November 23, 2009

Rox Smith
Pennsylvania State Board of Nursing
Bureau of Professional and Occupational Affairs
P.O. Box 2649
Harrisburg, PA 17105-2649

RE: 16A-5138: Proposed Clinical Nursing Education

Dear Ms. Smith:

The Hospital & Healthsystem Association of Pennsylvania (HAP), on behalf of its members, more than 250 acute and specialty hospitals and health systems, appreciates the opportunity to comment on the State Board of Nursing’s pre-draft regulations related to clinical nursing education requirements for nursing education programs approved by another state’s board of nursing. HAP appreciates the Board’s interests in ensuring the provision of safe patient care by students participating in clinical rotations in Pennsylvania’s health care organizations who are enrolled in nursing education programs approved by other state’s boards of nursing as they do for nursing students enrolled in nursing programs approved and monitored by the Pennsylvania Board of Nursing.

Understandably, the pre-draft regulations do not include the preamble that accompanies proposed regulations. HAP recommends that the Board clearly articulate where it derives the authority to regulate the use of clinical sites in Pennsylvania by schools of nursing which are not approved, regulated, or monitored by the Pennsylvania Board of Nursing. HAP also fully supports the Board’s interests in holding nursing programs approved by other state boards of nursing to the same standards as nursing education programs approved by the Pennsylvania Board of Nursing with respect to the use of clinical sites for nursing students. With this in mind, HAP would like to share concerns with existing regulations governing student supervision by faculty in the clinical setting that HAP believes warrants further discussion and possible modification by the Pennsylvania State Board of Nursing.

In §21.53(e)(3) of the proposed regulations, the Board states that the program requirements for faculty and preceptor qualifications for nursing programs approved by other state boards of nursing must be equivalent to the faculty and preceptor qualifications for Pennsylvania programs that obtain Board approval under §§21.51 and 21.71. Under §21.71(5)(ii) of the current regulations, faculty shall retain responsibility for planning and evaluating student learning experiences when students are engaged in clinical activities with a preceptor. Further, §21.71(5)(iii) states that if a faculty member is not physically present in the area in which students are practicing, a faculty member shall be immediately available by telephone or other means of telecommunication when students are engaged in clinical activities with a preceptor. Even though faculty must be masters-prepared in order to teach in a registered nursing education program, there is no stated qualification for preceptors providing clinical supervision of nursing students. HAP concludes that merely indicating that faculty from a nursing education program approved by another state board of nursing be available by telephone or other means of telecommunication when their students are engaged in clinical activities under the guidance of a preceptor puts an extremely heavy burden on Pennsylvania nurses who are serving as preceptors. Further, HAP is concerned that the current regulation as written does not provide any guidance as to how readily available in terms of time or distance the supervising faculty member should be to the nursing student or preceptor if problems arise. This concern applies to programs approved by the Pennsylvania State Board of Nursing and nursing programs approved by other state boards of nursing where nursing faculty are providing supervision remotely rather than on-site. However, this regulation raises even greater concerns with programs approved by other state boards of nursing where faculty may be a considerable distance from the clinical site.

HAP believes that the Board’s intent is to ensure the patients in Pennsylvania health care organizations receive proper and safe care from nursing students enrolled in nursing education programs regardless of whether the program is approved by the Pennsylvania Board of Nursing or another state board of nursing. Therefore, HAP respectfully recommends that the Board of Nursing revisit the clinical supervision language in the current regulations to determine if this provision needs to be tightened. If the Board determines that the current regulation need not be amended, HAP respectfully requests that the Board revise the language in the proposed regulations regarding nursing education programs approved by other state boards of nursing to ensure that clinical faculty is readily available to nursing students and preceptors should problems arise in the clinical setting necessitating the physical presence or immediate availability of program faculty as in the case where a patient is harmed while under the care of the nursing student and preceptor or if something untoward happens to the nursing student during his/her clinical rotation.

HAP appreciates the opportunity to provide comments on this pre-draft rulemaking. If you have any questions about HAP’s comments, please feel free to contact Mary Marshall, director, workforce and professional services at (717) 561-5312 or by email at mmarshall@haponline.org or me at (717) 561-5308 or by email at lgleighton@haponline.org.

Sincerely,

Lynn G. Leighton
Vice President, Health Services