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    Maryland Register

    Issue Date:  December 21, 2018

    Volume 45 • Issue 26 • Page 1264-1265

    Title 10 

    Subtitle 27 BOARD OF NURSING

    10.27.06 Practice of Nurse Anesthetist

    Authority: Health Occupations Article, §8-205(a)(1), (3), (4), and (5), Annotated Code of Maryland

    Notice of Proposed Action


    The Secretary of Health proposes to amend Regulations .01—.06 under COMAR 10.27.06 Practice of Nurse Anesthetist. This action was considered at a public meeting of the Board of Nursing held on September 26, 2018, notice of which was given by publication on the Board’s website beginning January 1, 2018, through September 26, 2018, pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.

    Statement of Purpose

    The purpose of this action is to:

    (1) Provide rules for initial and renewal licensure of advanced practice registered nurses;

    (2) Establish an expiration date for the advanced practice certification;

    (3) Repeal the requirement for a certified registered nurse anesthetist to name a collaborator;

    (4) Add definitions to implement the terms of the nurse licensure compact;

    (5) Amend the definition for perioperative assessment and management of a patient;

    (6) Change the renewal period to 2 years; and

    (7) Make technical changes to conform to statutory language.

    Comparison to Federal Standards

    There is no corresponding federal standard to this proposed action.

    Estimate of Economic Impact

    The proposed action has no economic impact.

    Economic Impact on Small Businesses

    The proposed action has minimal or no economic impact on small businesses.

    Impact on Individuals with Disabilities

    The proposed action has no impact on individuals with disabilities.

    Opportunity for Public Comment

    Comments may be sent to Jake Whitaker, Acting Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 22, 2019. A public hearing has not been scheduled.

    .01 Definitions.

    A. (text unchanged)

    B. Terms Defined.

    (1) (text unchanged)

    (2) “Advanced practice registered nurse (APRN)” means a registered nurse who is certified by the Board as:

    (a) A certified nurse midwife (CNM);

    (b) A certified registered nurse anesthetist (CRNA);

    (c) A certified nurse practitioner (CRNP); or

    (d) A clinical nurse specialist (CNS).

    [(2)(3) [(3)(4) (text unchanged)

    [(4) “BPQA” means the Board of Physician Quality Assurance.]

    (5) “Certification” means the permission to practice nurse anesthesia granted by the Board to a registered nurse who has:

    (a) Met all the specified requirements of a national certifying body recognized by the Board; and

    (b) Complied with the requirements of this chapter.

    [(5)(6) “Certified registered nurse anesthetist (CRNA)” means [a] an advanced practice registered nurse who is certified [to practice nurse anesthesia] by the Board to practice as a nurse anesthetist in this State.

    [(6) “Collaboration” means the development and implementation of an agreement between a nurse anesthetist and an anesthesiologist, licensed physician, or dentist concerning the practice of nurse anesthesia.]

    (7) (text unchanged)

    (8) “Multistate licensure privilege” has the meaning set forth in COMAR

    [(8)(9) “Perioperative assessment and management [of patients]” means the assessment and management of the patient preoperatively, intraoperatively,and postoperatively [, as well as monitoring of the patient during anesthesia].

    [(9)(10) ― [(10)(11) (text unchanged)

    (12) “Registered Nurse” means an individual who is licensed by the Board to practice registered nursing or has a multistate licensure privilege to practice registered nursing in this State under the Nurse Licensure Compact.

    .02 Certification.

    A. An applicant for certification as a CRNA shall:

    (1) Hold a current Maryland license in good standing or a multistate licensure privilege to practice registered nursing in this State under the Nurse Licensure Compact;

    (2) [Complete the application for certification as a nurse anesthetist;

    (3) Pay all fees established by the Board;

    (4) Complete the requirements for a degree or diplomaHave graduated from an education program in nurse anesthesia approved by the Board; [and]

    [(5)(3) Hold current national certification from the Council on Certification of Nurse Anesthetists or from another national certifying body [approvedrecognized by the Board;

    (4) Submit to the Board a completed application for certification as a nurse anesthetist;

    (5) Comply with all the requirements set forth in COMAR;

    (6) Demonstrate oral and written competency in the English language; and

    (7) Pay all fees.

    B. If the applicant’s nurse anesthetist program was completed after January 1, 2008, the applicant for certification as a CRNA shall also provide to the Board[verification of completion ofdocumentation that the applicant graduated from a graduate level accredited nurse anesthetist program with a master’s degree or higher.

    [C. A CRNA may not practice in this State until the CRNA has notified the Board of the name and license number of the collaborating physician or dentist.

    D. The Board shall forward the name and license number of the collaborating physician or dentist to the appropriate regulatory board.]

    .03 Practice Before Certification.

    A. A registered nurse who has completed a program for preparation of nurse anesthetists and who has applied to take a national certifying examination acceptable to the Board may practice as a nurse anesthetist graduate before certification in the State, on approval of the Board, if the nurse:

    (1) Has a current license or multistate privilege to practice registered nursing in the State;

    (2) ― (4) (text unchanged)

    (5) Practices under the supervision of an anesthesiologist or CRNA [, if the supervising CRNA has a collaborative agreement with an anesthesiologist, if]and the supervisor is on site and immediately available to the nurse anesthetist graduate;

    (6) Provides the Board a copy of the admission document to the national certification examination which must be taken not later than 6 months after program completion; and

    (7) (text unchanged)

    B. A nurse anesthetist graduate who fails the national certification examination shall immediately cease practice as a nurse anesthetist graduate.

    .04 Renewal of Certification.

    A. (text unchanged)

    B. Before a nurse anesthetist’s certification expires, the nurse anesthetist may renew the certification [for an additional 1-year termbiennially, if the nurse anesthetist:

    (1) ― (2) (text unchanged)

    (3) Submits to the Board:

    (a) A completed renewal application on the form required by the Board; and

    (b) [Satisfactory evidence that any certification received under Regulation .02 of this chapter is currentDocumentation of a current national certification as a nurse anesthetist from the Council on Certification of Nurse Anesthetists or some other national certifying body recognized by the Board.

    C. Nurse anesthetist renewal applicants who are authorized to practice registered nursing in this State under a multistate privilege shall be periodically required to submit to a criminal history records check in accordance with the schedule and requirements set forth in COMAR—N.

    D. The nurse anesthetist shall ensure that the Board has a record of the renewed national certification if the national certification expires before the renewal date.

    E. Practicing on an expired national certification is prohibited and subject to disciplinary action under Health Occupations Article, §8-316, Annotated Code of Maryland.

    .05 Scope of Practice.

    A. A [CRNAnurse anesthetist may perform the following functions:

    (1) ― (4) (text unchanged)

    B. A [CRNAnurse anesthetist has the right and obligation to refuse to perform [anya delegated act [, oral or written,] if, in the nurse anesthetist’s judgment, the act is:

    (1) ― (3) (text unchanged)

    C. Section A of this regulation may not be construed to authorize a nurse anesthetist to:

    (1) Diagnose a medical condition;

    (2) Provide care that is not consistent with the scope of practice of nurse anesthetists; or

    (3) Provide care for which the nurse anesthetist does not have proper education and experience.

    .06 Standards of Practice.

    A. A nurse anesthetist [certified under this chapter] shall collaborate with an anesthesiologist, licensed physician, or dentist in the following manner:

    (1) ― (3) (text unchanged)

    B. (text unchanged)

    C. The nurse anesthetist as part of the standards of practice shall:

    (1) ― (9) (text unchanged)

    Secretary of Health