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Alabama Board of Nursing Proposed Rule Changes Summary April 2020 ABN Administrative Code §610-X-1-.04 This proposal eliminates an outdated reference two-day Board meetings. The Board currently holds one-day Board meetings. ABN Administrative Code §610-X-3-.02 The ABN proposes to amend this section to require nursing education programs to establish a plan to account for remediation of didactic and clinical credits missed due to program closure or clinical site unavailability as a result of an emergency, such as the COVID-19 crisis. ABN Administrative Code §§610-X-7-.01 and 610-X-7-.11 The Board proposes rules allowing for delegation of nursing tasks to trained, qualified, and certified unlicensed personnel in licensed healthcare facilities.

Alabama Board of Nursing Proposed Rule Changes Summary 2020

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Alabama Board of Nursing Proposed Rule Changes

Summary April 2020

ABN Administrative Code §610-X-1-.04

This proposal eliminates an outdated reference two-day Board meetings. The Board currently holds one-day Board meetings.

ABN Administrative Code §610-X-3-.02

The ABN proposes to amend this section to require nursing education programs to establish a plan to account for remediation of didactic and clinical credits missed due to program closure or clinical site unavailability as a result of an emergency, such as the COVID-19 crisis.

ABN Administrative Code §§610-X-7-.01 and 610-X-7-.11

The Board proposes rules allowing for delegation of nursing tasks to trained, qualified, and certified unlicensed personnel in licensed healthcare facilities.

Chapter 610-X-1 Nursing

Supp. 9/30/19 1-10

610-X-1-.04 Meetings Of The Board.

(1) A minimum of six regular meetings shall be held

each year. The annual meeting shall be the November regular

meeting.

(a) Meeting notices shall be posted on the Secretary

of State’s web site as required by the Alabama Open Meetings Act.

(b) The Board may post meetings on the Board’s web

site.

(2) Special meetings may be called at the request of

the president or upon the request of three members of the Board.

(3) A majority of the Board, including at least one

officer, shall constitute a quorum at any meeting.

(4) Requests to present information to the Board

during a Board meeting shall be directed to the Executive Officer

at least fourteen days prior to the meeting.

(5) The secretary or designee shall keep a record of

all meetings. The minutes shall be transcribed and presented for

approval or amendment at the next regular two-day meeting. The

minutes or a true copy thereof, certified by a majority of the

Board, shall be open to public inspection. The minutes shall

reflect:

(a) The time and place of each meeting of the Board.

(b) Announcement of a quorum.

(c) A statement of compliance with the Alabama Open

Meetings Act.

(d) Names of the Board members present and those who

may be absent.

(i) Late arrivals or early departures shall be

documented in the minutes.

(ii) Any Board member’s absence during deliberation or

action on agenda items.

(e) All official acts of the Board.

(f) The vote of the individual Board members except

when the votes are unanimous. When requested by a dissenting

Board member, specific reasons for the dissenting vote shall be

recorded in the minutes.

Chapter 610-X-1 Nursing

Supp. 9/30/19 1-11

(6) A roll call vote may be taken upon the request of

a Board member.

(7) All meetings of the Board shall be held in

compliance with the Alabama Open Meetings Act.

(8) Meetings of the Board, except executive sessions,

may be openly recorded provided the recording does not disrupt

the conduct of the meeting. Requests to record Board meetings,

or portions thereof, shall be directed to the Executive Officer

at least 15 minutes prior to the beginning of the meeting to

allow assistance with placement of equipment and personnel. Any

disruption in the conduct of the meeting shall be addressed by

either the Executive Officer, the President of the Board, or the

Board members.

(9) Board members shall be conducted in accord with

Robert’s Rules of Order except as provided by law.

Author: Alabama Board of Nursing

Statutory Authority: Code of Ala. 1975, §34-21-2.

History: Filed September 29, 1982. Amended: Filed

February 17, 1984; effective March 24, 1984. Amended: Filed

September 18, 1985; effective October 24, 1985. Amended: Filed

September 20, 2002; effective October 25, 2002. Amended: Filed

March 24, 2006; effective April 28, 2006. Amended: Filed

May 23, 2011; effective June 27, 2011.

Nursing Chapter 610-X-3

Supp. 9/30/19 3-1

ALABAMA BOARD OF NURSING

ADMINISTRATIVE CODE

CHAPTER 610-X-3

NURSING EDUCATION PROGRAMS

TABLE OF CONTENTS

610-X-3-.01 Definitions

610-X-3-.02 Standards For Approval

610-X-3-.03 Distance Education

610-X-3-.04 Out Of State Programs Conducting

Clinical In Alabama

610-X-3-.05 Outcome Standards

610-X-3-.06 Deficiencies

610-X-3-.07 Establishing A New Program

610-X-3-.08 Closing A Program

610-X-3-.09 Nursing Education Program Hearing

610-X-3-.10 Withdrawal Of Board Approval

610-X-3-.02 Standards For Approval.

(1) The program must be accredited by a national

nursing accrediting agency recognized by the U.S. Department of

Education by the later of January 1, 2022 or within five (5)

years of Approval by the Board.

(2) The governing institution, nursing program

administrator, and nursing faculty are accountable for the

standards, processes, and outcomes of the nursing education

program.

(3) The governing institution offering the nursing

program shall be:

(a) A postsecondary education institution that is

authorized to offer nursing education and is accredited by an

organization recognized by the U.S. Department of Education.

(b) Approved and licensed by the appropriate State of

Alabama education agency(ies), as required by law.

(4) The governing institution shall provide financial

support and resources sufficient to meet the outcomes of the

nursing education program. Resources include, but are not

Chapter 610-X-3 Nursing

Supp. 9/30/19 3-2

limited to:

(a) Financial.

(b) Educational facilities.

(c) Equipment.

(d) Learning aids.

(e) Technology.

(f) Administrative, instructional, and support

personnel.

(5) The governing institution’s administrator or

program administrator shall notify the Board, in writing, of any

substantive changes in the program, including, but not limited

to:

(a) Nursing program administrator.

(b) Governing institution administrator, President,

CEO, Chancellor, or Provost.

(c) Governance structure of the institution.

(d) Accreditation status.

(e) Ownership or merger of parent institution.

(f) School name.

(g) Relocation.

(h) Curriculum changes.

(6) There shall be an organizational chart that

depicts the authority, responsibility, and channels of

communication of the nursing program to the governing

institution and other comparable programs within the governing

institution.

(7) A nursing education program shall be administered

by a qualified program administrator who is accountable for the

planning, implementation, and evaluation of the program.

Minimum qualifications of a nursing program administrator shall

include:

Nursing Chapter 610-X-3

Supp. 9/30/19 3-3

(a) An active, unencumbered Alabama registered nurse

license or a multistate registered nurse license issued by a

party state, as defined in Chapter 4 of these rules.

(b) An earned graduate degree in nursing.

(c) Be academically and experientially qualified to

administer a nursing program.

(8) The governing institution and nursing program

administrator shall provide sufficient numbers of qualified

faculty to ensure that curriculum implementation and expected

program outcomes are achieved and aligned with national nursing

accrediting standards. Minimum qualifications of nurse faculty

shall include:

(a) An active, unencumbered Alabama registered nurse

license, or a multistate registered nurse license issued by a

party state, as defined in Chapter 4 of these rules.

(b) An earned graduate degree in nursing or a related

health field.

(c) Be academically and experientially qualified to

teach in the area assigned.

(9) Institutional and program policies and procedures

shall:

(a) Be written, published, and publicly available.

(b) Address students' ability to assume clinical

assignments including, but not limited to, educational

preparedness and physical, mental, and emotional behaviors.

(c) Provide opportunities for students to regularly

participate in the development, evaluation, and continuous

improvement of the program.

(d) Include a detailed plan of action for

completion of didactic and clinical hours in the event of

cessation of academic activities or loss of clinical site

availability resulting from as a result of natural disaster,

inclement weather, public health emergency, or other

unforeseen emergent interruption. Any program approved on or

before March 20, 2020 shall provide the detailed plan of

action to the Board no later than September 1, 2020.

Chapter 610-X-3 Nursing

Supp. 9/30/19 3-4

(10) Faculty are accountable for curriculum

development, implementation, and evaluation.

(11) The curriculum of a nursing education program

shall:

(a) Enable the student to develop the knowledge,

skills, and abilities necessary for the level, scope, and

standards of competent nursing practice expected at the level of

licensure.

(b) Comply with the standards set forth in this

chapter.

(c) Be evidence-based and outcome-focused.

(d) Provide theoretical and clinical experiences

specific to the expected scope of practice of graduates from

each type of entry level nursing education program and shall

include:

1. Content for students to attain knowledge and

competence in providing a safe and effective care environment.

2. Prevention of illness.

3. Maintenance, promotion, and restoration of

health.

4. Psychological integrity of individuals across the

life span.

5. Clinical reasoning skills to assist in

recognizing, analyzing, and applying relevant knowledge and

skills to nursing care.

6. Clinical learning experiences to provide

opportunities for students to develop cognitive, psychomotor,

and affective skills in the provision of nursing care.

(e) The curriculum content of a nursing education

program shall include:

1. Liberal arts and sciences supportive of the

nursing program.

2. Anatomy and physiology with a corresponding lab.

Utilizing a ‘virtual lab’ in lieu of a ‘hands-on’ lab is

Nursing Chapter 610-X-3

Supp. 9/30/19 3-5

considered a substantive change and requires Board notification.

3. Nursing foundations, health assessment,

pharmacology, nutrition, and community-based nursing.

4. History and trends of nursing, cultural

diversity, legal and ethical responsibilities, and nursing

practice responsibilities, including leadership, management,

delegation, and health care delivery systems.

5. Theoretical and clinical learning experiences in

the areas of adult, maternal, child, and psychiatric/mental

health nursing that includes simulation, laboratory time, and

direct patient care in a licensed health care setting. This

does not prohibit additional experience in licensed non-health

care setting.

(6) Simulation learning experiences conducted

according to acceptable faculty training standards and

guidelines which incorporate clinical objectives, student

debriefing, and evaluation are acceptable components of the

clinical experience. Simulation may not comprise the entire

clinical learning experience.

7. Safe and Effective Care Environment, Health

Promotion and Maintenance, Psychosocial Integrity, and

Physiological Integrity.

8. Microbiology for students pursuing an associate

or baccalaureate degree.

(12) The governing institution, nursing program

administrator, and nursing faculty are accountable for selecting

and evaluating the teaching methods, delivery modalities, and

processes used to achieve expected program outcomes.

(13) Clinical supervision of students shall comply

with the standards set forth in this chapter.

(a) Clinical learning experiences shall be supervised

by a registered nurse with knowledge of educational strategies

and subject matter, and who is experienced in the clinical

technologies essential to the safe practice of nursing.

(b) The clinical supervisor shall hold an

unencumbered license to practice professional nursing in

Alabama, or a multistate registered nurse license issued by a

party state, as defined in Chapter 4 of these rules.

Chapter 610-X-3 Nursing

Supp. 9/30/19 3-6

(c) The clinical supervisor shall be readily

accessible to assign or prescribe a course of action, give

procedural guidance, direction, and evaluation for students

engaged in the clinical learning experience.

(d) The faculty-student ratio in clinical learning

experiences shall be collaboratively determined by the

professional nursing faculty, the School of Nursing

administration, and the professional nurse administrator, or

designee, in the clinical agency. In licensed hospitals that

provide inpatient acute care, the faculty to student ratio shall

not exceed 1:8 during clinical learning experiences. The

faculty-student ratio shall be determined according to the:

1. Complexity of the educational experience.

2. Acuity of the patient(s).

3. Physical layout of the clinical setting.

4. Student’s level of knowledge and skills necessary

to provide safe patient care.

(e) The nursing education program shall work with

clinical agencies for the planning, implementation, and

evaluation of clinical experiences.

(f) Clinical learning experiences shall include the

development of skills in clinical reasoning, management of care

for groups of patients, and delegation to and supervision of

other health care personnel performed in acute care and a

variety of health care settings.

(g) Nursing faculty shall maintain responsibility and

accountability for planning, implementation, and evaluation of

all student clinical learning experiences.

(14) Nursing programs that offer only simulations or

clinical testing do not meet the requirements for providing

clinical learning experiences for nursing students.

(15) Scores on external exams shall not be utilized as

the sole criterion for barring a student who otherwise has

successfully completed all required course work from graduating

from the nursing program.

Author: Alabama Board of Nursing

Statutory Authority: Code of Ala. 1975, §34-21-2(2).

History: Filed September 29, 1982. Amended: Filed

September 21, 1984; effective October 29, 1984. Amended: Filed

Nursing Chapter 610-X-3

Supp. 9/30/19 3-7

July 23, 1997; effective August 27, 1997. Repealed and New

Rule: Filed July 22, 2002; effective August 26, 2002. Amended:

Filed September 27, 2004; effective November 1, 2004. Amended:

Filed September 25, 2006; effective October 30, 2006. Amended:

Filed March 12, 2007; effective April 16, 2007. Amended: Filed

September 21, 2007; effective October 26, 2007. Amended: Filed

November 19, 2010; effective December 24, 2010. Amended: Filed

March 16, 2012; effective April 20, 2012. Amended: Filed

April 21, 2015; effective May 26, 2015. Amended: Filed

November 21, 2016; effective January 5, 2017. Amended: Filed

July 25, 2019; effective September 9, 2019; operative

January 1, 2020.

Ed. Note: Rule 610-X-3-.01 was renumber to .02 as per

certification filed September 25, 2006; effective

October 30, 2006.

Nursing Chapter 610-X-7

Supp. 9/30/19 7-1

ALABAMA BOARD OF NURSING

ADMINISTRATIVE CODE

CHAPTER 610-X-7

STANDARDS OF NURSING PRACTICE; SPECIFIC SETTINGS

TABLE OF CONTENTS

610-X-7-.01 Definitions

610-X-7-.02 Delegation By School Nurses

610-X-7-.03 State Of Alabama Independent Living

(SAIL) Program

610-X-7-.04 Registered Nurse As Surgical First

Assistant (RNFA)

610-X-7-.05 Sexual Assault Nurse Examiner (SANE)

610-X-7-.06 Alabama Department Of Mental Health

Residential Community Programs

610-X-7-.07 Occupational Safety And Health

Administration Respiratory Standard

610-X-7-.08 Behavioral Restraint And Seclusion

610-X-7-.09 Commercial Drivers License Examinations

610-X-7-.10 Delegation Of Insulin And Glucagon

Administration In The School Setting

610-X-7-.01 Definitions.

(1) Delegation: The act of authorizing a competent

individual to perform selected nursing activities supportive to

licensed nurses in selected situations while retaining the

accountability for the outcome if the delegation is to an

unlicensed individual.

(2) Medication Assistant, Certified (MAC): Mental

health worker or unlicensed assistive personnel who has

successfully completed a Board-approved curriculum for

assistance with medications, in community residential settings.

or a comparable program in another state, and holds a valid

medication assistant certification (MACE).

(3) Medication Assistant Supervisor (MAS): A licensed

nurse who supervises Medication Assistant, Certified (MAC). in

community mental health residential settings.

(4) Medication Assistant Train the Trainer (MATT): A

registered nurse who teaches the approved curriculum for mental

health community residential settings.

Supp. 9/30/19 7-2

Chapter 610-X-7 Nursing

(5) Registered Nurse First Assistant (RNFA): A

registered nurse who, through additional education and supervised

clinical practice, has acquired knowledge, skills, and judgment

specific to providing assistance during a surgical procedure, as

directed by the attending surgeon and as defined in standardized

procedures.

(6) Sexual Assault Nurse Examiner (SANE): A

registered nurse who, through additional education and supervised

clinical practice, has acquired knowledge, skills, and judgment

specific to providing health services to sexual assault or rape

victims, including a forensics examination.

Author: Alabama Board of Nursing

Statutory Authority: Code of Ala. 1975, §34-21-2(c)(21).

History: Filed September 28, 1982. Repealed: Filed

October 29, 2001; effective December 3, 2001. New Rule: Filed

November 23, 2009; effective December 28, 2009. Amended: Filed

May 21, 2013; effective June 25, 2013. Repealed and New Rule:

Filed July 25, 2016; effective September 8, 2016.

Supp. 9/30/19 7-3

Chapter 610-X-7 Nursing

610-X-7-.11 Delegation to Medication Assistants, Certified

in Settings Other than Mental Health Residential Community

Programs.

(1) A Medication Assistant, Certified (MAC) may

perform limited medication administration tasks delegated to

the MAC by a licensed nurse in a licensed healthcare facility

other than a mental health residential community program only

as permitted by this rule.

(7) In order to perform limited medication

administration tasks delegated to the MAC by a licensed nurse, a

MAC must successfully complete a Board-approved education

program or a comparable program in another state, and hold a

valid medication assistant certification (MACE).

(2) A licensed nurse may delegate limited

medication administration tasks to a MAC in a licensed

healthcare facility only when all of the following conditions

are met:

(a) At least one licensed nurse is on the premises

of the facility at the time when the delegated limited

medication administration task occurs.

(b) The licensed nurse is accountable and

responsible for the outcome of the delegated limited

medication administration task performed by the MAC.

(c) The limited medication administration task

delegated by the licensed nurse to the MAC is based on the

patient’s/resident’s needs, as documented in the comprehensive

and/or focused assessment by the registered nurse or licensed

practical nurse and the outcome of a comprehensive assessment

determines the medications that may safely be administered by

a MAC to the patient/resident.

(d) The delegated limited medication administration

task does not require the exercise of independent nursing

judgment or intervention. Specific tasks that require

independent nursing judgment or intervention that shall not be

delegated include, but are not limited to:

1. Administration of injectable medications, with the

exception of premeasured auto injectable medications for

anaphylaxis and opioid-related drug overdose.

2. Calculation of medication dosages, other than measuring

a prescribed amount of liquid medication or breaking a scored

tablet.

3. Receipt of verbal or telephone orders from a

licensed prescriber.

Supp. 9/30/19 7-4

Chapter 610-X-7 Nursing

4. Administration of medications ordered as

needed (PRN).

5. Administration of controlled substances.

(e) Subject to all other limitations imposed by

this rule, routes of medication administration for which

the MAC may perform delegated limited medication

administration tasks may include eye, ear, nose, oral,

topical, inhalant, rectal, or vaginal.

(f) The licensed nurse delegating the medication

administration may, at any time, suspend or withdraw the

delegation of specific tasks to MAC(s).

(g) The licensed healthcare facility has authorized

delegation of limited medication administration tasks and has

complied with the requirements of this rule.

(3) The chief nursing officer or, if no such position exists within the licensed healthcare facility, an Alabama-

licensed registered nurse who has oversight responsibility for

delegation of medication administration in the facility shall:

(a) Develop facility policies and procedures related to delegation of limited medication administration tasks to the

MAC which define the responsibilities of and required training

for the delegating licensed nurse and the MAC, congruent with

these rules.

(b) Submit, annually or upon request, a report to the Alabama Board of Nursing in a format specified by the Board,

including, but not limited to:

1. Total number of patients/residents served by MACs

participating in the nurse delegation program.

2. Total number of MACs that currently participate in

the nurse delegation program.

3. Total number of MACs trained during the reporting

period.

4. Total number of licensed nurses trained in MAC

delegation during the reporting year.

5. Total number of medication errors in each category

listed below:

Supp. 9/30/19 7-5

Chapter 610-X-7 Nursing

i. Wrong person

ii. Wrong medication

iii. Wrong dose

iv. Wrong time/day

v. Wrong route

vi. Wrong purpose

vii. No documentation

viii. Identify and implement a quality improvement plan

for medication errors.

(c) Provide and document an initial and annual competency

validation evaluation of the MAC performing the delegated

limited medication administration tasks for all routes of

administration.

Author: Alabama Board of Nursing

Statutory Authority: Code of Ala. 1975, §34-21-2(c)(21).

History: New rule: Filed April 7, 2020.