<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.27.01.03" title_num="10" subtitle_num="27" chapter_num="01" heading="Licensure Exceptions.">
  <paragraph num="A.">
    <text>Registered nurses or licensed practical nurses who hold a current active license in any other state or jurisdiction may render nursing care:</text>
    <paragraph num="(1)">
      <text>For not more than 30 days, to an individual who is visiting the State for medical, educational, or personal reasons;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For the purpose of the interstate transport and care of patients traveling to and from Maryland; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>During an emergency situation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A registered nurse or licensed practical nurse who holds a multistate licensure privilege under the Nurse Licensure Compact may practice nursing in this State in accordance with the laws of this State.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Nursing Graduate.</text>
    <paragraph num="(1)">
      <text>A nursing graduate is a graduate of:</text>
      <paragraph num="(a)">
        <text>A Board-approved registered nursing or licensed practical nursing education program; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An out-of-state nursing education program determined to be equivalent by the Board.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A nursing graduate may practice as set forth in §C(5)—(7) of this regulation if:</text>
      <paragraph num="(a)">
        <text>The nursing graduate has an application for a license pending before the Board; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>One of the following circumstances exists:</text>
        <paragraph num="(i)">
          <text>The nursing graduate has not taken the NCLEX examination;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The nursing graduate has taken the NCLEX examination, but the results of the NCLEX examination are not yet known;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The nursing graduate has taken and passed the NCLEX examination but is waiting for the completion of the criminal history records check; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>The nursing graduate has taken and failed the NCLEX examination but has not failed the NCLEX examination more than one time within the 120 day period immediately following the submission of the application to the Board.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A nursing graduate shall cease practice as a nursing graduate:</text>
      <paragraph num="(a)">
        <text>No later than 120 days after the date the nursing graduate submitted an application to the Board; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Immediately if the nursing graduate fails the second NCLEX examination.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>If the nursing graduate fails the NCLEX examination, the nursing graduate may practice as a nursing assistant provided the individual obtains certification as a nursing assistant and practices according to COMAR 10.39.01.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A nursing graduate shall:</text>
      <paragraph num="(a)">
        <text>Practice only under the direct supervision of a registered nurse who is physically present on the unit to:</text>
        <paragraph num="(i)">
          <text>Cosign medication transcription, medication administration, and nursing documentation; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Continually observe, assist, coordinate, evaluate, and monitor the nursing graduate; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Use the initials “NG” after the nursing graduate's name as credentials.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>After successful completion of an organized staff development program which includes an evaluation that the nursing graduate is competent and in compliance with §C(5) of this regulation, the nursing graduate may:</text>
      <paragraph num="(a)">
        <text>Transcribe medication orders if:</text>
        <paragraph num="(i)">
          <text>Written policies and procedures are available on the unit of care; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An organized staff development program which includes skill validation has been successfully completed by the nursing graduate;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>After competency has been validated by the facility:</text>
        <paragraph num="(i)">
          <text>Administer medications and controlled substances; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Sign controlled substances sheets;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Document in the medical record with the abbreviation “NG”;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Perform patient assessments after the initial assessment or after the first assessment of the shift performed by the registered nurse; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Perform and document routine procedures taught within the nursing graduate's generic nursing program, including but not limited to:</text>
        <paragraph num="(i)">
          <text>Placing nasal gastric tubes;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Performing urinary catheterizations;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Applying sterile dressings;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Performing blood sugar checks; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Obtaining specimens.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>A nursing graduate may not:</text>
      <paragraph num="(a)">
        <text>Work without the physical presence of and direct supervision by a registered nurse;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Refer to oneself or practice as a registered nurse (RN) or licensed practical nurse (LPN);</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Be considered a staff person for purposes of a staffing pattern;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Accept charge responsibilities; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Perform initial patient assessment or the first patient assessment of a shift, develop patient plans of care, evaluate or document patient discharge, or independently administer medications or intravenous therapy.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>