Title of Regulation: 18VAC90-19. Regulations Governing the Practice of Nursing (amending 18VAC90-19-120).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: December 13, 2017.

Effective Date: December 28, 2017.

Agency Contact: Jay P. Douglas, R.N., Executive Director, Board of Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4520, FAX (804) 527-4455, or email jay.douglas@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia establishes the general powers and duties of health regulatory boards, including the responsibility to promulgate regulations.

Purpose: Applicants who received their nursing education in another country are required to have a credentials review by the Commission on Graduates of Foreign Nursing Schools (CGFNS) and an examination of English proficiency. For applicants by endorsement, who have been licensed in another United States jurisdiction, those requirements may have already been met as qualification for licensure in the other jurisdiction. Therefore, it may be unnecessarily burdensome and create delays in licensure to repeat the credentials review and test of English proficiency. Verification from the jurisdiction that the qualification has been met is necessary.

Since assurance of completion of all educational and clinical requirements has already been verified by CGFNS, there is no risk of less competent nurses being granted a license. Public health and safety continues to be protected with assurance that a licensee has minimal competency to practice.

Rationale for Using Fast-Track Rulemaking Process: The amendment is less burdensome for all parties and will facilitate licensure by endorsement for certain applicants, and therefore, the Board of Nursing is confident that the rulemaking is noncontroversial and should be promulgated as a fast-track rulemaking action.

Substance: In examining its process for approval of applications by endorsement, staff has become aware that the requirement for a CGFNS credentials review and test of English proficiency may be duplicative of credentialing already performed by another state. The amendment will allow the board to waive requirements for a CGFNS credentials review and examination of English proficiency for a person whose nursing education was received in another country if the applicant has been licensed in another state and can provide evidence that those requirements were met for licensure in the other state.

Issues: The primary advantage of the amendment is an expedited process for licensure by endorsement of RNs and LPNs who are foreign trained and have been licensed and credentialed in another state. There are no disadvantages.

There is an advantage to the board because an attestation from the other state may eliminate the need for additional documents, which will result in less paperwork and more satisfied applicants. There are no disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. In regard to applying for licensure by endorsement, the Board of Nursing (Board) proposes to allow the waiving of a (new) credentials review by the Commission on Graduates of Foreign Nursing Schools (CGFNS) and examination of English proficiency for a person whose nursing education was received in another country if the applicant has been licensed in another state and she can provide evidence that those requirements were met for licensure in the other state.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. Applicants for nursing licensure by endorsement whose basic nursing education was received in another country must pass a CGFNS credentials review and a CGFNS-approved examination of English language proficiency.¹ The CGFNS review must show that the applicant's secondary education and nursing education are comparable to those required for registered nurses in the Commonwealth.² English proficiency can be demonstrated by achieving passing scores in either the TOEFL iBT³ or the IELTS exam.⁴

The Board proposes to waive the requirements for passing the CGFNS credentials review and a CGFNS-approved examination of English language proficiency if the applicant can provide evidence from another United States jurisdiction of passing: a) a CGFNS credentials evaluation for educational comparability and b) English language proficiency examination approved by the CGFNS, unless the applicant met the CGFNS criteria for an exemption from the requirement.⁵ CGFNS charges $350 for a credentials review.⁶ Under the current regulation the applicant would need a new CGFNS credentials review specific to Virginia. The proposed regulation would thus save the applicant who already had a satisfactory credentials evaluation for another state the $350 fee for a new review, plus the time waiting for the review to be completed.

If the applicant had already passed the English language proficiency exam for a different state, she would not need to take it again even under the current regulation. She would just need to have the examination organization send the scores to the Department of Health Professions (DHP). ETS, the producer of the TOEFL iBT exam, does not charge for sending additional recipients examination scores.^7,8 Thus the proposed regulation would not significantly affect costs in regard to the English language proficiency examination.

The proposed amendments introduce no new costs and do not change the required qualifications for nursing licensure. The reduced cost for foreign-trained nurses already licensed in another state may moderately increase the number of such individuals who seek licensure and nursing employment in the Commonwealth. Given the cost savings for the affected nurses, the Board's proposal would therefore create a net benefit.

Businesses and Entities Affected. The proposed amendments affect foreign-trained nurses who are already licensed in another United States jurisdiction and are considering applying for nursing licensure in Virginia. The number of such individuals is unavailable. According to DHP, the Board approves licenses for approximately 1,800 Registered Nurse applicants and 400 Licensed Practical Nurse applicants each quarter. Most nurses work for medical practices, long-term care facilities, or hospital systems.

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposed regulation reduces costs for nurses whose nursing education was received in another country, if the applicant has been licensed in another state and she can provide evidence that a satisfactory credentials review by CGFNS was completed by the other state. Such nurses may be more likely to apply for licensure and employment in the Commonwealth.

Effects on the Use and Value of Private Property. The proposed amendments do not affect the use and value of private property.

Real Estate Development Costs. The proposed amendments do not affect real estate development costs.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. The proposed amendments do not significantly affect costs for small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed amendments do not adversely affect small businesses.

Adverse Impacts:

Businesses. The proposed amendments do not adversely affect businesses.

Localities. The proposed amendments do not adversely affect localities.

Other Entities. The proposed amendments do not adversely affect other entities.

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¹ The passage of an English language proficiency examination is not required if: 1) the entry-level professional education occurred in the United Kingdom, Australia, Barbados, Canada (except most of Quebec), Ireland, Jamaica, New Zealand, South Africa, Trinidad & Tobago, or the United States, and 2) English was the language of instruction, and the language of the textbooks.

² See http://www.cgfns.org/services/ces-professional-report/

³ See https://www.ets.org/toefl/ibt/about

⁴ See https://www.ielts.org/en-us

⁵ See footnote #1.

⁶ Source: http://www.cgfns.org/services/ces-professional-report/ accessed on September 13, 2017.

⁷Source: https://www.ets.org/toefl/institutions/scores/reporting

⁸ Information concerning whether there is a charge for sending additional recipients IELTS scores was not available at the time this report was published. Nevertheless, the TOEFL iBT is believed to be more commonly used.

Agency's Response to Economic Impact Analysis: The Board of Nursing concurs with the analysis of the Department of Planning and Budget.

Summary:

The amendment allows the Board of Nursing to waive requirements for a Commission on Graduates of Foreign Nursing Schools credentials review and examination of English proficiency for a person whose nursing education was received in another country if the applicant has been licensed in another state and can provide evidence that those requirements were met for licensure in the other state.

18VAC90-19-120. Licensure by endorsement.

A. A graduate of an approved nursing education program who has been licensed by examination in another United States jurisdiction and whose license is in good standing, or is eligible for reinstatement if lapsed, shall be eligible for licensure by endorsement in Virginia provided the applicant satisfies the same requirements for registered nurse or practical nurse licensure as those seeking initial licensure in Virginia.

1. Applicants who have graduated from approved nursing education programs that did not require a sufficient number of clinical hours as specified in 18VAC90-27-100 may qualify for licensure if they can provide evidence of at least 960 hours of clinical practice with an active, unencumbered license in another United States jurisdiction.

2. Applicants whose basic nursing education was received in another country shall meet the requirements of 18VAC90-19-130 for a CGFNS credentials review and examination of English proficiency. However, those requirements may be satisfied if the applicant can provide evidence from another United States jurisdiction of:

a. A CGFNS credentials evaluation for educational comparability; and

b. Passage of an English language proficiency examination approved by the CGFNS, unless the applicant met the CGFNS criteria for an exemption from the requirement.

3. A graduate of a nursing school in Canada where English was the primary language shall be eligible for licensure by endorsement provided the applicant has passed the Canadian Registered Nurses Examination and holds an unrestricted license in Canada.

B. An applicant for licensure by endorsement who has submitted a criminal history background check as required by § 54.1-3005.1 of the Code of Virginia and the required application and fee and has submitted the required form to the appropriate credentialing agency for verification of licensure may practice for 30 days upon receipt of an authorization letter from the board. If an applicant has not received a Virginia license within 30 days and wishes to continue practice, he shall seek an extension of authorization to practice by submitting a request and evidence that he has requested verification of licensure.

C. If the application is not completed within one year of the initial filing date, the applicant shall submit a new application and fee.