By: Deuell, Zaffirini S.B. No. 1397
A BILL TO BE ENTITLED
AN ACT
relating to the licensure of nurses, including the assessment of
fees, the clinical competency of nursing program graduates, and the
establishment of the equivalency of certain competency-based
nursing education programs in other states.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsection (c), Section 301.155, Occupations
Code, is amended to read as follows:
(c) The board shall assess a [$3] surcharge of not less than
$3 or more than $5 for a registered nurse and a [$2] surcharge of not
less than $2 or more than $3 for a vocational nurse to the fee
established by the board under Subsection (a) for a license holder
to renew a license under this chapter. The board may use nine cents
of the registered nurse surcharge and six cents of the vocational
nurse surcharge to cover the administrative costs of collecting and
depositing the surcharge. The board quarterly shall transmit the
remainder of each surcharge to the Department of State Health
Services to be used only to implement the nursing resource section
under Section 105.002, Health and Safety Code. The board is not
required to collect the surcharge if the board determines the funds
collected are not appropriated for the purpose of funding the
nursing resource section.
SECTION 2. Section 301.157, Occupations Code, is amended by
amending Subsection (d-4) and adding Subsections (d-8), (d-9),
(d-10), and (d-11) to read as follows:
(d-4) The board may recognize and accept as approved under
this section a school of nursing or educational program operated in
another state and approved by a state board of nursing or other
regulatory body of that [another] state. The board shall develop
policies to ensure that the other state's [state board's] standards
are substantially equivalent to the board's standards.
(d-8) For purposes of Subsection (d-4), a nursing program is
considered to meet standards substantially equivalent to the
board's standards if the program:
(1) is part of an institution of higher education
located outside this state that is approved by the appropriate
regulatory authorities of that state;
(2) holds regional accreditation by an accrediting
body recognized by the United States secretary of education and the
Council for Higher Education Accreditation;
(3) holds specialty accreditation by an accrediting
body recognized by the United States secretary of education and the
Council for Higher Education Accreditation, including the National
League for Nursing Accrediting Commission;
(4) requires program applicants to be a licensed
practical or vocational nurse, a military service corpsman, or a
paramedic, or to hold a college degree in a clinically oriented
health care field with demonstrated experience providing direct
patient care; and
(5) graduates students who:
(A) achieve faculty-determined program outcomes,
including passing criterion-referenced examinations of nursing
knowledge essential to beginning a registered nursing practice and
transitioning to the role of registered nurse;
(B) pass a criterion-referenced summative
performance examination developed by faculty subject matter
experts that measures clinical competencies essential to beginning
a registered nursing practice and that meets nationally recognized
standards for educational testing, including the educational
testing standards of the American Educational Research
Association, the American Psychological Association, and the
National Council on Measurement in Education; and
(C) pass the National Council Licensure
Examination for Registered Nurses at a rate equivalent to the
passage rate for students of approved in-state programs.
(d-9) A graduate of a clinical competency assessment
program operated in another state and approved by a state board of
nursing or other regulatory body of another state is eligible to
apply for an initial license under this chapter if:
(1) the board allowed graduates of the program to
apply for an initial license under this chapter continuously during
the 10-year period preceding January 1, 2007;
(2) the program does not make any substantial changes
in the length or content of its clinical competency assessment
without the board's approval;
(3) the program remains in good standing with the
state board of nursing or other regulatory body in the other state;
and
(4) the program participates in the research study
under Section 105.008, Health and Safety Code.
(d-10) In this section, the terms "clinical competency
assessment program" and "supervised clinical learning experiences
program" have the meanings assigned by Section 105.008, Health and
Safety Code.
(d-11) This subsection and Subsections (d-8), (d-9), and
(d-10) expire December 31, 2017. As part of the first review
conducted under Section 301.003 after September 1, 2009, the Sunset
Advisory Commission shall:
(1) recommend whether Subsections (d-8) and (d-9)
should be extended; and
(2) recommend any changes to Subsections (d-8) and
(d-9) relating to the eligibility for a license of graduates of a
clinical competency assessment program operated in another state.
SECTION 3. Subsection (f), Section 63.202, Education Code,
is amended to read as follows:
(f) Notwithstanding the limitation provided by Subsection
(b), grants awarded under Subsection (c) for the state fiscal
biennium ending on August 31, 2009, and the fiscal biennium ending
on August 31, 2011, by the Texas Higher Education Coordinating
Board shall be awarded to programs preparing students for initial
licensure as registered nurses or programs preparing qualified
faculty members with a master's or doctoral degree for the program,
including programs at two-year institutions of higher education,
four-year general academic teaching institutions, health science
centers, and independent or private institutions of higher
education, or to the nursing resource section established under
Section 105.002(b), Health and Safety Code. In awarding grants
under this subsection, the coordinating board may:
(1) give priority to institutions proposing to address
the shortage of registered nurses by promoting innovation in
education, recruitment, and retention of nursing students and
qualified faculty;
(2) award grants on a competitive basis; [and]
(3) consider the availability of matching funds; and
(4) fund a study by the nursing resource section to
evaluate the competencies of clinical judgment and behaviors that
professional nursing students should possess at the time of
graduation.
SECTION 4. Chapter 105, Health and Safety Code, is amended
by adding Section 105.008 to read as follows:
Sec. 105.008. STUDY OF ALTERNATE WAYS TO ASSURE CLINICAL
COMPETENCY OF GRADUATES OF NURSING EDUCATIONAL PROGRAMS. (a) In
this section:
(1) "Clinical competency assessment program" means a
professional nursing prelicensure program that employs a
criterion-referenced summative performance examination, developed
by subject matter experts, to verify its graduates' attainment of
the clinical competency necessary for initial licensure as a
registered nurse.
(2) "Professional nursing prelicensure program" means
a professional nursing educational program that prepares students
to obtain an initial license as a registered nurse.
(3) "Research study" means the study described by
Subsection (b).
(4) "Supervised clinical learning experiences
program" means a professional nursing prelicensure program that
requires students to complete a required number of supervised
clinical learning experiences provided by qualified clinical
faculty involving multiple, ongoing assessments and feedback.
(b) To the extent funding is available, the nursing resource
section established under Section 105.002(b) shall conduct a
research study to identify:
(1) a set of expected student outcomes in terms of
clinical judgment and behaviors that professional nursing students
should possess at the time of graduation from a professional
nursing prelicensure program;
(2) standardized, reliable, and valid clinical exit
evaluation tools that could be used to evaluate the competencies in
clinical judgment and behaviors that professional nursing students
possess at the time of graduation from a professional nursing
prelicensure program;
(3) any correlation between the success rate of
graduates of professional nursing prelicensure programs on
standardized clinical exit evaluation tools and their educational
and experiential background, including:
(A) length and type of health care work
experience before entering the professional nursing prelicensure
programs;
(B) health care work experience during the
professional nursing prelicensure programs; and
(C) alternative methods of teaching clinical
judgment and behaviors, including supervised clinicals and
simulation laboratories; and
(4) any correlation between the required number of
hours in supervised clinical learning experiences and expected
student outcomes in terms of clinical judgment and behaviors.
(c) In addition to any other objective, the research study
must be designed to determine if the graduates of a clinical
competency assessment program are substantially equivalent to the
graduates of supervised clinical learning experiences programs in
terms of clinical judgments and behaviors. For purposes of this
subsection, the clinical competency assessment program must be one
that:
(1) has been requiring a clinical competency
assessment for at least 10 years;
(2) has students who reside in this state;
(3) has graduates who have been considered by the
Texas Board of Nursing to be eligible to apply for a registered
nurse license as a result of graduating from the program on or
before January 1, 2007; and
(4) conducts the clinical competency assessment at a
facility or facilities located in this state under the supervision
of a qualified clinical faculty member who is a registered nurse and
who holds a master's or doctoral degree in nursing.
(d) Considerations to be used in determining substantial
equivalence under Subsection (c) must include the differences
between the clinical competency assessment program and the
supervised clinical learning experiences program in:
(1) the methods of evaluating students' clinical
judgment and behaviors;
(2) performance on standardized clinical exit
evaluation tools;
(3) the ability of graduates to transition to and
assimilate in the registered nurse's role; and
(4) passage rates on the National Council Licensure
Examination for Registered Nurses.
(e) The nursing resource section shall contract with an
independent researcher to develop the research design and conduct
the research. The independent researcher must be selected by a
selection committee composed of:
(1) one representative elected by a majority of the
nursing advisory committee under Section 104.0155, who is the chair
of the selection committee;
(2) one representative designated by the Texas Health
Care Policy Council;
(3) the presiding officer of the Texas Board of
Nursing;
(4) one representative of the Texas Higher Education
Coordinating Board, designated by the governor;
(5) one representative designated by the Texas
Hospital Association;
(6) one representative designated by the Texas
Association of Business;
(7) one representative designated by a clinical
competency assessment program that meets the requirements of
Section 301.157(d-8), Occupations Code; and
(8) the nurse researcher member of the nursing
advisory committee under Section 104.0155.
(f) The nursing resource section shall complete the study
not later than June 30, 2014, and shall submit a report to the
office of the governor, the Senate Committee on Health and Human
Services, and the House Committee on Public Health. The report must
include a research abstract prepared by the independent researcher.
(g) The nursing resource section may cooperate with the
Texas Board of Nursing and the Texas Higher Education Coordinating
Board in conducting the study.
(h) The nursing advisory committee formed under Section
104.0155 shall serve as the oversight committee for the study.
(i) Any data collected as part of the study that contains
information identifying specific students, patients, or health
care facilities is confidential, is not subject to disclosure under
Chapter 552, Government Code, and may not be released unless all
identifying information is removed.
(j) In addition to funds appropriated by the legislature,
the nursing resource section may solicit, receive, and spend
grants, gifts, and donations from public or private sources for the
purpose of conducting the study.
(k) If grants or other funds are available through the
National Council of State Boards of Nursing that could be used to
fund the study, the nursing resource section shall apply for the
funds to the maximum amount available up to the estimated cost of
the study. In making the application or accepting the funding, the
nursing resource section may not relinquish any oversight
responsibility for the study, including responsibility for
designing and conducting the research or developing the findings.
SECTION 5. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.