Title of Regulation: 18VAC90-19. Regulations Governing the Practice of Nursing (amending 18VAC90-19-210, 18VAC90-19-220).

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

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: March 6, 2019.

Effective Date: March 22, 2019.

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 provides the Board of Nursing the authority to promulgate regulations to administer the regulatory system. Section 54.1-3018.1 of the Code of Virginia provides the requirements for registration of clinical nurse specialists (CNSs) and § 54.1-3005 authorizes the board to register clinical nurse specialists.

Purpose: The purpose is to align the regulation with statute. Section 54.1-3018.1 of the Code of Virginia requires national certification as a clinical nurse specialist, but the regulation specifies a specialty certification. Since all CNS applicants would have national certification, public health and safety would be adequately protected by registering a CNS without a specialty certification.

Rationale for Using Fast-Track Rulemaking Process: The action is intended to make the regulation consistent with the law, so there is a clearer understanding of the board's authority to register clinical nurse specialists. Since the amended regulation is less restrictive, it should not be controversial.

Substance: The amendments delete references to a specialty certification for a CNS and only require national certification as a clinical nurse specialist. The result is that a CNS who passed the core examination, without taking a specialty examination and having a specialty certification, could be registered as a CNS and could renew such registration by maintaining national certification.

Issues: The primary advantage of the amendment for the public is clearer language to avoid confusion or possible conflict between law and regulation. There are no disadvantages to the public. There are no advantages or disadvantages to the Commonwealth.

The Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to Chapter 83 of the 2016 Acts of Assembly,¹ the Board of Nursing (Board) proposes to amend language concerning clinical nurse specialists to conform to the Code of Virginia.

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

Estimated Economic Impact. Code of Virginia § 54.1-3018.1² states that "The Board may register an applicant as a clinical nurse specialist if the applicant: … holds a national clinical nurse specialist certification that prepares the professional nurse to deliver advanced nursing services." The current regulation states that for initial and renewal of registration as a clinical nurse specialist, the applicant must have current "specialty certification." For consistency with the Code of Virginia as amended by Chapter 83, the Board proposes to replace "specialty certification" with "national clinical nurse specialist certification." This would not have a significant impact in practice but would be beneficial in that it may reduce potential confusion among readers of the regulation.

Businesses and Entities Affected. The proposed regulation affects applicants for clinical nurse specialist registration. Thirty-one nurses applied for clinical nurse specialist registration in fiscal year 2017.

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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¹See http://leg1.state.va.us/cgi-bin/legp504.exe?161+ful+CHAP0083

²See https://law.lis.virginia.gov/vacode/title54.1/chapter30/section54.1-3018.1/

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

Summary:

The amendments replace specialty certification with national certification as a perquisite for registration as a clinical nurse specialist (CNS). Therefore, a CNS who passes the core examination, without taking a specialty examination and having a specialty certification, may be registered as a CNS and renew such registration by maintaining national certification.

Part IV
Clinical Nurse Specialists

18VAC90-19-210. Clinical nurse specialist registration.

A. Initial registration. An applicant for initial registration as a clinical nurse specialist shall:

1. Be currently licensed as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse;

2. Submit evidence of current specialty national clinical nurse specialist certification as required by § 54.1-3018.1 of the Code of Virginia or has have an exception available from March 1, 1990, to July 1, 1990; and

3. Submit the required application and fee.

B. Renewal of registration.

1. Registration as a clinical nurse specialist shall be renewed biennially at the same time the registered nurse license is renewed. If registered as a clinical nurse specialist with a multistate licensure privilege to practice in Virginia as a registered nurse, a licensee born in an even-numbered years year shall renew his license by the last day of the birth month in even-numbered years and a licensee born in an odd-numbered years year shall renew his license by the last day of the birth month in odd-numbered years.

2. The clinical nurse specialist shall complete the renewal form and submit it with the required fee. An attestation of current specialty national certification as a clinical nurse specialist is required unless registered in accordance with an exception.

3. Registration as a clinical nurse specialist shall lapse if the registered nurse license is not renewed or the multistate licensure privilege is lapsed and may be reinstated upon:

a. Reinstatement of RN license or multistate licensure privilege;

b. Payment of reinstatement and current renewal fees; and

c. Submission of evidence of continued specialty national certification as a clinical nurse specialist unless registered in accordance with an exception.

18VAC90-19-220. Clinical nurse specialist practice.

A. The practice of a clinical nurse specialist shall be consistent with the education and experience required for clinical nurse specialist certification.

B. The clinical nurse specialist shall provide those advanced nursing services that are consistent with the standards of specialist practice as established by a national certifying organization for the designated specialty clinical nurse specialists and in accordance with the provisions of Chapter 30 (§ 54.1-3000 et seq.) of Title 54.1 of the Code of Virginia.

C. Advanced practice as a clinical nurse specialist shall include performance as an expert clinician to:

1. Provide direct care and counsel to individuals and groups;

2. Plan, evaluate, and direct care given by others; and

3. Improve care by consultation, collaboration, teaching, and the conduct of research.