Title of Regulation: 18VAC90-20. Regulations Governing the Practice of Nursing (amending 18VAC90-20-200).

Statutory Authority: §§ 54.1-2400 and 54.1-3005 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comments: Public comments may be submitted until 5 p.m. on August 5, 2009.

Effective Date: December 31, 2009.

Agency Contact: Jay P. Douglas, R.N., Executive Director, Board of Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4515, 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. Specific regulatory authority for the powers and duties of the Board of Nursing is found in § 54.1-3005.

Purpose: The purpose of the proposed regulatory action is to provide an exception to the requirement for 500 clinical hours in a registered nurse educational program and 400 hours in a licensed practical nurse educational program for nurses who are licensed in another state or D.C. and have been engaged in clinical practice with an active, unencumbered license for at least 960 hours (or approximately six months). Currently, an applicant for licensure by endorsement who graduated from a nursing program without the required number of clinical hours would not qualify for licensure in Virginia. The result could be a loss in the number of nurses licensed by endorsement, which would have a negative impact on the availability of nurses in critical care, long-term care, and other health care settings and could exacerbate the workforce shortage. By requiring a minimum number of clinical hours of practice, there is some assurance that the nurse has adequate clinical skills to provide safe care to patients in Virginia.

The board has issued a guidance document that allows licensure until December 31, 2009, for applicants who do not have sufficient supervised clinical hours, but the board needs to have an amendment to regulations in effect by that date to be able to license such applicants by endorsement.

Rationale for Using Fast-Track Process: The issue of licensure for applicants who do not have sufficient clinical hours in an educational program has been continually discussed since the promulgation of regulations establishing a clinical hourly requirement (which became effective April 2, 2008). The board extended implementation or enforcement of that provision for applicants for licensure until December 31, 2009. The delay will allow students in programs without a sufficient number of clinical hours to complete their educational programs or to transfer to programs that meet the board's requirements.

However, the board needs to resolve the dilemma of insufficient clinical hours for other nurses who are now licensed and practicing in another state and may want to come to Virginia after the December 31 deadline. The exception proposed for 18VAC90-20-200 will resolve the issue for anyone who has demonstrated a minimum of clinical skills through at least 960 hours of practice.

Since the action is less restrictive and will allow more nurses to qualify for licensure, it is not expected to be controversial.

Substance: 18VAC90-20-200 is amended to allow the licensure of registered nurses and licensed practical nurses who graduated from approved nursing education programs that did not have the requisite number of clinical hours to be licensed in Virginia provided they hold a current, unrestricted license in another U.S. jurisdiction and can provide evidence of at least 960 hours of clinical practice.

Issues: The primary advantage to the public is the continued availability of nurses being licensed by endorsement with the assurance that they have safely engaged in clinical practice in another U.S. jurisdiction. There are no disadvantages.

The primary advantage to the agency is the partial resolution by regulatory action of an issue that has been troublesome for one distance learning program, whose students may qualify for licensure by endorsement.

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

Summary of the Proposed Amendments to Regulation. The Board of Nursing (Board) proposes to amend its Regulations Governing the Practice of Nursing to allow nurses who are applying for licensure by endorsement to use clinical hours accrued after licensure in another U.S. jurisdiction to meet Board licensure requirements.

Result of Analysis. The benefits likely exceed the costs for this proposed change.

Estimated Economic Impact. Currently, nurses who have been licensed by examination in another U.S. jurisdiction may apply for licensure by endorsement in Virginia so long as they satisfy all requirements for initial licensure set by the Board. Currently, candidates for initial licensure by the Board must have completed an educational program that includes 400 hours of clinical experience for practical nurses and 500 hours of clinical experience for registered nurses. The Board proposes to amend the rules to allow individuals who did not graduate from a program that included the requisite clinical hours to apply for licensure by endorsement so long as they have accrued at least 960 hours of post-licensure clinical experience and have an active, unencumbered license in another U.S. jurisdiction.

This change will likely benefit nurses who are licensed in other jurisdictions as it will allow a greater number of them to qualify for licensure by endorsement in Virginia. If this change increases the number of nurses who apply for licensure in the Commonwealth, facilities that employ nurses and patients may also benefit. Facilities will benefit from having a larger pool of nurses from which to hire their employees. Patients may benefit if this change eases the nursing shortage that likely has had an adverse impact on patient care.

Businesses and Entities Affected. The Department of Health Professions (DHP) reports that the Board currently licenses 5,200 registered nurses and 784 licensed practical nurses. This change will affect any nurses who currently do not qualify for licensure by endorsement but will qualify under these proposed regulations.

Localities Particularly Affected. No locality will be particularly affected by this proposed regulatory action.

Projected Impact on Employment. This regulatory action may increase the number of individuals who are employed as nurses in the Commonwealth.

Effects on the Use and Value of Private Property. This regulatory action will likely have no substantial effect on the use or value of private property in the Commonwealth.

Small Businesses: Costs and Other Effects. Small businesses in the Commonwealth are unlikely to incur any costs on account of this regulatory action.

Small Businesses: Alternative Method that Minimizes Adverse Impact. Small businesses in the Commonwealth are unlikely to incur any costs on account of this regulatory action.

Real Estate Development Costs. This regulatory action will likely have no effect on real estate development costs in the Commonwealth.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 36 (06). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to the Department of Planning and Budget's Economic Impact Analysis: The Board of Nursing concurs with the analysis of the Department of Planning and Budget on proposed amended regulations for 18VAC90-20, Regulations Governing the Practice of Nursing.

Summary:

The board has amended regulations for the licensure of registered nurses and licensed practical nurses to allow applicants who graduated from approved nursing education programs that did not have the requisite number of clinical hours to be licensed by endorsement provided the applicant holds a current, unrestricted license in another U.S. jurisdiction and can provide evidence of at least 960 hours of clinical practice.

18VAC90-20-200. Licensure by endorsement.

A. A graduate of an approved nursing education program who has been licensed by examination in another U.S. 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. Applicants who have graduated from approved nursing education programs that did not require a sufficient number of clinical hours, as specified in 18VAC90-20-120, may qualify for licensure if they can provide evidence of at least 960 hours of clinical practice with an active, unencumbered license in another U.S. jurisdiction.

1. 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 (CRNE) and holds an unrestricted license in Canada.

2. An applicant for licensure by endorsement who has not passed NCLEX may only be issued a single state license to practice in Virginia.

B. An applicant for licensure by endorsement who has submitted the required application and fee and 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.

FORMS (18VAC90-20)

Application for Licensure by Endorsement -- Registered Nurse (rev. 1/08).

Instructions for Licensure by Endorsement -- Registered Nurse (rev. 1/08) 6/09).

Instructions for Licensure by Endorsement -- Licensed Practical Nurse (rev. 1/08) 6/09).

Application for Licensure by Endorsement -- Licensed Practical Nurse (rev. 1/08).

Instructions for Filing Application for Licensure by Examination for Registered Nurses (rev. 7/07).

Application for Licensure by Examination -- Registered Nurse (rev. 7/07).

Instructions for Filing Application for Licensure by Examination for Practical Nurses (rev. 7/07).

Application for Licensure by Examination -- Licensed Practical Nurse (rev. 7/07).

Instructions for Filing Application for Licensure by Repeat Examination for Registered Nurses (rev. 8/08).

Application for Licensure by Repeat Examination for Registered Nurse (rev. 7/07).

Instructions for Filing Application for Licensure by Repeat Examination for Practical Nurses (rev. 8/08).

Application for Licensure by Repeat Examination for Licensed Practical Nurse (rev. 7/07).

Instructions for Filing Application for Licensure by Examination for Licensed Practical Nurses Educated in Other Countries (rev. 7/07).

Application for Licensure by Examination for Licensed Practical Nurses Educated in Other Countries (rev. 7/07).

Instructions for Filing Application for Licensure by Examination for Registered Nurses Educated in Other Countries (rev. 7/07).

Application for Licensure by Examination for Registered Nurses Educated in Other Countries (rev. 7/07).

Temporary Exemption to Licensure (rev. 7/07).

Instructions for Application for Reinstatement -- Registered Nurse (rev. 7/07).

Application for Reinstatement -- Registered Nurse (rev. 7/07).

Instructions for Application for Reinstatement -- Licensed Practical Nurse (rev. 7/07).

Application for Reinstatement of License as a Licensed Practical Nurse (rev. 7/07).

Instructions for Application for Reinstatement Following Suspension or Revocation -- Registered Nurse (rev. 7/07).

Application for Reinstatement of License as a Registered Nurse Following Suspension or Revocation (rev. 7/07).

Instructions for Application for Reinstatement Following Suspension or Revocation -- Licensed Practical Nurse (rev. 7/07).

Application for Reinstatement of License as a Licensed Practical Nurse Following Suspension or Revocation (rev. 7/07).

License Verification Form (rev. 1/08).

Application for Registration as a Clinical Nurse Specialist (rev. 7/07).

Procedure for Registration as a Clinical Nurse Specialist (rev. 7/07).

Survey Visit Report (rev. 7/07).

Application for Registration for Volunteer Practice (rev. 7/07).

Sponsor Certification for Volunteer Registration (rev. 8/08).