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COMMITTEE REPORT
February 26, 2004
S. 898
Introduced by Senators J. Verne Smith, Fair, Knotts, Thomas, Martin, Land, Moore and Alexander
S. Printed 2/26/04--S.
Read the first time February 3, 2004.
To whom was referred a Bill (S. 898) to amend Chapter 33, Title 40, Code of Laws of South Carolina, 1976, relating to the licensure and regulation of the nursing profession, so as to conform, etc., respectfully
That they have duly and carefully considered the same and recommend that the same do pass with amendment:
Amend the bill, as and if amended, Section 40-33-10(A), page 19, by striking line 24 and inserting:
/ on matters requested by the Board of Nursing. /
Amend further, Section 40-33-20(24), page 25, by striking lines 18-19 and inserting:
/ (24) 'Delivering' means the act of handing over to a patient medications as ordered by an authorized licensed provider and prepared by an authorized licensed provider. /
Amend further, Section 40-33-36(D)(1)(b), page 42, by striking lines 8-9 and inserting:
/ application, paid the fee, and has produced a valid license to practice in another jurisdiction. /
Amend further, Section 40-33-37(A)(1), page 42, by striking line 31 and inserting:
/ (1) has been granted inactive status and has practiced /
Amend further, beginning on page 45, by striking Section 40-33-43 in its entirety and inserting:
/ Section 40-33-43. In community residential care facilities, the provision of medications may be performed by selected unlicensed persons with documented medication training and skill competency evaluation. The provision of medications by selected unlicensed persons is limited to oral and topical medications, and regularly scheduled insulin, and prescribed anaphylactic treatments under established medical protocol and does not include sliding scale insulin or other injectable medications. Licensed nurses may train and supervise selected unlicensed persons to provide medications and, after reviewing their competency evaluations, may approve selected unlicensed persons for the provision of medications. /
Renumber sections to conform.
Amend title to conform.
J. VERNE SMITH for Committee.
TO AMEND CHAPTER 33, TITLE 40, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE LICENSURE AND REGULATION OF THE NURSING PROFESSION, SO AS TO CONFORM THIS CHAPTER TO THE STATUTORY ORGANIZATIONAL FRAMEWORK OF CHAPTER 1, TITLE 40 FOR BOARDS UNDER THE ADMINISTRATION OF THE DEPARTMENT OF LABOR, LICENSING AND REGULATION INCLUDING, BUT NOT LIMITED TO, INCREASING THE BOARD MEMBERSHIP FROM NINE TO TEN BY ADDING A LAY PERSON, TO CODIFY AND FURTHER SPECIFY THE REQUIREMENTS FOR LICENSURE AND SCOPE OF PRACTICE FOR A NURSE PRACTITIONER, CERTIFIED NURSE-MIDWIFE, CLINICAL NURSE SPECIALIST, AND CERTIFIED REGISTERED NURSE ANESTHETIST, TO FURTHER SPECIFY LICENSURE AND EXAMINATION PROCEDURES, TO PROVIDE PROCEDURES AND REQUIREMENTS FOR EXPANDED PRACTICE IN NURSING, AND TO FURTHER PROVIDE FOR THE LICENSURE AND REGULATION OF THE NURSING PROFESSION.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 33, Title 40 of the 1976 Code is amended to read:
Section 40-33-10. For the purposes of this chapter:
(a) "Board" means the State Board of Nursing for South Carolina.
(b) "Temporary permit" means a current time-limited document which permits the practice of nursing at the level for which one is seeking licensure.
(c) "License" means a current document permitting the practice of nursing as a registered nurse or a licensed practical nurse.
(d) "Registered nurse" means a person to whom the board has issued a license as registered nurse.
(e) "Licensed practical nurse" means a person to whom the board has issued a license as licensed practical nurse.
(f) "Practice of nursing" means the provision of services for compensation that assist individuals and groups to obtain or maintain optimal health. Nursing practice is commensurate with the educational preparation and demonstrated competencies of the individual who is accountable to the public for the quality of nursing care. Nursing practice includes the provision of direct care and treatment services including the implementation of a medical regimen as authorized and prescribed by a licensed physician, dentist, or other person authorized by law, teaching, counseling, administration, research, consultation, supervision, delegation, and evaluation of practice. Nursing process includes the assessment and nursing diagnosis of human responses to actual or potential health problems and the planning, intervention, and evaluation of care in the promotion and maintenance of health, the casefinding and nursing management of illness, injury, or infirmity, the restoration of optimum function, or the achievement of a dignified death.
(g) "Practice of professional nursing" means the performance for compensation of any acts in the health care process involving the process of assessment, intervention, and evaluation. This process includes observation, care, and counsel of the ill, injured, infirm, the promotion and maintenance of health, the administration of medications, and treatments as authorized and prescribed by a licensed physician or a licensed dentist. The application of the nursing process requires substantial specialized independent judgment and skill and is based on knowledge and application of the principles of biophysical and social sciences. The practice of professional nursing includes the teaching and administration, supervision, delegation, and evaluation of nursing practice. A professional nurse may perform additional acts in the extended role requiring special education and training which are agreed to jointly by both the Board of Nursing and the Board of Medical Examiners. Those additional acts agreed to by both boards must be promulgated by the Board of Nursing in its regulations.
(h) "Practice of practical nursing" means the performance for compensation, under the direction of a registered nurse, licensed physician, or licensed dentist, of acts in health care maintenance, care of the ill, injured, and infirm, and in administering treatments and medications as authorized and prescribed by a licensed physician or licensed dentist, which acts require knowledge, judgment, and skill as prerequisites to licensure under this chapter, and which do not include acts of diagnosis or prescription of therapeutic or corrective measures. A licensed practical nurse may perform additional acts requiring special education and training, approved by the board, which are proper for the licensee to perform and which are recognized by the board through its regulations.
(i) "Lapsed license" means the termination of an individual's privilege to practice nursing due to the individual's failure to renew the nursing license within a specified period of time.
(j) "Voluntary surrender" means the invalidation of the nursing license at the time of its relinquishment and thereafter. No person whose license is voluntarily surrendered may practice nursing or represent himself to be a registered nurse or a licensed practical nurse until the board takes action.
(k) "Inactive license" means the temporary retirement of an individual's privilege to practice nursing upon the individual's notice to the board that he does not plan to practice nursing for at least one year.
(l) "Accreditation" means official authorization or status granted by an agency other than a state board of nursing.
(m) "Approval" means the process by which the board evaluates and grants official recognition to nursing education programs which meet established uniform and reasonable standards.
(n) "Nursing diagnosis" means a clinical judgment about an individual, family, or community which is derived through a nursing assessment.
(o) "Attendant care services" means those basic and ancillary services that enable an individual in need of in-home care to live in the individual's home and community rather than in an institution and to carry out functions of daily living, self-care, and mobility.
(p) "Basic services" includes, but is not limited to:
(1) getting in and out of a bed, wheelchair, motor vehicle, or other device;
(2) assistance with routine bodily functions including, but not limited to, health maintenance activities, bathing and personal hygiene, dressing and grooming, and feeding, including preparation and cleanup.
(q) "Ancillary services" means services ancillary to the basic services provided to an individual in need of in-home care who needs one or more of the basic services and includes:
(1) homemaker-type services including, but not limited to, shopping, laundry, cleaning, and seasonal chores;
(2) companion-type services including, but not limited to, transportation, letter writing, reading mail, and escorting; and
(3) assistance with cognitive tasks including, but not limited to, managing finances, planning activities, and making decisions.
(r) "Health maintenance activities" include, but are not limited to, catheter irrigation, administration of medications, enemas and suppositories, and wound care, if these activities could be performed by the individual if the individual were physically capable.
(s) "Individual in need of in-home care" means a functionally disabled individual in need of attendant care services because of impairment who requires assistance to complete functions of daily living, self-care, and mobility including, but not limited to, attendant care services.
Section 40-33-20. It is unlawful for any person to practice as a registered nurse or a practical nurse, to use the abbreviation "R.N." or "L.P.N." or any sign, card, or device to indicate that a person is a registered nurse or a licensed practical nurse, within the meaning of this chapter, in this State, who fails to comply with the provisions of this chapter, to include a lapsed license, an inactive license, a voluntarily surrendered license, and anyone violating any of the provisions of this chapter is guilty of a misdemeanor and, upon conviction must be fined not less than five hundred dollars or imprisoned for a period of not less than thirty days, or both.
Section 40-33-30.The South Carolina Department of Health and Environmental Control may establish policies whereby duly registered nurses may provide such health care, under the direction of a physician licensed to practice medicine in South Carolina and under the guidance of a registered pharmacist, as the dispensing of drugs for the treatment of tuberculosis and venereal disease, maternal and infant care, crippled children, family planning, immunization, and any other public health program now existing, or approved by the South Carolina Medical Association. The original diagnosis and treatment as prescribed by the physician shall be maintained on the individual patient's records.
Section 40-33-40. The provisions of Section 40-33-30 shall not be construed to require the employment of registered pharmacists at local health clinics for the guidance of registered nurses in the dispensing of drugs in accordance with the provisions hereof.
Section 40-33-50. No provision of this chapter may be construed to prohibit:
(1) gratuitous nursing by friends or members of the family;
(2) the incidental care of the sick by domestic servants or persons primarily employed as housekeepers as long as they do not practice nursing within the meaning of this chapter;
(3) nursing assistance in case of an emergency;
(4) the practice of nursing by students enrolled in approved schools of nursing or approved schools of practical nursing, nor by graduates of these schools pending the results of the first licensing examination taken by the graduate following graduation;
(5) the practice of nursing in this State by a legally qualified nurse of another state whose engagement requires him to accompany and care for a patient temporarily residing in this State during the period of one engagement, not to exceed six months in length, provided a person does not represent or hold himself out as a nurse licensed to practice in this State;
(6) the practice of a legally qualified nurse of another state who is employed by the United States Government or a bureau, division, or agency thereof, while in the discharge of his official duties;
(7) nursing care given to their maternity patients, in the performance of their duties, by lay midwives trained and supervised under the authority of the South Carolina Department of Health and Environmental Control, so long as midwives confine nursing care to maternity patients only and do not claim to be licensed practical nurses;
(8) the practice of nursing by a licensed nurse of another state or country who is enrolled in a board-approved course of study or board-approved experimental project requiring nursing practice as a part of the educational program;
(9) a person not licensed under this chapter from providing attendant care services directed by or on behalf of an individual in need of in-home care; and
(10) performance of an act which a person would normally perform if the person were physically and cognitively able.
Section 40-33-210. There is created the State Board of Nursing composed of nine members. One must be a lay member from the State at large, six must be registered nurses, and two must be licensed practical nurses. One registered nurse shall represent each congressional district, one licensed practical nurse shall represent Region I which includes Congressional Districts 1, 2, and 3, and one licensed practical nurse shall represent Region II which includes Congressional Districts 4, 5, and 6. Representation of the licensed practical nurse in each region rotates from each district in successive terms. Registered nurse and licensed practical nurse members must be licensed in South Carolina, must be employed, must have at least three years of practice in their respective profession immediately preceding their appointment, and shall reside in the district they represent. A lay member must not be licensed or employed as a health care provider but shall represent the public at large as a consumer of nurse services. No member may serve as an officer of a professional health related state association.
The terms of the members are for four years and until successors are appointed and qualify. No member may serve more than two consecutive terms. All members must be appointed by the Governor.
An individual, group, or association may nominate qualified individuals and submit them to the Governor for his consideration. The board shall publish widely in the State and appropriate districts notice of all pending board vacancies. Vacancies must be filled for the unexpired portion of a term by appointment of the Governor.
The Governor may remove a member who has been guilty of continued neglect of his duties or who is found to be incompetent, unprofessional, or dishonorable. No member may be removed without first giving him an opportunity to refute the charges filed against him. He must be given a copy of the charges at the time they are filed.
Section 40-33-220. (A) The Board shall enforce the provisions of this chapter.
(B) The Board may:
(1) maintain an office to carry out its work and provide funds, facilities, and equipment for its operation;
(2) use minimum standards as a basis for evaluating safe and effective nursing practice;
(3) publish advisory opinions relating to nursing practice procedures or policies authorized or acquiesced to by any agency, facility, institution, or other organization that employs individuals licensed under this chapter to comply with acceptable standards of nursing practice;
(4) examine, license, and renew the licenses of duly qualified individuals;
(5) develop minimum standards for continued competency of licensees continuing in or returning to practice;
(6) conduct surveys of educational enrollments and licensure and report to the public;
(7) conduct investigations and hearings concerning alleged violations of this chapter;
(8) develop minimum standards for nursing education programs;
(9) approve nursing education programs that meet the prescribed standards;
(10) deny or withdraw approval of nursing education programs that fail to meet the prescribed standards;
(11) approve the qualifications of nurse practitioners and clinical nurse specialists functioning in an extended role;
(12) join organizations that develop and regulate the national nursing licensure examinations and promote the improvement of the legal standards of the practice of nursing for the protection of the public;
(13) establish policies governing finances and approve an annual budget;
(14) receive and expend funds in addition to that provided in the State General Appropriations Act. The funds must be expended for purposes authorized.
Section 40-33-230. A board member may receive for board service the usual per diem, mileage, and subsistence as provided by law for members of state boards for each day actually engaged in the duties of the office. These expenses must be paid from the fees received by the board under this chapter.
Section 40-33-240. The officers of the Board shall be a president, a vice president and a secretary. The election of the president will be from the registered nurse members of the Board and the vice president and secretary will be elected from the members at large.
The officers so elected shall serve for a period of one year and until their respective successors are elected and have qualified. Officers shall be elected by the Board annually, their terms of office beginning at the close of the meeting at which they are elected. In case of a vacancy among such officers, the Board shall, within thirty days after the vacancy occurs, elect one of its members to fill the unexpired term.
The secretary shall certify to the Governor the names of the officers elected for regular and unexpired terms. In the event of a vacancy in the office of secretary, the president of the Board shall certify to the Governor the name of the person chosen to fill the vacancy.
Section 40-33-250. The Director of the Department of Labor, Licensing, and Regulation, or his designee, pursuant to Section 40-73-15, shall appoint and employ a qualified person to serve as executive director, and shall fix his compensation and define his duties. The executive director of the board shall have the power to make contracts, with board approval, for the furtherance of the board's functions and the management of the office. The director, or his designee, may employ such other persons as may be necessary to carry on the board's work. The salaries of employees and necessary expenses incurred in the performance of their duties shall be paid out of funds held by the board.
Section 40-33-260. The board shall meet at least quarterly for the purpose of transaction of business.
Five members of the board constitute a quorum, but no action of the board is valid unless authorized by the affirmative vote of a majority of the members present.
Section 40-33-270. The Board may have and use an official seal bearing the words: "State Board of Nursing for South Carolina." It may make such rules and regulations as it may deem necessary for the purposes of carrying out the provisions of this chapter and shall fix such fees as it may deem necessary, and when such rules have been adopted, a copy of same shall be filed with the Secretary of State. Upon their adoption, they shall have the full force and effect of law.
Section 40-33-280. The presiding officer of the Board may administer oaths in the taking of testimony upon any and all matters pertaining to the business or duties of the Board.
Section 40-33-290. The Board shall keep a record of all its proceedings, a record of all applicants for licenses and of the action of the Board, and a record of all nurses who have complied with the requirements of this chapter and have been licensed to practice nursing or practical nursing in this State.
Records kept by the Board are prima facie evidence of all matters therein recorded. At all reasonable times, all records must be open to public inspection except as otherwise prohibited by law.
Section 40-33-410. The President or his designee of the State Board of Nursing shall serve as an advisory nonvoting member of the State Board of Medical Examiners to provide consultation on matters requested by the State Board of Medical Examiners. The Board of Examiners shall be required to send written notice, at least ten days prior to its meetings, of meetings it wants the president of the State Board of Nursing to attend. The president of the State Board of Nursing and the State Board of Medical Examiners shall meet at least twice a year and thereafter as necessary.
Section 40-33-510. It is unlawful for a person to practice registered nursing in this State or to use a title, abbreviation, sign, card, or other device to indicate that he is so practicing, unless he has been licensed under the provisions of this chapter pursuant to the law in force at the time of his authorization as a registered nurse.
Section 40-33-520. The Board shall examine all candidates for licensing as registered nurses as herein provided and pass upon their qualifications to practice nursing as registered nurses in this State and give each successful applicant a license to that effect. The license entitles the holder to practice nursing in this State as a registered nurse and to use the letters "R.N." after his name.
Section 40-33-530. Each applicant shall furnish evidence satisfactory to the Board that he is at least eighteen years of age, has completed at least four years of work in a high school accredited by the State Board of Education in the state in which the school is located or the equivalent of such work, satisfactory evidence of which must be furnished to the Board, has completed a course of study in an approved nursing education program, and has met other preliminary qualification requirements as the Board may prescribe. The Board may deny licensure based on evidence of unlawful acts, incompetence, unprofessional conduct, or other misconduct.
Section 40-33-550. Each applicant shall pay to the Board such fee as shall be determined by the Board.
Section 40-33-560. The Board shall issue licenses without examination to nurses licensed in other states, territories, the District of Columbia, or foreign countries, if the individual qualifications of the nurse meet the requirements of this chapter and the Board and the required fee is paid. The Board may deny licensure based on evidence of unlawful acts, incompetence, unprofessional conduct, or other misconduct.
Section 40-33-710. It shall be unlawful for any person to practice practical nursing in this State or to use any title, abbreviation, sign, card or other device to indicate that such a person is so practicing, unless such person has been licensed under the provisions of this chapter as a practical nurse.
Section 40-33-720. The Board shall examine all candidates for licensing as licensed practical nurses, as hereinafter provided, and shall pass upon their qualifications to practice practical nursing as licensed practical nurses in this State, and shall give each successful applicant a license to that effect. The license entitles the holder to practice practical nursing in this State as a licensed practical nurse and to use the letters "L.P.N." after his name.
Section 40-33-730. Each applicant for a license to practice as a licensed practical nurse shall submit evidence satisfactory to the Board that he is at least eighteen years of age, has successfully completed at least two years of work in an accredited high school or the equivalent of such work, satisfactory evidence of which must be furnished to the Board, has successfully completed the course of study in a nursing education program for practical nurses approved by the Board or has completed a course of study determined by the Board to be the equivalent thereof, and has met such other preliminary qualification requirements as the Board may prescribe. The Board may deny licensure based on evidence of unlawful acts, incompetence, unprofessional conduct, or other misconduct.
Section 40-33-750. The applicant, applying for a license to practice as a licensed practical nurse, shall pay to the Board such fee as shall be determined by the Board.
Section 40-33-760. The Board may issue a license to practice as a licensed practical nurse without examination to any applicant who is a licensed practical nurse or a person entitled to perform similar services under a different title under the laws of another state or territory, the District of Columbia, or a foreign country if, in the opinion of the Board, the applicant meets the requirements for licensed practical nurses in this State. Each applicant shall pay to the Board such fee as it may determine. The Board may deny licensure based on evidence of unlawful acts, incompetence, unprofessional conduct, or other misconduct.
Section 40-33-770. Notwithstanding Section 40-33-10(h) requiring the practice of practical nursing to be performed under the direction of a registered nurse, licensed physician, or licensed dentist, a licensed practical nurse may provide nursing care authorized for licensed practical nurses under this chapter without the on-site supervision of a registered nurse, licensed physician, or licensed dentist in:
(1) home or residential settings under the Medicaid program, or any other home or residential setting, if a registered nurse has approved the plan of care;
(2) public schools and the Department of Juvenile Justice and Department of Corrections institutions and facilities if the licensed practical nurse follows the policies, procedures, and guidelines of the employing entity and if a registered nurse is available on call by telecommunications.
Section 40-33-910. An applicant must pass the examinations prescribed by the board in subjects as may be determined by the board.
Section 40-33-920. An applicant who does not pass the first examination may repeat the examination within one year of taking the examination as provided by the board in regulation. An applicant who does not pass the examination within one year of first taking the examination must provide evidence satisfactory to the board of remediation before reexamination. An applicant who has not passed the examination within three (3) years of first taking the examination must requalify to take the examination as provided by the board in regulation.
Section 40-33-930. The board, if it has reason to believe grounds exist, may order the revocation or suspension of a license to practice nursing as a registered nurse or a licensed practical nurse or privately reprimand the registered nurse or licensed practical nurse or take other reasonable action short of revocation or suspension, such as requiring the licensee to undertake additional professional training subject to the direction and supervision of the board. The board may also impose restraint upon the nursing practice of the licensee as circumstances warrant until the licensee demonstrates to the board adequate professional competence. In addition to any other sanction imposed by the board upon the licensee, the board may require the licensee to pay a civil penalty of up to two thousand dollars to the board for each violation of the provisions of this chapter or of the regulations promulgated by the board, but the total penalty or fine for the violations may not exceed ten thousand dollars. All fines must be remitted to the State Treasurer and deposited in a special fund from which the board must be reimbursed for administrative costs for each case upon the approval of the Budget and Control Board. At any time when the special fund exceeds twenty thousand dollars, all excess funds must be remitted to the General Fund. Fines are payable immediately upon the effective date of discipline. Interest accrues after fines are due at the maximum rate allowed by law. No licensee against whom a fine is levied is eligible for reinstatement until the fine has been paid in full. An action of the board relating to the revocation or suspension of a license, or other action either restricting a license or limiting or otherwise disciplining a licensee, may be taken only after a written complaint of misconduct, as defined in Section 40-33-935, has been filed with the board in accordance with regulations promulgated by the board.
On deciding what discipline is appropriate the board shall consider, along with the nature and circumstances of the offense, the protection of the public, the standards of nursing, and the interests in rehabilitation of the respondent nurse. The board is not limited to considering only those factors.
Section 40-33-931. A decision by the board to revoke, suspend, or otherwise discipline a licensee must be by majority vote of the total membership of the board and is subject to review by an administrative law judge as provided under Article 5 of Chapter 23 of Title 1.
A decision by the board to revoke, suspend, or otherwise restrict a license or to limit or otherwise discipline a licensee becomes effective upon delivery of a copy of the decision to the licensee and a petition for review does not operate as a supersedeas.
Section 40-33-935. Misconduct, as defined in the regulations, which constitutes grounds for a revocation, suspension, or other restriction of a license or a limitation on or other discipline of a licensee, is a satisfactory showing to the board of any of the following:
(a) That the licensee has committed or been convicted of a felony. In the absence of a conviction, the board may receive evidence to reach an independent conclusion as to the commission of the felony, but the determination may be used only in making the administrative decision regarding the proposed discipline.
(b) That the licensee has violated a federal, state, or local alcohol or drug law. A conviction is not needed to prove misconduct under this paragraph.
(c) That the licensee is engaging in the practice of nursing when judgment or physical ability is impaired by alcohol, drugs, or controlled substances and has declined or been unsuccessful in accomplishing rehabilitation.
(d) That the licensee has participated knowingly in the fraudulent procurement of a license for himself or another person, or has allowed another person to use his license.
(e) That the licensee wilfully or repeatedly has followed a course of conduct which, by reasonable professional or ethical standards, renders him incompetent to assume, perform, or be entrusted with the duties, responsibilities, or trusts which normally devolve upon a licensed practical nurse or a registered nurse.
(f) That the licensee has had his license to practice nursing in another state suspended or revoked or other disciplinary action has been taken against him by another state. In those situations, the action by another state creates a rebuttable presumption that a South Carolina nursing license may be acted upon similarly. The finding may be based solely upon the record in the other state, and there is no requirement for a de novo hearing on the facts established in that proceeding. Other evidence is admissible to support or rebut the above presumption.
(g) That the licensee has violated a section of this chapter or a regulation or order of the board.
(h) Additionally, a nurse who is under investigation for any of the above items of misconduct or incapacity may voluntarily surrender his license to the board. The voluntary surrender invalidates the license at the time of its relinquishment and no person whose license is voluntarily surrendered may practice nursing or represent himself to be a registered nurse or licensed practical nurse until the board takes action. A person practicing as a registered nurse or licensed practical nurse during the period of voluntary license surrender is considered an illegal practitioner and is subject to the penalties provided by this chapter. The surrender of a license may not be considered as an admission of guilt by a panel, court, or other entity in revoking the license of a registered nurse or licensed practical nurse. The surrender is with the understanding that it does not preclude the board from imposing conditions on the acceptance of the proffered surrender, which the licensee must meet before the return of his license, nor does it preclude the board from taking disciplinary action under this section.
Section 40-33-936. Every communication, whether oral or written, made by or on behalf of any person, firm or corporation to the Board or any person designated by it to investigate or otherwise hear matters relating to the revocation, suspension, or other restriction on a license or the limitation on or other discipline of a licensee, whether by way of complaint or testimony, shall be privileged; and no action or proceeding, civil or criminal, shall lie against any such person, firm or corporation by or on whose behalf such communication shall have been made by reason thereof, except upon proof that such communication was made with malice.
No part of this article shall be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law, nor to prohibit the respondent from normal access to the charges and evidence filed against him as a part of due process under the law.
Section 40-33-940. The license of every person licensed under the provisions of this chapter to practice as a registered nurse or as a licensed practical nurse in this State must be renewed annually, except as otherwise provided. After January 31, 1993, a licensee who has not practiced nursing for a minimum of nine hundred sixty hours in the preceding five years is not eligible for an active license.
A licensee who allows his license to lapse, by failing to renew the license as provided above, may be reinstated by the board on payment of a reinstatement fee and the current renewal fee, and demonstration of nursing competence as defined in regulations of the board.
Section 40-33-941. A licensee who allows his license to lapse, by failing to renew the license, may be reinstated by the board on payment of a reinstatement fee and the current renewal fee and demonstration of nursing competence as defined in the regulations of the board. The board may deny reinstatement based on evidence of unlawful acts, incompetence, unprofessional conduct, or other misconduct.
A person practicing as a registered nurse or licensed practical nurse during the time his license has lapsed is considered an illegal practitioner and is subject to the penalties provided for violation of this chapter.
Section 40-33-950. (A) A person currently licensed under the provisions of this chapter who does not meet the minimum practice requirement for renewal, desiring to retire from practice temporarily, or who leaves the State, may send to the board a written request for official inactive status. Upon receipt of the request and appropriate fee, the board shall act and place the name of the person on the official inactive list. While remaining on this list, the person is not subject to the payment of any renewal fees and shall not practice nursing in this State. When the person desires to resume practice, an application for a renewal of license and payment of a renewal fee for the current period, and demonstration of nursing competence as defined in regulations of the board, must be made to the board. The board may deny reinstatement or renewal based on evidence of unlawful acts, incompetence, unprofessional conduct, or other misconduct.
(B) A volunteer license may be issued by the board without fee to a retired nurse who has been granted inactive status and who has practiced not less than twenty-five years or until age sixty-five after a minimum of fifteen years of practice and who wishes to donate nursing services through a charitable organization approved by the board, if the retired nurse files proper application on a form provided by the board satisfactorily demonstrating that not less than twenty-five hours of initial training with the charitable organization has been completed and that the retired nurse has been on the official inactive status list for not more than ten years. A volunteer license authorizes the retired nurse to provide nursing services to others without remuneration of any kind through one specifically identified charitable organization only. A volunteer license is not transferable. A separate application must be filed and a separate license must be issued for every charitable organization to which the retired nurse wishes to donate nursing services. A volunteer license may be renewed annually upon application and satisfactory demonstration of not less than twenty-five hours of service or additional training during the preceding year with the same charitable organization. A volunteer license may be renewed annually for an indefinite number of years, if the license has been renewed annually without interruption with the same charitable organization and all other qualifications have been met. The board may promulgate any additional regulations as necessary to carry out the provisions of this section.
Section 40-33-960. For the purpose of any investigation or proceeding under the provisions of this chapter, the board or any person designated by it may administer oaths and affirmations, subpoena witnesses, take evidence, and require the production of any documents or records which the board deems relevant to the inquiry. In the case of contumacy by, or refusal to obey a subpoena issued to any person, an administrative law judge as provided under Article 5 of Chapter 23 of Title 1, upon application by the board, may issue an order requiring the person to appear before the board or the person designated by it and produce documentary evidence and to give other evidence concerning the matter under inquiry.
Whenever the board has reason to believe that any person is violating or intends to violate any provision of this chapter, it may, in addition to all other remedies, order such person to immediately desist and refrain from such conduct. The board may apply to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 for an injunction restraining the person from such conduct. The examiner may issue a temporary injunction ex parte, and upon notice and full hearing may issue any other order in the matter it deems proper. No bond shall be required of the board by the examiner as a condition to the issuance of any injunction or order contemplated by the provisions of this section.
Section 40-33-970. All employers of nursing shall report any instances of the misconduct or the incapacities described in Section 40-33-935 to the State Board of Nursing.
Section 40-33-980. In community residential care facilities, the provision of selected prescribed medications may be performed by selected unlicensed persons with documented medication training and skill competency evaluation. The provision of medications by selected unlicensed persons is limited to oral and topical medications and to regularly scheduled insulin and prescribed anaphylactic treatments under established medical protocol and does not include sliding scale insulin or other injectable medications. Licensed nurses may train and supervise selected unlicensed persons to provide medications and, after reviewing competency evaluations, may approve selected unlicensed persons for the provision of medications.
Section 40-33-1110. The Board shall register as accredited such schools of nursing as shall meet the requirements of the Board as to courses and standards. It shall prescribe curricula and standards for schools and courses preparing persons for registration or licensing under this chapter. It shall provide for surveys of such schools and courses at such times as it may deem necessary. It shall accredit such schools and courses as meet the requirements of this chapter and the Board. It shall evaluate and approve courses for affiliation. At intervals regulated by its bylaws it shall prepare and make a report for public distribution of all schools of nursing or combinations of schools of nursing in this State and all courses for the training of practical nurses approved by the Board as meeting the requirements of this chapter and of the Board.
Section 40-33-1120. A survey of the institution with which the nursing education program is to be affiliated must be made by the executive director or other employee of the Board and a written report of the survey must be submitted to the Board. If, in the opinion of the Board, the basic standards are met by a nursing education program, it shall designate the program as an approved nursing education program.
Section 40-33-1130. As considered necessary, the Board, through its executive director, or other employee, shall survey all nursing education programs in the State. Written reports of surveys must be submitted to the Board. If the Board determines that any approved nursing education program is not maintaining the standards required by the statutes and by the Board, notice thereof in writing specifying the defect shall immediately be given to the program. A program which fails to correct the defects to the satisfaction of the Board within a reasonable time must be removed from the list of approved nursing education programs.
Section 40-33-5. Unless otherwise provided for in this chapter, Article 1, Chapter 1, Title 40 applies to the profession of nursing. However, if there is a conflict between this chapter and Article 1, Chapter 1, Title 40, the provisions of this chapter control.
Section 40-33-10. (A) There is created the State Board of Nursing composed of ten members. Two must be lay members from the State at large. Six must be registered nurses, each representing one congressional district, and at least one must be employed in a hospital setting and at least one must be licensed as an advanced practice registered nurse. Two must be licensed practical nurses, and one shall represent Region I, which includes Congressional Districts 1, 2, and 3, and one shall represent Region II, which includes Congressional Districts 4, 5, and 6. When appointing members to the board, consideration should be given to including a diverse representation of principal areas of nursing including, but not limited to, hospital, acute care, advanced practice, community health, and nursing education. Registered nurse and licensed practical nurse members must be licensed in South Carolina, must be employed in nursing, must have at least three years of practice in their respective professions immediately preceding their appointment, and shall reside in the district they represent. Lay members must not be licensed or employed as a health care provider but shall represent the public at large as a consumer of nurse services. No member may serve as an officer of a professional health related state association. The chairman or designee of the State Board of Medical Examiners shall serve as an advisory nonvoting member to the board to provide consultation on matters requested by the Board of Medical Examiners.
(B) Members shall serve terms of four years and until their successors are appointed and qualify. Board members must be appointed by the Governor with the advice and consent of the Senate. An individual, group, or association may nominate qualified persons and submit them to the Governor for consideration. Vacancies must be filled for the unexpired portion of a term by appointment of the Governor.
(C) The Governor may remove members pursuant to Section 1-3-240(C) or members who have been guilty of continued neglect of their duties or members who are found to be incompetent, unprofessional, or dishonorable. No members may be removed without first giving them the opportunity to refute the charges filed against them. The member must be given copies of the charges at the time they are filed.
(D) A board member, or person authorized and approved by the board, engaged in business for the board may receive for board service the usual per diem, mileage, and subsistence as provided by law. These expenses must be paid from the fees received by the board under this chapter.
(E) The board may have and use an official seal bearing the words: 'State Board of Nursing for South Carolina'. The board may promulgate regulations as it considers necessary for the purposes of carrying out the provisions of this chapter.
(F) The board shall meet at least quarterly for the purpose of transacting business. A majority of the members of the board constitutes a quorum; however, if there is a vacancy on the board, a majority of the members serving constitutes a quorum. A board member is required to attend meetings or to provide proper notice and justification of inability to do so. Unexcused absences from meetings may result in removal from the board as provided in Section 1-3-245.
(G) A chairman, a vice chairman, and a secretary comprise the officers of the board. The election of the chairman must be from the registered nurse members of the board, and the vice chairman and secretary must be elected from the members. Officers shall serve terms of one year and until their successors are elected. The administrator shall certify to the Governor the names of the officers elected for regular and unexpired terms.
(H) The Chairman of the State Board of Nursing, or the chairman's designee, shall serve as an advisory nonvoting member of the State Board of Medical Examiners to provide consultation on matters requested by the State Board of Medical Examiners. The Board of Medical Examiners shall send written notice at least ten days before meetings that the Board of Medical Examiners wants the chairman or designee of the State Board of Nursing to attend. The Chairman of the State Board of Nursing, or the chairman's designee, and the State Board of Medical Examiners shall meet at least twice a year and more often as necessary.
(I) In addition to the powers and duties enumerated in Section 40-1-70, the board may:
(1) publish advisory opinions and position statements relating to nursing practice procedures or policies authorized or acquiesced to by any agency, facility, institution, or other organization that employs persons authorized to practice under this chapter to comply with acceptable standards of nursing practice;
(2) develop minimum standards for continued competency of licensees continuing in or returning to practice;
(3) conduct surveys of educational enrollments and licensure and report to the public;
(4) conduct investigations and hearings concerning alleged violations of this chapter;
(5) develop minimum standards for nursing education programs;
(6) approve nursing education programs that meet the prescribed standards;
(7) deny or withdraw approval or limit new student admissions of nursing education programs that fail to meet the prescribed standards;
(8) use minimum standards as a basis for evaluating safe and effective nursing practice;
(9) examine, license, and renew the authorizations to practice of qualified applicants;
(10) join organizations that develop and regulate the national nursing licensure examinations and promote the improvement of the practice of nursing for the protection of the public;
(11) collect any information the board considers necessary, including social security numbers or alien identification numbers, in order to report disciplinary actions to national databanks of disciplinary information;
(12) establish guidelines to assist employers of nurses when errors in nursing practice can be handled through corrective action in the employment setting;
(13) establish a fee schedule in regulations.
Section 40-33-20. In addition to the definitions provided in Section 40-1-20, for purposes of this chapter:
(1) 'Accreditation' means official authorization or status granted by an agency other than a state board of nursing.
(2) 'Active license' means the status of a license that has been renewed for the current period and authorizes the licensee to practice nursing in this State.
(3) 'Additional acts' means activities performed by a nurse that expand the scope of practice, as established in law. The following must be submitted in writing to the board for approval before a nurse implements additional acts:
(a) additional activity being requested;
(b) statement with rationale as to how the activity will improve client outcomes;
(c) documentation based on the literature review to support the nurse's performing the additional activity;
(d) qualification requirements, including educational background and experience needed;
(e) special training required, including theory and clinical practice. A nurse must successfully complete a course of 'special education and training' acceptable to the board to perform additional acts;
(f) evaluation and follow-up procedures.
Additional acts that constitute delegated medical acts must be agreed to jointly by both the Board of Nursing and the Board of Medical Examiners and must be promulgated by the Board of Nursing in regulation.
(4) 'Administration of Medications' means the acts of preparing and giving drugs in accordance with the orders of a licensed, authorized nurse practitioner, certified nurse-midwife, clinical nurse specialist, or a physician, dentist, or other authorized licensed provider as to drug, dosage, route and frequency; observing, recording, and reporting desired effects, untoward reactions, and side effects of drug therapy; intervening when emergency care is required as a result of drug therapy; appropriately instructing the patient regarding the medication; recognizing accepted prescribing limits and reporting deviations to the prescribing nurse practitioner, certified nurse-midwife, or clinical nurse specialist, physician, dentist, or other authorized licensed provider.
(5) 'Advanced Practice Registered Nurse or 'APRN' means a registered nurse who is prepared for an advanced practice registered nursing role by virtue of additional knowledge and skills gained through an advanced formal education program of nursing in a specialty area that is approved by the board. The categories of APRN are nurse practitioner, certified nurse-midwife, clinical nurse specialist, and certified registered nurse anesthetist. An advanced practice registered nurse shall hold a doctorate, a post-nursing master's certificate, or a minimum of a master's degree that includes advanced education composed of didactic and supervised clinical practice in a specific area of advanced practice registered nursing. In addition to those activities considered the practice of registered nursing, an APRN may perform delegated medical acts.
(6) 'Agreed to jointly' means the agreement by the Board of Nursing and Board of Medical Examiners on delegated medical acts which nurses perform and which are promulgated by the Board of Nursing in regulation.
(7) 'Ancillary services' means services associated with the basic services provided to an individual in need of in-home care who needs one or more of the basic services and includes:
(a) homemaker-type services, including shopping, laundry, cleaning, and seasonal chores;
(b) companion-type services, including transportation, letter writing, reading mail, and escorting; and
(c) assistance with cognitive tasks, including managing finances, planning activities, and making decisions.
(8) 'Approval' means the process by which the board evaluates nursing education programs, which must meet established uniform and reasonable standards.
(9) 'Approved written guidelines' means specific statements developed by a certified registered nurse anesthetist and a supervising licensed physician or dentist or by the medical staff within the facility where practice privileges have been granted. (10) 'Approved written protocols' means specific statements developed collaboratively by a physician or the medical staff and a NP, CNM, or CNS that establishes physician delegation for medical aspects of care, including the prescription of medications.
(11) 'Attendant care services' means those basic and ancillary services that enable an individual in need of in-home care to live in the individual's home and community rather than in an institution and to carry out functions of daily living, self-care, and mobility that do not require a specialized knowledge base or the judgment and skill as defined as the practice of nursing.
(12) 'Authorized licensed provider' means a provider of health care services who is authorized to practice by a licensing board in this State where the scope of practice includes authority to order and prescribe drugs in treating patients.
(13) 'Basic services' includes:
(a) getting in and out of a bed, wheelchair, motor vehicle, or other device;
(b) assistance with routine bodily functions including health maintenance activities, bathing and personal hygiene, dressing and grooming, and feeding, including preparation and cleanup.
(14) 'Board' means the State Board of Nursing for South Carolina.
(15) 'Board approved credentialing organization' means an organization that offers a certification examination in a specialty area of nursing practice, establishes scope and standards of practice statements, and provides a mechanism for evaluating continuing competency in a specialized area of nursing practice which has been approved by the board.
(16) 'Business days' means every day except Saturdays, Sundays, and legal holidays.
(17) 'Cancellation' means the withdrawal or invalidation of an authorization to practice that was issued to an ineligible person either in error or based upon a false, fraudulent, or deceptive representation in the application process.
(18) 'Certification' of a registered nurse means approval by an established body, other than the board, but recognized by the board, that recognizes the unique, minimal requirements of specialized areas of nursing practice. Certification requires completion of a recognized formal program of study and specialty board examination, if the specialty board exists, and certification of competence in nursing practice by the certifying agency.
(19) 'Certified Nurse-Midwife' or 'CNM' means an advanced practice registered nurse who holds a master's degree in the specialty area and provides nurse-midwifery management of women's health care, focusing particularly on pregnancy, childbirth, postpartum, care of the newborn, family planning, and gynecological needs of women.
(20) 'Certified Registered Nurse Anesthetist' or 'CRNA' means an advanced practice registered nurse who:
(a) has successfully completed an advanced, organized formal CRNA education program at the master's level accredited by the national accrediting organization of this specialty area and that is recognized by the board;
(b) is certified by a board-approved national certifying organization; and
(c) demonstrates advanced knowledge and skill in the delivery of anesthesia services.
A CRNA must practice in accordance with approved written guidelines developed under supervision of a licensed physician or dentist or approved by the medical staff within the facility where practice privileges have been granted.
(21) 'Clinical Nurse Specialist' or 'CNS' means an advanced practice registered nurse who is a clinician with a high degree of knowledge, skill, and competence in a practice discipline of nursing. This nurse shall hold a master's degree in nursing, with an emphasis in clinical nursing. These nurses are directly available to the public through the provision of nursing care to clients and indirectly available through guidance and planning of care with other nursing personnel. A CNS who performs delegated medical acts is required to have physician support and to practice within approved written protocols. A CNS who does not perform delegated medical acts is not required to have physician support or to practice within approved written protocols as provided in Section 40-33-34.
(22) 'Competence' means the ability of a licensed nurse to perform safely, skillfully, and proficiently the functions within the role of the licensee. The role encompasses the possession and interrelation of essential knowledge, judgment, attitudes, values, skills, and abilities, which are varied and range in complexity. Competence is a dynamic concept, changing as the licensed nurse achieves a higher stage of development, responsibility, and accountability within the role.
(23) 'Delegated medical acts' means additional acts delegated by a physician or dentist to the NP, CNM, or CNS and may include formulating a medical diagnosis and initiating, continuing, and modifying therapies, including prescribing drug therapy, under approved written protocols as provided in Section 40-33-34. Delegated medical acts must be agreed to jointly by both the Board of Nursing and the Board of Medical Examiners. Delegated medical acts must be performed under the general supervision of a physician or dentist who must be readily available for consultation.
(24) 'Delivering' means the act of handing over to a patient medications as ordered by an authorized licensed provider.
(25) 'Dentist' means a dentist licensed by the South Carolina Board of Dentistry.
(26) 'Entity' means a sole proprietorship, partnership, limited liability partnership, limited liability corporation, association, joint venture, cooperative, company, corporation, or other public or private legal entity authorized by law.
(27) 'Expanded role' of a registered nurse means a process of diffusion and implies multi-directional change. Expansion, as a process of role change, is undertaken to fill perceived needs in the health care system, and also to project new components or systems of health care. The authority base for practice from which the expanded role emanates is the body of knowledge that constitutes a nurse's preparation for practice. The expanded role of a registered nurse requires specialized knowledge, judgment, and skill, but does not require or permit medical diagnosis or medical prescription of therapeutic or corrective measures. The expanded role of a licensed practical nurse with special education and training includes performing delegated professional nursing activities, as authorized by the board under the direction and supervision of a registered nurse, but does not authorize violation of state law pertaining to medical or pharmacy practice.
(28) 'Graduate Registered Nurse Anesthetist' or 'GRNA' means a new graduate of an advanced organized formal education program for nurse anesthetists accredited by the national accrediting organization who must achieve certification within one year of graduation of program completion.
(29) 'Graduate Registered Nurse-Midwife' or 'GRNM' means a new graduate of an advanced organized formal education program for nurse midwives accredited by the national accrediting organization. A GRNA is required to become certified within one year of graduation or program completion.
(30) 'Health maintenance activities' include, but are not limited to, catheter irrigation, administration of medications, enemas and suppositories, and wound care, if in the opinion of the attending physician, physician assistant, APRN, or RN may be performed by an individual if the individual were physically capable and the procedure may be safely performed in the home.
(31) 'Inactive license' means the official temporary retirement of a person's authorization to practice nursing upon the person's notice to the board that the person does not plan to practice nursing or the status of a license that does not currently authorize a licensee to practice nursing in this State.
(32) 'Incompetence' means the failure of a nurse to demonstrate and apply the knowledge, skill, and care that is ordinarily possessed and exercised by other nurses of the same licensure status and required by the generally accepted standards of the profession. Charges of incompetence may be based upon a single act of incompetence or upon a course of conduct or series of acts or omissions that extend over a period of time and that, taken as a whole, demonstrate incompetence. It is not necessary to show that actual harm resulted from the act or omission or series of acts or omissions if the conduct is such that harm could have resulted to the patient or to the public from the act or omission or series of acts or omissions.
(33) 'Individual in need of in-home care' means a functionally disabled individual in need of attendant care services because of impairment who requires assistance to complete functions of daily living, self-care, and mobility, including attendant care services. (34) 'Lapsed license' means the termination of a person's authorization to practice nursing due to the person's failure to renew his or her nursing license within the renewal period.
(35) 'Letter of caution' means a written caution or warning about past or future conduct issued when it is determined that no misconduct has been committed or that only minor misconduct not warranting the imposition of a sanction has been committed. The issuance of a letter of caution is not a form of discipline and does not constitute a finding of misconduct unless the letter of caution specifically states that misconduct has been committed. The fact that a letter of caution has been issued must not be considered in a subsequent disciplinary proceeding against a person authorized to practice unless the caution or warning contained in the letter of caution is relevant to the misconduct alleged in the proceedings. (36) 'License' means a current document issued by the board authorizing a person to practice as an advanced practice registered nurse, a registered nurse, or a licensed practical nurse.
(37) 'Licensed Practical Nurse' or 'LPN' means a person to whom the board has issued an authorization to practice as a licensed practical nurse.
(38) 'Misconduct' means violation of any of the provisions of this chapter or regulations promulgated by the board pursuant to this chapter or violation of any of the principles of nursing ethics as adopted by the board or incompetence or unprofessional conduct.
(39) 'NCLEX' means the National Council Licensure Examination for Registered Nurses or Licensed Practical Nurses. (40) 'Nurse' means a person licensed as an advanced practice registered nurse, registered nurse, or licensed practical nurse pursuant to this chapter.
(41) 'Nurse Practitioner' or 'NP' means a registered nurse who has completed an advanced formal education program at the master's level acceptable to the board, and who demonstrates advanced knowledge and skill in assessment and management of physical and psychosocial health, illness status of persons, families, and groups. Nurse practitioners who perform delegated medical acts must have a supervising physician or dentist who is readily available for consultation and shall operate within the approved written protocols.
(42) 'Nursing diagnosis' means a clinical judgment about a person, family, or community, that is derived through a nursing assessment and the standard nursing taxonomy.
(43) 'Orientation' means any introductory instruction into a new practice environment or employment situation where being a nurse is a requirement of employment or where the individual uses any title or abbreviation indicating that the individual is a nurse. Orientation is considered the practice of nursing in this State.
(44) 'Person' means a natural person, male or female.
(45) 'Physician' means a physician licensed by the South Carolina Board of Medical Examiners.
(46) 'Practice of nursing' means the provision of services for compensation, except as provided in this chapter, that assists persons and groups to obtain or promote optimal health. Nursing practice requires the use of nursing judgment. Nursing judgment is the logical and systematic cognitive process of identifying pertinent information and evaluating data in the clinical context in order to produce informed decisions, which guide nursing actions. Nursing practice is provided by advanced practice registered nurses, registered nurses, and licensed practical nurses. The scope of nursing practice varies and is commensurate with the educational preparation and demonstrated competencies of the person who is accountable to the public for the quality of nursing care. Nursing practice occurs in the state in which the recipient of nursing services is located at the time nursing services are provided.
(47) 'Practice of practical nursing' means the performance of health care acts that require knowledge, judgment, and skill and must be performed under the supervision of an advanced practice registered nurse, registered nurse, licensed physician, licensed dentist, or other practitioner authorized by law to supervise LPN practice. The practice of practical nursing includes, but is not limited to:
(a) collecting health care data to assist in planning care of persons:
(b) administering and delivering medications and treatments as prescribed by an authorized licensed provider;
(c) implementing nursing interventions and tasks;
(d) providing basic teaching for health promotion and maintenance;
(e) assisting in the evaluation of responses to interventions; (f) providing for the maintenance of safe and effective nursing care rendered directly or indirectly;
(g) participating with other health care providers in the planning and delivering of health care;
(h) delegating nursing tasks to qualified others;
(i) performing additional acts that require special education and training and that are approved by the board including, but not limited to, intravenous therapy and other specific nursing acts and functioning as a charge nurse.
(48) 'Practice of registered nursing' means the performance of health care acts in the nursing process that involve assessment, analysis, intervention, and evaluation. This practice requires specialized independent judgment and skill and is based on knowledge and application of the principles of biophysical and social sciences. The practice of registered nursing includes, but is not limited to:
(a) assessing the health status of persons and groups;
(b) analyzing the health status of persons and groups;
(c) establishing outcomes to meet identified health care needs of persons and groups;
(d) prescribing nursing interventions to achieve outcomes;
(e) implementing nursing interventions to achieve outcomes;
(f) administering and delivering medications and treatments prescribed by an authorized licensed provider;
(g) delegating nursing interventions to qualified others;
(h) providing for the maintenance of safe and effective nursing care rendered directly or indirectly;
(i) providing counseling and teaching for the promotion and maintenance of health;
(j) evaluating and revising responses to interventions, as appropriate;
(k) teaching and evaluating the practice of nursing;
(l) managing and supervising the practice of nursing;
(m) collaborating with other health care professionals in the management of health care;
(n) participating in or conducting research, or both, to enhance the body of nursing knowledge;
(o) consulting to improve the practice of nursing; and
(p) performing additional acts that require special education and training and that are approved by the board.
(49) 'Private reprimand' means a statement by the board that a violation was committed by a person authorized to practice which has been declared confidential and which is not subject to disclosure as a public document.
(50) 'Probation' means the issuance of an authorization to practice with terms and conditions imposed by the board. The holder of the authorization to practice on probation may petition the board for reinstatement to full, unrestricted practice upon compliance with all terms and conditions imposed by the board.
(51) 'Public reprimand' means a publicly available statement of the board that a violation was committed by a person authorized to practice.
(52) 'Readily available' means the physician must be in near proximity and is able to be contacted either in person or by telecommunications or other electronic means to provide consultation and advice to the nurse practitioner, certified nurse-midwife, or clinical nurse specialist performing delegated medical acts. When application is made for more than three NP's, CNM's, or CNS's, to practice with one physician, or when a NP, CNM, or CNS is performing delegated medical acts in a practice site greater than forty-five miles from the physician, the Board of Nursing and Board of Medical Examiners shall each review the application to determine if adequate supervision exists.
(53) 'Registered Nurse' means a person to whom the board has issued an authorization to practice as a registered nurse.
(54) 'Restriction' means a limitation on the activities in which a licensee may engage under an authorization to practice, including revocation, suspension, or probation.
(55) 'Revocation' means the cancellation or withdrawal of a license or other authorization issued by the board either permanently or for a period specified by the board before the person is eligible to reapply. A person whose license or other authorization has been permanently revoked by the board is permanently ineligible for a license or other authorization of any kind from the board.
(56) 'Special Education and training' means an organized advanced course of study acceptable to the board, required to expand a nurse's scope of practice. This educational training must be completed after graduation from one's basic nursing education program and includes both theory and clinical practice.
(57) 'Supervision' means the process of critically observing, directing, and evaluating another's performance.
(58) 'Suspension' means the temporary withdrawal of authorization to practice for either a definite or indefinite period of time ordered by the board. The holder of a suspended authorization to practice may petition the board for reinstatement to practice upon compliance with all terms and conditions imposed by the board.
(59) 'State or jurisdiction in this country' means a state of the United States or the District of Columbia and does not include a territory or dependency of the United States.
(60) 'Temporary permit' means a current time-limited document that authorizes the practice of nursing at the level for which one is seeking licensure.
(61) 'Unlicensed assistive personnel' or 'UAP' are persons not currently licensed by the board as nurses who perform routine nursing tasks that do not require a specialized knowledge base or the judgment and skill of a licensed nurse. Nursing tasks performed by a UAP must be performed under the supervision of an advanced practice registered nurse, registered nurse, or selected licensed practical nurse.
(62) 'Unprofessional conduct' means acts or behavior that fail to meet the minimally acceptable standard expected of similarly situated professionals including, but not limited to, conduct that may be harmful to the health, safety, and welfare of the public, conduct that may reflect negatively on one's fitness to practice nursing, or conduct that may violate any provision of the code of ethics adopted by the board or a specialty.
(63) 'Voluntary surrender' means the invalidation of a nursing license at the time of its surrender and thereafter. A person whose license is voluntarily surrendered may not practice nursing or represent oneself to be a nurse until the board takes action.
(64) 'Volunteer license' means authorization of a retired nurse to provide nursing services to others through an identified charitable organization without remuneration.
Section 40-33-30. (A) A person may not practice nursing without an active license issued in accordance with this chapter. A South Carolina license as an advanced practice registered nurse or registered nurse is required for a person located in another state to provide nursing services to a recipient located in this State at the time nursing services are provided. A licensee located in this State who provides nursing services to a recipient located in another state must be properly licensed in this State and comply with any applicable licensing requirements where the recipient of nursing services is located at the time the services are provided.
(B) It is unlawful for a person to practice as an advanced practice registered nurse, a registered nurse, or a licensed practical nurse in this State, or to use the abbreviation 'APRN', 'RN', or 'LPN' or any variation or subdesignation of these, or use any title, sign, card, or device to indicate that the person is a nurse, or that the person is practicing as a nurse, within the meaning of this chapter, unless the person is actively licensed under the provisions of this chapter.
(C) A person may not use the word 'nurse' as a title, or use an abbreviation to indicate that the person is practicing in this State as a nurse, unless the person is actively licensed as a nurse as provided for in this chapter. If the term 'nurse' is part of a longer title, such as 'nurse's aide', a person who is entitled to use that title shall use the entire title and may not abbreviate the title to 'nurse'. This does not prohibit the use of the title 'nurse' by persons who hold a temporary permit pending licensure by endorsement from another jurisdiction, and it does not prohibit the use of the title 'nurse' by persons enrolled in a board approved refresher course for the purpose of obtaining an active South Carolina license.
(D) A provision of this chapter may not be construed to prohibit:
(1) gratuitous nursing care by friends or members of the family;
(2) the incidental care of the sick by domestic servants or persons primarily employed as housekeepers as long as they do not practice nursing within the meaning of this chapter;
(3) nursing assistance in case of an emergency;
(4) the practice of nursing by students enrolled in approved nurse education programs;
(5) the practice of nursing in this State by a legally qualified nurse of another state whose engagement requires the nurse to accompany and care for a patient temporarily residing in this State during the period of one engagement, not to exceed six months, if the person does not represent or hold herself or himself out as a nurse licensed to practice in this State;
(6) the practice of any legally qualified nurse of another state who is employed by the United States government or any bureau, division, or agency of the United States government, while in the discharge of official duties;
(7) care given to maternity patients, in the performance of their duties by licensed midwives trained and supervised under the authority of the South Carolina Department of Health and Environmental Control, so long as these midwives confine care to maternity patients only and do not claim to be licensed nurses or certified nurse-midwives;
(8) the practice of nursing by a licensed nurse of another state who is enrolled in a board approved course of study or board approved experimental or experiential project requiring nursing practice as a part of the educational program;
(9) a person not licensed under this chapter from providing attendant care services limited by or on behalf of an individual in need of in-home care as long as the care provided is not the practice of nursing or medicine; and
(10) performance of an act which a person would normally perform if the person were physically and cognitively able.
(E) The South Carolina Department of Health and Environmental Control may establish policies that authorize licensed registered nurses to provide health care under the direction of a physician licensed to practice medicine in this State and under the guidance of a registered pharmacist including, but not limited to, the dispensing of drugs for the treatment of tuberculosis and sexually transmitted diseases, HIV/AIDS, maternal and child care, children with special health care needs, family planning, immunizations, and any other public health program. The original diagnosis and treatment as prescribed by the physician must be maintained on the individual patient's records. The provisions of this chapter must not be construed to require the employment of registered pharmacists at local health clinics for the guidance of registered nurses in the dispensing of drugs in accordance with these provisions.
Section 40-33-32. (A) An applicant for initial licensure must pass the appropriate National Council Licensure Examination (NCLEX) prescribed by the board. The applicant shall comply with all application procedures established by the governing body of the NCLEX and by the board. Applications for licensure are valid for one year from the date of filing with the board. An applicant who fails to attain licensure during this period shall submit a new application with the prescribed fee.
(B) The board shall admit an applicant for licensure examination if the applicant:
(1) submits a completed application on a form provided by the board;
(2) submits a 2" x 2" photograph, signed and dated;
(3) submits the appropriate application fee;
(4) submits a copy of the applicant's birth certificate or a valid passport issued by the applicant's country of origin demonstrating that the applicant is eighteen years of age or older;
(5) submits a copy of the applicant's social security card or permanent resident card; a resident alien who does not have a social security number must have an alien identification number;
(6) has not committed any acts that are grounds for disciplinary action;
(7) has completed all requirements for graduation from an approved school of nursing or nursing education program approved by the state or jurisdiction in this country or territory or dependency of the United States in which the program is located.
(C) Credit may not be given in an initial application for an unapproved correspondence course or for experience gained through employment.
(D) The board shall accept applicants for the National Council Licensure Examination-PN who;
(1) have successfully completed an approved nursing education program for professional nursing within the past five years of the date of the application;
(2) have received an equivalent education from an approved nursing education program within the past three years of the date of the application.
(E) An applicant who does not pass the licensure examination on the first attempt may retake the examination not more frequently than once every forty-five days for up to one year from the first attempt. An applicant who does not pass the examination within one year of the first examination shall provide evidence satisfactory to the board of remediation approved by the board before reexamination. An applicant who has not passed the National Council Licensure Examination within three years of graduation must requalify to take the examination by enrolling in an approved nursing education program and demonstrating knowledge, skills, and ability of a graduate nurse.
(F) A foreign educated nurse who holds a license to practice in a jurisdiction outside a state or jurisdiction in this country or territory or dependency of the United States who applies for licensure as a nurse shall satisfy all the requirements of this section and the following:
(1) An applicant's general education and nursing education must be at a level required of graduates of nursing education programs in this State who are candidates for licensure as verified by a certificate of the Commission on Graduates of Foreign Nursing Schools or another board approved credentials evaluation service. An applicant whose native language is not English shall submit evidence of passing the Test of English as First Language (TOEFL), Test of Written English (TWE), and Test of Spoken English (TSE) offered by TOEFL/TSE Services or another service approved by the board. An applicant whose education for nursing is not verified as equivalent may qualify for a license by completing a supplemental course as prescribed by the board to be covered in an approved nursing education program and, upon completion of the course, writing and passing the licensing examination.
(2) An applicant shall pass the appropriate National Council Licensure Examination and shall comply with all application procedures established by the governing body of the NCLEX and by the board. Applications for licensure are valid for one year from the date of filing with the board. An applicant who fails to attain licensure during this period shall submit a new application with the prescribed fee.
(3) An applicant shall submit verification of authorization to practice as a registered nurse, licensed practical nurse, or comparable title from the country of original licensure.
(4) A foreign educated applicant who does not become licensed within three years of first taking the examination shall requalify to take the National Council Licensure Examination (NCLEX) by enrolling in an approved nursing education program and demonstrating knowledge, skills, and ability of a graduate nurse.
Section 40-33-33. (A) When a licensed practical nurse becomes licensed as a registered nurse, the person's LPN license must be placed on inactive status.
(B) When a registered nurse becomes licensed as an advanced practice registered nurse, the person's RN license must be placed on inactive status. However, an APRN is authorized to practice as a RN while the person's APRN license is in good standing, unless otherwise specifically authorized by the board.
Section 40-33-34. (A) An advanced practice registered nurse applicant shall furnish evidence satisfactory to the board that the applicant:
(1) has met all qualifications for licensure as a registered nurse; and
(2) holds current specialty certification by a board approved credentialing organization. New graduates shall provide evidence of certification within one year of program completion; however, psychiatric clinical nurse specialists shall provide evidence of certification within two years of program completion; and
(3) has earned a master's degree from an accredited college or university, except for those applicants who;
(a) provide documentation as requested by the board that the applicant was graduated from an advanced, organized formal education program appropriate to the practice and acceptable to the board before December 31, 1994; or
(b) graduated before December 31, 2003, from an advanced, organized formal education program for nurse anesthetists accredited by the national accrediting organization of that specialty. CRNAs who graduate after December 31, 2003, must graduate with a master's degree from a formal CRNA education program for nurse anesthetists accredited by the national accreditation organization of the CRNA specialty. An advanced practice registered nurse must achieve and maintain national certification, as recognized by the board, in an advanced practice registered nursing specialty;
(4) has paid the board all applicable fees; and
(5) has declared specialty area of nursing practice and the specialty title to be used must be the title which is granted by the board approved credentialing organization or the title of the specialty area of nursing practice in which the nurse has received advanced educational preparation.
(B) An APRN is subject, at all times, to the scope and standards of practice established by the board approved credentialing organization representing the specialty area of practice and shall function within the scope of practice of this chapter and must not be in violation of Chapter 47.
(C)(1) A licensed nurse practitioner, certified nurse-midwife, or clinical nurse specialist must provide evidence of approved written protocols, as provided in this section. A licensed NP, CNM, or CNS performing delegated medical acts must do so under the general supervision of a licensed physician or dentist who must be readily available for consultation.
(2) When application is made for more than three NP's, CNM's, or CNS's to practice with one physician or when a NP, CNM, or CNS is performing delegated medical acts in a practice site greater than forty-five miles from the supervising physician, the Board of Nursing and Board of Medical Examiners shall each review the application to determine if adequate supervision exists.
(D)(1) Delegated medical acts performed by a nurse practitioner, certified nurse-midwife, or clinical nurse specialist must be performed pursuant to an approved written protocol between the nurse and the physician and must include, but is not limited to:
(a) this general information:
(i) name, address, and South Carolina license number of the nurse;
(ii) name, address, and South Carolina license number of the physician;
(iii) nature of practice and practice locations of the nurse and physician;
(iv) date the protocol was developed and dates the protocol was reviewed and amended;
(v) description of how consultation with the physician is provided and provision for backup consultation in the physician's absence;
(b) this information for delegated medical acts:
(i) the medical conditions for which therapies may be initiated, continued, or modified;
(ii) the treatments that may be initiated, continued, or modified;
(iii) the drug therapies that may be prescribed;
(iv) situations that require direct evaluation by or referral to the physician.
(2) The original protocol and any amendments to the protocol must be reviewed at least annually, dated and signed by the nurse and physician, and made available to the board for review within seventy-two hours of request. Failure to produce protocols upon request of the board is considered misconduct and subjects the licensee to disciplinary action. A random audit of approved written protocols must be conducted by the board at least biennially.
(3) Licensees who change practice settings or physicians shall notify the board of the change within fifteen business days and provide verification of approved written protocols. NP's, CNM's, and CNS's who discontinue their practice shall notify the board within fifteen business days.
(E)(1) A NP, CNM, or CNS who applies for prescriptive authority:
(a) must be licensed by the board as a nurse practitioner, certified nurse-midwife, or clinical nurse specialist;
(b) shall submit a completed application on a form provided by the board;
(c) shall submit the required fee;
(d) shall provide evidence of completion of forty-five contact hours of education in pharmacotherapeutics acceptable to the board, within two years before application or shall provide evidence of prescriptive authority in another state meeting twenty hours in pharmacotherapeutics acceptable to the board, within two years before application;
(e) shall provide at least fifteen hours of education in controlled substances acceptable to the board as part of the twenty hours required for prescriptive authority if the NP, CNM, or CNS has equivalent controlled substance prescribing authority in another state;
(f) shall provide at least fifteen hours of education in controlled substances acceptable to the board as part of the forty-five contact hours required for prescriptive authority if the NP, CNM, or CNS initially is applying to prescribe in Schedules III through V controlled substances.
(2) The board shall issue an identification number to the NP, CNM, or CNS authorized to prescribe medications. Authorization for prescriptive authority is valid for two years unless terminated by the board for cause. Initial authorization expires concurrent with the expiration of the Advanced Practice Registered Nurse license.
(3) Authorization for prescriptive authority must be renewed after the applicant meets requirements for renewal and provides documentation of twenty hours acceptable to the board of continuing education contact hours every two years in pharmacotherapeutics. For a NP, CNM, or CNS with controlled substance prescriptive authority, two of the twenty hours must be related to prescribing controlled substances.
(F)(1) Authorized prescriptions by a nurse practitioner, certified nurse-midwife, or clinical nurse specialist with prescriptive authority:
(a) must comply with all applicable state and federal laws;
(b) is limited to drugs and devices utilized to treat common well-defined medical problems within the specialty field of the nurse practitioner or clinical nurse specialist, as authorized by the physician and listed in the approved written protocols. The Board of Nursing, Board of Medical Examiners, and Board of Pharmacy jointly shall establish a listing of classifications of drugs that may be authorized by physicians and listed in approved written protocols;
(c) do not include prescriptions for Schedule II controlled substances; however, Schedules III through V controlled substances may be prescribed if listed in the approved written protocol and as authorized by Section 44-53-300;
(d) must be signed by the NP, CNM, or CNS with the prescriber's identification number assigned by the board and the DEA number. The prescription form must include the name, address, and phone number of the NP, CNM, or CNS and physician and must comply with the provisions of Section 39-24-40. A prescription must designate a specific number of refills and may not include a nonspecific refill indication;
(e) must be documented in the patient record of the practice and must be available for review and audit purposes.
(2) A NP, CNM, or CNS who holds prescriptive authority may request, receive, and sign for professional samples, except for controlled substances in Schedule II, and may distribute professional samples to patients as listed in the approved written protocol, subject to federal and state regulations.
(G) Prescriptive authorization may be terminated by the board if a NP, CNM, or CNS with prescriptive authority has:
(1) not maintained certification in the specialty field;
(2) failed to meet the education requirements for pharmacotherapeutics;
(3) prescribed outside the scope of the approved written protocols;
(4) violated a provision of Section 40-33-110; or
(5) violated any state or federal law or regulations applicable to prescriptions.
(H)(1) Nothing in this section may be construed to require a CRNA to obtain prescriptive authority to deliver anesthesia care.
(2) A CRNA shall practice pursuant to approved written guidelines developed with the supervising licensed physician or dentist or by the medical staff within the facility where practice privileges have been granted and must include, but are not limited to:
(a) the following general information:
(i) name, address, and South Carolina license number of the registered nurse;
(ii) name, address, and South Carolina license number of the supervising physician, dentist, or the physician director of anesthesia services or the medical director of the facility;
(iii) dates the guidelines were developed, and dates the guidelines were reviewed and amended;
(iv) physical address of the primary practice and any additional practice sites;
(b) these requirements for providing anesthesia services:
(i) documentation of clinical privileges in the institutions where anesthesia services are provided, if applicable;
(ii) copy of job description;
(iii) policies and procedures that outline the pre-anesthesia evaluation, induction, intra-operative maintenance, and emergence from anesthesia.
(iv) evidence of outcome evaluation for anesthesia services.
(3) The original and any amendments to the approved written guidelines must be reviewed at least annually, dated and signed by the CRNA and physician or dentist, and must be made available to the board for review within seventy-two hours of request. Failure to produce the guidelines is considered misconduct and subjects the licensee to disciplinary action. A random audit of approved written guidelines must be conducted by the board at least biennially.
(4) A person who changes primary practice settings or physician or dentist shall notify the board of this change within fifteen business days and provide verification of approved written guidelines. A CRNA who discontinues his or her practice shall notify the board within fifteen business days.
(5) The physician or dentist responsible for the supervision of a CRNA must be identified on the anesthesia record before administration of anesthesia.
Section 40-33-35. An applicant for a license who holds a current authorization to practice in another state or jurisdiction in this country or territory or dependency of the United States may be licensed by the board by endorsement, without examination, if the applicant:
(1) submits a completed application on a form provided by the board;
(2) submits one 2" x 2" photograph signed and dated;
(3) submits the appropriate application fee;
(4) submits a copy of the applicant's birth certificate or a valid passport issued by the applicant's country of origin demonstrating that the applicant is eighteen years of age or older;
(5) submits a copy of the applicant's social security card or permanent resident card; a resident alien who does not have a social security number must have an alien identification number;
(6) has not committed any acts that are grounds for disciplinary action;
(7) has completed all requirements for graduation from a nursing education program approved by the state or jurisdiction in this country or territory or dependency of the United States in which the program is located, as evidenced by a graduation transcript or other proof of education satisfactorily demonstrating graduation as determined by the board. The applicant's education must be equivalent to that required in this State at the time of the applicant's initial licensure in the other jurisdiction. An applicant shall comply with these educational requirements for basic RN licensure and satisfy the requirements of Section 40-33-34.
(8) submits verification of current authorization to practice as a nurse in another state or jurisdiction or territory or dependency of the United States and that a license:
(a) has been issued on the basis of passing the State Board Test Pool Examination before 1983 or the appropriate National Council Licensure Examination;
(b) was not issued on the basis of passing the State Board Test Pool Examination before 1983 or the appropriate National Council Licensure Examination, in which case the applicant shall demonstrate not fewer than three years of successful practice as a licensed nurse in another state or jurisdiction in this country without disciplinary action that resulted in restriction of practice, including probation;
(9) evidence of continued competency as provided in this chapter.
(10) whose native language is not English, submits evidence of passing the Test of English as First Language (TOEFL), Test of Written English (TWE), and Test of Spoken English (TSE) offered by the TOEFL/TSE Services or another service approved by the board.
Section 40-33-36. (A) The board shall examine all candidates for licensure as nurses, pass upon their qualifications to practice nursing in this State, and issue each successful applicant a license. A license is the property of the State and subject to return upon demand.
(B) A license must be issued in the person's legal name as verified by a birth certificate or other legal document acceptable to the board. If a licensee changes her or his name after a license has been issued, notification of the change must be filed with the board within fifteen business days, accompanied by a copy of the legal document that authorizes the change. A licensee's name may not be changed on a record in the office of the board without written authorization for the change and an adequate identification of the applicant.
(C) A statement verifying current license status may be secured from the board by a licensee who submits adequate identification and a written statement explaining the reason for the request, if the reason is satisfactory to the board.
(D)(1) The board may issue a temporary or limited license to practice nursing, in accordance with this subsection, or as may be provided for in regulation, to an applicant:
(a) for licensure as a registered nurse, or as a licensed practical nurse, if the applicant's preliminary credentials have been approved and whose fee has been paid;
(b) for licensure by endorsement as a registered nurse or as a licensed practical nurse, for up to sixty days, unless further authorized by the administrator or designee, pending completion and approval of the application, if the applicant has filed an application, paid the fee, and has produced a statement of authorization to practice in another jurisdiction;
(c) while participating in a refresher course for up to ninety days, unless further authorized by the administrator or designee, when the applicant is seeking reinstatement of a lapsed or an inactive license or licensure by endorsement and must submit evidence of nursing competence before returning to nursing practice.
(2) An applicant who has failed the licensing examination is not eligible for a temporary permit to practice nursing.
(3) The board must not issue a limited, temporary, or permanent license to a person licensed in another state who currently has disciplinary action pending against the person in that state or whose license is currently restricted in any way, including probationary status, in that state.
(4) The board or department may immediately cancel a temporary permit or license that was issued based upon false, fraudulent, or misleading information provided by an applicant.
Section 40-33-37. (A) The board may issue a volunteer license without a fee to a retired nurse, upon written application, to donate nursing services through one specific charitable organization approved by the board if the nurse:
(1) has been granted inactive status and who has practiced not less than twenty-five years or until age sixty-five after a minimum of fifteen years of practice;
(2) submits evidence of completing not less than twenty-five hours of initial training with the charitable organization; and
(3) has been on the official inactive status list for not more than ten years.
(B) A volunteer license is not transferable and authorizes the retired nurse to provide nursing services to others without remuneration of any kind. A separate application must be filed and a separate license must be issued for every charitable organization to which the retired nurse wishes to donate nursing services.
(C) A volunteer license may be renewed annually, except as otherwise provided in Section 40-1-50, upon application and satisfactory demonstration of continued competency or not less than twenty-five hours of service or additional training per year with the same charitable organization. A volunteer license may be renewed if the license has been renewed without interruption with the same charitable organization and all other qualifications have been met.
(D) The board may promulgate regulations to carry out the provisions of this section.
Section 40-33-38. (A) A license issued pursuant to this chapter may be renewed biennially or as otherwise provided by the board in regulation. A licensee who has not demonstrated continuing nursing competence, as required by this chapter, is not eligible for renewal or issuance of an active license.
(B) A licensee shall complete the renewal form and submit it to the board with the renewal fee. Upon receipt of the application and the fee, the board shall verify the accuracy of the application and renew the license for the applicable period. If a licensee fails to timely renew his or her license, the license is deemed lapsed at the close of the renewal period, and the licensee may not practice nursing in this State until the licensee is reinstated to practice. The board may reinstate the licensee on payment of a reinstatement fee, the current renewal fee, and demonstration of continued competency satisfactory to the board. The board may deny reinstatement based on evidence of misconduct.
(C) A licensee shall notify the board in writing within fifteen business days of any change of address.
Section 40-33-40. (A) Demonstration of competency for initial licensure requires documented evidence of the following:
(1) graduation from an approved nursing education program; and
(2) successful completion of the NCLEX appropriate to the area of licensure and appropriate credentials for advanced practice registered nursing licensure, if applicable.
(B) Demonstration of competency for:
(1) renewal of an active license biennially requires documented evidence of at least one of the following requirements during the licensure period:
(a) completion of thirty contact hours from a continuing education provider recognized by the board;
(b) maintenance of certification or re-certification by a national certifying body recognized by the board;
(c) completion of an academic program of study in nursing or a related field recognized by the board; or
(d) verification of competency and the number of hours practiced, as evidenced by employer certification on a form approved by the board.
(2) reinstatement from lapsed or inactive status of five years or less requires documented evidence of at least one of the following within the preceding two years:
(a) completion of thirty contact hours from a continuing education provider recognized by the board and successful completion of a course in legal aspects approved by the board;
(b) maintenance of certification or re-certification by a national certifying body recognized by the board;
(c) completion of an academic program of study in nursing or a related field recognized by the board;
(d) verification of competency and the number of hours practiced in another jurisdiction where authorized to practice, as evidenced by employer certification on a form approved by the board; or
(e) successful completion of a refresher course approved by the board.
(3) reinstatement from lapsed or inactive status of more than five years requires documented evidence of at least one of the following:
(a) successful completion of a refresher course approved by the board; or
(b) successful completion of the NCLEX appropriate to the area of licensure.
(C) Failure to comply with applicable continued competency requirements results in nonrenewal or denial of the application. A licensee shall maintain all documented evidence of compliance for at least four years. This documented evidence must be presented by the licensee within five business days of request by a representative of the department acting in its discretion or in accordance with a random audit of a sample of licensees. Failure to provide satisfactory documented evidence of compliance within the prescribed time results in the immediate temporary suspension or cancellation of the license pending compliance with all requirements for licensure and until order of the board.
Section 40-33-41. Upon request on a form provided by the board and payment of the applicable fee, the board shall place a person on the official inactive status if the person is currently licensed under this chapter and does not meet the minimum continued competency requirement for renewal or wishes to retire from practice temporarily. While on inactive status the person is not subject to the payment of any renewal fees and must not practice nursing in this State. To apply for reinstatement, the person shall submit an application, pay a reinstatement fee for the current period, and demonstrate continued competency as defined in regulation. The board may deny reinstatement based on evidence of unlawful acts, incompetence, unprofessional conduct, or other misconduct.
Section 40-33-42. (A) An advanced practice registered nurse, registered nurse, or licensed practical nurse is responsible for the delegation and supervision of nursing tasks to unlicensed assistive personnel. Tasks that may be assigned to unlicensed assistive personnel must be stated in the employers' policies, and the employer shall verify the training of this personnel and their competencies to perform the tasks.
(B) Tasks which may be delegated and performed under supervision may include, but are not limited to:
(1) meeting patients' needs for personal hygiene;
(2) meeting patients' needs relating to nutrition;
(3) meeting patients' needs relating to ambulation;
(4) meeting patients' needs relating to elimination;
(5) taking vital signs;
(6) maintaining asepsis;
(7) observing, recording, and reporting any of the tasks enumerated in the subsection.
(C) Subject to the rights of licensed physicians and dentists under state law, the administration of medications is the responsibility of a licensed nurse as prescribed by the licensed physician, dentist, other authorized licensed provider or as authorized in an approved written protocol or guidelines. Unlicensed assistive personnel must not administer medications, except as otherwise provided by law.
Section 40-33-43. An unlicensed person with documented medication training and skill competency evaluation may provide oral and topical medications, regularly scheduled insulin, and prescribed anaphylactic treatments under established medical protocol to patients in community residential care facilities; this does not include providing sliding scale insulin or other injectable medications. Licensed nurses may train and supervise selected unlicensed persons to provide medications and, after reviewing their competency evaluations, may approve persons to provide medications, in accordance with this section.
Section 40-33-44. Notwithstanding any other provision of law, requiring the practice of practical nursing to be performed under the direction of an advanced practice registered nurse, registered nurse, licensed physician, or licensed dentist, a licensed practical nurse may provide nursing care authorized for licensed practical nurses under this chapter without the on-site supervision of an advanced practice registered nurse, registered nurse, licensed physician, or licensed dentist in:
(1) home or residential settings, if a registered nurse has approved the plan of care;
(2) public schools and in institutions and facilities of the Department of Juvenile Justice and Department of Corrections, if the licensed practical nurse follows the policies, procedures, and guidelines of the employing entity and if a registered nurse is available on call by telecommunications.
Section 40-33-50. (A) The Department of Labor, Licensing and Regulation shall provide all administrative, fiscal, investigative, inspectional, clerical, secretarial, and license renewal operations and activities of the board in accordance with Section 40-1-50.
(B) Initial fees must be established by the board in regulation and shall serve as the basis for necessary adjustments in accordance with Section 40-1-50(D) to ensure that they are sufficient, but not excessive, to cover expenses, including the total of the direct and indirect costs to the State for the operations of the board.
Section 40-33-70. Nurses shall conduct themselves in accordance with the code of ethics adopted by the board in regulation.
Section 40-33-80. The department shall investigate complaints and violations of this chapter as provided in Section 40-1-80.
Section 40-33-90. In addition to the powers and duties enumerated in Section 40-1-90, the presiding officer of the board may administer oaths when taking of testimony upon any and all matters pertaining to the business or duties of the board.
Section 40-33-100. Restraining orders and cease and desist orders may be issued in accordance with Section 40-1-100.
Section 40-33-110. (A) In addition to the grounds provided in Section 40-1-110, upon finding misconduct the board may cancel, fine, suspend, revoke, issue a public reprimand or a private reprimand, or restrict, including probation or other reasonable action such as requiring additional education and training, the authorization to practice of a person who has:
(1) violated a federal, state, or local law involving alcohol or drugs or committed an act involving a crime of moral turpitude. A conviction is not required to prove misconduct under this item. The board may receive evidence to reach an independent conclusion as to the commission of the violation; however the determination may be used only in making the administrative decision regarding the proposed discipline;
(2) allowed another person to use the licensee's authorization to practice;
(3) wilfully or repeatedly followed a course of conduct that, by reasonable professional or ethical standards, renders the licensee incompetent to assume, perform, or be entrusted with the duties, responsibilities, or trusts which normally devolve upon a licensed nurse;
(4) had a license to practice nursing in another state suspended or revoked or had other disciplinary action taken by another state; in which case, the action by another state creates a rebuttable presumption that a South Carolina nursing license may be acted upon similarly. The finding may be based solely upon the record in the other state, and there is no requirement for a de novo hearing on the facts established in that proceeding. Other evidence is admissible to support or rebut this presumption. The licensee must produce a copy of all transcripts, documents, orders, or other items from the other state's proceedings upon request by the department. Failure to produce all requested items within ninety days of the request results in the immediate temporary suspension of the license until further order of the board;
(5) violated a provision of this chapter or a regulation or order of the board;
(6) failed to cooperate with an investigation or other proceeding of the board;
(7) failed to comply with a directive or order of the department or board;
(8) disseminated a patient's health or personal information acquired during the course of practice to persons not entitled by law or hospital or agency policy to disclosure of this information;
(9) falsified or altered, for the purpose of reflecting incorrect or incomplete information, any organization's records, including personnel records or patient records;
(10) misappropriated money, property, or drugs from an employer or patient;
(11) obtained or attempted to obtain a fee for patient service for one's self or for another through fraud, misrepresentation, or deceit;
(12) wilfully aided, abetted, assisted, or hired an individual to violate a provision of this chapter or a regulation of the board;
(13) obtained, possessed, administered, or furnished prescription drugs to a person including, but not limited to, one's self, except as directed by a person authorized by law to prescribe drugs;
(14) engaged in the practice of nursing when judgment or physical ability is impaired by alcohol, drugs, or controlled substances or has declined or been unsuccessful in accomplishing rehabilitation;
(15) sustained a physical or mental disability that renders further practice dangerous to the public;
(16) omitted, in a grossly negligent fashion, to record information concerning a patient that would be relevant to that patient's condition;
(17) indicated the witnessing of wastage of narcotics or controlled substances on record when the wastage was not witnessed or failed to obtain a witness to the wastage of narcotics or controlled substances;
(18) failed to make or keep accurate, intelligible entries in records as required by law, policy, or standards for the practice of nursing;
(19) obtained, or attempted to obtain, a license to practice nursing for one's self or for another through fraud, deceit, misrepresentation or any other dishonesty in any phase of the licensing process including, but not limited to, the examination;
(20) practiced nursing without a valid, current South Carolina license or aided, abetted, or assisted another to practice nursing without a valid, current South Carolina license;
(21) practiced outside the scope of the license by assuming duties and responsibilities without adequate education as determined by the board;
(22) failed to report incompetent or unprofessional practice of a licensed nurse to the appropriate authorities, including the board;
(23) assigned unqualified persons to perform nursing care functions, tasks, or responsibilities or failed to effectively supervise persons to whom nursing functions are delegated or assigned;
(24) abandoned a patient after accepting the patient assignment and establishing a nurse-patient relationship and disengaged the nurse-patient relationship without giving reasonable notice to the appropriate personnel responsible for making arrangements for continuation of nursing care;
(25) failed to comply with best practice standards and recommendations to minimize transmission of infectious or communicable diseases;
(26) failed to timely notify the department of changes in information required in an original or renewal application.
(B)(1) Acts or omissions by a licensee or applicant causing the denial, revocation, suspension, or restriction of a license to practice in another state supports the issuance of a formal complaint and the commencement of disciplinary proceedings. This subsection applies only if the disciplinary action taken in another state is based on grounds that would constitute misconduct in this State. Proof of these acts or omissions may be shown by a copy of the transcript of record of the disciplinary proceedings in another state or a copy of the final order, consent order, or similar order stating the basis for the action taken.
(2) Upon filing an application or an initial complaint alleging that the applicant or licensee has been disciplined in another state, the applicant or licensee must produce copies of all transcripts, documents, and orders used, relied upon, or issued by the licensing authority in the other state. Failure to produce these items within ninety days of written request results in the denial of the individual's application or suspension of the individual's license to practice in this State until these items have been provided.
(3) The applicant or licensee may present mitigating testimony to the board or hearing panel regarding disciplinary action taken in another state or evidence that the acts or omissions committed in another state do not constitute misconduct under this chapter.
Section 40-33-111. (A) An employer, including an agency, or supervisor of nurses, shall report any instances of the misconduct or the incapacities described in Section 40-33-110 to the State Board of Nursing not more than fifteen business days, excepting Saturdays, Sundays, and legal holidays, from the discovery of the misconduct or incapacity. A nurse supervisor who fails to timely report the misconduct or incapacity may be subject to disciplinary action and civil sanctions as provided for in Section 40-33-120. An employer who is not licensed by the board and who fails to timely report the misconduct or incapacity shall pay a civil penalty of one thousand dollars per violation upon notice of the board.
(B) The findings of the board, including the amount of the fine, are final unless within thirty days after receipt of their notice the employer submits a request in writing to the board for a review of the findings or the amount of the fine. If a request for review is made to the board, a final determination must be made after an opportunity for a hearing pursuant to the Administrative Procedures Act.
Section 40-33-115. The board has jurisdiction over the acts and omissions of current and former licensees as provided in Section 40-1-115.
Section 40-33-116. (A) If the board finds that probable cause exists that a licensee or applicant may be addicted to alcohol or drugs or may have sustained a physical or mental disability that may render practice by the licensee or applicant dangerous to the public, the board, without a formal complaint or opportunity for hearing, may require a licensee or applicant to submit to a mental or physical examination by authorized practitioners designated by the board. The results of an examination are admissible in a hearing before the board, notwithstanding a claim of privilege under a contrary rule of law or statute. A person who accepts the privilege of engaging in the licensed practice of nursing in this State, or who files an application for a license to practice under this chapter, is deemed to have consented to submit to a mental or physical examination and to have waived all objections to the admissibility of the results in a hearing before the board upon the grounds that this constitutes a privileged communication. If a licensee or applicant fails to submit to an examination when properly directed to do so by the board, unless the failure was due to circumstances beyond the person's control, the board shall enter an order automatically suspending or denying the license pending compliance and further order of the board. A licensee or applicant who is required to submit to a mental or physical examination may request within twenty-four hours of receipt of the requirement a review by an administrative hearing officer appointed by the board or its designee. Filing of a written request for a review by an administrative hearing officer does not stay the time directed in which to submit to a mental or physical examination, and no stay may be issued, except as provided in this section. Upon proper written request, a review hearing must be conducted within forty-eight hours of receipt of the request. Failure to provide a review hearing within the prescribed time stays the time required to submit to a mental or physical examination until a decision is issued by the administrative hearing officer. The review hearing for purposes of this section must be limited to the issues of whether the person is a licensee or applicant, whether reasonable grounds exist to require a mental or physical examination, and whether the licensee or applicant has been informed that failure to submit to an examination will result in the entry of an order automatically suspending or denying the license pending compliance and further order of the board. The administrative hearing officer's decision is not subject to appeal. A licensee or applicant who is prohibited from practicing under this subsection must be afforded at reasonable intervals an opportunity to demonstrate to the board the ability to resume or begin the practice with reasonable skill and safety.
(B) The board upon probable cause may obtain records relating to the mental or physical condition of a licensee or applicant including, but not limited to, psychiatric records; and these records are admissible in a hearing before the board, notwithstanding any other provision of law. A person who accepts the privilege of engaging in the licensed practice of nursing in this State, or who files an application to practice under this chapter, is deemed to have consented to the board obtaining these records and to have waived all objections to the admissibility of these records in a hearing before the board upon the grounds that this constitutes a privileged communication. If a licensee or applicant refuses to sign a written consent for the board to obtain these records when properly requested by the board, unless the failure was due to circumstances beyond the person's control, the board shall enter an order automatically suspending or denying the license pending compliance and further order of the board. A licensee or applicant who is prohibited from practicing under this subsection must be afforded at reasonable intervals an opportunity to demonstrate to the board the ability to resume or begin the practice of medicine with reasonable skill and safety.
(C) An order requiring a licensee or applicant to submit to a mental or physical examination or an order requiring the submission of records relating to the mental or physical condition of a licensee or applicant is confidential and must not be disclosed, except to the extent necessary for the proper disposition of the matter before the board. An order automatically suspending or denying a license pending compliance and further order of the board is public information under the South Carolina Freedom of Information Act. A decision of an administrative hearing officer is confidential, unless an order automatically suspending or denying a license pending compliance and further order of the board has been issued, in which case the administrative hearing officer's decision and the order requiring an examination of records is public information under the South Carolina Freedom of Information Act.
Section 40-33-120. (A) In addition to the powers and duties enumerated in Section 40-1-120, the board may issue private reprimands. The board may impose a fine of up to two thousand dollars for each violation of a provision of this chapter or of a regulation promulgated by the board, not to exceed a total of ten thousand dollars. Fines are payable immediately upon the effective date of discipline unless otherwise provided by the board. Interest accrues after fines are due at the maximum rate allowed by law. No licensee against whom a fine is levied is eligible for reinstatement until the fine has been paid in full.
(B) A decision by the board to revoke, suspend, or restrict a license or to limit or discipline a licensee becomes effective upon delivery of a copy of the decision to the licensee and a petition for review does not operate as a supersedeas or stay.
(C) No stay or supersedeas may be granted pending an appeal from a decision by the board to revoke, suspend, or restrict the license for six months or more. An appeal taken to an administrative law judge as provided under Article 5, Chapter 23, Title 1 has precedence on the calendar of an administrative law judge, is considered an emergency appeal if the board has revoked, suspended, or restricted a license for six months or more, and should be heard not later than thirty days from the date the petition is filed. The review is limited to the record established by the board hearing.
Section 40-33-130. As provided in Section 40-1-130, the board may deny licensure to an applicant based on the same grounds for which the board may take disciplinary action against a licensee.
Section 40-33-140. As provided for in Section 40-1-140, a license may not be denied based solely on a person's prior criminal record.
Section 40-33-150. A licensee under investigation for a violation of this chapter or a regulation promulgated under this chapter may voluntarily surrender the license to practice in accordance with and subject to the provisions of Section 40-1-150.
Section 40-33-160. A person aggrieved by a final action of the board may seek review of the decision to the Administrative Law Judge Division in accordance with Section 40-1-160. Service of a petition for review does not stay the board's decision pending completion of the appellate process.
Section 40-33-170. A person found in violation of this chapter or regulations promulgated under this chapter may be required to pay costs associated with the investigation and prosecution of the case in accordance with Section 40-1-170.
Section 40-33-180. All costs and fines imposed pursuant to this chapter must be paid in accordance with and are subject to the collection and enforcement provisions of Section 40-1-180. No person against whom a fine is levied is eligible for the issuance or reinstatement of an authorization to practice until the fine has been paid in full.
Section 40-33-190. (A) No person connected with any complaint, investigation, or other proceeding before the board including, but not limited to, a witness, counsel, counsel's secretary, board member, board employee, court reporter, or investigator may mention the existence of the complaint, investigation, or other proceeding, disclose any information pertaining to the complaint, investigation, or other proceeding, or discuss any testimony or other evidence in the complaint, investigation, or proceeding, and then only to the extent necessary for the proper disposition of the complaint, investigation, or other proceeding.
(B) Every communication, oral or written, to the board, department, staff, counsel, or any other person acting on behalf of the board or department during the investigation, hearing, or adjudication of the disciplinary matters including, but not limited to, investigative reports concerning interviews and issues under investigation, correspondence, summaries, incident reports, computer printouts, and documents created during peer review proceedings are privileged and these persons are immune from liability.
(C) Information that has been declared confidential or personal under this chapter or other applicable law must not be disclosed, except to the extent necessary for the proper disposition of the matter before the board, and is protected in the same manner as provided in Section 40-71-20, or as otherwise provided by law. (D) The identity of the initial complainant and any confidential informants or other witnesses who do not testify must not be disclosed to other parties, entities, or persons, and all information contained in confidential investigative files is privileged from disclosure for any reason whatsoever, except as provided for in subsection (E).
(E) Whenever the department receives information indicating a violation of state or federal law, the department may provide that information, to the extent the department considers necessary, to the appropriate state or federal law enforcement or regulatory body.
(F) No information in investigative files or disciplinary proceedings is required to be expunged pursuant to any other provision of state law.
Section 40-33-200. A person who practices or offers to practice nursing in this State in violation of this chapter or who knowingly submits false information for the purpose of obtaining a license is guilty of a misdemeanor and, upon conviction, must be imprisoned not more than one year or fined not more than fifty thousand dollars. Each violation constitutes a separate offense. The provisions of this chapter apply to a person or entity aiding and abetting in a violation of this chapter.
Section 40-33-210. The department, in addition to instituting a criminal proceeding, may institute a civil action through the Administrative Law Judge Division, in the name of the State, for injunctive relief against a person violating this chapter, a regulation promulgated under this chapter, or an order of the board. For each violation the administrative law judge may impose a fine of not more than ten thousand dollars.
Section 40-33-220. If a provision of this chapter or the application of a provision of this chapter to a person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this statute which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are severable."
SECTION 2. This act takes effect upon approval by the Governor.
This web page was last updated on Thursday, June 25, 2009 at 10:22 A.M.