PURPOSE: This rule defines the approval status and process for programs of professional nursing.

1. (1) Pre-licensure programs granting diploma, associate degree, baccalaureate degree, or master degree with a major in nursing shall obtain approval from the board.

2. (2) Purposes of Approval.

   1. (A) To promote the safe practice of professional nursing by setting minimum standards for programs preparing entry-level professional nurses.
   2. (B) To assure that educational requirements for admission to the licensure examination have been met and to facilitate endorsement in other states, territories, countries, or a combination of these.
   3. (C) To encourage continuing program improvement through assessment, evaluation, and consultation.
   4. (D) To assist programs of professional nursing in developing and maintaining academic standards (theory and clinical) that are congruent with current educational and nursing practice standards.

3. (3) Classification of Approval.

   1. (A) Initial approval is the status granted a program of professional nursing until full approval is granted or approval is withdrawn.
   2. (B) Full approval is the status granted a program of professional nursing after the program has met and continues to meet regulations or requirements.
   3. (C) Conditional approval is the status of a program that has failed to meet or maintain the regulations or requirements set by the board.

4. (4) Initial Approval Status.

   1. (A) Process for Obtaining Initial Approval—

      1. 1. An accredited institution of higher

education desiring to establish a program of professional nursing shall submit a petition to the board at least three (3) months prior to the submission of a proposal. Prior to submission of a petition, nursing programs operating under the institution’s sponsorship shall meet requirements for full program approval. The petition shall include: the name and location of the sponsoring institution and its accreditation status; the mission statement of the sponsoring institution and the mission statement of the proposed program; the proposed location (and satellites) in relation to the administrative offices of the sponsoring institution; statement of need and feasibility; type and length of the nursing program proposed; and tentative budget plans including evidence of financial resources adequate for planning, implementing, and continuing the nursing program. The statement of need and feasibility shall include:

1. A. Documentation of the need for the

nursing program including community and economic development need, rationale for why the program should be established, and documentation of employers’ need for graduates of the proposed program;

1. B. Number of professional nursing

and practical nursing programs in the area and potential impact on those nursing programs;

1. C. Number and source of anticipated

student population;

1. D. Letters of support for the proposed

nursing program;

1. E. Letter(s) from potential clinical

sites; including a description of potential clinical sites, average daily patient census, and the ability to provide clinical placement to potential students in addition to those of existing nursing programs to meet program objectives and outcomes; and

1. F. Source of potential qualified faculty

and anticipated ratio of faculty to student enrollment. Upon board review of the petition, the board has the authority to approve or deny the petition. The petition shall be accepted by the board prior to submission of a proposal. Revised petitions may be submitted to the board. Each petition shall remain active for no more than one (1) calendar year from the date of review by the board. The board will electronically notify nursing programs of the accepted petition;

1. 2. Each sponsoring institution shall have

only one (1) program proposal under consideration for initial approval at any one (1) time;

1. 3. A program proposal shall be written

and presented to the board by the administrator of the proposed program. The proposal shall comply with the Minimum Standards for Programs of Professional Nursing as prescribed in 20 CSR 2200-2.050 through 20 CSR 2200-2.130 and bear the signature of the administrator who meets the criteria in 20 CSR 2200-2.060(1)(B) and has been active in the position on a full-time basis at least nine (9) months and preferably one (1) year prior to the entry of the first class. The number of copies of the proposal, as specified by the board, shall be submitted with the required application fee. Submission of the application fee will initiate review of the proposal. The proposal shall be prepared following the reporting format and includes each component as indicated in paragraph (4)(A)4. of this rule. The proposal shall remain active for no more than one (1) calendar year from the date of review by the board. No more than two (2) proposal revisions shall be accepted. Members designated by the board will review the proposal and make recommendations prior to presentation of the proposal to the board. Board approval of the proposal with or without contingencies shall be obtained no later than six (6) months prior to the anticipated opening date;

1. 4. A proposal submitted shall contain

the following information:

1. A. Curriculum.

   1. (I) Philosophy and/or mission.
   2. (II) Graduate competencies.
   3. (III) Curriculum sequence.
   4. (IV) Course descriptions and objec-

tives with number of credit hours for all courses. Credit and clock hour allocations specific to theory, lab, and clinical portions shall be included.

1. (V) Systematic evaluation plan.
2. (VI) Evidence of eligibility for

articulation of credits related to baccalaureate completion programs;

1. B. Students.

   1. (I) Maximum number of students

per class.

1. (II) Number of classes admitted per

year.

1. (III) Number of students anticipat-

ed in initial class.

1. (IV) Plan for increase to maximum

enrollment, if applicable.

1. (V) Admission criteria.
2. (VI) Plans for progression and reten-

tion of students.

1. (VII) Appeal policies and proce-

dures. (VIII) Availability and accessibility of student services;

1. C. Faculty.

   1. (I) Plan for hiring full-time and

part-time theory and clinical faculty. This plan shall include full-time equivalents, student to faculty ratios, and full-time to parttime faculty ratios to meet initial and increasing enrollment.

1. (II) Position descriptions;

2. D. Support services personnel.

   1. (I) Number of full-time and part-

time ancillary support services personnel.

1. (II) Position descriptions;

2. E. Sponsoring institution.

   1. (I) Evidence of authorization to con-

duct the program of professional nursing by the governing body of the sponsoring institution.

1. (II) Evidence of accreditation by an

agency recognized by the United States Department of Education.

1. (III) Current organizational chart(s)

illustrating the relationship of the program to the sponsoring institution and the faculty structure within the proposed program.

1. (IV) Evidence of financial stability

and resources of the sponsoring institution and the program of nursing to include a sustainability plan for the purchase, replacement, and maintenance of skills lab supplies, furnishings, and equipment to meet program outcomes; and

1. F. Facilities.

   1. (I) Description of educational facil-

ities to be used by the professional nursing program such as classrooms, library, offices, clinical skills and simulation laboratories, and other facilities.

1. (II) Description of planned or avail-

able learning resources to include such items as equipment, supplies, library services, computers, simulation technology, and online educational resources to be utilized for instructional purposes.

1. (III) Letter(s) from potential clini-

cal sites; including a description of potential clinical sites, average daily patient census and the ability to provide clinical placement to potential students in addition to those of existing nursing programs to meet program objectives and outcomes.

1. (IV) A letter of intent from each

proposed cooperating agency stating its ability to provide the appropriate educational experiences to meet program objectives and outcomes;

1. 5. Site survey. Representatives from the

board will make an on-site survey to verify implementation of the proposal and compliance with 20 CSR 2200-2.050 through 20 CSR 2200-2.130; and

1. 6. The board’s decision to grant initial

approval is contingent upon evidence from the site survey that the program is being implemented in compliance with 20 CSR 2200-2.050 through 20 CSR 2200-2.130. Initial program approval contingent on the site survey shall remain active for no more than one (1) calendar year prior to program start.

1. (B) Throughout the period of initial approval, the program shall submit an annual report, an annual registration, and the annual registration fee as set by the board.

2. (C) Upon graduation of the program’s first class and receipt of results of the first official National Council Licensure Examination for Registered Nurses (NCLEX-RN®) program pass rate, as reported after completion of the fourth quarter of the respective calendar year, the board will review the following:

   1. 1. The program’s compliance with min-

imum standards during initial approval including the program’s adherence to the approved proposal and changes authorized by the board;

1. 2. Report of an on-site survey;
2. 3. Report of National Council Licensure

Examination for Registered Nurses (NCLEX- RN®) results (see 20 CSR 2200-2.180(1));

1. 4. Identification and analysis of class

graduation rate; and 20 CSR 2200-2

1. 5. Submission of program’s ongoing sys-

tematic evaluation plan with available data.

1. (D) After its review, the board shall decide to continue initial approval for a period of not more than one (1) calendar year, withdraw approval, or grant full approval.
2. (E) On-Site Surveys. At least two (2) representatives of the board will make on-site surveys on a regular basis throughout the initial approval period. A program may request additional visits. Programs retained on initial approval status will have on-site surveys on an annual basis and as directed by the board.
3. (F) A program’s approval may be withdrawn pursuant to section 335.071.3., RSMo, for noncompliance with minimum standards. A program which fails to correct identified deficiencies to the satisfaction of the board will, after notice and hearing, be removed from the board’s listing of approved programs.

1. (5) Full Approval Status.

   1. (A) Annual Report. Each program and each campus of each program shall complete and submit the board’s annual report by the established deadline. Following review by the board, each program will be notified of the board’s action(s).
   2. (B) A program’s approval status is subject to review by the board if the required annual report, annual registration, or annual registration fee is not received within thirty (30) days from the established deadline.
   3. (C) On-Site Surveys. On-site surveys will be made on a scheduled basis, at the direction of the board, or upon request of the nursing program. Each nursing program will be surveyed typically at five- (5-) year intervals. If the program is accredited by a national nursing accreditation agency, the nursing program may request that the on-site survey be scheduled in coordination with a national nursing accreditation agency visit. Representatives of the board will form a survey team to conduct each on-site survey. Each survey team shall consist of two (2) or more persons qualified to conduct on-site surveys. The program shall solicit public comments in preparation for each routine on-site survey. Evidence of solicitation of public comments shall be available for review during the on-site survey.
   4. (D) Additional Visits/Surveys. At least two
2. (2) representatives of the board will make additional visits/surveys as deemed necessary by the board. A program may request additional visits.

3. (6) Conditional Approval Status.

   1. (A) Should circumstances warrant, the board will notify the program administrator of concerns regarding the program and the AND INSURANCE

administrator will be requested to respond to those concerns.

1. (B) A program may be placed on conditional approval status if it has failed to meet or maintain the rules/regulations or requirements, or both, set by the board. The program will remain on conditional approval status until such time as the deficiencies are corrected to the satisfaction of the board.
2. (C) On-Site Surveys. At least two (2) representatives of the board will make on-site surveys. On-site surveys are conducted on regular basis throughout the conditional approval period as directed by the board. A program may request additional visits.
3. (D) A program’s approval may be withdrawn pursuant to section 335.071.3., RSMo, for noncompliance with minimum standards. A program which fails to correct identified deficiencies to the satisfaction of the board shall, after notice and hearing, be removed from the board’s listing of approved programs.

1. (7) Moratorium on Student Admissions.

   1. (A) Should circumstances be such that instructional quality and integrity of the program is jeopardized as determined by the board, the board may impose a moratorium on student admissions. A moratorium on student admissions may be imposed by the board during initial, full, and conditional approval status of the program. The moratorium may be lifted by the board upon proof submitted to the board that the program has cured any deficiencies in the instructional quality and integrity of the program.

2. (8) Annual Registration Requirements.

   1. (A) The board will send an application for annual registration to each approved program and each campus of each program from the board. Failure to receive the application will not relieve the program of its obligation to register.
   2. (B) A separate annual registration form and designated fee as established in 20 CSR 2200- 4.010(1)(F) shall be submitted to the board for each approved program and each campus of each program prior to June 1 of each year. Satellite locations do not qualify as a campus of an approved program.
   3. (C) A program’s approval status is subject to review by the board if the required registration fee is not received within thirty (30) days of the June 1 deadline.

AUTHORITY: sections 335.036 and 335.071, RSMo 2016.* This rule originally filed as 4 CSR 200-2.010. This version of rule filed April 20, 1973, effective May 1, 1973. Amended: Filed Dec. 12, 1975, effective Dec. 22, 1975. Readopted: Filed March 12, 1981, effective June 11, 1981. Amended: Filed Oct. 14, 1981, effective Jan. 14, 1982. Amended: Filed Dec. 10, 1981, effective March 11, 1982. Emergency rescission filed Oct. 22, 1981, effective Nov. 1, 1981, expired Feb. 19, 1982 (Original Rule). Rescinded: Filed Oct. 22, 1981, effective Feb. 11, 1982 (Original rule). Amended: Filed Oct. 14, 1987, effective Jan. 29, 1988. Rescinded and readopted: Filed Sept. 25, 1991, effective March 9, 1992. Amended: Filed Dec. 14, 1994, effective May 28, 1995. Amended: Filed Aug. 6, 1998, effective Feb. 28, 1999. Amended: Filed Dec. 1, 2000, effective May 30, 2001. Moved to 20 CSR 2200-2.010, effective Aug. 28, 2006. Rescinded and readopted: Filed April 17, 2007, effective Dec. 30, 2007. Amended: Filed Jan. 11, 2013, effective July 30, 2013. Amended: Filed Feb. 5, 2018, effective Aug. 30, 2018.

*Original authority: 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007, 2008, 2011 and 335.071, RSMo 1975, amended 1981, 1999.