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Summary of actions.

A Regular meeting of the Board of Nursing was held July 17-18, 2008, in Austin. The following is a summary of Board actions taken during this meeting.

The Texas Board of Nursing (BON) proposed an amendment to 22 Texas Administrative Code [section] 211.7 regarding the Executive Director in the August 8, 2008, edition of the Texas Register (Volume 33, Number 32). The amendment outlines the Board's current policies that delegate authority to the Executive Director. The Board, by policy, has authorized the Executive Director to offer proposed disciplinary orders upon evaluation of investigation findings. Under this amendment, the Executive Director may make these offers by mail at the conclusion of an investigation; or in person following an informal conference. Similarly, the Executive Director is authorized by Board policy to accept the voluntary surrender of a license, and Board ratification is not required. The Executive Director is authorized to accept and enter several types of agreed orders on behalf of the Board, and ratification by the Board is not necessary. No comments were received on the proposed amendment to [section] 211.7, and the amended rule becomes effective October 19, 2008.

The BON also proposed amendments to 22 Texas Administrative Code [section][section] 214.1-214.13, concerning Vocational Nursing Education and 22 Texas Administrative Code [section][section] 215.1-215.13, concerning Professional Nursing Education. At the July 2006 Board meeting, the Board issued a charge to the Advisory Committee on Education (ACE) to review rule language regarding clarity and consistency between Chapters 214 and 215. ACE addressed this charge during the June 13, 2008 meeting in Austin and continued the process during the June 24, 2008 telephonic conference. The proposed amendments to Chapters 214 and 215, through reorganization, rephrasing, addition and deletion of language to provide clarity for the intent of the rules, demonstrate consistency between the rules, and describe the processes that actually occur. Additional non-substantive changes were made throughout Chapters 214 and 215 for the purposes of correcting spelling/grammatical errors and providing correct numbering of items. No comments were received on the proposed amendments to Chapters 214 and 215, and the amended chapters become effective October 19, 2008.

The BON proposed an amendment to 22 Texas Administrative Code [section] 217.17, concerning the Texas Nursing Jurisprudence Exam (NJE). The proposed amendment is necessary to implement recommendations made by the Sunset Advisory Commission. House Bill 2426, enacted during the 80th Regular Texas Legislative Session, in part enacted the requirement for the exam in the Nursing Practice Act (NPA), adding language to [section] 301.252 which requires the BON to adopt a rule regarding the development of the examination, applicable fees, administration of the examination, reexamination procedures, grading procedures, and notice of results. This requirement affects applications received after September 1, 2008, from candidates for initial licensure by examination and those seeking to endorse their nursing licenses to Texas. Since the initial adoption of [section] 217.17 in November 2007, board staff have continued to work out the details of development and administration of the NJE. In doing so, staff determined that the original rule language required revision in order to accurately reflect the processes now being put into place for this new examination. No comments were received on the proposed amendment to [section] 217.17, and the amended rule becomes effective October 19, 2008.

The BON proposed amendments to 22 Texas Administrative Code [section] 221.4 and [section] 221.6 and the repeal of [section] 221.5, concerning Advanced Practice Nurses. The proposed amendments and repeal are necessary for the purpose of aligning 22 TAC Chapter 221 with Chapter 305 of the Nursing Practice Act (the Advanced Practice Registered Nurse (APRN) Compact) and national standards. At its October 2007 meeting, the Board charged the Advanced Practice Nursing Advisory Committee (APNAC) with reviewing Rule 221 and discussing issues related to recognition of advanced practice nurses in preparation for implementation of the APRN Compact. As part of its discussion, the Board directed the APNAC to examine two specific issues.

First, the issue of whether Texas should begin referring to nurses in advanced practice as APRNs rather than as APNs (advanced practice nurses). APRN is the term utilized in the compact language, and the term clearly identifies the licensee as both an advanced practice nurse and a registered nurse. It was the consensus of the APNAC to recommend that the Board begin using APRN in order to be consistent with Chapter 305 of the Nursing Practice Act. The other issue the Board directed the APNAC to discuss is whether it would be in the best interest of the public to refer to authorization to practice as licensure rather than continuing to refer to advanced practice approval as an authorization that is linked to registered nurse (RN) licensure. The process used to review and approve applicants as advanced practice nurses is a licensure process, even though it is not presently called a license. Calling the approval a license will not change the advanced practice nurse's scope of practice in any way. The APRN's scope of practice will remain as set forth in current laws and regulations. The Board utilizes a licensure process because it believes advanced practice nursing has evolved as a result of the complexity of services provided and the level of knowledge, skills, and competence required by individuals who provide such care. The services provided by APRNs exceed the scope of practice of RNs. Therefore, the potential for harm to the public is significantly greater for APRNs than for RNs, and a higher level of accountability is necessary.

The Board's approval process ensures public protection through activities that include but are not limited to a detailed review of the individual's advanced practice nursing educational preparation related to the specialty for which he/ she is seeking approval, verification of current RN licensure, and verification of appropriate national certification in the role and specialty that is congruent with the advanced practice nursing education. At least 50% of boards that are members of the National Council of State Boards of Nursing (NCSBN) already refer to their approval process for nurse anesthetists, nurse-midwives and nurse practitioners as licensure. Nearly 40% also license clinical nurse specialists (NCSBN Member Board Profiles, data last updated January 22, 2008). Typically, licensure is considered the preferred method of regulation when the regulated activities are complex, requiring specialized knowledge, skills, and decision-making.

Licensure in any profession is required when the potential for greater risk of harm to the public exists and the professional must be held to the highest level of accountability. Another key element of licensure is a unique and identifiable scope of practice. APRNs are engaged in activities that may include providing medical aspects of care in collaboration with a delegating physician. The knowledge, skills and abilities required to provide advanced practice nursing care significantly exceed those acquired through entry-level nursing education programs that prepare individuals as RNs. Likewise, their scope of practice goes well beyond that of the RN and cannot be performed without completing an advanced practice nursing educational program. Therefore, the Board has established the minimum qualifications necessary for safe and competent practice, and applications for licensure are reviewed to determine that all qualifications have been met. Calling the approval a license is not intended to replace RN licensure; rather, it will assist the public by providing greater clarity in identifying those RNs who are eligible to practice as APRNs in this state. The public is familiar with the concept of licensure for LVNs and RNs, and this change would reinforce to the public that APRNs complete formal education beyond the RN level and must meet certain criteria to practice at the advanced practice level. The APNAC recommends that the Board consider using the term licensure to describe the advanced practice recognition process.

One of the biggest changes recommended by the APNAC is to eliminate provisional authorization to practice for new graduates. The public, employers, and legislators have relayed to staff that the concept of provisional authorization is confusing. Eliminating this level will help to eliminate the confusion associated with it. Additionally, all certifying examinations are available via computer testing methods, allowing applicants to test quickly after graduation. Based on data from the NCSBN, graduates who delay taking VN or RN licensure examinations after graduation are less likely to be successful. It is reasonable to consider that this same concept is applicable to APRNs and certification examinations. In order to allow adequate time for test results to be received, the APNAC also recommends changing the interim approval period to 120 days from the current 90. Comments were received on the proposed amendments to Chapter 221, and the Board of Nursing will discuss the comments at the regularly scheduled meeting of the Board on October 23-24, 2008.

The BON proposed an amendment to 22 Texas Administrative Code [section] 223.1, concerning Fees. The proposed amendment sets a "not to exceed" fee for the jurisprudence exam. The jurisprudence exam was developed in-house by Board staff and a private consulting firm, the iBridge Group. The Board staff anticipates that the Board will be able to absorb all developmental and maintenance costs at this time but would like the option to charge of fee if it is deemed necessary at a later date. The Board staff will evaluate the costs of the jurisprudence examination on March 1, 2009 and again on August 31, 2009. No comments were received on the proposed amendment to [section] 223.1, and the amended rule becomes effective October 19, 2008.
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Publication:Texas Board of Nursing Bulletin
Date:Oct 1, 2008
Previous Article:Texas BON staff and board members impact National Nursing Regulation through participation on NCSBN committees.
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