CNE & Me: Understanding the Board's Continuing Competency Requirements.
To maintain active licensure as a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) in Texas, there is not a practice hour requirement; and, meeting the continuing competency requirements set forth in the Nursing Practice Act (NPA) Sections 301.303 - 301.307 and Board Rule 216 allows Texas nurses to demonstrate ongoing competence in lieu of a minimum practice hour requirement set by the Board. Continuing education programs and activities are designed to promote and enrich a nurse's knowledge, improve a nurse's skills, and develop attitudes to enhance nursing practice, all of which aim to improve the delivery of health care to the public [Board Rule 216.2]. Board Rule 216 was recently amended by the Board based on recommendations from the Nursing Practice Advisory Committee (NPAC). The revised version of the rule went into effect on December 5, 2018. This updated and current version of Board Rule 216 is available on the Board's website under the Laws & Rules drop-down menu on the BON homepage. Agenda Item 7.4 from the July 2018 Board Meeting details the line-by-line changes made to this rule, including both the significant modifications recommended by NPAC and the minor changes made concerning grammar, syntax, and text placement for clarity and consistency of the rule.
In Texas, a nurse's license(s) always expires on the last day of the nurse's birth month, typically every two years. Licensees born in odd-numbered years always renew in odd-numbered years, and licensees born in even-numbered years always renew in even-numbered years. For example, Anna, RN, was born in April 1961, so Anna will always need to renew by April 30th of odd-numbered years (e.g., 2019, 2021, etc.). And, Joseph, LVN, was born in December 1988, so he will always need to renew by December 31st of even-numbered years (e.g., 2020, 2022, etc.).
As mentioned, a nurse's license is usually valid for a two-year period; however, there are a few instances when the licensing period may not be the standard two-year period. Newly added Board Rule 216.1(14) defines "licensing period" as the period of time in which nursing licensure status is current; it is determined by the licensee's birth month and year (usually beginning on the first day of the month after the birth month and ending on the last day of the birth month). The specific time frame for initial licensure and for the immediate licensing period following renewal of a delinquent license or license reactivation may vary from six months to 29 months; but, subsequent licensing periods will be two years in length. For instance, DeShawn, RN, was born in January 1987, so examples of his standard two-year licensing periods are February 1, 2017 - January 31, 2019, February 1, 2019 - January 31, 2021, etc. When DeShawn renews his RN license in January 2019, he will need to have completed the continuing competency requirements sometime between February 1, 2017 and the day that he applies to renew in January 2019. And, Molly, LVN, was born in June 1976, making July 1, 2018-June 30, 2020, July 1, 2020-June 30, 2022, etc., examples of her standard, two-year licensing periods. When Molly renews her LVN license in June 2020, she will need to have completed the continuing competency requirements sometime between July 1, 2018 and the day that she applies to renew in June 2020.
Nurses must meet the Board's continuing competency requirements at each license renewal and may demonstrate such by having either completed 20 contact hours of Continuing Nursing Education (CNE) or achieving, maintaining, or renewing a Board approved national nursing certification in his or her area of practice. CNE contact hours must be earned by participating in activities and programs approved by a credentialing agency or provider recognized by the Board. A list of these agencies/providers is available on the BON website and includes, for example, the American Nurses Credentialing Center (ANCC), the Emergency Nurses Association (ENA), and other state boards of nursing. Also, a list of approved national nursing certifications is available on the Board's website. To further clarify the subject area in which nurses are to complete their continuing competency, "area of practice" is defined in Board Rule 216.1(4) as any activity, assignment, or task in which the nurse utilized nursing knowledge, judgment, or skills during the licensing period. If a nurse does not have a current area of practice, the nurse may refer to his or her most recent area of practice. Advanced practice registered nurses (APRNs) have additional requirements beyond what is described in the text of this article. For more information concerning APRN requirements, please see Board Rule 216.3(c).
As part of the 20 contact hours to renew each licensing period, nurses must complete applicable targeted continuing education topics. Targeted continuing education is required for nurses based upon their level of licensure and/or area of practice, and the definition of this term was recently added to the rule [Board Rule 216.1(21)]. Examples of targeted continuing education include: nursing jurisprudence and nursing ethics (all nurses); older adult/geriatric care and forensic evidence collection (if applicable to the nurse's area of practice); and tick-borne diseases, pharmacotherapeutics, and prescription of controlled substances (certain APRNs). All contact hours earned related to targeted continuing education requirements count toward the 20 total contact hours needed to renew, for LVNs and RNs. For more information about targeted continuing education, please see Board Rule 216.3.
Certain activities cannot be counted toward your contact hours to renew your license even if they are related to your area of practice. During the recent changes made to Board Rule 216 by the Board, no additional activities were added to the list of activities that are not acceptable as continuing education. Instead, courses that focus upon self-improvement, changes in attitude, self-therapy, and self-awareness are now acceptable for continuing competency providing they delineate an impact on nursing practice or improved patient outcomes. This change was recommended to the Board by the Texas Nurses Association (TNA) based upon their synthesis of research findings that have been published over the last decade. The findings revealed themes such as compassion fatigue, moral distress, fatigue, resilience, workplace violence, and nursing satisfaction do affect nursing practice and patient safety. NPAC agreed with the findings presented to the Board by TNA and recommended that the Board make this change. Please see Board Rule 216.6, recently revised, for more information.
There are many abbreviations and terms used by nurses around the subject of continuing competency, such as CEU, CE, or CNE. These terms are often incorrectly used interchangeably. The term Continuing Education Unit (CEU) is not used by the Board. The current terms to know are Continuing Nursing Education (CNE), continuing education (CE), and contact hour [Board Rule 216.1(10) & (11)]. Since "contact hour" is another term that often leads to confusion, the definition of a contact hour was recently amended in Board Rule 216. Rather than specifying a number of minutes or clock hours that equate to one contact hour, the new definition is a measure of time, determined by Board-recognized credentialing agencies and providers of continuing education, awarded to participants for successful completion of continuing education offerings [Board Rule 216.1(10)]. With the new rule in effect, so long as a nurse ensures the CNE offering is approved by a credentialing agency or provider recognized by the Board and it relates to the nurse's area of practice, the number of contact hours printed on the certificate of completion will apply directly (1:1) to the 20 contact hours of CNE needed for licensure renewal.
Did you know that after passing the NCLEX or endorsing into Texas, new Texas nurses are exempt from most continuing competency requirements for the issuance of the initial Texas license and for the immediate licensing period following initial Texas licensure, so long as the initial renewal occurs before the expiration date? (Please note that Board Rule 216.3(d), Forensic Evidence Collection, if applicable to the nurse's area of practice, cannot be exempted even during the first renewal.)
Beyond requiring a nurse to complete continuing education offerings in the nurse's area of practice that are approved by a credentialing agency or provider recognized by the Board, Board Rule 216.4 outlines the criteria for acceptable continuing education offerings. This includes a requirement that documented proof of successful completion must contain the name of the provider; program title, date, and location; number of contact hours; provider number; and name of the credentialing agency. Further, each individual nurse is personally responsible to select and participate in continuing competency activities that meet the requirements and criteria listed in Board Rule 216 and maintain a record of CNE activities, for example, original certificates of completion, contact hour certificates, or official academic transcripts, for a minimum of three consecutive licensing periods or six years (or longer if required by Board rule).
Did you know there are additional methods for meeting continuing competency requirements beyond traditional CNE contact hours or a national nursing certification? For example, academic courses within the framework of a curriculum that leads to an academic degree in nursing or any academic course directly relevant to the licensee's area of nursing practice allow a nurse to receive CNE credit for attending and completing such courses with a grade of "C" or better or a "Pass" on a Pass/Fail grading system. Contact hours may only be obtained by this means for academic courses that were completed within the licensing period. CNE credit for academic courses will convert on the following basis: one academic quarter hour equals 10 contact hours; one academic semester hour equals 15 contact hours. An official transcript is required upon audit by the Board. Additionally, nurses can receive CNE credit for developing and/or presenting CNE programs approved by one of the credentialing agencies or providers recognized by the Board and for authoring a manuscript related to nursing that is published in a nursing or health-related textbook or journal. Please see Board Rule 216.5 for more details.
When you renew your license, you are required to sign a statement attesting that the CNE contact hours or approved national nursing certification requirement have been met. The contact hours you use to renew must have been completed within the licensing period and by the time of application for license renewal. Renewing your license without completing the continuing competency requirements is grounds for disciplinary action by the Board. In other words, do not apply to renew your license until you have completed all of your requirements. For example, if your license expires in August, but you only have 18 contact hours of CNE by mid-August and plan to attend a course on August 28th awarding the remaining two contact hours you need, you have to wait until after you have completed the course on August 28th before you can renew because you will not have the required 20 contact hours of CNE until then. But, be sure to renew by August 31st (last day of birth month) to avoid having your license expire and go into delinquent status. Any contact hours earned in a previous licensing period will not be accepted, and additional contact hours earned may not be used for subsequent licensure renewals.
Nurses do not need to submit proof of compliance with CNE contact hours and/or a national nursing certification unless they are audited. The Board randomly audits licensees, and selected nurses will be sent an email and postal mail notice 90 days before their license expiration date letting them know they have been selected for an audit with instructions for the audit process.
The Board offers several CNE offerings nurses can use toward their continuing competency requirements. Please visit the CNE Course Catalog on the BON homepage for more details. Examples of online courses currently available by the Board include: Nursing Regulations for Safe Practice (a new version will be available Spring 2019), Documentation: So Let It Be Said... In Writing That Is, Determining APRN Scope of Practice, and Prescriptive Authority for APRNs. Online courses about nursing delegation and nursing peer review will also be available in 2019.
You can find more information about continuing competency on the Board's website under the Education drop-down menu on the BON homepage by selecting "Continuing Nursing Education & Competency." Look for updates to this section of the website, coming soon, to provide a more accessible, user-friendly layout of this important information. Also, be sure to keep an eye out for any additional changes related to continuing competency requirements that may be born out of the 86th Texas Legislative Session, which begins on January 8, 2019. Any legislative changes affecting nurses or nursing practice will be published in a future BON Bulletin.
** Determining Your Third Two-Year Licensing Period for the Nursing Jurisprudence and Nursing Ethics CNE Requirement
The nursing jurisprudence and nursing ethics CNE requirement must be completed before the end of every third two-year licensing period. To follow are various examples illustrating how to determine when a nurse needs to complete this requirement based upon his/her birth month and year and licensure date. This requirement only applies to licensing periods that began on or after January 1, 2014.
Examples of nurses licensed Examples of nurses licensed before the nursing jurisprudence after the nursing jurisprudence and nursing ethics CNE and nursing ethics CNE requirement went into effect (1/1/14): requirement went into effect Javier, LVN. Born 12/24/73. Licensed (1/1/14): in TX 8/10/96. Huan, RN. Born 1/9/92. Licensed in TX 5/23/14. * Licensing period = 1/1/14 - 12/31/15 * Licensing period = 5/23/14 - 1/31/16 * Licensing period = 1/1/16 - 12/31/17 * Licensing period = 2/1/16 -1/31/18 * Licensing period = 1/1/18 - 12/31/19 * Licensing period = 2/1/18 - 1/31/20 Thus, Javier must complete at least 2 contact hours of CNE relat- Thus, Huan must complete at ed to nursing jurisprudence and least 2 contact hours of CNE nursing ethics between 1/1/14 related to nursing jurisprudence and nursing ethics between 5/23/14 and 12/31/19. and 1/31/20. * Licensing period = 1/1/20 - 12/31/21 * Licensing period = 2/1/20 - 1/31/22 * Licensing period = 1/1/22 - 12/31/23 * Licensing period = 2/1/22 -1/31/24 * Licensing period = 1/1/24 - 12/31/25 * Licensing period = 2/1/24 - 1/31/26 And, Javier will need to complete at least 2 contact hours related And, Huan will need complete at least 2 contact hours related to to nursing jurisprudence and nursing ethics again between nursing jurisprudence and nursing ethics again between 2/1/20 1/1/20 and 12/31/25, and so forth. and 1/31/26, and so forth. Monica, RN. Born 3/17/86. Licensed in TX 2/5/09. Ernesto, RN. Born 9/29/61. Licensed in TX 1/9/16. * Licensing period = 4/1/14 - 3/31/16 * Licensing period = 1/9/16 - 9/30/17 * Licensing period = 4/1/16 - 3/31/18 * Licensing period = 10/1/17 - 9/30/19 * Licensing period = 4/1/18 - 3/31/20 * Licensing period = 10/1/19 - 9/30/21 Thus, Monica must complete at least 2 contact hours of CNE Thus, Ernesto must complete at least 2 contact hours of CNE related to nursing jurisprudence and nursing ethics between related to nursing jurisprudence and nursing ethics between 4/1/14 and 3/31/20. 1/9/16 and 9/30/21. * Licensing period = 4/1/20 - 3/31/22 * Licensing period = 10/1/21 - 9/30/23 * Licensing period = 4/1/22 - 3/31/24 * Licensing period = 10/1/23 - 9/30/25 * Licensing period = 4/1/24 - 3/31/26 * Licensing period = 10/1/25 - 9/30/27 And, Monica will need to complete at least 2 contact hours re- And, Ernesto will need to complete at least 2 contact hours related lated to nursing jurisprudence and nursing ethics again between to nursing jurisprudence and nursing ethics again between 4/1/20 and 3/31/26, and so forth. 10/1/21 and 9/30/27, and so forth. Targeted Continuing Education Forensic Evidence Collection Board Rule 216.3(d) Who? Any nurse who is employed in an emergency room (ER) setting, including any nurse who could float to an ER or have shifts scheduled in an ER, as well as any nurse employed under contractual, temporary, per diem, agency, traveling, or another employment relationship whose duties include working in an ER. <> <> <> <> <> Any nurse who performs a forensic examination on a sexual assault survivor. What? 2 contact hours of CNE relevant to forensic evidence collection and age-or population-specific nursing interventions that may be required by other laws and/or are necessary in order to assure evidence collection that meets requirements under the Government Code [section]420.031 regarding use of an Attorney General-approved evidence collection kit and protocol. Content may also include documentation, history-taking skills, use of sexual assault kit, survivor symptoms, and emotional and psychological support interventions for victims. <> <> <> <> <> Basic forensic evidence collection training or the equivalent education. How Often? One-time requirement within two years of the initial date of the nurse's employment in an ER setting. <> <> <> <> <> One-time requirement prior to performing a forensic collection exam on a sexual assault survivor. Do these contact hours count Yes toward the 20 needed for renewal? Can a relevant, Board- Yes approved certification be used to fulfill the requirement? Can APRNs use related Yes- Forensic evidence collection CME that continuing medical education is approved by the Texas Medical Board. (CME) to fulfill the requirement? Miscellaneous? A nurse who would otherwise be exempt from CNE requirements for issuance of the initial Texas license and for the immediate licensing period following initial Texas licensure is not exempt fromthis requirement. Retain record of course completion indefinitely, even if employment changes occur. Completion of the 2 contact hours of content described above for the ER setting can serve as 'basic forensic evidence collection training' for nurses performing forensic collection exams on sexual assaults survivors. Older Adult or Geriatric Care Board Rule 216.3(h) Who? Any nurse whose practice includes older adult or geriatric populations. What? 2 contact hours of CNE related to older adult or geriatric populations. Content may include elder abuse, age-related memory changes and disease processes, including chronic conditions, end of life issues, health maintenance, and health promotion. Note: this is a change from the prior rule that required specific older adult/geriatric topics be included; the rule is now more broad, leaving it up to individual nurses to determine what topics related to older adults or geriatric care are most applicable to their practice. How Often? Every licensing period, applicable to licensing periods that began on or after January 1, 2014. Do these contact hours count Yes toward the 20 needed for renewal? Can a relevant, Board- Yes approved certification be used to fulfill the requirement? Can APRNs use related Yes-Category 1 CME. continuing medical education (CME) to fulfill the requirement? Miscellaneous? Nursing Jurisprudence Pharmaco- and Nursing Ethics therapeutics Board Rule 216.3(g) Board Rule 216.3(c)(3) Who? All nurses. Any APRN who holds prescriptive authority. What? 2 contact hours of CNE At least 5 that must include the contact hours of Texas Nursing Practice continuing Act, the Board rules, education in including Board Rule pharmaco- 217.11 (Standards of therapeutics. Nursing Practice), the Board's position statements, principles of nursing ethics, and professional boundaries. How Often? Before the end of every Every licensing third two-year licensing period. period, applicable to licensing periods that began on or after January 1, 2014. ** Do these contact hours count Yes No. These are toward the 20 needed for extra hours renewal? required in addition tothe 20. Can a relevant, Board- No No approved certification be used to fulfill the requirement? Can APRNs use related No Yes-Category 1 continuing medical education CME. (CME) to fulfill the requirement? Miscellaneous? Prescription of Controlled Substances Board Rule 216.3(c)(3) Who? Any APRN who holds prescriptive authority and prescribes controlled substances. What? At least 3 contact hours of continuing education related to prescribing controlled substances. How Often? Every licensing period. Do these contact hours count No. These a re ext ra hours toward the 20 needed for required in addition to the renewal? 20. Can a relevant, Board- No approved certification be used to fulfill the requirement? Can APRNs use related Yes-Category 1 CME. continuing medical education (CME) to fulfill the requirement? Miscellaneous? These 3 are on top of the 5 additional contact hours in pharmacotherapeutics required for APRNs who hold prescriptive authority. Thus, an APRN who holds prescriptive authority and prescribes controlled substances must complete a minimum of 28 contact hours for each renewal. Tick-Borne Diseases Board Rule 216.3(f) Who? An APRN whose practice includes the treatment of tick-borne diseases. What? Continuing education relating tothe treatment of tick-borne diseases. Content should contain information relevant to treatment of the disease within the APRN's role and population focus area of licensure and may represent a spectrum of relevant medical clinical treatment relating to tick-borne disease. How Often? Encouraged every licensing period. Do these contact hours count Yes toward the 20 needed for renewal? Can a relevant, Board- No approved certification be used to fulfill the requirement? Can APRNs use related Yes-CME inthe continuing medical education treatment of tick-borne (CME) to fulfill the disease. requirement? Miscellaneous?