Part 11.
BOARD OF NURSE EXAMINERS
Chapter 214.
VOCATIONAL NURSING EDUCATION
22 TAC §§214.1 - 214.13
The Board of Nurse Examiners (Board) adopts new 22 Texas
Administrative Code Chapter 214, §§214.1 - 214.13, concerning Vocational
Nursing Education. The new sections are adopted without changes to the proposed
text as published in the November 12, 2004, issue of the
Texas Register
(29 TexReg 10335).
Effective February 1, 2004, the Board of Nurse Examiners and the Board
of Vocational Nurse Examiners were merged into one agency, the Board of Nurse
Examiners. The Board of Vocational Nurse Examiners ceased to exist as an agency.
House Bill 1483, passed by the 78th Regular Legislative Session, was the legislative
action that implemented the consolidation. House Bill 1483 changed the Board's
function of "accrediting" nursing education programs to "approving" nursing
education programs. Concurrent with this adoption is the repeal of the existing
Chapter 233 (Education) which addresses vocational nursing education.
The language in Chapter 214 addresses educational standards specific to
vocational nursing education. The proposed new chapter has been reorganized
to clearly reflect regulation of the same 13 critical sections of nursing
education as currently outlined in Chapter 215 (professional nursing education)
and Chapter 219 (advanced practice nursing program). Consistency in rule language
has been improved. Major revisions will provide positive changes for vocational
nursing education. A petition process for Director and faculty has been added
which will mirror the existing process found in Chapter 215. The required
NCLEX-PN pass rate has been increased to 80% from the current 75%. This will
be consistent with the required NCLEX-RN pass rate for professional nursing
programs. The student/faculty ratio in the clinical area has been reduced
to 10:1 from the current 12:1 ratio which is consistent with requirements
in Chapter 215. This new ratio, however, will not be implemented until the
vocational schools begin the admission process for the Fall 2005 incoming
class. The requirement for faculty to obtain 30 hours of continuing education
every two years was deleted. Faculty will now only be required to meet the
current licensure requirement for 20 hours of continuing education every two
years. "Full approval with Warning" was added to the current two types of
approval status, "full" and "conditional," to provide consistency with the
language and requirements in Chapter 215.
The Board received comments from the following interested groups or associations:
Texas Association of Community Colleges (TACC), Frank Phillips College administration,
Lamar State College-Port Arthur administration, Texas State University System
administration, Cisco Junior College nursing administration, Laredo Community
College nursing administration and Central Texas College nursing administration.
The following comments were received regarding §214.10(j)(1) which
states in part that "[W]hen a faculty member is the only person officially
responsible for a clinical group, then the group shall total no more than
ten students. Patient safety shall be a priority and may mandate lower ratios,
as appropriate...." The current requirements in Chapter 233 reflect a 1:12
faculty/student ratio in the clinical area. Three comments supported the change
to decrease the clinical ratio, but four comments opposed the proposed decreased
clinical ratio citing the following supporting rationale: 1) expected negative
economic impact on public community colleges particularly in light of the
decrease in formula funding; 2) expected difficulty in employing additional
faculty due to the acute shortage of nursing faculty; 3) anticipated reduction
in admissions to VN programs to accommodate the rule change; 4) VN graduates
have been successful on the licensing exam with the existing clinical ratio;
5) differences in the level of expected competencies places the LVN under
the supervision of the RN, thus it is not reasonable that VN education requirements
mirror professional nurse education requirements; and 6) rate of student attrition
usually decreases by second or third semester, thus the Board's desired ratio
would be met.
The Board disagrees with these comments opposing the decrease in the faculty/student
ratio due to the following reasons: 1) for more than ten years, professional
nursing programs have used this ratio; 2) the decrease in the ratio was necessary
due to the increasing acuity level of patients; 3) the acuity level of patients
in hospitals has continued to increase over time; 4) vocational nursing students
are providing care for the same patients as the professional nursing students,
which indicates a need for standardization of supervision; 5) vocational nursing
faculty have the same responsibility of supervising students as do the faculty
in professional nursing programs; and 6) attrition rates may be offset by
re-admissions. Additionally, §217.12(1)(G) describes unprofessional conduct
as "[f]ailure of a clinical nursing instructor to adequately supervise or
to assure adequate supervision of student experiences." This new rule supports
the need for adequate faculty oversight of students. In order to give the
education programs time to address any potential difficulty as stated above,
this new ratio will not be implemented until the vocational schools begin
the admission process for the Fall 2005 incoming class.
One comment opposed §214.4(c)(2)(A) regarding the proposed increase
in the NCLEX-PN pass rate from the current 75% to the proposed 80% because
of the increase in the level of difficulty of the exam beginning in Spring
2005.
The Board disagrees with this comment, because historically, increasing
the level of difficulty on the licensing exam has produced minimal effects
on program pass rates, and increasing the NCLEX-PN pass rate would have no
effect on approximately ninety percent of programs.
Two comments were in opposition to §214.10(k)(1) allowing the use
of clinical preceptors because of the lack of support by the local medical
community is contrary to institutional program commitment, and since preceptors
are hospital employees first, a difficulty will exist due to the lack of or
varying quality of experienced preceptors from day-to-day.
The Board disagrees with this comment and supports the use of clinical
preceptors because the use of clinical preceptors has proven to be successful
in professional nursing programs. Also, 1) some VN programs currently utilize
a successful preceptor model; 2) board guidelines have been developed to provide
direction for programs, preceptors, and facilities; 3) programs are required
to have contractual agreements signed by the preceptor and associated facility;
4) the use of preceptors would prevent any appreciable decrease in student
enrollment; and 5) in conjunction with the decrease in the faculty/student
clinical ratio, the use of preceptors will promote flexibility in student
supervision and competency development.
One comment requested that the Board continue to use the current instructor
qualifications for VN programs as described in §214.7(c)(1) which allows
employment of LVNs as faculty in vocational nursing programs. The Board has
asked that this section of the rule be reviewed by the Advisory Committee
on Education (ACE) with a formal recommendation to be submitted at the April
2005 Board meeting.
The new sections are adopted pursuant to the authority of Texas
Occupations Code §301.151 and §301.152 which authorizes the Board
of Nurse Examiners to adopt, enforce, and repeal rules consistent with its
legislative authority under the Nursing Practice Act.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on January 24, 2005.
TRD-200500327
Katherine Thomas
Executive Director
Board of Nurse Examiners
Effective date: February 13, 2005
Proposal publication date: November 12, 2004
For further information, please call: (512) 305-6823
Chapter 233.
EDUCATION
Subchapter A. DEFINITIONS
22 TAC §233.1
The Board of Nurse Examiners adopts the repeal of 22 Texas
Administrative Code Chapter 233, concerning Education, and specifically Subchapter
A (Definitions), §233.1. The other four subchapters in this chapter are
being adopted for repeal concurrently with this subchapter. The repeal is
adopted without changes to the proposal as published in the November 12, 2004,
issue of the
Texas Register
(29 TexReg 10354).
Effective February 1, 2004, the Board of Nurse Examiners and the Board
of Vocational Nurse Examiners were merged into one agency, the Board of Nurse
Examiners. The Board of Vocational Nurse Examiners ceased to exist as an agency.
House Bill 1483, passed by the 78th Regular Legislative Session, was the legislative
action that implemented the consolidation. The repeal implements House Bill
1483 and the make-up and function of the new Board of Nurse Examiners. Concurrent
with the adopted repeal is the adoption of a new Chapter 214 (Vocational Nursing
Education) which incorporates the education rules for Licensed Vocational
Nurses into the Board of Nurse Examiners' rules. This repeal is for the purpose
of preventing conflicting rules and consolidating the rules applicable to
all nurses under Part 11 (Board of Nurse Examiners) of the Texas Administrative
Code.
No comments were received in response to this proposal.
The repeal is adopted pursuant to the authority of Texas Occupations
Code §301.151 and §301.152 which authorizes the Board of Nurse Examiners
to adopt, enforce, and repeal rules consistent with its legislative authority
under the Nursing Practice Act.
The adoption will not affect any existing statute.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on January 24, 2005.
TRD-200500322
Katherine Thomas
Executive Director
Board of Nurse Examiners
Effective date: February 13, 2005
Proposal publication date: November 12, 2004
For further information, please call: (512) 305-6823
22 TAC §§233.11 - 233.26, 233.28 - 233.30
The Board of Nurse Examiners adopts the repeal of 22 Texas
Administrative Code Chapter 233, concerning Education, and specifically Subchapter
B (Operation of a Vocational Nursing Program), §§233.11 - 233.26
and §§233.28 - 233.30. The other four subchapters in this chapter
are being adopted for repeal concurrently with this subchapter. The repeal
is adopted without changes to the proposal as published in the November 12,
2004, issue of the
Texas Register
(29 TexReg
10354).
Effective February 1, 2004, the Board of Nurse Examiners and the Board
of Vocational Nurse Examiners were merged into one agency, the Board of Nurse
Examiners. The Board of Vocational Nurse Examiners ceased to exist as an agency.
House Bill 1483, passed by the 78th Regular Legislative Session, was the legislative
action that implemented the consolidation. The repeal implements House Bill
1483 and the make-up and function of the new Board of Nurse Examiners. Concurrent
with the adopted repeal is the adoption of a new Chapter 214 (Vocational Nursing
Education) which incorporates the education rules for Licensed Vocational
Nurses into the Board of Nurse Examiners' rules. This repeal is for the purpose
of preventing conflicting rules and consolidating the rules applicable to
all nurses under Part 11 (Board of Nurse Examiners) of the Texas Administrative
Code.
No comments were received in response to this proposal.
The repeal is adopted pursuant to the authority of Texas Occupations
Code §301.151 and §301.152 which authorizes the Board of Nurse Examiners
to adopt, enforce, and repeal rules consistent with its legislative authority
under the Nursing Practice Act.
The adoption will not affect any existing statute.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on January 24, 2005.
TRD-200500323
Katherine Thomas
Executive Director
Board of Nurse Examiners
Effective date: February 13, 2005
Proposal publication date: November 12, 2004
For further information, please call: (512) 305-6823
22 TAC §§233.41 - 233.43
The Board of Nurse Examiners adopts the repeal of 22 Texas
Administrative Code Chapter 233, concerning Education, and specifically Subchapter
C (Approval of Programs), §§233.41 - 233.43. The other four subchapters
in this chapter are being adopted for repeal concurrently with this subchapter.
The repeal is adopted without changes to the proposal as published in the
November 12, 2004, issue of the
Texas Register
(29
TexReg 10355).
Effective February 1, 2004, the Board of Nurse Examiners and the Board
of Vocational Nurse Examiners were merged into one agency, the Board of Nurse
Examiners. The Board of Vocational Nurse Examiners ceased to exist as an agency.
House Bill 1483, passed by the 78th Regular Legislative Session, was the legislative
action that implemented the consolidation. The repeal implements House Bill
1483 and the make-up and function of the new Board of Nurse Examiners. Concurrent
with the adopted repeal is the adoption of a new Chapter 214 (Vocational Nursing
Education) which incorporates the education rules for Licensed Vocational
Nurses into the Board of Nurse Examiners' rules. This repeal is for the purpose
of preventing conflicting rules and consolidating the rules applicable to
all nurses under Part 11 (Board of Nurse Examiners) of the Texas Administrative
Code.
No comments were received in response to this proposal.
The repeal is adopted pursuant to the authority of Texas Occupations
Code §301.151 and §301.152 which authorizes the Board of Nurse Examiners
to adopt, enforce, and repeal rules consistent with its legislative authority
under the Nursing Practice Act.
The adoption will not affect any existing statute.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on January 24, 2005.
TRD-200500324
Katherine Thomas
Executive Director
Board of Nurse Examiners
Effective date: February 13, 2005
Proposal publication date: November 12, 2004
For further information, please call: (512) 305-6823
Part 12.
BOARD OF VOCATIONAL NURSE EXAMINERS
Subchapter B. OPERATION OF A VOCATIONAL NURSING PROGRAM
Subchapter C. APPROVAL OF PROGRAMS
Subchapter D. VOCATIONAL NURSING EDUCATION STANDARDS