Date of Adoption: October 10, 2003.

     Purpose: Adopt emergency rules to implement chapter 258, Laws of 2003 requiring registration of nursing technicians: WAC 246-840-010 Definitions, 246-840-840 Nursing technicians, 246-840-850 Use of nomenclature, 246-840-860 Nursing technician criteria, 246-840-870 Functions of the nursing technician, 246-840-880 Functions of the registered nurse supervising the nursing technician, and 246-840-890 Responsibilities of the employing facility; and rescinding WAC 246-840-900 Responsibilities of the nurse administrator. Previous emergency rules will expire on October 18, 2003. Extensive stakeholder involvement and research for legal issues has delayed permanent adoption. Implementation is anticipated within ninety days.

     Citation of Existing Rules Affected by this Order: Repealing WAC 246-840-900; and amending WAC 246-840-010, 246-840-840, 246-840-850, 246-840-860, 246-840-870, and 246-840-890.

     Statutory Authority for Adoption: Chapter 18.79 RCW and chapter 258, Laws of 2003.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

     Reasons for this Finding: Chapter 258, Laws of 2003, requires registration of nursing technicians by emergency order.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 6, Repealed 1.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
     Effective Date of Rule: Immediately.

October 17, 2003

Frank Maziarski, RN, ARNP

Nursing Commission Chair

OTS-6382.3

AMENDATORY SECTION(Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)

WAC 246-840-010   Definitions.   (1) "Auxiliary services" are all nursing services provided to patients by persons other than the licensed practical nurse, the registered nurse and the nursing student.

     (2) "Beginning practitioner" means a newly licensed nurse beginning to function in the nurse role.

     (3) "Behavioral objectives" means the measurable outcomes of specific content.

     (4) "Client" means the person who receives the services of the practical nurse or registered nurse.

     (5) "Client advocate" means a supporter of client rights and choices.

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

     (7) "Competencies" means the tasks necessary to perform the standards.

     (8) "Conceptual framework" means the theoretical base around which the curriculum is developed.

     (9) "Conditional approval" of a school of nursing is the approval given a school of nursing that has failed to meet the requirements of the law and the rules and regulations of the commission, and it specifies conditions that must be met within a designated time to rectify the failure.

     (10) "Delegation" means the licensed practical nurse or registered nurse transfers the performance of selected nursing tasks to competent individuals in selected situations. The licensed practical nurse or registered nurse delegating the task retains the responsibility and accountability for the nursing care of the client. The licensed practical nurse or registered nurse delegating the task supervises the performance of the unlicensed person;

     (a) Nursing acts delegated by the licensed practical nurse or registered nurse shall:

     (i) Be within the area of responsibility of the licensed practical nurse or registered nurse delegating the act;

     (ii) Be such that, in the opinion of the licensed practical nurse or registered nurse, it can be properly and safely performed by the person without jeopardizing the patient welfare;

     (iii) Be acts that a reasonable and prudent licensed practical nurse or registered nurse would find are within the scope of sound nursing judgment.

     (b) Nursing acts delegated by the licensed practical nurse or registered nurse shall not require the unlicensed person to exercise nursing judgment nor perform acts which must only be performed by a licensed practical nurse or registered nurse, except in an emergency situation (RCW 18.79.240 (1)(b) and (2)(b)).

     (c) When delegating a nursing act to an unlicensed person it is the registered nurse who shall:

     (i) Make an assessment of the patient's nursing care need before delegating the task;

     (ii) Instruct the unlicensed person in the delegated task or verify competency to perform or be assured that the person is competent to perform the nursing task as a result of the systems in place by the health care agency;

     (iii) Recognize that some nursing interventions require nursing knowledge, judgment, and skill and therefore may not lawfully be delegated to unlicensed persons.

     (11) Direction and Supervision:

     (a) "Supervision" of licensed or unlicensed nursing personnel means the provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action.

     (b) "Consulting capacity" shall mean the recommendations to a professional entity, employed at that facility, which may be accepted, rejected, or modified. These recommendations shall not be held out as providing nursing services by the consulting nurse to the patient or public.

     (c) "Direct supervision" shall mean the licensed registered nurse is on the premises, is quickly and easily available and the patient has been assessed by the licensed registered nurse prior to the delegation of the duties to any caregiver.

     (d) "Immediate supervision" shall mean the registered nurse is on the premises and is within audible and visual range of the patient and the patient has been assessed by the registered nurse prior to the delegation of duties to any caregiver.

     (e) "Indirect supervision" shall mean the registered nurse is not on the premises but has given either written or oral instructions for the care and treatment of the patient and the patient has been assessed by the registered nurse prior to the delegation of duties to any caregiver.

     (12) "Extended learning sites" refers to any area external to the parent organization selected by faculty for student learning experiences.

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

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

     (15) "Good cause" as used in WAC 246-840-990 for extension of a nurse technician registration means that the nurse technician has had difficulty scheduling the examination, that the examination results did not arrive at the commission office within thirty days after the nurse technician's date of graduation or that the nurse technician can show that there was a family crisis which caused him or her to delay sitting for the examination.

     (16) "Minor nursing services." The techniques and procedures used by the nursing profession are extremely difficult to categorize as major or minor nursing services. The important factor with which this law is concerned is the determination of which nursing person and at what level of preparation that person may perform said technique or procedure in relation to the condition of a given patient, and this kind of determination rests with the registered nurse.

     (((16))) (17) "Minimum standards of competency" means the functions that are expected of the beginning level nurse.

     (((17))) (18) "Nurse administrator" is an individual who meets the qualifications contained in WAC 246-840-555 and who has been designated as the person primarily responsible for the direction of the program in nursing. Titles for this position may include, among others, dean, director, coordinator or chairperson.

     (((18) The phrase "nursing aide" used in RCW 18.79.240 (1)(c) shall mean a "nursing technician." "Nursing technician" is a nursing student currently enrolled in a commission or state board of nursing approved nursing education program and employed for the purpose of giving help, assistance and support in the performance of those services which constitute the practice of registered nursing. The nursing student shall use the title "nursing technician" while employed.))

     (19) (("Nursing student" is a person currently enrolled in an approved school of nursing.)) "Nursing technician" means a nursing student currently enrolled in good standing and who has completed at least one academic term (quarter or semester) of a nursing program approved by the commission (ADN, diploma or BSN). The term must have included a clinical component. The nursing technician is employed directly by a hospital licensed under chapter 70.41 RCW or a nursing home licensed under chapter 18.51 RCW. A nursing technician may also be a graduate of an approved program who graduated within the past thirty days. Approved nursing program means any registered nurse program approved by the nursing commission.

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

     (21) "Program" means a division or department within a state supported educational institution, or other institution of higher learning charged with the responsibility of preparing persons to qualify for the licensing examination.

     (22) "Provisional approval" of schools of nursing is the approval given a new school of nursing based on its proposed program prior to the admission of its first class.

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

     (24) "School" means an educational unit charged with the responsibility of preparing persons to practice as practical nurses or registered nurses. Three types of basic schools of nursing are distinguished by the certificate awarded to the graduate. Schools of nursing within colleges and universities award the associate degree or baccalaureate degree. Schools of nursing sponsored by a hospital award a diploma.

     (25) "Standards" means the overall behavior which is the desired outcome.

     (26) "Terminal objectives" means the statements of goals which reflect the philosophy and are the measurable outcomes of the total curriculum.

     (27) An "unapproved school of nursing" is a school of nursing that has been removed from the list of approved schools for failure to meet the requirements of the law and the rules and regulations of the commission or a school that has never been approved by the commission.

[Statutory Authority: RCW 43.70.280. 98-05-060, § 246-840-010, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-010, filed 6/18/97, effective 7/19/97.]

     (1) The nursing technician is as defined in WAC 246-840-010(19).

     (2) The nursing technician shall have knowledge and understanding of the laws and rules regulating the nursing technician and shall function within the legal scope of nursing practice.

     (3) The nursing technician shall be responsible and accountable for practicing within the scope and guidelines of policies defined by the employing agency.

     (4) The nursing technician shall not be employed by a temporary agency.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-840, filed 6/18/97, effective 7/19/97.]

     (2) No other person shall assume such title.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-850, filed 6/18/97, effective 7/19/97.]

     (1) Satisfactory completion of at least one academic term (quarter or semester) of a nursing program approved by ((a)) the commission ((or board of nursing)) (ADN, diploma, or BSN). 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) ((The period of time of notification to the commission of completion of nursing education, following graduation and application for examination, not to exceed ninety days from the date of graduation.

     (c))) Thirty days after graduation from an approved program.

     (3) Current enrollment will not be construed to include:

     (((i))) (a) Leaves of absence or withdrawal, temporary or permanent, from the nursing educational program.

     (((ii))) (b) Students enrolled in nursing department classes who are solely enrolled in academic nonnursing supporting course work, whether or not those courses are required for the nursing degree.

     (((iii))) (c) Students who are awaiting the opportunity to reenroll in nursing courses.

     (4) Good standing means the nursing technician is successfully passing all courses required for the registered nursing degree. The nursing program should notify the commission immediately if the nursing technician is no longer in good standing.

     (5) Applicants must complete seven clock hours of AIDS education as required by RCW 70.24.270 and chapter 246-12 WAC, Part 8.

[Statutory Authority: RCW 18.79.160. 97-17-049, § 246-840-860, filed 8/15/97, effective 9/15/97.]

     (1) Shall function only under the direct supervision of ((the)) a registered nurse who has agreed to act as supervisor and is immediately available.

     (2) May gather information about patients and administer care to patients.

     (3) Shall not be responsible for performing the ongoing assessment, planning, implementation, and evaluation of the care of patients.

     (4) Shall never function as an independent practitioner, as a team leader, charge nurse, or in a supervisory capacity.

     (5) ((May administer medications only under the direct supervision of a registered nurse and within the limits described in this section. "Direct supervision" means that the registered nurse is on the premises, is quickly and easily available, and that the patients have been assessed by the registered nurse prior to the delegation of the medication duties to the nursing technician.)) The nursing technician shall not administer chemotherapy, blood or blood products, intravenous medications, scheduled drugs, nor carry out procedures on central lines.

     ((There shall be written documentation from the nursing education program attesting to the nursing technician's preparation in the procedures of medication administration.))

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-870, filed 6/18/97, effective 7/19/97.]

     (1) Is accountable at all times for the client's safety and well-being.

     (2) Is responsible at all times for the nursing process as delineated in WAC 246-840-700 and this responsibility cannot be delegated.

     (3) Shall maintain at all times an awareness of the care activities of the nursing technician and of the current assessment of the patient.

     (((4) Shall be available at all times to the nursing technician and shall be physically present within the health care facility.))

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-880, filed 6/18/97, effective 7/19/97.]

     (7) Identify the student nurse as a "nursing technician.")) (1) An individual shall complete an application for registration on an application form prepared and provided by the department of health.

     (2) Every applicant shall provide:

     (a) The application fee as defined in WAC 246-980-990.

     (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 sent directly from the applicant's nursing program. If the applicant has not yet graduated, this statement will include the anticipated graduation date.

     (d) A signed statement sent directly 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 chapter 258, Laws of 2003.

[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-890, filed 6/18/97, effective 7/19/97.]

     The following section of the Washington Administrative Code is repealed:

WAC 246-840-900

Responsibilities of the nurse administrator.

© Washington State Code Reviser's Office