PROPOSED RULES
(Nursing Care Quality Assurance Commission)
Original Notice.
Preproposal statement of inquiry was filed as WSR 03-12-087.
Title of Rule: Amending WAC 246-840-010, 246-840-840, 246-840-850, 246-840-860, 246-840-870, 246-840-880, 246-840-890, 246-840-900 and adding new section WAC 246-840-905 Nursing technician registration.
Purpose: To implement chapter 258, Laws of 2003, requiring registration of nursing technicians.
Other Identifying Information: The proposal allows registration of nursing technicians which provides nursing students work related opportunities. The authorizing legislation contained an emergency clause and emergency rules have been in place since June 18, 2003.
Statutory Authority for Adoption: RCW 18.79.340(3).
Statute Being Implemented: Chapter 18.79 RCW.
Summary: The new law requires registration of nursing technicians. The proposal establishes an application process to register nursing technicians. The proposal includes AIDS education which is required for all health care registrations, certifications, and/or licenses. The proposal amends current rules so that the definition of nursing technician, the criteria for nursing technician, and the functions of the nursing technician will be consistent with the law. In addition, "good cause," as used in the new law, will be defined.
Reasons Supporting Proposal: The proposal provides an opportunity for nursing students to gain work related experience that will improve their skills. The proposal also allows nursing homes and hospitals to hire nursing technicians, and providing more staff to care for more patients.
Name of Agency Personnel Responsible for Drafting: Kendra Pitzler, P.O. Box 47864, Olympia, WA 98504-7864, (360) 236-4723; Implementation: Valerie Zandell, P.O. Box 47864, Olympia, WA 98504-7864, (360) 236-4708; and Enforcement: Shellie Carpenter, P.O. Box 47864, Olympia, WA 98504-7864, (360) 236-4744.
Name of Proponent: Department of Health, Nursing Care Quality Assurance Commission, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The new law requires registration of nursing technicians. The proposal establishes an application process to register nursing technicians. The proposal includes AIDS education which is required for all health care registration, certifications, and/or licenses. The proposal amends current rules including definition of nursing technician, the criteria for nursing technician, and the functions of the nursing technician to be consistent with the new law. In addition, "good cause," as used in the new law, will be defined. There is currently a nursing shortage. The proposal allows nursing homes and hospital to hire nursing technicians, and providing more staff to care for more patients during this time of nursing shortage.
Proposal Changes the Following Existing Rules: WAC 246-840-010, the proposal defines the terms "good cause," "good standing," "immediately available," and "nursing technician." The proposal deletes the term "nursing aide."
WAC 246-840-840, the proposal amends this section by clarifying the nursing technician's role in hospitals and nursing homes.
WAC 246-840-850, the proposal amends this section which limits the title of nursing technicians to those individuals that meet the definition in WAC 246-840-010.
WAC 246-840-860, the proposal amends the criteria that students must meet to qualify as a nursing technician to clarify the applicability of the rule to individuals who have recently graduated and add the ADIS [AIDS] education requirement.
WAC 246-840-870, the proposal clarifies the tasks, function, and supervision of nursing technicians.
WAC 246-840-880, the proposal clarifies the requirements for individuals who supervise nursing technicians.
WAC 246-840-890, the proposal amends the function requirements for facilities employing nursing technicians.
WAC 246-840-900, the proposal sets out the functions for the nursing program in which the nursing technician is enrolled.
No small business economic impact statement has been prepared under chapter 19.85 RCW. Those parts of the rule that are not explicitly dictated by statute do not impose more than minor costs on affected businesses. In particular, WAC 246-840-860(1) specifies that nursing technicians must have completed at least one academic term of a nursing program that includes clinical training; this does not impose more than minor costs on affected businesses because students without any clinical training are unlikely to be able to function effectively as nursing technicians.
Before the Nursing Commission followed through on its plans to repeal these rules based on the AAG's advice, the interest groups went to the legislature. The groups explained that it would hurt their industries if they were not allowed to hire "nursing students" as nursing technicians and requested legislation to allow registration of nursing technicians. The legislature passed such a bill this past session, effective May 12, 2003.
The Nursing Commission is currently registering nursing technicians per emergency rules. The emergency rules are derived from both the old rules the AAG advised repealing and the legislation passed in May. The permanent rules also result from both language in the old rules and the legislation passed in May.
Neither the old rules nor the emergency rules that currently register nursing technicians are considered permanent rules in Washington state. No previous SBEIS is relevant because past rules were not adopted properly and current rules are on an emergency situation.
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 impacts 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, and that has the purpose of making a profit, and that has fifty or fewer employees."
1. Briefly Describe the Proposed Rule: The proposed rule defines and regulates nursing technicians. Much of the rule follows state law (RCW 17.89.330 - [17.89].370).
2. Is a Small Business Economic Impact Statement (SBEIS) Required for this Rule? No. Much of the content of the proposed rule is explicitly dictated by statute. Those parts of the rule that are not explicitly dictated by statute do not impose more than minor costs on affected businesses. In particular, WAC 246-840-860(1) specifies that nursing technicians must have completed at least one academic term of a nursing program that includes clinical training; this does not impose more than minor costs on affected businesses because students without any clinical training are unlikely to be able to function effectively as nursing technicians.
3. Which Industries are Affected by this Rule? In preparing this small business economic impact statement (SBEIS), the Department of Health used the following SIC codes:
| SIC | Description | Minor Impact Threshold ($) |
| 8011 | Offices & clinics of medical doctor | 66.10 |
| 8051 | Skilled nurisng care facilities | 195.64 |
| 8062 | General medical & surgical hospital | 396.57 |
| SIC Industry Code and Title | No. of Businesses | No. of Employees | Average No. of Employees for Smallest Businesses | Average No. of Employees for 10% of Largest Businesses |
| 8011 Offices & clinics of medical doctor | 2821 | 43659 | 8 | 129 |
| 8051 Skilled nursing care facilities | 281 | 26407 | 15 | 144 |
| 8062 General medical & surgical hospital | 146 | 78593 | 11 | 2028 |
RCW 34.05.328 applies to this rule adoption. These rules require nursing technicians to be registered and to meet all the qualifications for registration which makes the rules significant.
Hearing Location: Department of Health, Point Plaza East, 310 Israel Road S.E., Olympia, WA 98501, on May 26, 2004, at 1:00 p.m.
Assistance for Persons with Disabilities: Contact Kendra Pitzler by May 19, 2004, TDD (800) 833-6388 or (360) 236-4723.
Submit Written Comments to: Kendra Pitzler, P.O. Box 47864, Olympia, WA 98504-7864, Kendra.Pitzler@doh.wa.gov, fax (360) 236-4738, by May 21, 2004.
Date of Intended Adoption: June 11, 2004.
April 6, 2004
Cheryl Payseno, Chair
Nursing Care
Quality Assurance Commission
OTS-6382.8
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)) means 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)) means 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)) means 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)) means 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 undue hardship such as difficulty scheduling the examination through no fault of their own, receipt of the examination results after thirty days after the nurse technician's date of graduation, or an unexpected family crisis which caused him or her to delay sitting for the examination. Failure of the examination is not "good cause."
(16) "Good standing" as applied to a nursing technician, means the nursing technician is enrolled in a registered nursing program approved by the commission and is successfully meeting all program requirements.
(17) "Immediately available" as applied to nursing technicians, means that a registered nurse who has agreed to act as supervisor is on the premises and is within audible range and available for immediate response as needed. This may include the use of two-way communication devices which allow conversation between the nursing technician and a registered nurse who has agreed to act as supervisor.
(a) In a hospital setting, a registered nurse who has agreed to act as supervisor is on the same patient care unit as the nursing technician and the patient has been assessed by the registered nurse prior to the delegation of duties to the nursing technician.
(b) In a nursing home setting, a registered nurse who has agreed to act as supervisor is in the same building and on the same floor as the nursing technician and the patient has been assessed by the registered nurse prior to the delegation of duties to the nursing technician.
(18) "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))) (19) "Minimum standards of competency" means the
functions that are expected of the beginning level nurse.
(((17))) (20) "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.)) (21) "Nursing technician" means a nursing student preparing for registered nurse licensure who is employed in a hospital licensed under chapter 70.41 RCW or a nursing home licensed under chapter 18.51 RCW, and who:
(a) Is currently enrolled in good standing and attending a nursing program approved by the commission and has not graduated; or
(b) Is a graduate of a nursing program approved by the commission who graduated:
(i) Within the past thirty days; or
(ii) Within the past sixty days and has received a determination that there is good cause to continue the registration period.
(c) Approved schools for nursing technicians include the list of registered nursing programs (schools) approved by state boards of nursing as preparation for the NCLEX registered nurse examination, and listed in the NCLEX bulletin as meeting minimum standards. Approved schools do not include nontraditional schools as defined in WAC 246-840-030(3).
(((20))) (22) "Philosophy" means the beliefs and
principles upon which the curriculum is based.
(((21))) (23) "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))) (24) "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))) (25) "Registered nurse" as used in these rules
shall mean a nurse as defined by RCW 18.79.030(1).
(((24))) (26) "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))) (27) "Standards" means the overall behavior
which is the desired outcome.
(((26))) (28) "Terminal objectives" means the statements
of goals which reflect the philosophy and are the measurable
outcomes of the total curriculum.
(((27))) (29) 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)) their authorization under
chapter 18.79 RCW and shall be responsible and accountable for
((practicing within the scope and guidelines of policies
defined by the employing agency.
(4))) the specific nursing functions which they can safely perform as verified by their nursing program.
(3) The nursing technician shall work directly for the
hospital or nursing home and may not be employed ((by)) in
these facilities through 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)) may
practice or represent oneself as a nursing technician by use
of any title or description of services without being
registered under chapter 18.79 RCW, unless otherwise exempted
by chapter 18.79 RCW.
[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; 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 ((will not be construed to)) does
not include:
(i) Leaves of absence or withdrawal, temporary or permanent, from the nursing educational program.
(ii) ((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))) 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.
[Statutory Authority: RCW 18.79.160. 97-17-049, § 246-840-860, filed 8/15/97, effective 9/15/97.]
(1) ((Shall)) May 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)) May not ((be responsible for performing
the)) assume ongoing responsibility for assessments, planning,
implementation, ((and)) or evaluation of the care of patients.
The nursing technician may participate in all aspects of the
nursing care process under the guidance of the registered
nurse and within the scope of the nursing technician's
education.
(4) ((Shall)) May never function ((as an independent
practitioner,)) independently, act as a ((team leader, charge
nurse, or in a supervisory capacity)) supervisor, or delegate
tasks to licensed practical nurses, nursing assistants, or
unlicensed personnel.
(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)) May 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.))
(6) May not perform any task or function that does not appear on the verification sent to the nursing technician's employer by the nursing program in which the nursing technician is enrolled. This document verifies that the nursing technician has demonstrated the ability and is safe to perform these tasks and functions. If the nursing technician is requested to perform any task not verified by the nursing program, the nursing technician must inform their supervisor that the task or function is not within their scope and must not perform the task.
[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/resident.
(4) Shall be immediately available at all times to the
nursing technician ((and shall be physically present within
the health care facility)).
(5) Shall have knowledge of the specific nursing functions the nursing technician is authorized to perform. The authorized functions appear on the verification sent to the nursing technician's employer by the nursing program in which the nursing technician is enrolled.
[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-880, filed 6/18/97, effective 7/19/97.]
(1) Verify the nursing technician's enrollment in a
nursing ((education)) program approved by the ((state board of
nursing or)) commission ((in the state in which the program is
located)).
(2) Verify ((satisfactory)) that the nursing technician
continues to qualify as a nursing technician and continues to
be in good standing within three weeks of completion of each
academic term (semester or quarter) ((within two weeks of
completion date)).
(3) Obtain and maintain written documentation of the
specific nursing functions that the nursing technician may
perform from the approved nursing ((education)) program ((of
the nursing technician's current level of education
preparation and his/her knowledge and skills)).
(4) ((Assign the nursing technician to perform only to
the level identified in subsection (3) of this section.))
Follow their own guidelines, policies, principles and
procedures relating to nursing technicians.
(5) ((Provide the nursing technician from an educational
program approved by a state board of nursing or commission
other than the Washington nursing commission with board
authorized information on the legal definition and parameters
of the nursing technician role, as in WAC 246-840-010(19) and
246-840-840 through 246-840-870. Such information shall be
provided prior to the commencement of patient care activities
by the nursing technician. The facility shall obtain written
verification from the nursing technician of receipt and review
of this information and the facility shall retain the written
verification for a minimum of three years from the last date
of employment.
(6) Advise the commission of the names and addresses of the nursing technician and the name and address of the nursing education program for any and all nursing technicians employed at the facility.
(7))) Identify the student nurse as a "nursing technician."
(6) Advise the department and nursing program of any practice-related action taken against the nursing technician. The employing facility shall notify the department at P.O. Box 47864, Olympia, Washington, 98504-7864.
(7) Provide training regarding the provisions of RCW 18.79.330 through 18.79.370 as specified in RCW 18.79.360 (4)(e).
[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-890, filed 6/18/97, effective 7/19/97.]
(1) Ensure that the nursing technician has been thoroughly oriented to the facility.
(2) Ensure that WAC 246-840-890 (3), (4), (5), (6), and (7) are accomplished prior to patient care assignments.
(3) Observe, evaluate, and document the skill level of the nursing technician in the administration of oral, intermuscular, and subcutaneous medication and nursing care skills.
(4) Convey in writing to all facility departments the scope within which the nursing technician may practice.
(5) Provide the supervising licensed registered nurse a written job description for the nursing technician.)) The nursing program in which the nursing technician is enrolled should:
(1) Provide to the employer written documentation of specific nursing functions the nursing technician may perform. This documentation should be based upon, and limited to, the nursing technician's education and demonstrated ability to safely perform the functions listed.
(2) Provide to the employer and the commission written documentation when a nursing technician is no longer considered to be in good standing as defined in WAC 246-840-010(16). The nursing program should notify the employer and the commission immediately if the nursing technician is no longer in good standing. Notification to the commission should be sent to P.O. Box 47864, Olympia, Washington, 98504-7864.
[Statutory Authority: Chapter 18.79 RCW. 97-13-100, § 246-840-900, filed 6/18/97, effective 7/19/97.]
(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) 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).
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