Amended 0716 1
CHAPTER 457
NURSES
SECTION
457-1 Purpose
457-1.5 Practice of nursing
457-2 Definitions
457-2.5 Registered nurse
457-2.6 Licensed practical nurse
457-2.7 Advanced practice registered nurse.
457-3 State board of nursing; appointment; term of office; removal from office
457-4 Qualifications of board members
457-5 Duties and powers of board
457-6 Repealed
457-6.5 Application of National Council of State Boards of Nursing Model Nursing
Practice Act and Model Nursing Administrative Rules.
457-7 Registered nurses; qualifications; licenses; fees; title; existing licensed nurses;
verification of licenses; eligibility
457-7.5 Delegation
457-8 Licensed practical nurse; qualifications; license; fees; title; existing licensed
nurses; verification of licenses; eligibility
457-8.5 Advanced practice registered nurse; qualifications; recognition; endorsement;
fees; eligibility
457-8.6 Prescriptive authority for advanced practice registered nurses
457-8.8 Advanced practice registered nurses; global signature authority
457-8.9 Advanced practice registered nurses; expedited partner therapy
Note - Additional fee
457-9 Renewal of license; denial, suspension, or revocation of license for default of
student loan, student loan repayment contract, or scholarship contract;
inactivation and reactivation of license; restoration of forfeited license
457- 9.2 Continuing competency requirements; exemptions; extensions; record retention;
audit
457-9.3 Learning activity option
457-10 Repealed
457-11 Nursing education programs
457-12 Discipline; grounds; proceedings; hearings
457-13 Exceptions
457-14 Violations of chapter; penalties
457-15 Injunctive relief
457-16 Severability
457- Nursys; verification of nurse license
457- Discipline based on action taken in another state; conditions; prohibition on
practice
457- Telehealth; privacy, security, and confidentiality
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§457-1 Purpose. In order to safeguard life and health, any person practicing or offering to
practice as an advanced practice registered nurse, a registered nurse, or a licensed practical nurse in
this State for compensation shall be required to submit evidence that the person is qualified to so
practice, and shall licensed as provided in this chapter. It shall be unlawful for any person not licensed
under this chapter to practice or offer to practice nursing as an advanced practice registered nurse, a
registered nurse or a licensed practical nurse; or to use any sign, card, or device, or in any manner
indicate or imply that the person is an advanced practice registered nurse, a registered nurse or a
licensed practical nurse.
§457-1.5 Practice of nursing. (a) Nursing is a scientific process founded on a body of
professional knowledge. It is learned profession based on an understanding of the human condition
across the lifespan of a client and the relationship of a client with others and within the environment.
It is also an art dedicated to caring for others. The practice of nursing means assisting clients in
attaining or maintaining optimal health, implementing a strategy of care to accomplish defined goals
within the context of a client-centered health care plan, and evaluating responses to nursing care and
treatment. Nursing is a dynamic discipline that is continually evolving to include more sophisticated
knowledge, technologies, and client care activities. Nursing applies evidence-based practice to
promote optimal client outcomes.
(b) The scope of nursing practices established in this chapter and by the rules of the board
shall serve as general guidelines and are not intended to address the appropriateness of the use of
specific procedures in any particular work setting or to grant permission to implement specific
procedures in any particular work setting.
§457-2 Definitions. (a) As used in this chapter unless the content otherwise requires:
"Advanced practice registered nurse" means a registered nurse who has met the qualifications
for advanced practice registered nurse licensure set forth in this chapter and through rules of the board,
which shall include educational requirements.
"Board" means the State board of nursing.
"Competency" means the ability of a nurse to integrate knowledge, skills, judgment and
personal attributes to practice safely and ethically in the professional nursing position and in
accordance with the scope of nationally recognized nursing practices.
"Contact hour" means the same as section 16-89-2, Hawaii Administrative Rules.
"Continuing competency" means the long-term educational and professional process by
which an individual undertakes and documents with verifiable evidence a personal learning plan
that encompasses a periodic self-assessment of personal strengths and weaknesses as present in
the individuals practice as a nurse as well as a commitment to furthering the individual's
professional knowledge relating to the nursing field."
""Distant site" means the location of the nurse delivering services through telehealth at
the time the services are provided.
""Licensure and discipline data" means identifying information that includes but is not
limited to the licensee's name, address, social security number, date of birth, and nursing
education.
"NCSBN" means the National Council of State Boards of Nursing.
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"Nurse" means a person licensed under this chapter or a person who holds a license under
the laws of another state or territory of the United States that is equivalent to a license under this
chapter.
"Nursys" means an integrated process for collecting, storing, and sharing information on
nurse licensure and enforcement activities related to nurse licensure laws that is administered by a
nonprofit organization composed of and controlled by licensing boards."
"Originating site" means the location where the patient is located, whether accompanied
or not by a health care provider, at the time services are provided by a nurse through telehealth,
including but not limited to a nurse's or health care provider's office, hospital, health care facility,
a patient's home, and other non-medical environments such as school-based health centers,
university-based health centers, or the work location of a patient."
"Telehealth" means the use of telecommunications as that term is defined in section 269-1,
to encompass four modalities: store and forward technologies, remote monitoring, live
consultation, and mobile health; and which shall include but not be limited to real-time video
conferencing-based communication, secure interactive and non-interactive web-based
communication, and secure asynchronous information exchange, to transmit patient medical
information, including diagnostic-quality digital images and laboratory results for medical
interpretation and diagnosis, to support long-distance clinical health care while a patient is at an
originating site and the nurse is at a distant site, patient and professional health-related education,
public health and health administration, to the extent that it relates to nursing.
"The practice of nursing as a licensed practical nurse" means the performance of those acts
commensurate with the required educational preparation and demonstrated competency of the
individual, whereby the individual shall be accountable and responsible to the consumer for the
quality of nursing care rendered. The foregoing may include, but shall not be limited to:
implementation of basic nursing procedures in the plan of care; observing and caring for individuals
at all levels of the health spectrum, giving counsel and acting to safeguard life and health and
functioning as a part of the health care team, under the direction of a dentist, physician, osteopathic
physician, registered nurse, osteopath, or podiatrist licensed in accordance with chapter 448, 453, 457,
460, or 463E, or under the orders of a physician assistant licensed pursuant to chapter 453,
practicing with physician supervision as required by chapter 453, and acting as the agent of the
supervising physician; administration of treatment and medication as prescribed; promotion of health
maintenance of individuals, families, or groups; or teaching and supervision of auxiliary personnel.
"The practice of nursing as a registered nurse" means the performance of professional services
commensurate with the educational preparation and demonstrated competency of the individual
having specialized knowledge, judgment, and skill based on the principles of the biological, physical,
behavioral, and sociological sciences and nursing theory, whereby the individual shall be accountable
and responsible to the consumer for the quality of nursing care rendered. The foregoing may include
but shall not be limited to observation, assessment, development, implementation, and evaluation of
a plan of care, health counseling, supervision and teaching of other personnel, and teaching of
individuals, families, and groups in any stage of health or illness; administration, supervision,
coordination, delegation, and evaluation of nursing practice; provision of health care to the patient in
collaboration with other members of the health care team as autonomous health care professionals
providing the nursing component of health care; or use of reasonable judgment in carrying out
prescribed medical orders of a licensed dentist, physician, osteopathic physician, or podiatrist licensed
in accordance with chapter 448, 453, 460, or 463E; orders of an advanced practice registered nurse
licensed in accordance with this chapter; or the orders of a physician assistant licensed pursuant to
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chapter 453, practicing with physician supervision as required by chapter 453, and acting as the
agent of the supervising physician.
(b) Definitions applicable to this chapter shall also include those used in the NCSBN
Model Nursing Practice Art and the Model Nursing Administrative Rules unless the context otherwise
requires. Where a definition in the NCSBN Model Nursing Practice Act or Model Nursing
Administrative Rules conflicts with a definition in chapter 457 or 436B, the definitions contained in
chapter 457 or 436B and the rules of the board shall apply.
§457-2.5 Registered nurse. Practice as a registered nurse means the full scope of nursing, regardless
of compensation or personal profit, that incorporates caring for all clients in all settings and is guided
by the scope of practice authorized by this chapter, the rules of the board, and nursing standards
established or recognized by the board including but not limited to:
(1) The National Council of State Boards of Nursing Model Nursing Practice Act, Article
II, Scope of Nursing Practice, Section 2; and
(2) The National Council of State Boards of Nursing Model Nursing Administrative
Rules, Chapter Two, Standards of Nursing Practice, Sections 2.2.2 through 2.2.6;
provided the NCSBN shall have no legal authority over the board and shall have no legal authority or
powers of oversight of the board in the exercise of its powers and duties authorized by law.
§457-2.6 Licensed practical nurse. Practice as a licensed practical nurse means the directed scope
of nursing practice, regardless of compensation or personal profit, that takes place under the direction
of a registered nurse, advanced practice registered nurse, licensed physician, or other health care
provider authorized by the State, and is guided by the scope of practice authorized by this chapter, the
rules of the board, and nursing standards established or recognized by the board including buy not
limited to:
(1) The National Council of State Boards of Nursing Model Nursing Practice Act, Article
II, Scope of Nursing Practice, Section 3; and
(2) The National Council of State Boards of Nursing Model Nursing Administrative
Rules, Chapter Two, Standards of Nursing Practice, Sections 2.3.1 through 2.3.3;
provided the NCSBN shall have no legal authority over the board and shall have no legal authority or
powers of oversight of the board in the exercise of its powers and duties authorized by law.
§457-2.7 Advanced practice registered nurse. (a) Practice as an advanced practice
registered nurse means the scope of nursing in a category approved by the board, regardless of
compensation or personal profit, and includes the registered nurse scope of practice. The scope of an
advanced practice registered nurse includes but is not limited to advanced assessment and the
diagnosis, prescription, selection, and administration of therapeutic measures including over the
counter drugs, legend drugs, and controlled substances within the advanced practice registered nurse's
role and specialty-appropriate education and certification.
(b) The advanced practice registered nurse's scope of practice supersedes the registered
nurse's scope of practice. Advanced practice registered nurses shall practice within standards
established or recognized by the board and be guided by the scope of practice authorized by this
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chapter, the rules of the board, and nursing standards established or recognized by the board including
but not limited to:
(1) The National Council of State Boards of Nursing Model Nursing Practice Act, Article
II, Scope of Nursing Practice, Section 4; and
(2) The National Council of State Boards of Nursing Model Nursing Administrative
Rules, Chapter Two, Standards of Nursing Practice, Section 2.4.1;
provided that NCSBN shall have no legal authority over the board and shall have no legal authority
or powers of oversight of the board in the exercise of its powers and duties authorized by law.
(c) An advanced practice registered nurse shall comply with the requirements of this
chapter; recognized limits of the advanced practice registered nurse's knowledge and experience and
planning for the management of situations that exceed the scope of authorized practice; and consult
with or refer clients to other health care providers, as appropriate.
§457-3 State board of nursing; appointment; term of office. The board shall consist of
nine members as follows:
(1) Six shall be registered nurses, one of whom shall be licensed as an advanced practice
registered nurse in this State;
(2) One shall be a licensed practical nurse; and
(3) Two shall be public members.
Both nursing education and direct providers of nursing services shall be represented on the board. The
term of office for members of the board shall be four years. No member shall be appointed to more
than two consecutive terms or serve more than eight consecutive years. Six members of the board
shall be residents of the city and county of Honolulu and three shall be residents of counties other
than the city and county of Honolulu.
§457-4 Qualifications of board members. (a) Each member of the board shall be a resident
of this State.
Each registered nurse member of the board shall also:
(1) Be a graduate of a state-accredited educational program to prepare for becoming a
registered nurse and have at least a bachelor's degree in nursing but preferably a
graduate degree in nursing;
(2) Have a current, unencumbered license as a registered nurse in the State; and
(3) Have at least five years of experience after graduation in the practice of nursing as a
registered nurse and at least three years of active nursing experience as a registered
nurse immediately preceding appointment or reappointment.
(b) Each licensed practical nurse member of the board shall also:
(1) Be a graduate of a state-accredited educational program to prepare for becoming a
licensed practical nurse;
(2) Have a current, unencumbered license as a licensed practical nurse in the State; and
(3) Have at least five years of successful experience in the practice of nursing as a licensed
practical nurse after graduation and at least three years of active nursing experience as
a licensed practical nurse immediately preceding appointment or reappointment.
(c) Each advanced practice registered nurse member of the board shall:
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(1) Have current, unencumbered licensure by the board as an advanced practice registered
nurse; and
(2) Have at least five years of experience in the practice of nursing as an advanced practice
registered nurse and at least three years of active nursing experience as an advanced
practice registered nurse immediately preceding appointment or reappointment.
§457-5 Duties and powers of board. (a) In addition to any other powers and duties
authorized by law, the board may:
(1) Adopt, amend, or repeal rules, pursuant to chapter 91, not inconsistent with the law,
as may be necessary to enable it to carry into effect this chapter, including the
definition of the scope of practice of nursing and the delegation of nursing tasks based
upon professional nursing standards, which include but are not limited to the standards
set forth by national certifying bodies recognized by the board;
(2) Prescribe standards for preparing persons for licensure as practical nurses, registered
nurses, and advanced practice registered nurses under this chapter;
(3) Conduct surveys of educational programs as it may deem necessary and practical;
(4) Approve educational programs that meet the requirements of this chapter and the rules
of the board;
(5) Deny or withdraw approval of educational programs for failure to meet or maintain
the standards prescribed in this chapter;
(6) License qualified applicants by examination or endorsement, including advanced
practice registered nurses, and renew, reinstate, reactivate and restore licenses and
shall conduct an investigation of the qualified applicant's background, character,
competency, and integrity, as the board deems appropriate. The board shall:
(A) Request, beginning July 1, 2017, the criminal history records of qualified
applicants, in accordance with section 846-2.7; and
(B) Request the criminal history records, pursuant to section 846-2.7, of
licensees who were issued licenses by the board prior to July 1, 2017; provided that
the board shall request criminal history records under this paragraph not less than
once for each individual qualified applicant or licensee; provided further that all
requests for criminal history records required for licensees issued a license by the
board prior to July 1, 2017, shall be made by the board no later than July 1, 2023.
The Hawaii criminal justice data center shall provide the information on request to
the director of commerce and consumer affairs;
(7) Conduct hearings upon request of a denied applicant or upon charges calling for
discipline of a licensee;
(8) Exercise the power to issue subpoenas, compel the attendance of witnesses, and
administer oaths to persons giving testimony at hearings;
(9) Cause the prosecution of all persons violating this chapter and to incur necessary
expenses therefor;
(10) Keep a record of all its proceedings;
(11) Provide consultation, conduct conferences, forums, studies, and research on nursing
education and practice;
(12) Communicate with national organizations that promote the improvement of the legal
standards of practice of nursing for the protection of public health, safety, and welfare;
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(13) Authorize the administration of examinations to eligible applicants for licensure as
registered nurses or licensed practical nurses, or other examinations required by the
board as designated in its rules;
(14) Employ, contract, and cooperate, to the extent allowable by law, with any
board-approved organization in the preparation and grading of an appropriate
nationally uniform examination; provided the board shall retain sole discretion and
responsibility for determining the standard of successful completion of such an
examination. When such a national examination is used, access to questions and
answers shall be restricted by the board; and
(15) Develop and adopt rules as necessary relating to the practice of nursing in telehealth.
(b) The board shall monitor and evaluate the scope of the practice of nursing in other
states and make recommendations to the legislature, when deemed desirable, for appropriate
amendment to the definitions under section 457-2 and any other provision of this chapter.
§457-6 REPEALED.
§457-6.5 Application of National Council of State Boards of Nursing Model Nursing
Practice Act and Model Nursing Administrative Rules. (a) In accordance with chapter 91, the
board shall adopt the provisions of the NCSBN Model Nursing Practice Act and Model Nursing
Administrative Rules relating to the scope and standards of nursing practice for registered nurses,
licensed practical nurses, and advanced practice registered nurses and shall adopt any subsequent
modifications adopted by the Delegate Assembly of the NCSBN; provided that the board shall not be
required to adopt rules or provisions that the board finds are inappropriate or inapplicable.
(b) If the board finds that any rule or provision of the NCSBN is inappropriate or
inapplicable, the board shall state clearly in the record of the board's proceedings the board's rationale
for rejecting or modifying the NCSBN's model rules.
(c) The NCSBN shall have no legal authority over the board and shall have no legal
authority or powers of oversight of the board in the exercise of its powers and duties authorized by
law.
§457-7 Registered nurses; qualifications; licenses; fees; title; existing licensed nurses;
verification of licenses; eligibility. "(a) An applicant for a license to practice nursing as a registered
nurse shall submit:
(1) An application on a form prescribed by the board;
(2) Beginning with the July 1, 2017, licensing biennium, a full set of electronic
fingerprints for the purpose of obtaining federal and state criminal history record
checks in accordance with section 846-2.7 directly to the Hawaii criminal justice
data center for processing with the Federal Bureau of Investigation. The applicant
shall bear the cost of the fingerprint processing and the application shall not be
considered complete until the results of the criminal history record check has been
received by the board; and
(3) Written evidence that the applicant has completed a nursing program approved by the
board."
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(b) Licenses shall be granted either by:
(1) Examination: The applicant shall be required to pass a written examination in nursing
subjects as determined by the board. Upon the applicant's passage of the examination
and compliance with the applicable requirements of this chapter and the rules of the
board, the board shall issue to the applicant a license to practice nursing as a registered
nurse; or
(2) Endorsement: The board may issue a license to practice nursing as a registered nurse
by endorsement to an applicant who has been licensed as a registered nurse under the
laws of another state, territory, or foreign country if the applicant has an
unencumbered license and, in the opinion of the board, the applicant meets the
qualifications required of registered nurses in this State at the time of graduation.
Pending verification of a valid, unencumbered license from another state, a temporary
permit may be issued for employment with a Hawaii employer.
(c) The applicant applying for a license to practice as a registered nurse by examination
shall pay application, examination, and reexamination fees, if applicable, as prescribed by the board.
Each applicant who successfully passes the examination shall pay a license fee. The applicant
applying for a license to practice as a registered nurse by endorsement shall pay application and
license fees.
(d) Any person who holds a license to practice nursing as a registered nurse in this State
shall have the right to use the title "Registered Nurse" and the abbreviation "R.N.". No other person
shall assume the title "nurse" or in any manner imply that the person is a nurse except as provided in
sections 457-8 and 457-8.5 or use the abbreviation "R.N." or any other words, letters, signs, or devices
to indicate that the person using the same is a registered nurse.
(e) Any person who requests verification of a registered nurse license to a nursing board
of another state shall pay a license verification fee.
(f) Applicants applying for a license to practice as a registered nurse by examination shall
submit to the board proof of eligibility. Applicants shall be eligible to apply for a license by
examination if they have:
(1) Graduated from a registered nursing program at an educational institution in the
United States or any territory or possession under the jurisdiction of the United States
and are qualified as determined by the board through rules adopted pursuant to chapter
91;
(2) Graduated from a registered nursing program at an educational institution in a foreign
jurisdiction and have had their transcripts evaluated by professional evaluators
designated by the board and are considered qualified as determined by the board
through rules adopted pursuant to chapter 91; or
(3) Graduated with a bachelor's degree and satisfactorily completed the pre-licensure
portion of a master's entry program in nursing at an accredited school of nursing in the
United States or any territory or possession under the jurisdiction of the United States
that is recognized by the board or other state boards of nursing and are qualified as
determined by the board.
(g) Unless determined to be insufficient or otherwise invalid by the board, all transcripts,
diplomas, certificates of graduation, and other credentials submitted by any applicant in compliance
with the application procedures for examination and licensure under this section shall be retained by
the board for two years and shall suffice as proof of graduation upon subsequent submittals of
applications for reexamination within two years by any applicant.
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§457-7.5 Delegation. (a) A registered nurse may delegate nursing care tasks, functions, and
activities to unlicensed assistive personnel in a manner that is appropriate to the level of knowledge
and skill of the unlicensed assistive personnel; provided that the delegation of tasks, functions, and
activities complies with applicable federal and state laws; and provided further that the practice-
pervasive functions of assessment, evaluation, and nursing judgment shall not be delegated.
(b) The delegating nurse is responsible for individually assessing the patient and the
situational circumstances and for ascertaining the competence of the delegatee before delegating any
task, function, or activity. The delegating nurse shall supervise, monitor, evaluate, and follow-up on
instructions to a delegatee after delegating any task, function, or activity. The delegatee shall assume
liability for accepting the delegation and for the delegatee's own actions in carrying out the delegated
task, function, or activity.
(c) When delegating a task, function, or activity, a delegating nurse shall use the NCSBN
delegation decision-making process as a model for decision-making. The delegating nurse shall
consider and carefully analyze:
(1) Patient needs and circumstances;
(2) Qualifications of the proposed delegatee;
(3) The nature of the delegating nurse's delegation authority set forth in this chapter;
(4) The delegating nurse's personal competence in the area of nursing relevant to the task,
function, or activity to be delegated; and
(5) The protocols contained in NCSBN documents, including but not limited to: Five
Rights of Delegation, Delegation-Decision Making Tree, and The Continuum of Care Framework.
§457-8 Licensed practical nurse; qualifications; license; fees; title; existing licensed
nurses; verification of licenses; eligibility. (a) An applicant for a license to practice nursing as a
licensed practical nurse shall submit:
(1) An application on a form prescribed by the board;
(2) Beginning with the July 1, 2017, licensing biennium, a full set of electronic
fingerprints for the purpose of obtaining federal and state criminal history record
checks in accordance with section 846-2.7 directly to the Hawaii criminal justice
data center for processing with the Federal Bureau of Investigation. The applicant
shall bear the cost of the fingerprint processing and the application shall not be
considered
complete until the results of the criminal history record check has
been received by the board; and
(3) Written evidence that the applicant has completed a licensed practical nurse
program, or its equivalent, approved by the board, and holds a diploma or
certificate therefrom."
(b) Licenses shall be granted either by:
(1) Examination: The applicant shall be required to pass a written examination in nursing
subjects as determined by the board. Upon the applicant's passage of the examination
and compliance with the applicable requirements of this chapter and the rules of the
board, the board shall issue to the applicant a license to practice nursing as a licensed
practical nurse; or
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(2) Endorsement: The board may issue a license to practice nursing as a licensed practical
nurse by endorsement to any applicant who has been licensed as a licensed practical
nurse, or a person entitled to perform similar services under a different title, under the
laws of another state, territory, or foreign country if the applicant has an
unencumbered license and, in the opinion of the board, the applicant meets the
requirements for licensed practical nurses in this State at the time of graduation.
Pending verification of a valid, unencumbered license from another state, a temporary
permit may be issued for employment with a Hawaii employer.
(c) The applicant applying for a license to practice as a licensed practical nurse by
examination shall pay application, examination, and reexamination fees, if applicable, as prescribed
by the board. Each applicant who successfully passes the examination shall pay a license fee. The
applicant applying for a license to practice as a licensed practical nurse by endorsement shall pay
application and license fees.
(d) Applicants who have graduated from a practical nursing program at an educational
institution in a foreign jurisdiction and are applying for a license to practice as a licensed practical
nurse by examination shall submit to the board proof of eligibility. Applicants shall be eligible to
apply for a license by examination if they have met the educational requirements prescribed in the
rules of the board and have had their transcripts evaluated by professional evaluators designated by
the board and are considered qualified as determined by the board through rules adopted pursuant to
chapter 91.
(e) Any person who holds a license to practice nursing as a licensed practical nurse in this
State shall have the right to use the title "Licensed Practical Nurse" and the abbreviation "L.P.N.".
No other person shall assume the title "nurse" or in any manner imply that the person is a nurse except
as provided in sections 457-7 and 457-8.5 or use the abbreviation "L.P.N." or any other words, letters,
signs, or devices to indicate that the person using the same is a licensed practical nurse.
(f) Any person who requests verification of a practical nurse license to a nursing board
of another state shall pay a license verification fee.
(g) Unless determined to be insufficient or otherwise invalid by the board, all transcripts,
diplomas, certificates of graduation, and other credentials submitted by any applicant in compliance
with the application procedures for examination and licensure under this section shall be retained by
the board for two years and shall suffice as proof of graduation upon subsequent submittals of
applications for reexamination within two years by any applicant.
§457-8.5 Advanced practice registered nurse; qualifications; licensure; endorsement;
fees; eligibility. (a) The board shall grant an advanced practice registered nurse license to a nurse
who has:
(1) A current, unencumbered license as a registered nurse in this state;
(2) An unencumbered license as a registered nurse in all other states in which the nurse
has a current and active license;
(3) An unencumbered license as an advanced practice registered nurse or similar
designation in all other states in which the nurse has a current and active license as an
advanced practice registered nurse;
(4) Completed an accredited graduate-level education program preparing the nurse for
one of the four recognized advanced practice registered nurse roles;
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(5) A current, unencumbered certification of having passed a national certification
examination that measures role and population-focused competencies and is
recognized by the board;
(6) Maintained continued competencies through recertification in role and
population-focused competencies through a national certification program recognized
by the board;
(7) Acquired advanced clinical knowledge and skills preparing the nurse to provide direct
care to patients through a significant educational and practical concentration on the
direct care of patients;
(8) Demonstrated a greater breadth of knowledge, a greater synthesis of data, greater
complexity of skills and interventions, and greater role autonomy than demonstrated
by a registered nurse;
(9) Been educationally prepared to assume responsibility and accountability for health
promotion and maintenance and to assess, diagnose, and manage patient problems
through the use and prescription of pharmacologic and non-pharmacologic
interventions;
(10) Acquired clinical experience of sufficient depth and breadth to reflect the intended
license;
(11) Beginning with the July 1, 2017, licensing biennium, submitted a full set of
electronic fingerprints for the purpose of obtaining federal and state criminal history
record checks in accordance with section 846- 2.7 directly to the Hawaii criminal
justice data center for processing with the Federal Bureau of Investigation. The
applicant shall bear the cost of the fingerprint processing and the application shall
not be considered complete until the results of the criminal history record check has
been received by the board; and.
(12) Paid the appropriate fees."
(b) Any person licensed as an advanced practice registered nurse prior to October 1, 2009,
whose license was granted based on a master's degree in nursing or a current certification for
specialized and advanced nursing practice from a national certifying body recognized by the board
shall be eligible to renew that license; provided that all nurse licenses and prescriptive authorities or
similar designations held by the person in any jurisdiction are unencumbered.
(c) Any person applying for advanced practice registered nurse licensure by endorsement
shall be licensed as an advanced practice registered nurse; provided that:
(1) The person applying is licensed as a registered nurse in this state; and
(2) All nurse licenses and prescriptive authorities or similar designations held by the
person under the laws of this state, another state, or a United States territory are
unencumbered, and the originating state's requirements were equal to or greater than
the board's advanced practice registered nurse requirements which were in effect prior
to October 1, 2009.
An advanced practice registered nurse shall be eligible to renew the license granted under this
subsection; provided that all nurse licenses and prescriptive authorities or similar designations held
by the person in this state, another state, or a United States territory are unencumbered.
(d) Only a person who has a current, unencumbered license from the board to practice as
an advanced practice registered nurse shall use the title "Advanced Practice Registered Nurse" and
the abbreviation "A.P.R.N.". No other person shall assume the title "nurse" or in any manner imply
that the person is a nurse except as defined in section 457-2 or as provided in sections 457-7 and 457-
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8 or use the abbreviation "A.P.R.N." or any other words, letter, sign, or device to indicate that the
person using the same is an advanced practice registered nurse. Nothing in this section shall preclude
a registered nurse who is not licensed by the board as an advanced practice registered nurse and who
is currently certified by a national certifying body recognized by the board from using another title
designated by certification.
§457-8.6 Prescriptive authority for advanced practice registered nurses. (a) The board
shall grant prescriptive authority to qualified advanced practice registered nurses and shall designate
the requirements for advanced nursing practice related to prescriptive authority. The board shall
determine the exclusionary formulary for qualified advanced practice registered nurses who are
granted prescriptive authority.
(b) The board shall establish requirements for advanced practice registered nurses'
education, experience, and national certification pursuant to rules adopted in accordance with chapter
91.
(c) Advanced practice registered nurses shall be considered qualified if they have met the
requirements of section 457-8.5(a), and have met the advanced pharmacology requirements for initial
prescriptive authority pursuant to rules adopted by the board. Only qualified advanced practice nurses
authorized to diagnose, prescribe, and institute therapy or referrals of patients to health care agencies,
health care providers, and community resources and, only as appropriate, to the practice specialty in
which the advanced practice nurse is qualified, may:
(1) Prescribe and administer over the counter drugs, legend drugs, and controlled
substances pursuant to this chapter and to chapter 329 and request, receive, and
dispense manufacturers' prepackaged samples of over the counter drugs and
non-controlled legend drugs to patients under their care; provided that an advanced
practice registered nurse shall not request, receive, or sign for professional controlled
substance samples;
(2) Prescribe, order, and dispense medical devices and equipment; and
(3) Plan and initiate a therapeutic regimen that includes nutritional, diagnostic, and
supportive services including home health care, hospice, and physical and
occupational therapy.
§457-8.8 Advanced practice registered nurses; global signature authority.
Notwithstanding any other law to the contrary, advanced practice registered nurses shall be
authorized to sign, certify, or endorse all documents relating to health care within their scope of
practice provided for their patients, including workers' compensation verification documents,
verification and evaluation forms of the department of human services and department of
education, verification and authorization forms of the department of health, and physical
examination forms; provided that nothing in this section shall be construed to expand the scope of
practice of advanced practice registered nurses.
§457-8.9 Advanced practice registered nurses; expedited partner therapy. Advanced
practice registered nurses who meet the definition of a health professional as defined in section 453-
A, shall be authorized to provide expedited partner therapy in accordance with part of chapter 453.
13
§457-9 Renewal of license; denial, suspension, or revocation of license for default of
student loan, student loan repayment contract, or scholarship contract; inactivation and
reactivation of license; restoration of forfeited license. (a) The license of every person licensed
or granted prescriptive authority shall expire on June 30 of every odd-numbered year and shall be
renewed biennially, except as provided in this section. Biennially in each odd-numbered year, the
board shall make available an application for renewal of license before the deadline set forth by the
board to every person to whom a license was issued or renewed during the biennium. The applicant
shall complete the application and submit it to the board with a renewal fee, and shall also submit
beginning with the July 1, 2019, licensing biennium, a full set of electronic fingerprints for the
purpose of obtaining federal and state criminal history record checks in accordance with section
846- 2.7 directly to the Hawaii criminal justice data center for processing with the Federal
Bureau of Investigation. The applicant shall bear the cost of the fingerprint processing and the
application shall not be considered complete until the results of the criminal history record check
has been received by the board; and all required documents on or before the deadline set by the
board. The applicant shall provide documents from proper agencies or parties of any criminal
conviction or any disciplinary action taken or pending in this State or any other state in the United
States or any territory or possession under the jurisdiction of the United States within the two years
prior to application for renewal of license. Upon receipt of the application and fee the board shall
verify the accuracy of the application and issue to the applicant a certificate of renewal for the
biennium expiring two years hence on the deadline set by the board. The renewal shall render the
holder thereof a legal practitioner of nursing for the period stated on the renewal form.
(b) Any licensee who fails to renew a license as provided in subsection (a) but continues
to practice shall be considered an illegal practitioner and shall be subject to the penalties provided for
violations of this chapter. The failure to timely renew a license, the failure to pay all applicable fees,
the dishonoring of any check upon first deposit, or the failure to comply with any other requirement
provided by law shall cause the license to be automatically forfeited; provided that the person's license
may be restored by the board within two years after the date of forfeiture upon compliance with the
licensing renewal fees, penalty fees, and compliance resolution fund fees.
A nurse who does not intend to practice nursing in the State and elects to be placed on
inactive status shall so indicate in writing during the license renewal period or by so indicating on
the license renewal application, and paying inactivation and all appropriate fees. Should the nurse
wish to resume nursing at some future time, the nurse shall notify the board in writing and remit the
reactivation and renewal fees; submit an application form as provided in subsection (a);
and
beginning with the July 1, 2019, licensing biennium, submit a full set of electronic fingerprints
for the purpose of obtaining federal and state criminal history record checks in accordance with
section 846-2.7 directly to the Hawaii criminal justice data center for processing with the Federal
Bureau of Investigation. The applicant shall bear the cost of the fingerprint processing and the
application shall not be considered complete until the results of the criminal history record check
has been received by the board. A nurse who has not actively practiced in this State or any other
state in the United States or any territory or possession under the jurisdiction of the United States for
more than five years may be required by the board to submit proof of continued competency by
retaking and passing the licensing examination or successfully completing appropriate continuing
education recognized by the board."
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(c) Notwithstanding any provision in this chapter to the contrary, the board shall not
renew or reinstate, or shall deny, suspend, or revoke, any license or application if the board has
received certification from an administering entity pursuant to chapter 436C that the licensee or
applicant is in default or breach of any obligation under any student loan, student loan repayment
contract, or scholarship contract that financed the licensee's or applicant's education, or has failed to
comply with a repayment plan.
The board in receipt of a certification pursuant to chapter 436C, as applicable, and without
further review or hearing, shall:
(1) Suspend the license;
(2) Deny the application or request for renewal of the license; or
(3) Deny the request for reinstatement of the license,
and unless otherwise provided by law, shall renew, reinstate, or grant the license only upon receipt of
an authorization from the administering entity.
§457-9.2 Continuing competency requirements; exemptions; extensions; records
retention; audit. (a) Beginning July 1, 2017, with the renewal of the licensing biennium, and
every biennial renewal thereafter, each registered nurse and practical nurse licensee shall have
completed one of the learning activity options recognized by the board within the two-year period
preceding the renewal date, in addition to the requirements of section 457-9.
(b) The following nurses shall be exempt from the continuing competency
requirements:
(1) Registered nurses licensed in this State who also maintain active advanced practice
registered nurse licenses in accordance with this chapter and have a current national
certification approved by the board;
(2) Registered nurses and practical nurses licensed in this State who also maintain
current national certification, approved by the board, in their practice role; or
(3) A licensee who graduated or completed pre-licensure requirements from an
accredited nursing program recognized by the board within twelve months prior to
the renewal date of the licensee's first license renewal period.
If a licensee graduated or completed pre-licensure requirements from an accredited nursing
program more than twelve months but less than two years prior to the renewal date, the registered
nurse or practical nurse licensee shall be required to obtain fifteen contact hours of continuing
education, one semester credit of post-licensure academic education related to nursing practice
from an accredited nursing program, completion of a board-recognized nurse residency program,
or other learning activity options from an approved provider recognized by the board prior to the
first renewal period.
(c) The board may extend the deadline for compliance with the continuing competency
requirements and shall consider each case on an individual basis. Prior to the expiration of the
license, a nurse licensee may submit a written request for an extension and any documentation
requested by the board to substantiate the reason for the extension of the deadline for compliance
with the continuing competency requirements of this section, based on the following
circumstances:
(1) Illness, as certified by a physician or osteopathic physician licensed under chapter
453 or advanced practice registered nurse licensed under chapter 457 in the
jurisdiction in which the licensee was treated; or
15
(2) Military service under extended active duty with the armed forces of the United
States.
(d) Each licensee shall maintain copies of the licensee's continuing competency records
for the past four years or two previous bienniums.
(e) Upon application for license renewal, restoration, or reinstatement, each licensee
shall have complied with and attest to completion of one of the learning activity options recognized
by the board pursuant to subsection (a) during the two years preceding the application for license
renewal, restoration, or reinstatement and shall be prepared to submit evidence of completion if
requested by the board.
(f) The board may conduct an audit to determine compliance with the continuing
competency requirement. The board shall provide written notice of an audit to all licensees selected
for audit. Within sixty days of notification, the licensee shall provide the board with documentation
verifying compliance with continuing competency requirements.
§457-9.3 Learning activity options. (a) The successful completion of one of the following
shall meet the learning activity options requirements for continuing competency:
(1) National certification or recertification related to the nurse's practice role;
(2) Thirty contact hours of continuing education activities:
(3) Completion of a board approved refresher course;
(4) Completion of a minimum of two semester credits of post-licensure academic
education related to nursing practice from an accredited nursing program;
(5) Participation as a preceptor, for at least one nursing student or employee
transitioning into new clinical practice areas for at least one hundred twenty hours,
in a one-to-one relationship as part of an organized preceptorship program;
provided that the licensee may precept more than one student or employee during
the one hundred twenty hours and shall be evidenced by documentation of hours
completed and objectives of the preceptorship by the institution supervising the
student;
(6) Completion as principal or co-principal investigator of a nursing research project
that is an institution review board project or evidence-based practice project that
has been preapproved by the board;
(7) Authoring or coauthoring a peer reviewed published nursing or health-related
article, book, or book chapter;
(8) Developing and conducting a nursing education presentation or presentations
totaling a minimum of five contact hours of actual organized instruction that
qualifies as continuing education;
(9) Completion of a board-recognized nurse residency program; or
(10) A similar type of learning activity option; provided that the type of activity shall be
recognized by the board.
§457-10 REPEALED.
§457-11 Nursing education programs. (a) An institution desiring to conduct a nursing
education program to prepare for the practice of nursing advanced practice registered nurses,
16
registered nurses, or licensed practical nurses shall apply to the board and submit evidence that it is
prepared to:
(1) Carry out a program in advanced practice nursing, registered nursing, or licensed
practical nursing; and
(2) Meet the standards as shall be established by law and by the board.
(b) If, in the opinion of the board, the requirements for an approved nursing education
program are met, the program shall be approved as a nursing education program for advanced
practice, registered, or licensed practical nurses.
(c) The approval standards shall include qualifications necessary for administrators and
faculty members of the nursing education program; provided that the standards shall not include a
requirement that each individual faculty member receive approval of the board prior to teaching in
the program. The qualifications shall be reasonable and relevant to the proper teaching of the practice
of nursing. In establishing the qualifications, the board shall consult with the University of Hawaii.
(d) From time to time as deemed necessary by the board, it shall be the duty of the board,
through its authorized representative, to survey nursing education programs in the State. Written
reports of the surveys shall be submitted to the board. If the board determines that any approved
nursing education program is not maintaining the standards required by law and by the board, notice
thereof in writing specifying the discrepancies shall be immediately given to the institution
conducting the program. A program which fails to correct these conditions to the satisfaction of the
board within a reasonable time shall be discontinued after a hearing held in conformance with chapter
91.
§457-12 Discipline; grounds; proceedings; hearings. (a) In addition to any other actions
authorized by law, the board shall have the power to deny, revoke, limit, or suspend any license to
practice nursing as a registered nurse or as a licensed practical nurse applied for or issued by the board
in accordance with this chapter, and to fine or to otherwise discipline a licensee for any cause
authorized by law, including but not limited to the following:
(1) Fraud or deceit in procuring or attempting to procure a license to practice nursing as
a registered nurse or as a licensed practical nurse;
(2) Gross immorality;
(3) Unfitness or incompetence by reason of negligence, habits, or other causes;
(4) Habitual intemperance, addiction to, or dependency on alcohol or other habit-forming
substances;
(5) Mental incompetence;
(6) Unprofessional conduct as defined by the board in accordance with its own rules;
(7) Willful or repeated violation of any of the provisions of this chapter or any rule
adopted by the board;
(8) Revocation, suspension, limitation, or other disciplinary action by another state of a
nursing license;
(9) Conviction, whether by nolo contendere or otherwise, of a penal offense substantially
related to the qualifications, functions, or duties of a nurse, notwithstanding any
statutory provision to the contrary;
(10) Failure to report to the board any disciplinary action taken against the licensee in
another jurisdiction within thirty days after the disciplinary action becomes final;
17
(11) Submitting to or filing with the board any notice, statement, or other document
required under this chapter, which is false or untrue or contains any material
misstatement of fact, including a false attestation of compliance with continuing
competency requirements; or
(12) Violation of the conditions or limitations upon which any license is issued.
(b) Notwithstanding any other law to the contrary, the board may deny a license to
any applicant who has been disciplined by another state. Any final order entered pursuant to this
subsection shall be matter of public record.
(c) Any fine imposed by the board after a hearing in accordance with chapter 91 shall be
no less than $100 and no more than $1,000 for each violation.
(d) The remedies or penalties provided by this chapter are cumulative to each other and
to the remedies or penalties available under all other laws of this State.
§457-13 Exceptions. This chapter does not prohibit:
(1) The furnishing of nursing assistance in an emergency;
(2) The practice of nursing which is incidental to their program of study by students
enrolled in nursing education programs accredited by the board;
(3) The practice of nursing under a nonrenewable permit by:
(A) A graduate of; or
(B) An applicant who has provided proof that the applicant has completed the
entire educational curriculum required for graduation for a nursing license
from a school which is in or under the jurisdiction of the United States, and
whose accreditation is recognized by the board; provided that following
completion of (A) or (B), the candidate takes the first licensing examination
scheduled by any board of nursing recognized by the board and has submitted
to the board an application for a license to practice nursing in this State; and
provided further that the permit shall be valid for three months or until the
results of the licensing examination are received by the board;
(4) The practice of any legally qualified nurse of another state who is employed by the
United States or any bureau, division, or agency thereof, while in the discharge of the
nurse's official duties;
(5) The practice of nursing in connection with healing by prayer or spiritual means alone
in accordance with the tenets and practice of any well recognized church or religious
denomination, provided that no person practicing such nursing claims to practice as a
registered nurse or a licensed practical nurse; or
(6) The administration of oral and topical medication and in emergency situations, other
premeasured medication, by school health aides as provided in section 321-242.
§457-14 Violations of chapter; penalties. It shall be a misdemeanor for any person,
including any corporation, association, or individual to:
(1) Sell or fraudulently obtain or furnish any nursing diploma, license, renewal, or record
or aid or abet therein; or
18
(2) Practice nursing as defined by this chapter under cover of any diploma, license, or
record illegally or fraudulently signed or issued unlawfully or under fraudulent
representation; or
(3) Practice nursing as a registered or as a licensed practical nurse unless licensed to
practice under this chapter; or
(4) Use in connection with the person's name any designation tending to imply that the
person is a registered nurse or a licensed practical nurse unless licensed to practice
under this chapter; or
(5) Practice nursing as a registered nurse or as a licensed practical nurse during the time
the person's license issued under this chapter is suspended or revoked; or
(6) Conduct a nursing education program not accredited by the board to prepare for a
registered nurse or licensed practical nurse unless the program has been accredited by
the board; or
(7) Otherwise violate any provisions of this chapter.
Any of these misdemeanors shall be punishable by a fine of not more than $500 for a first
offense. Each subsequent offense shall be punishable by a fine of not more than $1,000 or imprisoned
not more than one year, or both.
§457-15 Injunctive relief. The practice of nursing as a registered nurse or as a licensed
practical nurse by any person who has not been issued a license under this chapter or whose license
has been suspended or revoked or has expired is declared to be inimical to the public welfare and to
constitute a public nuisance. The board of nursing may, through the attorney general, apply for an
injunction in any court of competent jurisdiction to enjoin any person who has not been issued a
license or whose license has been suspended or revoked or expired, from practicing nursing as a
registered nurse or as a licensed practical nurse; and, upon the filing of a verified petition in court, the
court or any judge thereof, if satisfied by affidavit, or otherwise, that the person is or has been
practicing nursing as a registered nurse or as a licensed practical nurse without having been issued a
license, or after the person's license has been suspended or revoked or expired, may issue a temporary
injunction, without notice or bond, enjoining the defendant from further practicing nursing as a
registered nurse or as a licensed practical nurse. A copy of the verified petition shall be served upon
the defendant and the proceedings shall thereafter be conducted as in other civil cases. If it be
established that the defendant has been or is practicing nursing as a registered nurse or as a licensed
practical nurse without having been issued a license or has been or is practicing nursing as a registered
nurse or as a licensed practical nurse after the defendant's license has been revoked, or expired, the
court, or any judge thereof, may enter a decree perpetually enjoining the defendant from further
practicing nursing as a registered nurse or as a licensed practical nurse. In case of violation of any
injunction issued under this section, the court, or any judge thereof, may summarily try and punish
the offender for contempt of court. The injunction proceedings shall be in addition to, and not in lieu
of, all penalties and other remedies provided in this chapter.
§457-16 Severability. If any provision of this chapter, or the application thereof to any
person or circumstance is held invalid, the invalidity does not affect other provisions or applications
of this chapter which can be given effect without the invalid provision or application and to this end
the provisions of this chapter are severable.
19
§457- Nursys; verification of nurse license.
Notwithstanding any other law to the contrary, the board of nursing may fully participate in
Nursys by sharing licensure and discipline data with Nursys. By applying for nurse licensure,
individuals shall consent to allowing the board to share their licensure and discipline data with
Nursys."
"§457- Discipline based on action taken in another state; conditions; prohibition on
practice. (a) Upon receipt of evidence of revocation, suspension, or other disciplinary action
against a licensee in another state, the board may issue an order imposing the same disciplinary
action upon the licensee on the following conditions:
(1) The board shall serve the licensee with a proposed order imposing disciplinary
action as required by chapter 91;
(2) The licensee shall have the right to request a hearing pursuant to chapter 91 to
show cause why the action described in the proposed order should not be
imposed;
(3) Any request for a hearing shall be made in writing and filed with the board within
twenty days after mailing of the proposed order to the licensee; and
(4) If the licensee does not submit a written request for a hearing within twenty days
after mailing of the proposed order, the board shall issue a final order imposing
the disciplinary action described in the proposed order
(b) A certified copy of the disciplinary action in another state shall constitute prima
facie evidence of the disciplinary action.
(c) A licensee against whom the board has issued a proposed order under this section
shall be prohibited from practicing in this State until the board issues a final order if:
(1) The licensee was the subject of disciplinary action in another state; and
(2) The disciplinary action in the other state prohibits the licensee from practicing in
that state.
(d) In addition to the provisions of this section, the board may take any other action
authorized by this chapter or chapter 436B.
(e) Notwithstanding any law to the contrary, the final order of discipline taken
pursuant to this section shall be a matter of public record."
§457- Telehealth; privacy, security, and confidentiality. Services relating to the
practice of nursing and provided by telehealth pursuant to this chapter shall be consistent with all
federal and state privacy, security, and confidentiality laws."
Note
CENTER FOR NURSING FEE
Additional fee (Session Laws of Hawaii 2008, Act 173 requires continued assessment of this fee
until it is repealed on July 1, 2014, unless further extended by law). Upon issuance of new license
20
or at license renewal period, each practical and registered nurse shall pay an additional fee of $40
which shall be deposited to the compliance resolution fund established under §26-9(o) for quarterly
credit to the center for nursing special fund under §304D-5. L 2003, c 198, §§3, 6, and 10.