TITLE 16 OCCUPATIONAL AND PROFESSIONAL
LICENSING
CHAPTER 12 NURSING AND HEALTH CARE RELATED PROVIDERS
PART 4 HEMODIALYSIS TECHNICIANS
16.12.4.1 ISSUING AGENCY: New Mexico Board of Nursing.
[16.12.4.1 NMAC - Rp,
16.12.4.1 NMAC, 12/13/2022]
16.12.4.2 SCOPE: All New Mexico board of nursing approved hemodialysis programs and hemodialysis technicians certified by the New Mexico board of nursing.
[16.12.4.2 NMAC - Rp,
16.12.4.2 NMAC, 12/13/2022]
16.12.4.3 STATUTORY AUTHORITY: Nursing Practice Act, 61-3-10.1 NMSA 1978 Comp.
[16.12.4.3 NMAC - Rp,
16.12.4.3 NMAC, 12/13/2022]
16.12.4.4 DURATION: Permanent.
[16.12.4.4 NMAC - Rp,
16.12.4.4 NMAC, 12/13/2022]
16.12.4.5 EFFECTIVE DATE: December 13, 2022 unless a later date is cited at the end of a section.
[16.12.4.5 NMAC - Rp,
16.12.4.5 NMAC, 12/13/2022]
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 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]
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:
(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:
(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]
16.12.4.8 FEES: Payment of fees will
be accepted in the form as specified by the board. The initial application fee will be for a
period of one year, plus the months to the applicant’s birth month. Fee may be collected in whole or prorated to
commensurate with the length of the renewal period. Fees are not refundable.
A. Application for certification examination or national certification $45.00
B. Re-examination $30.00
C. Renewal of certificates $45.00
D. Reactivation from lapsed or inactive status $60.00
E. Reinstatement of certificate following board action $60.00
F. Initial certificate military personnel, spouse, dependent, or veteran $0
G. First renewal of certificate military personnel, spouse, dependent, or veteran $0
H Initial program review for approval $250.00
I. Program review per agency $200.00
J. Subsequent review due to a change in board policy or rules $50.00
K. Periodic program evaluation or program review per agency $200.00
[16.12.4.8 NMAC - Rp,
16.12.4.8 NMAC, 12/13/2022]
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 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 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 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 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 Initial
certification for CHT:
(1) Be a high school graduate 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 examination, the applicant cannot work as a CHT I 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. 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. 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.
(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.
(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 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.
H. 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 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. 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.
(6) Remit the required application and fee.
[16.12.4.9 NMAC - Rp,
16.12.4.9 NMAC, 12/13/2022]
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. 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 provider;
(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]
16.12.4.11 DISCIPLINARY ACTION: The board shall conduct hearings upon charges relating to discipline of a CHT, CHT I and CHT II, and may deny, place on probation, suspend or revoke a hemodialysis technician certificate in accordance with the Uniform Licensing Act Section 61-1-1 NMSA 1978 and 16.12.12 NMAC.
A. Grounds for disciplinary action:
(1) “Incompetence” which is defined to include, but not limited to, the following:
(a) inability to function with reasonable skill and safety as a CHT, CHT I and CHT II for any reason including, but not limited to, the use of drugs, alcohol or controlled substances which could impair judgment;
(b) performance of unsafe or unacceptable care of patients receiving dialysis treatments or failure to conform to the essential and prevailing standards of CHTs, CHT Is and CHT IIs;
(c) omitting to record information regarding procedures performed and care provided which could be relevant to the patient’s care;
(d) failure to report information regarding the consumer’s treatment or health status to appropriate person which could be relevant to the patient’s care and status;
(e) demonstrating a lack of competence in providing care to patient’s receiving a dialysis treatment.
(2) “Unprofessional conduct”, which is defined to include, but not limited to, the following:
(a) falsifying or altering patient records or personnel record for the purpose of reflecting incorrect or incomplete information;
(b) misappropriation of money, drugs, or property;
(c) obtaining or attempting to obtain any fee for patient services for one’s self or for another through fraud, misrepresentation or deceit;
(d) obtaining, possessing, administering or furnishing prescription drugs to any person, including, but not limited to one’s self, except as directed by a person authorized by law to prescribe;
(e) obtaining or attempting to obtain a certificate to function as a CHT, CHT I or CHT II for one’s self or for another through fraud, deceit, misrepresentation or any other act of dishonesty in any phase of the certification or recertification process;
(f) functioning as a CHT, CHT I and CHT II in NM without a valid, current New Mexico certificate, or aiding, abetting or assisting another to function as a CHT, CHT I and CHT II without a valid, current New Mexico certificate;
(g) failure to report a CHT, CHT I and CHT II who is suspected of violating the NPA or rules for certification of hemodialysis technicians;
(h) exceeding the scope of function of a CHT, CHT I and CHT II;
(i) intentionally abusing, neglecting or exploiting a patient;
(j) intentionally engaging in sexual contact toward or with a patient;
(k) felony conviction;
(l) dissemination of a patient’s health information or treatment plan acquired during the course of employment to individuals not entitled to such information and where such information is protected by law or hospital/agency policy from disclosure;
(m) failure to maintain appropriate professional boundaries which may cause harm to the patient.
B. Disciplinary proceedings are conducted in accordance with 16.12.2 NMAC Nurse Licensure.
[16.12.4.11 NMAC -
Rp, 16.12.4.11 NMAC, 12/13/2022]
16.12.4.12 APPROVAL FOR HEMODIALYSIS
PROGRAMS:
A. Initial program approval. A proposed hemodialysis technician training program shall submit an application for approval to the board’s hemodialysis technician advisory committee (HTAC). The hemodialysis technician advisory committee (HTAC) shall evaluate the application, evaluate any program review if completed and make a recommendation to the board regarding the approval of the program. The board shall consider the recommendation of the hemodialysis technician advisory committee at a regularly scheduled board meeting.
(1) The initial application shall be consistent with the minimum standards for approval of hemodialysis technician programs 16.12.4.14 NMAC, and shall contain the following:
(a) hemodialysis training program objectives;
(b) agency organizational chart;
(c) names and contact information of the medical director, administrator, and nursing director;
(d) names, license verification and resumes of the nurse educator(s) and other faculty to include clinical preceptor(s);
(e) verification of New Mexico department of health state licensure; and
(f) hemodialysis training program curriculum; and
(g) completion of initial training program application and remit the required fee.
(2) Representatives of the program may be scheduled to meet with the HTAC to present the proposed program.
(a) following the HTAC review of the application, a recommendation for approval shall be made to the board of nursing;
(b) programs not recommended for approval must provide evidence that the identified deficiencies have been corrected.
(3) After receipt of the HTAC recommendation(s), the board may:
(a) grant approval of the program;
(b) defer a decision regarding approval;
(c) deny approval; or
(d) direct staff to make a pre-approval visit.
B. Program renewal of approval:
(1) To ensure continued compliance with the minimum
standards for approval, the program shall be reviewed prior to the approval
expiration date and at least every two years with a program review. The review may include a site visit.
(2) A report of the program evaluation
shall be made to the HTAC.
(a) the HTAC will review the program
evaluation and make a recommendation to the board;
(b) the board is the final authority
regarding continued approval or probation;
(c) the board may authorize unannounced
site visits for the approved hemodialysis technician programs.
D. Criteria for full approval, probationary approval, and denial or withdrawal of approval.
(1) Criteria for full approval. Full approval shall be granted for no more than two years to a program when, in the opinion of the board, the program demonstrates compliance with the minimum standards for approval of hemodialysis technician programs.
(2) Criteria for full approval with warning:
(a) a program may be given
full approval with warning when there is evidence of deficiencies;
(b) the program must correct
all the deficiencies of the minimum standards not met;
(c) the program must submit a
corrective action plan (CAP) to the board;
(d) the program shall
maintain the minimum standards for certified hemodialysis technician program as
previously approved by the board;
(e) full approval with
warning shall not exceed two years;
(f) any other discretion or
conditions deemed necessary by the board may be imposed.
(2) Criteria for probationary approval:
(a) a program may be given probationary approval when there is evidence of:
(i) substantial non-compliance with the minimum standards for approval of hemodialysis technician programs;
(ii) continuous disruptions in retaining qualified faculty resulting in disorganization of the program and a breakdown of supervision and teaching of the program;
(iii) non-compliance with the program’s stated philosophy, objectives, policies and curriculum resulting in unsatisfactory student achievement;
(iv) failure to provide clinical experiences or supervision necessary to meet the objectives of the program;
(v) failure of seventy five percent of first time writers of the examination to correctly answer at least eighty percent of the items over a one year period.
(b) the program shall be advised, in writing, of the reason(s) for the probationary approval.
(c) the board shall designate a reasonable time period, not to exceed one year, in which the program must correct deficiencies and meet the minimum standards for approval.
(d) at least 60 days prior to the end of the probationary approval a site visit shall be made by representatives of the board.
(e) the HTAC shall review the program review and make a recommendation to the board.
(f) the board may grant approval to the program or it may withdraw approval of the program. All decisions of the board and recommendations of the HTAC shall be advised in writing of the reasons for probationary approval.
(g) probationary approval is not renewable. Failure to correct deficiencies will result in withdrawal of approval.
(3) Criteria for denial or withdrawal of approval:
(a) the board may deny approval of a program when a program fails to provide evidence of compliance or fails to correct deficiencies resulting in non-compliance with the minimum standards for approval of hemodialysis technician programs;
(b) a written notice detailing the reasons for denial or withdrawal of approval shall be provided to the agency;
(c) the program shall be removed from the list of board approved hemodialysis technician programs. The certified hemodialysis technician program shall wait 12 months before the program can re-apply for initial approval.
[16.12.4.12 NMAC -
Rp, 16.12.4.12 NMAC, 12/13/2022]
16.12.4.13 CHANGES REQUIRING NOTIFICATION:
A. Changes requiring notification of the board or the advisory committee:
(1) curriculum changes;
(2) changes in the program’s objectives or goals;
(3) changes in required didactic or clinical practice hours;
(4) changes in the nurse educator;
(5) changes in the hemodialysis technician job description.
B. Procedure for requesting board approval for program changes.
(1) The advisory committee shall be notified in writing of changes in the program requiring board approval. The notification shall include:
(a) the proposed change(s);
(b) rationale for the proposed change(s);
(c) anticipated effect on the current program; and
(d) timetable for implementation of the proposed change(s);
(e) presentation of the differences between the current system and proposed change(s);
(f) method of evaluation which will be used to determine the effect of the change;
(g) a description of the study or method used to determine need for a change;
(h) plans for continuing to meet the minimum standards for approval of the hemodialysis technician program.
(2) Major changes and recommendations will be presented to the board of nursing at a regularly scheduled board meeting.
C. Changes requiring notification to the advisory committee or board of nursing.
(1) Changes in the internal administration or organizational plan of the hemodialysis clinic or unit which affects the program.
(2) Changes of New Mexico, department of health licensure status.
[16.12.4.13 NMAC -
Rp, 16.12.4.13 NMAC, 12/13/2022]
16.12.4.14 MINIMUM STANDARDS FOR APPROVAL OF HEMODIALYSIS TECHNICIAN PROGRAMS:
A. Objectives: There shall be written objectives for the program which serve as the basis for planning, implementing and evaluating the program.
(1) The objectives shall be developed by the nurse educator.
(2) The program objectives shall describe the knowledge and skills expected of the CHT, CHT I and CHT II, and shall be consistent with the authorized functions of the CHT, CHT I and CHT II and the board approved core curriculum. After 12/31/2023, all programs must include curriculum consistent with CHT and CHT II scope of function.
(3) The program objectives shall be reviewed annually and revised as necessary by the nurse educator.
B. Curriculum:
(1) The curriculum shall be developed, implemented and evaluated by the nurse educator within the framework of the rules and the core knowledge statements.
(2) The curriculum shall extend over a period of time sufficient to provide essential, learning experiences which enable a hemodialysis technician student to develop competence in hemodialysis practice.
(3) There shall be a minimum of 80 hours of theory, and a minimum of 160 hours of supervised clinical experience for CHT I.
(4) Supervised clinical experience shall provide opportunities for the application of theory and for the achievement of stated objectives in a health care setting and shall include clinical learning experiences to develop the skills required by technicians to provide safe care. The nurse educator or clinical preceptor must be physically present and accessible to the hemodialysis technician student when the hemodialysis technician student is caring for the patient undergoing hemodialysis.
(5) The nurse educator shall develop a written plan for curriculum and program evaluation.
(6) The CHT and CHT II curriculum shall include a minimum of 16 additional hours of theory related to the expanded scope of practice and a minimum of 80 additional hours of supervised clinical experience. The clinical experience will include the initiation, monitoring and disconnection of a central venous catheter for a minimum of 20 times. The nurse educator must verify the successful completion of training with a written letter to the board with the application to test.
C. Administration and organization:
(1) The hemodialysis technician training program shall provide hemodialysis technician students opportunities to acquire clinical experiences caring for patients receiving hemodialysis at a licensed and accredited facility. These experiences should enhance the hemodialysis technician students’ clinical skills and knowledge base and be under the direct supervision of a registered nurse.
(2) Each program shall have a board approved nurse educator to administer the program who shall be responsible for the development, implementation, teaching and evaluation of the program, arrangements for and supervision of student’s clinical experiences and communication with the board and the hemodialysis technician advisory committee.
D. Qualifications and competencies of faculty:
(1) The nurse educator shall be a registered nurse and shall hold a current New Mexico or multistate license to practice nursing in New Mexico or hold a current compact state license.
(2) The nurse educator shall have at least two years of recent nursing practice experience including at least one year of nursing experience in hemodialysis. Previous nursing experience in nursing education is desirable.
(3) The nurse educator shall have a minimum of nine contact hours of continuing education annually in nephrology, or have current national certification in nephrology or dialysis.
(4) All new approved nurse educators shall participate in an orientation that is presented by the board staff.
(5) Clinical preceptor(s) shall be a registered nurse and shall hold a current New Mexico nursing license or hold a current compact state license.
(a) Clinical preceptors shall have a least one year of nursing practice experience including at least six months of nursing experience in dialysis.
(b) Clinical preceptors shall demonstrate knowledge and skills in dialysis nursing.
(6) A certified hemodialysis technician under supervision of the nurse educator or approved clinical preceptor may be assigned to assist with the clinical experience/orientation of hemodialysis technician trainees.
(7) The nurse educator or the clinical preceptor must be physically present in the agency while students are engaged in the clinical experience.
(8) A nurse educator may delegate classroom instruction to other agency affiliated approved program nurse educators.
[16.12.4.14 NMAC -
Rp, 16.12.4.14 NMAC, 12/13/2022]
16.12.4.15 HEMODIALYSIS TECHNICIAN ADVISORY COMMITTEE:
A. Composition and appointment of committee members: The board of nursing shall appoint a minimum of a five member, three of which should be registered nurses, voluntary advisory committee which shall be composed of licensed nurses with expertise in dialysis nursing and certified hemodialysis technicians in New Mexico.
(1) There shall be no more than one licensed nurse and one certified hemodialysis technician representative employed by one hemodialysis agency serving on the advisory committee at any one time.
(2) Members of the committee shall serve for staggered terms of two years; and may be reappointed to the advisory committee.
B. Responsibility of advisory committee:
(1) The advisory committee shall review applications for initial approval, program review, program evaluations, and changes in approved hemodialysis technician training programs, and shall provide recommendations to the board.
(2) The advisory committee shall provide consultation to programs as requested or as directed by the board.
(3) Members of the advisory committee shall serve as site visitors to hemodialysis technician training programs for approval, consultation and evaluation visits.
[16.12.4.15 NMAC -
Rp, 16.12.4.15 NMAC, 12/13/2022]
16.12.4.16 HEMODIALYSIS TECHNICIAN CURRICULUM SUBJECT AREAS:
A. Required subject areas After 12/31/2023, all hemodialysis technician curriculum must include subject areas for CHT, CHT I and CHT II.
(1) Objectives of the hemodialysis technician programs to include:
(a) federal, state and local regulations;
(b) nurse’s role and hemodialysis technician role including the meaning of delegation;
(c) standards of function for hemodialysis technician;
(d) certification expectations and requirements; and
(e) hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients.
(2) Orientation to the hemodialysis technician position including:
(a) review of job specifications;
(b) expectation and responsibilities;
(c) role of the health care team and the hemodialysis technician:
(i) roles and contributions of other health team members;
(ii) observation and reporting;
(iii) occupational safety and health administration (OSHA).
B. Legal roles and responsibilities of hemodialysis technicians including:
(1) patient’s rights;
(2) negligence and malpractice;
(3) ethical issues relating to patients including but not limited to confidentiality;
(4) documentation;
(5) identification of errors and required reporting of errors to the nurse.
C. Orientation to the patient population:
(1) Identifies major anatomical components of the renal system and the role of the normal kidney in maintaining homeostasis;
(2) Recognizes the physiological changes that occur in the body as a result of end stage renal disease;
(3) Verbalizes the principles of hemodialysis;
(4) Recognizes the psychosocial considerations that affect the hemodialysis patient/family and lifestyle;
(5) Identifies changes in the patient’s diet.
D. Introduction to dialysis therapy:
(1) Demonstrates efficient, accurate and safe preparation of the dialysis machine including but not limited to the discontinuation of dialysis;
(2) Demonstrates accurate and safe technique when performing arteriovenous punctures for dialysis access;
(3) Identifies patient complications and communicates with a registered nurse;
(4) Identifies and responds appropriately to machine alarms and other potential emergency situations to include but are not limited to:
(a) air leaks;
(b) power failures;
(c) temperature changes;
(d) unconscious patient;
(e) needle dislodgement; or
(f) air embolism;
(5) Identifies infection control principles and practices. Including but not limited to the use of personal protective equipment;
(6) Demonstrates the method of medication administration and identifies potential adverse reactions for medications used in hemodialysis therapy.
E. Hemodialysis technician procedures/skills check list for certification in New Mexico.
(1) identification of machine parts and functions;
(2) preparation of machine and extracorporeal circuit equipment monitoring and testing prior to initiation of treatment and disinfection of machine post dialysis;
(3) data collection for registered nurse assessment;
(4) vascular access and specimen collection;
(5) initiation, monitoring and termination of treatment;
(6) appropriate response to real and potential emergency care situations that can impact the patient, staff and the physical building;
(7) administration of medications required for dialysis therapy within the scope of practice as stated in Subsection B and C of 16.12.4.10 NMAC;
(8) correct practice of infection control principles;
(9) identification and comprehension of principles of water treatment system.
F. Certification for hemodialysis technician (CHT and CHT II) including their role and responsibilities.
(1) Philosophy and objectives of the advanced hemodialysis technician programs to include:
(a) federal, state and local regulations;
(b) nurse’s role and advanced hemodialysis technician role;
(c) standards of function for advanced hemodialysis technician;
(d) certification expectations and requirements.
(2) Orientation to the (CHT and CHT II) position including:
(a) review of job specifications;
(b) expectation and responsibilities;
(c) role of the health care team and the hemodialysis technician;
(i) roles and contributions of other health team members;
(ii) observation and reporting;
(3) Expanded roles and responsibilities of the advanced hemodialysis technicians (CHT and CHT II) including:
(a) patient’s rights;
(b) negligence and malpractice;
(c) ethical issues relating to patient including but not limited to confidentially and OSHA;
(d) documentation;
(e) identification of errors and required reporting or errors to the nurse.
(4) Review the concepts and practices of infection control.
(5) Understand the principles and rationale for the clamping and care of central venous line catheters:
(a) positive thoracic pressure;
(b) risk of complications with clamping/unclamping catheters;
(c) antiseptic solutions and catheter material.
(6) Understanding and administering heparin to central venous catheters:
(a) pre-dialysis blood work;
(b) identification of arterial and venous catheter ports;
(c) connection to dialysis blood lines.
(7) Preparation, initiation, monitoring and termination of dialysis with the central venous catheters:
(a) arterial pressure monitoring;
(b) documentation;
(c) verification with registered nurse of correct placement of a new central venous catheter.
(8) Maintaining central venous catheter patency including injection of heparin or saline into catheter ports.
(9) Identification of complications including, but not limited to:
(a) emergency life threatening care;
(b) access recirculation;
(c) inadequate flow;
(d) clotting; or
(e) catheter dislodgement.
G. CHT and CHT II candidate procedures/skills check list for certification in New Mexico shall also include the following:
(1) Identify difference between permanent and temporary central venous catheters;
(2) Demonstrate ability to maintain an aseptic field;
(3) Demonstrate correct infection control practices throughout all procedures including the proper selection of approved antiseptic solutions;
(4) Demonstrate aspiration of heparin or saline with the correct sized syringe;
(5) Demonstrate ability to maintain positive pressure in the catheter lumen;
(6) Identify and respond appropriately to complications with the central venous catheter;
(7) Determine correct lumen volume and instill heparin or saline aseptically post treatment;
(8) Correctly demonstrates catheter ports are capped, clamped and secured after termination of hemodialysis treatment.
[16.12.4.16 NMAC -
Rp, 16.12.4.16 NMAC, 12/13/2022]
HISTORY OF 16.12.4 NMAC:
Pre-NMAC History: The material in this part was derived from the previously filed with the state records center and archives under:
BON Manual #90-1, New Mexico Board of Nursing Rules and Regulations for Hemodialysis Technicians, filed 1/29/1990;
BON Manual 93-2, New Mexico Board of Nursing Rules and Regulations for Hemodialysis Technicians, filed 08/25/1993.
History of Repealed Material:
16.12.4 NMAC Certification of Hemodialysis Technicians and Training Programs repealed, 2/17/2006.
16.12.4 NMAC, Hemodialysis Technicians, filed 12/21/2005 - Repealed effective 10/1/2016.
16.12.4 NMAC, Hemodialysis Technicians, filed 9/1/2016 - Repealed effective 12/13/2022.
Other History:
BON Manual 93-2, New Mexico Board of Nursing Rules and Regulations for Hemodialysis Technicians (filed 8/25/1993)
was renumbered, reformatted to 16 NMAC 12.4, Certification of Hemodialysis
Technicians and Training Programs, effective 1/1/1998.
16 NMAC 12.4 amended Certification of Hemodialysis Technicians and Training Programs (filed 12/10/1997), renumbered, reformatted, amended and replaced by 16.12.4 NMAC Certification of Hemodialysis Technicians and Training Programs, effective 7/30/2001.
16.12.4 NMAC Certification of Hemodialysis Technicians and Training Programs (filed 6/12/2001) replaced by 16.12.4 NMAC Certification of Hemodialysis Technicians and Training Programs, effective, 2/17/2006.
16.12.4 NMAC Certification of Hemodialysis Technicians, effective, 10/1/2016.
16.12.4 NMAC, Hemodialysis Technicians, filed 9/1/2016 Replaced by 16.12.4 NMAC, Hemodialysis Technicians, effective 12/13/2022.