TITLE 22. EXAMINING BOARDS

PART 11. TEXAS BOARD OF NURSING

CHAPTER 217. LICENSURE, PEER ASSISTANCE AND PRACTICE

22 TAC §217.4

Introduction. The Texas Board of Nursing (Board) adopts amendments to §217.4, relating to Requirements for Initial Licensure by Examination for Nurses Who Graduate from Nursing Education Programs Outside of United States' Jurisdiction, without changes to the proposed text as published in the March 20, 2020, issue of the Texas Register (45 TexReg 1941). The rule will not be republished.

Reasoned Justification. The amendments are being adopted under the authority of the Occupations Code §§301.157(d), 301.252, 301.2511, and 301.151.

Background. Rule 217.4 addresses applicants who graduated from nursing education programs outside the United States' jurisdiction and are seeking initial nurse licensure by examination in Texas. Under the current rule, these applicants must provide a credential evaluation service full education course-by-course report from the Commission on Graduates of Foreign Nursing Schools, the Educational Records Evaluation Service, or the International Education Research Foundation. The adopted amendments, however, eliminate the requirement that an applicant must choose from these three specific credential evaluation services traditionally recognized by the Board, and, instead, allow applicants to utilize any credential evaluation service meeting the standards adopted by the Board. This change is intended to provide additional options for applicants and additional opportunity for credential evaluation services seeking to do business in Texas.

Minimum Criteria. Adopted §217.4(b) sets forth the minimum criteria credential evaluation services must meet in order to be approved by the Board. The Board utilizes credential evaluation service reports to inform its licensure decisions. Establishing approval criteria is important to ensure the Board receives reliable information from its credential evaluation services. For example, under the adopted requirements, a credential evaluation service must be a member of a national credentialing organization that sets performance standards for the industry, and the credential evaluation service must adhere to those standards. The credential evaluation service must also specialize in the evaluation of international nursing education and licensure and be able to demonstrate its ability to accurately analyze academic and licensure credentials and provide a course-by-course analysis of nursing academic records. While there are national associations, such as the National Association of Credential Evaluation Services (NACES), that set industry standards for these organizations, the term "specialize" in the adopted rule does not require a certification or certificate. Rather, the term is meant as an expression of experience in the field.

Further, in order to ensure reliable and efficient reports, credential evaluation services must have at least five years' experience in the industry. The majority of other state boards of nursing require the use of the same three credential evaluation services specified in the Board's current rule. In reviewing the few other state boards of nursing that have established their own criteria for approving credential evaluation services, one board adopted a requirement that an applicant credential evaluation service be in business for a minimum of ten years before being eligible for approval. The Board has determined that ten years is too long a time period and could eliminate many new companies from providing credential evaluation services in Texas, which would defeat the intent of the proposal. However, it is important for an organization to have an established reputation of providing quality services that can be evaluated on an objective basis. The Board must have a reasonable amount of confidence that any credential evaluation service it approves is capable of providing reliable information, has proven methods over time, has longevity and is fundamentally stable, and will be available and operational in the future. The Board has determined that a five-year benchmark is a reasonable amount of time for a credential evaluation service to be able to demonstrate these assurances.

Further, because the Board relies on the reports of credential evaluation services to determine if an applicant is eligible for licensure in Texas, reliability and credibility are of paramount importance. Similar to state agency contracting and purchasing requirements, customer feedback is expected and recorded. Agencies are required to provide feedback and record satisfaction ratings for entities it contracts with. In the same vein, the Board is interested in the feedback of customers that have utilized the services of an applicant credential evaluation service. Organizations whose customers indicate that an entity is slow to respond, is disorganized, is unable to support its report/opinion with objective evidence, is not qualified to review the information needed, is unreliable, or is unable to provide the services it advertises will be carefully considered by the Board during its approval process. While negative reviews/references will not necessarily disqualify an organization from being approved, it will be a cause of concern that will have to be reviewed carefully by the Board. Credential evaluation services must also be able to complete evaluation reports within a reasonable time period, not to exceed six weeks.

Each credential evaluation service must also complete a form and affidavit required by the Board, as well as supporting documentation, evidencing the credential evaluation service's ability to meet the Board's requirements. Further, a credential evaluation service may not provide an applicant's full education course-by-course report for Board consideration until the credential evaluation service has received Board approval. These standards are consistent with those required by other state boards of nursing and with industry standards established for credential evaluation services evaluating international education.

Remaining Amendments. The current rule also requires verification of a high school diploma or equivalent educational credentials, as established by the General Education Development Equivalency Test (GED). Because credential evaluation services ensure that an applicant has obtained a high school diploma or equivalent educational credentials, as established by the General Education Development Equivalency Test (GED), as part of their full education course-by-course report, the adopted amendments eliminate this unnecessarily redundant requirement from the section. The remaining adopted amendments make editorial and typographical corrections and eliminate obsolete provisions from the text. Specifically, the adopted amendments require applicants to submit their fingerprints to the Board for a complete criminal background check, in compliance with the Occupations Code §301.2511, and because the Board's fingerprinting process has changed over time and is now automated through a third party vendor. Second, the adopted amendments eliminate the fee associated with a six month accustomation permit, which the Board no longer assesses.

Proposal and Adoption. The Board approved the proposed amendments for publication in the Texas Register at its January 23-24, 2020 meeting. The proposal was published on March 20, 2020. The Board did not receive any comments on the proposal. However, on April 3, 2020, the Regulatory Compliance Division (Division) of the Office of the Governor informed the Board that the Division would be commencing a review of the proposal. The Division invited public comments on the proposed amendments for an additional thirty-day period ending June 25, 2020. The Division received no comments. On July 22, 2020, the Board received notice from the Division that it determined that the proposal was consistent with state policy and could be finally adopted.

Specifically, the Division found that the proposal facilitated the Board's evaluation of an applicant's education by requiring credential evaluation service reports to include a course-by-course analysis of nursing academic records and to describe the comparability of the foreign education to United States standards. The Division further stated that, building on standards employed by other states, the Board's proposed rules establish criteria to ensure credential evaluation services have sufficient knowledge and experience and an acceptable national reputation to accurately evaluate nursing education programs, and provide timely, responsive services to applicants and the Board. Additional proposed criteria require credential evaluation services to use reliable, verifiable sources to evaluate education and inform the Board of any identified fraud, furthering the goals in the Occupations Code §301.451. The Division found the proposed rules to be reasonably construed to ensure the Board has a legitimate, reliable means of evaluating the qualifications of applicants educated abroad and are consistent with state policy.

How the Section Will Function. The adopted amendments to §217.4(a)(1) first eliminate the requirement that a licensed vocational nurse applicant must provide evidence of a high school diploma issued by an accredited secondary school or equivalent educational credentials as established by the General Education Development Equivalency Test (GED). The adopted amendments to §217.4(a)(1) and (2) require an applicant to provide a credential evaluation service full education course-by-course report from a credential evaluation service approved by the Board. Adopted §217.4(a)(5) requires applicants to submit fingerprints for a complete background check. Adopted §217.4(b) sets forth the criteria a credential evaluation service must meet in order to be approved by the Board. The adopted amendments to §217.4(d)(1) eliminate the fee formerly associated with an accustomation permit. The remaining adopted amendments correct editorial and typographical errors.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the authority of the Occupations Code §§301.157(d), 301.2511, 301.252, and 301.151.

Section 301.157(d) provides that a person may not be certified as a graduate of any school of nursing or educational program unless the person has completed the requirements of the prescribed course of study, including clinical practice, of a school of nursing or educational program that: (1) is approved by the board; (2) is accredited by a national nursing accreditation agency determined by the Board to have acceptable standards; or (3) is approved by a state board of nursing of another state and the Board, subject to Subsection (d-4).

Section 301.2511 provides that an applicant for a registered nurse license must submit to the Board, in addition to satisfying the other requirements of the subchapter, a complete and legible set of fingerprints, on a form prescribed by the Board, for the purpose of obtaining criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation. Section §301.2511(b) provides that the Board may deny a license to an applicant who does not comply with the requirement of subsection (a). Issuance of a license by the Board is conditioned on the Board obtaining the applicant's criminal history record information under the section. Finally, §301.2511(c) states that the Board by rule shall develop a system for obtaining criminal history record information for a person accepted for enrollment in a nursing educational program that prepares the person for initial licensure as a registered or vocational nurse by requiring the person to submit to the Board a set of fingerprints that meets the requirements of subsection (a). The Board may develop a similar system for an applicant for enrollment in a nursing educational program. The Board may require payment of a fee by a person who is required to submit a set of fingerprints under this subsection.

Section 301.252(a) states that each applicant for a registered nurse license or a vocational nurse license must submit to the Board a sworn application that demonstrates the applicant's qualifications under this chapter, accompanied by evidence that the applicant: (1) has good professional character related to the practice of nursing; (2) has successfully completed a program of professional or vocational nursing education approved under Section 301.157(d); and (3) has passed the jurisprudence examination approved by the Board as provided by Subsection (a-1).

Section 301.252(b) provides that Board may waive the requirement of subsection (a)(2) for a vocational nurse applicant if the applicant provides satisfactory sworn evidence that the applicant has completed an acceptable level of education in: (1) a professional nursing school approved under Section 301.157(d); or (2) a school of professional nurse education located in another state or a foreign country.

Section 301.252(c) provides that the Board by rule shall determine acceptable levels of education under Subsection (b).

Section 301.151 addresses the Board's rulemaking authority. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 4, 2020.

TRD-202003134

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: August 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822


22 TAC §217.5

The Texas Board of Nursing (Board) adopts amendments to §217.5, relating to Temporary License and Endorsement, without changes to the proposed text as published in the March 20, 2020, issue of the Texas Register (45 TexReg 1944). The rule will not be republished.

Reasoned Justification. The amendments are being adopted under the authority of the Occupations Code and §301.151 and §301.259.

Background. Section 217.5 addresses applicants who have been licensed in another state or Canadian province and are seeking nurse licensure by endorsement in Texas. Under the current rule, these applicants must provide a credential evaluation service full education course-by-course report from the Commission on Graduates of Foreign Nursing Schools, the Educational Records Evaluation Service, or the International Education Research Foundation. The adopted amendments, however, eliminate the requirement that an applicant must choose from these three specific credential evaluation services traditionally recognized by the Board, and, instead, allow applicants to utilize any credential evaluation service meeting the standards adopted by the Board. This change is intended to provide additional options for applicants and additional opportunity for credential evaluation services seeking to do business in Texas.

Minimum Criteria. Adopted §217.5(b) sets forth the minimum criteria credential evaluation services must meet in order to be approved by the Board. The Board utilizes credential evaluation service reports to inform its licensure decisions. Establishing approval criteria is important to ensure the Board receives reliable information from its credential evaluation services. For example, under the adopted requirements, a credential evaluation service must be a member of a national credentialing organization that sets performance standards for the industry, and the credential evaluation service must adhere to those standards. The credential evaluation service must also specialize in the evaluation of international nursing education and licensure and be able to demonstrate its ability to accurately analyze academic and licensure credentials and provide a course-by-course analysis of nursing academic records. While there are national associations, such as the National Association of Credential Evaluation Services (NACES), that set industry standards for these organizations, the term ’specialize' in the adopted rule does not require a certification or certificate. Rather, the term is meant as an expression of experience in the field.

Further, in order to ensure reliable and efficient reports, credential evaluation services must have at least five years' experience in the industry. The majority of other state boards of nursing require the use of the same three credential evaluation services specified in the Board's current rule. In reviewing the few other state boards of nursing that have established their own criteria for approving credential evaluation services, one board adopted a requirement that an applicant credential evaluation service be in business for a minimum of ten years before being eligible for approval. The Board has determined that ten years is too long a time period and could eliminate many new companies from providing credential evaluation services in Texas, which would defeat the intent of the proposal. However, it is important for an organization to have an established reputation of providing quality services that can be evaluated on an objective basis. The Board must have a reasonable amount of confidence that any credential evaluation service it approves is capable of providing reliable information, has proven methods over time, has longevity and is fundamentally stable, and will be available and operational in the future. The Board has determined that a five-year benchmark is a reasonable amount of time for a credential evaluation service to be able to demonstrate these assurances.

Further, because the Board relies on the reports of credential evaluation services to determine if an applicant is eligible for licensure in Texas, reliability and credibility are of paramount importance. Similar to state agency contracting and purchasing requirements, customer feedback is expected and recorded. Agencies are required to provide feedback and record satisfaction ratings for entities it contracts with. In the same vein, the Board is interested in the feedback of customers that have utilized the services of an applicant credential evaluation service. Organizations whose customers indicate that an entity is slow to respond, is disorganized, is unable to support its report/opinion with objective evidence, is not qualified to review the information needed, is unreliable, or is unable to provide the services it advertises will be carefully considered by the Board during its approval process. While negative reviews/references will not necessarily disqualify an organization from being approved, it will be a cause of concern that will have to be reviewed carefully by the Board. Credential evaluation services must also be able to complete evaluation reports within a reasonable time period, not to exceed six weeks.

Each credential evaluation service must also complete a form and affidavit required by the Board, as well as supporting documentation, evidencing the credential evaluation service's ability to meet the Board's requirements. Further, a credential evaluation service may not provide an applicant's full education course-by-course report for Board consideration until the credential evaluation service has received Board approval. These standards are consistent with those required by other state boards of nursing and with industry standards established for credential evaluation services evaluating international education.

Remaining Amendments. The rule also currently requires individuals who have not taken the NCLEX examination or practiced nursing within the four years preceding an application by endorsement to complete the online Texas Board of Nursing Jurisprudence Prep Course; the Texas Board of Nursing Jurisprudence and Ethics Workshop; or a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course in addition to completing a refresher course, extensive orientation, or program of study. Fifteen percent (15%) of the required content of a Board approved refresher course, extensive orientation, or program of study must include the review of the Nursing Practice Act, Rules, Position Statements. This is the same content that is included in the online Texas Board of Nursing Jurisprudence Prep Course; the Texas Board of Nursing Jurisprudence and Ethics Workshop; and a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course. The Board recognizes that the existing requirements of the rule may be unnecessarily redundant in this regard. The adopted amendments, therefore, eliminate these redundant requirements from the rule. Individuals will still be required to complete a Board approved refresher course, extensive orientation, or program of study, which must include an adequate focus on nursing jurisprudence and ethics. Further, because a nurse will still be required to successfully pass the Board's nursing jurisprudence exam, the public can be adequately assured that the nurse has successfully mastered this content prior to renewal of licensure. The adopted amendments also re-number the section appropriately.

Proposal and Adoption. The Board approved the proposed amendments for publication in the Texas Register at its January 23-24, 2020 meeting. The proposal was published on March 20, 2020. The Board did not receive any comments on the proposal. However, on April 3, 2020, the Regulatory Compliance Division (Division) of the Office of the Governor informed the Board that the Division would be commencing a review of the proposal. The Division invited public comments on the proposed amendments for an additional thirty-day period ending June 25, 2020. The Division received no comments. On July 22, 2020, the Board received notice from the Division that it determined that the proposal was consistent with state policy and could be finally adopted.

Specifically, the Division found that the proposal facilitated the Board's evaluation of an applicant's education by requiring credential evaluation service reports to include a course-by-course analysis of nursing academic records and to describe the comparability of the foreign education to United States standards. The Division further stated that, building on standards employed by other states, the Board's proposed rules establish criteria to ensure credential evaluation services have sufficient knowledge and experience and an acceptable national reputation to accurately evaluate nursing education programs, and provide timely, responsive services to applicants and the Board. Additional proposed criteria require credential evaluation services to use reliable, verifiable sources to evaluate education and inform the Board of any identified fraud, furthering the goals in the Occupations Code §301.451. The Division found the proposed rules to be reasonably construed to ensure the Board has a legitimate, reliable means of evaluating the qualifications of applicants educated abroad and are consistent with state policy.

How the Section Will Function. Adopted §217.5(a) requires an applicant who has graduated from a nursing education program outside of the United States or National Council jurisdictions to submit verification of licensure from the country of education or as evidenced in a credential evaluation service full education course by course report from a credential evaluation service approved by the Board, as well as meeting all other requirements in paragraphs (2) and (3) of the subsection. Adopted §217.5(b) sets forth the requirements that a credential evaluation service must meet in order to be approved by the Board. The adopted amendments to §217.5(c)(3) eliminate the requirement that an applicant submit to the Board a course completion form from the online Texas Board of Nursing Jurisprudence Prep Course; the Texas Board of Nursing Jurisprudence and Ethics Workshop; or a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course. The remaining adopted amendments re-number the section appropriately.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the authority of the Occupations Code §301.259 and §301.151.

Section 301.259 provides that, on payment of a fee established by the Board, the Board may issue a license to practice as a registered nurse or vocational nurse in this state by endorsement without examination to an applicant who holds a registration certificate as a registered nurse or vocational nurse, as applicable, issued by a territory or possession of the United States or a foreign country if the Board determines that the issuing agency of the territory or possession of the United States or foreign country required in its examination the same general degree of fitness required by this state.

Section 301.151 addresses the Board's rulemaking authority. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 4, 2020.

TRD-202003137

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: August 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822