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CNE & Me: Understanding the Board's Continuing Competency Requirements.

The Texas Board of Nursing (BON or Board) licenses nurses and regulates the practice of nursing in the State of Texas. As the licensing agency for nurses in Texas, the Board has authority, granted by the Texas Legislature, to establish minimum continued competency requirements for nursing licensure renewal. Continuing competency is not only required to maintain an active nursing license in Texas, it is also an important part of a nurse's professional growth [Board Rules 216.3 & 217.11(1)(R)]. Continuing competency aims to ensure nurses stay abreast of current industry practices while enhancing their professional competency, educating them about new technology and treatment regimens, and updating their clinical skills [Board Rule 216.2]. The purpose of this article is to summarize the continuing competency requirements for nurses in Texas as well as describe the recent substantive changes to the Board's continuing competency rule, Board Rule 216.

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?
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Publication:Texas Board of Nursing Bulletin
Date:Jan 1, 2019
Words:3736
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