Title of Regulation: 18VAC90-19. Regulations Governing the Practice of Nursing (amending 18VAC90-19-30, 18VAC90-19-210).

Statutory Authority: §§ 54.1-2400 and 54.1-3505 of the Code of Virginia.

Public Hearing Information:

January 28, 2020 - 10 a.m. - Department of Health Professions, Board Room 2, Perimeter Center, 9960 Mayland Drive, Suite 201, Richmond, VA 23233

Public Comment Deadline: March 20, 2020.

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

Basis: Regulations are promulgated under the general authority of Chapter 24 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. The specific authority for the Board of Nursing to register clinical nurse specialist is found in §§ 54.1-3005 and 54.1-3018.1 of the Code of Virginia.

Purpose: Regulations were recently amended to align regulatory provisions on national certification with the language in § 54.1-3018.1 of the Code of Virginia, and the amendments became effective March 22, 2019. The proposed amendments clarify that the board will accept a specialty examination that has now been retired but the certification has been maintained or will accept the core examination for national certification as a clinical nurse specialist. Amendments are also necessary to assure that a registered nurse who has allowed his certified nurse specialist (CNS) registration to lapse for more than one renewal cycle is safe and competent to resume advanced practice by providing evidence of current certification.

Substance: The proposed amendments to 18VAC90-19-210 clarify that the board will accept for registration evidence of a clinical nurse specialist certification that has been retired or is the core certification, provided the certification has been maintained and is current. Likewise, a retired or core certification that remains current qualifies a clinical nurse specialist to renew registration.

In subsection B of 18VAC90-19-210, the proposed amendment addresses renewal of a lapsed registration and reinstatement of a registration that has been suspended or revoked. Regulations are aligned with those in 18VAC90-19-190 relating to the reinstatement of a nursing license.

Issues: The primary advantage of the amendment is clearer language to avoid confusion and to facilitate registration as a CNS. There are no disadvantages. 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 rulemaking² and a recent case decision,³ the Board of Nursing (Board) proposes to revise the regulation to accept a retired certification, either a clinical nurse specialist (CNS) certification or a core certification, as the required certification for initial registration or renewal provided it has been maintained and is current. The Board also proposes to amend the rules for reinstatement of an expired CNS registration to be similar to the rules for reinstatement of a registered nurse (RN) license.

Background. The CNS registration may be issued to RNs who are able to provide advanced services according to the specialized training received from a program satisfactory to the Board. In February 2019, the Virginia Association of Clinical Nurse Specialists filed the petition for rulemaking and among other things requested that a retired certification be accepted. According to the Department of Health Professions (DHP), sometimes the issuing entity retires (or discontinues) a particular certification but allows the existing certificate holders to maintain it. The Board notes it was allowed by the Office of the Attorney General to interpret the current regulation to accept an applicant who had a retired certification but was advised that the regulation needed to be revised to specify such acceptance. The Board now proposes to reflect this new policy in the regulation and also proposes to amend the reinstatement of a registration to be similar to that of the reinstatement of an RN license.

Estimated Benefits and Costs. Currently, there are 418 certified nurse specialists registered in Virginia. According to DHP, the proposed amendments could qualify a few applicants who would otherwise not be registered to practice in the role of a CNS. An RN with the specialist certification would be expected to receive slightly higher compensation than one without it. Thus, the proposed amendments could improve earning potential of RNs with a retired (but current) qualifying certification. The condition that the retired certification has been maintained and is current should minimize the potential health and safety risks to patients receiving advanced nursing services.

Additionally, the Board proposes to revise the requirements for reinstatement of an expired CNS registration to mimic the rules for reinstatement of an expired RN license. Under the current language, reinstatement of a CNS registration requires evidence of continued competency and payment of both the reinstatement fee ($125) and the renewal fee ($80). The proposed changes effectively separate the reinstatement procedure into three separate categories: reinstatement within one renewal cycle, reinstatement after one renewal cycle, and reinstatement of a suspended or revoked license.

The reinstatement within one renewal cycle would require the same continued competency requirements and renewal fee, but would require a late fee ($35) instead of the reinstatement fee ($125). Thus, the applicants for reinstatement within one renewal cycle would pay $90 less in fees. The fees for reinstatement after one renewal cycle would remain the same (a renewal fee and a reinstatement fee). The reinstatement of a suspended or revoked license would require a renewal fee plus a higher reinstatement fee ($300). Thus, the applicants in the third category would face an additional $175 fee burden. Applicants in both the second and third categories may also face additional burdens regarding submission of additional evidence of competency, depending on how the Board chooses to implement this requirement.

These potential effects would materialize only when an application is filed for reinstatement. However, DHP staff do not have any data on the number of reinstatements of a suspended or revoked registration cases.

Businesses and Other Entities Affected. The proposed amendments to the regulation are expected to affect only a few of the 418 CNSs, as well as perhaps a few RNs who may newly qualify as CNSs.

Localities⁴ Affected.⁵ The proposed amendments should not affect any locality more than others. The proposed amendments do not introduce costs for localities.

Projected Impact on Employment. The proposed amendments should not significantly affect total employment but may allow a few CNS with retired certifications to earn slightly more.

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

Adverse Effect on Small Businesses:⁶ The proposed amendments do not appear to adversely affect small businesses.

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²https://townhall.virginia.gov/l/viewpetition.cfm?petitionid=294

³The Agency Background Document, page 8.

⁴"Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁵§ 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

⁶Pursuant 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."

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 amendments clarify that the Board of Nursing will accept for registration evidence of a clinical nurse specialist (CNS) certification that has been retired or is the core certification, provided the certification has been maintained and is current. Similarly, a retired or core certification that remains current qualifies a clinical nurse specialist to renew registration. The proposed amendments also amend the requirements for renewal of a lapsed registration or reinstatement of a registration to be similar to the requirements for reinstatement of a registered nurse license. The action is in response to a petition for rulemaking.

18VAC90-19-30. Fees.

A. Fees required by the board are:

1. Application for licensure by examination - RN	$190
2. Application for licensure by endorsement - RN	$190
3. Application for licensure by examination - LPN	$170
4. Application for licensure by endorsement - LPN	$170
5. Reapplication for licensure by examination	$50
6. Biennial licensure renewal - RN	$140
7. Biennial inactive licensure renewal - RN	$70
8. Biennial licensure renewal - LPN	$120
9. Biennial inactive licensure renewal - LPN	$60
10. Late renewal - RN	$50
11. Late renewal - RN inactive	$25
12. Late renewal - LPN	$40
13. Late renewal - LPN inactive	$20
14. Reinstatement of lapsed license - RN	$225
15. Reinstatement of lapsed license - LPN	$200
16. Reinstatement of suspended or revoked license or registration	$300
17. Duplicate license	$15
18. Replacement wall certificate	$25
19. Verification of license	$35
20. Transcript of all or part of applicant or licensee records	$35
21. Returned check charge	$35
22. Application for CNS registration	$130
23. Biennial renewal of CNS registration	$80
24. Reinstatement of lapsed CNS registration	$125
25. Verification of CNS registration to another jurisdiction	$35
26. Late renewal of CNS registration	$35

B. For renewal of licensure or registration from July 1, 2017, through June 30, 2019, the following fees shall be in effect:

1. Biennial licensure renewal - RN	$105
2. Biennial inactive licensure renewal - RN	$52
3. Biennial licensure renewal - LPN	$90
4. Biennial inactive licensure renewal - LPN	$45
5. Biennial renewal of CNS registration	$60

Part IV
Clinical Nurse Specialists

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

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

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

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

3. Submit the required application and fee.

B. Renewal of registration.

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

2. The clinical nurse specialist shall complete the renewal form and submit it with the required fee. An attestation of current national certification as a clinical nurse specialist, including core certification or a certification that has been retired, is required unless registered in accordance with an exception.

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

a. Reinstatement of RN license or multistate licensure privilege, if lapsed;

b. Payment of reinstatement and current renewal fees and late renewal fees; and

c. Submission of evidence of continued national certification as a clinical nurse specialist, including core certification or a certification that has been retired, unless registered in accordance with an exception.

C. Reinstatement of registration.

1. A clinical nurse specialist whose registration has lapsed for more than one renewal period may be reinstated by submission of:

a. A reinstatement application and reinstatement fee;

b. Evidence of a current RN license or multistate privilege; and

c. Evidence of current national certification as a clinical nurse specialist, including core certification or a certification that has been retired, unless registered in accordance with an exception.

2. A clinical nurse specialist whose registration has been suspended or revoked by the board may apply for reinstatement by:

a. Filing a reinstatement application;

b. Fulfilling requirements specified in subdivision 1 c of this subsection; and

c. Paying the fee for reinstatement after suspension or revocation.

The board may request additional evidence that the clinical nurse specialist is prepared to resume practice in a competent manner. A clinical nurse specialist whose registration has been revoked may not apply for reinstatement sooner than three years from entry of the order of revocation.