TWENTY-SEVENTH LEGISLATURE, 2014
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO CONTINUING COMPETENCY FOR NURSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that to ensure public health, candidates for initial nurse licensure are required to pass a national examination that measures the minimum competencies needed to perform safely and effectively as newly licensed, entry-level registered or practical nurses. In today's health care environment, because technology and practice are continually changing and new health care systems are emerging, the challenge of licensure boards is to assure consumers that nurses are competent throughout their practice careers. Research shows that continuing education alone is not enough to ensure competency in post-entry nurses. According to the Institute of Medicine, "[A]n emerging concept ... includes components of [continuing education] but has a broader focus, such as teaching how to identify problems and apply solutions, and allowing health professionals to tailor the learning process, setting, and curriculum to their needs."
The legislature further finds that continuing competency that ensures continued patient health and safety requires lifelong learning and ongoing redefinition based on the individual's experience, change in practice setting, and educational advancement. Each nurse must maintain and augment the necessary knowledge and skills to be current in practice. To do this, each nurse needs a self-assessment tool that enables the nurse to: assess and adapt to their learning needs; stretch learning from the classroom to the point of care; match the need for continuing education to the learning for competence; and support increased personal accountability for lifelong learning to ensure safe practice.
The legislature therefore finds that the Hawaii nurse continued competency program, which contains these elements and learning activity options, must be established for nurses licensed in Hawaii.
Accordingly, the purpose of this Act is to require licensed registered nurses and licensed practical nurses to submit evidence of continuing competency at each renewal period, beginning with the June 30, 2015, licensing biennium.
SECTION 2. Chapter 457, Hawaii Revised Statutes, is amended by adding five new sections to be appropriately designated and to read as follows:
"§457- Continuing competence requirements; qualifying learning activities; documentation; audit. (a) In addition to the requirements of section 457-9, upon application for license renewal or reinstatement, each registered nurse and practical nurse licensee shall:
(1) Complete a self-assessment of practice, including the dimensions of professional responsibility, knowledge based practice, legal/ethical practice, and collaborating with others;
(2) Develop a plan for continued learning; and
(3) Select and implement a learning activity option pursuant to subsection (d).
(b) Registered nurses licensed in this State who also maintain active advanced practice registered nurse licenses in accordance with this chapter shall not be required to fulfill additional continuing competency requirements for registered nurses under subsection (a).
For first-time license renewals, if the initial license was issued twelve months or less prior to the renewal date, no continuing competence units will be required for the first renewal period. If the initial license was issued more than twelve months prior to the renewal date, the licensee shall be required to obtain fifteen units of approved continuing competence units for the first renewal period.
(c) Upon application for license renewal or reinstatement, each licensee shall attest to completion of one of the learning activity options pursuant to subsection (d) during the two years preceding the application for license renewal and shall be prepared to submit evidence of completion if requested by the board.
(d) Completion of one of the following learning activities shall meet the requirements for continuing competence under subsection (a):
(1) National certification or recertification related to the nurse's practice role;
(2) Thirty contact hours of continuing education activities;
(3) Completion of a board approved refresher course;
(4) Completion of a minimum of two semester hours of post-licensure academic education related to nursing practice;
(5) Fifteen contact hours of a continuing education activity and completion of a nursing research or evidence-based practice project as principal or co-principal investigator;
(6) Fifteen contact hours of a continuing education activity and authoring or coauthoring a peer reviewed published nursing or health-related article, paper, book, or book chapter;
(7) Fifteen contact hours of a continuing education activity and developing and conducting a nursing education presentation or presentations totaling a minimum of five contact hours;
(8) Fifteen contact hours of a continuing education activity and six hundred forty hours of active practice within the previous two years; or
(9) Completion of a recognized nurse residency program.
(e) The following activities do not meet the requirements for continuing competency:
(1) Offerings designed for lay persons;
(2) Offerings less than thirty minutes in duration;
(3) On-the-job orientation;
(4) On-the-job training related to new policies, procedures, or equipment; or
(5) Other educational activities not sufficiently professional in character to reasonably qualify as continuing education.
(f) Acceptable documentation for completion of the learning activities under subsection (d) includes the following evidence:
(1) For national certification or recertification: a copy of a certificate that includes the name of the licensee, name of the certifying body, date of certification, and date of certification expiration. Certification shall be initially attained during the licensure period, have been in effect during the entire licensure period, or have been recertified during the licensure period;
(2) For contact hours of continuing education: the name of the licensee, title of educational activity, name of the provider, number of contact hours, and date of activity;
(3) For a board approved refresher course: written correspondence from the provider with the name of the licensee, name of the provider, and verification of successful completion of the refresher course;
(4) For post-licensure academic education: a copy of the licensee's transcript with the name of the licensee, name of the educational institution, dates of attendance, name of course with grade, and number of credit hours received. Coursework shall demonstrate relevance to nursing, health, or both;
(5) For a nursing project: an abstract or summary of the project, the name of the licensee, role of the licensee as principal or co-principal investigator, date of project completion, statement of the problem, project objectives, methods used, and summary of findings;
(6) For authoring or co-authoring a peer reviewed published nursing-related article, paper, book, or book chapter: a copy of the publication, including the name of the licensee and the publication date;
(7) For developing and conducting a nursing education presentation or presentations totaling at least five contact hours: a copy of the program brochure or course syllabi, objectives, content, and teaching methods, and date and location of presentation; and
(8) For six hundred forty hours of active practice in nursing: name of the licensee, number of hours worked in a calendar or fiscal year, name and address of the employer, and signature of supervisor. If self-employed, hours worked may be validated through other methods, such as tax records or other business records. If active practice is of a volunteer or gratuitous nature, hours worked may be validated by the recipient agency.
(g) At the time of license renewal or reinstatement, licensees may be subject to audit for proof of compliance with the board's requirements for continuing competence.
(h) The board may randomly audit a licensee's continuing competence units and may establish guidelines for random audits. The board shall inform licensees of the licensees' selection for audit upon notice of license renewal or reinstatement. Documentation of acceptable evidence shall be consistent with subsection (f) and shall be submitted to the board no later than the last day of the renewal month.
(i) Unless exempted, failure of a licensee to meet continuing competency requirements shall result in disciplinary action in accordance with this chapter. Failure to present evidence of compliance to the board upon request shall constitute a forfeiture of the license.
§457- Authorized providers of continuing competence units. (a) Continuing education may be taken in a conventional classroom setting, via online courses, professional journals, correspondence, or other emerging venues.
(b) Continuing competence units shall be obtained from the following authorized providers:
(1) Any provider, recognized by a national credentialing body, offering certification in the licensed nurse's specialty area of practice, including but not limited to: American Nurses Credentialing Center Commission on Certification; Oncology Nursing Certification Corporation; Board of Certification for Emergency Nursing; National Association for Practical Nurse Education and Service, Inc.; and National Commission for Health Education Credentialing, Inc.;
(2) Any provider, recognized by a national credentialing body, offering certification to nurse practitioners, nurse midwives, nurse anesthetists, or clinical nurse specialists, including but not limited to: American Nurses Credentialing Center Commission on Certification; American Academy of Nurse Practitioners; National Certification Corporation; Pediatric Nursing Certification Board; and Council on Certification of Nurse Anesthetists;
(3) American Nurses Association, or any state professional nurses association with standards equal to or greater than the State's standards;
(4) Area Health Education Centers in the State or any state Area Health Education Center that is a member of the National Area Health Education Center Organization;
(5) National League for Nursing;
(6) National Association for Practical Nurse Education and Service, Inc.;
(7) National Federation of Licensed Practical Nurses;
(8) Any state board of nursing with standards equal to or greater than the State's standards;
(9) National Council of State Boards of Nursing;
(10) Employer-sponsored continuing education programs having a minimum of one course objective; provided that employer-sponsored continuing education may only be used for up to fifty per cent of total contact hours unless the program is accredited through one of the authorized providers in this subsection;
(11) Any provider of professional continuing education for health care professionals recognized by the board, with offerings related to specialty areas of nursing practice such as research, case management, health policy, forensics, mental health, or complementary alternative therapies offered by entities including but not limited to the Commission for Case Manager Certification, National Association for Healthcare Quality, or American Legal Nurse Consultant Certification Board;
(12) Professional journals such as American Journal of Nursing, Nursing 2006, Nursing Management, Journal of Practical Nursing, and The Nurse Practitioner, offering continuing education approved by authorized providers including but not limited to: American Nurses Credentialing Center; American Association of Critical-Care Nurses; and National Association for Practical Nurse Education and Service, Inc.
§457- Exemption from continuing competence requirements. (a) Prior to the expiration of a renewal period, a licensee may submit a written request to the board for an exemption from the continuing competence requirements in this chapter.
(b) The request for an exemption shall include evidence that, during the two-year period prior to the expiration of the license:
(1) The licensee was residing in another country for one year or longer, reasonably preventing completion of the continuing competence requirements;
(2) The licensee was ill or disabled for one year or longer as documented by a licensed physician, surgeon, clinical psychologist, or advanced practice registered nurse, preventing completion of the continuing competence requirements; or
(3) A dependent family member of the licensee was ill or disabled for one year or longer as documented by a licensed physician, surgeon, clinical psychologist, or advanced practice registered nurse, preventing completion of the continuing competence requirements.
(c) Exemptions shall be considered by the board on a case by case basis. Exemptions shall not be granted unless proof, deemed appropriate and sufficient by the board that the applicant can practice safely, is submitted to the board. Exemptions shall not be granted for more than one renewal period. In the event a licensee cannot complete the continuing competence requirements during the two-year period after receiving an exemption, the licensee may only renew the license on an inactive status.
(d) When a licensee is absent from the State because of military service for a period of one year or longer during the two-year renewal period, preventing completion of the continuing competence requirement, the board may provide an exemption from the continuing competence requirement for more than one renewal period.
§457- Record keeping for continuing competence. (a) Each licensee shall keep and maintain records showing that each course or activity for which credit is claimed has been completed.
(b) These records shall reflect the title of the course or activity, the date taken or completed, and the record of participation.
(c) Each licensee shall retain records required pursuant to this section for a period of four years after the course or activity concludes. Each licensee shall provide copies of the records to the board or its designee within fourteen calendar days after being requested to provide such documentation.
§457- Continuing competence; acceptable contact hours or continuing education units. (a) The following are acceptable contact hours or continuing education units that fulfill the continuing competence requirements of this chapter:
(1) One contact hour shall be equivalent to sixty minutes of instruction;
(2) One contact hour shall be equivalent to sixty minutes of clinical or laboratory practice in an informal offering or a minimum of fifty minutes of actual organized instruction;
(3) One continuing medical education unit shall be equivalent to one contact hour of instruction; and
(4) One continuing education unit shall be equivalent to ten contact hours of instruction.
(b) Academic credit shall be converted to contact hours as follows:
(1) One quarter academic credit shall be equivalent to twelve and one-half contact hours; and
(2) One semester academic credit shall be equivalent to fifteen contact hours.
(c) Contact hour equivalencies shall be as follows:
(1) One continuing education unit shall be equivalent to ten contact hours;
(2) One continuing medical education credit shall be equivalent to sixty minutes; and
(3) One American Medical Association credit shall be equivalent to sixty minutes."
SECTION 3. Section 457-2, Hawaii Revised Statutes, is amended by adding three new definitions to be appropriately inserted and to read as follows:
""Competence" means the application of knowledge, skills, and behaviors required to function effectively, safely, ethically, and legally within the context of the individual's role and environment.
"Continuing competence" means the lifelong process of maintaining and documenting competence through ongoing self-assessment, development, and implementation of a personal learning plan, and subsequent reassessment.
"Unit" means a relative value assigned to continuing competence activities in which one continuing competence unit is equivalent to at least fifty minutes of classroom or hands on instruction."
SECTION 4. New statutory material is underscored.
SECTION 5. This Act shall take effect upon its approval; provided that the continuing competence requirements for registered nurses and practical nurses shall take effect with the licensing biennium beginning on June 30, 2015.
Nurses; Registered Nurses; Practical Nurses; Continuing Competency; Licensing; Registration
Requires licensed registered nurses and licensed practical nurses to submit evidence of continuing competency at each renewal period, beginning with the June 30, 2015, licensing biennium. (SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.