Original Notice.

     Preproposal statement of inquiry was filed as WSR 00-11-163.

     Title of Rule and Other Identifying Information: WAC 246-840-505 Purposes of commission approval of nursing education programs, 246-840-510 Approval of initial nursing education programs, 246-840-515 Branch campus and distance learning nursing education programs, 246-840-520 Ongoing evaluation and approval of nursing education programs, 246-840-525 Commission action following survey visits, 246-840-530 Denial, conditional approval or withdrawal of approval, 246-840-535 Reinstatement of approval, 246-840-545 Closing of an approved nursing education program, 246-840-548 Standards and evaluation of nursing education, 246-840-550 Standard I. Purpose and outcomes for approved nursing education programs, 246-840-555 Standard II. Organization and administration for approved nursing education programs, 246-840-560 Standard III. Resources, facilities, and services for approved nursing education programs, 246-840-565 Standard IV. Students in approved nursing education programs, 246-840-570 Standard V. Faculty in approved nursing education programs, and 246-840-575 Curriculum for approved nursing education programs.

     Hearing Location(s): Department of Health, Point Plaza East, Rooms 152-153, 310 Israel Road S.E., Tumwater, WA 98501, on January 14, 2005, at 10:00 a.m.

     Date of Intended Adoption: January 14, 2005.

     Submit Written Comments to: Kendra Pitzler, P.O. Box 47864, Olympia, WA 98504-7864, e-mail Kendra.Pitzler@doh.wa.gov, fax (360) 236-4723, by January 7, 2005.

     Assistance for Persons with Disabilities: Contact Kendra Pitzler by December 27, 2004, TTY (800) 833-6388 or (360) 236-4723.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: This proposal makes changes to the rules governing approval of registered nurse and practical nurse education programs. The anticipated effect of this proposal is that requirements will be easier to understand; there will be better communication between Nursing Care Quality Assurance Commission (NCQAC) staff and the programs; updated requirements will assure that students graduating from these programs meet the minimum standards needed for safe nursing practice; and recognition of national accreditation will ease requirements for programs who have acquired such accreditation.

     Many of the changes are grammatical, clarifying what needs to be done and making the process easier to understand. Substantial changes include: Allowing programs that are accredited by an NCQAC recognized national nursing accreditation agency to submit evidence of accreditation rather than going through the site-review process; identifying situations that may be cause for a site-review; allowing administrators of practical or associate degree nursing programs to have a bachelor's of science in nursing and a masters degree rather than a masters with a major in nursing; recommending a clinical faculty to student ratio be 10 to 1 rather than 12 to 1; allowing a higher ratio with the use of trained preceptors for students; modifying exemptions of instructor requirements; and updating curriculum requirements.

     Statutory Authority for Adoption: RCW 18.79.110 and 18.79.150.

     Statute Being Implemented: Chapter 18.79 RCW.

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

     Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Agency agrees with the language proposed.

     Name of Proponent: Nursing Care Quality Assurance Commission (NCQAC), governmental.

     Name of Agency Personnel Responsible for Drafting: Kendra Pitzler, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4723; Implementation and Enforcement: Paula Meyer, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4713.

     A small business economic impact statement has been prepared under chapter 19.85 RCW.

     PROPOSED NEW SECTIONS: WAC 246-840-515 Branch campus and distance learning nursing education programs and 246-840-548 Standards and evaluation of nursing education.

     BACKGROUND: Chapter 18.79 RCW regulates the professions of nursing care in the state of Washington. The intentions of this regulation are to protect the public from being misled by incompetent, unethical and/or unauthorized persons; to assure the availability of nursing care services to persons in need; and to assure a minimum level of professional conduct and competency in the delivery of these services.

     Under RCW 18.79.110, NCQAC is authorized to define and establish qualifications and standards for education, examination, licensure, and practice of all nursing professions in the state of Washington. Ultimately, the commission establishes rules that it considers are appropriate for the protection of the consumers of nursing care services, the people of the state of Washington.

     The commission has found it necessary to revise the approval process for nursing education programs to more closely coincide with national standards and to update requirements to ascertain all nurses have received adequate and current education to meet the needs of all populations of Washington state. By amending and establishing new criteria and standards for the approval process of nursing education programs, the commission anticipates improvements that will benefit all parties involved, including nursing professionals, administrators, educators, faculty, and most importantly patients, the people of Washington state.

     PURPOSE AND OBJECTIVE: The NCQAC is proposing rule changes that will:

•     Add clarity to the existing rules, making it easier for nursing education programs, schools, students, applicants, professionals, faculty and administrators to understand the rules and requirements for approving nursing education programs.

•     Delete unnecessary and redundant requirements and add new ones specifically pertaining to nursing education programs and their approval by the Nursing Commission.

•     Ascertain the fair and appropriate review of all nursing education programs during their approval process.

•     Assure registered and practical nurses are educated to administer nursing care to minimally competent standards, assuring safe and ethical nursing care.

•     Improve the overall quality of nursing care administered to all persons of Washington state.

     RULE-MAKING REQUIREMENTS OF THE REGULATORY FAIRNESS ACT (CHAPTER 19.85 RCW): The Regulatory Fairness Act, RCW 19.85.030, requires the department to conduct a small business economic impact statement (SBEIS) for proposed rules that have more than minor impact on small businesses. As defined in RCW 19.85.020 a small business is "any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit, and that has fifty or fewer employees."

     I. WHAT DO THE RULES DO? The proposed rules provide clear, concise standards for the approval of nursing education programs by the Nursing Commission.

     Minor Changes:

•     Condensed, clarified wording, grammar, structure, and formatting.

•     Clarification in requirements for reporting budgets, resources, and survey visits.

     Changes Easing Requirements:

•     Removes most timeframes for submission of documents.

•     Removes requirement for administrators to present their proposals in person to the Nursing Commission.

•     Allows additional time to submit self-evaluations for full approval of a new school.

•     Allows the commission to accept accreditation from national agencies, eliminating the need for surveys for those institutions that are nationally accredited. Also, adds situations that may be cause for a review or survey because that was needed to eliminate the periodic required site surveys.

•     Eases requirements of administrators for PN and ADN programs, allowing for nonnursing master's degrees.

•     Eases requirements of instructors for the RN programs, allowing for nonnursing master's degrees.

•     Allows for the use of preceptors as clinical instructors.

•     For clinical instructors only, reduces qualifications from master's degree to bachelor's.

•     Eliminates clinical faculty to student ratio but recommends a lower ratio than was previously required.

     Changes Imposing Additional Requirements:

•     Adds a requirement for a plan for ongoing evaluation of a program (new only for PN programs, while others already had the requirement for national accreditation).

•     Adds publication of annual reports for satellite programs in addition to main programs.

•     Requires substantive changes be presented for approval three months in advance.

•     Places a waiting period of six months on reinstatement of school approval.

•     Requires philosophy statement to be consistent with generally accepted standards of nursing practice appropriate for graduates of the type of nursing program offered.

•     Requires schools to provide students with the opportunity to acquire and demonstrate knowledge, skills and abilities for safe, effective practice.

•     Requires a report to the commission if the clinical ratio is higher than one faculty for ten students.

•     Adds requirements for courses based on Washington state articulation plan and competencies project. Updates required theory and clinical sections, using nursing model language and NCLEX test categories.

•     Adds to curriculum, using nursing model language and NCLEX test categories, the following topics: Scope of practice, licensure, statistics, client/family needs, delegation of nursing care, case management, pharmacological and parenteral therapies, pain management, and working with multicultural patient populations.

     Added Requirements of the Nursing Commission:

•     Requires the survey report to be available to the nursing program within sixty days and requires the commission to give written notice of their decision within thirty days. Both documents must now be sent to additional administrators to include the nurse administrator of the program, the college president and the vice president for instruction.

     II. AFFECTED INDUSTRIES / DISPROPORTIONATE COSTS:

     HOSPITALS/CLINICS/EMPLOYERS OF NURSES: The following table lists SIC codes for businesses that hire nurses. The proposed rules do not impose immediate additional costs on these businesses. The future costs to these businesses depend upon the interaction of supply and demand for nursing services. The estimated cost to health care practitioners and facilities for amending these rules is minimal. Therefore, there is no disproportionate cost to small businesses that employ nurses.

SIC Industry Code and Title	No. of Businesses		No. of Employees		Average Number of Employees For Smallest Businesses		Average Number of Employees Largest 10% Businesses
8011 Offices & clinics of medical doctors	2,821		43,659		7.9		154.2
8031 Offices of osteopathic physicians	120		680		3.5		13.2
8049 Offices of health practitioners	370		1,627		3.7		13.5
8051 Skilled nursing facilities	913		5,450		2.6		27.4
8052 Immediate care facilities	281		26,407		14.7		144.2
8059 Nursing and personal care facilities	29		1,651		22.3		146.6
8062 General medical & surgical hospitals	110		4,081		35.2		159.5
8063 Psychiatric hospitals	146		78,593		11.1		2,027.7
8069 Specialty hospitals excluding psychiatric	6		3,177		N/A		147.3
8071 Medical laboratories	23		4,106		15.4		167.7
8082 Home health care services	139		3,412		9.4		127.2
8092 Kidney dialysis centers	169		7,408		14.2		162.6
8093 Specialty outpatient clinics	17		1,303		15.5		31.5
8099 Health and allied services	245		7,530		9.3		113.5

     SCHOOLS/COLLEGES/UNIVERSITIES: The following SIC codes indicate educational institutions that teach and prepare nurses. Because none hire fifty or fewer employees, none of the following are classified as small businesses as defined by RCW 19.85.020. Consequently, the rules are exempt from further SBEIS analysis.

SIC Industry Code and Title	No. of Businesses		No. of Employees		Average Number of Employees For Smallest Businesses		Average Number of Employees Largest 10% Businesses
8221 Colleges and universities	93		1,484		143.3		64.3
8222 Junior colleges	124		43,952		N/A		N/A
8249 Vocational schools	81		21,824		N/A		N/A

     How the Department of Health Will Notify Businesses: Upon adoption, these rules will be made available to businesses that involve nurses, educators, and administrators in a number of ways.

•     Available on the nursing website.

•     Copy sent to all businesses that have asked to be placed on the interested persons mailing list.

•     Included in the next updated law book which is sent upon request to businesses and licensees.

•     Copy will be mailed to all nursing schools.

•     Copy of rule is available through the Code Reviser's Office, which is available to all businesses and licensees.

     How the Department of Health Has Involved Businesses in the Rules-Making Process: Throughout the rules writing process, notices were sent to persons on the interested parties mailing list, including representatives of nursing schools, members of the Council of Nurse Educators of Washington State (CNEWS), and other interested individuals including licensees and applicants.

     Costs to the Department of Health to administer the regulation: There are no new additional costs to the Department of Health to amend these rules. No additional review time and no additional analyses are required as a result of the amendments.

     A copy of the statement may be obtained 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.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained 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.

September 20, 2004

Judith D. Personett, Ed.D, RN, Chair

Nursing Care Quality Assurance Commission

OTS-5820.8

NURSING EDUCATION PROGRAMS
AMENDATORY SECTION(Amending WSR 95-21-072, filed 10/16/95, effective 11/16/95)

WAC 246-840-505   Purposes of commission approval of nursing education programs.   The commission approves nursing education programs ((for the following purposes)) to:

     (1) ((To)) Assure preparation for the safe practice of nursing by setting minimum standards for nursing education programs preparing persons for licensure as registered nurses or practical nurses((;)).

     (2) ((To provide guidance for the development of new nursing education programs;

     (3) To foster continued improvement of established nursing education programs;

     (4) To provide criteria for the commission to evaluate new or established nursing education programs;

     (5) To assure the student adequate educational preparation;

     (6) To assure eligibility for admission to the licensing examinations for registered or practical nurses, and to)) Provide criteria for the development, evaluation, and improvement of new and established nursing education programs.

     (3) Assure candidates are educationally prepared for licensure at the appropriate level of nursing practice.

     (4) Facilitate interstate endorsement of graduates of commission approved schools of nursing.

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-505, filed 10/16/95, effective 11/16/95.]

     (((i))) (a) Submit to the commission ((at least eighteen months in advance of expected opening date)) a statement of intent to establish a nursing education program((.

     (ii) Submit to the commission, along with the statement of intent, a)) on a form provided by the commission, and a completed feasibility study ((to)) that includes at least the following information:

     (((A))) (i) Nursing studies documenting the need for entry level nurses in the area((.));

     (((B))) (ii) Purposes and classification of the program((.));

     (((C))) (iii) Availability of qualified faculty((.));

     (((D))) (iv) Budgeted faculty positions((.));

     (((E))) (v) Availability of adequate clinical facilities for the program((.));

     (((F))) (vi) Availability of adequate academic facilities for the program((.));

     (((G))) (vii) Potential effect on other nursing programs in the area((.));

     (((H))) (viii) Evidence of financial resources adequate for the planning, implementation, and continuation of the program((.));

     (((I))) (ix) Anticipated student population((.)); and

     (((J))) (x) Tentative time schedule for planning and initiating the program.

     (((iii))) (b) Respond to the commission's request(s) for additional information.

     (((b) The commission shall either grant or withhold)) (c) Receive or be denied nursing commission approval for program development.

     (2) Program development. (((a) At least twelve months in advance of the anticipated admission of students, the organization)) Upon approval for program development, the educational institution shall:

     (a) Appoint a qualified nurse administrator and provide appropriate resources, consultants, and faculty to develop a proposed nursing education program.

     (b) Prior to admission of students and with sufficient time for commission review, submit the proposed program plan ((shall)) that includes all of the following:

     (i) Purpose((, philosophy,)) and ((objectives.)) outcomes;

     (ii) Organization and administration((.)) including the nurse administrator;

     (iii) ((Budget.

     (iv) Resources, facilities, and services.

     (v) Provisions for faculty, including qualifications, responsibilities, organization, and faculty/student ratio.

     (vi) Curriculum, including course descriptions and course outlines.

     (vii) Policies and procedures for student selection, admission, progression, withdrawal and graduation, and record system.)) Resources, facilities, and services;

     (iv) Policies and procedures for student selection, admission, progression, withdrawal and graduation, and record system;

     (v) A plan for hiring and retaining faculty, including qualifications, responsibilities, organizational structure, and faculty/student ratio;

     (vi) Curriculum, including course descriptions and course outlines;

     (vii) Initial year and five-year sustaining budget;

     (viii) Projected plans for the orderly expansion and ongoing evaluation of the program.

     (((b) The nurse administrator shall submit to the commission a written report of the proposed program plan at least five weeks prior to a scheduled commission meeting at which time the plan is to be reviewed. This review shall take place six months prior to the scheduled opening date of the program.))

     (c) Arrange a survey visit to the campus to clarify and amplify materials included in the written proposed program plan. The visit will be conducted by a representative of the commission before a decision regarding approval is rendered.

     (d) ((Students may not be admitted to the program until approval has been granted by the commission.

     (e) The nurse administrator of the program and other administrative officers of the organization shall attend the commission meeting to present the formal application and clarify and amplify materials included in the written report of the proposed program plan.

     (f) The commission shall either grant or withhold provisional)) Receive or be denied initial approval of the proposed nursing program.

     (3) ((Provisional)) Initial approval.

     (a) ((The school shall submit course outlines to the commission for review and approval at least three months prior to offering the course;)) The program may only admit students if it has received initial approval by the commission;

     (b) The school shall submit progress reports as requested by the commission; and

     (c) Survey visits shall be scheduled as deemed necessary by the commission during the period of ((provisional)) initial approval. A site survey, conducted by the commission, will determine whether graduates may test for the licensure examination (NCLEX)¦.

     (4) Full approval.

     (a) A self-evaluation report of compliance with the standards for nursing education ((shall)) as identified in WAC 246-840-550 through 246-840-575, shall be submitted to the nursing commission within ((three)) six months following graduation of the first class((, and)).

     (b) The commission may conduct a survey visit ((shall be made for consideration of)) to determine full approval of the program.

     (((b))) (c) The commission will review the self-evaluation report, survey reports and ((added materials for)) program outcome data in order to grant or deny full approval of the nursing education program ((only at scheduled commission meetings.

     (c) The self-evaluation report, added materials and survey reports shall be in the commission office at least five weeks prior to the commission meeting.

     (5) Satellite nursing education programs. An approved nursing education program wishing to initiate an off-campus, extended or satellite nursing program must submit a plan to the commission demonstrating that:

     (a) A need for entry level nurses exists in the area.

     (b) Faculty on-site meet all the requirements and qualifications of the parent nursing education program.

     (c) Adequate clinical facilities are available and meet the requirements of the parent program.

     (d) Academic facilities and resources are comparable to those of the parent program)) under WAC 246-840-530(1).

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-510, filed 10/16/95, effective 11/16/95.]

     (1) The initial plan must demonstrate how:

     (a) Faculty for the off-campus, extended or satellite program will meet the nursing education standards (WAC 246-840-570);

     (b) The program will meet curriculum and academic standards of the main campus nursing education program;

     (c) Adequate clinical facilities are available and meet the requirements of the program purpose and outcomes;

     (d) Academic facilities and resources are comparable to those of the main program.

     (2) The branch campus and distance learning education program must coordinate annual reports and site survey evaluations with administration at the main campus.

[]

     (((a) The)) (2) Any proposed substantive nursing program change must be presented to the commission for approval at least three months prior to implementation. Substantive changes include, but are not limited to, changes in legal status, control, ownership, or resources of the institution; decreases in faculty below that which is required to staff clinical sections of WAC 246-840-570; changes in faculty composition whereby their expertise is not adequate to teach those areas of nursing described in WAC 246-840-575; and major curriculum revision or changes in the length of the program.

     (3) The program must submit annual reports on forms provided by the commission and on the date specified.

     EVALUATION OF A NURSING PROGRAM BY THE NATIONAL ACCREDITING BODY:

     (4) The commission may accept accreditation by a commission-recognized national nursing accreditation body as evidence of compliance with the standards of nursing education programs. The nursing program must submit to the commission a copy of the self-evaluation report submitted to the national agency.

     (a) Programs that seek accreditation from a commission recognized national nursing accreditation body shall file evidence of that accreditation with the commission within thirty days of receiving the report from the accreditation body. The nursing program must file notice of any change in program accreditation status with the commission within thirty days of receipt of notice from the accreditation body. The commission shall grant full approval based upon evidence of accreditation for eight or ten years. Failure to submit notice of accreditation survey results within thirty days may result in a site visit or other sanctions as described in WAC 246-840-530.

     (b) Programs holding approval based upon national accreditation must comply with WAC 246-840-550 through 246-840-575.

     (c) The commission may grant full approval for a continuing period, not to exceed ten years to nursing programs with maximum continuing national accreditation.

     (d) Any interim report requested by the national accrediting body must also be sent to the commission. The program must submit a copy to the commission.

     (e) If the nursing program receives notice from the accrediting body addressing interim reports, notice must be sent to the commission within thirty days of receiving the report.

     (f) If the program is accredited for less than maximum accreditation, then the program must provide the commission with a copy of the report addressing the items of noncompliance within thirty days of receipt from the accreditation body. The commission may require an additional report regarding noncompliance.

     EVALUATION OF A NURSING PROGRAM BY THE COMMISSION:

     (5) Programs that are not nationally accredited by a commission-recognized national nursing accreditation body are subject to a survey visit ((will be)) made by representative(s) of the commission on dates mutually agreeable to the commission and the nursing education program.

     (((b) Announcement of)) (a) The commission must notify the nurse administrator that a survey visit ((will be sent to programs)) is required at least twelve months in advance of the visit.

     (((c))) (b) Prior to the survey visit a program shall submit a self-evaluation report ((which)) that provides evidence of compliance with the standards of nursing education as identified in WAC 246-840-550 through 246-840-575.

     (((d) The self-evaluation report prepared for the national nursing accreditation body may be substituted in lieu of the commission's survey report for that year if a national accreditation survey is scheduled concurrently. Where appropriate the survey will be made in conjunction with a national accreditation visit. An addendum to the report for the national accreditation survey must be submitted to address requirements of the state not considered by the national accrediting body.

     (e))) (c) Within sixty days, and prior to commission consideration, a draft of the commission survey visit report will be made available to the school for review ((and)) for corrections in statistical data and for response to issues raised.

     (((f))) (d) Following the commission's review and decision, the commission will send to the program nurse administrator, the president and vice-president for instruction written notification regarding approval of the program ((and the commission comments and recommendations will be sent to the administrator of the nursing education program.

     (2) Any proposed major curriculum revision, such as changes affecting the philosophy and objectives, significant course content changes, or changes in the length of the program, shall be presented to the commission for approval at least three months prior to implementation.

     (3) Annual reports will be submitted on forms provided by the commission)).

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-520, filed 10/16/95, effective 11/16/95.]

     (2) The commission shall evaluate each program ((shall be evaluated)) in terms of its conformance to the ((curriculum)) nursing education standards ((as provided)) in this chapter.

     (3) Within thirty days of the commission's decision, the commission shall give written notice to the educational institution ((and the nurse administrator of the nursing program information)) regarding its decision on the program's approval status including the nurse administrator, the president and vice-president for instruction.

     (4) The commission shall grant continuing full approval ((shall be granted)) to a nursing program that meets the requirements of the law and ((rules and regulations of the commission)) this chapter. Full approval may carry recommendations for improvement and for correcting deficiencies.

     (5) If the commission determines that an approved nursing program is not maintaining the ((curriculum)) education standards required for approval, the commission shall give written notice specifying the deficiencies and shall designate the period of time in which the deficiencies must be corrected. The program's approval shall be ((suspended)) withdrawn if a program fails to correct the deficiencies within the specified period of time in WAC 246-840-530.

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-525, filed 10/16/95, effective 11/16/95.]

     (2) The commission may grant conditional approval ((shall be granted)) to a nursing education program that has failed to meet the minimum standards contained in the law and ((the rules and regulations of the commission)) this chapter.

     (a) Conditions ((that)) must be met within a designated time period shall be specified in writing.

     (b) A conditionally approved program shall be reviewed at the end of the designated time period. ((Such)) The review shall result in one of the following actions:

     (i) Restoration of full approval;

     (ii) Continuation of conditional approval for a specified period of time; or

     (iii) Withdrawal of approval.

     (3) ((The commission may withdraw approval from existing programs when it determines that a nursing education program fails substantially to meet the standards for nursing education as contained in WAC 246-840-550 through 246-840-575. All such actions shall be effected in accordance with the Administrative Procedure Act and/or the administrative rules and regulations of the commission.)) The following situations may be cause for review and/or a site visit by the commission to determine if the minimum standards for nursing programs are being met:

     (a) Complaints relating to violations of WAC 246-840-550 through 246-840-575.

     (b) Denial, withdrawal or change of program accreditation status by a commission-recognized national nursing accreditations agency or general academic accreditation agency.

     (c) Failure to obtain commission approval of changes that require approval of the commission under "program changes."

     (d) Providing false or misleading information to students or the public concerning the nursing program.

     (e) Violation of the rules or policies of the commission.

     (f) Inability to secure or retain a qualified director or faculty, resulting in substandard supervision and teaching of students.

     (g) Noncompliance with the program's stated purpose, objectives, policies, and curriculum resulting in unsatisfactory student achievement.

     (h) Failure to provide clinical experiences necessary to meet the objectives of the nursing program.

     (i) Faculty student ratio in direct patient care is greater than 1:10.

     (j) Failure to maintain an average NCLEX¦ examination annual passing rate of eighty percent. If a program:

     (i) Fails to maintain an average passing rate of eighty percent of first time writers for two consecutive years, the commission will send a letter asking for an assessment of the problem and a plan of correction.

     (ii) Fails to maintain an average passing rate of eighty percent of first time writers for three consecutive years, the program must complete an assessment of possible problem areas within six months and the commission may conduct an evaluation visit. The commission may offer technical assistance.

     (iii) Fails to maintain a passing rate of eighty percent for four out of five consecutive years, the commission will place the program on conditional approval and require an evaluation visit.

     (4) The commission may withdraw approval from ongoing programs if it determines that a nursing education program fails to substantially meet the standards for nursing education as contained in WAC 246-840-550 through 246-840-575.

     (5) All these actions shall be taken in accordance with the Administrative Procedure Act, chapter 34.05 RCW, and any applicable rules of the commission.

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-530, filed 10/16/95, effective 11/16/95.]

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-535, filed 10/16/95, effective 11/16/95.]

     (a) The program ((shall)) may continue until the last class enrolled is graduated((.)) if:

     (i) The program ((shall)) continues to meet the standards for approval, WAC 246-840-550 through 246-840-575 until all of the enrolled students have graduated((.));

     (ii) The date of closure is the date on the degree, diploma, or certificate of the last graduate((.)); and

     (iii) The ((commission shall be notified by the)) governing institution notifies the commission in writing of the closing date((.)); or

     (b) The program ((shall)) may close after assisting in the transfer of students to other approved programs((.)) if:

     (i) The program ((shall)) continues to meet the standards required for approval, WAC 246-840-550 through 246-840-575 until all students are transferred((.));

     (ii) The governing institution submits to the commission a list of the names of students who have been transferred to approved programs and the date on which the last student was transferred ((shall be submitted to the commission by the governing institution.)); and

     (iii) The date on which the last student was transferred shall be the closing date of the program.

     (((c) Custody of records.

     (i) If the program closes but the governing institution continues to function, it shall assume responsibility for the records of the students and graduates. The commission shall be advised of the arrangements made to safeguard the records.

     (ii) If the governing institution ceases to exist, the academic records of each student and graduate shall be transferred to the commission for safekeeping.

     (iii) The commission shall be consulted about the disposition of all other records.))

     (2) Closing as a result of withdrawal of approval. When the commission withdraws approval of a nursing education program, the governing institution shall comply with the following procedures:

     (a) Students of the program shall be notified in writing of their status and options for transfer to an approved program.

     (b) The program shall close after assisting in the transfer of students to other approved programs. The commission must establish a time frame for the transfer process ((will be established by the commission)).

     (c) The governing institution shall submit to the commission a list of the names of students who have transferred to approved programs and the date on which the last student was transferred ((shall be submitted to the commission by the governing institution.

     (d) Custody of records.

     (i) If the governing institution continues to function, it shall assume responsibility for the records of the students and the graduates. The commission shall be advised of the arrangements made to safeguard the records.

     (ii) If the governing institution ceases to exist, the academic records of each student and graduate shall be transferred to the commission for safekeeping.

     (iii) The commission shall be consulted about the disposition of all other records)).

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-545, filed 10/16/95, effective 11/16/95.]

     The nursing program shall implement a written, comprehensive, systematic plan for ongoing evaluation that is based on program outcomes and the input of faculty, students and consumers, and which incorporates continuing improvement.

[]

     ((They shall)) (1) The purpose and outcomes must be consistent with the definitions of nursing practice as outlined in RCW 18.79.040 and 18.79.060.

     (2) The nursing education program shall have a purpose statement ((of philosophy)) and outcomes that ((is)) are consistent with ((the philosophy of)) the governing institution and with generally accepted standards of nursing practice appropriate for graduates of the type of nursing program offered.

     (3) The ((objectives)) outcomes shall be consistent with the ((philosophy and shall describe the cognitive, affective, and psychomotor capabilities of the graduate)) scope of practice of the registered and practical nurse.

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-550, filed 10/16/95, effective 11/16/95.]

     (1) The governing institution accreditation must be by ((an)) a commission-approved accrediting body.

     (2) The relationship of the nursing education program to other units within the governing institution ((shall)) must be clearly delineated.

     (3) The nursing education program ((shall)) must be organized with clearly defined institutional authority((,)) and administrative responsibility((, and channels of communication)) for the nurse administrator.

     (4) The nursing education faculty shall be involved in determining academic policies and procedures of the nursing program.

     (5) The nursing education program ((shall)) must allow student participation in committees in the determination of program policies and procedures, curriculum planning and evaluation.

     (6) The nursing education program shall be administered by a professionally and academically qualified registered nurse currently licensed in this state ((with the following qualifications)).

     FOR PRACTICAL AND ASSOCIATE DEGREE PROGRAMS:

     (a) In a program offering practical nursing education or associate degree, a minimum of:

     (i) A bachelor's of science in nursing (BSN) and a masters ((with a major)) degree, (preferably in nursing((,))) or a master's of science in nursing (MSN) from an accredited college or university; and

     (ii) Educational preparation in ((education)) teaching nursing or two years experience in teaching nursing; and

     (iii) Curriculum development and administration((, and at least)) experience; and

     (iv) Five years of ((professional)) experience as a registered nurse including two years of experience in nursing education((. Exceptions allowed without prior commission approval:

     (i) Current tenured faculty.

     (ii) Ongoing reappointment of instructors or faculty prior to November 16, 1995)); and

     (v) Current knowledge of nursing practice at the practical nurse or associate degree program level as appropriate.

     FOR BACHELOR'S DEGREE PROGRAMS:

     (b) In a program offering the baccalaureate degree in nursing((,)):

     (i) A masters degree with a major in nursing, a doctoral degree preferably in nursing ((or a related field,)) from an accredited college or university; and

     (ii) Preparation in education and administration((,)); and

     (iii) At least five years of experience as a registered nurse including two years of experience in nursing education at the baccalaureate level.

     (7) The nurse administrator ((of the nursing education program)) shall be responsible for creation and maintenance of an environment conducive to teaching and learning through:

     (a) Facilitation of the development, implementation and evaluation of the curriculum.

     (b) ((Liaison)) Communication with central administration and other units of the governing institution.

     (c) Facilitation of faculty development and performance review consistent with the policies of the institution((. Encourage)), and encouragement of faculty to seek ways of improving clinical skills and methods of demonstrating continued educational and clinical competence.

     (d) Facilitation of faculty recruitment and appointment. The administration of the program is encouraged to establish a goal for acquiring faculty with diversity in ethnicity, gender, clinical specialty and experience ((that would be representative of the students enrolled in the program)).

     (e) Recommendation of faculty for appointment, promotion, tenure, and retention consistent with the policies of the institution.

     (f) Facilitation of the development of long-range goals and objectives for the nursing program.

     (g) Facilitation of recruitment, selection, and advisement of students.

     (h) Assurance that the rules and regulations of the state nursing commission are effectively implemented.

     (i) ((Notifying)) Notification of the commission of any major changes in the program or its administration.

     (8) The nurse administrator ((of the nursing education program)) shall have ((designated)) sufficient time provided to ((conduct)) fulfill relevant administrative duties and responsibilities.

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-555, filed 10/16/95, effective 11/16/95.]

     (1) Classrooms, laboratories, and conference rooms ((shall)) must be available and ((shall be)) adequate in size, number, and type according to the number of students and the educational purposes for which the rooms are to be used.

     (2) Offices ((shall)) must be available and adequate in size, number, and type to provide faculty with opportunity for uninterrupted work and privacy for the conferences with students. Adequate space ((shall)) must be provided for clerical staff, records, files, and other equipment.

     (3) Clinical facilities.

     (a) A nursing program shall utilize a variety of sites ((shall be utilized)) for learning experiences to enable the student to observe and practice safe nursing care of persons at each stage of the human life cycle. These experiences ((shall)) must include opportunities for the student to learn and provide nursing care to clients in the areas of acute and chronic illnesses, promotion and maintenance of wellness, prevention of illness, rehabilitation, and support in death. Clinical experiences shall include opportunities to learn and provide care to clients from diverse ethnic and cultural backgrounds. ((The emphasis placed on these areas and the scope encompassed shall be in keeping with the purpose, philosophy and objectives of the program.)) The experiences may include, but need not be limited to, hospitals, clinics, offices of health professionals, health centers, nursery schools, elementary and secondary schools, rehabilitation centers, mental health clinics, public health departments, and extended care resources.

     (b) Clinical facilities ((shall)) must be selected to provide learning experience of sufficient number and kind for student achievement of the course/curriculum objectives. The number of hours of class and clinical practice opportunities and distribution of these shall be in direct ratio to the amount of time necessary for the student at the particular stage of development to accomplish the objectives.

     (c) Clinical facilities ((shall)) must be approved by the appropriate accreditation or licensing evaluation bodies, if such exist.

     (d) Throughout the program the total hours of class and required clinical practice opportunities ((shall)) may not exceed forty hours per week.

     (4) Library facilities ((shall)) must be provided for use by the faculty and students. Physical facilities, hours, and scope and currency of learning resources shall be appropriate for the purpose of the program and for the number of faculty and students.

     (5) The administration, faculty and students must conduct periodic evaluations of resources, facilities, and services ((shall be conducted by the administration, faculty, and/or students)).

     (6) The nursing program must demonstrate adequate financial support for faculty, support personnel, equipment, supplies, and services ((shall be demonstrated)).

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-560, filed 10/16/95, effective 11/16/95.]

     (a) Provide in writing)) provide students the opportunity to acquire and demonstrate the knowledge, skills and abilities for safe and effective nursing practice.

     (1) Written policies and procedures for selection, admission, progression, graduation, withdrawal, and dismissal((. These policies shall)) of students must be available and consistent with the policies of the governing institution and must be communicated in a fair, accurate, inclusive, consistent and readily available format. ((Where necessary,))

     (2) The approved nursing education program shall:

     (a) Develop policies specific to nursing students ((may be adopted)), if justified by the nature and purposes of the nursing program.

     (b) Maintain a system of student records.

     (c) Provide a written statement of student rights and responsibilities.

     (d) Require that students, who seek admission by transfer from another approved nursing education program, or readmission for completion of the program, shall meet the equivalent of the program's current standards.

     (((2))) (3) The nursing education program shall provide the student in ((an ADN or BSN)) a registered nursing program with information on the legal ((definition and parameters)) role of the nursing technician ((role,)) as defined in WAC 246-840-010(((19))) and 246-840-840. ((Such)) The information ((shall)) must be provided prior to the time of completion of the first clinical course and shall clearly advise the student of ((their)) his or her responsibilities, ((should they)) if he or she chooses to be employed as a nursing technician.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-565, filed 6/18/97, effective 7/19/97. Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-565, filed 10/16/95, effective 11/16/95.]

     (((2))) (1) The maximum ratio of faculty to students recommended in clinical areas involving direct care of patients or clients ((shall be)) is one faculty member to ((twelve)) ten students. A lower ratio may be required by the nursing commission ((of nursing)) for students in initial or highly complex learning situations, or when student/client safety warrant. A higher ratio may be allowed, with use of trained preceptors for students. Factors to be considered in determining the ratio are:

     (a) The preparation and expertise of the faculty member;

     (b) The objectives to be achieved;

     (c) The level of students;

     (d) The number, type, and ((conditions)) acuity of patients;

     (e) The number, type, location, and physical layout of clinical facilities being used for a particular course(s);

     (f) Students in initial or highly complex learning situations; and

     (g) The use of trained preceptors.

     (2) If the faculty to student ratio in clinical areas involving direct care of patients or clients exceeds one faculty member to ten students, the program nurse administrator must submit a standardized report to the nursing commission. The report can be obtained from the nursing commission office. The contents of the standardized report must include, but is not limited to:

     (a) The nursing program pass rate for the last two years;

     (b) The results of the two most recent faculty satisfaction surveys;

     (c) The results of the two most recent student satisfaction surveys;

     (d) Rationale for the exception to the one faculty member to ten students ratio and information supporting the program's decision. The rationale must include how the program will maintain patient safety.

     The nursing commission must respond to the program nurse administrator, either electronically or in writing, regarding the report and its acceptance or denial, in a timely fashion. The nursing commission may request a site survey to be conducted based upon the report to gather information supporting the document. The commission must notify the program nurse administrator at least two weeks in advance of the site survey and indicate the purpose of the survey.

     (3) Clinical preceptors may be used to enhance clinical learning experiences, after a student has received clinical and didactic instruction from program faculty in all basic areas for that course or specific learning experience. Preceptors may be used with the following criteria:

     (a) Licensed at or above the level for which the student is preparing;

     (b) Experienced in the facility and specialty area;

     (c) Orientation to written course and student learning objectives and documented role expectations of faculty, preceptor and preceptee; and

     (d) The faculty member shall confer with each preceptor and student regularly during the precepted learning experience.

     (((3))) (4) Nursing faculty((, including those in career ladder programs,)) shall have a current unrestricted license to practice as a registered nurse in Washington ((the following qualifications)).

     (5) Degree requirements for faculty teaching in nursing education programs shall have:

     FOR PRACTICAL NURSING PROGRAMS:

     (a) ((A current license to practice as a registered nurse in Washington.)) In a program preparing practical nurses only, a baccalaureate degree with a major in nursing from an accredited college or university.

     FOR REGISTERED NURSING PROGRAMS:

     (b) In a program preparing registered nurses, a masters degree with a major in nursing or a baccalaureate degree in nursing with a masters in a related field from an accredited college or university ((shall be the minimum requirement for faculty appointment in a program preparing registered nurses)), unless:

     (i) For faculty teaching in the classroom or laboratory, the nursing program shall provide documentation to the commission within thirty days of hire that:

     (A) Despite aggressive recruitment efforts, it has been unable to attract properly qualified faculty; and

     (B) The individual will either teach one year or less or be currently enrolled in a masters in nursing program at an accredited college or university.

     (ii) For clinical faculty who will directly supervise students at a clinical facility, the nursing program shall provide documentation to the commission within thirty days of hire that:

     (A) The individual has at least a baccalaureate degree with a major in nursing from an accredited college or university; and

     (B) The individual has current clinical experience of at least three years in the clinical subject area taught.

     (iii) For faculty teaching in the classroom, laboratory or clinical setting, the individual is nursing faculty tenured prior to November 3, 1995.

     ((A Baccalaureate degree with a major in nursing from an accredited college or university shall be the minimum requirement for faculty appointment in program preparing practical nurses only.

     (i) Exceptions allowed without prior commission approval:

     (A) Current tenured faculty.

     (B) Ongoing reappointment of instructors or faculty prior to November 3, 1995.

     (C) Temporary faculty replacement for less than three quarters or two semesters.

     (ii) Exceptions allowed with prior commission approval:

     (A) Temporary short-term faculty appointment of less than one academic year.

     (B) Faculty specializing in a highly selected clinical area such as an operating room.

     (c) Clinical experience as a registered nurse relevant to area(s) of responsibility.

     (4) Nonnurse)) (6) Interdisciplinary faculty must have academic and professional education and experience in their field of specialization.

     (((5))) (7) Faculty shall be responsible for:

     (a) Developing, implementing, and evaluating the purpose((, philosophy,)) and ((objectives)) outcomes of the nursing education program.

     (b) Designing, implementing, and evaluating the curriculum.

     (c) Developing and evaluating student admission, progression, retention, and graduation policies within the framework of the policies of the governing institution.

     (d) Participating in or providing for academic advising and guidance of students.

     (e) Evaluating student achievement, in terms of curricular objectives as related to both nursing knowledge and practice, including preceptorship experiences.

     (f) Selecting, guiding, and evaluating student learning.

     (g) Participating in activities to improve their own nursing competency in area(s) of responsibility and to demonstrate current clinical competency.

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-570, filed 10/16/95, effective 11/16/95.]

     (1) ((The basic curriculum shall not be less than two academic years for preparation of a registered nurse. The basic curriculum shall not be less than nine months or forty weeks for preparation of a practical nurse.

     (2))) The length, organization, content, methods of instruction, and placement of courses ((shall)) must be consistent with the ((philosophy)) purpose and outcomes of the program.

     (((3) The curriculum shall include:))

     FOR PRACTICAL NURSE PROGRAMS:

     (((a))) (2)(a) The practical nurse certificate must be at least sixty quarter credits. Concepts of social, behavioral, and related foundation subjects ((which)) may be integrated, combined or presented as separate courses.

     (i) Normal growth and development.

     (ii) Psychology - social facts and principles; communication techniques and defense mechanisms, normal and abnormal behavior; loss, grief and dying.

     (iii) Personal and vocational relationships.

     (b) Biological and related foundation subjects((, which)) may be integrated, combined or presented as separate courses.

     (i) Anatomy and physiology.

     (ii) Microbiology - elementary concepts.

     (iii) Chemistry and physics - elementary concepts.

     (iv) Nutrition and diet therapy.

     (v) Pharmacology and applied mathematics.

     (c) Principles and ((practice)) skills of practical nursing consistent with the practical ((nursing)) nurse role of the beginning practitioner as provided by the standards of competency identified in WAC ((246-838-260)) 246-840-700 and 246-840-705.

     (i) Nursing ethics, nursing history and trends, ((vocational)) standards of practice, licensure and legal aspects of nursing.

     (ii) Medical and surgical nursing for clients throughout the life span.

     (iii) ((Parent/child)) Ante/intra/postpartum and newborn nursing with only an assisting role in the care of clients during labor and delivery and those with complications.

     (iv) Geriatric nursing.

     (v) Mental health nursing.

     (((vi))) (d) All nursing courses shall include:

     (i) Components of ((restorative, rehabilitative and supportive care)) client needs: Safe, effective care environment; health promotion and maintenance; psychosocial integrity; and physiological integrity.

     (((vii))) (ii) Skills laboratory and clinical practice in the functions of the practical nurse, including but not limited to, administration of medications, ((common medical surgical)) implementing and monitoring client care techniques and ((related client teaching)) promoting psychosocial and physiological techniques.

     (((viii))) (iii) Concepts of ((client)) coordinated care ((management)) and delegation.

     FOR REGISTERED NURSE PROGRAMS:

     (3)(a) Instruction in the physical ((and)), biological ((sciences and shall include content drawn)) social and behavioral sciences. Content is required from the areas of anatomy and physiology (two terms with laboratory), physics, chemistry, microbiology, pharmacology and nutrition, ((which may be integrated, combined, or presented as separate courses.

     (b) Instruction in the social and behavioral sciences and shall include content drawn from the areas of communications, psychology, sociology and anthropology, which may be integrated, combined, or presented as separate courses)) communication and computations.

     (((c))) (b) Theory and clinical experiences in the areas of medical nursing, surgical nursing, obstetric nursing, nursing of children and psychiatric nursing, which may be integrated, combined, or presented as separate courses. Baccalaureate programs also shall include theory and clinical experiences in community and public health nursing.

     (((d))) (c) History, health care trends, ((and)) legal and ethical issues, and scope of practice, and licensure and professional responsibility pertaining to the ((nursing profession, which)) registered nurse role. Content may be integrated, combined, or presented as separate courses. Baccalaureate programs shall include study of research principles and statistics.

     (((e))) (d) Programs must include opportunities for the student to learn assessment ((of)) and analysis of client and family needs, planning, implementation, ((and)) evaluation, and delegation of nursing care for diverse individuals and groups. Baccalaureate programs shall include the study and practice of leadership and care/case management.

     (((f))) (e) All nursing courses shall include:

     (i) Comprehensive content on client needs: Safe, effective care environment; health promotion and maintenance; psychosocial integrity and physiological integrity.

     (ii) Clinical experiences in the care of persons at each stage of the human life cycle((. These experiences shall include)), with opportunities for the student to learn and have direct involvement in, responsibility and accountability for providing basic nursing care ((in the areas of)) and comfort for clients with acute and chronic illnesses, ((promotion and maintenance of wellness)) pharmacological and parenteral therapies and pain management. The emphasis placed on these areas, the scope encompassed, and other allied experiences offered shall be ((in keeping)) consistent with the purpose((, philosophy,)) and ((objectives)) outcomes of the program.

     (((g))) (iii) Opportunities for ((the student to participate in multidisciplinary health care)) management of care and delegation working within a health care team.

[Statutory Authority: RCW 18.79.110. 95-21-072, § 246-840-575, filed 10/16/95, effective 11/16/95.]

© Washington State Code Reviser's Office