10.27.01.03

.03 Licensure Exceptions.

A. Registered nurses or licensed practical nurses who hold a current active license in any other state or jurisdiction may render nursing care:

(1) For not more than 30 days, to an individual who is visiting the State for medical, educational, or personal reasons;

(2) For the purpose of the interstate transport and care of patients traveling to and from Maryland; and

(3) During an emergency situation.

B. A registered nurse or licensed practical nurse who holds a multistate licensure privilege under the Nurse Licensure Compact may practice nursing in this State in accordance with the laws of this State.

C. Nursing Graduate.

(1) A nursing graduate is a graduate of:

(a) A Board-approved registered nursing or licensed practical nursing education program; or

(b) An out-of-state nursing education program determined to be equivalent by the Board.

(2) A nursing graduate may practice as set forth in §B(5)—(7) of this regulation until the earlier of:

(a) 90 days from graduation; or

(b) Receipt of the results from the initial NCLEX examination taken.

(3) A nursing graduate shall cease practice as a nursing graduate immediately if the nursing graduate fails the initial NCLEX examination.

(4) If the nursing graduate fails the NCLEX examination, the nursing graduate may practice as a nursing assistant provided the individual obtains certification as a nursing assistant and practices according to COMAR 10.39.01.

(5) A nursing graduate shall:

(a) Practice only under the direct supervision of a registered nurse who is physically present on the unit to:

(i) Cosign medication transcription, medication administration, and nursing documentation; and

(ii) Continually observe, assist, coordinate, evaluate, and monitor the nursing graduate; and

(b) Use the initials "NG" after the nursing graduate's name as credentials.

(6) After successful completion of an organized staff development program which includes an evaluation that the nursing graduate is competent and in compliance with §C(5) of this regulation, the nursing graduate may:

(a) Transcribe medication orders if:

(i) Written policies and procedures are available on the unit of care; and

(ii) An organized staff development program which includes skill validation has been successfully completed by the nursing graduate;

(b) After competency has been validated by the facility:

(i) Administer medications and controlled substances; and

(ii) Sign controlled substances sheets;

(c) Document in the medical record with the abbreviation "NG";

(d) Perform patient assessments after the initial assessment or after the first assessment of the shift performed by the registered nurse; and

(e) Perform and document routine procedures taught within the nursing graduate's generic nursing program, including but not limited to:

(i) Placing nasal gastric tubes;

(ii) Performing urinary catheterizations;

(iii) Applying sterile dressings;

(iv) Performing blood sugar checks; and

(v) Obtaining specimens.

(7) A nursing graduate may not:

(a) Work without the physical presence of and direct supervision by a registered nurse;

(b) Refer to oneself or practice as a registered nurse (RN) or licensed practical nurse (LPN);

(c) Be considered a staff person for purposes of a staffing pattern;

(d) Accept charge responsibilities; or

(e) Perform initial patient assessment or the first patient assessment of a shift, develop patient plans of care, evaluate or document patient discharge, or independently administer medications or intravenous therapy.