The Board shall evaluate continuously master planning by other agencies that may affect nursing practice in this State.
The Board shall appoint or recognize specific task advisory committees.
Each advisory committee consists of at least three members appointed by the Board.
Each committee member shall have expertise in the specific problem or area of nursing practice that is under investigation.
Each member of a committee is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.
Each advisory committee shall:
Help the Board to forecast directions in nursing practice;
Help the Board evaluate the impact of identified issues on nursing practice; and
Make recommendations to the Board when appropriate.
The Board may appoint peer advisory committees to provide the Board with expert advice related to the practice of nursing by advanced practice nurses and the practice of midwifery by licensed certified midwives.
A member of a peer advisory committee is entitled to receive:
Compensation, as determined by the Board; and
Reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.
In this section, “employer” means:
A public employer;
A private employer; or
An employment agency.
“Employer” does not include a private employer who employs a licensee for personal or family use.
On the request of the Board, an employer shall report the name and license number of each licensee employed or placed to practice registered nursing, licensed practical nursing, or certified midwifery.
Except as provided in subsection (b) of this section, the following applies:
If a nursing administrator, a registered nurse, an advanced practice registered nurse, a licensed practical nurse, or a certified nursing assistant knows of an action or condition that might be grounds for action under § 8–316 or Subtitle 6A of this title, the nursing administrator, registered nurse, advanced practice registered nurse, licensed practical nurse, or certified nursing assistant shall report the action or condition to the Board; and
An individual shall have the immunity from liability described under § 5–709 of the Courts and Judicial Proceedings Article for making a report as required by this subsection.
If a nurse administrator, a registered nurse, an advanced practice registered nurse, a licensed practical nurse, or a certified nursing assistant has reason to know that a licensee or certificate holder has committed an action or has a condition that might be grounds for reprimand or probation of the licensee or certificate holder or suspension or revocation of the license under § 8–316 or § 8–6A–10 of this title because the licensee or certificate holder has a substance use disorder, the nurse administrator, registered nurse, advanced practice registered nurse, licensed practical nurse, or certified nursing assistant is not required to report the licensee or certificate holder to the Board if:
The nurse administrator, registered nurse, advanced practice registered nurse, licensed practical nurse, or certified nursing assistant knows that the licensee or certificate holder is in an alcohol or drug treatment program that is accredited by the Joint Commission on Accreditation of Healthcare Organizations, is certified by the Department, or is under the care of a health care practitioner who is competent and capable of dealing with substance use disorder;
The nurse administrator, registered nurse, advanced practice registered nurse, licensed practical nurse, or certified nursing assistant is able to verify that the licensee or certificate holder remains in the treatment program until discharge; and
The action or condition of the licensee or certificate holder has not caused injury to any individual while the licensee is practicing registered nursing or licensed practical nursing or the certificate holder is working as an advanced practice registered nurse or a nursing assistant.
An individual is not required under this section to make any report that would be in violation of any federal or State law, rule, or regulation concerning the confidentiality of patient substance use disorder records.
In this section the following words have the meanings indicated.
“Midwife” means a registered nurse certified as a nurse–midwife or a licensed certified midwife.
“Nurse practitioner” means a registered nurse who is:
Certified as a nurse practitioner; and
Authorized to prescribe drugs under regulations adopted by the Board.
“Personally prepare and dispense” means that a nurse practitioner:
Is physically present on the premises where the prescription is filled; and
Performs a final check of the prescription before it is provided to the patient.
“Starter dosage” means an amount of drug sufficient to begin therapy:
Of short duration of 72 hours or less; or
Prior to obtaining a larger quantity of the drug to complete therapy.
A nurse practitioner or midwife may personally prepare and dispense a starter dosage of any drug the nurse practitioner or midwife is authorized to prescribe to a patient of the nurse practitioner or midwife if:
The starter dosage complies with the labeling requirements of § 12–505 of this article;
No charge is made for the starter dosage; and
The nurse practitioner or midwife enters an appropriate record in the patient’s medical record.
In accordance with the provisions of subsection (d) of this section, a nurse practitioner may personally prepare and dispense any drug that a nurse practitioner may prescribe to the extent permitted by law in the course of treating a patient at:
A medical facility or clinic that specializes in the treatment of medical cases reimbursable through workers’ compensation insurance;
A medical facility or clinic that is operated on a nonprofit basis;
A health center that operates on a campus of an institution of higher education;
A public health facility, a medical facility under contract with a State or local health department, or a facility funded with public funds; or
A nonprofit hospital or a nonprofit hospital outpatient facility as authorized under the policies established by the hospital.
A nurse practitioner who personally prepares and dispenses a drug in the course of treating a patient as authorized under subsection (c) of this section shall:
Comply with the labeling requirements of § 12–505 of this article;
Record the dispensing of the prescription drug on the patient’s chart;
Allow the Office of Controlled Substances Administration to enter and inspect the nurse practitioner’s office at all reasonable hours; and
Except for starter dosages or samples dispensed without charge, provide the patient with a written prescription, maintain prescription files, and maintain a separate file for Schedule II prescriptions for a period of at least 5 years.
In this section, “law enforcement agency” includes:
A State, county, or municipal police department or agency;
A sheriff’s office;
A State’s Attorney’s office; and
The Office of the Attorney General.
A law enforcement agency that receives a complaint of death or bodily harm allegedly caused by a nurse who holds a license or certificate under this title shall notify the Board of the complaint.
The Board may conduct a demonstration study to evaluate a proposed change to regulations regarding nursing practices or the activities of nursing assistants, dialysis technicians, or medication technicians in a practice setting.
A demonstration study enables the Board, in a controlled practice setting, to determine:
The safety of the proposed practice or activity; and
The appropriate education or training requirements for a proposed practice or activity.
The Board shall:
Approve the demonstration study design; and
Select the testing facilities.
The Board may waive selected nursing practice requirements during a demonstration study.
A registered nurse or licensed practical nurse working in a methadone clinic licensed by the Maryland Department of Health may dispense methadone in accordance with regulations jointly developed and adopted by the Board and the State Board of Pharmacy.
In this section the following words have the meanings indicated.
“Authorized prescriber” means a licensed registered nurse, licensed dentist, licensed physician, licensed physician’s assistant, licensed podiatrist, or other individual authorized by law to prescribe prescription or nonprescription drugs or devices.
“Device” means an item used in the diagnosis, treatment, or prevention of disease.
“Device” does not include:
Surgical or dental instruments;
Physical therapy equipment;
X–ray apparatuses; or
Component parts of or accessories for any of the items described in items 1 through 3 of this subparagraph.
“Dispense” means a procedure that results in the receipt of a drug or device by a patient or a patient’s agent.
“Dispense” includes:
Interpreting an authorized prescriber’s prescription for a drug or device;
Selecting and labeling the drug or device prescribed;
Measuring and packaging the drug or device in accordance with State and federal law; and
Documenting the transaction in the patient’s medical record.
“Drug” means, unless the context requires otherwise, a prescription or nonprescription drug.
“Formulary” means a list of drugs and devices.
“Nonprescription drug or device” means a drug or device that:
May be sold without a prescription; and
Is labeled for use by a consumer in accordance with State and federal law.
“Personally prepare and dispense” means to:
Physically prepare a prescription;
Perform a final check of the prescription before dispensing it to a patient; and
Not delegate any step of the dispensing process.
“Prescription drug” means a drug that, under § 21–220 of the Health – General Article, may be dispensed only on the prescription of an authorized prescriber.
If a registered nurse complies with the requirements of this section, the registered nurse may personally prepare and dispense drugs and devices or provide, without a prescription, nonprescription drugs and devices in a local health department:
In accordance with the Overdose Response Program under Title 13, Subtitle 31 of the Health – General Article or the Expedited Partner Therapy Pilot Program under § 18–214.1 of the Health – General Article; or
To patients in need of communicable disease, alcohol and drug abuse, family planning, or reproductive health services.
A registered nurse may personally prepare and dispense drugs and devices or provide, without a prescription, nonprescription drugs and devices if the registered nurse:
Complies with the formulary developed and approved under § 3–403(b) of the Health – General Article;
Has successfully completed a training program administered by the Department in accordance with § 3–405 of the Health – General Article;
Maintains the patient’s health record in a manner that ensures the confidentiality of the patient’s drug and device medication record in accordance with State and federal laws;
Complies with drug and device storage and inventory procedures in accordance with Department policy; and
For a prescription drug or device, has received a prescription from an authorized prescriber employed at a local health department.
In this section, “perioperative assessment and management” means the assessment and management of a patient preoperatively, intraoperatively, and postoperatively.
A nurse anesthetist may perform the following functions:
Perioperative assessment and management of patients requiring anesthesia services;
Administration of anesthetic agents;
Management of fluids in intravenous therapy;
Respiratory care; and
Subject to paragraph (4) of this subsection, prescription, ordering, and administration of drugs, including a drug that is classified as a controlled dangerous substance under Title 5, Subtitle 4 of the Criminal Law Article.
A nurse anesthetist has the right and obligation to refuse to perform a delegated act if in the nurse anesthetist’s judgment, the act is:
Unsafe;
An invalidly prescribed medical act; or
Beyond the clinical skills of the nurse anesthetist.
Paragraph (1) of this subsection may not be construed to authorize a nurse anesthetist to:
Diagnose a medical condition;
Provide care that is not consistent with the scope of practice of nurse anesthetists; or
Provide care for which the nurse anesthetist does not have proper education and experience.
A nurse anesthetist may prescribe drugs under paragraph (1) of this subsection:
Only in an amount that does not exceed a 10–day supply;
Only for an individual with whom the nurse anesthetist has, at the time of prescription, established a client or patient record; and
Only in connection with the delivery of anesthesia services.
A nurse anesthetist shall collaborate with an anesthesiologist, a licensed physician, or a dentist in the following manner:
An anesthesiologist, a licensed physician, or a dentist shall be physically available to the nurse anesthetist for consultation at all times during the administration of, and recovery from, anesthesia;
An anesthesiologist shall be available for consultation to the nurse anesthetist for other aspects of the practice of nurse anesthesia; and
If an anesthesiologist is not available, a licensed physician or dentist shall be available to provide this type of consultation.
The nurse anesthetist shall ensure that a qualified anesthesia provider:
Performs a thorough and complete preanesthetic assessment;
Obtains informed consent for the planned anesthetic intervention from the patient or an individual responsible for the patient; and
Formulates a patient–specific plan for anesthesia care.
The nurse anesthetist as part of the standards of practice shall:
Implement and adjust an anesthesia care plan as needed to adapt to the patient’s response to the anesthesia;
Monitor a patient’s physiologic condition for untoward identifiable reactions and initiate appropriate corrective actions as required;
Enter prompt, complete, and accurate documentation of pertinent information on a patient’s record;
Transfer responsibility for care of a patient to other qualified providers in a manner that ensures continuity of care and patient safety;
Ensure that appropriate safety precautions are taken to minimize the risks of fire, explosion, electrical shock, and equipment malfunction;
Maintain appropriate infection control standards;
Evaluate anesthesia care to ensure its quality;
Maintain continual competence in anesthesia practice; and
Respect and maintain the basic rights of patients.
This section may not be construed to require a written collaboration agreement between a nurse anesthetist and an anesthesiologist, a physician, or a dentist.
In this section the following words have the meanings indicated.
“Clinical nurse specialist” means an individual who:
Is licensed by the Board to practice registered nursing; or
Has a multistate licensure privilege to practice registered nursing under the Nurse Licensure Compact; and
Is certified by the Board to practice as a clinical nurse specialist.
“Practice as a clinical nurse specialist” means to:
Provide direct care to patients with complex needs;
Act as a consultant to another health care provider as needed;
Conduct health–related research; and
Provide education and guidance for staff nurses.
“Practice as a clinical nurse specialist” includes:
Ordering, performing, and interpreting laboratory tests;
Ordering diagnostic tests and using the findings or results in the care of patients;
Prescribing drugs and durable medical equipment under regulations adopted by the Board;
Ordering home health and hospice care; and
Initiating, monitoring, and altering appropriate therapies or treatments.
Practice as a clinical nurse specialist is governed by rules and regulations that are adopted under § 8–205 of this title and that concern additional acts in the practice of registered nursing.
Each advanced practice registered nurse practicing as an advanced practice registered nurse in the State shall notify a patient in writing if:
The advanced practice registered nurse does not maintain professional liability insurance coverage; or
The advanced practice registered nurse’s professional liability insurance coverage has lapsed for any period of time and has not been renewed.
The written notification provided to the patient under subsection (a) of this section shall be:
Provided:
At the first visit by the patient during any period in which the advanced practice registered nurse does not maintain professional liability insurance, unless the visit is for the purpose of receiving incidental medical care that will be rendered free of charge; and
As part of each informed consent obtained before any procedure or operation discussed or offered for the patient’s consideration is performed;
Signed by the patient at the time of the patient’s visit or at the time the informed consent is signed; and
Retained by the advanced practice registered nurse as part of the advanced practice registered nurse’s patient records.
Each advanced practice registered nurse practicing as an advanced practice registered nurse in the State who does not maintain professional liability insurance coverage shall post this information in a conspicuous location in the advanced practice registered nurse’s place of practice.