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A BILL TO BE ENTITLED
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AN ACT
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relating to a study of alternate ways to assure clinical competency |
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of graduates of nursing educational programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 105, Health and Safety Code, is amended |
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by adding Section 105.008 to read as follows: |
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Sec. 105.008. STUDY OF ALTERNATE WAYS TO ASSURE CLINICAL |
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COMPETENCY OF GRADUATES OF NURSING EDUCATIONAL PROGRAMS. (a) In |
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this section: |
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(1) "Clinical competency assessment program" means a |
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professional nursing prelicensure program that employs a |
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criterion-referenced summative performance examination, developed |
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by subject matter experts, to verify its graduates' attainment of |
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the clinical competency necessary for initial licensure as a |
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registered nurse. |
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(2) "Professional nursing prelicensure program" means |
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a professional nursing educational program that prepares students |
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to obtain an initial license as a registered nurse. |
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(3) "Research study" means the study described by |
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Subsection (b). |
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(4) "Supervised clinical learning experiences |
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program" means a professional nursing prelicensure program that |
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requires students to complete a required number of supervised |
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clinical learning experiences provided by qualified clinical |
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faculty involving multiple, ongoing assessments and feedback. |
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(b) To the extent funding is available, the nursing resource |
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section established under Section 105.002(b) shall conduct a |
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research study to identify: |
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(1) a set of expected student outcomes in terms of |
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clinical judgment and behaviors that professional nursing students |
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should possess at the time of graduation from a professional |
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nursing prelicensure program; |
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(2) standardized, reliable, and valid clinical exit |
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evaluation tools that could be used to evaluate the competencies in |
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clinical judgment and behaviors that professional nursing students |
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possess at the time of graduation from a professional nursing |
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prelicensure program; |
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(3) any correlation between the success rate of |
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graduates of professional nursing prelicensure programs on |
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standardized clinical exit evaluation tools and their educational |
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and experiential background, including: |
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(A) length and type of health care work |
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experience before entering the professional nursing prelicensure |
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programs; |
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(B) health care work experience during the |
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professional nursing prelicensure programs; and |
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(C) alternative methods of teaching clinical |
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judgment and behaviors, including supervised clinicals and |
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simulation laboratories; and |
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(4) any correlation between the required number of |
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hours in supervised clinical learning experiences and expected |
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student outcomes in terms of clinical judgment and behaviors. |
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(c) In addition to any other objective, the research study |
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must be designed to determine if the graduates of a clinical |
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competency assessment program are substantially equivalent to the |
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graduates of supervised clinical learning experiences programs in |
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terms of clinical judgments and behaviors. For purposes of this |
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subsection, the clinical competency assessment program must be one |
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that: |
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(1) has been requiring a clinical competency |
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assessment for at least 10 years; |
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(2) has students who reside in this state; |
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(3) has graduates who have been considered by the |
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Texas Board of Nursing to be eligible to apply for a registered |
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nurse license as a result of graduating from the program on or |
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before January 1, 2007; and |
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(4) conducts the clinical competency assessment at a |
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facility or facilities located in this state under the supervision |
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of a qualified clinical faculty member who is a registered nurse and |
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who holds a master's or doctoral degree in nursing. |
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(d) Considerations to be used in determining substantial |
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equivalence under Subsection (c) must include the differences |
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between the clinical competency assessment program and the |
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supervised clinical learning experiences program in: |
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(1) the methods of evaluating students' clinical |
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judgment and behaviors; |
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(2) performance on standardized clinical exit |
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evaluation tools; |
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(3) the ability of graduates to transition to and |
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assimilate in the registered nurse's role; and |
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(4) passage rates on the National Council Licensure |
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Examination. |
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(e) The nursing resource section shall contract with an |
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independent researcher to develop the research design and conduct |
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the research. The independent researcher must be selected by a |
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selection committee composed of: |
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(1) one representative elected by a majority of the |
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nursing advisory committee under Section 104.0155 who is the chair |
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of the selection committee; |
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(2) one representative designated by the Texas Health |
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Care Policy Council; |
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(3) the presiding officer of the Texas Board of |
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Nursing; |
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(4) one representative of the Texas Higher Education |
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Coordinating Board, designated by the governor; |
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(5) one representative designated by the Texas |
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Hospital Association; |
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(6) one representative designated by the Texas |
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Association of Business; |
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(7) one representative of a clinical competency |
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assessment program, designated by the governor; and |
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(8) the nurse researcher member of the nursing |
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advisory committee under Section 104.0155. |
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(f) The nursing resource section shall complete the study |
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not later than June 30, 2014, and shall submit a report to the |
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office of the governor, the Senate Committee on Health and Human |
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Services, and the House Committee on Public Health. The report must |
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include a research abstract prepared by the independent researcher. |
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(g) The nursing resource section may cooperate with the |
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Texas Board of Nursing and the Texas Higher Education Coordinating |
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Board in conducting the study. |
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(h) The nursing advisory committee formed under Section |
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104.0155 shall serve as the oversight committee for the study. |
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(i) Any data collected as part of the study that contains |
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information identifying specific students, patients, or health |
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care facilities is confidential, is not subject to disclosure under |
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Chapter 552, Government Code, and may not be released unless all |
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identifying information is removed. |
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(j) In addition to funds appropriated by the legislature, |
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the nursing resource section may solicit, receive, and spend |
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grants, gifts, and donations from public or private sources for the |
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purpose of conducting the study. |
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(k) If grants or other funds are available through the |
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National Council of State Boards of Nursing that could be used to |
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fund the study, the nursing resource section shall apply for the |
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funds to the maximum amount available up to the estimated cost of |
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the study. In making the application or accepting the funding, the |
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nursing resource section may not relinquish any oversight |
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responsibility for the study, including responsibility for |
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designing and conducting the research or developing the findings. |
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SECTION 2. Section 301.155(c), Occupations Code, is amended |
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to read as follows: |
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(c) The board shall assess a [$3] surcharge of not less than |
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$3 or more than $5 for a registered nurse and a [$2] surcharge of not |
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less than $2 or more than $3 for a vocational nurse to the fee |
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established by the board under Subsection (a) for a license holder |
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to renew a license under this chapter. The board may use nine cents |
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of the registered nurse surcharge and six cents of the vocational |
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nurse surcharge to cover the administrative costs of collecting and |
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depositing the surcharge. The board quarterly shall transmit the |
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remainder of each surcharge to the Department of State Health |
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Services to be used only to implement the nursing resource section |
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under Section 105.002, Health and Safety Code. The board is not |
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required to collect the surcharge if the board determines the funds |
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collected are not appropriated for the purpose of funding the |
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nursing resource section. |
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SECTION 3. Section 301.157, Occupations Code, is amended by |
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amending Subsection (d-4) and adding Subsections (d-8), (d-9), |
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(d-10), and (d-11) to read as follows: |
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(d-4) The board may recognize and accept as approved under |
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this section a school of nursing or educational program operated in |
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another state and approved by a state board of nursing or other |
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regulatory body of that [another] state. The board shall develop |
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policies to ensure that the other state's [state board's] standards |
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are substantially equivalent to the board's standards. |
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(d-8) For purposes of Subsection (d-4), a nursing program |
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is considered to meet standards substantially equivalent to the |
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board's standards if the program: |
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(1) is part of an institution of higher education |
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located outside this state that is approved by the appropriate |
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regulatory authorities of that state; |
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(2) holds regional accreditation by an accrediting |
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body recognized by the United States Secretary of Education and the |
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Council for Higher Education Accreditation; |
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(3) holds specialty accreditation by an accrediting |
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body recognized by the United States Secretary of Education and the |
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Council for Higher Education Accreditation, including the National |
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League for Nursing Accrediting Commission; |
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(4) requires program applicants to be a licensed |
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practical or vocational nurse, a military service corpsman, or a |
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paramedic, or to hold a college degree in a clinically oriented |
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health care field with demonstrated experience providing direct |
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patient care; and |
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(5) graduates students who: |
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(A) achieve faculty-determined program outcomes, |
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including passing criterion-referenced examinations of nursing |
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knowledge essential to beginning a registered nursing practice and |
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transitioning to the role of registered nurse; |
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(B) pass a criterion-referenced summative |
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performance examination developed by faculty subject matter |
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experts that measures clinical competencies essential to beginning |
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a registered nursing practice and that meets nationally recognized |
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standards for educational testing, including the educational |
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testing standards of the American Educational Research |
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Association, the American Psychological Association, and the |
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National Council on Measurement in Education; and |
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(C) pass the National Council Licensure |
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Examination for Registered Nurses at a rate equivalent to the |
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passage rate for students of approved in-state programs. |
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(d-9) A graduate of a clinical competency assessment |
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program operated in another state and approved by a state board of |
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nursing or other regulatory body of another state is eligible to |
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apply for an initial license under this chapter if: |
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(1) the board allowed graduates of the program to |
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apply for an initial license under this chapter continuously during |
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the 10-year period preceding January 1, 2007; |
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(2) the program does not make any substantial changes |
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in the length or content of its clinical competency assessment |
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without the board's approval; |
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(3) the program remains in good standing with the |
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state board of nursing or other regulatory body in the other state; |
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and |
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(4) the program participates in the research study |
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under Section 105.008, Health and Safety Code. |
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(d-10) In this section, the terms "clinical competency |
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assessment program" and "supervised clinical learning experiences |
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program" have the meanings assigned by Section 105.008, Health and |
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Safety Code. |
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(d-11) Subsections (d-8), (d-9), (d-10), and (d-11) expire |
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December 31, 2017. As part of the first review conducted under |
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Section 301.003 after September 1, 2009, the Sunset Advisory |
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Commission shall: |
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(1) recommend whether Subsections (d-8) and (d-9) |
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should be extended; and |
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(2) recommend any changes to Subsections (d-8) and |
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(d-9) relating to the eligibility for a license of graduates of a |
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clinical competency assessment program operated in another state. |
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SECTION 4. Section 63.202(f), Education Code, is amended to |
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read as follows: |
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(f) Notwithstanding the limitation provided by Subsection |
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(b), grants awarded under Subsection (c) for the state fiscal |
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biennium ending on August 31, 2009, and the fiscal biennium ending |
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on August 31, 2011, by the Texas Higher Education Coordinating |
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Board shall be awarded to programs preparing students for initial |
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licensure as registered nurses or programs preparing qualified |
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faculty members with a master's or doctoral degree for the program, |
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including programs at two-year institutions of higher education, |
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four-year general academic teaching institutions, health science |
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centers, and independent or private institutions of higher |
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education, or to the nursing resource section established under |
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Section 105.002(b), Health and Safety Code. In awarding grants |
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under this subsection, the coordinating board may: |
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(1) give priority to institutions proposing to address |
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the shortage of registered nurses by promoting innovation in |
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education, recruitment, and retention of nursing students and |
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qualified faculty; |
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(2) award grants on a competitive basis; [and] |
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(3) consider the availability of matching funds; and |
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(4) fund a study by the nursing resource section to |
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evaluate the competencies of clinical judgment and behaviors that |
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professional nursing students should possess at the time of |
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graduation. |
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SECTION 5. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2009. |