EDU-10-16-00017-EP Execution by Registered Professional Nurses of Non-Patient Specific Orders to Administer Tuberculosis Tests

3/9/16 N.Y. St. Reg. EDU-10-16-00017-EP

NEW YORK STATE REGISTER

VOLUME XXXVIII, ISSUE 10

March 09, 2016

RULE MAKING ACTIVITIES

EDUCATION DEPARTMENT

EMERGENCY/PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. EDU-10-16-00017-EP

Filing No. 216

Filing Date. Feb. 23, 2016

Effective Date. Feb. 23, 2016

Execution by Registered Professional Nurses of Non-Patient Specific Orders to Administer Tuberculosis Tests

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:

Proposed Action:

Amendment of section 64.7 of Title 8 NYCRR.

Statutory authority:

Education Law, sections 207(not subdivided), 6504(not subdivided), 6507(2)(a), 6527(6)(c), 6902(1) and 6909(4)(c); L. 2015, ch. 464

Finding of necessity for emergency rule:

Preservation of public health and general welfare.

Specific reasons underlying the finding of necessity:

The proposed amendment is necessary to implement Chapter 464 of the Laws of 2015, which is effective February 18, 2016. The amendment to the Education Law made by Chapter 464 of the Laws of 2015 allows registered professional nurses to administer other tests to detect or screen for tuberculosis infections, pursuant to non-patient specific orders prescribed by a licensed physician or a certified nurse practitioner, in addition to purified protein derivative (PPD) tests that registered professional nurses currently administer pursuant to such orders. These other and newer tests may be more effective than the purified protein derivative (PPD) tests in detecting or screening for tuberculosis infections.

Because the Board of Regents meets at fixed intervals, the earliest the proposed amendment can be presented for regular (non-emergency) adoption, after expiration of the required 45-day public comment period provided for in the State Administrative Procedure Act (SAPA) section 202(1) and (5), would be the May 16-17, 2016 Regents meeting. Furthermore, pursuant to SAPA section 203(1), the earliest effective date of the proposed amendment, if adopted at the May meeting, would be June 1, 2016, the date a Notice of Adoption would be published in the State Register. However, the provisions of Chapter 464 of the Laws of 2015 are effective February 18, 2016.

Therefore, emergency action is necessary at the February 2016 Regents meeting for preservation of the public health and general welfare in order to enable the State Education Department to immediately implement Chapter 464 of the Laws of 2015, so that registered professional nurses can administer potentially more effective tuberculosis tests to detect and screen for tuberculosis infections pursuant to non-patient specific orders prescribed by a licensed physician or a certified nurse practitioner.

It is anticipated that the proposed amendment will be presented for permanent adoption at the May 16-17, 2016 Regents meeting, which is the first scheduled meeting after the expiration of the 45-day public comment period prescribed in the State Administrative Procedure Act for State agency rule makings.

Subject:

Execution by registered professional nurses of non-patient specific orders to administer tuberculosis tests.

Purpose:

Authorize administration of other tests to detect/screen for tuberculosis in addition to purified protein derivative (PPD) tests.

Text of emergency/proposed rule:

Section 64.7 of the Regulations of the Commissioner of Education is amended, effective February 23, 2016, as follows:

64.7 Administration of immunizations, emergency treatment of anaphylaxis, [purified protein derivative (PPD) mantoux tuberculin skin] tuberculosis tests, human immunodeficiency virus (HIV) tests, opioid related overdose treatments and hepatitis C tests pursuant to non-patient specific orders and protocols.

(a) . . .

(b) . . .

[(c) Purified protein derivative (PPD) mantoux tuberculin skin tests.

(1) Pursuant to section 6909(5) of the Education Law, a registered professional nurse shall be authorized to execute the order to administer purified derivative (PPD) mantoux tuberculin skin tests, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner, provided the order and protocol meets the requirements of paragraph (2) of this subdivision.

(2) Order and protocol.

(i) The registered professional nurse shall either maintain or ensure the maintenance of a copy of the non-patient specific order and protocol prescribed by a licensed physician or a certified nurse practitioner, which authorizes a registered professional nurse to execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test, in accordance with the requirements of paragraph (1) of this subdivision. The order prescribed in subparagraph (ii) of this paragraph shall incorporate a protocol that meets the requirements of subparagraph (iii) of this paragraph. Such order and protocol shall be considered a record of the patient who has received a purified protein derivative (PPD) mantoux tuberculin skin test and maintained as a record for the period of time prescribed in section 29.2(a)(3) of this Title.

(ii) The order shall authorize one or more named registered professional nurses, or registered professional nurses who are not individually named but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, to execute the order to administer purified protein derivative (PPD) mantoux tuberculin skin tests for a prescribed period of time. In instances in which the registered professional nurses are not individually named in the order, but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, such registered professional nurses shall not be authorized by such order to execute the order to administer purified protein derivative (PPD) mantoux tuberculin skin tests outside of such employment or contract. The order shall contain but shall not be limited to the following information:

(a) identification of the purified protein derivative (PPD) mantoux tuberculin skin test;

(b) the period of time that the order is effective, including the beginning and ending dates;

(c) the name and license number of the registered professional nurse(s) authorized to execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test; or the name of the entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services with whom registered professional nurses who are not individually named are employed or under contract to execute the order to administer the prescribed purified protein derivative (PPD) mantoux tuberculin skin test;

(d) in instances in which registered professional nurses are not individually named in the order, but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, the order shall contain a statement limiting registered professional nurses to execute the order to administer purified protein derivative (PPD) mantoux tuberculin skin tests only in the course of such employment or pursuant to such contract; and

(e) the name, license number, and signature of the licensed physician or certified nurse practitioner that has issued the order.

(iii) The protocol, incorporated into the order prescribed in subparagraph (ii) of this paragraph, shall require the registered professional nurse to meet the following requirements:

(a) The registered professional nurse shall ensure that each potential recipient is assessed for untoward conditions that would preclude purified protein derivative (PPD) mantoux tuberculin skin testing and each recipient’s record of the purified protein derivative (PPD) mantoux tuberculin skin test with manufacturer and lot number or a potential recipient’s refusal to be tested shall be documented in accordance with section 29.2(a)(3) of this Title.

(b) The registered professional nurse shall be responsible for having emergency anaphylaxis treatment agents, related to syringes and needles available at the purified protein derivative (PPD) mantoux tuberculin skin testing site, except in an emergency as determined by the Commissioner of Health, a county commissioner of health, or a county public health director.

(c) When the recipient of the test is legally capable of consenting to the test, the registered professional nurse may execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test only after the recipient is adequately informed in writing as prescribed in this clause and consents to the purified protein derivative (PPD) mantoux tuberculin skin test. In the case of minors or other recipients incapable of consenting to the test, the registered professional nurse may execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test only after the person legally responsible for the recipient of the test is adequately informed in writing as prescribed in this clause and consents to the purified protein derivative (PPD) mantoux tuberculin skin test. Prior to the registered professional nurse executing the order to administer the test, the recipient of the test, or the person legally responsible for the recipient of the test in the case of minors or other recipients incapable of consenting to the test, shall be informed in writing about the potential side effects of and adverse reactions to the test, and the need for test evaluation within 48 to 72 hours after the test is administered.

(d) The registered professional nurse shall ensure that the recipient, or other person legally responsible for the recipient when the recipient is a minor or otherwise incapable of consenting to the test, is provided with a signed certificate of purified protein derivative (PPD) mantoux tuberculin skin testing and results, with the recipient’s name, date of the test, address where the test was administered, administering nurse, manufacturer and lot number and recommendations for future tests recorded thereon. With the consent of the recipient or a person legally responsible for the recipient when the recipient is a minor or otherwise incapable of consenting, the registered professional nurse shall ensure that this information is communicated to the recipient’s primary health care provider if one exists.

(e) Each registered professional nurse shall ensure that a record of all persons so testing including the recipient’s name, date of the test, address where the test was administered, administering nurse, test results, manufacturer, lot number and recommendations for future tests is recorded and maintained in accordance with section 29.2(a)(3) of this Title.]

(c) Tuberculosis tests.

(1) As used in this subdivision, tuberculosis tests means one or more laboratory or point of care tests approved by the federal Food and Drug Administration to detect or screen for tuberculosis infections, including, but not limited to, tuberculin skin tests (purified protein derivative [PPD] tests).

(2) A registered professional nurse may administer tuberculosis tests pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(3) Order and protocol.

(i) The non-patient specific order shall include, at a minimum, the following:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the non-patient specific order and protocol;

(b) the name of the specific tuberculosis tests to be administered;

(c) a protocol for administering the ordered tuberculosis tests or a specific reference to a separate written protocol for administering the ordered tuberculosis tests, which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be treated; and

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to administer the tuberculosis tests; or the name of the entity that employs or contracts with registered professional nurses to execute the non-patient specific order and protocol, provided that the registered professional nurse(s) execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and provided further that the entity that is legally authorized to employ or contract with registered professional to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, require the registered professional nurse(s) to ensure that:

(a) each potential recipient is assessed, pursuant to criteria in the protocol, for conditions that would qualify or preclude him or her from receiving the ordered tuberculosis tests;

(b) informed consent for administering the ordered tuberculosis tests or disclosing the tuberculosis tests results to a third party (if applicable) has been obtained pursuant to the criteria in the protocol from the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for the recipient;

(c) any tuberculosis test results are disclosed and any recommendations for follow up care are made in accordance with the criteria in the protocol; and

(d) the administration of the ordered tuberculosis tests and the test results are documented in the recipient’s medical record in accordance with the criteria in the protocol and that documentation relating to tuberculosis testing is maintained in accordance with section 29.2(a)(3) of this Title.

(e) additional requirements for tuberculin skin tests. If the non-patient specific order authorizes a tuberculin skin tests, the written protocol shall, in addition to the foregoing:

(1) require the registered professional nurse to have emergency anaphylaxis treatment agents available at the tuberculin skin testing site, except in an emergency determined by the Commissioner of Health, New York City Commissioner of the Department of Health and Mental Hygiene, a county commissioner of health, or a county public health director;

(2) require that, prior to administering the tuberculin skin tests, the potential test recipient or a person authorized pursuant to law to consent to health care for the recipient receives written information regarding the potential side effects and/or adverse reactions to the tuberculin skin tests and the appropriate course of action in the event of an adverse reaction to the test;

(3) require that, prior to administering the tuberculin skin tests, the potential test recipient or his or her authorized representative is informed of the need for a test evaluation within 48 to 72 hours after the test is administered;

(4) require that the test recipient or recipient’s authorized representative receives a signed certificate of tuberculin skin testing, which shall include the results with the recipient’s name, date of tests, address where the tests was administered, administering nurse, manufacturer and lot numbers for the tuberculin solution administered, as well as any recommendations for future tests; and

(5) require that the name of the manufacturer and lot number of the tuberculin solution that was administered to the recipient are documented in his or her medical record, along with the date that the tuberculin skin tests was administered and the date that the test results were evaluated.

(d) . . .

(e) . . .

(f) . . .

This notice is intended:

to serve as both a notice of emergency adoption and a notice of proposed rule making. The emergency rule will expire May 22, 2016.

Text of rule and any required statements and analyses may be obtained from:

Kirti Goswami, State Education Department, Office of Counsel, State Education Building, Room 148, 89 Washington Ave., Albany, NY 12234, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Office of the Professions, Office of the Deputy Commissioner, State Education Department, State Education Building 2M, 89 Washington Ave., Albany, NY 12234, [phone], email: [e-mail]

Public comment will be received until:

45 days after publication of this notice.

This rule was not under consideration at the time this agency submitted its Regulatory Agenda for publication in the Register.

Regulatory Impact Statement

1. STATUTORY AUTHORITY:

Section 207 of the Education Law grants general rule-making authority to the Board of Regents to carry into effect the laws and policies of the State relating to education.

Section 6504 of the Education Law authorizes the Board of Regents to supervise the admission to and regulation of the practice of the professions.

Paragraph (a) of subdivision (2) of section 6507 of the Education Law authorizes the Commissioner of Education to promulgate regulations in administering the admission to and the practice of the professions.

Paragraph (c) of subdivision (6) of 6527 of the Education Law, as amended by Chapter 464 of the Laws of 2015, authorizes registered professional nurses to administer other tests to detect or screen for tuberculosis infections, pursuant to a non-patient specific order and protocol prescribed by a licensed physician in accordance with regulations of the Commissioner of Education, in addition to purified protein derivative (PPD) tests that registered professional nurses currently administer pursuant to such orders.

Subdivision (1) of section 6902 of the Education Law defines the practice of the profession of nursing for registered professional nurses.

Paragraph (c) of subdivision (4) of section 6909 of the Education Law, as amended by Chapter 464 of the Laws of 2015, authorizes registered professional nurses to administer other tests to detect or screen for tuberculosis infections, pursuant to a non-patient specific order and protocol prescribed by a certified nurse practitioner in accordance with regulations of the Commissioner of Education, in addition to purified protein derivative (PPD) tests that registered professional nurses currently administer pursuant to such orders.

2. LEGISLATIVE OBJECTIVES:

Amendments to paragraph (c) of subdivision (6) of section 6527 and paragraph (c) of subdivision (4) of section 6909 of the Education Law were enacted to protect the public health in New York State by increasing access to potentially more effective newer tuberculosis tests for detecting or screening for tuberculosis infections. Paragraph (c) of subdivision (6) of section 6527 of the Education Law authorizes registered professional nurses to administer other tests to detect or screen for tuberculosis infections, pursuant to a non-patient specific order and protocol prescribed by a licensed physician in accordance with regulations of the Commissioner of Education, in addition to purified protein derivative (PPD) tests that registered professional nurses currently administer pursuant to such orders. Paragraph (c) of subdivision (4) of section 6909 of the Education Law authorizes registered professional nurses to administer other tests to detect or screen for tuberculosis infections, pursuant to a non-patient specific order and protocol prescribed by a certified nurse practitioner in accordance with regulations of the Commissioner of Education, in addition to purified protein derivative (PPD) tests that registered professional nurses currently administer pursuant to such orders.

3. NEEDS AND BENEFITS:

The purpose of the proposed amendment is to establish uniform requirements for registered professional nurses to meet when executing non-patient specific orders to administer tuberculosis tests. Specifically, the proposed amendment establishes the requirements for the types of information that should be included in these written non-patient specific orders and the requirements that should be included in the written protocols for a registered professional nurse to follow when administering tuberculosis tests pursuant to a non-patient specific order prescribed by a licensed physician or a certified nurse practitioner. The proposed amendment is needed to implement the requirements of paragraph (c) of subdivision (6) of section 6527 and paragraph (c) of subdivision (4) of section 6909 of the Education Law, as amended by Chapter 464 of the Laws of 2015.

4. COSTS:

(a) Costs to State government: None.

(b) Costs to local government: None.

(c) Cost to private regulated parties. No mandatory costs.

(d) Cost to the regulatory agency: None.

5. LOCAL GOVERNMENT MANDATES:

The proposed amendment does not impose any program, service, duty, responsibility or other mandate upon local governments.

6. PAPERWORK:

The proposed amendment does not impose any paperwork mandates because it does not require any licensed physician or certified nurse practitioner to issue non-patient specific orders or protocols and does not specifically require registered professional nurses to administer tuberculosis tests pursuant to a non-patient specific order and protocol. The proposed amendment will not impose any reporting, recordkeeping or other requirements on licensed physicians and certified nurse practitioners; they choose to issue a non-patient specific order and protocol for registered professional nurses to administer tuberculosis tests. If licensed physicians or certified nurse practitioners choose to issue such non-patient specific orders, the proposed amendment requires them to, inter alia, issue these orders and related protocols in writing. The proposed amendment also requires copies of the non-patient specific orders and protocols to be maintained in the patient’s medical records. In addition, registered professional nurses must document that they administered the ordered tuberculosis tests.

7. DUPLICATION:

There are no other state or federal requirements on the subject matter of this proposed amendment. Therefore, the proposed amendment does not duplicate other existing state or federal requirements, and is necessary to implement Chapter 464 of the Laws of 2015.

8. ALTERNATIVES:

The proposed amendment is necessary to conform the Regulations of the Commissioner of Education to Chapter 464 of the Laws of 2015. There are no viable significant alternatives to the proposed amendment and none were considered.

9. FEDERAL STANDARDS:

There are no relevant federal standards for authorizing registered professional nurses to execute non-patient specific orders to administer tuberculosis tests as prescribed by a licensed physician or certified nurse practitioner. Since there are no applicable federal standards, the proposed amendment does not exceed any minimum federal standards for the same or similar subject areas.

10. COMPLIANCE SCHEDULE:

The proposed amendment is necessary to conform the Regulations of the Commissioner of Education to Chapter 464 of the Laws of 2015. The proposed amendment will become effective on February 23, 2016. The proposed amendment does not impose any compliance schedules on regulated parties or local governments.

Regulatory Flexibility Analysis

The purpose of the proposed amendment is to implement Chapter 464 of the Laws of 2015, which authorizes registered professional nurses to execute non-patient specific orders prescribed by a licensed physician or a certified nurse practitioner to administer other tests to detect or screen for tuberculosis infections, in addition to purified protein derivative (PPD) tests that registered professional nurses currently administer pursuant to such orders. These other and newer tuberculosis tests may be more effective than the purified protein derivative (PPD) tests in detecting or screening for tuberculosis infections. The proposed amendment establishes the types of information that must be included in the written non-patient specific orders and the requirements that must be set forth in the written protocols, for registered professional nurses to follow when administering tuberculosis tests.

The proposed amendment will not impose any reporting, recordkeeping, or other compliance requirements or costs, or have any adverse economic impact, on small businesses or local governments. Because it is evident from the nature of the proposed amendment that it will not adversely affect small businesses or local governments, no affirmative steps were needed to ascertain that fact and none were taken. Accordingly, a regulatory flexibility analysis for small businesses and local governments is not required, and one has not been prepared.

Rural Area Flexibility Analysis

1. TYPES AND ESTIMATED NUMBER OF RURAL AREAS:

The proposed amendment will apply to all New York State registered professional nurses who administer tuberculosis tests pursuant to a non-patient specific order and protocol, including registered professional nurses located in the 44 rural counties with less than 200,000 inhabitants and the 71 towns in urban counties with a population density of 150 per square miles or less. Of the approximately 285,000 registered professional nurses who are registered to practice in New York State, approximately 30,200 reported that their permanent address of record is in a rural county of New York State.

The proposed amendment will also apply to all New York State certified nurse practitioners who issue non-patient specific orders and protocols to authorize registered professional nurses to administer tuberculosis tests, including nurse practitioners located in the 44 rural counties with less than 200,000 inhabitants and the 71 towns in urban counties with a population density of 150 per square miles or less. Of the approximately 20,000 certified nurse practitioners who are registered to practice in New York State, approximately 2,500 reported that their permanent address of record is in a rural county of New York State.

Additionally, the proposed rule will apply to all New York State licensed physicians who issue non-patient specific orders and protocols to authorize registered professional nurses to administer tuberculosis tests, including licensed physicians located in the 44 rural counties with less than 200,000 inhabitants and the 71 towns in urban counties with a population density of 150 per square miles or less. Of the approximately 93,300 licensed physicians registered to practice in New York State, approximately 2,550 reported that their permanent address of record is in a rural county of New York State.

2. REPORTING, RECORDKEEPING AND OTHER COMPLIANCE REQUIREMENTS; AND PROFESSIONAL SERVICES:

The proposed amendment to subdivision (c) of section 64.7 of the Regulations of the Commissioner of Education implements Chapter 464 of the Laws of 2015. On February 18, 2016, the effective date of Chapter 464 of the Laws of 2015, registered professional nurses will be authorized to administer, pursuant to non-patient specific orders prescribed by a licensed physician or a certified nurse practitioner, other tests to detect or screen for tuberculosis infections, in addition to the purified protein derivative (PPD) tests registered professional nurses are currently permitted to administer pursuant to such orders. These other and newer tuberculosis tests may be more effective than the purified protein derivative (PPD) tests in detecting or screening for tuberculosis infections.

The proposed amendment authorizes registered professional nurses to execute non-patient specific orders and protocols, ordered by a licensed physician or certified nurse practitioner, for administering tuberculosis tests. The proposed amendment will not require any licensed physician or certified nurse practitioner to issue non-patient specific orders or protocols and does not specifically require registered professional nurses to administer tuberculosis tests pursuant to a non-patient specific order and protocol. The proposed amendment will not impose any reporting, recordkeeping or other compliance requirements, or professional services requirements, on health care providers in rural areas, unless a licensed physician or certified nurse practitioner issues a non-patient specific order and protocol for registered professional nurses to administer tuberculosis tests. The proposed amendment of subdivision (c) of section 64.7 of the Regulations of the Commissioner of Education require licensed physicians and certified nurse practitioners to issue non-patient specific orders and protocols in writing. Copies of the non-patient specific orders and protocols must be maintained in the patient’s medical records. In addition, registered professional nurses must document that they administered the ordered tuberculosis tests.

3. COSTS:

The proposed amendment will not impose any costs on any licensed physician, certified nurse practitioner, registered professional nurse, or other party. Neither paragraph (c) of subdivision (4) of section 6909 nor paragraph (c) of subdivision (6) of section 6527 of the Education Law impose any obligations on licensed physicians or certified nurse practitioners to issue non-patient specific orders and protocol for tuberculosis tests.

4. MINIMIZING ADVERSE IMPACT:

The proposed amendment is necessary to conform the Regulations of the Commissioner of Education to Chapter 464 of the Laws of 2015. The statutory requirements do not make exceptions for individuals who live or work in rural areas. Thus, the Department has determined that the proposed amendment’s requirements should apply to all licensed physicians, certified nurse practitioners and registered professional nurses in New York State. Because of the nature of the proposed rule, alternative approaches for rural areas were not considered.

5. RURAL AREAS PARTICIPATION:

Comments on the proposed rule were solicited from statewide organizations representing all parties having an interest in the practice of certified nurse practitioners and registered professional nurses. These organizations included the State Board for Nursing and professional associations representing the nursing profession and nursing educators and the medical professions. These groups have members who live or work or provide nursing education in rural areas.

6. INITIAL REVIEW OF RULE (SAPA § 207):

Pursuant to State Administrative Procedure Act section 207(1)(b), the State Education Department proposes that the initial review of this rule shall occur in the fifth calendar year after the year in which the rule is adopted, instead of in the third calendar year. The justification for a five year review period is that the proposed amendment is necessary to implement Chapter 464 of the Laws of 2015, and, therefore, the substantive provisions of the proposed amendment cannot be repealed or modified unless there is a further statutory change. Accordingly, there is no need for a shorter review period. The State Education Department invites public comment on the proposed five year review period for this rule. Comments should be sent to the agency contact listed in item 16 of the Notice of Emergency Adoption and Proposed Rule Making published herewith, and must be received within 45 days of the State Register publication date of the Notice.

Job Impact Statement

The proposed amendment implements Chapter 464 of the Laws of 2015, which authorizes registered professional nurses to execute non-patient specific orders prescribed by a licensed physician or a certified nurse practitioner to administer other tests to detect or screen for tuberculosis infections, in addition to purified protein derivative (PPD) tests that registered professional nurses currently administer pursuant to such orders. These other and newer tuberculosis tests may be more effective than the purified protein derivative (PPD) tests in detecting or screening for tuberculosis infections.

The proposed amendment implements specific statutory requirements. Any impact on jobs and employment opportunities created by establishing criteria for authorizing registered professional nurses to administer tuberculosis tests, in addition to the purified protein derivative (PPD) tests, pursuant to a non-patient specific written order and written protocol prescribed by a licensed physician or a certified nurse practitioner is attributable to the statutory requirement.

Because it is evident from the nature of the proposed amendment, which implements specific statutory requirements and directives, that it will have no adverse impact on jobs or employment opportunities attributable to its adoption or only a positive impact, no affirmative steps were needed to ascertain these facts and none were taken. Accordingly, a job impact statement is not required and one was not prepared.