PROPOSED RULES
(Nursing Care Quality Assurance Commission)
Original Notice.
Preproposal statement of inquiry was filed as WSR 98-09-115.
Title of Rule: Amend WAC 246-840-730 Mandatory reporting defined.
Purpose: This rule requires persons, facilities and agencies to report findings, convictions and determinations to the Nursing Commission.
Statutory Authority for Adoption: RCW 18.79.110.
Statute Being Implemented: RCW 18.79.110.
Summary: The entire rule is proposed for amendment to make it more clear to the public, nurses and facilities as to when a conviction, determination or finding is to be reported to the Nursing Commission and how to report to the Nursing Commission.
Reasons Supporting Proposal: During a public rules review process it was identified that this rule is not as clear as it could be. These proposed changes should make the rule more understandable to the public and to nurses. The wording of this rule is consistent with the existing requirements under the Uniform Disciplinary Act and are currently in law.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Jeanne Giese, P.O. Box 47864, Olympia, WA 98504, (360) 236-4728.
Name of Proponent: Nursing Care Quality Assurance Commission, governmental.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: These amendments will enhance the language of the current rule.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The purpose of this rule is to require that persons, facilities and agencies report findings, convictions and determinations against nurses to the Nursing Care Quality Assurance Commission. This will benefit the public by having the Nursing Commission take appropriate action if necessary, against a nurse to ensure they are providing adequate and safe care to the public. This rule outlines what kinds of activities should be reported to the Nursing Commission and how to report to the Nursing Commission.
This rule already exists and reflects much of the requirements under the Uniform Disciplinary Act. These amendments should make the rule more clear and easier to understand and follow.
Proposal Changes the Following Existing Rules: The amendments will replace all of the current text with new text that is clearer and easier to understand. The new text is in a question and answer format and is easier to understand.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
Economic Impact Analysis
Necessity of Amendments to Nursing Rules: The current rule is written in a style that has proven to be less than user friendly. The staff receive telephone calls requesting interpretation of this rule. Callers frequently ask for directions on which kinds of activities they are supposed to report, when are they supposed to report and how to report. During investigations facilities often report that they were unaware that the rule also applied to them, in addition to individual nurses.
The proposed amendments rewrite the entire text into a question and answer style. All of the kinds of activities the Nursing Commission wants reported are listed in an easy to find manner. The section on how to report is rewritten and is much clearer.
Costs to a Business: There are no new additional costs to a business to comply with the proposed amendments to this existing rule. This rule already currently requires reporting to the Nursing Commission. The amendments will simply clarify the requirements and reporting procedures. There are no new expenses to individuals or businesses.
DOH Costs to Administer the Regulation: There are no new additional costs to the Department of Health to regulate these amendments. This rule requires that individuals, facilities and agencies report unprofessional conduct to the Nursing Commission. No additional review time and no additional analyses are required as a result of these amendments.
Magnitude of Amendments to Rule: The proposed amendments would not require any additional requirements, would not require additional documentation and would not require any additional course work. The requirement to report unprofessional conduct to the Nursing Commission is currently existing and these amendments will not change that requirement in any way.
Small Business Economic Impact Statement: In preparing this small business economic impact statement (SBEIS), the department used SIC code 809 Miscellaneous Health and Allied Services, Not Elsewhere Classified which has a minor impact threshold of $53.00. The estimated cost to health care practitioners for amending these rules is zero.
Therefore, there is no disproportionate cost for small businesses.
A copy of the statement may be obtained by writing to Terry J. West, Department of Health, P.O. Box 47864, Olympia, WA 98504, phone (360) 236-4712, fax (360) 236-4738.
RCW 34.05.328 does not apply to this rule adoption.
Hearing Location: Pacific Lutheran University, School of Nursing, Tacoma, Washington on November 19, 1999, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Terry J. West by November 12, 1999, TDD (360) 664-0064, or (360) 236-4712.
Submit Written Comments to: Jeanne Giese, fax (360) 236-4738, by November 12, 1999.
Date of Intended Adoption: November 19, 1999.
July 20, 1999
Paula Q. Meyer, RN, MSN
Executive Director
OTS-3098.1
AMENDATORY SECTION(Amending WSR 97-13-100, filed 6/18/97,
effective 7/19/97)
WAC 246-840-730
Mandatory reporting ((defined)).
((The
nursing commission does not intend to cause every nursing error
to be reported or that mandatory reporting take away the
disciplinary ability and responsibility from the employer of the
licensed practical nurse or registered nurse.
FOR PRACTICAL NURSES:
(1) Any person, including health care facilities and
agencies and state or local government, who is aware of a
conviction or has made a determination or finding that a
practical nurse has committed an act constituting unprofessional
conduct as defined in RCW 18.130.180, including violation of
chapter 246-840 WAC, shall report such conviction, determination
or finding to the commission.
(2) Any person, including health care facilities and agencies and state or local government, who has information that a practical nurse may not be able to practice with reasonable skill and safety as a result of a mental or physical condition, shall report such information to the commission.
FOR REGISTERED NURSES:
(3) Any person, including nurses, health care facilities and
agencies, and state or local government agencies, who has
knowledge or concern that a registered nurse has committed an act
which constitutes unprofessional conduct as provided in RCW 18.130.180, including violations of chapter 246-840 WAC, or
failed to meet accepted standards for the level at which the
registered nurse is licensed, or is unable to practice with
reasonable skill or safety as the result of a physical or mental
condition shall report or cause a report to be made to the
commission. Failure of any nurse to comply with the reporting
requirements may in itself constitute a violation of nursing
standards.
(4) The decision to report a suspected violation of chapter 18.130 or 18.79 RCW or the rules adopted thereunder shall be based on, but not limited to the following:
(a) The past history of the registered nurse's performance.
(b) A demonstrated pattern of unsafe practice or conduct in violation of the standards of nursing.
(c) The magnitude of any single occurrence for actual or potential harm to the public health and safety.
(5) The following shall always be reported to the nursing commission:
(a) A nurse impostor. As used herein "nurse impostor" means an individual who is ineligible for registered nursing licensure or advanced registered nurse practitioner licensure and who practices or offers to practice registered nursing or advanced nursing or uses any title, abbreviation, card, or device to indicate that the individual is licensed to practice in Washington.
(b) A person who is practicing registered nursing when the license has become void due to nonpayment of fees.
(c) A person who is practicing registered nursing as defined in chapter 18.79 RCW unless licensed as a registered nurse or practical nurse, or a person who is practicing as a nurse practitioner as defined in WAC 246-840-300 while not licensed as an advanced registered nurse practitioner.
(d) A registered nurse who has been convicted of a crime which relates to the practice of nursing.
(e) A registered nurse who has been dismissed from employment due to unsafe practice or conduct in violation of the standards of nursing.
(f) Client abuse by a registered nurse.
(g) A demonstrated pattern of conduct in violation of the standards of nursing as defined by the rules of the commission or a single occurrence that creates serious harm or risk to the client.
(h) Any violation of a disciplinary sanction imposed on a registered nurse's license by the commission.
(i) Substance abuse as defined in RCW 18.130.180 (6) and (23). Nursing professionals counseling impaired registered nurses for substance abuse are exempt from the reporting requirements except as provided in chapter 5.62 RCW.
(j) Any other cause for discipline as defined in RCW 18.130.170 and 18.130.180.)) Mandatory reporting assists the nursing care quality assurance commission (nursing commission) in protecting the public health and safety through the discovery of unsafe or substandard nursing practice or conduct. These rules are intended to define the information that is to be reported and the obligation of nurses and others to report.
The nursing commission does not intend every minor nursing error to be reported or that mandatory reporting serve as a substitute for employer-based disciplinary action.
Who must make reports and what must be reported to the nursing commission?
(1) Any person, including, but not limited to, registered nurses, practical nurses, advanced registered nurse practitioners, health care facilities and governmental agencies shall always report the following, except as provided for in subsections (2) and (3) of this section:
(a) Information that a nurse may not be able to practice with reasonable skill and safety as a result of a mental or physical condition;
(b) Information regarding a conviction, determination or finding, including employer-based disciplinary action, that a nurse has committed an act that would constitute unprofessional conduct, as defined in RCW 18.130.180, including violations of chapter 246-840 WAC, including, but not limited to:
(i) Conviction of any crime or plea of guilty, including crimes against persons as defined in chapter 43.830 RCW, and crimes involving the personal property of a patient, whether or not the crime relates to the practice of nursing;
(ii) Conduct which leads to dismissal from employment for cause related to unsafe nursing practice or conduct in violation of the standards of nursing;
(iii) Conduct which reasonably appears to be a contributing factor to the death of a patient;
(iv) Conduct which reasonably appears to be a contributing factor to the harm of a patient that requires medical intervention;
(v) Conduct which reasonably appears to violate accepted standards of nursing practice and reasonably appears to create a risk of physical and/or emotional harm to a patient;
(vi) Conduct involving a pattern of repeated acts or omissions of a similar nature in violation of the standards of nursing that reasonably appears to create a risk to a patient;
(vii) Drug trafficking;
(viii) Conduct involving the misuse of alcohol, controlled substances or legend drugs, whether or not prescribed to the nurse, where such conduct is related to nursing practice or violates any other drug or alcohol-related nursing commission law;
(ix) Conduct involving sexual contact with a patient under RCW 18.130.180(24) or other sexual misconduct in violation of nursing commission law under WAC 246-840-740;
(x) Conduct involving patient abuse, including physical, verbal and emotional;
(xi) Conduct indicating unfitness to practice nursing or that would diminish the nursing profession in the eyes of the public;
(xii) Conduct involving fraud related to nursing practice;
(xiii) Conduct involving practicing beyond the scope of the nurse's license;
(xiv) Nursing practice, or offering to practice, without a valid nursing permit or license, including practice on a license lapsed for nonpayment of fees;
(xv) Violation of a disciplinary sanction imposed on a nurse's license by the nursing commission.
(2) Persons who work in federally funded substance abuse treatment programs are exempt from these mandatory reporting requirements to the extent necessary to comply with 42 CFR Part 2.
(3) Persons who work in approved substance abuse monitoring programs under RCW 18.130.175 are exempt from these mandatory reporting rules to the extent required to comply with RCW 18.130.175(3) and WAC 246-840-780(3).
How is a report made to the nursing commission?
(4) In providing reports to the nursing commission, a person may call the nursing commission office for technical assistance in submitting a report. Reports are to be submitted in writing and include the name of the nurse, licensure identification, if available, the name of the facility, the names of any patients involved, a brief summary of the specific concern which is the basis for the report, and the name, address and telephone number of the individual submitting the report.
(5) Failure of any licensed nurse to comply with these reporting requirements may constitute grounds for discipline under chapter 18.130 RCW.
What are the criteria for whistleblower protection?
(6) Whistleblower criteria is defined in chapter 246-15 WAC and RCW 43.70.075.
[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-730, filed 6/18/97, effective 7/19/97.]