WSR 15-20-055 PROPOSED RULES DEPARTMENT OF HEALTH (Nursing Care Quality Assurance Commission) [Filed September 30, 2015, 4:54 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 14-21-007.
Title of Rule and Other Identifying Information: WAC 246-840-125 and 246-840-202 through 246-840-207, retired active credential and nurse continuing competency. Reorder and renumber sections. Review, update, clarify, and modify existing standards; create exemptions for those seeking advanced nursing degrees; and incorporate new suicide prevention training requirements.
Hearing Location(s): CenterPoint Conference Center, 20425 72nd Avenue South, Kent, WA 98032, on November 13, 2015, at 2:30.
Date of Intended Adoption: November 13, 2015.
Submit Written Comments to: Teresa Corrado, Licensing Manager, P.O. Box 47864, Olympia, WA 98504, e-mail http://www3.doh.wa.gov/policyreview/, fax (360) 236-4738, by November 2, 2015.
Assistance for Persons with Disabilities: Contact Bobbi Allison by November 2, 2015, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule creates an extension and changes the results of those who fail to meet continuing competency requirements, resulting in disciplinary action rather than completion of a refresher course. It also changes the time of audit to be prior to renewal rather than after. The sections are reordered and renumbered for improved readability. Definitions are updated. The updates establish audit exemptions for those nurses enrolled in an advanced nursing program beyond prelicensure. The rules implement suicide prevention legislation and deleted language regarding self-assessment and reflection as it is not enforceable.
Reasons Supporting Proposal: The proposed rules improve and clarify the audit process for better compliance and increase readability. They provide support to nurses furthering their nursing education and implement legislation for suicide prevention training. The proposal simplifies rules by removing nonenforceable requirements, improving consistency throughout the rules and giving due process for those failing to meet the continuing competency requirements.
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: Teresa Corrado, 111 Israel Road S.E., Tumwater, WA 98501, (360) 236-4708.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule would not impose more than minor costs on businesses in an industry.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Teresa Corrado, 111 Israel Road S.E., Tumwater, WA 98501, phone (360) 236-4708, fax (360) 236-4738, e-mail teresa.corrado@doh.wa.gov.
September 30, 2015
Paula R. Meyer, MSN, RN, FRE
Executive Director
Nursing Care Quality
Assurance Commission
AMENDATORY SECTION (Amending WSR 14-02-026, filed 12/20/13, effective 1/20/14)
WAC 246-840-125 Retired active credential.
(1) A registered or licensed practical nurse may place their credential in "retired active" status by meeting the requirements of this section.
(2) A registered or licensed practical nurse who holds a retired active credential may only practice in intermittent or emergent circumstances.
(a) Intermittent means the registered or licensed practical nurse will practice no more than ninety days a year.
(b) Emergent means the registered or licensed practical nurse will practice only in emergency circumstances such as earthquakes, floods, times of declared war, or other states of emergency.
(3) To obtain a retired active credential a registered or a licensed practical nurse must:
(a) Meet the requirements in WAC 246-12-120.
(b) Pay the appropriate fee in WAC 246-840-990.
(4) To renew a retired active credential the registered nurse or licensed practical nurse must:
(a) Meet the requirements in WAC 246-12-130. The retired active credential fee is in WAC 246-840-990.
(b) Have completed forty-five hours of continuing nursing education every three years in compliance with WAC ((246-840-203 (1)(a)(iii)(A) through (F))) 246-840-220 (2)(b). Education may include CPR and first aid.
(c) Demonstrate they have practiced at least ninety-six hours every three years. Practice may be paid or volunteer, but must require nursing knowledge or a nursing license.
(d) Renew their retired active credential every year on their birthday.
(5) To return to active status the registered or licensed practical nurse must:
(a) Meet the requirements in WAC 246-12-140. The active renewal fee is in WAC 246-840-990.
(b) Meet the continuing competency requirements in WAC ((246-840-205)) 246-840-230 (5)(d).
(6) A registered or licensed practical nurse who holds a retired active credential is subject to a continuing competency audit((.
(a) All late renewals and a percentage up to five percent of registered and licensed practical nurses renewing their license may be audited by the commission.
(b) A registered or practical nurse being audited will have thirty calendar days to complete and submit to the commission the audit form documenting at least ninety-six hours of active practice, and forty-five hours of continuing nursing education every three years. Active practice hours are not to exceed ninety days each year.
(c) To document practice hours and continuing nursing education a registered or licensed practical nurse shall comply with WAC 246-840-206 (4) and (5))) as outlined in WAC 246-840-220, 246-840-230, and 246-840-240.
NEW SECTION
WAC 246-840-200 Continuing competency purpose statement.
Patients, families, and communities expect safe, competent, and compassionate nursing care. WAC 246-840-200 through 246-840-260 establish a self-directed continuing competency program which includes participation in active practice and continuing nursing education for registered nurses and licensed practical nurses as a mechanism to help keep patients safe and improve nursing practice.
NEW SECTION
WAC 246-840-210 Continuing competency definitions.
The definitions in this section apply throughout WAC 246-840-200 through 246-840-260 unless the context clearly requires otherwise.
(1) "Active nursing practice" means engagement in paid, unpaid, or volunteer activity performing acts requiring substantial nursing knowledge, judgment, and skills described under RCW 18.79.040, 18.79.050, and 18.79.060. Active nursing practice may include, but is not limited to, working as an administrator, quality manager, policy officer, public health nurse, parish nurse, home health nurse, educator, consultant, regulator, and investigator or case manager.
(2) "Advanced nursing degree" means education preparation beyond one's initial education for nurse licensure.
(3) "Attestation" means the affirmation by signature of the nurse indicating compliance with the standards and terms of the continuing competency requirements.
(4) "Compliance audit" means a review of documents to determine whether the nurse has fulfilled the requirements in WAC 246-840-220 through 246-840-260.
(5) "Continuing competency" is the ongoing ability of a nurse to maintain, update and demonstrate sufficient knowledge, skills, judgment, and qualifications necessary to practice safely and ethically in a designated role and setting in accordance with the scope of nursing practice. A nurse achieves continuing competency through active practice and continuing nursing education.
(6) "Continuing nursing education" refers to systematic professional learning experiences obtained after initial licensure and designed to augment the knowledge, skills, and judgment of nurses and enrich nurses' contributions to quality health care and the pursuit of professional career goals, related to a nurse's area of professional practice, growth and development.
(7) "Nurse" means a registered nurse and licensed practical nurse.
(8) "Review period" is three full licensing renewal cycles. For purposes of a compliance audit, the review period will be the three years preceding the audit due date.
(9) "Technical assistance" means guidance provided by commission staff to help the nurse comply with laws and rules.
NEW SECTION
WAC 246-840-220 Continuing competency requirements—Active status.
(1) At the end of the three-year continuing competency cycle, a nurse must attest on a form provided by the department of health declaring completion of the required active nursing practice hours and continuing nursing education hours.
(2) The nurse must complete, within each three-year review period:
(a) A minimum of five hundred thirty-one hours of active nursing practice; and
(b) A minimum of forty-five hours of continuing nursing education.
(3) A nurse will have a full three years to meet the requirements in subsections (1) and (2) of this section. The hours may be accumulated at any time throughout the three-year review period. The review period begins on the licensee's first birthday after receiving the initial license.
(4) Nurses must complete a qualified suicide prevention training as follows:
(a) Beginning January 1, 2016, registered nurses, except for registered nurses holding an active certified registered nurse anesthetist license, and licensed practical nurses must complete a one-time training in suicide assessment, treatment, and management from a qualified suicide prevention training program. The training must be completed by the end of the first full continuing competency reporting period after or during the first full continuing competency reporting period after initial licensure, whichever is later.
(b) Beginning July 1, 2017, a qualified suicide training program must be on the model list, required under RCW 43.70.442, to be accepted.
(c) A qualified suicide prevention training program must be an empirically supported training including assessment treatment and management, and must be at least six hours in length which may be provided in one or more sessions.
(d) The hours spent completing a qualified training program in suicide assessment, treatment, and management under this section counts toward continuing competency requirements in subsection (2)(b) of this section.
(5) Nurses who are enrolled in, or have completed prerequisite classes for, an advanced nursing education program are exempt from the continuing competency requirements during their current review period. A final transcript or transcript of classes documenting current progress towards an advanced degree will be required by the commission for approval of the exemption.
NEW SECTION
WAC 246-840-230 Continuing competency audit process and compliance.
(1) The commission shall conduct a compliance audit:
(a) On all late renewals if continuing competency requirements under WAC 246-840-220(2) are due;
(b) Through random selection; and
(c) At the discretion of the commission, on nurses under the disciplinary process.
(2) The commission will notify a nurse selected for compliance audit at the address on record with the department. For a nurse selected randomly, notification will be sent with the renewal notice.
(3) The nurse must submit continuing education in clock hours.
(4) When the nurse is unable to document compliance with WAC 246-840-220, technical assistance may be provided.
(5) If the nurse is unable to provide the required documentation of compliance with WAC 246-840-220, the nurse may elect to:
(a) Place his or her license on inactive status as outlined in WAC 246-840-120;
(b) Let his or her license expire;
(c) Request an extension under WAC 246-840-240;
(d) Enter into an agreement, on a form provided by the commission, to complete a minimum of one hundred seventy-seven hours of active nursing practice and fifteen hours of continuing nursing education within one year. A compliance audit will be conducted at the end of the year to ensure compliance with the agreement.
(6) Failure to complete the required hours and provide the required documentation, or intentional deceit, fraud, or misconduct in reporting continuing competency may result in discipline for unprofessional conduct under RCW 18.130.180.
NEW SECTION
WAC 246-840-240 Extension.
A nurse who does not meet continuing competency requirements in WAC 246-840-220 within the three-year audit review period may request an extension of up to one year to allow the nurse to complete the remaining hours. The commission will conduct an audit at the end of the extension period to ensure compliance. In order to qualify for an extension, a nurse must agree to complete the remaining practice and continuing education hours within one year or less. If the remaining active nursing practice hours and continuing nursing education hours are not completed within one year, the commission will refer the nurse for disciplinary action.
NEW SECTION
WAC 246-840-250 Continuing competency requirements—Reactivation from expired status.
(1) All nurses applying for reactivation must meet the requirements of chapter 246-12 WAC, Part 2 and WAC 246-840-111.
(2) If a license is expired for more than one year, the nurse must provide evidence of five hundred thirty-one hours of active nursing practice in any United States jurisdiction, and forty-five hours of continuing nursing education in the last three years.
(3) If the nurse cannot provide the evidence required in subsection (2) of this section, the nurse shall agree, on the form provided by the commission, to complete a minimum of one hundred seventy-seven hours of active nursing practice and fifteen hours of continuing nursing education within the first year following reactivation. The commission will conduct an audit at the end of the year to ensure compliance with the agreement.
(4) If the practice hours and continuing nursing education hours required in this section are not completed within one year of reactivation, the commission will refer the nurse for disciplinary action.
NEW SECTION
WAC 246-840-260 Continuing competency requirements—Reactivation from inactive status.
(1) All nurses applying for reactivation must meet the requirements of chapter 246-12 WAC, Part 4 and WAC 246-840-120.
(2) If a license is inactive for more than one year, the nurse must provide evidence of five hundred thirty-one hours of active nursing practice in any United States jurisdiction, and forty-five hours of continuing nursing education in the last three years.
(3) If the licensee cannot provide the evidence required in subsection (2) of this section, the nurse shall agree, on a form provided by the commission, to complete a minimum of one hundred seventy-seven hours of active nursing practice and fifteen hours of continuing nursing education within the first year following reactivation. The commission will conduct an audit at the end of the year to ensure compliance with the agreement.
(4) If the active nursing practice hours and continuing nursing education hours required in this section are not completed within one year of reactivation, the commission will refer the nurse for disciplinary action.
REPEALER
The following sections of the Washington Administrative Code are repealed:
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