Title of Regulation: 18VAC90-19. Regulations Governing the Practice of Nursing (amending 18VAC90-19-130).

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

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 30, 2020.

Effective Date: October 15, 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, FAX (804) 527-4455, or email jay.douglas@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Nursing the authority to promulgate regulations to administer the regulatory system.

Purpose: The amendment will allow the use of the term "RN applicant" for foreign graduates awaiting approval for licensure, which is consistent with the nametag requirement for U.S. graduates practicing during a 90-day approval period. Since all applicants complete the same licensing examination and foreign graduates undergo a rigorous evaluation process, the amended nametag designation continues to protect public health and safety by indicating that the nurse providing care is an applicant for licensure who has been approved by the board to practice for a certain period of time.

Rationale for Using Fast-Track Rulemaking Process: The board is amending 18VAC90-19-130 in response to a petition for rulemaking. The petition was supported overwhelmingly by public comment, so the board has adopted the proposed amendment by a fast-track rulemaking process.

Substance: The board has amended 18VAC90-19-130 to allow an applicant who is a graduate of a foreign education program and is practicing nursing during a 90-day period following submission of an application to use the title "RN Applicant" on a nametag, rather than the designation of "Foreign graduate applicant."

Issues: There are no primary advantages or disadvantages to the public; the public is equally protected by use of the amended title.

There are no advantages or disadvantages to the department.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Nursing proposes to allow approved registered nurse (RN) applicants with education from countries other than the United States and Canada to use the "RN Applicant" designation in their name tags or when signing documents while their application is pending passage of the licensure examination.

Background. This action results from a petition for rulemaking.¹ All applicants for licensure as a RN whose basic nursing education was received in other countries are required to submit evidence showing: 1) that their secondary and nursing education is comparable to those required for RNs in the Commonwealth, and 2) that they are proficient in English. Applicants who meet these conditions are then allowed to practice for up to 90 days following approval of an application. Currently, during the 90 days, approved applicants with domestic or Canadian education backgrounds are designated as "RN Applicants," but other applicants are designated as "foreign nurse graduates." The petition seeks to use the "RN Applicant" designation for applicants from other counties during the 90-day period.

Estimated Benefits and Costs. The comments supporting the petition indicate that there is a perceived issue of discrimination due to differing name tags based on the origin of nursing education and point out that there should be no difference in name tag designation or when signing documents as the foreign educational credits must be deemed comparable to those from domestic or Canadian sources. The proposed amendment would allow all approved applicants to use the same designation and is expected to eliminate the perceived issue of discrimination.

Businesses and Other Entities Affected. The proposed amendment would primarily affect approved RN applicants up to 90 days whose education credits are earned in countries other than the United States or Canada. The Department of Health Professions does not track the number of applicants based on education background but reports that in the first quarter of fiscal year 2020, there were 3,025 new licenses issued for RNs.

Small Businesses² Affected. The proposed amendment does not appear to adversely affect small businesses.

Localities³ Affected.⁴ The proposed amendment does not appear to affect localities.

Projected Impact on Employment. The proposed amendment does not appear to affect employment.

Effects on the Use and Value of Private Property. The proposed amendment does not appear to affect the use and value of private property.

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¹https://townhall.virginia.gov/l/viewpetition.cfm?petitionid=311

²Pursuant 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."

³"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.

⁴§ 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

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

Summary:

The amendment allows an applicant who is a graduate of a foreign education program and is practicing nursing during a 90-day period following submission of an application to use the title "RN Applicant" on a nametag.

18VAC90-19-130. Licensure of applicants from other countries.

A. With the exception of applicants from Canada who are eligible to be licensed by endorsement, applicants whose basic nursing education was received in another country shall be scheduled to take the licensing examination provided they meet the statutory qualifications for licensure. Verification of qualification shall be based on documents submitted as required in subsection B or C of this section.

B. Such applicants for registered nurse licensure shall:

1. Submit evidence from the CGFNS that the secondary education and nursing education are comparable to those required for registered nurses in the Commonwealth;

2. Submit evidence of passage of an English language proficiency examination approved by the CGFNS, unless the applicant meets the CGFNS criteria for an exemption from the requirement; and

3. Submit the required application and fee for licensure by examination.

C. Such applicants for practical nurse licensure shall:

1. Submit evidence from the CGFNS that the secondary education and nursing education are comparable to those required for practical nurses in the Commonwealth;

2. Submit evidence of passage of an English language proficiency examination approved by the CGFNS, unless the applicant meets the CGFNS criteria for an exemption from the requirement; and

3. Submit the required application and fee for licensure by examination.

D. An applicant for licensure as a registered nurse who has met the requirements of subsections A and B of this section may practice for a period not to exceed 90 days from the date of approval of an application submitted to the board when he is working as a nonsupervisory staff nurse in a licensed nursing home or certified nursing facility.

1. Applicants who practice nursing as provided in this subsection shall use the designation "foreign nurse graduate" "RN applicant" on nametags or when signing official records.

2. During the 90-day period, the applicant shall take and pass the licensing examination in order to remain eligible to practice nursing in Virginia.

3. Any person practicing nursing under this exemption who fails to pass the licensure examination within the 90-day period may not thereafter practice nursing until he passes the licensing examination.

E. In addition to CGFNS, the board may accept credentials from other recognized agencies that review credentials of foreign-educated nurses if such agencies have been approved by the board.