Prepared by Jan Lanier (Updated 12-13-2011)

The Board of Nursing conducted its public hearing on its proposed rules on November 16th.  As a result of the testimony provided, several rules will be re-filed. 

In Rule 4723-5-01, the definition of “resume” will be broadened to clarify that it includes a record (not only a curriculum vitae) that summarizes an individual’s education and nursing related employment history including the locations (rather than addresses) of educational institutions and employers, dates of graduation, months and years of employment, and descriptions of job functions performed.  Rule 4723-5-19 dealing with responsibilities of faculty teaching a nursing course will be revised in an attempt to address concerns about using the term “guest lecturer” to describe someone other than a faculty member (as defined in Board rules) who is contributing to the course.  The new language will read, “Faculty teaching a nursing course shall  (A) provide a syllabus or outline to each nursing student that includes at least . . . (7) the teaching strategies, including the job title, credentials, or other information describing the background of an individual providing course content whose qualifications are directly related to the course.” (The underlined language is new and replaces the phrase “guest lecturer”).  Finally, Rule 4723-5-21 dealing with program records will be revised to reflect the changes made in rule 5-01 dealing with the definition of “resume”.  Rule 4723-5-14 will also be refilled to more accurately reflect the way practical nurse programs teach the IV therapy content. 

 

The new rules will be effective February 1, 2012. Be sure to check the Board’s web site (www.nursing.ohio.gov) to get the most up-to-date version of the rules or go to the Register of Ohio to review the actual filing/re-filing.

 

The rules under consideration by the Board in 2011 were in Chapters 4723-5 (Nursing education), 4723-7 (Licensure), 4723-9 (Advanced practice nurses prescriptive authority), 4723-13 (Delegation), and 4723-27 (Medication aides).  Generally the changes are more cosmetic than substantive; however, the rules in Chapter 4723-5 could have a significant impact on nursing education programs.  Following is an analysis of the rules as originally filed.

 Board officers for 2012

The Board members re-elected Bert Lovelace as president and named Melissa Meyer LPN as vice president. 

 

Fall, 2011

Prepared by Jan Lanier, RN JD

The following information was prepared to give nurses a brief overview of rules changes being proposed by the Ohio Board of Nursing.  To see the rules in their entirety please visit the Board’s web site at www.nursing.ohio.gov and then link to the Register of Ohio.  The Board will conduct a public hearing on these rules on Wednesday, November 16, 2011 beginning at 1:00 pm at the Board office, 17 South High Street, Suite 400, Columbus.  Oral and/or written testimony will be accepted.

 The rules under consideration by the Board of Nursing this fall are in Chapters 4723-5 (Nursing Education), 4723-7 (Licensure), 4723-9 (APN Prescription Authority); 4723-13 (Delegation); and 4723-27 (Medication Aides) of the Ohio Administrative Code (OAC).  Generally, the proposed changes are not especially significant; however, several revisions in Chapter 4723-5 deserve thoughtful analysis, particularly by nurse educators.  Following is a summary of the possible issues identified during my review of these rules.

Proposed Rule 4723-5-01—Definitions—At paragraph (N)—the definition of “faculty”.  Currently, the definition defines faculty as “persons” who meet the requirements set forth in rules 4723-5-10 or 4723-5-11 OAC.  The new definition defines “faculty” as registered nurses who plan and teach all courses with a nursing objective or who direct courses provided by a teaching assistant.  When read in conjunction with revised Rule 4723-5-10 (Qualifications of faculty et al), in which reference to the use of “other health care professionals who do not meet faculty requirements to provide instruction” has been deleted, it appears the changes could significantly restrain interdisciplinary educational opportunities available for nursing students.  This is particularly troublesome in light of the recommendations in the Institute of Medicine report on the future of nursing education that stress the importance of interdisciplinary educational opportunities for those who will be providing care in the evolving health care system.  Nursing courses may utilize “guest lecturers” [per revised Rule 4723-5-19 (A)] provided the lecturer is identified in the syllabi by job title, credentials, or other information describing the background of the lecturer”; however, it appears when all these changes are read together, that nurse educators will have limited ability to effectively (and appropriately) use non-faculty members to any meaningful extent.  (For example, pharmacology could not be taught by a pharmacologist if the course had a “nursing objective”.  The pharmacologist could only be a “guest lecturer”.  Similarly, an interdisciplinary ethics course taught by a team of professionals could be unacceptable to the Board if the course were to have a nursing objective).

Paragraph DD includes a new definition of “resume”.  The language reads “a resume or curriculum vitae (CV) that summarizes an individual’s education and nursing-related employment history and includes addresses of institutions and employers; dates of graduation; months and years of employment; and a description of the job functions performed”.  Some of this very detailed information currently may not be part of a faculty member’s resume or CV; therefore, the Board should clearly state when it expects nursing programs to obtain the updated resumes from existing faculty.  Without such clarification, programs may be at risk for a citations (and possible sanctions) should Board surveyors expect the records to immediately include the newly required data.  Further, updating the resumes might prove difficult for some individuals who have been in the faculty position for a long period of time.  Also of note, proposed Rule 4723-5-21 requires nursing education programs to maintain “resumes” of the preceptors used by the program. The preceptors’ resumes would be required to meet the definition of “resume” set forth in Rule 4723-5-01, which could be problematic.  Again, it would be important to get clarification from the Board as to when programs would be expected to obtain new resumes from existing preceptors.

Proposed Rule 4723-5-04—Provisions for Determining a Program’s Status. The proposed revision states that a program SHALL be placed on provisional status for failure to provide clinical or laboratory experiences; failure to timely designate a qualified administrator or interim administrator; provision or submission of false, misleading, or deceptive information; or pass rates on NCLEX ® of less than 95% of the national average for first time test takers for the fourth consecutive year.   The language requires provisional status for any of these infractions and does not allow the Board to consider potentially mitigating circumstances.  This is particularly problematic when considering the somewhat confusing series of dates for notifying the Board of vacancies in the program administrator position (Rule 4723-5-09). 

Proposed Rule 4723-5-09—Organization & Administration of a Program. The rule states at paragraph (D) that when a program administrator is absent for 30 consecutive business days, within 45 days after the 30th day the controlling agency must designate a qualified replacement.  Please note—one trigger specifies business days while the other is apparently days in general.  When an administrator position is vacant the controlling agency must notify the Board within 45 days of the vacancy and designate a replacement.  Paragraph (D) (3)(b) of the same rule allows for an individual with a Bachelor of Science in Nursing (BSN) to serve as an interim program administrator in a practical nurse education program for one year from the date of vacancy or absence.  When the void is the result of a vacancy, the date is probably clearly identifiable; however, when the opening results from an absent administrator the date for counting when the one-year begins is less clear.  Is it 30 business days or 45 days after the 30 days ends? Because of the potential consequences for making an error (provisional approval) this needs to be clarified.

Proposed Rule 4723-5-10—Qualification of Administrative, Faculty Personnel for RN Programs.  Paragraph (A) requires the program administrator and assistant program administrator to have experience for five years in the practice of nursing as a registered nurse, two of which are as a faculty member in a nursing education program.  The Board, in Rule 4723-5-12 OAC defines a year of full time study in a registered nurse education program to be 30 weeks.  In calculating the years required to satisfy the experience specified in Rule 4723-5-10 (and also Rule 4723-5-11 OAC) is it a 52-week year or 30-week year?

In paragraph (A)(5)(b) “preceptor” qualifications are set out.  It requires experience for at least two years in the practice of nursing “with demonstrated competence” in the area of clinical practice in which the preceptor provides supervision to students.  The language is not clear as to whether the two-year practice requirement means those two years must all be in the area of clinical practice in which supervision is being provided.  The answer appears to be “yes” when reading rule 4723-5-21—program records (E)(2) that requires the resume of the preceptor to demonstrate two years of nursing practice in the clinical area in which the preceptor is providing supervision.  The expectation should be clearer in rule 4723-5-10 so as to avoid unnecessary confusion and/or misunderstanding.

Please also note this is the rule in which the current language dealing with the use of faculty who do not meet the Board’s definition of “faculty” is deleted.

Proposed Rule 4723-5-12—Program Policies.  Paragraph (B) states that a program shall not implement changes to policies for student progression or for completion of the program with respect to students enrolled at the time the changes are adopted.  While the Board’s intent may be clear, a question arises as to how a student who is enrolled at the time of the change, who then drops out and subsequently returns at a later date would be affected.  Per the rule the student would be expected to meet former requirements while the rest of the class could have different expectations.  Would that be confusing and difficult for a program to administer?  Paragraph (A)(2) of this rule states that program policies must require readmitted students to meet curriculum requirements in effect at the time of readmission.  Whether “student progression or requirements for completion” is equivalent to “curriculum requirements” is not totally clear. Typically, when trying to discern the meaning of laws or rules, a rule of construction says when different words are used one can assume the author of those words was intending to address different concepts.

Proposed Rule 4723-5-21—Program Records.  At paragraph (D)(3) a program is required to retain licensure verification for the faculty at the time of employment and for each license renewal period thereafter.  Current rules only require this information be retained for five years.  The Board should clarify how surveyors will implement this new requirement should education programs have retained licensure verification evidence for the five years currently required by rule when this retention does not meet the new requirement of every licensure renewal period.

While some of the questions raised in this summary may seem self-evident or trivial, experience says that leaving these issues unresolved can lead to problems in the future when the original intent of the rule makers is no longer readily discernible.