PROPOSED RULEMAKING
[49 PA. CODE CH. 21]
Temporary Practice Permits
[34 Pa.B. 4897] The State Board of Nursing (Board) proposes to add §§ 21.7 and 21.149 (relating to temporary practice permits) to read as set forth in Annex A.
Effective Date
The proposed rulemaking will be effective upon final-form publication in the Pennsylvania Bulletin.
Statutory Authority
The proposed rulemaking is authorized under sections 2.1(k) and 4.1 of the Professional Nursing Law (act) (63 P. S. §§ 212.1(k) and 214.1) and sections 3.1 and 17.6 of the Practical Nurse Law (63 P. S. §§ 653.1 and 667.6).
Background and Need for the Proposed Rulemaking
Over the past 2 years, the Board has experienced a great increase in the number of applications for temporary practice permit (TPP) extensions, specifically among individuals seeking extensions to TPPs for currently-licensed nurses. Section 14.1 of the act and section 17.6 of the Practical Nurse Law authorize the Board to issue a TPP to a person who holds a current license issued by another state, territory or possession of the United States.
Qualifications for licensure vary from state to state. In this Commonwealth, individuals who have graduated from a school of nursing that is not approved by the Board (that is, a nursing education program outside this Commonwealth) shall have their educational program evaluated to determine if it is equivalent to the education required for licensure in this Commonwealth. In addition, an individual shall have passed the licensure examination (NCLEX-RN for professional nurses or NCLEX-PN for practical nurses). See section 7 of the act (63 P. S. § 217) and section 16 of the Practical Nurse Law (63 P. S. § 656).
In reviewing the applications for extension, the Board discovered that the vast majority of applicants have not timely completed their applications for licensure. The statute requires that an applicant file an application for licensure at the same time as the application for a TPP. Submission of an application for licensure triggers the review of the applicant's nursing education program for equivalency, because one of the supporting documents submitted is a transcript of the individual's course work in his nursing education program. Upon review of the requests for extension of TPPs, the Board has discovered that applicants fail to provide the Board with required supporting documents in their license applications. The Board has identified this failure to provide supporting documentation as the reason these nurses experience delays in obtaining licensure. This proposed rulemaking sets forth time limits by which an applicant shall request supporting documentation for licensure. These time limits should dramatically reduce the requests for extensions to TPPs.
The Board seeks to reduce multiple or lengthy extensions to TPPs for several reasons. First, until an applicant has completed the application for licensure, the Board has not reviewed the applicant's qualifications to practice nursing. Therefore, it is possible that some applicants for licensure may practice in this Commonwealth for a period of time before the Board has determined whether the individual meets the statutory qualifications, which may in turn pose a threat to public health and safety. Second, the statute does not provide a mechanism by which the Board can discipline an individual who holds a TPP for misconduct. The Board can demand the return of the TPP and, if the person does apply for licensure, any misconduct while holding a TPP may provide sufficient grounds to deny licensure. However, the Board cannot require that the TPP holder participate in educational programs or place the TPP on probation.
Section 21.7 and 21.149 are virtually identical except that § 21.7 applies to professional nurses and § 21.149 applies to practical nurses. Therefore, the Board will describe only § 21.7. Subsection (a) applies to TPPs for graduate nurses and subsection (b) applies to TPPs for currently licensed nurses.
Description of the Proposed Rulemaking
Section 21.7(a)(1) mirrors section 4.1 of the act in requiring an individual who has graduated from an approved nursing program who wishes to practice as a graduate nurse prior to taking the licensing examination to apply for a TPP. In addition, § 21.7(a)(1) mirrors the statutory restriction that a TPP is valid for up to 1 year and expires if the TPP holder fails the licensing examination.
Section 21.7(a)(2) requires that the TPP holder submit an application for licensure by examination to the Board and register with the professional testing organization at least 90 days prior to the expiration date of the TPP. This provision is based on the 90-day validity period of the ''authorization to test.'' In other words, once an applicant has been approved to take the licensing examination, that approval is valid for 90 days.
Section 21.7(a)(3) provides that a TPP holder who wishes to apply for an extension of the TPP shall apply for the extension at least 60 days prior to the date the TPP is set to expire. In addition, the applicant for extension shall provide the Board with a detailed explanation of the need for the extension. Finally, § 21.7(a)(3) notifies these applicants that the Board will only grant an extension in cases of illness or extreme hardship. The 60-day time period allows the Board sufficient time to process and consider a request for an extension at a meeting of the Board.
Section 21.7(a)(4) provides that an extension will not be granted to an individual who has failed to comply with the 90-day and 60-day deadlines in § 21.7(a)(2) and (3). This provision is necessary to relieve the Board from considering extension applications from applicants who have not taken the steps necessary to timely obtain permanent licensure from the Board.
Section 21.7(b) applies to TPPs for currently-licensed professional nurses. Section 21.7(b)(1) mirrors section 4.1 of the act by providing that an individual who is currently licensed and wishes to practice in this Commonwealth during the 1-year period from the date of application for licensure until the Board makes a determination on the application may apply for a TPP. The Board specifies that the applicant need only submit Form 1 of the application for licensure, because the other forms are essentially verifications of education and licensure from the other state and must be submitted directly from the individual's educational institution and the other state. Moreover, once all the forms are completed, the Board will consider the application for licensure and a TPP would not be necessary.
Section 27.1(b)(2) provides that the individual applying for a TPP as a currently-licensed nurse shall demonstrate proficiency in English. This is necessary to ensure that the nurse can pass the licensure examination and can take and execute orders in the course of the nurse's practice. Currently, all licensed nurses for whom English is a second language who apply for licensure through the Commission on Graduates of Foreign Nursing Schools (CGFNS) are required to pass an English proficiency examination. The Board's experience with the CGFNS strongly suggests that requiring this examination actually speeds the licensure process and helps to ensure public safety. The nurse may demonstrate English proficiency by submitting proof that the nursing education program was conducted in English or by passing an English proficiency examination. The nurse shall submit proof of English proficiency with Form 1 of the application. This provision is designed to ensure that a nurse who will be granted a TPP is sufficiently knowledgeable in English to communicate with patients, other nurses and doctors from whom the nurse will take orders. The provision ensures that the nurse will not be hindered from safe practice by an inability to understand English.
Section 21.7(b)(3) requires the TPP holder to submit Form 2 of the application for licensure within 45 days of the date the TPP is granted. Form 2 includes the application for verification of licensure from the foreign jurisdiction, request of certification of the individual's nursing education program, including a copy of the individual's transcript translated into English, if necessary, and verification that the applicant has submitted an application to the CGFNS. Section 5 of the act (63 P. S. § 215) and § 21.28(c) (relating to licensure by endorsement) mandate verification of a foreign-educated applicant's educational qualifications by the CGFNS. The Board's review of the date that applicants who were seeking TPP extensions had applied for verification of their foreign nursing license, certification of their nursing education program and verification of their nursing program through the CGFNS demonstrated that the applicants were not applying for these verifications until approximately 1 to 2 months prior to the expiration date of the TPP. The CGFNS verification procedure alone takes approximately 9 months, depending on the availability of documentation from a particular country. Prompt application for verifications will alleviate most of the need for applicants to apply for an extension of their TPP.
Section 21.7(b)(4) provides that each TPP applicant shall ensure that the Board has received all supporting documentation for an application for licensure at least 90 days prior to the expiration of the TPP. The Board will notify applicants at this 90-day point if their applications are incomplete. Section 21.7(b)(4) requires the applicant to submit a written explanation of the efforts made to timely secure the required documentation.
Section 21.7(b)(5) authorizes an individual who holds a TPP to apply for an extension of the TPP if the applicant has complied with this regulation and submitted an extension application, remitted the application fee, submitted a written explanation of the reasons for the extension request and provided proof of compliance with § 21.7(b)(3). Finally, § 21.7(b)(5) requires that the individual seeking an extension request the extension at least 60 days prior to the expiration date of the TPP. It has been the common practice of TPP holders to request an extension on the last day the TPP is valid. The Board may not meet for 3 or more weeks after the date the TPP expires and the individual continues to practice without benefit of licensure or a TPP. This paragraph should insure that nurses have no gap in their authority to practice, and insure the public safety because these nurses are not covered by insurance and an injured patient could be left without recourse.
Section 21.7(b)(6) reiterates that an individual who fails to meet the requirements of subsection (b) will not be granted an extension of the TPP expiration date.
Section 21.149 is very similar to § 21.7, but in reference to TPPs for practical nurses.
The Board requested input in drafting of the proposed rulemaking from nursing associations and hospital systems. These organizations were as follows: 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., Grane Healthcare and the North Philadelphia Health System. The Board did not receive any comments on the exposure draft.
Also, the Board considered the impact the proposed rulemaking would have on the regulated community and on public safety and welfare. The Board finds that the proposed rulemaking addresses a compelling public interest as described in this preamble.
Fiscal Impact and Paperwork Requirements
The proposed rulemaking will have no adverse fiscal impact on the Commonwealth or its political subdivisions. The proposed rulemaking will impose no additional paperwork requirements upon the Commonwealth, political subdivisions or the private sector.
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 Department 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 Department, 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 17105-2649 within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin.
JANET HUNTER SHIELDS, MSN, CRNP, CNS,
ChairpersonFiscal Note: 16A-5121. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL LICENSURE AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 21. STATE BOARD OF NURSING
Subchapter A. REGISTERED NURSES
GENERAL PROVISIONS § 21.7. Temporary practice permits.
(a) The Board may grant a temporary practice permit to a graduate registered nurse as follows:
(1) An individual who wishes to practice as a graduate registered nurse during the period from the date of completion of a Board-approved educational program and notification of the results of the licensing examination shall submit an application for a temporary practice permit for a graduate registered nurse on a form provided by the Board and remit the fee specified in § 21.5 (relating to fees). A temporary practice permit granted under this section is valid for up to 1 year from the date of issuance and immediately expires if the applicant fails the licensing examination.
(2) At least 90 days prior to the expiration date of the temporary practice permit, the graduate registered nurse shall:
(i) Submit an application for licensure by examination as a registered nurse.
(ii) Remit the fee specified in § 21.5.
(iii) Submit the licensure examination registration form and fee required to the professional testing organization.
(3) At least 60 days prior to the expiration date of the temporary practice permit, the graduate registered nurse who wishes to extend the expiration date of the temporary practice permit because of illness or extreme hardship shall:
(i) Submit an application for temporary practice permit extension on a form provided by the Board.
(ii) Remit the fee specified in § 21.5.
(iii) Provide a detailed, written explanation of the reason the extension is requested. If requesting an extension due to illness, the applicant shall provide certification of the illness from the applicant's treating physician.
(4) The Board will not grant an extension to an individual who fails to meet the requirements of paragraphs (2) and (3).
(b) The Board may grant a temporary practice permit to a currently-licensed registered nurse as follows:
(1) An individual who holds a current registered nurse license issued by any other state, territory or possession of the United States or Canada and who wishes to practice professional nursing during the period from the date of submission of Form 1 of the application for licensure until the Board makes a determination on the application for licensure or 1 year, whichever comes first, shall:
(i) Submit an application for temporary practice permit for a currently-licensed registered nurse on a form provided by the Board.
(ii) Remit the fee specified in § 21.5.
(2) An individual applying for a temporary practice permit for a currently-licensed registered nurse shall demonstrate proficiency in English by submitting proof that the individual's nursing education program was conducted in English or that the individual has received a passing score on a Board-approved English proficiency examination. A list of Board-approved English proficiency examinations is available upon request to the Board. This information must be submitted with Form 1 of the application for licensure.
(3) Within 45 days of the date the temporary practice permit is issued, an individual who has been granted a temporary practice permit for a currently-licensed registered nurse shall submit Form 2 of the application for licensure and shall:
(i) Request verification of licensure from the foreign jurisdiction and retain documentation of the submission of the request to provide to the Board upon request.
(ii) Request certification of the applicant's nursing education program from the licensing board or appropriate educational authorities. The certification of nursing education must be submitted to the Board in English directly from the appropriate educational authorities. The applicant shall retain documentation of the submission of the request to provide to the Board upon request.
(iii) Submit the Commission on Graduates of Foreign Nursing Schools (CGFNS) application if the applicant is required to meet CGFNS requirements in §§ 21.23(c) and 21.28(c) (relating to qualifications of applicant for examination; and licensure by endorsement) and retain documentation of the submission of the CGFNS application to provide to the Board upon request.
(iv) If the applicant is required to take the licensure examination, submit the licensure examination registration form and fee required to the professional testing organization and retain documentation of the submission of the application to take the examination to provide to the Board upon request.
(4) An individual who has been granted a temporary practice permit for a currently-licensed registered nurse shall ensure that all documentation in support of the application for licensure is received by the Board no later than 90 days prior to the expiration date of the temporary practice permit. Any individual whose supporting documentation has not been received by the Board at least 90 days prior to the expiration date of the temporary practice permit shall submit, within 10 days of receiving notice of the deficiency from the Board, a detailed written explanation of why the supporting documentation has not been supplied to the Board in a timely manner.
(5) An individual who has been granted a temporary practice permit for a currently-licensed registered nurse and who has complied with paragraphs (2)--(4) may request an extension of the temporary practice permit by:
(i) Submitting a temporary practice permit extension application provided by the Board.
(ii) Remitting the fee specified in § 21.5.
(iii) Submitting a written, detailed explanation of the reasons the extension is requested. If requesting an extension due to illness, the applicant shall provide certification of the illness from the applicant's physician.
(iv) Providing proof of the timely request for verification of licensure referenced in paragraph (3)(i).
(6) The request for temporary practice permit extension must be submitted to the Board at least 60 days prior to the expiration date of the temporary practice permit.
(7) The Board will not grant an extension to an individual who fails to meet the requirements of paragraphs (2)--(5).
Subchapter B. PRACTICAL NURSES
GENERAL PROVISIONS § 21.149. Temporary practice permits.
(a) The Board may grant a temporary practice permit to a graduate practical nurse as follows:
(1) An individual who wishes to practice as a graduate practical nurse during the period from the date of completion of a Board-approved educational program and notification of the results of the licensing examination shall submit an application for temporary practice permit for a graduate practical nurse on a form provided by the Board and remit the fee specified in § 21.5 (relating to fees). A temporary practice permit granted under this section is valid for up to 1 year from the date of issuance and immediately expires if the applicant fails the licensing examination.
(2) At least 90 days prior to the expiration date of the temporary practice permit, the graduate practical nurse shall:
(i) Submit an application for licensure by examination as a practical nurse.
(ii) Remit the fee specified in § 21.5.
(iii) Submit the licensure examination registration form and fee required to the professional testing organization.
(3) At least 60 days prior to the expiration date of the temporary practice permit, the graduate practical nurse who wishes to extend the expiration date of the temporary practice permit shall:
(i) Submit an application for temporary practice permit extension on a form provided by the Board.
(ii) Remit the fee specified in § 21.5.
(iii) Provide a detailed, written explanation of the reasons the extension is requested. If requesting an extension due to illness, the applicant shall provide certification of the illness from the applicant's physician.
(4) The Board will not grant an extension to an individual who fails to meet the requirements of paragraphs (2) and (3).
(b) The Board will grant a temporary practice permit for a currently-licensed practical nurse as follows:
(1) An individual who holds a current practical nurse license issued by any other state, territory or possession of the United States or Canada and who wishes to practice practical nursing during the period from the date of submission of Form 1 of the application for licensure until the Board makes a determination on the application for licensure or 1 year, whichever comes first, shall:
(i) Submit an application for temporary practice permit for a currently-licensed practical nurse on a form provided by the Board.
(ii) Remit the fee specified in § 21.5.
(2) An individual applying for a temporary practice permit for a currently-licensed practical nurse shall demonstrate proficiency in English by submitting proof that the individual's nursing education program was conducted in English or that the individual has received a passing score on a Board-approved English proficiency examination. A list of Board-approved English proficiency examinations is available upon request to the Board. This information shall be submitted with Form 1 of the application for licensure.
(3) Within 45 days of the date the temporary practice permit is issued, an individual who has been granted a temporary practice permit for a currently-licensed practical nurse shall submit Form 2 of the application for licensure and shall:
(i) Request verification of licensure from the foreign jurisdiction and retain documentation of submission of the request to provide to the Board upon request.
(ii) Request certification of the applicant's nursing education program from the licensing board or appropriate educational authorities. The certification of nursing education must be submitted to the Board in English directly from the appropriate educational authorities. The applicant shall retain documentation of submission of the request to submit to the Board upon request.
(iii) Submit the Commission on Graduates of Foreign Nursing Schools (CGFNS) application if the applicant is required to meet CGFNS requirements in § 21.155(d) (relating to licensure by endorsement) and retain documentation of the submission of the CGFNS application to provide to the Board upon request.
(iv) If the applicant is required to take the licensure examination, submit the licensure examination registration form and fee required to the professional testing organization and retain documentation of the submission of the application to take the examination to provide to the Board upon request.
(4) An individual who has been granted a temporary practice permit for a currently-licensed practical nurse shall ensure that all documentation in support of the application for licensure is received by the Board at least 90 days prior to the expiration date of the temporary practice permit. An individual whose supporting documentation has not been received by the Board at least 90 days prior to the expiration date of the temporary practice permit shall submit, within 10 days of receiving notice of the deficiency from the Board, a detailed written explanation of why the supporting documentation has not been supplied to the Board in a timely manner.
(5) An individual who has been granted a temporary practice permit for a currently-licensed practical nurse and who has complied with paragraphs (2)--(4) may request an extension of the temporary practice permit because of illness or extreme hardship by:
(i) Submitting a temporary practice permit extension application on a form provided by the Board.
(ii) Remitting the fee specified in § 21.5.
(iii) Submitting a written, detailed explanation of the reasons the extension is requested. If requesting an extension due to illness, the applicant shall provide certification of the illness from the applicant's treating physician.
(iv) Providing proof of the timely request for verification of licensure referenced in paragraph (3)(i).
(6) The request for temporary practice permit extension must be submitted to the Board at least 60 days prior to the expiration date of the temporary practice permit.
(7) The Board will not grant an extension to an individual who fails to meet the requirements of paragraphs (2)--(5).
[Pa.B. Doc. No. 04-1636. Filed for public inspection September 3, 2004, 9:00 a.m.]
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