Exemption Review Guidelines
for Employment Verification
NDCC 43-12.1-04. Persons Exempt from Provisions of Chapter. This chapter does not apply to an individual who performs nursing tasks for a family member. Nurses are excluded in the definition of an exempt person in NDCC 43-12.1-04 (6).
Within NDCC Section 43-12.1-03 any person who provides nursing care to a resident of this state must hold a current license issued by the board. It is unlawful for a person to practice nursing, offer to practice nursing, or use any title, abbreviation, or designation to indicate that the person is practicing nursing in this state unless that person is currently licensed.
Nurses caring for a family member may apply that type of nursing practice towards meeting the practice requirement for renewal of licensure provided the activities performed are those which require the judgment and skill of a licensed nurse.
Any nurse submitting practice hours involving care of family must:
1. Complete the Exemption Review Form.
2. Submit evidence of at least weekly documentation of care utilizing knowledge and skills that meet the definition of nursing. See ND Nurse Practices Act 43-12.1-02(5). Definitions.
3. Documentation must include the following:
a. Relationship to client
b. Age of client
c. Medical diagnosis
d. Length of time care provided
e. Approximate number of hours per day providing nursing care.
4. Documentation must reflect use of the nursing process.
a. Assessment of health status of the individual:
i. Include an assessment and status of all systems, i.e. lung sounds, bowel sounds, heart sounds, etc.
ii. Emotional status
iii. Psychological status
iv. Spiritual status
b. Establishes nursing diagnosis to identify client needs:
i. Client oriented. The client (not the nurse) is expected to meet outcomes. For instance:
“the client will walk around the room at least once every eight hours”, or
“by the end of the month client will routinely perform self-care activities independently without reminders”
c. Planning of care:
i. What skills were used in performing interventions?
ii. Intellectual, interpersonal, and technical skills. For example:
1. Offer fluids every two hours
2. Positioned for optimum breathing
3. Taught deep-breathing exercises
iii. Include medications, treatments, activity, diet
d. Implementation of nursing care plan
e. Evaluation of responses to nursing interventions:
i. What effect did the care provide to the family member?
ii. Communication of response to care to appropriate members of the health care team.
The renewal or license by endorsement applicant is required to submit proof that activities meet the practice requirement. The Board reviews the documentation that is submitted by the individual and makes determination of eligibility on a case by case basis. The Board considers the following elements and asks the following questions when evaluating applicants for licensure regarding meeting the practice requirement:
- Are the activities the nurse performs within the statutory definition of the practice of nursing?
- Do the activities require application of the knowledge and skill gained from nursing education?
- Does the nurse use the elements of the nursing process in their work?
- Are the activities with the scope of practice for which application for licensure is made (LPN or RN)?
- If the nurse was unavailable to provide the care, would the family member be required to utilize a nurse to provide the care?
- Can the nurse describe how they use nursing knowledge and elements of the nursing process in their work?
- Can the nurse articulate what parts of the volunteer role use elements of nursing practice?
The applicant is notified of the results of the review. If the submitted documentation is approved for nursing practice, the individual will be notified and instructed to proceed with their renewal or endorsement application. If the Board determines that the documentation submitted does not show sufficient evidence that the practice fits the definition of nursing, the individual will be notified that the hours submitted do not meet the criteria set forth in the law and rules.
For information on the Board’s Rules on Standards of Practice please refer to NDAC Section 54-05-02 Standards of Practice for Registered Nurses or NDAC Section 54-05-01 Standards of Practice for Licensed Practical Nurses.
Reviewed/Revised: 11/18, 10/22