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Anticipating the Future Maintaining Your License

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Title: Anticipating the Future Maintaining Your License


1
Anticipating the Future Maintaining Your License
  • By
  • Charlene Morris, RN, MSN

2
Texas Occupations Code
  • Governs many occupations
  • Chapter 301 - Law that establishes empowers
  • Board of Nursing for the State
  • of Texas
  • Contains the Nurse Practice Act
  • Contains law setting up rules and regulations for
    nursing practice in Texas Defines the SCOPE of
    PRACTICE
  • Texas Administrative Code
  • Provides more detail on how the requirements of
    the Occupations Code are to be carried out.
  • Appointment of members, meetings, proceedings,
    investigations, disciplinary actions, etc.

3
Texas Occupations Code
  • Chapter 301 Nursing Practice Act
  • Chapter 303 Nursing Peer Review
  • Chapter 304 Nurse Licensure Compact
  • Chapter 305 Advanced Practice Registered Nurse
    Licensure Compact

4
  • Texas Administrative Code
  • TITLE 22 EXAMINING BOARDS
  • PART 11 BOARD OF NURSING
  • CHAPTER 211 GENERAL PROVISIONS
  • RULE 211.1 Introduction
  • Name. Texas Board of Nursing
  • Decision-making board appointed by the
    Governor
  • (Texas Occupations Code).
  • (b) Location. Austin, Texas
  • (c) Legal Authority. Chapters 301, 303, 304. and
    305 - Texas Occupations Code.
  • (d) Composition. Persons appointed by the
    Governor with Senate approval.
  • (Source Note The provisions of this 211.1
    adopted to be effective March 31, 2002, 27 TexReg
    2236 amended to be effective May 17, 2004, 29
    TexReg 4884

5
Texas Administrative Code GENERAL PROVISIONS RULE
211.3 Organization and Structure ( (b) Terms of
office for Board members. Six years in length
with staggered terms. Members may be reappointed
by the Governor. (c) Eligibility. Board member
eligibility is governed by the Texas Occupations
Code 301.052 and 301.053. (d) Compensation.
Per diem as provided by law for each day that
the member engages in the business of the board
Travel expenses Source Note The provisions of
this 211.3 adopted to be effective March 31,
2002, 27 TexReg 2236 amended to be effective May
17, 2004, 29 TexReg 4884
6
TEXAS OCCUPATIONS CODE AND STATUTES REGULATING
THE  PRACTICE OF NURSING AGENCY MISSION The
mission of the Texas Board of Nursing (BON) is to
protect and promote the welfare of the people of
Texas by ensuring that each person holding a
license as a nurse in the State of Texas is
competent to practice safely. This mission,
derived from the Nursing Practice Act, supersedes
the interest of any individual, the nursing
profession, or any special interest group.
7
Protecting the People of Texas
8
Texas Administrative Code BOARD OF
NURSING Purpose and Functions Purpose. The
board fulfills its mission through two principle
areas of responsibility   (1) regulation of
the practice of professional and vocational
nursing   (2) accreditation of schools of
nursing.
9
Texas Administrative Code - Functions of BOARD OF
NURSING The board shall perform the following
functions as outlined in Texas Occupations Code
chapters 301, 303, 304, 305.   (1) Establish
standards and regulate the practice of
professional and vocational nursing.   (2)
Interpret the Nursing Practice Act and
Regulations Relating to Nurse Education
Licensure and Practice of nurses Employers
Public to ensure informed professionals,
allied health professionals, and consumers.   
10
Texas Administrative Code - Functions of BOARD OF
NURSING The board shall perform the following
functions as outlined in Texas Occupations Code
chapters 301, 303, 304, 305.     (3) Receive
complaints and investigate possible violations.
   (4) Discipline violators through
appropriate legal action.   (5) Provide a
mechanism for public comment and by which the
rules and regulations are modified when
appropriate.   
11
(6) Examine and license qualified applicants and
recognize qualified applicants for advanced
practice nursing as minimally competent.   (7)
Grant licensure by endorsement and grant
recognition of advanced practice nurses from
other states.   (8) Recommend to legislature
appropriate changes in the Nursing Practice Act
   (9) Establish standards for nursing
education and accredit or deny accreditation of
schools.   
12
   (10) Monitor the examination results of
applicants for variances in the level of
educational effectiveness.   (11) Consultation
and guidance to nurse schools for self-study,
evaluation, and the development of effective
education programs.   (12) Provide advice to
the faculty, staff of health care agencies
utilizing nursing services, and practitioners of
nursing to improve professional service.   (13)
Implement and manage all other programs and
responsibilities as authorized and mandated by
the Texas Legislature. Source Note The
provisions of this 211.2 adopted to be effective
March 31, 2002, 27 TexReg 2236 amended to be
effective May 17, 2004, 29 TexReg 4884
13
Standards of Nursing Practice in the state of
Texas
14
Texas Administrative Code Chapter 217 Rule
217.11- Standards of Nursing Practice in the
state of Texas
  • Know and conform to Nurse Practice Act Rules
  • Promote safe environment
  • Know rationale effects of meds treatments
  • Administer them safely, stabilize pts. and
    question orders PRN
  • Accurately document/report assessments and
    response to care and pt. status as well as
    contacts with other health care team members
  • Respect patients right to privacy
    confidentiality
  • Provide education/counseling to client, family,
    etc. referrals

15
Texas Administrative Code Chapter 217 Rule
217.11- Standards of Nursing Practice in the
state of Texas cont.
  • Obtain appropriate supervision, orientation,
    in-service info, CEs
  • Accept responsibility for competence growth
  • Notify supervisor when leaving nursing assignment
  • Maintain professional boundaries
  • Comply with reporting requirements
  • Provide care without discrimination within own
    abilities and those of others you are supervising
  • Implement measures to stabilize clients and
    prevent complications
  • Implement measures to prevent exposure to
    infectious disease

16
Texas Administrative Code Chapter 217 Rule
217.11- Standards of Nursing Practice in the
state of Texas cont.
  • Clarify any order or treatment that may be
    inaccurate, non-efficacious or contraindicated by
    consulting the appropriate licensed practitioner
    and notifying the ordering practitioner when
    deciding not to administer the medication or
    treatment
  • Collaborate with the client, care team, and when
    appropriate the clients family to provide
    optimal care.
  • Make appropriate referrals for continuity of
    care.

17
Texas Administrative Code Chapter 217 Rule
217.11- Standards of Nursing Practice in the
state of Texas cont.
  • Make appropriate/safe assignments based on
    ability and clients needs
  • Accept only those assignments that you can do
    safely.
  • Supervise those for whom they are responsible.
  • Ensure verification of current licensure or
    compact privilege when administratively
    responsible

18
Texas Administrative Code Chapter 217 Rule
217.11- Standards of Nursing Practice in the
state of Texas just for RNs.
  • Use systematic approach to provide
    individualized, goal directed nursing care based
    on nursing process.
  • Delegate tasks to unlicensed personnel in
    compliance with Chapter 224 (acute care settings)
    and Chapter 225 (independent living environments)
    with stable and predictable conditions.

19
Contacting the Texas Board of Nursing Location of
Boards office 333 Guadalupe, 3-460 Austin,
Texas 78701 Telephone 512/305-7400 Web
page http//www.bon.state.tx.us/contact/
Contact Person Katherine Thomas, MN, RN,
Executive Director
20
Texas Licensure
21
Assuring Competence
  • NCLEX-RN assures knowledge base
    decision-making ability
  • Graduation from accredited school
  • Psychomotor/technical skill safety
  • Legal/ethical knowledge values
  • Interpersonal skills
  • Decision-making skills
  • Basis for schools evaluation criteria from BON
    Rules Regulations
  • Standards of Nursing Practice in Texas
  • Unprofessional Conduct

22
Applying for your License
  • See the http//www.ncsbn.org/ and
  • www.pearsonvue.com/nclex web sites
  • See check list at end of application
  • BON Application
  • finger prints photo
  • BON application with fee
  • Registration for NCLEX-RN Exam
  • NCLEX-RN Examination application form
  • Pay NCLEX Registration fee
  • Affidavit of Graduation from Nursing Program

23
2010 New NCLEX Test Plan
  • Percentage of Items from Each Client Needs
    Category/Subcategory
  • Safe and Effective Care Environment
  • ..Management of Care 16-22
  • ..Safety and Infection Control 8-14
  • Heath Promotion and Maintenance 6-12
  • Psychosocial Integrity 6-12
  • Physiological Integrity
  • ..Basic Care and Comfort 6-12
  • ..Pharmacological and Parenteral Therapies 13-19
  • ..Reduction of Risk Potential 10-16
  • ..Physiological Adaptation 11-17

24
Test Plan cont.
  • Variety of test items are not limited to
  • multiple choice, multiple response,
    fill-in-the-blank calculation, drag and drop,
    and/or hot spots.
  • all item types may include multimedia, such as
    charts, tables, graphics, sound and video.
  • For more information, visit the NCSBN Web site at
    www.ncsbn.org to review Information about
    Alternate Item Formats.
  • Some questions will apply knowledge from 2
    different categories

25
Type of Testing
  • CAT Computer Adaptive Testing
  • Identifies 95 chance of safe practice
  • Various types of questions
  • Pictures, fill in the blank, multiple answer,
    etc.
  • Dont make wild guesses to finish items
  • Each test is different
  • Computer selects items for candidates skill
    level
  • Level of question based on answer to previous
    question
  • Different questions each time applicant tests
  • Contains some items that are not graded
  • Instructions, sample items, and breaks are
    included in testing time period allowed

www.pearsonvue.com/nclex
26
NCLEX-RN Success
  • Web sites
  • HESI exam as predictor danger lt 850
  • Review course or review books
  • Level 4 exam scores predictor of specific areas

27
Test Taking Tips
  • Study practice (1 question per 60 to 70
    seconds)
  • Plan
  • Austin testing sites
  • Pearson Professional Centers-Austin, TX
  • 301 Congress Avenue Suite 565
  • Austin,Texas78701
  • 512-469-0276
  • Schedule carefully
  • Sleep, eat, take precautions to promote calm
  • Strengthen testing strategies
  • Read carefully (1 to 2 min./item)
  • Think through but dont read into question
  • Remember entry level for LVN and/or CNA or UAP
  • Text book not the patient you saw in clinical
  • Use your breaks to rest

www.pearsonvue.com/nclex
28
What to Expect/Prepare
  • Arrive 30 minutes early, if you are more than 30
    min. late for testing, you will need to be
    rescheduled and pay fee again
  • Come alone no children/family/friends waiting or
    calling
  • No hats, scarves, coats, calculators, pencils,
    etc. permitted in testing area
  • Bring
  • Authorization to Test (ATT) form needed to
    schedule testing session Name same as on ID
  • Valid non-expired Photo ID with your signature
  • Finger print, Palm print, photo, signature will
    be taken on admission to test and after breaks

29
What to Expect/Prepare
  • May take up to 6 hours to complete test - raise
    hand dont get up
  • First optional break after 2 hrs. palm vein
    imaging before and after breaks
  • Second is 90 minutes after test resumes
  • Must use computer calculator
  • 75 to 265 questions 15 unscored
  • Number of questions does not predict Pass/Fail
  • 75 high pass or fail as computer determines
    trends
  • Must answer each item to continue the test after
    (ENTER), cant go back

30
What to Expect/Prepare
  • Official results come from BON- up to 14 days
    after BON receives scores
  • You can also get your unofficial results after
    48 business hours through the quick results
  • service available on the NCLEX Candidate Web site
    (7.95), or by calling 1-900-776-2539 (9.95)..
  • Retest every 45/90 days for 4 years in Texas
  • Sec. 301.255 Re-examination. (Texas Occupations
    Code- BON may require additional educational
    requirements or deny retesting if test is failed
    2 or more times.)

31
Jurisprudence Exam
  • You must take the exam and pass it once to become
    an RN.
  • Cost of exam will be part of application fee and
    will be taken on your computer from the BON
    website.
  • You may take it as many times as you need to for
    a passing score q 7 days.

32
Exam cont.
  • You will know if you passed upon completion 75
    is a passing score.
  • It will be open book from the NPA and it will be
    timed 2 hours.
  • 50 Questions and will be knowledge and
    application. (Will not ask for specific section
    numbers of Nurse Practice Act but will test for
    understanding)

33
Test Blueprint
  • 5 subject areas with weight
  • A. Nursing Licensure Regulation in Texas 15
  • B. Nursing Ethics 20
  • C. Nursing Practice - 30
  • D. Nursing Peer Review- 15
  • E. Disciplinary Action 20
    Topic areas to
    guide review of content are available on the BON
    website.

34
Test Review
  •         BON has developed an online Test
    Review/Prep Workshop which costs about 25 and
    takes about 2 hours to complete.
  •         This course is accessed on the BON
    website after applying and obtaining a pin number
    from the BON.

35
Guidelines for New Graduates New RNs
  • What are the requirements that must be met to
    obtain a GN Verification Letter?
  • Once granted, what are the limitations of
    practice placed on a GN using this privilege?
  • Compare these limitations to those that the BON
    recommends for newly licensed RNs.

36
Guidelines for New Graduates Employment
  • GN verification letter issued after
  • Completion of application for licensure
  • Criminal checks complete
  • Affidavit of graduation
  • Received your Authorization to Test
  • Registered with Pearson
  • NCLEX testing date set
  • No outstanding eligibility issues
  • 75 day period specified on GN Verification letter
    or results of first NCLEX attempt
  • If first NCLEX is failed MUST stop GN practice
  • Must know and follow Nurse Practice Act Rules
    and Regulations

37
Graduate Nurse Requirements
  • Temporary Authorization to Practice
  • Must work under direct supervision of RN
  • RN physically available
  • RN at same site
  • May not be in charge or supervising
  • May not function in an independent setting
  • May perform any function that falls within the
    scope of practice for which they have educational
    preparation and demonstrated minimal competency

38
BON Rule 217.3 Recommendations After Licensure
  • These are for your protection
  • Direct supervision for 6 months or less if agreed
    upon by new graduate and supervising RN
  • Competence agreed upon by both
  • Successful completion of orientation requirements
  • Newly licensed should not be in charge for 6
    months unless agreed upon by grad RN

39
Newly Licensed Nurse
  • Guideline
  • Amount of supervision and charge positions should
    be mutually agreed upon
  • 12-18 months experience in a structured setting
    before practicing in independent living
    environment

40
Continuing Competency
  • Identify how competency is maintained and
    validated.
  • How are CEs approved?
  • What type of learning experiences can be counted
    as CE credit toward license renewal? What
    learning experiences are not acceptable?
  • Describe required record keeping related to CEs.

41
Continuing Competency (Sec. 301.303 Occupations
Code
  • Completion of targeted cont. ed. programs
  • Professional portfolio including certifications
  • May not require more than 20 hours CE per 2 year
    period
  • Specific State Requirements
  • Hepatitis C between June 2002 June 2004
  • Bioterrorism Response was a one time requirement
  • Forensic Evidence Collection 2 hrs. for ER
    nurses by Sept. 1, 2008

42
Texas Administrative Code (216.1) - 2005
  • All CEs To count toward licensure renewal, a
    program must have been approved by one of the
    credentialing agencies recognized by the Board.
    The credentialing agencies have met
    nationally-predetermined criteria to approve
    programs and providers of CE.
  • RN planner
  • Approved by accepted credentialing agency
  • Class or individualized home study/programmed
    instruction
  • One CE hour 60 minutes not 50 as in the past
  • A 3hr. academic nursing course (part of a degree
    plan taken for credit with grade C or better or a
    pass of pass/fail) counts for 15 hours
  • ACLS, ATLS, and PALS, or national certification
    in a non-advanced nursing practice specialty
    (i.e. CCRN, RNFA, CWOCN, etc.) may be counted for
    CE credit
  • In-services, CPR, Refresher courses do not count.
  • Keep records for 4 years

43
License Renewal
  • Describe the license renewal process for new RNs
    and experienced RNs. What criteria must be met
    for standard renewal?
  • What are the requirements for reactivation when
    the license was in an official inactive status
    for more than 4 years?
  • What are the requirements for licensure for
    retired RNs who volunteer their service at a
    community agency?

44
Texas Administrative Code (216.1) - 2005
  • License Renewal every 2 years - 65
  • End of Birth month and odd or even years based on
    birth year
  • Receive post card reminder 30 days prior
  • (90 days if CE audit required)
  • Renew on line at BON web site credit/debit card
    if meet all criteria
  • No bars delinquent student loans/child support,
    legal issues, Psych illness, drugs, and lack of
    required CEs
  • Application implies legal signature/testimony of
    meeting criteria and makes nurse legally
    responsible for accuracy.
  • First renewal
  • Continuing education required not need 20 hours
  • ER Forensic Evidence Collection 2 hours
  • Six to 29 months after first issued depending on
    nurses date of birth.

45
Nursing Licensure Compact
  • States participating in a Licensure Compact
    accept similar requirements for licensure. What
    is a nurses Home State and how does that relate
    to licensure?
  • When a nurse practices in a party state whose
    laws and scope of practice guide the care
    provided by the nurse?
  • Can the nurse simultaneously hold a home state
    license in more than one party state? Under what
    circumstance can the nurse hold a license in more
    than one state at the same time?

46
Nursing Licensure Compact
  • Chapter 304
  • Rule 220

47
Nurse Licensure Compact
  • States agreeing to recognize each others nursing
    licenses
  • Texas among the first to adopt this plan - 2000
  • Premise
  • Only defines the requirements to hold a license
  • Similar licensure requirements in most states
  • Each state defines its own scope of practice
  • States share information related to problems
  • Warnings
  • Suspensions
  • Licenses that have been revoked
  • Imposters

48
Map indicates which states that have enacted the
RN and LPN/VN Nurse Licensure Compact  
Updated 2010
49
Compact Definitions
  • Party States
  • States who have adopted the compact
  • Primary state of residence (Home state)
  • Where you permanently reside or your declared
    fixed permanent principal home for legal
    purposes
  • Remote state
  • Where you practice using multistate privilege
  • Must be a party state

50
Compact Requirements
  • Nurse must
  • Maintain home state license
  • Adhere to practice laws of state in which the
    patient is located at time of care
  • Use multi state privilege only in party states
  • Hold a home state license in only one party state
    at a time
  • If permanent home address changes to another
    party state, relinquishes license of previous
    state
  • Applies for meets requirements for licensure in
    new Home state (30 day grace period for
    processing new license)

51
Practicing in a Different State
  • How is a nurses licensure impacted when he/she
    changes their permanent address from one state to
    another? Differentiate between movement from one
    party state to another as opposed to movement
    from a party state to a non-party (remote) state?
  • Can a nurse hold permanent residence on a party
    state and work in a remote state?
  • What are the requirements and limitations of a
    nurse licensed in a remote state when they wish
    to obtain a license to practice in Texas?

52
Practicing in a Non-Party State
  • Must obtain a license from the non-party state
  • May hold both a home state license and a license
    from the non-party state
  • If you live in a non-party state
  • Must obtain a non-resident Texas license to
    practice in Texas
  • Lose multistate licensure privilege in other
    party states

53
Impact of Licensure Compact
  • States share information
  • Nurses licensed
  • Disciplinary action
  • Protects public health and safety
  • More mobile workforce for employers
  • Allows nurses to be more mobile
  • Provides for new forms of practice
  • Online practice
  • Telephone practice

54
Peer Review
Incident-Based Peer Review Rule 217.19 And Safe
Harbor Peer Review Rule 217.20
55
Determine Scope of Practice
  • The Six Step Decision Making Model found in the
    back of Nursing Practice Act, Nursing Peer
    Review, Nurse Licensure Compact

56
Rule 217.11 and 217.12
  • Rule 217.11 Standards of Practice
  • and 217.12 Unprofessional Conduct
  • Provide baseline for safe and effective care
  • Establish minimal acceptable level
  • Identifies unprofessional behaviors

57
Unprofessional Conduct Peer Review
  • Discus unprofessional conduct.
  • Describe the types of agencies that must have a
    Peer Review Committee. Describe an incident based
    peer review process.
  • Are the findings always reported to the BON? What
    must be reported? How is it reported?

58
Incident-Based Nursing Peer Review
  • Evaluation of
  • Nursing services
  • Qualifications of a nurse
  • Quality of care provided
  • The merits of a complaint about a nurse
  • Recommendations about a complaint
  • Nurse under review given written notice to attend
    with info about complaint
  • Fact finding process, analysis studying events
    that occurred - due process as right to question
    witnesses and confidentiality
  • Climate of collegial problem solving
  • Not a legal proceeding but can have lawyer/peer
  • If fault is found nurse is subject to Reporting
    Requirements

59
Peer Review RNs LVNs
  • Employers of 10 or more licensed nurses must have
    a Peer Review Committee
  • Putting a patient or other person at risk of
    unnecessary harm
  • Failure to adequately care for a patient
  • Unprofessional conduct (217.12)
  • Failure to conform to minimum standards of
    practice (217.11)
  • Impairment or likely impairment of the nurses
    practice due to chemical dependency

60
The Nurses Duty to Report
  • Licensed care giver, agency, or facility
  • Exposing a patient to substantial risk of harm
    due to
  • lack of minimum standard of nursing care
  • Another nurse
  • Impairment, lack of minimum standard of care,
    unprofessional conduct, or unnecessary exposure
    of pt. to risk for harm
  • Nursing student
  • Chemical impairment
  • Ability to perform professional service within
    reasonable expectations

61
Reporting (for Peer Review or BON)
  • Must be in writing and signed
  • Must include name of nurse or student and
    information required by the Board
  • May take the report to the employer or school

62
Action Peer Review Committee/BON
  • Problem reported to employer
  • Proceedings are confidential
  • If committee finds cause they must report to BON
  • Identity
  • Problem
  • Corrective action taken
  • Recommendation for BON action

63
Minor Incidents - Rule 217.16
  • Describe a minor incident.
  • When and how are they reported and to whom?
  • What are the consequences of frequent minor
    incidents?
  • What types of incidents are considered major?

64
Minor Incidents Rule 217.16
  • Continued practice doesnt pose risk of harm to
    client(s)
  • Potential risk of harm is very low
  • Incident is singular
  • Nurses approach to practice is conscientious and
    accountable
  • Has knowledge and skill for safe practice
  • 5 minor incidents in any consecutive 12 month
    period must be reported to Peer Review Committee
  • If no Peer Review Committee is available must
    report to BON

65
Conduct Assistance
  • What is unprofessional conduct? Provide examples
    of this type of problem.
  • What types of problems fall under 217.13? What
    types of assistance is available to nurses who
    have these types of problems?
  • What can happen to their license if they can not
    comply with professional conduct or restrictions
    of supervision?

66
217.12 Unprofessional Conduct
  • Purpose
  • Protect the public from
  • Incompetent careless
  • Unethical
  • Illegal conduct of nurses
  • Applies to any licensed nurse

67
Peer Assistance Rule 217.13
  • Required by law
  • Identifies, assists, and monitors professional
    colleagues so they can work
  • Experiencing mental health, alcohol or drug
    problems
  • Problems impair or may impair job performance or
    safe care

68
Safe Harbor Peer Review
69
Safe Harbor Peer Review
  • Protects nurses asked to engage in conduct which
    they believe violates duty to patient
  • Duty to Patient means conduct including
    administrative decisions directly affecting a
    nurses ability to comply with that duty required
    by
  • Standards of practice Best Practices
    originate from Evidence Based Research
  • Professional conduct adopted by the Board in
    Section 303.005 (a)
  • Required by facilities employing/contracting at
    least 10 nurses

70
Safe Harbor Peer Review/Protection
  • Describe how Safe Harbor Peer Review differs from
    Incident Based Peer Review.
  • What is duty to patient? How is the nurse who
    invokes Safe Harbor protected? When Safe Harbor
    is invoked, how is the nurses accountability for
    safe patient care impacted?
  • How does a nurse invoke Safe Harbor? Describe the
    Safe Harbor Peer review process.

71
Safe Harbor Peer Review Protection
  • Nurse may not be disciplined or discriminated
    against for making the request
  • May engage in requested conduct pending the peer
    review
  • Is not subject to the reporting requirement just
    presented
  • May not be disciplined by BON for engaging in
    conduct while review is pending

72
Requesting Safe Harbor
  • Must be done in good faith
  • Must notify supervisor making the assignment that
    he/she is invoking safe harbor
  • Use form on BON web site
  • Or include all info. on required form
  • If used to question a medical order
  • Medical staff/director will make a determination
  • Nurse invoking Safe Harbor will get a copy of
    Peer Review Committees determination and the
    administrators review

73
Entry into Practice Issues
  • 1965 ANA paper recommended BSN
  • 50 years of debate
  • Same licensing exam
  • 2000 ANA reaffirmed its recommendation
  • Public Health Nursing usually requires BSN
  • Specialist positions may require MSN
  • Certification

74
Differentiated Practice
  • Structured nursing roles based on
  • Education
  • Experience
  • Competence
  • Education based different prep different
    roles
  • Assessment based all facets, competency focused

75
Differentiated Practice Models
  • 20 years of studies
  • Roles and compensation level delineated according
    to education level not widely used
  • Basis of competency models
  • ANAs standards of care with levels of practice
  • Novice to expert (RN 1 to RN 4)
  • Can be based on job description and evaluation

76
Questions to ASK at Interviews
  • How are competencies attained, maintained, and
    measured?
  • Orientation or internships available
  • Provision for continuing education
  • Regular skill updates or reviews competency
    evaluation
  • Career ladder, levels of practice, promotion, or
    specialization with compensation
  • Your job description
  • Criteria by which you will be evaluated

77
Regulatory Agencies
  • BON
  • Certification- government standards
  • Accreditation - non-government standards
  • Medicare/Medicaid federal standards
  • Accreditation non - government
  • JCAHO (Now known as TJC or The Joint Commission)
    - hospitals
  • CHAP Community Health Accreditation Program

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Advisory Groups
  • Secretary of Health, Congress National Advisory
    Council on Nurse Education and Practice
  • Workforce diversity
  • Cultural competency
  • Nursing shortage
  • JCAHO Nursing Advisory Council

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Examples of Texas Legislation
  • Nursing shortage
  • Hepatitis C Bioterrorism continuing education
    requirements

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Texas Nurses Association
  • Mission Promote excellence through leadership,
    advocacy, and innovation
  • Advocate for nursing in the legislature
  • Continuing education
  • Updates on legal issues and legislation
  • Interpretation of legal BON changes
  • www.texasnurses.org

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American Nurses Association
  • Advocates for Nursing Profession
  • Defines ethical standards of practice for
    Profession
  • General RN
  • Specialty areas
  • Provides avenue for nursing to be involved in
    national level of decision making
  • AJN

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The End
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