Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: An effective date of June 11, 2004, is necessary as allowed under RCW 34.05.380(3). There is an emergency clause in chapter 258, Laws of 2003. Emergency rules are in place and will expire on June 11, 2004.

     Purpose: Adopt rules to implement chapter 258, Laws of 2003, requiring registration of nursing technicians. This amends current rules and adds new section WAC 246-840-905 How to register as a nursing technician. Emergency rules currently in place are due to expire on June 11, 2004.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-840-010, 246-840-840, 246-840-850, 246-840-860, 246-840-870, 246-840-880, 246-840-890 and 246-840-900.

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

      Adopted under notice filed as WSR 04-09-057 on April 16, 2004.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 8, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 8, Repealed 0.

     Date Adopted: June 11, 2004.

June 11, 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.]

     (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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