CNAP and the Texas Nurses Association had concerns about three of the staff recommendations. Two of our concerns both related to Issue 1 on nursing education. Recommendation 1.1 would reduce the BNE’s role in approving nursing programs. Issue 1.1 in the staff report recommended nursing programs, once credentialed by an agency recognized by the U.S. Department of Education, should be exempt from BNE approval. Our organizations felt that it was vital that only accreditation by a nursing accrediting body should exempt a program from approval by the board. The Commission’s final decisions include this change.
Recommendation 1.7 seemed very strange to those of us in the nursing profession. It would require the BNE to develop a process to approve hospital-based diploma programs. The nursing shortage prompted a small resurgence of diploma programs and the Sunset Commission obviously thinks it is important that Texas not miss any opportunity to bring those nurses to Texas. From the state’s perspective, diploma programs are a bargain because the state does not pay for the programs. They correctly point out that it is not the job of the BNE to protect the nursing profession or nursing students: it is to ensure that nurses entering the profession meet basic standards. This recommendation remains in the final Sunset Commission decisions.
The recommendation that garnered the most concern from CNAP was Recommendation 5.1: Clarify that individuals and organizations required to report impaired nurses must notify the Board if they suspect the nurse also committed a practice violation. Since being impaired on the job or diverting drugs would both be practice violations, this would mean that any nurse being referred for the Texas Peer Assistance Program for Nurses (TPAPN) would also have to be reported to the BNE. Most nursing authorities agreed that such a requirement would probably delay nurses obtaining treatment for addictions since once of the big incentives for these nurses is that they will not be reported to the board if they enter and successfully complete TPAPN. The final decisions reflect an important change that only impaired nurses who also commit a practice error must be reported to the board.
Recommendation 4 is the only recommendation that specifically mentions APNs. This is the recommendation for Texas to join the Interstate APRN Compact. If this recommendation is included in the final BNE Sunset Bill, it will prompt a change in the term, “Advanced Practice Nurse (APN),” to “Advanced Practice Registered Nurse (APRN).” It will enable APRNs that are licensed or authorized in their home state to practice in any other compact states without seeking additional APRN authorization or licensure. However, because of the dramatic variation in prescriptive authority among the states, the APRN compact does not address prescriptive authority. If the APRN needs to prescribe for patients outside of the home state, then the APRN would have to seek and receive prescriptive authority from that state.
Because of disagreement among our member organizations, CNAP is taking a neutral position on this issue. We think it is important for each APN to become educated on the issue and seek guidance from his/her state professional organization. To read the APRN Compact and additional information, go to the National Council of State Boards of Nursing (NCSBN) Website, https://www.ncsbn.org/917.htm.
The Commissioners also received some misleading information that the nursing shortage was due to the clinical faculty to student ratio, and this prompted Commission members to adopt a new recommendation that had not been suggested by Sunset staff. The new recommendation states:
Require the Board of Nurse Examiners, in collaboration with nursing education stakeholders and the Texas Higher Education Coordinating Board, to create innovative models for nursing education that promote increased enrollment in Texas nursing programs. As a management action, the recommendation directs the Nurse Board to report back to the Sunset Commission by March 2007 regarding the Board’s efforts in creating these models so that the Legislature can make needed changes to the agency’s appropriations or statute. As a statutory change, the recommendation requires the Board to implement a statewide plan for creating these models and to report back to the Sunset Commission by September 1, 2008 regarding the plan and the Board’s efforts to increase enrollment in nursing education programs. (Motion by Senator Whitmire)
While this is somewhat repetitive of legislation that has already passed, CNAP thinks that continued emphasis on ways to increase the number of nurses will benefit the state, and therefore do not oppose including this requirement in the final BNE Sunset Bill. The bill will probably be filed sometime in February 2007.
All of the BNE Sunset reports may be accessed at http://www.sunset.state.tx.us/80.htm#bneAt this point in the process, your time will probably best be spent by reviewing the Sunset Commission Decisions. Much more information on the Sunset process is available on the Sunset Commission’s Website, www.sunset.state.tx.us. Also feel free to contact lynda@cnaptexas.org if you have questions.
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