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REGS : 10.27.19 Code of Ethics (BOARD OF NURSING);10.39.07 Certified Nursing Assistants/Certified Medication Technicians (CNA/CMT)—Code of Ethics (BON—CERTIFIED NURSING ASSIST.) and 10.53.05 Standards of Practice and Conduct (BON—ELECTROLOGY PRACTICE COMMITTEE)

PROPOSED
Maryland Register
Issue Date:  July 11, 2014
Volume 41 • Issue 14 • Pages 833-836
 
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Notice of Proposed Action
[14-197-P]
The Secretary of Health and Mental Hygiene proposes to:
(1) Amend Regulations .01 and .02 under COMAR 10.27.19 Code of Ethics;
(2) Amend Regulations .01 and .02 under COMAR 10.39.07 Certified Nursing Assistants/Certified Medication Technicians (CNA/CMT)—Code of Ethics; and
(3) Adopt new Regulation .01, recodify existing Regulations .01 and .03 to be Regulations .02 and .04, and amend and recodify existing Regulation .02 to be Regulation .03 under COMAR 10.53.05 Standards of Practice and Conduct.
 
Statement of Purpose
The purpose of this action is to amend the Code of Ethics regulations for licensed nurses, certified nursing assistants, certified medication technicians, and electrologists to clarify that privacy violations resulting from misuse of electronic devices and committing acts of moral turpitude, dishonesty, or corruption are unethical and to substitute current language for obsolete language.
 
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
 
Estimate of Economic Impact
The proposed action has no economic impact.
 
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
 
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
 
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through August 11, 2014. A public hearing has not been scheduled.
 
Subtitle 27 BOARD OF NURSING
10.27.19 Code of Ethics
Authority: Health Occupations Article, §§8-205 and 8-316(a)(25), Annotated Code of Maryland
 
.01 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) Abandonment.
(a) “Abandonment” means:
(i) Termination by a nurse of a [patient] client assignment which had been accepted by the nurse, without reasonable notification to the immediate supervisor to allow for the continuation of the [patient’s] client’s care;
(ii) (text unchanged)
(iii) In the case of a private duty assignment or hospice, if the nurse is the sole provider of care, failure to report for assigned duty or leaving the [patient] client unattended at the end of the assigned shift without prior notification to the nursing supervisor, the cognitive capable adult [patient] client, or the [patient’s] client’s designated representative.
(b) (text unchanged)
(2) “Accepting a [patient] client assignment” means a nurse has arrived on duty and assumed responsibility for [patient] client care based on the nurse’s reasonable and prudent professional judgment and the standards of nursing practice.
(3) (text unchanged)
(4) “Client” means a patient, resident, or recipient of care.
(5) “Electronic devices” means, but is not limited to, any of the following:
(a) Telephones with recording and picture-taking ability;
(b) Digital cameras or any other device that can record pictures and data;
(c) Facsimile machines, photocopiers, and scanners for copying; and
(d) Recording devices.
[(4)] (6) (text unchanged)
(7) “Social media” means any form of electronic communication, including, but not limited to, communication by use of websites for social networking and blogging through which users create online communities to share information, ideas, personal messages, and other content such as videos.
 
.02 Ethical Responsibilities.
A. A nurse shall:
(1)—(3) (text unchanged)
(4) Promptly report a breach of confidentiality or privacy;
[(4)] (5)[(7)] (8) (text unchanged)
B. A nurse may not, when acting in the capacity or identity of a licensed nurse:
(1)—(6) (text unchanged)
(7) Abandon a [patient] client.
C. A nurse may not engage in behavior that dishonors the profession whether or not acting in the capacity or identity of a licensed nurse, including, but not limited to:
(1) Verbal abuse, including use of racial or ethnic [slur of] slurs, directed toward a coworker, employer, Board staff member, [patient] client, or [patient’s] client’s family member;
(2) Physically abusing, threatening, or intimidating a coworker, employer, [patient] Board staff member, client, or [patient’s] client’s family member;
(3) Deceiving, defrauding, or stealing from a coworker, employer, [patient] client, or [patient’s] client’s family member;
(4)—(6) (text unchanged)
(7) Obtaining or copying any part of a [patient’s] client’s health record for purposes other than:
(a) Providing health care to the [patient] client;
(b)—(c) (text unchanged)
(d) Allowing a nursing student to use records for educational purposes if [patient] client identification has been redacted or disguised;
(8) (text unchanged)
(9) Reporting for employment under the influence of alcohol or [drugs] a controlled dangerous substance or submitting a [preemployment] pre-employment sample that is positive for alcohol or a controlled dangerous substance without having provided evidence of valid prescriptions for all [drugs] controlled dangerous substances in the sample; [or]
(10) Reporting for employment under the influence of an illicit drug or submitting a pre-employment sample that is positive for an illicit drug;
[(10)] (11) Using the power, influence, or knowledge, inherent in or obtained during the nurse-patient relationship, for the nurse’s personal gratification or benefit[.];
(12) Engaging in unprofessional or immoral conduct;
(13) Misrepresenting or concealing a material fact in obtaining a license, renewing a license, or reinstating a license; or
(14) Committing an act of moral turpitude, dishonesty, or corruption when the act directly or indirectly affects the health, welfare, or safety of the citizens of this State, and, if the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action.
D. (text unchanged)
(1) Sexual behavior with a [patient] client in the context of a professional evaluation, treatment, procedure, or service to the [patient] client, regardless of the setting in which the professional service is rendered;
(2) Sexual behavior with a [patient] client under the pretext of diagnostic or therapeutic intent or benefit;
(3) Solicitation of a sexual relationship, whether consensual or nonconsensual, with a [patient] client;
(4) Sexual advances toward, or the request of sexual favors from, a [patient] coworker, student, employer, client, or client’s family member;
(5) Discussion of nontherapeutic sexual matters while treating a [patient] client;
(6) Taking photographs of a [patient] client for a sexual purpose;
(7) Sexual harassment of a coworker, student, employer, [patient] client, or [patient’s] client’s family member;
(8) Sexual contact with an incompetent or unconscious [patient] client;
(9) (text unchanged)
(10) Intentionally exposing any of the [patient’s] client’s sexual body parts for a nontherapeutic purpose.
E. Electronic devices, including but not limited to telephones, may not be used to record medical records and take pictures or videos of clients without written client authorization.
F. A nurse:
(1) May not make use of electronic devices and social media to transmit or place any client information online; and
(2) Shall adhere to the following principles for the use of electronic devices and social media:
(a) Every nurse has an obligation to understand the nature, benefits, and consequences of the use of electronic devices and participating in social media networking;
(b) Nurses are bound to observe ethically prescribed client-nurse boundaries online as in any other setting;
(c) Client information shall be maintained in separate encrypted and secured files on personal computers and online;
(d) A nurse has an obligation to report any electronically generated material that could harm a client’s privacy rights; and
(e) The standards of professionalism are the same when using electronic devices and social media as in any other circumstance.
 
Subtitle 39 BOARD OF NURSING — CERTIFIED NURSING ASSISTANTS
10.39.07 Certified Nursing Assistants/Certified Medication Technicians (CNA/CMT)—Code of Ethics
Authority: Health Occupations Article, §§8-205(a)(1) and (2), 8-6A-05(a)(5), and 8-6A-10, Annotated Code of Maryland
 
.01 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(5) (text unchanged)
(6) “Electronic devices” means, but is not limited to, any of the following:
(a) Telephones with recording and picture-taking ability;
(b) Digital cameras or any other device that can record pictures and data;
(c) Facsimile machines, photocopiers, and scanners for copying; and
(d) Recording devices.
(7) “Social media” means any form of electronic communication, including, but not limited to, communication by use of websites for social networking and blogging through which users create online communities to share information, ideas, personal messages, and other content such as videos.
 
.02 Ethical Responsibilities.
A. A certificate holder shall:
(1)—(2) (text unchanged)
(3) Promptly report a breach of confidentiality or privacy;
[(3)] (4)[(8)] (9) (text unchanged)
B. (text unchanged)
C. A certificate holder may not engage in the following behaviors that dishonor the practice, whether or not acting in the capacity or identity of a certificate holder, including, but not limited to:
(1) Verbal abuse, including use of [a] racial or ethnic [slur] slurs, directed toward a coworker, employer, Board staff member, client, or client’s family member;
(2) [Physical abuse of, making threats toward, or intimidation of] Physically abusing, threatening, or intimidating a coworker, employer, Board staff member, client, or client’s family member;
(3)—(7) (text unchanged)
(8) Reporting for employment under the influence of alcohol or [drugs] a controlled dangerous substance or submitting a [preemployment] pre-employment sample that is positive for alcohol or a controlled dangerous substance without having provided evidence of valid prescriptions for all [drugs] controlled dangerous substances in the sample;
(9) Reporting for employment under the influence of an illicit drug or submitting a pre-employment sample that is positive for an illicit drug;
[(9)] (10) Using the power, influence, or knowledge obtained during the certificate holder’s relationship with the client for the certificate holder’s personal gratification or benefit; [or]
(11) Performing acts beyond the scope of practice for which the individual is certified, unless acting in accordance with COMAR 10.27.11;
(12) Engaging in unprofessional or immoral conduct;
(13) Misrepresenting or concealing a material fact in obtaining a certificate, renewing a certificate, or reinstating a certificate;
(14) Committing an act of moral turpitude, dishonesty, or corruption when the act directly or indirectly affects the health, welfare, or safety of the citizens of this State, and, if the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action; or
[(10)] (15) (text unchanged)
D. A certificate holder may not engage in sexual misconduct, including, but not limited to:
(1)—(3) (text unchanged)
(4) Sexual advances toward, or requesting sexual favors from, a coworker, student, employer, client, or client’s family member;
(5)—(10) (text unchanged)
E. Electronic devices, including but not limited to telephones, may not be used to record medical records and take pictures or videos of clients without written client authorization.
F. A certificate holder:
(1) May not make use of electronic devices and social media to transmit or place any client information online; and
(2) Shall adhere to the following principles for the use of social media:
(a) Every certificate holder has an obligation to understand the nature, benefits, and consequences of the use of electronic devices and participating in social media networking;
(b) Certificate holders are bound to observe ethically prescribed client-certificate holder boundaries online as in any other setting;
(c) Client information shall be maintained in separate encrypted and secure files on personal computers and online;
(d) A certificate holder has an obligation to report any content that could harm a client’s privacy rights; and
(e) The standards of professionalism are the same when using electronic devices and social media as in any other circumstance.
 
Subtitle 53 BOARD OF NURSING — ELECTROLOGY PRACTICE COMMITTEE
10.53.05 Standards of Practice and Conduct
Authority: Health Occupations Article, §§8-205 and 8-6B-03, Annotated Code of Maryland
 
.01 Definitions.
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) “Electronic devices” means, but is not limited to, any of the following:
(a) Telephones with recording and picture-taking ability
(b) Digital cameras or any other device that can record pictures and data;
(c) Facsimile machines, photocopiers, and scanners for copying; and
(d) Recording devices.
(2) “Social media” means any form of electronic communication, including, but not limited to, communication by use of websites for social networking and blogging through which users create online communities to share information, ideas, personal messages, and other content such as videos.
 
[.02] .03 Unprofessional Conduct.
A.—C. (text unchanged)
D. Electronic devices, including but not limited to telephones, may not be used to record medical records and take pictures or videos of clients without written client authorization.
E. An electrologist:
(1) May not make use of electronic devices and social media to transmit or place any client information online; and
(2) Shall adhere to the following principals for the use of electronic devices and social media:
(a) Every electrologist has an obligation to understand the nature, benefits, and consequences of using electronic devices and participating in social media networking;
(b) An electrologist is bound to observe ethically prescribed client-electrologist boundaries when using electronic devices and social media as in any other setting;
(c) Client information shall be maintained in separate encrypted and secured files on personal computers and online; and
(d) The standards of professionalism are the same when using electronic devices and social media as in any other circumstance.
F. An electrologist may not engage in behavior that dishonors the profession whether or not acting in the capacity of a licensed electrologist, including, but not limited to:
(1) Reporting for employment under the influence of alcohol or a controlled dangerous substance or submitting a pre-employment sample that is positive for alcohol or a controlled dangerous substance without having provided evidence of valid prescriptions for all controlled dangerous substances in the sample;
(2) Reporting for employment under the influence of an illicit drug or submitting a pre-employment sample that is positive for an illicit drug; or
(3) Committing an act of moral turpitude, dishonesty, or corruption when the act directly or indirectly affects the health, welfare, or safety of the citizens of this State, and, if the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action.
 
JOSHUA M. SHARFSTEIN, M.D.
Secretary of Health and Mental Hygiene
 
 
 

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