Title of Regulation: 18VAC90-20. Regulations Governing the Practice of Nursing (adding 18VAC90-20-215).

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

Effective Dates: August 1, 2013, through July 31, 2014.

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.

Preamble:

Legislation for provisional licensure was introduced at the request of Excelsior College, a nontraditional nursing education program that is competency-based and does not provide didactic coursework or any hours of precepted clinical experience. Therefore, its graduates do not meet the Board of Nursing requirement for licensure of 500 hours of supervised clinical experience (effective in 2008). While most other out-of-state, nontraditional nursing education programs do meet board requirements for hours of clinical experience, there are a few whose applicants have less than the requisite number of hours. In 2009, the board adopted regulations for endorsement of applicants from other states with a requisite number of clinical experience hours, but there has been no resolution for new graduates of programs such as Excelsior that do not meet Virginia's regulation for the number of clinical hours required for licensure by examination.

Chapter 712 of the 2011 Acts of Assembly authorizes the board to adopt regulations to provide a pathway to licensure by the issuance of a provisional license to allow a graduate who has met the educational and examination requirements but is lacking clinical experience to obtain such experience by practicing under the supervision of a registered nurse for a period of time. The regulations for provisional licensure will assure that the RN applicant gains experience across the life span in all areas of nursing practice and that his practice will be overseen by an RN with at least two years of clinical practice experience. The supervisor is responsible for the assignment of duties consistent with the knowledge and skills of the provisional licensee and must be prepared to intervene if necessary for the health and safety of clients receiving care from a provisional licensee.

Chapter 712 further required that the board promulgate regulations to implement the provisions of the act to be effective within 280 days of its enactment. The board submitted the emergency regulation for executive branch review on September 29, 2011. The statutory deadline for regulations to be in effect was December 31, 2011, but the Secretary of Health and Human Resources requested that the board reexamine the proposed emergency regulations to address concerns expressed by Excelsior College.

The key provisions of the regulations are (i) requirements for qualification and submission of documents for approval as a provisional licensee; (ii) requirements for 500 hours of direct client care in the role of a registered nurse including various areas of nursing; (iii) provisions for acceptance of previous clinical experience towards meeting the 500-hour requirement; (iv) requirements for supervision of a provisional licensee, including the qualifications and responsibilities of the supervising nurse; and (v) provisions for expiration and renewal of a provisional license.

At the request of the office of the Secretary of Health and Human Resources, the board reconsidered the regulation pertaining to credit for clinical experience for graduates of Excelsior College or any similar nursing education program. In the reconsidered emergency regulations, the board agreed to grant an applicant up to 100 hours of credit towards the 500-hour clinical practice requirement if he has successfully completed a nursing education program that:

1. Requires students to pass competency-based assessments of nursing knowledge as well as a summative performance assessment of clinical competency that has been evaluated by the American Council on Education or any other board-approved organization; and

2. Has a passage rate for first-time test takers on the NCLEX that is not less than 80%, calculated on the cumulative results of the past four quarters of all graduates in each calendar year regardless of where the graduate is seeking licensure.

18VAC90-20-215. Provisional licensure of applicants for licensure as registered nurses.

A. Pursuant to § 54.1-3017.1 of the Code of Virginia, the board may issue a provisional license to an applicant for the purpose of meeting the 500 hours of supervised, direct (hands-on) client care required of an approved registered nurse education program.

B. Such applicants for provisional licensure shall submit:

1. A completed application for licensure by examination and fee;

2. Documentation that the applicant has successfully completed a nursing education program; and

3. Documentation of passage of NCLEX in accordance with 18VAC90-20-190.

C. Requirements for hours of direct client care with a provisional license.

1. To qualify for licensure as a registered nurse, direct, hands-on hours of supervised clinical experience shall include the areas of adult medical/surgical nursing, geriatric nursing, maternal/infant (obstetrics, gynecology, neonatal) nursing, mental health/psychiatric nursing, nursing fundamentals, and pediatric nursing. Supervised clinical hours may be obtained in employment in the role of a registered nurse or without compensation for the purpose of meeting these requirements.

2. Hours of direct, hands-on clinical experience obtained as part of the applicant's nursing education program and noted on the official transcript shall be counted towards the minimum of 500 hours and in the applicable areas of clinical practice.

3. For applicants with a current, active license as an LPN, 150 hours of credit shall be counted towards the 500-hour requirement.

4. Up to 100 hours of credit may be applied towards the 500-hour requirement for applicants who have successfully completed a nursing education program that:

a. Requires students to pass competency-based assessments of nursing knowledge as well as a summative performance assessment of clinical competency that has been evaluated by the American Council on Education or any other board-approved organization; and

b. Has a passage rate for first-time test takers on the NCLEX that is not less than 80%, calculated on the cumulative results of the past four quarters of all graduates in each calendar year regardless of where the graduate is seeking licensure.

5. An applicant for licensure shall submit verification from a supervisor of the number of hours of direct client care and the areas in which clinical experiences in the role of a registered nurse were obtained.

D. Requirements for supervision of a provisional licensee.

1. The supervisor shall be onsite and physically present in the unit where the provisional licensee is providing clinical care of clients.

2. In the supervision of provisional licensees in the clinical setting, the ratio shall not exceed two provisional licensees to one supervisor at any given time.

3. Licensed registered nurses providing supervision for a provisional licensee shall:

a. Notify the board of the intent to provide supervision for a provisional licensee on a form provided by the board;

b. Hold an active, unrestricted license or multistate licensure privilege and have at least two years of active clinical practice as a registered nurse prior to acting as a supervisor;

c. Be responsible and accountable for the assignment of clients and tasks based on their assessment and evaluation of the supervisee’s clinical knowledge and skills;

d. Be required to monitor clinical performance and intervene if necessary for the safety and protection of the clients; and

e. Document on a form provided by the board the frequency and nature of the supervision of provisional licensees to verify completion of hours of clinical experience.

E. The provisional status of the licensee shall be disclosed to the client prior to treatment and shall be indicated on identification worn by the provisional licensee.

F. All provisional licenses shall expire six months from the date of issuance and may be renewed for an additional six months. Renewal of a provisional license beyond the limit of 12 months shall be for good cause shown and shall be approved by the board. A request for extension of a provisional license beyond 12 months shall be made at least 30 days prior to its expiration.

FORMS (18VAC90-20)

Application for Licensure by Endorsement -- Registered Nurse (rev. 5/11)

Instructions for Licensure by Endorsement -- Registered Nurse (rev. 5/11)

Instructions for Licensure by Endorsement -- Licensed Practical Nurse (rev. 5/11)

Application for Licensure by Endorsement -- Licensed Practical Nurse (rev. 6/11)

Verification of Clinical Practice -- Licensure by Endorsement (rev. 1/10)

Instructions and Application for Licensure by Examination for Registered Nurses (rev. 8/11)

Instructions and Application for Licensure by Examination -- Licensed Practical Nurse (rev. 8/11)

Instructions and Application for Licensure by Repeat Examination for Registered Nurse (rev. 8/11)

Instructions and Application for Licensure by Repeat Examination for Licensed Practical Nurse (rev. 8/11)

Instructions and Application for Licensure by Examination for Licensed Practical Nurses Educated in Other Countries (rev. 6/11)

Instructions and Application for Licensure by Examination for Registered Nurses Educated in Other Countries (rev. 6/11)

Declaration of Primary State of Residency for Purposes of the Nurse Licensure Compact (rev. 6/11)

Instructions for Application for Reinstatement -- Registered Nurse (rev. 10/10)

Application for Reinstatement -- Registered Nurse (rev. 6/11)

Instructions for Application for Reinstatement -- Licensed Practical Nurse (rev. 2/10)

Application for Reinstatement of License as a Licensed Practical Nurse (rev. 6/11)

Instructions and Application for Reinstatement of License as a Registered Nurse Following Suspension or Revocation (rev. 6/11)

Instructions and Application for Reinstatement of License as a Licensed Practical Nurse Following Suspension or Revocation (rev. 6/11)

License Verification Form (rev. 10/09)

Procedure (rev. 3/10) and Application for Registration as a Clinical Nurse Specialist (rev. 6/11)

Application for Reinstatement of Registration as a Clinical Nurse Specialist (rev. 6/11)

Application to Establish a Nursing Education Program (rev. 6/11)

Agenda and Survey Visit Report -- Registered Nurse Education Program (rev. 4/08)

Agenda and Survey Visit Report -- Practical Nurse Education Program (rev. 4/08)

NCLEX Survey Visit Report (rev. 4/08)

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

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

Verification of Supervised Clinical Practice -- Registered Nurse Provisional License (undated)

Notification of Intent to Supervise Clinical Practice -- Registered Nurse Provisional License (undated)