PROPOSED RULEMAKING
STATE BOARD OF NURSING
[49 PA. CODE CH. 21]
Certified Registered Nurse Practitioner Program Approval
[34 Pa.B. 4890] The State Board of Nursing (Board) proposes to add §§ 21.361--21.377 (relating to approval of certified registered nurse practitioner programs).
Effective Date
The proposed rulemaking will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.
Statutory Authority
The proposed 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 Need for the Proposed Rulemaking
In 1974, the General Assembly, in amendments to the act and the Medical Practice Act of 1974, authorized the Board and the State Board of Medical Education and Licensure (now the State Board of Medicine) to jointly promulgate regulations which would authorize qualified nurses to perform acts of medical diagnosis and prescribe medical, therapeutic or corrective measures.
In 1997, the Board and the State Board of Medicine jointly promulgated regulations granting certified registered nurse practitioner (CRNP) status to certain professional nurses (RNs). Section 21.271(b) (relating to currently licensed; course of study and experience; continuing education) and § 18.41(b) (relating to currently licensed; course of study and experience; continuing education) of the State Board of Medicine's regulations provide that ''[t]he applicant [for certification] shall have successfully completed a course of study consisting of at least 1 academic year in a program administered by nursing in an institution of higher education as approved by the Boards.''
The act of December 9, 2002 (P. L. 1567, No. 206) (Act 206) amended section 2.1 of the act (63 P. S. § 212.1) to give the Board exclusive jurisdiction over CRNPs, including CRNP education. Prior to the enactment of Act 206, these regulations were approved for publication as proposed rulemaking by both the Board and the State Board of Medicine. Section 6.1 of the act authorizes the Board to establish standards for the operation and approval of nursing education programs for RNs. Section 8.1(b)(1)(i), added by Act 206, requires the Board to approve CRNP education programs.
Description of Proposed Rulemaking
In developing the proposed rulemaking, the Board utilized the regulatory scheme developed for approving schools of nursing for RNs. The following is a section by section analysis of the proposed additions pertaining to CRNP education.
§ 21.361. Approval of programs.
Section 21.361 provides that the Board will approve CRNP programs that require a bachelor's degree for admission and that culminate in a master's degree in nursing or postmaster's certificate. The requirement of a bachelor's degree for admission is consistent with criteria established by the National League of Nursing (League), the organization that provides standardized guidelines for nursing education throughout the United States. This requirement is also consistent with section 8.1(b) of the act, added by section 3 of Act 206, which provides for a 2-year period before all approved programs must culminate in a master's or postmaster's degree. Section 21.361 also provides that the Board will approve RN to MSN (master of science in nursing) and RN to ND (doctorate degree in nursing) and other experimental or accelerated programs that culminate with at least a master's degree. This provision serves to permit nontraditional CRNP programs for RNs who obtained their education through an associate degree or diploma program to become approved for CRNP education. Finally, § 21.361 provides that the goal of approved programs is to prepare the RN to function as a nurse practitioner.
§ 21.362. Annual reports and compliance reviews; list of approved programs.
Section 21.362 sets forth the requirements that approved programs complete an annual report and conduct a compliance review triennially. This requirement is consistent with the requirements imposed by the Board on other nursing education programs. See § 21.31 (relating to surveys; list of approved schools). In response to the information provided in the compliance review sent to the Board, the Board will send each program a written report of recommendations or requirements. Finally, § 21.362 provides that the Board will annually publish a list of approved programs. The same procedures are already established for other nursing education programs. See § 21.31.
§ 21.363. Approval process.
Section 21.363 details the two types of approval status granted to nursing education programs. Approved programs are initially placed on full approval status. A program may be placed on provisional approval if it is not in compliance with the Board's regulations. The same procedures are already established for other nursing education programs. See § 21.33 (relating to types of approval).
§ 21.364. Removal from approved list; discontinuance of CRNP program.
Section 21.364 details the procedure the Board will follow if it determines that a program should be placed on provisional approval or disapproved. The procedure includes a right to a hearing and the right to cure the program's deficiencies. These same procedures are already established for other nursing education programs. See § 21.34 (relating to removal from approved list).
§ 21.365. Establishment.
Section 21.365 provides the criteria under which a program must be established, and the information proposed programs must submit to the Board to become approved programs. The program must be developed and maintained under a regionally or Nationally accredited university or college; must be under the direction of a CRNP with a current Pennsylvania license and an earned doctorate degree (or plan to complete doctoral preparation); may be under the school's nurse educational program; and must submit information to the Board about the program's administration. These provisions are consistent with the criteria imposed on other nursing education programs. See § 21.51 (relating to establishment).
§ 21.366. Organizational requirements.
Section 21.366 sets forth the organizational requirements for programs that are seeking Board approval. The program must be a definable entity within the institution with adequate funding. The college or university under which the program operates shall make resources available to the program and interact with the program and the program's faculty in accordance with university policies. These organizational requirements are consistent with the organizational requirements for other nursing education programs. See §§ 21.61 and 21.62 (relating to baccalaureate and associate degree programs: organizational requirements; and diploma programs: organizational requirements).
§ 21.367. Faculty requirements for certified registered nurse practitioner programs.
This section sets forth the requirements for faculty in the program and the program's clinical courses. Faculty shall demonstrate expertise and maintain expertise in the subject area they are teaching; clinical faculty shall have at least 2 years of nurse practitioner experience and shall maintain clinical competency through ongoing clinical practice. These requirements are consistent with the League guidelines for CRNP programs and requirements for other nursing programs. See §§ 21.71 and 21.74 (relating to faculty and staff requirements for baccalaureate and associate degree programs; and faculty and staff requirements for diploma programs).
§ 21.368. Faculty policies.
Section 21.368 relates the faculty policies and provides that faculty shall be employed by and responsible to the college or university, that CRNP faculty shall be governed by college- or university-wide policies, that faculty duties shall be defined in writing and that CRNP faculty hours must be consistent with the faculty hours in other college or university programs. These requirements are consistent with those imposed on other nursing education programs. See §§ 21.72 and 21.75 (relating to faculty policies).
§ 21.369. General curriculum requirements.
Section 21.369 relates to the general curriculum requirements for CRNP programs. The curriculum must be developed, implemented and evaluated by the program's faculty to include the knowledge, attitudes, skills and abilities necessary to practice as a CRNP. The curriculum must include both theoretical and clinical experiences, and instructional strategies must be appropriate to the program. The curriculum must include both general nursing courses and advanced nursing practice courses, including pharmacology. Section 21.369(c)(3) details requirements for clinical courses, including that students complete a minimum of 500 clinical hours. Section 21.369(c)(4) details requirements for advanced pharmacology courses. This section also provides that the program's clinical facilities must provide students with a variety of clinical experiences. Finally, the curriculum must prepare graduates for CRNP practice. These requirements are consistent with League guidelines for the education of CRNPs and Board requirements for other nursing programs. See § 21.81 (relating to general curriculum requirements).
§ 21.370. Evaluation.
Section 21.370 sets forth the requirements for the annual evaluation of the CRNP program conducted by the program and submitted to the Board under § 21.361(a). The evaluation must be conducted by faculty, administrators and students and include teacher effectiveness and curriculum. In addition, outcomes must be measured 1 and 3 years postgraduation. These requirements are consistent with those imposed on other nursing education programs. See § 21.82 (relating to curriculum evaluation).
§ 21.371. Curriculum changes requiring Board approval.
Section 21.371 provides that the Board approve curriculum changes that are substantial changes in program objectives, course content or instruction that affect the integration of material into the total curriculum and changes that confer a new or different certification specialty. Because Act 206 provides that, in 2 years, nurse practitioner certification may only be granted to nurses who hold certification from a Board-recognized National certification organization which required passing of a National certifying examination in the particular clinical specialty area, the Board anticipates that many programs will reorganize under Nationally-recognized certification specialties. These requirements are consistent with those imposed on other nursing education programs. See § 21.83 (relating to curriculum changes requiring Board approval).
§ 21.372. CRNP program philosophy; purposes and objectives.
Section 21.372 relates to the CRNP program philosophy. The section provides that the program must adopt a clear statement of the program's philosophy and purposes, and that the philosophy and purposes must be developed and reviewed by the faculty and consistent with the acceptable social, educational and CRNP standards. These requirements are consistent with the League guidelines and Board regulations for other nursing education programs. See §§ 21.84, 21.86 and 21.88 (relating to baccalaureate curriculum philosophy; purposes and objectives; associate degree curriculum philosophy; purposes and objectives; and diploma curriculum philosophy; purposes and objectives).
§ 21.373. Facility and resource requirements.
Section 21.373 provides that the support of the college or university must be adequate to meet the CRNP program's needs for physical plant, library resources and clinical areas. These requirements are consistent with financial and resource requirements placed on other schools of nursing. See § 21.91 (relating to facility and resource requirements).
§ 21.374. Selection and admission standards.
Section 21.374 relates to the selection and admission standards for CRNP programs. Programs may admit currently licensed RNs holding a baccalaureate degree, or its equivalent, who meet the admissions requirements to the college or university's graduate program. The Board regulates the admission standards of other nursing programs. See §§ 21.101 and 21.102 (relating to selection and admission standards; and admission of classes). The League guidelines require a baccalaureate degree for admission to a CRNP program.
§ 21.375. Advanced standing.
This section provides that a CRNP program must have a written policy, consistent with that of the college or university, regarding granting advanced standing. This requirement is consistent with the requirement placed on other nursing schools. See § 21.103 (relating to transfer of students or advanced standing).
§ 21.376. Program records.
Section 21.376 details the requirements for keeping the program's records. Student records must be maintained in locked files on forms specifically designed for the program, and must be kept for 50 years. Faculty records must include the Pennsylvania display license and certification, educational records and documentation of continuing education. Administrative records must include affiliation agreements, minutes of meetings, annual reports, follow-up studies of graduates, budgets and written policies. Finally, the school bulletin must be comprehensive and current, include refund policies and policies related to admission, promotion, retention, transfer, advanced placement and dismissal. These requirements are consistent with the requirements applied to other nursing education programs. See §§ 21.121--21.125 (relating to records).
§ 21.377. Custody of records.
This section relates to the custody of records and provides for transfer of records to the college or university if the program closes. If the college or university closes, the Board must be provided with information as to where the records are to be kept. This section is consistent with § 21.125 (relating to custody of records), which applies to other nursing programs.
The Board sent this proposed rulemaking to numerous nursing associations and hospital systems. These organizations were: American Association of Neuroscience Nurses; Emergency Nurses Association; GPC--Oncology Nursing Society; The Hospital and Healthsystem Association of Pennsylvania; Intravenous Nurse Society; Licensed Practical Nurses Association of Pennsylvania; Pennsylvania Association of Home Health Agencies; Pennsylvania Association of Private School Administrators; Pennsylvania Association of Non-Profit Homes for the Aging; Pennsylvania Association of Nurse Anesthetists; Pennsylvania Association of Practical Nursing Program Administrators; Pennsylvania Coalition of Nurse Practitioners; Pennsylvania College of Associate Degree Nursing; Pennsylvania Council of Operating Room Nurses; Pennsylvania Department of Health-Bureau of CH Systems; Pennsylvania Health Care Association; Pennsylvania Higher Education Nursing Schools Association; Pennsylvania League for Nursing, Inc.; Pennsylvania Organization of Nurse Leaders; Pennsylvania Society of Gastroenterology Nurses and Associates; Pennsylvania State Nurses Association; School Nurse Section, Southwestern Pennsylvania Organization for Nurse Leaders; Pennsylvania Medical Society; Nurses of Pennsylvania; Pennsylvania Association of School Nurses and Practitioners; Pennsylvania Nurses Association; and Professional Nursing Resources, Inc. In addition, the Board considered the impact the proposed rulemaking would have on the regulated community and on public safety and welfare.
Fiscal Impact and Paperwork Requirements
The proposed rulemaking will have no adverse fiscal impact on the Commonwealth or its political subdivisions because the costs of the Board's activities are supported by fees charged to licensees and others who benefit from specific activities of the Board. In this case, the fees for approval of CRNP programs will be identical to the fees charged for approval of RN programs. The proposed rulemaking will impose no additional paperwork requirements upon the Commonwealth or political subdivisions. CRNP educational programs will be required to submit documentation regarding their programs for the Board's review. In addition, these programs will be required to submit a brief annual report and more comprehensive triennial report to the Board, as is currently required of RN education programs.
Sunset Date
The Board continuously monitors the cost effectiveness of its regulations. Therefore, no sunset date has been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on August 23, 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.
Public Comment
Interested persons are invited to submit written comments, recommendations or objections regarding this proposed rulemaking to Ann Steffanic, Board Administrator, State Board of Nursing, P. O. Box 2649, Harrisburg, PA 17105 within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin.
JANET SHIELDS, CRNP,
ChairpersonFiscal Note: 16A-5119. No fiscal impact; (8) recommends adoption.
Annex
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. Approval of programs.
(a) The Board will consider for approval CRNP programs which require, at a minimum, a baccalaureate degree in nursing for admission and which culminate with a master's degree in nursing or postmaster's certificate.
(b) The Board will consider for approval Registered Nurse (RN) to MSN (Master of Science in Nursing), RN to N.D. (Nursing Doctorate), experimental or accelerated programs that culminate with at least a master's degree in nursing.
(c) The Board will consider for approval those programs with a primary goal to prepare the RN to function as a nurse practitioner in an expanded role in a particular specialty area and perform acts of medical diagnosis, prescription of medical therapeutic or corrective measures in collaboration with a physician licensed to practice medicine in this Commonwealth.
§ 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 must 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, 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 full approval status and programs on provisional approval status.
§ 21.363. Approval process.
(a) A program that meets 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. 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--21.378, 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 wishing 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 or Nationally accredited university or college.
(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 completing doctoral preparation. 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 certified registered nurse practitioner 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.
(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 must 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 certified nurse practitioner 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 ____ (Editor's Note: The blank refers to a date 2 years after adoption of this proposal.).
(2) Faculty members shall have at least 2 years of clinical nurse practitioner experience.
(3) Faculty members shall give evidence of maintaining expertise in their clinical or functional areas of specialization.
(4) Faculty members shall maintain currency in clinical practice through ongoing clinical practice.
(5) 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 must 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 must 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 must be taught in a separate or dedicated 3-credit or 45-hour course. Pharmacology content must also be integrated into the other content areas identified in the advanced practice nursing core. Additional application of this content must 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--21.287 (relating to CRNP practice).
(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 and must be consistent with the objectives of the CRNP courses.
(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 must 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 deem a new or different certification specialty title for graduates of that program require 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, must be formulated and adopted.
(b) The philosophy, purposes and objectives of the CRNP program must 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 can 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 6 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: advanced practice nurses who are currently licensed, physicians who are currently licensed and CRNPs who are currently licensed and certified. One preceptor may supervise no more than one student at any one time.
§ 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 programs 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 must 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 must employ a record system that ensures the operation of the program. Records must 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, must be kept for 50 years.
(2) Faculty records, including the following:
(i) ''Display portion'' of current Pennsylvania nursing licenses and CRNP certification.
(ii) Records of preparation and experience, including official college transcripts.
(iii) Current record of continuing education activities.
(iv) Record 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 bulletin, 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. 04-1635. Filed for public inspection September 3, 2004, 9:00 a.m.]
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