Sec. 20-87a. Definitions. Scope of practice.
Sec. 20-94a. Licensure as advanced practice registered nurse.
Sec. 20-101d. Covenants not to compete involving advanced practice registered nurse.
Sec. 20-87a. Definitions. Scope of practice. (a) The practice of nursing by a registered nurse is defined as the process of diagnosing human responses to actual or potential health problems, providing supportive and restorative care, health counseling and teaching, case finding and referral, collaborating in the implementation of the total health care regimen, and executing the medical regimen under the direction of a licensed physician, dentist or advanced practice registered nurse. A registered nurse may also execute orders issued by licensed physician assistants, podiatrists and optometrists, provided such orders do not exceed the nurse's or the ordering practitioner's scope of practice. A registered nurse may execute dietary orders written in a patient's chart by a certified dietitian-nutritionist.
(b) (1) Advanced nursing practice is defined as the performance of advanced level nursing practice activities that, by virtue of post-basic specialized education and experience, are appropriate to and may be performed by an advanced practice registered nurse. The advanced practice registered nurse performs acts of diagnosis and treatment of alterations in health status, as described in subsection (a) of this section.
(2) (A) An advanced practice registered nurse having been issued a license pursuant to section 20-94a shall, for the first three years after having been issued such license, collaborate with a physician licensed to practice medicine in this state. In all settings, such advanced practice registered nurse may, in collaboration with a physician licensed to practice medicine in this state, prescribe, dispense and administer medical therapeutics and corrective measures and may request, sign for, receive and dispense drugs in the form of professional samples in accordance with sections 20-14c to 20-14e, inclusive, except such advanced practice registered nurse licensed pursuant to section 20-94a and maintaining current certification from the American Association of Nurse Anesthetists who is prescribing and administrating medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present in the institution, clinic or other setting where the surgery is being performed. For purposes of this subdivision, “collaboration” means a mutually agreed upon relationship between such advanced practice registered nurse and a physician who is educated, trained or has relevant experience that is related to the work of such advanced practice registered nurse. The collaboration shall address a reasonable and appropriate level of consultation and referral, coverage for the patient in the absence of such advanced practice registered nurse, a method to review patient outcomes and a method of disclosure of the relationship to the patient. Relative to the exercise of prescriptive authority, the collaboration between such advanced practice registered nurse and a physician shall be in writing and shall address the level of schedule II and III controlled substances that such advanced practice registered nurse may prescribe and provide a method to review patient outcomes, including, but not limited to, the review of medical therapeutics, corrective measures, laboratory tests and other diagnostic procedures that such advanced practice registered nurse may prescribe, dispense and administer.
(B) An advanced practice registered nurse having been issued a license pursuant to subsection (d) of section 20-94a who collaborated, prior to the issuance of such license, with a physician licensed to practice medicine in another state may count the time of such collaboration toward the three-year requirement set forth in subparagraph (A) of this subsection, provided such collaboration otherwise satisfies the requirements set forth in said subparagraph.
(3) An advanced practice registered nurse having (A) been issued a license pursuant to section 20-94a, (B) maintained such license, or, for an advanced practice registered nurse having been issued a license pursuant to subsection (d) of said section, such license or a license to practice in another state as an advanced practice registered nurse or as a person entitled to perform similar services under a different designation, for a period of not less than three years, and (C) engaged in the performance of advanced practice level nursing activities in collaboration with a physician for a period of not less than three years and not less than two thousand hours in accordance with the provisions of subdivision (2) of this subsection, may, thereafter, alone or in collaboration with a physician or another health care provider licensed to practice in this state: (i) Perform the acts of diagnosis and treatment of alterations in health status, as described in subsection (a) of this section; and (ii) prescribe, dispense and administer medical therapeutics and corrective measures and dispense drugs in the form of professional samples as described in subdivision (2) of this subsection in all settings. Any advanced practice registered nurse electing to practice not in collaboration with a physician in accordance with the provisions of this subdivision shall maintain documentation of having engaged in the performance of advanced practice level nursing activities in collaboration with a physician for a period of not less than three years and not less than two thousand hours. Such advanced practice registered nurse shall maintain such documentation for a period of not less than three years after completing such requirements and shall submit such documentation to the Department of Public Health for inspection not later than forty-five days after a request made by the department for such documentation. Any such advanced practice registered nurse shall submit written notice to the Commissioner of Public Health of his or her intention to practice without collaboration with a physician after completing the requirements described in this subdivision and prior to beginning such practice. Not later than December first, annually, the Commissioner of Public Health shall publish on the department's Internet web site a list of such advanced practice registered nurses who are authorized to practice not in collaboration with a physician.
(4) An advanced practice registered nurse licensed under the provisions of this chapter may make the determination and pronouncement of death of a patient, provided the advanced practice registered nurse attests to such pronouncement on the certificate of death and signs the certificate of death not later than twenty-four hours after the pronouncement.
(c) The practice of nursing by a licensed practical nurse is defined as the performing of selected tasks and sharing of responsibility under the direction of a registered nurse or an advanced practice registered nurse and within the framework of supportive and restorative care, health counseling and teaching, case finding and referral, collaborating in the implementation of the total health care regimen and executing the medical regimen under the direction of a licensed physician, physician assistant, podiatrist, optometrist or dentist. A licensed practical nurse may also execute dietary orders written in a patient's chart by a certified dietitian-nutritionist.
(d) In the case of a registered or licensed practical nurse employed by a home health care agency, the practice of nursing includes, but is not limited to, executing the medical regimen under the direction of a physician licensed in a state that borders Connecticut.
(P.A. 75-166, S. 1, 6; P.A. 89-107, S. 1; 89-389, S. 1, 22; P.A. 94-213, S. 4; P.A. 97-112, S. 2; P.A. 99-168, S. 1; P.A. 03-8, S. 1; P.A. 04-221, S. 34; 04-255, S. 22; May Sp. Sess. P.A. 04-2, S. 108; P.A. 06-169, S. 1; P.A. 10-117, S. 18; P.A. 11-242, S. 33; P.A. 14-12, S. 1; 14-231, S. 52; P.A. 15-4, S. 2; 15-242, S. 55; P.A. 23-97, S. 20.)
History: P.A. 89-107 added Subsec. (c) re nurses' powers of administration of medical regimen under direction of physician in bordering state; P.A. 89-389 inserted new Subsec. (b) re duties of advanced practice registered nurses, relettered the existing Subsec. (b) as Subsec. (c) and added the reference in Subsec. (c) to an advanced practice registered nurse; P.A. 94-213 deleted Subsec. (b)(5) re other settings as prescribed in regulations and added conditions for prescribing and administering medical therapeutics and corrective measures and dispensing professional samples; P.A. 97-112 replaced “home for the aged” with “residential care home”; P.A. 99-168 redefined “advanced nursing practice” in Subsec. (b) to include collaboration with a physician, defined “collaboration” for purposes of Subsec. (b), modified prescriptive authority of advanced practice registered nurses and made technical changes in Subsecs. (b) and (d); P.A. 03-8 amended Subsec. (a) by adding “advanced practice registered nurse”; P.A. 04-221 amended Subsec. (b) to allow advanced practice registered nurses to request, sign for and receive drug samples; P.A. 04-255 amended Subsec. (b) by adding provision allowing advanced practice registered nurse to make determination and pronouncement of death; May Sp. Sess. P.A. 04-2 changed effective date of P.A. 04-221 from October 1, 2004, to June 8, 2004, effective May 12, 2004; P.A. 06-169 deleted former Subsec. (b)(1) to (4), inclusive, and authorized advanced practice registered nurses to prescribe, dispense and administer medical therapeutics and corrective measures and to request, sign for, receive and dispense professional drug samples in all settings; P.A. 10-117 amended Subsec. (a) by adding provision that permits registered nurse to execute orders issued by licensed physician assistants, podiatrists and optometrists provided such orders do not exceed the nurse's or ordering practitioner's scope of practice; P.A. 11-242 amended Subsec. (c) by adding provision that permits licensed practical nurse to execute medical regimen under direction of a licensed physician assistant, podiatrist or optometrist, effective July 13, 2011; P.A. 14-12 amended Subsec. (b) by designating existing provisions re definition of advanced nursing practice as Subdiv. (1), designating existing provisions re collaboration with a physician as Subdiv. (2) and adding provision re first 3 years after license issuance therein, adding Subdiv. (3) re practice alone or in collaboration with a physician or other health care provider, designating existing provisions re pronouncement of death as Subdiv. (4), and making technical changes, effective July 1, 2014; P.A. 14-231 amended Subsec. (b)(3) by adding “and not less than two thousand hours” in Subpara. (C) and adding provisions re documentation and notice to commissioner, effective July 1, 2014; P.A. 15-4 amended Subsec. (b)(3) by adding provision re publishing list of advanced practice registered nurses who are authorized to practice not in collaboration with a physician, effective May 11, 2015; P.A. 15-242 amended Subsec. (a) by adding provision allowing registered nurse to execute dietary orders written by a certified dietitian-nutritionist and amended Subsec. (c) by adding provision allowing licensed practical nurse to execute dietary orders written by a certified dietitian-nutritionist; P.A. 23-97 amended Subsec. (b)(2) by designating existing provisions as Subpara. (A) and adding Subpara. (B) re advanced practice registered nurses who collaborated with a physician licensed in another state and Subsec. (b)(3)(B) by adding provision re advanced practice registered nurses who obtained licensure by endorsement.
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Sec. 20-90. Duties of board. (a) The Connecticut State Board of Examiners for Nursing shall have the following duties: (1) Hear and decide matters concerning suspension or revocation of licensure; (2) adjudicate complaints filed against practitioners licensed under this chapter and impose sanctions where appropriate; (3) approve schools of nursing in the state that prepare persons for examination under the provisions of this chapter; and (4) consult, where possible, with nationally recognized accrediting agencies when approving schools pursuant to subdivision (3) of this subsection. The board may adopt a seal.
(b) All schools of nursing in the state that prepare persons for examination under the provisions of this chapter, shall be (1) visited periodically by a representative of the Department of Public Health who shall be a registered nurse or a person experienced in the field of nursing education, and (2) approved by the Connecticut State Board of Examiners for Nursing pursuant to subdivisions (3) and (4) of subsection (a) of this section.
(c) The Department of Public Health shall post a list of all nursing programs and all programs for training licensed practical nurses that are approved by the Connecticut State Board of Examiners for Nursing and maintain the standard for the education of nurses and the training of licensed practical nurses as established by the Commissioner of Public Health on the department's Internet web site.
(1949 Rev., S. 4426; 1953, S. 2215d; 1971, P.A. 472; P.A. 73-115, S. 1; P.A. 75-166, S. 3, 6; P.A. 77-614, S. 73, 388, 610; P.A. 80-484, S. 30, 176; P.A. 81-471, S. 23, 71; P.A. 90-13, S. 9; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 03-252, S. 10; P.A. 12-116, S. 87; P.A. 17-237, S. 100; P.A. 22-58, S. 15; P.A. 23-195, S. 10.)
History: 1971 act added provisions re practical nurses' training in high schools and vocational schools; P.A. 73-115 required that list of approved nursing programs rather than of nursing schools be kept by board of examiners; P.A. 75-166 changed quorum from four to three members and number of members requesting special meetings from two to three and added provision limiting voting privilege of licensed practical nurse members to matters pertaining to licensed practical nurses; P.A. 77-614 replaced public works commissioner with commissioner of administrative services and, effective January 1, 1979, deleted provisions re election of president and secretary/treasurer, re board's power to adopt bylaws and regulations for its operation and re limitation on voting privileges of licensed practical nurse members, changed number of members required for quorum and for calling special meeting to six and five, respectively, transferred power to make regulations re nursing programs standards from board to health services commissioner, retaining board in advisory capacity and required that nursing schools be visited yearly by health services department representative rather than by educational director of board or registered nurse appointed by the board; P.A. 80-484 deleted provisions re number of members required for quorum or calling of special meeting and re provision of meeting room by administrative services commissioner, required commissioner's consent for approval of courses and programs by board, required board to consult with recognized accrediting agencies and added Subsec. (b) re board's power to hear disciplinary matters and adjudicate complaints; P.A. 81-471 changed time for department of health services visits to nursing schools from once per year to “periodically”; P.A. 90-13 amended Subsec. (a) to except schools accredited by the National League for Nursing from requirement that health services department representative visit nursing schools periodically; P.A. 93-381 replaced department and commissioner of health services with department and commissioner of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 03-252 made technical changes in Subsec. (a); pursuant to P.A. 12-116, “vocational schools” was changed editorially by the Revisors to “technical high schools” in Subsec. (a), effective July 1, 2012; P.A. 17-237 amended Subsec. (a) by replacing “and technical high schools” with “or by the Technical Education and Career System”, effective July 1, 2017; P.A. 22-58 substantially revised Subsec. (a), including deleting or reorganizing various existing provisions and designating remaining provisions new Subsec. (b)and Subsec.(c) and making technical changes and deleted Subsec. (b), effective May 23, 2022; P.A. 23-195 amended Subsec. (a) by making a technical change.
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Sec. 20-90a. Pilot program offering licensed practical nursing education and training. Application process. Review and consideration by board. (a) Notwithstanding the provisions of this chapter, a public or independent institution of higher education that (1) is accredited as a degree-granting institution in good standing by a regional accrediting association recognized by the Secretary of the United States Department of Education and maintains such accreditation status; and (2) offers, or is seeking state approval to offer, a nursing program pursuant to section 10a-34, may apply to the Connecticut State Board of Examiners for Nursing to establish a pilot program that offers licensed practical nursing education and training on or before January 30, 2024. As used in this subsection, “public institution of higher education” and “independent institution of higher education” have the same meanings as described in section 10a-173.
(b) An institution of higher education that applies to the Connecticut State Board of Examiners for Nursing to establish a pilot program pursuant to subsection (a) of this section shall provide to said board the following information, in writing, not later than sixty days prior to the date on which it seeks to establish the pilot program:
(1) Identifying information regarding the pilot program, including, but not limited to, the name of the program, address where such program will be administered, responsible party for the program and contact information for the program;
(2) A description of the pilot program, including accreditation status, any clinical partner and anticipated enrollment by academic term;
(3) An identification of resources that support the program;
(4) Graduation rates and National Council Licensure Examination licensure and certification pass rates for the past three years for any existing nursing programs offered by the institution of higher education;
(5) A plan for employing qualified faculty and administrators and clinical experiences; and
(6) Other information as requested by the Connecticut State Board of Examiners for Nursing.
(c) The Connecticut State Board of Examiners for Nursing shall review and consider an application made by an institution of higher education described in subsection (a) of this section to establish a pilot program pursuant to said subsection if the institution of higher education provides the information required pursuant to subsection (b) of this section. The Connecticut State Board of Examiners for Nursing may hold a public hearing on such application.
(d) The pilot program established pursuant to this section shall comply with the relevant provisions of this chapter and sections 20-90-45 to 20-90-59, inclusive, of the regulations of Connecticut state agencies. Notwithstanding the provisions of section 10a-34, if such pilot program complies with such provisions for not less than two years, and provides evidence that the program is meeting its educational outcomes, as defined in section 20-90-47 of the regulations of Connecticut state agencies, such pilot program shall be deemed fully approved by the Connecticut State Board of Examiners for Nursing.
(P.A. 23-97, S. 22.)
History: P.A. 23-97 effective June 28, 2023.
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Sec. 20-94a. Licensure as advanced practice registered nurse. (a) The Department of Public Health may issue an advanced practice registered nurse license to a person seeking to perform the activities described in subsection (b) of section 20-87a, upon receipt of a fee of two hundred dollars, to an applicant who: (1) Maintains a license as a registered nurse in this state, as provided by section 20-93 or 20-94; (2) holds and maintains current certification as a nurse practitioner, a clinical nurse specialist or a nurse anesthetist from one of the following national certifying bodies that certify nurses in advanced practice: The American Nurses' Association, the Nurses' Association of the American College of Obstetricians and Gynecologists Certification Corporation, the National Board of Pediatric Nurse Practitioners and Associates or the American Association of Nurse Anesthetists, their successors or other appropriate national certifying bodies approved by the Board of Examiners for Nursing; (3) has completed thirty hours of education in pharmacology for advanced nursing practice; and (4) (A) holds a graduate degree in nursing or in a related field recognized for certification as either a nurse practitioner, a clinical nurse specialist, or a nurse anesthetist by one of the foregoing certifying bodies, or (B) (i) on or before December 31, 2004, completed an advanced nurse practitioner program that a national certifying body identified in subdivision (2) of subsection (a) of this section recognized for certification of a nurse practitioner, clinical nurse specialist, or nurse anesthetist, and (ii) at the time of application, holds a current license as an advanced practice registered nurse in another state that requires a master's degree in nursing or a related field for such licensure. No license shall be issued under this section to any applicant against whom professional disciplinary action is pending or who is the subject of an unresolved complaint.
(b) During the period commencing January 1, 1990, and ending January 1, 1992, the Department of Public Health may in its discretion allow a registered nurse, who has been practicing as an advanced practice registered nurse in a nurse practitioner role and who is unable to obtain certification as a nurse practitioner by one of the national certifying bodies specified in subsection (a) of this section, to be licensed as an advanced practice registered nurse provided the individual:
(1) Holds a current Connecticut license as a registered nurse pursuant to this chapter;
(2) Presents the department with documentation of the reasons one of such national certifying bodies will not certify him as a nurse practitioner;
(3) Has been in active practice as a nurse practitioner for at least five years in a facility licensed pursuant to section 19a-491;
(4) Provides the department with documentation of his preparation as a nurse practitioner;
(5) Provides the department with evidence of at least seventy-five contact hours, or its equivalent, of continuing education related to his nurse practitioner specialty in the preceding five calendar years;
(6) Has completed thirty hours of education in pharmacology for advanced nursing practice;
(7) Has his employer provide the department with a description of his practice setting, job description, and a plan for supervision by a licensed physician; and
(8) Notifies the department of each change of employment to a new setting where he will function as an advanced practice registered nurse and will be exercising prescriptive and dispensing privileges.
(c) Any person who obtains a license pursuant to subsection (b) of this section shall be eligible to renew such license annually provided he presents the department with evidence that he received at least fifteen contact hours, or its equivalent, eight hours of which shall be in pharmacology, of continuing education related to his nurse practitioner specialty in the preceding licensure year. If an individual licensed pursuant to subsection (b) of this subsection becomes eligible at any time for certification as a nurse practitioner by one of the national certifying bodies specified in subsection (a) of this section, the individual shall apply for certification, and upon certification so notify the department, and apply to be licensed as an advanced practice registered nurse in accordance with subsection (a) of this section.
(d) On and after October 1, 2023, a person, who is not eligible for licensure under subsection (a) of this section, may apply for licensure by endorsement as an advanced practice registered nurse. Such applicant shall (1) present evidence satisfactory to the Commissioner of Public Health that the applicant has acquired three years of experience as an advanced practice registered nurse, or as a person entitled to perform similar services under a different designation, in another state or jurisdiction that has requirements for practicing in such capacity that are substantially similar to, or higher than, those of this state and that there are no disciplinary actions or unresolved complaints pending against such person, and (2) pay a fee of two hundred dollars to the commissioner.
(e) A person who has received a license pursuant to this section shall be known as an “Advanced Practice Registered Nurse” and no other person shall assume such title or use the letters or figures which indicate that the person using the same is a licensed advanced practice registered nurse.
(P.A. 89-389, S. 3, 22; P.A. 91-106, S. 1, 2; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 99-168, S. 2; P.A. 00-135, S. 7, 21; P.A. 04-221, S. 8; June Sp. Sess. P.A. 09-3, S. 197; P.A. 11-242, S. 77; P.A. 12-197, S. 48; P.A. 23-97, S. 19.)
History: P.A. 91-106 amended Subsec. (b) to extend until January 1, 1992, the department's discretion to license under Subsec. (b) and to change the continuing education requirements of Subdiv. (5) to be 75 contact hours in the preceding five years and amended Subsec. (c) to increase from 8 to 15 hours the continuing education requirements; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 99-168 amended Subsec. (a)(1) by requiring maintenance of a registered nurse license rather than eligibility for licensure and amended Subsec. (a)(2) to include successor organizations or other appropriate national certifying bodies and to make a technical change; P.A. 00-135 amended Subsec. (a) by making a technical change and changing “maintains a license” to “is eligible for a license” in Subdiv. (1), effective May 26, 2000; P.A. 04-221 amended Subsec. (a)(1) by changing requirement from eligibility for a license to maintenance of a license; June Sp. Sess. P.A. 09-3 amended Subsec. (a) to increase fee from $100 to $200; P.A. 11-242 amended Subsec. (a)(4) by substituting “graduate degree” for “master's degree”; P.A. 12-197 amended Subsec. (a)(4) by deleting provision re certification after December 31, 1994, designating existing provision re qualifications as Subpara. (A) and adding Subpara. (B) re alternative qualifications; P.A. 23-97 amended Subsec. (b)(7) by making a technical change, added new Subsec. (d) re licensure by endorsement and redesignated existing Subsec. (d) as Subsec. (e).
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Sec. 20-101d. Covenants not to compete involving advanced practice registered nurse. (a) For purposes of this section: (1) “Covenant not to compete” means any provision of an employment or other contract or agreement that creates or establishes a professional relationship with an advanced practice registered nurse and restricts the right of an advanced practice registered nurse to practice as an advanced practice registered nurse in any geographic area of the state for any period of time after the termination or cessation of such partnership, employment or other professional relationship; (2) “advanced practice registered nurse” means an individual licensed as an advanced practice registered nurse pursuant to this chapter; and (3) “primary site where such advanced practice registered nurse practices” means any single office, facility or location where such advanced practice registered nurse practices, as mutually agreed to by the parties and defined in the covenant not to compete.
(b) (1) A covenant not to compete that is entered into, amended, extended or renewed on or after October 1, 2023, shall be valid and enforceable only if it is: (A) Necessary to protect a legitimate business interest; (B) reasonably limited in time, geographic scope and practice restrictions as necessary to protect such business interest; and (C) otherwise consistent with the law and public policy. The party seeking to enforce a covenant not to compete shall have the burden of proof in any proceeding.
(2) A covenant not to compete that is entered into, amended, extended or renewed on or after October 1, 2023, shall not: (A) Restrict the advanced practice registered nurse's competitive activities (i) for a period of more than one year, and (ii) in a geographic region of more than fifteen miles from the primary site where such advanced practice registered nurse practices; or (B) be enforceable against an advanced practice registered nurse if (i) such employment contract or agreement was not made in anticipation of, or as part of, a partnership or ownership agreement and such contract or agreement expires and is not renewed, unless, prior to such expiration, the employer makes a bona fide offer to renew the contract on the same or similar terms and conditions, or (ii) the employment or contractual relationship is terminated by the employer, unless such employment or contractual relationship is terminated for cause.
(3) A covenant not to compete that is entered into, amended, extended or renewed on or after October 1, 2023, shall not be enforceable if (A) the advanced practice registered nurse who is a party to the employment or other contract or agreement does not agree to a proposed material change to the compensation terms of such contract or agreement prior to or at the time of the extension or renewal of such contract or agreement; and (B) the contract or agreement expires and is not renewed by the employer or the employment or contractual relationship is terminated by the employer, unless such employment or contractual relationship is terminated for cause.
(4) Each covenant not to compete entered into, amended or renewed on or after October 1, 2023, shall be separately and individually signed by the advanced practice registered nurse.
(c) The remaining provisions of any contract or agreement that includes a covenant not to compete that is rendered void and unenforceable, in whole or in part, under the provisions of this section shall remain in full force and effect, including provisions that require the payment of damages resulting from any injury suffered by reason of termination of such contract or agreement.
(P.A. 23-97, S. 14.)
History: P.A. 23-97 effective July 1, 2023.
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