MEMORANDUM

To: Board Members Ohio Board of Nursing

From: Lisa Emrich Program Manager

Subject: Rules 4723-5-10, 4723-5-11, and 4723-5-21

Date: November 18, 2019

Attached are materials from the Advisory Group on Nursing Education that were previously provided to and reviewed by the Board recommending language changes to Rules 4723-5-10, 4723-5-11, and 4723-5-21.

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Advisory Group on Nursing Education

Meeting Minutes June 8, 2017, 10:00 a.m.

Members Attending: Patricia Sharpnack, Board President and Advisory Group Chair; Cheryl Boyd; Melisa Lepard; Connie Bowler; Sandra Walker; Melissa Bennett; Mary (Connie) Constance Stopper; Victoria Wright; Barbara Tassell; Judith Spath

Members Absent: Patricia Schrull; Juanita Reese Kline; Greg Lockhart; Jacqueline Schrock

Staff Attending: Lisa Emrich; Kristie Oles; Chantelle Coles-Neal

Guests Attending: Donna Glanker, Mount St. Joseph University; Kathy Finger, ATI

Call to Order and Welcome

Patricia Sharpnack, Chair, called the meeting to order at 10:00 a.m. and welcomed those in attendance. Advisory Group members introduced themselves.

Announcements

P. Sharpnack reminded everyone that reimbursement forms must be returned tothe Board within 30 days of the meeting to be processed.

Approval of February 2, 2017, Minutes

P. Sharpnack confirmed that members reviewed the February 2, 2017 meetingminutes. Melissa Bennett noted misspelling of "public." The minutes as correctedwere approved by consensus.

Education Program Annual Report Survey

Lisa Emrich stated that the survey is currently active and responses are due by July 31, 2017.

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Preceptor: minimum qualifications P. Sharpnack summarized the letter from University Hospitals asking the Board to re-evaluate the administrative rules that require twenty-four months of practice experience for preceptors. P. Sharpnack noted that in May 2016, the Board reviewed a request from Ohio Council of Deans and Directors of Baccalaureate and Higher Degree Nursing Education Programs to change the preceptor qualifications to one-year of experience with demonstrated competencies for nurses with a baccalaureate degree; however, the Board agreed by general consensus not to change the minimum twenty-four months of practice as a qualification. Cheryl Boyd provided a summary of national and international articles that discussed various preceptor models. One study elevated the preceptor role to an "adjunct faculty" status due to the faculty shortage. Others managed and evaluated competencies and expectations throughout the education process. In addition, some countries require two to five years of clinical experience. The majority of programs in the U.S. and Canada require one to two years of experience and a baccalaureate degree. P. Sharpnack discussed a study in northeast Ohio addressing the variability of precepted experiences. The clinical agencies utilize its most experienced nurses to orient or precept their new nurse employees, rather than assigning them to pre-license nursing students. Barbara Tassell stated that programs in rural northwest Ohio are considering eliminating the preceptor model due to the lack of available preceptors. Not all preceptors with twenty-four months of experience are adequately qualified to precept nursing students. Reducing the required clinical experience and implementing competency evaluation would provide programs and employers with an increased availability of qualified preceptors. Discussion ensued regarding the importance of defining a preceptor's qualifications through their competencies rather than by the length of their practice experience. The Advisory Group concluded that conducting external surveys to evaluate preceptor models used in other states would assist in determining a possible model for Ohio. In addition, it was suggested that the Ohio Organization of Nurse Executives (OONE) should be contacted to gain its collective employer perspective. Nursing Program Curriculum: minimum length P. Sharpnack summarized the letter from the Ohio Action Coalition, seeking revision to Rule 4723-5-13, OAC, to remove the two-year minimum length of time over which a program curriculum is to be taught. P. Sharpnack stated this was consistent with Western Governors University's competency-based education

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model where program progression varies based on the student's proven knowledge and skills. All agreed that this would be a significant change, would need thoughtful and deliberate consideration, and would need to be prefaced by other additional program structures necessary for ensure public safety. The NCLEX exam validates competency for entry-level practice. However, a competency-based education model would allow program graduates to test based on their individually paced progression, proven knowledge and outcomes, with a minimum amount of educational interface. All agreed that additional information is needed before considering a change to the required length of a program. Military Training and Academic Credit Sandra Walker summarized a May 19, 2017, meeting sponsored by the Ohio Department of Higher Education to address nursing programs granting credit for military training. For example, an individual with an EMT military tag can transfer that title to a paramedic. Additional military tags are being created in attempt to allow the transfer of trained military to other medical related programs, including registered nursing. Nursing program administrators attending were concerned that this type of transfer credit may not be consistent with Board of Nursing rules. The NCSBN's gap-analysis document that compares branches of military training to the education of licensed practical nurse was discussed. Tom Dilling and L. Emrich discussed the difference among states in reviewing credits for military training. In Ohio, the technical related training of enlisted non-commission officers generally translates to the LPN role, and transcripts received from military are compared to the curriculum of a licensed practical nurse. Next Generation NCLEX; Regional Workshop The Next Generation NCLEX Regional Workshop is scheduled on November 1, 2017, at the Lobby Hearing Room in the James A. Rhodes State Office Tower. Education Program Workshop: June 16, 2017 The Education Program Workshop is June 16, 2017 at the auditorium at the Ohio Department of Transportation (ODOT) located at 1980 W. Broad Street, Columbus, 43223. Currently, over 190 individuals are registered representing over 120 programs; there is room for fifty additional registrants. The fall workshop is scheduled for December 1, 2017, also at the ODOT's auditorium. Reminder NEGP Submission Deadline The NEGP deadline is Thursday, June 15, 2017; information is posted on the Board website.

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Legislative Updates

T. Dilling provided the following legislative updates:

Ø S.B. 232T. Dilling stated the bill went into effect in April, requires the Boardto provide continuing education courses and opportunities toaddress cultural competencies in health care treatment, and tocollaborate with schools to develop and implement a curriculum onpatient counseling regarding contraceptives.

Ø H.B. 290This bill allows volunteer experience to count toward continuingeducation requirements. The proposed amendment to Rule 4723-14-03, OAC adds language to authorize RNs and LPNs to utilize upto eight hours of health care services to indigent and uninsuredpersons as continuing education units.

Update: 2017 eLicense 3.0 Renewal Process

Renewal will begin July 1, 2017 for RNs and APRNs. Documents providing instruction to register in order to create a user account were distributed and are available on the Board website. All RNs and APRNs are encouraged to register early prior to renewal on or after July 1.

Other

T. Dilling asked for information regarding programs discussing opioid abuse withstudents.

Remaining 2017 Meeting Dates

October 19

Adjourn

Having no further business, the meeting adjourned at 11:33 a.m.

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Advisory Group on Nursing Education

Meeting Minutes October 19, 2017, 10:00 a.m.

Members Attending: Patricia Sharpnack, Board President and Advisory Group Chair; Cheryl Boyd; Connie Bowler; Sandra Walker; Melissa Bennett; Barbara Tassell; Juanita Reese Kline; Patricia Schrull; Mary (Connie) Constance Stopper; Greg Lockhart (arrived at 10:20 a.m.)

Members Absent: Jacqueline Schrock; Victoria Wright; Judith Spath

Staff Attending: Lisa Emrich; Kristie Oles; Lisa Hashemian; Anita DiPasquale; Chantelle Coles-Neal

Guests Attending: Kim Schippits, University Hospitals; Tracey Motter, Kent State University College of Nursing; Austin Vannatta, Capital University; Judy Rudokas, Galen College of Nursing; Donna Glankler, Mount St. Joseph University

Call to Order and Welcome Patricia Sharpnack, Chair, called the meeting to order at 10:00 a.m. and welcomed those in attendance. Advisory Group members introduced themselves.

Announcements Chair Sharpnack reminded members that reimbursement forms must be returned to the Board within thirty days of the meeting to be processed.

Approval of June 8, 2017, Minutes Chair Sharpnack confirmed members have reviewed the June 8, 2017, meeting minutes. Sandra Walker noted misspelling of "Sandra.” The minutes as corrected were approved by consensus.

Preceptor: Minimum Qualifications Chair Sharpnack requested that Kim Schippits, Director of Nursing Education at University Hospitals Health Systems, and Tracey Motter, Associate Dean at Kent State University College of Nursing, provide practice partner input regarding the preceptor qualifications specified in Chapter 4723-5, OAC.

K. Schippits asked the Advisory Group to reconsider that two years of nursing practiceexperience is needed for nurses to qualify as preceptors. She stated research does notsupport a correlation between two years of nursing experience and demonstratedcompetency. The Affordable Care Act and a changing healthcare environment havecreated more opportunities for nurses to move to positions other than bedside care. Thishas caused a more rapid turnover of nurses within hospitals and a shortage of nurseswho have two years experience in practice. Northeast Ohio is also seeing experienced

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nurses moving to other geographic areas. Twenty-one percent of University Hospital personnel who left cited relocation as the primary reason. It is estimated that by 2020, Ohio will have a shortage of 3,500 nurses. To meet both the pre-license nursing education and employer need for nurse preceptors, she recommended revising the administrative rules to require twelve months of practice and competency qualifiers.

Tracey Motter provided a brief history on the current preceptor model in nursing education. It has been used to bridge the gap between education and practice, provide an opportunity for the student to develop nursing skills, including effective communication, and build student self-confidence. Education programs increase their capacity when precepted practicum experiences are available; however, some programs eliminated the preceptor model from the curricula due to the lack of available preceptors. Because of the circumstances explained by K. Schippits, programs are learning that the experienced nurses employed by the clinical agency/practice partner are being used by clinical sites to precept their new nurse employees. T. Motter suggested the required nursing practice experience be 12-18 months with the use of competency evaluations completed by faculty at the time the preceptor is identified.

Barbara Tassell stated she believes nursing programs and institutions in northwest Ohio would agree with the recommendation. She read a research assessment that determined 1,200 senior students enrolled in thirteen nursing education programs throughout northwest Ohio and southeast Michigan needed a precepted practicum placement each year. The data does not include practical nursing students or newly licensed nurses who the employers place with nurse preceptors. She noted that health care institutions place experienced nurses with newly licensed nurse employees, rather than assigning them to students.

Cheryl Boyd stated that Nationwide Children's Hospital offers an elective preceptor course to nurse employees, and have unit-based competency evaluations. Affiliated nursing education programs request between twenty and forty preceptors per semester, but the hospital can only accommodate ten to fifteen. Most of their nurse employees use the hospital's tuition reimbursement program to continue their education to become nurse practitioners and move to different positions where they do not serve as preceptors.

Sandra Walker stated that about seven years ago the Central Ohio Technical College adjusted their program because their clinical partners were not able to provide the number of preceptors needed. Program administrators need to be sensitive to the changing needs of their clinical partners and consider changing the preceptor model as a whole, and not just the practice experience, or eliminating the precepted practicums. Programs could be effective by providing supervised clinical groups at the senior level with carefully selected instructors in lieu of using preceptors.

S. Walker stated that associate degree program administrators have expressed concernthat a nurse could be a preceptor for students with only one year of clinical experience.S. Walker cited Patricia Benner's nursing theory, which states that there are five levels ofproficiency from novice to expert. A preceptor model that reduces the practiceexperience to one year could add pressure to an already stressed novice nurse.

K. Schippits stated she respectfully disagrees because precepted practicums offernursing students a rich and immersed learning experience, and acculturation into the

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nursing profession. She reiterated her recommendation to preserve the precepted clinical experience and adjust the requirements for preceptors to meet the increased demand. P. Sharpnack added that research suggests that students from programs with a precepted practicum tend to transition into practice more quickly and decrease orientation costs.

Lisa Emrich stated the Board recently surveyed other state boards of nursing about their regulations for nurse preceptors. Thirty-two boards responded to the survey to date. Of those, sixteen boards do not establish a minimum time in practice. She reviewed the comments provided in the survey. For example, some boards issue permits for nurses to serve as preceptors, certain boards allow the nursing education program to establish minimum requirements for nurses used as preceptors, and some recognize employer-provided preceptor courses.

The members discussed that a nursing program could choose to exceed the minimum qualifications established in the administrative rules and/or require a competency evaluation of the nurse preceptor. The idea of a standard, high-quality preceptor course being required was discussed but the members concluded that it would create a burden for rural programs and be difficult to monitor.

The members agreed to review the preceptor qualifications. Staff will distribute the survey results when finalized, the preceptor competencies document provided by K. Schippits, and other information in advance of the next Advisory Group meeting. Chair Sharpnack asked everyone to be prepared to discuss and present a recommendation regarding minimum preceptor qualifications at the February Advisory Group meeting.

Nursing Program Curriculum: Minimum Length L. Emrich stated the Ohio Action Coalition previously requested the Board remove thetwo-year minimum length of time for a registered nursing program curriculum, citing theincreased use of competency-based curriculum models. The Advisory Group agreed bygeneral consensus that at this time it would not recommend this as a rule changebecause they do not believe there is enough research or data about this type ofcurriculum. Board staff suggested this topic for a National Council of State Boards ofNursing (NCSBN) 2018 Education Network conference, and it was accepted.

New Rule Implementation: Clinical and Lab hours L. Emrich requested comments regarding implementation of Rule 4723-5-19(F), OAC,effective April 1, 2017. The Board guidance document states that the "actual" clinicaland laboratory hours provided within the course should be consistent among allstudents, however program administrators are reporting there are potential variancesamong clinical groups where students in one clinical group may participate in more orless actual clinical experience hours than another clinical group within the same coursebecause of circumstances that cannot be controlled. For example, without notice aclinical site may deny student access due to an unscheduled survey of the facility. If thisoccurs, the program does not want to reduce the clinical hours for all students in thecourse when only a few students are impacted. It was noted that the rule allows forreporting of variable clinical and laboratory experiences for clinical groups within thesame course. The guidance document will be updated to clarify this provision.

Military Training and Academic Credit: September 21, 2017 Meeting

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S. Walker summarized the Ohio Department of Higher Education meeting held inSeptember to address nursing programs granting credit for military training. It wasgenerally agreed that nursing program pre-requisites may be met with military training innursing assistant education, CPR certification and certain other pre-admission testing.

L. Emrich noted the Nurse Practice Act was amended to recognize the CommunityCollege of the Air Force (CCAF) associate degree for PNs as an education program soindividuals who complete the program are eligible to take the NCLEX-PN examination.This was accomplished through cooperative work with Chief Master Sergeant KandiHughes, Medical Group Superintendent at the Ohio Air National Guard 121st AirRefueling Wing in Columbus, and Danny Eakins, Military and Veterans Policy Directorfor the Ohio Department of Veterans Affairs, who the Board recognized at the July 2017meeting.

Next Generation NCLEX (NGN); Regional Workshop Registration Update Chantelle Coles-Neal reported the NCLEX Regional Workshop that includes a presentation on the NGN will be held November 1, 2017, at the Riffe Center. Registration is at capacity with about twenty programs on the waiting list.

Education Program Workshop: December 1, 2017 C. Coles-Neal reported the fall Education Program Workshop is December 1, 2017, atthe Ohio Department of Transportation (ODOT), 1980 W. Broad Street, Columbus.Registration will open at the end of October or early November. The spring workshop istentatively scheduled in June 2018.

Legislative Updates – No legislative report was given.

Update: Implementation of eLicense 3.0 and HB 216 The Timeline/Plan outlining communications and activities regarding renewal, licensing, and implementation of HB 216 was distributed. Over ninety percent of the RN renewals have been completed at this time.

Advisory Group Application L. Emrich stated that the application for 2018 Advisory Groups, information, and a listopen positions are posted on the Board website. Applications will be accepted throughOctober 31, 2017.

Other It was noted this is the last meeting for Barbara Tassell, Connie Stopper, and Greg Lockhart. Chair Sharpnack thanked them for their contributions.

B. Tassell asked for clarification regarding the preceptor qualification form. Staffprovided information about the program verifying preceptor qualifications in accordancewith Chapter 4723-5, OAC.

2018 Meeting Dates The following 2018 dates were agree upon: February 1, June 14, and October 11.

Adjourn Having no further business, the meeting was adjourned at 11:57 a.m.

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Advisory Group on Nursing Education

Meeting Minutes February 1, 2018 10:00 a.m.

Members Attending: Patricia Sharpnack, Board President and Advisory Group Chair; Cheryl Boyd; Tiffany Kennerk; Patricia Schrull; Crystal Goods; Sandra Walker; Juanita Reese Kline; Sandra Harris; Sheryl Feeney; Christina Devlin

Members Absent: Jacqueline Shrock; Judi Spath; Melissa Bennett; Connie Bowler

Staff Attending: Lisa Emrich; Lisa Hashemian; Kristie Oles; Chantelle Sunderman

Guests Attending: Donna Glankler, Mount St. Joseph University ______________________________________________________________________________

Call to Order and Welcome Patricia Sharpnack, Chair, called the meeting to order at 10:00 a.m. and welcomed those in attendance. Advisory Group members introduced themselves.

Announcements Chantelle Sunderman reminded members that reimbursement forms must be returned to the Board within thirty days of the meeting to be processed.

Approval of October 2, 2017, Minutes Chair Sharpnack confirmed members have reviewed the October 2, 2017, meeting minutes. Sandra Walker moved to approve the minutes and Cheryl Boyd seconded. Tiffany Kennerk, Christina Devlin, Crystal Goods, Sandra Harris and Sheryl Feeney abstained. Voting members unanimously approved the minutes as submitted.

Preceptor: Minimum Qualifications P. Sharpnack summarized the information provided and the discussion of the last meetingconcerning minimum qualifications for preceptors. Specifically, the reduction of the nurse'spractice experience from the current two-year requirement. Another tool or model may be used toidentify a nurse's readiness to serve as a student's preceptor. Information collected through asurvey of other nursing boards reflected that some boards do not require a minimum practiceexperience though they do consider other qualifying factors.

Lisa Emrich stated she participated in a recent National Council State Board of Nursing conference call during which guest speaker Kathy Lasater explained her work regarding nursing clinical judgment and correlation to amount of practice experience. L. Emrich stated she thought the call's discussion and materials were applicable to the Advisory Group's review of preceptor qualifications and included the materials for today's meeting. The requested preceptor competencies document sent by Kim Shipits from University Hospitals is also inlcuded.

S. Walker stated that she stands by the comments she made at the previous meeting. Theworkforce is experiencing an exodus of nurses from bedside positions that increases practice

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partners' burden of providing preceptors for nursing students. As a result of the preceptor shortage, her program makes the precepted experience available only to select higher-performing students who academically compete for those spots. Educators should recognize the added pressure on practice partners. The Board does not require programs to offer a precepted experience for students. Programs are charged with providing nursing education that is consistent with Board rules and prepares students for entry into practice. She expressed concern that national patient outcomes are not improving and she fears that reducing nursing education regulations, including the current minimum preceptor qualifications, will lead to negative outcomes. She uses preceptors that meet the current minimum qualifications when they are available, and recommends that all variables pertaining to the precepted experience should be carefully considered prior to making any decisions.

P. Sharpnack emphasized the importance and value of the precepted nursing educationexperience, and expressed concern with programs' inability to offer the opportunity based on lackof available, qualified preceptors under the current Rule. There is no information that indicatesstates with more stringent preceptor qualifications have higher outcomes. It is not the time inpractice but the overall quality of the preceptor that drives a positive educational experience forstudents

Patricia Schrull asked whether the Board could regulate a competency-based model for preceptor qualiafications. L. Emrich responded that it is possible to draft a regulation where the program would be responsible for determining the qualifications of individual preceptors based on the course clinical objectives. There is no intent to add more regulation for programs. The Board's rules regulate the minimum qualifications of administrators, faculty, teaching assistants and preceptors; programs may certainly exceed the minimum requirements.

Cheryl. Boyd stated that at Nationwide Children's Hospital, certain programs have varied requirements above the minimum qualifications, ranging from specific academic degrees, certifications, specialization in practice, and past experience as a preceptor.

L. Emrich stated that the Lasater article suggested nurses with a significant number of years ofexperience may not be the best preceptors because their nursing actions are intuitive andtherefore are not likely to talk a student through a specific patient care learning situation. C. Boydagreed and stated that nurses with fewer years in practice, and who choose to precept, have ahigher passion, interest, and drive to teach clinically. T. Kennerk agreed and stated that, within herfacility, after eighteen months of experience, new nurses are usually seeking additionalresponsibilities, and she has found they are ready, willing and capable of precepting newly hirednurses. They would be good student preceptors because of their ability to assist the students withthe common entry to practice issues.

K. Oles stated that current rule requires teaching assistants, who often serve as clinical instructorsto have two-years practice experience. She questioned the difference between reducing therequirements for preceptors and the requirements for teaching assistants supervising students in aclinical setting.

P. Sharpnack responded that the role of the teaching assistant is significantly different than that ofa preceptor. The preceptor is the nurse employed by the clinical setting, directly responsible forhis/her patients. Students are integrated into this practice in the role of the nurse, who guidesstudents through their thought processes in their practice.

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Discussion ensued regarding the multiple clinical experience models utilized in nursing education programs and the importance of communication between the program faculty and preceptors. P. Sharpnack stated that many practice partners welcome students to a precepted clinical experience to identify possible future employees. The experience is opportunity for new hire prospects to become socialized to the facility's work environment. Tiffany Kennerk agreed, stating that she depends on their local nursing education program to supply new nurses to her hospital, and the majority of her staff were precepted as students there. Having students in a preceptor experience is added value to the organization. However, there is a finite number of available nurses that have two years of experience and she fears turning students away, as she indeed views them as possible future employees. Many nurses are available and willing to precept but they often have less than two years of practice experience. L. Emrich stated that after contacting the Ohio Organization of Nurse Executives (OONE) regarding its members' perspective of two years of practice to meet minimum preceptor qualifications, the OONE Board of Directors extended an invitation to discuss the topic during their regularly scheduled meeting. L. Emrich will attend on February 8, 2018, gather information and report back. The Advisory Group concluded that the information gathered from OONE and reviewing previous materials and articles would assist in determining a recommendation to the Board regarding the current two years of practice experience as one of the minimum preceptor qualifications. Legislative Updates L. Emrich summarized recent enacted New York law requiring all new RNs to obtain a baccalaureate degree within ten years of initial licensure. The history of "BSN in 10," and North Dakota's experience in requiring BSN for initial licensure that was later reversed were discussed. All agreed that employer hiring policies supporting BSN and higher education, the work of the Ohio Action Coalition, dual enrollment, articulation agreements, all support seamless academic progression without lessening the availability of qualified experienced registered nurses to the public. C. Boyd stated that in 2012, Nationwide Children's Hospital implemented a requirement that all newly hired RNs with an associate degree must progress to a baccalaureate degree within five years of hire as a condition of their continued employment. Many RNs did fulfill the requirement; however, they also experienced a high turnover rate. She stated that it is not a system that would work for all employers or settings, especially those in rural settings. S. Walked expressed her appreciation that the Ohio Nurse Practice Act does not mandate a BSN as a requirement for licensure or to maintain licensure. Associate Degree prepared RNs are valued and needed throughout the state. The idea of asking an experienced Associate Degree RN to stop practicing, or to require a BSN for licensure would place a burden on especially smaller hospitals and rural areas. RN and APRN Workforce Data The RN and APRN Workforce Data Reports for 2017were reviewed and discussed. It was noted that fifty-two percent of RNs responding were not planning to obtain a BSN or higher nursing degree. Discussion ensued regarding advanced practice registered nurses struggling to obtain work in a competitive market.

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L. Emrich stated that the raw data is available on the Board's website and that there was a request to include in future APRN Workforce Reports the number and type of national certifications held by APRNs. Ohio Department of Higher Education: Admission of Military Veterans Position Statements L. Emrich stated that as a result of a meeting convened in May 2017 by the Ohio Department of Higher Education (ODHE)'s Military and Apprenticeship Initiatives, representatives of associate degree and baccalaureate degree programs worked to identify some common elements of program admission requirements that may be satisfied by specific military training/education. S. Walker attended as an associate degree program representative and was a contributor to the resulting documents. The goal of the ODHE Military and Apprenticeship Initiative is to decrease unnecessary licensure barriers for veterans and military personnel. The Board has an existing Rule requiring nursing education programs to have a policy regarding the review of military training to determine credit for the nursing education program. S. Walker stated that the resulting document developed jointly by the Ohio Council of Associate Degree Education Administrators and ODHE articulates and provides guidance on removing barriers for military veterans who seek admission to nursing education programs. The Ohio Council of ADN Education Administrators (OCADNEA) approved the position statement in October 2017. A similar document was developed by the Ohio Council of Deans and Directors of Baccalaureate and Higher Degree Programs, and she understands it is slated for review by that organization. L. Emrich added the Board was asked by the ODHE to review, consider and comment on the position statements. She notified ODHE of a needed correction to the Administrative Rule cited within each document. The Advisory Group by consensus recommended the following statement in support:

“The Ohio Board of Nursing has not established pre-admission requirements for nursing education program applicants, and is supportive of eliminating barriers to military applicants as set forth in the Position Statement."

2018 Meeting Dates The scheduled meetings are June 14, 2018, and October 11, 2018. Adjourn Having no further business, the meeting was adjourned at 11:02 a.m.

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Advisory Group on Nursing Education

Meeting Minutes June 14, 2018, 10:00 a.m.

Members Attending: Patricia Sharpnack, Board President and Advisory Group Chair; Cheryl Boyd; Tiffany Kennerk; Patricia Schrull; Christina Devlin; Crystal Goods; Sandra Walker; Juanita Reese Kline; Sandra Harris; Melissa Bennett; Sheryl Feeney; Connie Bowler Members Absent: Judith Spath; Jacqueline Schrock Staff Attending: Lisa Emrich; Lisa Hashemian, Anita DiPasquale; Kristie Oles; Chantelle Sunderman Guests Attending: Jane Mahowald, OLN and OAC; Carol Drennen, OAC; Judy Kreye, Walsh University; Linda Council, NDC; Nancy Cichra, VA; Christina Kline VA; Mary Kutchin, Kent State University; Kim Schippits, UH; Melissa Kline, Metro Health _______________________________________________________________ Call to Order and Welcome Patricia Sharpnack, Chair, called the meeting to order at 10:02 a.m. and welcomed members and guests. Advisory Group members introduced themselves. Announcements Chair P. Sharpnack reminded everyone that reimbursement forms must be returned to the Board within 30 days of the meeting to be processed. Approval of February 2018, Minutes Chair P. Sharpnack confirmed that members reviewed the February 2018 meeting minutes. The minutes were approved by consensus with Melissa Bennett and Connie Bowler abstaining. Competency-based Education Carol Drennen and Jane Mahowald of the Ohio Action Coalition (Action Coalition), presented information regarding competency-based education. The Action Coalition sent a letter to the Board in November 2016 addressing competency-based curricula and the parameters established in Rule 4723-5-13, OAC, Curriculum for a registered

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nurse program. C. Drennen stated that the Action Coalition is not seeking a Rule change, but is explaining the competency-based education model. Jane Mahowald discussed the Action Coalition's competency-based education model and implementation. The initial focus was to increase the number of baccalaureate prepared nurses in Ohio’s workforce and to address this primarily through articulation models. This work progressed to the drafting of the Ohio competency-based model by the Action Coalition's RN to BSN work group that was subsequently adopted by the Action Coalition. She stated that Western Governors University (WGU) has successfully used the competency-based education model. She anticipates the number of institutions that use this model will increase. WGU has implemented this model mostly in its post-licensure programs, but it has pre-licensure nursing education programs in California, Florida, Utah, Texas and Indiana. She said many post-licensure programs have moved to competency-based education and accept competencies based on previous education, similar to LPN to RN programs. In addition, continuing education has changed from objectives to outcomes. She provided the definition of competency-based education according to the National Education Progression in Nursing (NEPIN):

A model of education that is entirely self-paced and requires the learner to ‘demonstrate’ their competence through assessments rather than requiring ‘seat time’ for acquiring credit toward a degree. Learner driven, self-paced learning means learners can progress at their own pace and build on competencies they have already acquired through their career. There is no minimum time requirement for course completion. The model may be referred to as “time variable”. The focus is on achieving the required competencies. True competency based models have no fixed course completion times and often do not require alignment with a traditional academic calendar.

C. Drennen provided a national overview of competency-based education and stated the chancellor and governor have endorsed competency-based education for K-12 and higher education. She said competency-based education is supported at a state and national level. She read the November 2017 Secretary’s proposal from the US Department of Education:

Meeting this challenge requires starting early in a student's education. Each American student is unique and enters school with a distinct set of strengths and challenges. Each student learns and grows at his or her own pace and in his or her own way; therefore, states, districts, schools, institutions of higher education, and other local providers must help every student build upon his or her unique strengths and address his or her unique challenges. Competency-based learning is one possible approach to improve student outcomes and prepare students for careers. Under this approach, instead of equating seat time with learning—assuming all students need the same amount of time to learn material—students can work at their own pace and progress as they demonstrate mastery of content.

C. Drennen stated that competency-based education enables students to have a stronger understanding of content to accelerate, versus the risk of being unchallenged

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academically and decreasing their engagement in education. Students who struggle with content can progress at their individual pace, giving them opportunity to grasp the content. She noted that this concept is not new; education programs currently use competency-based examinations to determine if a student may be given credit for a general education course by "testing out." Challenges for implementing competency-based education within higher education include how to address financial aid standards because credit hours are not relevant in this model. WGU solved this by implementing a six-month term with "competency units" rather than standardized credit hours. Credit hours were developed years ago to measure faculty workload and were not intended to measure student learning or to dictate time spent in a course. Competencies are measured through well-defined assessments of laboratory, didactic, and clinical work. Sandra Walker agreed that the current higher education time and credit financial aide models would need to be addressed. The Advisory Group discussed CCNE's accreditation of WGU and questioned how the University determines and reports its graduation rates and expected graduation dates as required by CCNE. Tiffany Kennerk stated she completed her post-licensure BSN, MSN, and MBA through WGU and described her experience. A program mentor is assigned to each student for the program to provide guidance and assistance through scheduled mandatory interactions. Mentor permission is required to move forward beyond the initial competency units, and the mentor may reduce the required mentor interactions depending on success and progression. If a student is permitted to accelerate through content, the student may begin work for the next term. The entire program is accessible to students at any time. Competency assessments include examinations, the preparation of videos, PowerPoint presentations, group projects, etc. She was not required to complete a nursing clinical practice component for her RN-BSN program, but she did complete an extensive 90-hour practicum. Christina Devlin stated technical schools are under the authority of the Ohio Department of Education, use clock hours instead of credit hours, and are not permitted to teach distant learning courses. The Ohio Department of Education requires information about the number of hours a student is physically in a classroom. The Advisory Group compared competency-based education with the methods used by Excelsior College, which is a pre-license RN program approved by the New York Board of Nursing. Juanita Reese Kline stated she worked for Excelsior College for a number of years and stated that Excelsior's curriculum is not truly competency-based but includes competency assessments, which she believes the competency assessment made her a better educator. Discussion ensued regarding business and medical professional education that use a competency-based model. C. Drennen stated she understands the Board's

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administrative rule requirement for a minimum length of time for the teaching of a curriculum. Implementing a competency-based education model where students could progress at their individual pace would be easier without the requirement, but she believes such as model could fit within the current rule. A rule change would not be necessary at this time but she suggested that it could be reviewed in the future. She believes competency-based education will produce a higher number of quality nurses and increase the retention of students in education programs. J. Mahowald stated that the changes being made to the NCLEX examination to assess application of clinical judgment also supports the competency-based education model. Chair P. Sharpnack thanked the guests for their thoughtful presentation and information. Preceptor: minimum qualifications Kim Schippits, University Hospitals Health Systems and Mary Kutchin, Kent State University, provided additional information to the Advisory Group in support of reducing the requirement of two years of nursing practice to serve as a preceptor. K. Schippits summarized the results of a survey of academic centers in Ohio that reflect their considerations when selecting a preceptor. The sample group was small but verified the shortage of available nurse preceptors who had at least two-years of practice experience. An additional survey was distributed to practice partners regarding preceptors. That survey is still active and will be forwarded to the Board when the results are available. Nursing student preceptorships are integral to nursing education and future nursing employment; precepted experiences are essential to bridge the gap between education and practice. However, University Hospitals Health Systems, like other hospitals, is challenged with a high turnover rate of bedside nurses due to other nursing career opportunities. She also referenced the article included in the meeting materials that addresses state boards of nursing practice requirements for preceptors. Many boards do not require a minimum of two years practice. Mary Kutchin, Kent State University, stated that nursing education faculty oversee the preceptor's clinical instruction of the student and work in collaboration to provide students and patients a safe and informative clinical experience. She said precepted clinical experiences are utilized and recommended internationally. L. Emrich discussed her attendance of the Ohio Organization of Nurse Executives (OONE) February 2018 meeting. OONE members provided feedback and comments regarding minimum qualifications of preceptors. Nurses with one-year experience may be better qualified to precept than nurses with two or more years of experience. Organizations select nurse preceptors who are competent, skilled, articulate, demonstrate the organization’s values, and show interest in precepting nursing students. Hospitals are seeing an increase in requests for clinical placement of students on second and third shifts, which have a higher number of newly employed nurses. Overall, OONE members agreed that the qualities of the individual nurse preceptor are more important than the number of years in nursing practice.

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Chair P. Sharpnack stated she was informed that the Cleveland Clinic has experienced similar issues with selecting preceptors. She fears preceptors are selected simply based on meeting the two-year requirement versus being a good fit. L. Emrich stated that some states leave the responsibility of defining preceptor qualifications to the education programs. C. Devlin suggested a competency model for preceptor qualifications. Crystal Goods recommended establishing a minimum time in practice within a specific unit. S. Walker reiterated the need to be considerate of nursing programs' practice partners and avoid adding to their burdens when making a recommendation. She suggested removing "for at least two years" from current Rules 4723-5-10(A)(5)(b) and 4723-5-11(A)(5)(b), OAC, which would leave the "demonstrated competence" in place. The Advisory Group discussed concerns about removing a required minimum time in practice; however, C. Boyd stated that education programs could implement more stringent requirements. The Advisory Group agreed by consensus to recommend revising Rules 4723-5-10(A)(5)(b) and 4723-5-11(A)(5)(b), OAC, by removing from each the words "for at lest two years." Chair P. Sharpnack thanked the guests for their attendance and for providing the additional information. 2017 NCLEX Pass Rates L. Emrich summarized the NCLEX Pass Rate Report in relation to the implementation of revised Rule 4723-5-23, OAC, on April 1, 2017. The administrative rule now limits the calculation of program pass rates to first time test candidates who took the NCLEX within six months of program completion. The national average and 95% of the national average remains the same and is based on all first-time test candidates. Due to the effective date of the rule, program NCLEX pass rates first quarter was calculated based on all first-time candidates, and the second, third and fourth quarters of 2017 included only first-time candidates. When calendar year 2018 pass rates are determined, the entire year will be based on first time candidates who attempted the NCLEX within six months of program completion. She noted that overall Ohio's average pass rates have been trending upward. The Advisory Grouped discussed programs whose pass rates have continued to be below the 95% of national average benchmark for longer than four years. The NCLEX pass rates pertain to success at first attempts of the NCLEX and do not include individuals who may pass the exam on subsequent attempts. It was acknowledged that other factors about an education program must be taken into consideration; a program's pass rate cannot be used as the sole indicator of quality.

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Education Program Annual Report Survey L. Emrich stated that the Annual Report Survey was distributed June 8th and is online for programs to complete. The Survey must be submitted no later than July 31, 2018. June 15, 2018 Education Program Workshop The Board's Nursing Education Program Workshop will be held June 15, 2018, at the Ohio Department of Transportation. Currently, 150 individuals representing about 80 programs are registered. The fall workshop is schedule for December 6, 2018 at the same location. Ohio Department of Higher Education: Military/Veterans S. Walker summarized a May 21, 2018, meeting convened by the Ohio Department of Higher Education (ODHE) to address nursing programs granting credit for military training. She said the current challenge is defining a statewide bridge course with multiple military backgrounds that differ by sector. L. Emrich added that ODHE discussed its work with nursing programs to identify how to streamline courses to improve the transfer of course credit among post-licensure nursing education institutions. M. Bennett said ODHE staff previously asked her to replicate her program's LPN to RN advanced placement model for military training and education. Advisory Group Application Period L. Emrich reviewed the terms of current Advisory Group members. The Board will publish an Advisory Group application and the open positions on its website in October, and the Board will review and make appointments at its November 2018 meeting. Remaining 2018 Meeting Dates October 4, 2018 Adjourn The meeting adjourned at 11:56 a.m.

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