N/A
2. Detailed Description of the Objective of the Proposed Rule
The primary intent of this proposed rule is to respond to recent legislation and incorporate such provisions that allow the administration of nitrous oxide inhalation analgesia by licensed dental hygienists. Currently, the Dentistry Examining Board certifies qualified dental hygienists to administer anesthesia, which does not include nitrous oxide inhalation analgesia (nitrous oxide). Licensed dentists, having met the training requirements may administer nitrous oxide and with supervision, hygienists may monitor patients. The practice of hygiene will be reviewed and revisions proposed to reflect current practice and use of technology within the practice of dentistry and dental hygiene.
Typographical errors, formatting, and other corrections and cross-references will be made, as some these chapters have not been revised since the 1990's. Where applicable, notes will be updated to reflect current information.
3. Description of the Existing Policies Relevant to the Rule, New Policies Proposed to be Included in the Rule, and an Analysis of Policy Alternatives
Currently, a dental assistant and dental hygienist may assist the dentist in the monitoring of the patient's condition while undergoing nitrous oxide treatment, [s.
DE 12.01 (2)]. A dental hygienist may not administer or adjust the concentration of nitrous oxide as s.
DE 3.03 (1) prohibits a dental assistant or dental hygienist from administering or prescribing nitrous oxide. In addition, a licensee is not required to apply for a permit for administering sedation separate from an application for a professional license. A Class I sedation permit is not required before the administration of nitrous oxide inhalation analgesia. Under s.
DE 11.03 (2), a dentist utilizing nitrous oxide inhalation shall be trained and certified in administering basic life support. This certification is renewed in compliance with the standards set forth by the American Heart Association, the American Red Cross, or other organizations approved by the board (or DHS). In the current rules, an Application for Dental Hygiene Certificate to Administer Local Anesthesia is required. There are no proposed changes in the type or level of training for a dental hygienist applying for a sedation permit to administer nitrous oxide inhalation analgesia.
Nitrous oxide inhalation analgesia is just one option available for sedation in the practice or dentistry. Research has shown that this class of sedation is used for not only pain control, but also as a sedation that is highly effective in the management of mild to moderate levels of dental anxiety. Nitrous oxide inhalation analgesia is also used in routine procedures undertaken by hygienists such as planing and scaling. It is also administered to patients of all ages having advanced periodontal disease due to dental anxiety or lack of dental care. Nitrous oxide inhalation analgesia has been highly effective in allowing on-going audible and verbal communication between the patient and health-care provider during examination and dental procedures.
4. Detailed Explanation of Statutory Authority for the Rule (Including the Statutory Citation and Language)
Section
447.02 (1) reads: “447.02 Dentistry examining board. (1) The examining board may promulgate rules:
(a) Governing the reexamination of an applicant who fails an examination specified in s.
447.04 (1) (a) 5. or
(2) (a) 5. The rules may specify additional educational requirements for those applicants and may specify the number of times an applicant may be examined.
(b) Governing the standards and conditions for the use of radiation and ionizing equipment in the practice of dentistry.
(c) Subject to ch.
553 and s.
447.06 (1), governing dental franchising.
(d) Specifying practices, in addition to the practices specified under s.
447.01 (3) (a) to
(f), that are included within the practice of dental hygiene.
(e) Providing for the granting of temporary licenses under this chapter."
Section
447.02 (2) (b) and
(e) reads: “447.02 (2) The examining board shall promulgate rules specifying all of the following:
(b) The standards, conditions and any educational requirements that are in addition to the requirements specified in s.
447.04 (1) that must be met by a dentist to be permitted to induce general anesthesia or conscious sedation in connection with the practice of dentistry.
(e) The educational requirements for administration of local anesthesia by a dental hygienist licensed under this chapter under s.
447.06 (2) (e) 2."
5. Estimate of Amount of Time that State Employees Will Spend Developing the Rule and of Other Resources Necessary to Develop the Rule
The staff time needed to develop the rules is expected to be about 160 hours, depending on the complexity. This includes coordinating the rule-making process with the Board, research, rule drafting, and processing the rules through public hearings, legislative review, and adoption. The agency will utilize existing staff. There are no other resources necessary to develop the rules.
6. List with Description of all Entities that may be Affected by the Proposed Rule
Licensed dental hygienists and dentists.
7. Summary and Preliminary Comparison with any Existing or Proposed Federal Regulation that is Intended to Address the Activities to be Regulated by the Proposed Rule
There is no known exiting or proposed federal regulations addressing the administration of nitrous oxide inhalation analgesia by licensed dental hygienists. With regard to the definition of “dentistry" or limitations on dental specialties, no exiting or proposed federal regulations were found.
8. Anticipated Economic Impact of Implementing the Rule (Note if the Rule is Likely to Have a Significant Economic Impact on Small Businesses)
The proposed rule is not expected to have a significant adverse economic impact on small business, as defined in s.
227.114 (1), Stats.
Contact Person
Jean MacCubbin, (608) 266-0955.
Safety and Professional Services —
Board of Nursing
This statement of scope was approved by the governor on March 19, 2014, for publication.
Rule No.
Chapters
N 5 and
6 (revise).
Relating to
Renewal and standards of practice.
Rule Type
Permanent.
1. Finding/Nature of Emergency (for Emergency Rules Only)
N/A
2. Detailed Description of the Objective of the Proposed Rule
The objective of the proposed rule is to do a comprehensive review and update of the renewal process and standards of practice chapters in order to bring them up-to-date with current practice.
3. Description of the Existing Policies Relevant to the Rule, New Policies Proposed to be Included in the Rule, and an Analysis of Policy Alternatives
The current renewal chapter contains rules which are inconsistent with current practices for renewal and include outdated references. The proposed policies for the renewal chapter are to update the renewal rules to recognize modern practices, technologies and procedures, remove obsolete references and correct inconsistencies with statutes.
The Board plans to review the standards of practice chapter to ensure the rules are updated to current nursing practice standards.
The alternative to the proposed policies is to not update to current practices and procedures.
4. Detailed Explanation of Statutory Authority for the Rule (Including the Statutory Citation and Language)
Section
15.08 (5) (b) Each examining board: shall promulgate rules for its own guidance and for the guidance of the trade or profession to which it pertains and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the particular trade or profession.
Section
441.01 (3) The board may establish minimum standards for schools for professional nurses and schools for licensed practical nurses, including all related clinical units and facilities, and make and provide periodic surveys and consultations to such schools. It may also establish rules to prevent unauthorized persons from practicing professional nursing. It shall approve all rules for the administration of this chapter in accordance with ch.
227.
5. Estimate of Amount of Time that State Employees Will Spend Developing the Rule and of Other Resources Necessary to Develop the Rule
125 hours
6. List with description of all entities that may be affected by the proposed rule
Nurses and health care entities.
7. Summary and preliminary comparison with any existing or proposed federal regulation that is intended to address the activities to be regulated by the proposed rule:
None
8. Anticipated Economic Impact of Implementing the Rule (Note if the Rule is Likely to Have a Significant Economic Impact on Small Businesses)
None or minimal. It is not likely to have a significant economic impact on small businesses.
Contact Person
Sharon Henes, Administrative Rules Coordinator, (608) 261-2377.
Safety and Professional Services —
Board of Nursing
This statement of scope was approved by the Governor on March 25, 2014.
Rule No.
Relating to
Advanced practice nurse prescribers.
Rule Type
Permanent.
1. Finding/Nature of Emergency (for Emergency Rules Only)
N/A
2. Detailed Description of the Objective of the Proposed Rule
The current ch.
N 8 was created in 1995 with only a few minor revisions. The Board's intention is to do a comprehensive review, evaluation and update to the rules governing advance practice nurse prescribers.
3. Description of the Existing Policies Relevant to the Rule, New Policies Proposed to be Included in the Rule, and an Analysis of Policy Alternatives
The Board will update the chapter to reflect current procedures and the changes in the profession.
Stakeholders have brought to the Board's attention that national certification bodies which previously certified clinical nurse specialist in a specific specialty no longer certifies that specialty. Other states have addressed with requirements which did not include relying on a national certification. The Board will consider options to address this stakeholder concern as part of the rule-making project.
The alternative is to keep the current rules which have some inconsistency with the statute and rules, and maintain procedures and practice of the profession which remain out-of-date.
4. Detailed Explanation of Statutory Authority for the Rule (Including the Statutory Citation and Language)
Section
15.08 (5) (b) Each examining board: shall promulgate rules for its own guidance and for the guidance of the trade or profession to which it pertains and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the particular trade or profession.
Section
441.01 (3) The board may establish minimum standards for schools for professional nurses and schools for licensed practical nurses, including all related clinical units and facilities, and make and provide periodic surveys and consultations to such schools. It may also establish rules to prevent unauthorized persons from practicing professional nursing. It shall approve all rules for the administration of this chapter in accordance with ch.
227.
Section
441.16 (3) The board shall promulgate rules necessary to administer this section, including rules for all of the following:
(a) Establishing the education, training or experience requirements that a registered nurse must satisfy to be an advanced practice nurse. The rules promulgated under this paragraph shall require a registered nurse to have education, training or experience that is in addition to the education, training or experience required for licensure as a registered nurse.
(am) Establishing the appropriate education, training and examination requirements that an advanced practice nurse must satisfy to qualify for a certificate to issue prescription orders.
(b) Defining the scope of practice within which an advanced practice nurse may issue prescription orders.
(c) Specifying the classes of drugs, individual drugs or devices that may not be prescribed by an advanced practice nurse.
(cm) Specifying the conditions to be met for a registered nurse to do the following:
1. Administer a drug prescribed by an advanced practice nurse who is certified to issue prescription orders.
2. Administer a drug at the direction of an advanced practice nurse who is certified to issue prescription orders.
(d) Establishing procedures for maintaining a certificate to issue prescription orders, including requirements for continuing education and a requirement to complete the nursing workforce survey and submit the fee required under s.
441.01 (7).
(e) Establishing the minimum amount of malpractice liability insurance coverage that an advanced practice nurse shall have if he or she is certified to issue prescription orders. The board shall promulgate rules under this paragraph in consultation with the commissioner of insurance.
5. Estimate of Amount of Time that State Employees Will Spend Developing the Rule and of Other Resources Necessary to Develop the Rule
175 hours
