DEPARTMENT OF HEALTH

(Nursing Care Quality Assurance Commission)

[Filed November 28, 2018, 3:18 p.m.]

Preproposal statement of inquiry was filed as WSR 18-08-018.

Title of Rule and Other Identifying Information: WAC 246-840-533 Nursing preceptors, interdisciplinary preceptors, and proctors in clinical or practice settings for nursing education programs located in Washington state. The nursing care quality assurance commission (commission) proposes amendments to existing rule that will provide rule clarification and reduce barriers for nursing student access to preceptors for the purpose of completing clinical experience. The proposed amendments also reduce barriers for qualified individuals to become preceptors and proctors in Washington state.

Hearing Location(s): On January 11, 2019, at 1:15 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, 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: The commission proposes amendments to WAC 246-840-533 in response to concerns expressed through a petition for rule making. The commission evaluated all concerns during rules workshops with stakeholders and determined necessary amendments to the rule that will likely result in improved access for nursing students to complete clinical experience with a preceptor or proctor. The proposed amendments to WAC 246-840-533 establish minimum qualifications for preceptors and proctors when utilized in nursing education programs.

The proposed amendments to WAC 246-840-533 would improve nursing student access to qualified preceptors for the purpose of gaining clinical nursing experience and reduce barriers for qualified individuals to act as a preceptor. Improving access to clinical experiences, prior to graduating from a nursing education program, contributes to better prepared nurses upon licensure and the protection of the public. A nursing shortage within the health care system has been occurring at the state and national levels over the last several years. The proposed amendments to the rule would assist in addressing the nursing shortage by more rapidly increasing the pool of qualified nurses in the state.

Reasons Supporting Proposal: The proposed amendments to WAC 246-840-533 would improve nursing student access to qualified preceptors and proctors for the purpose of gaining clinical nursing experience and reduce barriers for qualified individuals to act as a preceptor or proctor. Reducing barriers and improving access to clinical experiences, prior to graduating from a nursing education program, contributes to better prepared nurses upon licensure and ultimately, safety of the public. The commission does not require nursing education programs to utilize preceptor and proctor clinical experiences for nursing students, but many nursing education programs find these experiences to be invaluable. The current nursing shortage has negatively affected the nursing education program staffing levels and the availability of clinical nurse educators. Preceptor and proctor clinical experiences help fill the gap and provide students with an opportunity to learn from individuals currently working in the health care field. Since preceptors and proctors are not educationally and experientially prepared as faculty, minimum qualification standards determined by the commission help protect the public. The proposed amendments also improve clarity by adding definitions and strengthening language to reduce confusion regarding preceptor and proctor qualifications when used in nursing education programs.

Statutory Authority for Adoption: RCW 18.79.110.

Statute Being Implemented: RCW 18.79.110.

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.

Paula R. Meyer, MSN, RN, FRE

Nursing Care Quality

Assurance Commission

AMENDATORY SECTION(Amending WSR 16-17-082, filed 8/17/16, effective 9/17/16)

WAC 246-840-533Nursing preceptors, interdisciplinary ((mentors))preceptors, and proctors in clinical or practice settings for nursing ((education programs))students located in Washington state.

(1) Nursing preceptors, interdisciplinary preceptors, and proctors may be used to enhance clinical or ((practice-learning))practice learning experiences after a student has received instruction and orientation from program faculty who ((assure))confirm the student is adequately prepared for the clinical or practice experience((.

(2) Nursing education faculty in prelicensure nursing education programs shall not assign more than two students to each nurse preceptor.

(3) Nursing education faculty in a program leading to licensure as an advanced registered nurse practitioner shall not assign more than one student to each preceptor)). For the purpose of this section:

(a) A nursing preceptor means a practicing licensed nurse who provides personal instruction, training, and supervision to a nursing student or graduate nurse, and meets all requirements of subsection (4) of this section.

(b) An interdisciplinary preceptor means a practicing health care provider who is not a licensed nurse, but provides personal instruction, training, and supervision to a nursing student or graduate nurse, and meets all requirements of subsection (5) of this section.

(c) A proctor means an individual who holds an active credential in one of the professions identified in RCW 18.130.040 who monitors students during an examination, skill, or practice delivery, and meets all requirements of subsection (6) of this section.

(2) Nursing education faculty are responsible for the overall supervision and evaluation of the student and must confer with each nursing and interdisciplinary preceptor, and student at least once during each phase of the student learning experience:

(a) Beginning;

(b) Midpoint; and

(3) A nursing preceptor or an interdisciplinary preceptor shall not precept more than two students at any one time.

(4) A nursing preceptor may be used in ((practical and registered)) nursing education programs when the nursing preceptor:

(a) Has an active, unencumbered nursing license at or above the level for((,)) which the student is preparing;

(b) ((Is experienced in the specialty area for at least two years;))Has at least one year of clinical or practice experience as a licensed nurse at or above the level for which the student is preparing;

(d) Is ((not related to, or a personal friend of the student))oriented to the written role expectations of faculty, preceptor, and student prior to beginning the preceptorship; and

(e) Is ((oriented to the written role expectations of faculty, preceptor, and student))not a member of the student'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 preceptor's duties to impartially supervise and evaluate the nurse.

(5) ((A))An interdisciplinary preceptor may be used in nursing education programs ((leading to licensure as an advanced registered nurse practitioner)) when the interdisciplinary preceptor:

(a) Has an active, unencumbered license ((as an ARNP under chapter 18.79 RCW, a physician under chapter 18.71 RCW, an osteopathic physician under chapter 18.57 RCW, or equivalent license in other states or jurisdictions;

(b) Is experienced in the specialty area for at least two years))in the area of practice appropriate to the nursing education faculty planned student learning objectives;

(b) Has the educational preparation and at least one year of clinical or practice experience appropriate to the nursing education faculty planned student learning objectives;

(d) Is ((not related to, or a personal friend of the student))oriented to the written role expectations of faculty, preceptor, and student prior to beginning the preceptorship; and

(e) Is ((oriented to the written role expectations of faculty, preceptor, and student.

(6) A preceptor may be used in graduate nursing programs as appropriate to the course of study when the preceptor:

(a) Is experienced in the specialty area for at least two years;

(b) Is oriented to the written course and student learning objectives;

(d) Is oriented to the written role expectations of faculty, preceptor, and student.

(7) An interdisciplinary mentor who has experience and educational preparation appropriate to the faculty planned student learning experience may be used in some clinical or practice experiences.

(8) Faculty are responsible for the overall supervision and evaluation of the student and must confer with each preceptor or interdisciplinary mentor and student at least once before the student learning experience, at the mid-point of the experience, and at the end of the learning experience.

(9)))not a member of the student'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 preceptor's duties to impartially supervise and evaluate the nurse.

(6) A proctor who monitors, teaches, and supervises students during the performance of a task or skill must ((be qualified with)):

(a) Have the educational and experiential preparation ((in the area))for the task or skill being proctored ((and must be credentialed as a licensed health care provider listed in chapter 18.130 RCW. Such a person may));

(b) Have an active, unencumbered credential in one of the professions identified in RCW 18.130.040;

(c) Only be used on rare, short-term occasions to proctor students when a faculty member has determined that it is safe for a student to receive direct supervision from the proctor for the performance of a particular task or skill that is within the scope of practice for the nursing student; and

(d) Is not a member of the student'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 preceptor's duties to impartially supervise and evaluate the nurse.