Title 10 — Subtitle 39. Board of Nursing — Certificate Holders

Is practicing under the direct supervision of qualified faculty or preceptors; or

Successfully completed the portion of the approved nursing education program that the Board determines meets the requirements of an approved nursing assistant training program as described in Regulation .05D of this chapter;

While a student enrolled in an approved nursing assistant training program or approved acute care nursing assistant training program; and

While practicing under the direct supervision of qualified faculty or preceptors;

“Acute care nursing assistant training program” means a course of training that meets the acute care nursing assistant training program curriculum approved by the Board.

“Board” means the Maryland Board of Nursing.

“Central Repository” means the Maryland Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services.

“Certificate” means a certificate issued by the Board to practice as a certified nursing assistant in the State.

Certified Nursing Assistant (CNA).

Certified Nursing Assistant-I (CNA-I).

“Certified nursing assistant-II (CNA-II)” means a CNA who:

“Criminal history records check (CHRC)” means the performance of both a State criminal history records check by the Central Repository and a national criminal history records check performed by the Federal Bureau of Investigation (FBI).

“Criminal history record information” means information provided by the criminal history records check regarding an applicant’s criminal arrests, charges, and convictions and other dispositions of criminal charges.

“Good standing” means without an encumbrance that limits or restricts practice, such as revocation, suspension, or probation.

“Nursing assistant competency evaluation” means an examination approved by the Board that:

“Nursing assistant training program” means a course of training approved by the Board that meets the requirements under federal and State law.

“Service member” has the meaning stated in State Government Article, §9-901, Annotated Code of Maryland.

“Temporary nurse aide” means an individual who practiced as a geriatric nursing assistant without certification during the national Coronavirus Disease 2019 (COVID-19) Public Health Emergency, as declared on January 31, 2020, and periodically continued by the United States Secretary of Health and Human Services, pursuant to the waiver of the requirements of 42 CFR §483.35(d) issued by the Centers for Medicare and Medicaid Services on March 6, 2020.

“Technical task” means a routine clinical act or task that does not require clinical judgment and is performed with the supervision as specified in COMAR 10.69.02.

“Temporary nurse aide training” means an 8-hour online training and examination program offered by:

Initial certification fee — $20;

Endorsement fee — $20;

Renewal fee — $40;

Verification of certification to another jurisdiction — $25;

Returned check fee — $25;

Duplicate certificate fee — $10.

A completed application to the Board on the form that the Board requires;

To a CHRC in accordance with Health Occupations Article, §8-303, Annotated Code of Maryland;

Written evidence satisfactory to the Board that the applicant has submitted to a CHRC as required by §A(2) of this regulation by submitting:

Any documentation requested from the applicant by the Board including, but not limited to, official certified or true test court documents and a signed, dated explanation written by the applicant, regarding the facts and circumstances, outcome, and current status of any criminal history record information received by the Board:

Any additional documentation requested by the Board if the documentation received from the applicant under §A(4) of this regulation is incomplete or insufficient.

Completed:

Passed a nursing assistant competency evaluation.

Hold a certificate to practice as a nursing assistant that:

Have successfully completed a nursing assistant training program that meets the standards for an approved nursing assistant training program set by the Board.

Committed any act or omission that would be grounds for discipline or denial of certification under Health Occupations Article, §8-6A-10, Annotated Code of Maryland; or

A record of abuse, negligence, or misappropriation of a client's property or any disciplinary action taken or pending in any other state or territory of the United States against the certification of the CNA.

To meet the requirements of a nursing assistant training program set by the Board, a portion of a nursing education program must include courses with content that primarily focuses on:

If a portion of a nursing education program does not include courses with content that primarily focuses on the subject matters set forth in § D(1) of this regulation, the Board may review and approve other equivalent subject matters as meeting the requirements of a nursing assistant training program set by the Board.

A temporary nurse aide applying for certification as a CNA-1 shall be deemed to have completed a nursing assistant training program approved by the Board if the temporary nurse aide:

A temporary nurse aide whose on-the-job training did not meet all of the requirements under 42 CFR 483.152(a) and 42 CFR 483.152(b)(2)—(7) may receive supplemental training in those requirements and be deemed to meet the requirement of §F(1)(b)(i) of this regulation.

An applicant for initial certification shall:

Verification Requirements.

A program coordinator or faculty of a nursing assistant or acute care nursing assistant training program:

An applicant shall submit an application for initial certification after 24 months of the date of completion of an approved nursing assistant training program, an approved acute care nursing assistant training program, or portion of an approved nursing education program.

If an applicant fails to meet §A(4) of this regulation, an applicant still seeking certification shall take or re-take an approved nursing assistant training program or approved acute care nursing assistant training program and comply with §A(4) of this regulation.

Comply with all of the requirements under Regulation .04A of this chapter;

Pay the required fee to the Board; and

Submit the following verifications directly to the Board from the appropriate authority:

Committed any act or omission that would be grounds for discipline or denial of certification; and

A record of abuse, neglect, or misappropriation of a client’s property or any disciplinary action taken or pending in any state or territory of the United States against the certification of the applicant.

Submit an application to the Board on the form required by the Board; and

Comply with §§A(1)(c) and A(3)—(5) of this regulation.

Comply with §A of this regulation; and

Ensure that the administrator, director of nursing, or human resources representative of the applicant’s employer submits to the Board an attestation, on the form required by the Board, that:

Meets the education requirements set forth in Regulation .05A(1) of this chapter; or

Must retake a nursing assistant competency evaluation in order to renew or reinstate a certification in accordance with Regulation .10C(2)(a) of this chapter.

An individual who fails to obtain a passing score on the first examination may retake a nursing assistant competency evaluation three additional times.

An individual shall wait at least 45 calendar days from the date of the prior evaluation before retaking a nursing assistant competency evaluation.

An individual who fails to obtain a passing score after taking a nursing assistant competency evaluation four times must complete a new approved nursing assistant training program or approved acute care nursing assistant training program before retaking a nursing assistant competency evaluation.

Has met the appropriate certification requirements to the satisfaction of the Board;

Does not have a criminal record; and

Has not been the subject of a health professional disciplinary action in this State or another jurisdiction.

Received and reviewed the criminal history record information of the applicant; and

Approved the application.

Unless renewed for an additional two-year term, and except as otherwise provided in §A(2) of this regulation, a certificate expires in accordance with the following schedule:

A certificate shall not expire within 180 calendar days of the date of issuance.

At least 3 months before a certificate expires, the Board shall send the certificate holder a renewal notice by either:

The renewal notice shall provide:

It is the responsibility of the certificate holder to:

Failure of a certificate holder to receive the renewal notice sent by the Board does not relieve the certificate holder of the responsibility to renew a certificate before it expires.

The Board shall renew a certificate if the individual applying for renewal:

If the individual applying for renewal does not have 16 hours of active employment as a nursing assistant within the 2-year period immediately preceding the date of expiration the individual shall:

In 2025 — all applicants with an August or September birth month;

In 2026 — all applicants with a September or October birth month;

In 2027 — all applicants with an October or November birth month;

In 2028 — all applicants with a November or December birth month;

In 2029 — all applicants with a December or January birth month;

In 2030 — all applicants with a January or February birth month;

In 2031 — all applicants with a February or March birth month;

In 2032 — all applicants with a March or April birth month;

In 2033 — all applicants with an April or May birth month;

In 2034 — all applicants with a May or June birth month;

In 2035 — all applicants with a June or July birth month; and

In 2036 — all applicants with a July or August birth month.

“Acute care nursing assistant training program” means a course of training that meets the acute care nursing assistant training program curriculum approved by the Board.

“Board” means the Maryland Board of Nursing.

“Certified Nursing Assistant (CNA)” has the meaning stated in COMAR 10.39.01.02B.

Certified Nursing Assistant-I (CNA-I).

“Classroom laboratory training” means instruction and demonstration, on an individual or a mannequin, of patient care skills by an instructor and return demonstration of competence in these skills by the student.

“Clinical facility” means a setting where clients are physically present and that provides facilities for supervised clinical training.

“Direct supervision” means that the registered nurse or licensed practical nurse is physically present while the student demonstrates patient care skills.

“Distance education” means a formal education process in which the delivery of instruction occurs through the use of telecommunication technologies because the students and instructors are in different places.

“Hybrid training program” means a nursing assistant training program that provides:

“Licensed Practical Nurse (LPN)” means an individual who:

“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.

“Nursing assistant competency evaluation” means an examination approved by the Board that:

“Nursing assistant training program” means a course of training approved by the Board that meets the requirements under federal and State law.

“Program completion” means that the student:

“Program provider” means an individual, organization, facility, or educational institution that conducts a nursing assistant training program or an acute care nursing assistant training program.

“Registered nurse (RN)” means an individual who:

“Supervised clinical training” means training in person at a clinical facility in which the student demonstrates knowledge and skills while performing tasks on a client under the supervision of an RN or an LPN.

“Traditional program” means a training program that provides on-site didactic instruction, classroom laboratory training, and supervised clinical training.

“Training program” means a nursing assistant training program or an acute care nursing assistant training program.

“Unencumbered” means without limitation or restriction on practice, such as revocation, suspension, or probation.

“Written agreement” means a contract between a program provider and a clinical facility outlining the terms required, by both the program and the facility, for supervised clinical training of students.

All training programs shall be approved by:

Public High School Training Programs. If the training program is offered by a public high school, the training program shall be approved by the State Board of Education.

The approval process shall be completed before the training program is offered.

Submit a complete application on the form required by the Board;

Demonstrate that the training program meets all of the applicable requirements in this chapter; and

Provide any additional information requested by the Board during the Board’s review of the application.

Following receipt of a complete application, the Board’s professional staff may conduct a survey visit and submit a survey visit report to the Board.

The Board shall:

A training program shall obtain approval from the Board before making any substantial changes to the program.

Substantial changes include:

A training program shall submit to the Board an annual report, on the form required by the Board, that includes statistics on enrollments, program completions, attrition rates, and nursing assistant competency evaluation results.

A training program shall maintain an average pass rate of 90 percent of the average pass rate for all states using the applicable Board-approved vendors for the nursing assistant competency evaluation.

The Board shall annually review the performance of graduates from each training program on the nursing assistant competency evaluation.

Each course instructor and program coordinator shall have:

Long-Term Care Facility Experience Requirements. Either the program coordinator or all course instructors shall have at least 1 year of experience in the provision of long-term care facility services, which may include:

Course instructors in training programs in public secondary schools in the State shall also meet the requirements set forth in COMAR 13A.12.02.02.

The course instructor is responsible for:

Each training program shall have a program coordinator who:

Except as provided in §C(3) of this regulation, the program coordinator may also be a course instructor.

In a facility-based program, the facility’s director of nursing may be the program coordinator but may not perform any actual training.

Other health professional personnel may supplement the course instructor, including, but not limited to:

Supplemental personnel shall have at least 1 year of experience in their respective field.

A registered nurse functioning as supplemental personnel shall:

A licensed practical nurse functioning as supplemental personnel shall:

Other supplemental personnel providing instruction shall provide instruction under the supervision of the course instructo.

Shall be approved by the Board;

Shall be approved or accredited by the appropriate agency;

May not be on conditional or provisional approval status; and

May not meet any of the factors set forth in 42 CFR §483.151(b)(2)—(3).

Adequate space for privacy of faculty-student conferences; and

Space for equipment and instructional materials.

All instructional learning resources and materials shall:

Laboratory Equipment.

Clinical facilities shall:

There shall be a minimum of 1 course instructor for each 8 students in the clinical area.

Written Agreements.

A training program shall provide a minimum of 100 hours of instruction.

Of the 100 hours, a minimum of:

A training program shall have at least 16 of the 40 hours of supervised clinical training in the provision of long-term care facility services or caring for the elderly or chronically ill of any age, which shall be performed under direct supervision.

The curriculum for a training program shall include the subject matters and skills listed in 42 CFR §483.152(b).

The curriculum for an acute care nursing assistant training program shall include:

The pre-clinical curriculum of a training program shall include the following topics:

A training program shall provide instruction in the pre-clinical curriculum before a student has any direct contact with a client.

Each training program shall provide laboratory instruction in and require students to demonstrate clinical competence in performing skills consistent with the subjects under §B of this regulation.

A training program shall ensure that students may not perform any services during their clinical learning experience for which they have not trained and been found proficient by the course instructor.

Complete the required minimum hours provided in Regulation .06A of this chapter;

Demonstrate the ability to perform nursing functions with clients of any age and with various levels of physical, sensory, cognitive, and emotional ability;

Achieve a passing score of at least 75 percent on the written final examination; and

Demonstrate competence in meeting the objectives and performance indicators during didactic, laboratory, and clinical instruction.

A certificate of completion using the form required by the Board; and

Registration information for a nursing assistant competency evaluation.

May sign a student’s application for certification as a nursing assistant before graduation; and

Shall submit to the Board written verification, as required by the Board, of each student’s program completion within 5 business days of program completion.

A complete application on the form required by the Board; and

All accompanying documentation required by the application or requested by the Board.

Renew approval of a training program for another 2-year term if the training program meets the applicable requirements of this chapter; or

Initiate withdrawal of approval proceedings in accordance with Regulation .09 of this chapter if the training program fails to meet the applicable requirements of this chapter.

Shall be listed on nonrenewed status in the Board’s records; and

May not enroll any new students to the program following the expiration of approval.

If the Board determines that there is a basis for withdrawal of approval under §C of this regulation, the Board shall issue a written notice of deficiencies to the training program.

The notice of deficiencies shall notify the training program of the:

A training program shall submit a written plan of correction after 30 calendar days of the date of the notice of deficiencies unless granted an extension by the Board for good cause.

The written plan of correction shall:

The Board shall review the plan of correction and may approve or modify the dates of completion for correcting deficiencies.

The training program shall correct the deficiencies within the time frame approved by the Board.

Fails to comply with any of the applicable requirements of this chapter;

Fails to correct deficiencies within the time frame approved by the Board;

Enrolls new students after expiration of approval; or

Has a graduate pass rate of less than 90 percent of the pass rate for all states using the applicable Board-approved vendors for a nursing assistant competency evaluation.

Before withdrawing approval of a training program under §C of this regulation, the Board shall:

The notice of intent to withdraw approval and hearing shall comply with the Administrative Procedure Act.

Notify the Board in writing of:

Continue the program until the committed class schedule of currently enrolled students is completed.

If the training program provider is a facility or educational institution that will continue to function, the facility or educational institution shall assume responsibility for the student and graduate records of the closed training program.

Except as provided in §B(1) of this regulation, a training program provider that is required to obtain approval from the Maryland Higher Education Commission (MHEC) shall file student and graduate records, or legible copies of those records, with MHEC in accordance with Education Article, §11-401, Annotated Code of Maryland.

A training program provider that is not required to obtain MHEC approval shall reach a mutual agreement with the Board about the disposition of student records.

Comply with the requirements set forth in Regulation .02 of this chapter;

Be approved by the Board as a traditional training program for at least 2 years before the program applies for initial approval as a hybrid training program; and

Comply with all requirements set forth under this chapter and be in good standing with the Board at the time that the program applies for initial approval as a hybrid training program.

A training program seeking initial approval as a hybrid training program shall apply for approval on a form required by the Board.

To be eligible for Board approval, a hybrid training program shall:

“Board” means the Maryland Board of Nursing.

“Certificate” means a certificate issued by the Board to practice as a nursing assistant in this State.

“Certified medicine aide (CMA)” means an individual certified in good standing as an active CNA who:

Certified Nursing Assistant (CNA).

Certified Nursing Assistant-I (CNA-I).

“Certified nursing assistant-II (CNA-II)” means a CNA who:

“Controlled schedule drugs” means drugs listed as Schedule I, II, III, IV, or V controlled dangerous substances under Criminal Law Article, §§5-402 — 5-406, Annotated Code of Maryland.

“Licensed practical nurse (LPN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland.

“Registered nurse (RN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland.

Current certification by the Board as an active CNA-1 in good standing;

Current employment and work experience as required by the Board in a setting acceptable to the Board, including:

Successful completion as evidenced by a certificate of completion from a Board-approved CMA training program.

Successfully complete a Board-approved 8-hour medicine aide continuing education program as required by Regulation .03B of this chapter; and

Provide satisfactory evidence of completion of 100 hours of practice as a certified medicine aide in the 2-year period preceding the date of renewal.

Requires a candidate for admission to the program have current employment and work experience as set forth in Regulation .02A(2) of this chapter;

Requires before admission that a candidate have a positive recommendation from the director of nursing in the facility where the candidate is employed;

Is at least 60 hours in length with a minimum of 30 clock hours devoted to theoretical instruction and a minimum of 30 clock hours of supervised clinical training experience in a facility licensed under COMAR 10.07.02;

Includes instruction in both theory and clinical regarding all approved routes of medication administration and the scope of responsibility of the CMA; and

Includes each of the following subjects:

A 3-hour core content that includes:

3 hours on at least three of the following topics:

2 hours of assessment testing administered at the completion of the continuing education course.

The licensed nursing supervision requirements in Regulation .05 of this chapter have been met;

The CMA is assigned to administer medication;

There is a written medication order;

The CMA is physically present on a continuing basis in the unit of care to accomplish the following as instructed and directed by the RN or LPN:

Prepare, administer, and chart medications administered:

Prepare, administer, and chart:

When the licensed nurse delegating medication administration provides access to the controlled schedule drug cabinet, sign for and administer controlled schedule drugs.

Chronic;

Stable;

Uncomplicated; and

Permitting placement in the community.

Injection;

Intravenous route; and

By way of a tube inserted in a cavity of the body, including nasogastric or gastrostomy tube feeding;

“Board” means the Maryland Board of Nursing.

“Certificate” means a certificate issued by the Board to practice as a certified medication technician in this State.

Certified Nursing Assistant (CNA).

“Clinical refresher course” means a course of study approved by the Board to maintain the medication technician's knowledge and skill to administer medication.

“Licensed practical nurse (LPN)” means an individual who:

“Medication technician (MT)” means an individual who:

“Medication technician training program” means a course of training approved by the Board that meets the basic MT core curriculum and content training specific to the setting in which the MT will work.

“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.

“Registered nurse (RN)” means an individual who:

Initial certification fee . . . $20;

Renewal fee . . . $30;

Returned check fee . . . $25; and

Duplicate certification fee . . . $10.

Be 18 years old or older; and

Submit to the Board:

Be of good moral character.

Committed any act or omission that would be grounds for discipline or denial of certification under this subtitle; or

A record of abuse, negligence, misappropriation of a resident's property, or any disciplinary action taken or pending in any state or territory of the United States against any certificate or license issued to the applicant.

Any documentation requested from the applicant by the Board including, but not limited to, official certified or true test court documents and a signed, dated explanation written by the applicant, regarding the facts and circumstances, outcome, and current status of any criminal history record information received by the Board:

Any additional documentation requested by the Board if the documentation received from the applicant under §D(1) of this section is incomplete or insufficient.

First-class mail to the last known address of the certificate holder; or

Electronic means to the last known electronic address of the certificate holder.

Satisfactory completion of a Board-approved clinical refresher course; and

Completion of 100 hours of practice as a certified medicine technician within the 2-year period preceding the date of renewal.

Shall utilize the Board-approved uniform curriculum, including the math and English proficiency examinations, to teach the MT training program;

Shall contain 20 hours of curriculum content, including 4 hours of content addressing common disease processes and high-risk medications specific to the client population of the practice setting in which the enrolled student will practice upon certification;

May not have classes exceeding 6 classroom clock hours at one time;

Shall have at least one instructor per 15 students; and

Shall submit verification of the applicant's successful completion of the MT course on a form required by the Board within 5 business days.

Is licensed by the Board to practice registered nursing or has a multistate licensure privilege to practice registered nursing; and

Has completed a course of instruction approved by the Board designed to instruct the RN on how to teach the MT training program for the specific practice setting in which the enrolled students are to work.

Fails to renew a certificate within 30 days after the expiration date; and

Practices as an MT during the period of expiration.

May perform delegated medication administration functions as set forth in COMAR 10.27.11.05G(3) and 10.07.14; and

Shall be supervised by the RN as specified in COMAR 10.27.09, 10.27.11, and 10.07.14.

Medication by metered dose inhalant or nebulizer, and oxygen by nasal cannula or mask;

Medication by gastrostomy tube or rectal tube if the nurse has calculated the dosage;

Oral medication, including:

Medication by subcutaneous injection after the nurse has calculated the dose;

Medication administered by topical route as specified in COMAR 10.27.11.05H(3)(e) and (h);

Medication administered by suppository route; and

Medication drops administered by routes involving eye, ear, or nose.

Calculate any medication dose;

Administer medications by:

Transcribe verbal orders;

Fill medication assistive devices such as mediplanners or time-dose medication containers with medication;

Package or repackage medications that are prescribed, ordered, over-the-counter, or herbal;

Perform certified nursing assistant duties unless certified as a nursing assistant by the Board or otherwise authorized by Health Occupations Article, Title 8, Annotated Code of Maryland;

Provide medication administration teaching; or

Delegate medication administration.

Represent by title of “certified medication technician” or “MT”, by description of services, methods, or procedures or otherwise, that the individual is authorized to practice as a certified medication technician;

Use the words or terms “medication technician”, “MT”, “CMT”, or any other abbreviation, title, symbol, sign, card, device, or other representation, with the intent to represent that the person practices as a certified medication technician; or

Practice, attempt to practice, or offer to practice as a certified medication technician.

“Assessment” means a comprehensive, dynamic process by which the registered nurse collects and analyzes data through interaction with:

“Certified nursing assistant (CNA)” means an individual certified by the Board to practice as a nursing assistant.

“Delegate” means the nurse:

“Health care team” means a group of individuals that includes licensed health care providers, CNAs, and unlicensed personnel working in collaboration with the client, family, and friends to achieve identified outcomes.

“Health status data” means and includes, but is not limited to:

“Nurse” means a licensed registered nurse (RN) or a licensed practical nurse (LPN).

“Nursing plan of care” means an established set of goals, priorities, and methods designed to solve, prevent, and manage a client’s identified problems.

“Outcome” means a measurable, expected, client-focused goal which is observable by the client’s behavior or status.

A CNA:

In a team relationship with a registered nurse, and under the instruction, direction, and supervision of a nurse, the CNA shall:

Adhere to local, State, and federal guidelines and regulations regarding client confidentiality and privacy rights; and

Direct all client requests for information to a nurse.

Advocate for the client by reporting to the nurse statements expressed by the client or family regarding:

Collaborate with other health care team members by reporting information and data regarding the client in a timely, truthful, and complete manner.

Reinforce the nurse’s health teaching:

Report the client’s response to the teaching; and

Report any request by the client for additional information.

Comply with all policies and procedures of the:

Comply with all local, State, and federal guidelines and regulations governing nursing assistant practice;

Perform competently all activities as assigned or delegated;

Report to the nurse;

Provide the client with a safe therapeutic environment;

Recognize the CNA’s individual limits of knowledge and experience;

As needed, request assistance, direction, and supervision from the nurse;

Recognize the CNA’s responsibility and accountability to perform functions safely and competently;

Comply with the CNA code of ethics in accordance with COMAR 10.39.07;

Report all errors, omissions, or incidents which may have occurred during the CNA’s own practice or the practice of others; and

Follow the basic principle of nursing practice: “First, do no harm to the client”.

“Accountability” means being answerable for actions of self or others.

“Board” means the Maryland Board of Nursing.

“Central Repository” means the Maryland Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services.

“Certificate” means a certificate issued by the Board to practice as a certified dialysis technician in this State.

Certified Dialysis Technician (CDT).

“Certified nursing assistant (CNA)” means an individual certified by the Board as a nursing assistant in accordance with COMAR 10.39.01.

“Clinical facility” means a setting where patients are present and that provides facilities for supervised clinical training.

“Criminal history records check (CHRC)” means the performance of both a State criminal history records check by the Central Repository and a national criminal history records check performed by the Federal Bureau of Investigation.

“Criminal history record information” means information provided by the criminal history records check regarding an applicant’s criminal arrests, charges, convictions, and other dispositions of criminal charges.

“Delegation” means the act of authorizing a certified dialysis technician to perform acts of registered nursing or licensed practical nursing.

“Direct supervision” means the individual is on site, physically present, accessible in the immediate patient care area, and available to intervene if necessary.

“Evaluation” means the review and analysis of the extent to which the assessment, nursing diagnosis, planning, and implementation phases of the nursing process were effective in resolving the patient’s identified problems.

“Family” means related family members, foster parents, domestic partners, and legal guardians.

“Good standing” means without an encumbrance that limits or restricts practice, such as revocation, suspension, or probation.

“Licensed practical nurse (LPN)” means an individual who:

Licensed Practitioner.

Model of Nursing Practice.

“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.

“National certification” means certification as a:

“Nurse” means a registered nurse or licensed practical nurse.

“Patient” means the recipient of nursing care.

“Practice as a certified dialysis technician” means to provide, under the supervision of a registered nurse or licensed practical nurse, direct care to patients undergoing renal dialysis treatments.

“Program completion” means that the student:

“Qualified faculty” means an instructor or instructors as described in Regulation .10A of this chapter.

“Readily available” means:

“Registered nurse (RN)” means an individual who:

“Routine care” means those activities necessary on a daily basis for the patient to gain or maintain a level of functioning.

“Structured setting” means a dialysis facility, hospital, nursing home, long-term care facility, ambulatory care setting, or any other acute care, chronic care, or correctional facility that has a location in which dialysis care is provided.

“Supervised clinical training” means training in person in a clinical facility during which the student demonstrates knowledge and skills while performing tasks on a patient under the direct supervision of an RN.

“Supervision” means the process of critical watching, directing, and evaluating another's performance.

“Unlicensed individual” means an individual who is not licensed or certified to provide nursing care in accordance with Health Occupations Article, Title 8, Annotated Code of Maryland.

“Written agreement” means a contract between a training program and a clinical facility outlining the terms required, by both the program and the facility, for supervised clinical training of students.

A completed application to the Board on the form required by the Board;

To a CHRC in accordance with Health Occupations Article, §8-303, Annotated Code of Maryland;

Written evidence satisfactory to the Board that the applicant has submitted to a CHRC as required by §A(2) of this regulation by submitting:

Any documentation requested from the applicant by the Board including, but not limited to, official certified or true test court documents and a signed, dated explanation written by the applicant, regarding the facts and circumstances, outcome, and current status of any criminal history record information received by the Board:

Any additional documentation requested by the Board if the documentation received from the applicant under §A(4) of this regulation is incomplete or insufficient.

Hold a certificate to practice as a dialysis technician that:

Have successfully completed a dialysis technician training program that meets the standards for an approved dialysis technician training program set by the Board.

Except as otherwise provided in this chapter, an applicant for initial certification as a dialysis technician shall:

An applicant shall submit an application for initial certification within 24 months of the date of completion of an approved dialysis technician training program.

If an applicant fails to comply with §A(2) of this regulation, an applicant still seeking certification shall re-take an approved dialysis technician training program and comply with §A(1) of this regulation.

Comply with all of the requirements under Regulation .03 of this chapter;

Pay the required fee to the Board; and

Submit the following verifications directly to the Board from the appropriate authority:

Has met the appropriate certification requirements to the satisfaction of the Board;

Does not have a criminal record; and

Has not been the subject of a health professional disciplinary action in this State or another jurisdiction.

Received and reviewed the criminal history record information of the applicant; and

Approved the application.

On or after the effective date of this regulation, the Board shall issue an initial dialysis technician certificate to all individuals then-certified as a CNA-DT.

The status of an initial dialysis technician certificate issued pursuant to §C(1) of this regulation shall be the same as the status of the individual’s CNA-DT certificate.

The certificate of a certificate holder with an odd-numbered birth year expires on the 28th day of the certificate holder’s birth month in an odd-numbered year; and

The certificate of a certificate holder with an even-numbered birth year expires on the 28th day of the certificate holder’s birth month in an even-numbered year.

It is the responsibility of the certificate holder to:

Failure of a certificate holder to receive the renewal notice sent by the Board does not relieve the certificate holder of the responsibility to renew a certificate before it expires.

The Board shall renew a certificate if the certificate holder:

If a renewal applicant cannot meet the requirements of §D(1)(d)(i)—(ii) of this regulation, the applicant shall re-take a Board-approved dialysis technician training program.

If a renewal applicant is not yet eligible for a national certification before the first renewal, the applicant:

A dialysis technician shall not practice on an expired national certification.

The dialysis technician shall submit a record of a renewed national certification to the Board if the national certification expires before renewal.

The Board may review and approve continuing education courses that provide didactic instruction in the principles and applications of dialysis.

The Board shall approve a course, seminar, or speaker session as a continuing education course if it is:

Course Review Requests.

In 2025 — all applicants with an August or September birth month;

In 2026 — all applicants with a September or October birth month;

In 2027 — all applicants with an October or November birth month;

In 2028 — all applicants with a November or December birth month;

In 2029 — all applicants with a December or January birth month;

In 2030 — all applicants with a January or February birth month;

In 2031 — all applicants with a February or March birth month;

In 2032 — all applicants with a March or April birth month;

In 2033 — all applicants with an April or May birth month;

In 2034 — all applicants with a May or June birth month;

In 2035 — all applicants with a June or July birth month; and

In 2036 — all applicants with a July or August birth month.

Before a training program is offered, the dialysis technician training program shall be approved by the Board.

Board approval of a dialysis technician training program is valid for 2 years.

At least 90 days before the proposed start date of the program, a program provider seeking initial approval of a dialysis technician training program shall:

Board Action.

Board Approval of Substantial Program Changes.

An approved training program shall submit to the Board an annual report, on the form required by the Board, that includes:

The Board may make survey visits from time to time, without prior notice, to all approved dialysis technician training programs.

Expiration. Unless renewed, Board approval of a training program expires 2 years from the last date of approval.

Renewal application. At least 90 days before the date of expiration of approval, an approved training program applying for renewal shall submit:

Survey visit. Following receipt of a renewal application, the Board’s professional staff may conduct an announced or unannounced on-site survey visit and submit a survey visit report to the Board.

Board Action. The Board shall:

Enrollment. A training program that fails to renew its approval:

Notice of Deficiencies.

Plan of Correction.

Grounds for withdrawal. The Board may withdraw approval of a training program that:

Procedure for Withdrawal.

The training program shall be administered by a registered nurse approved by the Board who meets the following qualifications:

The registered nurse who is responsible for administering the training program may utilize other licensed practitioners to assist in conducting classroom and clinical portions of the program in accordance with the professional’s educational background and applicable scope of practice.

CDT Assistance.

The course instructor is responsible for:

Classroom, laboratory, and clinical facilities shall be approved by the Board.

All instructional learning resources and materials shall:

Clinical Facilities.

A dialysis technician training program shall provide a minimum of 220 hours of instruction, of which a minimum of:

A dialysis training program shall include curriculum content that ensures sufficient preparation for national certification and for safe and effective practice as a dialysis technician.

Didactic instruction shall include the following content:

Clinical instruction shall:

Each training program shall identify the unit objectives and performance indicators for each of the areas in §C(3) of this regulation in its training criteria.

A training program shall provide at least 16 hours of didactic and classroom laboratory training before a trainee’s direct assignment to patient care. This instruction shall include the following topics:

Each training program shall have an objective final written examination that measures achievement of the performance indicators.

To successfully complete the program, each student shall:

The training program shall provide a certificate of completion, using the form required by the Board, to students upon program completion.

An administrator or faculty of a training program:

A certified dialysis technician shall administer only the following medications:

When administering the medications set forth in §A(1) of this regulation, the certified dialysis technician shall:

A certified dialysis technician shall administer the medications authorized under §A(1) of this regulation only if the task has been delegated to the dialysis technician by a registered nurse or licensed practical nurse in accordance with Regulations .11—.13 of this chapter.

The certified dialysis technician shall be under the direct supervision of a registered nurse or licensed practical nurse when administering medications.

A certified dialysis technician shall provide dialysis care only when the performance of the care is delegated to the certified dialysis technician by a registered nurse or licensed practical nurse.

A certified dialysis technician shall demonstrate competence and accountability in all areas of dialysis care in which the technician is engaged, including, but not limited to, the following:

A certified dialysis technician shall timely:

When clarifying the prescribed dialysis care order, the certified dialysis technician shall timely:

A dialysis technician shall timely report to and consult as necessary with other members of the dialysis care team, including, but not limited to, the licensed nurse or physician when a patient refuses to follow the prescribed dialysis care order.

A dialysis technician shall comply with the code of ethics for certificate holders set forth in COMAR 10.39.07.

A dialysis technician shall do the following to promote patient safety:

A dialysis technician shall only work in a structured setting.

Within the area of responsibility of the nurse delegating the act;

Such that, in the judgment of the nurse, it can be properly and safely performed by the certified dialysis technician without jeopardizing patient welfare; and

A task that a reasonable and prudent nurse would find is within the scope of sound nursing judgment.

Make an assessment of the patient's nursing care needs related to the delegated task;

Either instruct the certified dialysis technician in the delegated task or verify the certified dialysis technician's competency to perform the nursing task;

Supervise the performance of the delegated nursing task in accordance with Regulation .13 of this chapter;

Be accountable and responsible for the delegated task;

Evaluate the performance of the delegated nursing task; and

Be responsible for ensuring accurate documentation of outcomes on the medical record.

Identifying those individuals to whom nursing tasks may be delegated;

Reevaluation of the competency of those to whom nursing tasks may be delegated;

Recognizing that the final decision regarding delegation is within the scope of the nurse's professional judgment;

Determining the competency of the nurse to delegate; and

Determining to whom nursing tasks may be delegated, which includes input by nurses employed in the structured setting.

Stability of the condition of the patient;

Training of the individual to whom the nursing task is being delegated;

Nature of the nursing task being delegated;

Orientation of the certified dialysis technician to the specific patient environment;

Ability of the certified dialysis technician to perform the delegated nursing task in a safe and competent manner; and

Reevaluation of the patient's health status.

Be readily available when delegating a nursing task to a certified dialysis technician; and

Provide direct supervision of the certified dialysis technician when the certified dialysis technician is administering medications.

The nursing assessment including, but not limited to, the admission, shift, transfer, or discharge assessment;

Development of the nursing diagnosis;

The establishment of the nursing care goal;

Development of the nursing care plan;

Evaluation of the patient's progress, or lack of progress, toward goal achievement; and

Any nursing task which requires nursing knowledge, judgment, and skill.

The licensed nursing staff of the specific dialysis setting has identified the function as being routinely performed;

The specific treatments are performed at a high frequency necessary to retain competency;

The treatment has an inherently low risk to the patient, as determined by weighing the following factors:

There is a quality assurance mechanism in place to ensure the function is performed safely and patient outcomes meet accepted professional nursing standards, including, but not limited to:

Calculation of any medication dose;

Administration of medications by injection route;

Administration of medications by way of a tube inserted in a cavity of the body; and

Administration of medication by intravenous route.

The administration of medication may be delegated to certified dialysis technicians only in structured settings.

A nurse may delegate the administration of only the medications set forth in Regulation .11A(1) of this chapter to a certified dialysis technician.

Patient education; and

Participation of the patient and significant others in implementation of health goals.

Request for information; and

Response to teaching provided by the nurse or reinforcement provided by the certified dialysis technician.

Abandonment.

“Accepting an assignment” means a certificate holder has arrived on duty and assumed responsibility for client care.

“Board” means the Board of Nursing.

“Certificate holder” means an individual who is certified by the Board as a certified nursing assistant in any category, a certified dialysis technician, or a medication technician.

“Client” means a patient, resident, or recipient of care.

“Electronic devices” means, but is not limited to, any of the following:

“Social media” means any form of electronic communication, including, but not limited to, communication by use of websites for social networking and blogging through which users create online communities to share information, ideas, personal messages, and other content such as videos.

Respect the human dignity and uniqueness of a client and provide services unrestricted by consideration of social or economic status, religious affiliation, personal attributes, or the nature of health problems;

Safeguard a client's right to privacy by maintaining confidentiality of information;

Promptly report a breach of confidentiality or privacy;

Act to safeguard a client and the public if health care and safety are affected by the incompetent, unethical, or illegal practice of any individual;

Assume responsibility and accountability for the individual certificate holder's judgments and actions;

Maintain practice competence;

Inform the Board of unethical conduct by another certificate holder;

Demonstrate honesty and integrity in the performance of tasks, functions, and activities; and

Perform nursing tasks, functions, and activities based on a certificate holder's education and training, and at the direction of the supervising nurse.

Abandon a client or assignment after assuming care for the client or accepting the assignment;

Knowingly participate in or condone dishonesty, fraud, deceit, or misrepresentation;

Engage or participate in an action that violates or diminishes the civil or legal rights of a client;

Assume duties and responsibilities without adequate preparation or maintaining competency; or

Practice if unfit to perform procedures because of physical or mental impairment including, but not limited to, the effects of prescription drugs.

Verbal abuse, including use of racial or ethnic slurs, directed toward a coworker, employer, Board staff member, client, or client’s family member;

Physically abusing, threatening, or intimidating a coworker, employer, Board staff member, client, or client’s family member;

Deceiving, defrauding, or stealing from a coworker, employer, client, or client's family member;

Diverting any medication or providing false or misleading information to an authorized prescriber or a pharmacist to obtain or attempt to obtain any medication;

Knowingly employing another individual to practice or engage in or attempt to practice or engage in an occupation or profession licensed under this title if the employee is not licensed to do so under Health Occupations Article, Title 8, Annotated Code of Maryland;

Obtaining or copying any part of a client's health record;

Using, possessing, supplying, administering, or attempting to use, possess, supply, or administer prescription drugs or controlled dangerous substances without valid medical indication;

Reporting for employment under the influence of alcohol or a controlled dangerous substance or submitting a pre-employment sample that is positive for alcohol or a controlled dangerous substance without having provided evidence of valid prescriptions for all controlled dangerous substances in the sample;

Reporting for employment under the influence of an illicit drug or submitting a pre-employment sample that is positive for an illicit drug;

Using the power, influence, or knowledge obtained during the certificate holder’s relationship with the client for the certificate holder’s personal gratification or benefit;

Performing acts beyond the scope of practice for which the individual is certified, unless acting in accordance with COMAR 10.27.11;

Engaging in unprofessional or immoral conduct;

Misrepresenting or concealing a material fact in obtaining a certificate, renewing a certificate, or reinstating a certificate;

Committing an act of moral turpitude, dishonesty, or corruption when the act directly or indirectly affects the health, welfare, or safety of the citizens of this State, and, if the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action; or

Arranging or permitting another certificate holder or unlicensed person to replace the certificate holder or utilize the certificate holder's certificate to provide care to a client.

Sexual behavior with a client during the performance of a procedure or service for the client, regardless of the setting in which the service is rendered;

Sexual behavior with a client under any pretext of therapeutic intent or benefit;

Solicitation of a sexual relationship, whether consensual or nonconsensual, with a client;

Sexual advances toward, or requesting sexual favors from, a coworker, student, employer, client, or client’s family member;

Discussion of sexual matters while caring for a client;

Taking photographs of a client for a sexual purpose or personal gratification;

Sexual harassment of a coworker, student, employer, client, or client's family member;

Sexual contact with an incompetent or unconscious client;

Intentionally exposing any of the certificate holder's sexual body parts; and

Intentionally exposing any of the client's sexual body parts for a nontherapeutic purpose.

May not make use of electronic devices and social media to transmit or place any client information online; and

Shall adhere to the following principles for the use of social media: