PERMANENT RULES
(Nursing Care Quality Assurance Commission)
Effective Date of Rule: Thirty-one days after filing.
Purpose: The rules define and clarify the requirements that nurses must meet in order to be licensed in Washington state. Changes remove outdated requirements and barriers to licensure, allowing easier access for qualified applicants. These rules assure that only appropriately trained nurses are licensed. Changes are also made to clarify the definitions of client advocate, delegation, supervision, substance abuse monitoring and nursing program approval rules.
Citation of Existing Rules Affected by this Order: Repealing WAC 246-840-040, 246-840-070, 246-840-080 and 246-840-299; and amending WAC 246-840-010, 246-840-020, 246-840-030, 246-840-050, 246-840-060, 246-840-090, and 246-840-760.
Statutory Authority for Adoption: RCW 18.79.110.
Adopted under notice filed as WSR 08-02-088 on January 2, 2008.
Changes Other than Editing from Proposed to Adopted Version: Changes were made to the definition of delegation. Under WAC 246-840-010, a sentence was moved from subsection (7)(a) up to the introductory paragraph in subsection (7). The other change added "licensed practical nurse" to subsection (7)(c) so that it would be consistent with the introductory paragraph in subsection (7).
A final cost-benefit analysis is available by contacting Kendra Pitzler, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4723, fax (360) 236-4738, e-mail kendra.pitzler@doh.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 3, Amended 7, Repealed 4.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 3, Amended 7, Repealed 4.
Date Adopted: February 5, 2008.
Judith Personett, EdD, RN, Chair
Nursing Care Quality Assurance Commission
OTS-7826.9
AMENDATORY SECTION(Amending WSR 04-13-053, filed 6/11/04,
effective 6/11/04)
WAC 246-840-010
Definitions.
(1) (("Auxiliary services"
are all nursing services provided to patients by persons other
than the licensed practical nurse, the registered nurse and
the nursing student.
(2) "Beginning practitioner" means a newly licensed nurse beginning to function in the nurse role.
(3) "Behavioral objectives" means the measurable outcomes of specific content.
(4) "Client" means the person who receives the services of the practical nurse or registered nurse.
(5))) An "advanced registered nurse practitioner (ARNP)" is a registered nurse who has had formal graduate education and has achieved national specialty certification for the nurse practitioner, nurse anesthetist, or nurse midwife role. A nurse with this preparation may qualify as an ARNP as described in WAC 246-840-300.
(2) "Advanced nursing practice" is the delivery of nursing care by registered nurses who have acquired experience and formal education that prepares them for independent practice.
(3) "Client advocate" means ((a supporter of client
rights and choices)) a licensed registered nurse or practical
nurse who actively supports client's rights and choices,
including the client's right to receive safe, high quality
care, and who facilitates the client's ability to exercise
those rights and/or choices by providing the client has
adequate information about their care and options.
(((6))) (4) "Commission" means the Washington state
nursing care quality assurance commission.
(((7) "Competencies" means the tasks necessary to perform
the standards.
(8) "Conceptual framework" means the theoretical base around which the curriculum is developed.
(9))) (5) "Competency" means demonstrated knowledge, skill and ability in the practice of nursing.
(6) "Conditional approval" of a school of nursing is the
approval given a school of nursing that has ((failed to meet))
not met the requirements of the law and the rules and
regulations of the commission((, and it specifies));
conditions are specified that must be met within a designated
time to rectify the ((failure)) deficiency.
(((10))) (7) "Delegation" means the licensed practical
nurse or registered nurse transfers the performance of
selected nursing tasks to competent individuals in selected
situations. The licensed practical nurse or registered nurse
delegating the task retains the responsibility and
accountability for the nursing care of the client. The
licensed practical nurse or registered nurse delegating the
task supervises the performance of the unlicensed person((;)).
Delegation in community and in-home care settings is defined
by WAC 246-840-910 through 246-840-970.
(a) Nursing acts delegated by the licensed practical nurse or registered nurse shall:
(i) Be within the area of responsibility of the licensed practical nurse or registered nurse delegating the act;
(ii) Be such that, in the opinion of the licensed practical nurse or registered nurse, it can be properly and safely performed by the unlicensed person without jeopardizing the patient welfare;
(iii) Be acts that a reasonable and prudent licensed practical nurse or registered nurse would find are within the scope of sound nursing judgment.
(b) Nursing acts delegated by the licensed practical nurse or registered nurse shall not require the unlicensed person to exercise nursing judgment nor perform acts which must only be performed by a licensed practical nurse or registered nurse, except in an emergency situation (RCW 18.79.240 (1)(b) and (2)(b)).
(c) When delegating a nursing act to an unlicensed person it is the licensed practical nurse or the registered nurse who shall:
(i) Make an assessment of the patient's nursing care need before delegating the task;
(ii) Instruct the unlicensed person in the delegated task or verify competency to perform or be assured that the person is competent to perform the nursing task as a result of the systems in place by the health care agency;
(iii) Recognize that some nursing interventions require nursing knowledge, judgment, and skill and therefore may not lawfully be delegated to unlicensed persons.
(((11) Direction and Supervision:
(a) "Supervision" of licensed or unlicensed nursing personnel means the provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action.
(b) "Consulting capacity" means the recommendations to a professional entity, employed at that facility, which may be accepted, rejected, or modified. These recommendations shall not be held out as providing nursing services by the consulting nurse to the patient or public.
(c) "Direct supervision" means the licensed registered nurse is on the premises, is quickly and easily available and the patient has been assessed by the licensed registered nurse prior to the delegation of the duties to any caregiver.
(d) "Immediate supervision" means the registered nurse is on the premises and is within audible and visual range of the patient and the patient has been assessed by the registered nurse prior to the delegation of duties to any caregiver.
(e) "Indirect supervision" means the registered nurse is not on the premises but has given either written or oral instructions for the care and treatment of the patient and the patient has been assessed by the registered nurse prior to the delegation of duties to any caregiver.
(12) "Extended learning sites" refers to any area external to the parent organization selected by faculty for student learning experiences.
(13))) (8) "Faculty" means persons who are responsible
for the educational ((program of the school of)) nursing
program and who hold faculty appointment in the school.
(((14))) (9) "Full approval" of a school of nursing is
the approval ((given)) signifying that a ((school of)) nursing
((that)) program meets the requirements of the law and the
rules and regulations of the commission.
(((15))) (10) "Good cause" as used in WAC ((246-840-990))
246-840-860 for extension of a nurse technician registration
means that the nurse technician has had undue hardship such as
difficulty scheduling the examination through no fault of
their own, receipt of the examination results after thirty
days after the nurse technician's date of graduation, or an
unexpected family crisis which caused him or her to delay
sitting for the examination. Failure of the examination is
not "good cause."
(((16))) (11) "Good standing" as applied to a nursing
technician, means the nursing technician is enrolled in a
registered nursing program approved by the commission and is
successfully meeting all program requirements.
(((17))) (12) "Immediately available" as applied to
nursing technicians, means that a registered nurse who has
agreed to act as supervisor is on the premises and is within
audible range and available for immediate response as needed. This may include the use of two-way communication devices
which allow conversation between the nursing technician and a
registered nurse who has agreed to act as supervisor.
(a) In a hospital setting, a registered nurse who has agreed to act as supervisor is on the same patient care unit as the nursing technician and the patient has been assessed by the registered nurse prior to the delegation of duties to the nursing technician.
(b) In a nursing home setting, a registered nurse who has agreed to act as supervisor is in the same building and on the same floor as the nursing technician and the patient has been assessed by the registered nurse prior to the delegation of duties to the nursing technician.
(((18) "Minor nursing services." The techniques and
procedures used by the nursing profession are extremely
difficult to categorize as major or minor nursing services. The important factor with which this law is concerned is the
determination of which nursing person and at what level of
preparation that person may perform said technique or
procedure in relation to the condition of a given patient, and
this kind of determination rests with the registered nurse.
(19))) (13) "Initial approval" of nursing programs is the approval given a new nursing program based on its proposal prior to the graduation of its first class.
(14) "Limited educational authorization" is an authorization to perform clinical training through a commission approved refresher course. This authorization does not permit practice for employment. A limited educational authorization may be issued to:
(a) A person whose Washington state license has been expired or inactive for three years or more and who applies for reinstatement and enrolls in a refresher course; or
(b) An applicant endorsing from another state or territory if the applicant's license from that jurisdiction is on inactive or expired status. The applicant must be enrolled in a refresher course.
(15) "Minimum standards of competency" means the
((functions)) knowledge, skills and abilities that are
expected of the beginning ((level nurse)) practitioner.
(((20))) (16) "Nontraditional program of nursing" means a
school that has a curriculum which does not include a faculty
supervised teaching/learning component in clinical settings.
(17) "Nurse administrator" is an individual who meets the qualifications contained in WAC 246-840-555 and who has been designated as the person primarily responsible for the direction of the program in nursing. Titles for this position may include, among others, dean, director, coordinator or chairperson.
(((21))) (18) "Nursing technician" means a nursing
student preparing for registered nurse licensure who is
employed in a hospital licensed under chapter 70.41 RCW or a
nursing home licensed under chapter 18.51 RCW, and who:
(a) Is currently enrolled in good standing and attending a nursing program approved by the commission and has not graduated; or
(b) Is a graduate of a nursing program approved by the commission who graduated:
(i) Within the past thirty days; or
(ii) Within the past sixty days and has received a determination that there is good cause to continue the registration period.
(c) Approved schools for nursing technicians include the
list of registered nursing programs (schools) approved by
state boards of nursing as preparation for the NCLEX
registered nurse examination, and listed in the NCLEX bulletin
as meeting minimum standards. Approved schools do not include
nontraditional schools as defined in ((WAC 246-840-030(3)))
subsection (16) of this section.
(((22))) (19) "Philosophy" means the beliefs and
principles upon which the curriculum is based.
(((23))) (20) "Program" means a division or department
within a state supported educational institution, or other
institution of higher learning charged with the responsibility
of preparing persons to qualify for the licensing examination.
(((24) "Provisional approval" of schools of nursing is
the approval given a new school of nursing based on its
proposed program prior to the admission of its first class.
(25))) (21) "Registered nurse" as used in these rules shall mean a nurse as defined by RCW 18.79.030(1).
(((26) "School" means an educational unit charged with
the responsibility of preparing persons to practice as
practical nurses or registered nurses. Three types of basic
schools of nursing are distinguished by the certificate
awarded to the graduate. Schools of nursing within colleges
and universities award the associate degree or baccalaureate
degree. Schools of nursing sponsored by a hospital award a
diploma.
(27) "Standards" means the overall behavior which is the desired outcome.
(28) "Terminal objectives" means the statements of goals which reflect the philosophy and are the measurable outcomes of the total curriculum.
(29) An "unapproved school of nursing" is a school of nursing that has been removed from the list of approved schools for failure to meet the requirements of the law and the rules and regulations of the commission or a school that has never been approved by the commission.)) (22) "Supervision" of licensed or unlicensed nursing personnel means the provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action.
(a) "Direct supervision" means the licensed registered nurse who provides guidance to nursing personnel and evaluation of nursing tasks is on the premises, is quickly and easily available, and has assessed the patient prior to the delegation of the duties.
(b) "Immediate supervision" means the licensed registered nurse who provides guidance to nursing personnel and evaluation of nursing tasks is on the premises, is within audible and visual range of the patient, and has assessed the patient prior to the delegation of duties.
(c) "Indirect supervision" means the licensed registered nurse who provides guidance to nursing personnel and evaluation of nursing tasks is not on the premises but has given either written or oral instructions for the care and treatment of the patient and the patient has been assessed by the registered nurse prior to the delegation of duties.
(23) "Traditional program of nursing" means a program that has a curriculum which includes a faculty supervised teaching/learning component in clinical settings.
[Statutory Authority: Chapter 18.79 RCW and 2003 c 258. 04-13-053, § 246-840-010, filed 6/11/04, effective 6/11/04. Statutory Authority: RCW 43.70.280. 98-05-060, § 246-840-010, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-010, filed 6/18/97, effective 7/19/97.]
(1) Active status license. A license is issued upon
completion of all requirements for licensure((, confers the
right to)). The license holder may use the title licensed
practical nurse or ((licensed)) registered nurse and the use
of its abbreviation, ((L.P.N. or R.N., and to)) LPN or RN.
The license allows practice as a licensed practical nurse or
registered nurse in the state of Washington.
A student who has graduated from a basic professional
nursing course and who is pursuing a baccalaureate degree in
nursing, an advanced degree in nursing or an advanced
certification in nursing ((shall)) must hold an active
Washington RN license before participating in the practice of
nursing as required to fulfill the learning objectives in a
clinical course.
((Exception to this requirement may be granted by the
commission on an individual basis upon a petition submitted by
the dean or director of a school of nursing, on a case-by-case
basis.
(a) The exception allows the student to practice in a clinical setting only under the direct supervision of an RN faculty member. The commission requires that any RN faculty member supervising these students meet the requirements of direct supervision as defined in WAC 246-840-010 (13)(c)(ii) and, in addition, that supervising faculty document that all clients under the care of the student be assessed by the RN faculty each clinical day.
(b) The dean or director of the school of nursing shall ensure that each faculty member who supervises these students be provided a copy of these rules and be assigned in a manner that allows for direct supervision.
(c) Nursing students who participate in clinical courses under this section are not eligible for the nursing technician role.))
(2) Inactive status license. A license issued to a person previously holding an active license in this state, is in good standing, and does not practice in Washington state. Refer to chapter 246-12 WAC, Part 4.
(3) ((Limited educational license. A limited educational
license may be issued to a person who has been on inactive or
lapsed status for three years or more and who wishes to return
to active status. A limited educational license does not
authorize practice for employment.
(4))) Advanced registered nurse practitioner (ARNP)
((recognition document)) license. An ARNP ((recognition
document)) license may be issued to any person who meets the
requirements of the commission as contained in WAC 246-840-300
through 246-840-365. Only persons holding this ((recognition
document shall)) license have the right to use the title
"advanced registered nurse practitioner" or the abbreviation
"ARNP" or any title or abbreviation which ((may)) indicates
that the person is entitled to practice at an advanced and
specialized ((level)) role as a nurse practitioner, ((a
specialized nurse practitioner,)) a nurse midwife, or a nurse
anesthetist. ((This document authorizes)) The ARNP ((to)) may
engage in the scope ((of practice)) allowed for his or her
((specialty)) area ((and)) of national certification as
approved by the commission. The license is valid only with a
current registered nurse license. The ARNP's scope of
practice is defined by national certification standards and
approved by the commission.
(((5) ARNP interim permit. An interim permit may be
issued following satisfactory completion of an advanced formal
education program, registration for the first certification
examination of an approved program following completion of the
education and filing of an application, fee and requested
documentation. If the applicant passes the examination the
department shall grant advanced registered nurse practitioner
status. If the applicant fails the examination, the interim
permit shall expire upon notification and is not renewable.
(6) ARNP prescriptive authorization. A notation of prescriptive authorization may be placed on the ARNP recognition document issued to any person who meets the requirements of the commission as contained in WAC 246-840-410. This authorizes the ARNP to prescribe drugs within his or her scope of practice and is valid only with a current registered nurse license.))
[Statutory Authority: RCW 18.79.110. 99-10-079, § 246-840-020, filed 5/4/99, effective 6/4/99. Statutory Authority: RCW 43.70.280. 98-05-060, § 246-840-020, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-020, filed 6/18/97, effective 7/19/97.]
(1) Successfully complete a commission approved nursing education program. For applicants from a commission approved registered nurse program who are applying for a practical nurse license:
(a) Complete all course work required of commission approved practical nurse programs as listed in WAC 246-840-575(2). Required courses not included in the registered nurse program may be accepted if the courses were obtained through a commission approved program.
(b) Be deemed as capable to safely practice within the scope of practice of a practical nurse by the nurse administrator of the candidate's program.
(2) Complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(3) Successfully pass the commission approved licensure examination as provided in WAC 246-840-050. Testing may be allowed upon receipt of a certificate of completion from the administrator of the nursing education program.
(4) Submit the following documents:
(a) A completed licensure application with the required fee as defined in WAC 246-840-990.
(b) An official transcript sent directly from the applicant's nursing education program to the commission. The transcript must include course names and credits accepted from other programs. Transcripts must be received within ninety days of the applicant's first taking of the examination. The transcript must show:
(i) The applicant has graduated from an approved nursing program or has successfully completed the prelicensure portion of an approved graduate-entry registered nursing program; or
(ii) That the applicant has completed all course work required in a commission approved practical nurse program as listed in WAC 246-840-575(2).
(c) Applicants from a commission approved registered nurse program who are applying for a practical nurse license must also submit an attestation sent from the nurse administrator of the candidate's nursing education program indicating that the applicant is capable to safely practice within the scope of practice of a practical nurse.
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(2) Graduates from a nursing school approved by a board of nursing in another U.S. jurisdiction shall be eligible to take the examination provided that:
(a) The nursing school meets the minimum standards approved for state board school of nursing in Washington at the time of the applicant's graduation;
(b) Graduate has completed all institutional requirements for the degree/diploma in nursing education per attestation from the administrator of the approved nursing education program;
(c) All other requirements of the statute and regulations shall be met.
(3) Graduates of a nontraditional school of nursing which meet the requirements of subsection (2)(a), (b) and (c) of this section, are eligible to take the registered nurse examination provided that the following conditions are met: (For purposes of this section, nontraditional schools of nursing are defined as schools that have curricula which do not include a faculty supervised teaching/learning component in clinical settings.)
(a) The candidate is a licensed practical nurse in Washington state; and
(b) There is documentation of at least two hundred hours of supervised clinical experience (preceptorship) in the role of a registered nurse. The required elements of a preceptorship are as follows:
(i) Acceptable clinical sites - Acceptable clinical sites include acute care or subacute care settings or skilled nursing facilities. Other sites must be approved by the commission.
(ii) Qualifications of preceptor (instructor) - The preceptor must be a licensed registered nurse in Washington state with at least two years experience in a practice setting and have no history of disciplinary actions. The candidate must provide documentation that the preceptor meets these requirements when he/she applies for licensure and must also provide a written agreement between the candidate and the preceptor (or facility) that preceptorship supervision will occur.
(iii) Experiences in the preceptorship - Experiences must include delegation and supervision, decision making and critical thinking, patient assessment as part of the nursing process and evaluation of care. A checklist, provided by the commission, must be completed by the preceptor which indicates the candidate's satisfactory completion of the identified skills. This checklist must be submitted with the candidate's application for licensure; and
(c) The candidate receives a satisfactory evaluation from their preceptor meeting commission requirements as previously identified ((b)(iii) of this subsection); and
(d) All other requirements of the nursing statute and regulations are met.
(4) In order to be eligible for licensure by examination the applicant shall have satisfactorily completed an approved practical nursing program, fulfilling all the basic course content as stated in WAC 246-840-575, or its equivalent as determined by the board. Every applicant must have satisfactorily completed an approved practical nursing program within two years of the date of the first examination taken or the applicant must meet other requirements of the board to determine current theoretical and clinical knowledge of practical nursing practice.
(5) An applicant who has not completed an approved practical nurse program must establish evidence of successful completion of nursing and related courses at an approved school preparing persons for licensure as registered nurses, which courses include personal and vocational relationships of the practical nurse, basic science and psychosocial concepts, theory and clinical practice in medications and the nursing process, and theory and clinical practice in medical, surgical, geriatric, pediatric, obstetric and mental health nursing. These courses must be equivalent to those same courses in a practical nursing program approved by the board.
(6) A notice of eligibility for admission to the licensing examination may be issued to all new graduates from board approved practical nursing programs after the filing of a completed application, payment of the application fee, and official notification from the program certifying that the individual has satisfactorily completed all requirements for the diploma/certification.
(7) All other requirements of the statute and regulations shall be met.)) Registered nursing and practical nursing applicants educated in a traditional nursing education program approved by another United States nursing board and applying for initial licensure must:
(1) Successfully complete a board approved nursing education program. Applicants from a board approved registered nurse program who are applying for a practical nurse license:
(a) Complete all course work required of board approved practical nurse programs as listed in WAC 246-840-575(2). Required courses not included in the registered nurse program may be accepted if the courses were obtained through a commission approved program.
(b) Be deemed as capable to safely practice within the scope of practice of a practical nurse by the nurse administrator of the applicant's nursing education program.
(2) Complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(3) Successfully pass the commission approved licensure examination as provided in WAC 246-840-050.
(4) Submit the following documents:
(a) A completed licensure application with the required fee as defined in WAC 246-840-990.
(b) An official transcript sent directly from the applicant's nursing education program to the commission. The transcript must include course names and credits accepted from other programs. The transcript must show:
(i) The applicant has graduated from an approved nursing program or has successfully completed the prelicensure portion of an approved graduate-entry registered nursing program; or
(ii) That the applicant has completed all course work required in a commission approved practical nurse program as listed in WAC 246-840-575(2).
(c) Applicants from a board approved registered nurse program who are applying for a practical nurse license must also submit an attestation sent from the nurse administrator of the applicant's nursing education program indicating that the applicant is capable to safely practice within the scope of practice of a practical nurse.
[Statutory Authority: Chapter 18.79 RCW. 99-01-098, § 246-840-030, filed 12/17/98, effective 1/17/99. Statutory Authority: RCW 18.79.160. 97-17-015, § 246-840-030, filed 8/8/97, effective 9/8/97.]
(1) Successfully complete the board or commission approved practical nurse program which included multiple clinical experiences supervised by nursing faculty and possess a current Washington state practical nurse license which is in good standing. The commission may verify that this requirement is met through review of documents previously submitted to the commission.
(2) Successfully complete a board approved nontraditional registered nursing program.
(3) Complete at least two hundred hours of supervised clinical experience (preceptorship) in the role of a registered nurse. The preceptorship must be accomplished within six months following completion of the applicant's nursing education program. The required elements of a preceptorship are:
(a) Clinical sites may include acute care or subacute care settings or skilled nursing facilities. Other sites must be approved by the commission.
(b) The preceptor must be a licensed registered nurse with at least two years experience in a clinical practice setting that is the same type of practice setting where the preceptorship will occur.
(c) The preceptor shall not have a history of disciplinary actions.
(d) There must be a written agreement between the applicant and the preceptor (or facility) that preceptorship supervision will occur. The written agreement shall state that the registered nurse agrees to act as preceptor and understands that the practical nurse is practicing under the preceptor's registered nurse license. The written agreement must be signed before the preceptorship begins.
(e) A checklist, on a form provided by the commission, must be completed by the preceptor indicating satisfactory completion by the applicant of identified skills.
(f) Skills performed by the applicant within the role of a registered nurse, under the immediate supervision of the RN preceptor, must include: Delegation and supervision, decision making and critical thinking, patient assessment and evaluation of care and communication with health team members.
(4) Complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(5) Successfully pass the commission approved registered nurse licensure examination.
(6) Submit the following documents:
(a) A completed licensure application with the required fee as described in WAC 246-840-990.
(b) An official transcript sent directly from the applicant's nursing education program to the commission. The transcript must contain adequate documentation to demonstrate that the applicant has graduated from an approved nursing program.
The transcripts shall include course names and credits accepted from other programs.
(c) Documentation of two hundred hours of supervised clinical experience that meet the requirements of subsection (3) of this section.
(d) Additional documentation as requested by the commission if the commission cannot verify the applicant's successful completion of a board or commission approved practical nurse program which included multiple clinical experiences supervised by nursing faculty.
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(1) Successfully complete a basic nursing education program approved in that country.
(a) The nursing education program must be equivalent to the minimum standards prevailing for nursing education programs approved by the commission.
(b) Any deficiencies in the nursing program (theory and clinical practice in medical, psychiatric, obstetric, surgical and pediatric nursing) must be satisfactorily completed in a commission approved nursing program.
(2) Demonstrate English language proficiency by passing a commission approved English proficiency examination at a commission designated standard. Individuals from countries where English is the primary language and where nursing education (theory and clinical) is conducted in English will have this requirement waived.
(3) Complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(4) Successfully pass the commission approved licensure examination as provided in WAC 246-840-050.
(5) Submit the following documents:
(a) A completed licensure application with the required fee as defined in WAC 246-840-990.
(b) LPNs must submit an:
(i) Official transcript directly from the nursing education program or licensure agency in country where the applicant was educated or previously licensed.
Transcript must be in English or accompanied by an official English translation. If the applicant's original documents (education and licensing) are on file in another state or with an approved credential evaluating agency, the applicant may request that the state board or approved credential evaluating agency send copies directly to the commission in lieu of the originals.
The transcript must:
(A) Include the applicant's date of graduation and credential conferred.
(B) Describe the course names and credit hours completed.
(C) Document equivalency to the minimum standards in Washington state.
(ii) Documentation from a commission approved nursing program showing that any deficiency in theory and clinical practice in medical, psychiatric, obstetric, surgical and pediatric nursing has been satisfactorily completed.
(iii) Documents must show the applicant has passed a commission approved English proficiency examination at a commission designated standard. This documentation will not be required from individuals from countries where English is the primary language and where nursing education (theory and clinical) is conducted in English.
(c) RNs must submit:
(i) A certificate or credential from a commission approved credential evaluating service verifying that the educational program completed by the applicant is equivalent to registered nursing education in Washington state. This documentation will not be required for individuals who have passed the national licensing examination and are licensed as a registered nurse by another United States nursing board.
(ii) Documents showing the applicant has passed a commission approved English proficiency examination at a commission designated standard. This documentation will not be required for individuals from countries where English is the primary language or where nursing education, theory and clinical, is conducted in English.
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(2) In order to be licensed in this state, all nurse
applicants shall take and pass the National Council Licensure
Examination (NCLEX-RN¦ or NCLEX-PN¦) ((within four attempts
and within two years of completion of the nursing program)).
(((2) The NCLEX will consist of a Computerized Adaptive
Test that will be individualized with the score for the
examination reported as either pass or fail. Specific
parameters of the exam will be as prescribed by contract with
National Council of State Boards of Nursing, Inc. (NCSBN).))
(3) ((Examinations shall be conducted throughout the
year.)) Only applicants who complete the education,
experience, and application requirements of WAC 246-840-025,
246-840-030, 246-840-035 or 246-840-045 will be eligible for
the examination.
(4) The commission will notify applicants who have filed the required application documents and met all qualifications of their eligibility to take the examination.
(5) Applicants must file an examination application directly to the testing service, along with the testing service's required fee.
(6) The executive director of the commission shall
negotiate with NCSBN for the use of the NCLEX¦ ((CAT)).
(((5))) (7) The examination shall be administered in
accord with the NCSBN security measures and contract. All
appeals of examination procedures and results shall be managed
in accord with policies in the NCSBN contract.
[Statutory Authority: RCW 18.79.110. 99-13-086, § 246-840-050, filed 6/14/99, effective 7/15/99. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-050, filed 6/18/97, effective 7/19/97.]
(2) ((Candidates who pass shall)) Applicants who pass
receive a license to practice as a ((licensed)) practical
nurse or registered nurse from the commission provided all
other requirements are met.
(3) ((Candidates who fail shall)) Applicants who fail the
examination will receive a letter of notification ((regarding
their eligibility to rewrite)) from the commission, including
information on retaking the examination. The applicant may
retake the examination no sooner than forty-five days
following the date of the last exam taken.
(4) The ((candidate's)) applicant's examination results
will be maintained in his/her application file ((in the health
professions quality assurance division,)) with the department
of health.
[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-060, filed 6/18/97, effective 7/19/97.]
FOR PRACTICAL NURSE PROGRAMS:
(1) The applicant has graduated and holds a credential
from:
(a) A commission or state board approved program preparing candidates for licensure as a practical nurse; or
(b) Its equivalent as determined by the commission, which program must fulfill the minimum requirement for commission or state board approved practical nursing programs in Washington at the time of graduation.
(2) Applicants shall have passed a state board constructed test, the SBTPE (state board test pool examination), or NCLEX in their original state of licensure within four attempts and within two years of completion of the nursing program.
(3) The applicant held or currently holds a license to practice as a practical nurse in another state or territory. If the license is lapsed or inactive for three years or more, the applicant must successfully complete a commission approved refresher course before an active Washington license is issued.
(4) That grounds do not exist for denial under chapter 18.130 RCW.
(5) The applicant shall:
(a) Submit a completed application with the required fee.
(b) Applicants must complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
FOR REGISTERED NURSE PROGRAMS:
(6) The applicant has graduated and holds a
degree/diploma from a commission or state board approved
school of nursing preparing candidates for licensure as a
registered nurse provided such nursing program is equivalent
to the minimum nursing educational standards prevailing for
commission or state board approved schools of nursing in
Washington at the time of the applicant's graduation.
(a) Applicants who were licensed prior to January 1, 1953, must have scored at least seventy-five percent on the commission or state board examination in the state of original licensure.
(i) Applicants licensed after January 1, 1953, but before June 1, 1982, must have passed the state board test pool examination for registered nurse licensure with a minimum standard score of 350 in each test.
(ii) Applicants licensed after July 1, 1982, must have passed with a minimum standard score as established by contract with the National Council of State Boards of Nursing.
(b) The applicant holds a valid current license to practice as a registered nurse in another state or territory.
(c) Applicants must complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(d) The application must be completed and notarized, the fee must be filed with the application. A notarized copy of a valid current license shall be filed with the application.
(e) Verification of licensure by examination must be obtained from the state or territory of original licensure. Any fee for verification required by the state or territory of original license must be paid by the applicant.
(7) Applicants from countries outside the United States who were granted a license in another United States jurisdiction or territory prior to December 31, 1971, and who were not required to pass the state board test pool examination must meet the following requirements:
(a) The nursing education program must meet the minimum approved standards prevailing for schools of nursing in Washington at the time of the applicant's graduation.
(b) The applicant holds a valid current license to practice as a registered nurse in another United States jurisdiction or territory.
(c) The applicant must submit to the commission:
(i) A complete notarized application. The fee must be filed with the application.
(ii) Verification of original licensure obtained in the United States jurisdiction or territory.
(iii) Notarized copies of educational preparation and licensure by examination submitted directly from the country of original licensure or from the state commission or territory of original United States licensure.
(iv) Verification of current nursing practice for three years prior to application for Washington licensure.
(v) Applicants must complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(d) The applicant shall meet all requirements of chapter 18.79 RCW and regulations of the commission.)) Registered nursing and practical nursing applicants for interstate endorsement as a nurse may be issued a license without examination provided the applicant meets the following requirements:
(1) The applicant has graduated and holds a credential from:
(a) A commission or state board approved program preparing candidates for licensure as a nurse; or
(b) Its equivalent as determined by the commission, which program must fulfill the minimum requirements for commission or state board approved registered nursing programs in Washington at the time of graduation.
(2) The applicant was originally licensed to practice as a nurse in another state or territory after passing a state approved examination.
(3) The applicant possesses a current active nursing license without discipline in another state or territory, or, possess an inactive or expired license in another state or territory and successfully complete a commission approved refresher course.
(a) An applicant whose license was inactive or expired must be issued a limited education authorization by the commission to enroll in the clinical portion of the refresher course.
(b) The limited education authorization is valid only while working under the direct supervision of a preceptor and is not valid for employment as a registered nurse.
(4) For RNs: If the applicant is a graduate of a nontraditional program in nursing and:
(a) Was licensed as a practical/vocational nurse prior to licensure as a registered nurse, the applicant must document two hundred hours of preceptorship in the role of a registered nurse as defined in WAC 246-840-035 or at least one thousand hours of practice as a registered nurse without discipline of the registered nurse license by any other state or territory.
(b) Was not licensed as a practical/vocational nurse prior to licensure as a registered nurse, the applicant must document at least one thousand hours of practice as a registered nurse without discipline of the registered nurse license by any other state or territory.
(5) Complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(6) Applicants must submit the following documents:
(a) A completed licensure application with the required fee as defined in WAC 246-840-990.
(b) An official transcript sent directly from the applicant's nursing education program to the commission.
(i) The transcript must contain adequate documentation to demonstrate that the applicant has graduated from an approved nursing program or has successfully completed the prelicensure portion of an approved graduate-entry registered nursing program.
(ii) The transcripts shall include course names and credits accepted from other programs.
(c) Verification of an original registered nurse license sent directly to the commission from the state or territory of original licensure. This document must include verification that the original licensure included passing a state examination or computerized verification from NurSYS¦.
(d) Verification of a current active or expired nurse license in another state or territory sent directly to the commission from that state's or territory's licensure agency. Verification that the applicant has successfully completed a commission approved refresher course may be accepted if the applicant's out-of-state licensure is on inactive or expired status.
(e) For RNs: If the applicant is a graduate of a nontraditional program in nursing and:
(i) Was licensed as a practical/vocational nurse prior to licensure as a registered nurse, the applicant must submit documentation of two hundred hours of preceptorship in the role of a registered nurse as defined in WAC 246-840-035 or at least one thousand hours of practice as a registered nurse without discipline of the registered nurse license by any other state or territory.
(ii) Was not licensed as a practical/vocational nurse prior to licensure as a registered nurse, the applicant must submit documentation of at least one thousand hours of practice as a registered nurse without discipline of the registered nurse license by any other state or territory.
[Statutory Authority: RCW 18.79.110. 99-13-086, § 246-840-090, filed 6/14/99, effective 7/15/99. Statutory Authority: RCW 43.70.280. 98-05-060, § 246-840-090, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-090, filed 6/18/97, effective 7/19/97.]
(2) "Contract" is a comprehensive, structured agreement between the recovering nurse and the approved monitoring program wherein the nurse consents to comply with the monitoring program and its required components of the nurse's recovery activity.
(3) "Approved treatment facility" is a facility approved
by the ((bureau)) division of alcohol and substance abuse,
department of social and health services according to chapter 70.96A RCW or RCW 69.54.030 to provide concentrated alcoholism
or drug treatment if located within Washington state. Drug
and alcohol treatment programs located out-of-state must be
equivalent to the standards required for approval under
chapter 70.96A RCW or RCW 69.54.030.
(4) "Substance abuse" means the impairment((, as
determined by the commission,)) of a nurse's professional
services by an addiction to, a dependency on, or the use of
alcohol, legend drugs, or controlled substances.
(5) "Aftercare" is that period of time after intensive substance abuse treatment that provides the nurse and the nurse's family with group or individual counseling sessions, discussions with other families, ongoing contact and participation in self-help groups and ongoing continued support of treatment program staff.
(6) "Nurse support group" is a group of nurses meeting regularly to support the recovery of its members from substance abuse issues. The group provides a confidential setting with a trained and experienced nurse facilitator in which nurses may safely discuss drug diversion, licensure issues, return to work and other professional issues related to recovery.
(7) "Twelve-step groups" are groups such as alcoholics anonymous, narcotics anonymous, and related organizations based on a philosophy of anonymity, belief in a power outside of oneself, peer group association, and self-help.
(8) "Random drug screens" are laboratory tests to detect the presence of drugs of abuse in body fluids which are performed at irregular intervals not known in advance by the person to be tested.
[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-760, filed 6/18/97, effective 7/19/97.]
The following sections of the Washington Administrative Code are repealed:
| WAC 246-840-040 | Filing of application for licensing examination. |
| WAC 246-840-070 | Failures -- Repeat examination. |
| WAC 246-840-080 | Licensure of graduates of foreign schools of nursing. |
| WAC 246-840-299 | Definitions. |