Original Notice.

     Exempt from preproposal statement of inquiry under RCW 34.05.310(4).

     Title of Rule and Other Identifying Information: WAC 246-840-010 Definitions and 246-840-840 Nursing technician, this proposed rule adds clinics to the types of facilities where a nursing technician may work, and clarifies that nursing technicians may be enrolled in an approved school of nursing "in the United States or its territories."

     Hearing Location(s): Department of Health, 243 Israel Road S.E., Town Center 3, Room 224, Tumwater, WA 98501, on June 11, 2013, at 3:15 p.m.

     Date of Intended Adoption: June 11, 2013.

     Submit Written Comments to: Mary Dale, P.O. Box 47864, Olympia, WA 98504-7864, e-mail http://www3.doh.wa.gov/policyreview/, fax (360) 236-4738, by June 4, 2013.

     Assistance for Persons with Disabilities: Contact Louise Lloyd by June 4, 2013, TTY (800) 833-6388 or 711.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The Washington state legislature enacted ESSB 6237 in 2012, amending RCW 18.79.340 and adding "clinics" to the list of facilities where a nursing technician may be employed. Rules need to be amended to reflect the change in the law. The definition of nurse technician in WAC 246-840-010 needs to be amended to include "clinics" to the defined list of facilities where a nursing technician may be employed. WAC 246-840-840 needs to be amended to include "clinic" in the list of locations where the nursing technician may work. WAC 246-840-010(18) needs to be amended to clarify that nursing technicians may be enrolled in an approved school of nursing "in the United States or its territories." This change does not alter the intent of the rule.

     Reasons Supporting Proposal: ESSB 6237, chapter 153, Laws of 2012, includes "clinics" in the list of types of facilities that a nurse technician may work in. Updating the rules will make them consistent with the change in law. Other amendments are necessary to provide clarification.

     Statutory Authority for Adoption: RCW 18.79.110.

     Statute Being Implemented: ESSB 6237, chapter 153, Laws of 2012.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Nursing care quality assurance commission, governmental.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Paula Meyer, 111 Israel Road S.E., Tumwater, WA 98501, (360) 236-4713.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. Under RCW 19.85.025 and 34.05.310 (4)(e), a small business economic impact statement is not required for a proposed rule where the content of the rule is explicitly and specifically dictated by statute.

     A cost-benefit analysis is not required under RCW 34.05.328. The agency did not complete a cost-benefit analysis under RCW 34.05.328. RCW 34.05.328 (5)(b)(v) exempts rules the content of which is explicitly and specifically dictated by statute.

April 29, 2013

Paula R. Meyer, MSN, RN

Executive Director

OTS-4803.5

AMENDATORY SECTION(Amending WSR 10-24-047, filed 11/24/10, effective 1/1/11)

WAC 246-840-010   Definitions.   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

     (1) 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 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 with adequate information about their care and options.

     (4) "Commission" means the Washington state nursing care quality assurance commission.

     (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 not met the requirements of the law and the rules and regulations of the commission; conditions are specified that must be met within a designated time to rectify the deficiency.

     (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.

     (8) "Faculty" means persons who are responsible for the educational nursing program and who hold faculty appointment in the school.

     (9) "Full approval" of a school of nursing is the approval signifying that a nursing program meets the requirements of the law and the rules and regulations of the commission.

     (10) "Good cause" as used in WAC 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."

     (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.

     (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 or clinic 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.

     (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 knowledge, skills and abilities that are expected of the beginning practitioner.

     (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.

     (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, or clinic, 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((.)); or

     (c) Is enrolled in an approved school of nursing in the United States or its territories. Approved schools for nursing technicians include the list of registered nursing programs (schools) approved by state boards of nursing in the United states or its territories 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 subsection (16) of this section.

     (19) "Philosophy" means the beliefs and principles upon which the curriculum is based.

     (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.

     (21) "Registered nurse" as used in these rules shall mean a nurse as defined by RCW 18.79.030(1).

     (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: RCW 18.79.010 and 18.79.110. 10-24-047, § 246-840-010, filed 11/24/10, effective 1/1/11. Statutory Authority: RCW 18.79.110. 08-11-019, § 246-840-010, filed 5/12/08, effective 6/12/08. 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) The nursing technician is as defined in WAC 246-840-010(((19))) (18).

     (2) The nursing technician shall have knowledge and understanding of the laws and rules regulating the nursing technician and shall function within the legal scope of their authorization under chapter 18.79 RCW and shall be responsible and accountable for the specific nursing functions which they can safely perform as verified by their nursing program.

     (3) The nursing technician shall work directly for the hospital, clinic or nursing home and may not be employed in these facilities through a temporary agency.

[Statutory Authority: Chapter 18.79 RCW and 2003 c 258. 04-13-053, § 246-840-840, filed 6/11/04, effective 6/11/04. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-840, filed 6/18/97, effective 7/19/97.]