STATE BOARD OF NURSING [49 PA. CODE CH. 21] Approval of Diploma Programs in Transition to Degree-Granting Status [34 Pa.B. 851] The State Board of Nursing (Board) proposes to amend § 21.51 (relating to establishment) governing the establishment of approved programs of nursing for professional nurses (registered nurses (RNs)) to read as set forth in Annex A.
A. Effective Date
The proposed rulemaking will be effective upon final-form publication in the Pennsylvania Bulletin.
B. Statutory Authority
Section 6.1 of the Professional Nursing Law (act) (63 P. S. § 216.1) requires the Board to establish standards for the operation and approval of nursing education programs for the preparation of RNs. The Board is authorized to establish rules and regulations for the practice of professional nursing and the administration of the act under section 2.1(k) of the act (63 P. S. § 212.1(k)). Section 6 of the act (63 P. S. § 216) requires that every applicant for examination for licensure as an RN successfully complete an approved program of professional nursing. Prior to June 29, 2002, three classes of approved programs were listed under section 6 of the act: baccalaureate degree, associate degree and diploma programs. Under the act of June 28, 2002 (P. L. 651, No. 99) (Act 99) (effective September 29, 2002), section 6 of the act was amended to include ''programs in transition from approved diploma to degree granting programs.''
C. Background and Purpose
This proposed rulemaking was initially generated by the Board in the fall of 2001 after it considered a request by the Lancaster Institute for Health Education to approve the transition of a hospital-based nursing program to a degree-granting program, where the nursing school would no longer be under the auspices of a hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Under current § 21.51(a), the Board was unable to approve the request or assist a diploma nursing education program in this type of transition. A draft of this proposed rulemaking was sent on October 1, 2001, to 27 agencies, associations, health care entities and individuals who have been identified as interested parties or who have expressed an interest in proposed rulemakings by the Board. The Board reviewed their comments at its meetings of November 29-30, 2001, and January 10-11, 2002. Act 99 was subsequently enacted and explicitly includes programs in transition from approved diploma to degree granting programs in the category of Board-approved programs of professional nursing.
The Board seeks in this proposed rulemaking to accomplish the legislative intent of Act 99, which is to increase flexibility for hospital-based diploma programs to transition to degree-granting programs. At the same time, the Board seeks to set parameters for that transition to assure that students receive an educationally sound nursing education while maintaining eligibility for a license.
D. Description of Amendments
Under current § 21.51(a), a school of nursing to educate RNs must be developed under the authority of a regionally accredited university or college or a hospital approved by the JCAHO. Three types of programs currently exist to educate RNs: diploma programs, associate degree programs and baccalaureate degree programs. Diploma granting nursing education programs are conducted by hospitals, while associate and baccalaureate degree granting programs are conducted by regionally accredited universities or colleges. Hospitals wishing to establish their own degree-granting nursing education programs are unable to gain approval by the Board to operate a program until the school receives regional accreditation from the Department of Education (Department). However, a school of nursing may not receive regional accreditation until it graduates its first class. Moreover, it may take up to 6 years for an institution to gain regional accreditation from the Department. Nurses educated in this Commonwealth must satisfactorily complete a Board-approved nursing education program in order to sit for the nursing licensure examination. Thus, unless a hospital-based diploma program teams with an already-accredited college or university, it is unable to smoothly transition to degree-granting status and retain Board approval for its nursing education program.
The Board proposes to allow hospital-based diploma programs to transition to degree-granting status under the authority of a university or college pursuing regional accreditation, provided the controlling institution has begun the process of regional accreditation, in that it has been given initial approval by the Department to seek degree-granting status and shows that it continues to pursue regional accreditation. Only diploma programs which are in good standing with the Board, maintaining full approval status under § 21.33 (relating to types of approval) for at least 3 years prior to the transition, may undertake to establish a degree-granting nursing education program. The Board proposes 3 years as a reasonable time period in which a diploma program must attain and maintain acceptable standards and adhere to the policies and regulations of the Board to undertake the transition. It is in the best interests of students and the public to ensure that the program undertaking the transition to a degree-granting nursing education program is stable, established and has maintained acceptable standards for a minimum time period.
A program wishing to transition from diploma to degree-granting status must comply with all other Board regulations pertaining to nursing education programs and submit annual progress reports to the Board. The Board does not intend to single out nursing education programs in transition for increased monitoring, but will monitor the programs to ensure that the transition is occurring smoothly and to ensure the quality of the education program. To that end, the program in transition must undergo a site visit and review by a nursing education advisor after the first class graduates and results of the licensing examination have been received. This requirement is consistent with the current practice for any new nursing education program approved by the Board, where the nursing education program is established within an existing college or university. Section 21.33 gives the Board the authority to grant initial approval status to new schools with evidence that acceptable standards are being met, for a period of time necessary to evaluate the results of the licensing examination taken by the first graduates of the school. Presuming it meets all other requirements of the regulations, the program in transition will be maintained on initial approval status for a maximum of 6 years or until it receives full approval from the Department, whereupon it may be granted full approval by the Board. The Board bases this 6-year time frame on information it received from the Department indicating that an institution may need up to 6 years to achieve full approval for regional accreditation. The Board wishes to emphasize the importance of the role of the Department in approving institutions for degree-granting status. The Board does not intend in any way to usurp the duties and powers of the Department, and, in fact, in this proposed rulemaking defers to the requirements that the Department has established for degree-granting institutions.
While the Board does not anticipate a rush by hospital-based diploma programs to begin their own degree-granting schools of nursing, the Board wishes to remove unnecessary restrictions which impede that transition, while ensuring that the quality of nursing education remains high.
E. Fiscal Impact and Paperwork Requirements.
The proposed rulemaking will have no fiscal impact and will not impose additional paperwork on the private sector, the general public and the Commonwealth and its political subdivisions. The proposed rulemaking will have no fiscal impact on programs seeking to transition and will impose only minimal additional paperwork on those programs beyond what is already required for establishment of a nursing education program.
F. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
G. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on February 2, 2004, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor of comments, recommendations or objections raised.
H. Public Comment
Interested persons are invited to submit written comments, recommendations or objections regarding this proposed rulemaking to Martha Brown, Counsel, State Board of Nursing, P. O. Box 2649, Harrisburg, PA 17105-2649 within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin. Reference (16A-5118) Programs in Transition when submitting comments.
JANET HUNTER SHIELDS, MSN, CRNP, CS,
ChairpersonFiscal Note: 16A-5118. No fiscal impact; (8) recommends adoption.
Annex A TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS PART I. DEPARTMENT OF STATE Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS CHAPTER 21. STATE BOARD OF NURSING Subchapter A. REGISTERED NURSES APPROVED PROGRAMS OF NURSING § 21.51. Establishment.
(a) A nursing program shall be developed under the authority of a regionally accredited university or college, or hospital approved by the Joint Commission on Accreditation of Hospitals, and under the leadership of a registered nurse[.], except as follows:
(1) A Board-approved hospital-based diploma nursing education program wishing to transition to an associate or baccalaureate degree nursing education program may be developed under the authority of a university or college pursuing regional accreditation, if:
(i) The university or college has initial approval for degree-granting status from the Department of Education.
(ii) The university or college provides documentation of its pursuit of regional accreditation.
(iii) The hospital-based diploma nursing education program has maintained full approval status under § 21.33 (relating to types of approval) for at least 3 years prior to the transition.
(2) A nursing education program wishing to transition under paragraph (1) shall:
(i) Comply with all other Board regulations pertaining to nursing education programs.
(ii) Submit annually to the Board a written report of its progress and may be asked to appear before the Board to respond to questions or concerns which arise from the annual progress report.
(iii) Be reviewed onsite, after the first class has completed the new program and the results of the licensing examination taken by the first graduates within 1 year of graduation have been received.
(iv) Continue on initial approval under § 21.33 until the university or college has full approval for degree-granting status from the Department of Education or for 6 years, whichever occurs first.
* * * * * [Pa.B. Doc. No. 04-238. Filed for public inspection February 13, 2004, 9:00 a.m.]
