1. (a) Purpose. Continuing education in nursing includes programs beyond the basic preparation which are designed to promote and enrich knowledge, improve skills, and develop attitudes for the enhancement of nursing practice, thus improving health care to the public. Pursuant to authority set forth in Texas Civil Statutes, Article 4518, §7, the board is establishing rules requiring participation in continuing education activities for license renewal. The procedures set forth in these rules provide a variety of means for licensees to comply with this requirement. The board assumes licensed nurses will maintain the high standards of the profession in selecting quality educational programs to fulfill the continuing education requirement. The board also assumes that providers will plan and implement quality educational programs which meet the criteria of the board.

2. (b) Requirements. Twenty contact hours of continuing education within the two years immediately preceding renewal of registration are required.

   1. (1) Type I. Ten contact hours shall be obtained by participation in programs approved by a credentialing agency recognized by the board. The program shall meet all criteria listed in subsection (c) of this section. In addition, there shall be a nurse on the planning committee and target audience shall include nurses. The board recognizes agencies/organizations to approve providers and/or programs for Type I credit. A list of these agencies/organizations may be obtained from the board's office.
   2. (2) Type II. The remaining 10 contact hours shall be obtained by participation in additional Type I programs or by participation in activities listed in subsection (c) of this section.

3. (c) Criteria for acceptable continuing education activity. The following criteria have been established to guide the licensed nurse in selecting appropriate programs and to guide the provider in planning and presenting continuing education programs. Activities which may meet these criteria include: classroom instruction, individualized instruction, academic courses, self-directed study, and institutional-based instruction.

   1. (1) Length. The program shall be at least one contact hour (50 consecutive minutes) in length.

   2. (2) Learner objectives.

      1. (A) Objectives shall be written and shall be the basis for determining content, learning experience, teaching methodologies, and evaluation.
      2. (B) Objectives shall be specific, attainable, measurable, and describe expected outcomes of the learner.
   3. (3) Target audience. The target audience for the program is identified.
   4. (4) Planned program. There shall be evidence of program planning based on needs of potential target audience.

   5. (5) Content.

      1. (A) The content shall be relevant to nursing practice and/or health care and provide for the professional growth of the licensee.
      2. (B) Content is related to and consistent with the program objectives.

   6. (6) Instructor qualifications.

      1. (A) There shall be documentation of the instructor's expertise in the content area. The instructor should apply principles of adult learning.
      2. (B) If the program includes a clinical nursing component, a licensed nurse with expertise in that specific component shall provide supervision with a ratio of no more than 12 participants to one faculty.
      3. (C) If the program includes a clinical component other than nursing, an instructor possessing the appropriate credentials of the discipline shall provide supervision.

   7. (7) Teaching methods.

      1. (A) Learning experiences and teaching methods shall be appropriate to achieve the objectives of the program.
      2. (B) Principles of adult education shall be used in the design of the program.
      3. (C) Time allotted for each activity shall be sufficient for the learner to meet the objectives of the program.
      4. (D) A schedule of the program shall be provided which describes content with corresponding time frames.
      5. (E) Facilities and educational resources shall be adequate to implement the program.

   8. (8) Evaluation.

      1. (A) Participants shall complete a written evaluation of the:

         1. (i) teaching effectiveness of each instructor;
         2. (ii) learner's achievement of objectives;
         3. (iii) relevance of content to stated objectives;
         4. (iv) effectiveness of teaching methods; and
         5. (v) appropriateness of physical facilities and educational resources.
      2. (B) If participation is in an academic course or other program in which grades are granted, a grade equivalent to "C" or better shall be required, or "pass" on a pass/fail grading system.

   9. (9) Records.

      1. (A) Records of programs shall be kept by the provider for a minimum period of four years from the date of completion.
      2. (B) Records shall include target audience, program planning materials, content, objectives, outline of instructor qualifications, teaching methods and materials, evaluation tools and summary, and a list of participants.
      3. (C) The provider shall furnish each participant a record of attendance specifying the provider; title, date, and location of program; number of contact hours; and provider number, grades, and organization granting approval, if applicable. This record shall be kept by the nurse for a minimum period of four years from the date of completion.

4. (d) Additional criteria for specific continuing education programs. In addition to those listed in subsection (c) of this section, the following guidelines shall apply to the selection and/or planning and implementation of specific CE programs.

   1. (1) Academic course.

      1. (A) The course shall be within the framework of a curriculum that leads to an academic degree in nursing or any academic course relevant to nursing practice/health care.
      2. (B) Participants, upon audit by the board, shall be able to present an official transcript indicating completion of the course with a grade of "C" or better, or a "pass" on a pass/fail grading system.
      3. (C) Academic courses in this category are acceptable for Type I CE credit.

   2. (2) Individualized instruction (home study/programmed instruction). The program shall:

      1. (A) be developed by a professional group such as an educational institution, corporation, professional association, or other provider of continuing education;
      2. (B) follow a logical sequence;
      3. (C) involve the learner by requiring an active response to the educational materials presented;
      4. (D) contain a means to measure achievement of learning objectives of the program; and
      5. (E) provide a record of attendance which complies with subsection (c)(9)(C) of this section concerning records indicating completion of the program;
      6. (F) up to 20 contact hours of Type I or five contact hours of Type II credit for one renewal period may be obtained through individualized instruction.

   3. (3) Self-directed study.

      1. (A) Program development and presentation.

         1. (i) The program or presentation must not be a part of the licensee's primary employment responsibilities.
         2. (ii) Credit shall be awarded only once regardless of the number of times the program/work was presented.
         3. (iii) Upon audit by the board, the licensee must submit program objectives and an outline including date and location of the presentation not to exceed one page.
         4. (iv) Two hours of Type II credit per program topic may be obtained through this means.

      2. (B) Auditing of academic courses.

         1. (i) Academic courses in nursing or health care may be audited. Audited courses meet Type II requirements.
         2. (ii) Upon audit by the board, the licensee must submit a letter from the course instructor on the academic institution's letterhead indicating that the licensee attended the course.
         3. (iii) Two hours of Type II credit per course may be obtained through this means.

      3. (C) Certification.

         1. (i) A licensee who completes the requirements for certification in a nursing specialty by a national credentialing body may receive Type II continuing education credit.
         2. (ii) This is a one-time approval for initial certification only.
         3. (iii) Upon audit by the board, the licensee must furnish a letter from the national specialty organization indicating initial certification.
         4. (iv) Five hours of Type II credit for initial certification may be obtained through this means.

      4. (D) Authorship.

         1. (i) A licensee may receive CE credit for development and publication of a manuscript related to nursing and health care.
         2. (ii) Credit for publication shall be awarded only once per renewal period.
         3. (iii) Upon audit by the board, the licensee must submit a letter from the publisher indicating acceptance of manuscript for publication or a copy of the published work.
         4. (iv) Five contact hours of Type II credit may be obtained through this means.

   4. (4) Out-of-state programs. A continuing education program attended or undertaken in a jurisdiction outside of Texas may be accepted:

      1. (A) for Type I credit if all criteria are met and if it is approved by one of the board's recognized credentialing agencies/organizations; and
      2. (B) for Type II credit if it meets the criteria listed in subsection (c) and this subsection concerning criteria for acceptable continuing education activity and additional criteria for specific continuing education programs.

5. (e) Activities which are not acceptable as continuing education. The following activities do not meet continuing education requirements for licensure renewal.

   1. (1) Basic cardiopulmonary resuscitation (CPR) courses.
   2. (2) Inservice programs. Programs sponsored by the employing agency to provide specific information about the work setting and orientation or other programs which address the institution's philosophy, policies, and procedures; on-the-job training; basic cardiopulmonary resuscitation; and equipment demonstration are not acceptable for CE credit.
   3. (3) Refresher courses. Programs designed to update knowledge or current nursing theory and clinical practice, which consist of a didactic and clinical component to ensure entry level competencies into professional practice are not accepted for CE credit.
   4. (4) Orientation programs. A program designed to introduce employees to the philosophy, goals, policies, procedures, role expectations, and physical facilities of a specific work place are not acceptable for CE credit.
   5. (5) Courses which focus upon self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, and yoga.
   6. (6) Economic courses for financial gain, e.g., investments, retirement, preparing resumes, and techniques for job interview.
   7. (7) Courses which focus on personal appearance in nursing.
   8. (8) Liberal art courses in music, art, philosophy, and others when unrelated to patient/client care.
   9. (9) Courses designed for lay people.

6. (f) Responsibilities of individual licensee.

   1. (1) It shall be the licensee's responsibility to select and participate in continuing education activities that will meet the criteria listed in subsection (c) of this section concerning criteria for acceptable continuing education activity.
   2. (2) The licensee shall be responsible for maintaining a record of CE activities. These records shall document attendance as evidenced by original certificates of attendance, contact hour certificates, academic transcripts, or grade slips and copies of these shall be submitted to the board upon audit.
   3. (3) These records shall be maintained by the licensee for a minimum of two consecutive renewal periods or four years.

7. (g) Relicensure process.

   1. (1) Renewal of license.

      1. (A) Upon renewal of the license, the licensee shall sign a statement attesting that the CE requirements have been met.
      2. (B) The contact hours must have been completed in the biennium immediately preceding the license renewal. CE contact hours from a previous renewal period will not be accepted. Additional contact hours earned may not be used for subsequent renewal periods.
   2. (2) Persons licensed by examination. A candidate licensed by examination shall be exempt from the CE requirement for issuance of the initial license and for the immediate renewal period following licensure.
   3. (3) Persons licensed by endorsement. An applicant licensed by endorsement shall be exempt from the CE requirement for the issuance of the initial Texas license and for the immediate renewal period following initial Texas licensure.

   4. (4) Delinquent license.

      1. (A) A license that has been delinquent for less than four years may be renewed by the licensee showing evidence of having completed 20 contact hours of acceptable continuing education within two years immediately preceding the application for relicensure and by meeting all other board requirements. A licensee shall be exempt from the continuing education requirement for the immediate renewal period following renewal of the delinquent license.
      2. (B) A license that has been delinquent for four or more years may be renewed upon completion of requirements listed in §217.7(b) of this title (relating to Failure To Renew Certificates of Reregistration).

   5. (5) Reactivation of a license.

      1. (A) A license that has been inactive for less than four years may be reactivated by the licensee submitting verification of having completed at least 20 contact hours of continuing education within the past two years immediately prior to application for reactivation.
      2. (B) A license that has been inactive for four or more years may be reactivated upon completion of requirements in §217.8(b) of this title (relating to Reactivation from Inactive Status).
   6. (6) Reinstatement of a license. A licensee whose license has been revoked and subsequently applies for reinstatement must show evidence that the CE requirement and other board requirements have been met prior to reinstatement of the license by the board.

8. (h) Audit process. The board shall select a random sample of licensees for each renewal month. Audit forms shall be sent to selected licensees to substantiate compliance with the continuing education requirements.

   1. (1) Within 30 days following notification of audit these selected licensees shall submit audit form, documentation as specified in subsections (c) and (d) of this section concerning criteria for acceptable continuing education activity and additional criteria for specific continuing education programs, and any additional documentation the board deems necessary to verify compliance with continuing education requirements for the period of licensure being audited.
   2. (2) The board shall notify the licensee of the results of the audit.
   3. (3) Failure to notify the board of a current mailing address will not absolve the licensee from audit requirements.
   4. (4) By this rule, an audit shall be automatic for a licensee who has been found noncompliant in an immediately preceding audit.
   5. (5) Failure to complete the audit satisfactorily or falsification of records shall constitute unprofessional conduct and provide grounds for disciplinary action.

9. (i) Appeals.

   1. (1) Any individual who wishes to appeal a determination of noncompliance with continuing education requirements must submit a letter of appeal within 20 days of notification of the audit results.
   2. (2) The board or its designee shall conduct a review in which the appellant may appear in person to present reasons why the audit decision should be set aside or modified.
   3. (3) The decision of the board after the appeal shall be considered final and binding.
10. (j) Consequences of noncompliance. Licensees found noncompliant shall be referred to the board's practice and compliance department for possible disciplinary action.

Source Note:The provisions of this §217.15 adopted to be effective September 1, 1991, 16 TexReg 3191; amended to be effective January 17, 1997, 22 TexReg 113.