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PA Bulletin, Doc. No. 06-973

RULES AND REGULATIONS

Title 49--PROFESSIONAL AND VOCATIONAL STANDARDS

STATE BOARD OF NURSING

[49 PA. CODE CH. 21]

Certified Registered Nurse Practitioner Program Approval

[36 Pa.B. 2667]
[Saturday, June 3, 2006]

   The State Board of Nursing (Board) adopts §§ 21.361--21.377 (relating to approval of certified registered nurse practitioner programs) to read as set forth in Annex A.

Statutory Authority

   The final-form rulemaking is authorized under sections 6.1 and 8.1 of the Professional Nursing Law (act) (63 P. S. §§ 216.1 and 218.1).

Background and Purpose

   Notice of proposed rulemaking was published at 34 Pa.B. 4890 (September 4, 2004). Publication was followed by a 30-day public comment period. The Board did not receive comments from the general public. On October 5, 2004, the House Professional Licensure Committee (HPLC) submitted a comment for a typographical correction which has been made. On November 3, 2004, the Independent Regulatory Review Commission (IRRC) submitted comments and suggestions to the Board.

Summary of Comments and Responses to Proposed Rulemaking

§ 21.361.  General criteria for approval of programs.

   IRRC commented that the phrase ''experimental or accelerated programs'' in § 21.361(b) should be defined. The Board has changed the phrase to ''pilot or accelerated programs,'' but has not added a definition. The Board intends to permit nontraditional programs, such as those operating at Drexel University and the University of Pittsburgh, to submit applications for approval without regulatory impediment. A statutory change was required to permit a diploma professional nursing program in transition to degree-granting nursing education program to apply to the Board for approval. The act of June 29, 2002 (P. L. 651, No. 99), effective September 29, 2002, amended section 6 of the act (63 P. S. § 216) to authorize the Board to approve nursing education ''programs in transition from approved diploma to degree granting programs.''

   IRRC commented that § 21.361(c) was unwieldy. The Board has shortened subsection (c) by moving some information into subsection (b). The Board added a subsection (d), which includes information formerly in subsection (b).

§ 21.362.  Annual reports and compliance reviews; list of approved programs.

   IRRC suggested that the final-form rulemaking should specify how long a certified registered nurse practitioner (CRNP) program would be given to comply with recommendations of the Board under § 21.362(c). The Board has amended § 21.362(c) to provide that the Board will include compliance deadlines with its recommendations. The Board also amended subsection (d) to accurately reflect that the Board's list of approved programs will include programs on initial as well as full and provisional approval status.

§ 21.363.  Approval process.

   IRRC asked what ''other information'' the Board could consider when determining whether to place a program on provisional approval status under § 21.363(b). The Board declines to specify acceptable information in the final-form rulemaking because doing so has the potential to limit the information that might be useful to the Board in considering whether to place a program on provisional status.

   IRRC also asked when and how often a program on provisional approval status would be required to submit progress reports to the Board. The time frame varies depending on each individual school's situation and the type and extent of changes needed to come into compliance with the Board's regulations. The Board has added language to § 21.363(b) to notify schools that the Board will require progress reports at its discretion.

§ 21.364.  Removal from approved list; discontinuance of CRNP program.

   The Board changed the word ''wishing'' to ''planning'' in § 21.364(b).

§ 21.365.  Establishment.

   IRRC questioned whether it was necessary to include both regional accreditation and National accreditation in § 21.365(a). Regional accreditation is awarded to the college or university by entities approved by the United States Department of Education. National accreditation is awarded to the nursing education program by one of several accreditation services. The Board has amended the final-form rulemaking to specifically name the National accrediting bodies. IRRC also suggested that the Board amend § 21.51 (relating to establishment). The Board finds that this amendment is beyond the scope of the proposed rulemaking. Because medical schools are situated within accredited colleges or universities, a medical school could apply to the Board for approval to institute a CRNP educational program.

   IRRC asked whether § 21.365(b) required the CRNP program director to hold a doctoral degree in a specific area or field. It does not. IRRC also asked for clarification on the language ''a specific plan for completing doctoral preparation.'' The Board has amended the language to clarify that the program director must have both a specific plan to complete the doctoral degree within 5 years and evidence effort toward completion of the degree. Most universities require doctoral candidates to complete their degrees within 7 years. The 5-year time frame assumes the program director has already enrolled in a doctoral degree program. The Board has adopted IRRC's suggestion of the term ''degree'' rather than ''preparation.''

§ 21.367.  Faculty requirements for CRNP programs.

   Regarding § 21.367(b)(1), IRRC asked about the phrases ''evidence of expertise'' and ''when appropriate.'' Evidence of expertise may be shown in many ways, through National certification, independent research and writing or work experience. Certification is only required ''when appropriate'' because it is common for some CRNP courses to be taught by individuals who hold credentials other than CRNP certification. For example, individuals who hold doctorate degrees in pharmacy, rather than a master's degree in nursing, teach many advanced pharmacology courses. Other courses are taught by medical or osteopathic doctors rather than by CRNPs.

   The Board also deleted the requirement in § 21.367(b)(2) that faculty members have at least 2 years of clinical nurse practitioner experience. There is a shortage of individuals that meet the requirements to become faculty members and the Board believes that eliminating this requirement will allow more qualified individuals who are qualified to teach to become faculty members. Subsequent paragraphs were renumbered accordingly.

§ 21.369.  General curriculum requirements.

   IRRC questioned whether it was necessary to mention advanced pharmacology in both § 21.369(c)(2) and (4). The three pillars of advanced practice nursing are advanced health and physical assessment, advanced physiology and pathophysiology and advanced pharma- cology. For this reason, advanced pharmacology must be listed in § 21.369(c)(2). The Board provides for specific regulation of the advanced pharmacology curriculum in § 21.369(c)(4). The Board does not believe that this minor duplication will provoke any confusion.

   IRRC also noted that § 21.369(g) should reference § 21.373(c)(3)(ii) (relating to facility and resource requirements) to specify student to faculty ratios. The Board has added the cross-reference.

§ 21.376.  Program records.

   The Board amended § 21.376(b)(2)(i) to account for faculty members, such as medical doctors, who have licenses or certifications other than a nursing license or CRNP certification.

Miscellaneous Comments

   Finally, IRRC raised two typographical concerns, which have been corrected. In addition, IRRC questioned whether the word ''nationally'' should be capitalized. The Legislative Reference Bureau capitalized this word prior to publication. The Board defers to the Legislative Reference Bureau's knowledge of proper regulatory style.

Fiscal Impact and Paperwork Requirements

   The final-form rulemaking will have no adverse fiscal impact on the Commonwealth or its political subdivisions. The final-form rulemaking will impose no additional paperwork requirements upon the Commonwealth, political subdivisions or the private sector. CRNP programs already apply to the Board for approval and submit information as set forth in this final-form rulemaking. The Board did not previously promulgate the regulations because CRNP educational programs were jointly regulated with the State Board of Medicine and a joint rulemaking was not feasible. A program seeking Board approval pays an application fee under § 21.5 (relating to fees). The Board intends to promulgate regulations to update its fees and will provide a separate fee for CRNP program approval at that time.

Regulatory Review

   Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on September 4, 2004, the Board submitted a copy of the notice of proposed rulemaking, published at 34 Pa.B. 4890, to IRRC and the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) and the HPLC for review and comment.

   Under section 5(c) of the Regulatory Review Act, IRRC, the SCP/PLC and the HPLC were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the SCP/PLC and the HPLC and the public.

   Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on March 14, 2006, the final-form rulemaking was approved by the HPLC and was deemed approved by the SCP/PLC on April 18, 2006. Under section 5.1(e) of the Regulatory Review Act, IRRC met on April 19, 2006, and approved the final-form rulemaking.

Additional Information

   Further information may be obtained by contacting Ann Steffanic, Administrative Assistant, State Board of Nursing, P. O. Box 2649, Harrisburg, PA 17105-2649 or from the Department of State's website: www.dos.state.pa.us.

Findings

   The Board finds that:

   (1)  Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2.

   (2)  A public comment period was provided as required by law and all comments were considered.

   (3)  The amendments to the final-form rulemaking do not enlarge the purpose of proposed rulemaking published at 34 Pa.B. 4890.

   (4)  This final-form rulemaking is necessary and appropriate for administering and enforcing the authorizing acts identified in this preamble.

Order

   The Board, acting under its authorizing statutes, orders that:

   (a)  The regulations of the Board, 49 Pa. Code Chapter 21, are amended by adding §§ 21.361--21.377 to read as set forth in Annex A.

   (b)  The Board shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General as required by law.

   (c)  The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.

   (d)  This order shall take effect immediately upon publication in the Pennsylvania Bulletin.

JOANNE L. SORENSEN, RN, MS,   
Chairperson

   (Editor's Note:  For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 36 Pa.B. 2251 (May 6, 2006).)

   Fiscal Note:  Fiscal Note 16A-5119 remains valid for the final adoption of the subject regulations.

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 C.  CERTIFIED REGISTERED NURSE PRACTITIONERS

APPROVAL OF CERTIFIED REGISTERED NURSE PRACTITIONER PROGRAMS

§ 21.361.  General criteria for approval of programs.

   (a)  A CRNP program must require, at a minimum, a baccalaureate degree in nursing for admission and must culminate with a master's degree in nursing or postmaster's certificate.

   (b)  A CRNP program must prepare the registered nurse (RN) to function as a nurse practitioner in an expanded role in a particular specialty.

   (c)  A CRNP program must prepare the registered nurse to perform acts of medical diagnosis and prescription of medical, therapeutic or corrective measures in collaboration with a physician licensed to practice medicine in this Commonwealth.

   (d)  A CRNP program may be formed as a master's program, an RN to master's program, an RN to nursing doctorate program or a pilot or accelerated program that culminates with at least a master's degree in nursing.

§ 21.362.  Annual reports and compliance reviews; list of approved programs.

   (a)  Approved programs must complete an annual report to the Board on a form provided by the Board. The annual report must update information regarding the program's administration, faculty, curriculum and student enrollment.

   (b)  Approved programs must conduct a compliance review of CRNP programs at least once every 3 years. The compliance review shall be submitted to the Board on a form provided by the Board. The compliance review must include information regarding accreditation, administration, clinical sites, faculty, curriculum, testing, educational resources and student body of the program.

   (c)  The Board will send a written report of recommendations or requirements, or both, including compliance deadlines, based on the CRNP program's compliance review, to the CRNP program. The Board will conduct an announced or unannounced site compliance visit at its discretion.

   (d)  Lists of approved CRNP programs will be compiled and published annually (the approved list) and will be made available for distribution. The approved list will consist of programs on initial, full and provisional approval status.

§ 21.363.  Approval process.

   (a)  A program that meets and maintains the requirements of §§ 21.361, 21.365--21.369 and 21.372--21.375 will be granted full approval status.

   (b)  The Board will place a CRNP program on provisional approval status if, as evidenced by the compliance review or other information, the program is not in compliance with the Board's regulations. At its discretion, the Board will require progress reports or other information deemed necessary for the evaluation of a program on provisional approval status. Two years will be the maximum time allowed for the correction of the deficiencies that resulted in the program being placed on provisional approval status. If the program on provisional approval status is not in compliance within this designated time, the CRNP program will be removed from the approved list.

   (c)  The Board may return a CRNP program on provisional approval status to full approval status if the program attains and maintains the acceptable standards in §§ 21.365--21.377, and adheres to the policies and regulations of the Board.

§ 21.364.  Removal from approved list; discontinuance of CRNP program.

   (a)  The Board will give at least 30 days notice of intent to remove a CRNP program from full approval status to provisional approval status or from provisional approval status to removal from the approved list and will provide an opportunity for the program's officials to present documentation, within 10 days of notification of intent to remove, to show why approval should not be withdrawn. The Board will hold a hearing, within 30 days of the submission of documentation, at which the program official may appear and present additional evidence to show cause as to why approval should not be withdrawn. The 30 day period for holding a hearing may be waived by consent of the parties. Failure to hold a hearing within 30 days will not be cause to withdraw the notice of intent to remove.

   (b)  Programs planning to discontinue must follow the procedures in § 21.41 (relating to discontinuance of a program of nursing).

§ 21.365.  Establishment.

   (a)  A CRNP program must be developed and maintained under the authority of a regionally accredited university or college or have current accreditation by the Credentialing Commission for Nurse Education or the National League of Nursing.

   (b)  A CRNP program must be under the direction of a faculty member who holds an active certification as a Pennsylvania CRNP and an earned doctorate degree or a specific plan for and evidence toward completion of the doctoral degree within 5 years. The length of appointment of temporary and acting directors of CRNP programs may not exceed 1 year.

   (c)  A university or college may conduct CRNP programs within the graduate program of the university or college where it resides, if the college or university has a professional nurse program and the philosophy of the parent institution encompasses dual programs of education. A college or university desiring to establish a program of nursing is required to:

   (1)  Submit a proposal to the Board, at least 12 months prior to the first intended admission of students, which includes the following:

   (i)  Sufficient statistical data to support the need for a CRNP program within the community and to assure availability of an adequate number of interested candidates.

   (ii)  Letters of intent from the cooperating agencies indicating positive commitment to the CRNP program and the availability of sufficient clinical resources to meet the educational requirements of the CRNP program.

   (iii)  The projected cost of the CRNP program including costs for faculty, clinical teaching resources, educational supplies, office supplies, and the like, and sufficient evidence of stable financial support.

   (2)  Employ the director of the CRNP program prior to the intended admission date of students.

   (d)  The planned CRNP educational program proposal must include:

   (1)  A statement of the organization and administrative policies of the college or university.

   (2)  A statement of the administrative structure and functions of the nursing school.

   (3)  A statement of the educational preparation and nursing experience of faculty members employed, which conforms to § 21.367(b) (relating to faculty requirements for CRNP programs).

   (4)  A statement of the philosophy, purposes and objectives of the program, which are congruent with the philosophy of the university or college.

   (5)  A statement of the curriculum, based on sound educational concepts, and including detailed course descriptions, objectives and descriptions of the relevant clinical practice related to the specialty area.

   (6)  A statement of admissions policies.

   (7)  A statement identifying the National educational standards and guidelines used in the development of the nursing practitioner program.

   (8)  Statements of financial viability for 5 years.

   (9)  A description of the clinical facilities.

   (e)  Following the review of the CRNP program proposal and before final Board action is taken to grant permission to recruit students, an initial facility survey may be made by the designee of the Board.

§ 21.366.  Organizational requirements.

   (a)  The CRNP program must be a definable entity distinguishable from other educational programs and services within the institution.

   (b)  Relationships with central administrative officers, interrelationships among other disciplines and services of the college or university, and representation on college or university councils and committees for faculty in a CRNP program must be consistent with the interaction and responsibilities accorded to other faculty members of the college or university.

   (c)  Adequate funds shall be allocated and properly budgeted for the sound and effective operation of the CRNP program.

   (d)  Policies in effect for faculty members of the CRNP program must be those in effect for faculty members throughout the college or university.

   (e)  The resources, facilities and services of the college or university must be available to and used by the CRNP program and be adequate to meet the needs of the faculty and students.

§ 21.367.  Faculty requirements for CRNP programs.

   (a)  The minimum faculty requirements submitted under § 21.365(d)(3) (relating to establishment) for the program are:

   (1)  Qualified faculty members teaching in their areas of specialized practice encompassed within the curriculum.

   (2)  Additional faculty members as needed to insure an educationally effective student-faculty ratio.

   (b)  Faculty qualifications for clinical courses in the CRNP program are as follows:

   (1)  Faculty members shall provide evidence of expertise in their subject areas, and when appropriate, be currently licensed and certified in this Commonwealth and hold and maintain National certification. Faculty members already employed in a CRNP program who do not hold National certification in their area of specialization shall obtain National certification, if available, by June 3, 2008.

   (2)  Faculty members shall give evidence of maintaining expertise in their clinical or functional areas of specialization.

   (3)  Faculty members shall maintain currency in clinical practice through ongoing clinical practice.

   (4)  Faculty members shall meet specialty requirements for continuing competency in accordance with their educational program responsibilities.

§ 21.368.  Faculty policies.

   (a)  The faculty shall be employed by and be responsible to the college or university.

   (b)  Policies, including personnel policies in effect for CRNP program faculty, must be those in effect for faculty members throughout the college or university.

   (c)  Functions and responsibilities of each faculty member shall be defined in writing.

   (d)  Teaching hours of CRNP faculty must be consistent with the policies of the college or university.

§ 21.369.  General curriculum requirements.

   (a)  The curriculum shall be developed, implemented and evaluated by the faculty and be based on the philosophy and objectives of the school.

   (b)  The curriculum must be organized and developed to include the knowledge, attitudes, skills and abilities necessary for practice as a CRNP and in accordance with this chapter as related to CRNP practice.

   (c)  The curriculum must provide for both clinical and theoretical experiences. The curriculum must have the following components incorporated into each CRNP program:

   (1)  Graduate nursing core. The graduate nursing core must include the following content:

   (i)  Research.

   (ii)  Health care policy and organization.

   (iii)  Ethics.

   (iv)  Professional role development.

   (v)  Theoretical foundations of nursing practice.

   (vi)  Human diversity and social issues.

   (vii)  Health promotion and disease prevention.

   (2)  Advanced nursing practice core. The advanced nursing practice core must include the following content:

   (i)  Advanced health/physical assessment.

   (ii)  Advanced physiology and pathophysiology.

   (iii)  Advanced pharmacology.

   (3)  Specialty content. The CRNP student shall receive sufficient clinical experience to provide depth and breadth in a given specialty or with designated populations, geared to nurse practitioner practice. Clinical hours must meet at least National certification requirements with a minimum of 500. Additional hours must be provided for specialties that provide care to multiple age groups (for example, family CRNPs) or for those who will practice in multiple care settings. When defining additional clinical hours, the complexity of the specialty content, as well as the need for clinical experience to enhance retention and skills, shall be considered. The expected graduate competencies must be the key determinant of the clinical component.

   (4)  Advanced pharmacology.

   (i)  CRNP program graduates shall have a well-grounded understanding of pharmacologic principles, which includes the cellular response level. This area of core content must also include both pharmacotherapeutics and pharmacokinetics of broad categories of pharmacologic agents. Advanced pharmacology shall be taught in a separate or dedicated 3-credit or 45-hour course. Pharmacology content shall also be integrated into the other content areas identified in the advanced practice nursing core. Additional application of this content shall also be presented within the specialty course content and clinical experiences of the program to prepare the CRNP to practice within a specialty scope of practice.

   (ii)  The purpose of this content is to provide the graduate with the knowledge and skills to assess, diagnose and manage (including the prescription of pharmacologic agents) a patient's common health problems in a safe, high quality, manner.

   (iii)  The course work must provide graduates with the knowledge and skills to:

   (A)  Comprehend the pharmacotherapeutics of broad categories of drugs.

   (B)  Analyze the relationship between pharmacologic agents and physiologic/pathologic responses.

   (C)  Understand the pharmacokinetics and pharmacodynamics of broad categories of drugs.

   (D)  Understand the motivations of clients in seeking prescriptions and the willingness to adhere to prescribed regimens.

   (E)  Safely and appropriately select pharmacologic agents for the management of client health problems based on client variations, the problem being managed, and cost effectiveness.

   (F)  Provide comprehensive and appropriate client education in relation to prescribed pharmacologic agents.

   (G)  Analyze the effects of single and multiple drug regimens on the client's health and functioning.

   (H)  Understand the variety of State legal requirements for CRNP prescriptive authority.

   (I)  Fulfill legal requirements for writing prescriptions as a CRNP in this Commonwealth in accordance with §§ 21.283--21.387.

   (5)  Professional role content. The course work must provide graduates with curriculum in:

   (i)  Management of client health/illness status.

   (ii)  The nurse-client relationship.

   (iii)  The teaching-mentoring function.

   (iv)  Professional role.

   (v)  Managing and negotiating health care delivery systems.

   (vi)  Monitoring and ensuring the quality of health care practice.

   (d)  The instructional strategies must be appropriate and consistent with the program's philosophy, mission and objectives.

   (e)  The clinical facilities of the CRNP program must provide a variety of experiences with sufficient quality and quantity. Clinical experiences must be consistent with the scope of practice.

   (f)  CRNP courses and curriculum must be organized to continue the development of values, understandings, knowledge and skills needed in all aspects of practice as a CRNP and emphasize specialty areas.

   (g)  The ratio of students to faculty must insure optimal learning opportunities in clinical laboratory sessions, be consistent with the objectives of the CRNP courses, and comply with § 21.373(c)(3)(ii) (relating to facility and resource requirements).

   (h)  The curriculum for CRNP programs must give evidence of providing learning experiences which will prepare graduates for CRNP practice. The standards of practice are defined and delineated by the profession and §§ 21.18 and 21.284 (relating to standards of nursing conduct; and prescribing and dispensing parameters).

   (i)  Course syllabi that identify all aspects of each course must be developed and readily available.

§ 21.370.  Evaluation.

   (a)  As part of the CRNP program approval process, the CRNP program shall submit an outline of, and appropriate time line for, its planned evaluative process. The evaluative process must include, at a minimum, the following:

   (1)  A self-evaluation process completed by faculty, administrators and students of the CRNP program evidencing input into the CRNP program by faculty, administrators and students. The self-evaluative process must include:

   (i)  Peer evaluation of teacher effectiveness.

   (ii)  Student evaluation of teaching and program effectiveness.

   (iii)  Periodic evaluation of the program by faculty, students and graduates of the program.

   (iv)  Periodic evaluation of the program's human and fiscal resources, program policies, facilities and services.

   (2)  Provisions for the program's curriculum evaluation process, completed by faculty, students and graduates of the program. The curriculum must:

   (i)  Assess the program's effectiveness relative to current standards of practice.

   (ii)  Assess the program's effectiveness relative to current trends in education and health care.

   (iii)  Assess the program's effectiveness in attaining program objectives.

   (iv)  Demonstrate that curriculum changes have been evaluated by the CRNP program faculty and are consistent with core competencies in the CRNP specialties.

   (3)  Provision for ongoing student evaluative process that assesses the student's progress toward and ultimate achievement of program objectives. The student evaluative process must:

   (i)  Be evident in the course outlines provided to students at the beginning of each course.

   (ii)  Include documentation of faculty-supervised performance evaluation of students.

   (iii)  Utilize evaluation tools that reflect nurse practitioner National competencies in the specialty areas.

   (iv)  Include student evaluation of the quality of clinical experiences.

   (b)  Programs must measure outcomes of graduates at 1-year and 3-year intervals postgraduation.

§ 21.371.  Curriculum changes requiring Board approval.

   Curriculum changes that require Board approval include changes in:

   (1)  Program objectives, course content or instruction that affect the integration of material into the total curriculum.

   (2)  An approved program which deems a new or different certification specialty title for graduates of that program requires approval as a new CRNP education program.

§ 21.372.  CRNP program philosophy; purposes and objectives.

   (a)  A clear statement of philosophy and purposes of the CRNP program, consistent with the philosophy and purposes of the college or university, shall be formulated and adopted.

   (b)  The philosophy, purposes and objectives of the CRNP program shall be developed and clearly stated by the faculty and be reviewed and revised at stated time intervals by this group.

   (c)  The philosophy and purposes of the CRNP program must be consistent with currently accepted social, educational and CRNP standards.

§ 21.373.  Facility and resource requirements.

   (a)  The support of the college or university must be adequate to meet CRNP program needs and include the following:

   (1)  Faculty and staff offices.

   (2)  Classrooms, conference rooms and laboratories.

   (3)  Administrative and secretarial support.

   (4)  Interactive information systems (computer/technical support) sufficient to develop, manage and evaluate the program.

   (b)  There must be current, appropriate, adequate and available learning resources to include audio/visual equipment, computers and library materials.

   (c)  The CRNP program must provide appropriate clinical resources and experience for students, including:

   (1)  Space for faculty's and students' needs.

   (2)  Exposure of appropriate duration to a patient population sufficient in number to insure that the student will meet program goals.

   (3)  Faculty to provide adequate supervision and evaluation.

   (i)  Supervision of all students in the clinical areas is the responsibility of the CRNP program faculty.

   (ii)  One program faculty member shall supervise no more than six students in a clinical course. If faculty are providing onsite preceptorship, the maximum ratio is two students per faculty member. If faculty are managing their own caseload of patients, the maximum ratio is one student per faculty member.

   (iii)  Onsite clinical preceptors may include:

   (A)  Advanced practice nurses who are currently licensed.

   (B)  Physicians who are currently licensed.

   (C)  CRNPs who are currently licensed and certified.

§ 21.374.  Selection and admission standards.

   (a)  Policies and procedures related to the selection and admission of students are the responsibility of the individual program. Consideration must be given to scholastic aptitude, academic achievement, personal qualities and physical and emotional health necessary to fulfill the objectives of the program.

   (b)  Students admitted to CRNP programs shall meet the requirements for admission to the university or college for a master's degree in nursing program and additional requirements that may be established for the CRNP program.

   (c)  Students admitted to CRNP programs shall have successfully completed the equivalent of a baccalaureate degree in nursing from an accredited institution of higher learning in a nursing program.

   (d)  Students admitted to CRNP programs shall be currently licensed as a registered nurse (RN) or, if enrolled in an RN to Master of Science in Nursing (MSN) or RN to Nursing Doctorate (ND) program, shall complete all competencies for undergraduate requirements prior to taking graduate courses.

§ 21.375.  Advanced standing.

   The school shall have a written policy consistent with its philosophy and objectives concerning criteria for granting advanced standing. The policy of master's degree programs must be consistent with that of the college or university.

§ 21.376.  Program records.

   (a)  The program shall employ a record system that ensures the operation of the program. Records shall be maintained in locked files which assure their safe keeping.

   (b)  Each nursing faculty shall select record forms specifically for the CRNP program that include the following:

   (1)  Student records, including the permanent record, containing both clinical and theoretical experience and achievement, shall be kept for 50 years.

   (2)  Faculty records, including the following:

   (i)  ''Display portion'' of current Pennsylvania licenses and certifications.

   (ii)  Records of preparation and experience, including official college transcripts.

   (iii)  Current records of continuing education activities.

   (iv)  Records of National certification, if applicable.

   (3)  Administrative records, including the following:

   (i)  Affiliation agreements with cooperating agencies.

   (ii)  Minutes of meetings.

   (iii)  Annual reports.

   (iv)  Follow-up studies of graduates.

   (v)  Budgets.

   (vi)  Current written policies.

   (4)  School bulletins, including the following:

   (i)  Comprehensive and current information.

   (ii)  Clearly defined refund policies governing fees and tuition paid by the students.

   (iii)  Clearly defined policies relating to admission, promotion, retention, transfer, advanced placement and dismissal.

§ 21.377.  Custody of records.

   (a)  When a program closes, the college or university is responsible for the safekeeping of the records of students for at least 50 years after graduation of the last class.

   (b)  If the college or university also closes, advice should be obtained from the Board concerning the permanent safekeeping and availability of the records of the school of nursing.

   (c)  The Board shall be informed in writing concerning the permanent placement of these records.

[Pa.B. Doc. No. 06-973. Filed for public inspection June 2, 2006, 9:00 a.m.]



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