Guidance regarding the interpretation and application of the Nurse Practices Act (NPA) may be adopted by the ND Board of Nursing (Board) as a means of providing direction to licensees and stakeholders who seek to ensure safe nursing practice and to address issues of concern relevant to public protection. (North Dakota Century Code (NDCC) 43-12.1-08(2)(p)).
Board approved practice guidance does not carry the force and effect of the law/rules. Each licensed nurse (nurse) is “responsible and accountable to practice according to the standards of practice prescribed by the board and the profession”; and must “accept responsibility for judgments, individual nursing actions, competence, decisions, and behavior in the course of nursing practice.” (Standards of Practice, North Dakota Administrative Code (NDAC) 54-05-01-07 and 54-05-02-04). “Competence": means the application and integration of knowledge, skills, ability, and judgment necessary to meet standards. (NDAC 54-01-03-01(16)).
In April 2021, the NDBON endorsed the ND Medical Imaging and Radiation Therapy Board (NDMIRTB) position statement related to APRNs and the supervising/performing of fluoroscopy. The position statement encompasses both boards, as APRNs are exempt per NDCC 43-62-03; and the scope and standards of practice for the APRN is under the jurisdiction of the NDBON per NDCC 43-12.1. Therefore, after further deliberation, the NDMIRTB and NDBON collaborated to provide a joint statement which supersedes the original position statement adopted by NDMIRTB in January 2022. The ND Department of Environmental Quality (DEQ) has authority over sources of ionizing radiation and registrants, including fluoroscopy devices under NDCC 23.1-03. The DEQ provided a statement in November 2021 supporting the educational framework and certification in this joint position statement for the APRN supervising or performing fluoroscopy procedures.
An educational framework provides a cognitive base supporting the development of knowledge and skills for an APRN who supervises/performs fluoroscopic guidance in their practice. This educational framework is intended for use by the APRN only and does not apply to the RN or LPN.
The APRN is expected to supervise/perform each examination in a safe and competent manner. The APRN must understand the rationale of the exam purpose and how it fits into the continuum of patient care. The APRN is encouraged to monitor their progress in the development of such competency.
Knowledge and skills required, but not limited to, are radiation safety, production and those characteristics, radiobiology, contrast media, health physics, fluoroscopic unit operation, safety, and image correlation with anatomy, physiology, and pathology. This education must include hands-on training.
The APRN must work closely with a medical physicist, radiologist, or other properly trained and licensed medical provider with specialized training in fluoroscopy to gain competence in each area of training.
The recommended educational framework is divided into didactic and clinical sections. Additionally, the APRN must meet the requirement of passing a nationally recognized fluoroscopic examination, such as the American Registry of Radiologic Technologists (ARRT) fluoroscopic examination.
The three-step process is outlined below:
After successful completion of all requirements, the APRN is considered to have expanded their scope to supervise/perform fluoroscopy. To continue this advanced scope of practice, the APRN must submit five (5) hours of continuing education relevant to the practice of fluoroscopy safety and radiation protection, upon each renewal cycle. The continuing education must be recognized continuing education evaluation mechanism (RCEEMs) eligible for consideration of acceptance for continuing education in fluoroscopy.
An APRN with evidence of proper specialized, comprehensive, and accredited training, both didactic and clinical components, which include fluoroscopy modality must submit portfolios to be considered on a case-by-case basis. Portfolios must include evidence, syllabi, clinical experience, and certifications/fellowships. The portfolios will be jointly reviewed by NDBON and NDMIRTB. In addition, the APRN seeking case-by-case consideration must comply with the requirements set forth in NDCC 23.1-03 by contacting the DEQ.
North Dakota Medical Imaging and Radiation Board
North Dakota Board of Nursing
NDBON Adopted 10/2021
List of Didactic Educational Sources