Nancy Spector

A Regulatory Model on Transitioning Nurses From Education to Practice

he National Council ofState Boards of Nursing’s(NCSBN) Board of Direc-tors charged their Practice, Regu-lation, and Education Committeewith developing a regulatorymodel for transitioning newnurses from education to practice.Because the mission of the boardsof nursing is to protect the public,they are responsible for ensuringthat safe and competent nursesare entering the workforce. There-fore, the Board requested an evi-dence-based transition model thatboards of nursing could use as aresource for the transition issuesthat many states are facing.

Evidence-based Nursing Education for Regulation

he National Council of State Boards of Nursing (NCSBN) is responsible for assisting its 60 member boards in meeting their mission of protecting the public through the regulation of safe nursing practice. Related to this mission of public protection, 58 of the 60 boards of nursing approve nursing programs in their states or territories to ensure that nursing is practiced by minimally competent, licensed nurses within their authorized scope of practice. The Institute of Medicine’s 1999 widely publicized report on the problem of medical errors in healthcare and 2003 report on the need to improve healthcare education suggest the importance of regulatory oversight of nursing education programs. Boards of nursing are governmental agencies that approve nursing programs, promulgating rules and regulations that address entry-into-practice standards that nursing programs must meet. If the programs fail to meet the boards’ regulations, the boards have the authority to sanction them after allowing for a reasonable opportunity to comply with the standards. This differs from national nursing accreditation, which is accomplished through either the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education. Nursing accreditation is a voluntary process (in most states) that addresses quality through a nongovernmental peer review process. If nursing programs do not meet national accreditation standards, the accreditors do not have the authority to sanction or close the programs. Therefore, national accreditation and state or territory approval processes have different objectives and methods. In many states, the national nursing accreditors and the boards of nursing work together closely to prevent duplication of efforts. Because the boards of nursing are mandated to approve nursing programs, the boards are interested in knowing the evidence-based elements of nursing education that are essential for preparing new nurses for safe entry-level practice. Although

Development of a standardized medication assistant curriculum.

A crossthecountry,many nonnurses are administering medications to individuals in nonacute healthcare settings and in other settings where healthcare is not the primary focus (hereinafter, these will be referred to as nonacute settings). Because many states are using medication assistants in nonacute settings, the Boards of Nursing, in their mission to protect the public, became concerned about a lack of uniformity in the qualifications and training of these unlicensed assistive personnel. Therefore, the Member Boards of the National Council State Boards of Nursing (NCSBN)* passed a resolution asking NCSBN to conduct a job analysis of medication assistants, develop a model curriculum, and explore the feasibility for administering a competency examination. At NCSBN’s 2007 annual meeting, the information on the job analysis and feasibility study was presented, and the Member Boards adopted, through a majority vote, the model medication assistant curriculum. This article will discuss the development of that NCSBN model curriculum, thus enabling employers and regulators to understand how and why it was established and to learn about its recommendations. The National Council State Boards of Nursing took the position in their 2004 Model Nursing Practice Act and Model Administrative Rules, Article XVIII, Chapter 18, that if jurisdictions use medication assistants, they should be regulated by Boards of Nursing. The NCSBN model practice act and rules termed the medication assistant who received and passed an approved training program and successfully completed a comprehensive examination, a medication assistant certified. Currently, 14 Boards of Nursing regulate medication assistants. This model curriculum will provide those Boards that do regulate medication assistants, as well as those that may in the future, with a resource for regulating and training medication assistants.

Focus group on licensed practical nurse scope of practice at National Council of State Boards of Nursing.

n April 29, 2004, the National Council of State Boards of Nursing (NCSBN) convened a focus group to discuss the findings of the 2003 Licensed Practical Nurse/Vocational Nurse (LPN/ VN) practice analysis and to make recommendations to the NCBSN board of directors. To ensure the broadest possible range of experience and knowledge, participants were selected from a variety of nursing-related disciplines across the United States. Some of the areas of nursing that were represented included the boards of nursing and members of the NCSBN Examination Committee, Joint Commission’s Long-term Care, National League for Nursing Accrediting Commission, Institute for the Future of Aging Services, American Organization of Nurse Executives, National Federation of Licensed Practical Nurses, and the National Association for Practical Nurse Education and Service. We had an objective facilitator from England who is not a nurse but who is experienced with leading focus groups. The NCSBN is a not-for-profit organization whose mission is to provide leadership to advance regulatory excellence for public protection. The NCSBN is composed of all 60 boards of nursing, which include the RN boards in the 50 states, the 5 US territories, the District of Columbia, and 4 LPN/VN boards of nursing. One role of NCSBN is to prepare legally defensible and psychometrically sound examinations (NCLEX-PNB and NCLEX-RNB) to ensure that the graduate has met minimal criteria for entering LPN or RN practice. Periodically, NCSBN’s Research Services Department does an incumbent practice analysis (job analysis) for nurses who have practiced for up to 6 months that provides the basis for the NCLEX-PNB test plan. These analyses are conducted on a 3-year cycle, and NCSBN uses

A primer: the National Council of State Boards of Nursing Nurse Licensure Compact.

n the late 1990s, the National Council of State Boards of Nursing (NCSBN) began exploring the mutual recognition model of nurse licensure. This model, which NCSBN called the Nurse Licensure Compact (NLC), allows a nurse to have one license (in the nurse’s state of residency) and to practice in other states as long as that nurse acknowledges that he or she is subject to each state’s practice laws and discipline. Similar to the US driver’s license model, nursing practice across state lines is allowed, whether physical or electronic, unless the nurse is under discipline or a monitoring agreement that restricts a nurse with a NLC license from practicing across state lines. The NLC is a legal contract between states that enables nursing practice across state lines. In each state that adopts the NLC, the NLC is an additional statutory layer above the individual state’s Nurse Practice Act, which remains in place. To date, 20 states have either passed legislation or adopted the NLC through regulation. States that are actively participating in the NLC include Arizona, Arkansas, Delaware, Idaho, Iowa, Maine, Maryland, Mississippi, Nebraska, New Mexico, North Carolina, North Dakota, South Dakota, Tennessee, Texas, Utah, and Wisconsin. States who will be actively participating in the NLC in the future are New Jersey and Virginia. What determines primary residency for NLC purposes? Primary residence is defined in the model rules and regulations of the NLC. Sources used to verify a nurse’s primary residence for the NLC may include, but are not limited to, driver’s license,

Building a Sphere of Influence

Sharon Weisenbeck, MS, RN, Executive Director, Kentucky Board of Nursing, advises us that all nurses should remember that the mission of the boards of nursing is to protect the public. The board of nursing is the authorized state entity with the legal authority to regulate nursing. Nursing is regulated because it is one of the health professions that poses a risk of harm to the public if practiced by someone who is unprepared and incompetent. The public may not have sufficient information and experience to identify an unqualified health care provider and is vulnerable to unsafe and incompetent practitioners. Therefore, boards of nursing provide oversight for nursing practice in each state or territory, and all boards of nursing take this mission very seriously. Ms. Weisenbeck recommends a few pointers on becoming more involved with your board of nursing. She says that nurses are not always aware of the various ways of communicating with or having a voice in their boards of nursing, although the specifics will depend on the individual boards of nursing. It is always important for nurses to keep themselves updated on any changes in their boards’ rules, regulations, and practice acts. They can do this by reading their boards’ newsletters in states and territories that have one or by reading their boards’ Web site. If nurses do not know their boards’ Web site addresses, they can access them from the landing page of the NCSBN Web site: http://www. ncsbn.org. There are several other ways for nurses to interact with their boards of nursing, according to Ms. Weisenbeck, and this input can be valuable not only to nurses’ professional growth and their contributions to their profession but also for protecting the public. Nurses can attend board meetings at their boards of nursing. It is helpful to obtain an agenda from the board of nursing first to see if there are any items of interest. Some boards of nursing have forums during the board meetings where

NCSBN takes a stand on prelicensure clinical experiences.

t the 2005 National Council of State Boards of Nursing (NCSBN) annual meeting in August, a position paper entitled Clinical Instruction in Prelicensure Nursing Programs was adopted by the NCSBN member boards. This position paper was written by the NCSBN Practice, Regulation and Education Committee (PR&E), in response to a resolution made at the 2004 annual meeting. The resolution asked NCSBN’s PR&E Committee to develop a position paper to guide boards of nursing in evaluating whether entry-level nurses have received effective, supervised clinical nursing education to ensure safe nursing practice. The boards of nursing asked the committee to investigate the available research, and other evidence, supporting traditional programs that offer clinical experiences with actual patients. They also wanted the committee members to search the available evidence supporting those programs that have alternative clinical education, using distance learning, simulation, and other technical teaching modalities, but little or no clinical experiences. Because the mission of the boards of nursing is to protect the public, boards have the responsibility of making sure that new graduates are prepared to practice safely. Recent discussion at the boards of nursing has focused on whether nursing programs leading to initial licensure can successfully educate nurses with alternative methodologies that take the place of traditional clinical experiences. In the face of a nursing shortage, programs are asking for education rules addressing faculty qualifications to be waived and are developing programs with only limited (in some cases none) clinical experiences with actual patients. At the same time, nursing employers are reporting that fewer than 50% of new nurses (41.9% for both ADN and BSN graduates) are prepared to provide safe and effective care. The PR&E Committee engaged in the following activities in response to this important charge: