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News & Press: BORN / DPH Practice Update

BORN News - Revised Ruling on Nurse Practitioner as First Assistant in Cardiac Catheterization

Wednesday, March 9, 2016  
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The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Division of Health Professions Licensure
Board of Registration in Nursing
239 Causeway Street, Suite 500, Boston, MA 02114

March 9, 2016


To:       Massachusetts Nursing and Professional Healthcare Organizations
From:   Laurie Talarico, MS, RN, CNP Nursing Practice Coordinator
Re:       Revised Advisory Ruling 0201: Nurse Practitioner as First Assistant
            in Cardiac Catheterization

At the March 9, 2016 Board of Registration in Nursing (Board) meeting, the Board revised Advisory Ruling (AR) 0201: Nurse Practitioner as First Assistant in Cardiac Catheterization to ensure compliance with current statutes, regulations and scope of practice standards.

The AR guides the practice of the Certified Nurse Practitioner (CNP) who functions as First Assistant at cardiac catheterization procedures to meet client goals including, but not limited to, health promotion, client teaching, health risk reduction, and promotion of safety and comfort.

AR 0201: Nurse Practitioner as First Assistant in Cardiac Catheterization revisions:
1)  Specify the CNP who performs as First Assistant at cardiac catheterization must complete the educational and clinical requirements at 105 CMR 120.405(K)(3), or complete comparable institutional education to ensure competency;

2)  Specify that CNPs who perform as First Assistants at cardiac catheterization may operate fluoroscopic systems when required for the production and display of serial x-ray images for the purpose of observing real-time motion of anatomical structures;

3)  Clarify that CNPs may operate fluoroscopic systems in the capacity as first assistant in cardiac catheterization procedures. In addition, CNPs may operate fluoroscopic systems in clinical areas beyond the cardiac catheterization laboratory in order to produce and display serial x-ray images for the purpose of observing real-time motion of anatomical structures in order to safely perform diagnostic or therapeutic interventional procedures. Employer policies and procedures direct the education and training requirements of the CNP who operate fluoroscopic systems;

4)  Identify that CNPs who perform as First Assistants at cardiac catheterization must participate in the employer’s credentialing and privileging process to assess, document and determine competency in performing procedures that include operation of fluoroscopy systems; and

5)  Add references to the American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions Expert Consensus Document on Cardiac Catheterization Laboratory Standards and The Accreditation for Cardiovascular Excellence;

6)  Update “authority” statement to the Board approved statement for all AR;

7)  For clarity, remove the AR references to the CNP requirement for physician supervision for practice.

CLICK HERE to review the entire Advisory Ruling 0201.



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