Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009 Page: 5,531
5445-5614 p. ; 28 cm.View a full description of this periodical.
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be competent. Further, the commenter states that her organi-
zation would be very supportive of stronger rules with regard to
refresher courses for nurses re-entering practice in clinical set-
tings.
A commenter representing another organization states that the
organization supports the Board's decision to permit nurses to
demonstrate competency through means other than continuing
education. The commenter states that the proposed rules permit
a nurse to demonstrate continued competency through continu-
ing education in the nurse's area of practice; national certifica-
tion in the nurse's area of practice; or completion of an academic
course in the nurse's area of practice. The commenter's organ-
ization supports this model because implementing it should be
the Board's and nursing's goal. The commenter states that her
organization has studied this issue for over five years and has
compiled a short and long version. Her organization believes
nursing has taken, like other health professions, a very long time
in addressing competency. For that reason, her organization en-
courages the Board to move forward with the rule it proposed,
but she states that her organization is quick to say it does not
have all the answers with regard to area of practice and would
recommend that the Board put into place all aspects of the pro-
posed rules, but delete that section to see if, after a short period
of time of study (3-6 months), her organization and others can
come up with answers to questions that nurses are just begin-
ning to ask. The commenter states that this is a very complex
issue and she believes an agreement can be reached, but at this
point in time, there are more questions arising than can be an-
swered.
The commenter states that, while the concept of "area of prac-
tice" is one that nurses intuitively understand, it is a concept that
is difficult to define with the precision needed for this rule. The
commenter states that if area of practice is defined too broadly,
it becomes diluted as being a measure of true competency and
fails to achieve the desired objective that continuing education
enhance a nurse's competency in the specific knowledge and
skills needed by the nurse in the nurse's area of practice. How-
ever, the commenter states that if it is defined too narrowly, there
will be many outliers in the nursing profession that don't fit into
the mainstream and it precludes the use of general continuing
education, such as jurisprudence from being used to fulfill the
continuing education requirement.
The commenter states that, before area of practice can be sat-
isfactorily defined, nursing needs to try to reach consensus on
some questions, such as:
Should a nurse be permitted to use continuing education (e.g.,
jurisprudence) applicable to all areas of practice to satisfy the
continuing education component of the new model? If so, to
satisfy the entire continuing education requirement or only some
of it? If only some, how much?
If a nurse primarily practices in one area of practice but infre-
quently practices in several others, can the nurse take continu-
ing education in any of these areas? Should the nurse have to
take at least some continuing education in the nurse's primary
area of practice?
What if the nurse does not engage in any nursing during the li-
cense renewal period, e.g., takes three years off to raise a fam-
ily?
Does it make any difference in the type of continuing education
a nurse should take if he or she is involved in direct patient care?The commenter states that her organization does not believe
the continuing education component of the new model can be
satisfactorily addressed until more thought is devoted to these
questions and some consensus is achieved. The commenter
notes that TNA's Competency Task Force did not work through
all of the implications of these questions.
The commenter also suggests coming up with a broad base.
The commenter suggests utilizing the four modalities outlined
in TNA's original paper on the subject. As an example, the com-
menter states that a nurse in clinical practice could select from
the first and second domain, while other areas could utilize do-
mains three and four.
The commenter's organization recommends that the continuing
education component in the proposed rules be modified to delete
the requirement that the continuing education be in the nurse's
area of practice. However, the commenter's organization also
recommends that the Board announce that its intent is to add
such a requirement in the near future and immediately appoint
a work group to begin working out the details of how some of
the previously identified questions should be answered and how
area of practice should be defined.
The commenter's organization believes that any questions that
may arise about area of practice as applied to national certifi-
cation problems do not present the same level of difficulty and
supports retaining the requirement that national certification be
in the nurse's area of practice.
Finally, the commenter states that if the Board decides to pro-
ceed with immediately requiring that continuing education be in
the nurse' area of practice, her organization believes that the
rules need to incorporate some type of transition to the new re-
quirement. One possibility would be to provide that nurses gets
credit for any continuing education taken prior to the rules' effec-
tive date or some other time certain.
Agency Response: The Board is committed to protecting and
promoting the welfare of the people of Texas by ensuring that
each person holding a license as a nurse in the State of Texas
is competent to practice safely. The Board believes that enact-
ing rules that promote competency in a nurse's area of prac-
tice is one way to support this mission. While the Board contin-
ues to support the demonstration of continuing competency in
a nurse's specific area of practice, the Board agrees that there
may be unanticipated or unintended consequences of the rule
as proposed, specifically regarding those nurses working in non-
traditional nursing occupations or those nurses who are not ac-
tively practicing nursing. The Board recognizes the complexi-
ties that have been raised by various commenters and that are
associated with requiring a nurse to obtain continuing educa-
tion in his or her area of practice. While the Board agrees that
the rules as proposed do not adequately address the particular
complexities associated with an "area of practice" competency
requirement, the Board feels that an "area of practice" compo-
nent should be incorporated into the continuing competency re-
quirements at some point in the future. The Board considers
the completion of appropriate continuing education to be an es-
sential method in demonstrating a nurse's ability to safely prac-
tice nursing. However, in response to comments received, the
Board has modified the rules as proposed to eliminate the re-
quirement that a nurse must obtain continuing education in his
or her area of practice. Further, because the Board continues to
believe that there is value in requiring nurses to obtain contin-
uing education in their specific area of practice, the Board has
assigned a working group to study the issue in depth, payingADOPTED RULES August 14, 2009 34 TexReg 5531
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Texas. Secretary of State. Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009, periodical, August 14, 2009; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth90865/m1/84/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.