This chapter does not apply to an individual who: Practices a health occupation, other than certified dialysis technician, that the individual is authorized to practice in accordance with Health Occupations Article, Annotated Code of Maryland; Provides for the gratuitous care of friends, domestic partners, or family members; Performs dialysis technician tasks as a student while under the direct supervision of qualified faculty; Performs nursing tasks delegated by a registered nurse or licensed practical nurse so long as the delegated nursing tasks do not become a routine part of the unlicensed or uncertified individual’s job duties; and Is an unlicensed caregiver hired by a cognitively capable adult to assist the individual at their home in treatments of a routine nature and in self-administration of medication. In this chapter, the following terms have the meanings indicated. Terms Defined. “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 dialysis technician” means an individual who is certified by the Board to practice as a dialysis technician. “Certified dialysis technician” does not include a: Medication technician; or Certified nursing assistant. “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: Is licensed by the Board to practice licensed practical nursing; or Has a multistate licensure privilege to practice licensed practical nursing. Licensed Practitioner. “Licensed practitioner” means an individual licensed in the healthcare field. “Licensed practitioner” includes RNs, LPNs, advanced practice registered nurses, physicians, physician’s assistants, physical therapists, and respiratory therapists. Model of Nursing Practice. “Model of nursing practice” means the policies, procedures, and practice guidelines: Established by the facility, which are consistent with this chapter regarding delegation of nursing functions and regulations governing the facility; and That provide direction to nursing staff on the delivery of care to the patient population which the facility serves. “Model of nursing practice” may not supersede a delegating nurse’s prudent judgment regarding: Delegation of a nursing function to a dialysis technician; or A particular delegated nursing function to that individual or individuals. “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B. “National certification” means certification as a: Certified Clinical Hemodialysis Technician issued by the Nephrology Nursing Certification Commission; Clinical Nephrology Technician issued by the National Nephrology Certification Organization; or Certified Hemodialysis Technician issued by the Board of Nephrology Examiners Nursing Technology. “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: Completed and demonstrated competency in the program objectives and performance indicators during the didactic, laboratory, and clinical portions of the training program; and Passed the final written examination. “Qualified faculty” means an instructor or instructors as described in Regulation .10A of this chapter. “Readily available” means: The delegating nurse is physically present on the unit; and The nurse may transfer responsibility for the nursing supervision and delegation to another nurse who then becomes the nurse delegating the nursing functions. “Registered nurse (RN)” means an individual who: Is licensed by the Board to practice registered nursing; or Has a multistate licensure privilege to practice registered nursing. “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. An applicant shall submit: 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: Two sets of fingerprints, as required by the Central Repository and the Federal Bureau of Investigation; and All fees required by the Central Repository and the Federal Bureau of Investigation; 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: Under §A(2) of this regulation; In an answer to a question on the Board's application form; or From any other source; and Any additional documentation requested by the Board if the documentation received from the applicant under §A(4) of this regulation is incomplete or insufficient. If an application is not complete when initially submitted to the Board by the applicant, the applicant shall have no longer than 12 months from the date the application is received by the Board to complete the application and provide all information and documents required in §A of this regulation. If an applicant fails to provide to the Board a complete application and any additional documentation requested by the Board under §A of this regulation within 12 months from the date the application is received by the Board, then the application shall be considered abandoned and may be destroyed. Once an application is deemed abandoned under §C of this regulation, an individual seeking certification as a dialysis technician shall submit a new application on the form required by the Board and meet all the requirements for certification as a dialysis technician and pay the required fees that are in effect at the time of re-application. Initial certification. Except as provided in §D of this regulation, an applicant for initial certification as a dialysis technician shall have successfully completed a dialysis technician training program approved by the Board. Certification by Endorsement. An applicant for certification as a dialysis technician by endorsement shall: Hold a certificate to practice as a dialysis technician that: Was issued by another state or territory of the United States that has certification requirements that are essentially similar to those set forth in Health Occupations Article, §8-6A-05, Annotated Code of Maryland; and Is in good standing; and Have successfully completed a dialysis technician training program that meets the standards for an approved dialysis technician training program set by the Board. A certified dialysis technician shall obtain national dialysis technician certification within 18 months of the date of hire as a certified dialysis technician. An individual certified as a certified nursing assistant with the status of dialysis technician (CNA-DT) shall be deemed to meet the requirements for initial certification as a dialysis technician under §A of this regulation. Initial Certification. Except as otherwise provided in this chapter, an applicant for initial certification as a dialysis technician shall: Comply with all of the requirements under Regulation .03 of this chapter; Pay the required fee to the Board; and Submit to the Board an application that has been signed by the administrator or faculty of the approved dialysis technician training program completed by the applicant. 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. Certification by Endorsement. An applicant for certification as a dialysis technician by endorsement shall: 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: A certificate to practice as a dialysis technician in good standing from another state or territory with certification requirements that are essentially similar to the requirements in this State; and A certificate of completion from a dialysis technician training program in that state or territory that meets the standards for an approved dialysis technician training program set by the Board. The Board may issue a temporary practice certificate to an applicant who: 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. Unless the Board suspends or revokes a temporary practice certificate, the temporary practice certificate expires 90 days after the date of issuance. A temporary practice certificate may be extended up to an additional 90 days if the applicant is awaiting the completion of the criminal history records check. The Board may not issue a certificate to an applicant until the Board has: Received and reviewed the criminal history record information of the applicant; and Approved the application. Unless an applicant is subject to discipline, the Board shall issue a dialysis technician certificate to each applicant who meets all the requirements of this chapter and Health Occupations Article, §§8-6A-05 and 8-6A-06, Annotated Code of Maryland. CNA-DT Certificates. 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. Expiration. Unless renewed for an additional 2-year term, and except as otherwise provided in this regulation, a certificate expires in accordance with the following schedule: 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. Unless an initial certificate is issued pursuant to Regulation .07C of this chapter, an initial dialysis technician certificate shall not expire within 180 days of the date of issuance. Certificate Holder Responsibility. It is the responsibility of the certificate holder to: Be aware of the expiration date of the certificate; and Renew the certificate before it expires. 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. Renewal Requirements. The Board shall renew a certificate if the certificate holder: Is otherwise entitled to be certified; Submits a complete application for renewal on the form required by the Board; Pays the renewal fee to the Board; Provides satisfactory evidence, as required by the Board, of: 16 hours of active practice as a dialysis technician, for monetary compensation, in the last 24 months immediately preceding the date of expiration; Completion of 3 hours of continuing education approved by the Board in the 24 months immediately preceding the date of expiration; and Except as provided in §D(3) of this regulation, an active national certification; and If required to submit to a CHRC in accordance with §G of this regulation, complies with the requirements of Regulation .03A of this chapter. 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: May renew the certificate; and Shall submit evidence of an active national certification at the next renewal. National Certification. 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. Continuing Education Courses. 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: Relevant to the practice of a dialysis technician; and Offered by a: College or university approved by the Maryland Higher Education Commission; State or national professional dialysis association; Board-approved certified dialysis technician program; or Health department or hospital. Course Review Requests. If a course does not meet the requirements under §F(2) of this regulation, a certified dialysis technician may request that the Board approve the course by submitting, in writing, at least 2 months before the course registration date, the following information on an application provided by the Board: Title, location, and date of the course; Course sponsors; Course objectives and contents; Hours of study; Name, qualifications, and curriculum vitae of each presenter; and The specific information that relates to the continuing education course. The Board shall notify the applicant of the Board's decision. A certified dialysis technician shall submit a course to the Board for reapproval if there is a change of subject matter, length, or presenter of a previously approved course. Criminal History Records Checks. CHRCs for renewal applicants shall be scheduled according to the certificate holder’s birth month as follows: 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. Approval. 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. Procedure for Initial Approval. 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: Submit to the Board a complete application on the form required by the Board; Demonstrate that the training program meets all the requirements of this regulation; and Provide any additional information requested by the Board during the Board’s review of the application. Board Action. 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: Approve a training program that meets all the requirements of this regulation; or Deny approval of a training program that does not meet all the requirements of this regulation. Ongoing Responsibilities. Board Approval of Substantial Program Changes. An approved dialysis technician training program shall obtain approval from the Board before making any substantial changes to the program. Substantial program changes include: Changes to faculty; Significant changes to curriculum, including an increase or decrease in program hours and changes to the modality of teaching; and Removal or addition of clinical facilities or classroom locations. An approved training program shall submit to the Board an annual report, on the form required by the Board, that includes: Statistics on enrollments; Program completions; and Attrition rates. The Board may make survey visits from time to time, without prior notice, to all approved dialysis technician training programs. Renewal of Approval. 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: A complete application on the form required by the Board; and All accompanying documentation required by the application or requested by the Board. 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: Renew approval of a training program for another 2-year term if the training program meets the requirements of this regulation; or Initiate withdrawal proceedings in accordance with §E of this regulation if the training program fails to meet the requirements of this regulation. Enrollment. A training program that fails to renew its approval: 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. Withdrawal of Approval. Notice of Deficiencies. If the Board determines that there is a basis for withdrawal of approval under §E(3) 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: Requirements with which the program has not complied; Reasons for the Board’s determination; and Requirement to submit a written plan of correction in accordance with §E(2) of this regulation. Plan of Correction. A training program shall submit a written plan of correction within 30 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: Address all deficiencies noted by the Board; and Include dates of completion for correcting the deficiencies. 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. Grounds for withdrawal. The Board may withdraw approval of a training program that: Fails to comply with any of the requirements of this regulation; Fails to correct deficiencies within the time frame approved by the Board; or Enrolls new students after expiration of approval. Procedure for Withdrawal. Before withdrawing approval of a training program, the Board shall: Notify the program of its intent to withdraw approval; and Give the program an opportunity to request an evidentiary hearing before the Board. The notice of intent to withdraw approval and hearing shall comply with State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. Reinstatement. A dialysis technician training program whose approval was withdrawn may apply for reinstatement of approval by submitting a reinstatement application demonstrating that the program meets all of the requirements of this regulation. Faculty. The training program shall be administered by a registered nurse approved by the Board who meets the following qualifications: An active license to practice as a registered nurse in good standing in the State or a multistate licensure privilege to practice registered nursing in the State; A minimum of 2 years of experience practicing as a registered nurse, of which at least 1 year was in the care of renal patients; and Education or experience in adult education in the form of: Experience as a staff development instructor for a minimum of 1 year; Completion of at least 6 credit hours of an adult education program at a college or university; or Completion of an adult education course approved by the Board. 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. A certified dialysis technician may assist in aspects of supervised clinical training in a clinical facility, under the direct supervision of the registered nurse. A certified dialysis technician assisting in aspects of the training program shall: Hold a Certified Dialysis Technician certificate from the Board; Possess a current national certification; and Have at least 2 years' experience in hemodialysis services. The course instructor is responsible for: Participating in development and evaluation of the training program, including the acquisition of learning resources and instructional materials; Implementing the approved training program; Supervising classroom laboratory experiences; Evaluating student performance during didactic and laboratory training; and Providing direct supervision and clinical evaluation of each student at the clinical facility. Facilities and Resources. Classroom, laboratory, and clinical facilities shall be approved by the Board. All instructional learning resources and materials shall: Be accessible and relevant to the role of a dialysis technician; Be written at a level appropriate for a dialysis technician; and Have a publication date not older than 5 years from the current year. Clinical Facilities. Clinical facilities shall: Have a sufficient number and variety of patients to provide training experiences for all students to achieve the stated course objectives; Have a sufficient number of RNs and other nursing personnel to ensure safe and continuous care of patients; and Conform with accepted standards of nursing care and practice. There shall be a minimum of one course instructor for each eight students in the clinical area. Except for facility-based programs, the training program shall have a written agreement with a clinical facility that shall: Be developed jointly with the clinical facility and the training program; Be reviewed periodically by the clinical facility and the training program; Include a provision for adequate notice of termination; Specify the responsibility of the training program to the clinical facility and the responsibility of the clinical facility to the training program; and Identify the functions and responsibilities of the parties involved. Curriculum. A dialysis technician training program shall provide a minimum of 220 hours of instruction, of which a minimum of: 80 hours shall be devoted to didactic instruction and classroom laboratory training; and 140 hours shall be devoted to supervised clinical training in a clinical facility. 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: Content required under 42 CFR §494.140E(3); A review of the relevant laws and regulations regarding the practice of a dialysis technician and appropriate program policies; Data collection; Environment; Renal anatomy and physiology; Infection control and universal precautions; Basic chemistry of body fluids and electrolytes; Manifestations of renal failure; Blood work and laboratory values related to dialysis; Principles of dialysis; Pharmacology of the drugs commonly used during dialysis; Medication administration techniques specific to the drugs used in dialysis, including lidocaine, heparin, and normal saline; Management of the complications of dialysis and renal failure; The role of the dialysis technician in a dialysis setting including, but not limited to, legal and ethical considerations and concepts of delegation; Water treatment relevant to dialysis; Principles of patient education related to renal failure; Principles of and requirements for documentation; Communication and teamwork skills, including: Observing, recording, and reporting; Interpersonal skills; and Listening; Operation of dialysis delivery systems that includes the machines, dialysate, and dialyzer; Principles of safe effective dialysis care; Principles related to the nutritional considerations for patients receiving dialysis; Psychosocial aspects of renal disease; Principles of dialyzer reprocessing; Principles for initiating, monitoring, and discontinuing dialysis; Principles related to the adequacy of dialysis; and Establishing and maintaining professional boundaries with a patient. Clinical instruction shall: Provide the student with the opportunity to practice the cognitive, psychomotor, and affective skills required for the safe performance of dialysis care by the dialysis technician; Meet the learning needs of each student; Meet the established program objectives or outcomes; and Be provided concurrently with the related classroom theory instruction. 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: The role of the dialysis technician; Infection control; Safety and environment; Data collection; Treatments; and Laboratory procedures. Evaluation. 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: Complete the required minimum hours provided in §C(1) of this regulation; 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. 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: May sign a student’s application for certification as a dialysis technician 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. Medication Administration. A certified dialysis technician shall administer only the following medications: Intradermal lidocaine or another single therapeutically equivalent local anesthetic for the purpose of initiating dialysis treatment; Intravenous heparin or other single therapeutically equivalent anti-coagulant for the purpose of initiating and maintaining dialysis treatment; Intravenous normal saline; and Oxygen, when the administration of the oxygen has been delegated to the certified dialysis technician by a registered nurse. When administering the medications set forth in §A(1) of this regulation, the certified dialysis technician shall: Ensure that the right dose of the right medication is given to the right individual through the right route of administration at the right time; Accurately and timely document the administration of the medication and notify a physician or licensed nurse of the patient’s response to the medication as appropriate; Consult with an appropriate licensed practitioner when the certified dialysis technician believes or has reason to believe that a prescribed medication is inaccurate, not properly authorized, harmful or potentially harmful to a patient, or contraindicated by other documented information; and Take any other action needed to ensure the safety of the patient. 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. Practice Standards. 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: Consistent performance of all aspects of dialysis care according to acceptable standards; and Appropriate recognition, referral, consultation, or intervention when a complication arises in conjunction with dialysis or when a change in patient status occurs. A certified dialysis technician shall timely: Implement the prescribed dialysis care order for a patient unless the technician believes or should have reason to believe that the prescribed order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to the patient, or contraindicated by other documented information; and Clarify any prescribed dialysis care order for a patient when the technician believes or should have reason to believe that the order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to the patient, or contraindicated by other documented information. When clarifying the prescribed dialysis care order, the certified dialysis technician shall timely: Consult with an appropriate licensed practitioner; Notify the delegating nurse when the technician believes that it would not be appropriate to follow the prescribed dialysis care order; Document: That the delegating nurse was notified; The outcome of the consultation with the delegating nurse; and The treatment plan for the patient; and Take any other action needed to ensure the safety of the patient. 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: Display the applicable CDT title or initials at all times when providing dialysis care; Completely, accurately, and timely document and report all patient data obtained while providing dialysis care and the patient’s response to the care; Completely, accurately, and timely document and report to the appropriate practitioner all errors in or deviations from the prescribed dialysis care regimen; Not falsify any patient record or any other documents prepared in the course of or in conjunction with the provision of dialysis care. This includes, but is not limited to, case management documents or reports, time records or reports, and other documents related to billing for dialysis services; and Implement measures to provide a safe environment for the patient. A dialysis technician shall only work in a structured setting. The nurse may delegate the responsibility to perform a dialysis-related nursing task to a certified dialysis technician. The delegating nurse retains the accountability for the dialysis-related nursing task. A dialysis-related nursing task delegated by the nurse shall be: 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. A dialysis-related nursing task delegated by the nurse may not require the certified dialysis technician to exercise nursing judgment or intervention except in an emergency situation. When delegating a dialysis-related nursing task to a certified dialysis technician, the nurse shall: 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. The nurse shall be the primary decision maker when delegating a dialysis-related nursing task to a certified dialysis technician. Nursing judgment shall be exercised within the context of the employer’s model of nursing practice which includes a mechanism for: 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. Except as provided in §B(2) of this regulation, the nurse shall determine the required degree of supervision after an evaluation of appropriate factors including, but not limited to, the: 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. The delegating nurse shall: 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 following nursing functions require nursing knowledge, judgment, and skill and may not be delegated: 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 nurse may delegate treatments of a routine nature if: 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: Type of equipment utilized to perform the function; Nurse staffing ratio that allows for close supervision; Basic educational preparation of the certified dialysis technician performing the delegated function; and Knowledge and skill set of the nurse delegating and supervising the delegated function; and 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: An ongoing formalized documented performance appraisal mechanism designed to ensure that the certified dialysis technician’s revalidation of continued competency is a component of the quality assurance mechanism; and Patient outcomes meeting accepted professional standards, as reflected by: Infection rates; Rates of adverse events; Error rates; and Patient satisfaction surveys. The nurse may delegate the obtaining of specific information to a certified dialysis technician. When implementing the interdisciplinary plan of care, the nurse may delegate a nursing task to a certified dialysis technician when the delegation of that task does not jeopardize the patient's welfare. Administration of medication is a nursing function. As such, the nurse retains full responsibility for medication administration. The following activities related to medication administration may not be delegated except as provided in Regulation .11A(1) of this chapter: 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. Delegation of Medication Administration. 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. The registered nurse shall be accountable and responsible for the development and initiation of the health teaching plan and for health counseling of the patient. The nurse shall be accountable and responsible for facilitating and promoting: Patient education; and Participation of the patient and significant others in implementation of health goals. Certified dialysis technicians given instruction and direction by the nurse may supplement the health teaching by providing standardized information to the patient. The certified dialysis technician is responsible and accountable for reporting information to the nurse regarding the patient's: Request for information; and Response to teaching provided by the nurse or reinforcement provided by the certified dialysis technician. Health Occupations Article, §§ 8-205, 8-303, 8-6A-01 through 8-6A-10, 8-6A-12, 8-6A-14.1, 8-6A-15, 8-701, 8-703, 8-705, and 8-706, Annotated Code of Maryland Effective date: August 4, 2025 (52:15 Md. R. 812) Regulation .08D, F amended effective April 27, 2026 (53:8 Md. R. 356) Regulation .08G adopted effective April 27, 2026 (53:8 Md. R. 356) Regulation .10C, D amended effective April 27, 2026 (53:8 Md. R. 356)