CHAPTER 26

FORMERLY

SENATE SUBSTITUTE NO. 1 FOR SENATE BILL NO. 2

AS AMENDED BY SENATE AMENDMENT NO. I

AN ACT TO AMEND CHAPTER 19, TITLE 24 OF THE DELAWARE CODE RELATING TO THE PRACTICE OF NURSING, AND PROVIDING FOR A BOARD OF NURSING.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1. Amend Chapter 19, Title 24 of the Delaware Code by striking said chapter in its entirety, and substituting in lieu thereof the following:

"CHAPTER 19. NURSING

§1901. Declaration of Legislative Intent

The legislature hereby declares the practice of nursing by competent persons is necessary for the protection of the public health, safety and welfare and further finds that the levels of practice within the profession of nursing should be regulated and controlled in the public interest. In order to safeguard life and health, the general administration and supervision of the education, examination, licensing and regulation of professional and practical nursing is declared essential, and such general administration and supervision is vested in the Board of Nursing. Nothing in this Chapter shall be construed to impact negatively on the practice of practical nursing, nor is it the intent of this Chapter to address the question of change in the educational level at which one may enter the practice of professional or practical nursing. Nothing contained in this Act shall be deemed to permit acts of surgery or medical diagnosis; nor shall it be deemed to permit dispensing of drugs, medications or therapeutics independent of the supervision of a physician who is licensed to practice medicine and surgery, or those licensed to practice dentistry or podiatry. "Therapeutics" refers to treatment of diseases and/or disease processes.

§1902. Definitions

A. The profession of nursing is an art and process based on a scientific body of knowledge. The practitioner of nursing assists patients in the maintenance of health, the management of illness, injury or infirmity or in the achieving of a dignified death.

B. The practice of professional nursing as a registered nurse means the performance of professional nursing services by a person who holds a valid license pursuant to the terms of this Chapter, and who bears primary responsibility and accountability for nursing practices based on specialized knowledge, Judgment and skill derived from the principles of biological, physical, and behavioral sciences. The registered nurse practices in the profession of nursing by the performance of activities, among which are:

(I) Assessing human responses to actual or potential health conditions;

(2) Identifying the needs of the individual and/or family by developing a nursing diagnosis;

(3) Implementing nursing interventions based on the nursing diagnosis;

(4) Teaching health care practices. Nothing contained herein shall limit other qualified persons or agencies from teaching health care practices without being licensed under this Chapter.

(5) Advocating the provision of health care services through collaboration with other health service personnel;

(6) Executing regimens, as prescribed by a licensed physician, dentist, or podiatrist, including: the dispensing and/or administration of medications and treatments;

(7) Administering, supervising, delegating and evaluating nursing activities.

with the licensed practical nurse's continuing education and demonstrated competencies.

D. Advanced registered nurse practitioner means a currently licensed registered nurse who has gained added knowledge and skills through an organized post-basic program of study and clinical experience and who has met national certification requirements as approved by the Board of Nursing and is designated to perform advanced or specialized nursing practice. Advanced registered nurse practitioner shall include, but not be limited to, pediatric nurse practitioner, family nurse practitioner, maternal-gynecological nurse practitioner, clinical specialist in psychiatric-mental health nursing, nurse anesthetist and gerontological nurse practitioner.

E. Nursing education program means a course of Instruction offered and conducted to prepare persons for I censure as a registered or licensed practical nurse, and/or a course of instruction offered and conducted to increase the knowledge and skills of the nurse and leads to an academic degree in nursing, and/or refresher courses in nursing.

F. Administration of medications means a process whereby a single dose of a prescribed drug or biological is given to a patient by an authorized licensed person by one of several routes, oral, inhalation, topical, or parenteral. The person verifies the properly prescribed drug order, removes the individual dose from a previously dispensed, properly labeled container (including a unit dose container), assesses the patient's status to assure that the drug is given as prescribed to the patient for whom it is prescribed and that there are no known contraindications to the use of the drug or the dosage that has been prescribed, gives the individual dose to the proper patient, records the time and dose given, and assesses the patient following the administration of medication for possible untoward side effects.

A. Assistance with medications means the designated care provider assists the patient in the self-administration of a drug, provided that the medication is in the original container, with proper label and direction. The designated care provider may hold the container for the patient, assists with the opening of the container, and assists patient in taking the medication.

A. Standards of nursing practice means those standards of practice adopted by the Board that interpret the legal definitions of nursing, as well as provide criteria against which violations of the law can be determined. Such standards of nursing practice shall not be used to directly or indirectly affect the employment practices and deployment of personnel by duly licensed or accredited hospitals and other duly licensed or accredited health care facilities and organizations. In addition, such standards shall not be assumed the only evidence in civil malpractice litigation, nor shall they be given a different weight than any other evidence.

A. Nursing diagnosis means the description of the individual's actual or potential health needs which are Identified through a nursing assessment and are amenable to nursing intervention. The focus of the nursing diagnosis is on the individual's response to illness or other factors that may adversely affect the attainment/or maintenance of wellness. These diagnostic acts are distinct from medical, osteopathic, and dental diagnosis.

(J) Dispensing means providing drugs and/or medication according to standing orders of a physician, dentist, or podiatrist duly licensed to practice.

S1903. Delaware Board of Nursing; Appointments; Qualifications; Terms of Office; Vacancies.

A. The Delaware Board of Nursing (hereafter referred to as the Board) shall consist of eleven (11) members. The term of office of every member appointed to the Board, except those appointed to fill vacancies occurring during any term of office, is three (3) years. The Board shall be composed of five (5) registered nurses, four (4) licensed practical nurses, and two (2) public members.

Registered nurse appointees shall have a diploma or an earned degree in nursing, nursing education, or education, and at least three (3) years active practice as a registered nurse in nursing service, administration or teaching.

Practical nurse appointees shall be licensed practical nurses, who are graduates of an approved school of practical nursing, with at least three (3) years active practice as a practical nurse.

The public members shall be residents of Delaware for a minimum of three (3) years, shall be knowledgeable about the health needs of Delaware, but shall not be licensees of any health occupation board, employees of a health care occupational board, employees of a health care facility or agency, or engaged in governance or administration of a health care facility or agency.

A. The nursing experience referred to in this section shall have been within the last five (5) years preceding appointment and said appointee must be currently licensed in Delaware.

A. The Governor shall appoint all members to the Board of Nursing.

D. Sixty days prior to the expiration of the term of any member of the Board, a successor shall be appointed by the Governor. Registered Nurse appointees shall be appointed from a list of at least three (3) nominees for each vacancy to be furnished by the Delaware Nurses' Association and other professional nursing organizations. Licensed Practical Nurse appointees shall be appointed from a list of at least three (3) nominees for each vacancy to be furnished by the Delaware Licensed Practical Nurses' Association and others in the practical nursing community. The Governor shall seek nominees from the consumer population for the public members appointees. Vacancies occurring for any cause other than expiration of term shall be filled by the Governor for the unexpired term from a like list of nominees furnished by the appropriate groups.

E. At least one of the professional nurse members of the Board shall be a resident of New Castle County, one a resident of Kent County, one a resident of Sussex County. Licensed practical nurse members shall be representatives of at least two (2) counties simultaneously. If there is no qualified person available in the geographical subdivision, then appointments shall be made from qualified persons available in any of the other geographical subdivisions.

F. Each member shall serve for a term of three years, and may succeed himself for one additional term; provided however, that where a member was Initially appointed to fill a vacancy, such member may succeed himself for only one additional full term. Any person appointed to fill a vacancy on the Board shall hold office for the remainder of the unexpired term of the former member.

G. A member of the Board shall be suspended or removed by the Governor for misfeasance, non-feast:nee or malfeasance. A member subject to disciplinary proceedings shall be disqualified from Board business until the charge is adjudicated or the matter is otherwise concluded. A Board member may appeal any suspension or removal to the Superior Court.

H. No member of the Board shall hold elected office in a local, state, regional, or national nursing association if such participation might result in potential, actual, or the appearance of conflict of interest to the Board or the individual.

§1904. Election of Officers; Quorum; Rules dr Regulations; Special Meetings.

A. The Board shall, annually in the month of June, elect from its members a president and vice-president.

B. Six (6) members of the Board, including one officer, shall constitute a quorum.

C. The Board may adopt and promulgate such rules and regulations as may be necessary to govern its proceedings, to define the duties of its officers and to effectuate the intent and purpose of this Chapter.

D. Special meetings of the Board may be called by the Executive Director upon request of the president or any two (2) members.

E. The members of the Board shall receive compensation for each day, or part thereof, actually engaged in service and shall be reimbursed for all proper and necessary expenses.

F. The Board shall adopt a seal and may use that seal on official documents. §1905. Executive Director; Appointment; Qualifications.

The Board may appoint an Executive Director who shall receive an annual salary fixed by the Board, and shall be reimbursed for necessary travel and other expenses incurred in the discharge of his/her duties. The Executive Director shall be a registered nurse with at least five (5) years experience in an administrative or teaching position, have earned a master's degree in nursing, nursing education, education or a related health field.

§1906. Powers and Duties of the Board. The Board shall:

A. Adopt and, from time to time, revise such rules and regulations and standards not inconsistent with the law, as may be necessary to enable it to carry into effect the provisions of this Chapter.

B. Approve curricula and develop criteria and standards for evaluating educational programs preparing persons for license under this Chapter;

C. Provide for surveys of such programs at such times as it may deem necessary;

E. Approve such programs as meet the requirements of this Chapter and of the Board;

F. Deny or withdraw approval from educational programs for failure to meet approved curricula or other criteria;

G. Examine, license, and renew licenses of duly qualified applicants, including applicants for conducting nursing educational programs;

H. The Board shall establish categories of advanced registered nurse practitioners which shall include, but not be limited to, pediatric nurse practitioner, family nurse practitioner, maternal-gynecological nurse practitioner, clinical specialist in psychiatric-mental health nursing, nurse anesthetist and gerontological nurse practitioner and standards for the advanced registered nurse practitioner in each category. Such standards shall take into account the type of advanced levels of nursing practice which are or may be performed and the clinical and didactic education, experience, or both needed to practice safely at those levels. In setting such standards, the Board shall consult with advanced registered nurse practitioners and physicians and health care organizations utilizing advanced registered nurse practitioners. The standards shall be consistent with the national certifying organization standards of practice recognized by the Board in its Rules and Regulation."

I. Issue a temporary permit to practice nursing to applicants who apply for licensure by endorsement and to new graduates awaiting results of the first licensing examination;

A. Conduct hearings upon charges calling for discipline of a licensee or revocation of a license;

B. Have the power to issue subpoenas and compel the attendance of witnesses, and administer oaths to persons giving testimony at hearings;

C. Cause the prosecution of all persons violating this Chapter and have the power to incur such necessary expenses therefore;

D. Keep a record of all its proceedings;

E. Make an annual report to the Governor;

F. Appoint an Executive Director who shall not be a member of the Board; 0. Define the duties and fix compensation of the Executive Director;

P. Employ other persons to assist the Board;

Q. Have all of the duties, powers, and authority necessary to the enforcement of this Act, as well as such other duties, powers, and authority as it may be granted, from time to time by appropriate statute;

R. Appoint advisory committees as the Board deems desirable;

S. Maintain a system of statistics related to nursing education programs and registered nurse and licensed practical nurse licensure in the State;

T. Participate in and pay fees to the national organization of state boards of nursing, the National Council of State Boards of Nursing, Inc.

U. Establish appropriate fees for licensure by examination, re-examination, endorsement, renewal, and reinstatement, and initial and renewal applications for practice as an advanced registered nurse practitioner, and such other fees as the Board determines necessary.

§1907. Revenue and Expenses of the Board.

A. All fees and other money received by the Board shall be paid over to the State Treasurer, in accordance with Chapter 81 of Title 29.

IL Expenses of the Board, within the limits of appropriations made to it, shall be shall paid by the State Treasurer upon warrants signed by the proper officers of the Board.

§1908. Meetings; Examinations; Fee.

A. The Board shall meet as often as necessary to carry out its responsibilities as defined in this law.

13. The Board shall examine all applicants for licensing as professional or practical nurses. It shall also prescribe the procedures for subsequent examinations of applicants who fail an examination.

C. The Board shall consider and act upon applications to conduct a nursing education program.

D. Each applicant for examination, licensing and/or designation for practice as an advanced registered nurse practitioner shall submit to the Board an application and pay a fee, not to exceed $50, to be determined by the Board in the Board's Rules and Regulations.

§1909. Requirements for Nursing.

No unlicensed person, except those persons issued a temporary permit by the Board, shall practice professional or practical nursing, including the practice as an advanced registered nurse practitioner. Upon request, any persons engaged in the practice of professional or practical nursing shall exhibit a license authorizing such practice, and/or a certificate of state designation authorizing the practice as an advanced registered nurse practitioner.

§1910. Requirements for Registered Nurse.

An applicant for a license to practice as a registered nurse shall submit to the Board written evidence, verified by oath, that the applicant:

A. Is a graduate of a State Board of Nursing approved nursing education program that is authorized to prepare persons for licensure as a registered nurse;

B. Demonstrates competence In English related to nursing;

C. Must show evidence of an earned high school diploma or its equivalent;

D. Is of satisfactory physical and mental health.

E. Has committed no acts which are grounds for disciplinary action as set forth in §1922 (A) of this Chapter, or if such act has been committed the Board has found after investigation that sufficient restitution has been made; and

F. If seeking licensure by endorsement, demonstrates active employment in professional nursing in the past five (5) years, or satisfactory completion of a professional nursing refresher program with an approved agency within a one-year period prior to filing an application. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge in professional nursing.

§1911. Licensure by Examination for Registered Nurses.

An applicant for ((censure as a registered nurse by examination shall have completed a program in professional nursing and shall hold a certificate from a school for the preparation of professional nurses approved by a State Board of Nursing. The applicant shall be required to pass the standard national examination for professional nursing. The passing score shall be as recommended by the National Council of State Boards of Nursing. Every applicant who shall pass the prescribed examination shall receive a license to practice nursing as a registered nurse.

§1912. Licensure by Endorsement for Registered Nurses.

A. The Board may, by endorsement, without written examination, license as a registered nurse an applicant who, on or after July 1, 1983 is duly licensed as a registered nurse or is entitled to perform similar services under a different title under the laws of another state, territory, or foreign country if, in the opinion of the Board, the applicant meets the qualifications specified by this Chapter for registered nurses in this State.

13. In the event the applicant has not been actively employed in professional nursing in the past five (5) years, the applicant will be required to give evidence of satisfactory completion of a professional nursing refresher program with an approved agency within a one-year period prior to endorsement before licensure by endorsement will be granted. In the event no refresher ourse is available the Board may consider alternate methods of evaluating current knowledge in professional nursing.

C. Verification of current Delaware license is provided upon request to other state boards of nursing.

§1913. Nurses Licensed Under a Previous Law.

Any person holding a license to practice nursing as a registered nurse that is valid on July I, 1983 shall be deemed to be licensed as a registered nurse under the provisions of this Chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by Section 1918 of this Chapter.

Any person eligible for reactivation or reinstatement of a license to practice nursing as a registered nurse in this state on or after July 1, 1983 shall be deemed to be eligible to be licensed as a registered nurse under the provisions of this Chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by Section 1918 of this Chapter.

Any person whose license to practice nursing as a registered nurse has lapsed in this State on or after July 1, 1983 because of failure to renew may become licensed as a registered nurse under the provisions of this Chapter by applying for reinstatement according to the Rules and Regulations established by the Board of Nursing.

Any person, who was licensed to practice nursing as a registered nurse, and who had requested to be placed on Inactive status in this State on or after July 1, 1983, may become licensed as a registered nurse under the provisions of this Chapter by applying for reactivation according to the Rules and Regulations established by the Board of Nursing.

§1914. Requirements for Licensed Practical Nurses.

An applicant for a license to practice as a licensed practical nurse shall submit to the Board written evidence, verified by oath, that such applicant:

A. Is a graduate of a State Board of Nursing approved practical nursing education program;

A. demonstrates competence in English related to nursing;

A. must show evidence of an earned high school diploma or its equivalent;

A. is In satisfactory physical and mental health.

A. has committed no acts which are grounds for disciplinary action as set forth in §1922 (A) of this Chapter, or if such act has been committed the Board has found after investigation that sufficient restitution has been made; and

A. if seeking licensure by endorsement, demonstrates active employment in practical nursing in the past five (5) years, or satisfactory completion of a practical nursing refresher program with an approved agency within a one-year period prior to filing an application. In the event no refresher course Is available the Board may consider alternate methods of evaluating current knowledge in practical nursing.

A. §1915. Licensure by Examination for Licensed Practical Nurses.

A. An applicant for licensure as a practical nurse by examination shall have completed a program in practical nursing and shall hold a certificate from a school for the preparation of practical nursing approved by a State Board of Nursing.

A. The applicant shall be required to pass the standard national examination for practical nursing. The passing score shall be as recommended by the National Council of State Boards of Nursing. Every appliant who shall pass the prescribed examination shall receive a license to practice as a licensed practical nurse.

§1918. Licensure by Endorsement for Licensed Practical Nurses.

A. The Board may, by endorsement, without written examination, license as a practical nurse an applicant who, as of July 1, 1983, is duly licensed as a practical nurse or is entitled to perform similar services under a different title under the laws of another state, territory, or foreign country, if in the opinion of the Board, the applicant meets the qualifications specified by this Chapter for licensed practical nurses in this State.

B. In the event the applicant has not been actively employed in practical nursing in the past five (5) years, the applicant will be required to give evidence of satisfactory completion of a practical nursing refresher program within an approved agency within a one-year period prior to endorsement before licensure by endorsement will be granted. In the event no refresher course is available the Board may consider alternate methods of evaluating current know/edge in practical nursing.

C. Verification of current Delaware license is provided upon request to other state boards of nursing.

§1917. Licensed Practical Nurses Licensed Under a Previous Law.

Any person holding a license to practice nursing as a licensed practical nurse that is valid on July 1, 1983 shall be deemed to be licensed as a licensed practical nurse under the provisions of this Chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by Section 1918 of this Chapter.

Any person eligible for reactivation or reinstatement of a license to practice nursing as a licensed practical nurse In this State on or after July 1, 1983 shall be deemed to be eligible to be licensed as a licensed practical nurse under the provisions of this Chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by Section 1918 of this Chapter.

Any person whose license to practice nursing as a licensed practical nurse has lapsed in this State on or after July 1, 1983 because of failure to renew may become licensed as a licensed practical nurse under the provisions of this Chapter by applying for reinstatement according to the Rules and Regulations established by the Board of Nursing.

Any person, who was licensed to practice nursing as a licensed practical nurse, and who had requested to be placed on inactive status in this State on July I, 1983 may become licensed as a licensed practical nurse under the provisions of this Chapter by applying for reactivation according to the Rules and Regulations established by the Board of Nursing.

§1918. Renewal of License; Lapse of License; Penalties; Retirement from Practice.

A. Every registered or licensed practical nurse licensed under this Chapter shall re-register biennially by filing an application before the date determined by the Board. In the event the applicant has not been actively employed in professional or practical nursing in the past five (5) years, the applicant will be required to give evidence of satisfactory completion of a professional or practical nursing refresher program within an approved agency within a one-year period prior to renewal before licensure by renewal will be granted. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge In professional or practical nursing. With each application a fee, as determined by the Board, shall be paid.

B. Upon receipt of the application and fee, the Board shall verify the accuracy of the information set forth in the application and issue to the applicant a certificate of renewal of license for two years. Such certificate shall entitle the holder to engage in the practice of professional or practical nursing for the period stated therein. Any licensee whose license lapses for failure to renew the license may be reinstated by the Board upon satisfactory evidence of active employment in professional or practical nursing within the past five years or satisfactory completion of a refresher program in professional or practical nursing within an approved agency within a one-year period prior to renewal and upon satisfactory explanation for the failure to renew the license and payment of a penalty fee to be determined.

C. After a license has lapsed or been inactive for five or more years and the applicant has not been in active practice in professional or practical nursing in the past five (5) years the applicant will be required to give evidence of satisfactory completion of a professional or practical nursing refresher program within an approved agency within a one-year period prior to reinstatement before licensure by reinstatement will be granted. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge In professional or practical nursing.

D. Any person practicing nursing during the dine his or her license has lapsed shall be considered an illegal practitioner and shall be subject to the penalties provided for violations of this Chapter.

A. Any person licensed under this chapter who desires to retire from practice in this state shall so notify the Board. Upon receipt of such notice, the Board shall place the name of such person on a non-practicing list. While on this list, such person shall not be required to pay any license fee, and shall not practice nursing in this state. When such person desires to resume practice, application for renewal shall be made under subsection (B) of this section and the license shall be reactivated If the requirements of the Board are met.

A. Temporary permits to practice nursing may be issued by the Board to persons who have requested reinstatement of their license, if they have practiced nursing within the past five years.

§1919. Nursing Educational Programs.

A. An institution desiring to conduct a nursing education program shall apply to the Board and submit satisfactory evidence that it is ready and qualified to instruct students In the prescribed basic curriculum for educating nurses and that it is prepared to meet other standards which may be established by the Board. The Board may authorize the temporary operation of a nursing education program pending evaluation for approval. The Board shall grant approval In writing. The Board may visit and survey any nursing education program at any reasonable time.

B. If the Board determines that any approved nursing education program is not maintaining the standards required by this chapter and by the Board, written notice thereof, specifying the deficiency and the time within which the same shall be corrected shall immediately be given to the program. The Board shall withdraw such program's approval if it falls to correct the specified deficiency, and such nursing education program shall discontinue its operations, provided, however, that the Board shall grant a hearing to such program upon written application and extend the period for correcting specified deficiency upon good cause being shown.

C. An approved nursing education program which plans substantive changes, as defined in the Board's Rules and Regulations, shall obtain the written approval of the Board prior to the date of the change.

D. Any nursing education program In the State that Is recognized as an approved program by the Board of Nursing on or after July 1, 1983 shall be deemed to be an approved education program for the purpose of this Act.

§1920. License Required to Practice as a Graduate of a Professional or Practical Nursing Program, Registered Nurse, or Licensed Practical Nurse.

A. No person shall engage in the practice of professional nursing in Delaware without being licensed by the Board, except those persons issued a temporary permit by the Board.

B. No person shall engage in the practice as an advanced registered nurse practitioner without a Board authorized certificate of state designation as an advanced registered nurse practitioner.

C. No person shall knowingly employ a graduate of a professional nursing program or a registered nurse to engage in the practice of professional nursing without a temporary permit or license from the Board.

D. Only registered nurses shall use that title, the abbreviation of M.N.', or any other words, letters, signs, or figures indicating that the person using the same is a registered nurse.

E. No person shall practice practical nursing in Delaware without being licensed by the Board, except those persons issued a temporary permit by the Board.

F. No person shall knowingly employ a graduate of a practical nursing program or a licensed practical nurse to engage in the practice of practical nursing without a temporary permit or license from the Board.

G. Only licensed practical nurses shall use that title, the abbreviation, "L.P.N.n or any other words, letters, signs, or figures indicating that the person using the same is a licensed practical nurse.

§1921. Exceptions.

This Chapter shall not apply to the following situations:

A. Nursing services rendered during an epidemic or a state or national disaster;

B. The rendering of assistance by anyone in the case of an emergency;

C. Emergency services rendered by ambulance personnel trained in advanced life support under a licensed physician's supervision' 29 Del. C., Chapter 9, Subchapter IV. Advanced life support is defined In 29 Del. C., Chapter 79, Subchapter W.

D. The incidental care of the sick In private homes by members of the family, friends, domestic servants or persons primarily employed as housekeepers.

E. Nursing services rendered by a student enrolled in a State Board of Nursing approved school of professional or practical nursing when these services are incidental to the course of study;

or those nursing services rendered by a professional nurse or practical nurse enrolled in a State Board of Nursing approved refresher course pending reinstatement, reactivation, or endorsement of licensure.

F. The practice of nursing in this state by a nurse licensed In another state whose employment requires such nurse to accompany and care for a patient temporarily In this state, provided the nursing services are not rendered for more than three months within one year and such nurse does not claim to be licensed in this state.

G. The practice of nursing by a nurse licensed in another state employed by the United States Government or any bureau, division, or agency thereof.

H. The practice of non-medical nursing in connection with healing by prayer or spiritual means in accordance with the tenets and practice of a well-recognized church or religious denomination, provided that persons practicing such non-medical nursing do not claim to be licensed under this chapter.

I. Auxiliary care services performed by nurses aides, attendants, orderlies, and other auxiliary workers in medical care facilities, or elsewhere by persons under the direction and supervision of a person licensed to practice nursing, medicine, dentistry or podiatry, and performing those services which are routine, repetitive, and limited in scope, and that do not require the professional judgment of a registered nurse or a licensed practical nurse; provided however, that nothing contained herein shall limit the right of any person to act pursuant to 24 Delaware Code, 51703 (e) (7), or persons employed in similar positions in the offices of podiatrists or dentists without being licensed under this Chapter.

J. Child care homes or child day care centers or residential child care facilities regulated by the State of Delaware under 31 Del. C., Chapter 3, §341-2 where designated child care providers, who have successfully completecri-135ard approved medication training program, assist children in the taking of medication, other than by injection, provided that the medication is in original container, properly labeled.

K. Foster Homes, Group Homes, or Adult Day Habilitation Centers for individuals who are developmentally disabled regulated by the State of Delaware under 16 Del. C., Chapter 55 where designated care providers,who have successfully completed a Board approvia medication training program, assist developmentally disabled clients in the taking of medication, other than by injection, provided that the medication is in the original container, properly labeled.

L. Nursing services rendered by a graduate of a state board of nursing approved school of professional or practical nursing working under supervision, pending results of the first licensing examination. The Board shall establish the procedure and extent to which subsequent examinations may be taken and the length of time and the character of nursing service which may be rendered pending subsequent examinations.

§1922. Disciplinary Proceedings; Appeal.

A. The Board may impose any of the following sanctions (Section 1922(B)) singly or in combination when it finds a licensee or former licensee is guilty of any offense described here in 1922 (A):

(I) Is guilty of fraud or deceit in procuring or attempting to procure a license to practice nursing; or

(2) Is convicted of a felony; or

(3) Is convicted of a crime involving moral turpitude or gross immorality; or

(4) Is unfit or incompetent by reason of negligence, habits, or other causes; or

(5) Is habitually intemperate or is addicted to the use of habit-forming drugs; or

(6) Is mentally incompetent; or

(7) Whose physical condition is such that the performance of nursing service is or may be injurious or prejudicial to patients or to the public; or

(8) Has had a license to practice as a registered nurse or licensed practical nurse suspended or revoked in any jurisdiction; or

(9) Is guilty of unprofessional conduct as shall be determined by the Board, or the willful neglect of a patient; or

(10) Has willfully or negligently violated this Chapter.

B. Disciplinary Sanctions.

(t) Permanently revoke a license to practice.

(2) Suspend a license.

(3) Censure a licensee.

(4) Issue a letter of reprimand.

(5) Place a licensee on probationary status and require the licensee to:

(a) Report regularly to the Board upon the matters which are the basis of probation.

(b) Limit practice to those areas prescribed by the Board.

(c) Continue or renew professional education until satisfactory degree of skill has been attained in those areas which are the basis of the probation.

(6) Refuse a license.

(7) Refuse to renew a license.

(8) Or otherwise discipline. C. Procedure.

(I) Upon the Mingo( a sworn complaint or on Its own motion the Board shall hold a hearing to determine whether a licensee or former licensee has engaged In activity specified in this Chapter as grounds for disciplinary action. The Board may, upon sworn complaint, or whenever It shall think proper, upon its own motion, shall cause an investigation to be held whether a licensee has engaged in activities specified in this Chapter as grounds for disciplinary action. The Board shall fix the time and place for a hearing.

(2) The Board shall cause a copy of the charges, together with a notice of the time and p lace fixed for the hearing, to be served on the accused at least 15 days prior to the date fixed for the hearing. When personal services cannot be effected, and such fact is certified on oath by any person authorized to make legal notice, the Board shall cause to be published, twice In each of two successive weeks, a notice of the hearing in a newspaper of general circulation in the county In which the accused last practiced according to records of the Board, and shall mall a copy of the charges and of such notice to the accused at his last known address according to his records of the Board.

(3) In all proceedings herein:

(a) The accused may be represented by counsel who shall have the right of examination and cross-examination.

(b) The accused and the Board may subpoena witnesses. Subpoenas shall be issued by the President or the Vice-President of the Board upon written request and shall be served as provided by the rules of the Superior Court and shall have like effect as a subpoena issued by said Court.

(c) Testimony before the Board shall be under oath. Any member of the Board shall have power to administer oaths for this purpose.

(d) A stenographic record of the hearing shall be made by a qualified court reporter. At the request and expense of any party such record shall be transcribed with a copy to the other party.

(e) The decision of the Board shall be based upon sufficient legal evidence. If the charges are supported by such evidence, the Board may refuse to issue, or revoke or suspend a license, or otherwise discipline a licensee. A suspended license may be reissued upon a further hearing Initiated at the request of the suspended licensee by written application in accordance with the rules of the Board.

(f) Every decision of the Board shall be final and conclusive. If, within 20 days after a copy of the said decision has been sent to the accused by registered mail, such accused shall appeal to the Superior Court for the county in which he resides; the Court may upon motion made, decide to stay the Board's decision.

§1923. Judicial Review by Superior Court.

On appeal, the cause shall be determined by the Court without fury. Upon such appeal the Court shall hear the evidence de novo.

§1924. Unlawful Practice of Nursing.

A. No person shall practice or offer to practice professional or practical nursing or shall represent himself or herself as a registered nurse or licensed practical nurse in this state, or shall use any title, abbreviation, sign, card, or device to indicate that such person is a registered nurse or licensed practical nurse, unless such person is licensed under this Chapter.

A. No person, hospital, or institution shall conduct or shall offer to conduct a professional or practical nursing education program unless such person, hospital, or institution is approved under this chapter.

§1925. Penalties. Whoever shall:

A. Sell or fraudulently obtain or furnish any nursing diploma, license, or renewal, or record of the same, or aid or abet therein; or

13. Practice professional or practical nursing and/or hold or represent himself or herself as a registered or licensed practical nurse under cover of any diploma, license, or record illegally or fraudulently obtained, signed, or issued; or

B. Practice professional or practical nursing unless licensed under this Chapter; or

C. Use, in connection with his or her name any designation tending to imply that he/she is a registered or practical nurse, unless licensed under this Chapter; or

D. Practice professional or practical nursing when his/her license is suspended or revoked; or

E. Conduct a professional or practical nursing education program which has not been approved by the Board; or

A. Violate standards of nursing practice as adopted by the Board, shall be fined not more than $1,000, or be imprisoned not more than one year, or both.

§1926. Status of Present Board Members.

Each member of the Board of Nursing on July 1, 1983 becomes a member of the Board created by this Chapter until the expiration of the term which he or she was serving on that date. Any vacancy occurring in the membership of the former Board shall be filled in the manner provided in this Chapter.

§1927. Severability.

If any clause, sentence, section, provision, or part of this Chapter shall be adjudged to be unconstitutional or invalid for any reason by any court of competent jurisdiction, such judgment shall not impair, invalidate, or affect the remainder of this Chapter, which shall remain in full force and effect."

Section 2. The effective date of this act shall be July 1, 1983.

Approved May 10, 1983.