CHAPTER 7
ADVANCED REGISTERED NURSE PRACTITIONERS
[Prior to 8/26/87, Nursing Board[590] Ch 7]
655—7.1(152) Definitions.
“Advanced registered nurse practitioner (ARNP)” is a nurse with current licensure as a registered nurse in Iowa who is registered in Iowa to practice in an advanced role. The ARNP is prepared for an advanced role by virtue of additional knowledge and skills gained through an organized postbasic program of nursing in a specialty area approved by the board. In the advanced role, the nurse practices nursing assessment, intervention, and management within the boundaries of the nurse-client relationship. Advanced nursing practice occurs in a variety of settings within an interdisciplinary health care team which provide for consultation, collaborative management, or referral. The ARNP may perform selected medically delegated functions when a collaborative practice agreement exists.
“Basic nursing education” as used in this chapter is a nursing program that prepares a person for initial licensure to practice nursing as a registered nurse.
“Board” as used in this chapter means Iowa board of nursing.
“Certified clinical nurse specialist” is an ARNP prepared at the master’s level who possesses evidence of current certification as a clinical specialist in an area of nursing practice by a national professional nursing association as approved by the board.
“Certified nurse-midwife” is an ARNP educated in the disciplines of nursing and midwifery who possesses evidence of current certification by a national professional nursing association approved by the board. The certified nurse-midwife is authorized to manage the care of normal newborns and women, antepartally, intrapartally, postpartally or gynecologically.
“Certified nurse practitioner” is an ARNP educated in the disciplines of nursing who has advanced knowledge of nursing, physical and psychosocial assessment, appropriate interventions, and management of health care, and who possesses evidence of current certification by a national professional nursing association approved by the board.
“Certified registered nurse anesthetist” is an ARNP educated in the disciplines of nursing and anesthesia who possesses evidence of current certification by a national professional nursing association approved by the board.
“Collaboration” is the process whereby an ARNP and physician jointly manage the care of a client.
“Collaborative practice agreement” means an ARNP and physician practicing together within the framework of their respective professional scopes of practice. This collaborative agreement reflects both independent and cooperative decision making and is based on the preparation and ability of each practitioner.
“Consultation” is the process whereby an ARNP seeks the advice or opinion of a physician, pharmacist, or another member of the health care team. ARNPs practicing in a noninstitutional setting as sole practitioners, or in small clinical practice groups, shall regularly consult with a licensed physician or pharmacist regarding the distribution, storage, and appropriate use of controlled substances.
“Controlled substance” is a drug, substance, or immediate precursor in Schedules I through V of division II, Iowa Code chapter 124.
“Fees” means those fees collected which are based upon the cost of sustaining the board. The fees set by the board are as follows:
	1.	For a license registration or renewal to practice as an ARNP, $16 per year or any period thereof.
	2.	For a duplicate registration card/original certificate to practice as an ARNP, $15.
	3.	For ARNP late renewal, $10 plus the renewal fee.
	4.	For ARNP delinquent registration fee, $50 plus all renewal fees to date due.
	5.	For a check returned for any reason, $10.
“National professional nursing association” is a professional nursing organization approved by the board. Agencies approved by the board include the American Nurses Credentialing Center, the American Academy of Nurse Practitioners, the American College of Nurse-Midwives, the Council on Certification of Nurse Anesthetists, the National Certification Board of Pediatric Nurse Practitioners and Nurses, the National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties, and the Oncology Nursing Certification Organization.
“Physician” means a medical doctor licensed under Iowa Code chapter 148 or osteopathic physician and surgeon licensed under Iowa Code chapter 150A.
“Prescriptive authority” is the authority granted to an ARNP registered in Iowa in a recognized nursing specialty to prescribe, deliver, distribute, or dispense prescription drugs, devices, and medical gases when the nurse is engaged in the practice of that nursing specialty. Registration as a practitioner with the Federal Drug Enforcement Administration and the Iowa board of pharmacy examiners extends this authority to controlled substances. ARNPs shall obtain a copy of the Iowa Pharmacy Law and Informational Manual. ARNPs are encouraged to subscribe to the Iowa Board of Pharmacy Newsletter.
“Referral” is the process whereby the ARNP directs the client to a physician or another health care professional for management of a particular problem or aspect of the client’s care.
655—7.2(152) General requirements for the advanced registered nurse practitioner.
	7.2(1) Specialty areas of nursing practice for the advanced registered nurse practitioner. The board derives its authority to define the educational and clinical experience that is necessary to practice at an advanced registered nurse practitioner level under the provisions of Iowa Code section 152.1(6)“d.” The specialty areas of nursing practice for the advanced registered nurse practitioner which shall be considered as legally authorized by the board are as follows:
	a. 	Certified clinical nurse specialist.
	b. 	Certified nurse-midwife.
	c. 	Certified nurse practitioner.
	d. 	Certified registered nurse anesthetist.
	7.2(2) Titles and abbreviations. A registered nurse who has completed all requirements to practice as an advanced registered nurse practitioner and who is registered with the board to practice shall use the title advanced registered nurse practitioner (ARNP). Utilization of the title which denotes the specialty area is at the discretion of the advanced registered nurse practitioner.
	a. 	No person shall practice or advertise as or use the title of advanced registered nurse practitioner for any of the defined specialty areas unless the name, title and specialty area appear on the official record of the board and on the current license.
	b. 	No person shall use the abbreviation ARNP for any of the defined specialty areas or any other words, letters, signs or figures to indicate that the person is an advanced registered nurse practitioner unless the name, title and specialty area appears on the official record of the board and on the current license.
	c. 	Any person found to be practicing under the title of advanced registered nurse practitioner or using the abbreviation ARNP without being registered as defined in this subrule shall be subject to disciplinary action.
	7.2(3) General education and clinical requirements.
	a. 	The general educational and clinical requirements necessary for recognition by the board as a specialty area of nursing practice are as follows:
	(1)	Graduation from a program leading to a master’s degree in a nursing clinical specialty area with preparation in specialized practitioner skills as approved by the board; or
	(2)	Satisfactory completion of an organized postbasic program of study and appropriate clinical experience as approved by the board.
	b. 	Additional requirements. Nothing in this rule shall be construed to mean that additional general educational or clinical requirements cannot be defined in a specialty area.
	7.2(4) Application process. A registered nurse who wishes to practice as an advanced registered nurse practitioner shall submit the following to the office of the board:
	a. 	An advanced registered nurse practitioner application form which may be obtained from the office of the board.
	b. 	A registration fee as established by the board.
	c. 	A copy of certification by appropriate national organization; copy of official transcript from formal postbasic training necessary to document that all requirements have been met in one of the specialty areas of nursing practice as listed in subrule 7.2(1). A registered nurse may make application to practice in more than one specialty area of nursing practice.
	7.2(5) Initial registration. The executive director or a designee shall have the authority to determine if all requirements have been met for registration as an advanced registered nurse practitioner. If it has been determined that all requirements have been met:
	a. 	Official licensure records of the registered nurse shall denote registration as an advanced registered nurse practitioner as well as the specialty area(s) of nursing practice.
	b. 	The registered nurse shall be issued a registration card and a certificate to practice as an ARNP which clearly denotes the name, title, specialty area(s) of nursing practice, and expiration date of registration. The expiration date shall be based on the same period of license to practice as a registered nurse.
	7.2(6) Denial of registration. If it has been determined that all requirements have not been met, the registered nurse shall be notified in writing of the reason(s) for the decision. The applicant shall have the right of appeal to the Iowa board of nursing within 30 days of denial by the executive director or designee.
	7.2(7) Application process for renewal of registration. Renewal of registration for the advanced registered nurse practitioner shall be for the same period of license to practice as a registered nurse. The executive director or a designee shall have the authority to determine if all requirements have been met for renewal as an advanced registered nurse practitioner. A registered nurse who wishes to continue practice as an advanced registered nurse practitioner shall submit the following at least 30 days prior to the license expiration to the office of the Iowa board of nursing:
	a. 	Completed renewal application form.
	b. 	Renewal fee as outlined in rule 7.1(152), definition of “fees.”
	c. 	Copy of current certification by appropriate national organization.
	7.2(8) Continuing education requirements. Continuing education shall be met as required for certification by the relevant national certification board or agency, as outlined in subrule 5.2(3), paragraph “e.”
	7.2(9) Denial of renewal registration. If it has been determined that all requirements have not been met, the applicant shall be notified in writing of the reason(s) for the decision. Failure to obtain the renewal will result in termination of registration and of the right to practice in the advanced registered nurse practitioner specialty area(s). The applicant shall have the right of appeal to the Iowa board of nursing within 30 days of denial of the executive director or designee.
	7.2(10) License to practice as an advanced registered nurse practitioner revoked, suspended, etc. The board may restrict, suspend or revoke a license to practice as an advanced registered nurse practitioner on any of the grounds stated in Iowa Code section 147.55 or 152.10 or chapter 272C. In addition:
	a. 	The board may refer a complaint against an advanced registered nurse practitioner to a peer review committee for investigation and review in accordance with Iowa Code section 272C.6(2).
	b. 	The peer review committee shall be comprised of three advanced registered nurse practitioners in the same specialty area of nursing practice.
	c. 	The board may appoint a physician from a related area of medical specialty to serve as a consultant to the peer review committee.
These rules are intended to implement Iowa Code sections 17A.3, 147.10, 147.53, 147.76, 147.107(6) and 152.1.
[Filed 2/11/83, Notice 9/1/82—published 3/2/83, effective 4/6/83]
[Filed emergency 3/25/83—published 4/13/83, effective 4/6/83]
[Filed 5/18/83, Notice 4/13/83—published 6/8/83, effective 7/13/83]
[Filed emergency 5/31/83—published 6/22/83, effective 7/13/83]
[Filed 7/29/83, Notice 5/11/83—published 8/17/83, effective 9/21/83]
[Filed 4/20/84, Notice 2/29/84—published 5/9/84, effective 6/13/84]
[Filed 7/26/84, Notice 6/20/84—published 8/15/84, effective 9/19/84]
[Filed 10/17/84, Notice 8/29/84—published 11/7/84, effective 12/12/84]
[Filed 12/8/86, Notice 10/22/86—published 12/31/86, effective 2/4/87]
[Filed emergency 7/29/87—published 8/26/87, effective 7/29/87]
[Filed 7/7/89, Notice 4/5/89—published 7/26/89, effective 8/30/89]
[Filed 3/12/91, Notice 1/9/91—published 4/3/91, effective 5/8/91]
[Filed emergency 2/20/92—published 3/18/92, effective 2/20/92]
[Filed 12/9/92, Notice 10/14/92—published 1/6/93, effective 2/10/93]
[Filed emergency 1/14/93—published 2/3/93, effective 2/10/93]
[Filed emergency 2/10/93 after Notice 1/6/93—published 3/3/93, effective 2/10/93]
[Filed 11/16/94, Notice 7/6/94—published 12/7/94, effective 1/11/95]