Don’t lower Texas’ RN standards

San Antonio Express-News, April 10, 2009

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The 81st Legislature is weighing legislation that would lower nursing basic educational standards to help fight the nursing shortage in Texas. Bad idea.

Some background: The New York-based Excelsior College offers a self-paced “RN education” course online for people with a “degree” (not defined) in a clinically oriented health-care field. Supervised clinical instruction isn’t part of the course.

While these students, such as military service corpsmen or paramedics, may have significant clinical health-care experience, they haven’t had supervised RN clinical instruction. Instead, after passing eight nursing-theory exams, Excelsior students undergo a 2½-day monitored clinical experience where a check-off list is used to assess nursing competency.

In contrast, the Nursing Practice Act requires Texas registered nurse educational programs to have supervised clinical learning experiences involving multiple assessments and feedback to students during an extended period of time.

The Texas Board of Nursing allows Excelsior graduates to apply for RN initial licensure, but not without tapping into a thick vein of discomfort.

Other states also are uncomfortable with the Excelsior model. Georgia last week passed legislation requiring additional training for Excelsior graduates. The California Board of Nursing sued Excelsior and won. Arizona requires a supervised clinical experience for Excelsior graduates. Other states have imposed special clinical requirements on Excelsior graduates as a condition of licensing.

The Texas nursing board does not want the program to close; it wants Excelsior to have the same safety requirements other Texas nursing programs have. Two proposed legislative remedies have been offered:

•HB 4355 proposes a research study to evaluate if the Excelsior model is equivalent to the supervised clinical experience required of Texas programs. The bill is supported by the Texas Nurses Association and 14 other Texas nursing organizations.

•HB 3230 and SB 1397 were initiated by Excelsior College and would amend the Nursing Practice Act to permanently “deem” the Excelsior model to be “substantially equivalent” to the supervised clinical experience Texas schools require.

Excelsior College has deep pockets, has hired high-powered lobbyists and garnered the support of many legislators and governors nationwide, including Gov. Rick Perry.

After committee hearings, the bills are pending in the House Public Health Committee and the Senate Health and Human Services Committee, and could be called for a vote at any time.

With a focus on patient safety, this is no time to permanently deem that a program with a minimal competency assessment produces RNs equivalent to those with extensive supervised clinical experiences.

The Excelsior model won’t eliminate our nurse shortage. The solution is to maintain and improve our existing education standards by having more faculty in board-approved programs and adding more clinical sites.

By supporting HB 4355 and opposing SB 1397/HB 3230, Texas legislators can preserve the integrity of nursing programs and ensure public safety.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.