PURPOSE: This rule defines the educational program, curriculum plan and requirements, simulation, and distance education requirements for Veteran’s Bridge Programs of Practical Nursing. (1) General Purpose.

1. (A) The program shall have a philosophy and/or mission which guides the curriculum practices.
2. (B) The curriculum incorporates established professional standards, guidelines, and competencies with clearly stated objectives, graduate competencies, and program outcomes.
3. (C) The educational program shall provide planned learning experiences essential to the achievement of the stated philosophy and/or mission and graduate competencies of the program and demonstrate logical progression.
4. (D) The educational program shall provide clinical education to facilitate transition to practice as a practical nurse, which includes clinical decision making, leadership, and management under the supervision of a registered nurse or a physician.
5. (E) Clinical learning should focus on Maternal/Newborn, Pediatric, Geriatric, and Complex Care Nursing (chronic illness care and multiple co-morbidities); although Medical-Surgical Nursing should be included.
6. (F) The program that uses clinical simulation shall adhere to model standards of best practice.
7. (G) The plan of study may be implemented in traditional or blended format. No more than twenty-five percent (25%) of theory instruction shall be delivered through distance learning.

8. (2) Curriculum Organization and Development.

   1. (A) The nursing faculty shall have the authority and the responsibility to develop, implement, and evaluate the curriculum.
   2. (B) There shall be a written curriculum plan that is logically structured to achieve expected individual and aggregate student outcomes.
   3. (C) Curriculum design of the program shall foster seamless academic articulation toward a program of professional nursing.
   4. (D) Policies for evaluation and awarding of credit for military education, training, and service that shall be in place.
   5. (E) Number of credit or clock hours required for completion of the program shall not exceed seventeen (17) credit hours equivalent to four hundred (400) clock hours of instruction. This shall include no more than twelve (12) credit hours (one hundred eighty

9. (180) clock hours) of theory and five (5) credit hours (two hundred twenty (220) clock hours) of lab/clinical/simulation instruction.

   1. (F) Adjustments in credit or clock hour requirements shall be approved by the board.
   2. (G) Total number of clock or credit hours, of Practical Nursing

to include credit transcripted for military education, training, and service, shall not exceed clock or credit hour requirements of a comparable (generic) program of practical nursing.

1. (H) Student learning experiences shall be directed and evaluated by the faculty and be consistent with the curriculum plan.

1. (3) Curriculum Requirements. Content may be developed as a separate course or integrated. Integrated concepts shall be evident in the course objectives.

   1. (A) Nursing Science. Theory and clinical instruction in nursing shall be based on the nursing process and encompass the promotion, maintenance, and restoration of physical and mental health and the prevention of illness for individuals and groups throughout the life cycle. Content shall enable the student to develop competency in each of the following areas while preparing for safe and effective practice as a practical nurse.

   2. (B) The following program outcomes and competencies shall be addressed:

      1. 1. Discuss the differences between cur-

rent military healthcare role and practical nursing;

1. 2. Demonstrate therapeutic communica-

tion skills and caring behaviors to clients and their families across the lifespan;

1. 3. Demonstrate critical thinking skills

and problem-solving to provide holistic nursing care to clients;

1. 4. Review types, classifications, phar-

macokinetics, and pharmacodynamics properties of selected drugs;

1. 5. Apply principles of safe medication

administration for childbearing, pediatric, adult, and geriatric clients;

1. 6. Perform data collection techniques

for childbearing, pediatric, adult, and geriatric clients;

1. 7. Implement the established plan of

care for childbearing, pediatric, adult, and geriatric clients;

1. 8. Apply anatomy, physiology, and

pathophysiologic concepts to the care of clients with selected health alterations across the lifespan;

1. 9. Apply integrated nutritional concepts

that support health promotion and disease prevention to clients across the lifespan;

1. 10. Describe laboratory and diagnostic

examinations utilized for selected health alterations throughout the lifespan;

1. 11. Identify developmental stages and

transitions for adult, child-bearing, pediatric, and geriatric clients;

1. 12. Demonstrate safe techniques and

competent care in providing interventions for clients receiving intravenous therapy;

1. 13. Calculate medication dosages safely

and accurately;

1. 14. Practice within the regulatory, legal,

and ethical frameworks of practical nursing;

1. 15. Demonstrate safe performance of

selected clinical skills/procedures;

1. 16. Communicate significant client find-

ings and events to the registered nurse and other members of the healthcare team;

1. 17. Demonstrate culturally sensitive

care;

1. 18. Describe the role of the practical

nurse in the management of a group of clients under the direction of a registered nurse using time management, interpersonal communication, delegation, and organizational skills;

1. 19. Apply elements of technology and

information management to document and report client findings and conditions;

1. 20. Demonstrate safe and competent care

in providing nursing interventions for clients across the lifespan;

1. 21. Identify various healthcare roles that

are part of the healthcare team and differentiate the LPN role as defined by the Missouri State Board of Nursing;

1. 22. Identify and complete the necessary

steps of the licensure process;

1. 23. Demonstrate skills that will aid in

obtaining a position as a licensed practical nurse; and

1. 24. Apply principles of lifelong learning.

1. (4) Instruction shall be provided in the following areas:

   1. (A) Foundations/Fundamentals of Nursing Care: Theoryfour (4) credit hours (sixty (60) clock hours); lab/clinical/simulationone and one-half (1.5) credit hours (sixty-eight (68) clock hours).

      1. 1. Clinical skills and therapeutic proce-

dures.

1. A. Assisting with activities of daily

living—

1. (I) Feeding;
2. (II) Dressing;
3. (III) Bathing;
4. (IV) Positioning; ( V ) A m b u l a t i ng / t ra n s f e r r i ng

patients;

1. (VI) Toileting;
2. (VII) Grooming.
3. 2. Vital Signs – Measurement of body

temperature, pulse, respirations, and blood pressure.

1. 3. Pain management.
2. 4. Internal/external disaster planning.
3. 5. Handling of hazardous and infectious

materials.

1. 6. Ergonomic principles.
2. 7. Restraints and safety devices.
3. 8. Admission/discharge/transfer proce- 20 CSR 2200-8

dures.

1. 9. Wound care.
2. 10. Oxygen therapy, tracheostomy care.
3. 11. Urinary catheterization.
4. 12. Ostomy care.
5. 13. Care of nasogastric and feeding

tubes.

1. 14. Chest tube management.
2. 15. Electrocardiogram/cardiac monitor-

ing.

1. 16. Medication administration through-

out the lifespan-

1. A. Medication orders;
2. B. Drug preparations;
3. C. Dosage calculations;
4. D. Preparation of medications;
5. E. Medication administration methods;
6. F. Documentation.

7. 17. Data collection—

   1. A. Full-body assessment;
   2. B. Focused assessment.
8. 18. Intravenous infusion therapy/

venipuncture.

1. A. Scope of the practical nurse—

   1. (I) Missouri State Board of Nurs-

ing – Nursing Practice Act;

1. (II) Legal implications;
2. (III) Documentation.
3. B. Blood collection.

4. C. Principles of IV therapy—

   1. (I) Routine care and maintenance;
   2. (II) Catheter site care;
   3. (III) Flushing with saline or hep-

arinized saline;

1. (IV) Client evaluation;
2. (V) Equipment.

3. D. Complications/adverse reactions—

   1. (I) Local;
   2. (II) Mechanical;
   3. (III) Systemic.
4. E. Insertion of peripheral-short IV

catheters.

1. F. Discontinuation of peripheral IV

catheters—

1. (I) Peripheral-short.
2. G. Pharmacokinetics/pharmacodynam-

ics for select IV fluids and medications—

1. (I) Hypo-/iso-/hypertonic solutions;
2. (II) Premixed/admixture medica-

tions;

1. (III) Care of the blood transfusion

patient.

1. H. Dosage calculations/regulating

rates.

1. I. Administration of select intravenous

solutions—

1. (I) Un-medicated solutions;
2. (II) Premixed/admixed medications.
3. J. Care and Maintenance of central

line.

1. 19. Clinical skills/therapeutic procedures

for the child-bearing. Client/family/neonate. FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION

1. A. Data collection.
2. 20. Clinical skills/therapeutic procedures

for the pediatric client.

1. A. Data collection;
2. (B) Medical-Surgical Nursing Through the Lifespan: Theoryfour (4) credit hours (sixty

1. (60) clock hours); Lab/clinical/simulationtwo and one-half (2.5) credit hours (one hundred twelve (112) clock hours).

   1. 1. Holism.

      1. A. Developmental lifespan considera-

tions.

1. B. Stages of growth and development

for pediatric/adult/geriatric and childbearing patients.

1. C. Health promotion and disease pre-

vention for pediatric/adult/geriatric and childbearing patients.

1. 2. Safe nursing practice.

   1. A. Nursing care of adult/geriatric/pedi-

atric patients with select alterations in health, human anatomy/physiology/pathophysiology, applicable laboratory and diagnostic examinations, medical management, nursing process, pharmacokinetics and pharmacodynamics of applicable medication classifications, diet and nutritional therapy—

1. (I) Disorders of the cardiovascular

and peripheral vascular system;

1. (II) Disorders of the respiratory

system;

1. (III) Disorders of the gastrointesti-

nal system;

1. (IV) Disorders of the endocrine

system;

1. (V) Disorders of the immune sys-

tem;

1. (VI) Disorders of the integumen-

tary system;

1. (VII) Disorders of the hematologic

and lymphatic system; (VIII) Disorders of the reproductive system;

1. (IX) Disorders of the muscu-

loskeletal system;

1. (X) Disorders of the genitourinary

system;

1. (XI) Disorders of the neurologic

system;

1. (XII) Fluid/electrolyte and acid/base

imbalances; (XIII) Cancer;

1. (XIV) Mental health disorders—

   1. (a) Behavior management;
   2. (b) Crisis intervention;

2. (XV) Surgical patient—

   1. (a) Preoperative;
   2. (b) Intraoperative;
   3. (c) Postoperative;

3. (C) Maternal/Newborn Nursing Practice: Theorytwo (2) credit hours (thirty (30) clock hours); lab/clinical/simulationone (1) credit hour (forty (40) clock hours).

   1. 1. Nursing care of the antepartum

patient and family.

1. 2. Nursing care of the intrapartum

patient and family.

1. 3. Nursing care of the postpartum

patient and family.

1. 4. Nursing care of the neonate;

2. (D) Personal and vocational concepts shall exist as a discrete course in the curriculum; and include the following content and meet credit or clock hour requirements: Theorytwo (2) credit hours (thirty (30) clock hours).

   1. 1. Critical thinking.

      1. A. Nursing process—

         1. (I) Data collection (assessment)—

            1. (a) Components of a health his-

tory;

1. (b) Full versus focused assess-

ment;

1. (II) Diagnosis;
2. (III) Planning;
3. (IV) Implementation;
4. (V) Evaluation.

5. B. Documentation—

   1. (I) Electronic health records.

6. C. Therapeutic communication—

   1. (I) Caring for the pediatric/adult/

geriatric and childbearing patient.

1. 2. Role development.

   1. A. Collaboration within the health-

care team—

1. (I) Communication;
2. (II) Conflict resolution;
3. (III) Delegation;
4. (IV) Role in patient education, dis-

charge planning, and patient involvement;

1. (V) Inter-professional patient care;
2. (VI) Continuous quality improve-

ment.

1. B. Scope of practice—

   1. (I) Nursing history and trends;
   2. (II) Role transition;
   3. (III) Standards of practice for the

PN, RN;

1. (IV) State Nurse Practice Act;
2. (V) Agency specific guidelines.
3. C. Legal and ethical considerations in

patient care.

1. D. Licensure process—

   1. (I) National Council Licensure

Examination;

1. (II) State Board of Nursing.
2. E. Transition into employment/fur-

ther education—

1. (I) Professional appearance;
2. (II) Professional communication;
3. (III) Résumés;
4. (IV) Interview skills;

5. (V) Leadership and management—

   1. (a) Concepts of delegation;
   2. (b) Prioritization of care;
6. (VI) Life-long learning.

7. 3. Holism.

   1. A. Religious and spiritual considera-

tions.

1. B. Cultural considerations;
2. (E) External nursing examinations, if used, shall not be used solely for program progression or graduation.

1. (5) Syllabus Construction. Syllabi shall be current and available to all faculty, students, and cooperating agencies. Each syllabus shall include:

   1. (A) Course title, current date and year the course is offered, and required pre-requisites;
   2. (B) Course description;
   3. (C) Course objectives;
   4. (D) Teaching or learning strategies;
   5. (E) Evaluation methodologies;
   6. (F) Grading scale;
   7. (G) Course policies; and
   8. (H) Clock hour requirements related to theory, lab, and clinical instruction. Each syllabus should reflect credit hour requirements for theory, lab, and clinical instruction, if used.

2. (6) Distance Learning Measures and Opportunities.

   1. (A) Veteran’s Bridge programs to practical nursing in part through distance learning technologies shall meet the same academic program and learning standards as programs provided in face-to-face format, to include the following:

      1. 1. Budgetary support specific to distant

learning resources;

1. 2. Course management/delivery plat-

form(s) that are reliable and navigable for students and faculty;

1. 3. Sufficient technical support to assist

students and faculty to consistently meet program outcomes;

1. 4. Learning and technology resources,

to include library resources, that are selected with input of the nursing faculty and are comprehensive, current, and accessible to students and faculty;

1. 5. Student outcomes consistent with

stated mission, goals, and objectives of the program;

1. 6. Collaborative and interactive learning

activities that assist students in achieving course objectives;

1. 7. Planned, faculty-guided clinical

learning experiences that involve direct contact with patients;

1. 8. Learning opportunities that facilitate

development of students’ clinical competence and judgment, role socialization, and transition to nursing practice;

1. 9. Evaluation of student outcomes at set of Practical Nursing

intervals;

1. 10. Tracking of student retention and

completion rates;

1. 11. Faculty and student input into the

evaluation process; and

1. 12. Evidence that outcome data are con-

sistently utilized to plan and improve distance learning.

AUTHORITY: sections 324.007 and 335.036, RSMo 2016.* Original rule filed April 14, 2017, effective Oct. 30, 2017. Amended: Filed Feb. 2, 2018, effective Aug. 30, 2018. *Original authority: 324.007, RSMo 2013 and 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007, 2008, 2011.