New Mexico Register / Volume XXXV, Issue 10
/ May 21, 2024
This is an amendment to 16.12.4 NMAC, Sections 6, 7, 9
and 10 effective 5/21/2024.
16.12.4.6 OBJECTIVE: Pursuant to the Nursing Practice Act, this
part establishes the requirements for fees, examinations, endorsement,
recertification standards and functions, [supervision/director] supervision,
direction and disciplinary action for hemodialysis
technicians. It also establishes
requirements for approval of hemodialysis technician programs, minimum
standards for hemodialysis training programs, and the hemodialysis technician
advisory committee.
[16.12.4.6 NMAC - Rp,
16.12.4.6 NMAC, 12/13/2022, A, 5/21/2024]
16.12.4.7 DEFINITIONS:
A. Definitions beginning with the letter A:
(1) ”administrator”, means an operating officer of an agency with the authority to make notification of change to the New Mexico board of nursing;
(2) “agency”, means a business, organization or facility at specified location that is approved by the New Mexico board of nursing to train hemodialysis technician students;
(3) “approval”, means action taken by the board to accept and grant specific recognition.
(4) “audit”, means a verification of continuing education documents and work hour requirements.
B. Definitions beginning with the letter B: “board”, means New Mexico board of nursing (NMBON).
C. Definitions beginning with the letter C:
(1) “central venous catheter”, means a synthetic tube place into a high flowing central vein used to provide hemodialysis;
(2) “certificate”, means a document issued by the board identifying legal privilege and authorization to perform specific certified hemodialysis technician functions and procedures in the state of New Mexico;
(3) “certification examination”, means a board-approved tool designed to evaluate an applicant’s knowledge of a specific subject;
(4) “certified hemodialysis technician (CHT)”, refers to a person who has received national certification and is certified by the board to assist in the direct care of patients undergoing hemodialysis, under the supervision and at the direction of a registered nurse according to the rules adopted by the board;
(5) “certified hemodialysis technician I (CHT I )”, refers to a person who is certified by the board to assist in the direct care of patient undergoing hemodialysis under the supervision and direction of a registered nursing according to the rules adopted by the board;
(6) “certified hemodialysis technician II (CHT II)”: refers to a person who has met the requirements of a certified hemodialysis technician (CHT) and has successfully completed the training for the expanded scope of practice as defined in the rules from an approved hemodialysis technician training program and receives certification from the board for the expanded scope of practice;
(7) “clinical experience”, refers to the supervised skills component of the hemodialysis training program;
(8) “clinical preceptor”, means a registered nurse who supervises and observes hemodialysis technician students providing hemodialysis patient care:
(9) “competency”, means the demonstration of knowledge in a specific area and the ability to perform specific skills and tasks in a safe, efficient manner:
(10) “continuing
education (CE)”, means a planned
learning experience for certified hemodialysis technicians which includes
experiences designed to promote the development, knowledge, skills, and
attitudes for the enhancement of care to the patient and may be offered by
the nurse educator of the agency;
(11) “contact hour”, means a unit of measurement to describe an approved organized learning experience. One contact hour is equivalent to a continuous 60 minute clock hour:
(12) “curriculum”, means a detailed course outline, description or syllabus, which, includes objectives, content, teaching-learning activities and evaluation strategies, and includes the minimum required program hours.
D. Definitions beginning with the letter D:
(1) “delegation”, means transferring to a competent individual the authority to perform a delegated nursing task in a selected situation. The licensed nurse retains accountability for the delegation;
(2) “direct supervision”, refers to the supervision by a licensed nurse who is physically present, and readily accessible to the certified hemodialysis technician and hemodialysis technician student when providing patient care. Direct supervision includes observing, evaluating and directing the care being provided.
E. Definitions beginning with the
letter E: [RESERVED]
F. Definitions beginning with the letter F: “faculty”, means any professional or paraprofessional person(s) who teaches for the hemodialysis technician program including clinical preceptors.
G. Definitions beginning with the
letter G: [RESERVED]
H. Definitions beginning with the
letter H: “hemodialysis technician
training program”, means an educational program approved by the board for
persons seeking certification as hemodialysis technicians.
I. Definitions beginning with the
letter I: [RESERVED]
J. Definitions beginning with the
letter J: [RESERVED]
K. Definitions beginning with the
letter K: [RESERVED]
L. Definitions beginning with the
letter L: “license”, means a document identifying the legal privilege and
authorization to practice within a professional category.
M. Definitions beginning with the letter
M: [RESERVED]
N. Definitions beginning with the
letter N:
(1) “national certification”, means a certification obtained by completing an examination through a nationally recognized certifying organization which indicates a certified hemodialysis technician has knowledge and competence in providing care to patients undergoing hemodialysis as evidenced by passing an examination and maintaining a minimum number of work hours and continuing education during the renewal period;
(2) “nurse educator”, means the registered nurse who is responsible for the development, implementation and evaluation of a hemodialysis technician training program and retains ultimate responsibility for determining hemodialysis technician student’s competency.
O. Definitions beginning with the
letter O: [RESERVED]
P. Definitions beginning with the
letter P:
(1) “program evaluation”, means the process whereby the program at the agency is evaluated at the request of the board for approval status;
(2) “program review”, means the routine process whereby the program at the agency is reviewed prior to the approval expiration date to assure compliance with the rules and regulations governing hemodialysis technician programs. This may include a stie visit with or without official notification to the agency.
Q. Definitions beginning with the
letter Q: [RESERVED]
R. Definitions beginning with the
letter R:
(1) “reactivation”, the process of making a certificate current which has been in a lapsed status as result of the certificate holder failing to comply with renewal requirements. This does not involve board action;
(2) “reinstatement”, means the process whereby a certificate which has been subject to revocation or suspension is returned to its former status by individual board action; this process always involves board action.
S. Definitions beginning with the
letter S:
(1) “site visit”, means visit made directly to the hemodialysis technician training program by board staff;
(2) “standards of function”, means a range of tasks or activities performed by certified hemodialysis technicians for patients who are stable and predictable, supervised by a licensed registered nurse who may need to limit the range of tasks based on the patient’s needs.
T. Definitions beginning with the
letter T: [RESERVED]
U. Definitions beginning with the
letter U: [RESERVED]
V. Definitions beginning with the
letter V: [RESERVED]
W. Definitions beginning with the letter
W: [RESERVED]
X. Definitions beginning with the
letter X: [RESERVED]
Y. Definitions beginning with the
letter Y: [RESERVED]
Z. Definitions beginning with the
letter Z: [RESERVED]
[16.12.4.7 NMAC - Rp,
16.12.4.7 NMAC, 12/13/2022, A, 5/21/2024]
16.12.4.9 CERTIFICATION REQUIREMENTS FOR HEMODIALYSIS TECHNICIANS: New Mexico certification of hemodialysis technicians is mandatory.
A. Prerequisites:
(1) [Be
a high school graduate] Hold a high school diploma or have proof of
successfully passing a general education development test.
(2) The applicant for certified hemodialysis technician will demonstrate completion of adequate training by:
(a) submitting proof of successful completion of a board approved hemodialysis technician training program; or
(b) submitting proof of a valid national hemodialysis technician certificate from a recognized organization.
(3) Submit the required application to the agency with required fees.
B. Applications and fees:
(1) Board staff will verify eligibility. Applications received by the board staff are valid for one year.
(2) Applications containing fraudulent or misrepresented information could be the basis for denial of certification.
(3) Incomplete applications for certification will not be processed. The applicant will be notified within 30 days of submission of application about incomplete information.
(4) Written verification of successful completion according to the minimum standards for approval of hemodialysis technician programs indicating the date of completion must be received, directly from the hemodialysis technician program, and signed by the nurse educator within 30 days of completion.
(5) The applicant will request that the national certifying body for hemodialysis technicians send verification directly to the board.
(6) A re-examination fee will be charged for all re-examinations of the state-based examination.
[ C. Hemodialysis
technician initial certification examination for CHT I.
(1) The
board shall develop and maintain the board-approved certification examination
for hemodialysis technicians. Applicants
[maybe] may only take the state board-approved examination for the CHT I
certificate issued before 1/1/2024.
After 1/1/2024 all initial applications for the certified hemodialysis
technician will require a national hemodialysis technician certificate.
(2) Board
approved examination centers shall comply with the security procedures
developed by the board for distribution and administration of the examination.
(3) Applicants
for certification as a hemodialysis technician shall be required to pass the
hemodialysis technician certification examination with a minimum score of
eighty percent.
(4) Applicants
must obtain New Mexico state certification within six months of successfully
completing a board approved training program.
(a) Applicants
who fail the examination may repeat the examination one time within a two month
period without repeating an approved training program.
(b) Applicants
must remain under the supervision of a board-approved clinical preceptor until
they successfully pass a hemodialysis technician certification examination.
(5) Applicants
observed giving or receiving unauthorized assistance during the writing of the
examination shall be dismissed from the examination center and the
individual(s) shall be referred to the board by a sworn complaint filed by the
proctor.
(6) Results of the examination shall be
reported by the online portal to the applicants no later than four weeks
following the examination date. If the applicant passes the examination, the
applicant cannot work as a CHT I until the certificate has been issued by the
board.
(7) An initial certificate shall be valid
until the last day of the applicant’s birth month after the first anniversary
of the initial certificate.
D. Certification
by examination for CHT II.
(1) CHT
II shall be required to pass a certification examination with a minimum score
of eighty percent that is specific to their expanded scope of practice. Applicants [maybe] may only take the
state board-approved examination for the CHT II certificate issued before
1/1/2024. After 1/1/2024 all initial
applications for the certified hemodialysis technician will require a national
hemodialysis technician certificate.
(2) CHT
II applicants who fail the exam may repeat the examination one time within a
two month period without repeating an approved training program. [If the CHT II does not pass the second
examination they must take a refresher course specific to the expanded scope of
function.] Applicants must remain under
the supervision of a board approved clinical preceptor while practicing their
extended scope of practice until they successfully pass the CHT II state exam.
(3) Written
verification of successful completion according to the minimum standards for
approval of the CHT II programs indicating the date of completion must be
received, directly from the hemodialysis technician program, and signed by the
nurse educator in the board office within 30 days of completion of the training
program.
(4) Complete
the required application form in the specified deadline and remit the required
fee.
(5) A
re-examination fee will be charged for all re-examinations.
(6) Results
of the examination shall be reported, by the online portal to the applicants no
later than four weeks following the examination date. If the applicant passes the examination, the
applicant cannot work as a [CHT I] CHT II until the certificate has been
issued by the board.
(7) The expiration date for the CHT II
will align with the expiration date of the CHT I.]
[E.] C. Initial certification for CHT:
(1) [Be a high school graduate] Hold
a high school diploma or have proof of successfully passing a general
education development test.
(2) The applicant must submit proof of a
valid national hemodialysis technician certificate from a recognized
organization. If the applicant passes
the national hemodialysis technician examination, the applicant cannot
work as a [CHT I] CHT until the certificate has been issued by
the board.
(3) Attestation from the agency nurse
educator that the applicant has been oriented to the scope of function of the
certified hemodialysis technician.
[F.]
D. Endorsement:
(1) If an applicant holds hemodialysis certification from another jurisdiction in the United States, the application must:
(a) meet all the prerequisites;
(b) submit verification from another jurisdiction directly to the board that certificate is in good standing. If the applicant is unable to provide verification, then the applicant must follow the process for initial certification;
(c) submit the required application and fee.
(2) An initial certificate shall be valid until the last day of the applicant’s birth month after the first anniversary of the initial certificate.
[G.]
E. Requirements for
hemodialysis technicians’ renewal:
(a) Failure to receive a notification for renewal shall not relieve the CHT I of the responsibility of renewing the certificate by the expiration date.
(b) If the certificate is not renewed by the end of the renewal month, the CHT I does not hold a valid certificate and shall not function as a CHT I in New Mexico until the lapsed certificate has been reactivated.
(c) If a CHT I certificate holder has a national certification as a hemodialysis technician, for the first renewal after 12/31/2023, the certificate will be transitioned to a CHT certificate. The CHT I must fulfill continuing education and work requirements to complete the transition.
(d) If the CHT I certificate holder does not have national certification as a hemodialysis technician, the certificate will remain a CHT I. If the CHT I certificate is allowed to lapse and remain inactive for more than one year past the expiration date, the CHT I certificate holder must complete the hemodialysis technician training program and meet the requirements for the CHT certificate, including obtaining a valid national hemodialysis technician certificate from a recognized organization.
(2) Certified hemodialysis technicians II (CHT IIs) renewing their certificate shall be required to complete the process by the end of their renewal month. CE and work hour requirements may be prorated to commensurate with the length of the renewal period. CHT II certificate holder for the first renewal period after 12/31/2023, will transition to a CHT certificate.
(a) The CHT II must fulfill continuing education and work requirements to complete the transition to CHT.
(b) If the CHT II certificate is allowed to lapse and remain inactive for more than one year past the expiration date, the CHT II certificate holder must complete the hemodialysis technician training program and meet the requirements for the CHT certificate, including obtaining a valid national hemodialysis technician certificate from a recognized organization.
(3) Certified hemodialysis technicians (CHTs) renewing their certificate shall be required to complete the process by the end of their renewal month. CE and work hour requirements may be prorated to commensurate with the length of the renewal period.
(a) The CHT must supply a current valid national hemodialysis technician certificate from a recognized organization. For the CHT II who transitioned to CHT without a national certification, passing the state based CHT II examination will substitute for the national certification.
(b) If the CHT certificate is allowed to
lapse and remain inactive for more than one year past the expiration date, the
CHT certificate holder must [attend] complete the hemodialysis
training program and meet the requirements for the CHT certificate, including
obtaining a valid national hemodialysis technician
certificate from a recognized organization.
(4) Continuing education requirements:
(a) 16 contact hours of continuing education must be accrued within the 24 months immediately preceding renewal. CE may be prorated to commensurate with the length of the renewal period.
(b) Recertification by a national CHT certifying body will meet the mandatory CE requirements for New Mexico certification renewal. Continuing education obtained for national certification is applicable if completed during the renewal period.
(c) Continuing education records are subject to audit by the board. Certificate holders may be subject to disciplinary action by the board if non-compliant within 60 days of the first notification of the audit.
(d) CHT and CHT II shall accrue four additional contact hours of continuing education within the 24 months that preceded the expiration of the certificate. These additional contact hours must be specific to their expanded scope of function and may be prorated to commensurate with the length of the renewal period if less than 24 months.
(5) Work requirement: Applicant must provide evidence of a minimum of 1,000 hours work as a CHT, CHT I, or CHT II during the 24 month period immediately preceding certification renewal.
(a) Work requirement records are subject to audit by the board. Work hours may be prorated to commensurate with the length of the renewal period if less than 24 months.
(b) Certificate holders may be subject to disciplinary action by the board if noncompliant within 60 days of the first notification of the audit.
(6) Remit the required fee.
(7) Failure
to meet the continuing education or employment requirements for recertification
shall result in denial of recertification until [completion of a refresher
course with the appropriate application and fee have been submitted to the
board.] reactivation requirements are met.
[H.]
F. Reactivation of
certificate for CHT, CHT I, CHT II:
(1) If the certificate has been inactive for less than one year, the applicant may reactivate the license by submitting an application for reactivation, paying the required fee, and submitting proof of required continuing education contact hours for a 24 month certificate period and required work hours.
(a) In substitution of continuing education and work hours, the applicant for reactivation of a CHT I certificate may take a refresher course.
(b) In addition, a CHTs lapsed certificate holder must submit a valid national hemodialysis technician certificate from a recognized organization.
(2) If the CHT, CHT 1, and CHT II
certificate is allowed to lapse and remain inactive for more than one year past
the expiration date, the CHT certificate holder must [attend] complete
the hemodialysis training program and meet the requirements for the CHT
certificate, including obtaining a valid national hemodialysis technician
certificate from a recognized organization.
[I.] G. Refresher course requirements:
(1) Completion of a minimum of 80 hours of supervised clinical practice in a board approved hemodialysis technician training program under the supervision of an approved clinical preceptor.
(2) Successful completion of the hemodialysis technician training program’s skills list identified in the core curriculum 16.12.4.16 NMAC.
(3) Successful completion of the hemodialysis technician training program final examination.
(4) Written verification, on agency letterhead, of successful completion of supervised clinical practice, skills list, and the final examination results shall be provided to the board by the program’s board-approved nurse educator.
(5) Completion
of a refresher course shall meet both the employment and continuing education
requirements for the [two year renewal period.] reactivation of the
CHT I certificate.
(6) Remit the required application and fee.
[16.12.4.9 NMAC - Rp,
16.12.4.9 NMAC, 12/13/2022, A, 5/21/2024]
16.12.4.10 STANDARDS
OF FUNCTION FOR THE CERTIFIED HEMODIALYSIS TECHNICIAN:
A. Purpose:
(1) To establish standards for
supervision and direction of the CHT, CHT I and CHT II.
(2) To identify basic functions for the CHT, CHT I and CHT II.
(3) To identify the authorized and prohibited functions for the CHT, CHT I and CHT II.
(4) To
identify the expanded role of the CHT II and CHT.
B. Authorized functions of the CHT I with supervision of a registered nurse:
(1) perform arteriovenous punctures for dialysis access;
(2) inject intradermal lidocaine
in preparation for dialysis access;
(3) administer a heparin bolus;
(4) administer a fluid bolus of
isotonic saline;
(5) connect a dialysis access to isotonic saline or heparinized isotonic saline;
(6) administer oxygen via nasal cannula or mask;
(7) collect data for the nursing
assessment;
(8) initiate and discontinue treatment
via arterio-venous access;
(9) re-infusion of blood upon termination of treatment of central venous catheters.
C. Authorized functions of the CHT and CHT II with the supervision of a registered nurse:
(1) perform arteriovenous punctures for dialysis access;
(2) initiate, monitor, and discontinue dialysis via central venous catheter;
(3) inject intradermal lidocaine
in preparation for dialysis access;
(4) administer a heparin bolus via intravenous route;
(5) administer a fluid bolus of
isotonic saline;
(6) connect a dialysis access to isotonic saline or heparinized isotonic saline;
(7) administer oxygen via nasal cannula or mask;
(8) collect data for the nursing
assessment;
(9) initiate and discontinue treatment
via arterio-venous access;
(10) re-infusion of blood upon termination
of treatment of central venous catheters;
[ (11) may remove catheter
dressing to evaluate for potential complication, but may not redress site;
(12) shall not initiate or
discontinue a central venous catheter that is not functioning as intended. Under no circumstance should there be any
attempt to manipulate a malfunctioning catheter.]
[E.] D. Prohibited
functions of the CHT, CHT I, and CHT II:
(1) shall not administer medications by oral, intramuscular, intravenous or subcutaneous routes except those agents addressed in authorized functions of these rules;
(2) shall not take orders for dialysis treatments;
(3) shall not alter dialysis orders as prescribed by a health care provide
(4) CHT I shall not initiate or discontinue via central venous catheters.
(5) shall not perform hemodialysis treatments without direct supervision of a registered nurse.
[16.12.4.10 NMAC -
Rp, 16.12.4.10 NMAC, 12/13/2022, A, 5/21/2024]