WSR 18-24-049

PROPOSED RULES

DEPARTMENT OF HEALTH

(Nursing Care Quality Assurance Commission)

[Filed November 28, 2018, 3:14 p.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 18-06-009.

Title of Rule and Other Identifying Information: WAC 246-840-035, 246-840-048, 246-840-340, 246-840-342, 246-840-344, 246-840-360, 246-840-365 and 246-840-367, interim permits for nontraditional nursing students and advanced registered nurse practitioners (ARNP) needing to complete clinical practice hours necessary for licensure. The nursing care quality assurance commission (commission) proposes permanently adopting the current emergency rule adopted on December 15, 2017, in WSR 18-01-079 regarding interim permits for graduates of nontraditional nursing education programs. In addition, the commission proposes amendments to existing rules to establish interim permits for ARNP applicants to allow for the completion of supervised clinical practice hours.

Hearing Location(s): On January 11, 2019, at 3:00 p.m., at the Department of Health, Point Plaza East, Room 152/153, 310 Israel Road S.E., Tumwater, WA 98501.

Date of Intended Adoption: January 11, 2019.

Submit Written Comments to: Amber Zawislak-Bielaski, P.O. Box 47864, Olympia, WA 98504-7864, email https://fortress.wa.gov/doh/policyreview, fax 360-236-4738, 360-236-4785, by January 2, 2019.

Assistance for Persons with Disabilities: Contact Amber Zawislak-Bielaski, phone 360-236-4785, fax 360-236-4738, TTY 360-833-6388 or 711, email amber.zawislak@doh.wa.gov, by January 2, 2019.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: RCW 18.79.380 Licensed practical nurse/nontraditional registered nurse program, was repealed by HB 1721 (chapter 203, Laws of 2017). The prior law allowed graduates of registered nurse (RN) programs, who did not complete clinical practice instruction during their degree program, to practice under the license of a preceptor RN to gain those clinical hours. With the repeal of RCW 18.79.380, a student currently enrolled in a nontraditional program can no longer practice under the license of another nurse, therefore no mechanism exists for these students to complete the required clinical practice experience to become licensed as an RN in Washington. The commission adopted an emergency rule on December 15, 2017 (WSR 18-01-079), to repeal WAC 246-840-035, since it is no longer authorized in statute, and to establish standards to ensure a student is able to complete the required clinical practice experience.

The commission is proposing to adopt emergency WAC 246-840-048 as a permanent rule, with minor amendments. The proposed rule protects the public by assuring graduates of nontraditional programs have adequate clinical practice prior to licensure. The rules also allow nurses in practice to continue to advance their career, which will contribute to improved public protection.

In addition, the commission is proposing amendments to WAC 246-840-340, 246-840-342, 246-840-344, 246-840-360, 246-840-365, and 246-840-367 to establish interim permits for ARNP applicants to allow for completion of supervised clinical practice hours.

Currently, ARNP applicants who graduated more than one year prior to applying for licensure by examination and ARNP applicants who are unable to demonstrate proof of having worked two hundred fifty hours of active clinical practice upon renewal, reactivation, or endorsement, must obtain supervised clinical practice hours. Existing rules require ARNP applicants to submit a supervised practice agreement and work under their RN license to obtain the required clinical practice hours. ARNP interim permits would allow these applicants to practice at the full scope of an ARNP while obtaining required clinical practice hours, instead of working under their RN license outside of the intended scope of practice.

Reasons Supporting Proposal: The commission determined that proposed WAC 246-840-048 was needed because without it, students of nontraditional nursing education programs would have no method of completing clinical practice hours required for licensure in Washington state. Adopting emergency WAC 246-840-048 as a permanent rule would provide students, who have recently graduated from nontraditional RN nursing education programs, with an ongoing mechanism for completing required clinical practice experience prior to licensure. Clinical practice experience is a mandatory component of nursing prelicensure to ensure students are competent in the provision of direct patient care.

Proposed amendments to WAC 246-840-340, 246-840-342, 246-840-344, 246-840-360, 246-840-365, and 246-840-367 meet the intent of RCW 18.79.010 by establishing mechanisms for ARNP applicants to meet the qualifications for licensure and continuing competency. ARNP applicants applying for initial licensure by examination in Washington state are required to apply within one year of graduating from an advanced nursing education program. If the ARNP applicant does not apply for licensure within the first year following graduation, the ARNP applicant must complete one hundred twenty-five hours of supervised clinical practice in the role of an ARNP, for each year following graduation. Additionally, all ARNPs in Washington are required to attest to having completed two hundred fifty hours of clinical practice as an ARNP every two years. Current rules require ARNP applicants who are noncompliant with the clinical practice hour requirement, to complete supervised practice under the scope of their active RN license.

Instituting the use of interim permits, for the purpose of completing required clinical practice hours for initial licensure, renewal, and reactivation, would provide applicants with a mechanism for completing clinical practice hours under the correct licensure scope of practice. Individuals holding an interim permit are also subject to the Uniform Disciplinary Act found in chapter 18.130 RCW.

Statutory Authority for Adoption: RCW 18.79.110.

Statute Being Implemented: RCW 18.79.110 and 18.79.180.

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

Name of Proponent: Washington state nursing care quality assurance commission, governmental.

Name of Agency Personnel Responsible for Drafting and Implementation: Amber Zawislak-Bielaski, 111 Israel Road S.E., Tumwater, WA 98504, 360-236-4785; and Enforcement: Catherine Woodard, 111 Israel Road S.E., Tumwater, WA 98504, 360-236-4757.

A school district fiscal impact statement is not required under RCW 28A.305.135.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Amber Zawislak-Bielaski, P.O. Box 47864, Olympia, WA 98504, phone 360-236-4785, fax 360-236-4738, TTY 360-833-6388 or 711, email amber.zawislak@doh.wa.gov.

The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The NAICS code for ARNPs, LPNs, and RNs is 621399, and was used to calculate industry threshold which is one percent of annual payroll. The total $13,992,420,000.00 annual payroll from the NAICS table was multiplied by one percent of the result [and] was used as threshold for the industry as follows: (13,992,420,000)*(0.01) = $13,992,420. There are no estimated costs for this rule, which falls below the NAICS threshold of $13,992,420. It was determined that a small business economic impact statement was not required.

November 28, 2018

Paula R. Meyer, MSN, RN, FRE

Executive Director

Nursing Care Quality

Assurance Commission

NEW SECTION

WAC 246-840-048Students enrolled in a nontraditional nursing program.

This section applies to a licensed practical nurse (LPN) enrolled in a nontraditional LPN to registered nurse (RN) program on July 27, 2017, and describes the eligibility requirements for obtaining a Washington state interim permit.

(1) Graduates of a nontraditional nursing program may apply for an interim permit after degree confirmation by the nontraditional program.

(a) An LPN enrolled in a nontraditional nursing program on July 27, 2017, has until July 27, 2020, to complete the nontraditional program, as defined in WAC 246-840-010.

(b) An LPN successfully completing a nontraditional nursing program after July 27, 2020, may obtain licensure by endorsement in Washington state after completing one thousand hours of practice under an RN license in another state, without discipline.

(2)(a) An LPN successfully completing the nontraditional nursing program and passing the National Council of State Boards of Nursing Registered Nurse Licensing Examination (NCLEX-RN®) may be eligible to receive an interim permit for the purpose of completing one thousand hours of practice experience in the role of an RN.

(b) Only students licensed as an LPN in Washington state and identified by the nontraditional program on July 27, 2017, will be considered eligible to obtain initial licensure from the commission under this section.

(3) An LPN successfully completing a nontraditional nursing program as identified in subsection (2)(b) of this section shall:

(a) Submit a completed RN application indicating the need for an interim permit with the required fee, as defined in WAC 246-840-990;

(b) Request an official transcript be sent directly to the commission from the nontraditional nursing education program confirming a conferred associate degree in nursing;

(c) Successfully pass the National Council of State Boards of Nursing Registered Nurse Licensing Examination (NCLEX-RN®);

(d) Complete one thousand hours of practice under an interim permit in the role of an RN; and

(e) Provide documented evidence from a commission approved supervising licensed RN verifying the interim permit holder successfully completed the one thousand hours of practice in an RN role.

(4) The supervising RN from the acute care, skilled nursing, or transitional care facility:

(a) Shall submit a commission approved application;

(b) Must have an active, unencumbered RN license;

(d) Must have at least three years of experience as an RN;

(e) Must have demonstrated teaching and mentoring skills; and

(f) Must be able to evaluate, with input from others, the practice of the interim permit holder in the role of an RN.

(5) The interim permit expires one year after the submission of the application and is not renewable.

(6) An interim permit holder who does not successfully fulfill the practice requirements, as identified in subsection (3)(c) and (d) of this section, does not meet the requirements for licensure by examination as an RN in the state of Washington.

(7) The holder of the interim permit is subject to disciplinary action under chapter 18.130 RCW.

REPEALER

The following section of the Washington Administrative Code is repealed:

WAC 246-840-035

Initial licensure for registered nurses—Out-of-state nontraditional nursing education program approved by another United States nursing board as defined by WAC 246-840-010(16).

AMENDATORY SECTION(Amending WSR 16-08-042, filed 3/30/16, effective 4/30/16)

WAC 246-840-340Initial ARNP requirements.

(1) An applicant for licensure as an ARNP ((must))shall have the following qualifications:

(a) An active Washington state RN license, without sanctions or restrictions;

(b) A graduate degree from an advanced nursing education program accredited by a national nursing accreditation body recognized by the United States Department of Education;

(d) Completion of advanced clinical practice hours, as defined in WAC 246-840-010(1) and in the role of an advanced practice nurse as defined in WAC 246-840-010(2), when applicable, in situations under subsection (3) of this section.

(2) An applicant for ARNP licensure ((must))shall submit:

(a) A completed ARNP application for licensure to the commission;

(b) The license fee as specified in WAC 246-840-990;

(c) A request to the certifying body, as identified in WAC 246-840-302, to send official documentation of certification directly to the commission;

(d) A request to the advanced nursing educational program to send an official transcript directly to the commission showing courses, grades, degree or certificate granted, official seal, and appropriate registrar; and

(e) Program objectives and course descriptions when requested by the commission.

(3) To be granted a license without meeting the advanced clinical practice requirements identified in subsection (4) of this section, the ARNP shall initiate the application process within one year of earning a graduate degree from an advanced nursing education program.

(4) An ARNP applicant who does not apply within one year of earning a graduate degree from an advanced nursing education program ((must complete))may be eligible to receive an ARNP interim permit for the purpose of completing one hundred twenty-five hours of advanced clinical practice for ((each))every additional year following graduation, not to exceed one thousand hours. The ARNP interim permit expires one year after the submission of the application.

(a) An ARNP applicant's clinical practice must be supervised by an ARNP under chapter 18.79 RCW, a physician licensed under chapter 18.71 RCW, an osteopathic physician licensed under chapter 18.57 RCW, or equivalent licensure in another state or United States jurisdiction. The ARNP interim permit holder must complete supervised advanced clinical practice as defined in subsections (((3) through))(4) and (5) of this section.

(b) The supervisor must be in the same practice specialty in which the applicant is seeking licensure. The supervising ARNP or physician ((must)):

(i) Shall have an active ARNP or physician license, for two or more years, without sanctions or restrictions((, for two or more years));

(ii) ((Not be a relative of the applicant;

(iii) Not have a personal or financial relationship with the applicant;

(iv)))Must not be a member of the applicant's immediate family, as defined in RCW 42.17A.005(27); or have a financial, business, or professional relationship that is in conflict with the proper discharge of the supervisor's duties to impartially supervise and evaluate the nurse;

(iii) Must not have current disciplinary action on their license;

(((v) Submit a written evaluation to the commission))(iv) Shall submit documented evidence to the commission verifying the applicant's successful completion of the required supervised clinical practice hours ((and that the applicant's knowledge and skills are at a safe and appropriate level to practice as an ARNP))in an ARNP role.

(5) An ARNP applicant needing to complete supervised advanced clinical practice ((must)):

(a) Shall meet the requirements of subsection (1)(a) and (b) of this section; ((and

(b) Have commission approval for the following:

(i) The clinical site in which the supervision will take place; and

(ii) The supervising ARNP or physician.

(6) The nursing commission may request additional evidence supporting the applicant's completion of advanced clinical practice hours for the purposes of this section. The commission reserves the right to conduct on-site visits.

(7) The nurse will not use the designation ARNP during the time))

(b) Shall indicate on the ARNP application the need for an interim permit; and

(i) Commission approval of the supervising ARNP or physician; and

(ii) The interim permit.

(6) The nurse must use the designation interim ARNP at all times and on all documentation of the supervised clinical practice hours.

(((8)))(7) An applicant holding an active RN license, without sanctions or restrictions((,)); and current national certification as a CNS((,)); and is practicing in Washington state in an advanced nursing role, will be exempt from the supervised practice requirement if they can provide evidence of two hundred fifty hours of advanced clinical practice within the last two years.

AMENDATORY SECTION(Amending WSR 16-08-042, filed 3/30/16, effective 4/30/16)

WAC 246-840-342Licensure for ARNP applicants by interstate endorsement.

(1) An applicant for interstate endorsement for Washington state licensure as an ARNP ((must))shall meet the following requirements:

(a) Have an active RN and ARNP license, or recognition in another state or jurisdiction, as practicing in an advanced practice role, without sanctions or restrictions;

(b) Have a graduate degree from an advanced nursing education program as identified in WAC 246-840-340 (1)(b);

(d) Have been performing advanced clinical practice as defined in WAC 246-840-010(1) as a licensed ARNP, or in the role of an advanced practice nurse as defined in WAC 246-840-010(2), for at least two hundred fifty hours within the two years prior to the date of application.

(2) An applicant for an ARNP license through interstate endorsement ((must))shall:

(a) Apply for and be granted a Washington state RN license as identified in WAC 246-840-090;

(b) Submit a completed ARNP application for licensure to the commission;

(d) Request the certifying body, as identified in WAC 246-840-302, to send official documentation of certification directly to the commission;

(e) Request the advanced nursing educational program to send an official transcript directly to the commission showing courses, grades, degree or certificate granted, official seal and appropriate registrar;

(f) Submit nursing education program objectives and course descriptions when requested by the commission; and

(g) Submit evidence of at least two hundred fifty hours of advanced clinical practice as an ARNP, or at an advanced nursing practice level, within the two years prior to the date of application. The two hundred fifty hours may include teaching advanced nursing practice if ((the faculty member is)) providing direct patient care as a faculty member or serving as a preceptor in a clinical setting.

(3) An ARNP applicant who does not meet practice requirements ((must))shall complete two hundred fifty hours of supervised advanced clinical practice for ((each))every two years the applicant may have been out of practice, not to exceed one thousand hours.

(4) An ARNP applicant needing to complete the supervised advanced clinical practice ((must meet))shall obtain an ARNP interim permit consistent with the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).

AMENDATORY SECTION(Amending WSR 16-08-042, filed 3/30/16, effective 4/30/16)

WAC 246-840-344Licensure for ARNP applicants educated and licensed outside the United States.

(1) An applicant for ARNP licensure in Washington state, educated and licensed outside the United States, ((must))shall:

(a) Apply for and be granted an active RN license, or recognition in another state or jurisdiction, without sanctions or restrictions, issued by a regulatory entity outside the United States, and have been practicing at an advanced practice level;

(b) Submit a course-by-course evaluation of education from a commission approved credential evaluating service verifying the advanced nursing educational program completed by the applicant is equivalent to the ARNP education identified in WAC 246-840-455;

(d) Have been performing advanced clinical practice in his or her country for at least two hundred fifty hours within the two years prior to the date of application for ARNP licensure.

(2) ((The))An applicant educated and licensed outside of the United States ((must))shall:

(a) Apply for and be granted a Washington state RN license, without sanctions or restrictions, as identified in WAC 246-840-045;

(b) Submit a completed ARNP application to the commission;

(d) Submit a course-by-course evaluation of education completed from a commission approved credential evaluating service;

(e) Request the certifying body, as identified in WAC 246-840-302(3), to send official documentation of certification directly to the commission; and

(f) Submit evidence of at least two hundred fifty hours of advanced clinical practice as an ARNP, or in an advanced practice role, within the two years prior to the date of application. The two hundred fifty hours may include teaching advanced nursing practice if ((the faculty member is)) providing direct patient care as a faculty member or serving as a preceptor in a clinical setting.

(3) Internationally educated ARNP applicants who do not meet advanced clinical practice requirements ((must))shall complete two hundred fifty hours of supervised advanced clinical practice for ((each))every two years the applicant may have been out of practice, not to exceed one thousand hours.

(4) ((The))An ARNP applicant needing to complete supervised advanced clinical practice ((must meet))shall obtain an ARNP interim permit consistent with the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).

AMENDATORY SECTION(Amending WSR 16-08-042, filed 3/30/16, effective 4/30/16)

WAC 246-840-360Renewal of ARNP licensure.

(1) An applicant applying for ARNP license renewal, ((must))shall have:

(a) An active Washington state RN license, without sanctions or restrictions;

(b) Current certification from a certifying body as identified in WAC 246-840-302;

(c) ((Obtained))Thirty contact hours of continuing education obtained during the renewal period in each ARNP designation. An ARNP who has certification in more than one area of practice may count the continuing education hours for more than one certification when applicable to each area of practice; and

(d) ((Practiced for))At least two hundred fifty hours in advanced clinical practice for each ARNP designation within the two-year licensing renewal cycle. The two hundred fifty hours may include teaching advanced nursing practice only when the faculty member is providing patient care or serving as a preceptor in a clinical setting.

(2) An applicant for ARNP licensure renewal ((must))shall comply with the requirements of chapter 246-12 WAC, Part 2 and submit:

(a) The renewal license fee as specified in WAC 246-840-990; ((and))

(b) Evidence of current certification by the commission approved certifying body for each designation;

(i) Completion of thirty contact hours of continuing education during the renewal period for each ARNP designation; and

(ii) Completion of a minimum of two hundred fifty hours of advanced clinical practice for each designation in the ARNP role within the last two years.

(d) Evidence of completion of continuing education contact hours and advanced clinical practice hours when requested by the commission.

(3) An applicant for ARNP licensure renewal who does not meet advanced clinical practice requirements shall complete two hundred fifty hours of supervised advanced clinical practice for every two years the applicant may have been out of practice, not to exceed one thousand hours.

(4) An applicant for ARNP licensure renewal needing to complete supervised advanced clinical practice shall obtain an ARNP interim permit consistent with the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).

AMENDATORY SECTION(Amending WSR 16-08-042, filed 3/30/16, effective 4/30/16)

WAC 246-840-365Inactive and reactivating an ARNP license.

To apply for an inactive ARNP license, an ARNP ((must))shall comply with WAC 246-12-090 or 246-12-540, ((as appropriate))if military related.

(1) An ARNP may apply for an inactive license if he or she holds an active Washington state ARNP license without sanctions or restrictions.

(2) To return to active status the ((nurse must))ARNP:

(a) Shall meet the requirements identified in chapter 246-12 WAC, Part 4;

(b) Must hold an active RN license under chapter 18.79 RCW without sanctions or restrictions;

(d) Shall submit evidence of current certification by the commission approved certifying body identified in WAC 246-840-302(1);

(e) Shall submit evidence of thirty contact hours of continuing education for each designation within the past two years; and

(f) Shall submit evidence of two hundred fifty hours of advanced clinical practice for each designation within the last two years.

(3) An ARNP applicant who does not have the required practice requirements, ((must))shall complete two hundred fifty hours of supervised advanced clinical practice for ((each))every two years the applicant may have been out of practice, not to exceed one thousand hours.

(4) The ARNP applicant needing to complete supervised advanced clinical practice ((must meet))shall obtain an ARNP interim permit consistent with the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).

(5) To regain prescriptive authority after inactive status, the applicant must meet the prescriptive authority requirements identified in WAC 246-840-410.

AMENDATORY SECTION(Amending WSR 16-08-042, filed 3/30/16, effective 4/30/16)

WAC 246-840-367Expired license.

When an ARNP license is not renewed, it ((will be))is placed in expired status and the nurse must not practice as an ARNP.

(1) To return to active status when the license has been expired for less than two years, the nurse ((must))shall:

(a) Meet the requirements of chapter 246-12 WAC, Part 2;

(b) Meet ARNP renewal requirements identified in WAC 246-840-360; and

(2) Applicants who do not ((meeting))meet the required advanced clinical practice requirements must complete two hundred fifty hours of supervised advanced clinical practice for ((each))every two years the applicant may have been out of practice, not to exceed one thousand hours.

(((2)))(3) The ARNP applicant needing to complete supervised advanced clinical practice ((must meet))shall obtain an ARNP interim permit consistent with the requirements for supervised practice defined in WAC 246-840-340 (4) and (5).

(((3)))(4) If the ARNP license has expired for two years or more, the applicant ((must))shall:

(a) Meet the requirements of chapter 246-12 WAC, Part 2;

(b) Submit evidence of current certification by the commission approved certifying body identified in WAC 246-840-302(3);

(c) Submit evidence of thirty contact hours of continuing education for each designation within the ((past))prior two years;

(d) Submit evidence of two hundred fifty hours of advanced clinical practice completed within the ((past))prior two years; and

(e) Submit evidence of an additional thirty contact hours in pharmacology if requesting prescriptive authority, which may be granted once the ARNP license is returned to active status.

(((4)))(5) If the applicant does not meet the required advanced clinical practice hours, ((he or she must complete)) the applicant shall obtain an ARNP interim permit consistent with the requirements for supervised advanced clinical practice as defined in WAC 246-840-340 (4) and (5).