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CHAPTER 6
GUAM BOARD OF NURSE EXAMINERS
SOURCE: Rules establishing the board were filed with the
Legislative Secretary on December 31, 1986. Amended by P.L.
24-020:1 (May 12, 1997) (regarding certification of nurse
assistants) and P.L. 24-206 (May 13, 1998) (regarding Advance
Practice of Registered Nurse). Entire chapter repealed and new
rules adopted by P.L. 29-071:1 (May 7, 2008). Article 5 repealed
and reenacted by P.L. 34-078:3 (Feb. 09, 2018).
2019 NOTE: The original version of the rules filed in 1986 are
available in the 1997 print publication of the GAR. As originally
submitted, the rules consisted of the following six articles:
Article 1. Standards of Professional Conduct
Article 2. Standards of Nursing Practice
Article 3. Advance Practitioner Nursing
Article 4. Regulations on Nursing Education
Article 5. Disciplinary Action
Article 6. Fees
Past print publications included the following annotation:
NOTE: Rule-making authority cited for Guam Board of
Nurse Examiners, 10 GCA Chapter 12 Article 3. New rules
were filed with the Legislative Secretary on December 31,
1986.
Title 10 Guam Code Annotated Chapter 12 Article 3 includes
laws concerning qualifications of applicant for a license to
practice professional nursing and for a license to practice as a
licensed practical nurse, renewal of license and revocation of
licenses.
The original publication was made on February 15, 1975.
Article 1. Title and Purpose.
Article 2. Guam Board of Nurse Examiners.
Article 3. Professional Conduct, Scope of Practice,
Pronouncement of Death and Definitions.
Article 4. Licensure.
Article 5. Advanced Practice Registered Nurse (APRN).
Article 6. Nursing Education.
Article 7. Certification of Nurse Assistants (NAs).
Article 8. Legal Responsibilities and Dereliction of Duties.
Article 9. Discipline and Proceedings.
Article 10. Emergency Relief.
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Article 11. Reporting Requirements.
Article 12. Exemptions.
Article 13. Fees/Record of Payment.
ARTICLE 1
TITLE AND PURPOSE
SOURCE: Rules establishing the board were filed with the Legislative
Secretary on December 31, 1986. Entire chapter repealed and adopted by
P.L. 29-071:1 (May 7, 2008).
§ 6101. Title.
§ 6102. Description of Act.
§ 6103. Purpose.
§ 6101. Title.
The Nurse Practice Act shall be known and may be cited as
the “Act” of the Guam Board of Nurse Examiners (GBNE) in
accordance with Article 3 of Title 10 Guam Code Annotated
(1983; 1997, 1998 and 2003 Updates). The Guam Board of
Nurse Examiners (GBNE) may also be referred to as the
“Board”.
§ 6102. Description of the Act.
The Act establishes the regulation of the practice of nursing.
The Act also creates, authorizes and empowers the GBNE to
regulate the practice of nursing and to enforce the provisions of
the Act. P.L. 24-20 further authorizes the Board to regulate the
practice of nurse assistants and P.L. 24-206 authorizes the Board
to regulate the practice of advanced practice registered nurses.
§ 6103. Purpose.
The Legislature finds that the practice of nursing is directly
related to the public welfare of the citizens of Guam and is
subject to regulations and control in the public interest to assure
that practitioners are qualified and competent. It is further
declared that the practice of nursing, as defined in the Act, merits
and deserves the confidence of the public and that only qualified
persons be permitted to engage in the practice of nursing. The
legislature recognizes that the practice of nursing is continually
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evolving and responding to changes within health care patterns
and systems.
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ARTICLE 2
GUAM BOARD OF NURSE EXAMINERS
SOURCE: Rules establishing the board were filed with the Legislative
Secretary on December 31, 1986. Entire chapter repealed and adopted by
P.L. 29-071:1 (May 7, 2008).
NOTE: Rule making authority were established pursuant to P.L. 16-
123:21 (Dec. 29, 1982).
§ 6201. Establishment.
§ 6202. Board Composition.
§ 6203. Qualification of Members.
§ 6204. Powers and Duties of the Board.
§ 6205. Removal of a Board Member.
§ 6206. Compensation.
§ 6207. Executive Officer.
§ 6201. Establishment.
There is within the Department of Public Health & Social
Services of the Government of Guam the Guam Board of Nurse
Examiners.
§ 6202. Board Composition.
(a) The Board shall be composed of seven (7) members
appointed by the Governor. The term of office shall be three (3)
years. No member shall serve more than two (2) consecutive
terms. All members shall serve, in addition to their regular term,
until their successors are appointed.
(b) The term of office of each member shall commence on
July 1 following the appointment and the terms of the members
shall be rotated so that no more than three (3) members’ term
shall expire each year. The present members of the Board shall
serve as members of this Board until their successors are
qualified, appointed and sworn.
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(c) Any vacancy in the membership of the Board shall be
filled for the period of the un-expired term in the same manner as
was the original appointment.
§ 6203. Qualifications of Members.
(a) The Board members shall include five (5) Registered
Nurses (RNs), one (1) Licensed Practical Nurse (LPN) and one
(1) public member. Of the six (6) licensed nurses (5 RNs and 1
LPN), there will always be at least one representation from:
(1) a nursing education program
(2) community health nursing
(3) hospital nursing
(4) advanced practice registered nursing (APRN)
(b) The Board shall solicit nominees of qualified candidates
from nursing agencies and nursing organizations and submit
such listing to the Governor for his selection, appointment and
swearing in.
(c) Each member shall be a citizen or permanent resident of
the United States and be a resident of the Territory of Guam for
at least two (2) years immediately preceding appointment.
(d) Each licensed nurse member shall be a current holder of
a valid Guam license to practice as a Registered Nurse (RN),
Licensed Practical Nurse (LPN) and/or Advanced Practice
Registered Nurse (APRN) and have been actively engaged in the
practice of nursing for five (5) years immediately preceding
appointment. Four members shall have a minimum of a
baccalaureate degree in nursing.
(e) Each RN member shall be a member of the island’s
professional nursing organization.
(f) The public member shall be a person who is not licensed
as a health care provider; is not a parent, spouse, sibling, or child
of any living person licensed as a health care provider, and is not
a student in a health educational program; does not have a direct
or indirect financial interest in health care services; is not a
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member of any public or private health care organization board
of control; and has at least a high school diploma or equivalency.
(g) Membership shall represent both genders.
§ 6204. Powers and Duties of the Board.
(a) The Board shall:
(1) Meet annually in the month of January and elect a
Chairperson, a Vice Chairperson, and a Secretary. The
Board may hold other meetings as necessary to conduct its
business. Four (4) members, including one officer, shall
constitute a quorum.
(2) Interpret and enforce the provisions of the Act. The
Board shall have all of the duties, powers, and authority
specifically granted by and necessary to the enforcement of
the Act, as well as other duties, powers and authority as it
may be granted by appropriate status.
(3) Make, adopt, amend, repeal, and enforce such
administrative rules and regulations in compliance with the
Administrative Adjudication Law (Chapter 9, Title 5 of the
Guam Code Annotated) and with the approval of the
Commission on Licensure as it deems necessary for the
proper administration and enforcement of the Act and to
protect the public health, safety and welfare.
(4) Conduct the following in accordance with
subsection (a)(3) above:
(A) Develop standards for and periodically
evaluate basic nursing and nurse assistant educational
programs to ensure adherence to established standards.
(B) Enforce educational standards and rules set
forth in these administrative rules and regulations.
(C) Require criminal background checks on all
applicants.
(D) License qualified applicants for registered
nurses, licensed practical nurses and certified nurse
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assistants by examination, endorsement, renewal and
reinstatement.
(E) Regulate the practice of Advanced Practice
Registered Nurses (APRNs).
(F) Maintain a record of all persons regulated by
the Board.
(G) Develop and enforce standards for nursing
practice.
(H) Develop rules to govern delegation by and to
nurses.
(I) Develop standards for maintaining competence
of licensees continuing or returning to practice,
including the use of continuing education units.
(J) Require agencies employing nurses, nurse
assistants and APRNs to appoint a Chief
Administrative Nurse.
(K) Collect and analyze data regarding nursing
education, nursing practice, and nursing resources.
(L) Issue subpoenas in connection with
investigations, inspections and hearings.
(M) Have reasonable access to records to assist
the Board in its investigations. The Board shall
maintain any records obtained pursuant to this
paragraph.
(N) Order licensees to submit to physical, mental
health or chemical dependency evaluations for cause.
(O) Cause prosecution of allegations of violation
of the Act.
(P) Conduct hearings, compel attendance of
witnesses and administer oaths to persons giving
testimony at hearings.
(Q) Close discipline sessions and hearings to the
public.
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(R) Discipline licensees as needed.
(S) Maintain membership in national
organizations that develop and regulate national
licensure examinations and exclusively promote the
improvement of the legal standards of the practice of
nursing for the protection of the public health, safety
and welfare.
(T) Facilitate the National Council of Licensure
Examination (NCLEX) according to the rules of the
National Council of State Boards of Nursing or its
designated testing services and the Board.
(U) Establish alternative programs for monitoring
nurses who voluntarily seek treatment for chemical
dependency, mental health, or physical health
conditions that can lead to disciplinary actions by the
Board.
(V) Regulate the manner in which nurses
announce their practice to the public.
(W) Issue a modified license to practice nursing to
an individual to practice within a limited scope of
practice or with accommodations or both, as specified
by the Board.
(X) Inform licensees about changes in the law and
rules and regulations regarding the practice of nursing.
(Y) Maintain records of proceedings as required
by the laws of Guam.
(Z) Provide consultation, conduct conferences,
forums, studies and research on nursing education and
practice.
(AA) Ensure that a qualified registered nurse is
employed to serve as the Executive Officer and
approve such additional staff positions as may be
necessary, in the opinion of the Board, to administer
and enforce the provision of the Act.
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(BB) Delegate to the Executive Officer those
activities that expedite the functions of the Board.
(CC) Employ or have access to professional and
support staff, investigators, legal counsel, and other
personnel necessary for the Board to carry out its
functions.
(DD) Determine and collect reasonable fees.
(EE) Receive and expend funds, in addition to
appropriations from the Government of Guam,
provided such funds are received and expended for the
pursuit of the authorized objectives of the Board; such
funds are maintained in a separate account; and
periodic reports of the receipt and expenditures of
funds are submitted to the Governor.
(FF) Adopt a seal that shall be in the care of the
Executive Officer and shall be affixed only in such a
manner as prescribed by the Board.
(GG) Submit an Annual Report to the Governor
and the Legislature in January of each year on the
activities of the Board over the past fiscal year.
(HH) Appoint advisory committees to assist the
Board in the implementation of the Act. Members of
the advisory committees shall not be compensated.
(II) Have immunity from individual civil liability
for damages for any act done or omitted in good faith
in performing the functions of the Board (P.L . 18-
48:9; P.L. 20-26:1; and, P.L. 20-177:30).
(5) Comply with the requirements of the Open
Government Law (P.L. 13-35, as amended) but when the
Board is preparing examinations, grading examinations
discussing the eligibility of a person to be licensed or
reviewing evidence obtained at a hearing or disciplinary
action, the Board shall meet in executive session and may
exclude the press and members of the public.
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(6) These rules shall not be construed to require the
Board of Nursing to report violations of the provisions of
the Act whenever, in the opinion of the Board, the public
interest will be served adequately by a suitably written
notice of warning.
§ 6205. Removal of a Board Member.
The Governor may remove any member from the Board for
cause including, but not limited to, neglect of any duty required
by law, incompetence, unprofessional or dishonorable conduct.
A member subject to disciplinary proceedings shall disqualify
himself/herself from Board business until such charge(s) are
adjudicated.
§ 6206. Compensation.
Each member of the Board shall be compensated in the
same manner as are other members of board and commissions of
the Government of Guam.
§ 6207. Executive Officer.
(a) The Board shall ensure the employment of the Executive
Officer with the following qualifications:
(1) Master’s degree or higher from an accredited
college or university with at least three (3) yearsexperience
in nursing practice, including administration, teaching, or
supervision in nursing educational programs, supervision in
health agencies or nursing regulations; or
(2) Bachelor’s degree in nursing and at least five (5)
years experience in nursing practice, including
administration, teaching or supervision in nursing
educational programs, supervision in health agencies or
nursing regulations.
(b) The Executive Officer shall be responsible for:
(1) Performing the administrative responsibilities of
the Board.
(2) Employment of personnel needed to carry out the
functions of the Board.
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(3) Maintaining and securing the Seal of the Board.
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ARTICLE 3
PROFESSIONAL CONDUCT, SCOPE OF PRACTICE,
PRONOUNCEMENT OF DEATH AND DEFINITIONS
SOURCE: Rules establishing the board were filed with the Legislative
Secretary on December 31, 1986. Entire chapter repealed and adopted by
P.L. 29-071:1 (May 7, 2008).
§ 6301. Professional Conduct.
§ 6302. Scope of Practice.
§ 6303. Pronouncement of Death.
§ 6304. Definitions.
§ 6301. Professional Conduct.
(a) The Registered Nurse (RN), including all
Advanced Practice Registered Nurses (APRNs) shall:
(1) Practice in accordance with the Act and the
GBNE Administrative Rules and Regulations;
(2) Uphold federal and state regulations regarding
controlled substances and alcohol;
(3) Practice nursing only when in functional,
physical and mental health;
(4) Be accountable for own nursing actions and
competencies;
(5) Practice or offer to practice only within the
scope permitted by law and within registrant’s own
educational preparation and competencies;
(6) Seek instruction and supervision from
qualified individuals when implementing new or
unfamiliar nursing activities;
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(7) Delegate professional responsibilities only to
individuals whom the registrant knows or believes to
be qualified by education, experience or licensure to
perform and supervise those persons to whom nursing
activities have been delegated;
(8) Be accountable for the quality of nursing care
delegated to others;
(9) Report unsafe, unethical, illegal health care or
conditions to appropriate authorities;
(10) Maintain a functional level of practice
consistent with education and experience background
and in accordance with professional responsibilities;
(11) Assume responsibility for continued
professional and personal growth and education to
reflect knowledge and understanding of current
nursing care practice.
(b) The Licensed Practical Nurse (LPN) shall:
(1) Practice in accordance with the Act and the
GBNE Administrative Rules and Regulations;
(2) Uphold federal and state regulations regarding
controlled substances and alcohol;
(3) Practice nursing only when in functional,
physical and mental health;
(4) Be accountable for own nursing actions and
competencies;
(5) Perform only those nursing activities within
the scope permitted by law and for which
educationally prepared;
(6) Perform nursing actions only under direction
except as stated in the Act in the event of an
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emergency in which an individual’s life or health are in
imminent danger;
(7) Seek instruction and supervision from
qualified individuals when implementing new or
unfamiliar nursing activities;
(8) Report unsafe, unethical, illegal health care or
conditions to appropriate authorities;
(9) Assume responsibility for continued growth
and education to reflect knowledge and understanding
of current nursing care practice.
§ 6302. Scope of Practice.
(a) Registered Nurse (RN).
(1) The scope of practice for a Registered Nurse
means that full scope of professional nursing, with or
without compensation or personal profit that
incorporates caring for all clients in all settings and, it
includes, but is not limited to:
(A) Providing comprehensive assessment of
the health status of clients, families, groups and
communities;
(B) Developing a comprehensive nursing plan
that establishes nursing diagnoses, goals to meet
the identified health care needs and nursing
interventions to resolve the identified nursing
diagnoses;
(C) Implementing nursing care through the
execution of independent nursing strategies and
prescribed medical regimen;
(D) Managing nursing care through cohesive,
coordinated care management within and across
care settings;
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(E) Delegating and assigning nursing
interventions to implement the plan of care;
(F) Providing for the maintenance of safe and
effective nursing care rendered directly or
indirectly;
(G) Promoting a safe and therapeutic
environment;
(H) Providing health teaching and counseling
to promote, attain and maintain the optimum
health care of clients, families, groups and
communities;
(I) Advocating for clients, families, groups
and communities by attaining and maintaining
what is in the best interest of the clients, families,
groups and or communities;
(J) Evaluating responses to interventions and
the effectiveness of the plan of care;
(K) Communicating and collaborating with
other health care professionals in the management
of health care and the implementation of the total
health care regimen;
(L) Acquiring and applying critical new
knowledge and technologies to practice domain;
(M) Managing, supervising and evaluating the
practice of nursing;
(N) Teaching the theory and practice of
nursing;
(O) Participating in development of policies,
procedures and systems to support the client;
(P) Other acts that require education and
training as prescribed by the Board;
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(Q) Additional nursing services shall
commensurate with the Registered Nurse’
experience, continuing education and
demonstrated competencies.
(2) Each Registered Nurse is accountable to
clients, the nursing profession and the Board for
complying with the requirements of the Act and the
quality of nursing care rendered; and, for recognizing
limits of knowledge and experience and planning for
management of situations beyond the RN’s expertise.
(b) Licensed Practical Nurse (LPN).
(1) The scope of practice for the Licensed
Practical Nurse (LPN) means a directed scope of
nursing practice, with or without compensation or
personal profit, under the supervision of the Registered
Nurse, Advanced Practice Registered Nurse (APRN),
licensed physician or licensed dentist who are
authorized by statute to delegate health care activities
and functions; and, includes but is not limited to:
(A) Collecting data and conducting focused
assessments of the health status of clients;
(B) Planning nursing care during care episode
for clients with stable conditions;
(C) Participating in the development and
modification of the comprehensive plan of care for
all types of clients;
(D) Implementing the appropriate aspects of
the strategy of care within the LPN scope of
practice;
(E) Participating in nursing care management
through delegating, assigning and directing
nursing interventions that may be performed by
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others, including other licensed practical nurses
that do not conflict with the Act;
(F) Maintaining safe and effective nursing
care rendered directly or indirectly;
(G) Promoting a safe and therapeutic
environment;
(H) Participating in health teaching and
counseling to promote, attain and maintain the
optimum health level of client;
(I) Serving as an advocate for the client by
communicating and collaborating with other
health service personnel;
(J) Participating in the evaluation of client
responses to interventions;
(K) Communicating and collaborating with
other health care professionals in the nursing
practice management;
(L) Providing input into the development of
policies and procedures;
(M) Other acts that require education and
training as prescribed by the Board;
(N) Additional nursing services shall
commensurate with the licensed practical nurse’
experience, continuing education and
demonstrated competencies.
(2) Each nurse is accountable to clients, the
nursing profession and the Board for complying with
the requirements of the Act and the quality of nursing
care rendered; and, for recognizing limits of
knowledge, experience and planning for management
of situations beyond the LPN’s experience.
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(c) Advanced Practice Registered Nurse (APRN).
(1) The scope of practice for the Advanced
Practice Registered Nurse (APRN) by Certified
Registered Nurse Practitioners (CRNPs), Certified
Registered Nurse Anesthetists (CRNAs), Certified
Nurse Midwives (CNMs) and Clinical Nurse
Specialists (CNSs) is based on knowledge and skills
acquired in basic nursing education, licensure as a
Registered Nurse, graduation from or completion of a
graduate level APRN program accredited by a national
accrediting body and, current certification by a
national certifying body in the appropriate APRN
specialty. Practice as an APRN means an expanded
scope of nursing practice, with or without
compensation or personal profit, and includes but is
not limited to:
(A) Assessing clients, synthesizing and
analyzing data; and understanding and applying
nursing principles at an advanced level of nursing
practice;
(B) Analyzing multiple sources of data,
identifying alternative possibilities as to the nature
of a health care problem and selecting appropriate
treatment;
(C) Making independent decisions in solving
complex client care problems;
(D) Developing a plan that establishes
diagnoses, goals to meet the identified health care
needs and prescribing a regimen of health care
treatment;
(E) Performing acts of diagnosing,
prescribing, administering and dispensing
therapeutic measures, including legend drugs and
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controlled substances within the APRN’s focus of
practice;
(F) Managing clients’ physical and
psychosocial health-illness status;
(G) Providing for the maintenance of a safe
and effective nursing care rendered directly or
indirectly;
(H) Promoting a safe and therapeutic
environment;
(I) Providing expert guidance and teaching;
(J) Participating in client and health systems
management;
(K) Advocating for clients, groups and
communities by attaining and maintaining what is
in the best interest of the client or group;
(L) Evaluating responses to interventions and
the effectiveness of the plan of care and the health
regimen;
(M) Communicating and working effectively
with clients, families and other members of the
health care team;
(N) Utilizing research skills, acquiring and
applying critical new knowledge and technologies
to practice domain;
(O) Teaching the theory and practice of
advance practice nursing;
(2) Each APRN is accountable to clients, the
nursing profession and the Board for complying with
the requirements of the Act and the quality of nursing
care rendered; for recognizing limits of knowledge and
experience; planning for management of situations
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beyond the APRN’s expertise; and, for consulting with
or referring clients to other health care providers as
appropriate.
(d) Certified Nurse Assistant (CNA).
(1) The scope of practice for the Certified Nurse
Assistant (CNA) requires the individual to complete a
prescribed Nurse Assistant (NA) program approved by
the Board and shall pass the National Council of State
Boards of Nursing (NCSBN) certification examination
for Nurse Assistants and be issued a certification to
practice on Guam. The scope of practice, with or
without compensation or personal profit, shall be
limited to the supervision of a Registered Nurse,
Licensed Practical Nurse or Advanced Practice
Registered Nurse. The delegated activities include but
are not limited to:
(A) Conducting assigned assessments of the
health status of clients, i.e. taking, recording and,
as indicated, reporting client’s blood pressure
readings, pulse rates, respiration rates, body
temperature readings and fluid intake and output
measurements;
(B) Providing personal and oral hygiene care,
basic and routine treatment procedures and range
of motion exercises as directed;
(C) Promoting a safe, clean and therapeutic
environment conducive to patient’s safety,
comfort and privacy when providing care;
(D) Reporting events that pose an actual or
potential safety risk to patients, staff and others;
(E) Documenting clearly, concisely and
accurately nursing assistant procedures done and
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observations made using proper notation and
abbreviation requirements;
(F) Serving as an advocate for the client by
communicating expressed or observed needs to the
Registered Nurse;
(G) Participating in the development and
modification of the client’s plan of care;
(H) Completing ongoing certification and
regular assessment of skills and training needs;
(I) Performing other Nursing Assistant acts
that require education and training as prescribed
by the Board.
(2) Each Certified Nurse Assistant (CNA) is
accountable to the clients, the nursing profession and
the Board for complying with the requirements of the
Act and the quality of care rendered; and, for
recognizing limits of knowledge and experience
beyond the expertise of the CNA.
§ 6303. Pronouncement of Death (P.L. 27-15:2).
A Registered Nurse may pronounce death in
compliance with the following:
(a) The health care facility, agency or licensed
home health care provider has adopted written policies
and procedures that provide for the determination and
pronouncement of death by an RN;
(b) Person/Patient/Client is certified “anticipated
death” by the attending physician;
(c) Person/Patient/Client is in a health care
facility, a private home served by a licensed home
health care provider, or in a government/private health
care agency;
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(d) After diagnosing the absence of human
responses, the RN shall:
(1) Document the clinical criteria for the
determination and pronouncement in the
person’s/patient’s medical or clinical record;
(2) Notify the certifying physician;
(3) Complete the Death Certificate by
entering the name of the deceased, presence of
contagious disease if known, date and time of
death and signature;
(4) Contact the funeral home identified by
the family who shall be responsible for
transporting the corpse to the funeral home;
(5) Notify the Guam Police Department and
the Chief Medical Examiner immediately if there
is any suspicious nature that may be different from
the anticipated death.
§ 6304. Definitions.
(a) Abuse – physical injury caused by other than
accidental means; neglect which leads to physical harm;
failure to provide direct care for resident or client; verbal
abuse; theft or misuse of resident funds or property;
wrongful touching; or any other deprivation of patient or
resident’s rights, which may be the result of intentional or
negligent behavior.
(b) Absolute discharge from sentence – completion of
any court imposed sentence including imprisonment,
probation, parole, community supervision or any form of
court supervision.
(c) Accredited Program for Advanced Practice Nurse
Practitioner – an educational program accredited by the
American Association of Nurse Anesthetists, American
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College of Nurse Midwives, American Nurses Association,
National League for Nursing or State Board of Nursing.
(d) Accredited School of Professional Nursing – a
school conducted for the purpose of giving professional
nursing education that complies with the standards
prescribed by these Rules and Regulations; included are
schools of nursing of states, countries, islands or territories
which are accredited by the boards of nurse examiners of
such states and have standards equivalent to those of Guam.
(e) Accountability – a state of being responsible and
answerable or legally liable for action, including
supervision.
(f) Action Taken – collective decision made by a
majority of the members of a public agency; a collective
commitment or promise by a majority of the members of a
public agency to make a positive or a negative decision; or,
an actual vote by a majority of the members of a public
agency when sitting as a body or entity, upon a motion,
proposal, resolution or order (GCA Section 3228-A).
(g) Adjunct Faculty – temporary nursing faculty, in
addition to regular program faculty, used to enrich student
experiences.
(h) Advanced Assessment – assessment by an APRN
based on additional knowledge and skill developed, a
graduate level nursing education program in APRN
category, and the APRN’s experience working in the
APRN role.
(i) Advanced Nursing Education – an additional
approved program of study in nursing which results in a
certificate or degree beyond the basic nursing education.
(j) Alford Plea – plea agreements where the defendant
may plead guilty yet not admit all the facts that comprise
the crime.
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(k) Approval – the process by which the Board
evaluates and grants official recognition to a nursing
education or nurse assistant program which meets
established uniform and reasonable standards. There are
four (4) categories of approval:
(1) Initial Approval – an authorization granted by
the Board for new nursing programs to admit students
and to enter into contractual agreements with clinical
facilities. No student shall be admitted until the
institution has received the written notification of
Initial Approval from the Board subsequent to the
application review and site visit.
(2) Full Approval – status granted by the Board to
programs that meet the requirements of the law and the
Administrative Rules and Regulations of the Board.
(3) Continuation of Full Approval – status granted
annually by the Board to programs that meet the
standards set forth herein. A Certificate of Continuing
Full Approval is contingent upon an annual review of
the program by the Board.
(4) Conditional/Probational Approval – status
designated to a program which is determined to be
deficient in a specified area. The Board shall notify
the program of the specific deficient area(s) and the
time limitation to correct the stated deficiencies.
(l) Anticipated Death – a death caused by a life-
limiting illness, infirmity or disease as certified by the
attending physician and that the prognosis was discussed
with the patient and the patient’s family; and, that the
patient consented to a “No Resuscitation” order or has
executed an Advanced Directive indicating the same.
(m) Assignment – designating nursing activities to be
performed by another nurse, nurse assistant or assistive
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personnel that are consistent with his/her scope of practice
and role description.
(n) Authorized Person – professional nurse, physician
or dentist currently licensed on Guam.
(o) Board – Guam Board of Nurse Examiners.
(p) Board of Nursing – other nursing boards.
(q) Certification by Endorsement – the process by
which a nurse assistant, currently certified by any of the
United States or its Territories, can practice as a nurse
assistant on Guam, upon meeting the requirements set forth
by the Board.
(r) Chief Administrative Nurse – the registered nurse
who shall be employed to oversee the provision of nursing
care and services by registered nurses, licensed practical
nurses and certified nurse assistants in an organization,
regardless of title.
(s) Client – any recipient of nursing care be it an
individual, family, group or community.
(t) Client-Centered Health Care Plan – identification of
desired goals, strategies for meeting goals and processes for
promoting, attaining and maintaining optimal client health
outcomes. The multidisciplinary health care team partners
with the client to develop the plan of care. Team members
identify, respect and care about client differences, values,
preferences and expressed needs.
(u) Clinical Facilities – those institutions which are
established in a community for the delivery of health care
services, such as hospitals, extended care facilities, nursing
homes, etcetera.
(v) Clinical Judgment – the application of the nurse’
knowledge and experience in making decisions about the
care of the client.
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(w) Content Validity – the degree to which an
examination is representative of a defined body of
knowledge.
(x) Commission on Graduates of Foreign Nursing
Schools (CGFNS) Qualifying Examination – an
examination administered by the CGFNS that must be
taken and passed by all graduates of schools of nursing in
foreign countries prior to applying for a nursing licensure
by examination with Guam as the original RN licensure.
(y) Community Health Nursing – a specialty of nursing
practice that focuses on the health needs of communities
and aggregates and in particularly vulnerable populations; a
synthesis of nursing practice and public health practice
applied to promoting and preserving the health of
populations and communities.
(z) Compact – an agreement between two or more
states established for the purpose of remedying a particular
problem of interstate concern.
(aa) Competence – the application of knowledge and
the interpersonal, decision-making and psychomotor skills
expected for the practice role within the context of nursing,
health care, public safety and welfare.
(bb) Competence Assessment – evaluation of the
practitioner’s knowledge, skills and abilities. Assessment
mechanisms may include examination, peer review,
professional portfolio and professional certification.
(cc) Competence Conduct – the health and behavior
expectations that may be evaluated through reports from
the individual practitioner, employer reports and discipline
checks. Part of competence conduct is assurance that
licensees possess the functional abilities to perform the
essential functions of the nursing role.
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(dd) Competence Development – the method by which
a practitioner gains, maintains or refines practice
knowledge, skills and abilities. This development can
occur through a formal education program, continuing
education or clinical practice and, is expected to continue
throughout the practitioner’s career.
(ee) Competency – the ability to perform skillfully and
proficiently the role of the license/certificate holder. The
role encompasses essential knowledge, judgment, attitudes,
values, skills and abilities which are varied in range and
complexity. Competency is a dynamic concept, changing
as the licensee achieves a higher stage of development
within the role. It is based on educational training,
preparation, expertise and standards of practice.
(ff) Comprehensive Assessment by an RN – an
extensive data collection, initially and ongoing, for clients,
families, groups and communities addressing anticipated
changes in client conditions as well as emergent changes in
a client’s health status; recognizing alterations to previous
client conditions; synthesizing the biological, psychological
and social aspects of the client’s condition; evaluating the
impact of nursing care; and, using this broad and complete
analysis to make independent decisions and nursing
diagnoses; plan nursing interventions; evaluate need for
different interventions; and, the need to communicate and
consult with other health care members.
(gg) Cooperating Agency – an independent health care
facility used by a program to provide its students with
practical clinical experience and training.
(hh) Cooperation – a joint effort of cooperating,
assisting and working together for a common benefit.
(ii) Course – a series of sessions devoted to one
specific area of a subject. It may include a number of
related topics.
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(jj) Cultural Bias – non-nursing elements of
examination items that may influence the performance of
culturally distinct groups of examinees.
(kk) Curriculum – the systematic arrangement of
learning experiences that include courses, clinical
experience and other activities needed to meet the
requirements of the basic nursing or the nurse assistant
program and of the degree or certificate conferred by the
program provider/parent institution.
(ll) Date of Application – the actual date on which the
completed application form/packet was received by GBNE.
(mm) Delegation – entrusting the performance of
selected nursing duties to qualified and competent as well
as legally able individuals to perform selected nursing tasks
in a selected situation while retaining the accountability and
responsibility for the completion of such tasks.
(nn) Denial – the Board’s decision to refuse issuance
of a current license for cause upon application.
(oo) Direction – monitoring and guiding the practice of
another through written or verbal communication.
(pp) Direct Supervision – being in close physical
proximity within the facility to provide direct observation,
direction, procedural guidance and evaluation of nursing
care rendered.
(qq) Director – a registered professional nurse who
shall be employed by the controlling authority to administer
the (1) nursing educational program or the nurse assistant
educational program of a learning institution; or, (2)
nursing services of a health facility or school health.
(rr) Distance Education – teaching/learning strategies
used to meet the learning needs of students when students
and faculty are separate from each other.
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(ss) Emergency – a sudden state of danger, conflict or
crisis requiring immediate intervention.
(tt) Episodic Care – nursing care that occurs at non-
specific intervals, focused on the individual and situation at
hand.
(uu) Faculty-Directed Clinical Practice – the role of
nursing program faculty in overseeing student clinical
learning including those programs utilizing preceptors.
(vv) Federal Requirement – requirements imposed by
the Omnibus Budget Reconciliation Act (OBRA) of 1987
and the regulations adopted pursuant thereto.
(ww) Focused Assessment by the LPN – an appraisal
of the client’s status and situation at hand, contributing to
ongoing data collection and comprehensive assessment by
the registered nurse, deciding who needs to be informed of
the information and when to inform.
(xx) Governing Institution – refers to an institution of
higher learning which administers a nursing education
program.
(yy) Graduate Nurse – refers to an individual who has
successfully completed a basic nursing educational
program but has not been licensed through the national
(NCLEX-RN) examination.
(zz) Graduate Practical Nurse – refers to an individual
who has successfully completed a practical nurse
educational program but has not been licensed through the
national (NCLEX-PN) examination.
(aaa) Graduate Nurse Assistant – refers to an
individual who has successfully completed a nurse assistant
educational program but has not been certified through the
national (NNAAP) certification examination.
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(bbb) Grandfathering – the provision in the local law
exempting those individuals who are already in or a part of
the existing system that is being regulated. It is an
exception to a restriction that allows all those who are
already practicing to continue practicing even if they would
be denied licensure or certification by the newly established
restriction.
(ccc) Health Care Provider – an individual authorized
by licensure or certification to prescribe and or administer
various aspects of health care services.
(ddd) Health Care Facility – a private, municipal, state,
federal or military hospital, mental health and substance
abuse hospital, public health, skilled nursing facility,
kidney disease, cancer treatment center (excluding
freestanding units), intermediate care facility, long-term
care facility, nursing home, hospice facility or home health
agency.
(eee) Inactive – status of the licensed nurse who
voluntarily chooses not to engage in nursing during the
succeeding year and chooses not to renew his/her license at
the time of renewal shall not be required to pay the renewal
fee as long as he/she remains inactive. Should the nurse
wish to resume his/her nursing practice at some future time,
he/she shall notify the Board and become reinstated by
meeting such requirements as the Board may prescribe.
(fff) Independent Nursing Strategy – nursing activities
based on nursing assessment within the nurse’ scope of
practice and standards and not subject to control by others.
(ggg) Informatics – information technology that can be
used to communicate, manage knowledge and data,
mitigate error and support decision making processes and
options.
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(hhh) Interdisciplinary Faculty – faculty from other
professions who, in addition to regular program faculty,
add diversity and enrich student learning experiences.
(iii) Interdisciplinary Team – all individuals involved
in providing a client’s care, who cooperate, collaborate,
communicate and integrate care to ensure that care is
continuous and reliable.
(jjj) Internationally Educated Nurse – a nurse educated
outside of the U.S. who applies for state licensure or seeks
temporary authorization to practice as a graduate nursing
student to complete program objectives.
(kkk) Interpretive Statement – a statement developed
by a board of nursing to provide guidance, clarification and
direction regarding nursing practice, procedures or policies
to ensure compliance with acceptable standards of nursing
practice as defined in the Act and the GBNE
Administrative Rules and Regulations.
(lll) Lapsed Certificate – the termination of an
individual’s certificate to practice due to the certificate
holder’s failure to renew one’s certificate within the
specified time and is therefore unauthorized to practice.
(mmm) Lapsed License – the termination of an
individual’s nursing license to practice due to the license
holder’s failure to renew his/her license within a specified
period of time and is therefore unauthorized to practice.
(nnn) License – a current document
permitting/authorizing an individual to practice as a
registered nurse, licensed practical nurse or as an advanced
practice registered nurse.
(ooo) Licensure by Endorsement – the granting of
authority to practice nursing based on an individual’s
licensure in another jurisdiction with comparable
requirements.
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(ppp) Licensure by Examination – the granting of
authority to practice nursing based on successfully passing
the national licensure (NCLEX) RN or LPN examination.
(qqq) Licensure Reinstatement – the granting of
authority to restore or reestablish a nursing licensure that
has lapsed, suspended, revoked or voluntarily surrendered.
(rrr) Licensure Renewal – the process in which legal
authority to practice is renewed periodically.
(sss) Limited License – the granting of authority to
practice nursing within a specified legal scope of practice
or in a restricted capacity.
(ttt) Medicaid – the federal government program of
medical care designed for those who are unable to afford
the cost of regular medical services which is financed by
the state and federal governments.
(uuu) Medicare – the federal government program of
medical care specifically designed for the elderly.
(vvv) Modified License – a license to practice nursing
within a scope of practice, with or without limitations,
accommodations or both as specified by the Board through
a non-disciplinary process.
(www) Moral Turpitude – conduct that involves one or
more of the following:
(1) Intentional, knowing or reckless conduct that
causes injury or places another in fear of imminent
harm;
(2) Conduct done knowingly contrary to justice or
honesty;
(3) Conduct that is contrary to the accepted and
customary rule of right and duty that a person owes to
fellow human beings and society in general; and,
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(4) Conduct that is wrong in itself even if no
statute were to prohibit the conduct.
(xxx) National Certifying Body – an organization that
has as one of its purposes the issuance of certification of
registered nurses, nurse anesthetists, nurse midwives, nurse
practitioners, or clinical nurse specialists referred to in
these regulations as professional certification, and whose
certification of such persons by examination is accepted by
the Board.
(yyy) NCLEX-PN – the National Council Licensure
Examinations for Practical Nurses is used in the U.S. and
its territories to assess licensure applicant’s knowledge,
skills and abilities.
(zzz) NCLEX-RN – the National Council Licensure
Examinations for Registered Nurses is used in the U.S. and
its territories to assess licensure applicant’s knowledge,
skills and abilities.
(aaaa) Nolo Contendere – a “no contest” plea in a
criminal case that result in a similar effect as pleading
guilty.
(bbbb) Nurse Assistant Educational Program – a
program designed to prepare nurse assistants which is
offered by a school, college, nursing facility or other
institutions that have been granted Initial Approval, Full
Approval or Continuation of Full Approval by the Board to
provide such a program.
(cccc) Nurse Licensure Compact (NLC) – compact
between participating states to facilitate the regulation of
nurses. The compact is adopted by each state legislature,
and allows a nurse licensed in a compact state to practice
under a multi-state privilege in all other compact states.
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(dddd) Nurse Licensure Compact Administrators
(NLCA) – nurse administrators of each compact state
responsible for implementing and coordinating the NLC.
(eeee) Nursing – both an art and a scientific process
founded on a professional body of knowledge. It is a
learned profession based on an understanding of the human
condition across the lifespan and the relationship of a client
with others and within the environment. It is a dynamic
discipline that is continually evolving to include more
sophisticated knowledge, technologies and client care
activities.
(ffff) Nursing Program Faculty – individuals employed
full or part time by academic institutions responsible for
developing, implementing, evaluating and updating
curricula.
(gggg) Nursing Services – the professional practice
and auxiliary functions that support the client’s meeting of
the client’s desired health goals and processes for
promoting, attaining and maintaining optimal health
outcomes.
(hhhh) Nursing Student – a person who is studying
nursing in an approved educational program.
(iiii) Omnibus Budget Reconciliation Act (OBRA) – a
mandate (P.L. 100-203 of 1987) that created federal
statutory requirements for nurse assistants’ education and
certification, and requiring the establishment of a registry
of nurse assistants employed in long-term care facilities,
home care agencies and home health aides.
(jjjj) Person – an individual, corporation, partnership,
association, unit of government or other legal entity.
(kkkk) Practice – the performance of services by a
licensed or certified person that requires specific education,
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training and skills as specified in these rules and
regulations.
(llll) Practice of Nursing – the assisting of clients or
groups to attain or maintain optimal health, implementing a
strategy of care to accomplish defined goals and evaluating
responses to nursing care and treatment. It incorporates:
(1) basic health care that helps both clients and
groups of people cope with difficulties in daily living
associated with their actual or potential health or
illness;
(2) those nursing activities that require a
substantial amount of scientific knowledge or technical
skills.
(mmmm) Prescribed Devices – an instrument or an
apparatus intended for use in diagnosis or treatment and in
the prevention of disease or restoration of health.
(nnnn) Prescribing – the act of determining which
legend drugs and controlled substances shall be used by or
administered to a client in compliance with applicable state
and federal law.
(oooo) Prescriptive Authority – the power granted to
the APRN to assess the need for drugs, immunizing agents,
or devices, selecting the remedy and writing a prescription
to be filled by a licensed pharmacist.
(pppp) Primary Instructor – refers to the registered
nurse who is responsible for teaching and evaluating the
students enrolled in a nurse assistant educational program
and is currently licensed to practice on Guam.
(qqqq) Professional Boundaries – the space between
the nurse’ power and the client’s vulnerability. The power
of the nurse comes from the professional position and
access to private knowledge to control this power
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differential and allows a safe relationship to meet the
client’s needs.
(rrrr) Professional Certification – a credential issued by
a national certifying body meeting specified requirements
acceptable to the Board that is used as a requirement for
APRN licensure.
(ssss) Program – a course of instruction designed to
enable its students to practice as an RN, APRN, LPN or
CNA.
(tttt) Program Provider – refers to a school, college,
nursing facility or other institutions that conducts a nursing
assistant program.
(uuuu) Quality Improvement Processes – to identify
errors and hazards in care; understand and implement basic
safety design principles, such as standardization and
simplification; continually understand and measure quality
of care in terms of structure, process and outcomes in
relation to client and community needs; and design and test
interventions to change processes and system of care with
the objective of improving quality.
(vvvv) Registry – the listing of all individuals who
have been issued a license or certificate by the Board.
(wwww) Re-issuance – the process of replacing a
license or certificate by issuing a duplicate copy.
(xxxx) Revocation – the withdrawal of a nurse’ license
or a nurse assistant’s certificate for cause or an order of
annulment or cancellation of a license or certificate.
(yyyy) Reinstatement – the process of restoring a
license or certificate to practice on Guam that has expired,
lapsed, been suspended or revoked.
(zzzz) Site Visit – a visit to the program site by an
agent of the Board to review the nursing or the nurse
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assistant educational program sponsored by the program
provider.
(aaaaa) Standards of Nursing Practice – those
standards adopted by the Board that define and interpret
legal definition of practice.
(bbbbb) Strategy of Nursing Care – goal-oriented
nursing activities developed within the client-centered
health care plan to assist clients achieve optimal health
potential.
(ccccc) Supervision – the provision of guidance by a
qualified registered nurse for the accomplishment of a
nursing task, function or activity. The guidance consists of
direct, indirect or periodic observation and monitoring as
well as establishing the initial direction, delegating, setting
expectations, directing activities and courses of action,
critical watching, overseeing, evaluating and changing a
course of action.
(ddddd) Suspension – an order of withdrawal of a
nurse’ or a nurse assistant’s right to practice for a definite
or indefinite period of time due to cause.
(eeeee) These Standards – refers to the standards for
accreditation and licensing as established in these rules and
regulations.
(fffff) Unauthorized Practice – the practice of nursing,
such as a nurse assistant, licensed practical nurse, registered
nurse or advanced practice registered nurse by any person
who has not been authorized or licensed to practice under
the provisions of the Act.
(ggggg) Unlicensed Assistive Personnel – any
personnel who is unlicensed to whom nursing tasks are
delegated, regardless of title.
(hhhhh) Violation – failure of an employer of a
licensed nurse or certified nurse assistant or any person
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acting as an agent for the nurse or nurse assistant in
obtaining employment to verify the current status of the
licensee’s authorization to practice nursing or nurse
assistant on Guam. As used in the Act, the term “agent”
includes, but not limited to, nurse recruiters and nurse
registries.
---------
ARTICLE 4
LICENSURE FOR APRNS, RNS AND LPNS
SOURCE: Rules establishing the board were filed with the Legislative
Secretary on December 31, 1986. Entire chapter repealed and adopted by
P.L. 29-071:1 (May 7, 2008).
§ 6401. Requirements.
§ 6402. Responsibility of Applicant.
§ 6403. Responsibility of Employer.
§ 6404. Licensure by Examination for RNs and LPNs.
§ 6405. Temporary Work Permit.
§ 6406. Retakes.
§ 6407. Arrival of Results.
§ 6408. Licensure by Endorsement.
§ 6409. Special Licensure Situations.
§ 6410. Continuing Education (CE) Requirements.
§ 6411. Application for Renewals – RNs and LPNs .
§ 6412. Reinstatement of License.
§ 6413. Reinstatement Following Disciplinary Action.
§ 6414. Verification of License to Another Jurisdiction.
§ 6415. Licensure/Certification Issued in Error.
§ 6401. Requirements.
(a) In order to practice nursing in Guam, it is mandatory to
obtain a license from the Guam Board of Nurse Examiners.
Obtaining a Guam license to practice nursing is the
responsibility of the individual nurse pursuant to P.L. 16-123,
Nurse Practice Act of Title 10 Guam Code Annotated, Article
3(1983; 1997, 1998 and 2003 Updates).
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(b) Any person who holds a license to practice nursing in
Guam shall use the legal title or the abbreviation as set forth in
the Guam Nurse Practice Act of Title 10 Guam Code Annotated
and Article 3, (1983; 1997, 1998 and 2003 Updates). No other
person shall assume any other name, title or abbreviation or any
words, letters, signs, or devices that would cause a reasonable
person to believe the user is licensed/certified to practice as a
registered nurse (RN), an advanced practice registered nurse
(APRN) or licensed practical nurse (LPN).
(c) Any person licensed to practice nursing shall wear an
insignia to identify himself or herself by his/her name and
appropriate legal title or abbreviation during times when such
person is providing health care to the public for compensation.
(d) The insignia shall be prominently displayed and clearly
legible such that the person receiving care may readily identify
the type of nursing personnel providing the care.
§ 6402. Responsibility of the Applicant.
It shall be the responsibility of the applicant to:
(a) Correspond or communicate directly with the
Board.
(b) Follow through with the submission of all required
documents until his/her application is completed.
(c) Periodically contact the Board concerning the status
of the application.
(d) Inform the Board of his/her intention to withdraw
an application in writing prior to the remittance of the
applicable fee. Fees remitted to the Board are non-
refundable.
(e) Inform the Board of any change in name and/or
address. A licensee who has a change in name shall submit
a notarized copy of a marriage certificate, or court order
evidencing the change to the Board. A duplicate license
with the change shall be issued by the Board upon receipt of
such evidence and the required fee. All license renewals
will be sent to the most current known address on file.
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(f) Notify the Board, in writing, of the loss of a current
license. A duplicate license for the current renewal period
shall be issued by the Board upon receipt of the required
form(s) and fee.
(g) Keep in his/her possession a signed current Guam
nursing license while on duty status.
§ 6403. Responsibility of the Employer.
(a) Nursing Administrators, agency heads or other
employers, who hire individuals without a license or who allow
nurses to practice after the expiration of the licenses or
temporary licenses, may be cited for aiding and abetting the
unlicensed practice of nursing which is in violation of Section
12327 of Title 10 of the Guam Code Annotated.
(b) Agency Heads, other employers or physicians who
allow APRNs, RNs or LPNs to perform duties and activities
beyond the legal Scope and Standards of Nursing Practice may
be cited for aiding and abetting the illegal practice of nursing
which is in violation of the Act.
§ 6404. Licensure by Examination for RNs and LPNs.
In order to be licensed in Guam, all registered nurse or
practical nurse applicants shall take and pass the National
Council Licensure Examination for Registered Nurses (NCLEX-
RN) or Licensed Practical Nurses (NCLEX-PN). The results
will be reported to the applicant as pass or fail.
(a) Requirements.
(1) The applicant shall submit a completed and
notarized application for licensure by examination
which shall include:
(A) Verification of graduation or completion
and eligibility for graduation from a state-
approved registered or practical nursing program
as evidenced by an official Certificate of Nursing
Education document received directly from the
state-approved nursing education program for the
level of licensure being sought. The document
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shall verify the date of graduation, credential
conferred and evidence of meeting the standards
of nursing education comparable to the U.S. and
Guam. An official transcript directly from the
School of Nursing is required prior to the issuance
of a permanent license.
(B) Two (2) current (within 3 months)
passport-size photographs signed by applicant.
(C) Payment of the required application fees
for the examination which shall be made payable
to the Treasurer of Guam. The NCLEX-RN and
NCLEX-PN application fees are paid separately
for each examination and are NOT refundable.
(D) Payment for the NCLEX Data Center
registration fee which shall be paid directly to
NCSBN.
(2) If the applicant is a graduate of a registered
nursing program who applies to take the NCLEX-PN
examination, the Board may require additional
coursework addressing the limitations of the LPN
scope of practice and the rules that govern the practice
of practical nursing.
(3) If the Board allows a graduate of a registered
nursing program to take the NCLEX-PN examination,
the Board may require the RN educational program to
identify a Practical Nurse exit point.
(4) In addition to the above requirements, the
applicant seeking licensure by examination shall
provide the following as applicable to the applicant’s
status:
(A) Identification of any state, territory or
country in which the applicant holds a
license/certification/credential to practice in a
health profession other than nursing. Identification
shall include the number and status of the
license/certification/credential and the original
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state or country of
licensure/certification/credentialing.
(B) Information about current or previous
employer if employed in health care, to include
address, telephone number, position and dates of
employment.
(C) Information related to the applicant’s
background such as pending disciplinary action or
investigation; any pending criminal charges
(national or international); criminal conviction;
nolo contender plea, Alford plea or other plea
arrangement in lieu of conviction; any chemical,
physical or mental impairment and/or disability
that impacts the applicant’s ability to practice
nursing safely and a description of
accommodations and/or practice limitations
needed, if any; and, any current substance abuse.
(5) Official record of local, state and federal
criminal background checks (police and court
clearances) completed within the last two (2) months.
(b) Application for Licensure by Examination for
Internationally Educated Applicants.
(1) An internationally educated applicant for RN
or LPN licensure by examination shall submit to the
Board, in addition to the above (a)(1-5) Licensure by
Examination requirements, the following:
(A) Verification of graduation or completion
of an international nursing program comparable to
an approved nursing education program in the
United States or Guam, as documented in an
official Certificate of Nursing Education and an
official transcript sent directly from the
international nursing education program to
GBNE. The transcript must be verified by a
credentials evaluation organization
approved/authorized by the Board.
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(B) Acceptable documentation shall verify
the date of enrollment, date of graduation and
credentials conferred. An official transcript and,
if not in English, a certified translation is required
prior to the approval to take NCLEX.
(C) Credentials shall be reviewed internally
or by an external agency specializing in
international academic credentials review to
verify the comparability of the international
nursing education program to nursing education
program(s) in Guam and/or in the U.S.
(D) The Commission on Graduates of
Foreign Nursing Schools (CGFNS) certificate
program for internationally educated and licensed
nurses is the Board approved and recognized
authority to review and certify educational
credentials of internationally educated nurse
applicants.
(E) International PN graduates, in addition to
the above, shall submit a notarized copy of the
Commission on Graduates of Foreign Nursing
Schools (CGFNS) credentials and education
verification and may be requested to demonstrate
proficiency in the English language by means of
an approved test such as TOEFL if the Board
designee has reason to believe that the applicant
lacks sufficient verbal or reading skills.
(c) Licensure by Examination as LPN for
applicants/candidates from the Medical Corp of the U.S.
Armed Forces. Individuals who served on active duty in the
Medical Corp of the U.S. Armed Forces as a member of the
nursing service may apply to the Board for evaluation of
records for eligibility for LPN licensure examination.
Applicant must submit, in addition to the above (a) (1-5)
Licensure by Examination requirements, the following:
(1) Proof of having had at least twelve (12)
months service on active duty in the Medical Corp of
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any of the Armed Forces rendering bedside (direct
patient) care. Operating room and other non-bedside
nursing experience is NOT acceptable.
(2) Proof of having completed a basic course of
instruction in nursing while in the Armed Forces which
shall be equivalent to the course requirement set by
these rules. The minimum nursing course
requirements shall include:
Core Nursing Subjects/Content Theory Hrs
Clinical Hrs
Health Assessment 30 hours 60
hours
Nursing Fundamentals
& MedSurg Nursing 100 hours 300
hours
Pediatric Nursing 30 hours 90
hours
Obstetric Nursing 30 hours 90
hours
Pharmacology 30 hours 60
hours
Mental Health/Psychiatric Nursing 30 hours 90
hours
Total Nursing Subjects/Content: 250 hours 690
hours
Support Courses
Anatomy & Physiology 4 Qtr hrs/3 semester
credits
Microbiology 4 Qtr hrs/3 semester
credits
Nutrition 3 Qtr hrs/3 semester
credits
Human Growth & Development 4 Qtr hrs/3 semester
credits
Psychology 3 Qtr hrs/3 semester
credits
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(3) Proof that claimed service was honorable.
These documents shall be certified and submitted
directly to the Board by the Officer in Charge of
Education Services no later than the deadline set by the
Board.
(d) Other Requirements.
(1) Applications that are not complete and/or inactive
will become null and void after one (1) year. The Board
will dispose of the application as governed by the
Government of Guam statute.
(2) Applicants for examination shall be required to
pass the national licensing examination within two (2) years
after graduation from a Board-approved school of nursing.
Applicants applying after the two (2) year limitation period
shall be considered by the Board on an individual basis.
The applicant may be required to satisfactorily complete an
approved program or course of study, including theory and
practice, or follow specific remedial measures, as prescribed
by the Board, prior to being approved to take each
examination.
(3) Transcripts shall include information on nursing
education programs which were completed in less than the
usual length of time, through advanced standing or transfer
of credits from one institution to another.
(4) Any change of name, after filing the original
application, must be supported by an affidavit or marriage
certificate.
(5) Any applicant who cannot demonstrate fulfillment
of the education requirements shall be notified in writing
and must satisfy the deficiency before being approved to
take the examination. Deficiencies in nursing theory and/or
clinical practice may be removed by taking the required
course(s) in an approved nursing education program.
§ 6405. Temporary Work Permits/Licenses/Certifications.
(a) The Board may issue a temporary work permit to
graduate of an accredited U.S., foreign or Guam professional
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nursing education program, upon application, payment of the
required fee, and after verifying the applicant’s official transcript
and certificate of education; provided, however, that such
applicant has received the Board’s authorization to sit for the
licensing examination immediately following such applicant’s
graduation.
(b) New graduates of U.S. Board-approved nursing
education programs may be given a temporary work permit to
practice nursing on Guam while waiting to take the first National
Council Licensing Examination. This temporary work permit
option is only available for a six-month period from the date of
graduation. The graduate nurse must submit an application, an
official transcript sent directly to the GBNE office and
certification of nursing education to take the national
examination within six (6) months from the date of graduation in
order to qualify for the six-month GN Temporary Work Permit.
Such candidates with temporary work permits:
(1) Shall be identified as and authorized to use the title
‘Graduate Registered Nurses (GN’S) or ‘Graduate Practical
Nurses’ (GPN’S); and,
(2) May practice nursing only under the direct
supervision of a licensed registered nurse and shall not
assume charge responsibilities.
(c) The Board may issue a temporary work permit to
applicants enrolled in refresher courses, to provide direct client
nursing care as part of a nursing refresher course. The applicant
shall have been previously licensed to practice. The refresher
course may be for completing continued competence
requirements, for seeking reinstatement of license or application
for licensure by endorsement at the applied level of licensure.
(d) The Board may issue a temporary work permit to
applicants for licensure as advanced practice registered nurse
(APRN) to work under the supervision of another APRN or
physician.
(e) A three (3) month temporary license/certification may be
issued to an APRN, RN, LPN, or CNA applicant for
endorsement upon submission:
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(1) A completed and notarized application for
endorsement;
(2) A current/valid license from a State or its territories
as a registered nurse or practical/vocational nurse; or
(3) A current/valid National or State Board
Certification as an APRN; or
(4) A current/valid State Board Certification as a
nursing assistant; and,
(5) An official record of local, state and federal
criminal background checks completed within the last two
(2) months; and,
(6) Payment of appropriate fee.
(f) The temporary permit/license/certification is valid for a
period of three months upon issuance for those seeking licensure
by endorsement and six months for new graduates of accredited
U.S., foreign or Guam professional nursing schools seeking
licensure by examination for the first time.
(g) The board may use its discretion to extend the temporary
work permit with the exception of APRNs [Article 5, Section 5.6
f. (4) and (5)] and shall not exceed six (6) months.
(h) The temporary work permit becomes null and void upon
issuance of a current license, upon expiration, or upon
withdrawal by Board action.
(i) It is the responsibility of the applicant to assure that the
Endorsement Verification form is received by the Guam Board
of Nurse Examiners from the jurisdiction of the original
licensure prior to the expiration date of the temporary license.
(j) Internationally educated applicants for licensure by
examination or endorsement are not eligible for a temporary
work permit on Guam unless such applicant has been licensed by
examination in another state or territory of the United States.
§ 6406. Retakes.
(a) All applicants wishing to retake the National Council
Licensing Examination (NCLEX) exam shall submit a Retake
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Application for examination to the Board with a 2x2 passport-
size photo taken within the past 3 months and payment of the
retake examination fee.
(b) Applicants retaking the examination for the second or
third time shall be responsible for self-study or available
refresher course tutorial program.
(c) Applicants rewriting the examination for the fourth time
shall be considered individually by the Board and shall be
required to follow specific remedial measures, as prescribed by
the Board.
(d) Applicants failing the NCLEX four or more times shall
be considered individually by the Board and shall be required to
satisfactorily complete a course of study in nursing approved by
the Board. The course of study shall include theory and practice
or follow equivalent remedial measures, as prescribed by the
Board.
§ 6407. Arrival of Results.
(a) Candidates who pass shall receive:
(1) A “PASS” result;
(2) The initial license;
(3) An employment data information sheet;
(4) A Certificate of Licensure;
(5) A letter of transmittal which shall instruct the
licensee that his/her score shall not be requested from this
Board for purposes other than licensure.
(b) Candidates who fail shall receive:
(1) A “FAIL” result;
(2) A diagnostic profile from testing center.
(c) On -island school(s) of nursing shall receive:
(1) General information on graduates of respective
schools:
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(A) Copy of summary information for candidates
from the program who were examined in this
jurisdiction-PROGRAM NAME.
(B) Copy of percent of first-time candidates
educated in member board jurisdiction that have met or
exceeded scale scores.
(C) Copy of ranked means and score ranges for
first-time candidates educated in member board
jurisdictions.
(D) Copy of jurisdiction program summary of
first-time candidates.
(E) Letter of transmittal to include scores of
graduates who have signed authorization to release
their scores with names to their respective school of
nursing.
(d) The Board may release examination scores only upon
the written authorization from the applicant or licensee.
(e) A copy of the examination scores shall be filed in each
candidate's permanent record in the Board office.
§ 6408. Licensure by Endorsement.
(a) An RN or LPN applicant for licensure by endorsement
in Guam shall submit to the Board the required fee for licensure
by endorsement and a completed application for licensure by
endorsement. Verification of current licensure in another
jurisdiction, whether electronically or by paper copy, is required
for licensure by endorsement.
(b) The Board shall verify licensure by examination by the
state of original licensure and receive from that board
information regarding graduation or successful program
completion from a nursing education program for the level of
license, date of original licensure and current licensure status in
the jurisdiction.
(c) The Board shall also verify date of the applicant’s
licensure and licensure status with the state of most recent
employment, if different from the state of original licensure.
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(d) The applicant is required to provide evidence of having
passed the licensure examination required by this jurisdiction at
the time the applicant was initially licensed in another
jurisdiction. Applicant must also provide evidence of continued
competency requirements as prescribed in these rules.
(e) Other Requirements. In addition to these requirements,
the applicant seeking licensure by endorsement must provide:
(1) Identification of any state, territory or country in
which the applicant has held a health profession license or
credentials other than nursing. Identification shall include
the number and status of the license or credential and the
original state or country of licensure or credentialing.
(2) Information about current employer if employed in
health care, to include address, telephone number, position
and date of employment.
(3) Information regarding previous employer in health
care, if any, if current employment is less than 12 months.
(4) Information related to the applicant’s background
in the following areas:
(A) disciplinary action or investigation regarding
any professional license or credential.
(B) Any pending criminal charges - national or
international. Criminal conviction, nolo contender plea,
Alford plea or other plea arrangement in lieu of
conviction.
(C) Any chemical, physical or mental impairment
and/or disability that impacts the nurse’s ability to
practice nursing safely, and a description of
accommodations and/or practice limitations needed, if
any.
(D) Any current substance abuse.
(5) Official record of local, state and federal criminal
background checks completed within the last 2 months.
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(f) The Board shall review applications only after all the
above requirements have been submitted.
§ 6409. Special Licensure Situations.
(a) Nurses transporting patients in and out of Guam shall be
currently licensed in the jurisdiction in which they are employed.
(b) Nurses from other U.S. jurisdictions or its territories
attending or providing short (90 days or less) continuing
education courses or participating in clinical preceptorship
experiences shall hold a current license to practice in at least one
U.S. jurisdiction or its territories.
(c) Licensed nurses from other U.S. jurisdictions or it's
territories that provide care during an official declared
emergency or disaster situation shall not be required to obtain a
Guam license to practice nursing.
§ 6410. Continuing Education Requirements.
(a) All licensed nurses shall submit evidence of thirty (30)
hours of Continuing Education (CE) activities/seminars within
the renewal period.
(b) Exemptions for first-time renewals. If a licensed nurse
obtained his/her initial RN or LPN license by passing the
NCLEX within the past six (6) months and this is the first
renewal, the RN/LPN may be exempted from the CE
requirement.
(c) Licensed nurses who have been practicing but do not
meet the thirty (30) hours of CE requirements at the time of
renewal, may be issued a “conditional license” to last no more
than three (3) months to fulfill the CE requirements.
§ 6411. Application for Renewal of License as a Registered
Nurse or Licensed Practical Nurse.
(a) Registered, Practical and APRN nurse licenses shall be
renewed biennially by September 30 of odd numbered years.
(b) The licensee shall submit to the Board a completed
renewal application form, verification of continuing education
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requirements, renewal fee and other required documents, on or
before the expiration date of the license.
(c) Information pertaining to the applicant’s background in
the following areas shall also be required of the licensee to
submit to the Board:
(1) Pending disciplinary action or investigation
regarding any professional license or credential;
(2) Pending criminal conviction;
(3) Criminal conviction, nolo contendere plea, Alford
plea or other plea arrangement in lieu of conviction since
the last renewal;
(4) Any chemical, physical or mental impairment
and/or disability that impacts the nurse’s ability to practice
nursing safely, and a description of accommodations and/or
practice limitations needed, if any;
(5) Any current substance abuse;
(6) A detailed explanation and supporting
documentation for any of the above information.
(7) Official record of local, state and federal criminal
background checks completed within the last two (2)
months.
(d) A license shall be issued upon submission and
verification of all documents.
(e) Applications for renewal shall be mailed to the last
known address of the licensee. Failure to receive the application
for renewal shall not relieve the licensee of the responsibility for
renewing the license by the renewal date.
(f) Failure to renew the license shall result in forfeiture of
the right to practice nursing in Guam.
(g) Any person practicing nursing during the time a license
has lapsed shall be considered an illegal practitioner and shall be
subject to prosecution under the provisions of Section 12328
Nurse Practice Act.
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§ 6412. Reinstatement of Lapsed or Inactive License.
(a) A nurse who has allowed his or her license to lapse or
become inactive may apply for reinstatement upon:
(1) Submission of completed application for
reinstatement.
(2) Verification of at least thirty (30) hours of approved
continuing education (CE) activities/seminars is required at
the time of application for reinstatement.
(3) Payment of appropriate fee.
(b) Other requirements. In addition to these requirements,
the applicant seeking licensure by reinstatement must provide:
(1) Identification of any state, territory or country in
which the applicant holds a health profession license or
credentials other than nursing. Identification shall include
the number and status of the license or credential and the
original state or country of licensure or credentialing.
(2) Information about current employer if employed
in health care, to include address, telephone number,
position and date of employment.
(3) Information regarding previous employer in health
care, if any, if current employment is less than 12 months.
(4) Information related to the applicant’s background
in the following areas:
(A) Pending disciplinary action or investigation
regarding any professional license or credential.
(B) Any pending criminal charges - national or
international.
(C) Criminal conviction, nolo contender plea,
Alford plea or other plea arrangement in lieu of
conviction.
(D) Any chemical, physical or mental impairment
and/or disability that impacts the nurse’s ability to
practice nursing safely, and a description of
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accommodations and/or practice limitations needed, if
any.
(E) Any current substance abuse.
(5) Official record of local, state and federal criminal
background checks completed within the last 2 months.
(c) The Board shall review applications only after all the
above requirements have been submitted.
(d) At any time after a license has lapsed or been inactive,
the Board may require evidence of the licensee’s current nursing
knowledge and skill before reinstating the license to the status of
active license.
(e) An individual who applies for licensure reinstatement
who has been out of practice for three (3) years or longer shall
provide evidence of passing a nursing refresher course approved
by the Board.
§ 6413. Reinstatement Following Disciplinary Action.
Individuals applying for reinstatement following
disciplinary action must meet compliance with all Board
licensure requirements as well as any specific requirements set
forth in the Board’s discipline proceedings.
§ 6414. Verification of License to Another Jurisdiction.
(a) Nurses requesting verification of license to another
jurisdiction shall submit a signed release of information.
(b) The request shall be accompanied by the fee for license
verification.
§ 6415. Licensure/Certification Issued in Error.
The Board reserves the right to revoke
licenses/certifications issued in error by the previous or current
Board.
---------
ARTICLE 5
ADVANCED PRACTICE REGISTERED NURSE (APRN)
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SOURCE: Rules establishing the board were filed with the Legislative
Secretary on December 31, 1986. Entire chapter repealed and adopted by
P.L. 29-071:1 (May 7, 2008). This Article repealed and reenacted by P.L.
34-078:3 (Feb. 09, 2018).
§ 6501. Purpose.
§ 6502. Definitions.
§ 6503. Titles and Abbreviations.
§ 6504. Scope of Practice for the Advanced Practice
Registered Nurse (APRN).
§ 6505. Licensure.
§ 6506. APRN Education.
§ 6507. Prescriptive Authority.
§ 6508. Implementation.
§ 6509. Name or Address Change.
§ 6510. Disciplinary Provisions.
§ 6501. Purpose.
To assure the health, safety, and welfare of the people of
Guam by regulating the practice of the Advanced Practice
Registered Nurse (APRN).
(a) The APRN shall comply with the standards for
RNs as specified in Title 25, Chapter 6, Article 3, Guam
Administrative Rules and Regulations, 10 GCA Chapter 12,
Article 3, and to the standards of the national professional
nursing associations recognized by the Guam Board of
Nurse Examiners (GBNE). Standards for a specific role and
population focus of APRN supersede standards for RNs
where conflict between the standards, if any, exists.
(b) APRNs shall practice within standards established
by the Board in rule and assure patient care is provided
according to relevant patient care standards recognized by
the Board, including standards of national professional
nursing associations.
§ 6502. Definitions.
(a) Act means the Nurse Practice Act, 10 GCA, Chapter 12,
Article 3.
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(b) Advanced Nursing Practice means the delivery of
nursing care at an advanced level of independent nursing
practice that maximizes the use of graduate educational
preparation, and in-depth nursing knowledge and expertise in
such roles as autonomous clinical practitioner, professional and
clinical leader, expert practitioner, and researcher.
(c) Advanced Practice Registered Nurse (APRN) means a
registered nurse who has obtained formal graduate education and
national specialty certification through a commission-approved,
certifying body and is authorized by the Board to perform
advanced nursing practice in one (1) or more of the designations,
and who is licensed as an APRN. The designations include the
following:
(1) Nurse Practitioner (NP);
(2) Certified Registered Nurse Anesthetist (CRNA);
(3) Certified Nurse Midwife (CNM); and
(4) Clinical Nurse Specialist (CNS).
(d) Board means the Guam Board of Nurse Examiners.
(e) Certification means recognition by examination
acceptable as an element of eligibility for APRN licensure, the
applicant’s advanced knowledge, skills and abilities attained
through a defined program of study preparing the graduate in one
(1) of the four (4) recognized APRN roles (NP, CRNA, CNM,
CNS) by a national organization recognized by the Board. The
certification process measures the theoretical and clinical content
denoted in the advanced scope of practice, and is developed in
accordance with generally accepted standards of validation and
reliability. These national organizations include:
(1) For NP designation:
(A) the American Academy of Nurse
Practitioners;
(B) the American Nurses Credentialing Center;
(C) the National Certification Corporation;
(D) the Pediatric Nursing Certification Board;
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(E) the American Association of Critical Care
Nurses; or
(F) the Oncology Nursing Certification
Corporation.
(2) For CNM designation: the American Midwifery
Certification Board.
(3) For CRNA designation: the National Board of
Certification and Recertification for Nurse Anesthetists.
(4) For CNS designation:
(A) the American Nurses Credentialing Center;
(B) the American Association of Critical Care
Nurses; or
(C) the Oncology Nursing Certification
Corporation.
(f) Certified Registered Nurse Anesthetist (CRNA) means a
registered professional nurse who has successfully completed
graduate educational preparation from a nurse anesthetist
program, is currently certified by the National Board of
Certification and Recertification for Nurse Anesthetists, and is
licensed by the Board.
(g) Nurse Practitioner (NP) means a registered professional
nurse who has successfully completed graduate educational
preparation from a nurse practitioner program, is licensed to
practice by the Board, and is currently certified by a nationally
recognized certifying agent of the appropriate advanced nursing
practice organization. For example, the certifying agent of:
(1) the American Academy of Nurse Practitioners;
(2) the American Nurses Credentialing Center;
(3) the National Certification Corporation;
(4) the Pediatric Nursing Certification Board;
(5) the American Association of Critical Care Nurses;
or
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(6) the Oncology Nursing Certification Corporation.
(h) Certified Nurse-Midwife (CNM) means a registered
professional nurse who has successfully completed graduate
educational preparation from a nurse-midwifery program and is
currently certified by a nationally recognized certifying agent of
the appropriate advanced nursing practice organization. For
example, the certifying agent of the American Midwifery
Certification Board, and is licensed to practice by the Board.
(i) Clinical Nurse Specialist (CNS) means a registered nurse
who has graduated from a program of graduate study with
supervised clinical practice in an area of specialty, is licensed to
practice by the Board, and is certified by the nationally
recognized certifying agent in the appropriate specialty. For
example; the certifying agent of
(1) the American Nurses Credentialing Center;
(2) the American Association of Critical Care Nurses;
or
(3) the Oncology Nursing Certification Corporation.
(j) Consultation means conferring with another health care
provider for the purpose of obtaining information or advice.
(k) Diagnosis means identification of actual or potential
health problems and the need for intervention based on analysis
of data collected. Diagnosis depends upon the synthesis of
information obtained during the interview, physical exam and/or
diagnostic tests.
(l) Intervention means measures to promote health, protect
against disease, treat illness in its earliest stages, manage acute
and chronic illness, and treat disability. Interventions may
include, but are not limited to, ordering diagnostic studies,
performing direct nursing care, prescribing pharmacologic, non-
pharmacologic, or other therapies and consultation with or
referral to other health care providers.
(m) Inactive status means the status of the licensed APRN
who voluntarily chooses not to engage in APRN practice during
the succeeding year and chooses not to renew his/her license at
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the time of renewal. The APRN shall not be required to pay the
renewal fee as long as he/she remains inactive. This status must
be officially requested in writing by the licensee prior to the
expiration of his/her license. Should the APRN wish to resume
his/her APRN practice at some future time, he/she shall notify
the Board and become reinstated by meeting such requirements
as the Board may prescribe.
(n) Lapsed license means the termination of an individual’s
APRN license to practice due to the license holder’s failure to
renew his/her license within a specified period of time, and is
therefore unauthorized to practice.
(o) License means a current document permitting the
practice of nursing as an APRN.
(p) Practitioner means an APRN, as defined in 10 GCA,
Chapter 12, Article 3, who is authorized to prescribe, order or
administer drugs in connection with medical treatment to the
extent provided by the rules and regulations of the practitioner’s
respective Board.
(q) Prescription means an order for drugs, treatment,
diagnostic studies or devices written, signed, or transmitted by
word of mouth or telephone by those licensed to prescribe or a
practitioner of the healing arts.
(r) Prescriptive and Dispensing Authority means the legal
permission to prescribe deliver, distribute and dispense
pharmacologic and non-pharmacologic agents in compliance
with Board rules and applicable federal and Guam laws.
Pharmacologic agents include legend and schedule II through V
controlled substances.
§ 6503. Titles and Abbreviations.
(a) Individuals are licensed or granted privilege to practice
as APRNs in the roles of nurse practitioner (NP), certified
registered nurse anesthetist (CRNA), certified nurse-midwife
(CNM), and clinical nurse specialist (CNS) in the population
focus of family/individual across the lifespan, adult-gerontology,
neonatal, pediatrics, women’s health/gender-related or
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psychiatric/mental health, and others regulated by national
certification.
(b) Each APRN shall use the designation “APRN”
followed by role title, as a minimum, for purposes of
identification and documentation. The APRN may only identify
as a doctor, or use the abbreviation “Dr.” in a healthcare context,
upon earning a doctorate degree from an accredited institution of
higher education in a relevant discipline, such as Doctor of
Nursing Practice (DNP); Doctor of Nurse Anesthesia Practice
(DNAP); Doctor of Philosophy in Nursing (PhD); or another
related doctorate degree in a healthcare discipline.
(c) When providing nursing care, the APRN shall provide
clear identification that indicates his or her APRN designation.
§ 6504. Scope of Practice for the Advanced Practice
Registered Nurse (APRN).
The scope of practice of a licensed APRN is as provided in
this Section.
(a) The APRN is prepared and qualified to assume
primary responsibility and accountability for the care of
patients.
(b) APRN practice is grounded in nursing process and
incorporates the use of independent judgment. Practice
includes interdisciplinary consultation with other health care
professionals in the assessment and management of
wellness and health conditions.
(c) The APRN functions within a scope of practice
following the standards of care defined by the applicable
national certifying body. An APRN may choose to limit the
area of practice within the approved national certification.
(d) An APRN shall obtain instruction, supervision,
and consultation as necessary before implementing new or
unfamiliar techniques or practices within the scope of
national certification.
(e) Performing within the scope of the APRN’s
knowledge, experience and practice, the licensed APRN
may perform the following:
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(1) examine patients and establish diagnoses by
patient history, physical examination, and other
methods of assessment;
(2) admit, manage, and discharge patients to and
from health care facilities;
(3) order, collect, perform, and interpret
diagnostic tests;
(4) manage health care by identifying,
developing, implementing, and evaluating a plan of
care and treatment for patients;
(5) prescribe therapies and medical equipment;
(6) prescribe medications when granted
prescriptive authority under this Chapter;
(7) refer patients to other health care
practitioners, services, or facilities; and
(8) perform procedures, provide care services, or
provide duties that are within the APRN's scope of
practice according to their national certification.
(f) Supervision of Support Staff. The APRN may
delegate to employees or support staff activities relating to
advanced practice registered nursing carried out by custom
and usage when the activities are under the control and
direct supervision of the APRN. The APRN is legally liable
for properly delegated activities, and the employee or
support staff to which the APRN has delegated activities is
considered the APRN’s agent when performing such
activities.
(g) Global Signature Authority of an Advanced
Practice Registered Nurse (APRN). When a provision of
law or administrative rule requires a signature, certification,
stamp, verification, affidavit or endorsement by a physician,
that requirement may be fulfilled by an advanced practice
registered nurse. This Section may not be construed to
expand the scope of practice of an advanced practice
registered nurse.
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§ 6505. Licensure.
(a) Application for Initial Licensure.
(1) An applicant for licensure as an APRN in Guam
shall submit to the Board
the required nonrefundable fees,
verification of licensure or eligibility for licensure as an RN
in this jurisdiction, and a completed notarized application
that provides the following information:
(A) Graduation from an APRN graduate or post-
graduate program as evidenced by official transcript
(including electronic versions) received directly from
an APRN program accredited by the Accreditation
Commission for Education in Nursing (ACNE), the
Commission on Collegiate Nursing Education
(CCNE), or the National League for Nursing
Commission for Nursing Education Accreditation
(CNEA), or its successor organization, as acceptable
by the Board.
(B) The official transcript shall verify the date of
graduation; credential conferred; number of clinical
hours completed; completion of three (3) separate
graduate level courses in advanced physiology and
pathophysiology, advanced health assessment,
advanced pharmacology, which includes
pharmacodynamics, pharmacokinetics and
pharmacotherapeutics of all broad categories of agents;
role and population focus of the education program;
and evidence of meeting the standards of nursing
education.
(2) In order to be licensed in Guam, all APRN
applicants must be currently licensed as an RN or hold a
privilege to practice as an RN in Guam.
(3) In order to be licensed in Guam, all APRN
applicants must take and pass the appropriate APRN
national certification examination in the APRN role and
population focus congruent with educational preparation.
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(4) The Board shall determine whether a certification
program can be used as a requirement for licensure of
APRNs based upon the following standards:
(A) the program is national in the scope of its
credentialing;
(B) educational requirements are consistent with
the requirements of the advanced practice role and
population focus; and
(C) certification programs are accredited by
CCNE or its successor organization, as acceptable by
the Board.
(b) Application for Licensure by Endorsement.
An applicant for licensure by endorsement as an APRN in
Guam shall submit to the Board the required nonrefundable fees,
verification of eligibility for a license or privilege to practice as
an RN in this jurisdiction, and a completed, notarized application
that provides the following information:
(1) Graduation from an APRN graduate or post-
graduate program, as evidenced by an official transcript
(including electronic versions) received directly from an
APRN program accredited by the Accreditation
Commission for Education in Nursing (ACNE), the
Commission on Collegiate Nursing Education (CCNE), or
the National League for Nursing Commission for Nursing
Education Accreditation (CNEA), or its successor
organization, as acceptable by the Board.
(2) The official transcript shall verify the date of
graduation; credential conferred; number of clinical hours
completed; completion of three (3) separate graduate level
courses in advanced physiology and pathophysiology,
advanced health assessment, advanced pharmacology,
which includes pharmacodynamics, pharmacokinetics and
pharmacotherapeutics of all broad categories of agents; role
and population focus of the education program; and
evidence of meeting the standards of nursing education.
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(3) Current certification by a national certifying body
in the APRN role and population focus appropriate to
educational preparation. Primary source of verification of
certification is required.
(4) If the applicant has not been in clinical practice
for more than the past two (2) years, and is not a recent
graduate within two (2) years, the applicant shall provide
evidence of satisfactory completion of sixty (60) contact
hours, forty-five (45) in pharmacotherapeutics and fifteen
(15) in the clinical management of patients, within the two
(2) years prior to applying for approval to practice.
(5) If the applicant has not been in clinical practice
for more than the past five (5) years, the applicant shall
provide evidence of satisfactory completion of, at
minimum, forty-five (45) contact hours of advanced
pharmacology and forty-five (45) contact hours in a subject
or subjects related to the role and population focus of
certification. Upon completion of the coursework, the
APRN shall engage in a supervised clinical component by a
qualified preceptor in the appropriate advanced practice role
and population focus. The APRN shall complete hours
according to the following schedule:
(A) three hundred (300) hours if the applicant has
practiced less than nine hundred sixty (960) hours in
the last five (5) years;
(B) six hundred (600) hours if the applicant has
practiced less than nine hundred sixty (960) hours in
the last five (5) years, but has practiced at least nine
hundred sixty (960) hours in the last six (6) years.
(C) one thousand (1000) hours if the applicant
has not practiced at least nine hundred sixty (960)
hours in the last six (6) years, but has practiced nine
hundred sixty (960) hours in the last seven (7) to ten
(10) years; or
(6) If the nurse has not practiced in the advanced
practice nursing role and population focus for ten (10) or
more years he or she will be ineligible for renewal in Guam.
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(7) Qualified preceptor must
meet the following
requirements:
(A) holds an active license or privilege to
practice as an APRN or physician that is not
encumbered and practices in a comparable practice
focus; and
(B) functions as a supervisor and teacher and
evaluates the individual’s performance in the clinical
setting.
(8) At the end of the supervised period, the supervisor
shall provide a written evaluation of the applicant on a
company letterhead. The evaluation will verify whether or
not the applicant has successfully completed the required
hours. If the supervision period was successful, the letter
must state that the applicant’s knowledge and skills are at a
safe and appropriate level to practice as an APRN.
(c) Application for License Renewal.
An applicant for license renewal as an APRN shall submit
to the Board the proof of payment of required fee for license
renewal, and a completed, notarized license renewal application
including:
(1) detailed explanation and supporting
documentation for each affirmative answer to questions
regarding the applicant’s background; and
(2) evidence of current certification(s), or
recertification as applicable, by a national professional
certification organization that meets the requirements of §
6520(e) of this Article.
(3) Renewal of licensure is subject to the following:
(A) License as an APRN shall be renewed
biennially at the same time the license to practice as a
registered nurse in Guam is renewed.
(B) Failure to receive renewal notice does not
relieve anyone of the responsibility of renewing his/her
own APRN license.
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(C) At any point that such national certification
expires it is the responsibility of the APRN to submit a
renewed certification to the board.
(4) If the applicant has not been in clinical practice
for more than the past two (2) years, the applicant shall
provide evidence of satisfactory completion of sixty (60)
contact hours, forty-five (45) in pharmacotherapeutics and
fifteen (15) in the clinical management of patients, within
the two (2) years prior to applying for approval to practice.
(5) If the applicant has not been in clinical practice
for more than the past five (5) years, the applicant shall
provide evidence of satisfactory completion of, at
minimum, forty-five (45) contact hours of advanced
pharmacology and forty-five (45) contact hours in a subject
or subjects related to the role and population focus of
certification. Upon completion of the coursework, the
APRN shall engage in a supervised clinical component by a
qualified preceptor in the appropriate advanced practice role
and population focus. The APRN shall complete hours
according to the following schedule:
(A) three hundred (300) hours if the applicant has
practiced less than nine hundred sixty (960) hours in
the last five (5) years;
(B) six hundred (600) hours if the applicant has
practiced less than nine hundred sixty (960) hours in
the last five (5) years, but has practiced at least nine
hundred sixty (960) hours in the last six (6) years; or
(C) one thousand (1000) hours if the applicant
has not practiced at least nine hundred sixty (960)
hours in the last six (6) years, but has practiced nine
hundred sixty (960) hours in the last seven (7) to ten
(10) years.
(6) If the nurse has not practiced in the advanced
practice nursing role and population focus for ten (10) or
more years he or she will be ineligible for renewal in Guam.
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(7) Qualified preceptor must
meet the following
requirements:
(A) holds an active license or privilege to
practice as an APRN or physician that is not
encumbered and practices in a comparable practice
focus; and
(B) functions as a supervisor and teacher and
evaluates the individual’s performance in the clinical
setting.
(8) At the end of the supervised period, the supervisor
shall provide a written evaluation of the applicant on a
company letterhead. The evaluation will verify whether or
not the applicant has successfully completed the required
hours. If the supervision period was successful, the letter
must state that the applicant’s knowledge and skills are at a
safe and appropriate level to practice as an APRN.
(d) Quality Assurance/Documentation and Audit.
The Board may conduct a random audit of nurses to verify
current APRN certification or continuing education. Upon
request of the Board, licensees shall submit documentation of
compliance.
(e) Lapsed License.
(l) A license is lapsed if it was not renewed or placed
in an inactive status by the expiration date.
(2) Any licensee whose license has lapsed may apply
for reinstatement.
(3) Any person engaged in advanced practice during
the time his or her license has lapsed shall be considered an
illegal APRN and shall be subject to applicable penalties for
violation of the Nurse Practice Act.
(f) Reinstatement of License.
When seeking reinstatement of APRN licensure, a licensee
is subject to the licensing requirements provided by 10 GCA §§
12311, 12313, 12315, in addition to the following:
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(1) A licensee applying for reinstatement of an APRN
license following disciplinary action shall be in compliance
with all Board licensure requirements, as well as any
specified requirements set forth in the Board’s discipline
order.
(2) A licensee applying for reinstatement of an APRN
license following suspension or revocation shall:
(A) petition the Board for a hearing;
(B) present evidence that she/he is currently
licensed to practice nursing in Guam; and
(C) present evidence, as required by the Board,
that she/he is competent to practice as a practitioner in
Guam.
(3) A licensee applying for reinstatement of a lapsed
APRN license shall:
(A) submit the required application and
reinstatement fee;
(B) be currently licensed as a registered nurse in
Guam; and
(C) meet the requirements for renewal of license.
(4) Reinstatement of Inactive License.
The APRN may request in writing to be placed on
inactive status. In this status, the licensee may not function
in an APRN capacity until such license is reactivated. To be
placed on inactive status, the APRN, prior to the expiration
date or his/her license, shall submit a written request to be
placed on inactive status. A licensee applying for
reinstatement of an inactive license shall:
(A) submit the required application for
reinstatement and the fee;
(B) be currently licensed as a registered nurse in
Guam;
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(C) be currently certified as an APRN by a
nationally recognized certifying agent of the
appropriate advanced practice organization; and
(D) meet the requirements for renewal of license.
(g) Temporary APRN License.
(1) A temporary APRN license may be issued by the
Board to the APRN who holds a current national
certification to practice as an Advanced Practice Registered
Nurse upon submission of the following:
(A) an application to meet the temporary license
requirement to practice as a registered professional
nurse;
(B) documentation as required by these rules and
regulations for license as an APRN; and
(C) the non-refundable initial licensure fee and
the temporary APRN licensure fee.
(2) The temporary APRN license is valid for a period
of three (3) months upon issuance. The temporary APRN
license becomes null and void upon issuance of a current
license, upon expiration, or upon withdrawal by board
action. The temporary license is not renewable.
(3) An APRN’s license shall be automatically
suspended upon the occurrence of any of the following:
(A) failure of the APRN to attain recertification
from the national certifying body. The APRN may not
practice as or use the title of certified or licensed
APRN until she/he has submitted to the Board a copy
of current national certification. The license must be
returned immediately to the Board; or
(B) the revocation of the APRN’s national
certification for any reason. The APRN shall notify the
Board immediately in writing and shall not practice as
or use the title of certified or licensed APRN until
she/he has submitted to the Board a copy of a current
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national certification. The license must be returned
immediately to the Board.
(4) It is the responsibility of the APRN to maintain
and submit a current national certification to the Board.
§ 6506. APRN Education.
(a) Required Criteria for APRN Education Programs.
The Guam Board of Nurse Examiners shall determine
whether an APRN education program meets the qualifications
for the establishment of a program based upon the following
standards:
(1) An APRN program shall appoint the following
personnel:
(A) An APRN program administrator, whose
qualifications shall include:
(i) a current, active APRN license or
privilege to practice that is not encumbered in the
state where the program is approved and/or
accredited;
(ii) a doctoral degree in a health-related
field;
(iii) at least two (2) years of clinical
experience as an APRN; and
(iv) a current national APRN certification.
(B) A lead faculty member, educated and
nationally certified in the same role and population foci
and licensed as an APRN, who shall coordinate the
educational component, including curriculum
development, for the role and population foci in the
APRN program.
(C) Nursing faculty, to teach any APRN nursing
course that includes a clinical learning experience,
whose qualifications shall include:
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(i) a current, active APRN license or
privilege to practice that is not encumbered in the
state where the program is approved and/or
accredited;
(ii) a minimum of a master’s degree in
nursing or health-related field in the clinical
specialty;
(iii) two (2) years of APRN clinical
experience; and
(iv) current knowledge, competence and
certification as an APRN in the role and
population foci consistent with teaching
responsibilities.
(D) Adjunct clinical faculty, employed solely to
supervise clinical nursing experiences of students, who
shall meet all the faculty qualifications for the program
level they are teaching.
(E) Interdisciplinary faculty, to teach non-clinical
nursing courses, who shall have advanced preparation
appropriate to these areas of content.
(F) Clinical preceptors, who shall have
demonstrated competencies related to the area of
assigned clinical teaching responsibilities, will serve as
a role model and educator to the student. Clinical
preceptors may be used to enhance faculty-directed
clinical learning experiences but not to replace them.
Clinical preceptors will be approved by faculty and
shall meet the following requirements:
(i) hold an active license or privilege to
practice that is not encumbered as an APRN or
physician and practices in a comparable practice
focus; and
(ii) function as a supervisor and teacher and
evaluate the individual’s performance in the
clinical setting.
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(2) The curriculum of the APRN nursing education
program must prepare the graduate to practice in one (1) of
the four (4) identified APRN roles (NP, CRNA, CNM,
CNS), and at least one (1) of the six (6) population foci
provided by 10 GCA § 12313(a)(2). The curriculum shall
include:
(A) Three (3) separate graduate level courses (the
APRN core) in:
(i) advanced physiology and
pathophysiology, including general principles that
apply across the lifespan;
(ii) advanced health assessment, which
includes assessment of all human systems,
advanced assessment techniques, concepts and
approaches; and
(iii) advanced pharmacology, which includes
pharmacodynamics, pharmacokinetics and
pharmacotherapeutics of all broad categories of
agents.
(B) Diagnosis and management of diseases
across practice settings, including diseases
representative of all systems.
(C) Preparation that provides a basic
understanding of the principles for decision making in
the identified role.
(D) Preparation in the core competencies for the
identified APRN role.
(E) Role preparation in one (1) of the six (6)
population foci of practice.
(3) Additional required components of graduate or
post-graduate education programs preparing APRNs shall
include the following:
(A) Each student enrolled in an APRN program
shall have an RN license or privilege to practice that is
not encumbered in the state of clinical practice, unless
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exempted from this licensure requirement by any law,
rule, or regulation.
(B) Education programs offered by an accredited
college or university that offers a graduate degree with
a concentration in the advanced nursing practice role
and at least one (1) population focus; or post-masters
certificate programs offered by an accredited college or
university which shall include the following
components:
(i) clinical supervision congruent with
current national professional organizations and
nursing accrediting body standards applicable to
the APRN role and population focus; and
(ii) curriculum that is congruent with
national standards for graduate level and advanced
practice nursing education and is consistent with
nationally recognized APRN roles and population
foci, and includes, but is not limited to:
(aa) graduate APRN program core
courses; and
(bb) an advanced practice nursing core,
including legal, ethical, and professional
responsibilities of the APRN.
(C) The curriculum shall be consistent with
competencies of the specific areas of practice.
(D) APRN programs preparing for two (2)
population foci or combined nurse practitioner/clinical
nurse specialist shall include content and clinical
experience in both functional roles and population foci.
(E) Each instructional track/major shall have a
minimum of five hundred (500) supervised clinical
hours as defined by the Board. The supervised
experience is directly related to the role and population
foci, including pharmacotherapeutic management of
patients.
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(F) There shall be provisions for the recognition
of prior learning and advanced placements in the
curriculum for individuals who hold a master’s in
nursing and are seeking preparation in a different role
and population focus. Post-master’s nursing students
shall complete the requirements of the master’s APRN
program through a formal graduate level certificate in
the desired role and population focus. Post-master’s
students must meet the same APRN outcome
competencies as the master’s level students.
(b) Determining Compliance with Standards.
The Board shall determine compliance with the APRN
education standards as set forth in this Section, and consistent
with procedures for determining approved schools of nursing
under 10 GCA § 12321.
(c) Establishment of a New APRN Education Program.
Before establishing a new nursing education program, the
APRN program shall complete the process outlined below:
(1) Application to the professional accrediting body:
the Accreditation Commission for Education in Nursing
(ACNE), the Commission on Collegiate Nursing Education
(CCNE), or the National League for Nursing Commission
for Nursing Education Accreditation (CNEA).
(2) The proposed program shall provide the following
information to the Board:
(A) results of a needs assessment, including
identification of potential students and employment
opportunities for program graduates;
(B) identification of sufficient financial and other
resources;
(C) governing institution approval and support;
(D) community support;
(E) type of educational program proposed;
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(F) clinical opportunities and availability of
resources;
(G) availability of qualified faculty;
(H) a pool of available students; and
(I) a proposed timeline for initiating and
expanding the program.
§ 6507. Prescriptive Authority.
(a) An APRN applicant for prescriptive authority shall:
(1) Be currently licensed as an APRN to practice in
Guam.
(2) Provide evidence from the national certifying
body that differential diagnosis and prescribing practices
are recognized as being within the scope of practice for
the applicant’s certification category.
(3) Provide documentation of successful completion
of pharmacology coursework which shall include
pharmacokinetics principles and their clinical application
and the prescription of pharmacological agents in the
prevention and treatment of illness, and the restoration
and maintenance of health. The coursework shall contain
a minimum of:
(A) Three (3) graduate credit hours of a post-
baccalaureate pharmacology offered by an accredited
college or university; or,
(B) Forty-five (45) contact hours [a contact hour
is fifty (50) minutes] of continuing education in
pharmacology, offered by an accredited college or
university, or sanctioned by a nationally recognized
continuing education accrediting body acceptable to
the Board; or,
(C) Three (3) graduate credit hours pharmacology
course included as part of an advanced practice nursing
education program.
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(4) Provide evidence of a minimum of one thousand
(1,000) hours of practice in an advanced practice nursing
category prior to application for prescriptive authority. The
1,000 hours shall not include clinical hours obtained in the
advanced practice nursing education program. The 1,000
hours shall include clinical hours completed and verified by
the collaborative physician within the past twenty-four (24)
months.
(5) Submit the nonrefundable processing fee with the
application for prescriptive authority.
(6) When approved, a new APRN license card will be
issued indicating prescriptive authority.
(7) Renewal of prescriptive authority will be part of
the APRN renewal process and no additional fee will be
assessed.
(b) Protocols for Prescriptive Authority. Protocols shall be
made available upon request of the Board. Such protocols shall,
at a minimum, include:
(1) Indications for and classifications of legend drugs,
controlled substances (if prescriber holds a DEA
registration number) and the therapeutic devices which will
be prescribed or administered by the APRN;
(2) Date the protocol was adopted or last reviewed,
which shall be at least annually.
(c) Prescribing Privileges.
(1) The APRN, applying for prescriptive authority,
shall acknowledge in the application that he/she is familiar
with Guam’s and federal laws and regulations regarding
prescribing; and shall agree to comply with these laws and
regulations.
(2) The APRN with prescriptive authority may receive
and prescribe legend drugs, medicines, diagnostic studies or
therapeutic devices appropriate to the APRN’s area of
practice. The prescriptive authority for controlled drugs
shall only extend to drugs listed in Schedules II through V.
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(3) Prescribing stipulations are as follows:
(A) Legend drugs, diagnostic studies and
therapeutic devices that are prescribed by the APRN
shall be included as outlined in the protocols section.
(B) Controlled substances (Schedule II – V),
defined by PL 24-149 and/or federal controlled
substances lists, will be prescribed, administered or
ordered as established in the protocols provided that
the APRN has an assigned DEA registration number
which is entered on each written prescription for a
controlled substance.
(C) The APRN shall file his/her DEA registration
number with the Board upon receipt.
(D) Advanced practice registered nurses shall not
delegate to unlicensed ancillary staff the calling in of
prescriptions to the pharmacy.
(4) The APRN may prescribe a legend drug, medicine,
diagnostic studies or therapeutic device not included in the
written protocols only as follows:
(A) Upon specific written or verbal order
obtained from the collaborating physician before the
prescription or order is issued by the APRN; and
(B) Include documentation of consultation as
described above in the client’s medical record to be
signed by the APRN;
(C) Schedule I controlled substance shall not be
prescribed under the APRN’s certificate of prescriptive
authority.
(5) The APRN shall note prescriptions on the client’s
medical record and include the following information:
(A) Medication and strength;
(B) Dose;
(C) Amount prescribed;
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(D) Directions for use;
(E) Number of refills; and
(F) Initials or signature of APRN.
(6) The Board shall be responsible for keeping an up-
to-date record, available to the public, of the APRNs
authorized to prescribe in Guam.
(7) Advanced practice registered nurses in the
category of certified registered nurse anesthetists shall not
be required to have prescriptive authority to provide
anesthesia care, including the administration of drugs or
medicines necessary for such care.
(d) Written Prescription Format.
(1) All written prescriptions issued by the APRN
shall contain the name of the client, the APRN’s name,
telephone number, signature with the appropriate
identifying initials prescribing identification number issued
by the Board, and should include information contained in
(c) (5) i-vi of this Article 5.
(2) All prescriptions for controlled substances shall be
written in accordance with federal regulations. The
APRN’s assigned DEA registration number shall be written
on the prescription form when a controlled substance is
prescribed.
(e) Receiving prepackaged drug samples.
(1) APRNs who have fulfilled requirements for
prescriptive authority may receive legend drugs samples
and therapeutic devices appropriate to their area of practice,
including controlled substances contained in Schedules II
through V of the Controlled Substance Act, which have
been prepared, packaged, or fabricated by a pharmaceutical
manufacturer in accordance with Guam Control Substance
Act, Pharmacy Practice Act, and their rules and regulations.
(2) Records must comply with all applicable federal
and Guam laws and regulations.
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(f) Termination of Prescriptive Authority. Prescriptive
authority may be terminated by the Board when the prescriber:
(1) Failed to maintain current active licensure as a
registered nurse and or as an APRN;
(2) Violates provisions of the Nurse Practice Act and
/or regulations established by the Board and/or Pharmacy
Practice Act and its administrative rules.
(3) Violates any of Guam’s or federal law or
regulations applicable to prescriptions; or
(4) Fails to follow any of the imposed conditions.
(g) Lapsed Prescriptive Authority.
(1) The authority to prescribe is automatically
terminated if the APRNs license is not renewed or placed in
an inactive status by the expiration date.
(2) Any licensee whose prescriptive authority has
lapsed or been inactive over a twenty-four month period
must submit to the Board:
(A) A new application for prescriptive authority
and a current license as an APRN;
(B) Evidence of a minimum of one thousand
(1,000) hours of practice in an APRN category prior to
application for prescriptive authority. The 1,000 hours
shall not include clinical hours obtained in the
advanced practice nursing education program. The
1,000 hours shall include hours completed within the
past twenty-four months and verified by the
collaborating physician.
(C) The non-refundable reinstatement fee.
(3) Any person engaged in practicing within the
scope of his or her certificate of prescriptive authority
during the time his or her APRN license has lapsed shall be
considered an illegal practitioner and is subject to the
penalties provided for violation of the Nurse Practice Act.
(h) Inactive Status.
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(1) A prescriptive authority will automatically be
considered lapsed and subject to the requirements of these
rules when a licensee places his or her APRN license in
inactive status.
(2) While the prescriptive authority or APRN license is
inactive, the licensee shall not engage in any practice within
the scope of an APRN with prescriptive authority.
(3) If the nurse desires to resume practice in Guam, he
or she shall request a reinstatement/renewal application,
which shall be completed and submitted with a renewal fee
or reinstatement fee. Fees are nonrefundable.
(4) All licensure requirements for
reinstatement/renewal shall apply.
(5) If disciplinary proceedings on an inactive licensee
have been initiated, the license shall not be re-
instated/renewed until the proceedings have been
completed.
§ 6508. Lost, Stolen or Destroyed License.
(a) A duplicate license shall be issued when the licensee
submits a notarized statement to the Board that the document is
lost, stolen, or destroyed, and pays a re-issuance fee.
(b) The license will be marked “duplicate” and date of
issuance noted.
§ 6509. Name or Address Change.
(a) A licensee whose name is legally changed shall be
issued a replacement license following submission of the current
license, along with an affidavit, copy of marriage license or court
action, and the required re-issuance fee.
(b) A licensee whose address changes from the address
appearing on the current license shall immediately notify the
Board of the change. The Board shall not issue a new license;
but shall make such changes in current license files.
§ 6510. Disciplinary Provisions.
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(a) The Board may deny licensure or re-licensure, revoke
or suspend licensure, place on probation and censure or
reprimand an APRN upon proof that the license holder has:
(1) Had a license to practice nursing revoked or
suspended or has been otherwise disciplined;
(2) Used the title APRN or any similar title or has
acted as an APRN without having obtained a license
pursuant to these rules and regulations.
(3) Directly or indirectly held or represented herself/
himself to the public as a physician, or as practicing
independently as a physician;
(4) Exceeded her/his authority as an APRN;
(5) Violated or cooperated in the violation of the laws
or regulations governing the practice of medicine, nursing
or APRNs;
(6) Become unable to practice with reasonable skill
and safety as the result of physical or mental illness or the
excessive use of alcohol, drugs, narcotics, chemicals or any
other substance;
(7) Violated or attempted to violate or has cooperated
with others in violating or attempting to violate any law or
regulations, territorial, state or federal, relating to the
possession, use, dispensing, administration or distribution of
drugs; or,
(8) Breached the approved agreements or protocols
contained therein.
(b) Hearing:
(1) The provision of the Administrative Adjudication
Law shall govern proceedings on questions of violation of
these regulations.
(2) The Commission on Licensure to practice the
Healing Art in Guam, as well as the collaborating
physician/agency, shall be notified promptly of any
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complaint filed with the Board against an APRN shall be
informed of any action taken by the Board.
(3) The Board shall conduct all hearings prescribed
herein and shall take action as appropriate.
§ 6511. Standards of Education for APRNs.
(a) The purpose, philosophy, and objectives of the program
of study shall be in written form and shall meet the following
criteria:
(1) Purpose - the purpose shall be the preparation of
registered nurses to provide primary health care.
(2) Philosophy - the philosophy shall be clearly
defined.
(3) Objectives - the objectives shall reflect the
philosophy, using behavioral terms, and describe the
theoretical knowledge and clinical competencies of the
graduates.
(b) The program of study shall be administered to ensure
that it will:
(1) Be conducted in conjunction with an institution of
higher education that offers a baccalaureate or higher degree
in Nursing, medicine or public health.
(2) Have admission requirements and policies for
withdrawal, dismissal and readmission clearly stated and
available to the student in written form.
(3) Have written policies that clearly inform applicants
of the academic status of the program (i.e., its
accreditation).
(4) Provide the graduates with official evidence
indicating that they have demonstrated clinical competence
in delivering primary health care and have achieved all
other objectives of the program.
(5) Maintain systematic, retrievable records of the
program including philosophy, objectives, administration,
faculty, curriculum, students, graduates, and transcripts. In
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case of program discontinuance, the Board shall be notified
of the method provided for record retrieval.
(6) Provide for program evaluation by faculty and
students during and following the program and make results
available for public review.
(c) There shall be an adequate number of qualified faculty
members to develop and implement the program and to achieve
the stated objectives.
(1) Each faculty member shall demonstrate current
competence in the area in which she/he teaches.
(2) The director or co-director and faculty of the
program shall meet the same requirements as those set for
school of professional nursing.
(3) Faculty in the theoretical portion of the program
shall hold a Master's or higher degree in the area in which
they teach.
(4) Clinical instructors shall hold a current Guam
Registered Professional Nurse License to practice their
profession, be licensed by the Board as APRNs or licensed
physician, and must demonstrate current clinical
competence.
(5) Clinical instructors shall participate in teaching,
supervising and evaluating students in areas pertaining to
their specialty.
(d) The curriculum of the program shall meet the
following criteria:
(1) The program shall include all theoretical and
clinical instruction necessary to enable the graduate to
provide primary health care for persons for whom she/he
will provide care.
(2) The program shall provide evaluation of previous
education and/or experience to primary health care for the
purpose of granting credit for meeting program
requirements.
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(3) Training for practice in an area of specialization
shall be broad enough to not only detect and control
presenting symptoms but to minimize the potential for
disease progression.
(4) Curriculum, course content, and plans for clinical
experience shall be developed through collaboration of the
total faculty.
(5) Curriculum, course content, methods of
instruction and critical experience shall he consistent with
the philosophy and objectives of the program.
(6) Outlines and descriptions of all learning
experiences shall be available, in writing, prior to
enrollment of students in the program.
(7) The program shall be a minimum of one academic
year in length. It may be full-time or part-time and shall be
comprised of not less than thirty (30) semester units or
forty-five (45) quarter units. It shall include theory and
planned clinical practice under the direction of a preceptor.
(8) The course of instruction shall be calculated
according to the following formula:
(A) One (1) hour of instruction in theory each
week throughout a semester or quarter, equal one (1)
unit/credit.
(B) Three (3) hours of clinical practice each
week throughout a semester or quarter equals one (1)
unit/credit.
(C) One (1) semester equals 16 to 15 weeks and
one (1) quarter equals 10 to 12 weeks.
(9) Following acquisition of basic theoretical
knowledge prescribed by the curriculum, the student shall
receive supervised experience and instruction in an
appropriate clinical setting.
(10) The duration of clinical experience and the setting
shall be such that the student will receive intensive
experience in performing the diagnostic and treatment
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procedures essential to the practice for which the student is
being prepared.
(11) The program shall have responsibility for
arranging the supervised clinical instruction of the student.
(12) The curriculum shall include, but is not limited to,
the following courses which shall be relevant to the practice
of the APRN in the specialized field:
(A) Normal growth and development
(B) Pathophysiology
(C) Interviewing and communication skills
(D) Eliciting, recording and maintaining a
developmental health history
(E) Comprehensive physical examination
(F) Psychosocial assessment
(G) Interpretation of laboratory findings
(H) Evaluation assessment data to define health
and developmental problems
(I) Pharmacology
(J) Nutrition
(K) Disease management
(L) Principles of health maintenance
(M) Assessment of community resources
(N) Initiating and providing emergency
treatments
(O) Practitioner role development
(P) Instruction in legal ethical and professional
responsibilities of an APRN
(Q) Health care delivery systems
(R) Supervised clinical practice of those skills
essential for the APRN in the specialized field
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(13) The course of instruction of a program conducted
in a nonacademic setting shall be equivalent to that
conducted in an academic setting.
(14) Major curriculum changes must first be approved
by the Board.
(e) Continued approval/withdrawal of approval of a
program shall be governed by the requirements set forth in
Article 6, Nursing Education.
---------
ARTICLE 6
NURSING EDUCATION
SOURCE: Rules establishing the board were filed with the Legislative
Secretary on December 31, 1986. Entire chapter repealed and adopted by
P.L. 29-071:1 (May 7, 2008).
§ 6601. Legal Authorization.
§ 6602. Purpose of Nursing Education Standards.
§ 6603. Nursing Education Standards.
§ 6604. Required Criteria for Nursing Education Programs.
§ 6605. Approval of Nursing Education Programs.
§ 6606. Revocation of Approval.
§ 6607. Reinstatement of Approval.
§ 6608. Voluntary Discontinuance of an Approved Nursing
Education Program.
§ 6609. Re-opening Programs of Professional Nursing.
§ 6610. Program Changes Requiring Board Notification
and/or Approval.
§ 6611. List of Approved Schools of Nursing.
§ 6612. Records.
§ 6613. Student Records.
§ 6614. Faculty File Records.
§ 6615. Evaluations.
§ 6616. School Bulletins or Catalogues.
§ 6617. Continuing Education.
§ 6618. Advisory Committee.
§ 6619. School Offices.
§ 6620. Nurse Assistant Educational Programs.
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§ 6621. Requirements for Establishing a Nurse Assistant
Program.
§ 6622. Approval of a Nurse Assistant Program.
§ 6623. Conditional Approval.
§ 6624. Personnel Requirements for a Nurse Assistant
Program.
§ 6625. Instruction Requirements for Nurse Assistant
Programs.
§ 6626. Unit Objectives for a Nurse Assistant Program.
§ 6627. Characteristics of a Nurse Assistant Graduate.
§ 6628. Records of an Approved Nurse Assistant Program.
§ 6629. Faculty Records.
§ 6630. Evaluations.
§ 6631. Revisions of an Approved Nurse Assistant Program.
§ 6632. Revocation of Approval of an Approved NA
Program.
§ 6633. Voluntary Discontinuation of an Approved NA
Program.
§ 6634. Reinstatement of Full Approval.
§ 6635. Re-Opening of NA Programs.
§ 6601. Legal Authorization.
Title 10 Guam Code Annotated, Sections 12307 and 12321,
authorizes the Board of Nurse Examiners to adopt administrative
rules and regulations which establishes standards concerning
approval of practical nursing, basic and advanced nursing
education/training programs on Guam.
§ 6602. Purpose of Nursing Education Standards.
(a) To ensure that graduates of nursing education
programs are prepared for safe and effective nursing practice.
(b) To establish criteria for the development, evaluation and
improvement of new and existing nursing education programs.
(c) To assure candidates are educationally prepared for
licensure and recognition at the appropriate level and to facilitate
their licensure by endorsement in other jurisdictions.
§ 6603. Nursing Education Standards.
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All nursing education programs shall meet these standards:
(a) The purpose and outcomes of the nursing program
shall be consistent with the Nurse Practice Act and Board-
promulgated administrative rules, regulations and other
relevant state statutes.
(b) The purpose and outcomes of the nursing program
shall be consistent with generally accepted standards of
nursing practice appropriate for graduates of the type of
nursing program offered.
(c) The input of consumers shall be considered in
developing and evaluating the purpose and outcomes of the
program.
(d) The nursing program shall implement a
comprehensive, systematic plan for ongoing evaluation that
is based on program outcomes and incorporates continuous
improvement.
(e) The curriculum shall provide diverse didactic and
clinical learning experiences consistent with program
outcomes.
(f) Faculty and students shall participate in program
planning, implementation, evaluation, and continuous
improvement.
(g) The nursing program administrator shall be a
professionally and academically qualified registered nurse
with institutional authority and administrative responsibility
for the program.
(h) Professionally, academically and clinically
qualified nurse faculty shall be sufficient in number and
expertise to accomplish program outcomes and quality
improvement.
(i) The fiscal, human, physical, clinical and technical
learning resources shall be adequate to support program
processes, security and outcomes.
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(j) Program information communicated by the nursing
program shall be accurate, complete, consistent and readily
available.
§ 6604. Required Criteria For Nursing Education Programs.
(a) The organization and administration of the nursing
education program shall be consistent with the laws governing
the practice of nursing. The nursing education program shall be
an integral part of a governing academic institution that is
accredited by a body recognized by the U. S. Secretary of
Education, or other accrediting organization acceptable to the
Board.
(b) The following minimal criteria serve to support
implementation of the nursing education standards:
(1) Evaluation: A comprehensive nursing education
program self-evaluation shall be performed and submitted
to the Board annually for quality improvement and shall
include but not be limited to:
(A) Students’ achievement of program outcomes.
(B) Evidence of adequate program resources
including fiscal, physical, human, clinical and technical
learning resources; and the availability of clinical sites
and the viability of those sites to meet the objectives of
the program.
(C) Multiple measures of program outcomes for
graduates. Examples of measures include NCLEX
pass rates, student and/or employer survey, and
successful completion of national certification
programs.
(D) Evidence that accurate program information
for consumers is readily available. Examples of
information include fees and admission criteria, which
can be made available by oral, written and electronic
means.
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(E) Evidence of support for the program
outcomes from the head of the academic institution and
its administration.
(F) Program administrator and program faculty
who meet Board qualifications and are sufficient in
number to achieve program outcomes.
(G) Recruitment.
(H) Faculty changes.
(I) Curriculum changes.
(J) Changes in use of clinical facilities.
(K) Evidence that the academic institution
assures security and confidentiality of student
information.
(L) Any other information that may be required
by the Board.
(2) Curriculum:
(A) The curriculum of the nursing education
program shall enable the student to develop nursing
knowledge, skills and competencies necessary for the
level, scope and standards of nursing practice
consistent with the level of licensure.
(B) The curriculum shall reflect the philosophy of
the organization, conceptual framework, purpose and
objectives of the nursing education program.
(C) Faculty members shall be responsible for the
development, implementation, and evaluation of the
curriculum. Part-time and non-nursing faculty
members may be utilized as desired within their area of
expertise.
(D) There shall be measurable objectives for each
nursing course that reflect the philosophy and
objectives of the educational program.
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(E) Related clinical experiences shall be provided
concurrently with theory.
(F) The ratio between nursing and non-nursing
credit shall be based on a rationale to ensure sufficient
preparation for the safe and effective practice of
nursing.
(G) There shall be a general plan of the total
curriculum, showing the sequence of courses and
clinical experiences, as well as the number of hours
allotted to class and clinical experiences.
(H) When credit for courses is shown in terms of
credit hours, the school shall provide the Board the
means to interpret the credit hours used.
(I) Current course outlines shall be on file at the
school and Board office. They shall include:
requirements of the course, expected outcomes,
content, suggested learning experiences, methods of
teaching, method of evaluation, reference list of texts
utilized.
(J) The minimum length of an educational
program preparing professional nurses shall be two
years for an Associate Degree program and four years
for a Baccalaureate of Science in Nursing Program.
(K) The minimum length of an educational
program preparing practical nurses shall be one
academic year in a Practical Nurse program or two
academic years in an Associate Degree Program.
(L) The minimum curriculum shall include:
(i) Content regarding legal and ethical issues,
history and trends in nursing and health care,
fundamentals of nursing and professional
responsibilities;
(ii) Experiences that promote the
development of clinical judgment, leadership and
management skills, and professional socialization
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consistent with the scope of practice and level of
licensure/certification. This includes
demonstration of the ability to supervise others
and provide leadership of the profession.
(iii) Learning experiences and methods of
instruction, including distance education methods,
consistent with the written curriculum plan; and
(iv) Coursework in the following areas of
study:
(aa) Scientific understanding: Subject
matter in this area shall include anatomy and
physiology, chemistry, microbiology,
pharmacology and nutrition. This area shall
serve as a foundation for nursing practice.
The principles learned shall be applied
throughout the program.
(bb) Social Sciences: Subject matter in
this area shall include content drawn from
psychology, sociology, growth and
development, and mental health.
(cc) Didactic content and supervised
clinical experience in the prevention of
illness and the promotion, restoration, and
maintenance of health in clients across the
lifespan and in a variety of clinical settings to
include:
(1) Using informatics to
communicate, manage knowledge,
mitigate error and support decision
making
(2) Employing evidence-based
practice to integrate best research with
clinical expertise and client values for
optimal care, including skills to identify
and apply best practices to nursing care.
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(3) Providing client-centered,
culturally competent care.
(4) Working in interdisciplinary
teams to cooperate, collaborate,
communicate and integrate client care
and health promotion.
(5) Participating in quality
improvement processes to measure
client outcomes, identify hazards and
errors, and develop changes in processes
of client care.
(6) Subject matter that include
medical-surgical nursing, community
health, nursing leadership, maternal and
newborn nursing, nursing of children,
and psychiatric-mental health nursing.
(M) Supervised clinical practice shall include
development of skill in making clinical judgments,
management and care of groups of clients, and
delegation to and supervision of other health care
providers.
(i) Clinical experience shall be comprised of
sufficient hours to meet these standards, be
supervised by qualified faculty and ensure
students’ ability to practice at an entry level.
(ii) All student clinical experiences,
including those with preceptors, shall be directed
by nursing faculty.
(iii) All experiences of students in the clinical
setting shall be under the direct supervision of a
faculty member who shall have no other
responsibilities during the period of such
supervision.
(iv) There shall be no more than ten (10)
students for every faculty member in the clinical
area.
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(N) Delivery of instruction by distance education
methods must be consistent with the program
curriculum plan including supervised clinical practice
pursuant to section 6604 (b)(2)(M) above, and enable
students to meet the goals, competencies, and
objectives of the educational program and standards of
the Board.
(3) Student Policies will include:
(A) Students shall be admitted without
discrimination as to age, creed, ethnic origin, marital
status, race, or sex.
(B) Students shall be provided the opportunity to
acquire and demonstrate the knowledge, skills, and
abilities for safe and effective nursing practice, in
theory and clinical experience with faculty oversight.
(C) All policies relevant to applicants and
students shall be available in writing.
(D) Students shall be required to meet health
standards.
(E) Students shall be required to submit recent
criminal background checks.
(F) Students shall receive faculty instruction,
advisement and oversight.
(G) Students shall be held accountable for the
integrity of their work.
(H) Students shall have the opportunity to
participate in the development, conduct, and evaluation
of the nursing education program.
(I) The number of students to be admitted to the
program is determined by the size of the faculty, and
the availability of clinical and other educational
resources.
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(J) Students shall be required to maintain a level
of personal health that does not jeopardize the welfare
of clients.
(K) Counseling and guidance shall be made
available to all students in the nursing program.
(4) Administrative and Instructional Personnel:
(A) Every program must employ a sufficient
amount of full-time faculty members to plan,
implement, and evaluate the instructional program. The
number of faculty shall be determined by the number
of students enrolled, classes admitted per year,
programs, clinical facilities used and activities for
which faculty are responsible.
(B) There shall be at least one qualified nursing
administrator (an associate or assistant administrator as
needed), for each nursing education program. In
institutions that offer nursing education programs for
more than one level of preparation and where the scope
of administrative responsibility so requires, there shall
be an individual administrator for each nursing
education program.
(C) Every nursing education program shall
maintain and file with the Board the following items:
(i) A statement regarding the qualifications,
rights, and responsibilities of faculty members.
(ii) Faculty personnel policies concerning
evaluation of performance, promotion, and tenure.
(iii) Job description and terms of
employment for all faculty members and
administrators.
(iv) A statement regarding the percentage of
time to be allowed the nursing education
administrator to carry out administrative
responsibilities.
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(v) A statement assuring that instructional
assignments of the administrator are consistent
with the governing policies of the parent
institution.
(vi) A statement regarding faculty workload
that shall provide for equitable distribution of
workload among faculty members and adequate
time for class and laboratory preparation,
teaching, curriculum revision, improvement of
teaching methods, guidance of students,
participation in faculty organization and
committees, attendance at professional meetings,
participation in continuing education activities,
research, and community service.
(D) There shall be sufficient secretarial and
clerical staff, and supporting services to maintain
records, file correspondence and do support work for
faculty and administrative personnel. Persons who
provide supporting services shall be responsible to the
Director of the nursing education program.
(5) Administrator Qualifications:
(A) The qualifications for the Director of Nursing
in a program preparing for practical nurse licensure
shall include:
(i) A current, active and unencumbered
registered nurse license on Guam.
(ii) Must possess both a Bachelor’s degree in
nursing and a Master’s degree in nursing.
(iii) Educational preparation and at least two
years of experience in teaching and learning
principles for adult education, including
curriculum development and administration, and
at least four years of clinical experience; and
(iv) Current knowledge of nursing practice.
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(B) The qualifications for the Director of Nursing
in a program preparing for registered nurse licensure
shall include:
(i) A current, active and unencumbered
registered nurse license on Guam.
(ii) A Bachelor’s degree in nursing and a
Master’s degree in nursing and an earned doctoral
degree in nursing or a related field;
(iii) Have additional professional
qualifications in nursing administration,
leadership, curriculum development, research,
teaching and evaluation. These qualifications shall
have been attained in a baccalaureate and/or
higher degree nursing program;
(iv) Have at least four years experience in
professional nursing practice and
(v) Have current knowledge of registered
nursing practice.
(6) Faculty:
(A) There shall be sufficient number of qualified
faculty to meet the objectives and purposes of the
nursing education program.
(B) The nursing faculty shall hold a current,
active, and unencumbered registered nurse license on
Guam.
(C) Evidence that the faculty has maintained
competence through such activities as continuing
education programs, conferences, workshops,
seminars, academic courses, research projects, and
professional writings.
(D) Qualifications for nursing faculty who teach
in a program leading to licensure for Practical Nurse
(PN):
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(i) Have a minimum of a baccalaureate
degree with a major in nursing and preferably a
Master’s degree with a major in nursing or a
nursing Doctorate degree;
(ii) Have at least four years of professional
nursing practice of which two years must have
been within the previous five years;
(iii) Current evidence of preparation in
teaching and learning principles for adult
education.
(iv) Experience in curriculum development
and implementation is preferred.
(v) Have current knowledge of licensed
practical nursing practice.
(E) Qualifications for nursing faculty who teach
in a program leading to licensure for Registered Nurse
(RN):
(i) Have a minimum of a Master’s degree
with a major in nursing or a nursing Doctorate and
preferably an earned doctorate related to nursing
education and/or the specific content area that the
individual teaches.
(ii) Have at least four years of professional
nursing practice of which two years must have
been within the previous five years;
(iii) Current evidence of preparation in
teaching and learning principles for adult
education.
(iv) Experience in curriculum development
and implementation is preferred.
(v) Have current knowledge of registered
nursing practice.
(F) Adjunct clinical faculty employed solely to
supervise clinical nursing experiences of students shall
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have at least five years of professional nursing practice
of which two years must have been within the previous
five years.
(G) Clinical preceptors shall have demonstrated
competencies related to the area of assigned clinical
teaching responsibilities and will serve as a role model
and educator to the student. Clinical preceptors may be
used to enhance faculty-driven clinical learning
experiences. Clinical preceptors shall be licensed as a
nurse at or above the level for which the student is
preparing.
(H) Faculty members who do not meet
qualifications: A nursing education program may
appoint a faculty member who does not meet all of the
above qualifications if it submits to the Board, within
four weeks after the appointment, a plan agreed upon
by the nursing program and the faculty member for
meeting the above requirements. This plan must be
approved by the Board and shall indicate how the
faculty member intends to meet the requirements and
the time frame in which he/she will do so. In its annual
report to the Board, the nursing program shall present
evidence concerning the faculty member’s attainment
of the qualifications.
(7) Responsibilities of Administrative and Instructional
Personnel.
(A) The Director of each program shall be
responsible to the governing institution and shall:
(i) Prepare and administer the program’s
budget.
(ii) Screen and recommend candidates for
faculty appointments, retention, tenure, and
promotion.
(iii) Develop and supervise the program.
(iv) Develop and maintain satisfactory
relationships with the governing institution, other
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programs, cooperating agencies, and community
groups.
(v) Organize and administer the program by
having:
(aa) The relationship between the
faculty and the Director clearly defined.
(bb) Appropriate distribution of the
workload.
(cc) Provision for regularly scheduled
meetings available for reference
(vi) Create and maintain an environment
conducive to teaching, learning, scholarly pursuits
and the sharing of faculty expertise through
involvement in professional and community
activities.
(vii) Facilitate and coordinate activities
related to academic policies, personnel policies,
curriculum, resource facilities and services, and
program evaluation.
(B) The faculty of each nursing education
program shall assist and advise the Director in all
matters regarding:
(i) Development, implementation, and
evaluation of the philosophy and objectives of the
program.
(ii) Development, implementation, and
evaluation of the curriculum.
(iii) Budget preparation and administration.
(iv) Development of criteria for student
admission, progression, and graduation.
(v) Selection, assignment, and supervision of
clinical learning experiences.
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(vi) Evaluation of student achievement on the
basis of curriculum objectives as related to both
nursing knowledge and practice.
(vii) Academic guidance and counseling of
students.
(viii) The activities of the total faculty of the
parent institution in ways that benefit the
institution, the program of nursing, and the
faculty.
(ix) Maintenance and improvement of their
nursing competence in areas outside of teaching.
(x) Development of effective working
relationships between students and clinical
facilities.
(xi) Professional and community activities
for the purpose of bringing education, service, and
research findings together for the improvement of
health care.
(xii) Screening and recommending
candidates for faculty appointments, retention,
tenure, and promotion.
(C) Part-time faculty members, guest lecturers,
and others who contribute to the education of students
on a part-time basis shall be utilized in accordance with
the policies of the parent institution.
(8) Admission Requirements:
(A) Applicants to an approved nursing education
program shall meet the admission requirements of the
governing institution.
(B) The program’s faculty shall be responsible for
developing admission policies in keeping with the
admission requirements of the governing institution.
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(C) The Admission requirements shall be printed
in at least one school document in accordance with
institutional policies.
(9) Special Admissions. Every nursing program shall
maintain specific written policies for advanced standing
challenge examinations, transfer of courses and readmission
of students, which shall provide that:
(A) A student requesting admission to a program
from another approved nursing program, or requesting
readmission to the program, shall meet the program’s
current standards for the regularly enrolled students;
(B) The programs faculty shall determine the
amount of course credit to be allowed a transfer
student;
(C) A program may permit student to shorten the
time period for fulfillment of academic requirements
only according to a written plan which has been
mutually agreed upon by the student and approved by
the Board;
(D) A minimum of one school year shall be spent
in the school of professional nursing granting the
diploma or degree. A minimum of four months shall be
spent in the school of practical nursing granting the
diploma or degree. The student during this period shall
gain an understanding of the philosophy, objectives,
and conceptual framework of the nursing program; and
(E) The transfer student’s official record shall
indicate which courses he/she was given advanced or
transfer credit for, the nursing courses it is equivalent
to, and the amount of credit(s) given.
(10) Promotion, Continuation and Graduation. Each
program shall maintain written policies regarding:
(A) The level of achievement required for a
student to remain in the school or to progress from one
level to another;
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(B) Absence from class;
(C) The requirements of each course; and,
(D) The requirements for graduation.
(11) Termination. Every program shall maintain
written policies on resignation, suspension, and dismissal of
students as well as a written grievance policy, which
protects the rights of both the student and the school.
§ 6605. Approval of Nursing Education Programs.
Programs recognized by the Board shall have the status of
either Initial Approval, Full Approval, Continuation of Full
Approval, or Conditional (Probational) Approval.
(a) Initial Approval:
(1) Initial Approval constitutes an authority for a
new program to admit students and to enter into written
agreements with clinical sites. Initial Approval must be
given before the new program admits students and
shall continue unless revoked by the Board or until the
Board grants Full Approval. Initial Approval is subject
to the following:
(2) An institution desiring to establish a program
of nursing education shall send a Letter of Intent to the
Board prior to submitting a completed proposal.
(3) The proposal shall include:
(A) Results of a needs assessment, including
identification of potential students and
employment opportunities for program graduates;
(B) Evidence that the program will meet
professional nursing needs and has community
support;
(C) Philosophy and objectives of the
program. Descriptions shall include terminal
objectives which identify behaviors expected of
the graduates at completion of the program;
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(D) Copies of the governing institution’s
charter or articles of incorporation authorizing the
institution to conduct the nursing program;
(E) A description and organization chart of
the governing institution and the nursing program;
(F) Corporate balance sheets, financial
statements, documents describing funding
sources, and all other documents describing the
institution’s finances;
(F) Positions, qualifications, and duties of the
nursing faculty;
(G) Availability of qualified faculty;
(H) A description of the clinical facilities to
be used by the students and evidence of
availability of resources;
(I) Proposed curriculum to include:
(i) Content
(ii) Schedule (course sequence)
(iii) Course descriptions
(iv) Program evaluation plan
(v) Course syllabi
(J) Proposed number of students and faculty;
(K) Scholastic standards to be met by the
students;
(L) Student policies for admission,
progression, retention and graduation.
(M) A description of the program’s
provisions for health and welfare of the students;
(N) A proposed timeline for initiating and
expanding the program, and
(O) Any other information requested by the
Board.
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(4) Before establishment of a new nursing
education program, the institution shall employ a
Registered Nurse (RN) Director for the proposed
program for at least one (1) year.
(5) A Board member and/or representative of the
Board shall make a general survey/site visit to the
proposed new program and submit in writing to the
Board the following:
(A) Justification for the establishment of the
nursing education program.
(B) Accreditation status/licensing of the
institution and the proposed clinical facilities.
(C) Evaluation of the clinical resources and
the program’s physical facility and availability of
qualified instructional personnel.
(6) Upon submission of the evaluative report and
prior to implementation of the program. The Board, at
a scheduled meeting, shall consider the proposal, the
report of the survey, and such other information as may
be presented to the Board. The Board shall determine if
all components and processes are completed and in
place. The Board shall determine if the program is
granted Initial Approval. Within fifteen days of the
Board’s determination, the Board will notify the
program of its decision in writing.
(7) After initial approval is granted, the Director
of the program shall submit 12 copies of an Annual
Report to the Board by June 30 of each year regardless
of the program’s status. Refer to section 6604(b)(1)(A-
L), for Evaluation requirements.
(8) The nursing program shall be evaluated by the
Board after the first class of students has graduated and
the scores for the licensing examination have been
reviewed. The Board shall determine if the program
continues to meet Board standards, and is therefore
eligible to apply for Full Approval.
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(9) Initial Approval shall NOT exceed beyond the
second (2
nd
) class of graduates.
(b) Full Approval:
(1) The Board may grant Full Approval and an
annual Continuation of Full Approval status to a
nursing program.
(2) The program shall apply within six (6) months
after eligibility for Full Approval has been determined
by the Board.
(3) Application for Full Approval shall include the
following:
(A) Submission of the program’s annual
reports;
(B) Submission of the Self-Evaluation report
which addresses compliance with these standards
and regulations, success rate of the graduates on
the national licensure examination, and the
ongoing evaluation plan and data;
(C) Evidence that the authorities responsible
for the administration of the school allocate funds
to enable the school to achieve its stated
objectives and to comply with the requirements of
the Board;
(D) Evidence that the Director of the
program and faculty participate in the preparation
of the budget for the school and that the Director
administers the budget; and,
(E) A site visit assessment made by a Board
member(s) or its representatives.
(4) Failure to apply for Full Approval may result
in the Board initiating the revocation process.
(5) The Board shall determine adherence of the
criteria and may grant Full Approval status within 60
days of the institution’s application for Full Approval.
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(6) The Board shall notify the institution, in
writing, within 15 days of its decision to grant Full
Approval.
(7) The Board may request periodic reports from
the new program regarding initial program operations
before granting approval.
(c) Continuation of Full Approval:
(1) The Board shall periodically hire a qualified
consultant, not associated with the Board or local
nursing programs, to evaluate and report to the Board
in writing on the continued compliance of the
established criteria by the approved programs.
(2) The Board shall forward a notice of a survey
site visit to the nursing programs at least thirty (30)
days prior to the scheduled site visit.
(3) The consultant shall assess each program on
dates mutually acceptable to the Board and the
Director of the program:
(A) At least once every four years for
professional nursing programs.
(B) At least once every two years for
practical nursing and nurse assistant programs.
(4) The Director of the program shall provide a
copy of the self-evaluation report and a copy of the
nursing program’s catalog to the Board for each of the
site visitors. An interim summary report may be
requested between survey site visits as the Board
deems necessary.
(5) The Board shall retain a copy of the
consultant’s report in the office of the Board.
(6) The Board shall issue an annual Certificate of
Continuation of Full Approval to nursing programs that
meet the standards set forth herein based on the
following criteria:
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(A) Submission of the program’s annual
report;
(B) Information obtained by the Board’s
professional staff and/or representatives through
consultation and site visits;
(C) A minimum success rate of 75% on the
national licensing examination achieved by the
program’s first-write graduates of the PN and RN
programs and 80% for the Nurse Assistant
programs.
(D) Evidence that the authorities responsible
for the administration of the school allocate funds
to enable the school to achieve its stated
objectives and to comply with the requirements of
the Board;
(E) Evidence that the Director of the program
and faculty participate in the preparation of the
budget for the school and that the Director
administers the budget; and,
(F) Accreditation visits and reports such as
the National League of Nursing (NLN) and
Western Association of Schools and Colleges
(WASC).
(d) Conditional (Probational) Approval. Conditional
Approval will be subject to the following:
(1) Nursing education programs having Initial or
Full Approval that fail to meet the standards
established by the Board may be placed on Conditional
(Probational) Approval status. The Board may
establish such conditions and requirements as it sees fit
to ensure compliance within a reasonable time frame
not to exceed two years.
(2) The Board shall inform the program in writing
of its Conditional (Probational) Approval status and the
rationale for such action. One of more of the following
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reasons shall warrant a determination of Conditional
(Probational) Approval:
(A) Failure to submit the required Annual
Reports to the Board.
(B) Failure to adhere to the program’s stated
philosophy and curriculum objectives, and
repeated violations of stated academic and/or
admission policies.
(C) Failure to employ and retain an
administrator and faculty of adequate size and
qualification.
(D) Failure to admit and retain students.
(E) Utilization of nursing students for
nursing service or other purposes whose objective
is not primarily educational.
(F) Failure to provide adequate learning
resources for cognitive and classroom learning
and clinical practice.
(G) Discrimination against faculty, students,
or prospective students on the basis of race, sex,
creed, national origin or handicaps irrelevant to
the practice of nursing.
(H) Two consecutive letters of warning
issued by the Board to the school because 25% or
more of its graduates failed to pass the national
licensing examination.
(I) Any other deficiency that, in the opinion
of the Board, detrimentally affects the educational
process.
(3) The Board may require that the program
submit special progress and/or consultant reports as a
condition to acquiring Full Approval status or take
other reasonable steps to monitor the program status
and determine if the deficiencies are being corrected.
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(4) Conditional Approval shall not exceed two
consecutive years.
§ 6606. Revocation of Approval.
(a) The Board may initiate a revocation process for due
cause in accordance with the Administrative Adjudication Law.
(b) Grounds for withdrawal/revocation of a Full Approval
status may include but are not limited to the following:
(1) Substantial noncompliance with the standards set
forth in these administrative rules and regulations;
(2) Failure to resolve/clear the Conditional
(Probational) Approval status beyond the acceptable two (2)
consecutive years;
(3) Failure to comply with the standards and
requirements imposed by the Board within the time period
established.
(c) The nursing program will have ten (10) days to submit
to the Board a written request for a hearing. The written request
shall include supporting documents and other the materials to be
presented in the hearing. Failure to submit the written request
shall be cause for denial for a hearing.
(d) Admission of new students to the program during this
period is prohibited.
(e) Nursing programs without Full Approval or
Continuation of Full Approval status shall be removed from the
official Board approved listing.
(f) Upon notice of revocation from the Board, the governing
institution shall provide:
(1) Assistance to students desiring to transfer to
another nursing program; and,
(2) The Board a list of the names of students who
have transferred to other approved programs within six
months after the revocation.
§ 6607. Reinstatement of Approval.
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The Board shall reinstate Full Approval for a program on
conditional approval if the program submits evidence that the
program has met the standards set forth herein and has complied
with the requirements the Board has imposed on it. The
procedure for reinstatement is the same as for Full Approval.
§ 6608. Voluntary Discontinuance of an Approved Nursing
Education Program.
(a) The governing institution that desires to voluntarily
close its nursing education program shall:
(1) Notify the Board in writing, stating the reasons for
closure, the intended date of closure, and the plan for
closure.
(2) Maintain the records of the students and graduates
and shall advise the Board in writing of the arrangements
for safeguarding and maintaining the records. The plan
adopted by the governing institution for closing its program
shall ensure that:
(b) The plan for closure shall ensure that the standards for
Approval shall continue to be met until all of the students have
graduated or been transferred.
(c) The effective closing date of the program shall be the
date of the degree, diploma or certificate of the last class of
graduates or, the date on which the last student was transferred.
(d) The governing institution shall provide:
(1) Assistance to students desiring to transfer to
another program.
(2) The Board a list of students who transferred to
other approved nursing programs within thirty (30) days of
the last transfer.
§ 6609. Reopening Programs of Professional Nursing.
The procedure for reopening a program of professional
nursing is the same as for Initial Approval.
§ 6610. Program Changes Requiring Board Notification
and/or Approval.
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(a) Any of the following major program changes requires
Board approval and shall be submitted along with the description
of the change(s) to the Board in writing at least six months prior
to the proposed change:
(1) Curriculum changes or course content and
description;
(2) Integration of courses;
(3) The length of the program;
(4) Governing institution;
(5) Educational or clinical facilities;
(6) Projected increase in the ratio of students to faculty
which exceeds the ratio approved by the Board; or,
(7) Closing of the program.
(b) Any of the following program changes requires Board
notification and shall be submitted to the Board in writing:
(1) The program’s or institution’s name;
(2) Proposal for pilot project(s);
(3) Faculty membership; or,
(4) Any other item of information required of programs
seeking accreditation.
§ 6611. List of Approved Schools of Nursing.
The Board shall maintain a current list of ALL Board
approved schools of nursing and nurse assistant educational
programs in Guam.
§ 6612. Records.
(a) The nursing education program shall maintain an
accurate and complete system of records which shall:
(1) Be safely stored to prevent loss, destruction or
unauthorized use; and,
(2) Be available to the faculty.
(b) Records shall include:
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(1) Course outlines
(2) Minutes of faculty and committee meetings
(3) Pertinent correspondence
(4) Reports of standardized tests
(5) Reports of the program
(6) Reports from territorial, regional and national
accrediting bodies
(7) Fiscal accounting records
(8) Program bulletins
(c) Be available to the Board during evaluation visits.
§ 6613. Student Records.
(a) Each nursing education program shall maintain a file
on each student which must include:
(1) The student’s application, health record, high
school transcript or a copy of high school equivalency or
achievement and performance evaluations.
(2) A final or current record/transcript.
(3) Student evaluations.
(b) Student files shall be made available to the Board
during evaluation visits.
§ 6614. Faculty File Records.
Records shall be kept current and shall include:
(a) Curriculum vitae (filed with the Board upon
employment and upon revision).
(b) Job descriptions and terms of employment.
(c) Evidence of appropriate educational degree for the
level of the nursing program.
(d) Evidence of continuing education activities.
(e) Evidence of membership and participation in
relevant professional and community activities.
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(f) Evidence of a current Guam RN license.
(g) Evidence of current and completed faculty
evaluations.
§ 6615. Evaluations.
(a) Written evaluations of students, which shall include
academic achievement and clinical performance, shall be made
by the faculty following the conclusion of each course. Students
shall be allowed to participate in their evaluations.
(b) Written evaluations of each course shall be made by
the students and the faculty following the conclusion of each
course.
(c) Written performance evaluations of the faculty shall be
made annually by the Director and the students of the program.
(d) A systematic program evaluation of the total nursing
program shall be made by the faculty biannually to appraise the
following:
(1) Evidence of implementation of the stated
philosophy, objectives, and conceptual framework of the
program;
(2) Achievement of graduates on National Council
Licensing/Certification Examination; and,
(3) Professional performance of graduates.
(e) Written evaluations of the current Program Director
§ 6616. School Bulletins or Catalogues.
The nursing education program shall maintain written
bulletins or catalogues which shall include information
pertaining to:
(a) Policies regarding admission, attendance,
progression, and graduation of students;
(b) The nature, philosophy, and objectives of the
governing institution and the nursing program; curriculum
plan; course description; list of courses to be taken and
proposed schedule; and faculty staff roster;
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(c) School’s grievance policy;
(d) Policy statement that addressing discrimination of
students or employees on the basis of age, creed, ethnic
origin, marital status or gender;
(e) Fees, expenses and financial aid;
(f) Educational facilities;
(g) Living accommodations;
(h) Student activities and services.
§ 6617. Continuing Education.
Continuing education courses offered shall meet the criteria
and guidelines developed by a National Continuing Education
approving organizations.
§ 6618. Advisory Committee.
All nursing programs approved by the Board shall have an
advisory committee which meets at least two (2) times during the
school year whose major function shall be advisory and
supportive. There shall be written rules describing its purpose,
objectives, function, structure, and membership. Minutes of all
its meetings shall be on file in the administrative records of the
governing facility.
§ 6619. School Offices.
The Director of a program shall have an office which will
provide privacy for work and individual conferences. Faculty
members shall be provided with offices which shall be accessible
to students and convenient to classrooms.
§ 6620. Nurse Assistant Educational Program.
The nurse assistant educational program shall prepare
students to function in the role of nurse assistants under the
supervision of a registered nurse. The nurse assistant shall be
able to perform basic, non-invasive nursing procedures in a
variety of settings.
§ 6621. Requirements for Establishing a Nurse Assistant
Educational Program.
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To establish a Nurse Assistant educational program, the
institution shall have employed a Registered Nurse (RN)
Director for the proposed program for at least one (1) year.
(a) Application to the Board. The program provider
shall submit an application with a Letter of Intent to the
Board at least Ninety (90) days in advance of the expected
opening date. The Application and Letter of Intent shall
include, but not be limited to:
(1) Results of a needs assessment, including
identification of potential students and employment
opportunities for program graduates;
(2) Identification of sufficient financial and other
resources;
(3) Governing institution approval and support;
(4) Description and organizational chart of the
governing institution and nurse assistant program;
(5) Community support;
(6) Type of Nurse Assistant educational program
proposed;
(7) Student policies for admission, progression,
retention and graduation;
(8) Philosophy, conceptual framework and
objectives of the program. Description shall include
terminal objectives which identify behaviors expected
of the graduates at the completion of the program;
(9) Content of educational program to be offered;
(10) Total number of hours of theoretical,
laboratory and clinical instructions;
(11) The behavioral objectives of each module of
instruction;
(12) The methods of instruction to be used to
teach each module;
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(13) The methods to be used to evaluate the
achievement of behavioral objectives;
(14) A description of the facilities to be used for
theoretical, laboratory and clinical instructions;
(15) Clinical opportunities and availability of
qualified faculty;
(16) Proposed timeline for initiating and
expanding the program; and,
(17) Any other information requested by the
Board;
(18) The application shall be accompanied by all
applicable fees.
(2) When the Board evaluates the application and
determines that all components are complete and in place,
the Board shall notify the institution of its decision of Initial
Approval in writing for the institution to establish the
proposed Nurse Assistant educational program and admit
students into the program.
(3) If the application to establish a Nurse Assistant
program is disapproved, the program provider may request
for a hearing before the Board, pursuant to the provisions of
the Administrative Adjudication Law.
§ 6622. Approval Process for the Nurse Assistant
Educational Program.
The institution of the proposed Nurse Assistant educational
program shall provide verification to the Board that the
following program components and processes have been
completed in order for the Board to approve/authorize the
program provider/institution to admit students to the Nurse
Assistant program.
(a) Phase I. Initial Approval - Admission of Students
(1) Nursing faculty employed to develop the
program
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(2) Overview of the total Nurse Assistant
curriculum.
(3) Course sequence
(4) Course descriptions and syllabi
(5) Contracts for clinical sites
(6) Program evaluation plan
(7) Program must provide at least one hundred
(100) hours of instruction which must include forty
(40) hours classroom instruction, twenty (20) hours
laboratory instruction and forty (40) hours in clinical
practice.
(8) Curriculum shall include:
(A) The roles and responsibilities of a nurse
assistant; and
(B) Basic nursing care.
(9) At least forty (40) hours of instruction in the
classroom must be completed, before a student is
directly involved with a client, in the areas of:
(A) Communication and interpersonal skills;
(B) The control of infections;
(C) Safety and emergency procedures;
(D) Confidentiality of information;
(E) Observation skills; and
(F) Promoting the independence of clients
and respecting their rights.
(10) The instructor, student-ratio shall be one (1)
instructor to twelve (12) students in laboratory and
clinical; and one (1) instructor to twenty (20) students
in the classroom setting.
(11) Instructional personnel must be on site solely
to supervise the students, when they are giving direct
patient care to clients. The nurse assistant program
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shall be responsible for ensuring the facilities meet the
learning needs of the students.
(12) A Board member and/or representative of the
Board may make a general survey/site visit to the
Nurse Assistant program facility.
(b) Phase II. Full Approval. The Board may grant Full
Approval of the Nurse Assistant program upon:
(1) Graduation of the first class;
(2) Completion of Board program survey visit
concurrent with graduation of the first class or
eligibility for the national certification examination;
(3) Submission of program’s ongoing evaluation
plan and data;
(4) Satisfactory survey report that verifies that the
program is in compliance with the Board’s Nursing
Education Standards in Article 6.
(5) The Board may request periodic reports from
the program/institution regarding initial program
operations before granting full approval.
(c) A program is valid for three (3) years from the date
of Full Approval by the Board. An annual report shall be
submitted to the Board by July 31
st
of each year. The Board
has the discretion to re-evaluate the program in the interim.
(d) Phase III. Continuation of Full Approval.
(1) The Board shall periodically hire a qualified
consultant, not associated with the Board or local
nursing programs, to evaluate and report to the Board
in writing on the continued compliance of the
established criteria by the approved programs.
(2) The Board shall forward a notice of a survey
site visit to the nursing programs at least thirty (30)
days prior to the scheduled site visit.
(3) The consultant shall assess each program on
dates mutually acceptable to the Board and the
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Director of the program at least once every two years
for nurse assistant programs.
(4) The Director of the program shall provide a
copy of the self-evaluation report and a copy of the
nursing program’s catalog to the Board for each of the
site visitors. An interim summary report may be
requested between survey site visits as the Board
deems necessary.
(A) The Board shall retain a copy of the
consultant’s report in the office of the Board.
(B) The Board shall issue an annual
Certificate of Continuation of Full Approval to
nurse assistant educational programs that meet the
standards set forth herein based on the following
criteria:
(i) Submission of the program’s annual
report;
(ii) Information obtained by the Board’s
professional staff and/or representatives
through consultation and site visits;
(iii) A minimum success rate of 80% on
the national certification examination
achieved by the program’s first-write
graduates of the Nurse Assistant programs.
(iv) Evidence that the authorities
responsible for the administration of the
school allocate funds to enable the school to
achieve its stated objectives and to comply
with the requirements of the Board;
(v) Evidence that the Director of the
program and faculty participate in the
preparation of the budget for the school and
that the Director administers the budget; and,
(vi) Accreditation visits and reports such
as the National League of Nursing (NLN),
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Western Association of Schools and Colleges
(WASC) or other nationally recognized
accrediting organization.
§ 6623. Conditional Approval of the Program.
(a) The program shall be placed on conditional approval if:
(1) The program fails to comply with the
requirements of the statute of these rules and regulations;
(2) Less than eighty percent (80%) of the students in
the program pass the nurse assistant national certification
examination.
(3) The program has not admitted any students within
the previous twelve (12) months; or
(4) The Board finds three (3) or more instances in
which one (1) or more students of the program has engaged
in unsafe or abusive conduct during the year.
(b) The executive director of the Board shall send a written
notice of the conditional approval by certified mail to the
administrative body and Program Director of the approved
program.
(c) The Board shall provide the program with the list of
deficiencies and a time frame of at least one (1) year to correct
the deficiencies.
(d) The program shall submit to the Board a plan of
correcting the deficiencies.
§ 6624. Personnel Requirements for Nurse Assistant
Program.
(a) Program Director. The program director shall be a
Registered Nurse (RN) who shall be administratively responsible
and accountable for the nurse assistant educational program and
has been employed for at least one (1) year prior to the start of
the Nurse Assistant program.
(b) The primary instructor may be the program Director of
the nurse assistant educational program.
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(c) Duties of the program director shall be to:
(1) Assist with the development of the budget for the
program.
(2) Assist with the development of procedures for
admission to the Program
(3) Select and supervise such number of qualified
instructors as is necessary to carry out the program.
(4) Obtain adequate educational facilities for training,
including areas to practice nursing skills.
(5) Obtain adequate clinical facilities for training.
(6) Provide each student with the necessary
instructional materials.
(7) Plan an orientation program for students at each
clinical facility used for instruction. The time spent for
orientation is not included in the one hundred (100) hours
required for the program.
(8) Ensure that each student is clearly identified as a
student in a manner which is easily recognizable to each
patient, member of a patient's family, visitor or member of
the medical staff with whom the students works.
(9) Develop a system of maintaining permanent
records essential to the operations of the program which
includes the current and final records of each student
including a list of the duties to be performed and the skills
to be learned in the program, with notation of satisfactory or
unsatisfactory performances, the date of the performance
and the name of the supervising instructor.
(d) The primary instructor shall have a current Guam
license as a registered nurse.
(e) The responsibilities of the primary instructor shall
include:
(1) Participation in the planning of each learning
experience;
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(2) Ensuring that course objectives are accomplished;
(3) Ensuring that students perform direct services only
in the areas they have received instructions.
(4) Ensuring that these regulations are maintained;
(5) Maintenance of records as required;
(6) Performance of other activities necessary to comply
with these regulations; and
(f) Other instructional personnel shall be required to:
(1) Hold a current Guam license as a registered nurse;
and
(2) Have had at least one (1) year of direct patient care
experience as a registered nurse, within the preceding five
(5) years.
(g) The program may utilize resource personnel who have
had at least one (1) year of experience in their specialty field,
within the past two (2) years.
§ 6625. Instruction Requirements for Nurse Assistant
Programs.
Instructions in the classroom, laboratory and clinical
practice shall include:
(a) Basic nursing care;
(b) Personal care;
(c) Basic rehabilitation;
(d) Mental health and social needs;
(e) Care of the cognitively impaired patient/client;
(f) Patient/clients' rights;
(g) Legal and ethical concepts in relation to self, health
team members, patients, and families.
§ 6626. Unit Objectives for Nurse Assistant Program.
(a) Objectives for each unit of instruction shall be stated in
behavioral terms which are measurable.
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(b) Objectives shall be reviewed with the students at the
beginning of each unit.
§ 6627. Characteristics of Nurse Assistant Graduates.
The graduate of the Nurse Assistant educational program
shall be prepared to:
(a) Communicate and interact competently, effectively
and respectfully on a one-to-one basis with clients, co-
workers and supervisors;
(b) Demonstrate sensitivity to clients' emotional, social
and mental health needs through skillful directed
interactions;
(c) Assists clients in attaining and maintaining
functional independence;
(d) Exhibit attitude and behaviors that supports and
promotes the rights of clients;
(e) Demonstrate professional, ethical and legal
behavior consistent with the application of the standards of
practice for nurse assistants, local and federal laws and
regulations and agency policies;
(f) Demonstrate skills in observation, monitoring and
documentation of the assessment of client’s health, physical
condition and well-being as delegated by the licensed nurse
or physician;
(g) Demonstrate attitude and behaviors or
responsibility and flexibility in personal and workplace
environments;
(h) Demonstrate competency and compliance in the
application of health and safety policies, procedures and
regulations, including equipment and hazardous material
handling; and,
(i) Demonstrate the ability to perform duties and
responsibilities as a nurse assistant under stress especially
when confronted with emergency or critical situations with
clients.
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§ 6628. Records of Nurse Assistant Approved Programs.
The Program Director of an approved nurse assistant
program shall maintain the permanent records and reports of the
program. The records shall include:
(a) The name, address, birth date, and social security
number of each student who enters, withdraws and
completes the program.
(b) A transcript of each student.
(c) A copy of the certificate of completion given to
each student.
(d) The date on which each training cycle begins and
ends.
(e) The name, address, and license number of each
registered nurse instructor.
§ 6629. Faculty File Records.
Records shall be kept current and shall include:
(a) Curriculum vitae (filed with the Board upon
employment and upon revision).
(b) Job descriptions and terms of employment.
(c) Evidence of appropriate educational degree for the
level of the nursing program.
(d) Evidence of continuing education activities.
(e) Evidence of membership and participation in
relevant professional and community activities.
(f) Evidence of a current Guam RN license.
(g) Evidence of current and completed faculty
evaluations.
§ 6630. Evaluations.
(a) Written evaluations of students, which shall include
academic achievement and clinical performance, shall be made
by the faculty following the conclusion of each course. Students
shall be allowed to participate in their evaluations.
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(b) Written evaluations of each course shall be made by
the students and the faculty following the conclusion of each
course.
(c) Written performance evaluations of the faculty shall be
made annually by the Director and the students of the program.
(d) A systematic program evaluation of the total nursing
program shall be made by the faculty biannually to appraise the
following:
(1) Evidence of implementation of the stated
philosophy, objectives, and conceptual framework of the
program;
(2) Achievement of graduates on National Council
Licensing Examination; and,
(3) Professional performance of graduates.
(e) Written evaluations of the current Program Director
§ 6631. Revisions of Approved Programs.
(a) The following major program revisions requires Board
approval and must submitted along with the description of the
change(s) to the Board in writing prior to implementation.
(1) Curriculum changes or course content and
description;
(2) Integration of courses;
(3) The length of program;
(4) Governing institution;
(5) Educational or clinical facilities;
(6) Projected increase in the ratio of students to faculty
which exceeds or is less than the ratio approved by the
Board; and
(7) Closing of the program.
(b) The following program changes require Board
notification and shall be included in the program’s annual report
to the Board.
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(1) The program’s or institution’s name:
(2) Proposal for pilot project (s);
(3) Faculty membership; and
(4) Any other item of information required of programs
seeking accreditation.
§ 6632. Revocation of Approval of a Nurse Assistant
Program.
(a) The Board may revoke its approval of a nurse assistant
program if the program fails to correct the deficiencies within the
required time frame.
(b) The executive director of the Board shall send a written
notice by certified mail to the administrative body and the
Program Director of an approved program of the Board's intent
to revoke its approval of that program. The notice must specify
the reasons for the revocation. The Program Director of the
administrative body may request for an appeals hearing to
provide evidence within fifteen (15) days after the date the notice
is received. The executive director will send a written notice of
the final determination of the Board of the administrative body
and the program director, in compliance with the Administrative
Adjudication Law, Chapter 9 of Title 5, Guam Code Annotated.
(c) If the Board revokes its approval, the Program Director
and the Administrative body shall take such action as is
necessary to retain safely the record of each student in the
program and shall assist in the placement of students in other
programs to complete their education.
§ 6633. Voluntary Discontinuance of an Approved Nursing
Education Program.
(a) The governing institution that desires to voluntarily
close its nursing education program shall:
(1) Notify the Board in writing, stating the reasons for
closure, the intended date of closure, and the plan for
closure.
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(2) Maintain the records of the students and graduates
and shall advise the Board in writing of the arrangements
for safeguarding and maintaining the records. The plan
adopted by the governing institution for closing its program
shall ensure that:
(b) The plan for closure shall ensure that the standards for
Approval shall continue to be met until all of the students have
graduated or been transferred.
(c) The effective closing date of the program shall be the
date of the degree, diploma or certificate of the last class of
graduates or, the date on which the last student was transferred.
(d) The governing institution shall provide:
(1) Assistance to students desiring to transfer to
another program.
(2) The Board a list of students who transferred to
other approved nursing programs within thirty (30) days of
the last transfer.
§ 6634. Reinstatement of Approval.
The Board shall reinstate Full Approval for a program on
conditional approval if the program submits evidence that the
program has met the standards set forth herein and has complied
with the requirements the Board has imposed on it. The
procedure for reinstatement is the same as for Full Approval.
§ 6635. Reopening of Nursing Programs.
The procedure for reopening a nursing program begins with
the same process as the Initial Approval.
---------
ARTICLE 7
CERTIFICATION OF NURSE ASSISTANTS
SOURCE: Added by P.L. 24-020: (May 12, 1997). Entire chapter
repealed and adopted by P.L. 29-071:1 (May 7, 2008).
, Revised by P.L. 29-071 (May 7, 2008).
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§ 6701. Purpose.
§ 6702. Legal Authority.
§ 6703. Powers and Duties of the Board.
§ 6704. Definitions.
§ 6705. Certification Requirements.
§ 6706. Scope of Practice.
§ 6707. Grandfather Clause.
§ 6708. Responsibilities of the Nurse Assistant Applicant.
§ 6709. Responsibilities of the Employer.
§ 6710. Certification by Examination.
§ 6711. Policies for Examination.
§ 6712. Examination Retakes.
§ 6713. Prioritization of Examination Candidates.
§ 6714. Certification by Endorsement.
§ 6715. Renewal of Certification.
§ 6716. Continuing Education Requirements.
§ 6717. Reinstatement of Lapsed Certification.
§ 6718. Characteristics of Nurse Assistants.
§ 6719. Grounds for Disciplinary Action.
§ 6720. Fees.
§ 6701. Purpose.
(a) The purpose of these rules and regulations is to ensure
that persons functioning as Nurse Assistants on Guam have met
minimum standards of competency as prescribed in these rules;
and
(b) To ensure that Nurse Assistants meet minimum
standards of proficiency and competency as set forth by the
Guam Board of Nurse Examiners (GBNE); and
(c) To ensure programs that qualify Nurse Assistants meet
the educational requirements as set forth by the Board; and
(d) To regulate the scope of practice for Nurse Assistants in
the interest of the consumer protection in Guam.
§ 6702. Legal Authority.
(a) Public Law 24-20 and § 12316.1 of Title 10, Guam
Code Annotated empowers the Guam Board of Nurse Examiners
to establish minimum qualifications through rules and
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regulations and to set standards for Certified Nurse Assistant
educational programs. Section 12316.1 of Title 10, Guam Code
Annotated, provides “Minimum Requirements for and
Certification of Nurse Assistants and the Education Programs”.
(b) The Board shall establish by regulation minimum
requirements for Nurse Assistants and criteria for evaluating
such requirements. The Board may also establish and administer
such procedures as may be necessary to certify that an applicant
meets duly established minimum requirements. Such procedures
shall include a provisional period for remedial training of Nurse
Assistants who are employed as of the effective date of such
regulations and do not meet minimum requirements.
Disciplinary procedures for decertification of incompetent nurse
assistants may be established by the Board. The Board shall
maintain a registry of Certified Nurse Assistants. The Board
may approve and re-approve nurse assistants educational and
continuing education programs.
§ 6703. Powers and Duties.
The Board shall enforce the provisions of section12316.1 of
Title 10, Guam Code Annotated, as well as other duties, powers
and authority as granted by appropriate statutes to include the
following:
(a) Adopt, and from time to time, revise such rules and
regulations as may be necessary to carry out the provisions
of section 12316.1 of Title 10, Guam Code Annotated, in
compliance with the Administrative Adjudication Law,
Chapter 9 of Title 5, Guam Code Annotated;
(b) Develop and maintain a Nurse Assistant registry;
(c) Develop and enforce standards and periodically
evaluate the basic Nurse Assistant educational program and
approve the programs that meet the requirements as set
forth in these rules;
(d) Deny or withdraw approval of Nurse Assistant
educational programs that do not meet the prescribed
standards in accordance with Chapter 2 of the
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Administrative Adjudication Law and Chapter 9 of Title 5,
Guam Code Annotated;
(e) Develop and enforce standards and criteria for
certification of Nurse Assistants;
(f) Implement a disciplinary process consistent with the
Administrative Adjudication Law, Chapter 9 of Title 5,
Guam Code Annotated;
(g) Issue certification documentation to the nurse
assistants who have successfully met the requirements for
inclusion on the Nurse Assistants registry;
(h) Notify all nurse assistants listed on the Nurse
Assistants registry of changes in laws, rules and regulations
pertaining to nurse assistants;
(i) Determine and collect reasonable fees;
(j) Act as an evaluating and approving body for the
nurse assistants educational programs in the American
Pacific region. The request must come from the appropriate
governing body, and all expenses for the evaluation shall be
paid by the requesting jurisdiction;
(k) Give the Nurse Assistants’ examination according
to the rules and regulations formulated by the National
Council of State Boards of Nursing, its designated testing
service and the Board;
(l) Deny certification to unqualified applicants;
(m) Issue certificate to qualified applicants who have
successfully met the requirements of a Nurse Assistant;
(n) Have the power to issue subpoenas, require the
attendance of witnesses, administers oaths to persons giving
testimony and enforce compliance upon application to the
Superior Court of Guam;
(o) Maintain records as required by Guam law; and
(p) Conduct public hearings, investigations, and studies
of nurse assistants’ practice, nurse assistants’ education and
related matters; and to prepare and issue such publications
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as will allow the nurse assistants’ profession to provide safe
and effective nurse assistants’ services to the public.
§ 6704. Definitions.
For purposes of these Rules and Regulations, the following
terms are defined to mean:
(a) “Abuse” includes, but is not limited to physical
injury caused by other than accidental means; neglect which
leads to physical harm; failure to provide direct care for
resident or patient; verbal abuse; theft or misuse of resident
funds or property; wrongful touching; or any other
deprivation of patient or resident’s rights, which may be the
result of intentional or negligent behavior.
(b) Accountability means the state of being
responsible, answerable or legally liable for actions done by
a nurse assistant.
(c) Approval – the process by which the Board
evaluates and grants official recognition to a nursing
education or nurse assistant program which meets
established uniform and reasonable standards. There are
four (4) categories of approval:
(d) Initial Approval – an authorization granted by the
Board for new nursing programs to admit students and to
enter into contractual agreements with clinical facilities. No
student shall be admitted until the institution has received
the written notification of Initial Approval from the Board
subsequent to the application review and site visit.
(e) Full Approval – status granted by the Board to
programs that meet the requirements of the law and the
Administrative Rules and Regulations of the Board.
(f) Continuation of Full Approval – status granted
annually by the Board to programs that meet the standards
set forth herein. A Certificate of Continuing Full Approval
is contingent upon an annual review of the program by the
Board.
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(g) Conditional/Probational Approval – status
designated to a program which is determined to be deficient
in a specified area. The Board shall notify the program of
the specific deficient area(s) and the time limitation to
correct the stated deficiencies.
(h) Approved program means a course of training
conducted by an educational or health care institution which
implements the basic nurse assistant curriculum as
prescribed and approved by the Board.
(i) Basic emergency procedures mean the care of
individuals of all ages with perceived physical or emotional
alterations which are undiagnosed and may require prompt
intervention.
(j) Certificate of endorsement means the process by
which individuals holding a current certification, within the
United States or its territories, upon meeting all
requirements set forth by the Board, can practice as a nurse
assistant on Guam.
(k) Clinical facilities means those institutions which
are established in a community for the delivery of health
care services such as hospitals, extended care facilities,
nursing homes or other sites.
(l) Competency means the ability to perform skillfully
and proficiently the role of the certificate holder. The role
encompasses essential knowledge, judgment, attitudes,
values, skills and abilities which are varied in range and
complexity. Competency is a dynamic concept, changing as
a Certified Nurse Assistant achieves a higher stage of
development within the role. Competency is based on
educational training, preparation and expertise.
(m) Date of application means the date stamped on the
application form as received by the Health Professional
Licensing Office staff.
(n) Denial means refusal to issue certification.
(o) Director means a professional Registered Nurse
(RN) of a health agency who has been designated by the
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controlling authority or program provider to administer the
nurse assistants’ educational program.
(p) Graduate Nurse Assistant means an individual who
has successfully completed a basic nurse assistants’
educational program but has not received certification
through examination.
(q) Inactive status means the status of a nurse assistant
who is not currently certified on Guam.
(r) Lapsed certificate means an individual’s certificate
to practice as a nurse assistant has expired.
(s) Licensed nurse means a Registered Nurse (RN) or a
Licensed Practical Nurse (LPN) currently licensed in Guam.
(t) Nurse Assistant (N.A.) means a nurse aide or home
health aide who has been certified by successfully
completing the educational requirements for the Nurse
Assistant and passing a Board approved examination after
the enactment of these rules. Only a certified nurse
assistant shall use the title N.A. and provide nursing support
services as supervised by the Registered Nurse licensed to
practice in Guam. Nurse assistants prior to the enactment of
these rules and regulations are waived from the examination
requirements.
(u) Nurse Assistant (N.A.) certification examination
means the nationally board approved examination required
for certification to practice as a Nurse Assistant.
(v) Nurse Assistant (N.A.) educational program means
a program designed to prepare nurse assistants, which is
offered by a school, college, nursing facility or other
institution that has received prior authorization by the Board
to conduct such a program.
(w) Nurse Assistant (N.A.) registry means a listing of
all individuals who have been certified by the Board.
(x) “OBRA” means the “Omnibus Budget
Reconciliation Act” of 1987 or “OBRA ‘87” (PL#100-203)
that creating Federal statutory requirements for nurse
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assistants’ education and certification and requiring the
establishment of a registry of nurse assistants employed in
long-term care facilities. The Federal guidelines now
include home care agencies and home health aides.
(y) Standards means an authoritative statement by
which the Board can judge the quality of the Nurse
Assistants’ education or practice.
(z) Supervision means provision of guidance of a nurse
assistant’s task or activity with specific direction of the task
or activities by a licensed registered nurse.
(aa) Suspension means an order of withdrawal of a
nurse assistant’s right to practice for a definite or indefinite
period of time.
§ 6705. Certification Requirements.
Certification with the Guam Board of Nurse Examiners is
mandatory and is the responsibility of the individual Nurse
Assistant who provides services for compensation on Guam.
The certification shall be obtained prior to employment.
(a) In order to practice as a nurse assistant in Guam, it
is mandatory to obtain a certificate from the Guam Board of
Nurse Examiners. Obtaining a Guam certificate to practice
as a nurse assistant is the responsibility of the individual
nurse assistant pursuant to P.L. 24-20, “An Act to Establish
Rules and Regulations for Certification of Nurse Assistants
for the Guam Board of Nurse Examiners” of Title 10 Guam
Code Annotated (Effective Date: May 12, 1997).
(b) Any person who holds a license or certificate to
practice nursing or nurse assistant in Guam shall use the
legal title or the abbreviation as set forth in the Guam Nurse
Practice Act of Title 10 Guam Code Annotated, Article 3,
(1983; 1997; 1998; and, 2003 Updates) and P.L. 24-20. No
other person shall assume any other name, title or
abbreviation or any words, letters, signs, or devices that
would cause a reasonable person to believe the user is
licensed/certified to practice as a registered nurse (RN), an
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advanced practice registered nurse (APRN), licensed
practical nurse (LPN) or certified nurse assistant (CNA).
(c) Any person licensed or certified to practice nursing
or as a nurse assistant shall wear an insignia to identify
himself or herself by his/her name and appropriate legal title
or abbreviation during times when such person is providing
health care to the public for compensation.
(d) The insignia shall be prominently displayed and
clearly legible such that the person receiving care may
readily identify the type of nursing personnel providing the
care.
§ 6706. Scope of Practice.
The Nurse Assistant, under the supervision of a Registered
Nurse shall:
(a) Demonstrate competence in providing patient
personal care, basic treatment procedures and exercise plan
as directed;
(b) Facilitate the maintenance of a safe, clean, healthful
environment that demonstrates awareness of the patient’s
safety, comfort and privacy when providing care and report
all events that pose an actual or potential safety risk to
patients or staff;
(c) Demonstrate the ability to follow patient care plans,
directions, assignments and designated responsibilities;
(d) Demonstrate the ability to perform general nursing
care following established procedures;
(e) Document clearly and concisely, using proper
notations and abbreviations all patient care and procedures;
(f) Maintain open communication and positive working
relationships with patients, peers, other employees,
supervisors and managers;
(g) Maintain certification and regularly assess own
skills and training needs.
§ 6707. Responsibilities of the Nurse Assistant Applicant.
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It shall be the responsibility of the applicant to:
(a) Correspond or communicate directly with the
Board.
(b) Follow through with the submission of all required
documents until application is completed.
(c) Periodically contact the Board concerning the status
of the application.
(d) Inform the Board in writing to withdraw an
application.
(e) Inform the Board of any change in name or address.
A nurse assistant who has a change in name shall submit a
notarized copy of a marriage certificate, or court order
showing the change to the Board. A duplicate certificate
with the change shall be issued by the Board upon receipt of
such evidence and payment of the required fee. All
certificate renewals will be mailed to the most current
known address on file.
(f) Give written notification to the Board office prior to
an examination date, if unable to take the scheduled
examination. A specific reason must be indicated. If the
reason is acceptable to the Board, for example, candidate is
ill, death in immediate family, accident, etcetera, the
applicant’s examination date may be extended to the next
examination date. An examination fee will be charged to all
applicants who are rescheduled to take the examination.
(g) Notify the Board, in writing, of the loss of a
certificate. A duplicate certificate for the current renewal
period shall be issued by the Board upon receipt of the
required documents and payment of fees.
(h) Maintain a current Guam Nurse Assistant
certification.
§ 6708. Responsibilities of the Employer.
Nursing administrators, agency heads or other employers,
who employ Nurse Assistants without current certification, are in
violation of the Guam Nurse Practice Act, Article 3, Chapter 12
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of Title 10, Guam Code Annotated and these rules and
regulations.
§ 6709. Certification by Examination.
The following certification by examination shall apply to
those applicants who wish to be certified as a Nurse Assistant:
(a) The Nurse Assistant certification examination of
the National Council of State Boards of Nursing is the
Board’s examination for Nurse Assistant certification.
(b) The minimum passing score on the examination for
nurse assistants will be the passing score as established by
the National Council of State Boards of Nursing.
(c) The Board shall administer examination for nurse
assistant certification in accordance with the regulations as
set forth by the National Council of State Boards of
Nursing.
(d) Student nurses and graduates of a board approved
nursing program who meets Guam’s minimum educational
nurse assistants’ requirements may be allowed to take the
examination.
(e) If a candidate does not write the examination when
scheduled, the application may be retained on file for one
(1) year.
§ 6710. Examination Requirements.
Individuals seeking to write the Nurse Assistant
examination must meet the following requirements:
(a) Be a graduate of an approved high school or the
equivalent General Education Courses (GED) certificate.
High School students who complete a nurse assistant
program may be allowed to take the National Certification
Examination and will be issued the certification upon
completion of graduation from high school.
(b) Complete a Board-approved program for the
preparation of Nurse Assistants or a program or course of
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study that meets the requirements as set by these rules and
regulations.
(c) Complete and submit a notarized Board application
form within the deadlines and policies of the Board.
(d) Request the school providing the nursing program
or nurse assistants’ program to submit an official Certificate
of Nursing Education and transcript directly to the Board.
(e) Submit a two inch by two inch (2”x2”) signed
photograph taken within the past year.
(f) Submit the required examination fee.
(g) In addition to these requirements, the applicant
seeking certification by examination must provide:
(1) Identification of any state, territory or country
in which the applicant holds a health-related
licensure/certification or credentials other than as a
nurse assistant. Identification shall include the number
and status of the license/certification or credential and
the original state or country of licensure or
credentialing.
(2) Information about current employer if
employed in health care, to include address, telephone
number, position and date of employment.
(3) Information regarding previous employer in
health care, if any, if current employment is less than
12 months.
(4) Information related to the applicant’s
background in the following areas:
(A) Pending disciplinary action or
investigation regarding any professional license or
credential.
(B) Any pending criminal charges - national
or international.
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(C) Criminal conviction, nolo contender plea,
Alford plea or other plea arrangement in lieu of
conviction.
(D) Any chemical, physical or mental
impairment and/or ddisability that impacts the
applicant’s ability to practice safely, and a
description of accommodations and/or practice
limitations needed, if any.
(E) Any current substance abuse.
(5) Official record of local, state and federal
criminal background checks completed within the last
2 months.
(h) Persons who served on active duty in a health
related field of the U. S. Armed Forces may apply to the
Board for evaluation of records. Applicant must:
(1) Submit proof of having had at least twelve
(12) months service on active duty in a health related
field of any of the U.S. Armed Forces rendering
bedside direct patient care.
(2) Submit proof of having completed a basic
course of instruction which shall be equivalent to the
course requirements set by these rules and regulations
while in the Armed Forces.
(3) Submit proof that the claimed service was
honorable. These documents shall be certified by the
Armed Forces and submitted directly to the Board.
§ 6711. Policies for Examination.
The following policies shall apply for nurse assistant
examinations.
(a) Applications and fees for the certifying examination
shall be submitted to the Board office by the Board’s
examination deadline.
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(b) Applications containing fraudulent or
misrepresented information shall be cause for denial of
certification.
(c) Applications that are not completed and/or inactive
will become null and void after one (1) year. The Board
will dispose of the application as governed by the
Government of Guam statute.
(d) Candidates shall take the first certifying
examination offered after approval of application by the
Board.
(e) Applicants for examination shall be required to pass
the National Council of State Boards of Nursing Nurse
Assistants’ certifying examination within two (2) years after
graduation from a Board approved nursing program or nurse
assistants’ training program. Applicants applying after two
(2) year limitation period shall be considered by the Board
on a case by case basis. The applicant may be required to
satisfactorily complete an approved program or course of
study, including basic skills in nurse assistants’ practice or
follow specific remedial measures as prescribed by the
Board prior to being scheduled to take an examination.
(f) Transcripts shall include information on the nursing
education program(s), including programs which were
completed in less than the usual length of time, through
advance standing or transfer of credits from one institution
to another.
(g) Credentials of education and certification, if not in
English, shall be accompanied by a certified translation.
(h) Any change of name, after filing the original
application, must be supported by an affidavit satisfactory
to the Board.
(i) Any applicant who cannot demonstrate fulfillment
of the education requirements shall be notified in writing
and must satisfy the deficiency before being admitted to the
examination.
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(j) Candidates with disabilities shall be requested to
submit a completed application at least one hundred twenty-
five (125) days in advance of the scheduled exam date to
facilitate necessary modification of testing service.
(k) Applicant(s) giving and/or receiving unauthorized
access or assistance on the national certifying examination
shall:
(1) Not be allowed to continue writing the
examination and will be removed from the examination
site;
(2) Forfeit the examination results;
(3) Be reported in writing to the Board:
(4) Be allowed an appeals hearing if requested.
(l) Candidates shall be required to rewrite lost or
destroyed test(s) at no cost to the applicant.
§ 6712. Examination Retakes.
All applicants wishing to retake the National Council of
State Boards of Nursing certification examination for Nurse
Assistants shall submit to the Board an examination application
form, applicable fees and any updates as necessary.
(a) Applicants retaking the examination for the second
or third time shall be responsible for self-study remedial
measures.
(b) Applicants retaking the examination four or more
times shall be required to follow specific remedial measures
that include basic nurse assistant skills as prescribed by the
Board.
§ 6713. Prioritization of Examination Candidates.
Admission to the Nurse Assistants’ national certification
examination shall be based on the following priority of graduates
from:
(a) A Board approved Nurse Assistants’ program on
Guam;
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(b) A Nurse Assistants’ program of the United States
or its territories;
(c) A nursing or nurse assistants’ program, approved
for proctoring, by a Board of Nursing of the United States
or its territories or an equivalent training/experience in the
U.S. Armed Forces;
(d) An approved foreign nursing program that meets
the Board’s requirements.
§ 6714. Certification by Endorsement.
An applicant for endorsement to practice as a nurse assistant
on Guam shall submit and remit:
(a) A current registration or certification as a nurse
assistant from a certifying U.S. state or territory that meets
Guam’s requirements; and
(b) An official transcript and certification of training
from an approved nurse assistant educational program or an
approved program that meets the requirements set by these
rules and regulations; and
(c) A completed, notarized application, provided by the
Board; and
(d) A two inch by two inch (2” x 2”) signed
photograph taken within the past year; and,
(e) A verification of passing the National Council of
State Boards of Nursing nurse assistant certification
examination; and,
(f) Verification of original certification and evidence
that the certification has not been suspended, revoked or
restricted for any reason other than failure to renew or
obtain the required continuing education credits to be
completed by the certifying U.S. state or territory; and,
(g) Verification of last employment;
(h) In addition to the above requirements, the applicant
seeking a Guam certification by endorsement shall provide
the following as applicable to the applicant’s status:
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(1) Identification of any state, territory or country
in which the applicant holds a
license/certification/credential to practice in a health
profession other than as a nurse assistant.
Identification shall include the number and status of
the license/certification/credential and the original state
or country of licensure/certification/credential.
(2) Information about current or previous
employer if employed in health care, to include
address, telephone number, position title and dates of
employment.
(3) Information related to the applicant’s
background such as pending disciplinary action or
investigation; any pending criminal charges – national
or international; criminal conviction; nolo contender
plea, Alford plea or other plea arrangement in lieu of
conviction; any chemical, physical or mental
impairment and/or disability that impacts the
applicant’s ability to practice safely and a description
of accommodations and/or practice limitations needed,
if any; and any current substance abuse.
(4) Official record of local, state or federal
criminal background checks completed within the last
two (2) months; and,
(i) Payment of the required fee.
§ 6715. Renewal of Certification.
(a) Nurse assistant certifications shall be renewed biennially
by September 30
th
of even numbered years. Failure to renew
certification shall result in forfeiture of the right to work as a
nurse assistant on Guam, until such time the certification has
been renewed.
(b) Applications for renewal will be mailed to the last
known address. Failure to receive the application for renewal
shall not relieve the certificate holder from the responsibility of
renewing his or her certificate.
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(c) The certified nurse assistants shall return to the Board a
completed renewal application form with the required fee.
(d) Information pertaining to the applicant’s background in
the following areas shall also be required of the licensee to
submit to the Board:
(1) Pending disciplinary action or investigation
regarding any professional license or credential;
(2) Pending criminal conviction;
(3) Criminal conviction, nolo contender plea, Alford
plea or other plea arrangement in lieu of conviction since
the last renewal;
(4) Any chemical, physical or mental impairment
and/or disability that impacts the nurse’s ability to practice
nursing safely, and a description of accommodations and/or
practice limitations needed, if any;
(5) Any current substance abuse;
(6) A detailed explanation and supporting
documentation for any of the above information.
(7) Official record of local, state and federal criminal
background checks completed within the last two (2)
months.
(e) Any person employed as a nurse assistant after a
certificate has lapsed or been revoked shall be considered as
working illegally and shall be subjected to prosecution under the
provisions of the Nurse Practice Act, Article 3, Chapter 12 of
Title 10, Guam Code Annotated.
§ 6716. Continuing Education Requirements.
(a) Nurse assistants shall submit to the Board evidence of
fifteen (15) Continuing Education hours or such other amount as
the Board may determine:
(1) In a health related education/training program as
accepted by the Board;
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(2) Within the renewal period to be eligible for
certification renewal or endorsement.
(b) Nurse assistants, who have been practicing, but do not
meet (a) of this Section, at time of renewal may be issued a
conditional certification to last no more than three (3) months for
the applicant to meet the requirements.
§ 6717. Reinstatement of Lapsed Certification.
(a) Any person whose certification has lapsed due to failure
to renew by September 30
th
of the renewal year may apply to the
Board for reinstatement upon submission of:
(1) A completed application for reinstatement;
(2) Verification of continuing education units as
required by the Board;
(3) A written explanation why the certification has
lapsed; and
(4) Payment of the reinstatement fee.
(b) Other requirements. In addition to these requirements,
the applicant seeking certification by reinstatement must
provide:
(1) Identification of any state, territory or country in
which the applicant holds a health profession license or
credentials other than nursing. Identification shall include
the number and status of the license or credential and the
original state or country of licensure or credentialing.
(2) Information about current employer if employed
in health care, to include address, telephone number,
position and date of employment.
(3) Information regarding previous employer in
health care, if any, if current employment is less than 12
months.
(4) Information related to the applicant’s background
in the following areas:
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(A) Pending disciplinary action or investigation
regarding any professional license or credential.
(B) Any pending criminal charges - national or
international.
(C) Criminal conviction, nolo contender plea,
Alford plea or other plea arrangement in lieu of
conviction.
(D) Any chemical, physical or mental impairment
and/or disability that impacts the nurse’s ability to
practice nursing safely, and a description of
accommodations and/or practice limitations needed, if
any.
(E) Any current substance abuse.
(5) Official record of local, state and federal criminal
background checks completed within the last 2 months.
(c) The Board shall review applications only after all the
above requirements have been submitted.
(d) At any time after a certification has lapsed or been
inactive, the Board may require evidence of the applicant’s
current nursing knowledge and skill before reinstating the
certification to active status.
(e) An individual who applies for reinstatement of
certification who has been out of practice for three (3) years or
longer shall provide evidence of passing a refresher course
approved by the Board.
(f) The Board may request a nurse assistant seeking
reinstatement to appear before the Board.
(g) The holder of a lapsed certificate is subject to all laws in
effect at the time of the application.
§ 6718. Characteristics of Nurse Assistants.
The graduate of the Nurse Assistant educational program
shall be prepared to:
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(a) Communicate and interact competently, effectively
and respectfully on a one-to-one basis with clients, co-
workers and supervisors;
(b) Demonstrate sensitivity to clients' emotional, social
and mental health needs through skillful directed
interactions;
(c) Assists clients in attaining and maintaining
functional independence;
(d) Exhibit attitude and behaviors that supports and
promotes the rights of clients;
(e) Demonstrate professional, ethical and legal
behavior consistent with the application of the standards of
practice for nurse assistants, local and federal laws and
regulations and agency policies;
(f) Demonstrate skills in observation, monitoring and
documentation of the assessment of client’s health, physical
condition and well-being as delegated by the licensed nurse
or physician;
(g) Demonstrate attitude and behaviors or
responsibility and flexibility in personal and workplace
environments;
(h) Demonstrate competency and compliance in the
application of health and safety policies, procedures and
regulations, including equipment and hazardous material
handling; and,
(i) Demonstrate the ability to perform duties and
responsibilities as a nurse assistant under stress especially
when confronted with emergency or critical situations with
clients.
§ 6719. Grounds for Disciplinary Action.
The Board may deny, suspend, or revoke a nurse assistant
certificate in accordance with the Administrative Adjudication
Law or issue a reprimand to a certified nurse assistant for the
following causes:
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(a) Conviction of a crime where such crime bears a
demonstrable relationship to the duties of a nurse assistant
as determined by the Board;
(b) Any willful fraud or misrepresentation in applying
for or procuring a certificate or renewal thereof:
(c) Physical or mental condition that makes the
certificate holder unable to perform the duties of a nurse
assistant
(d) Conduct unbecoming a nurse assistants in the
performance of duties.
(1) Leaving a nurse assistant assignment without
properly notifying appropriate personnel;
(2) Failure to report to proper authorities, facts
known regarding incompetent, unethical, or illegal
practice of any health care provider;
(3) Failure to respect clients rights and dignity,
regardless of social or economic status, personal
attributes, or nature of health problems;
(4) Failure to report actual or suspected incidents
of client abuse;
(5) Aiding, abetting, or assisting an individual in
violating or circumventing any law, rule or regulation
intended to guide the conduct of other health care
providers;
(6) Violating the rights of privacy, confidentially
of information, or knowledge concerning the client,
unless required by law to disclose such information;
(7) Discriminating against a client on the basis of
age, race, religion, sex, sexual preference, national
origin, handicap or socioeconomic status;
(8) Engaging in sexual misconduct or sexual
offenses as described in §25.10 through 25.45 of Title
9; Guam Code Annotated;
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(9) Providing, selling, applying form, or
attempting to procure a certificate through willful fraud
or misrepresentation;
(10) Suspicious use of intoxicants, prescription,
over the counter, or controlled drugs to an extent or in
a manner injurious to the nurse assistants or others, or
to the extent that such use impairs the ability to
conduct safely the duties of a nurse assistant. A
positive drug screen result for which there is no lawful
prescription;
(11) Unlawful use or possession, or obtaining,
selling or furnishing controlled substances;
(12) Neglecting or abusing a client physically,
verbally, emotionally or financially;
(13) Failure to competently perform duties of a
nurse assistants;
(14) Soliciting , borrowing, or removing a client's
property or money without prior approval of the client;
(15) Taking drugs, supplies, property, or money,
not belonging to the nurse assistant, without prior
authorization; and,
(16) Threatening or violent behavior in the
workplace.
§ 6720. Fees.
In addition to the application fee, the applicant shall remit
payment for the fee of the exam and the applicant shall remit
payment for the examination fee directly to the examining
center. Fees shall be assessed for the approval of nurse assistant
educational programs and certification and recertification of
nurse assistants, as well as for other actions to be taken by the
Board. All fees are payable at the time of application and are not
refundable.
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ARTICLE 8
VIOLATIONS AND PENALTIES
SOURCE: Added by P.L. 29-071:1 (May 7, 2008).
§ 6801. Violations
§ 6802. Penalties
§ 6803. Criminal Prosecution
§ 6801. Violations.
It is unlawful for any person to:
(a) Engage in the practice of nursing or use any
designation by which a person represents to the public that
he/she is a licensed nurse, an APRN or a nurse assistant as
defined in these Administrative Rules and Regulations
without a valid, current license or certification, except as
otherwise permitted under the Act;
(b) Practice nursing under the cover of any diploma,
license/certification or record illegally or fraudulently
obtained, signed or issued unlawfully or under fraudulent
representation;
(c) Practice nursing during the time a license or
certification is suspended, revoked, surrendered, inactive or
lapsed;
(d) Use any words, abbreviations, figures, letters, title,
sign, card or device tending to imply that he or she is a
registered nurse, licensed practical nurse, advanced practice
registered nurse or nurse assistant unless such person is duly
licensed or certified to practice under the provisions of the
Act;
(e) Sell or fraudulently obtain or furnish any nursing
diploma, license or certification or renewal of a license,
certification or record, or aid or abet therein;
(f) Knowingly employ unlicensed or uncertified
persons in the practice of nursing;
(g) Fail to report information in relation to the
violations of the Act;
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(h) Conduct a program for the preparation for licensure
under the Act unless the Board has approved the program;
(i) Conduct courses or provide consultation that
conflicts with the scope and standards of practice set forth
in the Act;
(j) Otherwise violate, or aid or abet another person to
violate any provision of the Act; or
(k) Engage in irregular behavior in connection with the
licensure or certification examination, including, but not
limited to, the giving or receiving of aid in the examination
or the unauthorized possession, reproduction or disclosure
of examination questions or answers.
§ 6802. Penalties.
(a) Any person who violates the provisions of Article 8.1 is
guilty of a misdemeanor upon conviction of the first such
offense. Unless otherwise provided in this Article or any other
law, any person who violates the provisions of section 6801,
except Subsection (f) of section 6801 shall be guilty of a felony
upon conviction of the second or subsequent offense.
(b) Any person who violates the provisions of Subsection
(f) of section 6801 shall be guilty of a second degree felony.
§ 6803. Criminal Prosecution.
Nothing in this Article shall be construed as a bar to
criminal prosecution for violation of the provisions of these
Administrative Rules and Regulations.
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ARTICLE 9
DISCIPLINE AND PROCEEDINGS
SOURCE: Added by P.L. 29-071:1 (May 7, 2008).
§ 6901. Authority
§ 6902. Grounds for Denial of License/Certification
§ 6903. Grounds for Discipline
§ 6904. Procedures
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§ 6905. Immunity
§ 6906. Notification
§ 6901. Authority.
The Board may exercise its disciplinary authority in
accordance with the Act. This authority includes, but is not
limited to, the power to:
(a) Deny the application for a license;
(b) Refuse to renew a license;
(c) Revoke a license;
(d) Suspend a license;
(e) Limit or restrict a license
(f) Impose fines of up to$1,000.00
(g) Take any other action justified by the facts in the
case; or
(h) Otherwise discipline or place on probation a
licensee
§ 6902. Grounds for Denial of a License.
Any of the following will be deemed to be grounds for
denial of a license:
(a) Failure to meet any requirement or standard
pertaining to nursing practice or licensure established by
law or by rules and regulations adopted by the Board.
(b) Failure to pass the licensing exam.
§ 6903. Grounds for Discipline.
(a) The Board may discipline a licensee or applicant for
any one or a combination of the following grounds:
(1) False, fraudulent or forged statement or
misrepresentation in procuring a license to practice nursing.
This shall mean, but shall not be limited to:
(2) Procuring or attempting to procure a license to
practice nursing by filing forged or altered documents or
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credentials, falsifying or misrepresenting facts on any
application for licensure, examination, re-licensure, or
reinstatement;
(3) Impersonating any applicant or acting as proxy for
any applicant in any examination for licensure; or
(4) Practicing nursing under a false or assumed name
or carrying out licensed nursing functions while using other
than legal name.
(b) Licensing Exam Violations - conduct that violates the
security of the examination, including but not limited to:
(1) Copying, disseminating, or receiving of any
portion of an examination.
(2) Having unauthorized possession of any portion of
a future, current, or previously administered examination.
(3) Violating the standard of test administration.
(4) Permitting an impersonator to take the
examination on one’s behalf or impersonating an examinee.
(c) Criminal Convictions - convictions by a court or entry
of an Alford plea or a nolo contendere plea to a crime in any
jurisdiction that relates adversely to the practice of nursing or to
the ability to practice nursing; conviction or a felony, or crime
involving moral turpitude.
(d) Fraud and/or Deceit - employing fraud or deceit in
representation of self to Board or public, in filing any reports or
completing client records, in authenticating any report or records
in the nurse’s capacity as a registered nurse, licensed practical
nurse or advanced practice registered nurse or nurse assistant in
submitting any information to the Board.
(e) Unethical Conduct - including but not limited to
conduct likely to deceive, defraud or harm the public; or
demonstrating a willful or careless disregard for the health and
safety of a client. Actual injury need not be established.
Unethical conduct may include behavior that demeans the
nursing profession at large.
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(f) Action in Another Jurisdiction - a nurse’s license to
practice nursing or a multi-state practice privilege or another
professional license or other credential has been denied, revoked,
suspended, restricted or otherwise disciplined in this or any other
state or territory.
(g) Unsafe Practice/Unprofessional Practice - actions or
conduct including, but not limited to:
(1) Failure or inability to perform registered nursing,
practical nursing, advanced practice nursing or nurse
assisting as defined and established in these rules and
regulations, with reasonable skill and safety.
(2) Unprofessional conduct, including but not limited
to:
(A) A departure from or failure to conform to
nursing standards and current rules and regulations.
Performance of acts which are beyond the limits of the
practice of professional or practical nursing or nurse
assistant, as the case may be;
(B) Improper management of client records;
(C) Delegating or accepting the delegation of a
nursing function or a prescribed health function in a
manner contrary to the Nurse Practice Act and/or when
the delegation or acceptance could reasonably be
expected to result in unsafe or ineffective client care
(D) Failure to supervise the performance of acts
by any individual working at the nurse’s delegation or
assignment
(E) Failure to take appropriate action in
safeguarding the patient from incompetent health care
practice;
(F) Failure of a clinical nursing instructor to
supervise student experiences;
(G) Failure to prepare and submit incident reports.
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(3) Administration of medications and treatments in a
negligent manner;
(4) Employment or assignment of unqualified persons
to perform functions that require a license or a certification
to engage in the practice of nursing;
(5) Assumption of duties and responsibilities in the
practice of nursing without adequate education and training
or when competency has not been maintained;
(6) Practicing nursing without a current Guam license,
with a lapsed license or beyond the period of a valid
temporary work permit;
(7) Leaving a nursing assignment without properly
notifying personnel;
(8) Violating the confidentiality of information or
knowledge concerning a patient;
(9) Discriminating in the rendering of nursing services
as it relates to human rights and the dignity of the
individual;
(10) Failure of a chief administrative nurse to follow
appropriate and recognized standards and guidelines in
providing oversight of the nursing organization and nursing
services of a health care delivery system;
(11) Conduct or any nursing practice that may create
unnecessary danger to a client’s life, health or safety.
(12) Failure to practice within a modified scope of
practice or with the required accommodations, as specified
by the Board in granting a modified license as defined in
these rules and regulations or any stipulated agreement with
the Board.
(13) Inability to Practice Safely- demonstration of
actual or potential inability to practice nursing with
reasonable skill and safety to clients by reason of illness,
use of alcohol, drugs, chemicals, or any other material, or as
a result of any mental or physical conditions, or by court
order adjudging that a licensee is mentally incompetent, or
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an evaluation by a qualified person indicating that the
licensee is mentally or physically incapable of engaging in
professional or practical nursing in a manner consistent with
sound patient care.
(h) Misconduct - actions or conduct that include, but are
not limited to:
(1) Falsifying reports, client documentation, agency
records or other essential health documents;
(2) Inaccurate recording or other alteration of patient or
employee records;
(3) Misappropriating drugs, money, supplies or
equipment;
(4) Failure to cooperate with a lawful investigation
conducted by the Board;
(5) Failure to maintain professional boundaries with
clients and/or family members;
(6) Use of excessive force upon or mistreatment or
abuse of any client;
(7) Engaging in sexual conduct with a client, touching
a client in a sexual manner, requesting or offering sexual
favors of language or behavior suggestive of the same;
(8) Threatening or violent behavior in the workplace.
(i) Failure to meet any requirement or standard pertaining
to nursing practice or licensure established by law or by rules
and regulations adopted by the Board.
(j) Gross negligence or recklessness in performing nursing
functions, which shall include, but shall not be limited to:
(1) Any act which deviates from standard of care,
which under similar circumstances, would have been
exercised by a licensed peer; or,
(2) Any act or omission, where there was a legal duty
to act or to refrain from acting, that a reasonable and
prudent practitioner of nursing under same or similar facts
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and circumstances would have done, would have refrained
from doing or would have done in a different manner, and
which did or could have resulted in harm or injury to a
patient/client; or,
(3) A substantial departure from the accepted
standard of care shall be the exercise of so slight a degree of
care as to justify the belief that there was a conscious or
overt disregard or indifference for the health, safety, well-
being, or welfare of the public.
(k) Drug Diversion - diversion or attempts to divert drugs
or controlled substances.
(l) Failure to Comply with Alternative Program
Requirements – failure of a participant of an alternative (to
discipline) program to comply with terms of her/her alternative
program agreement. This regulation provides a specific ground
for failure to comply with terms of program agreement with the
Alternatives to Discipline Program. This addresses the Board to
investigate if a nurse or nurse assistant who has been in a
program for some time were to relapse and is referred to the
Board for possible disciplinary action.
(m) Other Drug Related - actions or conduct that include,
but are not limited to:
(1) Use or solicitation of any controlled substance or
any drug or device or alcoholic beverages, to an extent or in
a manner dangerous or injurious to himself or herself, any
other person, or the public or to the extent that such use may
impair his or her ability to conduct with safety to the public
the practice authorized by his or her license;
(2) Falsification of or making incorrect, inconsistent
or unintelligible entries in any agency, client or other record
pertaining to drugs or controlled substances;
(3) A positive drug screen for which there is no
lawful prescription.
(n) Unlawful Practice - actions or conduct that include, but
are not limited to:
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(1) Knowingly aiding, assisting, advising or allowing
an unlicensed person to engage in the unlawful practice of
registered or practical nursing or nursing assistant;
(2) Violating a rule adopted by the Board, an order of
the Board, or a Guam or Federal law relating to the practice
of registered or practical nursing, or a Guam or Federal
narcotics or controlled substance law;
(3) Practicing beyond the scope of practice as stated in
the Nurse Practice Act;
(4) Failing to report violations of the Act.
§ 6904. Procedures.
(a) Complaint Investigation:
(1) When a complaint is filed with the Board that
charges any persons with an act or omission in violation of
the Nurse Practice Act and/or these rules and regulations,
the Board shall provide for an investigation to determine
whether there are sufficient grounds stated in the complaint
to warrant further action.
(2) The written complaint shall include the name and
address of the person against whom the complaint is made,
a concise statement of the complaint, and the names and
addresses of the persons having knowledge of the incident
and signed by the complainant.
(b) Complaint Resolution:
(1) Complaints may be settled through informal
negotiations with the subject nurse and/or subject nurse’s
attorney
(2) Negotiated settlements shall be reviewed to
determine that any proposed remedy is appropriate for the
facts as admitted or stipulated.
(3) If a complaint cannot be resolved through informal
negotiations, the case may be referred for formal
administrative hearings.
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(4) The Board shall review the evidence and record
produced at administrative hearings, and recommendations
of the administrative law judge to determine whether the
burden of proof has been met showing that the licensee has
violated one or more grounds for disciplinary action. The
Board is responsible for making complain resolution
decisions.
(c) Hearings. If, after an investigation is conducted, the
Board determines that there are sufficient grounds to believe that
a violation of the Nurse Practice Act and/or these rules and
regulations may have been committed, the Chairman of the
Board shall schedule a hearing pursuant to the provisions and
procedures of the Administrative Adjudication Law. The Board
shall have the power to issue subpoenas in accordance with the
Administrative Adjudication, Law.
(d) Disciplinary Action in another State. When the Board
receives information that a person applying for a license or who
is currently licensed in Guam has had a license to practice
nursing revoked or suspended in another state, the Board shall:
(1) Obtain the findings of fact and conclusions of law
from the board of the state or territory that took the
disciplinary action; and
(2) Determine if the findings warrant suspension or
revocation of the person’s Guam license or denial of his
application for licensure on Guam, and if so, shall take
appropriate action.
(e) Costs Resulting From Disciplinary Action. Any
licensed nurse whose license has been suspended, restricted or
revoked, may have his/her license reinstated when, in the
discretion of the Board, the action is warranted; provided, that
such nurse may be required by the Board to pay up to 50 percent
of the costs of the proceedings resulting in the suspension,
revocation, or reinstatement of his/her license or registration
certificate, and, in addition thereto, pay the fee for the current
year’s registration/renewal fee.
§ 6905. Immunity.
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Any member of the Board or staff, or any person reporting
to the Board of Nursing in good faith information relating to
alleged incidents of negligence or malpractice or the
qualifications, fitness or character of a person licensed or
applying for a license to practice nursing shall not be subject to a
civil action of damages as a result of reporting such information.
The immunity provided by this section shall extend to the
members of any professional review committee and witnesses
appearing before the committee authorized by the Board to act
pursuant to this section.
§ 6906. Notification.
The Board shall provide information as required by federal
law to federal databanks, to the National Council of State Boards
of Nursing centralized licensing and discipline databank
(Nursys) and may develop procedures for communicating with
others in board policy.
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ARTICLE 10
EMERGENCY RELIEF
SOURCE: Added by P.L. 29-071:1 (May 7, 2008).
§ 61001. Summary Suspension
§ 61002. Automatic Suspension
§ 61003. Injunctive Relief
§ 61004. Preservation of Other Remedies
§ 61001. Summary Suspension.
(a) Authority. The Board is authorized to temporarily suspend
the license of an RN, LPN, APRN or the certification of a Nurse
Assistant without a hearing if:
(1) The Board finds that there is probable cause to
believe that the nurse or nurse assistant has violated a statue
or rule that the Board is empowered to enforce; and
(2) Continued practice by the nurse or nurse assistant
would create imminent and/or serious risk of harm to others.
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(b) Duration. The suspension shall remain in effect until the
Board issues a stay of suspension or a final order in the matter
after a hearing or upon agreement between the Board and
licensee.
(c) Hearing. The Board shall schedule a disciplinary hearing
to be held under the Administrative Procedures act, to begin no
later than thirty (30) days notice of the hearing.
§ 61002. Automatic Suspension.
(a) Unless the Board orders otherwise, a license to practice
nursing is automatically suspended if:
(1) A guardian of a nurse or nurse assistant is
appointed by order of a court of competent jurisdiction;
(2) The nurse or nurse assistant is committed by order
of a court of competent jurisdiction;
(3) The nurse or nurse assistant is determined to be
mentally incompetent, mentally ill, chemically dependent or
a person dangerous to the public by a court of competent
jurisdiction within or outside of Guam.
(b) The license/certification remains suspended until the
nurse or nurse assistant is restored to capacity by a court of
competent jurisdiction. The nurse or nurse assistant shall petition
the Board for reinstatement. The Board may terminate the
suspension after a hearing or upon agreement between the Board
and the nurse or nurse assistant.
§ 61003. Injunctive Relief.
(a) Authority. The Board or any prosecuting officer upon a
proper showing of the facts is authorized to petition a court of
competent jurisdiction for an order of injunctive relief – to enjoin
the individual from practicing professional or practical nursing,
as the case may be.
(1) Any person who is engaging in the practice of
nursing within the meaning of this Act from practicing
without a valid license, unless exempted under Article 12.
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(2) Any person, firm, corporation, institution or
association from employing any person who is not licensed
or certified to practice as a nurse or nurse assistant under
this act or exempted under Article 12.
(3) Any person, firm, corporation, institution or
association from operating a school of nursing without
approval.
(4) Any person whose license or certification has been
suspended or revoked for practicing as an RN, LPN, APRN
or NA.
(5) Any person to use the title “nurse,” “registered
nurse,” “advanced practice registered nurse,” “licensed
practical nurse,” or “certified nurse assistant” or other
authorized abbreviations unless licensed or certified to
engage in the practice of nursing in Guam.
(b) The court may without notice or bond, enjoin such acts
and practice. A copy of the complaint shall be served on the
defendant and the proceedings thereafter shall be conducted as in
other civil cases. In case of violation of an injunction issued
under this section, the court, or any judge thereof, may
summarily try and punish the offender for contempt of court.
§ 61004. Preservation of Other Remedies.
The emergency proceedings herein described shall be in
addition to, not in lieu of, all penalties and other remedies
provided by law.
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ARTICLE 11
REPORTING REQUIREMENTS
SOURCE: Added by P.L. 29-071:1 (May 7, 2008).
§ 61101. Duty to Report by Licensed Nurses.
§ 61102. Duty to Report by Other Individuals.
§ 61103. Immunity.
§ 61104. Board Surveillance.
§ 61105. Minor Incidents.
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§ 61101. Duty to Report by Licensed Nurses or Certified
Nurse Assistants.
A licensed nurse or a certified nurse assistant shall report
names of subject individuals to the Board if the licensed nurse or
certified nurse assistant has reasonable cause to suspect that an
individual/practitioner has violated any of the grounds for
discipline found in Article 9, except for minor incidents as
described in this rule.
§ 61102. Duty to Report by Other Individuals.
(a) Hospitals, nursing homes, temporary staffing agencies,
and other employers of registered nurses, licensed practical
nurses, advanced practice registered nurses or certified nursing
assistants shall report to the Board the names of any licensee,
certificate holder or applicant for nursing licensure or
certification whose employment has been terminated or who has
resigned in order to avoid termination for any reasons stipulated
in Article 9.
(b) Hospitals, nursing homes, temporary staffing agencies,
and other employers of registered nurses, licensed practical
nurses, advanced practice registered nurses or certified nursing
assistants shall report to the Board the names of any licensees,
certificate holders or applicants who participated in
medical/surgical procedures, interventions or activities that
resulted in a malpractice claim or lawsuit. The licensee or
certificate holder or applicant may not necessarily be identified
or named in the malpractice claim or lawsuit but was involved in
the performance of the acts.
(c) A state/territory agency that licenses registers or certifies
a hospital, nursing home, home health agency or other types of
health care facilities or agency sections, or surveys one of these
agencies shall report to the Board when that agency has evidence
that the licensed nurse or certified nurse assistant has violated the
Act.
(d) Each insurer that provides professional liability
insurance that covers claims arising from providing or failing to
provide nursing care shall report any payment made on behalf of
a licensed nurse or certified nurse assistant in a claim or lawsuit.
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(e) A person who is required to report a licensed nurse or
certified nurse assistant under this Article because the licensed
nurse or certified nurse assistant is impaired or suspected of
being impaired by chemical dependency or mental illness may
report to the alternate appropriate authorities.
(f) The Board shall inform, in the manner the Board
determines appropriate, nurses, facilities, agencies and other
persons of their duty to report under this Article.
(g) The Board shall develop procedures to identify criminal
convictions of licensed nurses or certified nurse assistants
involving:
(1) Moral turpitude.
(2) Violation of a state or federal narcotics or
controlled substances law.
(3) Fraud or abuse under the Medicare or Medicaid
programs.
(4) Court determination that a nurse or nurse assistant
is mentally ill or mentally incompetent.
(h) The Board shall access the National Databank
concerning any licensed nurse or certified nurse assistant against
whom a malpractice award has been made or who has been a
party to a settlement. The Board shall request a report with the
following information:
(1) Total number of settlement(s) or award(s);
(2) Date(s) settlement(s) or award(s) were made;
(3) Allegations contained in the claim(s) or
complaint(s) leading to the settlement(s) or award(s);
(4) The dollar amount of each malpractice settlement
or award and whether that amount was paid off as a result of
a settlement or of an award; and,
(5) The name and address of the licensed nurse or
certified nurse assistant against whom an award was made
or with whom a settlement was made.
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§ 61103. Immunity of Persons Making Reports.
Any member of the Board or professional review committee
authorized by the Board and any witness appearing before the
Board, a hearing office, or such a professional review committee
shall be immune from suit in any civil action taken by a licensee
or certificate holder who is a subject of a professional review
proceedings.
§ 61104. Board Surveillance.
(a) The Board may query the National Practitioner Data
Bank any information pertaining to nurses licensed or nurse
assistant certified in Guam.
(b) The Board will request information from the Superior
Court of Guam four (4) times a year, by the first of February,
May, August and November, about any judgments pertaining to
nurses licensed and nurse assistants certified in Guam.
§ 61105. Minor Incidents.
(a) The chief administrative nurse or designee responsible
for reviewing incidents of practice breakdown may determine
that an incident need not be reported to the Board if all of the
following factors exist:
(1) The potential risk of physical, emotional, or
financial harm to the client due to the incident is minimal;
(2) The nurse or nurse assistant exhibits a
conscientious approach to and accountability for his or her
practice;
(3) The nurse or nurse assistant has demonstrated the
knowledge and skill to practice safely.
(b) The review of the incident shall include evaluation of
the significance of the event in the practice setting, the context of
the event, and the presence of contributing or mitigating
circumstances in the nursing care system.
(c) If an event is determined to be a minor incident:
(1) An incident/variance report shall be completed
according to the employing facility’s policy, including a
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complete description of the incident, client record number,
names of witnesses, identification of subject nurse or nurse
assistant and actions taken to correct or remediate the
problem.
(2) The chief administrative nurse or designee shall
maintain a record of each minor incident involving nurses and
nurse assistants under his/her supervision.
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ARTICLE 12
EXEMPTIONS
SOURCE: Added by P.L. 29-071:1 (May 7, 2008).
§ 61201. No Provisions of this Act Shall be Construed to
Prohibit.
§ 61201. No Provisions of this Act Shall be Construed to
Prohibit:
(a) The practice of nursing that is an integral part of a
program by nursing students enrolled in Board-approved nursing
education programs leading to initial licensure/certification;
(b) The clinical practice needed to fulfill program
requirements by a graduate nursing student currently licensed in
another jurisdiction who meets criteria set forth in these rules
and regulations;
(c) The practice of professional nursing or the practice of
practical nursing in an emergency;
(d) The rendering of assistance by any nurse or nurse
assistant who is currently licensed/certified in another
jurisdiction while assisting in a state of an emergency or disaster
as a volunteer of any recognized organization;
(e) The incidental and gratuitous care of the sick by
members of the family, friends or companions, or household
aides at the direction of a person needing such care who resides
independently outside any hospital, nursing or health care
facility, or other similar institutional setting;
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(f) Caring for the sick in accordance with tenets or
practices of any church or religious denomination that teaches
reliance upon spiritual means for healing;
(g) The practice of any professional nursing by a
registered nurse or the practice of practical nursing by a licensed
practical nurse who is currently licensed in another state,
jurisdiction or territory while in the discharge of his or her
official governmental duties as an employee of any bureau,
division or agency of the United States government;
(h) The practice of any professional nursing by a
registered nurse or the practice of practical nursing by a licensed
practical nurse who is currently licensed in another jurisdiction
and employed by an individual, agency or corporation located in
such other jurisdiction and whose employment responsibilities
include the transporting of patients to health care facilities within
Guam. Such exemptions shall be limited to a period no longer
than necessary to transfer the care of persons qualified under this
Act and shall not exceed five (5) days.
(i) The practice of professional nursing by a registered
nurse who is currently licensed in another state or territory who
is in this state/territory on a non-routine basis for a period not to
exceed ninety (90) days to:
(1) provide professional nursing consulting services;
or,
(2) attend or present a continuing nursing education
program; or,
(3) provide other short-term clinical or non-clinical
nursing services.
(j) Any person permitted by these exemptions to practice
professional nursing or practical nursing without a license issued
by the Guam Board shall be held to the same standard of care as
any practitioner licensed by the Guam Board. A person
permitted by these exemptions to practice without a license shall
register his/her name and practice location with the Board before
commencing practice, unless such registration is not possible
because of the time or emergency involved.
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ARTICLE 13
FEES/RECORD OF PAYMENT
SOURCE: Added by P.L. 29-071:1 (May 7, 2008).
§ 61301. Licensure Fees.
§ 61302. Nurse Assistant Certification Fees.
§ 61303. APRN Fees.
§ 61304. Nurse Assistant Certification Fees.
§ 61305. Renewal Fees.
§ 61306. Other Fees.
GUAM BOARD OF NURSE EXAMINERS
Government of Guam
P.O. Box 2816
Hagåtña, Guam 96932
RECORD OF PAYMENT
I. IDENTIFICATION
NAME
__________________________________________________________________
(Last) (First) (Middle)
MAILING ADDRESS
_______________________________________________________
(Street or P.O. Box #)
______________________________________________
(City) (State) (Zip Code)
SIGNATURE: _________________________ DATE _________________
II. VERIFICATION OF CERTIFICATION
Please print the complete name used on original certification and your social
security number
__________________________________________________
SS#
III. FEE
Fee paid is NON-REFUNDABLE. Make all checks or money orders payable to
TREASURER OF GUAM.
Please check your request (s):
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$100.00 □ RN Exam
$100.00 □ PN Exam
$100.00 □ Endorsement
$125.00 □ Reinstatement of Lapsed
or Inactive License
$ 80.00 □ RN License Renewal
$ 60.00 □ LPN License Renewal
$ 25.00 □ License Verification
$ 25.00 □ Temporary Work Permit
(RN, LPN, CNA)
$ 20.00 □ Reissuance of License
$400.00 □ RN or PN Nursing
Education Program
Approval Fee
$200.00 □ RN or PN Continuation of
Full Approval Fee
$150.00 □ APRN License
Application Fee
$150.00 □ APRN Reinstatement of
License
$100.00 □ APRN License Renewal
$ 75.00 □ APRN Temporary Work
Permit
$150.00 □ APRN Prescriptive
Authority
OTHER
$ 35.00 □ Examination Proctoring
$ 10.00 □ Nurse Practice Act
$ 10.00 □ Rules and Regulations
$ 50.00 □ Nurse Assistant
Application For Exam
$ 25.00 □ Nurse Assistant
Endorsement
$ 40.00 □ Nurse Assistant
Reinstatement
$ 25.00 □ Nurse Assistant
Certification Renewal
$ 25.00 □ Certification Verification
$ 20.00 □ Reissuance of Certification
$ 200.00 □ Nurse Assistant Program
Approval Fee
Present this form with payment to the cashier at the Department of Public Health &
Social Services/ Treasurer’s Office then return the processed form to GBNE.
OFF-ISLAND APPLICANTS: Return this form with your payment to GBNE at the
above address.
FOR OFFICE USE ONLY
Payment: □ CHECK □ MONEY ORDER □ CASH □ CREDIT CARD
Field Receipt # __________________________ Date Paid _____________________
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