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Report of Nevada State Board of Nursing meeting: September 20, 2006.

The NSBON ("the Board") held its September meeting at the Palace Station Hotel in Las Vegas. On its agenda was "review, discussion and action regarding proposed concept and wording of NAC 632.675," which is the regulation that now specifies a master's degree as the minimum educational preparation for faculty in schools of professional nursing. The Board's Education Advisory Committee, which is "to advise and report to the Board on matters related to education and continuing education," had proposed a change in this regulation to allow baccalaureate (BSN) nurses to be clinical instructors in nursing programs. The proposed revision would have added the following:

(3) Each clinical faculty member shall:

(a) Hold at least a baccalaureate degree in nursing,

(b) Have at least three years of nursing experience, and

(c) Be directly supervised by a faculty member as described in subsection 2.

To see the names of committee members (who are billed as representing "nursing education, nursing associations, and employers)," go to http://www.nursing board.state.nv.us/advcomm/commem.htm. Please note that there are several vacancies on the committee, if you would like to serve.

The Nevada Nurses Association (NNA) board and legislative committee opposed this change and drafted testimony for the NSBON meeting, which is included at the end of this article. Because of pressure from the legislators to promote this change or legislators would proceed with a bill filed by Senator Heck allowing physicians and attorneys to be nursing faculty members, NNA offered a compromise solution. The testimony called for a waiver system, with the NSBON allowing BSN-prepared nurses matriculated in a master's program to be clinical instructors. This would accomplish several things: responding to legislative pressure to lower standards while at the same time producing more master's prepared nurses, which the original proposal would not have accomplished. The author (Nancy Menzel), a faculty member at the University of Nevada Las Vegas, agreed to read the testimony into the record at the opening of the meeting, when there is a public comment period.

There was a public turnout of approximately 20 individuals. During the public comment period, in addition to the NNA's testimony, others offered comments, some in support of the change, some against. The NSBON pointed out that there was already a waiver system in place, which allows associate degree programs to hire BSN instructors enrolled in a master's program. So, the proposed change would affect primarily baccalaureate programs. Once the public comment period ended, the NSBON graciously decided to discuss this regulation change first on the agenda. It then called for additional testimony. A representative from the Clark County Medical Society testified that it strongly supported the change to allow the production of more nurses to address the severe shortage in the state. He pointed out that neighboring states, California, Arizona, and Utah, now allow BSNs to teach and have experienced "no problems." He pointed out in particular that the new program the University of Southern Nevada (a private institution) was "in desperate straights" for instructors.

Individuals identifying themselves as being associated with Las Vegas hospitals and the Nevada Nurse Leaders group spoke in favor of lowering the requirement, asserting that bedside nurses had the skills needed to teach nursing students without further coursework, as evidenced by "good outcomes" in other states where standards are lower. They viewed the lowering of educational standards as a step towards increasing the RN supply.

Board member Mary Ann Lambert, a faculty member at the University of Nevada Reno, spoke candidly about the issues surrounding faculty shortage, primarily salary level. She pointed out that few clinical nurses are motivated to earn a master's degree, which qualifies them for a lower paying job (faculty) than they now have (staff nurse). She said that until faculty salaries are raised to equity with the market that the faculty shortage would persist. Even lowering standards to allow a BSN to teach would be unlikely to produce more instructors unless pay was raised. She disputed the assertion that BSN-only nurses have all the skills they need to "educate" nursing students and spoke about the differences between education and training. Finally, she expressed unhappiness with threats from the legislature and physician groups and their attempts to set educational standards for nurses, which should be the prerogative of nurses alone.

More testimony, questions, and statements were made on both sides of the issue. The Clark County Medical Society representative urged the Board not to "punish the people of Nevada" by rejecting the change. David Burgio, Board Vice President, then made a motion to reject the proposed change; Ms. Lambert seconded it. The Board continued its discussion after the motion was made, with one member stating that she feared legislative action if the Board didn't accept the change. Mr. Burgio replied that his obligation was the safety of the public, and he had to vote according to his conscience. The legislature would be similarly accountable for its actions to the public. When a vote was called, all but one Board member voted the change down.

Help NNA with Legislative Issues

Please contact NNA at etbetty@stcglobal.net with your name and e-mail address if you would like more information about how you can help with state legislative issues. As a first step, we will add you to the Adjunct NNA Legislative Committee listserv to receive communications about meetings, hearings, and pertinent discussions. We are interested in hearing your opinions and suggestions regarding upcoming issues so that we can better represent you. Thank you for agreeing to help make NNA more representative of Nevada nurses.

Testimony

To: The Nevada Board of Nursing

From: The Nevada Nurses Association

Date: 9/20/2006

Presented by: Nancy Menzel, PhD, RN, NNA member

The Nevada Nurses Association (NNA) is acutely aware of the continued shortage of nurses and qualified nursing faculty in Nevada. We continue to base our position on patient safety.

The Nevada Nurse Practice Act now incorporates the standards of the Model Nurse Practice Act published by the National Council of State Boards of Nursing (2003), which requires faculty in professional nursing programs to have a minimum of a master's degree with a major in nursing or a nursing doctorate degree.

NNA would support baccalaureate preparation for clinical faculty in schools of nursing in Nevada for those nurses with a BSN who are matriculated in a master's degree program with a major in nursing. NAC 632.675 states "The Executive Director of the Board may, for good cause shown, waive the requirements of paragraph (b) of subsection 2." We urge the Board to use its authority under this rule to grant waivers to the existing rules, rather than lower standards.

Programs wishing to hire BSN-only faculty for clinical teaching positions could apply to the Board for such waivers. Requirements for granting a waiver of NAC 632.675 would be satisfactory evidence of a potential instructor's academic credentials, including evidence of matriculation in a graduate nursing program and at least three years of direct patient care experience. Programs for nurse educators are available in Nevada (and elsewhere), both in person and on line. A waiver program would raise the educational qualifications of those nurses with clinical skills wishing to teach, while at the same time allowing them to fill vacant clinical instructor positions. The long term result would be a better educated nursing faculty workforce while at the same time Nevada could continue to move towards full compliance with national standards.

We feel that clinical instructors should have dual competence in education and clinical practice. Clinical instruction should be provided by nurses who have the ability to help students integrate theoretical knowledge with patient care using critical thinking. Assuring the competence of clinical instructors in both educational theory and clinical practice would ensure that patients receive competent care while students receive competent instruction.
Analysis of the Issues

 Issue There are no studies documenting or
Comment even identifying appropriate outcomes
States contiguous to Nevada or problems that might be associated
have lower standards but have with lower faculty preparation. The
"good outcomes" or have regulations in these states are
experienced "no problems." permissive, not restrictive. They do
 not REQUIRE a program to hire only
 BSN-prepared nurses, so the actual
 percent of faculty who hold only BSNs
 in those states is unknown. Instead
 of comparing Nevada to what
 neighboring states do, it is optimal
 to look at national standards. The
 National Council of State Boards of
 Nursing has a Model Nurse Practice
 Act (2003) that specifies master's
 degree preparation for all faculty.

Lowering faculty standards will There is no evidence that lowering
solve the nursing shortage. standards will allow schools to fill
 poorly-paid clinical instructor
 positions. California has lower
 standards than Nevada for nurse
 educators and still has the worst
 nurse to population ratio in the
 country. The reasons for the nursing
 shortage are complex and depend on
 more than just supply. Retention of
 nurses is the most powerful tool to
 maintain supply and completely within
 the control of hospitals (or "the
 health care industry," as it was
 referred to in the meeting). With no
 ANCC Magnet-designated healthcare
 organizations in Nevada, hospitals
 should focus on improving working
 conditions rather than pressing to
 have schools "crank out" (in the
 words of the Clark County Medical
 Society's representative to Patricia
 Van Betten after the meeting) new
 graduates.

Nevada has a shortage of One way to increase master's prepared
master's prepared nurses, which nurses is to require BSN nurses to
is why we must lower the matriculate and complete a master's
standards. degree concurrently with teaching.
 Nevada has several on line and in
 person programs. Raising the salaries
 of master's prepared faculty will
 produce a larger supply.

The people of Nevada will Patient safety is the responsibility
suffer if we do not lower of the Board and of paramount
educational standards to allow interest to NNA. Flooding the market
more new nurses to be with inexperienced new graduates
graduated. educated by faculty with no
 background in the principles of adult
 education is unlikely to improve
 safety. Preventing the "brain drain"
 of experienced nurses from the
 bedside will improve patient safety.

The Board is not being Nursing should be allowed to set its
cooperative or is "on the own educational standards. The days
wrong side of this issue," are over when nursing was considered
requiring physicians and a vocation dependent for leadership
legislators to step in. and education on physicians. The
 Institute of Medicine, in its report
 on medical errors (Crossing the
 Quality Chasm: A New Health System
 for the 21st Century, 2001), cited
 the need for the various health care
 professions to communicate and
 respect each other's skills and
 abilities. Attempts by outside groups
 to step in and dictate nursing
 educational standards are not based
 on evidence and are arrogant.
COPYRIGHT 2006 Nevada Nurses Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2006 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:Legislative Issues
Author:Menzel, Nancy N.
Publication:Nevada RNformation
Geographic Code:1U8NV
Date:Nov 1, 2006
Words:1796
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