Title of Regulation: 18VAC90-27. Regulations for Nursing Education Programs (amending 18VAC90-27-10, 18VAC90-27-70).

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

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 5, 2018.

Effective Date: September 20, 2018.

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: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Nursing the authority to promulgate regulations to administer the regulatory system, and § 54.1-3005 of the Code of Virginia, which gives the board authority to regulate nursing educational programs.

Purpose: Hospitals and clinics that serve as settings for clinical training are better assured of the safety and welfare of their patients by having a more recent criminal background check rather than relying on the initial check at the time of a student's application to nursing school. There may be as much as a two-year gap from the time an applicant to nursing school has a background check and the time that nursing student begins a clinical experience involving direct patient care. By requiring a background check prior to the clinical experience rather than prior to admission, any prior or subsequent criminal activity will be known, and there is more protection for patient health and safety.

Rationale for Using Fast-Track Rulemaking Process: The action is intended to clarify the term "full approval" and to address the gap of time between the criminal background check conducted at the time of admission to a nursing education program and the time a student would begin clinical experience. The action was recommended by the Nursing Education Informal Conference Committee and unanimously approved by the board. It is beneficial to students, nursing programs, and clinical settings, so it should not be controversial.

Substance: The board is adding a definition for "full approval" of a nursing education program and changing the timing of a criminal background check for nursing students from requiring the check prior to admission to prior to the clinical experience involving direct patient care.

Issues: The primary advantage to the public of the amendment is better assurance that nursing students providing direct patient care have had a recent criminal background check. There are no disadvantages to the public. There are no advantages or disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Nursing (Board) proposes to add a definition for "full approval" of a nursing education program and to change the timing of a required criminal background check for nursing students from requiring the check prior to admission to prior to the clinical experience involving direct patient care.

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

Estimated Economic Impact. Sections 150 and 160 of the regulation reference "full approval," but the current regulation does not define "full approval." The Board proposes to add a definition to improve clarity. The proposed definition is consistent with the meaning as it has been interpreted. To the extent that adding the definition reduces confusion among potential readers of the regulation, the proposal would be beneficial.

The current regulation provides that "Except for high school students, all applicants to a nursing education program shall be required to submit to a criminal background check prior to admission."¹ The Board proposes to instead provide that "Except for high school students, all students enrolled in a nursing education program shall be required to submit to a criminal background check prior to a clinical experience involving direct patient care."² This proposed amendment should not affect health and safety since the students will still be checked prior to direct patient care. The proposed amendment is beneficial in that the expense of criminal background checks can be saved for applicants who are not granted admission. The Virginia State Police fee for a national criminal background check for employees or volunteers providing care to children, the elderly, and disabled is $25 for employees and $19 for volunteers.³

According to the Department of Health Professions, hospitals and clinics where students are engaged in a clinical experience require a criminal background check prior to providing direct patient care. Typically, there is a gap of months or even years between the time a check was submitted prior to admission and the time of the clinical experience. Therefore, the clinical settings often require a second check to ensure that there has not been any criminal activity during that gap period. By just requiring that there be criminal background check prior to a clinical experience involving direct patient care rather than prior to admission may thus effectively reduce the number of background checks that admitted nursing students are subjected to from two to one. Consequently, the cost for background checks for admitted students may decrease as well.

Businesses and Entities Affected. The proposed amendments affect the 138 programs⁴ approved by the Board to provide education for practical and professional nursing.

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

Projected Impact on Employment. The proposed amendments do not significantly affect employment.

Effects on the Use and Value of Private Property. The proposed amendments do not significantly 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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¹Bold on "prior to admission" is for emphasis and is not in the regulation.

²Ibid.

³See http://www.vsp.state.va.us/downloads/SP-024.pdf.

⁴Data source: Department of Health Professions.

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

Summary:

The amendments (i) add a definition for "full approval" of a nursing education program and (ii) change the timing of a criminal background check for nursing students from requiring the check prior to admission to requiring it prior to the clinical experience involving direct patient care.

Part I
General Provisions

18VAC90-27-10. Definitions.

In addition to words and terms defined in § 54.1-3000 of the Code of Virginia, the following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Accreditation" means having been accredited by an agency recognized by the U.S. Department of Education to include the Accreditation Commission for Education in Nursing, the Commission on Collegiate Nursing Education, the Commission for Nursing Education Accreditation, or a national nursing accrediting organization recognized by the board.

"Advisory committee" means a group of persons from a nursing education program and the health care community who meets regularly to advise the nursing education program on the quality of its graduates and the needs of the community.

"Approval" means the process by which the board or a governmental agency in another state or foreign country evaluates and grants official recognition to nursing education programs that meet established standards not inconsistent with Virginia law.

"Associate degree nursing program" means a nursing education program preparing for registered nurse licensure, offered by a Virginia college or other institution and designed to lead to an associate degree in nursing, provided that the institution is authorized to confer such degree by SCHEV.

"Baccalaureate degree nursing program" or "prelicensure graduate degree program" means a nursing education program preparing for registered nurse licensure, offered by a Virginia college or university and designed to lead to a baccalaureate or a graduate degree with a major in nursing, provided that the institution is authorized to confer such degree by SCHEV.

"Board" means the Board of Nursing.

"Clinical setting" means any location in which the clinical practice of nursing occurs as specified in an agreement between the cooperating agency and the school of nursing.

"Conditional approval" means a time-limited status that results when an approved nursing education program has failed to maintain requirements as set forth in this chapter.

"Cooperating agency" means an agency or institution that enters into a written agreement to provide clinical or observational experiences for a nursing education program.

"Diploma nursing program" means a nursing education program preparing for registered nurse licensure, offered by a hospital and designed to lead to a diploma in nursing, provided the hospital is licensed in this state.

"Full approval" means the status granted to a nursing education program when compliance with regulations pertaining to nursing education programs has been verified.

"Initial approval" means the status granted to a nursing education program that allows the admission of students.

"National certifying organization" means an organization that has as one of its purposes the certification of a specialty in nursing based on an examination attesting to the knowledge of the nurse for practice in the specialty area.

"NCLEX" means the National Council Licensure Examination.

"NCSBN" means the National Council of State Boards of Nursing.

"Nursing education program" means an entity offering a basic course of study preparing persons for licensure as registered nurses or as licensed practical nurses. A basic course of study shall include all courses required for the degree, diploma, or certificate.

"Nursing faculty" means registered nurses who teach the practice of nursing in nursing education programs.

"Practical nursing program" means a nursing education program preparing for practical nurse licensure that leads to a diploma or certificate in practical nursing, provided the school is authorized by the Virginia Department of Education or by an accrediting agency recognized by the U.S. Department of Education.

"Preceptor" means a licensed nurse who is employed in the clinical setting, serves as a resource person and role model, and is present with the nursing student in that setting, providing clinical supervision.

"Program director" means a registered nurse who holds a current, unrestricted license in Virginia or a multistate licensure privilege and who has been designated by the controlling authority to administer the nursing education program.

"Recommendation" means a guide to actions that will assist an institution to improve and develop its nursing education program.

"Requirement" means a mandatory condition that a nursing education program must meet to be approved or maintain approval.

"SCHEV" means the State Council of Higher Education for Virginia.

"Site visit" means a focused onsite review of the nursing program by board staff, usually completed within one day for the purpose of evaluating program components such as the physical location (skills lab, classrooms, learning resources) for obtaining initial program approval, in response to a complaint, compliance with NCLEX plan of correction, change of location, or verification of noncompliance with this chapter.

"Survey visit" means a comprehensive onsite review of the nursing program by board staff, usually completed within two days (depending on the number of programs or campuses being reviewed) for the purpose of obtaining and maintaining full program approval. The survey visit includes the program's completion of a self-evaluation report prior to the visit, as well as a board staff review of all program resources, including skills lab, classrooms, learning resources, and clinical facilities, and other components to ensure compliance with this chapter. Meetings with faculty, administration, students, and clinical facility staff will occur.

18VAC90-27-70. Admission of students.

A. Requirements for admission to a registered nursing education program shall not be less than the requirements of § 54.1-3017 A 1 of the Code of Virginia that will permit the graduate to be admitted to the appropriate licensing examination. The equivalent of a four-year high school course of study as required pursuant to § 54.1-3017 shall be considered to be:

1. A General Educational Development (GED) certificate for high school equivalence; or

2. Satisfactory completion of the college courses required by the nursing education program.

B. Requirements for admission to a practical nursing education program shall not be less than the requirements of § 54.1-3020 A 1 of the Code of Virginia that will permit the graduate to be admitted to the appropriate licensing examination.

C. Requirements for admission, readmission, advanced standing, progression, retention, dismissal, and graduation shall be available to the students in written form.

D. Except for high school students, all applicants to students enrolled in a nursing education program shall be required to submit to a criminal background check prior to admission a clinical experience involving direct patient care.

E. Transfer students may not be admitted until a nursing education program has received full approval from the board.