# COMAR Title 10 — Maryland Department of Health

## Subtitle 27 — Board of Nursing

### Chapter 28 — Delegation of Acts by an Advanced Practice Registered Nurse

#### Regulation .02 Definitions.

*COMAR 10.27.28.02*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Advanced practice registered nurse (APRN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland.

  (2) “Assistant” means an individual:

    (a) To whom only routine nursing and technical tasks are delegated by an advanced practice registered nurse;

    (b) Who is trained as defined in §B(12) of this regulation; and

    (c) Who is not licensed, certified, registered, or otherwise authorized by law by the Board, or any other State health occupations board, to practice any health occupation in the State.

  (3) “Asynchronous telehealth interaction” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland.

  (4) “Board” means the Maryland Board of Nursing.

  (5) “Delegating APRN” means an advanced practice registered nurse who directs an assistant to perform nursing and technical tasks.

  (6) “Direct supervision” means oversight exercised by a delegating APRN who is:

    (a) Personally treating the patient; and

    (b) In the physical presence of the patient and the assistant.

  (7) Mechanical Act.

    (a) “Mechanical act” means an act which does not require professional judgment, medical or pharmaceutical training, or discretion.

    (b) “Mechanical act” does not include:

      (i) Selecting a drug;

      (ii) Labeling;

      (iii) Measuring or calculating dosages;

      (iv) Substituting one drug for another, including substituting a generic or brand drug for the prescribed drug;

      (v) Substituting one dosage form of a drug for another;

      (vi) Altering the route of administration; or

      (vii) Counseling patients.

  (8) “On-site supervision” means oversight exercised by a delegating APRN who is present at the same site as the assistant and the patient and is:

    (a) Able to be immediately available in person during the assistant’s performance of a delegated act;

    (b) In the context of a synchronous telehealth interaction, able to be immediately available via secure telecommunications technology to the telehealth visit during the assistant’s performance of a delegated act; or

    (c) In the context of an asynchronous telehealth interaction, able to review the assistant’s work and interact with the assistant before communication with the patient.

  (9) “Site” means any facility or location, including those defined in Health-General Article, §§19-114 and 19-3B-01(b), Annotated Code of Maryland, used for the delivery of health care services.

  (10) “Synchronous telehealth interaction” has meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland.

  (11) “Technical task” means a routine clinical act or task that does not require clinical or nursing judgment and is performed with supervision as specified within this chapter.

  (12) “Trained” means possessing the knowledge, skills, and abilities, as determined by the delegating APRN, to perform delegated nursing and technical tasks.