Nurse Practitioner Refresher Course Application Packet Table of Contents NP Refresher Course Overview Pages 2-3 NP Refresher Course Guidelines Pages 4-6 NP Refresher Course Application Pages 7-8 Educational Design Documentation Form Page 9 Clinical Experience Sample Sheet Page 10 Agreement for Preceptor Sample Sheet Page 11 LINKS FOR LAW AND RULES NP Law G.S. 90-18.2 and 90-18.3 www.ncga.state.nc.us and www.ncbon.com Practice APRN NP General Statutes NP Rules - 21 NCAC 36.0800 Section www.ncbon.com Practice NP Rules www.oah.state.nc.us Office of Administrative Hearings Rules Division Administrative Code Online Title 21 Chapter 36 Badge Law G.S. 90-640 www.ncga.state.nc.us and www.ncbon.com Law and Rules Badge Law & Exceptions Badge Law Rule 21 NCAC 36.0231 Exceptions to Health Care Practitioners Identification Requirements www.ncbon.com Law and Rules Administrative Code(Rules) Page 1 of 11
REFRESHER COURSE APPLICATION FOR NURSE PRACTITIONERS (NPs) OVERVIEW Who Must Take the Refresher Course? A nurse practitioner who has not been engaged in clinical nurse practitioner practice in greater than two (2) years. The nurse practitioner shall complete a nurse practitioner refresher course approved by the North Carolina Board of Nursing in accordance with paragraphs (o) and (p) of 21 NCAC 36.0220 and consisting of common conditions and their management directly related to the nurse practitioner s area of education and certification. 21 NCAC 36.0808 (d)(e) In order to be eligible to submit the NP Refresher Course application to the Board, the NP must meet all other requirements for registration and NP approval to practice that were in place at the time of initial application for approval and hold current national certification* in the NP's area of education and practice. The NP must complete the NP refresher course prior to seeking approval to practice. *If previously approved to practice in NC prior to the national certification requirement, national certification is not required. The refresher course is an individually planned and self-directed course of study containing required components. The components required are based on the number of years the NP has been out of active clinical NP practice as follows: Refresher course requirements: 1. Inactive greater than two years: a. 24 contact hours of pharmacology continuing education; b. 40 contact hours of continuing education consistent with the NP s education and area of practice; c. 160 hours of precepted clinical experience consistent with the NPs education and area of practice. 2. Inactive greater than three years: a. 36 hours of pharmacology continuing education; b. 60 contact hours of continuing education consistent with the NP s education and area of practice; c. 240 hours of precepted clinical experience consistent with the NP s education and area of practice. 3. Inactive greater than 4 years: a. a graduate level pharmacology course for advanced practice registered nurses; b. 80 contact hours of continuing education consistent with the NP s education and area of practice; c. 320 hours of precepted clinical experience consistent with the NP s education and area of practice. 4. Inactive greater than 5 years: a. a graduate level pharmacology course for advanced practice registered nurses; b. 100 contact hours of continuing education consistent with the NP s education and area of practice; c. 400 hours of precepted clinical experience consistent with the NP s education and area of practice. Page 2 of 11
Procedure for Submitting an NP Refresher Course Application: 1. The applicant shall submit a completed NP refresher course application to the Board along with their curriculum vitae. 2. As part of the application, the applicant shall develop an NP Refresher Course Plan (Plan) which includes (form is provided in this packet): a. Clinical site(s) which will provide the clinical experience consistent with the NP's education and area of practice. The clinical experience must be under the supervision of either an MD, a physician assistant, or an NP with approval to practice. b. A plan for obtaining the required graduate level pharmacology course for advanced practice registered nurses or pharmacology continuing education as applicable. c. The required number of contact hours of continuing education consistent with the NP s education and area of practice. 3. Following approval of the refresher course application, the Plan must be satisfactorily completed within one year for NPs inactive greater than two and less than four years, and two years for NPs inactive greater than four years. What are the Steps to begin the Refresher Course? Step 1 Submit an Application for Registration as a Nurse Practitioner (go to www.ncbon.com Online Services Advanced Practice - NP at the NCBON website). Step 2 A Nurse Practitioner refresher course is intended to be an individually planned and self-directed course of study. If you have questions about your Plan prior to submission of the application, please contact the Manager - Practice at 919-782-3211 Ext. 255 to discuss your Plan. Step 3 Submit a Nurse Practitioner Refresher Course Application (See page 7 of this document) NOTE: For additional information regarding the Nurse Practitioner Refresher Course see contacts below: For questions regarding the components for your independent study NP Refresher Course, such as didactic or clinical questions, please contact Eileen Kugler, RN, FNP, Manager Practice, 919-782-3211, ext. 255. For questions regarding completing the application process, please contact Paulette Hampton, Practice Coordinator, 919-782-3211 Ext. 244. Page 3 of 11
NURSE PRACTITIONER REFRESHER COURSE APPLICATION GUIDELINES The Nurse Practitioner Refresher Course is an individually planned, self-directed course of study. APPLYING FOR NP REFRESHER COURSE 1. Complete and submit the Application for Registration as a Nurse Practitioner. The registration application must be approved before you can begin the NP Refresher Course. You may obtain the Application for Registration as a Nurse Practitioner by going to http://www.ncbon.com Online Services Advanced Practice - NP All NP online applications Registration Application Only for Nurse Practitioner in NC. 2. After your Application for Registration has been approved and prior to beginning the Nurse Practitioner Refresher Course, please submit the following documents: A Nurse Practitioner Refresher Course Application along with your curriculum vitae. The Educational Design Documentation Form that outlines your individualized plan of study. With prior notification and approval from the Manager - Practice, your plan may be updated as often as necessary to enhance your refresher course experience. The Clinical Experience Sheet that outlines the patient populations that will be included in your clinical preceptorship. Signed agreement(s) with a nurse practitioner(s) and/or physician preceptor(s). Preceptors shall be nurse practitioners, physician assistants, and/or physicians, consistent with the applicant s area of nurse practitioner education, national certification, if applicable, and scope of practice. Preceptors do not have to be potential employers or employees of potential employers. In the signed agreement(s), the preceptors are to acknowledge in writing that the NP who is in the NCBON approved Refresher Course will not assume the final responsibility for the diagnosis, treatment, writing of prescriptions, and billing for patients in the practice (sample form included). Please Note: 1. Your Refresher Course Application must be approved before you begin your refresher course. 2. All refresher course requirements must be completed within the required timeframe of Refresher Course application approval. If one of your requirements for approval to practice is to obtain national certification or recertification, this must be obtained within the required timeframe for completion of the Refresher Course, or before applying for NP approval to practice. Page 4 of 11
CLINICAL EXPERIENCE 1. Chosen clinical site(s) must be able to provide the MINIMUM number of hours of clinical experience based on years NP has been inactive. The clinical experience must be in the area of the applicant s nurse practitioner education and national certification, if applicable. NOTE: You may have more than one preceptor and more than one site. 2. Required Components of Precepted Clinical Experience: a. Health assessment and diagnostic reasoning; b. Clinical management of common health problems and diseases that reflect the Nurse Practitioner s formal education program; and national certification, if applicable; and, c. Clinical preventive services and client education. 3. Mid-way through the clinical experience, the following information should be submitted to the Board: a. A summary of progress of how the NP applicant fulfilled the clinical practice component; listing the clinical site(s), types of patient populations, name(s) of preceptor(s), and number of hours completed. (Submitted by NP applicant) b. A letter confirming satisfactory progress and substantiating the number of clinical hours that have been completed by the NP applicant. (Submitted by preceptor) 4. Upon completion of the clinical experience, the following information should be submitted to the Board: The preceptor(s) should mail final letter(s) directly to Eileen Kugler, Manager - Practice, substantiating the number of clinical hours that have been completed by the applicant, confirming satisfactory performance of clinical hours; and attesting that in the preceptor s judgment, the Nurse Practitioner applicant is competent to practice as a nurse practitioner in the area of her/his formal academic education and national certification, if applicable. ADDITIONAL REQUIREMENTS TO COMPLETE REFRESHER COURSE In addition to successful completion of your clinical experience, the following requirements must be met to complete the course: A. Pharmacology: Required continuing education contact hours or a graduate level course reflective of the applicant s formal education and national certification, if applicable, is required. Once the course is completed, documentation by transcript or a COPY of the CE certificate shall be submitted directly to Eileen Kugler, Practice Consultant, NCBON PO Box 2129 Raleigh, NC 27602. B. Continuing Education (CE): Required contact hours of continuing education must be completed in addition to the pharmacology requirement. Once CE is obtained, the applicant shall submit COPIES of the CE certificate(s) to Eileen Kugler, Manager - Practice, NCBON PO Box 2129 Raleigh, NC 27602. The Nurse Practitioner, when providing care to the public, shall use appropriate identification as specified in G.S. 90-640 and 21 NCAC 36.0231. Page 5 of 11
AFTER NP REFRESHER COURSE HAS BEEN COMPLETED Once the Refresher Course Applicant has successfully completed the NP Refresher Course, the individual will receive a letter from the Manager - Practice stating that she/he has met all the requirements for the NP Refresher Course. After receipt of this letter, and upon obtaining a position and primary supervising physician, the individual may submit an application for Nurse Practitioner Approval to Practice in NC. You may access this form at http://www.ncbon Online Services Advanced Practice - NP. A $100.00 fee is required upon submission of the application for approval to practice. Each additional primary supervising physician requires a separate application and the fee of $100.00 for approval to practice. A NOTE ABOUT NP LAWS AND RULES The NP s Approval to Practice is granted by the Joint Subcommittee (comprised of representatives of both the NC Board of Nursing and the NC Medical Board); therefore, identical rules have been promulgated by both Boards. RULES: 21 NCAC 36.0800 Section - Approval and Practice Parameters for Nurse Practitioners are the rules promulgated by the NC Board of Nursing. Go to www.ncbon.com - (Practice APRN NP). LAWS: G.S. 90-18.2 and 90-18.3 www.ncga.state.nc.us and www.ncbon.com Practice APRN NP NP General Statutes. IT IS YOUR RESPONSIBILITY TO KNOW YOUR NP LAWS AND RULES. Page 6 of 11
NCBON Office Use Only NURSE PRACTITIONER Application Received REFRESHER COURSE APPLICATION Registration Verified RN Verified Preceptor(s) Verified Date: Application Approved Name: Address: (Street) (City) (State) (Zip Code) Telephone Numbers: Home Work Email Address: RN License Number: Expiration Date: Type of NP (please select from below): Cell ACNP ANP FNP GNP NNP SNP OB/GYN NP OHNP PNP PNP-AC PSY/MH NP Women's Health NP How long have you been out of NP practice? greater than 2 years greater than 3 years greater than 4 years greater than 5 years: If greater than 5 years, how many years? I have completed the Nurse Practitioner Registration Application. Yes No The Nurse Practitioner Registration application must be submitted first. Upon written notification by the NC Board of Nursing that her/his Nurse Practitioner Registration has been approved, the Applicant may complete an application for the Refresher Course. Following approval of the refresher course application, the Plan must be satisfactorily completed within one year for NPs inactive greater than two and less than four years, and two years for NPs inactive greater than four years. Signature (Original) Date Plan submitted includes: (See guidelines) Attach additional pages if needed. 1. Name of Preceptor(s): with signed agreement(s) attached. 2. List clinical site(s) to be used: Attach additional pages if needed. 3. Patient population defined: 4. Refresher course objectives with content outline. (Use Educational Design Documentation Form pg 9) 5. Pharmacology Course: a. Name: b. Location: c. Once the course is completed, documentation by transcript or a COPY of the CE certificate shall be submitted directly to Eileen Kugler, Manager - Practice, at the NCBON PO Box 2129 Raleigh, NC 27602 6. The completed Educational Design Form must be submitted with the application. Page 7 of 11
7. As part of the completion of the Nurse Practitioner Refresher Course, the required number of contact hours of continuing education must be completed. Once CE is obtained, the applicant shall submit COPIES of the CE certificate(s) to Eileen Kugler, Manager - Practice, at the NCBON PO Box 2129 Raleigh, NC 27602. 8. Clinical Experiences: Please see Clinical Experiences Sample Sheet describing how clinical experience will be obtained (Please see page 10). The MINIMUM number of hours of clinical experience based on years NP has been inactive is required in the NP's area of academic educational preparation and national certification, if applicable. 9. The NP Refresher Course applicant s curriculum vitae must be submitted with the application. Page 8 of 11
EDUCATIONAL DESIGN DOCUMENTATION FORM Title: NURSE PRACTITIONER REFRESHER COURSE Purpose: RETURN TO NP PRACTICE Learning Objective(s) Related Content (Outline Form) Time Frame Faculty and/or Preceptor Teaching Methodologies (Copy additional pages as necessary) Page 9 of 11
SAMPLE CLINICAL EXPERIENCE SHEET THIS SHEET IS ONLY AN EXAMPLE of a nurse practitioner s clinical experience plan. Please provide the Manager Practice with a plan suited to your particular scope of practice. As an FNP, my experience will encompass the following patient age range (including both males and females): Newborn Toddlers School-age Teenagers Adults Elderly As an FNP, my experience will encompass the following, for example: Male and female Maternity/GYN Urgent care suturing Patients with psychiatric conditions in office setting and/or hospital Pediatric- birth to 21 years of age Patients that are seen in the family practice and/or internal medicine office Depending on preceptor arrangement may have in-patient hospital experience Page 10 of 11
AGREEMENT FOR PRECEPTOR OF NURSE PRACTITIONER IN REFRESHER COURSE is currently in the North Carolina Board of Nursing approved refresher course. The purpose of this course is to prepare her/him for approval by the Board of Nursing to resume practice as a Nurse Practitioner. While is in this refresher course, he/she will NOT assume the final responsibility for the diagnosis, treatment, writing of prescriptions, and billing for patients in the preceptor s practice. SIGNATURES Nurse Practitioner Signature (original) Date PRINTED NAME OF NP Physician, Physician Assistant, or Nurse Practitioner Preceptor Signature (original) Date PRINTED NAME OF PRECEPTOR PRECEPTOR LICENSE NUMBER Name of Practice Practice Address (Street) (City) (State) (Zip Code) Type of Practice Patient Population Telephone Number Page 11 of 11