PART 11. TEXAS BOARD OF NURSING
CHAPTER 216. CONTINUING EDUCATION
(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Board of Nursing or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Board of Nursing (Board) proposes the repeal of Chapter 216, §§216.1 - 216.11, concerning Continuing Education. This repeal is necessary because the Board is proposing a new chapter for adoption that promotes a comprehensive approach to continuing competency in nursing. Traditionally, nurses have primarily demonstrated continuing competency through the completion of continuing education courses. The requirements of the proposed new chapter, however, permit nurses to demonstrate continuing competency through other means. It is anticipated that this new approach to continuing competency will provide necessary flexibility to nurses while ensuring the ongoing delivery of safe nursing care. Ultimately, the proposed new chapter is designed to protect the public health, safety, and welfare by requiring nurses to maintain a skill level appropriate for their practice areas. The proposed new chapter is also published in this edition of the Texas Register.
Katherine Thomas, Executive Director, has determined that for each year of the first five years the proposed repeal will be in effect, there will be no fiscal impact to state or local governments as a result of the enforcement or administration of the proposal. There will be no anticipated effect on local employment or the local economy as a result of the proposed repeal.
Ms. Thomas has also determined that for each year of the first five years the proposed repeal is in effect, the anticipated public benefit will be the repeal of outdated requirements and the adoption of new requirements that will promote a comprehensive approach to continuing competency in nursing, provide nurses with additional options for meeting continuing competency requirements; and ensure the protection of the public health, safety and welfare through the demonstration of competent, quality nursing care. There are no anticipated economic costs to persons who are required to comply with the proposed repeal.
As required by the Government Code §2006.002(c) and (f), the Board has determined that the proposed repeal will not have an adverse economic effect on any small or micro business because there are no anticipated economic costs to any person who is required to comply with the proposed repeal.
The Board has determined that no private real property interests are affected by this proposed repeal and that this proposed repeal does not restrict or limit an owner's right to property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking or require a takings impact assessment under the Government Code §2007.043.
To be considered, written comments on the proposal or any request for a public hearing must be submitted no later than 5:00 p.m. on June 14, 2009, to James W. Johnston, General Counsel, Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, or by e-mail to dusty.johnston@bon.state.tx.us, or faxed to (512) 305-8101. An additional copy of the comments on the proposal or any request for a public hearing must be simultaneously submitted to Denise Benbow, Nursing Practice Consultant, Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, or by e-mail to denise.benbow@bon.state.tx.us, or faxed to (512) 305-8101. If a hearing is held, written and oral comments presented at the hearing will be considered.
The repeal of §§216.1 - 216.11 is proposed pursuant to the Occupations Code §301.303 and §301.151. The Occupations Code §301.303(a) provides that the Board may recognize, prepare, or implement continuing competency programs for license holders under Chapter 301 and may require participation in continuing competency programs as a condition of renewal of a license. Further, §301.303(a) provides that the programs may allow a license holder to demonstrate competency through various methods, including completion of targeted continuing education programs and consideration of a license holder's professional portfolio, including certifications held by the license holder. Section 301.303(b) provides that the Board may not require participation in more than a total of 20 hours of continuing education in a two-year licensing period. Section 301.303(c) authorizes the Board by rule to establish a system for the approval of programs and providers of continuing education if the Board requires participation in continuing education programs as a condition of license renewal. Section 301.303(e) authorizes the Board to adopt rules as necessary to implement §301.303. Section 301.303(f) states that the Board may assess each program and provider under §301.303 a fee in an amount that is reasonable and necessary to defray the costs incurred in approving programs and providers. Section 301.303(g) provides that the Board by rule may establish guidelines for targeted continuing education required under Chapter 301. Further, §301.303(g) requires the rules adopted under §301.303(g) to address (i) the nurses who are required to complete the targeted continuing education program; (ii) the type of courses that satisfy the targeted continuing education requirement; (iii) the time in which a nurse is required to complete the targeted continuing education; (iv) the frequency with which a nurse is required to meet the targeted continuing education requirement; and (v) any other requirement considered necessary by the Board. The Occupations Code §301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to perform its duties and conduct proceedings before the Board; regulate the practice of professional nursing and vocational nursing; establish standards of professional conduct for license holders under Chapter 301; and determine whether an act constitutes the practice of professional nursing or vocational nursing.
The following statutes are affected by the proposed repeal:
Rule -- Statute
Sections 216.1 - 216.11 -- Occupations Code §301.303
§216.1.Definitions.
§216.2.Purpose.
§216.3.Requirements.
§216.4.Criteria for Acceptable Continuing Education Activity.
§216.5.Additional Criteria for Specific Continuing Education Programs.
§216.6.Activities Which are not Acceptable as Continuing Education.
§216.7.Responsibilities of Individual Licensee.
§216.8.Relicensure Process.
§216.9.Audit Process.
§216.10.Appeals.
§216.11.Consequences of Non-Compliance.
This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on May 1, 2009.
TRD-200901639
James W. Johnston
General Counsel
Texas Board of Nursing
Earliest possible date of adoption: June 14, 2009
For further information, please call: (512) 305-6811
The Texas Board of Nursing (Board) proposes new Chapter 216, §§216.1 - 216.11, concerning Continuing Competency. New Chapter 216 is necessary to implement the requirements of the Occupations Code §§301.152, 301.303, and 301.306 and to better define the role of continuing competency in nursing. Simultaneously with the proposal of the new chapter, the Board has proposed the repeal of existing Chapter 216, §§216.1 - 216.11, relating to Continuing Education, which is also published in this edition of the Texas Register.
The proposed new chapter implements a comprehensive approach to continuing competency in nursing. Board staff has extensively studied, reviewed, and evaluated continuing competency methodologies and national and local initiatives relating to continuing competency over the last few years. Board staff presented summaries of these methodologies and national and local initiatives to the Board during its regularly scheduled April, 2006; July, 2006; October, 2006; January, 2007; April, 2007; July, 2007; October, 2007; January, 2008; April, 2008; July, 2008, October, 2008; January, 2009; and April, 2009 Board meetings. At the April 2009, Board meeting, Board staff recommended, and the Board approved, adopting a comprehensive approach to continuing competency in Texas. A history of the methodologies and initiatives supporting this comprehensive approach are summarized in the following paragraphs.
The concept of implementing and evaluating continuing competency requirements in nursing is not new. In fact, nursing boards, commissions, and organizations have been developing continuing competency programs since the early 1990s. The Board began actively evaluating and testing models of continuing nursing competency after SB 617 (effective September 1, 1997) was enacted by the 75th Texas Legislature. SB 617 authorized the Board to conduct pilot programs to evaluate the continued competency of nurses in Texas. Pursuant to SB 617, the Board approved and funded six pilot studies, including (i) evaluation of a mandatory competency evaluation program of an urban county hospital and the validity and reliability of a 360 degree performance appraisal system in an urban specialty hospital; (ii) delineation of competencies for nurses working in rural health care settings; (iii) the use of vignettes for targeted continuing education in psychiatric nursing; (iv) assessment of certification in ACLS and PALs as a valid indication of competence; (v) identification and assessment of competencies of nurses in long-term care; and (vi) development of reliable and validity information for assessing home health nurse competencies. Various recommendations resulted from these studies, including a recommendation from the Competency Advisory Committee that acceptable components of competency maintenance should not be limited solely to continuing education hours. The Board reported its findings and recommendations regarding continuing competency in a 2000 publication, Ensuring Professional Nursing Competency . Shortly thereafter, ongoing competency evaluation began receiving further national attention and review. For example, the National Council of State Boards of Nursing (NCSBN) formed a special task force to survey over 20,000 licensed vocational nurses and 20,000 registered nurses with at least one year of practice experience to determine competencies that were required in their work environments. The NCSBN also compiled state-by-state information about continued competency processes using the APPLE criteria (Administratively feasible, Publicly credible, Professionally acceptable, Legally defensible, and Economically feasible) for an analysis of best practices among states. Around the same time, the following groups in Texas began evaluating and testing competency models: The Alliance for Innovation in Nursing Education; North Texas Consortium School of Nursing; Texas Higher Education Coordinating Board Nursing Innovative Grant Program - Midwestern State University High Fidelity Clinical Simulation; and Texas Nurses Association Competency Task Force. In February, 2006, these groups formed the Texas Competency Consortium to share information and coordinate competency development in the state of Texas.
Board staff actively participated in the Texas Nurses Association Competency Task Force (Task Force) during this time period and routinely reported the activities and initiatives of the Task Force to the Board. The Task Force focused on two specific approaches to continuing competency: (i) whether competencies should be developed that are related to a nurse's specific role/practice in his or her work environment; or (ii) whether broad-based competencies for all nurses should be developed. The NCSBN also considered these approaches on a national level, opting to develop and test a core set of broad-based competencies for all nurses. Ultimately, this approach was also adopted by the Task Force. The Task Force spent five years evaluating and testing different approaches to continuing competency. In July, 2008, the Task Force issued Continuing Competency: Movement Toward Assurance in Nursing , in which the Task Force outlined its recommendations for continuing competency requirements in Texas. Specifically, the Task Force recommended allowing nurses to meet their continuing competency requirements through either the completion of 20 hours of continuing education in their area of practice or through national certification in their area of practice.
The requirements of the proposed new chapter are patterned after the studies, findings, and recommendations of the aforementioned national and local groups. Traditionally, continuing competency has been demonstrated primarily through the completion of continuing education courses. However, based upon the recommendations of the Task Force and the Texas Competency Consortium and the studies conducted by the NCSBN over the last five to ten years, the Board is proposing a departure from this approach by authorizing nurses to utilize other methods of demonstrating continuing competency. Under the proposed new chapter, a nurse is authorized to demonstrate continuing competency through the achievement, maintenance, or renewal of an approved national nursing certification in the nurse's area of practice, as well as through the completion of continuing education courses. Recognizing this additional method of compliance provides nurses with the option of pursuing and maintaining a certification in a specific area of practice. The additional education and training associated with obtaining and maintaining such a certification serves the purpose of the proposed new chapter, which is to protect the public health, safety, and welfare by ensuring that nurses stay abreast of current industry practices, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. This additional method of compliance is also consistent with the Occupations Code §301.303(a), which authorizes the demonstration of competency through various methods, including consideration of a license holder's professional portfolio and certifications held by the license holder.
The proposed new chapter also requires a nurse to demonstrate continuing competency in the nurse's specific area of practice. This proposed new requirement is designed to ensure that nurses maintain competency in the area in which they are currently practicing. The Board recognizes that there is benefit in continuing education activities that generally apply to all nursing practice. However, the Board has determined that there is more benefit in continuing education activities that apply to a nurse's specific area of practice. This is because a nurse is able to provide a better quality of care in the area of practice in which she is most knowledgeable. A nurse who enhances his or her expertise through practice specific continuing education activities is more likely to provide his or her patients with efficient and effective care than a nurse who has not received the same specified training. For example, assume that a nurse who works in a cardiac unit completes a continuing competency activity relating to the use of technology in rhythm interpretations. When the nurse begins working in his or her cardiac unit later that week, it is anticipated that the nurse's enhanced knowledge will better assist him or her in recognizing and interpreting variations in a patient's heart monitor readout. As a result, the nurse may be able to initiate medical interventions faster because she is able to recognize the subtle changes in the readout more quickly and accurately. In this way, the proposed new requirements are anticipated to ensure a better quality of care for the public.
The Board anticipates that some nurses working in specialized areas of practice, such as nursing administration or nursing education, may have questions about the kinds of continuing competency activities that relate to their specific area of practice. A continuing competency activity should incorporate and relate to the knowledge, skills, or activities performed or required by the nurse in his or her area of practice. In the case of a nurse educator, the Board anticipates that continuing competency activities related to nursing education should meet the requirements of the proposed new chapter. In the case of a nurse administrator, the Board anticipates that continuing competency requirements related to nursing administration should meet the requirements of the proposed new chapter.
Proposed New Sections. The following paragraphs summarize the intended purpose of the proposed new sections.
Proposed new §216.3(a) and (b) are necessary to implement the continuing competency requirements under the Occupations Code §301.303(a) and (b). The Occupations Code §301.303(a) authorizes the Board to recognize, prepare, and implement continuing competency programs for license holders under Chapter 301 and to require participation in continuing competency as a condition of renewal of a license. Section 301.303(b) states that the Board may not require participation in more than a total of 20 hours of continuing education in a two-year licensing period. Proposed new §216.3(a) and (b) prescribe the continuing competency requirements applicable to nurses for each two-year licensing period and authorize two acceptable methods of satisfying those requirements. Under proposed new §216.3(a) and (b), a nurse must either complete (i) 20 contact hours of continuing education in the nurse's area of practice within the two years immediately preceding renewal of registration; or (ii) achieve, maintain, or renew an approved national nursing certification in the nurse's area of practice. These proposed new requirements emphasize the proposed new chapter's comprehensive approach to continuing competency by authorizing a viable alternative to completing traditional continuing education courses.
Proposed new §216.3(c), (d), and (e) address specific continuing competency requirements applicable to advanced practice registered nurses; advanced practice registered nurses holding prescriptive authority; nurses working in emergency room settings; and volunteer retired registered nurses. These proposed new requirements are necessary to implement the Occupations Code §301.152(b) and (c) and §301.306. The Occupations Code §301.152(b) authorizes the Board to adopt rules to approve registered nurses as advanced practice nurses and advanced practice nurses with prescriptive authority. Further, §301.152(b) authorizes the Board to adopt rules to establish specialized training, including pharmacology, that a registered nurse must have to carry out a prescription drug order. Section 301.152(c) requires the rules adopted under §301.152(b) to require continuing education in clinical pharmacology and related pathology in addition to any continuing education otherwise required under §301.303. Consistent with the requirements of §301.152(b) and (c), proposed new §216.3(c) specifies the continuing competency requirements for advanced practice registered nurses and advanced practice registered nurses holding prescriptive authority and the methods that may be utilized to achieve compliance. The proposed new continuing competency requirements for advanced practice registered nurses do not differ significantly from the proposed new continuing competency requirements for registered or vocational nurses. Proposed new §216.3(c) generally requires an advanced practice registered nurse to either obtain 20 contact hours of continuing education appropriate to the advanced specialty area and role recognized by the Board or to attain, maintain, or renew a national certification recognized by the Board. However, additional continuing competency requirements apply to an advanced practice registered nurse holding prescriptive authority. Proposed new §216.3(c)(3) requires an advanced practice registered nurse holding prescriptive authority to complete at least five contact hours of continuing education in pharmacotherapeutics, in addition to satisfying the continuing competency requirements in proposed new §216.3(c). This proposed new requirement is particularly important because advanced practice registered nurses holding prescriptive authority are authorized to prescribe medications for their patients. It is important for these nurses to stay abreast of any changes in medication and treatment regimens so they may continue to safely prescribe medications and treatments for their patients.
The Occupations Code §301.306(a) requires a license holder who is employed to work in an emergency room setting to complete at least two hours of continuing education relating to forensic evidence collection. Further, §301.306(c) requires the Board to adopt rules to identify which license holders are required to comply with the requirements of §301.306(a) and to establish the content of the continuing education required under §301.306(a). Pursuant to §301.306, proposed new §216.3(d) clarifies that each nurse licensed in Texas and employed in an emergency room setting on or after September 1, 2006 shall complete a minimum of two hours of continuing education relating to forensic evidence collection. Proposed new §216.3(d) also defines the types of emergency room settings that are implicated by the proposed new requirements and specifies the information that must be addressed in continuing education courses focusing on forensic evidence collection. In addition to implementing the statutory requirements of the Occupations Code, proposed new §216.3(d) also helps ensure the preservation of valuable evidence. Persons who are the victims of crimes, such as sexual assault, assault, or abuse, often seek treatment in emergency rooms. In such situations, it may be necessary for an emergency room nurse to collect evidence of such crimes from the patient. While some institutions have a trained and certified Sexual Assault Nurse Examiner (SANE) on site to collect such evidence, not every institution will be able to provide a SANE nurse for evidence collection at certain times or locations. Proposed new §216.3(d) requires all nurses working in an emergency room setting to maintain competency in forensic evidence collection so that evidence may be appropriately preserved and collected from a patient at any time. This proposed new requirement furthers the public interest by ensuring the preservation of valuable evidence necessary for the prosecution of violent crimes.
Lastly, proposed new §216.3(e) addresses the continuing competency of retired nurses over the age of 65 who choose to volunteer their nursing services. The Board recognizes that these nurses are not compensated for providing volunteer nursing services and are generally not practicing nursing full time. However, these nurses are still providing patient care, and must comply with the requirements of the Nursing Practice Act. Further, because these nurses are providing patient care, it is important that they maintain their competency and clinical skills, stay abreast of current industry practices, and learn about new technology and treatment regimens. The Board recognizes that it may be inappropriate and financially burdensome to require a retired nurse who volunteers his or her nursing services on a part time basis to complete the same number of continuing education hours as a nurse who is not retired and practices nursing on a full time basis. As such, proposed new §216.3(e) requires a volunteer retired nurse to complete at least 10 contact hours of continuing education in his or her area of nursing practice. In this way, proposed new §216.3(e) appropriately balances the need for retired volunteer nurses to demonstrate an acceptable level of continuing competency, while reducing the financial burden associated with completing continuing education courses.
Proposed new §216.4 and §216.5 address the criteria that a continuing education program must meet under the proposed new requirements. First, proposed new §216.4 requires all continuing education programs to be approved by a credentialing agency, or an affiliated entity of such an agency, recognized by the Board. In order to be recognized by the Board, a credentialing agency must meet nationally, pre-determined criteria to approve programs and providers of continuing education. Second, proposed new §216.4 clarifies that a nurse may only receive credit for completing a continuing education program in the nurse's area of practice. This proposed new requirement is consistent with the primary goal of continuing competency in nursing, which is to ensure the ongoing delivery of safe nursing care. Patients are able to immediately realize the benefits of a nurse's continuing competency when the nurse has focused on the area of care that she is working in at that specific point in time. Therefore, while the Board recognizes the value of training and education in other areas of nursing practice, the Board has determined that it is more important for nurses to maintain continuing competency in their current area of practice before considering other areas of practice.
Further, the Board recognizes that some nurses will choose to further their formal education and training and encourages those nurses to do so. As such, proposed new §216.5 permits certain, qualifying academic courses to satisfy all or a portion of a nurse's continuing competency requirements under the proposed new chapter. In order to qualify under proposed new §216.5, an academic course must either be included within the framework of a curriculum that leads to an academic degree in nursing or be relevant to nursing practice. Further, a nurse must be able to demonstrate that she completed the course with a grade of "C" or better or with a "Pass" on a "Pass/Fail" grading system. Proposed new §216.5 is intended to encourage nurses to further their nursing education through academic courses and to authorize the completion of these academic courses as an additional method of demonstrating continuing competency.
Proposed new §216.6 prohibits 11 categories of programs, activities, and courses from satisfying the proposed new continuing competency requirements. The Board recognizes that some continuing education programs, activities, and courses that are prohibited under proposed new §216.6 may provide nurses with helpful or valuable knowledge or may refresh a nurse's basic skills. While the Board recognizes that such knowledge is of value, the Board has determined that these programs, activities, and courses are not sufficient to advance or improve a nurse's knowledge or skill level or to develop a nurse's attitude for the enhancement of nursing practice. As such, while these programs, activities, and course may provide helpful information, they cannot be used to satisfy the continuing competency requirements of the proposed new chapter.
Proposed new §216.7 is necessary to clarify a nurse's responsibility for satisfying the continuing competency requirements of the proposed new chapter. Proposed new §216.7 specifically requires each nurse to select, participate in, and maintain a record of qualifying continuing education programs, activities, and courses. Further, proposed new §216.7 prescribes the specific amount of time that a nurse must maintain a record of the completion of continuing education programs, activities, and courses. Not only do these proposed new requirements clearly delineate a nurse's compliance obligations under the proposed new chapter, but they also provide important information regarding compliance with proposed new §216.9. Proposed new §216.9 prescribes the audit process through which the Board will monitor a nurse's compliance with the proposed new continuing competency requirements. A nurse who is audited pursuant to proposed new §216.9 may be required to produce documentation to verify his or her continuing competency compliance for a specific period of licensure. If a nurse maintains records of the completion of continuing education programs, activities, and courses in compliance with proposed new §216.7, the nurse should also be able to provide the documentation necessary to prove his or her compliance during an audit conducted under proposed new §216.9.
Proposed new §216.8 clarifies the continuing competency requirements applicable to: licensees seeking renewal of their license; persons licensed by examination or endorsement; persons whose license is delinquent or inactive; and persons whose license has been revoked. These proposed new requirements provide important guidance to nurses regarding their responsibilities in meeting continuing competency requirements upon initial licensure and renewal and upon their license being returned to current or active status.
Proposed new §216.9 prescribes the process the Board will utilize in auditing and monitoring a nurse's compliance with the requirements of the proposed new chapter. The Board considers a nurse's compliance with the proposed new continuing competency requirements to be of utmost importance because a nurse's continuing competency directly affects the ongoing delivery of safe nursing care. Proposed new §216.9 implements an audit system, by which nurses will be randomly selected for a compliance audit 90 days prior to each renewal month. If a nurse is selected to be audited, the Board will review the nurse's continuing competency activities to determine compliance. To the extent that an audit reveals a nurse's non-compliance with any of the proposed new continuing competency requirements, it is anticipated that the Board will be able to take corrective action in a timely manner in order to prevent the nurse from providing potentially unsafe or incompetent care.
Proposed new §216.10 affords a nurse an opportunity to appeal a Board determination of continuing competency non-compliance. This proposed new section serves an important purpose. Under proposed new §216.9, the Board seeks to monitor and enforce compliance with its proposed new continuing competency requirements. However, the Board recognizes that incorrect compliance determinations may be made at times, due to human error. In such situations, it is important for a nurse to be afforded an opportunity to dispute the incorrect compliance determination. Proposed new §216.10 affords each nurse an opportunity to appeal a non-compliance determination and provide the Board with evidence of continuing competency compliance. The Board's goal in monitoring compliance with the proposed new continuing competency requirements is to identify non-compliant nurses so that corrective action may be taken as appropriate. However, corrective action is not necessary or appropriate in situations where a compliant nurse has been identified in error as non-compliant. Proposed new §216.10 seeks to minimize this risk by providing nurses the opportunity to challenge a determination of non-compliance and prove their compliance so that inappropriate corrective action may be timely avoided.
Finally, proposed new §216.11 clearly identifies the Board's expectations with regard to compliance with the proposed new continuing competency requirements. Proposed new §216.11 clearly states that a nurse's failure to comply with the continuing competency requirements will result in denial of renewal by the Board. Nurses are entrusted with the care of those most vulnerable by virtue of illness or injury. As such, their level of competence is of utmost importance in creating safe environments for patients. Because a nurse's continuing competency is such an integral part of providing safe nursing care to the public, the Board considers the denial of renewal one of the appropriate sanctions for non-compliance with the proposed new continuing competency requirements.
Section-by-Section Overview. The following is a section-by-section overview of the proposal.
Proposed new §216.1 defines the terms to be used in the proposed new chapter.
Proposed new §216.2 states that the purpose of continuing competency is to ensure that nurses stay abreast of current industry practices, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. Further, proposed new §216.2 makes clear that continuing education in nursing includes programs beyond the basic preparation which are designed to promote and enrich knowledge, improve skills and develop attitudes for the enhancement of nursing practice, thus improving health care to the public. Additionally, proposed new §216.2 recognizes that nursing certification is another method of demonstrating continuing competence. Proposed new §216.2 also states that, pursuant to authority set forth in the Occupations Code §301.303, the Board requires participation in continuing competency activities for license renewal. Further, the procedures set forth in the proposed new chapter provide guidance to fulfilling the continuing competency requirement. Finally, proposed new §216.2 requires nurses to participate in continuing education courses that relate to their practice area or to attain, maintain, or renew an approved national nursing certification in their practice area, which benefits the public welfare.
Proposed new §216.3(a) and (b) require a nurse to either (i) complete 20 contact hours of continuing education within the two years immediately preceding renewal of registration or (ii) demonstrate the achievement, maintenance, or renewal of an approved national nursing certification in the nurse's area of practice. Proposed new §216.3(a) further requires the 20 contact hours of continuing education to be obtained in the nurse's area of practice and to be in programs approved by a credentialing agency recognized by the Board. Further, proposed new §216.3(a) states that a list of these agencies/organizations may be obtained from the Board's office or web site. Proposed new §216.3(b) states that a list of approved national nursing certification criteria may be obtained from the Board's office or web site. Proposed new §216.3(c) states that a licensee authorized by the Board as an advanced practice registered nurse (APRN) is required to obtain 20 contact hours of continuing education or attain, maintain or renew the national certification recognized by the Board as meeting the certification requirement for the advanced practice registered nurse's role and population focus area of licensure within the previous two years of licensure. Further, proposed new §216.3(c) provides that national certification will only meet the requirement for licensure renewal. Additionally, proposed new §216.3(c)(1) states that the required hours are not in addition to the requirements of §216.3(a) or (b). Proposed new §216.3(c)(2) provides that the 20 contact hours of continuing education must be appropriate to the advanced specialty area and role recognized by the Board. Proposed new §216.3(c)(3) provides that the APRN who holds prescriptive authority must complete, in addition to the required continuing competency requirements in §216.3(c), at least five contact hours of continuing education in pharmacotherapeutics. Proposed new §216.3(c)(4) states that Category I Continuing Medical Education (CME) contact hours will meet requirements as described in the proposed new chapter. Proposed new §216.3(d)(1) requires each nurse licensed in Texas and employed in an emergency room setting on or after September 1, 2006 to complete a minimum of two hours of continuing education relating to forensic evidence collection, as required by the Occupations Code §301.306 and proposed new §216.3(d) by (i) September 1, 2008 for nurses to whom this requirement applies who are employed in an emergency room setting on or before September 1, 2006; or (ii) within two years of the initial date of employment in an emergency room setting. This requirement may be met through completion of approved continuing education activities, as set forth in §216.4 (relating to Criteria for Acceptable Continuing Education Activity). Further, proposed new §216.3(d)(2) provides that this requirement applies to nurses who work in an emergency room setting that is: (i) the nurse's home unit; (ii) an ER unit to which the nurse "floats" or schedules shifts; or (iii) a nurse employed under contractual, temporary, per diem, agency, traveling, or other employment relationship whose duties include working in an emergency room. Additionally, proposed new §216.3(d)(3) states that a licensed nurse in Texas who would otherwise be exempt from continuing education requirements during the nurse's initial licensure or first renewal periods under §216.8(b) or (c) (relating to Relicensure Process) shall comply with the requirements of §216.3. This is a one time requirement for each nurse employed in an emergency room setting. In compliance with §216.7(b) (relating to Responsibilities of Individual Licensee), each licensee is responsible for maintaining records of continuing education attendance. Validation of course completion in Forensic Evidence Collection should be retained by the nurse indefinitely, even if a nurse changes employment. Further, proposed new §216.3(d)(4) provides that the minimum two hours of continuing education requirement shall include information relevant to forensic evidence collection and age or population-specific nursing interventions that may be required by other laws and/or are necessary in order to assure evidence collection that meets requirements under the Government Code §420.031 regarding use of a service-approved evidence collection kit and protocol. The content may also include, but is not limited to: documentation, history-taking skills, use of sexual assault kit, survivor symptoms, and emotional and psychological support interventions for victims. Lastly, proposed new §216.3(d)(5) provides that the required hours under proposed new §216.3(d) are included in the continuing education requirements for nurses. Proposed new §216.3(e)(1) provides that a nurse who is 65 years old or older and who holds or is seeking to hold a valid volunteer retired nurse authorization in compliance with the Occupations Code §112.051 and §217.9(d) of this title (relating to Inactive Status) must have completed at least 10 hours of continuing education in the nurse's area of nursing practice during the previous biennium, unless the nurse also holds valid recognition as an advanced practice registered nurse or is a Volunteer Retired Registered Nurse with advanced practice authorization in a given role and specialty in the State of Texas. Further, proposed new §216.3(e)(2) provides that a nurse who is 65 years old or older and who holds or is seeking to hold a valid volunteer retired nurse authorization in compliance with the Occupations Code §112.051 and §217.9(d) of this title must have completed at least 20 hours of continuing education as defined in the proposed new chapter if authorized by the Board in a specific advanced practice role and specialty. The 20 hours of continuing education must meet the same criteria as advanced practice registered nurse continuing education defined under §216.3(c). An advance practice registered nurse authorized as a volunteer retired registered nurse with advance practice registered nurse authorization may not hold prescriptive authority. This does not preclude a registered nurse from placing his/her advance practice registered nurse authorization on inactive status and applying for authorization only as a volunteer retired registered nurse. Finally, proposed new §216.3(e)(3) provides that a nurse who is 65 years old or older and who holds or is seeking to hold a valid volunteer retired nurse authorization in compliance with the Occupations Code §112.051 and §217.9(d) of this title is exempt from fulfilling targeted continuing education requirements except as required for volunteer retired advanced practice registered nurses.
Proposed new §216.4 states that continuing education programs must be approved by a credentialing agency or an affiliated entity of one of these agencies, and must be in the nurse's area of practice. Proof of successful completion shall contain the name of the provider; the program title, date, and location; number of contact hours; provider number; and credentialing agency.
Proposed new §216.5 states that in addition to those programs reviewed by a Board-approved entity, a licensee may attend an academic course that meets certain criteria. First, the course shall be within the framework of a curriculum that leads to an academic degree in nursing or any academic course relevant to nursing practice. Second, participants, upon audit by the Board, shall be able to present an official transcript indicating completion of the course with a grade of "C" or better, or a "Pass" on a Pass/Fail grading system.
Proposed new §216.6 enumerates the following list of activities that do not meet continuing education requirements for licensure renewal: Basic Life Support or cardiopulmonary resuscitation courses; in-service programs; nursing refresher courses; orientation programs; courses which focus upon self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, and yoga; economic courses for financial gain, e.g., investments, retirement, preparing resumes, and techniques for job interview; courses which focus on personal appearance in nursing; liberal art courses in music, art, philosophy, and others when unrelated to patient/client care; courses designed for lay people; self-directed study; and continuing education that is not the nurse's area of practice unless required by the Occupations Code or the proposed new chapter.
Proposed new §216.7(a) provides that it shall be the licensee's responsibility to select and participate in continuing competency activities that will meet the criteria listed in the proposed new chapter. Proposed new §216.7(b) provides that the licensee shall be responsible for maintaining a record of continuing education activities. These records shall document attendance as evidenced by original certificates of attendance, contact hour certificates, academic transcripts, or grade slips and copies of these shall be submitted to the Board upon audit. Proposed new §216.7(c) provides that these records shall be maintained by the licensee for a minimum of two consecutive renewal periods or four years.
Proposed new §216.8(a) provides that, upon renewal of the license, the licensee shall sign a statement attesting that the continuing education or approved national nursing certification requirements have been met. The contact hours must have been completed in the biennium immediately preceding the license renewal. Continuing education contact hours from a previous renewal period will not be accepted. Additional contact hours earned may not be used for subsequent renewal periods. Proposed new §216.8(b) states that a candidate licensed by examination shall be exempt from the continuing education or approved national nursing certification requirement for issuance of the initial license and for the immediate renewal period following licensure. Proposed new §216.8(c) states that an applicant licensed by endorsement shall be exempt from the continuing education or approved national nursing certification requirement for the issuance of the initial Texas license and for the immediate renewal period following initial Texas licensure. Proposed new §216.8(d)(1) provides that a license that has been delinquent for less than four years may be renewed by the licensee showing evidence of having completed 20 contact hours in their current or prior area of practice of acceptable continuing education or an approved national nursing certification within two years immediately preceding the application for relicensure and by meeting all other Board requirements. A licensee shall be exempt from the continuing education requirement for the immediate renewal period following renewal of the delinquent license. Further, proposed new §216.8(d)(2) provides a license that has been delinquent for four or more years may be renewed upon completion of requirements listed in §217.6(b) of this title (relating to Failure to Renew License). Proposed new §216.8(e)(1) provides that a license that has been inactive for less than four years may be reactivated by the licensee submitting verification of having completed at least 20 contact hours of continuing education in their current or prior area of practice or a current approved national nursing certification in their current or prior area of practice within the past two years immediately prior to application for reactivation. Proposed new §216.8(e)(2) provides that a license that has been inactive for four or more years may be reactivated upon completion of requirements in §217.9(e) of this title (relating to Reactivation from Inactive Status). Proposed new §216.8(f) states that a licensee whose license has been revoked and subsequently applies for reinstatement must show evidence that the continuing competency requirement and other Board requirements have been met prior to reinstatement of the license by the Board.
Proposed new §216.9(1) provides that the Board shall select a random sample of licensees 90 days prior to each renewal month. Audit forms shall be sent to selected licensees to substantiate compliance with the continuing competency requirements. Within 30 days following notification of audit, these selected licensees shall submit an audit form and documentation as specified in §216.4 and §216.5 and any additional documentation the Board deems necessary to verify compliance with continuing education requirements for the period of licensure being audited or a copy of the current approved national nursing certification and any additional documentation the Board deems necessary to verify compliance with continuing competency requirements for the period of licensure being audited. Further, proposed new §216.9(2) provides that failure to notify the Board of a current mailing address will not absolve the licensee from audit requirements. Additionally, proposed new §216.9(3) provides that an audit shall be automatic for a licensee who has been found noncompliant in an immediately preceding audit. Finally, proposed new §216.9(4) states that failure to complete the audit satisfactorily or falsification of records shall constitute unprofessional conduct and provide grounds for disciplinary action.
Proposed new §216.10 states that any individual who wishes to appeal a determination of non-compliance with continuing competency requirements must submit a letter of appeal within 20 days of notification of the audit results. The Board or its designee shall conduct a review in which the appellant may appear in person to present reasons why the audit decision should be set aside or modified. Further, the decision of the Board after the appeal shall be considered final and binding.
Proposed new §216.11 provides that failure to comply with the Board's continuing competency requirements will result in the denial of renewal.
Katherine Thomas, Executive Director, has determined that for each year of the first five years the proposed new sections are in effect, there will be no additional fiscal implications for state or local government as a result of implementing the proposed new sections.
Ms. Thomas has also determined that for each year of the first five years the new sections are in effect, there will be public benefits, and there will be potential costs for individuals required to comply with the proposal.
Anticipated Public Benefits. The anticipated public benefits will be the adoption of new requirements that: (i) promote a comprehensive approach to continuing competency in nursing, (ii) provide nurses with additional options for meeting continuing competency requirements; and (iii) ensure the protection of the public health, safety, and welfare through the demonstration of competent, quality nursing care.
The ever evolving landscape of medical care requires nurses to stay abreast of the most current changes in medical techniques, treatments, and technology. The proposed new continuing competency requirements are designed to assist nurses in maintaining and improving their knowledge, skills, and attitudes so that the public may continue to receive safe, nursing care. The proposed new sections also encourage nurses to further their nursing education and to develop expertise in their current area of practice. Requiring a nurse to maintain competence in his or her current area of practice is especially important because it ensures that the nursing skills necessary for that particular setting are thoroughly developed and enriched. As a result, the nurse's patients directly benefit because the nurse is more knowledgeable and competent in his or her practice. In this way, the proposed new requirements seek to provide a higher quality of care in each area of nursing.
The proposed new sections also promote a new comprehensive approach to continuing competency in nursing. This new approach is beneficial to both individual nurses required to comply with the proposal and to the public. Traditionally, continuing competency has been demonstrated through the completion of continuing education courses. While continuing education courses continue to be a valuable method in promoting and enriching a nurse's knowledge and skills, they are not the only method for doing so. The proposed new sections recognize other methods in which nurses may develop expertise, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. This approach provides nurses with the flexibility of choosing courses, activities, and certifications that compliment their personality, skill level, learning style, and area of practice. Further, this approach encourages nurses to explore options beyond continuing education courses, such as national nursing certifications and academic courses related to the nursing practice. Because these additional methods of compliance are authorized under the proposed new sections, nurses will be able to consider a wider variety of continuing competency activities. These additional options should result in nurses with better training, education, subject matter expertise, and enriched skill sets, which ultimately should provide the public with access to better health care.
Potential Costs for Individuals Required to Comply with the Proposal.
Nurses required to comply with the proposed new requirements may incur compliance costs. Potential compliance costs result from the proposed new requirements in §§216.3, 216.7, 216.8, 216.9, and 216.10.
Pursuant to proposed new §216.3(a), nurses have the option of completing 20 hours of continuing education in their area of practice within the two years immediately preceding renewal of registration. For nurses who choose to comply with proposed new §216.3(a), the probable economic costs of compliance are estimated to range between $0.00 per credit hour and $20 per credit hour, with an average of $6.40 per credit hour. This estimated cost is based on the following considerations. The Board collected a sampling of continuing education courses currently being offered by various continuing education providers. The Board then compared the total cost of each course with the cost per credit hour. It should be noted that several continuing education providers offer free continuing education courses. Of the continuing education courses surveyed that were not free, the credit hours ranged from one hour to 35 credit hours and their total associated costs ranged from $5.00 to $90.00. Based on the continuing education courses surveyed, the range of cost per credit hour is $0.00 to $20, with an average cost per hour of $6.40. This cost estimate includes contact hour estimates for a variety of continuing education course subjects, including oncology and cancer courses, cardiovascular, cardiac, and heart disease courses, critical care courses, respiratory care courses, advanced assessment courses, bio-terrorism courses, nurse practitioner review courses, wound care courses, and family nurse practitioner courses.
Under proposed new §216.3(c), an advanced practice registered nurse has the option of completing 20 contact hours of continuing education. Additional continuing competency requirements apply to an advanced practice registered nurse with prescriptive authority. Proposed new §216.3(c)(3) requires advanced practice registered nurses with prescriptive authority to complete five additional contact hours of continuing education in pharmacotherapeutics, in addition to meeting the continuing competency requirements of proposed new §216.3(c). The probable estimated costs of complying with proposed new §216.3(a) have already been addressed in the foregoing paragraphs of this Public Benefit/Cost note. The probable estimated costs of complying with proposed new §216.3(c) are estimated to be the same as the estimated costs of complying with proposed new §216.3(a) because the Board anticipates the range of credit hours and costs for continuing education courses relating to an advanced practice registered nurse's specialty area to be similar to the credit hours and costs of the continuing education courses previously addressed in the foregoing paragraphs of this Public Benefit/Cost note. The probable estimated costs of complying with proposed new §216.3(c)(3) are estimated to be the same as the estimated costs of complying with proposed new §216.3(a) because the Board anticipates the range of credit hours and costs for pharmacotherapeutic continuing education courses to be similar to the credit hours and costs of the continuing education courses previously addressed in the foregoing paragraphs of this Public Benefit/Cost note.
Pursuant to the Occupations Code §301.306, proposed new §216.3(d) requires each nurse licensed in Texas and employed in an emergency room setting on or after September 1, 2006, to complete two hours of continuing education relating to forensic evidence collection. The probable estimated costs of completing continuing education hours in compliance with proposed new §216.3(a) have already been addressed in the foregoing paragraphs of this Public Benefit/Cost note. The probable estimated costs of complying with proposed new §216.3(d) are estimated to be the same as the estimated costs of completing continuing education hours in compliance with proposed new §216.3(a) because the Board anticipates the range of credit hours and costs for forensic evidence collection continuing education courses to be similar to the credit hours and costs of the continuing education courses previously addressed in the foregoing paragraphs of this Public Benefit/Cost note. However, the Board anticipates that the probable estimated costs associated with proposed new §216.3(d) may be somewhat reduced because proposed new §216.3(d) is a one-time requirement. Thus, once a nurse completes the required number of forensic evidence collection continuing education hours under proposed new §216.3(d), the nurse will not be required to complete those continuing education hours again. As such, the estimated costs of compliance with proposed new §216.3(d) are anticipated to be one-time costs only. Further, proposed new §216.3(d) permits forensic evidence collection continuing education hours to satisfy a portion of the continuing competency requirements in proposed new §216.3(a). This further reduces the estimated compliance costs for nurses subject to proposed new §216.3(d) because these nurses may simultaneously apply the completion of forensic evidence collection continuing education hours to the requirements of both proposed new §216.3(a) and §216.3(d).
Proposed new §216.3(e) requires a retired nurse over the age of 65 who continues to volunteer nursing services to complete 10 hours of continuing education in the nurse's area of practice. The probable estimated costs of completing continuing education hours in compliance with proposed new §216.3(a) have already been addressed in the foregoing paragraphs of this Public Benefit/Cost note. The probable estimated costs of complying with proposed new §216.3(e) are estimated to be similar to the estimated costs of completing continuing education hours in compliance with proposed new §216.3(a) because the Board anticipates that the range of credit hours and costs for continuing education courses required under proposed new §216.3(e) will be similar to the credit hours and costs of the continuing education courses required under proposed new §216.3(a), which were previously addressed in the foregoing paragraphs of this Public Benefit/Cost note. However, the Board anticipates that the probable estimated costs associated with proposed new §216.3(d) may be somewhat reduced because proposed new §216.3(e) requires the completion of substantially less continuing education hours than proposed new §216.3(a). This is because retired nurses who volunteer their nursing services are not compensated for those services. Further, these nurses generally do not provide nursing services on a full time basis, and do not provide nursing services in acute care, intensive care, or emergency room settings. The Board recognizes that the costs of continuing competency compliance may be a financial burden to these retired nurses. As a result, proposed new §216.3(e) requires the completion of 10 hours of continuing education for these nurses. In this way, proposed new §216.3(e) reduces the estimated compliance costs for retired nurses, while maintaining an appropriate number of continuing education hours to ensure the ongoing delivery of safe nursing care.
It is anticipated that individuals subject to proposed new §216.3(a), (c), (d), and (e) will incur the aforementioned estimated costs of compliance every two years. The proposed new requirements, however, also provide options to defray some of these estimated costs of compliance. First, several continuing education providers offer continuing education courses at no cost. The proposed new continuing competency requirements do not limit the number of free continuing education courses that a nurse may complete. A nurse may take as many free continuing education courses as he or she chooses or is able, provided that the courses meet the applicable requirements of the proposed new chapter, such as being approved by a credentialing agency approved by the Board and being in the nurse's area of practice. Second, many continuing education courses are offered online so nurses may complete the courses during non-business hours, preventing a nurse from having to miss work to complete a course. Third, proposed new §216.5 permits a nurse to meet the proposed new continuing competency requirements of §216.3(a) by attending and passing an academic course that is either within the framework of a curriculum that leads to an academic degree in nursing or is relevant to the nursing practice. The Board permits one qualifying academic semester hour to satisfy 15 contact hours of required continuing education. As a result, some nurses may be able to satisfy all or a portion of their continuing competency requirements under proposed new §216.3(a) while simultaneously furthering their nursing education. This additional option provides potential cost savings to these nurses. Finally, proposed new §216.8 provides an exemption from the continuing competency requirements of proposed new §216.3(a) for nurses licensed by examination and endorsement for the issuance of an initial Texas license and for the immediate renewal period following Texas licensure. This option eliminates the costs of continuing competency compliance for the first renewal period following initial Texas licensure for these nurses.
For nurses who choose to comply with §216.3(b) by achieving, maintaining, or renewing an approved national nursing certification in the nurse's area of practice, the probable economic costs of compliance will vary substantially based upon the following factors: (i) whether the nurse is a licensed registered nurse or a licensed vocational nurse; (ii) the specific certification sought; (iii) the credentialing body offering the specific certification; and (iv) the requirements and associated fees of the credentialing body offering the certification, including application fees, which are estimated to range between $200 - $500; exam fees, which are estimated to range between $270 - $400; renewal fees, which are estimated to range between $200 - $350, and the completion of a required number of continuing education or practice hours. A nurse is not required to achieve, maintain, or renew an approved national nursing certification in the nurse's area of practice under the proposed new requirements. Rather, a nurse is required to either (i) complete 20 contact hours of continuing education or (ii) achieve, maintain, or renew an approved national nursing certification. Thus, a nurse may choose to comply with the proposed new continuing competency requirements by achieving, maintaining, or renewing a national nursing certification. Proposed new §216.3(b) does not dictate the precise credentialing body that must be used by a nurse seeking a national nursing certification. As a result, each nurse is free to choose the most economical means of complying with the requirements of proposed new §216.3(b). Further, each nurse has the information necessary to estimate his or her own individual suitability for achieving, maintaining, or renewing a national nursing certification, including his or her individualized area of practice and individualized professional accomplishments that might be used to satisfy a portion of a credentialing body's initial requirements for certification, such as the completion of required clinical or continuing education hours. These estimated compliance costs may be reduced, however, for certain nurses. For nurses licensed by examination and endorsement for the issuance of an initial Texas license, proposed new §216.8 provides an exemption from the continuing competency requirements of proposed new §216.3(b) for the immediate renewal period following Texas licensure. This option eliminates the costs of continuing competency compliance for the first renewal period following initial Texas licensure for these nurses.
Proposed new §216.7 requires a nurse to maintain a record of his or her continuing education activities for a minimum of two consecutive renewal periods, or four years. The Board anticipates the costs of compliance with this proposed new requirement to be minimal. The Board accepts original or copied certificates of attendance, contact hour certificates, transcripts, and grade slips as acceptable evidence of completion of a continuing education activity. The Board anticipates that there should be minimal costs associated with storing these pieces of information for a four year time period. Further, because proposed new §216.7 does not prescribe the method by which a nurse must store this information, a nurse is able to choose the most economic and feasible method for doing do.
Proposed new §216.8(d)(1) requires a nurse whose license has been delinquent for less than four years to renew the license by showing evidence of (i) the completion of 20 contact hours of continuing education in the nurse's current or prior area of practice or (ii) an approved national nursing certification within the two years immediately preceding the application for relicensure. Proposed new §216.3(e)(1) requires a nurse whose license has been inactive for less than four years to reactivate the license by showing evidence of (i) the completion of 20 contact hours of continuing education in the nurse's current or prior area of practice or (ii) a current, approved national nursing certification within the two years immediately prior to the application for reactivation. Proposed new §216.3(f) requires a nurse who applies for reinstatement after the nurse's license has been revoked by the Board to satisfy the continuing competency requirements of proposed new §216.3(a) and (b). The probable estimated costs of complying with proposed new §216.3(a) and (b) have already been addressed in the foregoing paragraphs of this Public Benefit/Cost note. The estimated costs of complying with proposed new §216.3(d)(1), (e)(1), and (f) are estimated to be the same as the estimated costs of complying with proposed new §216.3(a) and (b), which have been previously addressed in the foregoing paragraphs of this Public Benefit/Cost note.
Proposed new §216.9 requires each nurse who receives an audit notice to submit a completed audit form and verification of the completion of the proposed new continuing competency requirements to the Board within 30 days following notification of the audit. The Board anticipates the costs of compliance with proposed new §216.9 to be less than $25. The Board anticipates the costs of compliance to include: an envelope suitable for mailing, an appropriate number of copies of appropriate/requested documentation, and postage. The Board anticipates that the cost of an envelope suitable for mailing will not exceed $5 and that the cost of postage will not exceed $10. Further, proposed new §216.9 does not prescribe a specific delivery method. As such, each nurse required to comply with proposed new §216.9 may choose the most economical way of mailing the requested documentation to the Board. The Board further anticipates that the cost of copies of the appropriate/requested documentation should not exceed $10. These estimated costs of compliance may be reduced further because not every nurse will be subject to compliance with proposed new §216.9. Pursuant to proposed new §216.9, a random sample of nurses are selected for audit 90 days prior to each renewal month. Thus, the estimated costs of compliance with proposed new §216.9, while minimal, may be further defrayed due to the random selection of nurses who will be required to comply with proposed new §216.9.
Finally, proposed new §216.10 affords nurses an opportunity to challenge the Board's determination of continuing competency non-compliance by filing a letter of appeal with the Board within 20 days of notification of the nurse's audit results. The Board anticipates the costs of compliance associated with proposed new §216.10 to be less than $25. First, a nurse is not required to appeal the Board's determination of continuing competency non-compliance. Rather, it is an option made available to each nurse. For nurses who choose to exercise this option, the Board estimates the costs of compliance to include: an envelope suitable for mailing, an appropriate number of copies of necessary documentation, and postage. The Board anticipates that the cost of an envelope suitable for mailing will not exceed $5 and that the cost of postage will not exceed $10. Further, proposed new §216.10 does not prescribe a specific delivery method. As such, each nurse may choose the most economical means of mailing the documentation to the Board. The Board anticipates that the cost of copies of any necessary documentation should not exceed $10. Further, while a nurse is required to submit a letter of appeal to the Board under proposed new §216.10 in order to challenge an audit decision, a nurse is not required to appear in person before the Board to challenge an audit decision. Rather, proposed new §216.10 provides nurses with the option of appearing in person before the Board to present reasons why an audit decision should be set aside or modified. Nurses who choose to appear in person to contest an audit decision may incur travel costs in doing so. However, nurses are free to choose the most economical means of traveling to Austin, Texas, to appear before the Board.
Any other costs to comply with the proposed new sections result from the enactment of the Occupations Code Chapter 301 and are not a result of the adoption, enforcement, or administration of the proposal.
As required by the Government Code §2006.002(c) and (f), the Board has determined that the proposed new requirements of Chapter 216 will not have an adverse economic effect on any individual, Board regulated entity, or other entity required to comply with the proposed new chapter because no individual, Board regulated entity, or other entity required to comply with the requirements of the proposed new chapter meets the definition of a small or micro business under the Government Code §2006.001(1) or §2006.001(2). The Government Code §2006.001(1) defines a micro business as a legal entity, including a corporation, partnership, or sole proprietorship that: (i) is formed for the purpose of making a profit; (ii) is independently owned and operated; and (iii) has not more than 20 employees. The Government Code §2006.001(2) defines a small business as a legal entity, including a corporation, partnership, or sole proprietorship, that: (i) is formed for the purpose of making a profit; (ii) is independently owned and operated; and (iii) has fewer than 100 employees or less than $6 million in annual gross receipts. Each of the elements in §2006.001(1) and §2006.001(2) must be met in order for an entity to qualify as a micro business or small business. The only entities subject to the proposed new requirements of Chapter 216 are individual nurses. Because individual nurses are not independently owned and operated legal entities that are formed for the purpose of making a profit, no individual nurse qualifies as a micro business or small business under the Government Code §2006.001(1) or §2006.001(2). Therefore, in accordance with the Government Code §2006.002(c) and (f), the Board is not required to prepare a regulatory flexibility analysis.
The Board has determined that no private real property interests are affected by this proposal and that this proposal does not restrict or limit an owner's right to property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking or require a takings impact assessment under the Government Code §2007.043.
To be considered, written comments on the proposal or any request for a public hearing must be submitted no later than 5:00 p.m. on June 14, 2009, to James W. Johnston, General Counsel, Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, or by e-mail to dusty.johnston@bon.state.tx.us, or faxed to (512) 305-8101. An additional copy of the comments on the proposal or any request for a public hearing must be simultaneously submitted to Denise Benbow, Nursing Practice Consultant, Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, or by e-mail to denise.benbow@bon.state.tx.us, or faxed to (512) 305-8101. If a hearing is held, written and oral comments presented at the hearing will be considered.
The new rules are proposed under the Occupations Code §§301.152, 301.303, 301.306, and 301.151. The Occupations Code §301.152(a) defines advanced practice nurse as a registered nurse approved by the Board to practice as an advanced practice nurse on the basis of completion of an advanced educational program. The term includes a nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist. The term is synonymous with advanced nurse practitioner. Section 301.152(b) authorizes the Board to adopt rules to: (i) establish any specialized education or training, including pharmacology, that a registered nurse must have to carry out a prescription drug order and a system for assigning an identification number to a registered nurse who provides the Board with evidence of completing the required specialized education and training requirement; (ii) approve a registered nurse as an advanced practice nurse; and (iii) initially approve and biennially renew an advanced practice nurse's authority to carry out or sign a prescription drug order. Section 301.152(c) requires the rules adopted under §301.152(b) to (i) require completion of pharmacology and related pathology education for initial approval; (ii) require continuing education in clinical pharmacology and related pathology in addition to any continuing education otherwise required under §301.303; and (iii) provide for the issuance of a prescription authorization number to an advanced practice nurse approved under §301.152. Section 301.152(d) provides that the signature of an advanced practice nurse attesting to the provision of a legally authorized service by the advanced practice nurse satisfies any documentation requirement for that service established by a state agency. Section 301.303(a) authorizes the Board to recognize, prepare, or implement continuing competency programs for license holders under Chapter 301 and to require participation in continuing competency programs as a condition of renewal of a license. The programs may allow a license holder to demonstrate competency through various methods, including completion of targeted continuing education programs and consideration of a license holder's professional portfolio, including certifications held by the license holder. Section 301.303(b) provides that the Board may not require participation in more than a total of 20 hours of continuing education in a two-year licensing period. Section 301.303(c) authorizes the Board by rule to establish a system for the approval of programs and providers of continuing education if the Board requires participation in continuing education programs as a condition of license renewal. Section 301.303(e) authorizes the Board to adopt other rules as necessary to implement §301.303. Section 301.303(f) states that the Board may assess each program and provider under this section a fee in an amount that is reasonable and necessary to defray the costs incurred in approving programs and providers. Section 301.303(g) authorizes the Board by rule to establish guidelines for targeted continuing education required under Chapter 301. The rules adopted under §301.303(g) must address: (i) the nurses who are required to complete the targeted continuing education program; (ii) the type of courses that satisfy the targeted continuing education requirement; (iii) the time in which a nurse is required to complete the targeted continuing education; (iv) the frequency with which a nurse is required to meet the targeted continuing education requirement; and (v) any other requirement considered necessary by the Board. Section 301.306(a) provides that, as part of continuing education requirements under §301.303, a license holder who is employed to work in an emergency room setting and who is required under Board rules to comply with §301.303 shall complete at least two hours of continuing education relating to forensic evidence collection not later than September 1, 2008 or the second anniversary of the initial issuance of a license under this chapter to the license holder. Section 301.303(b) states that the continuing education required under §301.303(a) must be part of a program approved under §301.303(c). Section 301.303(c) authorizes the Board to adopt rules to identify the license holders who are required to complete continuing education under §301.303(a) and to establish the content of that continuing education. Further, the Board may adopt other rules to implement §301.303, including rules under Section 301.303(c) for the approval of education programs and providers. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under this chapter; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.
The following statutes are affected by this proposal:
Rule -- Statute
Sections 216.1 - 216.11 -- Occupations Code §§301.152, 301.303 and 301.306
§216.1.Definitions.
The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:
(1) Academic course--A specific set of learning experiences offered in an accredited school, college or university. Academic credit will convert on the following basis: One academic quarter hour = 10 contact hours; one academic semester hour = 15 contact hours.
(2) Advanced Practice Registered Nurse (APRN)--A nurse anesthetist, nurse practitioner, nurse midwife, or clinical nurse specialist approved by the board to practice as an advanced practice registered nurse based on completion of an advanced educational program acceptable to the board.
(3) Approved--Recognized as having met established standards and pre-determined criteria of the:
(A) credentialing agencies recognized by the board (applies to providers and programs); and
(B) certifying bodies accredited by a national certification accreditation body recognized by the board.
(4) Area of Practice--Any nursing practice the nurse engaged in during the licensure renewal cycle.
(5) Audit--A random sample of licensees taken to verify satisfactory completion of the board's requirements for continuing competency during a biennial license renewal period.
(6) Authorship--Development and publication of a manuscript related to nursing and health care.
(7) Certification--Nursing certification from an approved certifying body accredited by a national accreditation body recognized by the board.
(8) Classroom instruction--Workshops, seminars, institutes, conferences or short term courses which the individual attends which may be acceptable for continuing education credit.
(9) Clinical learning experiences--Faculty-planned and guided learning experiences designed to assist students to meet the course objectives and to apply nursing knowledge and skills in the direct care of patients/clients. This includes laboratories, acute care facilities, extended care facilities, and other community resources.
(10) Competency--The application of knowledge and the interpersonal decision making, and psychomotor skills expected for the nurse's practice role, within the context of public health, safety, and welfare.
(11) Contact hour--Sixty consecutive minutes of participation in a learning activity.
(12) Continuing Education (CE)--Programs beyond the basic preparation which are designed to promote and enrich knowledge, improve skills, and develop attitudes for the enhancement of nursing practice, thus improving health care to the public.
(13) Continuing education program--An organized educational activity, e.g, self paced (online), classroom, approved through an external review process based on a predetermined set of criteria. The review is conducted by an organization(s) recognized by the board to approve programs and providers.
(14) Credentialing agency--An organization recognized by the board as having met nationally predetermined criteria to approve programs and providers of CE.
(15) Prescriptive Authority--Authorization granted to an advanced practice registered nurse who meets the requirements to carry out or sign a prescription drug order.
(16) Program number--A unique number assigned to a program upon approval which shall identify it regardless of the number of times it is presented.
(17) Provider--An individual, partnership, organization, agency or institution approved by an organization recognized by the board which offers continuing education programs.
(18) Provider number--A unique number assigned to the provider upon approval by the credentialing agency or organization.
§216.2.Purpose.
The purpose of continuing competency is to ensure that nurses stay abreast of current industry practices, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. Continuing education in nursing includes programs beyond the basic preparation which are designed to promote and enrich knowledge, improve skills and develop attitudes for the enhancement of nursing practice, thus improving health care to the public. Nursing certification is another method of demonstrating continuing competence. Pursuant to authority set forth in the Occupations Code §301.303, the board requires participation in continuing competency activities for license renewal. The procedures set forth in these rules provide guidance to fulfilling the continuing competency requirement. The board requires nurses to participate in continuing education courses that relate to their practice area or to attain, maintain, or renew an approved national nursing certification in their practice area, which benefits the public welfare.
§216.3.Requirements.
(a) A nurse must meet either the requirements of this subsection or subsection (b) of this section. A nurse may choose to complete 20 contact hours of continuing education within the two years immediately preceding renewal of registration. These hours shall be obtained in the nurse's area of practice and be in programs approved by a credentialing agency recognized by the board. A list of these agencies/organizations may be obtained from the board's office or web site.
(b) A nurse must meet either the requirements of this subsection or subsection (a) of this section. A nurse may choose to demonstrate the achievement, maintenance, or renewal of an approved national nursing certification in the nurse's area of practice. A list of approved national nursing certification criteria may be obtained from the board's office or web site.
(c) Requirements for the Advanced Practice Registered Nurse. The licensee authorized by the board as an advanced practice registered nurse (APRN) is required to obtain 20 contact hours of continuing education or attain, maintain or renew the national certification recognized by the board as meeting the certification requirement for the advanced practice registered nurse's role and population focus area of licensure within the previous two years of licensure. National certification as discussed in this section will only meet the requirement for licensure renewal.
(1) The required hours are not in addition to the requirements of subsection (a) or (b) of this section.
(2) The 20 contact hours of continuing education must be appropriate to the advanced specialty area and role recognized by the board.
(3) The APRN who holds prescriptive authority must complete, in addition to the requirements of this subsection, at least five additional contact hours of continuing education in pharmacotherapeutics.
(4) Category I Continuing Medical Education (CME) contact hours will meet requirements as described in this chapter.
(d) Forensic Evidence Collection.
(1) Each nurse licensed in Texas and employed in an emergency room (ER) setting on or after September 1, 2006 shall complete a minimum of two hours of continuing education relating to forensic evidence collection, as required by the Occupations Code §301.306 and this subsection:
(A) by September 1, 2008 for nurses to whom this requirement applies who are employed in an ER setting on or before September 1, 2006; or
(B) within two years of the initial date of employment in an ER setting. This requirement may be met through completion of approved continuing education activities, as set forth in §216.4 of this chapter (relating to Criteria for Acceptable Continuing Education Activity).
(2) This requirement shall apply to nurses who work in an ER setting that is:
(A) the nurse's home unit;
(B) an ER unit to which the nurse "floats" or schedules shifts; or
(C) a nurse employed under contractual, temporary, per diem, agency, traveling, or other employment relationship whose duties include working in an ER.
(3) A licensed nurse in Texas who would otherwise be exempt from CE requirements during the nurse's initial licensure or first renewal periods under §216.8(b) or (c) of this chapter (relating to Relicensure Process) shall comply with the requirements of this section. This is a one-time requirement for each nurse employed in an ER setting. In compliance with §216.7(b) of this chapter (relating to Responsibilities of Individual Licensee), each licensee is responsible for maintaining records of CE attendance. Validation of course completion in Forensic Evidence Collection should be retained by the nurse indefinitely, even if a nurse changes employment.
(4) The minimum 2 hours of continuing education requirement shall include information relevant to forensic evidence collection and age or population-specific nursing interventions that may be required by other laws and/or are necessary in order to assure evidence collection that meets requirements under the Government Code §420.031 regarding use of a service-approved evidence collection kit and protocol. Content may also include but is not limited to documentation, history-taking skills, use of sexual assault kit, survivor symptoms, and emotional and psychological support interventions for victims.
(5) The required hours under this subsection are included in the continuing education requirements for nurses.
(e) A nurse who is 65 years old or older and who holds or is seeking to hold a valid volunteer retired (VR) nurse authorization in compliance with the Occupations Code §112.051 and §217.9(d) of this title (relating to Inactive Status):
(1) Must have completed at least 10 hours of continuing education in the nurse's area of nursing practice during the previous biennium, unless the nurse also holds valid recognition as an advanced practice registered nurse or is a Volunteer Retired Registered Nurse (VR-RN) with advanced practice authorization in a given role and specialty in the State of Texas.
(2) Must have completed at least 20 hours of CE as defined in this chapter if authorized by the board in a specific advanced practice role and specialty. The 20 hours of CE must meet the same criteria as APRN CE defined under subsection (c) of this section. An APRN authorized as a VR-RN with APRN authorization may not hold prescriptive authority. This does not preclude a registered nurse from placing his/her APRN authorization on inactive status and applying for authorization only as a VR-RN.
(3) Is exempt from fulfilling targeted CE requirements except as required for volunteer retired advanced practice registered nurses.
§216.4.Criteria for Acceptable Continuing Education Activity.
Continuing Education programs must be approved by a credentialing agency or an affiliated entity of one of these agencies and must be in the nurse's area of practice. Proof of successful completion shall contain the name of the provider; the program title, date, and location; number of contact hours; provider number; and credentialing agency.
§216.5.Additional Criteria for Specific Continuing Education Programs.
In addition to those programs reviewed by a board-approved entity, a licensee may attend an academic course that meets the following criteria:
(1) The course shall be within the framework of a curriculum that leads to an academic degree in nursing or any academic course relevant to nursing practice.
(2) Participants, upon audit by the board, shall be able to present an official transcript indicating completion of the course with a grade of "C" or better, or a "Pass" on a Pass/Fail grading system.
§216.6.Activities Which are not Acceptable as Continuing Education.
The following activities do not meet continuing education requirements for licensure renewal.
(1) Basic Life Support (BLS) or cardiopulmonary resuscitation (CPR) courses.
(2) In service programs. Programs sponsored by the employing agency to provide specific information about the work setting and orientation or other programs which address the institution's philosophy, policies and procedures; on-the-job training; basic CPR; and equipment demonstration are not acceptable for CE credit.
(3) Nursing refresher courses. Programs designed to update knowledge or current nursing theory and clinical practice, which consist of a didactic and clinical component to ensure entry level competencies into professional practice are not accepted for CE credit.
(4) Orientation programs. A program designed to introduce employees to the philosophy, goals, policies, procedures, role expectations and physical facilities of a specific work place are not acceptable for CE credit.
(5) Courses which focus upon self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, and yoga.
(6) Economic courses for financial gain, e.g., investments, retirement, preparing resumes, and techniques for job interview.
(7) Courses which focus on personal appearance in nursing.
(8) Liberal art courses in music, art, philosophy, and others when unrelated to patient/client care.
(9) Courses designed for lay people.
(10) Self-directed study--An educational activity wherein the learner takes the initiative and the responsibility for assessing, planning, implementing and evaluating the activity including, but not limited to:
(A) academic courses that are audited, or that are healthcare-related courses but not part of a nursing degree program, or that are prerequisite courses such as mathematics, physiology, biology, government, or other similar courses are not acceptable;
(B) authorship; and
(C) program development and presentation.
(11) CE that is not the nurses area of practice unless required by the Occupations Code or this chapter.
§216.7.Responsibilities of Individual Licensee.
(a) It shall be the licensee's responsibility to select and participate in continuing competency activities that will meet the criteria listed in this chapter.
(b) The licensee shall be responsible for maintaining a record of CE activities. These records shall document attendance as evidenced by original certificates of attendance, contact hour certificates, academic transcripts, or grade slips and copies of these shall be submitted to the board upon audit.
(c) These records shall be maintained by the licensee for a minimum of two consecutive renewal periods or four years.
§216.8.Relicensure Process.
(a) Renewal of license.
(1) Upon renewal of the license, the licensee shall sign a statement attesting that the CE or approved national nursing certification requirements have been met.
(2) The contact hours must have been completed in the biennium immediately preceding the license renewal. CE contact hours from a previous renewal period will not be accepted. Additional contact hours earned may not be used for subsequent renewal periods.
(b) Persons licensed by examination. A candidate licensed by examination shall be exempt from the CE or approved national nursing certification requirement for issuance of the initial license and for the immediate renewal period following licensure.
(c) Persons licensed by endorsement. An applicant licensed by endorsement shall be exempt from the CE or approved national nursing certification requirement for the issuance of the initial Texas license and for the immediate renewal period following initial Texas licensure.
(d) Delinquent license.
(1) A license that has been delinquent for less than four years may be renewed by the licensee showing evidence of having completed 20 contact hours in their current or prior area of practice of acceptable continuing education or an approved national nursing certification within two years immediately preceding the application for relicensure and by meeting all other board requirements. A licensee shall be exempt from the continuing education requirement for the immediate renewal period following renewal of the delinquent license.
(2) A license that has been delinquent for four or more years may be renewed upon completion of requirements listed in §217.6 of this title (relating to Failure to Renew License).
(e) Reactivation of a license.
(1) A license that has been inactive for less than four years may be reactivated by the licensee submitting verification of having completed at least 20 contact hours of continuing education in their current or prior area of practice or a current approved national nursing certification in their current or prior area of practice within the past two years immediately prior to application for reactivation.
(2) A license that has been inactive for four or more years may be reactivated upon completion of requirements in §217.9 of this title (relating to Inactive Status).
(f) Reinstatement of a license. A licensee whose license has been revoked and subsequently applies for reinstatement must show evidence that the continuing competency requirement and other board requirements have been met prior to reinstatement of the license by the board.
§216.9.Audit Process.
The board shall select a random sample of licensees 90 days prior to each renewal month. Audit forms shall be sent to selected licensees to substantiate compliance with the continuing competency requirements.
(1) Within 30 days following notification of audit, these selected licensees shall submit an audit form and:
(A) documentation as specified in §216.4 and §216.5 of this chapter (relating to Criteria for Acceptable Continuing Education Activity and Additional Criteria for Specific Continuing Education Programs) and any additional documentation the board deems necessary to verify compliance with continuing education requirements for the period of licensure being audited; or
(B) a copy of the current approved national nursing certification and any additional documentation the board deems necessary to verify compliance with continuing competency requirements for the period of licensure being audited.
(2) Failure to notify the board of a current mailing address will not absolve the licensee from audit requirements.
(3) Pursuant to this section, an audit shall be automatic for a licensee who has been found noncompliant in an immediately preceding audit.
(4) Failure to complete the audit satisfactorily or falsification of records shall constitute unprofessional conduct and provide grounds for disciplinary action.
§216.10.Appeals.
(a) Any individual who wishes to appeal a determination of non-compliance with continuing competency requirements must submit a letter of appeal within 20 days of notification of the audit results.
(b) The board or its designee shall conduct a review in which the appellant may appear in person to present reasons why the audit decision should be set aside or modified.
(c) The decision of the board after the appeal shall be considered final and binding.
§216.11.Consequences of Non-Compliance.
Failure to comply with the board's continuing competency requirements will result in the denial of renewal.
This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on May 1, 2009.
TRD-200901640
James W. Johnston
General Counsel
Texas Board of Nursing
Earliest possible date of adoption: June 14, 2009
For further information, please call: (512) 305-6811
CHAPTER 470. ADMINISTRATIVE PROCEDURE
The Texas State Board of Examiners of Psychologists proposes amendments to §470.10, Subpoenas. The amendments are being proposed to conform with the Administrative Procedure Act as cited.
Sherry L. Lee, Executive Director, has determined that for the first five-year period the amendments will be in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the proposed amendments.
Ms. Lee also has determined that for each year of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be to help the Board protect the public. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State Board of Examiners of Psychologists, 333 Guadalupe, Suite 2-450, Austin, TX 78701, (512) 305-7700 or email brenda.skiff@tsbep.state.tx.us.
The amendments are proposed under Texas Occupations Code, Title 3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners of Psychologists with the authority to make all rules, not inconsistent with the Constitution and Laws of this State, which are reasonably necessary for the proper performance of its duties and regulations of proceedings before it.
No other code, articles or statutes are affected by this section.
§470.10.Subpoenas.
On [Upon on] its own motion or, on [
upon] the written request of any party to a contested
case pending before it, for good cause shown and on deposit
of sums [with the executive director/secretary] that will
reasonably, ensure [insure] payment of [
in] the amounts estimated to accrue under Administrative
Procedure Act, Tex. Gov't Code Ann. §2001.103 (relating to expenses
of witness or deponent) [§155.31 of Title 1 of the
Texas Administrative Code (relating to Discovery)], the agency
shall issue a subpoena addressed to the [an authorized
agency employee or] sheriff or to a [any]
constable to require the attendance of a witness or [witnesses
and] the production of books, records, papers, or other objects
that [as] may be necessary and proper for the purpose
of a proceeding [the proceedings].
This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on May 1, 2009.
TRD-200901645
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: June 14, 2009
For further information, please call: (512) 305-7706
The Texas State Board of Examiners of Psychologists proposes amendments to §473.3, Annual Renewal Fees (Not Refundable). The amendments are being proposed to cover the cost of the shared Data Base Migration System for the Board.
Sherry L. Lee, Executive Director, has determined that for the first five-year period the amendments will be in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the proposed amendments.
Ms. Lee also has determined that for each year of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be to help the Board protect the public. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the rule as proposed.
Comments on the proposal may be submitted to Brenda Skiff, Texas State Board of Examiners of Psychologists, 333 Guadalupe, Suite 2-450, Austin, TX 78701, (512) 305-7700 or email brenda.skiff@tsbep.state.tx.us.
The amendments are proposed under Texas Occupations Code, Title 3, Subtitle I, Chapter 501, which provides the Texas State Board of Examiners of Psychologists with the authority to make all rules, not inconsistent with the Constitution and Laws of this State, which are reasonably necessary for the proper performance of its duties and regulations of proceedings before it.
No other code, articles or statutes are affected by this section.
§473.3.Annual Renewal Fees (Not Refundable).
(a) Psychological Associate Licensure--$111 [$98].
(b) Psychological Associate Licensure over the age of 70--$16.
(c) Provisionally Licensed Psychologist--$106 [$93].
(d) Provisionally Licensed Psychologist over the age of 70--$16.
(e) Psychologist Licensure--$202 [$189].
(f) Psychologist Licensure over the age of 70--$16.
(g) Psychologist Health Service Provider Status--$20.
(h) Psychologist Health Service Provider status over the age of 70--No Fee.
(i) Licensed Specialist in School Psychology--$54 [$41].
(j) Licensed Specialist in School Psychology over the age of 70--$14.
This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on May 1, 2009.
TRD-200901646
Sherry L. Lee
Executive Director
Texas State Board of Examiners of Psychologists
Earliest possible date of adoption: June 14, 2009
For further information, please call: (512) 305-7706