PART 11. TEXAS BOARD OF NURSING
CHAPTER 214. VOCATIONAL NURSING EDUCATION
22 TAC §§214.2 - 214.10, 214.12, 214.13
Introduction. The Board is proposing amendments to Chapter 214, relating to Vocational Nursing Education. Specifically, the Board is proposing amendments to §§214.2 - 214.10, 214.12 and 214.13. The proposed amendments correct outdated references; contain clarifying and editorial changes; and simplify the existing numbering system for the Board's educational guidelines that are currently referenced in the rule.
The Board considered the proposed amendments at its regularly scheduled April 2023 meeting and approved the proposal for publication in the Texas Register for public comment.
Section by Section Overview. Section 214.2 contains the definitions for the chapter. Proposed amended §214.2 clarifies existing definitions within the section and corrects outdated references. Additionally, proposed amended 214.2 adds a new definition of nursing clinical judgment for use in the chapter.
Section 214.3 contains the Board's requirements for nursing education program development, expansion, and closure. First, the proposed amendments clarify factors that will be considered by the Board when determining whether to approve a new nursing education program. Second, the proposed amendments simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule. Third, the proposed amendments clarify factors that will be considered by the Board when determining whether a nursing education program is high-risk. The proposal also specifies that the Board may require the appointment of a mentor to assist the director of a nursing education program who does not have prior experience in the director role in an effort to ensure the success of a high-risk program. Finally, the proposed amendments clarify how NCLEX-PN® examination testing codes will be addressed in the event of program consolidation.
Section 214.4 addresses nursing education program approval status. Consistent with other proposed changes throughout the chapter, the proposed amendments simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule. The remaining proposed changes are non-substantive in nature and clarify existing provisions within the section.
The proposed amendments to §214.5 update an outdated reference.
The proposed amendments to §214.6 simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule.
The proposed amendments to §214.7 make editorial changes for better readability within the section.
The proposed amendments to §214.8 clarify existing requirements related to increases in enrollment of 25% or more for accredited and non-accredited programs. The remaining proposed amendments also simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule and include editorial changes.
The proposed amendments to §214.9 update an outdated reference, remove obsolete provisions from the section, and simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule.
The proposed amendments to §214.10 add clarity to the section and remove obsolete provisions from the section.
The proposed amendments to §214.12 make editorial changes.
The proposed amendments to §214.13 include a reference to the Board's guidelines for additional clarity in the section.
Fiscal Note. Katherine Thomas, Executive Director, has determined that for each year of the first five years the proposed amendments will be in effect, there will be no change in the revenue to state government as a result of the enforcement or administration of the proposal.
Public Benefit/Cost Note. Ms. Thomas has also determined that for each year of the first five years the proposed amendments are in effect, the anticipated public benefit will be the adoption of rules that provide additional clarity and guidance to vocational nursing education programs operating in Texas. There are no anticipated costs of compliance with the proposal. The proposed amendments do not impose any new requirements on vocational nursing education programs either operating in Texas or seeking to operate in Texas. The vast majority of the proposed amendments provide only editorial changes to the chapter. The remaining proposed amendments simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule and include clarifying language. However, the Board does not anticipate that any of these proposed changes will result in new costs of compliance or alter the manner in which vocational nursing education programs have been complying, or will comply, with the requirements of the chapter.
Costs Under the Government Code §2001.0045. The Government Code §2001.0045 prohibits agencies from adopting a rule that imposes costs on regulated persons unless the agency repeals a rule that imposes a total cost on regulated persons that is equal to or greater than the total cost imposed on regulated persons by the proposed rule or amends a rule to decrease the total cost imposed on regulated persons by an amount that is equal to or greater than the cost imposed on the persons by the proposed rule. Pursuant to §2001.0045(c)(9), this prohibition does not apply to a rule that is necessary to implement legislation, unless the legislature specifically states §2001.0045 applies to the rule. There are no anticipated costs of compliance with the proposal.
Economic Impact Statement and Regulatory Flexibility Analysis for Small and Micro Businesses. The Government Code §2006.002(c) and (f) require, that if a proposed rule may have an economic impact on small businesses, micro businesses, or rural communities, state agencies must prepare, as part of the rulemaking process, an economic impact statement that assesses the potential impact of the proposed rule on these businesses and communities and a regulatory flexibility analysis that considers alternative methods of achieving the purpose of the rule. Because there are no anticipated costs of compliance associated with the proposal, an economic impact statement and regulatory flexibility analysis is not required.
Government Growth Impact Statement. The Board is required, pursuant to Tex. Gov't Code §2001.0221 and 34 Texas Administration Code §11.1, to prepare a government growth impact statement. The Board has determined for each year of the first five years the proposed amendments will be in effect: (i) the proposal does not create or eliminate a government program; (ii) the proposal is not expected to have an effect on current agency positions; (iii) implementation of the proposal does not require an increase or decrease in future legislative appropriations to the Board; (iv) the proposal does not affect the fees paid to the Board; (v) the proposal does not create a new regulation; (vi) the proposal amends existing regulations primarily through non-substantive, editorial changes and provides additional clarity and simplicity to the chapter; (vii) there is no increase or decrease in the number of individuals subject to the rule's applicability; and (viii) the proposal will not affect the state's economy.
Takings Impact Assessment. 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.
Request for Public Comment. To be considered, written comments on this proposal should be submitted 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.texas.gov, or faxed to (512) 305-8101. If a hearing is held, written and oral comments presented at the hearing will be considered.
Statutory Authority. The proposed amendments are proposed under the authority of the Occupations Code §301.151, which permits the Board to regulate the practice of professional nursing and vocational nursing. Further, the Occupations Code §301.157(b) authorizes the Board to: prescribe and publish the minimum requirements and standards for a course of study in each program that prepares registered nurses or vocational nurses; prescribe other rules as necessary to conduct approved schools of nursing and educational programs for the preparation of registered nurses or vocational nurses; approve schools of nursing and educational programs that meet the Board's requirements; select one or more national nursing accrediting agencies, recognized by the United States Department of Education and determined by the Board to have acceptable standards, to accredit schools of nursing and educational programs; and deny or withdraw approval from a school of nursing or educational program that fails to meet the prescribed course of study or other standard under which it sought approval by the Board; fails to meet or maintain accreditation with the national nursing accrediting agency selected by the Board; or fails to maintain the approval of the state board of nursing of another state and the Board under which it was approved.
Cross Reference To Statute. The following statutes are affected by this proposal: the Occupations Code §301.151 and §301.157.
§214.2.Definitions.
Words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise:
(1) - (10) (No change.)
(11) Clinical preceptor--a licensed nurse who meets
the requirements in §214.10(i)(6) of this chapter (relating to
Clinical Learning Experiences), who practices in the clinical
setting [is not employed as a faculty member by the governing
entity], and who directly supervises clinical learning experiences
for no more than two (2) students. A clinical preceptor assists in
the evaluation of the student during the experiences and in acclimating
the student to the role of nurse. A clinical preceptor facilitates
student learning in a manner prescribed by a signed written agreement
between the governing entity, preceptor, and affiliating agency (as applicable).
(12) - (16) (No change.)
(17) Differentiated Essential Competencies (DECs)--the
expected educational outcomes to be demonstrated by nursing students
at the time of graduation, as published in the Differentiated
Essential Competencies of Graduates of Texas Nursing Programs Evidenced
by Knowledge, Clinical Judgment, and Behaviors: Vocational (VN), Diploma/Associate
Degree (Diploma/ADN), Baccalaureate Degree (BSN), 2021 [October 2010] (DECs).
(18 - (21) (No change.)
(22) Faculty waiver--a waiver granted by a director
or coordinator of a vocational nursing education program to an individual
who meets the criteria specified in §214.7(e) [§214.7(e)(1)
- (3)] of this chapter.
(23) - (28) (No change.)
(29) Nursing Clinical Judgment--the observed outcome of critical thinking and decision-making that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care. It is a decision-making model that is consistent with the nursing process model where the nurse determines and implements nursing interventions based on recognizing and analyzing patient cues (assessment and analysis), prioritizing hypotheses and generating solutions (planning), taking action (implementation), and evaluating outcomes.
(30) [(29)] Objectives/Outcomes--expected
student behaviors that are attainable and measurable.
(A) - (C) (No change.)
(31) [(30)] Observation experience--a
clinical learning experience where a student is assigned to follow
a health care professional in a facility or unit and to observe activities
within the facility/unit and/or the role of nursing within the facility/unit,
but where the student does not participate in hands-on patient/client care.
(32) [(31)] Pass rate--the percentage
of first-time candidates within the examination year, as that term
is defined in paragraph (19) of this section, who pass the National
Council Licensure Examination for Vocational Nurses (NCLEX-PN®).
(33) [(32)] Philosophy/Mission--statement
of concepts expressing fundamental values and beliefs as they apply
to nursing education and practice and upon which the curriculum is based.
(34) [(33)] Program of study--the
courses and learning experiences that constitute the requirements
for completion of a vocational nursing education program.
(35) [(34)] Recommendation--a
specific suggestion based upon program assessment that is indirectly
related to the rules to which the program must respond but in a method
of their choosing.
(36) [(35)] Requirement--mandatory
criterion based on program assessment that is directly related to
the rules that must be addressed in the manner prescribed.
(37) [(36)] Shall--denotes mandatory requirements.
(38) [(37)] Simulation--activities
that mimic the reality of a clinical environment and are designed
to demonstrate procedures, decision-making, and critical thinking.
A simulation may be very detailed and closely imitate reality, or
it can be a grouping of components that are combined to provide some
semblance of reality. Components of simulated clinical experiences
include providing a scenario where the nursing student can engage
in a realistic patient situation guided by trained faculty and followed
by a debriefing and evaluation of student performance. Simulation
provides a teaching strategy to prepare nursing students for safe,
competent, hands-on practice.
(39) [(38)] Staff--employees
of the Texas Board of Nursing.
(40) [(39)] Supervision--immediate
availability of a faculty member or clinical preceptor to coordinate,
direct, and observe first-hand the practice of students.
(41) [(40)] Survey visit--a
virtual or [an] on-site visit to a vocational nursing
education program by a Board representative. The purpose of the visit
is to evaluate the program of study by gathering data to determine
whether the program is in compliance with Board requirements. A
visit to a program with an approval status other than full approval
focuses on examining factors that may have contributed to the changed
approval status and implementation of corrective measures.
(42) [(41)] Systematic approach--the
organized nursing process approach that provides individualized, goal-directed
nursing care whereby the licensed vocational nurse role engages in:
(A) (No change.)
(B) participating in the planning of the nursing care needs of an individual based upon analyzing patient cues;
(C) participating in the development and modification of the nursing care plan based on the vocational nurse's nursing clinical judgment;
(D) - (E) (No change.)
(43) [(42)] Texas Higher Education
Coordinating Board (THECB)--the state agency described in Texas Education
Code, Title 3, Subtitle B, Chapter 61.
(44) [(43)] Texas Workforce Commission
(TWC)--the state agency described in Texas Labor Code, Title 4, Subtitle
B, Chapter 301.
(45) [(44)] Vocational nursing
education program--an educational unit within the structure of a school,
including a college, university, or career school or college or a
hospital or military setting that provides a program of nursing study
preparing graduates who are competent to practice safely and who are
eligible to take the NCLEX-PN® examination.
§214.3.Program Development, Expansion and Closure.
(a) New Programs.
(1) (No change.)
(2) Proposal to establish a new vocational nursing education program.
(A) (No change.)
(B) The new vocational nursing education program must be approved/licensed or deemed exempt by the appropriate Texas agency, the THECB or the TWC, as applicable, before approval can be granted by the Board for the program to be implemented. The proposal to establish a new vocational nursing education program may be submitted to the Board at the same time that an application is submitted to the THECB or the TWC, but the proposal cannot be approved by the Board until such time as the proposed program is approved by the THECB or the TWC. If the governing entity has nursing programs in other jurisdictions, the submitted program proposal must include evidence that the nursing program's NCLEX-PN® pass rates are at least 80% for the current examination year, as that term is defined in §214.2(19) of this chapter (relating to Definitions), and that the nursing programs hold full approval from the state boards of nursing in the other states and are in good standing. Evidence of poor performance by a governing entity's nursing program in another jurisdiction is sufficient grounds for denial of a proposal. Additionally, a proposal will be denied by the Board in accordance with governing statutory requirements.
(C) - (E) (No change.)
(F) The proposal shall include information outlined
in Board Education Guideline 3.1.1. available at https://www.bon.texas.gov
[3.1.1.a. Proposal to Establish a New Vocational Nursing
Education Program].
(G) After the proposal is submitted and determined
to be complete, a preliminary survey visit may [shall]
be conducted by Board Staff [prior to presentation to the Board].
(H) The proposal shall be considered by the Board following a public hearing at a regularly scheduled meeting of the Board. The Board may approve the proposal and grant initial approval to the new program, may defer action on the proposal, or may deny further consideration of the proposal. In order to ensure success of newly approved programs, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary.
(i) (No change.)
(ii) A program may be considered high-risk if it meets
one or more of the following criteria, including, but not limited
to: unfamiliarity[;] of the governing entity with nursing
education; inexperience of the potential director or coordinator in
directing a nursing program; potential for director or faculty turnover;
multiple admission cycles per year; lack of rigor in admission
criteria; use of a national curriculum; or potential for a high
attrition rate among students. If the director has no experience
in the director role, an appropriate mentor will be required to assist
the director during the first year of operation.
(iii) Board monitoring of a high-risk program may include
the review and analysis of program reports; extended communication
with program directors; and additional survey visits. A monitoring
plan may require the submission of quarterly reports of students'
performance in courses and clinical learning experiences; remediation
strategies and attrition rates; and reports from an assigned mentor
to the program director. Additional survey visits by a Board representative
may be conducted at appropriate intervals to evaluate the status of
the program. The Board may alter a monitoring plan as necessary to
address the specific needs of a particular program. [When the
Board requires monitoring activities to evaluate and assist the program,
monitoring fees will apply.]
(I) - (M) (No change.)
(3) (No change.)
(b) Extension Site/Campus.
(1) - (2) (No change.)
(3) An approved vocational nursing education program desiring to establish an extension site/campus that is consistent with the main campus program's current curriculum and teaching resources shall comply with Board Education Guideline 3.1.5 available at https://www.bon.texas.gov and:
(A) - (B) (No change.)
(4) When the curriculum of the extension site/campus
deviates from the original program in any way, the proposed extension
is viewed as a new program and Board Education Guideline 3.1.1
available at https://www.bon.texas.gov [3.1.1.a] applies.
(5) Extension programs of vocational nursing education
programs that have been closed may be reactivated by submitting notification
of reactivation to the Board at least four (4) months prior to reactivation,
using [the] Board Education Guideline 3.1.5 available
at https://www.bon.texas.gov [3.1.2.a. Initiating or Reactivating
an Extension Nursing Education Program for initiating an extension program].
(6) A program intending to close an extension site/campus shall:
(A) (No change.)
(B) Submit required information according to Board
Education Guideline 3.1.7 available at https://www.bon.texas.gov [3.1.2.a.], including:
(i) - (iv) (No change.)
(7) Consolidation. When a governing entity oversees an extension site/campus or multiple extension sites/campuses with curricula consistent with the curriculum of the main campus, the governing entity and the program director/coordinator may request in a formal letter to the Board consolidation of the extension site(s)/campus(es) with the main program, utilizing one (1) NCLEX-PN® examination testing code thereafter. After the effective date of consolidation, the NCLEX-PN® examination testing code(s) for the extension site(s) will be deactivated/closed. The NCLEX-PN® examination testing code assigned to the main campus will remain as the active code.
[(A) The request to consolidate the extension site(s)/campus(es) with the main campus shall be submitted in a formal letter to the Board office at least four (4) months prior to the effective date of consolidation and must meet Board Education Guideline 3.1.2.b. Consolidation of Vocational Nursing Education Programs.]
[(B) The notification of the consolidation will be presented, as information only, to the Board at a regularly scheduled Board meeting as Board approval is not required.]
[(C) The program will receive an official letter of acknowledgment following the Board meeting.]
[(D) After the effective date of consolidation, the NCLEX-PN®examination testing code(s) for the extension site(s) will be deactivated/closed.]
[(E) The NCLEX-PN® examination testing code assigned to the main campus will remain active.]
(c) Transfer of Administrative Control by the Governing
Entity. The authorities of the governing entity shall notify the Board
office in writing of an intent to transfer the administrative authority
of the program. This notification shall follow Board Education Guideline 3.1.6 available at https://www.bon.texas.gov [3.1.3.a.
Notification of Transfer of Administrative Control of a Vocational
Nursing Education Program or a Professional Nursing Education Program
by the Governing Entity].
(d) Closing a Program.
(1) When the decision to close a program has been made, the director/coordinator must notify the Board by submitting a written plan for closure complying with Board Education Guideline 3.1.7 available at https://www.bon.texas.gov, which includes the following:
(A) - (E) (No change.)
(2) - (6) (No change.)
(e) Approval of a Vocational Nursing Education Program Outside Texas' Jurisdiction to Conduct Clinical Learning Experiences in Texas.
(1) (No change.)
(2) A written request, the required fee set forth in §223.1(a)(20) [§223.1(e)(27)] of this title,
and all required supporting documentation shall be submitted to the
Board office following Board Education Guideline 3.1.3 available
at https://www.bon.texas.gov [3.1.1.f. Process for Approval
of a Nursing Education Program Outside Texas' Jurisdiction to Conduct
Clinical Learning Experiences in Texas].
(A) [(3)] Evidence that the program
has been approved/licensed or deemed exempt from approval/licensure
by the appropriate Texas agency (i.e., the THECB, the TWC), to conduct
business in the State of Texas, must be provided before approval can
be granted by the Board for the program to conduct clinical learning
experiences in Texas.
(B) [(4)] Evidence that the program's
NCLEX-PN® examination rate is at
least 80% for the current examination year, as that term is defined
in §214.2(19) of this chapter (relating to Definitions).
(3) [(5)] The Board may withdraw
the approval of any program that fails to maintain the requirements
set forth in Board Education Guideline 3.1.3 available at https://www.bon.texas.gov
[3.1.1.f.] and this section.
§214.4.Approval.
(a) The progressive designation of approval status is not implied by the order of the following listing. Approval status is based upon each program's performance and demonstrated compliance to the Board's requirements and responses to the Board's recommendations. Change from one status to another is based on NCLEX-PN® examination pass rates, compliance audits, survey visits, and other factors listed under subsection (b) of this section. Types of approval include:
(1) Initial Approval.
(A) - (B) (No change.)
(C) Change from initial approval status to full approval status cannot occur until the program has demonstrated compliance with this chapter, has met requirements and responded to all recommendations issued by the Board, and the NCLEX-PN® examination pass rate is at least 80% after a full examination year. In order to ensure the continuing success of the program, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary for continued operation and/or as a condition for changing the approval status.
(2) (No change.)
(3) Full with warning or initial approval with warning is issued by the Board to a vocational nursing education program that is not meeting the Board's requirements.
(A) (No change.)
(B) Following the survey visit, the program will be given a list of identified areas of concern and a specified time in which to respond with a set of corrective measures. Further, in order to ensure the continuing success of the program, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary for continued operation and/or as a condition for changing the approval status.
(4) Conditional Approval. Conditional approval is issued
by the Board for a specified time to provide the program opportunity
to correct any areas of concern identified by the Board or from findings
in the program's self-study [self study] report.
(A) - (B) (No change.)
(C) Depending upon the degree to which the Board's
requirements are currently being or have been met, the Board may change
the program's approval status [from conditional approval
to full approval or to full approval with warning,] or may withdraw
approval. In order to ensure the continuing success of the program,
the Board may, in its discretion, impose any restrictions or conditions
it deems appropriate and necessary for continued operation and/or
as a condition for changing the approval status.
(5) Withdrawal of Approval. The Board may withdraw
approval from a program which fails to meet the Board's requirements
within the specified time. A program may also elect to voluntarily
close a program, as provided for in subsection (c)(12) of this section. The director/coordinator shall submit a plan for closure according
to Board Education Guideline 3.1.7 available at https://www.bon.texas.gov
and outlined in subsection (d) of this section. [The program
shall be removed from the list of Board approved vocational nursing
education programs.]
(6) When a program closes by Board action or voluntary decision, the program will be removed from the list of Board approved vocational nursing education programs, but students may complete the program in teach-out.
(b) Factors Jeopardizing Program Approval Status.
(1) When a program demonstrates non-compliance with
Board requirements, approval status may be changed [to
full with warning or conditional status], approval may
be withdrawn, or the Board, in its discretion, may impose restrictions
or conditions it deems appropriate and necessary. In addition to imposing
restrictions or conditions, the Board may also require additional monitoring
of the program. Board monitoring may include the review and analysis
of program reports; extended communication with program directors;
and additional survey visits. A monitoring plan may require the submission
of quarterly reports of students' performance in courses and clinical
learning experiences; remediation strategies and attrition rates;
and reports from an assigned mentor to the program director. Additional
survey visits by a Board representative may be conducted at appropriate
intervals to evaluate the status of the program. The Board may alter
a monitoring plan as necessary to address the specific needs of a
particular program. [When the Board requires monitoring activities
to evaluate and assist the program, monitoring fees will apply.]
(2) A change in approval status, requirements for restrictions or conditions, or a monitoring plan may be issued by the Board for any of the following reasons:
(A) (No change.)
(B) substantiated student complaints [utilization
of students to meet staffing needs in health care facilities];
(C) - (I) (No change.)
(J) other activities or situations that demonstrate to the Board that a program is not meeting Board requirements or lacks institutional control necessary for successful student outcomes.
(c) Ongoing Approval Procedures. Ongoing approval status
is determined biennially by the Board on the basis of information
reported or provided in the program's NEPIS and CANEP, NCLEX-PN® examination pass rates, program compliance
with this chapter, and other program outcomes. Certificates of Board
approval will be sent [mailed] to all Board-approved
nursing programs biennially in even-numbered years.
(1) (No change.)
(2) NCLEX-PN® Pass Rates. The annual NCLEX-PN® examination pass rate for each vocational nursing education program is determined by the percentage of first time test-takers who pass the examination during the examination year.
(A) (No change.)
(B) When the passing score of first-time NCLEX-PN® candidates is less than 80% on the examination
during the examination year, the nursing program shall submit a Self-Study
Report that evaluates factors that may have contributed to the graduates'
performance on the examination and a description of the corrective
measures to be implemented. The report shall comply with Board Education
Guideline 3.2.1 available at https://www.bon.texas.gov [3.2.1.a.
Writing a Self-Study Report on Evaluation of Factors that Contributed
to the Graduates' Performance on the NCLEX-PN® or
NCLEX-RN® Examination]. Within
one year of the submission of the Self-Study Report to the Board,
the program shall provide to Board Staff evaluation data on the effectiveness
of corrective measures implemented.
(3) Change in Approval Status. The progressive designation of a change in approval status is not implied by the order of the following listing. A change in approval status is based upon each program's performance and demonstrated compliance to the Board's requirements and responses to the Board's recommendations. A change from one approval status to another may be determined by program outcomes, including the NCLEX-PN® examination pass rates, compliance audits, survey visits, and other factors listed under subsection (b) of this section.
(A) A warning may be issued to a program when:
(i) the pass rate of first-time NCLEX-PN®, candidates, as described in paragraph
(2)(A) of this subsection, is less than 80% for two (2) consecutive
examination years; or [and]
(ii) (No change).
(B) A program may be placed on conditional approval status if:
(i) - (ii) (No change.)
(iii) the program has continued to engage in activities or situations that demonstrate to the Board that the program is not meeting Board requirements and standards or lacks institutional control necessary for successful student outcomes; or
(iv) (No change.)
(C) Approval may be withdrawn if:
(i) - (ii) (No change.)
(iii) the program continues to engage [persists
in engaging] in activities or situations that demonstrate to
the Board that the program is not meeting Board requirements and standards or lacks institutional control necessary for successful student outcomes.
(D) The Board may consider a change in approval status at a regularly scheduled Board meeting for a program on initial, full approval, full approval with warning, or conditional approval if:
(i) - (ii) (No change.)
(E) The Board may, in its discretion, change the approval
status of a program on full approval with warning [to full approval,
to full approval with restrictions or conditions,] or impose
a monitoring plan. The Board may restrict enrollments.
(F) The Board may, in its discretion, change
the approval status of a program on conditional approval [to
full approval, full approval with restrictions or conditions, full
approval with warning,] or impose a monitoring plan. The Board
may restrict enrollments.
(4) Survey Visit. Each vocational nursing education program shall be visited at least once every six (6) years after full approval has been granted, unless accredited by a Board-recognized national nursing accrediting agency.
(A) Board Staff may conduct a survey visit at any time
based upon Board Education Guideline 3.2.2 available at https://www.bon.texas.gov
[3.2.3.a. Criteria for Conducting Survey Visits].
(B) - (C) (No change.)
(5) The Board will select one (1) or more national nursing accrediting agencies, recognized by the United States Department of Education, and determined by the Board to have standards equivalent to the Board's ongoing approval standards according to Board Education Guideline 3.2.3 available at https://www.bon.texas.gov. Identified areas that are not equivalent to the Board's ongoing approval standards will be monitored by the Board on an ongoing basis.
(6) (No change.)
(7) Accredited Programs. The Board may
review and/or change the approval status of an accredited [will
deny or withdraw approval from a] vocational nursing education
program that fails to:
(A) - (C) (No change.)
(8) A vocational nursing education program is considered
approved by the Board and exempt from Board rules that require ongoing
approval as described in Board Education Guideline 3.2.3 available
at https://www.bon.texas.gov [3.2.4.a. Specific Exemptions
from Education Rule Requirements for Nursing Education Programs Accredited
by a Board-Approved National Nursing Accreditation Organization]
if the program:
(A) - (C) (No change.)
(9) - (10) (No change.)
[(11) The Board may assist the program
in its effort to achieve compliance with the Board's requirements
and standards.]
(11) [(12)] A program that voluntarily
closes or from which approval has been withdrawn by the Board may
submit a new proposal. A new proposal may not be submitted to the
Board until at least twelve (12) calendar months have elapsed from
the date the program's voluntary closure is accepted by the Executive
Director or from the date of the program's withdrawal of approval
by the Board.
(12) [(13)] A vocational nursing
education program accredited by a national nursing accrediting agency
recognized by the Board shall:
(A) - (D) (No change.)
(d) (No change.)
§214.5.Philosophy/Mission and Objectives/Outcomes.
(a) (No change.)
(b) Program objectives/outcomes derived from the philosophy/mission
shall reflect the Differentiated Essential Competencies of Graduates of Texas Nursing Programs Evidenced by Knowledge, Clinical Judgment, and Behaviors: Vocational (VN), Diploma/Associate Degree (Diploma/ADN), Baccalaureate Degree (BSN), 2021 [October 2010] (DECs).
(c) - (e) (No change).
§214.6.Administration and Organization.
(a) - (f) (No change.)
(g) When the director/coordinator or of the program changes, the director/coordinator shall submit to the Board office written notification of the change indicating the final date of employment.
(1) A new Dean/Director/Coordinator Qualification Form
shall be submitted to the Board office by the governing entity for
approval prior to the appointment of a new director/coordinator or
an interim director/coordinator in an existing program or a new vocational
nursing education program according to Board Education Guideline 3.3.1
available at https://www.bon.texas.gov [3.4.1.a. Approval
Process for a New Dean/Director/Coordinator or New Interim/Dean/Director/Coordinator].
(2) A curriculum vitae and all applicable official
transcripts for the proposed new director/coordinator shall be submitted
with the new Dean/Director/Coordinator Qualification Form, according
to Board Education Guideline 3.3.1 available at https://www.bon.texas.gov
[3.4.1.a].
(3) (No change.)
(h) - (j) (No change.)
§214.7.Faculty.
(a) - (c) (No change.)
(d) Faculty Qualifications [and Responsibilities].
(1) - (2) (No change.)
(e) - (f) (No change.)
(g) Non-nursing faculty are exempt from meeting the
faculty qualifications of this chapter as long as the teaching assignments do not include [are not] nursing content or clinical
nursing courses.
(h) - (j) (No change.)
(k) Faculty Responsibilities [shall
be responsible for]:
(1) - (4) (No change.)
(l) - (n) (No change).
§214.8.Students.
(a) The number of students admitted to the program
shall be determined by the number of qualified faculty, adequate educational
facilities and resources, and the availability of appropriate clinical
learning experiences for students. [Programs shall not accept
admissions after the third day of class.]
(b) If a program that is accredited by a national
nursing accreditation agency plans an increase of enrollment of 25%
or more, it must file a substantive change proposal with the accreditation
agency. Programs that are not accredited by a national nursing accreditation
agency [A program] must seek approval prior to an
increase in enrollment of twenty-five percent (25%) or greater by
headcount in one (1) academic year for each nursing program offered.
The program must notify Board Staff four (4) months prior to the anticipated
increase in enrollment by following Board Education Guideline
3.5.2 available at https://www.bon.texas.gov. The Executive
Director shall have the authority to approve a requested increase
in enrollment on behalf of the Board. When determining whether to
approve a request for an increase in enrollment under this rule, the
Executive Director and/or the Board shall consider:
(1) - (6) (No change.)
(c) - (f) (No change.)
(g) Student policies shall be furnished manually or electronically to all students at the beginning of the students' enrollment in the vocational nursing education program.
(1) (No change.)
(2) The program shall maintain evidence of student
receipt of the Board's licensure [criteria regarding]
eligibility information [for licensure], as
specifically outlined in subsection (c) of this section.
(3) (No change.)
(h) - (j) (No change.)
§214.9.Program of Study.
(a) The program of study shall include both didactic and clinical learning experiences and shall be:
(1) - (7) (No change.)
(8) designed and implemented to prepare students to
demonstrate the Differentiated Essential Competencies of Graduates
of Texas Nursing Programs Evidenced by Knowledge, Clinical Judgment,
and Behaviors: Vocational (VN), Diploma/Associate Degree (Diploma/ADN),
Baccalaureate Degree (BSN), 2021 [October 2010]
(DECs); and
(9) (No change.)
(b) (No change.)
(c) Instruction shall include, but not be limited to: organized student/faculty interactive learning activities, formal lecture, audiovisual presentations, nursing skills laboratory instruction and demonstration, simulated laboratory instruction, and faculty-supervised, hands-on patient care clinical learning experiences.
(1) - (3) (No change.)
(4) Clinical [practice] learning experiences
shall include actual hours of practice in nursing skills and computer
laboratories; simulated clinical experiences; faculty supervised hands-on
clinical care; clinical conferences; debriefing; and observation experiences.
Observation experiences provide supplemental learning experiences
that meet specific learning objectives.
[(5) The total weekly schedule throughout
the length of the program shall not exceed forty (40) hours per week,
including both classroom instruction and clinical practice hours.]
[(6) Students shall be assigned two (2) consecutive non-class/clinical days off each week.]
[(7) Students shall be allocated at least eighteen (18) days leave for vacation and/or holidays.]
[(8) All scheduled holidays are to be observed on the holidays designated by the governing entity.]
[(9) Vacation time shall be scheduled at the same time for all students.]
(d) - (g) (No change.)
(h) Faculty shall develop and implement evaluation
methods and tools to measure progression of students' cognitive, affective,
and psychomotor achievements in course/clinical objectives, according
to Board Education Guideline 3.6.3 available at https://www.bon.texas.gov
[3.7.3.a. Student Evaluation Methods and Tools]. A
guideline that outlines the effective use of standardized examinations
as an evaluation of student progress is Board Education Guideline 3.6.4 available at https://www.bon.texas.gov [3.7.4.a.
Using Standardized Examinations outlines the effective use of standardized
examinations as an evaluation of student progress].
[(1) A system of grading shall be
in place which does not allow grades of less than a "C" on any required
subject areas in the program of study.]
[(2) A program may develop admission policies to allow students to challenge course content the student may have previously completed that meets the program's course objectives/outcomes.]
(i) Curriculum changes shall be developed by the faculty
according to Board standards and shall include information outlined
in the Board Education Guideline 3.6.1 available https://www.bon.texas.gov
[3.7.1.a. Proposals for Curriculum Changes]. The
two (2) types of curriculum changes are:
(1) - (2) (No change).
(j) (No change.)
(k) Vocational nursing education programs planning
major curriculum changes shall submit a curriculum change proposal,
as outlined in Board Education Guideline 3.6.1 available at https://www.bon.texas.gov
[3.7.1.a.,] to the Board office for approval at
least four (4) months prior to implementation.
(l) (No change.)
§214.10.Clinical Learning Experiences.
(a) Faculty shall be responsible and accountable for managing clinical learning experiences and observation experiences of students. Board Education Guideline 3.6.2 available at https://www.bon.texas.gov describes the purposes of clinical settings and reported hands-on clinical hours to meet program and course objectives.
(b) - (c) (No change.)
(d) The faculty member shall be responsible for the supervision of students in clinical learning experiences and scheduling of student time and clinical rotations.
[(1) Selected clinical learning experiences
will remain unchanged unless a client's condition demands reassignment.]
[(2) Reassignment must be approved with prior consent of faculty.]
[(3) The student's daily client assignment shall be made in accordance with clinical objectives/outcomes and learning needs of the students.]
[(4) The total number of daily assignments shall not exceed five (5) clients.]
(e) - (i) (No change.)
[(j) During clinical learning experiences,
programs shall not permit utilization of students for health care
facility staffing.]
[(k) The affiliating agency shall:]
[(1) provide clinical facilities for student experiences;]
[(2) provide space for conducting clinical conferences for use by the school if classrooms are located elsewhere;]
[(3) provide assistance with clinical supervision of students, including preceptorships, by mutual agreement between the affiliating agency and governing entity; and]
[(4) have no authority to dismiss faculty or students. Should the affiliating agency wish to recommend dismissal of faculty or students, such recommendation(s) shall be in writing.]
§214.12.Records and Reports.
(a) Accurate and current records shall be maintained for a minimum of two (2) years in a confidential manner and be accessible to appropriate parties, including Board representatives. These records shall include, but are not limited to:
(1) records of current students, including the student's
application and required admission documentation, evidence of student's
ability to meet objectives/outcomes of the program, final clinical
practice evaluations, signed receipt of written student policies furnished
by manual and/or electronic means, evidence of student receipt of
the Board's licensure [Board license] eligibility
information as specifically outlined in §214.8(c) [§214.8(b)
] of this chapter (relating to Students), and the statement
of withdrawal from the program, if applicable;
(2) - (6) (No change.)
(b) - (e) (No change.)
§214.13.Total Program Evaluation.
(a) There shall be a written plan for the systematic evaluation of the effectiveness of the total program following Board Education Guideline 3.8.1 available at https://www.bon.texas.gov. The plan shall include evaluative criteria, methodology, frequency of evaluation, assignment of responsibility, and indicators (benchmarks) of program and instructional effectiveness. The following broad areas shall be periodically evaluated:
(1) - (10) (No change.)
(b) - (d) (No change).
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on June 19, 2023.
TRD-202302196
John Vanderford
Assistant General Counsel
Texas Board of Nursing
Earliest possible date of adoption: July 30, 2023
For further information, please call: (512) 305-6879
22 TAC §§215.2 - 215.10, 215.12, 215.13
Introduction. The Board is proposing amendments to Chapter 215, relating to Professional Nursing Education. Specifically, the Board is proposing amendments to §§215.2 - 215.10, 215.12, and 215.13. The proposed amendments correct outdated references; contain clarifying and editorial changes; and simplify the existing numbering system for the Board's educational guidelines that are currently referenced in the rule.
The Board considered the proposed amendments at its regularly scheduled April 2023 meeting and approved the proposal for publication in the Texas Register for public comment.
Section by Section Overview. Section 215.2 contains the definitions for the chapter. Proposed amended §215.2 clarifies existing definitions within the section and corrects outdated references. Additionally, proposed amended 215.2 adds a new definition of nursing clinical judgment for use in the chapter.
Section 215.3 contains the Board's requirements for nursing education program development, expansion, and closure. First, the proposed amendments clarify factors that will be considered by the Board when determining whether to approve a new nursing education program. Second, the proposed amendments simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule. Third, the proposed amendments clarify factors that will be considered by the Board when determining whether a nursing education program is high-risk. The proposal also specifies that the Board may require the appointment of a mentor to assist the director of a nursing education program who does not have prior experience in the director role in an effort to ensure the success of a high-risk program. Finally, the proposed amendments correct typographical errors in the section.
Section 215.4 addresses nursing education program approval status. Consistent with other proposed changes throughout the chapter, the proposed amendments simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule. The remaining proposed changes are non-substantive in nature and clarify existing provisions within the section and make editorial edits.
The proposed amendments to §215.5 update an outdated reference.
The proposed amendments to §215.6 simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule.
The proposed amendments to §215.7 make editorial changes for better readability within the section.
The proposed amendments to §215.8 clarify existing requirements related to increases in enrollment of 25% or more for accredited and non-accredited programs. The remaining proposed amendments also simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule and include editorial changes.
The proposed amendments to §215.9 update an outdated reference and simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule.
The proposed amendments to §215.10 adds reference to an education guideline for additional guidance and clarity.
The proposed amendments to §215.12 make editorial changes.
The proposed amendments to §215.13 include a reference to the Board's guidelines for additional clarity in the section.
Fiscal Note. Katherine Thomas, Executive Director, has determined that for each year of the first five years the proposed amendments will be in effect, there will be no change in the revenue to state government as a result of the enforcement or administration of the proposal.
Public Benefit/Cost Note. Ms. Thomas has also determined that for each year of the first five years the proposed amendments are in effect, the anticipated public benefit will be the adoption of rules that provide additional clarity and guidance to professional nursing education programs operating in Texas. There are no anticipated costs of compliance with the proposal. The proposed amendments do not impose any new requirements on professional nursing education programs either operating in Texas or seeking to operate in Texas. The vast majority of the proposed amendments provide only editorial changes to the chapter. The remaining proposed amendments simplify the existing numbering system for the Board's education guidelines that are currently referenced in the rule and include clarifying language. However, the Board does not anticipate that any of these proposed changes will result in new costs of compliance or alter the manner in which professional nursing education programs have been complying, or will comply, with the requirements of the chapter.
Costs Under the Government Code §2001.0045. The Government Code §2001.0045 prohibits agencies from adopting a rule that imposes costs on regulated persons unless the agency repeals a rule that imposes a total cost on regulated persons that is equal to or greater than the total cost imposed on regulated persons by the proposed rule or amends a rule to decrease the total cost imposed on regulated persons by an amount that is equal to or greater than the cost imposed on the persons by the proposed rule. Pursuant to §2001.0045(c)(9), this prohibition does not apply to a rule that is necessary to implement legislation, unless the legislature specifically states §2001.0045 applies to the rule. There are no anticipated costs of compliance with the proposal.
Economic Impact Statement and Regulatory Flexibility Analysis for Small and Micro Businesses. The Government Code §2006.002(c) and (f) require, that if a proposed rule may have an economic impact on small businesses, micro businesses, or rural communities, state agencies must prepare, as part of the rulemaking process, an economic impact statement that assesses the potential impact of the proposed rule on these businesses and communities and a regulatory flexibility analysis that considers alternative methods of achieving the purpose of the rule. Because there are no anticipated costs of compliance associated with the proposal, an economic impact statement and regulatory flexibility analysis is not required.
Government Growth Impact Statement. The Board is required, pursuant to Tex. Gov't Code §2001.0221 and 34 Texas Administration Code §11.1, to prepare a government growth impact statement. The Board has determined for each year of the first five years the proposed amendments will be in effect: (i) the proposal does not create or eliminate a government program; (ii) the proposal is not expected to have an effect on current agency positions; (iii) implementation of the proposal does not require an increase or decrease in future legislative appropriations to the Board; (iv) the proposal does not affect the fees paid to the Board; (v) the proposal does not create a new regulation; (vi) the proposal amends existing regulations primarily through non-substantive, editorial changes and provides additional clarity and simplicity to the chapter; (vii) there is no increase or decrease in the number of individuals subject to the rule's applicability; and (viii) the proposal will not affect the state's economy.
Takings Impact Assessment. 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.
Request for Public Comment. To be considered, written comments on this proposal should be submitted 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.texas.gov, or faxed to (512) 305-8101. If a hearing is held, written and oral comments presented at the hearing will be considered.
Statutory Authority. The amendments are proposed under the authority of the Occupations Code §301.151, which permits the Board to regulate the practice of professional nursing and vocational nursing. Further, the Occupations Code §301.157(b) authorizes the Board to: prescribe and publish the minimum requirements and standards for a course of study in each program that prepares registered nurses or vocational nurses; prescribe other rules as necessary to conduct approved schools of nursing and educational programs for the preparation of registered nurses or vocational nurses; approve schools of nursing and educational programs that meet the Board's requirements; select one or more national nursing accrediting agencies, recognized by the United States Department of Education and determined by the Board to have acceptable standards, to accredit schools of nursing and educational programs; and deny or withdraw approval from a school of nursing or educational program that fails to meet the prescribed course of study or other standard under which it sought approval by the Board; fails to meet or maintain accreditation with the national nursing accrediting agency selected by the Board; or fails to maintain the approval of the state board of nursing of another state and the Board under which it was approved.
Cross Reference To Statute. The following statutes are affected by this proposal: the Occupations Code §301.151 and §301.157.
§215.2.Definitions.
Words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise:
(1) - (10) (No change.)
(11) Clinical preceptor--a registered nurse who meets
the requirements in §215.10(j)(6) of this title (relating to
Clinical Learning Experiences), who practices in the clinical
setting [is not employed as a faculty member by the governing
entity], and who directly supervises clinical learning experiences
for no more than two (2) students. A clinical preceptor assists in
the evaluation of the student during the experiences and in acclimating
the student to the role of nurse. A clinical preceptor facilitates
student learning in a manner prescribed by a signed written agreement
between the governing entity, preceptor, and affiliating agency (as applicable).
(12) Clinical teaching assistant--a registered nurse
licensed in Texas, who is employed to assist in the clinical area
and work under the supervision of a Master's or Doctoral [Doctorally] prepared nursing faculty member and who meets the
requirements of §215.10(j)(8) of this title.
(13) - (18) (No change.)
(19) Differentiated Essential Competencies (DECs)--the
expected educational outcomes to be demonstrated by nursing students
at the time of graduation, as published in the Differentiated
Essential Competencies of Graduates of Texas Nursing Programs Evidenced
by Knowledge, Clinical Judgment, and Behaviors: Vocational (VN), Diploma/Associate
Degree (Diploma/ADN), Baccalaureate Degree (BSN), 2021 [October
2010] (DECs).
(20) - (22) (No change.)
(23) Faculty waiver--a waiver granted by a dean or
director of a professional nursing education program to an individual
who meets the criteria specified in §215.7(e) [§215.7(e)(1)
- (3)] of this title.
(24) - (29) (No change.)
(30) Nursing Clinical Judgment--the observed outcome of critical thinking and decision-making that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care. It is a decision-making model that is consistent with the nursing process model where the nurse determines and implements nursing intervention based on recognizing and analyzing patient cues (assessment and analysis), prioritizing hypotheses and generating solutions (planning), taking action (implementation), and evaluating outcomes.
(31) [(30)] Objectives/Outcomes--expected
student behaviors that are attainable and measurable.
(A) - (C) (No change.)
(32) [(31)] Observation experience--a
clinical learning experience where a student is assigned to follow
a health care professional in a facility or unit and to observe activities
within the facility/unit and/or the role of nursing within the facility/unit,
but where the student does not participate in hands-on patient/client care.
(33) [(32)] Pass rate--the percentage
of first-time candidates within the examination year, as that term
is defined in paragraph (20) of this section, who pass the National
Council Licensure Examination for Registered Nurses (NCLEX-RN®).
(34) [(33)] Philosophy/Mission--statement
of concepts expressing fundamental values and beliefs as they apply
to nursing education and practice and upon which the curriculum is based.
(35) [(34)] Professional Nursing
Education Program--an education unit that offers courses and learning
experiences preparing graduates who are competent to practice nursing
safely and who are eligible to take the NCLEX-RN® examination,
often referred to as a pre-licensure nursing program. Types of pre-licensure
professional nursing education programs:
(A) - (D) (No change.)
(36) [(35)] Program of study--the
courses and learning experiences that constitute the requirements
for completion of a professional nursing education program.
(37) [(36)] Recommendation--a
specific suggestion based upon program assessment that is indirectly
related to the rules to which the program must respond but in a method
of their choosing.
(38) [(37)] Requirement--mandatory
criterion based upon program assessment that is directly related to
the rules that must be addressed in the manner prescribed.
(39) [(38)] Shall--denotes mandatory requirements.
(40) [(39)] Simulation--activities
that mimic the reality of a clinical environment and are designed
to demonstrate procedures, decision-making, and critical thinking.
A simulation may be very detailed and closely imitate reality, or
it can be a grouping of components that are combined to provide some
semblance of reality. Components of simulated clinical experiences
include providing a scenario where the nursing student can engage
in a realistic patient situation guided by trained faculty and followed
by a debriefing and evaluation of student performance. Simulation
provides a teaching strategy to prepare nursing students for safe,
competent, hands-on practice.
(41) [(40)] Staff--employees
of the Texas Board of Nursing.
(42) [(41)] Supervision--immediate
availability of a faculty member, clinical preceptor, or clinical
teaching assistant to coordinate, direct, and observe first hand the
practice of students.
(43) [(42)] Survey visit--a
virtual or [an] on-site visit to a professional nursing
education program by a Board representative. The purpose of the visit
is to evaluate the program of study by gathering data to determine
whether the program is in compliance with Board requirements. A
visit to a program with an approval status other than full approval
focuses on examining factors that may have contributed to the changed
approval status and implementation of corrective measures.
(44) [(43)] Systematic approach--the
organized nursing process approach that provides individualized, goal-directed
nursing care whereby the registered nurse engages in:
(A) (No change.)
(B) analyzing patient cues and establishing a
plan of care based on nursing science and evidence-based practice [making nursing diagnoses that serve as the basis for the strategy
of care];
(C) making nursing diagnoses that serve as the
basis for the strategy of care [developing a plan of care
based on the assessment and nursing diagnosis];
(D) implementing nursing care based on the registered nurse's nursing clinical judgment; and
(E) (No change).
(45) [(44)] Texas Higher Education
Coordinating Board (THECB) the state agency described in Texas Education
Code, Title 3, Subtitle B, Chapter 61.
(46) [(45)] Texas Workforce Commission
(TWC)--the state agency described in Texas Labor Code, Title 4, Subtitle
B, Chapter 301.
§215.3.Program Development, Expansion, and Closure.
(a) New Programs.
(1) (No change.)
(2) Proposal to establish a new professional nursing education program.
(A) The proposal to establish a new professional nursing education program may be submitted by:
(i) a college, [or] university,
or career school or college accredited by an agency recognized
by the THECB or holding a certificate of authority from the THECB
under provisions leading to accreditation of the institution; or
(ii) (No change.)
(B) The new professional nursing education program must be approved/licensed or deemed exempt by the appropriate Texas agency, the THECB, or the TWC, as applicable, before approval can be granted by the Board for the program to be implemented. The proposal to establish a new professional nursing education program may be submitted to the Board at the same time that an application is submitted to the THECB or the TWC, but the proposal cannot be approved by the Board until such time as the proposed program is approved by the THECB or the TWC. If the governing entity has nursing programs in other jurisdictions, the submitted program proposal must include evidence that the nursing programs' NCLEX-RN® pass rates are at least 80% for the current examination year, as that term is defined in §215.2(20) of this title (relating to Definitions), and that the nursing programs hold full approval from the state boards of nursing in the other states and are in good standing. Evidence of poor performance by a governing entity's nursing program in another jurisdiction is sufficient grounds for denial of a proposal. Additionally, a proposal will be denied by the Board in accordance with governing statutory requirements.
(C) - (E) (No change.)
(F) The proposal shall include information outlined
in Board Education Guideline 3.1.1 available at https://www.bon.texas.gov
[Guidelines 3.1.1.b. Proposal to Establish a New Diploma
Nursing Education Program and 3.1.1.c. Proposal to Establish a New
Pre-Licensure Associate, Baccalaureate, or Entry-Level Master's Degree
Nursing Education Program].
(G) A proposal for a new diploma nursing education
program must include a written plan addressing the legislative mandate
that all nursing diploma programs in Texas must have a process in
place [by 2015] to ensure that their graduates are entitled
to receive a degree from a public or private institution of higher
education accredited by an agency recognized by the THECB or the TWC,
as applicable, and, at a minimum, entitle a graduate of the diploma
program to receive an associate degree in nursing.
(H) After the proposal is submitted and determined
to be complete, a preliminary survey visit may [shall]
be conducted by Board Staff [prior to presentation to the Board].
(I) The proposal shall be considered by the Board following a public hearing at a regularly scheduled meeting of the Board. The Board may approve the proposal and grant initial approval to the new program, may defer action on the proposal, or may deny further consideration of the proposal. In order to ensure success of newly approved programs, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary.
(i) (No change.)
(ii) A program may be considered high-risk if it meets one or more of the following criteria, including, but not limited to: unfamiliarity of the governing entity with nursing education; inexperience of the potential dean or director in directing a nursing program; potential for director or faculty turnover; multiple admission cycles per year; lack of rigor in admission criteria; use of a national curriculum; or potential for a high attrition rate among students. If the director has no experience in the director role, an appropriate mentor will be required to assist the director during the first year of operation.
(iii) Board monitoring of a high-risk program may include
the review and analysis of program reports; extended communication
with program deans and directors; and additional survey visits. A
monitoring plan may require the submission of quarterly reports of
students' performance in courses and clinical learning experiences;
remediation strategies and attrition rates; and reports from an assigned
mentor to the program director. Additional survey visits by a Board
representative may be conducted at appropriate intervals to evaluate
the status of the program. The Board may alter a monitoring plan as
necessary to address the specific needs of a particular program. [When
the Board requires monitoring activities to evaluate and assist the
program, monitoring fees will apply].
(J) - (N) (No change).
(3) (No change.)
(b) Extension Site/Campus.
(1) - (2) (No change).
(3) An approved professional nursing education program desiring to establish an extension site/campus that is consistent with the main campus program's current curriculum and teaching resources shall comply with Board Education Guideline 3.1.5 available at https://www.bon.texas.gov and:
(A) - (B) (No change.)
(4) When the curriculum of the extension site/campus
deviates from the original program in any way, the proposed extension
is viewed as a new program and Board Education Guideline 3.1.1
available at https://www.bon.texas.gov applies [Guidelines
3.1.1.b and 3.1.1.c apply].
(5) Extension programs of professional nursing education
programs which have been closed may be reactivated by submitting notification
of reactivation to the Board at least four (4) months prior to reactivation,
using [the] Board Education Guideline 3.1.5 available
at https://www.bon.texas.gov [3.1.2.a. for initiating an
extension program].
(6) A program intending to close an extension site/campus shall:
(A) (No change.)
(B) Submit required information according to Board
Education Guideline 3.1.7 available at https://www.bon.texas.gov [3.1.2.a.], including:
(i) - (iv) (No change.)
(c) Transfer of Administrative Control by Governing
Entity. The authorities of the governing entity shall notify the Board
office in writing of an intent to transfer the administrative authority
of the program. This notification shall follow Board Education Guideline 3.1.6 available at https://www.bon.texas.gov [3.1.3.a.
Notification of Transfer of Administrative Control of a Professional
Nursing Education Program or a Professional Nursing Education Program
by the Governing Entity].
(d) Closing a Program.
(1) When the decision to close a program has been made, the dean or director must notify the Board by submitting a written plan for closure complying with Board Education Guideline 3.1.7 available at https://www.bon.texas.gov, which includes the following:
(A) - (E) (No change.)
(2) - (6) (No change.)
(e) Approval of a Professional Nursing Education Program Outside Texas' Jurisdiction to Conduct Clinical Learning Experiences in Texas.
(1) (No change.)
(2) A written request, the required fee set forth in §223.1(a)(20) [§223.1(a)(27)] of this title,
and all required supporting documentation shall be submitted to the
Board office following Board Education Guideline 3.1.3 available
at https://www.bon.texas.gov [3.1.1.f. Process for Approval
of a Nursing Education Program Outside Texas' Jurisdiction to Conduct
Clinical Learning Experiences in Texas].
(A) [(3)] Evidence that the program
has been approved/licensed or deemed exempt from approval/licensure
by the appropriate Texas agency, (i.e., the THECB, the TWC) to conduct
business in the State of Texas, must be provided before approval can
be granted by the Board for the program to conduct clinical learning
experiences in Texas.
(B) [(4)] Evidence that the program's
NCLEX-RN® examination rate is at least 80% for the current examination
year, as that term is defined in §215.2(20) of this title (relating
to Definitions).
(C) [(5)] The Board may withdraw
the approval of any program that fails to maintain the requirements
set forth in Board Education Guideline 3.1.3 available at https://www.bon.texas.gov
[3.1.1.f.] and this section.
§215.4.Approval.
(a) The progressive designation of approval status is not implied by the order of the following listing. Approval status is based upon each program's performance and demonstrated compliance to the Board's requirements and responses to the Board's recommendations. Change from one status to another is based on NCLEX-RN® examination pass rates, compliance audits, survey visits, and other factors listed under subsection (b) of this section. Types of approval include:
(1) Initial Approval.
(A) - (B) (No change).
(C) Change from initial approval status to full approval status cannot occur until the program has demonstrated compliance with this chapter, has met requirements and responded to all recommendations issued by the Board, and the NCLEX-RN® examination pass rate is at least 80% after a full examination year. In order to ensure the continuing success of the program, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary for continued operation and/or as a condition for changing the approval status.
(2) (No change.)
(3) Full with warning or initial approval with warning is issued by the Board to a professional nursing education program that is not meeting the Board's requirements.
(A) (No change.)
(B) Following the survey visit, the program will be given a list of identified areas of concern and a specified time in which to respond with a set of corrective measures. Further, in order to ensure the continuing success of the program, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary for continued operation and/or as a condition for changing the approval status.
(4) Conditional Approval. Conditional approval is issued
by the Board for a specified time to provide the program opportunity
to correct any areas of concern identified by the Board or from findings
in the program's self-study [self study] report.
(A) - (B) (No change.)
(C) Depending upon the degree to which the Board's
requirements are currently being or have been met, the Board may change
the program's approval status [from conditional approval
to full approval or to full approval with warning,] or may withdraw
approval. In order to ensure the continuing success of the program,
the Board may, in its discretion, impose any restrictions or conditions
it deems appropriate and necessary for continued operation and/or
as a condition for changing the approval status.
(5) Withdrawal of Approval. The Board may withdraw
approval from a program which fails to meet the Board's requirements
within the specified time. A program may also elect to voluntarily
close a program, as provided for in subsection (c)(12) of this section. The dean/director shall submit a plan for closure according to Board
Education Guideline 3.1.7 available at https://www.bon.texas.gov and
outlined in subsection (d) of this section. [The program
shall be removed from the list of Board approved professional nursing
education programs.]
(6) When a program closes by Board action or voluntary decision, the program will be removed from the list of Board approved professional nursing education programs, but students may complete the program in teach-out.
(7) [(6)] A diploma program of
study in Texas that leads to an initial license as a registered nurse
under this chapter must have a process in place [by 2015]
to ensure that their graduates are entitled to receive a degree from
a public or private institution of higher education accredited by
an agency recognized by the THECB or the TWC, as applicable. At a
minimum, a graduate of a diploma program will be entitled to receive
an associate degree in nursing.
(b) Factors Jeopardizing Program Approval Status.
(1) When a program demonstrates non-compliance with
Board requirements, approval status may be changed [to
full with warning or conditional status], approval may
be withdrawn, or the Board, in its discretion, may impose restrictions
or conditions it deems appropriate and necessary. In addition to imposing
restrictions or conditions, the Board may also require additional
monitoring of the program. Board monitoring may include the review
and analysis of program reports; extended communication with program
directors; and additional survey visits. A monitoring plan may require
the submission of quarterly reports of students' performance in courses
and clinical learning experiences; remediation strategies and attrition
rates; and reports from an assigned mentor to the program director.
Additional survey visits by a Board representative may be conducted
at appropriate intervals to evaluate the status of the program. The
Board may alter a monitoring plan as necessary to address the specific
needs of a particular program. [When the Board requires monitoring
activities to evaluate and assist the program, monitoring fees will apply.]
(2) A change in approval status, requirements for restrictions or conditions, or a monitoring plan may be issued by the Board for any of the following reasons:
(A) (No change.)
(B) substantiated student complaints [utilization
of students to meet staffing needs in health care facilities];
(C) - (I) (No change.)
(J) other activities or situations that demonstrate to the Board that a program is not meeting Board requirements or lacks institutional control necessary for successful student outcomes.
(c) Ongoing Approval Procedures. Ongoing approval status
is determined biennially by the Board on the basis of information
reported or provided in the program's NEPIS and CANEP, NCLEX-PN® examination pass rates, program compliance
with this chapter, and other program outcomes. Certificates of Board
approval will be sent [mailed] to all Board-approved
nursing programs biennially in even-numbered years.
(1) (No change.)
(2) NCLEX-RN® Pass Rates. The annual NCLEX-RN® examination pass rate for each professional nursing education program is determined by the percentage of first time test-takers who pass the examination during the examination year.
(A) (No change.)
(B) When the passing score of first-time NCLEX-RN® candidates is less than 80% on the examination
during the examination year, the nursing program shall submit a Self-Study
Report that evaluates factors that may have contributed to the graduates'
performance on the NCLEX-RN® examination and a description of the corrective measures to be implemented. The report shall comply with Board Education Guideline 3.2.1 available at https://www.bon.texas.gov [3.2.1.a. Writing a Self-Study Report on Evaluation of Factors that Contributed to the Graduates' Performance on the NCLEX-PN® or NCLEX-RN® Examination]. Within one year of the submission of the Self-Study Report to the Board, the program shall provide to Board Staff evaluation data on the effectiveness of corrective measures implemented.
(3) Change in Approval Status. The progressive designation of a change in approval status is not implied by the order of the following listing. A change in approval status is based upon each program's performance and demonstrated compliance to the Board's requirements and responses to the Board's recommendations. A change from one approval status to another may be determined by program outcomes, including the NCLEX-RN® examination pass rates, compliance audits, survey visits, and other factors listed under subsection (b) of this section.
(A) A warning may be issued to a program when:
(i) the pass rate of first-time NCLEX-RN® candidates, as described in paragraph
(2)(A) of this subsection, is less than 80% for two (2) consecutive
examination years; or [and]
(ii) (No change.)
(B) A program may be placed on conditional approval status if:
(i) - (ii) (No change.)
(iii) the program has continued to engage in activities or situations that demonstrate to the Board that the program is not meeting Board requirements and standards or lacks institutional control necessary for successful student outcomes; or
(iv) (No change.)
(C) Approval may be withdrawn if:
(i) - (ii) (No change.)
(iii) the program continues to engage [persists
in engaging] in activities or situations that demonstrate to
the Board that the program is not meeting Board requirements and standards or lacks institutional control necessary for successful student outcomes.
(D) The Board may consider a change in approval status at a regularly scheduled Board meeting for a program on initial, full approval, full approval with warning, or conditional approval if:
(i) - (ii) (No change.)
(E) The Board may, in its discretion, change the approval
status of a program on full approval with warning [to full approval,
to full approval with restrictions or conditions,] or impose
a monitoring plan. The Board may restrict enrollment.
(F) The Board may, in its discretion, change
the approval status of a program on conditional approval [to
full approval, full approval with restrictions or conditions, full
approval with warning,] or impose a monitoring plan. The Board
may restrict enrollment.
(4) Survey Visit. Each professional nursing education program shall be visited at least once every six (6) years after full approval has been granted, unless accredited by a Board-recognized national nursing accrediting agency.
(A) Board Staff may conduct a survey visit at any time
based upon Board Education Guideline 3.2.2 available at https://www.bon.texas.gov
[3.2.3.a. Criteria for Conducting Survey Visits].
(B) - (C) (No change.)
(5) The Board will select one (1) or more national nursing accrediting agencies, recognized by the United States Department of Education, and determined by the Board to have standards equivalent to the Board's ongoing approval standards according to Board Education Guideline 3.2.3 available at https://www.bon.texas.gov. Identified areas that are not equivalent to the Board's ongoing approval standards will be monitored by the Board on an ongoing basis.
(6) (No change.)
(7) Accredited Programs. The Board may
review and/or change the approval status of an accredited [will
deny or withdraw approval from a] professional nursing education
program that fails to:
(A) - (C) (No change.)
(8) A professional nursing education program is considered
approved by the Board and exempt from Board rules that require ongoing
approval as described in Board Education Guideline 3.2.3 available
at https://www.bon.texas.gov [3.2.4.a. Specific Exemptions
from Education Rule Requirements for Nursing Education Programs Accredited
by a Board-Approved National Nursing Accreditation Organization]
if the program:
(A) - (C) (No change.)
(9) - (10) (No change.)
[(11) The Board may assist the program
in its effort to achieve compliance with the Board's requirements
and standards.]
(11) [(12)] A program that voluntarily
closes or from which approval has been withdrawn by the Board may
submit a new proposal. A new proposal may not be submitted to the
Board until at least twelve (12) calendar months have elapsed from
the date the program's voluntary closure is accepted by the Executive
Director or from the date of the program's withdrawal of approval
by the Board.
(12) [(13)] A professional nursing
education program accredited by a national nursing accrediting agency
recognized by the Board shall:
(A) - (D) (No change.)
(d) (No change.)
§215.5.Philosophy/Mission and Objectives/Outcomes.
(a) (No change.)
(b) Program objectives/outcomes derived from the philosophy/mission
shall reflect the Differentiated Essential
Competencies of Graduates of Texas Nursing Programs Evidenced by Knowledge,
Clinical Judgment, and Behaviors: Vocational (VN), Diploma/Associate
Degree (Diploma/ADN), Baccalaureate Degree (BSN), 2021 [October
2010] (DECs).
(c) - (e) (No change.)
§215.6.Administration and Organization.
(a) - (g) (No change.)
(h) When the dean/director of the program changes, the dean/director shall submit to the Board office written notification of the change indicating the final date of employment.
(1) A new Dean/Director/Coordinator Qualification Form
shall be submitted to the Board office by the governing entity for
approval prior to the appointment of a new dean/director or interim
dean/director in an existing program or a new professional nursing
education program according to Board Education Guideline 3.3.1
available at https://www.bon.texas.gov [3.4.1.a. Approval
Process for a New Dean/Director/Coordinator or New Interim/Dean/Director/Coordinator].
(2) A curriculum vitae and all official transcripts
for the proposed new dean/director shall be submitted with the new
Dean/Director/Coordinator Qualification Form according to Board Education
Guideline 3.3.1 available at https://www.bon.texas.gov [3.4.1.a].
(3) (No change.)
(i) - (k) (No change.)
§215.7.Faculty.
(a) - (c) (No change.)
(d) Faculty Qualifications [and Responsibilities].
(1) - (2) (No change.)
(e) (No change.)
(f) Non-nursing faculty are exempt from meeting the
faculty qualifications of this chapter as long as the teaching assignments do not include [are not] nursing content or clinical
nursing courses.
(g) - (i) (No change.)
(j) Faculty Responsibilities [shall
be responsible for]:
(1) - (4) (No change).
(k) - (m) (No change.)
§215.8.Students.
(a) (No change.)
(b) If a program that is accredited by a national
nursing accreditation agency plans an increase of enrollment of 25%
or more, it must file a substantive change proposal with the accreditation
agency. Programs that are not accredited by a national nursing accreditation
agency [A program] must seek approval prior to an
increase in enrollment of twenty-five percent (25%) or greater by
headcount in one (1) academic year for each nursing program offered.
The program must notify Board Staff four (4) months prior to the anticipated
increase in enrollment by following Board Education Guideline
3.5.2 available at https://www.bon.texas.gov. The Executive
Director shall have the authority to approve an increase in enrollment
on behalf of the Board. When determining whether to approve a request
for an increase in enrollment under this rule, the Executive Director
and/or the Board shall consider:
(1) - (6) (No change.)
(c) - (f) (No change.)
(g) Student policies shall be furnished manually or electronically to all students at the beginning of the students' enrollment in the professional nursing education program.
(1) (No change.)
(2) The program shall maintain evidence of student
receipt of the Board's licensure [license] eligibility
information as specifically outlined in subsection (c) of this section.
(3) (No change.)
(h) - (j) (No change.)
§215.9.Program of Study.
(a) The program of study shall include both didactic and clinical learning experiences and shall be:
(1) - (6) (No change.)
(7) designed and implemented to prepare students to
demonstrate the Differentiated Essential
Competencies of Graduates of Texas Nursing Programs Evidenced by Knowledge,
Clinical Judgment, and Behaviors: Vocational (VN), Diploma/Associate
Degree (Diploma/ADN), Baccalaureate Degree (BSN), 2021 [October
2010] (DECs); and
(8) (No change.)
(b) - (g) (No change.)
(h) Faculty shall develop and implement evaluation
methods and tools to measure progression of students' cognitive, affective,
and psychomotor achievements in course/clinical objectives, according
to Board Education Guideline 3.6.3 available at https://www.bon.texas.gov.
A guideline that [3.7.3.a. Student Evaluation Methods and
Tools. Board Education Guideline 3.7.4.a. Using Standardized Examinations.
] outlines the effective use of standardized examinations as
an evaluation of student progress is Board Education Guideline
3.6.4 available at https://www.bon.texas.gov.
(i) Curriculum changes shall be developed by the faculty
according to Board standards and shall include information outlined
in the Board Education Guideline 3.6.1 available at https://www.bon.texas.gov
[3.7.1.a. Proposals for Curriculum Changes]. The
two (2) types of curriculum changes are:
(1) - (2) (No change.)
(j) (No change.)
(k) Professional nursing education programs planning
major curriculum changes shall submit a curriculum change proposal,
as outlined in Board Education Guideline 3.6.1 available at https://www.bon.texas.gov
[3.7.1.a.], to the Board office for approval at
least four (4) months prior to implementation.
(l) (No change.)
§215.10.Clinical Learning Experiences.
(a) Faculty shall be responsible and accountable for managing clinical learning experiences and observation experiences of students. Board Education Guideline 3.6.2 available at https://www.bon.texas.gov describes the purposes of clinical settings and reported hands-on clinical hours to meet program and course objectives.
(b) - (j) (No change.)
§215.12.Records and Reports.
(a) Accurate and current records shall be maintained for a minimum of two (2) years in a confidential manner and be accessible to appropriate parties, including Board representatives. These records shall include, but are not limited to:
(1) records of current students, including the student's
application and required admission documentation, evidence of student's
ability to meet objectives/outcomes of the program, final clinical
practice evaluations, signed receipt of written student policies furnished
by manual and/or electronic means, evidence of student receipt of
the Board's licensure [Board license] eligibility
information as specifically outlined in §215.8(c) [§215.8(b)
] of this chapter (relating to Students), and the statement
of withdrawal from the program, if applicable;
(2) - (6) (No change.)
(b) - (e) (No change.)
§215.13.Total Program Evaluation.
(a) There shall be a written plan for the systematic evaluation of the effectiveness of the total program following Board Education Guideline 3.8.1 available at https://www.bon.texas.gov. The plan shall include evaluative criteria, methodology, frequency of evaluation, assignment of responsibility, and indicators (benchmarks) of program and instructional effectiveness. The following broad areas shall be periodically evaluated:
(1) - (10) (No change.)
(b) - (d) (No change.)
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on June 19, 2023.
TRD-202302197
John Vanderford
Assistant General Counsel
Texas Board of Nursing
Earliest possible date of adoption: July 30, 2023
For further information, please call: (512) 305-6879