July 2018 Board of Nursing Updates Charlette Ridout, R.N., M.S., CNE Senior Nursing Education Consultant

Our mission is to ensure safe and competent patient care by licensing health professionals, enforcing standards of practice, and providing information to health care practitioners and the public.

What are the responsibilities of the Board of Nursing?

https://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm#law Laws Governing Nursing § 54.1-3005. Specific powers and duties of Board.

How many members service on the Board of Nursing?

§ 54.1-3002. Board of Nursing; membership; terms; meetings; quorum; administrative officer. The Board of Nursing shall consist of 14 members as follows: eight registered nurses, at least two of whom are licensed nurse practitioners; three licensed practical nurses; and three citizen members. The terms of office of the Board shall be four years. https://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm#law Laws Governing Nursing

How many informal conferences and formal hearings were conducted by the Board in 2017?

Informal Conferences – 744 281 nurse aide 463 nursing Formal Hearings – 150 22 nurse aide 128 nursing Cases received - 1894 920 RN 495 PN 288 NP, CNS, AP 51 Licensed Massage Therapist 115 Registered Medication Aide 25 education programs https://www.dhp.virginia.gov/nursing/nursing_calendar.htm

Nursing Education 2017 Survey Visits - 20 NCLEX Site Visits- 2 Consultation Visits- 5 Presentation- 12 Informal Proceeding - 20 Formal Hearings - 2 Investigations -5 2018 ( as of July) Survey Visits - 24 NCLEX Site Visits- 4 Consultation Visits-5 Presentation- 10 Informal Proceeding -14 Formal Hearings - 3 Investigations -4

What is the current license count for Registered Nurses What is the current license count for Registered Nurses? Licensed Practical Nurses? What is the current certification count for Nurse Aides?

Registered Nurses 107,676 Practical Nurses 29,014 Nurse Aide 52,211 (60 are advanced NA)

Changes in Regulation Requirements for Identification https://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm Regulations Governing the Practice of Nursing - Revised 4-4-2018 18VAC90-19-50. Identification; accuracy of records. A. Any person regulated by this chapter who provides direct client care shall, while on duty, wear identification that is clearly visible and indicates the appropriate title for the license, registration, or student status under which he is practicing in that setting. Name identification on a badge for identification of health care practitioners shall follow the policy of the health care setting in which the nurse is employed. Any person practicing in hospital emergency departments, psychiatric and mental health units and programs, or in health care facilities units offering treatment for clients in custody of state or local law-enforcement agencies may use identification badges with first name and first letter only of last name and appropriate title.

eNLC Enhanced Nurse Licensure Compact https://www.dhp.virginia.gov/nursing/nursing_compact.htm Uniform Licensure Requirements 30 enacted 4 pending legislation 2 pending implementation 19 no pending legislation (includes AS, CNMI, GU, VI)

Nursing Program Accreditation https://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm#law Regulations for Nursing Education Programs - Revised 2-7-2018 18VAC90-27-220. Maintaining an approved nursing education program. … “After February 7, 2021, each registered nursing education program shall have accreditation or candidacy status and shall be reevaluated at least every 10 years by submission of a comprehensive self- evaluation report as provided by the board.”

Simulation Guidance Document Developed in 2008 Limited research in 2008 and regulation No longer is a Guidance Document specific to simulation Today there is published evidence Research articles Guidelines Professional organizations and accreditors Regulations 18VAC90-27-100. Curriculum for direct client care

Links for Simulation Information https://www.ncsbn.org/9535.htm http://www.inacsl.org/i4a/pages/index.cfm?pageid=1 http://virginiasimulationallianceinc.org/ http://www.ssih.org/

Pending Changes Define full approval Clarification regarding criminal background check requirements Simulation Keep up with changes at: https://www.dhp.virginia.gov/ http://townhall.virginia.gov/um/toc.cfm

Direct Client Care Clinical Learning 18VAC90-27-90. Curriculum. B. Nursing education programs preparing for licensure as a registered or practical nurse shall include: 1. Evidence-based didactic content and supervised clinical experience in nursing, encompassing the attainment and maintenance of physical and mental health and the prevention of illness for individuals and groups throughout the life cycle and in a variety of acute, nonacute, community-based, and long-term care clinical settings and experiences to include adult medical/surgical nursing, geriatric nursing, maternal/infant (obstetrics, gynecology, neonatal) nursing, mental health/psychiatric nursing, nursing fundamentals, and pediatric nursing;

18VAC90-27-100. Curriculum for direct client care. Clinical hours required (PN, RN, advanced placed LPN) Observational experiences Objectives for experiences Simulation for direct client clinical hours No more than 25% of the total required hours No more than 50% “for any course” Guidance Document 90-21 90-21, Clinical Learning Experience in Nursing Education Programs, revised February 24, 2017

Make sure the students are able to meet the course objectives Make sure the students are caring for the types of patients for which the clinical hours are allotted Example: family practice doctor office being used for pediatric clinical hours but no pediatric patients were seen More than location goes into verifying compliance regarding clinical

When accounting for your students direct client care hours: Make sure you are recording the number of hours of actual direct client care experiences If you are leaving early, you cannot account for completing the number of hours as planned on the schedule As the faculty recording incorrect hours, this can be fraud As the program director, you could be attesting that students completed the required hours for the program

Preceptors 18VAC90-27-10. Definitions. "Preceptor" means a licensed nurse who is employed in the clinical setting, serves as a resource person and role model, and is present with the nursing student in that setting, providing clinical supervision. 18VAC90-27-110. Clinical practice of students. Student and faculty responsibility for safe client care Faculty to student ratio, Preceptor to student ratio Specific requirements when use Preceptors Faculty assume ultimate responsibility for implementation, periodic monitoring and evaluation

18VAC90-27-10. Definitions. "Accreditation" means having been accredited by an agency recognized by the U.S. Department of Education to include the Accreditation Commission for Education in Nursing, the Commission on Collegiate Nursing Education, the Commission for Nursing Education Accreditation, or a national nursing accrediting organization recognized by the board. "Nursing faculty" means registered nurses who teach the practice of nursing in nursing education programs. Teaching in the classroom, skills lab, simulation lab, clinical- wherever they are teaching students

Faculty 18VAC90-27-60 A. Qualifications for all faculty. 1. Every member of the nursing faculty, including the program director, shall (i) hold a current license or a multistate licensure privilege to practice nursing in Virginia as a registered nurse without any disciplinary action that currently restricts practice and (ii) have had at least two years of direct client care experience as a registered nurse prior to employment by the program. Persons providing instruction in topics other than nursing shall not be required to hold a license as a registered nurse.

2. Every member of a nursing faculty supervising the clinical practice of students shall meet the licensure requirements of the jurisdiction in which that practice occurs. Faculty shall provide evidence of education or experience in the specialty area in which they supervise student clinical experience for quality and safety. Prior to supervision of students, the faculty providing supervision shall have completed a clinical orientation to the site in which supervision is being provided. 3. The program director and each member of the nursing faculty shall maintain documentation of professional competence through such activities as nursing practice, continuing education programs, conferences, workshops, seminars, academic courses, research projects, and professional writing. Documentation of annual professional development shall be maintained in employee files for the director and each faculty member until the next survey visit and shall be available for board review.

6. For practical nursing programs: a. The program director shall hold a baccalaureate degree with a major in nursing. b. The majority of the members of the nursing faculty shall hold a baccalaureate degree, preferably with a major in nursing.

18VAC90-19-110. Licensure by examination. A. The board shall authorize the administration of the NCLEX for registered nurse licensure and practical nurse licensure. B. A candidate shall be eligible to take the NCLEX examination (i) upon receipt by the board of the completed application, the fee, and an official transcript or attestation of graduation from the nursing education program and (ii) when a determination has been made that no grounds exist upon which the board may deny licensure pursuant to § 54.1-3007 of the Code of Virginia. https://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm#reg   Virginia nursing programs can send an attestation letter in lieu of transcripts to transcriptbyexam@dhp.virginia.gov .  In the subject line of the email containing the attestation letter, you do need to write Attestation Letter. The attestation letter will include all names of the graduating cohort. There is no specific format but most schools have developed a letter stating degree conferral with a table below to include the required information.   Attestation letters must contain the following information: student’s name last 4 of the SSN DOB enrollment date graduation/conferral date type of degree earned.

If you send a letter of attestation to the email transcriptbyexam@dhp If you send a letter of attestation to the email transcriptbyexam@dhp.virginia.gov , you do not need to send transcripts. If you send the attestation letter to the email address  transcriptbyexam@dhp.virginia.gov you should not send a hard copy of the attestation letter to the Board. Duplicate documentation does slow the process.  You will get a confirmation of receipt of the attestation letter via email. If you do not get a return email confirming receipt of the attestation letter, please alert us.  The attestation letter can be sent once the degree has been conferred which may be different than the day of graduation ceremonies. 

18VAC90-19-110. Licensure by examination. F. Practice of nursing pending receipt of examination results. 1. A graduate who has filed a completed application for licensure in Virginia and has received an authorization letter issued by the board may practice nursing in Virginia from the date of the authorization letter. The period of practice shall not exceed 90 days between the date of successful completion of the nursing education program, as documented on the applicant's transcript, and the publication of the results of the candidate's first licensing examination.

2. Candidates who practice nursing as provided in subdivision 1 of this subsection shall use the designation "R.N. Applicant" or "L.P.N. Applicant" on a nametag or when signing official records. 3. The designations "R.N. Applicant" and "L.P.N. Applicant" shall not be used by applicants who either do not take the examination within 90 days following receipt of the authorization letter from the board or who have failed the examination

Part V Disciplinary and Delegation Provisions 18VAC90-19-230. Disciplinary provisions. 2. Unprofessional conduct means, but shall not be limited to: b. Assuming duties and responsibilities within the practice of nursing without adequate training or when competency has not been maintained; c. Obtaining supplies, equipment, or drugs for personal or other unauthorized use; d. Employing or assigning unqualified persons to perform functions that require a licensed practitioner of nursing; e. Falsifying or otherwise altering patient, employer, student, or educational program records, including falsely representing facts on a job application or other employment-related documents; l. Entering into a relationship with a patient or client that constitutes a professional boundary violation in which the nurse uses his professional position to take advantage of the vulnerability of a patient, a client, or his family, to include actions that result in personal gain at the expense of the patient or client, or a nontherapeutic personal involvement or sexual conduct with a patient or client;

Board of Nursing Education tab https://www.dhp.virginia.gov/nursing/nursing_edprogs.htm Dates for program updates List of approved programs NCLEX pass rates, current year by quarter and previous 5 years Guidelines for choosing a nursing program Information for attending BON hearings Forms