WSR 20-18-045
EXPEDITED RULES
DEPARTMENT OF HEALTH
(Nursing Care Quality Assurance Commission)
[Filed August 28, 2020, 11:26 a.m.]
Title of Rule and Other Identifying Information: WAC 246-840-025, 246-840-030, 246-840-045, 246-840-090, 246-840-539, 246-840-541, 246-840-860, 246-840-905, 246-841-490, 246-841-578, 246-841-585 and 246-841-610, AIDS education and training requirements. The nursing care quality assurance commission (commission) is proposing amending or repealing rules as a result of ESHB 1551 Modernizing the control of certain communicable diseases (chapter 76, Laws of 2020).
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Section 22(11) of ESHB 1551 repeals RCW
70.24.270 Health professionals
—Rules for AIDS education and training. This repeal no longer requires health professionals to obtain AIDS education and training as a condition of licensure. As a result, the commission proposes to repeal the requirement for AIDS training in WAC 246-840-025, 246-840-030, 246-840-045, 246-840-090, 246-840-539, 246-840-541, 246-840-860, 246-840-905, 246-841-490, 246-841-578, 246-841-585, and 246-841-610.
The anticipated effect of ESHB 1551 and the amendment of the impacted rules is to help reduce stigma toward people living with HIV/AIDS by not singling out AIDS as an exceptional disease requiring special training and education separate from other communicable health conditions.
Reasons Supporting Proposal: When Washington adopted statutes concerning AIDS, very little was known about the disease compared to today. Now, AIDS is very treatable and preventable. In 2014, Governor Inslee issued a proclamation, which included efforts to reduce stigma, which included updating state law. ESHB 1551 repeals statutes concerning AIDS education and training for emergency medical personnel, health professionals, and health care facility employees, which helps reduce stigma towards people living with HIV/AIDS by not singling out AIDS as an exceptional disease that requires specific training and education separate from other communicable health conditions.
Statute Being Implemented: ESHB 1551 (chapter 76, Laws of 2020).
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 and Implementation: Chris Archuleta, 111 Israel Road S.E., Tumwater, WA 98504, 360-236-2748; and Enforcement: Catherine Woodard, 111 Israel Road S.E., Tumwater, WA 98504, 360-236-4757.
This notice meets the following criteria to use the expedited repeal process for these rules:
The statute on which the rule is based has been repealed and has not been replaced by another statute providing statutory authority for the rule.
Explanation of the Reason the Agency Believes the Expedited Rule-Making Process is Appropriate: ESHB 1551, chapter 76, Laws of 2020, repeals RCW
70.240.270, as a result the commission is proposing to repeal rules to implement the bill.
NOTICE
THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Chris Archuleta, Nursing Care Quality Assurance Commission, P.O. Box 47864, Olympia, WA 98504, phone 360-236-2748, fax 360-236-4738, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY November 2, 2020.
June 25, 2020
Paula R. Meyer, MSN, RN, FRE
Executive Director
AMENDATORY SECTION(Amending WSR 08-11-019, filed 5/12/08, effective 6/12/08)
WAC 246-840-025Initial licensure for registered nurses and practical nurses—Commission approved Washington state nursing education program.
Registered nursing and practical nursing applicants' educated in a commission approved Washington state nursing education program and applying for initial licensure must:
(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)))(3) 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.
AMENDATORY SECTION(Amending WSR 08-11-019, filed 5/12/08, effective 6/12/08)
WAC 246-840-030Initial licensure for registered nurses and practical nurses—Out-of-state traditional nursing education program approved by another United States nursing board.
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)))(3) 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.
AMENDATORY SECTION(Amending WSR 16-17-082, filed 8/17/16, effective 9/17/16)
WAC 246-840-045Initial licensure for registered nurses and practical nurses who graduate from an international school of nursing.
(1) Registered nurse and practical nurse applicants educated in a jurisdiction which is not a member of the National Council of State Boards of Nursing and applying for initial licensure must:
(a) Successfully complete a basic nursing education program approved in that country.
(i) The nursing education program must be equivalent to the minimum standards prevailing for nursing education programs approved by the commission.
(ii) Any deficiencies in the nursing program (theory and clinical practice in medical, psychiatric, obstetric, surgical and pediatric nursing) may be satisfactorily completed in a commission approved nursing program or program created for internationally educated nurses identified in WAC 246-840-549, 246-840-551 or 246-840-552.
(b) Obtain an evaluation or certificate from a commission approved credential evaluation service verifying that the educational program completed by the applicant is equivalent to nursing education in the state of Washington.
(c) Demonstrate English language proficiency by passing a commission approved English proficiency examination at a commission designated standard, or provide evidence directly from the school of earning a high school diploma or college degree from a United States institution prior to commission approval to take the national licensing examination.
Individuals from Canada (except for Quebec), United Kingdom, Ireland, Australia, New Zealand, American Samoa, Guam, Northern Mariana Island, and U.S. Virgin Islands will have this requirement waived.
(d) ((Complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(e))) Successfully pass the commission approved licensure examination as provided in WAC 246-840-050.
(2) Registered nurse and practical nurse applicants must submit the following documents:
(a) A completed licensure application with the required fee as defined in WAC 246-840-990.
(b) Official transcript directly from the nursing education program or licensure agency in the country where the applicant was educated and previously licensed.
(i) 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 evaluation 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.
(ii) The transcript must:
(A) Include the applicant's date of enrollment, 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. Course descriptions or syllabi may be requested to determine equivalency to Washington state standards.
(c) Documentation from a commission approved nursing program showing that any deficiency has been satisfactorily completed.
(d) Documents must show the applicant has passed a commission approved English proficiency examination or the requirement is waived as identified in subsection (1) of this section.
AMENDATORY SECTION(Amending WSR 16-17-082, filed 8/17/16, effective 9/17/16)
WAC 246-840-090Licensure for nurses by interstate endorsement.
Registered nurse and practical nurse applicants for interstate endorsement may be issued a license without examination provided the applicant meets the following requirements:
(1) The applicant graduated and holds a degree from:
(a) A commission or state board approved program preparing candidates for licensure as a nurse; or
(b) A nursing program that is equivalent to commission approved nursing education in Washington state at the time of graduation as determined by the commission.
(2) The applicant holds a current active nursing license in another state or territory, or holds an inactive or expired license in another state or territory and successfully completes 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.
(3) The applicant was originally licensed to practice as a nurse in another state or territory after passing the National Council Licensure Examination (NCLEX).
(4) Applicants graduating from nursing programs outside the U.S. must demonstrate English proficiency by passing a commission approved English proficiency test if the nursing education is not in one of the following countries: Canada (except for Quebec), United Kingdom, Ireland, Australia, New Zealand, American Samoa, Guam, Northern Mariana Islands, and U.S. Virgin Islands, or complete one thousand hours of employment as a licensed nurse in another state, or provide evidence directly from the school of earning a high school diploma or college degree from a United States institution.
The one thousand hours of employment must be in the same licensed role as the nurse is applying for licensure in Washington state. Proof of employment must be submitted to the commission.
(5) For RNs: If the applicant is a graduate of a nontraditional nursing education program and:
(a) Was licensed as a practical/vocational nurse prior to licensure as a registered nurse, the applicant must submit evidence 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.
(b) Was not licensed as a practical/vocational nurse prior to licensure as a registered nurse, the applicant must submit evidence 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.
(6) ((Complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.
(7))) 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 if the education cannot be verified from the original board of nursing, or commission-approved evaluation agency.
(i) The transcript must contain adequate documentation demonstrating that the applicant graduated from an approved nursing program or 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 or practical nurse license from the state or territory of original licensure. The verification must identify that issuance of the original licensure included passing the NCLEX.
(d) For applicants educated outside the United States and in territories or countries not listed in subsection (4) of this section, successful results of a commission approved English proficiency exam, or, evidence of one thousand hours worked as a nurse.
(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.
AMENDATORY SECTION(Amending WSR 16-17-082, filed 8/17/16, effective 9/17/16)
WAC 246-840-539Curriculum for practical nurse nursing education programs.
The practical nurse nursing education program of study must include both didactic and clinical learning experiences and must be:
(1) Effective September 1, 2017, designed to include prerequisite classes in the physical, biological, social and behavior sciences that are transferable to colleges and universities in the state of Washington;
(2) Planned, implemented, and evaluated by the faculty;
(3) Based on the philosophy, mission, objectives, and outcomes of the program and consistent with chapters
18.79 RCW and this chapter;
(4) Organized by subject and content to meet program outcomes;
(5) Designed to teach students to use a systematic approach to clinical decision making and safe patient care;
(6) Designed to teach students:
(a) Professional relationships and communication;
(b) Nursing ethics;
(c) Nursing history and trends;
(d) Commission approved scope of practice decision tree;
(e) Standards of practice;
(f) Licensure and legal aspects of nursing including the disciplinary process, substance abuse and professional values;
(g) Concepts and clinical practice experiences in geriatric nursing, and medical, surgical, and mental health nursing for clients throughout the life span;
(h) Concepts of antepartum, intrapartum, postpartum and newborn nursing with only an assisting role in the care of clients during labor and delivery and those with complications; and
(i) Concepts and practice in the prevention of illness and the promotion, restoration, and maintenance of health in patients across the life span and from diverse cultural, ethnic, social, and economic backgrounds((; and
(j) AIDS education as required in chapter 246-12 WAC, Part 8)).
(7) Designed to prepare graduates for licensure and to practice practical nursing as identified in WAC 246-840-700 and 246-840-705; and
(8) Designed to prepare graduates to practice according to competencies recognized by professional nursing organizations.
(a) Practical nursing courses shall include:
(i) Components of: Client needs; safe, effective care environment; health promotion and maintenance; interdisciplinary communication and collaboration; discharge planning; basics of multicultural health; psychosocial integrity; and physiological integrity.
(ii) Skills laboratory and clinical practice in the functions of the practical nurse including, but not limited to, administration of medications, implementing and monitoring client care, and promoting psychosocial and physiological health.
(iii) Concepts of coordinated care, delegation and supervision.
(b) Practical nurse programs teaching intravenous infusion therapy shall prepare graduates for national certification by a nursing professional practical nurse certifying body.
AMENDATORY SECTION(Amending WSR 16-17-082, filed 8/17/16, effective 9/17/16)
WAC 246-840-541Curriculum for prelicensure registered nursing education programs.
(1) The program of study for a registered nursing education program must include both didactic and clinical learning experiences and must be:
(a) Effective September 1, 2017, designed so that all prerequisite nonnursing course credits and nursing credits are transferable to the bachelor's in nursing programs as identified in the statewide associate in nursing direct transfer agreement between community colleges, colleges, and universities, or the statewide associate of applied science transfer degree;
(b) Designed to include instruction in the physical, biological, social and behavioral sciences. Content is required from the areas of anatomy and physiology (equivalent to two quarter credit terms with laboratory), chemistry, microbiology, pharmacology, nutrition, communication, and computations;
(c) Designed to include theory and clinical experiences in the areas of medical surgical nursing and mental health nursing across the life span, teaching students to use a systematic approach to clinical decision making and preparing students to safely practice professional nursing through the promotion, prevention, rehabilitation, maintenance, restoration of health, and palliative and end of life care for individuals of all ages across the life span;
(d) Designed to include nursing history, health care trends, legal and ethical issues such as professional values, substance abuse and the disciplinary process, scope of practice and commission approved scope of practice decision tree, and licensure and professional responsibility pertaining to the registered nurse role. Content may be integrated, combined, or presented as separate courses;
(e) Designed to include opportunities for the student to learn assessment and analysis of client and family needs, planning, implementation, evaluation, and delegation of nursing care for diverse individuals and groups;
(f) Planned, implemented, and evaluated by faculty;
(g) Based on the philosophy, mission, objectives and outcomes of the program;
(h) Organized logically with scope and sequence of courses demonstrating student learning progression;
(i) Based on sound educational principles and standards of educational practice;
(j) Designed so articulation or dual enrollment agreements between associate and bachelor's degree nursing programs or associate and master's degree nursing programs exists to facilitate higher levels of nursing education in a timely manner;
(k) Designed to prepare graduates for licensure and to practice as registered nurses as identified in WAC 246-840-700 and 246-840-705; and
(l) Designed to prepare graduates to practice as associate degree or bachelor degree nurses as identified by professional nursing organizations((; and
(m) Designed to include AIDS education as required in chapter 246-12 WAC, Part 8)).
(2) Baccalaureate and entry-level master's degree programs shall also include:
(a) Theory and clinical experiences in community and public health nursing;
(b) The study of research principles and application of statistics to health care practice and intervention; and
(c) The study and practice of leadership, interdisciplinary team coordination, quality assurance and improvement, care coordination and case management.
(3) Registered nursing curricula shall include:
(a) Comprehensive content on: Client needs; safe practice; effective care environment; discharge planning; health promotion, prevention and maintenance; psychosocial integrity and physiological integrity.
(b) Clinical experiences in the care of persons at each stage of the human life cycle, with opportunities for the student to learn and have direct involvement in and responsibility and accountability for the provision of basic nursing care and comfort for clients with acute and chronic illnesses, pharmacological and parenteral therapies, and pain management.
(c) Opportunities for management of care, delegation, supervision, working within a health care team, and interdisciplinary care coordination.
AMENDATORY SECTION(Amending WSR 04-13-053, filed 6/11/04, effective 6/11/04)
WAC 246-840-860Nursing technician criteria.
To be eligible for employment as a nursing technician a student must meet the following criteria:
(1) Satisfactory completion of at least one academic term (quarter or semester) of a nursing program approved by the commission. The term must have included a clinical component.
(2) Currently enrolled in a nursing commission approved program will be considered to include:
(a) All periods of regularly planned educational programs and all school scheduled vacations and holidays;
(b) Thirty days after graduation from an approved program; or
(c) Sixty days after graduation if the student has received a determination from the secretary that there is good cause to continue the registration period.
(d) Current enrollment does not include:
(i) Leaves of absence or withdrawal, temporary or permanent, from the nursing educational program.
(ii) Students who are awaiting the opportunity to reenroll in nursing courses.
((
(3) Applicants must complete seven clock hours of AIDS education as required by RCW 70.24.270 and chapter 246-12 WAC, Part 8.))
AMENDATORY SECTION(Amending WSR 04-13-053, filed 6/11/04, effective 6/11/04)
WAC 246-840-905How to register as a nursing technician.
(1) An individual shall complete an application for registration on an application form prepared and provided by the secretary of the department of health. This application shall be submitted to P.O. Box 47864, Olympia, Washington, 98504-7864.
(2) Every applicant shall provide:
(a) The application fee under WAC 246-840-990.
(b) ((
Verification of seven clock hours of AIDS education as required by RCW 70.24.270 and chapter 246-12 WAC, Part 8.(c))) A signed statement from the applicant's nursing program verifying enrollment in, or graduation from, the nursing program. If the applicant has not yet graduated, this statement will include the anticipated graduation date.
((
(d)))
(c) A signed statement from the applicant's employer or prospective employer certifying that the employer understands the role of the nursing technician and agrees to meet the requirements of RCW
18.79.360(4).
AMENDATORY SECTION(Amending WSR 08-06-100, filed 3/5/08, effective 4/5/08)
WAC 246-841-490Core curriculum in approved nursing assistant-certified training programs.
(1) The curriculum must be competency based. It must be composed of learning objectives and activities that will lead to knowledge and skills required for the graduate to demonstrate mastery of the core competencies as provided in WAC 246-841-400.
(2) The program director will determine the amount of time required in the curriculum to achieve the objectives. The time designated may vary with characteristics of the learners and teaching or learning variables. There must be a minimum of eighty-five hours total, with a minimum of thirty-five hours of classroom training and a minimum of fifty hours of clinical training.
(a) ((Of the thirty-five hours of classroom training, a minimum of seven hours must be in AIDS education as required by chapter 246-12 WAC, Part 8.
(b))) Of the fifty hours of clinical training, at least forty clinical hours must be in the practice setting.
(((c)))(b) Training to orient the student to the health care facility and facility policies and procedures are not to be included in the minimum hours above.
(3) Each unit of the core curriculum will have:
(a) Behavioral objectives, which are statements of specific observable actions and behaviors that the learner is to perform or exhibit.
(b) An outline of information the learner will need to know in order to meet the objectives.
(c) Learning activities such as lecture, discussion, readings, film, or clinical practice designed to enable the student to achieve the stated objectives.
(4) Clinical teaching in a competency area is closely correlated with classroom teaching to integrate knowledge with manual skills.
(a) Students must wear name tags clearly identifying them as students when interacting with patients, clients or residents, and families.
(b) An identified instructor(s) will supervise clinical teaching or learning at all times. At no time will the ratio of students to instructor exceed ten students to one instructor in the clinical setting.
(5) The curriculum must include evaluation processes to assess mastery of competencies. Students cannot perform any clinical skill on clients or residents until first demonstrating the skill satisfactorily to an instructor in the practice setting.
AMENDATORY SECTION(Amending WSR 11-16-042, filed 7/27/11, effective 8/27/11)
WAC 246-841-578Application requirements.
To be eligible to apply for nursing assistant-certified from an alternative program the applicant must:
(1) Be currently credentialed as a home care aide-certified; or
(2) Be a medical assistant-certified as defined in WAC 246-841-535;
(3) Have completed a cardiopulmonary resuscitation course; and
(4) ((Have completed seven hours of AIDS education and training as required in chapter 246-12 WAC, part 8; and
(5))) Have successfully completed the competency evaluation.
AMENDATORY SECTION(Amending WSR 11-16-042, filed 7/27/11, effective 8/27/11)
WAC 246-841-585Application for nursing assistant-certified from an alternative program.
(1) An applicant for nursing assistant-certified who has successfully completed an approved alternative program as a home care aide-certified must submit to the department:
(a) A completed application for nursing assistant-certified.
(b) A copy of certificate of completion from an approved alternative program for home care aides-certified.
(c) Documentation verifying current certification as a home care aide.
(d) Evidence of completion of a cardiopulmonary resuscitation course.
(e) ((Evidence of completion of seven hours of AIDS education and training.
(f))) Applicable fees as required in WAC 246-841-990.
(2) An applicant for nursing assistant-certified who successfully completed an approved alternative program as a medical assistant-certified must submit to the department:
(a) A completed application for nursing assistant-certified;
(b) A copy of certificate of completion from approved alternative program for medical assistant-certified;
(c) An official transcript from the nationally accredited medical assistant program;
(d) Evidence of completion of an adult cardiopulmonary resuscitation course; and
(e) ((Evidence of completion of seven hours of AIDS education and training; and
(f))) Applicable fees as required in WAC 246-841-990.
REPEALER
The following section of the Washington Administrative Code is repealed:
WAC 246-841-610 | AIDS prevention and information education requirements. |