Title of Regulation: 18VAC90-19. Regulations Governing the Practice of Nursing (amending 18VAC90-19-50).

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

Public Hearing Information:

September 19, 2017 - 10 a.m. - Perimeter Center, 9960 Mayland Drive, Suite 201, Richmond, VA 23233

Public Comment Deadline: September 22, 2017.

Agency Contact: Jay P. Douglas, R.N., Executive Director, Board of Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4520, FAX (804) 527-4455, or email jay.douglas@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia provides the Board of Nursing the authority to promulgate regulations that are reasonable and necessary to administer effectively the regulatory system.

Among the powers and duties of the Board of Nursing in § 54.1-3005 of the Code of Virginia is a provision relating to name tags for nurses in certain employment settings.

Purpose: The purpose of the proposed action is to promulgate a regulation that adequately protects nurses but also offers sufficient information for patients who need to know what type of practitioner is providing care and how to identify the practitioner in case there is evidence of unprofessional conduct. The board had to balance nurses' privacy and personal security concerns with its responsibility to adopt regulations that protect the public health and safety.

Substance: The proposed amendment specifies that the policy of the employment setting for name identification of health care practitioners can determine how the nurse's name is displayed on a name badge.

Issues: The primary advantage of the proposed amendment is greater flexibility and potentially greater protection for nurses who are concerned about their security both within and outside their practice setting. There are no disadvantages to the public because the badge must still indicate the appropriate title, so a patient would know whether this person is an RN, LPN, "patient care technician," or some other title. There are no advantages or disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. In response to a petition for rulemaking,¹ the Board of Nursing (Board) proposes to amend the requirements for nurses identification badges.

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

Estimated Economic Impact. The current regulation requires that registered nurses (RNs) and licensed practical nurses (LPNs) wear identification that indicates the person's first and last name. It also provides for exceptions by stating that "Any person practicing in hospital emergency departments, psychiatric and mental health units and programs, or in health care facilities units offering treatment for clients in custody of state or local law-enforcement agencies may use identification badges with first name and first letter only of last name and appropriate title."

The Board proposes to eliminate the requirement that the badge indicates the person's first and last name, and instead state that "Name identification on a badge for identification of health care practitioners shall follow the policy of the health care setting in which the nurse is employed."² In both the current and proposed regulations, the identification badge would be required to have the person's appropriate title for the license, registration, or student status under which she is practicing.

In a survey of 320 nurses in the Commonwealth conducted by the Virginia Nurses Association, 81% preferred that that the badge not include their full name.³ Concerns with safety and an increase in stalking were cited. The proposal to allow employers flexibility concerning name identification on the badge would potentially be beneficial in that some or many employers may choose to not have the full name listed, which may reduce the occurrences of stalking and harassment of nurses.

The proposed regulation keeps the requirement that the badge have the person's appropriate title, but does not require a minimum for name identification. An employer could potentially choose to not have the name on the badge at all. It seems likely though, that most employers would prefer to have a form of name (first name and last initial for example) on the badge so that patients or family members could correctly identify a nurse being referenced. Overall, the proposed amendments likely produce a net benefit.

Businesses and Entities Affected. The proposed amendments affect the 29,831 LPNs and 104,956 RNs licensed in the Commonwealth and their employers.⁴ Most nurses work for medical practices, long-term care facilities, or hospital systems.

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

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

Effects on the Use and Value of Private Property. The proposed amendments do not affect the use and value of private property.

Real Estate Development Costs. The proposed amendments do not affect real estate development costs.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. The proposed amendments do not significantly affect costs for small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed amendments do not adversely affect small businesses.

Adverse Impacts:

Businesses. The proposed amendments do not adversely affect businesses.

Localities. The proposed amendments do not adversely affect localities.

Other Entities. The proposed amendments do not adversely affect other entities.

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¹ More information about the petition can be found on the Virginia Regulatory Town Hall at http://townhall.virginia.gov/l/viewpetition.cfm?petitionid=249.

² The petition for rulemaking requested that the requirement that nurses include first and last name on identification badges be replaced with a requirement for only first name and last initial.

³ See http://townhall.virginia.gov/L/viewcomments.cfm?commentid=55675.

⁴ Data source: Department of Health Professions

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

Summary:

The proposed amendment requires that a nurse's name badge must follow the policy of the employment setting for name identification of health care practitioners.

18VAC90-19-50. Identification; accuracy of records.

A. Any person regulated by this chapter who provides direct 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, registration, or student status under which he is practicing in that setting. Name identification on a badge for identification of health care practitioners shall follow the policy of the health care setting in which the nurse is employed. Any person practicing in hospital emergency departments, psychiatric and mental health units and programs, or in health care facilities units offering treatment for clients in custody of state or local law-enforcement agencies may use identification badges with 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, a certificate of naturalization, 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 electronically or 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.