[Federal Register Volume 68, Number 212 (Monday, November 3, 2003)]
[Notices]
[Pages 62299-62301]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-27563]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Proposed Revisions to Nurse Practitioner and Nurse-Midwifery 
Education Program Guidelines

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of request for comments.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
invites comments on the proposed revised Nurse Practitioner and Nurse-
Midwifery Education Program Guidelines for use in the Advanced 
Education Nursing Grant Program.

DATES: Comments must be postmarked by December 3, 2003.

ADDRESSES: Written comments should be submitted to the Division of 
Nursing, Bureau of Health Professions (BHPr), Health Resources and 
Services Administration (HRSA), Room 9-35, Parklawn Building, 5600 
Fishers Lane, Rockville, Maryland 20857. Respondents should provide a 
rationale for their suggested changes or additions. All comments will 
be available for public inspection and copying at the Division of 
Nursing, BHPr, Room 9-35, Parklawn Building at the address above 
weekdays between 8:30 a.m. and 5 p.m.

FOR FURTHER INFORMATION CONTACT: Irene Sandvold, Division of Nursing, 
BHPr, HRSA, at (301) 443-6333.

SUPPLEMENTARY INFORMATION: The Guidelines for Nurse Practitioner and 
Nurse-Midwifery Programs were initially developed in 1976 through a 
process that included consultation with appropriate educational and 
professional nursing and medical organizations, and public comment. The 
original final guidelines were published in the Federal Register (43 FR 
43416) as regulation on November 29, 1977. On August 27, 2001 HHS 
issued a final rule in the Federal Register (66 FR 44981) that 
rescinded and removed most of the BHPr regulations, including the 
previous guidelines related to nurse practitioner and nurse-midwifery 
education programs. This action was taken by the Department in its 
effort to simplify government procedures.
    These proposed Guidelines implement Section 811(c) of the PHS Act, 
which states that--
    Nurse Practitioner and nurse-midwifery programs eligible for 
support under this section are educational programs for registered 
nurses (irrespective of the type of school of nursing in which the 
nurses received their training) that--
    (1) Meet guidelines prescribed by the Secretary, and
    (2) Have as their objective the education of nurses who will upon 
completion of their studies in such programs be qualified to 
effectively provide primary health care, including primary health care 
in homes and in ambulatory care facilities, long-term care facilities, 
acute care, and other health care settings.
    These Guidelines are intended to promote the quality of nurse 
practitioner and nurse-midwifery programs funded by the Division of 
Nursing. Definitions in these Guidelines are those used by other 
Federal and State health entities. The Department invites comments on 
the following proposed Guidelines for the Nurse Practitioner and Nurse-
Midwifery Education Program.

Federal Nurse Practitioner and Nurse-Midwifery Education Program 
Guidelines

Overview

    Nurse practitioner education programs funded under this authority 
are graduate level programs that can provide evidence of accreditation 
from a recognized body or by a State agency, approved for such purpose 
by the U.S. Department of Education. In addition, programs are expected 
to be consistent with the current Advanced Nursing Practice: Curriculum 
Guidelines & Program Standards for Nurse Practitioner Education and 
current Criteria for Evaluation of Nurse Practitioner Programs, A 
Report of the National Task Force on Quality Nurse Practitioner 
Education. Both documents are available from the National Organization 
of Nurse Practitioner Faculties, 1522 K Street, NW 702, 
Washington, DC 20005; telephone: (202) 289-8044. At a minimum, 
graduates must be prepared to meet national competencies established in 
Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, 
Family, Gerontological, Pediatric, and Women's Health. This document is 
available online at http://www.nonpf.com; http://www.aacn.nche.edu/Education/NPCompetencies.htm; and can be obtained from the HRSA 
Information Center (1-800-CALL-HRSA).
    Nurse-Midwifery education programs must provide evidence of pre-
accreditation or accreditation from the American College of Nurse-
Midwives (ACNM), Division of Accreditation, recognized for this purpose 
by the U.S. Department of Education, prior to Notice of Grant Award. 
Programs must comply with the following criteria, as applicable:
    (a) the current Criteria for Pre-accreditation of Education 
Programs in Nurse-Midwifery and Midwifery with Guidelines for 
Elaboration and Documentation of Pre-accreditation Criteria; or
    (b) The current Criteria for Accreditation of Education Programs in 
Nurse-Midwifery and Midwifery with Guidelines for Elaboration and 
Documentation of Accreditation Criteria.
    At a minimum, graduates of these programs must be prepared to meet 
national competencies established in The Core Competencies for Basic 
Midwifery Practice. The above three documents are available from the 
ACNM at Suite 900, 818 Connecticut Avenue, NW., Washington, DC 20006; 
telephone: (202) 728-9860.

Organization and Administration

    A nurse practitioner or nurse-midwifery education program should 
actively collaborate with nurses and other health professionals who 
have expertise relevant to nurse practitioner or nurse-midwifery 
practice and primary health care, to assist in the initial and ongoing 
planning, implementation, and evaluation of the program.

[[Page 62300]]

Student Enrollment

    All students enrolled in a nurse practitioner or nurse-midwifery 
education program should be licensed to practice nursing--
    (a) At the time of enrollment, or
    (b) In the case of a program leading to a graduate degree in 
nursing, at or prior to the time of completion of a program.
    The policies for the recruitment, selection and progression of 
students should be consistent with the requirements of the sponsoring 
institution and developed in cooperation with the faculty responsible 
for conducting the nurse practitioner and/or nurse-midwifery program. 
Programs should develop, implement, and evaluate specific plans to 
achieve recruitment, retention, timely progression and graduation of a 
diverse student body.

Length of Program

    A nurse practitioner or nurse-midwifery education program is a 
formal program of study of a minimum of 1 academic year (9 months) in 
length and should include at least 4 months in the aggregate of full-
time didactic instruction. Post-master=s programs must also meet this 
requirement.

Curriculum

    A nurse practitioner or nurse-midwifery education program should be 
a distinct program of study consisting of didactic instruction and 
supervised clinical practice designed to teach registered nurses the 
knowledge and competencies needed to perform the functions and scope of 
practice of a nurse practitioner or nurse-midwife. The faculty has the 
ultimate responsibility for evaluation of student clinical performance 
and achievement of competence. The nurse practitioner and nurse-
midwifery specialty portion of the graduate curriculum should be 
developed and implemented cooperatively by nurse practitioner and/or 
nurse-midwife educators, other graduate nursing faculty, and 
appropriate representatives of other health disciplines. 
Interdisciplinary academic and practice learning experiences are 
recommended to prepare graduates to serve underserved populations in 
complex health systems. The program content, both didactic and clinical 
portions, should prepare the nurse practitioner or nurse-midwife to 
provide primary health care within community settings. The nurse 
practitioner and nurse-midwife should be knowledgeable about the 
cultural factors that affect the health status of the populations 
served and how to assist the community in making decisions about its 
priorities and health services.
    The curriculum must include student preceptorships and/or other 
clinical learning experiences. Faculty should develop and assess 
clinical learning sites through site visits and prepare clinical 
faculty and preceptors for teaching, evaluating, and problem solving 
with nurse practitioner and nurse-midwifery students. Nurse 
practitioner or nurse-midwifery program faculty retain full 
responsibility for assuring the quality and effectiveness of each 
practicum site for student learning. The grant applicant should 
document in the application the specific criteria used for the 
selection of clinical learning sites.

Faculty Qualifications

    A nurse practitioner or nurse-midwifery education program should 
have a sufficient number of qualified nursing, medical and other 
related health professional faculty with academic preparation and 
clinical expertise relevant to their areas of teaching responsibility 
and with demonstrated ability in the development and implementation of 
educational programs. The program director should be a nationally 
certified nurse practitioner or nurse-midwife, with appropriate 
academic preparation, clinical expertise and experience as an educator. 
Nurse practitioner and nurse-midwife clinical faculty and preceptors 
should have national and/or State certification as appropriate for 
their specialty and should have at least one year of practice 
experience as a nurse practitioner or certified nurse-midwife. Other 
clinicians serving as clinical preceptors should be authorized by the 
State licensing entity to practice in their specific scope of practice. 
Faculty qualifications should be consistent with the requirements of 
their academic institution. The faculty should participate in 
maintenance of competency and clinical practice according to the 
National Task Force on Quality Nurse Practitioner Education guidelines 
and ACNM guidelines for continued competency.

Resources

    A nurse practitioner or nurse-midwifery education program must have 
available sufficient educational and clinical resources in a variety of 
practice settings with adequate space and equipment, number, age and 
type of clients needed for the number of students enrolled in the 
program. Where the institution or organization conducting the program 
does not provide the clinical practice settings itself, it should 
provide for such settings through written agreements with other 
appropriate institutions or organizations.

Definitions

    The following terms are defined for purposes of the Nurse 
Practitioner and Nurse-Midwifery Program.
    Culturally and Linguistically Appropriate Services means health 
care services that are respectful of and responsive to cultural and 
linguistic needs.
    Full-time Student means a student enrolled in at least the number 
of credits defined as full-time by the institution.
    Full-time educational program means an educational program that 
provides for a full-time program of study as defined by the 
institution. Students progressing through the program are able to 
enroll on a full-time basis to complete the program in a timely manner. 
Students in such a program may be part-time or full-time.
    Nurse-Midwife means a registered nurse educated in the two 
disciplines of nursing and midwifery, who has successfully completed a 
nurse-midwifery education program accredited by the American College of 
Nurse-Midwives (ACNM). Following national ACNM/American College of 
Nurse-Midwives Certification Council (ACC) certification, the nurse-
midwife has abilities to provide independent management of primary 
health care for women, in the context of family-centered care, focusing 
particularly on pregnancy, childbirth, the postpartum period, care of 
the newborn, and the family planning and gynecological needs of women 
within a health care system that provides for consultation, 
collaborative management or referral as indicated by the health status 
of the client, including the abilities to:
    [sbull] Assess the health status of women and infants, through 
health and medical history taking, physical examination, ordering and 
interpreting diagnostic tests and making diagnoses;
    [sbull] Institute and provide continuity of primary health care to 
women and refer to other health care providers as appropriate;
    [sbull] Prescribe pharmacological and non-pharmacological 
therapeutics, consistent with current standards of care;
    [sbull] Provide instruction and counseling to individuals, 
families, and groups in the areas of promotion and maintenance of 
health and disease prevention, including involving such persons in 
planning for their health care; and
    [sbull] Collaborate with other health care providers and agencies 
to provide, and

[[Page 62301]]

where appropriate, coordinate services to individual women, children, 
and families.
    Nurse Practitioner means a registered nurse who has successfully 
completed a formal program of study designed to prepare registered 
nurses to deliver primary health care, involving independent and 
interdependent decision making and direct accountability for clinical 
judgment, including the abilities to:
    [sbull] Assess the health status of individuals and families 
through health and medical history taking, physical examination, 
ordering and interpreting diagnostic tests and making diagnoses;
    [sbull] Institute and provide continuity of primary health care to 
individuals and families; and refer to other health care providers when 
appropriate;
    [sbull] Prescribe treatments including pharmacological and non-
pharmacological therapeutics, consistent with current standards of 
care;
    [sbull] Provide instruction and counseling to individuals, 
families, and groups in the areas of promotion and maintenance of 
health and disease prevention, including involving such persons in 
planning for their health care; and
    [sbull] Collaborate with other health care providers and agencies 
to provide, and where appropriate, coordinate services to individuals 
and families.
    Nurse Practitioner or Nurse-Midwifery Program means a full-time 
educational program of study, as defined by the institution, (although 
students may be progressing through the program on a full-time or part-
time basis), which meets the Guidelines prescribed herein. The 
program's objective is the education of nurses who will, upon 
completion of their studies in the program, be qualified to effectively 
provide primary health care in a variety of settings, including in 
homes, ambulatory care facilities, long-term care facilities, acute 
care, and other health care settings.
    Post-Nursing Master's Certificate Program means a formal, post-
graduate program for Registered Nurses with master's degrees that 
awards a certificate and academic credit for completion of the program 
of study as a Nurse Practitioner or Nurse-Midwife.
    Preceptorship means a clinical learning experience in which the 
student is assigned to a faculty member or with oversight by program 
faculty to a designated preceptor who is a nurse practitioner or nurse-
midwife or other health professional for specific aspects of the 
clinical learning experience. The preceptorship provides the student 
with practice experiences conducive to meeting the defined goals and 
objectives of the particular clinical course. The preceptor is 
responsible for the daily teaching and assignment of individuals to be 
cared for, supervision, and participation in the evaluation of the 
nurse practitioner or nurse-midwifery student. The preceptor teaches, 
supervises, and evaluates the student and provides the student with an 
environment that permits observation, active participation, and 
management of primary health care. Before and during this preceptorship 
program faculty visits and assesses clinical learning sites and 
prepares clinical faculty/preceptors for teaching their students.
    Primary Care means the provision of integrated, accessible health 
care services by clinicians, including nurse practitioners and nurse-
midwives, who are accountable for addressing a large majority of 
personal health care needs within their scopes of practice, developing 
a sustained partnership with clients, and practicing in the context of 
family and communities. Critical elements also include accountability 
of clinicians and systems for quality of care, consumer satisfaction, 
efficient use of resources, and ethical behavior. Clients have direct 
access to an appropriate source of care, which continues over time for 
a variety of problems and includes needs for preventive services. 
Primary care and Primary Health Care are used interchangeably in this 
document. (Definition adapted from Barbara Starfield, Primary Care 
Concept, Evaluation, and Policy, Oxford University Press, New York, 
1992 p. 4 and Institute of Medicine:
    Moila S. Donaldson, Karl D. Yordy, Kathleen N., and Neal A. 
Vanselow, Editors, Committee on the Future of Primary Care, Division of 
Health Care Services, Primary Care: America's Health in a New Era, 
Summary , National Academy Press, Washington, DC, 1996, p. 23.)

    Dated: October 27, 2003.
Elizabeth M. Duke,
Administrator.
[FR Doc. 03-27563 Filed 10-31-03; 8:45 am]
BILLING CODE 4165-15-P