TITLE XXX
OCCUPATIONS AND PROFESSIONS

Chapter 326-B
NURSE PRACTICE ACT

Section 326-B:1

    326-B:1 Purpose. – In order to safeguard the life, health, and public welfare of the people of New Hampshire and in order to protect the people of the state from the unauthorized, unqualified, and improper application of services by individuals in the practice of nursing, it is necessary that a regulatory authority be established and adequately funded. To further this policy, the practice of nursing shall be regulated through the New Hampshire board of nursing, and such board shall have the power to enforce the provisions of this chapter. Licensees under this chapter are accountable to clients, the nursing profession, and the board for complying with the requirements of this act and the quality of nursing care rendered, and for recognizing limits of knowledge and experience and planning for management of situations beyond the licensee's experience.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:2

    326-B:2 Definitions. –
In this chapter:
I. "Advanced practice registered nurse" or "APRN" means a registered nurse currently licensed by the board under RSA 326-B:18.
I-a. "Advanced practice registered nurse-patient relationship" means a medical connection between a licensed APRN and a patient that includes an in-person or face-to-face 2-way real-time interactive communication exam, a history, a diagnosis, a treatment plan appropriate for the licensee's medical specialty, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have an APRN-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by another licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient's first appointment.
II. "Board" means the New Hampshire board of nursing established in RSA 326-B:3.
III. "Continuing competence" means integrated learning by which a licensee gains, maintains, or refines practice knowledge, skills, and abilities. This development may occur through a formal education program, continuing education, and clinical practice, and is expected to continue throughout the practitioners' career.
IV. "Licensed nursing assistant" or "LNA" means an individual who holds a current license to provide client care under the direction of a registered nurse or licensed practical nurse.
V. "Licensed practical nurse" or "LPN" means an individual who holds a current license to practice practical nursing as defined in paragraph IX.
VI. "Medication nursing assistant" means a licensed nursing assistant holding a currently valid certificate authorizing the delegation to the nursing assistant of tasks of medication administration.
VII. "Nursing" means assisting clients or groups of clients to attain or maintain optimal health by implementing a strategy of care to accomplish defined goals and by evaluating responses to nursing care and medical treatment. Nursing includes basic health care that helps both clients and groups of clients cope with difficulties in daily living associated with their actual or potential health or illness status and also those nursing activities that require a substantial amount of scientific knowledge or technical skill.
VII-a. "Nurse" means a person authorized to practice nursing and who holds a current license to provide care as an APRN, RN, or LPN.
VIII. "Nursing-related activities" means client care provided by a licensed nursing assistant directed by an APRN, an RN, or an LPN.
IX. "Practical nursing" means the practice of nursing as defined in paragraph VII by a person who:
(a) Uses sound nursing judgment based on preparation, knowledge, skills, understanding, and past nursing experience.
(b) Works under the direction of a registered nurse, advanced practice registered nurse, dentist, or physician.
(c) Functions as a member of a health care team and contributes to the assessment, planning, implementation, and evaluation of client care.
X. "Registered nurse" or "RN" means an individual who holds a current license to practice registered nursing as defined in paragraph XI.
XI. "Registered nursing" means the application of nursing knowledge, judgment, and skill drawn from broad in-depth education in the biological, psychological, social, and physical sciences in assessing and diagnosing the health status of a client, and in planning, implementing, and evaluating client care which promotes the optimum health, wellness, and independence of the individual, the family, and the community.
XII(a) "Telemedicine" means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment.
(b) An out-of-state APRN providing services by means of telemedicine shall be deemed to be in the practice of medicine and shall be required to be licensed under this chapter.
(c) It shall be unlawful for any person to prescribe by means of telemedicine a controlled drug classified in schedule II through IV.
(d)(1) The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating a patient with whom the prescriber has an in-person practitioner-patient relationship, for purposes of monitoring or follow-up care, or who are treating patients at a state designated community mental health center pursuant to RSA 135-C or at a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified state opioid treatment program, and shall require an initial in-person exam by a practitioner licensed to prescribe the drug. Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition and drug, but not less than annually.
(2) The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a), who are treating patients at a SAMHSA-certified state opioid treatment program. Such prescription authority shall require an initial in-person exam by a practitioner licensed to prescribe the drug and subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and opioid, but not less than annually.
(e) An APRN providing services by means of telemedicine directly to a patient shall:
(1) Use the same standard of care as used in an in-person encounter;
(2) Maintain a medical record; and
(3) Subject to the patient's consent, forward the medical record to the patient's primary care or treating provider, if appropriate.
(f) Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.

Source. 2005, 293:1. 2009, 54:4, 5. 2011, 245:1. 2015, 246:7, 8. 2016, 221:4, eff. Aug. 8, 2016. 2020, 27:15, eff. July 21, 2020.

Section 326-B:3

    326-B:3 Board of Nursing. –
I. The board of nursing shall comprise 11 members to be appointed by the governor with the consent of the council. Any interested individual, association, or entity may make recommendation to the governor. The members of the board shall include 5 registered nurses, one of whom shall be an advanced practice registered nurse, 2 licensed practical nurses, 2 licensed nursing assistants, one of whom shall be a medication licensed nursing assistant if possible, and 2 representative members of the public. The terms of members shall be staggered as determined by the governor and council. All terms shall be for 3 years, and no member of the board shall be appointed to more than 3 consecutive terms.
II. Each RN member shall be a resident of this state, licensed in good standing under the provisions of this chapter, and currently engaged in the practice of nursing as an RN and shall have no fewer than 5 years of experience as an RN, at least 3 of which shall have immediately preceded appointment. RN members of the board shall represent the various areas of nursing practice including education, administration, and clinical practice.
III. The LPN members of the board shall be residents of this state, licensed in good standing under the provisions of this chapter, and currently engaged in the practice of nursing and shall have had no fewer than 5 years of experience as an LPN, at least 3 of which shall have immediately preceded the date of appointment.
IV. The LNA members of the board shall be residents of this state, licensed in good standing under the provisions of this chapter, and currently engaged in nursing-related activities. These members shall have a minimum of 5 years of experience as an LNA, at least 3 of which shall have immediately preceded the date of their appointment.
V. The public members shall be residents of the state of New Hampshire who are not, and never have been, members of the nursing profession or the spouse of any such person. The public members shall not have, and shall never have had, a material financial interest in either the provision of nursing services or an activity directly related to nursing, including the representation of the board or its predecessor or the profession for a fee at any time during the 5 years preceding the date of appointment.
VI. No more than 2 board members shall be associated with a particular agency, corporation, or other enterprise or subsidiary at one time.
VII. [Repealed.]
VIII. An appointee to a full term on the board shall be appointed by the governor with the consent of the council before the expiration of the term of the member being succeeded and shall become a member of the board on the first day following the appointment expiration date of the previous appointee. Appointees to unexpired portions of full terms shall become members of the board on the day following such appointment, and shall serve the unexpired term and then be eligible to serve 3 full 3-year terms.
IX. The governor may remove any member from the board for neglect of any duty under RSA 326-B:4 or for incompetence or unprofessional or dishonorable conduct. Any person may file a complaint against a board member with the office of professional licensure and certification. The provisions of RSA 4:1 controlling the removal of public officials from office shall be followed in dismissing board members.
X. All members of the board and its agents or employees shall enjoy immunity from individual civil liability while acting within the scope of their duties as board members, agents, or employees, as long as they are not acting in a wanton or reckless manner.
XI. Board meetings shall be open to the public. In accordance with RSA 91-A:3, the board may conduct part of a meeting in nonpublic session.

Source. 2005, 293:1. 2009, 54:5. 2015, 276:69, eff. July 1, 2015. 2019, 346:249, eff. July 1, 2019. 2021, 197:95, eff. July 1, 2021.

Section 326-B:4

    326-B:4 Powers and Duties of the Board. –
The board may:
I. Establish reasonable and uniform standards for nursing practice consistent with the criteria identified by the National Council of State Boards of Nursing.
II. Provide consultation regarding nursing practice for institutions and agencies and investigate reports of illegal practice.
III. Examine, license, and renew the licenses of duly qualified individuals. The board shall select an appropriate nationally approved licensing examination.
IV. Gather and report to the public statistical information regarding, but not limited to, the education and licensure of registered and practical nurses.
V. Conduct investigations, hearings, and proceedings concerning alleged violations of this chapter or of rules adopted under this chapter.
VI. Subpoena witnesses, records, and documents, as needed, and administer oaths to those testifying at hearings.
VII. Determine and enforce appropriate disciplinary action against all individuals found guilty of violating this chapter or the rules adopted under this chapter.
VIII. Deny or withdraw approval of nursing educational programs that do not meet the minimum requirements of this chapter.
IX. Maintain records of proceedings as required by the laws of New Hampshire.
X. Conduct conferences, forums, studies, and research on nursing practice and education.
XI. [Repealed.]
XII. [Repealed.]
XIII. Establish and collect fees, under rules adopted by the board under RSA 541-A, relative to applicants seeking any type of license issued by the board under this chapter, including fees for applications for temporary licenses, reinstatement of inactive licenses, licenses by examination, and renewal of licenses, as well as fees for verifying license status, program graduation, or computerized lists, and fees for site visits associated with nursing education programs under RSA 326-B:32.
XIV. In accordance with state due process laws, limit the multistate licensure privilege of any registered nurse or licensed practical nurse to practice in New Hampshire and may take any other actions under applicable state laws necessary to protect the health and safety of New Hampshire citizens. If the board does take such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such action taken by the state of New Hampshire.

Source. 2005, 293:1. 2008, 179:1. 2015, 276:108, VII, eff. July 1, 2015.

Section 326-B:5

    326-B:5 Repealed by 2015, 276:108, VIII, eff. July 1, 2015. –

Section 326-B:6

    326-B:6 Collection and Expenditure of Funds. – The office of professional licensure and certification shall receive and expend funds provided such funds are received and expended for the pursuit of the objectives authorized by this chapter. Fees collected shall be deposited in the office of professional licensure and certification fund. Fines and administrative charges, including those related to RSA 326-B:26, shall be deposited in the general fund.

Source. 2005, 293:1. 2011, 245:2. 2015, 276:70, eff. July 1, 2015. 2018, 330:7, eff. July 1, 2018.

Section 326-B:7

    326-B:7 Repealed by 2011, 245:4, I, eff. July 1, 2011. –

Section 326-B:8

    326-B:8 Fees; Charges. –
I. The board shall charge fees for the issuance, renewal, and reinstatement of all licenses, specialty licenses, and specialty certificates authorized by this chapter.
II. The board may provide the following services and make administrative charges for:
(a) The administration of examinations required by this chapter.
(b) Verification of licensure status.
(c) The sale of lists of licensees who have given their written authorization to have their names included on such lists.
(d) The actual costs of a criminal conviction record check required pursuant RSA 326-B:15.
(e) The actual cost of collection of statistical data provided to private entities.
(f) Site visits associated with nursing education programs under RSA 326-B:32.

Source. 2005, 293:1. 2008, 179:2, eff. Aug. 10, 2008. 2019, 284:1, eff. July 19, 2019.

Section 326-B:9

    326-B:9 Rulemaking Authority. –
The board shall adopt rules, in accordance with RSA 541-A, relative to the following:
I. Eligibility requirements for the issuance of all initial, temporary, and renewal licenses, specialty licenses, and certificates issued by the board, including the issuance of such licenses to applicants holding a currently valid license or other authorization to practice in another jurisdiction.
II. Eligibility requirements for the reinstatement of licenses after lapse and after disciplinary action.
III. Recognition of national certifying bodies issuing specialty certifications required for licensure as an APRN which shall also be recognized by the National Council of State Boards of Nursing.
IV. The standards to be met by, and the process for approval of, education programs designed to prepare applicants to qualify for licensure or certification in any of the disciplines regulated by the board under RSA 326-B:32, including the time period within which noncompliance must be corrected before such approval is withdrawn.
V. The standards to be met by, and the process for approval of, education programs designed to prepare LPNs in intravenous therapy and by programs designed to prepare LNAs to perform tasks not addressed in the basic curriculum required for licensure.
VI. The determination of disciplinary sanctions authorized by this chapter, including the determination of administrative fines.
VII. The administration of examinations authorized by this chapter, and the manner in which information regarding the contents of any licensing examinations may be disclosed, solicited, or compiled.
VIII. Ethical standards for the practice of nursing and nursing-related activities.
IX. Continuing competence requirements.
X. Designations that may be used by persons regulated by the board and retired persons regulated by the board.
XI. The implementation and coordination of the nurse licensure compact adopted in RSA 326-B:46. The board shall use model rules developed for the nurse licensure compact by the National Council of State Boards of Nursing as the basis for adopting rules which shall be modified as necessary to comply with state statutes.
XII. Prescribing controlled drugs pursuant to RSA 318-B:41.
XIII. A process for registering practitioners who have been granted a special registration to prescribe controlled substances via telemedicine pursuant to 21 U.S.C. section 831(h).
XIV. The implementation of strategies and procedures necessary to increase the acceptance of military training and experience towards licensure for military veterans seeking to be licensed as a nurse. For the purposes of this subparagraph, "veterans" means veterans as defined in 38 U.S.C. section 101(2).

Source. 2005, 293:1. 2008, 179:3. 2009, 54:4. 2016, 213:4, eff. June 7, 2016. 2020, 27:10, eff. July 21, 2020; 34:12, eff. Sept. 26, 2020. 2021, 197:93, eff. July 1, 2021.

Section 326-B:9-a

    326-B:9-a Completion of Survey; Rulemaking. –
I. The board shall adopt rules, pursuant to RSA 541-A, for APRNs only requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T. Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.
II. The board shall adopt rules, pursuant to RSA 541-A, for RNs and LPNs only requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the National Council of State Boards of Nursing regarding minimum data sets. Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.

Source. 2017, 131:5, eff. June 16, 2017. 2019, 254:7, eff. July 1, 2019.

Section 326-B:10

    326-B:10 Repealed by 2009, 54:6, eff. July 21, 2009. –

Section 326-B:11

    326-B:11 Scope of Practice and Authority; Advanced Practice Registered Nurse. –
I. Advanced practice registered nursing shall consist of a combination of knowledge and skills acquired in basic nursing education. The APRN scope of practice, with or without compensation or personal profit, shall be limited to:
(a) Performing acts of advanced assessment, diagnosing, prescribing, selecting, administering, and providing therapeutic measures and treatment regimes;
(b) Obtaining consultation, planning, and implementing collaborative management, referral, or transferring the care of the client as appropriate; and
(c) Providing such functions for which the APRN is educationally and experientially prepared and which are consistent with standards established by a national credentialing or certification body recognized by the National Council of State Boards of Nursing and approved by the board in the appropriate APRN role and specialty.
II. An APRN shall practice within standards consistent with standards established by a national credentialing or certification body recognized by the National Council of State Boards of Nursing and approved by the board in the appropriate APRN role and specialty. The board shall not approve a new advanced practice specialty category that has not been developed by a national credentialing or certifying body recognized by the National Council of State Board of Nursing without approval of the legislature under RSA 332-G:6. Each APRN shall be accountable to clients and the board:
(a) For complying with this chapter and the quality of advanced nursing care rendered;
(b) For recognizing limits of knowledge and experience and planning for the management of situations beyond the APRN's expertise; and
(c) For consulting with or referring clients to other health care providers as appropriate.
III. An APRN shall have plenary authority to possess, compound, prescribe, administer, and dispense and distribute to clients controlled and non-controlled drugs within the scope of the APRN's practice as defined by this chapter. Such authority may be denied, suspended, or revoked by the board after notice and the opportunity for hearing, upon proof that the authority has been abused.
IV. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.

Source. 2005, 293:1. 2009, 54:3, 5, eff. July 21, 2009. 2019, 284:2, eff. July 19, 2019.

Section 326-B:12

    326-B:12 Scope of Practice; Registered Nurse. –
I. An RN shall, with or without compensation or personal profit, practice nursing that incorporates caring for all clients in all settings, is guided by nursing standards consistent with standards established by the National Council of State Boards of Nursing and approved by the board, and shall be limited to:
(a) Providing comprehensive nursing assessment of the health status of clients, families, groups, and communities.
(b) Collaborating with a health care team to develop an integrated client-centered plan of health care.
(c) Developing a plan of nursing strategies to be integrated within the client-centered health care plan that establishes nursing diagnoses, setting goals to meet identified health care needs, prescribing nursing interventions, and implementing nursing care through the execution of independent nursing strategies and prescribed medical regimen.
(d) Delegating and assigning nursing interventions to implement the plan of care.
(e) Providing for the maintenance of safe and effective nursing care rendered directly or indirectly.
(f) Promoting a safe and therapeutic environment.
(g) Providing health teaching and counseling to promote, attain, and maintain the optimum health level of clients, families, groups, and communities.
(h) Advocating for clients, families, groups, and communities by attaining and maintaining what is in the best interest of the client or group.
(i) Evaluating responses to interventions and the effectiveness of the plan of care.
(j) Communicating and collaborating with other health care professionals in the management of health care and the implementation of the total health care regimen within and across care settings.
(k) Acquiring and applying critical new knowledge and technologies to the practice of nursing.
(l) Managing, supervising, and evaluating the practice of nursing.
(m) Teaching the theory and practice of nursing.
(n) Participating in the development of policies, procedures, and systems to support the client.
(o) Other nursing services that require education and training prescribed by the board and in conformance with national nursing standards. Additional nursing services shall be commensurate with the RN's experience, continuing education, and demonstrated competencies.
II. Each RN is accountable to clients, the nursing profession, and the board for complying with the requirements of this act and the quality of nursing care rendered, and for recognizing limits of knowledge and experience and planning for management of situations beyond the nurse's experience.
III. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:13

    326-B:13 Scope of Practice; Licensed Practical Nurse. –
I. An LPN shall, with or without compensation or personal profit, practice under the supervision of an RN, APRN, licensed physician, or dentist. Such practice is guided by nursing standards established by the National Council of State Boards of Nursing and approved by the board, and shall be limited to:
(a) Collecting data and conducting focused nursing assessments of the health status of clients.
(b) Planning nursing care for clients with stable conditions.
(c) Participating in the development and modification of the comprehensive plan of care for all types of clients.
(d) Implementing appropriate aspects of the strategy of care within the LPN scope of practice.
(e) Participating in nursing care management through delegating, assigning, and directing nursing interventions that may be performed by others, including other LPNs, that do not conflict with this chapter.
(f) Maintaining safe and effective nursing care rendered directly or indirectly.
(g) Promoting a safe and therapeutic environment.
(h) Participating in health teaching and counseling to promote, attain, and maintain the optimum health level of clients.
(i) Serving as an advocate for the client by communicating and collaborating with other health service personnel.
(j) Participating in the evaluation of client responses to interventions.
(k) Communicating and collaborating with other health care professionals.
(l) Providing input into the development of policies and procedures.
(m) Other nursing services that require education and training prescribed by the board and in conformance with national nursing standards. Additional nursing services shall be commensurate with the LPN's experience, continuing education, and demonstrated LPN competencies.
II. Each nurse is accountable to clients, the nursing profession, and the board for complying with the requirements of this chapter and the quality of nursing care rendered and for recognizing limits of knowledge and experience and planning for management of situations beyond the nurse's expertise.
III. LPNs who have successfully completed the curriculum of a board- approved LPN intravenous therapy course may administer intravenous solutions under the direction of a physician or dentist, or as delegated by an RN.
IV. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.

Source. 2005, 293:1. 2009, 54:4, eff. July 21, 2009.

Section 326-B:14

    326-B:14 Scope of Practice; Licensed Nursing Assistant. –
I. An LNA shall, with or without compensation or personal profit, practice under the supervision of an RN, APRN, or LPN.
II. An LNA is responsible for competency in the nursing assistant curriculum approved by the board.
II-a. An LNA is authorized to administer medication if:
(a) The LNA holds a currently valid certificate of medication administration; or
(b) A licensed nurse delegates the task of medication administration to the LNA who is employed in the home care, hospice, residential care, public school, or adult day care setting. The board, in consultation with the commissioner of health and human services or a designee, shall adopt rules under RSA 541-A establishing standards for such delegation of medication administration which include, but are not limited to, limitations on the number of delegations per assistive personnel, training and competency requirements, documentation requirements, and medication administration error reporting requirements.
III. Following successful completion of the curriculum, a nursing assistant shall be able to:
(a) Form a relationship, communicate, and interact effectively with individuals and groups.
(b) Demonstrate comprehension related to individuals' emotional, mental, physical, and social health needs through skillful, direct nursing-related activities.
(c) Assist individuals to attain and maintain functional independence.
(d) Exhibit behaviors supporting and promoting care recipients' rights.
(e) Demonstrate observational and documenting skills required for reporting of people's health, safety, welfare, physical and mental condition, and general well-being.
(f) Provide safe nursing-related activities under the supervision of an RN or an LPN.
IV. LNAs may perform tasks not addressed in the basic curriculum required for licensure if they obtain additional training in the performance of such tasks through programs approved by the board. Additional tasks may be delegated provided:
(a) The task has been properly delegated to the nursing assistant by the supervising licensed nurse pursuant to RSA 326-B:28.
(b) The task has not been made exempt from nursing assistant practice.
(c) The policies of the employing health care facility allow the delegation of the task to an LNA.
V. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.

Source. 2005, 293:1. 2009, 54:4. 2015, 239:1. 2016, 273:2, eff. June 16, 2016. 2020, 6:4, eff. Mar. 9, 2020.

Section 326-B:15

    326-B:15 Criminal History Record Checks. –
I. Every applicant for initial licensure shall submit to the board a criminal history record release form, as provided by the New Hampshire division of state police, department of safety, which authorizes the release of his or her criminal history record, if any, to the board.
II. The applicant shall submit with the release form a complete set of fingerprints taken by a qualified law enforcement agency or an authorized employee of the department of safety. In the event that the first set of fingerprints is invalid due to insufficient pattern, a second set of fingerprints shall be necessary in order to complete the criminal history records check. If, after 2 attempts, a set of fingerprints is invalid due to insufficient pattern, the board may, in lieu of the criminal history records check, accept police clearances from every city, town, or county where the person has lived during the past 5 years.
III. The board shall submit the criminal history records release form and fingerprint form to the division of state police which shall conduct a criminal history records check through its records and through the Federal Bureau of Investigation. Upon completion of the records check, the division of state police shall release copies of the criminal history records to the board. The board shall maintain the confidentiality of all criminal history records information received pursuant to this section.
IV. The applicant shall bear the cost of a criminal history record check.

Source. 2005, 293:1. 2007, 303:6. 2008, 268:3, eff. June 26, 2008; 268:4, eff. March 1, 2009. 2018, 318:17, eff. Aug. 24, 2018.

Section 326-B:16

    326-B:16 Licensure; All Applicants. –
All applicants shall:
I. Submit a completed application and fees as established by the board.
II. Have the ability to read and write in the English language.
III. Report any pending criminal charges, criminal convictions, or plea arrangement in lieu of convictions.
IV. Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made.
V. Meet continuing competence requirements as defined in rules adopted under RSA 541-A.
VI. Meet other criteria as established by the board.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:16-a

    326-B:16-a License Requirements Suspended; Manchester Veterans Administration Medical Center. –
I. New Hampshire state licensure laws, rules, and regulations for nurses are hereby suspended for those nurses from other states or countries who are employed by the United States Department of Veterans Affairs and who are offering medical services to patients of the Manchester Veterans Administration Medical Center (VAMC) at licensed medical facilities outside of the Manchester VAMC, provided that such nurses are acting within the scope of their employment at the VAMC and possess a current medical license in good standing in their respective state or country of licensure.
II. The acting director of the Manchester VAMC shall submit to the executive director of the New Hampshire office of professional licensure and certification, or designee, a list of all out-of-state or out-of-country nurses offering services in the state of New Hampshire.
III. Nothing in this section shall be construed to preempt or supplant an individual licensed medical facility's policies regarding the emergency credentialing of nurses or any other medical personnel.

Source. 2018, 266:3, eff. June 14, 2018.

Section 326-B:17

    326-B:17 Registered Nurse and Licensed Practical Nurse; Initial License by Examination. –
I. The board shall administer the examination to applicants for licensure as RN's or LPN's.
II. The board may employ, contract, and cooperate with any entity in the preparation and process for determining results of a valid, reliable, legally defensible and uniform licensure examination. When such an examination is utilized, the board shall restrict access to questions and answers.
III. The board shall determine whether a license examination may be repeated, the frequency of reexamination, and any requisite education prior to reexamination.
IV. An applicant for licensure by examination to practice as an RN or LPN who successfully meets the requirements of this section shall be entitled to licensure as an RN or LPN, whichever is applicable.
V. Applicants for licensure by exam as an RN or LPN shall graduate from or verify successful completion and eligibility for graduation from a board approved nursing education program or a program that meets criteria comparable to those established by the board.
VI. An internationally educated applicant for RN or LPN licensure by examination shall meet the requirements as established by the board.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:18

    326-B:18 Advanced Practice Registered Nurse; Licensure. –
I. An applicant for initial APRN licensure shall:
(a) Hold a current license as a registered nurse;
(b) Have graduated with a graduate degree earned in an accredited advanced practice registered nurse education program or have graduated before July 1, 2004 from an APRN education program accredited by a national accrediting body;
(c) Be currently certified by a board-recognized national certifying body in the specialty for which the applicant was educated; and
(d) Meet other criteria as established by the board.
II. The board may issue one or more licenses to applicants meeting the qualifications established in paragraph I.

Source. 2005, 293:1. 2009, 54:4, 5, eff. July 21, 2009.

Section 326-B:19

    326-B:19 Licensed Nursing Assistant; Licensure by Examination. –
Applicants for an initial LNA license shall:
I. Submit documentation of successful completion and certification from a board approved nursing assistant education program.
II. Pass an examination approved by the board.
III. Meet other criteria as established by the board.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:20

    326-B:20 Registered Nurse and Licensed Practical Nurse; Licensure by Endorsement. –
An applicant for licensure by endorsement to practice as an RN or LPN who is currently licensed or certified in any other state or jurisdiction shall:
I. Hold an active unencumbered license as an RN or LPN.
II. Have committed no acts or omissions which are grounds for disciplinary action in another jurisdiction, or, if such acts have been committed and would be grounds for disciplinary action as set forth in this chapter, the board has found, after investigation, that sufficient restitution has been made.
III. Pass an examination approved by the board.
IV. Submit verification of licensure status directly from the jurisdiction of licensure by examination.
V. Meet other criteria established by the board.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:20-a

    326-B:20-a Repealed by 2017, 213:2, eff. July 1, 2019. –

Section 326-B:21

    326-B:21 Licensed Nursing Assistant; Licensure by Endorsement. –
An applicant for licensure by endorsement as a licensed nursing assistant who is currently licensed or certified in any other state or jurisdiction shall:
I. Provide proof of current and original licensing, certification, or nursing assistant registry status;
II. Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made; and
III. Meet other criteria as established by the board.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:21-a

    326-B:21-a Licensed Nursing Assistant; Licensure by Alternate Experience. –
I. A current or former military service member who has been assigned a military occupational specialty (MOS) code of 68W (Army) or 4N0X1 (Air Force), with or without additional skill identifiers, and who, as part of such member's service in the military, has utilized their MOS within the last 3 years, shall be deemed to have taken a board-approved nursing assistant course and may apply for a license as a nursing assistant in New Hampshire. An applicant under this paragraph shall:
(a) Provide proof that the applicant has been assigned a MOS code of 68W (Army) or 4N0X1 (Air Force) and that the applicant has used their MOS as part of their service in the last 3 years;
(b) Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made; and
(c) Meet other criteria as established by the board.
II. An individual licensed as an emergency medical technician-basic, emergency medical technician-advanced, or paramedic in any United States jurisdiction who presently holds a certification from the National Registry of Emergency Medical Technicians (NREMT), shall be deemed to have taken a board-approved nursing assistant course and may apply for a license as a licensed nursing assistant in New Hampshire. An applicant under this paragraph shall:
(a) Provide proof that the applicant is currently licensed as an emergency medical technician-basic, emergency medical technician-advanced, or paramedic in any United States jurisdiction;
(b) Provide a copy of the applicant's certification from the National Registry of Emergency Medical Technicians;
(c) Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made; and
(d) Meet other criteria as established by the board.

Source. 2021, 97:1, eff. July 1, 2021.

Section 326-B:22

    326-B:22 License Renewal; All Licensees. –
I. All license renewals shall be issued biennially.
II. Any person licensed who intends to continue practicing as a nurse or nursing assistant shall:
(a) By midnight on his or her date of birth in the renewal year submit a completed application and fees as established by the board;
(b) Report any pending criminal charges, criminal convictions, or plea arrangements in lieu of convictions;
(c) Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made;
(d) Meet continuing competence requirements as defined in rules adopted under RSA 541-A;
(e) For those licensees applying for renewal following disciplinary action, comply with all board licensure requirements as well as any specific requirements set forth in the board's discipline order; and
(f) Meet other criteria as established by the board.
III. Failure to renew the license shall result in forfeiture of the ability to practice nursing or nursing activities in the state of New Hampshire.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:23

    326-B:23 License Reinstatement; All Licensees. –
An individual whose license has lapsed by failure to renew may apply for reinstatement by meeting all requirements for renewal, or satisfying the following conditions:
I. An individual who applies for license reinstatement who does not meet the continuing competence requirements shall demonstrate current nursing or nursing assistant knowledge and skill, as defined in rules adopted by the board under RSA 541-A.
II. For those licensees applying for reinstatement following disciplinary action, compliance with all board licensure requirements as well as any specific requirements set forth in the board's discipline order.
III. Application for reinstatement of a license which has lapsed under this section shall include payment of a reinstatement fee and be made, and granted or denied, in accordance with rules adopted by the board pursuant to RSA 541-A.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:24

    326-B:24 Temporary Licenses; All Licensees. –
I. The board may issue temporary licenses, as provided in paragraph II, to applicants who meet entry level licensing requirements in the license category. A temporary license shall expire on the date the board approves or denies the permanent license sought by the holder of the temporary license, or in 120 days, whichever is less.
II. The following applicants for licensure as RNs or LPNs may be issued temporary licenses:
(a) Unlicensed applicants for licensure under paragraph I and applicants for licensure under RSA 326-B who have met all requirements for licensure except that they have not yet taken the required examination or the results of the examination are not yet available to the board.
(b) If they can demonstrate proficiency in English, currently foreign-licensed applicants for licensure under RSA 326-B who have met all requirements for licensure except that they have not yet taken the required examination or the results of the examination are not yet available to the board.
(c) Applicants for licensure under RSA 326-B who have met all of the requirements of that paragraph and are awaiting the board's decision on their application for permanent licensure.
III. Applicants described in paragraph II who have received temporary licenses shall practice only under the supervision of an RN currently licensed in New Hampshire.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m. 2017, 202:2, eff. Sept. 3, 2017; 202:4, eff. June 30, 2019.

Section 326-B:25

    326-B:25 Modified License; Registered Nurse or Licensed Practical Nurse. – The board may issue a modified license to an individual who has met licensure requirements and who is able to practice without compromising public safety within a modified scope of practice or with accommodations or both as specified by the board.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:26

    326-B:26 Nursing Assistant Registry. – The board shall maintain a registry of nursing assistants who qualify pursuant to 42 C.F.R. section 483.156. Nursing assistants who are registered shall comply with all provisions of the Omnibus Budget Reconciliation Act (OBRA) of 1987, sections 1819 and 1919 of the Social Security Act, and all provisions of this chapter.

Source. 2005, 293:1. 2011, 245:3, eff. July 1, 2011.

Section 326-B:27

    326-B:27 Certificate of Medication Administration for Licensed Nursing Assistants. –
I. The board may issue a certificate of medication administration to a current LNA who:
(a) Has participated in and completed a board-approved medication administration education program;
(b) Has passed an examination approved by the board; and
(c) Has paid the certification fee.
II. Certification may be renewed on a biennial basis.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:28

    326-B:28 Delegation of Nursing Activities and Tasks. – A nurse holding a currently valid license as an RN or an LPN may delegate specific nursing activities and tasks under the circumstances, and in accordance with the constraints, set forth in rules of the board adopted under RSA 541-A.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:29

    326-B:29 Delegation; Circumstances Not Subject to Disciplinary Action by the Board of Nursing. –
I. A licensee who delegates or has delegated a specific nursing activity or task in compliance with this chapter shall not be subject to disciplinary action because of the performance of the person to whom the nursing activity or task is or was delegated.
II. No person may coerce an RN or an LPN into compromising client safety by requiring the nurse to delegate a nursing activity or task when the nurse determines that it is inappropriate to do so. A licensee shall not be subject to disciplinary action for refusing to delegate or refusing to provide training related to such delegation when the licensee has determined that such delegation may compromise client safety except as provided in RSA 326-B:37, II(h)(2).

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:30

    326-B:30 Obligations of Licensees. –
I. In response to board inquiries relevant to a licensee's status or practice of nursing or nursing-related activities, each licensee shall provide complete and truthful information.
II. Each licensee shall notify the board if a license is lost or stolen.
III. Each licensee shall notify the board of a change of name or address.
IV. Each licensee shall report to the board those acts or omissions which are violations of this chapter or grounds for disciplinary action.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m. 2019, 284:3, eff. July 19, 2019.

Section 326-B:31

    326-B:31 Continuing Education. –
Applicants for license renewal and license reinstatement after lapse shall complete continuing education as follows:
I. An LNA shall complete 12 hours of continuing education in programs approved by the board each year, provided that licensees who hold a certificate of medication administration shall complete at least 4 hours of those 12 hours in medication administration.
II. An LPN or an RN shall complete 30 hours of continuing education every 2 years.
III. An APRN, in addition to the continuing education requirements to renew or reinstate a license as an RN, shall complete 30 hours of continuing education every 2 years, 20 hours of which shall be specific to the specialty for which renewal or reinstatement is sought, and 5 hours of which shall be training in pharmacology appropriate to the specialty for which license renewal or reinstatement is sought.

Source. 2005, 293:1. 2009, 54:4, eff. July 21, 2009.

Section 326-B:32

    326-B:32 Education Programs. –
I. (a) The board shall establish standards for the establishment and outcomes for nursing and nursing assistant education programs intended to prepare students for licensure or for certification, including clinical learning experiences.
(b) The board shall approve, disapprove, or withdraw approval for nursing education programs that meet or fail to meet the requirements of this chapter and the rules adopted by the board. Nursing education programs under this subparagraph shall not include education for nursing assistants. The board shall require that nursing education programs:
(1) Seek and receive approval from the department of education, division of educator support and higher education prior to applying for approval from the board.
(2) Receive institutional regional or national accreditation in addition to specialized nursing accreditation by accrediting bodies recognized by the United States Department of Education.
(3) Be affiliated with an existing degree-granting institution with institutional regional or national accreditation recognized by the United States Department of Education.
(c) The board shall approve, disapprove, or withdraw approval for nursing assistant education programs that meet or fail to meet the requirements of this chapter and the rules adopted by the board. The board shall require that nursing assistant education programs seek and receive approval from the department of education, division of educator support and higher education prior to applying for approval from the board.
(d) An educational institution or other entity conducting such an education program shall comply with paragraphs II and III and rules adopted by the board pursuant to RSA 541-A.
II. The board shall establish the process for determining nursing and nursing assistant education program compliance.
III. The board:
(a) Shall set requirements for establishment of:
(1) New nursing education programs, including requirements relative to affiliation, accreditation, and site visits required for initial nursing education program approval and subsequent evaluations.
(2) New nursing assistant education programs.
(b) Shall periodically review nursing and nursing assistant education programs and require such programs to submit evidence of compliance with standards.
(c) Shall grant continuing approval if, upon review of evidence, the board determines that the program meets the established standards. The board shall publish a list of approved programs.
(d) Shall deny or withdraw approval or take such action as deemed necessary when nursing or nursing assistant education programs fail to meet the standards established by the board.
(e) Shall reinstate approval of a nursing or nursing assistant education program upon submission of satisfactory evidence that its program meets the standards established by the board.
(f) Shall establish the process for nursing and nursing assistant programs that cease operation.
IV. Any education program conducted in another state shall be deemed to be an education program approved by the board if that program meets the requirements for approval established by this section and the program has been approved by the regulatory authority of its state.

Source. 2005, 293:1. 2008, 179:4. 2011, 224:141, 142, eff. July 1, 2011. 2018, 315:31, 32, eff. Aug. 24, 2018.

Section 326-B:33

    326-B:33 Duty to Warn of Violent Acts of Client; Civil Liability. –
I. A licensee has a duty to warn of, or to take reasonable precautions to provide protection from, a client's violent behavior when the client has communicated to the licensee, a serious threat of physical violence against a clearly identified or reasonably identifiable victim or victims or a serious threat of substantial damage to real property.
II. A licensee shall discharge the duty either by notifying the licensee's supervisor or the treating provider. A psychiatric APRN shall discharge the duty by making reasonable efforts to communicate the threat to the victim or victims, notifying the police department closest to the client's or potential victim's residence, or obtaining civil commitment of the client to the state mental health system.
III. No monetary liability or cause of action based on breach of client privacy, confidentiality, or any other ground shall arise from an act or communication done in a good faith effort to discharge a duty.

Source. 2005, 293:1. 2006, 297:1. 2009, 54:4, eff. July 21, 2009.

Section 326-B:34

    326-B:34 Duties of Licensees Relating to Reports of Sexual Relations. –
I. If, during the course of diagnosis or treatment by a licensee, a client alleges that another mental health counselor or health care practitioner licensed by the board of nursing or another state licensing or certifying agency has engaged with the client in sexual relations, the licensee shall have a duty to inform the client that the act reported by the client may be unprofessional or unethical and may subject the actor to disciplinary action by the actor's licensing or certifying agency.
II. No liability for breach of client confidentiality, slander, or defamation, or other civil or criminal liability, shall arise from the disclosure by a licensee of information related to reported sexual relations between a client and any mental health counselor or health care licensee of a state licensing or certifying agency when the disclosure is made in good faith and made to the board or any other state licensing or certifying agency.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:35

    326-B:35 Privileged Communications Between Licensees and Their Clients. –
I. Confidential communications between licensees and their clients are privileged in the same manner as those provided by law between physician and patient, and, except as otherwise provided by law, no licensee shall be required to disclose such privileged communications. Confidential communications between a client of a licensee and any person working under the supervision of such licensee to provide services that are customary and necessary for diagnosis and treatment are privileged to the same extent as would be the same communications between the supervising licensee and the client.
II. This section shall not apply to disciplinary proceedings conducted by:
(a) The board;
(b) The board of examiners of nursing home administrators under RSA 151-A:11; or
(c) Any other statutorily-created health care occupational licensing board conducting disciplinary proceedings.
III. This section shall not apply to hearings conducted pursuant to RSA 135-C or RSA 464-A.
IV. This section shall also not apply to the release of blood samples and the results of laboratory tests for blood alcohol content taken from a person who is under investigation for driving a motor vehicle while such person was under the influence of intoxicating liquors or controlled drugs. The use and disclosure of such information shall be limited to the official criminal proceedings.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:36

    326-B:36 Emergency Treatment; Assisting the Board; Immunity From Civil Liability. –
I. No person licensed to practice under this chapter or under the laws of any other state who, in good faith, renders emergency care at the scene of an emergency, which occurs outside both the place and the course of employment, shall be liable for any civil damages as a result of acts or omissions in rendering such emergency care, or as a result of any act or failure to act to provide or arrange for further medical treatment or care.
II. Any person acting in good faith shall be immune from civil liability to a licensee or an applicant for licensure for making any report or other information available to the board or assisting the board in carrying out any of its duties.
III. Nurses licensed in other states who respond to emergencies in New Hampshire during a civil disaster event shall be immune from civil liability and board action for acts or omissions in rendering such emergency care, or as a result of any act or failure to act to provide or arrange for further medical treatment or care.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:36-a

    326-B:36-a Alternative Recovery Monitoring Program. –
I. (a) Any person or qualified health care professional committee may report relevant facts to the board relating to the acts of any person licensed by the board in this state if they have knowledge relating to the licensee which, in their opinion, might provide grounds for disciplinary or remedial action as specified in RSA 326-B:37, II.
(b) A person or qualified health care professional committee who may report under subparagraph (a) shall include:
(1) A self-reporting licensee, whether without a prior history of substance use disorder or a previously impaired licensee returning to practice under a probationary license who requests participation in an alternative recovery monitoring program;
(2) A quality assurance committee acting in a clinical setting;
(3) Any committee of a professional society comprised primarily of licensees of the board of nursing, or its staff; or
(4) Any person participating in a program established to aid licensees impaired by substance use disorder or mental or physical illness.
(c) No person furnishing any such information to the board in good faith for the purpose of protecting the safety of patients or the public or the health of an impaired licensee shall be liable in damages to any person, including the allegedly impaired licensee.
II. Upon a determination by the board that a report or complaint submitted by any person or qualified health care professional committee is without merit, the report shall be kept confidential or nonpublic in the subject licensee's individual record in the board's office. A licensee subject to a report under this section or the licensee's authorized representative shall be entitled on written request to examine the licensee's individual record in the board's office, including any such report submitted to the board, and to place into the record a statement of reasonable length of the licensee's view with respect to any information existing in the report, in accordance with rules established by the board.
III. (a) If the board determines that a report or complaint submitted by any person or qualified health care professional committee has or may have merit, the board may either:
(1) Refer the matter for disciplinary proceedings under RSA 326-B:37, subject to paragraph IV of this section; or
(2) Refer the impaired licensee to an alternative recovery monitoring program under paragraph VI.
(b) Among the factors bearing on the board's decision whether to proceed with disciplinary proceedings or refer the licensee to an alternative recovery monitoring program, the board may consider whether the affected licensee has taken the initiative to voluntarily self-report under subparagraph I(b)(1), or whether a report or complaint has been initiated by a third party under subparagraph I(b)(2), (3), or (4).
IV. Notwithstanding the provisions of RSA 91-A, the records and proceedings of the board compiled in connection with a report made under paragraph I shall be confidential and are not to be considered open records unless the subject licensee so requests, provided, however, the board may disclose this confidential information only:
(a) In a disciplinary hearing before the board or in a subsequent appeal of a board action or order;
(b) To the nurse licensing or disciplinary authorities of other jurisdictions; or
(c) Pursuant to an order of a court of competent jurisdiction.
V. (a) No person, including any employee or member of the board, any member of a qualified health care professional committee, or any other individual furnishing in good faith information, data, reports, or records for the purpose of aiding an impaired licensee shall by reason of furnishing such information be liable in damages to any person.
(b) No employee or member of the board, member of any qualified health care professional committee, or staff member or participant in any alternative recovery monitoring program shall be liable in damages to any person for any action taken or recommendation made by such board, committee, staff, or participant unless he or she is found to have acted with wanton disregard for patient or public safety, or for the rights or reputation of the subject licensee, or for the reputation of the organization in which the subject licensee is employed or volunteers.
VI. (a) The office of professional licensure and certification shall contract with other organizations to operate the alternative recovery monitoring program for licensees who are impaired by substance use disorder or mental or physical illness. This program may include, but shall not be limited to, assessment, education, intervention, drug and alcohol testing, temporary suspension or limitation of clinical privileges, drug addiction counseling, participation in peer support groups, record keeping with respect to success and failure rates, post-treatment assessment and monitoring, and other alternatives approved by the board.
(b) The office of professional licensure and certification may allocate amounts determined by the board from the annual license renewal fees it collects from licensees in each class of nurses licensed by the board, to provide funding for the alternative recovery monitoring program as set forth in subparagraph (a).
(c) Rules governing this program shall be implemented through the office of professional licensure and certification pursuant to RSA 310-A:1-d, II(h)(4).

Source. 2018, 270:2, eff. Aug. 17, 2018. 2021, 197:94, eff. July 1, 2021.

Section 326-B:37

    326-B:37 Disciplinary Action; Misconduct. –
I. The board may undertake investigations and disciplinary proceedings:
(a) Upon its own initiative.
(b) Upon written complaint of any person which charges that a licensee has committed any acts of misconduct under this section and which specifies the grounds for such complaint.
II. The board may discipline a licensee or applicant for any one or a combination of the following grounds:
(a) Failing to demonstrate the qualifications or satisfy the requirements.
(b) Conduct that violates the security of the examination, including, but not limited to:
(1) Copying, disseminating, or receiving any portion of an examination.
(2) Having unauthorized possession of any portion of a future, current, or previously administered examination.
(3) Violating test administration.
(4) Permitting an impersonator to take the examination on one's behalf or impersonating an examinee.
(c) Convictions by a court or any plea to a crime in any jurisdiction that relates adversely to the practice of nursing or to the ability to practice nursing.
(d) Employing fraud or deceit in procuring or attempting to procure a license to practice nursing, in filing any reports or completing client records, in representation of oneself to the board or public, in authenticating any report or records in the nurse's capacity as an APRN, RN, LPN, or LNA, or in submitting any information or record to the board.
(e) Unethical conduct including but not limited to conduct likely to deceive, defraud, or harm the public or demonstrating a willful or careless disregard for the health or safety of a client. Actual injury need not be established.
(f) If a nurse's license to practice nursing or a multi-state privilege or another health care related license or other credential has been denied, revoked, suspended, or restricted, or the licensee has been otherwise disciplined in this or any other state.
(g) Conduct including but not limited to failure or inability to perform nursing or nursing assistant practice as defined in this chapter, with reasonable skill and safety.
(h) Unprofessional conduct including but not limited to:
(1) A departure from or failure to conform to nursing standards, including improper management of client records.
(2) Delegating or accepting the delegation of a nursing function or a prescribed health function when the delegation or acceptance could reasonably be expected to result in unsafe or ineffective client care.
(3) Failure to supervise the performance of acts by any individual working at the nurse's delegation or assignment.
(4) Failure of a clinical nursing instructor to supervise student experiences.
(i) Failure of a chief administrative nurse to follow appropriate and recognized standards and guidelines in providing oversight of the nursing organization and nursing services of a health care delivery system.
(j) Failure to practice within a modified scope of practice or with the required accommodations, as specified by the board in granting a modified license under this act.
(k) Any nursing practice that may create unnecessary danger to a client's life, health, or safety. Actual injury to a client need not be established.
(l) Inability to practice safely, including demonstration of actual or potential inability to practice nursing with reasonable skill and safety to clients by reason of illness or as a result of any mental or physical condition.
(m) Actions or conduct that include, but are not limited to, falsifying reports, client documentation, agency records, or other essential health documents, failure to cooperate with a lawful investigation conducted by the board, failure to maintain professional boundaries with clients or family members, use of excessive force upon or mistreatment or abuse of any client, engaging in sexual conduct with a client, touching a client in a sexual manner, requesting or offering sexual favors or language or behaviors suggestive of same, or threatening or violent behavior in the workplace.
(n) Diversion or attempts to divert drugs or controlled substances.
(o) Failure of a licensee to comply with terms of any alternative program agreement made with the board.
(p) Other drug-related actions or conduct that include but are not limited to:
(1) Use of any controlled substance or any drug or device or alcoholic beverages to an extent or in a manner dangerous or injurious to himself or herself, any other person, or the public, or to the extent that such use may impair his or her ability to conduct with safety to the public the practice of nursing.
(2) Falsification or making incorrect, inconsistent, or unintelligible entries in any agency, client, or other record pertaining to drugs or controlled substances.
(3) A positive drug screen for which there is no lawful prescription.
(q) Actions or conduct that include but are not limited to:
(1) Knowingly aiding, assisting, advising, or allowing an unlicensed person to engage in the practice of nursing.
(2) Violating a rule adopted by the board under RSA 541-A, an order of the board, a state or federal law relating to the practice of nursing, or a state or federal narcotics or controlled substance law.
(3) Practicing beyond the scope of practice as stated in this chapter, and failing to report violations of this chapter.
(r) Upon notification by the licensing authority of another jurisdiction that a licensee has been disciplined.
III. The board may refuse to renew or reinstate a license on disciplinary grounds, or take disciplinary action in any one or more of the following ways:
(a) By reprimand or by suspension, limitation, conditions, or probation of a licensee for a period of time as determined reasonable by the board.
(b) By revocation of a license.
(c) By requiring licensees to participate in educational or rehabilitative programs in the area or areas in which they have been found deficient or incompetent.
(d) By requiring the licensee to submit to the care, counseling, or treatment of a licensed health care provider, counseling service, health care facility, professional assistance program established under RSA 326-B:36-a, or any comparable person, facility, or program approved by the board.
(e) By requiring the person to practice under the direct supervision of an RN for a period of time specified by the board.
(f) By imposition, after notice and the opportunity for hearing, of fines not to exceed $1,000 for each violation or, in the case of a continuing violation, $100 for each day the violation continues.
IV. In cases involving imminent danger to public health, safety, or welfare, the board may order the immediate suspension of a license pending an adjudicative proceeding. The board shall commence this adjudicative proceeding not later than 10 working days after the date of the board order suspending the license. The licensee may waive the 10-day commencement requirement to allow for additional time to prepare for a hearing. If the licensee waives the requirement, the license shall remain suspended until the completion of the hearing. A record of the proceeding shall be made by a certified court reporter provided by the board. Unless expressly waived by the licensee, board failure to commence an adjudicative proceeding within 10 working days shall mean that the suspension order is automatically vacated. The board shall not again suspend the license for the same conduct which formed the basis of the vacated suspension without granting the licensee prior notice and an opportunity for an adjudicative proceeding.
V. Every individual, agency, facility, institution, or organization that employs licensed nursing personnel within the state shall report to the board within 30 days any action by a licensee that willfully violates any provision of paragraph II. The board shall have authority, after notice and the opportunity for hearing, to impose civil penalties of up to $1,000 per violation upon persons found to have willfully violated the reporting requirements of this paragraph.

Source. 2005, 293:1. 2009, 54:4, eff. July 21, 2009. 2018, 270:3, eff. Aug. 17, 2018.

Section 326-B:38

    326-B:38 Investigations and Hearings. –
I. The board shall investigate possible misconduct by licensees and other matters governed by the provisions of this chapter. Investigations shall be conducted with or without the issuance of a board order setting forth the general scope of the investigation. Board investigations and any information obtained by the board pursuant to such investigations shall be exempt from the public disclosure provisions of RSA 91-A, unless such information subsequently becomes part of a public disciplinary hearing. However, the board may disclose information acquired in an investigation to law enforcement or health licensing agencies in this state or any other jurisdiction, or in accordance with specific statutory requirements or court orders.
II. The board may appoint legal counsel, health care advisors, or other investigators retained through the office of professional licensure and certification to assist with any investigation and with adjudicative hearings.
III. The form taken by an investigation is a matter within the discretion of the board. The board may conduct investigations on an ex parte basis.
IV. (a) The board may administer oaths or affirmations, preserve testimony, and issue subpoenas for witnesses, documents, and things, relative to investigations or adjudicative hearings, except that subpoenas for records issued pursuant to paragraph V may be issued at any time.
(b) The board may serve a subpoena on any licensee by certified mail, but shall serve a subpoena on any other person in accordance with the procedures and the fee schedules established by the superior court.
(c) A person licensed by the board shall not be entitled to a witness fee or mileage expenses for travel within the state related to his or her appearance at a hearing or investigatory proceeding.
(d) In order to be valid, any subpoena issued by the board, except one issued to a licensee, shall be annotated "Fees guaranteed by the New Hampshire board of nursing."
(e) A minimum of 48 hours' notice shall be given for compliance with a subpoena issued under this paragraph.
V. The board may at any time subpoena a licensee's health care records, employment records, and nursing education academic records in the possession of its licensees, nursing education programs licensed by the board, or hospitals, and other health care providers and facilities regulated in this state, except that it may not subpoena quality assurance records of health facilities licensed under RSA 151. Subpoenas shall be served by certified mail or personal delivery to the address currently on file with the board in the case of delivery to a licensee. No witness or other fee shall be required. A minimum of 15 days' advance notice shall be allowed for complying with a subpoena issued under this paragraph.
VI. Complaints of licensee misconduct shall be in writing and shall be treated as petitions for the commencement of a disciplinary hearing. The board shall determine whether a complaint alleges misconduct sufficient to support disciplinary proceedings. If the board determines that it does, the board shall forward a copy of the complaint to the licensee complained against within 5 business days of its determination. If the board determines that it does not, the board shall send the complainant a written notice of dismissal of the complaint. Some or all of the allegations in a complaint may be consolidated with another complaint or with issues the board wishes to investigate or hear on its own motion. If an investigation of a complaint results in an offer of settlement by the licensee, the board may settle the allegations against the licensee without the consent of a complainant, provided that material facts are not in dispute.
VII. At any time during an investigation of a complaint, and without issuing a subpoena, the board may mail a copy of a complaint to the licensee named in the complaint, and may require in a written request that the licensee and the licensee's employer provide detailed and good faith written responses to allegations identified by the board and also provide copies of all records concerning any client identified in the complaint. The licensee and others receiving inquiries from the board shall respond within a reasonable time period of not less than 15 days as the board may specify. This procedure may also be used in connection with matters the board has undertaken to investigate on its own motion.
VIII. The board may hold adjudicative hearings concerning allegations of misconduct or other matters within the scope of this chapter. Such hearings shall be public proceedings. Any member of the board, or any other qualified person appointed by the board, shall have authority to preside at such a hearing and to issue oaths or affirmations to witnesses.
IX. The board shall give the respondent and the complainant, if any, at least 15 days' written notice of the date, time, and place of a hearing, except as otherwise provided in this chapter. Such notice shall comply with RSA 541-A and include an itemization of the issues to be heard, and, in the case of a disciplinary hearing, a statement as to whether the action has been initiated by a written complaint or upon the board's own motion, or both. If a written complaint is involved, the notice shall provide the complainant with a reasonable opportunity to intervene as a party. Such notice shall be sent by certified mail, return receipt requested, to the complainant and to the respondent at the address provided by the respondent currently on file at the board offices. Notice mailed in compliance with this section shall be deemed served.
X. The board may at any time dispose of allegations in a complaint, investigation, or disciplinary hearing by settlement, default, or consent order, by issuing an order of dismissal for failing to state a proper basis for disciplinary action, or by summary judgment order based upon undisputed material facts. In disciplinary hearings, the board may hold prehearing conferences which shall be exempt from the provisions of RSA 91-A, but any final disciplinary action or decision which occurs without holding a public hearing shall be publicly released at the time it is served upon the parties.
XI. Final disciplinary actions and other adjudicative decisions made by the board shall be in writing and served upon the parties. Such decisions shall not be released to the public until they are served upon the parties.
XII. Any person appearing at a board hearing or investigation may be represented by legal counsel or other representative, but the board shall have no obligation or authority to appoint or provide such representation.
XIII. The board shall hear any complaint not resolved at or prior to a preliminary hearing.
XIV. In the case of sanctions for discipline in another jurisdiction, the decision of the other jurisdiction's disciplinary authority may not be collaterally attacked and the board may impose any of the sanctions set forth in this chapter, but shall provide notice and an opportunity to be heard if it intends to impose sanctions above those imposed by the other jurisdiction.

Source. 2005, 293:1. 2015, 276:71, eff. July 1, 2015. 2021, 205:2, Pt. III, Sec. 1, eff. Aug. 10, 2021.

Section 326-B:39

    326-B:39 Rehearing; Appeals. –
I. Any person who has been refused a license by the board or has been disciplined by the board shall have the right to petition for a rehearing within 30 days after the original decision.
II. Appeals from a decision on rehearing shall be by appeal pursuant to RSA 541.
III. No sanction shall be stayed by the board during an appeal.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:40

    326-B:40 Injunctive Relief. – The attorney general, the board of nursing, any citizen, or the prosecuting attorney of any county or municipality where the act occurs may maintain an action to enjoin a person not currently licensed to do so from practicing, or purporting to practice, nursing or nursing-related activities. The action to enjoin shall not replace any other civil, criminal, or regulatory remedy. An injunction without bond is available to the board.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:41

    326-B:41 Unlawful Acts. –
It shall be unlawful for any person or entity to:
I. Sell or fraudulently obtain or furnish any nursing diploma, license, or record, or to aid and abet in such an act.
II. Practice as a licensee without a license or when the license to do so has been revoked or suspended or when the license to do so has lapsed.
III. Use, in connection with the individual's name, any designation tending to imply licensure as an RN, an LPN, or an LNA unless so licensed.
IV. Represent or imply that the person or entity is conducting a nursing education program or a program for the education of nursing assistants which has been approved by the board when the program has not been so approved.
V. Disclose, solicit, or compile information regarding the contents of any licensing examinations relative to this chapter, except as authorized by the board.

Source. 2005, 293:1. 2006, 76:7, eff. July 1, 2006.

Section 326-B:41-a

    326-B:41-a Penalty. –
I. Any person who shall practice or attempt to practice as a registered nurse, advanced practice registered nurse, licensed practical nurse, or licensed nursing assistant in this state without a license shall be guilty of a class A misdemeanor if a natural person or guilty of a felony if any other person.
II. Any person who violates any of the other provisions of this chapter shall be guilty of a misdemeanor.

Source. 2006, 76:8. 2009, 54:5, eff. July 21, 2009.

Section 326-B:42

    326-B:42 Persons Licensed Under Previous Laws. – Any person authorized to practice nursing by authority of this state as of the effective date of this section shall continue to be licensed under the provisions of this chapter and shall be eligible for license renewal pursuant to this chapter.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:43

    326-B:43 Exemptions. –
The provisions of this chapter shall not prohibit or limit:
I. The employment in federal government institutions and agencies of nurses who are members of federal agencies and are currently licensed in some state of the United States.
II. The practice of nursing by persons enrolled in nursing programs approved by the board when such practice is part of their program of study.
III. The furnishing of nursing assistance in an emergency.
IV. Nursing services by anyone when done in accordance with the practice of the religious principles or tenets of any well-recognized church or denomination which relies upon prayer or spiritual means alone for healing.
V. The practice of nursing in this state by any nurse currently licensed by another state engaged to accompany and care for a person passing through or temporarily residing in this state, during the period of one visit not to exceed 2 months.
VI. The administration of medications, by any person employed or under contract, to provide direct care to clients receiving community-based services pursuant to RSA 135-C or RSA 171-A, provided that persons delivering such care who administer medications shall have successfully completed a medication administration educational program conducted by an RN and approved by the board under rules adopted pursuant to RSA 541-A. The commissioner of health and human services, in consultation with the board, shall adopt rules under RSA 541-A establishing criteria for the administration of medications, and for the process of approving an RN to conduct the medication administration educational program.
VII. The practice of any nurse currently licensed in another state who is in this state on a non-routine basis to provide nursing consulting services.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:44

    326-B:44 Certified Midwifery Not the Practice of Nursing. – Midwives certified under RSA 326-D, and practicing midwifery as defined by RSA 326-D:2, V, shall not be construed as practicing nursing.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:45

    326-B:45 Direct Care in Community-Based Services. – The administration of medications by non-licensees to individuals receiving community-based services pursuant to RSA 135-C or RSA 171-A shall not be construed as practicing nursing.

Source. 2005, 293:1, eff. July 1, 2005 at 12:01 a.m.

Section 326-B:45-a

    326-B:45-a Certain Contract Restrictions Upon Nurses Unenforceable. – Any contract or agreement which creates or established the terms of a partnership, employment, or any other form of professional relationship with a nurse licensed by the board to practice in this state, which includes any restriction to the right of such nurse to also practice in any geographic area for any period of time after the termination of such partnership, employment, or professional relationship shall be void and unenforceable with respect to said restriction; provided however, that nothing herein shall render void or unenforceable the remaining provision of any such contract or agreement. The requirements of this section shall apply to new contracts or renewals of contracts entered into on or after the effective date of this section.

Source. 2018, 322:1, eff. June 25, 2018.

Section 326-B:46

    326-B:46 Nurse Licensure Compact. –
The nurse licensure compact is adopted and entered into with all other jurisdictions that legally join the compact, which is substantially as follows:
ARTICLE I
Findings and Declaration of Purpose
(a) The party states find that:
(1) The health and safety of the public are affected by the degree of compliance with and the effectiveness of enforcement activities related to state nurse licensure laws;
(2) Violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public;
(3) The expanded mobility of nurses and the use of advanced communication technologies as part of our nation's health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation;
(4) New practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex;
(5) The current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states; and
(6) Uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits.
(b) The general purposes of this compact are to:
(1) Facilitate the states' responsibility to protect the public's health and safety;
(2) Ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation;
(3) Facilitate the exchange of information between party states in the areas of nurse regulation, investigation, and adverse actions;
(4) Promote compliance with the laws governing the practice of nursing in each jurisdiction;
(5) Invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses;
(6) Decrease redundancies in the consideration and issuance of nurse licenses; and
(7) Provide opportunities for interstate practice by nurses who meet uniform licensure requirements.
ARTICLE II
Definitions
As used in this compact:
(a) "Adverse action" means any administrative, civil, equitable or criminal action permitted by a state's laws which is imposed by a licensing board or other authority against a nurse, including actions against an individual's license or multistate licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee's practice, or any other encumbrance on licensure affecting a nurse's authorization to practice, including issuance of a cease and desist action.
(b) "Alternative program" means a nondisciplinary monitoring program approved by a licensing board.
(c) "Coordinated licensure information system" means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws that is administered by a nonprofit organization composed of and controlled by licensing boards.
(d) "Current significant investigative information" means:
(1) Investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond, if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction; or
(2) Investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.
(e) "Encumbrance" means a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board.
(f) "Home state" means the party state which is the nurse's primary state of residence.
(g) "Licensing board" means a party state's regulatory body responsible for issuing nurse licenses.
(h) "Multistate license" means a license to practice as a registered or a licensed practical/vocational nurse (LPN/VN) issued by a home state licensing board that authorizes the licensed nurse to practice in all party states under a multistate licensure privilege.
(i) "Multistate licensure privilege" means a legal authorization associated with a multistate license permitting the practice of nursing as either a registered nurse (RN) or LPN/VN in a remote state.
(j) "Nurse" means RN or LPN/VN, as those terms are defined by each party state's practice laws.
(k) "Party state" means any state that has adopted this compact.
(l) "Remote state" means a party state, other than the home state.
(m) "Single-state license" means a nurse license issued by a party state that authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state.
(n) "State" means a state, territory, or possession of the United States and the District of Columbia.
(o) "State practice laws" means a party state's laws, rules, and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline. "State practice laws" do not include requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state.
ARTICLE III
General Provisions and Jurisdiction
(a) A multistate license to practice registered or licensed practical/vocational nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a nurse to practice as a registered nurse (RN) or as a licensed practical/vocational nurse (LPN/VN), under a multistate licensure privilege, in each party state.
(b) A state must implement procedures for considering the criminal history records of applicants for initial multistate license or licensure by endorsement. Such procedures shall include the submission of fingerprints or other biometric-based information by applicants for the purpose of obtaining an applicant's criminal history record information from the Federal Bureau of Investigation and the agency responsible for retaining that state's criminal records.
(c) Each party state shall require the following for an applicant to obtain or retain a multistate license in the home state:
(1) Meets the home state's qualifications for licensure or renewal of licensure as well as all other applicable state laws;
(2)(i) Has graduated or is eligible to graduate from a licensing board-approved RN or LPN/VN prelicensure education program; or
(ii) Has graduated from a foreign RN or LPN/VN prelicensure education program that (a) has been approved by the authorized accrediting body in the applicable country and (b) has been verified by an independent credentials review agency to be comparable to a licensing board-approved prelicensure education program;
(3) Has, if a graduate of a foreign prelicensure education program not taught in English or if English is not the individual's native language, successfully passed an English proficiency examination that includes the components of reading, speaking, writing, and listening;
(4) Has successfully passed an NCLEX-RN or NCLEX-PN Examination or recognized predecessor, as applicable;
(5) Is eligible for or holds an active, unencumbered license;
(6) Has submitted, in connection with an application for initial licensure or licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history record information from the Federal Bureau of Investigation and the agency responsible for retaining that state's criminal records;
(7) Has not been convicted or found guilty, or has entered into an agreed disposition, of a felony offense under applicable state or federal criminal law;
(8) Has not been convicted or found guilty, or has entered into an agreed disposition, of a misdemeanor offense related to the practice of nursing as determined on a case-by-case basis;
(9) Is not currently enrolled in an alternative program;
(10) Is subject to self-disclosure requirements regarding current participation in an alternative program; and
(11) Has a valid United States Social Security number.
(d) All party states shall be authorized, in accordance with existing state due process law, to take adverse action against a nurse's multistate licensure privilege such as revocation, suspension, probation or any other action that affects a nurse's authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such actions by remote states.
(e) A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. The practice of nursing is not limited to patient care, but shall include all nursing practice as defined by the state practice laws of the party state in which the client is located. The practice of nursing in a party state under a multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts and the laws of the party state in which the client is located at the time service is provided.
(f) Individuals not residing in a party state shall continue to be able to apply for a party state's single-state license as provided under the laws of each party state. However, the single-state license granted to these individuals will not be recognized as granting the privilege to practice nursing in any other party state. Nothing in this compact shall affect the requirements established by a party state for the issuance of a single-state license.
(g) Any nurse holding a home state multistate license, on the effective date of this compact, may retain and renew the multistate license issued by the nurse's then-current home state, provided that:
(1) A nurse, who changes primary state of residence after this compact's effective date, must meet all applicable Article III(c) requirements to obtain a multistate license from a new home state.
(2) A nurse who fails to satisfy the multistate licensure requirements in Article III(c) due to a disqualifying event occurring after this compact's effective date shall be ineligible to retain or renew a multistate license, and the nurse's multistate license shall be revoked or deactivated in accordance with applicable rules adopted by the Interstate Commission of Nurse Licensure Compact Administrators ("commission").
ARTICLE IV
Applications for Licensure in a Party State
(a) Upon application for a multistate license, the licensing board in the issuing party state shall ascertain, through the coordinated licensure information system, whether the applicant has ever held, or is the holder of, a license issued by any other state, whether there are any encumbrances on any license or multistate licensure privilege held by the applicant, whether any adverse action has been taken against any license or multistate licensure privilege held by the applicant and whether the applicant is currently participating in an alternative program.
(b) A nurse may hold a multistate license, issued by the home state, in only one party state at a time.
(c) If a nurse changes primary state of residence by moving between 2 party states, the nurse must apply for licensure in the new home state, and the multistate license issued by the prior home state will be deactivated in accordance with applicable rules adopted by the commission.
(1) The nurse may apply for licensure in advance of a change in primary state of residence.
(2) A multistate license shall not be issued by the new home state until the nurse provides satisfactory evidence of a change in primary state of residence to the new home state and satisfies all applicable requirements to obtain a multistate license from the new home state.
(d) If a nurse changes primary state of residence by moving from a party state to a nonparty state, the multistate license issued by the prior home state will convert to a single-state license, valid only in the former home state.
ARTICLE V
Additional Authorities Invested in Party State Licensing Boards
(a) In addition to the other powers conferred by state law, a licensing board shall have the authority to:
(1) Take adverse action against a nurse's multistate licensure privilege to practice within that party state.
(i) Only the home state shall have the power to take adverse action against a nurse's license issued by the home state.
(ii) For purposes of taking adverse action, the home state licensing board shall give the same priority and effect to reported conduct received from a remote state as it would if such conduct had occurred within the home state. In so doing, the home state shall apply its own state laws to determine appropriate action.
(2) Issue cease and desist orders or impose an encumbrance on a nurse's authority to practice within that party state.
(3) Complete any pending investigations of a nurse who changes primary state of residence during the course of such investigations. The licensing board shall also have the authority to take appropriate actions and shall promptly report the conclusions of such investigations to the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the new home state of any such actions.
(4) Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses as well as the production of evidence. Subpoenas issued by a licensing board in a party state for the attendance and testimony of witnesses or the production of evidence from another party state shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state in which the witnesses or evidence are located.
(5) Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-based information to the Federal Bureau of Investigation for criminal background checks, receive the results of the Federal Bureau of Investigation record search on criminal background checks and use the results in making licensure decisions.
(6) If otherwise permitted by state law, recover from the affected nurse the costs of investigations and disposition of cases resulting from any adverse action taken against that nurse.
(7) Take adverse action based on the factual findings of the remote state, provided that the licensing board follows its own procedures for taking such adverse action.
(b) If adverse action is taken by the home state against a nurse's multistate license, the nurse's multistate licensure privilege to practice in all other party states shall be deactivated until all encumbrances have been removed from the multistate license. All home state disciplinary orders that impose adverse action against a nurse's multistate license shall include a statement that the nurse's multistate licensure privilege is deactivated in all party states during the pendency of the order.
(c) Nothing in this compact shall override a party state's decision that participation in an alternative program may be used in lieu of adverse action. The home state licensing board shall deactivate the multistate licensure privilege under the multistate license of any nurse for the duration of the nurse's participation in an alternative program.
ARTICLE VI
Coordinated Licensure Information System and Exchange of Information
(a) All party states shall participate in a coordinated licensure information system of all licensed registered nurses (RNs) and licensed practical/vocational nurses (LPNs/VNs). This system will include information on the licensure and disciplinary history of each nurse, as submitted by party states, to assist in the coordination of nurse licensure and enforcement efforts.
(b) The commission, in consultation with the administrator of the coordinated licensure information system, shall formulate necessary and proper procedures for the identification, collection, and exchange of information under this compact.
(c) All licensing boards shall promptly report to the coordinated licensure information system any adverse action, any current significant investigative information, denials of applications (with the reasons for such denials) and nurse participation in alternative programs known to the licensing board regardless of whether such participation is deemed nonpublic or confidential under state law.
(d) Current significant investigative information and participation in nonpublic or confidential alternative programs shall be transmitted through the coordinated licensure information system only to party state licensing boards.
(e) Notwithstanding any other provision of law, all party state licensing boards contributing information to the coordinated licensure information system may designate information that may not be shared with nonparty states or disclosed to other entities or individuals without the express permission of the contributing state.
(f) Any personally identifiable information obtained from the coordinated licensure information system by a party state licensing board shall not be shared with nonparty states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information.
(g) Any information contributed to the coordinated licensure information system that is subsequently required to be expunged by the laws of the party state contributing that information shall also be expunged from the coordinated licensure information system.
(h) The compact administrator of each party state shall furnish a uniform data set to the compact administrator of each other party state, which shall include, at a minimum:
(1) Identifying information;
(2) Licensure data;
(3) Information related to alternative program participation; and
(4) Other information that may facilitate the administration of this compact, as determined by commission rules.
(i) The compact administrator of a party state shall provide all investigative documents and information requested by another party state.
ARTICLE VII
Establishment of the Interstate Commission of Nurse Licensure Compact Administrators
(a) The party states hereby create and establish a joint public entity known as the Interstate Commission of Nurse Licensure Compact Administrators.
(1) The commission is an instrumentality of the party states.
(2) Venue is proper, and judicial proceedings by or against the commission shall be brought solely and exclusively, in a court of competent jurisdiction where the principal office of the commission is located. The commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings.
(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity.
(b) Membership, Voting and Meetings.
(1) Each party state shall have and be limited to one administrator. The head of the state licensing board or designee shall be the administrator of this compact for each party state. The administrator for New Hampshire shall hold a current license issued by the New Hampshire board of nursing and shall represent the board of nursing. Any administrator may be removed or suspended from office as provided by the law of the state from which the administrator is appointed. Any vacancy occurring in the commission shall be filled in accordance with the laws of the party state in which the vacancy exists.
(2) Each administrator shall be entitled to one vote with regard to the adoption of rules and creation of bylaws and shall otherwise have an opportunity to participate in the business and affairs of the commission. An administrator shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for an administrator's participation in meetings by telephone or other means of communication.
(3) The commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in the bylaws or rules of the commission.
(4) All meetings shall be open to the public, and public notice of meetings shall be given in the same manner as required under the rulemaking provisions in Article VIII.
(5) The commission may convene in a closed, nonpublic meeting if the commission must discuss:
(i) Noncompliance of a party state with its obligations under this compact;
(ii) The employment, compensation, discipline or other personnel matters, practices or procedures related to specific employees or other matters related to the commission's internal personnel practices and procedures;
(iii) Current, threatened, or reasonably anticipated litigation;
(iv) Negotiation of contracts for the purchase or sale of goods, services, or real estate;
(v) Accusing any person of a crime or formally censuring any person;
(vi) Disclosure of trade secrets or commercial or financial information that is privileged or confidential;
(vii) Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;
(viii) Disclosure of investigatory records compiled for law enforcement purposes;
(ix) Disclosure of information related to any reports prepared by or on behalf of the commission for the purpose of investigation of compliance with this compact; or
(x) Matters specifically exempted from disclosure by federal or state statute.
(6) If a meeting, or portion of a meeting, is closed pursuant to this provision, the commission's legal counsel or designee shall certify that the meeting may be closed and shall reference each relevant exempting provision. The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons therefor, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and documents of a closed meeting shall remain under seal, subject to release by a majority vote of the commission or order of a court of competent jurisdiction.
(c) The commission shall, by a majority vote of the administrators, prescribe bylaws or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of this compact, including but not limited to:
(1) Establishing the fiscal year of the commission;
(2) Providing reasonable standards and procedures:
(i) For the establishment and meetings of other committees; and
(ii) Governing any general or specific delegation of any authority or function of the commission;
(3) Providing reasonable procedures for calling and conducting meetings of the commission, ensuring reasonable advance notice of all meetings and providing an opportunity for attendance of such meetings by interested parties, with enumerated exceptions designed to protect the public's interest, the privacy of individuals, and proprietary information, including trade secrets. The commission may meet in closed session only after a majority of the administrators vote to close a meeting in whole or in part. As soon as practicable, the commission must make public a copy of the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed;
(4) Establishing the titles, duties, and authority and reasonable procedures for the election of the officers of the commission;
(5) Providing reasonable standards and procedures for the establishment of the personnel policies and programs of the commission. Notwithstanding any civil service or other similar laws of any party state, the bylaws shall exclusively govern the personnel policies and programs of the commission; and
(6) Providing a mechanism for winding up the operations of the commission and the equitable disposition of any surplus funds that may exist after the termination of this compact after the payment or reserving of all of its debts and obligations;
(d) The commission shall publish its bylaws and rules, and any amendments thereto, in a convenient form on the website of the commission.
(e) The commission shall maintain its financial records in accordance with the bylaws.
(f) The commission shall meet and take such actions as are consistent with the provisions of this compact and the bylaws.
(g) The commission shall have the following powers:
(1) To adopt uniform rules to facilitate and coordinate implementation and administration of this compact. The rules shall have the force and effect of law and shall be binding in all party states;
(2) To bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing of any licensing board to sue or be sued under applicable law shall not be affected;
(3) To purchase and maintain insurance and bonds;
(4) To borrow, accept or contract for services of personnel, including, but not limited to, employees of a party state or nonprofit organizations;
(5) To cooperate with other organizations that administer state compacts related to the regulation of nursing, including but not limited to sharing administrative or staff expenses, office space or other resources;
(6) To hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this compact, and to establish the commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel and other related personnel matters;
(7) To accept any and all appropriate donations, grants and gifts of money, equipment, supplies, materials and services, and to receive, utilize and dispose of the same; provided that at all times the commission shall avoid any appearance of impropriety or conflict of interest;
(8) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use, any property, whether real, personal or mixed; provided that at all times the commission shall avoid any appearance of impropriety;
(9) To sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of any property, whether real, personal or mixed;
(10) To establish a budget and make expenditures;
(11) To borrow money;
(12) To appoint committees, including advisory committees comprised of administrators, state nursing regulators, state legislators or their representatives, and consumer representatives, and other such interested persons;
(13) To provide and receive information from, and to cooperate with, law enforcement agencies;
(14) To adopt and use an official seal; and
(15) To perform such other functions as may be necessary or appropriate to achieve the purposes of this compact consistent with the state regulation of nurse licensure and practice.
(h) Financing of the commission.
(1) The commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and ongoing activities.
(2) The commission may also levy on and collect an annual assessment from each party state to cover the cost of its operations, activities, and staff in its annual budget as approved each year. The aggregate annual assessment amount, if any, shall be allocated based upon a formula to be determined by the commission, which shall adopt a rule that is binding upon all party states.
(3) The commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same; nor shall the commission pledge the credit of any of the party states, except by, and with the authority of, such party state.
(4) The commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the commission shall be subject to the audit and accounting procedures established under its bylaws. However, all receipts and disbursements of funds handled by the commission shall be audited yearly by a certified or licensed public accountant, and the report of the audit shall be included in and become part of the annual report of the commission.
(i) Qualified Immunity, Defense and Indemnification.
(1) The administrators, officers, executive director, employees, and representatives of the commission shall be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred, within the scope of commission employment, duties or responsibilities; provided that nothing in this paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the intentional, willful, or wanton misconduct of that person.
(2) The commission shall defend any administrator, officer, executive director, employee, or representative of the commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties or responsibilities, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities; provided that nothing herein shall be construed to prohibit that person from retaining his or her own counsel; and provided further that the actual or alleged act, error, or omission did not result from that person's intentional, willful, or wanton misconduct.
(3) The commission shall indemnify and hold harmless any administrator, officer, executive director, employee, or representative of the commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result from the intentional, willful, or wanton misconduct of that person.
ARTICLE VIII
Rulemaking
(a) The commission shall exercise its rulemaking powers pursuant to the criteria set forth in this Article and the rules adopted thereunder. Rules and amendments shall become binding as of the date specified in each rule or amendment and shall have the same force and effect as provisions of this compact.
(b) Rules or amendments to the rules shall be adopted at a regular or special meeting of the commission.
(c) Prior to adoption of a final rule or rules by the commission, and at least 60 days in advance of the meeting at which the rule will be considered and voted upon, the commission shall file a notice of proposed rulemaking:
(1) On the website of the commission; and
(2) On the website of each licensing board or the publication in which each state would otherwise publish proposed rules.
(d) The notice of proposed rulemaking shall include:
(1) The proposed time, date and location of the meeting in which the rule will be considered and voted upon;
(2) The text of the proposed rule or amendment, and the reason for the proposed rule;
(3) A request for comments on the proposed rule from any interested person; and
(4) The manner in which interested persons may submit notice to the commission of their intention to attend the public hearing and any written comments.
(e) Prior to adoption of a proposed rule, the commission shall allow persons to submit written data, facts, opinions, and arguments, which shall be made available to the public.
(f) The commission shall grant an opportunity for a public hearing before it adopts a rule or amendment.
(g) The commission shall publish the place, time, and date of the scheduled public hearing.
(1) Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing. All hearings will be recorded, and a copy will be made available upon request.
(2) Nothing in this section shall be construed as requiring a separate hearing on each rule. Rules may be grouped for the convenience of the commission at hearings required by this section.
(h) If no one appears at the public hearing, the commission may proceed with adoption of the proposed rule.
(i) Following the scheduled hearing date, or by the close of business on the scheduled hearing date if the hearing was not held, the commission shall consider all written and oral comments received.
(j) The commission shall, by majority vote of all administrators, take final action on the proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule.
(k) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule without prior notice, opportunity for comment, or hearing, provided that the usual rulemaking procedures provided in this compact and in this section shall be retroactively applied to the rule as soon as reasonably possible, in no event later than 90 days after the effective date of the rule. For the purposes of this provision, an emergency rule is one that must be adopted immediately in order to:
(1) Meet an imminent threat to public health, safety or welfare;
(2) Prevent a loss of commission or party state funds; or
(3) Meet a deadline for the adoption of an administrative rule that is required by federal law or rule.
(l) The commission may direct revisions to a previously adopted rule or amendment for purposes of correcting typographical errors, errors in format, errors in consistency or grammatical errors. Public notice of any revisions shall be posted on the website of the commission. The revision shall be subject to challenge by any person for a period of 30 days after posting. The revision may be challenged only on grounds that the revision results in a material change to a rule. A challenge shall be made in writing, and delivered to the commission, prior to the end of the notice period. If no challenge is made, the revision will take effect without further action. If the revision is challenged, the revision may not take effect without the approval of the commission.
ARTICLE IX
Oversight, Dispute Resolution and Enforcement
(a) Oversight.
(1) Each party state shall enforce this compact and take all actions necessary and appropriate to effectuate this compact's purposes and intent.
(2) The commission shall be entitled to receive service of process in any proceeding that may affect the powers, responsibilities, or actions of the commission, and shall have standing to intervene in such a proceeding for all purposes. Failure to provide service of process in such proceeding to the commission shall render a judgment or order void as to the commission, this compact, or adopted rules.
(b) Default, Technical Assistance and Termination.
(1) If the commission determines that a party state has defaulted in the performance of its obligations or responsibilities under this compact or the adopted rules, the commission shall:
(i) Provide written notice to the defaulting state and other party states of the nature of the default, the proposed means of curing the default, or any other action to be taken by the commission; and
(ii) Provide remedial training and specific technical assistance regarding the default.
(2) If a state in default fails to cure the default, the defaulting state's membership in this compact may be terminated upon an affirmative vote of a majority of the administrators, and all rights, privileges, and benefits conferred by this compact may be terminated on the effective date of termination. A cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default.
(3) Termination of membership in this compact shall be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given by the commission to the governor of the defaulting state and to the executive officer of the defaulting state's licensing board and each of the party states.
(4) A state whose membership in this compact has been terminated is responsible for all assessments, obligations, and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination.
(5) The commission shall not bear any costs related to a state that is found to be in default or whose membership in this compact has been terminated unless agreed upon in writing between the commission and the defaulting state.
(6) The defaulting state may appeal the action of the commission by petitioning the U.S. District Court for the District of Columbia or the federal district in which the commission has its principal offices. The prevailing party shall be awarded all costs of such litigation, including reasonable attorneys' fees.
(c) Dispute Resolution.
(1) Upon request by a party state, the commission shall attempt to resolve disputes related to the compact that arise among party states and between party and nonparty states.
(2) The commission shall adopt a rule providing for both mediation and binding dispute resolution for disputes, as appropriate.
(3) In the event the commission cannot resolve disputes among party states arising under this compact:
(i) The party states may submit the issues in dispute to an arbitration panel, which will be comprised of individuals appointed by the compact administrator in each of the affected party states and an individual mutually agreed upon by the compact administrators of all the party states involved in the dispute.
(ii) The decision of a majority of the arbitrators shall be final and binding.
(d) Enforcement.
(1) The commission, in the reasonable exercise of its discretion, shall enforce the provision and rules of this compact.
(2) By majority vote, the commission may initiate legal action in the U.S. District Court for the District of Columbia or the federal district in which the commission has its principal offices against a party state that is in default to enforce compliance with the provisions of this compact and its adopted rules and bylaws. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorneys' fees.
(3) The remedies herein shall not be the exclusive remedies of the commission. The commission may pursue any other remedies available under federal or state law.
ARTICLE X
Effective Date, Withdrawal and Amendment
(a) This compact shall become effective and binding on the earlier of the date of legislative enactment of this compact into law by no less than 26 states or December 31, 2018. All party states to this compact, that also were parties to the prior nurse licensure compact, superseded by this compact, ("prior compact"), shall be deemed to have withdrawn from said prior compact within 6 months after the effective date of this compact.
(b) Each party state to this compact shall continue to recognize a nurse's multistate licensure privilege to practice in that party state issued under the prior compact until such party state has withdrawn from the prior compact.
(c) Any party state may withdraw from this compact by enacting a statute repealing the same. A party state's withdrawal shall not take effect until 6 months after enactment of the repealing statute.
(d) A party state's withdrawal or termination shall not affect the continuing requirement of the withdrawing or terminated state's licensing board to report adverse actions and significant investigations occurring prior to the effective date of such withdrawal or termination.
(e) Nothing contained in this compact shall be construed to invalidate or prevent any nurse licensure agreement or other cooperative arrangement between a party state and a nonparty state that is made in accordance with the other provisions of this compact.
(f) This compact may be amended by the party states. No amendment to this compact shall become effective and binding upon the party states unless and until it is enacted into the laws of all party states.
(g) Representatives of nonparty states to this compact shall be invited to participate in the activities of the commission, on a nonvoting basis, prior to the adoption of this compact by all states.
ARTICLE XI
Construction and Severability
This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact shall be severable, and if any phrase, clause, sentence or provision of this compact is declared to be contrary to the constitution of any party state or of the United States, or if the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person or circumstance shall not be affected thereby. If this compact shall be held to be contrary to the constitution of any party state, this compact shall remain in full force and effect as to the remaining party states and in full force and effect as to the party state affected as to all severable matters.

Source. 2005, 293:1. 2016, 238:1, eff. July 20, 2017.