I reviewed the sources for which the board will accept credit to meet this requirement.  I believe nurses should be able to use approved CME for credit, especially for advanced practice nurses as often the ANCC credits are for programs which are basic in the knowledge they cover for experienced nurses.  I also hope that nursing practice is not just considered staff nursing/direct patient care.  Nurses have many roles but are one profession. 

I would like to recommend three suggestions to the proposed continuing competence regulations:

• Rewording proposed 18VAC90-20-221A7 which, to me, seems unclear;

• Include developing a course as a continuing education activity; and,

• Increasing the requirement for reactivating an inactive license (I’m not sure that this suggestion can be implemented in this promulgation since it involves a slightly different subject [inactive licenses instead of active] but I’ll mention it in case it can).

These suggestions are in more detail as follows.

• Proposed 18VAC90-20-221A7 seems to indicate that any teaching of nursing related continued education courses would suffice for the requirement as long as it does not exceed 30 hours (“Teaching…up to thirty contact hours”).  This does not appear to be the intent of the Board, since proposed 18VAC90-20-222B7 states (in the second sentence) that additional hours in activities have to be obtained if the number of hours taught was less than 30.  I would suggest moving the second sentence of proposed 18VAC90-20-222B7 to proposed 18VAC90-20-221A7 with small wording changes emphasized in bold:

7. Teaching nursing-related continuing education courses totaling at least 30 contact hours.  If the total number of contact hours totals less than 30, the licensee shall obtain additional hours in continuing learning activities or courses.

• Also, I would recommend that the Board consider developing a continuing education course as a continuing competence activity.  Wording could be similar to 7, again with changes in bold:

Developing nursing-related continuing education courses totaling at least 30 contact hours.  If the total number of contact hours totals less than 30, the licensee shall obtain additional hours in continuing learning activities or courses.

It’s my understanding that some states combine the two, requiring the nurse to develop and teach a continuing education presentation (I believe that North Carolina and Kentucky are examples), but I would suggest that teaching and developing courses remain separate since a nurse can teach a course she doesn’t completely develop on her own, and, more so, develop a course she doesn’t teach, such as an online course.

The documentation requirement could be combined, and proposed 18VAC90-20-222B7 could be rewritten as follows with the addition in bold:

7. Evidence of teaching or developing a course for continuing education credit shall include a written attestation from the director of the program or authorizing entity including the date or dates of the course or courses and the number of contact hours awarded.  

·        Finally, I believe that reactivating inactive licenses should not have weaker requirements (currently 15 contact hours) than renewing active licenses.  Not all of the activities in A would be appropriate for reactivation (subsection A8, for example, which has a work requirement).  I feel that one of the activities in A2, A3, or A9 could be required for reactivation.  I would suggest the following wording, which is a rewording of 18VAC90-20-225, and adding it at the end of proposed 18VAC90-20-221 (copied below with the change in bold):

H. A registered nurse or licensed practical nurse who holds a current, unrestricted license in Virginia may, upon a request on the renewal application and submission of the required fee, be issued an inactive license. The holder of an inactive license shall not be entitled to practice nursing in Virginia or practice on a multistate licensure privilege but may use the title "registered nurse" or "licensed practical nurse."

I. Reactivation of an inactive license.

1. A nurse whose license is inactive may reactivate within one renewal period by payment of the difference between the inactive renewal and the active renewal fee.

2. A nurse whose license has been inactive for more than one renewal period may reactivate by:

a. Submitting an application;

b. Paying the difference between the inactive renewal and the active renewal fee; and

c. Providing evidence of completion of any one of the activities mentioned in A2, A3, or A9 of this section or providing evidence of passage of the National Council Licensing Examination during the period in which the license has been inactive.

3. The board may waive all or part of the continuing education requirement for a nurse who holds a current, unrestricted license in another state and who has engaged in active practice during the period the Virginia license was inactive.

4. The board may request additional evidence that the nurse is prepared to resume practice in a competent manner.

5. The board reserves the right to deny a request for reactivation to any licensee who has been determined to have committed an act in violation of § 54.1-3007 of the Code of Virginia or any provision of this chapter.

Then 18VAC90-20-225 would be repealed.

I can well appreciate the difficulty in writing regulations that are effective, clear and fair.   My suggestions for the rewording of regulations are, I’m sure, less than optimal and  function only as starting points for discussion of my recommendations, and as an attempt to make myself clear.  I sincerely hope they are taken in that vein.  Thank you for the opportunity to present my opinions on these proposed regulations.

CCI support of Virginia Board of Nursing’s proposal to accept specialty certification for renewal of an active nursing license (18VAC 90-220-221 A.1)

The Competency and Credentialing Institute (CCI) would like to join the Association of periOperative Registered Nurses in strongly supporting the Virginia Board of Nursing’s proposal to accept specialty certification as a continuing competency requirement for renewal of an active nursing license. As the specialty certification organization providing the CNOR and CRNFA credentials for perioperative registered nurses, CCI is committed to promoting lifelong learning and validating knowledge and skills as required elements in the provision of safe patient care. CCI’s rigorous exam development process assures that perioperative nurses are tested on the knowledge required to practice in their specialty.

CCI would like to call attention to section 18VAC 20-90-10 which defines “accreditation” as “being accredited by the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE)”.  Accreditation by a respected national organization is important in assuring that specialty certification organizations maintain the high standards demanded by quality professional practice. However, restricting acceptable accrediting organizations to NLNAC and CCNE would limit eligibility to academic nursing programs. CCI recommends expanding the list to include the National Commission for Certifying Agencies and the American Board of Nursing Specialty Certification. These two groups would be more likely to accredit nursing specialty certification organizations. Both associations are highly respected in the certification community.

CCI recognizes that holding a specialty certification is an integral part of continued competency, which is an underlying assumption for license renewal. Assuring that specialty certification organizations are able to meet the requirements as outlined by state boards of nursing will facilitate this process.

Thank you for your consideration.

James X Stobinski

RN PhD CNOR

Director of Credentialing and Education

The American Board of Nursing Specialties (ABNS) and the Accreditation Board for Specialty Nursing Certification (ABSNC) appreciate the opportunity to provide comments regarding the VA Board of Nursing Proposal on continuing competence requirements for renewal of an active license as defined in 18VAC90-20-221. On behalf of our ABNS member organizations and those organizations accredited by ABSNC, we fully support the VA Board of Nursing proposal to accept nursing certification for re-licensure purposes as a means of demonstrating continuing competence and life-long learning of registered nurses and advanced practice registered nurses. Nursing certification has long been recognized as a means of “protecting the public.” Accepting nursing certification programs that have been accredited is a means for the Board of Nursing to be assured that such programs are developed and based on rigorous quality standards in the credentialing industry. The Accreditation Board for Specialty Nursing Certification (ABSNC), which focuses specifically on accrediting nursing certification programs, is one of two organizations that grant accreditation to such programs that demonstrate compliance with its standards. The other national organization is the National Commission for Certifying Agencies.

We would like to bring your attention to section 18VAC20-90-10 which defines “accreditation by the National League for Nursing Accrediting Commission (NLNAC) or by the Commission on Collegiate Nursing Education (CCNE).” This definition limits the definition of accreditation to the accreditation of academic educational programs and does not allow for accreditation by the two accrediting bodies for national nursing certification programs.

Thank you for recognizing that re-licensure and specialty nursing certification allow a registered nurse and advanced practice registered nurse to demonstrate continuing competence directed at providing safe care to the public.

Sincerely,

Bonnie Niebuhr, MS, RN, CAE

Chief Executive Officer

ABNS and ABSNC