1/2014)
17 DE Reg. 1193 (6/1/2014)
18 DE Reg. 705 (3/1/2015)
20 DE Reg. 301 (10/1/2016)
21 DE Reg. 735 (3/1/2018)
23 DE Reg. 130 (8/1/2019)
23 DE Reg. 682 (2/1/2020)
24 DE Reg. 379 (10/1/2020)
25 DE Reg. 199 (8/1/2021)
25 DE Reg. 786 (2/1/2022)
26 DE Reg. 327 (10/1/2022)
26 DE Reg. 407 (11/1/2022)
27 DE Reg. 61 (7/1/2023)
27 DE Reg. 619 (2/1/2024) (Final)