Frequently Asked Questions (FAQs)

Your Primary State of Residency (PSOR) must be in New Mexico to become eligible for multi-state privileges. You will need to log into your Nurse Portal account, submit a message through the message center requesting the multi-state status. You will need to upload your NM driver’s license and social security card as well as complete fingerprints for a background check.

What makes a US Educated graduate eligible for the NCLEX exam?

Graduated within the last four years from an approved nursing program in the US. Must provide transcripts and complete fingerprints for a background check. US educated graduates can test up to a maximum of 5 times in NM.

What makes an international graduate eligible for the NCLEX exam?

An evaluation completed by a credentialing agency of the foreign education that meets U.S. education standards, a background check, can test up to a maximum of 5 times in NM.

Is there a time limit on the NCLEX application process?

Board of Nursing applications for licensure are valid for 1 year from the time the application is submitted. Pearson Vue, who oversees administration of the NCLEX exam, has a separate application that is good for one year. Once an ATT (authorization to test) is issued, it is good for 6 months.

I’m an RN, how much continuing education do I need to renew my RN license?

RN’s need 30 CEs to renew their license: 16.12.2.13.L. 2.(i) NMAC

When do I need to pay Pearson Vue for the test?

You need to register with Pearson Vue and pay for the test at the same time you apply for your initial examination application at the NM Board of Nursing.

How do I complete a profile change?

How do I renew Online for the first time?

Use Chrome or Internet Explorer on a PC (not mobile compatible), Go to your nurse portal through the NM Board of Nursing website at www.bon.nm.gov. Once logged in, a renewal link will be “active” next to your name and license number. Follow directions. Note: Have all CEU’s completed and uploaded in CE Broker prior to renewing application as applicant will attest to having completed all of them requirements.

Renewal reminders are autogenerated and sent to the email on file 60 days and 30 days prior to expiration.

Do I need my registration code to renew online again?

No, a registration code is no longer required but an account must be created in the Nurse Portal.

Diversion

How can a nurse be referred to the Diversion Program?

Nurses are admitted into the Diversion Program through one of three methods. Because the program is only for chemically dependent nurses and is voluntary, the nurse must specifically request admission in writing and indicate that they are chemically dependent. This letter is sent to the Diversion Program staff or Director of Compliance. A nurse may request admission after the receipt of a complaint received in the Board of Nursing office. A nurse may report his/her own problem with drugs/alcohol and request admission in the program.

A nurse may request admission into the program in lieu of formal Board action against their license or as a condition of reinstatement of their license following a suspension or revocation.

The applicant with discipline in NM or another state is not eligible for a temporary license or permit to practice. The applicant is responsible for submitting legal documents to the Board of Nursing for review. The Board meets every other month. When the applicants file is complete, it will be taken to the next regularly scheduled meeting. The Board may decide to issue the license or to issue an NCA (Notice of Contemplated Action) and have a hearing to determine if a license will be issued or denied.

How do investigations start?

Apart from complaints alleging chemical dependency in which the licensee requests admission into the Diversion Program, all complaints alleging a violation of the Nursing Practice Act are investigated. An investigation is initiated when the board receives a complaint through the nurse portal or website.

What is the Diversion Program?

The Diversion Program is a confidential, voluntary alternative to formal disciplinary action for nurses who may be chemically dependent because of habitual or regular use of drugs and/or alcohol.

What are the requirements for participation in the Diversion Program?

Nurses who request admission to the Diversion Program will be sent a new participant packet to review prior to their admission. This packet includes all the pertinent information about the requirements for participation, including a copy of the initial contract that will be signed by all participants. They will be scheduled to meet with the Diversion Program Case Manager for an admission interview.

The initial contract signed by all participants is a five-year contract, in which the nurse agrees to be monitored by the Diversion Program during that five-year time frame.

Why was the Diversion Program established?

It is estimated that 14% of all licensed nurses are dependent on alcohol and/or other mind-altering drugs. Historically, a disciplinary approach to problems with addiction was the normal course of action in the nursing profession, as well as in other health care professions. In the early 1980’s, the nursing profession began to proactively address the problem of addiction in its ranks. They began to examine the issues of chemical dependency and addiction in nurses from a rehabilitative, rather than a disciplinary, approach. The first two alternative diversion programs were established in California and Florida. New Mexico became the third in the country to establish a diversion program.

In 1987, the New Mexico state legislature enacted Section 61-3-29.1 of the Nursing Practice Act that authorized the Board of Nursing to establish a diversion program for chemically dependent nurses. A nurse who habitually or regularly uses alcohol and/or other mind-altering drugs presents a potential danger to her/her patients because the use of chemicals can impair the nurse’s ability to safely practice nursing. When identified, the nurse can be referred to the Diversion Program and begin a program of rehabilitation to address the chemical dependency problem.

The purpose of the Diversion Program is to monitor nurses in the first months and years of their recovery, and track compliance with their sobriety and recovery work. It is not the intent of the program to provide treatment or therapy to chemically dependent nurses. However, the initial contract signed by all nurses requires them to receive some form of treatment for chemical dependency. The program initially provides a strict external structure of recovery for nurses whose lives have become unmanageable due to their abuse or addiction. The goal of the Diversion Program is to enable these nurses to integrate this structure internally and be able to manage their lives effectively again. When this has been accomplished, the nurses are ready for discharge.

Compliance and Complaints

Are licensed nurses required to report other nurses who violate the Nursing Practice Act?

Yes, unless the nurse is a patient and patient confidentially is involved.

Who can file a complaint?

Complaints may be filed by anyone with knowledge of the alleged violation. Any person filing a complaint is immune from liability arising out of civil action if the complaint is filed in good faith and without actual malice.

What are the statutory grounds for filing a complaint?

Some situations may include (not a complete list) nurse that is guilty of fraud or deceit in procuring or attempting to procure a license or certificate of registration; Is convicted of a felony; Is unfit or incompetent; Is intemperate or is addicted to the use of habit-forming drugs; Is mentally incompetent.

What information should be provided in the complaint?

What happens during an investigation?

The investigator interviews both the complainant and the licensee. Information is gathered from relevant sources, such as patient records and personnel records etc. After all available information, both positive and negative, is collected the investigator will prepare and present a report for determination by the board.

Who conducts the investigation?

The Board has internal investigators on staff. If you wish to verify the name of an investigator, contact the Board office.

How can I obtain a complaint form?

Download from our website – www.bon.nm.gov

What action may be taken?

Disciplinary action may include many actions such as but not limited to : denial of a license, reprimand, probation, suspension, summary suspension, or revocation of the license. Conditions may also be imposed including a fine, administrative costs, supervision, continuing education.

How long will the investigation take?

On average an investigation takes three to six months to complete and be presented to the board.

What happens after the investigation?

The Board of Nursing reviews the investigative report and decides how to proceed. The Board considers alleged violations based on the merits of each case and potential danger to the public. The threshold for imposing discipline is a violation of the Nurse Practice Act.

The Board is a public agency, and as such, subject to the Public Records Act. Disciplinary action, whether past or present, is available to the public. Questions should be directed to the Executive Director at the Board of Nursing, 6301 Indian School Rd NE, Suite 710, Albuquerque NM.87110

What is a formal hearing?

A formal disciplinary hearing held before the Board of Nursing is an administrative hearing. The State of New Mexico through a prosecuting attorney from the Attorney General’s office presents State’s case. The licensee is given the opportunity to present his/her case. Licensees may choose to be represented by an attorney, a member of the profession or may represent themselves. The formal hearing allows the licensee a full opportunity to respond directly to the stated allegations. After hearing all the evidence, the Board in an Executive Session, deliberates the matter before it. The Board’s decision is announced in a public session immediately following the Executive Session. A copy of the written decision is mailed via certified mail to the licensee in accordance with the ULA.

What disciplinary action may be taken?

Disciplinary action may include denial of a license, reprimand, probation, suspension, summary suspension, or revocation of the license. Conditions may also be imposed including a fine, administrative costs, supervision, continuing education, drug screening, counseling or other conditions that are appropriate.

If I have had an arrest that will appear on the background results, what should I do?

Any arrests or convictions should be disclosed on your application. Submit court documentation pertaining to the outcome of the arrest with your application. The Board of Nursing will review the submitted documentation while processing your application. If additional information is needed, a message will be sent via the message center.

What happens if a nurse or licensee requests a hearing?

Disciplinary proceedings are conducted in accordance with the Uniform Licensing Act (ULA) and Open Meetings Act. Upon receipt of a written request for a hearing, the Hearing Notice, designating the date, time and place of the hearing is mailed to the licensee via certified mail.

How do I as an employer know if a nurse applicant is in the Diversion Program?

Nurses in the Diversion Program are required to inform their employers and prospective employers that they are participants in the DP. Upon request from the employer, they should be able to provide a copy of their initial contract with the DP, as well as any subsequent contract amendments. These documents will provide information about current practice stipulations and contract requirements. Contract amendments are completed with each nurse in the DP at their mandatory face-to-face evaluations, which are conducted a minimum of every three months while the nurse is in the DP. These contract amendments provide a status report on the nurses’ participation and ongoing compliance with the DP.

What information should be provided in a complaint?

The complaint must include the name, address and telephone number of the complainant and the name, address, telephone number and license number of the nurse. A detailed description of the alleged behavior which violates the Nursing Practice Act must also be provided in the complaint. The complaint should also include any documentation which supports the allegations.

I have submitted my renewal application online, when will my license be renewed?

Your license will be renewed within 24-48 hours after submission if there are no complications or additional information needed to complete the renewal process. Please allow 72 hours for reactivation of a license.

Why is it my APRN only licensed for less than two years?

APRN licenses are aligned to expire with your NM Multistate license or your multistate from another jurisdiction. Original time frame should be between 13-24 months.

Ketamine

“The Board of Nursing (“BON”) receives many inquiries regarding rule interpretation related to nursing practice and/ or education. The FAQs page was developed by the Board of Nursing (“Board”) agency as a general interpretation of the rules promulgated by the Board on what the Nursing Practice Act states or requires. FAQs give general responses to questions which may not include other critical information that would provide particular and/or situational factors. FAQs are NOT legal opinions and cannot be cited as legal authority. FAQs do not change, amend, or modify the Nursing Practice Act in New Mexico or BON regulations. Only Board members can speak for the Board regarding the specifics of each case. FAQs are for informational purposes only and subject to change at any time.”

What specialty types of APRNs can order Ketamine?

It isn’t a one size fits all for each of the four types of APRN (CNP, CNS, CRNA, and CNM). While CRNA’s may of course order Ketamine as they use it frequently in their practice, the setting and situation outside the perioperative area is an important consideration. Furthermore, for certified nurse practitioners and certified clinical nurse specialists, it is dependent on their population foci or specialty. Certified nurse midwives should check with the Department of Health office.

An Advanced Practice Registered Nurse (APRN) scope of practice is determined by Licensure by the state in which the APRN practices, Accreditation of the educational program, Certification (National from ANCC, AANPCB, NBCRNA, etc.) and Education/Experience in the specialty. This is referred to as the LACE model. These four elements provide the setting, population, and acuity of the patients that the APRN attends (See Appendix 1).

The question is does the APRN have all LACE elements for their practice? For example, the FNP credential is a primary care context, across the lifespan population, with an appropriate acuity focus. The assessment, diagnosis, intervention and evaluation of complex and refractory psychiatric/behavioral health conditions is not within that scope. Maintaining a treatment plan being managed by another provider with psychiatric/behavioral health expertise may be appropriate, similarly to an FNP continuing a treatment plan set by a cardiology ACNP for a patient with a cardiac condition for example.

See the table on Nurse Practitioner Population Foci divided into Primary Care and Acute Care below, noting that Adult and Geriatric Nurse Practitioner Roles are sunsetting.

NURSE PRACTITIONER POPULATION FOCI	PRIMARY CARE	ACUTE CARE
NEONATATAL: ACROSS THE SETTING CONTINUUM	NNP-BC	NNP-BC
PEDIATRIC: PRIMARY CARE or ACUTE CARE	CPNP-PC or PCNP-BC	CPNP-AC
SCHOOL-AGE PRACTITIONER	SNP-BC
WOMEN’S HEALTH (NON-OB): ACROSS THE ADULT CONTINUUM	WHNP
ADULT: PRIMARY CARE or ACUTE CARE	CAGNP or AGPCNP-BC	AGACNP-BC or ACNPC-AG
ADULT ONLY (SUNSETTING)	ANP-BC
GERIATRIC ONLY (SUNSETTING)	GNP-BC
FAMILY ALL AGES: PRIMARY CARE	FNP-BC or CFNP
PSYCHIATRIC/MENTAL HEALTH: ACROSS THE AGE/SETTING CONTINUUM	PMHNP	PMHNP

12.2.12.A. (2) Successfully complete a graduate level nursing program designed for the education and preparation of nurse practitioners as providers of primary, or acute, or chronic, or long-term, or end of life health care.

(e) Additional population foci can be added with transcripts from an accredited institution and a current national nurse practitioner certification.

12.2.12.L. Nurse practitioner practice:

(3) The CNP may assume specific functions or perform specific procedures which are beyond the advanced educational preparation and certification for the CNP provided the knowledge and skills required to perform the function or procedure emanates from a recognized body of knowledge or advanced practice of nursing and the function or procedure is not prohibited by any law or statute. When assuming specific functions and performing specific procedures, which are beyond the CNP’s advanced educational preparation and certification, the CNP is responsible for obtaining the appropriate knowledge, skills, and supervision to ensure he/she can perform the function/procedure safely and competently and recognize and respond to any complications that may arise.

Ketamine is classified by the FDA as an anesthetic, however its use outside the operative area is evolving. In settings for procedural sedation, a qualified airway manager’s presence is warranted.

In psychiatric/behavioral health care it is indicated for severe resistant unipolar depression. Prescribing in these situations requires psychiatric/behavioral health training to manage complex patient assessment, diagnosis, and evaluation in adults (see the Appendix 2: Joint Statement on Ketamine from the Boards of Medicine, Pharmacy and Nursing with important references). Caution is indicated due to the need for safety plans for care before, during, and after administration.

Complicating the discussion is the use of very low dose Ketamine for pain relief as an alternative to opiates. Some APRNs may have extensive experience in the area of primary care pain assessment and management. However, for IV ketamine this would also require the ability to manage safety plans and airway intervention if needed.

I am an FNP clinic practice owner that receives referrals from psychiatric/behavioral health providers who have ordered Ketamine infusions for their patients. Is that within my scope of practice?

Possibly. Please see Appendix 1 & 2 for guidance on Ketamine administration safety elements.

Appendix 1: LACE Statement on APRNs Changing a Population or Role

Approved LACE Network Nov. 1, 2021

The purpose of this document is to provide guiding principles when an APRN changes a population or role, in accordance with the information in the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education, 2008.

When an APRN changes a role or population, the APRN must complete an accredited graduate program which includes a post-graduate certificate, master’s, a Doctor of Nursing Practice (DNP) or Doctor of Nurse Anesthesia Practice (DNAP) program that aligns with the new role or population. The APRN sits for the national certification examination that aligns with the new role or population of the education program successfully completed. This includes the national certification examination for either primary or acute care for the for NP with a pediatric or adult-gerontology population focus.

The 2008 Consensus Model for APRN Regulation set forth the four recognized advanced practice registered nurse (APRN) roles and six population foci. The four roles are certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). The six population foci are family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related, and psychiatric/mental health. The APRN is educated at the graduate level in at least one of the four (4) roles and at least one of the six (6) populations. The APRN sits for the national certification examination that aligns with the APRN role and population of the graduate program successfully completed. This includes the national certification examination for either primary or acute care for the for NP with a pediatric or adult-gerontology population focus

Considerations when changing an APRN role or population:

RN or APRN experience is not accepted in lieu of completing an accredited graduate level program i.e., post-graduate APRN certificate, master’s degree, or DNP or DNAP degree, that aligns with the new role and population.

The institution offering an accredited post-graduate APRN certificate completes a formal gap analysis to determine if any courses or faculty supervised clinical hours can be accepted from the candidate’s previous APRN graduate education and determine the additional courses and faculty supervised clinical hours required to enable the student to meet national competencies for the new role and population and obtain the institution’s post-graduate certificate.

Programs outside of a graduate institution, e.g., post-graduate APRN residency and fellowship programs, are not a substitute for the completion of a formal accredited post-graduate APRN certificate, master’s degree, or DNP or DNAP degree in the new role or population.

Specialty preparation or certification, i.e., orthopedics, endocrinology, pain management, cannot be used in lieu of completing a formal accredited post-graduate APRN certificate, master’s degree, or DNP or DNAP degree in the new APRN population or role and sitting for the national certification examination that aligns with the new APRN role and population.

Appendix 2: New Mexico Board of Nursing Advisory: Ketamine

A Joint Advisory from New Mexico Boards of Nursing and Medicine

Review by Board of Pharmacy

Over the past decade, the use of Ketamine has expanded beyond anesthesia and pain management in surgical, hospital and emergency departments. There is some evidence that this medication, as well as an enantiomer, esketamine, may be effective in the treatment of certain psychiatric disorders. See selected research at the conclusion of this advisory, particularly the well-done documents adopted by Texas and Pennsylvania.

The use of these medications in the treatment of severe resistant unipolar depression and possibly other mental illnesses is evolving, but usually entails using significantly lower doses (aka “VLD” Ketamine, “Very Low Dose”) administered by intravenous, intramuscular, subcutaneous, oral, and intranasal routes. Guidelines for the use of these medications have been published but still indicate some variability and the need to establish effective treatment, dosing and delivery methods and plans.

While Ketamine is an approved medication for anesthesia, its subanesthetic use for mental health treatment is off label, so it is subject to additional caution and review, including clinical and ethical guidelines.

Ketamine is also a controlled substance and therefore subject to additional state and federal laws and requirements. There is risk for abuse, misuse, diversion, and drug seeking, therefore extra care in its procurement, storage, security, records, and use is necessary. It is required to be reported in the Prescription Monitoring Program.

It is becoming apparent from the national press and health care publications that Ketamine is being provided by health care providers across the country for reasons outside of the legitimate treatment of medical illnesses as well as for illnesses outside their area of expertise.

This is a concern of the Board, as we are compelled by the Nurse Practice Act to “Protect the public”. This includes protecting the public from improper, unprofessional, incompetent, and unlawful practice. Ketamine for mental health diagnosis requires the Licensed Independent Provider (LIP), meaning the APRN, to have education and certification in the diagnosis and management of this population.

Therefore, in the interest of promoting the safe, effective, and ethical practice of Nursing, the NMBON offers the following guidance in the use of Ketamine.

If Ketamine is being offered as a treatment, it must be for the treatment of a legitimate, medically recognized illness. This includes a valid provider-patient relationship, including a full history and physical, a complete medical record, a full treatment plan, ongoing monitoring, and documentation of patient response by the LIP.
Ketamine must be offered as a treatment only if there is a valid scientific basis, such as recognized evidence-based standards for its use for a particular diagnosis and it is administered as outlined per protocols developed by the relevant professional society.
Before being considered as a candidate for Ketamine treatment, the patient must be evaluated and diagnosed by a provider with documented and validated educational expertise in the diagnosis and treatment of the patient’s condition, and the provider is certified as such.
Ketamine, if utilized, must be part of a complete ongoing treatment plan for the patient’s condition, which includes a safety plan and appropriate concomitant therapy, such as anti-psychotic and anti-depressant medications.
Ketamine must be administered only by a provider that has been trained in its clinical indications, effect monitoring, and outcomes evaluation; in a setting that has the full safety response equipment and trained staff, including Advanced Cardiac Life Support.
Safety measures for the use of this medication must be in place for managing both immediate, short-term, and long-term side effects, to include on-going follow-up once ketamine treatment ends.

Using ketamine outside these guidelines may subject licensees to investigation for violations of the advanced practice requirements within the Nurse Practice Act and its regulations.

Selected References

Ashburn, M. et al. (2020). Guidelines for the safe administration of low dose ketamine: Prescribing Guidelines for Pennsylvania, The Commonwealth of Pennsylvania. for Safe

Hall, C. (2018). Ketamine, a monograph, Texas Department of Health & Human Services.

Sanacora, G., et al. (2017). A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry. 2017;74(4):399-405. doi: 10.1001/jamapsychiatry.2017.0080 Published online March 1, 2017.

Shiroma et al. (2020) A randomized, double-blind, active placebo-controlled study of efficacy, safety, and durability of repeated vs single subanesthetic ketamine for treatment-resistant depression, Translational Psychiatry, 10:206. https://doi.org/10.1038/s41398-020-00897-0

UpToDate (2023). Ketamine and esketamine for treating unipolar depression in adults: Administration, efficacy, and adverse effects – UpToDate. https://www.uptodate.com/contents/ketamine-and-esketamine-for-treating-unipolar-depression-in-adults-administration-efficacy-and-adverse-effects/print 1/20

Sedation

I am a Registered Nurse recently moved to New Mexico and just got myself licensed. I am curious about sedation rules. The American Society of Anesthesiologists changes their lingo sometimes, and I am not sure how the NM board categorizes sedation levels. Where can I find this information?

In March 2024 the NM Board of Nursing promulgated new rules; these went into effect in July 2024. The updated definitions were added to Part 1 General Provisions of the rules. Additionally, under Part 2: Nurse Licensure, there is specific guidance on sedation. See both sections below.

NMAC 16.12.1.7 DEFINITIONS: S. Definitions beginning with the letter S:

(1) “sedation”, means the administration of medications to produce various levels of calmness, relaxation, or sleep. The various levels include:

(a) “Minimum sedation/anxiolysis,” means a drug-induced state during which patients respond normally to verbal commands, may have impaired cognitive function or coordination but respiratory and cardiovascular functions remain stable:

(b) “Moderate sedation/analgesia (also known as conscious sedation),” means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained:

(c) “Deep sedation,” means a drug-induced depression of consciousness, during which a patient cannot be easily aroused but responds purposefully, following repeated or painful stimulation. While cardiovascular function is usually maintained, the ability to independently maintain respiratory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate resulting in intubation and mechanical ventilation. Reflex withdrawal from a painful stimulus is not considered a purposeful response;

(d) “General anesthesia,” means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. General anesthesia affects the patient’s ability to maintain an adequate airway and respiratory function, and may impair cardiovascular function;

(e) “Palliative sedation,” means the monitored use of medications at end of life intended to provide relief of intolerable and refractory symptoms but not to intentionally hasten death. A refractory symptom is one that cannot be controlled in a tolerable time frame despite use of therapies and seems unlikely to be controlled by further therapies without excessive or intolerable acute or chronic side effects/complications.

16.12.2.11 STANDARDS OF NURSING PRACTICE: H. Professional registered nursing practice. Registered nurses practice in accordance with the definition of professional registered nursing in the NPA. Subsection J of Section 61-3-3 NMSA 1978.

(1) RNs may assume specific functions and perform specific procedures which are beyond basic nursing preparation for professional registered nursing Subsection J of Section 61-3-3 NMSA 1978 provided the knowledge and skills required to perform the function and procedure emanates from a recognized body of knowledge and practice of nursing, and the function or procedure is not prohibited by any law or statute:

(a) emerging functions and procedures that do not emanate from a nursing body of knowledge will require national certification from a recognized body to denote mastery and assess competency as the RN is recognized as being certified;

(b) certificates of course completion are not evidence of mastery nor evidence of competency.

(2) When assuming specific functions and performing specific procedures, which are beyond the nurse’s basic educational preparation, the RN is responsible for obtaining the appropriate knowledge, skills and supervision to assure he/she can perform the function/procedure safely and competently:

(a) administration of medication for the purposes of moderate sedation and analgesia requires particular attention;

(b) a nurse shall possess specialized nursing knowledge, judgment, skill and current clinical competence to manage the nursing care of the patient receiving moderate sedation including:

(i) being currently trained with demonstrated proficiency in ageappropriate advanced life support, including but not limited to; Advanced cardiac life support (ACLS), Pediatric advanced life support (PALS), Neonatal resuscitation program (NRP);

(ii) knowledge of anatomy, physiology, pharmacology, cardiac arrhythmia recognition, oxygen delivery, respiratory physiology, transport and uptake and the use of an oxygen mask, bag-valve mask, oral airway, nasal airway adjunct, or the maintenance of a supraglottic airway, or endotracheal tube;

(iii) ability to recognize emergency situations and institute emergency procedures as appropriate to the patient condition and circumstance.

(i) shall not have other responsibilities during or after the procedure that would compromise the nurse’s ability to adequately monitor the patient during moderate sedation/analgesia;

(ii) shall assess the physical setting for safe administration of medications for sedation and proceed only if the resources needed for reasonable anticipated emergencies are available;

(iii) shall ensure that a qualified airway specialist is immediately available during and after the procedure for respiratory emergencies. Immediately available meaning being present in the facility, in the vicinity of the care being administered, and not otherwise engaged in any other uninterruptible procedure or task.

(iv) a qualified airway specialist is trained in and maintains a current competency in endotracheal intubation, such as but not limited to a CRNA, anesthesiologist, emergency physician, paramedic, respiratory therapist or a registered nurse;

(v) shall decline to administer medications classified as sedatives or other medication if the registered nurse assesses the administration of sedatives or other medication would be unsafe under the circumstances;

(vi) shall maintain adequate oxygenation and ventilation via an appropriate method.

(d) Administration of anesthetics is restricted to an anesthesia provider; pursuant to Section 61-3-6 NMSA 1978. However, RNs may maintain anesthetic medication drips on intubated and mechanically ventilated patients. RNs with education and competency may also administer anesthetic medications under the supervision of a qualified airway specialist, acting as a “provider’s third hand,” and assist with airway management when the provider is unable to free their hands or otherwise administer anesthetics during airway management. This restriction does not apply to surface or air transport RNs providing emergency airway care while in direct communication with their medical director or while following approved medical protocols.

(e) A RN may administer ketamine at a very-low dose only in the following situations:

(i) for providing moderate sedation for diagnostic or therapeutic procedures;

(ii) for analgesia or management of psychiatric disorders, and

(iii) for palliative (end of life) care.

A very-low dose permitted under this rule, means a dose of ketamine that is a fraction of the anesthetic maintenance dose and will not exceed a moderate sedation level of consciousness for non-ventilated patients. Proper protocols, training and education of the RN must be in place to assure patient/client safety, rescue equipment is readily available, and the supervising provider is knowledgeable of the medications and can intervene if assistance is required.

How do I as a nurse know if a provider is a qualified airway specialist?

Licensed facilities credential providers for specific procedures. Nurses must be able to access those credentialled activities per provider.

Ketamine is being administered in my Emergency Department for pain instead of the usual opiates. What are the requirements that I am expected to follow for safe patient care?

Ketamine administration should follow additional education and competency for the providers and the nursing staff. It may not be administered by an LPN, requires additional cautions and observation (see the FAQ on Ketamine), and an understanding that there is not a reversal agent for Ketamine. As is always the case, patients may also present to your facility under the influence of other substances that may effect their response to new medications.

Telehealth

Can an APRN with a Nursing Compact License living in New Mexico provide patient care in Minnesota?

There are 42 jurisdictions (states and territories) within these United States that participate in the National Nursing License Compact as of September 2024. More are expected. However, at this time, Minnesota is not part of the RN compact.

For an APRN to practice in Minnesota one would need a single-state RN license, but that is only part of your question. You are asking about your APRN license. There is no APRN Nursing License Compact. Seven states are needed to launch the compact, only four (4) states have enacted the compact. To provide care to patients in Minnesota, an APRN would need to e licensed in that state. The table below gives some examples:

Primary Scenarios:

Patient Resides	Location of Patient during receipt of services	APRN Located	APRN Licensed	Lawful
New Mexico	New Mexico	New Mexico	New Mexico	Yes
Texas	New Mexico	New Mexico	New Mexico	Yes
Texas	Texas	New Mexico	New Mexico	No
Texas	Texas	Texas	New Mexico	No
New Mexico	New Mexico Traveling to Texas	New Mexico	New Mexico	Maybe
New Mexico	New Mexico	New Mexico Traveling to Texas	New Mexico	Probably

*APRN License and Patient Location receiving telehealth must match.

What are the secondary factors that should be considered?

Each state’s Scopes of Practice and the Nursing Practice Acts and the Rules are different. In some states certain medications are prohibited for APRN’s to prescribe. It is the APRN’s responsibility to understand these differences to avoid action by other states on your compact license. Additionally, here are some secondary questions and scenarios:

Scenario: Patient is visiting children in Austin, Texas. Patient calls NM provider for a telehealth visit in follow-up to a medication adjustment. Now what? Not sure:

How does insurance reimburse?
What is the medication?
What are the rules for the board of pharmacy? For instance, does the telehealth state require an NP to have a collaborative relationship to prescribe? Can a pharmacy in another state with collaborative practice fill any prescription from an NP licensed in an independent state?
If it is urgent/emergent, would the patient be better served by going to urgent care/ER?
If it is in the patient’s best interest to continue care with the provider who knows the patient and where they will follow-up?
If the provider doesn’t understand the laws in the location of the patient, is it in their best interest?
In the case of services for abortifacients, it would be important for the provider to know the implications of any prescription. Is multistate RN license at risk?
In some states, providers cannot provide gender confirming services for those with gender identity disorder until the patient is an adult.
In other states, gender confirming treatment is not allowed at all.

Where can I get guidance within the New Mexico Nursing Practice Act on telehealth?

The New Mexico Nursing Practice Act [Chapter 61, Article 3 NMSA 1978] clearly defines advanced practice and the defines the role of the certified nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialists. For an advanced practice registered nurse (APRN) to practice in New Mexico, the APRN must be licensed to practice in New Mexico by the New Mexico Board of Nursing.

Furthermore, the New Mexico Nursing Practice Act refer to additional New Mexico Laws such as the Uniform Licensing Act [Chapter 61, Article 1 NMSA 1978], Controlled Substances Act [Chapter 30, Article 31 NMSA 1978], Pharmacy Act [Chapter 61, Article 11 NMSA 1978], and the New Mexico Drug, Device, and Cosmetic Act {Chapter 26, Article 1 NMSA 1978].

There are no provisions for telehealth or telemedicine in the Nursing Practice Act. In addition, New Mexico, as a full practice authority state, cannot extend its definition of scope of practice to the laws for APRN practice in another state.

Generally, the authority to practice is linked to the location of the patient. This is to assure that wherever the patient is located that the appropriate state laws are followed. For example, a patient is in Texas and requires a controlled substance prescription for pain control. However, Texas law requires a practice agreement with a physician and limits prescriptions for schedule II-controlled substances. If an APRN prescribed a schedule II-controlled substance to a patient who was physically in Texas and did not meet the requirements for practice set forth by Texas laws, New Mexico laws could not protect the APRN for any potential violation brought forth by the state of Texas.

Again, there is no licensure compact that has been enacted in New Mexico or across the country for APRNs. Therefore, if an APRN would like to practice with a patient who is in another state, the APRN is required to obtain the legal authority to practice in the state where the patient resides. In addition, the APRN should familiarize themselves with all state laws that regulate the practice of the APRN in each state. State laws vary for prescription of controlled substances, prescription of medical devices, and reproductive health care; this list is not exhaustive.

I am an FNP and would like to work for a company prescribing Ketamine remotely for patients in multiple states. Would I have to get a license in every state that I will be seeing patients in?

Yes, at a minimum, and also ensure that if you are using an RN compact license, all states that you plan on practicing in are part of the Nursing Licensure Compact or add additional single states.

However, the issue will also include whether your specialty license, accreditation, certification and experience/education. Ketamine is an emerging intervention (See NMBON Ketamine FAQ). Simply being a licensed and certified APRN does not necessarily convey the required expertise. Extensive knowledge and demonstrated competence in Psychiatric/Behavioral Health Advanced Practice scope of practice is essential.

Licensed Practical Nurse (LPN) Scope of Practice

I recently moved here from another state where LPN’s may not administer I.V. fluids. Is it within the scope of practice for an LPN to administer I.V.’s in New Mexico?

LPNs are an important and integral component of the New Mexico health care system. In the regulatory oversight of LPN programs that the New Mexico Board of Nursing provides, the agency supports the matriculation of LPNs to registered nurse (RN) licensure. And yes, LPNs who received or obtain IV education and demonstrate competence are able to administer I.V. fluids. Any procedure beyond the level that is taught in a practical nursing program requires the LPN to have the competency and knowledge to take appropriate action in a timely manner for any negative outcome, delayed outcome, or positive outcome.

The scope of practice of a licensed practical nurse [LPN] is broadly defined in the New Mexico Nursing Practice Act (Chapter 61, Article 3 NMSA 1978) and broadly in the rules 16.12.2.11 (I) of New Mexico Administrative Code [NMAC] (Appendix B).

The NPA and the rules do not exhaustively list which skills an LPN can perform and those which an LPN cannot perform. The NPA and rules do outline that an LPN must be supervised by a registered nurse, physician, or dentist. Appendix A provides a table with guidance for selected interventions.

I am a newly graduated registered nurse, and I work on an adult medical-surgical unit. My question is about LPNs and their scope of practice around a patient’s care plan. What may an LPN provide on the patient’s plan of care?

The LPN cannot initiate a plan of care. The LPN has a different level of anatomy and physiology, assessment, pathophysiology, pharmacology, and thus, different levels of knowledge and skills than a registered nurse. An LPN may not perform an initial assessment. A RN must perform the initial assessment. The initial assessment determines a patient’s baseline and informs the development of an initial nursing plan of care. LPNs may assist the RN in the nursing process, once the initial assessment and nursing plan of care are completed. An LPN may add to a patient’s plan of care. This must be consistent with accepted and prevailing nursing practice. The LPN is to communicate any change of a patient’s status to the RN.

The National Council State Boards of Nursing (NCSBN) practice analysis for a newly licensed LPNs provides some guidance. The practice analysis is available at: 21_NCLEX_PN_PA.pdf (ncsbn.org). The practice analysis is based on a survey sent to newly licensed LPNs to measure the most common activities performed by LPNs. Subject matter experts also send in their measures of what they see are the most common activities performed by LPNs. The respondents to the survey also provide their practice areas. From the most recent practice analysis, the most common practice areas reported are long term care facilities, rehabilitation facilities, and ambulatory care facilities. Less than 15% of LPNs reported working in a hospital.

What is the target patient acuity for an LPN?

The target acuity for LPN care has historically been long-term care, rehabilitation settings or lower acuity settings where the patient’s expected trajectory is stable, and the health care course is more routine. As is commonly known, the nursing process comprises five steps: assessment, diagnosis, planning, implementation, and evaluation (Toney-Butler & Thayer, 2022). The scope of practice of the LPN asserts that the LPN is only part of four of these five steps; the diagnosis step is reserved for APRNs and RNs (NCSBN, 2005a). Higher acuity patients would require frequent and ongoing assessment and intervention from an RN.

Appendix A: LPN Scope of Practice; Selected Interventions

Since the type of procedures in each practice setting changes as the overall health care system changes, this matrix focuses on specific procedures. Based on the NPA, New Mexico Administrative Code [NMAC], task analysis from NCSBN, and scope of practice from the National Association of Licensed Practical Nurses, the following skills/tasks/responsibilities are outlined as appropriate or not appropriate for a licensed practical nurse in New Mexico based on the level of assessment required for a specific task or skill.

Task/Responsibility	If in an LPN’s individual scope, may:	May not:
Assessment & Care Plan	· Perform a focused nursing assessment to gather and record data, observe, monitor, and report signs, symptoms, and changes in condition to RN, physician, or dentist. · Participate in the development and modification of the plan of care	· Perform a comprehensive assessment. · Develop or initiate a plan of care. · Initiate independent nursing interventions not in the plan of care.
Patient Teaching	· Assist with health counseling, admission, and discharge teaching of patients.
Prescriber Orders	· Receive and document orders according to facility policies.
Charge Nurse & Delegation	· Assisted living for charge nurse · Delegate to and supervise nursing assistants (CNA, CMA) only those tasks the LPN is competent to perform and in accordance with 16.12.2.11 NMAC	· Supervise licensed health care professionals in a licensed health care facility.
Foley Catheter	· Insert, remove, irrigate tube.
Suprapubic Catheter	· Change or replace tube.
Gastrostomy Tube	· Change or replace tube. · Administer medication via tube.
Nasogastric Tube	· Insert and remove tube. · Administer medication via tube.
Wound Care	· Perform sterile, complex dressing changes. · Remove sutures and staples.
Medication Administration	· Administer oral, SQ, IM, topical, rectal, vaginal, inhalation, eye, and ear. See IV therapy section for additional information.	· Administer fluids, medications, or agents via an epidural, intrathecal, intraosseous, umbilical, or ventricular reservoir routes.
Tracheostomy Care	· Suction, perform dressing changes.
Dialysis: Hemodialysis & Peritoneal	· Provide dialysis treatments for clients. · Initiate, monitor, and discontinue dialysis treatments for peripheral or central catheter access devices according to IV therapy guidelines described below
Laboratory Blood Draws	· Perform peripheral venipuncture according to lab requirements and facility policy, same as a phlebotomist. · Obtain blood samples from a peripheral or central line according to standards of nursing practice and lab requirements.	· Insert or remove/discontinue midline IV catheter, PICCs, or central lines. · Insert port-a-cath needles.
Intravenous (IV) Therapy	Both peripheral & central lines:
	· Initiate and maintain IV according to order and standards. · Obtain blood samples. · Assemble and maintain infusion equipment. · Administer IV fluids, with or without added medication, that have been prepared and labeled by a pharmacist, RN, physician, dentist, or manufacturer. · Calculate and adjust infusion rates using standard formulas. · Reconstitute medications by activation of a manufacturer’s prepared bag and vial system. · Flush with heparin or saline solutions. · Assemble and maintain patient-controlled analgesia (PCA) infusion equipment, program the pump pursuant to an order that prescribes a specific dose and assist a client with self-bolus when needed. · Discontinue IV therapy infusion, blood products, and plasma volume expanders. · Perform routine dressing changes.	· Administer medications for the purpose of inducing moderate or deep sedation or general anesthesia (§61-3-6 NMSA 1978, 16.12.2.11 NMAC). · Administer the following IV medications · Antiarrhythmics · Chemotherapy (may monitor) · Biologics, including immunotherapy · Fibrinolytics · Immunoglobulins · Investigative or experimental · Oxytocic agents · Paralytic agents · Thrombolytics · Tocolytics · Vaso actives · Titrate medications requiring continuous assessments to determine the dosage of medication or agent.
	Peripheral lines only; may:
	· Insert peripheral venous access devices, using a needle or catheter not to exceed 3 inches in length. · Administer intradermal, SQ, or topical local anesthetics for pain control with peripheral catheter insertion. · IV push medications in a licensed facility with over the shoulder supervision · Remove IV catheters that are less than 3 inches in length.	· Push an IV medication outside of a licensed hospital or without direct supervision.
	Central lines only:
	· Administer TPN and fat emulsions. · Remove implanted venous access device needle (porta-a-cath).
Blood Administration	· Monitor blood product and plasma volume expander administration after RN administers blood product and monitors client for initial 15 minutes.	· Administer a blood product outside of a licensed hospital or without direct supervision.

Appendix B: Sections from the Nursing Practice Act and Rules references used in this FAQ

The Nursing Practice Act [NPA] defines the practice of a licensed practical nurse (LPN) as from § 61-3-3:

“licensed practical nurse” means a nurse who practices licensed practical nursing and whose name and pertinent information are entered in the register of licensed practical nurses maintained by the board or a nurse who practices licensed practical nursing pursuant to a multistate licensure privilege as provided in the Nurse Licensure Compact [61-3-24.1NMSA 1978];
“licensed practical nursing” means the practice of a directed scope of nursing requiring basic knowledge of the biological, physical, social and behavioral sciences and nursing procedures, which practice is at the direction of a registered nurse, physician or dentist licensed to practice in this state. This practice includes but is not limited to:

(1) contributing to the assessment of the health status of individuals, families and communities;

(2) participating in the development and modification of the plan of care;

(3) implementing appropriate aspects of the plan of care commensurate with education and verified competence;

(4) collaborating with other health care professionals in the management of health care; and

(5) participating in the evaluation of responses to interventions;

“practice of nursing” means assisting individuals, families or communities in maintaining or attaining optimal health, assessing and implementing a plan of care to accomplish defined goals and evaluating responses to care and treatment. This practice is based on specialized knowledge, judgment and nursing skills acquired through educational preparation in nursing and in the biological, physical, social and behavioral sciences and includes but is not limited to:

(1) initiating and maintaining comfort measures;

(2) promoting and supporting optimal human functions and responses;

(3) establishing an environment conducive to well-being or to the support of a dignified death;

(4) collaborating on the health care regimen;

(5) administering medications and performing treatments prescribed by a person authorized in this state or in any other state in the United States to prescribe them;

(6) recording and reporting nursing observations, assessments, interventions and responses to health care;

(7) providing counseling and health teaching;

(8) delegating and supervising nursing interventions that may be performed safely by others and are not in conflict with the Nursing Practice Act; and

(9) maintaining accountability for safe and effective nursing care;

The rules set the standards of practice of an LPN as:

Standards for licensed practical nursing practice. Licensed practical nurses practice in accordance with the definition of licensed practical nursing in the NPA Subsection G of Section 61-3-3 NMSA 1978.

(1) LPNs may assume specific functions and perform specific procedures which are beyond basic preparation for licensed practical nursing Subsection G of Section 61-3-3 NMSA 1978 provided the knowledge and skills required to perform the function and procedure emanates from the recognized body of knowledge and practice of nursing, and the functions or procedure is not prohibited by any law or statute. LPNs who perform procedures which are beyond basic preparation for practical nursing must only perform these procedures under the supervision/direction of a RN.

(2) LPNs may perform intravenous therapy, including initiation of IV therapy, administration of intravenous fluids and medications, and may administer medications via the intraperitoneal route provided the LPN has the knowledge and skills to perform IV therapy safely and properly.

(3) When assuming specific functions and performing specific procedures which are beyond the LPN’s basic educational preparation, the LPN is responsible for obtaining the appropriate knowledge, skills and supervision to assure he/she can perform the function/procedure safely and competently.

In addition, the nursing practice standards for the licensed practical and licensed vocational nurse are published by the National Association of Licensed Practical Nurses (Nurse Practice Standards – NALPN). The practice standards follow.

PRACTICE

The “Licensed Practical Nurse/Licensed Vocational Nurse”

As an accountable member of the health care team; shall accept assigned responsibilities.
As related to the assigned duties; shall function within the limits of educational preparation and experience.
With other members of the health care team; shall function in promotion of and in maintenance of good health. Shall aide in preventing disease and disability. Shall care for and rehabilitate individuals who are experiencing an altered state of health. Shall contribute to the ultimate quality of life until death.
For the individual patient or group; shall know and utilize the nursing process in planning, implementing, evaluating.
Planning: The planning of nursing includes:

assessment and data collection of health status of the patient, the family, and community groups.
reporting information received from assessment.
identifying health goals.

Implementation: The plan for nursing care is put into practice to achieve the stated goals and this includes:

Observing, reporting and recording significant changes which require different goals or intervention.
Apply skills and nursing knowledge to help promote and maintain health, to help prevent disease and disability, and to optimize functional capabilities of a patient.
Encouraging self-care as appropriate and assisting the patient and family with activities of daily living.
Carrying out therapeutic protocols and regimens prescribed by personnel in conjunction to state law.

Evaluations: The plan for nursing care and its implementations are evaluated to measure the progress toward the stated goals and will include appropriate person and/or groups to determine:

The relevancy of current goals in relation to the progress of the patient.
The recipient’s involvement of care in the evaluation process.
The nursing action quality in implementation of the plan.
New goal setting or changing priorities in the care plan.
Shall participate in peer review and other evaluation processes.
Shall participate in the development of policies concerning the health, nursing needs of society, and in the roles and functions of the LPN/LVN.

SPECIALIZED NURSING PRACTICE

The “Licensed Practical Nurse/Licensed Vocational Nurse”

As set forth in this document, shall meet all standards of practice.
For practice in the chosen specialized nursing area, candidate shall present personal qualifications that demonstrate potential abilities.
At the staff level, shall have had at least one year nursing experience.
Shall provide documentation of completion of an approved agency course or program providing the knowledge and skills necessary for adequate nursing services in the specialized field.

Aesthetic Healthcare Facilities

Is it within the scope of practice for an APRN to provide simultaneous supervision at multiple aesthetic health care facility sites?

Simultaneous supervision of staff at multiple aesthetic health care facilities/sites is not permitted if direct supervision is required. Direct supervision means the APRN is on-site and the duty to the patient could be required at any time. For procedures that may be provided by registered nurses who have demonstrated competence with national certiﬁcation, indirect supervision is permitted.

Is there a deﬁnition for emerging practice? And at what point is it no longer considered an emerging practice?

It is understandable to think of an emerging practice as a new medication or new technology, rather than a new area that requires specialization. Throughout health care there are multiple examples of new education programs that develop specialists in new areas.

For example, in advanced practice nursing, before there were acute care nurse practitioners, there were family nurse practitioners with extensive backgrounds in critical care who provided in-patient hospitalist care. Geriatric nurse practitioner roles are now incorporated into adult nurse practitioner roles that are divided into primary care and acute care roles. Before there were psychiatric/behavioral health nurse practitioner roles generalist family nurse practitioners provided care. Individual advancements in diagnostic tests for subtypes of different pathologies and more speciﬁc pharmacologic treatment lead to the need for more speciﬁc skills in assessment, diagnosis, management and evaluation. Please see #3 below for the Consensus Model rubric on emerging practice.

Unfortunately, the lack of additional expertise often results in increased incidents of patient harm and poor outcomes. Each of these emerging practice areas often results from substandard patient care due to lack of knowledge. With each emerging practice area, the APRN skill set, ethical considerations, deﬁnition of competence, measurement of patient safety with risk/beneﬁt analysis and ability to manage complications also grows through objective research and study. It can be anticipated that in the future there may be additional types of advanced practice roles for nurse practitioners. At that time, the rules may be updated.

Why do emerging functions and procedures that do not emanate from a recognized body of knowledge require a national certiﬁcation?

The Consensus Model for APRN’s (see Appendix 1) seeks to ensure consistency in licensure, accreditation, certiﬁcation, and education, facilitating regulation of APRNs throughout the US which permits an increasing scope of practice. The Consensus Model, which was adopted in 2008, is a rather recent development relative to the observation that varied APRN roles have existed for decades, and still vary across ﬁfty states. The ﬁrst global deﬁnition occurred in 2002, when the ICN provided deﬁnitions at a time when the master’s degree was still only a recommendation. The more recent ICN deﬁnition of the APRN set the master’s degree as the minimal education requirement and emphasized an advanced level of decision-making and responsibility. From the days when APRN’s were not required to have a bachelor’s degree, nor a national exam, national certiﬁcation is a mark of demonstrated competence. Those standards increased to permit an increased scope of practice among other beneﬁts.

Within nursing, the non-APRN roles, such certiﬁcations as wound care/ostomy, air rescue services, lactation care, diabetes management (to name but a few) have allowed nursing to increase their scope of practice and bill for services. Demonstrated competence matters. These specialty areas are not covered in the NCLEX, just as the nurse practitioner certiﬁcations do not provide demonstrated competence in aesthetics. It is essential that APRNs who are supervising and delegating invasive health care procedures are competent in these areas. As there is no requirement for this in the current NP national certiﬁcation exam that conveys licensure, a subsequent method is necessary.

The need for a specialty to be grounded in nursing, “emanate from a body of knowledge in nursing”, is due to the fundamentals underpinning the profession, developing a standardized skill set, independent and objective study and research to validate the science, and scrutiny of patient outcomes in a formal manner.

Are there other areas NMBON currently considers emerging that would require certiﬁcation?

No.

Will NMBON accept the certiﬁcation MEP-C which is not from a nationally recognized certifying body?

The agency does not endorse one certiﬁcation over another. Throughout the history of any health care professions certifying body, or the initiation of a new program, there is a period until accreditation is achieved. The resource document prepared by the agency simply noted that point. Any nurse sitting for a certiﬁcation of any type should assess the certiﬁcation for ﬁt and status.

Contacting the office of a body offering a national certiﬁcation, such as American Academy of Medical Esthetic Professionals at www.mep-c.com , about future plans may be prudent.

What evidence exists that requiring aesthetic certiﬁcation ensures patient safety?

Certiﬁcations in health care have a long track record of improving patient care. They provide a recognized authority on correct standards, assist with regard to elevation of practice scope, assist with networking of groups who impact standards, provide ongoing education to maintain current practice, and convey the accountability for these expanded scopes of practice. For example, APRNs have national certiﬁcation for these very reasons.

What is the timeline for compliance?

Rules went into effect on 5/21/2024. The Board is aware that nurses are enrolling in certiﬁcation programs, and that certiﬁcation registration and documents take some time to upload. A date of 12/31/2024 is a reasonable target. Registered nurses, including APRN’s, who do not have the hours of experience needed to sit for an exam are, of course, not required to achieve a certiﬁcation for which they are not eligible. However, since they do not have the level of competence and experience needed to sit for certiﬁcation, they would then be required to have direct supervision. Provider exam, diagnosis, treatment plan has never been in the scope of practice for non-APRN nurses and thus is a requirement effective immediately. Also note that LPN’s (see NM BON Rules Part 2) may not perform aesthetic injections.

Comments

Aesthetic Health Care facilities require particular attention due to the rapid proliferation of these unlicensed facilities, which offer services primarily for cash, and unlike most states there is no requirement that ownership include a licensed provider. The lack of standards, whether intentional or unintentional by facility owners, about the rules of the boards of medicine, pharmacy, barbering and cosmetology, as well as the Board of Nursing is concerning. Ignorance regarding statutes and rules and violations of scope of practice cannot be tolerated. In some facilities, the lack of a health care standard of care is concerning. In any setting, a duty to a patient is the nurses’ only priority. Patient safety is of utmost importance for obvious reasons, followed closely by the professional integrity of nurses.

Statute References

The CNP provides primary or acute, or chronic, or long-term, or end of life health care to meet

the health care needs of individuals, families and communities in any health care setting.

The CNP may assume speciﬁc functions or perform speciﬁc procedures which are beyond the advanced educational preparation and certiﬁcation for the CNP provided the knowledge and skills required to perform the function or procedure emanates from a recognized body of knowledge or advanced practice of nursing and the function or procedure is not prohibited by any law or statute. When assuming speciﬁc functions and performing speciﬁc procedures, which are beyond the CNP’s advanced educational preparation and certiﬁcation, the CNP is responsible for obtaining the appropriate knowledge, skills, and supervision to ensure he/she can perform the function/procedure safely and competently and recognize and respond to any complications that may

Appendix 1: APRN Scope of Practice: LACE

Licensure
Accreditation
Certification
Education

Four roles are recognized as Advanced Practice Registered Nurse (APRNs) roles:

CRNAs – Certified Registered Nurse Anesthetist.

Scope includes all ages in all aspects of operative and perioperative care.

CNMs – Certified Nurse Midwife.

Scope includes only females, thru childbirth and the child-bearing years.

CNS – Clinical Nurse Specialist.

Scope may include varied settings; however, the type is based on age-range population:

Neonatal, Pediatric, Adult-Geriatric.

CNPs – Certified Registered Nurse Practitioner.

Scope includes population/age, and competencies are based Primary Care or Acute Care.

The CNP is prepared with either the acute care or primary care competencies. At this point in time, delineation will apply only to the pediatric and adult-gerontology CNP population foci. Scope of practice of the primary care or acute care CNP is not setting specific but is based on patient care needs. While programs may prepare individuals across both primary care and acute care CNP roles, the graduate must be prepared with the consensus-based competencies for both roles, and the graduate must also successfully obtain certification in both the acute care and the primary care roles. CNP certification in the acute care or primary care roles must match the educational preparation for CNPs in these roles.

Age-Based Nurse Practitioners	Primary Care	Acute Care
Neonatal	NNP-BC	NNP-BC
Pediatric	CPNP-PC or PPCNP-BC	CPNP-AC
School-Age Practitioner	SNP-BC
Women’s Health (Non-OB)	WHNP
Adult	CAGNP or AGPCNP-BC	AGACNP-BC or ACNPC-AG
Adult Only (Sunsetting)	ANP-BC
Geriatric Only (Sunsetting)	GNP-BC
Family All Ages	FNP-BC or CFNP

Intravenous Hydration

Is I.V. hydration administration outside of a licensed facility within the scope of practice and permitted by LPNs and RNs?

Answer: It is within the Scope of Practice of the registered nurse (RN) and licensed practical nurse (LPN), and Advanced Practice Registered Nurse (APRN) who can demonstrate the necessary education, knowledge, judgment, skills, and licensure/certification, where applicable, to administer intravenous (IV) fluids hydration, nutrient therapies, and medications, as authorized by a valid order prescribed by a licensed independent provider (LIP means APRN, MD/DO, DDS) with prescriptive authority and acting within their scope of practice.

For APRNs this means the population foci of their License, Accreditation, Certification and Education (LACE). Orders need to be individualized and based upon the patient-specific needs with a medical rationale for the order. As an example, a neonatal nurse practitioner would not prescribe adult therapy.

The issuance of standing orders for elective IV therapies, including hydration, nutrients, or medications, by an APRN for a nurse or other healthcare staff is not permitted as it does not satisfy the APRN’s duties to the patient.

It is not within the scope of practice for an RN or LPN to independently engage in acts that require independent medical judgment, medical diagnosis, or the ordering, compounding, or prescribing of IV fluids, IV medications, or IV therapeutic regimens. An LPN or RN must have a medical order to administer an IV medication or IV therapy/hydration. This includes elective services marketed by aesthetic health care facilities, medical spas, wellness centers, etc. provided at the request of a patient in any setting, such as the home, mobile hydration clinic, drip bars, or other non-licensed facility locations. There are risks involved with any medical procedure, including the need for a risk/benefit analysis for elective IV administration.

Is it within the scope of practice of RNs and LPNs to add IV additives (IV admixture) to infusion bags? Would this be considered compounding?

It is crucial for nurses to understand the differences between adding medication to an existing IV line (IV admixture) and compounding IVs.

IV Admixture: Adding Medication to an IV involves introducing a medication into an existing IV fluid bag or line. This is commonly done urgently or emergently to administer drug doses at the point of care. The critical aspects of adding medications to IVs:

Immediate Use: This process is typically performed to administer a dose of medication quickly and efficiently, often in response to changing patient needs or emergency situations.
Additives: A total of two substances may be added to an IV bag (the IV bag counts as the third substance) from single-use vials for immediate use.
Standard Preparations: Unlike compounding, adding medication to an IV usually involves using commercially available, pre-prepared drugs that are added to IV bags of fluids like saline or dextrose.
Technique: The technique is critical to ensure safety and efficacy. Nurses must use aseptic techniques to avoid contamination and check for compatibility and stability of the medication with the IV fluid.

Let’s define compounding next by using the New Mexico Board of Pharmacy’s definition.

Drug compounding is often regarded as the process of combining, mixing, or

altering ingredients to create a medication tailored to the needs of an individual patient.

Compounding includes the combining of two or more drugs. Compounded drugs are not

FDA-approved (US Food and Drug Administration, 2022).

Critical points about IV compounding:

Sterile Environment: Compounding IVs must be done in a sterile environment to prevent contamination and infection. This often happens in a pharmacy or a dedicated compounding facility within a health care setting, such as a hospital.
Custom Formulations: Compounded IVs are often used when standard drug formulations are not suitable, such as when a patient needs a specific dosage, a different formulation to avoid an allergy, or a medication that is not commercially available.
Regulations and Standards: Compounding must adhere to strict guidelines and standards, such as those set by the US Pharmacopeia (USP), particularly USP Chapter 797, which outlines the standards for sterile compounding.
Reconstituted Medications: Reconstituted medications include mixing and reconstituting medications approved by the FDA following the directions by the product’s manufacturer and other manufacturer directions consistent with that labeling.

Does the APRN or LIP have to see the patient first?

Yes, the APRN or LIP has a duty to the patient which includes a valid patient/provider relationship. Please see Part 14 of the NM BON rules for more information, however:

A permanent health record must be established
The APRN must establish a patient relationship and assess the patient.
The APRN completes a history and physical
The APRN develops an individualized treatment plan
Orders need to be individualized, and based upon the patient-specific needs

with a medical rationale for the order.

Issuing standing orders for elective IV therapies, including hydration, nutrients, or medications, by an APRN does not satisfy the APRN’s duties to the patient.
The APRN discusses the treatment plan with the patient for informed consent
The APRN evaluates the outcome of the treatment.
The APRN follows state or federal requirements for the procurement of medications, IV solutions, or additives, including vitamins, minerals, or electrolytes.

What are the specific steps that I as an RN or one of my LPN colleagues have to follow?

These steps are the same as for any intervention provided by a nurse, even if it is an elective procedure the standards of practice are the same:

The nurse must have an order from a qualified APRN or LIP who has established a

patient relationship and completed an examination with the patient prior to

the order;

Must ensure that the APRN or LIP has assessed the patient and ordered an

individualized treatment/medication(s) for the patient;

Follow state or federal requirements for the procurement of medications, IV

solutions, or additives, including vitamins, minerals, or electrolytes.

Follow state or federal requirements for the preparation and administration of

medications, IV solutions, or additives, including vitamins, minerals, or

electrolytes that meet United States Pharmacopeia (USP) Pharmaceutical

Compounding-Sterile Preparations compounding standards;

Because of the nature of infusion therapy and vascular access device (VAD)

insertion and/or management, nurses engaged in any IV treatment must have

competency with this role. LPNs may need additional education;

The nurse must follow facility policy and procedures, be knowledgeable in

vascular access procedures and complications;

The nurse performing the infusion must have ongoing competency validation

appropriate to the responsibilities, treatment provided and targeted patient

population;

The nurse must maintain standard nursing documentation including, but not

limited to:

Patient assessment and medical history data;
Education provided to the patient on the prescribed infusion and/or IV

medication therapy;

iii. Patient’s informed consent for procedure(s);

Nurse’s assessments/notes and orders;
Specific procedures performed and patient’s response to procedure.
The nurse must provide continuous monitoring of the patient for adverse

reactions and have emergency protocols and equipment in place.

Reminders

A nurse may perform nursing interventions in any setting, including the provision of IV

therapies and IV medication administration as ordered by a qualified APRN or LIP.

It is not within the RN or LPN scope to prescribe, order, or procure drugs or substances for

IV medication administration or IV therapy/hydration without an authorized APRN or LIP’s order specific to the individual patient.

An LPN may assist and participate in the performance of IV therapy and IV medication

administration as ordered by an APRN or LIP under the supervision of an RN or LIP.

References

Arizona Board of Nursing (2024). Advisory Opinion on IV Hydration. https://www.azbn.gov/scope-of-practice/advisory-opinions

Becker S, Jinger L. “USP Compounding Standards: Prepare with Care.” American Nurse

Association (2019):

https://www.myamericannurse.com/usp-compounding-standards-prepare-care/

California Board of Nursing (2023). An Explanation of the Scope of RN Practice including

Standardized Procedures. Retrieved from

https://www.rn.ca.gov/pdfs/regulations/npr-b-03.pdf

Gorski L.A., Hadaway L, Hagle M.E., et al. (2021) Infusion therapy standards of practice,

8th edition. Journal of Infusion Nursing. 44(1S).

doi:10.1097/nan.0000000000000396

Institute for Safe Medication Practices. (2021). Guidelines for Safe Preparation of

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http://epubs.nsla.nv.gov/statepubs/epubs/620964-2019-9.pdf

Nevada Board of Nursing. (2021). Practice Decision: RN Scope in Out of Hospital

Administration of IV Solutions and Medications. Retrieved from

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ce-Decision.pdf

North Carolina Board of Nursing. (2022). Position Statement: Administration of

Intravenous Fluids, (IV Hydration), Nutrient Therapies, and Medications for

Hydration, Health, and Wellness . Retrieved from

https://www.ncbon.com/myfiles/downloads/position-statements-decision-tree

s/iv-hydration-clinics.pdf

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http://doh.sd.gov/boards/nursing/title-opinion.aspx#Prostaglandin

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Washington State Board of Nursing (2017) Advisory Opinion.

Appendix

From the New Mexico Medical Board with concurrence of the Board of Nursing and Board of Pharmacy:

For guidance, the NMMB endorses the following guidelines on this practice as recommended by the American IV Therapy Association, as follows:

Licensure and Certification:

o All practitioners providing elective IV therapy services must hold a valid and

current license in their respective healthcare profession, as required by your

Board/Pharmacy Board/Department of Health Services/etc.

Scope of Practice:

o Practitioners must operate within the scope of practice defined by their licensure.

o Practitioners will have the appropriate medical oversight and direction, as/if

required by your state Board or relevant regulatory authority.

Patient Assessment and Screening:

o Before administering IV therapy, practitioners must conduct an assessment of

each patient’s medical history, current health status, and any contraindications to

treatments.

o Patients should receive a medical screening examination with a licensed

prescriber regardless of regulatory requirement.

Patient Education and Informed Consent:

o Prior to initiating any and all treatment, practitioners must obtain valid informed

consent from the patient, ensuring they understand the nature of the treatment,

associated risks, benefits, and alternatives.

o Medical claims and advertising regarding treatment must meet clinical guidelines

to avoid misrepresentation and end user confusion.

Treatment Protocols and Administration:

o IV therapy treatments must be administered in subsequent to and in accordance

with provider order.

o IV therapy must be prepared and administered using aseptic techniques and

utilizing appropriate equipment.

o IV therapy treatments must be prepared and administered in accordance with

USP regulations.

Monitoring and Management of Adverse Reactions:

o Patients receiving IV therapy must be monitored closely for signs and symptoms

of adverse effects or complications.

o Practitioners should be prepared to intervene promptly and manage any adverse

events that may arise.

Documentation and Record-Keeping:

o Comprehensive medical records must be maintained for each patient.

o Records must include patient history, vital signs, physical examination, indication

for service, IV therapy administered, patient response, and any adverse reactions

or complications.

Emergency Preparedness:

o Practitioners must be trained and equipped to handle medical emergencies that

may occur during therapy, equipment for cardiopulmonary resuscitation (CPR),

and protocols for activating emergency medical services.

Quality Assurance and Safety:

o Providers must adhere to rigorous quality assurance standards, including regular

calibration and maintenance of equipment, adherence to infection control

protocols, and compliance with regulatory authorities governing the storage,

possession, handling, and administration of medications and medical devices.

o Practice must maintain policy to track, monitor and reconcile drug inventory

against documented treatments.

Continuing Education and Training:

o Practitioners should receive background training to include at minimum, topics on

supplementation, fluid homeostasis, fluid compartment physiology, intravenous

fluids and dehydration, nutrition, safety and clinical regulatory considerations,

pharmacodynamic assessments, medical eligibility and assessment, risks and

complications of IV drip therapy, management of adverse events, and clinical

skills.

o Practitioner should engage in ongoing education and training to stay current with

advances in injectable hydration and nutrition therapy, best practices, and

regulatory requirements.