Title of Regulation: 18VAC90-20. Regulations Governing the Practice of Nursing (amending 18VAC90-20-10, 18VAC90-20-35, 18VAC90-20-40, 18VAC90-20-70, 18VAC90-20-80, 18VAC90-20-90, 18VAC90-20-100 through 18VAC90-20-170; adding 18VAC90-20-121, 18VAC90-20-122, 18VAC90-20-131, 18VAC90-20-132, 18VAC90-20-133, 18VAC90-20-134, 18VAC90-20-135, 18VAC90-20-136, 18VAC90-20-137, 18VAC90-20-161; repealing 18VAC90-20-50, 18VAC90-20-60, 18VAC90-20-95, 18VAC90-20-96).

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

Public Hearing Information:

January 28, 2014 - 10:30 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 201, Richmond, VA 23233

Public Comment Deadline: February 14, 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.

Basis: Regulations are promulgated under the general authority of Chapter 24 (§ 54.1-2400 et seq.) of Title 54.1 of the Code of Virginia. Section 54.1-2400 provides the Board of Nursing the authority to promulgate regulations to administer the regulatory system, and § 54.1-3005 of the Code of Virginia specifies the powers and duties of the board, which include: (i) prescribing minimum standards and approving curricula for educational programs preparing persons for licensure or certification under this chapter; (ii) approving programs that meet the requirements of this chapter and of the board; (iii) providing consultation service for educational programs as requested; (iv) providing for periodic surveys of educational programs; (v) denying or withdrawing approval from educational programs for failure to meet prescribed standards; and (vi) approving programs that entitle professional nurses to be registered as clinical nurse specialists and to prescribe minimum standards for such programs.

Purpose: The Board of Nursing has identified several problems with the quality and effectiveness of some nursing education programs and applications for approval of such programs. The intent of the proposed regulatory action is to address problems and inadequacies that exist in some programs by requiring more accountability in reporting on clinical sites for training, in the enrollment and progression of students through the program, in oversight of programs through required site visits and surveys, and in the quality of the curriculum. By specifying certain outcome measures, the board will be better assured that programs will graduate a minimally competent entry-level nurse who practices with skill and integrity.

There is a problem in Virginia with the quality of some nursing education programs. Virginia ranks below the national average in nursing students passing the National Council Licensure Examination (NCLEX), especially graduates of the practical nursing programs. The national passage rate for practical nursing programs in 2010 was 87.06%; in Virginia the average was 77.55%. Neighboring states far exceed Virginia in the passage of NCLEX for practical nurses: North Carolina was 95.50%, Maryland was 91.58%, Kentucky was 93.03%, Tennessee was 94.14%, and West Virginia was 88.82%. The low NCLEX pass rates negatively impact any attempt to increase the nursing workforce and leave students with loans to pay back and no ability to practice.

In the 2010 report of NCLEX passage (from 1/1/10 to 12/31/10), 24 of the 77 practical nursing programs in Virginia fell below the 80% benchmark set by the board in current regulations; another 14 fell below the national average for passage of the licensing examination. Of the 24 programs that fell below 80% passage, 10 are proprietary (for-profit) schools. Applications for new programs are primarily from for-profit entities from areas of Virginia near bordering states. As a result, a majority of these students reside outside of Virginia. Maryland does not approve proprietary nursing education programs; North Carolina has approved one proprietary program.

These indicators and the increase in the number of proceedings for noncompliance with Board of Nursing regulations by nursing education programs are evidence that the Board of Nursing needs to revise its regulations to add specificity and rigor to its requirements and approval process. By assuring more accountability in the academic and clinical programs, the board intends to address the issues of inadequacy in clinical sites and experiences, problems with the majority of clinical sites located outside Virginia, lack of integrity in the information provided on an application, transfer of unsuccessful students from one program to another, high failure rates in examinations, and exploitation of students for profit. By addressing these issues and strengthening regulations for program approval, the board intends to assist nursing education programs in graduating nurses who will be successful on the NCLEX and able to practice with clinical skills and nursing knowledge adequate to protect the health and safety of patients in Virginia.

Substance: In order to set more specific standards to address some of the issues and problems the board has encountered in recent years, the following amendments are proposed:

1. Prohibit acceptance of transfer students until a program has attained full approval to prevent a program from building a new class by accepting failing or problem students from other programs.

2. Require more specificity about the clinical training sites in the application to ensure oversight and adequacy, including a percentage of the clinical experience that must be completed in a facility licensed in Virginia and more specificity about the number of students and amount of time the facility allows for training.

3. Require disclosure of actions or adverse decisions against a program in another jurisdiction and add adverse action in another jurisdiction as grounds for denial of approval.

4. Add a 12-month limitation of the length of the application process to ensure currency in the information initially provided with an expectation that the program admit students within that time frame.

5. Require an analysis that describes the geographic area and population the program intends to serve, the number of nursing programs currently in the area, the number of clinical sites available for training, and the potential impact on existing schools of nursing in order to demonstrate a need for a new nursing program.

6. Clarify that advertisement of a program or enrollment of students is not acceptable until full approval is given; such advertisement could be grounds for denial.

7. Clarify that the board has the authority to monitor and take action at any stage in the approval process for a program that is not showing progress toward meeting the requirements for approval.

8. Specify that the approval by an "appropriate state agency" is approval from the Virginia Department of Education or from the State Council of Higher Education in Virginia.

9. Rather than submission of the philosophy and objectives, add specific requirements and detail about the development of a written, systematic plan of evaluation that will be used by the program for program review and be available to the board to review program progress.

10. Add provisions (definition and ratio) on simulation for clinical training currently contained in a guidance document.

11. Specify that the information about the nursing education program must be published and provided to applicants and students and must include a grievance policy, accreditation status, and a record of complaints and their resolution.

12. Specify that the curriculum content is applicable to all programs, regardless of the method of delivery (online or in person) and include definition and language about "direct client care" from the guidance document.

13. Add prevention and response to disaster planning and intimate partner violence to the curriculum.

14. Clarify that the board must be notified about a change in location for an educational program or about the addition of another location, and make arrangements for a site visit to be conducted by board staff and approval granted by the board before classes can be conducted at the new location. The board must also be notified if there are other changes that may significantly impact the program's approval status.

15. Examine frequency of survey visits for approved programs to ensure that certain requirements of Virginia regulations are examined consistently for all programs.

Specify that the requirements for closing of a nursing education program are applicable at any stage of the process and that failure to comply with such requirements may be grounds for withdrawal of approval.

Issues: The most significant benefit of the proposed amendments is to the patients or nursing clients in Virginia who are dependent on quality nursing care. Better oversight and quality control in nursing education programs, especially in the clinical experiences, may result in better trained graduates who have sufficient knowledge and skills to pass the national licensing exam and then to be employed in the provision of safe, effective nursing care. There are definitely advantages to students and potential students, who will not experience poor quality, inadequate education that does not prepare them for licensure or practice. Many of these students are saddled with significant debt and no means by which to be employed and practice in the profession.

There are also advantages to entities or persons who want to initiate a program or to improve the quality of an existing program. Clearer standards and processes will provide a better road map to board approval. Programs will be required to engage in a systematic valuation that guides them to address their weaknesses and provides clearer standards by which to measure progress.

There are no disadvantages to the public or to programs that intend to adequately prepare nurses. The board works diligently with such programs on addressing any deficiencies and on plans of correction.

The primary advantage to the board (the agency) and the Commonwealth is that clearer, more explicit requirements may result in fewer problematic programs that necessitate the expenditure of a great amount of time and resources. Persons or entities that consider opening a nursing education program will have a clearer set of regulations to follow and will be more knowledgeable about board expectations before they engage in the process of seeking approval. There are no disadvantages.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Nursing (Board) proposes to reorganize and amend the portions of its regulations that govern approval of nursing education programs. The Board proposes numerous clarifying changes as well as several substantive changes for these regulations. In addition to clarifying changes, the Board specifically proposes to 1) require entities that are applying for approval as nursing schools to submit the results of a community assessment or market analysis, 2) require that all nursing students undergo a criminal background check as a requirement for admission to nursing school and 3) require 80% of clinical hours to be conducted in Virginia.

Result of Analysis. Benefits likely outweigh costs for most of these proposed regulatory changes. There is insufficient information to determine whether benefits will outweigh costs for several of the proposed changes.

Estimated Economic Impact. Most of the proposed changes to these regulations are not substantive. Portions of the regulations are being moved around so that they more closely follow the chronological order of the approval process for nursing schools, and some requirements that are already in guidance are being moved into the regulatory text; the Board is, for instance, moving the requirement that school "faculty shall provide evidence of education and/or experience in the specialty area in which they supervise students' clinical experience" from guidance documents into regulation. Changes such as these will likely not subject regulated entities to any additional costs as those entities already have to follow all regulations and Board guidance to gain approval of nursing education programs now. These changes will likely benefit anyone who has to read and understand the rules under which nursing education programs are approved as they bring added clarity to those rules.

The Board also proposes three new requirements in the proposed regulations.

First, the Board proposes to require entities that are seeking approval of new nursing education programs to submit the results of a community assessment or market analysis along with other, already required, paperwork. Board staff reports that this requirement is being added because some education programs have been approved in the past when those programs did not have access to enough clinical sites to meet the needs of their student populations. Board staff reports that the Board seeks to eliminate this problem by requiring entities to verify that there are sufficient clinical resources in any community where they might open an educational facility. Both proprietors of nursing education programs and their future students will benefit from this requirement if it better ensures that nursing programs actually have the resources to provide the education that is promised. Since market analyses have not been required before, Board staff is unsure of what expenses will be incurred statewide in generating them. Some entities may already be conducting market analyses as part of their private decision to open an education program. For these entities, extra costs would be minimal and would likely be limited to costs for copying and mailing documents that already exist. Entities that do not already plan on conducting a market analysis may incur, according to Board estimates, costs of between $1,000 and $5,000. There is insufficient information to ascertain whether benefits will outweigh costs for this proposed change.

The Board also proposes to newly require all potential nursing students to undergo a criminal background check as a condition of admittance to an approved nursing education program. Board staff reports that there have been issues with current nursing students who have been accepted into nursing schools, but who could not complete their required clinical hours because they had been convicted of barrier crimes that precluded them being allowed to work at the nursing homes or hospitals with whom their education program had contracted. The Board also requires applicants for nursing licensure to self report any criminal convictions so, in theory, students could get completely through their education program and then be denied licensure because they have a criminal history. In order to forestall these problems, the Board now proposes to require a criminal background check. Either potential students or educational facilities will have to pay the approximately $35 per person that the State Police charges for this check. Board staff reports that 12,080 nursing students were admitted to various education programs across the state during the 2009-2010 academic year. If this requirement had been in place then, and all entering students would later have had to undergo a second criminal background check when starting their clinical work, affected entities statewide would have incurred extra costs of $422,800. Information gathered from talking to various nursing schools and clinical sites would indicate, if this proposed change is promulgated, some but not all incoming nursing students would have to undergo a criminal background check upon admittance to a nursing program in addition to the one they currently undergo when they start their clinical experience. Given this, the costs of compliance for this change will likely be somewhat less than $422,800 per year. Whether benefits will outweigh costs statewide will depend on whether tuition and time costs incurred by students with criminal records outweigh the costs of all students submitting to a criminal background check. The Board could likely lower costs, but accomplish the same goal, by requiring schools to inform potential students (who are likely aware of their own criminal backgrounds) of which past or future criminal convictions are likely to keep them from successfully completing a nursing education program or gaining licensure. Schools could also err on the side of caution by also informing potential students of how they might get their own criminal background check run if they are unsure of their criminal history.

Finally, the Board proposes to require that at least 80% of student nurses' clinical experiences occur within Virginia. Current regulations are silent on where students complete their required clinical hours. The Board has, however, had a number of complaints from students who have had to travel some distance and to bordering states in order to work at clinical sites that have contracts with Virginia-based nursing schools. Board staff reports that this has been a particular problem with nursing education programs in Northern Virginia. To minimize the adverse impact that this issue can have on nursing students, the Board proposes to require that 80% of clinical experience for any student be completed within Virginia. Board staff reports that this requirement would not affect schools' current clinical contracts but that any newly contracted clinical sites would have to meet the new requirements. To the extent that currently contracted clinical sites are outside of Virginia and also represent the most efficient and cost-saving choice for obtaining educational services for their students, some educational institutions are likely to see costs increase because of this proposed regulatory change. There is insufficient information to measure these costs against the savings that will accrue to students who will not have to travel as far to complete clinical hours.

Businesses and Entities Affected. The Department of Health Professions (DHP) reports that there are currently 83 full nursing education programs and 77 LPN nursing education programs approved by the Board and that the Board receives approximately 15 new applications for new nursing programs each year. Board staff reports that some of these programs are likely small businesses but does not know how many would so qualify.

Localities Particularly Affected. No localities will be particularly affected by these proposed regulatory changes.

Projected Impact on Employment. This regulatory action will likely have little impact on employment in the Commonwealth.

Effects on the Use and Value of Private Property. This regulatory action will likely have little effect on the use or value of private property in the Commonwealth.

Small Businesses: Costs and Other Effects. Affected small businesses will likely incur costs for conducting criminal background checks and may also incur costs associated with conducting market analyses and/or contracting with in-state clinical sites.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The Board could likely lower costs for these proposed regulations by requiring schools to inform potential students (who are likely aware of their own criminal background) of which past or future criminal convictions are likely to keep them from successfully completing a nursing education program or gaining licensure instead of requiring that all potential students undergo a criminal background check. Schools could also err on the side of caution by also informing potential students of how they might get their own criminal background check run if they are unsure of their criminal history.

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 14 (10). 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 Economic Impact Analysis: The Board of Nursing makes the following comment on the economic impact analysis (EIA) of the Department of Planning and Budget on proposed amendments to 18VAC90-20, Regulations Governing the Practice of Nursing, relating to rules for nursing education programs.

The EIA refers to the cost for conducting market analyses as part of a program's application for board approval of a new nursing education program. It was acknowledged that many programs already conduct such an analysis to assess the viability of and need for an educational program in the area from which the program intends to draw students. In the EIA, there is a statement that a program conducting a market analysis may incur costs of "many thousands of dollars." In fact, programs that have conducted an analysis report to board staff that the costs ranged from $1,000 to $5,000, depending on the extensiveness of the analysis and the geographic location of the school. Therefore, the board takes exception to the assumption that an analysis would cost many thousands of dollars and would recommend that the range of actual cost be stated. (The Department of Planning and Budget subsequently revised its EIA accordingly.)

Additionally, the EIA states that the requirement for potential nursing students to have a criminal background check would cost affected entities $422,800. In fact, a criminal background check is already a requirement before any student can be engaged in a clinical setting. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has such a requirement, and all hospitals and long-term care facilities require the criminal background check for employees and students working in their facilities. Therefore, there would be no additional cost for the background check since it is already required for persons enrolled in nursing education programs.

Summary:

The proposed amendments reorganize provisions for approval of nursing education programs to clarify all criteria that must be met to obtain initial approval, full approval, and continued full approval. The proposed amendments (i) incorporate current guidance on observational experiences and simulation into the regulation; (ii) provide processes and procedures for granting initial or full approval, for placing a program on conditional approval, and for denial or withdrawal of approval of a program; (iii) require entities that are applying for approval as nursing schools to submit the results of a community assessment or market analysis; and (iv) require 80% of clinical hours to be conducted in Virginia.

Part I
General Provisions

18VAC90-20-10. Definitions.

In addition to words and terms defined in § 54.1-3030 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 the Accreditation Commission for Education in Nursing (ACEN) or by the Commission on Collegiate Nursing Education (CCNE).

"Active practice" means activities performed, whether or not for compensation, for which an active license to practice nursing is required.

"Advisory committee" means a group of persons from a nursing education program and the health care community who meet 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 the State Council of Higher Education for Virginia.

"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 the State Council of Higher Education for Virginia.

"Board" means the Board of Nursing.

"CGFNS" means the Commission on Graduates of Foreign Nursing Schools.

"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 which that results when an approved nursing education program has failed to maintain requirements as set forth in Article 2 (18VAC90-20-70 et seq.) of Part II of this chapter.

"Contact hour" means 50 minutes of continuing education coursework or activity.

"Cooperating agency" means an agency or institution that enters into a written agreement to provide learning 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.

"FERPA" means the Family Educational Rights and Privacy Act (20 USC § 1232g).

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

"NCLEX" means the National Council Licensure Examination.

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

"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.

"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 State Board Department of Education or the appropriate governmental credentialing agency by an accrediting agency recognized by the U.S. Department of Education.

"Preceptor" means a licensed health care provider 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.

"Primary state of residence" means the state of a person's declared fixed permanent and principal home or domicile for legal purposes.

"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.

"Provisional approval" means the initial status granted to a nursing education program which shall continue until the first class has graduated and the board has taken final action on the application for approval.

"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.

"Site visit" means a focused on-site 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 on-site 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.

18VAC90-20-35. Identification; accuracy of records.

A. Any person regulated by this chapter who provides direct patient client care shall, while on duty, wear identification that is clearly visible and indicates the person's first and last name and the appropriate title for the license, certification, or registration issued to such person by the board, or student status under which he is practicing in that setting. Any person practicing in hospital emergency departments, psychiatric and mental health units and programs, or in health care facilities units offering treatment for patients clients in custody of state or local law-enforcement agencies may use identification badges of first name and first letter only of last name and appropriate title.

B. A licensee who has changed his name shall submit as legal proof to the board a copy of the marriage certificate or court order evidencing the change. A duplicate license shall be issued by the board upon receipt of such evidence and the required fee.

C. Each licensee shall maintain an address of record with the board. Any change in the address of record or in the public address, if different from the address of record, shall be submitted by a licensee in writing to the board within 30 days of such change. All notices required by law and by this chapter to be mailed by the board to any licensee shall be validly given when mailed to the latest address of record on file with the board.

Part II
Nursing Education Programs

Article 1
Establishing Initial Approval of a Nursing Education Program

18VAC90-20-40. Application for initial approval.

A. An institution wishing to establish a nursing education program shall:

1. Provide documentation of attendance by the program director at a board orientation on establishment of a nursing education program prior to submission of an application and fee.

2. Submit to the board, at least 12 months in advance of expected opening date, a statement of intent an application to establish a nursing education program along with an a nonrefundable application fee as prescribed in 18VAC90-20-30.

a. The application shall be effective for 12 months from the date the application was received by the board.

b. If the program does not meet the board's requirements for approval within 12 months, it shall file a new application and fee.

3. Submit the following information on the organization and operation of a nursing education program:

a. A copy of a business license and zoning permit to operate a school in a Virginia location, a certificate of operation from the State Corporation Commission, evidence of approval from the Virginia Department of Education, and documentation of accreditation, if applicable;

b. The organizational structure of the institution and its relationship to the nursing education program therein;

c. The type of nursing program, as defined in 18VAC90-20-10;

d. An enrollment plan specifying the beginning dates and number of students for each class for a two-year period from the date of initial approval including (i) the planned number of students in the first class and in all subsequent classes and (ii) the planned frequency of admissions. Any increase in admissions that is not stated in the enrollment plan must be approved by the board. Also, transfer students are not authorized until full approval has been granted to the nursing education program; and

e. A tentative time schedule for planning and initiating the program through graduation of the first class and the program's receipt of results of the NCLEX examination.

2. 4. Submit to the board evidence documenting adequate resources for the projected number of students and the ability to provide a program that can meet the requirements of Article 2 (18VAC90-20-70 et seq.) of this part to include the following information:

a. Organizational structure of the institution and relationship of nursing program therein The results of a community assessment or market analysis that demonstrates the need for the nursing education program in the geographic area for the proposed school. The assessment or analysis shall include employment opportunities of nurses in the community, the number of clinical facilities or employers available for the size of the community to support the number of graduates, and the number and types of other nursing education programs in the area;

b. Purpose and type of program;

c. Availability b. A projection of the availability of qualified faculty sufficient to provide classroom instruction and clinical supervision for the number of students specified by the program;

d. c. Budgeted faculty positions sufficient in number to provide classroom instruction and clinical supervision;

e. d. Availability of clinical training facilities for the program as evidenced by copies of contracts or letters of agreement specifying the responsibilities of the respective parties and indicating sufficient availability of clinical experiences for the number of students in the program, the number of students, and clinical hours permitted at each clinical site and on each nursing unit;

e. Documentation that at least 80% of all clinical experiences are to be conducted in Virginia, unless an exception is granted by the board. There shall be documentation of written approval for any clinical experience conducted outside of Virginia by the agency that has authority to approve clinical placement of students in that state. The use of any clinical site in Virginia located 50 miles or more from the school shall require board approval;

f. Availability A diagram or blueprint showing the availability of academic facilities for the program, including classrooms, skills laboratory, and library learning resource center. This information shall include the number of restrooms for the student and faculty population, classroom and skills laboratory space large enough to accommodate the number of the student body, and sufficient faculty office space that meets FERPA requirements; and

g. Evidence of financial resources for the planning, implementation, and continuation of the program with line-item budget projections for the first three years; of operations beginning with the admission of students.

h. Tentative time schedule for planning and initiating the program; and

i. An enrollment plan specifying the beginning dates and number of students for each class for a two-year period from the date of initial approval.

3. 5. Respond to the board's request for additional information within a time frame established by the board.

B. A site visit may be conducted by a representative of the board.

C. The Education Special Conference Committee (the "committee"), composed of not less than two members of the board, shall, in accordance with § 2.2-4019 of the Code of Virginia, receive and review applications and the report of the site visit and shall make recommendations to the board regarding the granting or denial of approval of the program application.

1. If the board accepts the recommendation to approve the program application, the institution may apply for provisional approval of the nursing education program as set forth in this chapter.

2. If the committee recommendation is to deny approval of the program application, no further action will be required of the board unless the program requests a hearing before the board or a panel thereof in accordance with § 2.2-4020 and subdivision 9 of § 54.1-2400 of the Code of Virginia.

18VAC90-20-50. Provisional approval. (Repealed.)

A. The application for provisional approval shall be complete when the following conditions are met:

1. A program director has been appointed, and there are sufficient faculty to initiate the program as required in 18VAC90-20-90; and

2. A written curriculum plan developed in accordance with 18VAC90-20-120 has been submitted.

B. The committee shall, in accordance with § 2.2-4019 of the Code of Virginia, make recommendations to the board to grant or deny provisional approval.

1. If provisional approval is granted:

a. The admission of students is authorized; and

b. The program director shall submit quarterly progress reports to the board which shall include evidence of progress toward program approval and other information as required by the board.

2. If the committee recommendation is to deny provisional approval, no further action will be required of the board unless the program requests a hearing before the board or a panel thereof in accordance with § 2.2-4020 and subdivision 9 of § 54.1-2400 of the Code of Virginia.

18VAC90-20-60. Program approval. (Repealed.)

A. The application for approval shall be complete when:

1. A self-evaluation report of compliance with Article 2 (18VAC90-20-70 et seq.) of this part has been submitted along with the fee for a survey visit as required by 18VAC90-20-30;

2. The first graduating class has taken the licensure examination, and the cumulative passing rate for the program's first-time test takers taking the NCLEX over the first four quarters following graduation of the first class is not less than 80%; and

3. A satisfactory survey visit and report has been made by a representative of the board verifying that the program is in compliance with all requirements for program approval.

B. The committee shall, in accordance with § 2.2-4019 of the Code of Virginia, receive and review the self-evaluation, the NCLEX results and survey reports and shall make a recommendation to the board for the granting or denial of approval or for continuance of provisional approval.

C. If the committee's recommendation is to deny approval, no further action will be required of the board unless the program requests a hearing before the board or a panel thereof in accordance with § 2.2-4020 of the Code of Virginia.

Article 2
Requirements for Initial and Continued Approval

18VAC90-20-70. Organization and administration.

A. The governing or parent institution offering Virginia nursing education programs shall be approved or accredited by the appropriate state agencies by the Virginia Department of Education or accredited by an accrediting agency recognized by the United States U.S. Department of Education.

B. Any agency or institution used for clinical experience by a nursing education program shall be in good standing with its licensing body.

C. The program director of the nursing education program shall hold an unencumbered:

1. Hold a current license or multistate licensure privilege to practice as a registered nurse or a multistate licensure privilege to practice nursing in the Commonwealth, with the without any disciplinary action that currently restricts practice;

2. Have additional education and experience necessary to administer, plan, implement, and evaluate the nursing education program.;

3. Ensure that faculty are qualified by education and experience to teach in the program or to supervise the clinical practice of students in the program;

4. Maintain a current faculty roster, a current clinical agency form, and current clinical contracts available for board review and subject to an audit; and

5. Only serve as program director at one location or campus for the program.

D. The program shall provide evidence that the director has authority to:

1. Implement the program and curriculum;

2. Oversee the admission, academic progression and graduation of students;

3. Hire and evaluate faculty; and

4. Recommend and administer the program budget, consistent with established policies of the controlling agency.

D. E. An organizational plan shall indicate the lines of authority and communication of the nursing education program to the controlling body; to other departments within the controlling institution; to the cooperating agencies; and to the advisory committee, if one exists for the nursing education program.

E. F. There shall be evidence of financial support and resources sufficient to meet the goals of the nursing education program as evidenced by a copy of the current annual budget or a signed statement from administration specifically detailing its financial support and resources.

18VAC90-20-80. Philosophy and objectives.

Written statements of philosophy and objectives shall be the foundation of the curriculum and shall be:

1. Formulated and accepted by the faculty and the program director;

2. Descriptive of the practitioner to be prepared; and

3. The basis for planning, implementing, and evaluating the total program through the implementation of a systematic plan of evaluation that is documented in faculty or committee meeting minutes.

18VAC90-20-90. Faculty.

A. Qualifications for all faculty.

1. Every member of the nursing faculty, including the program director, shall hold a current, unencumbered license as a registered nurse or a multistate licensure privilege to practice nursing in Virginia as a registered nurse without any disciplinary action that currently restricts practice and have had at least two years of direct client care experience as a registered nurse prior to employment by the program. Persons providing instruction in topics other than nursing shall not be required to hold a license as a registered nurse.

2. Every member of a nursing faculty supervising the clinical practice of students shall meet the licensure requirements of the jurisdiction in which that practice occurs. Faculty shall provide evidence of education or experience in the specialty area in which they supervise students' clinical experience for quality and safety. Prior to supervision of students, the faculty providing supervision shall have completed a clinical orientation to the unit in which supervision is being provided.

3. The program director and each member of the nursing faculty shall maintain documentation of professional competence through such activities as nursing practice, continuing education programs, conferences, workshops, seminars, academic courses, research projects and professional writing. Documentation of annual professional development shall be maintained in employee files for the director and each faculty member until the next survey visit and shall be available for board review.

4. For baccalaureate degree and prelicensure graduate degree programs:

a. The program director shall hold a doctoral degree with a graduate degree in nursing.

b. Every member of the nursing faculty shall hold a graduate degree; the majority of the faculty shall have a graduate degree in nursing. Faculty members with a graduate degree with a major other than in nursing shall have a baccalaureate degree with a major in nursing.

5. For associate degree and diploma programs:

a. The program director shall hold a graduate degree, preferably with a major in nursing.

b. The majority of the members of the nursing faculty shall hold a graduate degree, preferably with a major in nursing.

c. Other All members of the nursing faculty shall hold a baccalaureate or graduate degree, preferably with a major in nursing.

6. For practical nursing programs:

a. The program director shall hold a baccalaureate degree, preferably with a major in nursing.

b. The majority of the members of the nursing faculty shall hold a baccalaureate degree, preferably with a major in nursing.

7. Exceptions to provisions of subdivisions 4, 5, and 6 of this subsection shall be by board approval.

a. Initial request for exception.

(1) The program director shall submit a request for initial exception in writing for consideration prior to the academic year during which the nursing faculty member is scheduled to teach or whenever an unexpected vacancy has occurred.

(2) A description of teaching assignment, a curriculum vitae, and a statement of intent from the prospective faculty member to pursue the required degree shall accompany each request.

b. Request for continuing exception.

(1) Continuing exception will be based on the progress of the nursing faculty member toward meeting the degree required by this chapter during each year for which the exception is requested.

(2) The program director shall submit the request for continuing exception in writing prior to the next academic year during which the nursing faculty member is scheduled to teach.

(3) A list of courses required for the degree being pursued and college transcripts showing successful completion of a minimum of two of the courses during the past academic year shall accompany each request.

(4) Any request for continuing exception shall be considered by the committee, which shall make a recommendation to the board.

c. The executive director of the board shall be authorized to make the initial decision on requests for exceptions. Any appeal of that decision shall be in accordance with the provisions of the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia)

B. Number of faculty.

1. The number of faculty shall be sufficient to prepare the students to achieve the objectives of the educational program and to ensure safety for patients clients to whom students provide care.

2. When students are giving direct care to patients clients, the ratio of students to faculty shall not exceed 10 students to one faculty member, and the faculty shall be on site solely to supervise students.

3. When preceptors are utilized for specified learning experiences in clinical settings, the faculty member may supervise up to 15 students.

C. Functions. The principal functions of the faculty shall be to:

1. Develop, implement and evaluate the philosophy and objectives of the nursing education program;

2. Design, implement, teach, evaluate and revise the curriculum. Faculty shall provide evidence of education and experience necessary to indicate that they are competent to teach a given course;

3. Develop and evaluate student admission, progression, retention and graduation policies within the framework of the controlling institution;

4. Participate in academic advisement and counseling of students in accordance with FERPA requirements;

5. Provide opportunities for and evidence of student and graduate evaluation of curriculum and teaching and program effectiveness; and

6. Document actions taken in faculty and committee meetings using a systematic plan of evaluation for total program review.

18VAC90-20-95. Preceptorships. (Repealed.)

A. Clinical preceptors may be used to augment the faculty and enhance the clinical learning experience. The clinical preceptor shall be licensed at or above the level for which the student is preparing.

B. When giving direct care to patients, students shall be supervised by faculty or preceptors as designated by faculty. In utilizing preceptors to supervise students, the ratio shall not exceed two students to one preceptor at any given time.

C. Faculty shall be responsible for the designation of a preceptor for each student and shall communicate such assignment with the preceptor. A preceptor may not further delegate the duties of the preceptorship.

D. Preceptorships shall include:

1. Written objectives, methodology, and evaluation procedures for a specified period of time;

2. An orientation program for faculty, preceptors, and students;

3. The performance of skills for which the student has had faculty-supervised clinical and didactic preparation; and

4. The overall coordination by faculty who assume ultimate responsibility for implementation, periodic monitoring, and evaluation.

18VAC90-20-96. Clinical practice of students. (Repealed.)

A. In accordance with § 54.1-3001 of the Code of Virginia, a nursing student, while enrolled in an approved nursing program, may perform tasks that would constitute the practice of nursing. The student shall be responsible and accountable for the safe performance of those direct patient care tasks to which he has been assigned.

B. Faculty members or preceptors providing supervision in the clinical care of patients shall be responsible and accountable for the assignment of patients and tasks based on their assessment and evaluation of the student's clinical knowledge and skills. Supervisors shall also monitor clinical performance and intervene if necessary for the safety and protection of the patients.

18VAC90-20-100. Admission, promotion and graduation of students.

A. Requirements for admission to the 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. The equivalent of a four-year high school course of study is 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 subdivision 1 of § 54.1-3020 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. A criminal background check shall be required for admission to a nursing education program.

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

18VAC90-20-110. School records; student records; school bulletin or catalogue Resources, facilities, publications, and services.

A. A system of records shall be maintained and be made available to the board representative and shall include:

1. Data relating to accreditation by any agency or body.

2. Course outlines.

3. Minutes of faculty and committee meetings.

B. A file shall be maintained for each student. Each file shall be available to the board representative and shall include the student's:

1. Application;

2. High school transcript or copy of high school equivalence certificate; and

3. Current record of achievement.

A final transcript shall be retained in the permanent file of the institution.

Provision shall be made for the protection of student and graduate records against loss, destruction and unauthorized use.

C. Current information about the nursing education program shall be published periodically and distributed to students, applicants for admission and the board. Such information shall include:

1. Description of the program.

2. Philosophy and objectives of the controlling institution and of the nursing program.

3. Admission and graduation requirements.

4. Fees.

5. Expenses.

6. Financial aid.

7. Tuition refund policy.

8. Education facilities.

9. Student activities and services.

10. Curriculum plan.

11. Course descriptions.

12. Faculty-staff roster.

13. School calendar.

14. Annual passage rates on NCLEX for the past five years.

A. Classrooms, conference rooms, laboratories, clinical facilities, and offices shall be sufficient to meet the objectives of the nursing education program and the needs of the students, faculty, administration, and staff and shall include private areas for faculty-student conferences. The nursing education program shall provide facilities that meet federal and state requirements including:

1. Comfortable temperatures;

2. Clean and safe conditions;

3. Adequate lighting;

4. Adequate space to accommodate all students; and

5. Instructional technology and equipment needed for simulating client care.

B. The program shall have learning resources and technology that are current, pertinent, and accessible to students and faculty, and sufficient to meet the needs of the students and faculty.

C. Current information about the nursing education program shall be published and distributed to applicants for admission and shall be made available to the board. Such information shall include:

1. Description of the program;

2. Philosophy and objectives of the controlling institution and of the nursing program;

3. Admission and graduation requirements, including the policy on the use of a final comprehensive exam;

4. Fees and expenses;

5. Availability of financial aid;

6. Tuition refund policy;

7. Education facilities;

8. Availability of student activities and services;

9. Curriculum plan to include course progression from admission to graduation, the name of each course, theory hours, skills lab hours, simulation hours (if used in lieu of direct client care hours), and clinical hours;

10. Course descriptions to include a complete overview of what is taught in each course;

11. Faculty-staff roster;

12. School calendar;

13. Student grievance policy; and

14. Information about implication of criminal convictions.

D. Administrative support services shall be provided.

E. There shall be written agreements with cooperating agencies that:

1. Ensure full control of student education by the faculty of the nursing education program, including the selection and supervision of learning experiences to include the dismissal of students from the clinical site if client safety is or may be compromised by the acts of the student;

2. Provide that faculty members or preceptors are present in the clinical setting when students are providing direct client care;

3. Provide for cooperative planning with designated agency personnel to ensure safe client care;

4. Provide that faculty be readily available to students and preceptors while students are involved in preceptorship experiences; and

5. State the number of students allowed on each nursing unit from the nursing education program.

F. Cooperating agencies shall be approved by the appropriate accreditation, evaluation, or licensing bodies, if such exist.

18VAC90-20-120. Curriculum.

A. Curriculum Both classroom and online curricula shall reflect the philosophy and objectives of the nursing education program and shall be consistent with the law governing the practice of nursing.

B. Nursing education programs preparing for nursing licensure as a registered or practical nurse shall include:

1. Didactic Evidence-based didactic content and supervised clinical experience in nursing encompassing the attainment and maintenance of physical and mental health and the prevention of illness for individuals and groups throughout the life cycle and in a variety of acute, nonacute, and long-term care clinical settings and experiences to include adult medical/surgical nursing, geriatric nursing, maternal/infant (obstetrics, gynecology, neonatal) nursing, mental health/psychiatric nursing, nursing fundamentals, and pediatric nursing;

2. Concepts of the nursing process that include conducting a focused nursing assessment of the client status that includes decision making about who and when to inform, identifying client needs, planning for episodic nursing care, implementing appropriate aspects of client care, and contributing to data collection and the evaluation of client outcomes, and the appropriate reporting and documentation of collected data and care rendered;

3. Concepts of anatomy, physiology, chemistry, microbiology, and the behavioral sciences;

4. Concepts of communication, growth and development, nurse-client interpersonal relations, and patient client education, including:

a. Development of professional socialization that includes working in interdisciplinary teams; and

b. Conflict resolution;

5. Concepts of ethics and the vocational and legal aspects of nursing, including:

a. Regulations and sections of the Code of Virginia related to nursing;

b. Patient Client rights, privacy, and confidentiality;

c. Prevention of patient client abuse, neglect, and abandonment throughout the life cycle, including instruction in the recognition, intervention, and reporting by the nurse of evidence of child or elder abuse;

d. Professional responsibility to include the role of the practical and professional nurse; and

e. Professional boundaries to include appropriate use of social media and electronic technology; and

e. f. History and trends in nursing and health care;

6. Concepts of pharmacology, dosage calculation, medication administration, nutrition, and diet therapy;

7. Concepts of client-centered care, including:

a. Respect for cultural differences, values, and preferences and expressed needs;

b. Promotion of healthy life styles for clients and populations;

c. Promotion of a safe client environment; and

d. Prevention and appropriate response to situations of bioterrorism, natural and man-made disasters, and domestic intimate partner and family violence; and

e. Use of critical thinking and clinical judgment in the implementation of safe client care; and

f. Care of clients with multiple, chronic conditions; and

8. Development of management and supervisory skills., including:

a. The use of technology in medication administration and documentation of client care;

b. Participation in quality improvement processes and systems to measure client outcomes and identify hazards and errors; and

c. Supervision of certified nurse aides, registered medication aides and unlicensed assistive personnel.

C. In addition to meeting curriculum requirements set forth in subsection B of this section, registered nursing education programs preparing for registered nurse licensure shall also include:

1. Didactic Evidence-based didactic content and supervised clinical experiences in conducting a comprehensive nursing assessment that includes:

a. Extensive data collection, both initial and ongoing, for individuals, families, groups, and communities addressing anticipated changes in client conditions as well as emerging changes in a client's health status;

b. Recognition of alterations to previous client conditions;

c. Synthesizing the biological, psychological and social aspects of the client's condition;

d. Evaluation of the effectiveness and impact of nursing care;

e. Planning for nursing interventions and evaluating the need for different interventions for individuals, groups and communities;

f. Evaluation and implementation of the need to communicate and consult with other health team members; and

g. Use of a broad and complete analysis to make independent decisions and nursing diagnoses;

2. Didactic Evidence-based didactic content and supervised experiences in:

a. Development of clinical judgment;

b. Development of leadership skills and knowledge unit management;

c. Knowledge of the rules and principles for delegation of nursing tasks to unlicensed persons;

d. Supervision of licensed practical nurses;

c. e. Involvement of clients in decision making and a plan of care; and

d. Participation in quality improvement processes to measure client outcomes and identify hazards and errors;

3. f. Concepts of pathophysiology; and.

4. Principles of delegation of nursing tasks to unlicensed persons.

D. On and after July 1, 2007, all nursing education programs shall provide instruction in child abuse recognition and intervention.

E. A nursing education program preparing for licensure as a practical nurse shall provide a minimum of 400 hours of direct client care supervised by qualified faculty. A nursing education program preparing for licensure as a registered nurse shall provide a minimum of 500 hours of direct client care supervised by qualified faculty.

18VAC90-20-121. Curriculum for direct client care.

A. A nursing education program preparing a student for licensure as a registered nurse shall provide a minimum of 500 hours of direct client care supervised by qualified faculty. A nursing education program preparing a student for licensure as a practical nurse shall provide a minimum of 400 hours of direct client care supervised by qualified faculty. Direct client care hours shall include experiences and settings as set forth in 18VAC90-20-120 B 1.

B. Licensed practical nurses transitioning into prelicensure registered nursing programs may be awarded no more than 150 clinical hours of the 400 clinical hours received in a practical nursing program. In a practical nursing to registered nursing transitional program, the remainder of the clinical hours shall include registered nursing clinical experience across the life cycle in adult medical/surgical nursing, maternal/infant (obstetrics, gynecology, neonatal) nursing, mental health/psychiatric nursing, and pediatric nursing.

C. Any observational experiences shall be planned in cooperation with the agency involved to meet stated course objectives. Observational experiences shall not be accepted toward the 400 or 500 minimum clinical hours required. Observational objectives shall be available to students, the clinical unit, and the board.

D. Simulation for direct client clinical hours.

1. No more than 20% of direct client contact hours may be simulation. For prelicensure registered nursing programs, the total of simulated client care hours cannot exceed 100 hours (20% of the required 500 hours). For prelicensure practical nursing programs, the total of simulated client care hours cannot exceed 80 hours (20% of the required 400 hours).

2. No more than 50% of the total clinical hours for any course may be used as simulation.

3. Skills acquisition and task training alone, as in the traditional use of a skills laboratory, do not qualify as simulated client care and therefore do not meet the requirements for direct client care hours.

4. Clinical simulation must be led by faculty who meet the qualifications specified in 18VAC90-20-90.

5. Documentation of the following shall be available for all simulated experiences:

a. Course description and objectives;

b. Type of simulation and location of simulated experience;

c. Number of simulated hours;

d. Faculty qualifications; and

e. Methods of debriefing.

18VAC90-20-122. Clinical practice of students.

A. In accordance with § 54.1-3001 of the Code of Virginia, a nursing student, while enrolled in an approved nursing program, may perform tasks that would constitute the practice of nursing. The student shall be responsible and accountable for the safe performance of those direct client care tasks to which he has been assigned.

B. Faculty shall be responsible for ensuring that students perform only skills or services in direct client care for which they have received instruction and have been found proficient by the instructor. Skills checklists shall be maintained for each student.

C. Faculty members or preceptors providing on-site supervision in the clinical care of clients shall be responsible and accountable for the assignment of clients and tasks based on their assessment and evaluation of the student's clinical knowledge and skills. Supervisors shall also monitor clinical performance and intervene if necessary for the safety and protection of the clients.

D. Clinical preceptors may be used to augment the faculty and enhance the clinical learning experience. Faculty shall be responsible for the designation of a preceptor for each student and shall communicate such assignment with the preceptor. A preceptor may not further delegate the duties of the preceptorship.

E. Preceptors shall provide to the nursing education program evidence of competence to supervise students' clinical experience for quality and safety in each specialty area where they supervise students. The clinical preceptor shall be licensed as a nurse at or above the level for which the student is preparing.

F. Supervision of students.

1. When faculty are supervising direct client care by students, the ratio of students to faculty shall not exceed 10 students to one faculty member. The faculty member shall be on site in the clinical setting solely to supervise students.

2. When preceptors are utilized for specified learning experiences in clinical settings, the faculty member may supervise up to 15 students. In utilizing preceptors to supervise students in the clinical setting, the ratio shall not exceed two students to one preceptor at any given time. During the period in which students are in the clinical setting with a preceptor, the faculty member shall be available for communication and consultation with the preceptor.

G. Prior to beginning any preceptorship, the following shall be required:

1. Written objectives, methodology, and evaluation procedures for a specified period of time to include the dates of each experience;

2. An orientation program for faculty, preceptors, and students;

3. A skills checklist detailing the performance of skills for which the student has had faculty-supervised clinical and didactic preparation; and

4. The overall coordination by faculty who assume ultimate responsibility for implementation, periodic monitoring, and evaluation.

18VAC90-20-130. Resources, facilities and services. Granting of initial program approval.

A. Periodic evaluations of resources, facilities and services shall be conducted by the administration, faculty, students and graduates of the nursing education program.

B. Secretarial and other support services shall be provided.

C. Classrooms, conference rooms, laboratories, clinical facilities and offices shall be sufficient to meet the objectives of the nursing education program and the needs of the students, faculty, administration and staff.

D. The program shall have learning resources that are current, pertinent and accessible to students and faculty, and sufficient to meet the needs of the students and faculty.

E. Written agreements with cooperating agencies shall be developed, maintained and periodically reviewed. The agreement shall:

1. Ensure full control of student education by the faculty of the nursing education program, including the selection and supervision of learning experiences.

2. Provide that faculty members or preceptors be present in the clinical setting when students are assigned for direct patient care.

3. Provide for cooperative planning with designated agency personnel to ensure safe patient care.

4. Provide that faculty be available to students and preceptors while students are involved in preceptorship experiences.

F. Any observational experiences shall be planned in cooperation with the agency involved to meet stated course objectives.

G. Cooperating agencies shall be approved by the appropriate accreditation, evaluation or licensing bodies, if such exist.

A. Initial approval may be granted when all documentation required in 18VAC90-20-40 has been submitted and is deemed satisfactory to the board and when the following conditions are met:

1. There is evidence that the requirements for organization and administration and the philosophy and objectives of the program, as set forth in 18VAC90-20-70 and 18VAC90-20-80, have been met;

2. A program director who meets board requirements has been appointed, and there are sufficient faculty to initiate the program as required in 18VAC90-20-90;

3. A written curriculum plan developed in accordance with 18VAC90-20-120 has been submitted and approved by the board;

4. A written systematic plan of evaluation has been developed and approved by the board; and

5. The program is in compliance with requirements of 18VAC90-20-110 for resources, facilities, publications, and services as verified by a satisfactory site visit conducted by a representative of the board.

B. If initial approval is granted:

1. The advertisement of the nursing program is authorized.

2. The admission of students is authorized, except that transfer students are not authorized to be admitted until the program has received full program approval.

3. The program director shall submit quarterly progress reports to the board that shall include evidence of progress toward full program approval and other information as required by the board.

18VAC90-20-131. Denying or withdrawing initial program approval.

A. Denial of initial program approval.

1. Initial approval may be denied for causes enumerated in 18VAC90-20-132.

2. If the initial approval is denied:

a. The program shall be given an option of correcting the deficiencies cited by the board during the time remaining in its initial 12-month period following receipt of the application.

b. No further action regarding the application shall be required of the board unless the program requests, within 30 days of the mailing of the decision, an informal conference pursuant to §§ 2.2-4019 and 54.1-109 of the Code of Virginia.

3. If denial is recommended following the informal conference, the recommendation shall be presented to the board or a panel thereof for review and action.

4. If the recommendation of the informal conference committee to deny initial approval is accepted by the board or a panel thereof, the decision shall be reflected in a board order and no further action by the board is required. The program may request a formal hearing within 30 days from entry of the order, in accordance with § 2.2-4020 of the Code of Virginia.

5. If the decision of the board or a panel thereof, following a formal hearing, is to deny initial approval, the program shall be advised of the right to appeal the decision to the appropriate circuit court in accordance with § 2.2-4026 and Part 2A of the Rules of the Supreme Court of Virginia.

B. Withdrawal of initial program approval.

1. Initial approval shall be withdrawn and the program closed if:

a. The program has not admitted students within six months of approval of its application;

b. The program fails to submit evidence of progression toward full program approval; or

c. For any of the causes enumerated in 18VAC90-20-132.

2. If a decision is made to withdraw initial approval, no further action shall be required by the board unless the program, within 30 days of the mailing of the decision, requests an informal conference pursuant to §§ 2.2-4019 and 54.1-109 of the Code of Virginia.

3. If withdrawal of initial approval is recommended following the informal conference, the recommendation shall be presented to the board or a panel thereof for review and action.

4. If the recommendation of the informal conference committee to withdraw initial approval is accepted by the board or a panel thereof, the decision shall be reflected in a board order and no further action by the board is required unless the program requests a formal hearing within 30 days from entry of the order, in accordance with § 2.2-4020 of the Code of Virginia.

5. If the decision of the board or a panel thereof following a formal hearing is to withdraw initial approval, the program shall be advised of the right to appeal the decision to the appropriate circuit court in accordance with § 2.2-4026 of the Code of Virginia and Part 2A of the Rules of the Supreme Court of Virginia.

18VAC90-20-132. Causes for denial or withdrawal of nursing education program approval.

A. Denial or withdrawal of program approval may be based upon the following:

1. Failing to demonstrate compliance with program requirements in Article 1 (18VAC90-20-40 et seq.), Article 2 (18VAC90-20-133 et seq.), or Article 3 (18VAC90-20-151 et seq.) of this part.

2. Failing to comply with terms and conditions placed on a program by the board.

3. Advertising for or admitting students without authority, board approval, or contrary to a board restriction.

4. Failing to progress students through the program in accordance with an approved time frame.

5. Failing to provide evidence of progression toward initial program approval within a time frame established by the board.

6. Failing to provide evidence of progression toward full program approval within a time frame established by the board.

7. Failing to respond to requests for information required from board representatives.

8. Fraudulent submission of documents or statements to the board or its representatives.

9. Having had past actions taken by the board, other states, or accrediting entities regarding the same nursing education program operating in another jurisdiction.

10. Failing to maintain a pass rate of 80% on the NCLEX for graduates of the program as required by 18VAC90-20-151.

11. Failing to comply with an order of the board or with any terms and conditions placed upon it by the board for continued approval.

12. Having the program director, owner, or operator of the program convicted of a felony or a misdemeanor involving moral turpitude or his professional license disciplined by a licensing body or regulatory authority.

13. Failing to pay the required fee for a survey or site visit.

B. Withdrawal of nursing education program approval may occur at any stage in the application or approval process pursuant to procedures enumerated in 18VAC90-20-131, 18VAC90-20-134, and 18VAC90-20-161.

C. Programs with approval denied or withdrawn may not accept or admit additional students into the program effective upon the date of entry of the board's final order to deny or withdraw approval. Further, the program shall submit quarterly reports until the program is closed, and the program shall comply with board requirements regarding closure of a program as stated in 18VAC90-20-170.

Article 2
Full Approval for a Nursing Education Program

18VAC90-20-133. Granting full program approval.

A. Full approval may be granted when:

1. A self-evaluation report of compliance with Articles 1 (18VAC90-20-40 et seq.) and 2 (18VAC90-20-133 et seq.) of this part and a survey visit fee as specified in 18VAC90-20-30 have been submitted and received by the board;

2. The program has achieved a passage rate of not less than 80% for the program's first-time test takers taking the NCLEX based on at least 20 graduates within a two-year period; and

3. A satisfactory survey visit and report have been made by a representative of the board verifying that the program is in compliance with all requirements for program approval.

B. If full approval is granted, the program shall continue to comply with all requirements in Articles 1, 2, and 3 (18VAC90-20-151 et seq.) of this part, and admission of transfer students is authorized.

18VAC90-20-134. Denying full program approval.

A. Denial of full program approval may occur for causes enumerated in 18VAC90-20-132.

B. If full program approval is denied, the board shall also be authorized to do one of the following:

1. The board may continue the program on initial program approval with terms and conditions to be met within the time frame specified by the board; or

2. The board may withdraw initial program approval.

C. If the board takes one of the actions specified in subsection B of this section, the following shall apply:

1. No further action will be required of the board unless the program, within 30 days of the mailing of the decision, requests an informal conference pursuant to §§ 2.2-4019 and 54.1-109 of the Code of Virginia.

2. If continued initial program approval with terms and conditions or withdrawal of initial approval is recommended following the informal conference, the recommendation shall be presented to the board or a panel thereof for review and action.

3. If the recommendation of the informal conference committee is accepted by the board or a panel thereof, the decision shall be reflected in a board order and no further action by the board regarding the application is required. The program may request a formal hearing within 30 days from entry of the order, in accordance with § 2.2-4020 and subdivision 11 of § 54.1-2400 of the Code of Virginia.

4. If the decision of the board or a panel thereof following a formal hearing is to deny full and/or withdraw or continue on initial approval with terms or conditions, the program shall be advised of the right to appeal the decision to the appropriate circuit court in accordance with § 2.2-4026 of the Code of Virginia and Part 2A of the Rules of the Supreme Court of Virginia.

D. If a program is denied full approval and initial approval withdrawn, no additional students may be accepted into the program, effective upon the date of entry of the board's final order to deny or withdraw approval. Further, the program shall submit quarterly reports until the program is closed, and the program shall comply with board requirements regarding closure of a program as stated in 18VAC90-20-170.

18VAC90-20-135. Requests for exceptions or requirements for faculty.

After full approval has been granted, a program may request board approval for exceptions to requirements of 18VAC90-20-90 for faculty as follows:

1. Initial request for exception.

a. The program director shall submit a request for initial exception in writing to the board for consideration prior to the academic year during which the nursing faculty member is scheduled to teach or whenever an unexpected vacancy has occurred.

b. A description of teaching assignment, a curriculum vitae, and a statement of intent from the prospective faculty member to pursue the required degree shall accompany each request.

c. The executive director of the board shall be authorized to make the initial decision on requests for exceptions. Any appeal of that decision shall be in accordance with the provisions of the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia).

2. Request for continuing exception.

a. Continuing exception will be based on the progress of the nursing faculty member toward meeting the degree required by this chapter during each year for which the exception is requested.

b. The program director shall submit the request for continuing exception in writing prior to the next academic year during which the nursing faculty member is scheduled to teach.

c. A list of courses required for the degree being pursued and college transcripts showing successful completion of a minimum of two of the courses during the past academic year shall accompany each request.

d. Any request for continuing exception shall be considered by the committee, which shall make a recommendation to the board.

18VAC90-20-136. Records and provision of information.

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

B. A system of records shall be maintained and be made available to the board representative and shall include:

1. Data relating to accreditation by any agency or body.

2. Course outlines.

3. Minutes of faculty and committee meetings including documentation of the use of a systematic plan of evaluation for total program review and including those faculty members in attendance.

4. Record of and disposition of complaints.

C. A file shall be maintained for each student. Provision shall be made for the protection of student and graduate files against loss, destruction, and unauthorized use. Each file shall be available to the board representative and shall include the student's:

1. Application, including the date of its submission and the date of admission into the program;

2. High school transcript or copy of high school equivalence certificate, and if the student is a foreign graduate, a transcript translated into English and the results of passage of an examination of English proficiency as determined by the board;

3. Current record of achievement to include classroom grades, skills checklists, and clinical hours for each course; and

4. A final transcript retained in the permanent file of the institution to include dates of admission and completion of coursework, graduation date, name and address of graduate, the dates of each semester or term, number of clinical hours for each clinical course, course grades, and authorized signature.

D. Current information about the nursing education program shall be published and distributed to students and applicants for admission and shall be made available to the board. In addition to information specified in 18VAC90-20-110 C, the following information shall be included:

1. Annual passage rates on NCLEX for the past five years; and

2. Accreditation status.

18VAC90-20-137. Evaluation of resources; written agreements with cooperating agencies.

A. Periodic evaluations of resources, facilities, and services shall be conducted by the administration, faculty, students, and graduates of the nursing education program including an employer evaluation for graduates of the nursing education program. Such evaluation shall include assurance that at least 80% of all clinical experiences are conducted in Virginia unless an exception has been granted by the board.

B. Current written agreements with cooperating agencies shall be maintained and reviewed annually and shall be in accordance with of 18VAC90-20-110 E.

C. Upon request, a program shall provide a clinical agency summary on a form provided by the board.

D. Upon request and if applicable, the program shall provide (i) documentation of board approval for use of clinical sites located 50 or more miles from the school; and (ii) for use of clinical experiences conducted outside of Virginia, documented approval from the agency that has authority to approve clinical placement of students in that state.

18VAC90-20-140. Program changes.

A. The following shall be reported to the board within 10 days of the change or receipt of a report from an accrediting body:

1. Change in the program director, governing body, or parent institution;

2. Adverse action taken by a licensing authority against the program director, governing body, or parent institution;

3. Conviction of a felony or misdemeanor involving moral turpitude against the program director, owner, or operator of the program;

2. 4. Change in accreditation status the physical location of the program;

3. 5. Change in content of curriculum, faculty or method of delivery that affects 25% or more of the hours of instruction the availability of clinical sites;

4. 6. Change in financial resources that could substantively affect the nursing education program;

7. Change in content of curriculum, faculty, or method of delivery that affects 25% or more of the hours of instruction;

5. 8. Change in the physical location of the program accreditation status; and

6. 9. A final report with findings and recommendations from the accrediting body.

B. Other curriculum or faculty changes shall be reported to the board with the annual report required in 18VAC90-20-160 A.

Article 3
Continued Approval of Nursing Education Programs

18VAC90-20-151. Passage rate on national examination.

A. For the purpose of continued approval by the board, a nursing education program shall maintain 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.

B. If an approved program falls below 80% for one year, it shall submit a plan of correction to the board. If a an approved program falls below 80% for two consecutive years, the board shall place the program on conditional approval with terms and conditions, require the program to submit a plan of correction, and conduct a site visit and place the program on conditional approval. Prior to the conduct of such a visit, the program shall submit the fee for a site visit pursuant to the NCLEX passage rate as required by 18VAC90-20-30. If a program falls below 80% for three consecutive years, the board may withdraw program approval.

C. For the purpose of program evaluation, the board may provide to the program the NCLEX examination results of its graduates. However, further release of such information by the program shall not be authorized without written authorization from the candidate.

Article 3
Maintaining or Closing an Approved Nursing Education Program

18VAC90-20-160. Maintaining an approved nursing education program.

A. The program director of each nursing education program shall submit an annual report to the board.

B. Each nursing education program shall be reevaluated as follows:

1. A Every nursing education program that has not achieved accreditation as defined in 18VAC90-20-10 shall be reevaluated at least every eight five years for a practical nursing program and every six years for a registered nursing program by submission of a comprehensive self-evaluation report based on Article Articles 1 (18VAC90-20-40 et seq.) and 2 (18VAC90-20-70 (18VAC90-20-133 et seq.) of this part, and a survey visit by a representative(s) representative or representatives of the board on dates mutually acceptable to the institution and the board.

2. A program that has maintained accreditation as defined in 18VAC90-20-10 shall be reevaluated at least every 10 years by submission of a comprehensive self-evaluation report as provided by the board. As evidence of compliance with specific requirements of this chapter, the board may accept the most recent study report, site visit report, and final decision letter from the accrediting body. The board may require additional information or a site visit to ensure compliance with requirements of this chapter. If accreditation has been withdrawn or a program has been placed on probation by the accrediting body, the board shall conduct an on-site may require a survey visit within one year of such action. If a program fails to submit the documentation required in this subdivision, the requirements of subdivision 1 of this subsection shall apply.

C. The Education Special Conference Committee (the "committee"), composed of not less than two members of the board, shall, in accordance with § 2.2-4019 of the Code of Virginia, receive and review the self-evaluation and survey reports and shall make a recommendation to the board to grant continued approval, place the program on conditional approval or withdraw approval.

1. A nursing education program shall continue to be approved provided the requirements set forth in Article 2 of this part are attained and maintained.

2. If the committee determines that a nursing education program is not maintaining the requirements of Article 2 of this part, the committee shall recommend to the board that the program be placed on conditional approval and the governing institution shall be given a reasonable period of time to correct the identified deficiencies.

a. The committee shall receive and review reports of progress toward correcting identified deficiencies and, when a final report is received at the end of the specified time showing correction of deficiencies, make a recommendation to the board to grant continued approval, continue the program on conditional approval or withdraw approval.

b. If the nursing education program fails to correct the identified deficiencies within the time specified by an order of the board, the board may withdraw the approval following a formal hearing.

c. The governing institution may request a formal hearing before the board or a panel thereof pursuant to § 2.2-4020 and subdivision 9 of § 54.1-2400 of the Code of Virginia if it objects to any action of the board relating to conditional approval.

D. C. Interim site or survey visits shall be made to the institution by board representatives at any time within the initial approval period or full approval period either by request or as deemed necessary by the board. Prior to the conduct of such a visit, the program shall submit the fee for a survey visit as required by 18VAC90-20-30.

E. D. Failure to submit the required fee for a survey or site visit may subject an education program to board action or withdrawal of board approval.

18VAC90-20-161. Continuing and withdrawing full approval.

A. The board shall receive and review the self-evaluation and survey reports pursuant to 18VAC90-20-160 B or complaints relating to program compliance. Following review, the board may continue the program on full approval so long as it remains in compliance with all requirements in Articles 1 (18VAC90-20-40 et seq.), 2 (18VAC90-20-133 et seq.) and 3 (18VAC90-20-151 et seq.) of this part.

B. If the board determines that a program is not maintaining the requirements of Articles 1, 2, and 3, or for causes enumerated in 18VAC90-20-132, it may:

1. Place the program on conditional approval with terms and conditions to be met within the time frame specified by the board; or

2. Withdraw program approval.

C. If the board either places a program on conditional approval with terms and conditions to be met within a time frame specified by the board or withdraws approval, the following shall apply:

1. No further action will be required of the board unless the program requests an informal conference pursuant to §§ 2.2-4019 and 54.1-109 of the Code of Virginia.

2. If withdrawal or continued program approval with terms and conditions is recommended following the informal conference, the recommendation shall be presented to the board or a panel thereof for review and action.

3. If the recommendation of the informal conference committee is accepted by the board or a panel thereof, the decision shall be reflected in a board order and no further action by the board is required unless the program requests a formal hearing within 30 days from entry of the order in accordance with § 2.2-4020 of the Code of Virginia.

4. If the decision of the board or a panel thereof following a formal hearing is to withdraw approval or continue on conditional approval with terms or conditions, the program shall be advised of the right to appeal the decision to the appropriate circuit court in accordance with § 2.2-4026 of the Code of Virginia and Part 2A of the Rules of the Supreme Court of Virginia.

D. If a program approval is withdrawn, no additional students may be admitted into the program effective upon the date of entry of the board's final order to withdraw approval. Further, the program shall submit quarterly reports until the program is closed, and the program must comply with board requirements regarding closure of a program as stated in 18VAC90-20-170.

18VAC90-20-170. Closing of an approved nursing education program; custody of records.

A. When the governing institution anticipates the closing of a nursing education program, it shall notify the board in writing, stating the reason, plan, and date of intended closing.

The governing institution shall assist in the transfer of students to other approved programs with the following conditions:

1. The program shall continue to meet the standards required for approval until all students are transferred and shall submit a quarterly report to the board regarding progress toward closure.

2. A The program shall provide to the board a list of the names of students who have been transferred to approved programs, and the date on which the last student was transferred shall be submitted to the board by the governing institution.

3. The date on which the last student was transferred shall be the closing date of the program.

B. When the board denies or withdraws approval of a program, the governing institution shall comply with the following procedures:

1. The program shall be closed according to a time frame established by the board.

2. A The program shall provide to the board a list of the names of students who have transferred to approved programs and the date on which the last student was transferred shall be submitted to the board by the governing institution.

3. The program shall provide quarterly reports to the board regarding progress toward closure.

C. Provision shall be made for custody of records as follows:

1. If the governing institution continues to function, it shall assume responsibility for the records of the students and the graduates. The institution shall inform the board of the arrangements made to safeguard the records.

2. If the governing institution ceases to exist, the academic transcript of each student and graduate shall be transferred by the institution to the board for safekeeping.