Iowa Board of Nursing

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Iowa Board of Nursing
RiverPoint Business Park
400 S.W. 8th Street, Suite B
Des Moines, IA 50309-4685
Tel: 515/281-3255
Fax: 515/281-4825

Office Hours:
8:00 a.m.–4:30 p.m.
Monday – Friday

Agency Plan for Regulatory Review

Iowa Board of Nursing
Proposed Agency Plan For Regulatory Review
February 2000

I. About the Board

The Board derives its legal authority for regulating and enforcing nursing education, nursing practice and continuing education requirements pursuant to Iowa Code chapters 147, 147A, 152 and 272C. The mission of the Board is to protect the public health, safety and welfare by ensuring that nursing is practiced by at least minimally competent licensed individuals, who provide care within their authorized scope of practice.

The Board consists of seven volunteer members appointed for three-year terms by the Governor and confirmed by the Iowa Senate. Five members are currently licensed nurses (four registered nurses and one licensed practical nurse) and two members represent the general public. The composition of the Board is defined in Iowa Code subsection 147.14(3) and Iowa Code section 147.19.

To carry out its mandated mission, the Board adopts rules establishing standards for the practice of nursing in Iowa. The Board licenses nurses to practice in Iowa by examination and endorsement. IAC 655 addresses nursing education programs, licensure, license renewal and continuing education. The Board promulgates rules and registers advanced registered nurse practitioners.

The Board regularly reviews all nursing education programs and continuing education providers to ensure compliance with Board rules, thus ensuring quality education for both nursing students and licensees.

The Board investigates all complaints involving licensees, registrants and education programs. In response to alleged violations of Iowa nurse practice laws and regulations, the Board conducts disciplinary hearings and determines appropriate disciplinary sanctions ensuring public protection. The Board actively monitors sanctioned licensees ensuring compliance with Board orders

II. Executive Order Number 8

On September 14, 1999, Governor Thomas J. Vilsack signed Executive Order Number 8, requiring all state agencies to undertake a comprehensive review of all state administrative rules. The goal of the review is to identify and eliminate outdated, redundant, over-broad, ineffective, unnecessary, or otherwise undesirable rules. The Board of Nursing is committed to implementing this executive order and believes the proposed plan for regulatory review will serve the Board, the public, and licensees by reducing inconvenience and confusion, increasing public confidence in state government, and enabling the Board to deal fairly with licensees, registrants, and the public to meet the challenges of the twenty-first century.

III. Agency Plan

The Agency Plan for Regulatory Review includes a schedule identifying when the review of each chapter of rules will take place, stating a method by which the Board will determine whether rules meet the criteria specified in Executive Order Number 8, providing a means for public participation, identifying instances where exceptions to the review requirements may be required, and providing a process for the on-going review of rules. (EO8:IV.A)

IV. Method for Review

To determine whether the Board's rules meet the review criteria identified in Executive Order Number 8, the Board will utilize the following method: (EO8:II.A;IV.A)

A. The Agency Rules Administrator for the Board of Nursing will identify and group all chapters of administrative rules adopted under the Board's authority.

B. Every chapter of rules will be subject to review except for those chapters identified in section VII. of this plan, Exceptions to Review Requirements.

C. The schedule for rule review will be prioritized according to any currently known or anticipated updates needed to Board rules, followed by chapters with the largest impact on public health and safety or Board operations, maintaining logical organization and rule groupings with similar subject matter.

D. Each chapter of the rules will first be reviewed by Board staff involved with the administration of the particular rules. Preliminary reports of their findings concerning each rule grouping will be prepared and submitted to the Board for review. Preliminary reports will provide the following information:

1. A list of all written complaints or requests for waiver or variance of rules received during the last five years;

2. A list of all requests for declaratory rulings/orders and a summary of the declaratory rulings/orders issued on the rules;

3. A summary of any formal disciplinary orders that may have established standards of practice relative to the rules or that further interpret the rules;

4. The Board will conduct an internal review to determine if any policies, interpretive statements, or similar documents exist, that by law, must be adopted as rules.

5. Any problems staff or Board have encountered in applying the rule effectively, equitably, relevantly, and expeditiously; and

6. Any national trends or standards relative or pertinent to the issue in question.

E. The Board will form review committees and will invite representatives from the groups identified in section VI of this plan to participate in the review of applicable Board rules.

1. The committees will hold meetings to evaluate each group of rules based on the criteria

for review.

2. The committees will seek public input on each group of rules.

a. Staff will hold at least one public hearing to seek public input and comment on the rules. Comments received at public hearings will be reported to the appropriate review committees.

b. A copy of this plan and the criteria for review will be made available to constituents and major stakeholders for each of the rule groupings and interested parties will be invited to provide suggestions, comments and input concerning the rules under review. All feedback received from constituents, stakeholders, and other interested parties during the review will be considered in making decisions regarding modification of Board rules.

c. Information regarding this review and the criteria for review will be published at least once, no later than December 2000, in the Board's quarterly newsletter. This newsletter is currently sent at no charge to all registered nurses, licensed practical nurses, advanced registered nurse practitioners and all parties requesting inclusion on that mailing list.

d. Feedback will be sought from the public and any interested parties via the Board's web site and through other means of dissemination.

3. The committees will make recommendations to the Board based on the preliminary staff reports, stakeholder, constituent and public comments received, and the subsequent review of those comments.

F. The Board will perform a final review of all rules considering all information gathered as a result of this plan. Based on the final review, the Board will compile a list of recommended modifications including the rationale for each recommendation.

G. Staff will prepare a report on the results of the review for each chapter or rule grouping. The report will include the preliminary staff reports, a summary of all comments received, the review committee's findings and recommendations to the Board, and the Board's recommendations for rule modifications, including the rationale for each Board recommendation.

V. Criteria for Review

All rules subject to review will be evaluated according to the following criteria.

(EO8:III.A-E)

A. Need.

1. What is the objective of the rule for the Board and the public?

2. Is the rule effective in meeting its objective?

3. Is the rule broader than necessary to accomplish its objective?

4. Is the rule necessary to protect the public health, safety or welfare?

5. Is the rule outdated?

6. Is the rule duplicative?

7. Have laws or other circumstances changed to the extent the rule should be amended or repeated?

8. Have complaints about the rule been received?

B. Clarity.

1. Is the rule clear and concise?

2. Do the Board, licensees and the public readily understand the rule?

C. Intent and Statutory Authority.

1. What is the statutory authority for the rule?

2. Is the rule necessary to comply with the statute that authorizes it?

3. Is the rule consistent with the legislative intent of the statute?

4. Does the rule conflict with the authority or rules of another agency?

5. Is there a need to develop additional legislative authorization in order to protect the public health, safety and welfare?

D. Cost.

1. Are there quantifiable costs and benefits to the rule?

2. Are there qualitative costs and benefits to the rule?

3. Do the benefits of the rule exceed the costs of the rule?

4. Is there a less burdensome way to achieve the positive result of the rule?

E. Fairness.

1. Is the rule applied consistently and predictably?

2. Is the rule fair in its application?

3. Are additional protections needed?

4. Should the rule be modified to eliminate or minimize any disproportionate impacts on the regulated community?

5. Should it be possible to waive compliance with the rule under certain circumstances?

VI. Public Participation in the Review (EO8:I;II.A.3)

The Board welcomes and encourages any interested party to participate in the review of the Board's rules. To encourage public participation, the Board will take the following steps:

A. The Board has identified the following stakeholder groups as interested parties affected by Board activities. These groups will be invited to participate in the Board's rules review processes as appropriate.

1. Bureau of Professional Licensure, Iowa Department of Public Health.

2. Health Facilities Division, Iowa Department of Inspections and Appeals.

3. Iowa Board of Medical Examiners.

4. Iowa Board of Pharmacy Examiners

5. Iowa Department of Education

B. The Board has identified the following constituency groups as interested parties affected by Board activities. These groups will be invited to participate in the Board's rules review process as appropriate.

1. Iowa nursing education programs (Appendix A)

2. Iowa nursing continuing education providers

3. Health care organizations:

American Association of Critical Care Nurses, Iowa Chapter
American College of Nurse-Midwives, Iowa Chapter
Association for Women's Health, Obstetric & Neonatal Nurses, Iowa Chapter
Association of Iowa Hospitals and Health Systems
Association of Occupational Health Nurses, Iowa Chapter
Association of Operating Room Nurses, Iowa Chapter
Emergency Nurses Association, Iowa Chapter
Iowa Association for Home Care
Iowa Association of Colleges of Nursing
Iowa Association of Diabetes Educators
Iowa Association of Enterostomal Therapists
Iowa Association of Health Care Recruiters
Iowa Association of Nurse Anesthetists
Iowa Association of Nurse Practitioners
Iowa Association of Occupational Health Nurses
Iowa Association on Homes for the Aging
Iowa Caregivers Association
Iowa Community College Nursing Education Directors' Association
Iowa Council of Health Care Centers
Iowa Council of Nephrology Nurses and Technicians
Iowa Federation of Licensed Practical Nurses
Iowa Foundation for Medical Care
Iowa Health Care Association
Iowa Health Ministries Network
Iowa Hospice Organization
Iowa Hospital Home Care Council
Iowa League for Nursing
Iowa Managed Care Association
Iowa Nurse Practitioner Society
Iowa Nurses' Association
Iowa Nursing Home Administrators' Association
Iowa Organization for Associate Degree Nurses
Iowa Organization of Nurse Leaders
Iowa Psychiatric Nurses Association
Iowa Public Health Association
Iowa School Nurses Organization
Iowa Society of Pediatric Nurses
Iowa Society of PeriAnesthesia Nurses
Midwest Society of Gastroenterology Nurses
National Association of Orthopedic Nurses, Hawkeye Chapter
National Nurses Society on Addictions
Network of Psychiatric Nurse Managers
Oncology Nursing Society, Iowa Chapter
Parish Nurses
Wound, Ostomy, and Continence Nurses Society, Iowa Chapter

4. Iowa Board of Nursing subcommittees:

Advanced Practice

Statewide Planning

Validation

C. The Agency Plan for Regulatory Review will be posted on the Board's web site and on the Iowa Department of Public Health's web site. Stakeholders, constituents and the public will be invited to participate in the review process or to submit comments and suggestions regarding rules via the web site or by contacting the Board. Information on Board meetings and review committee activities will also be posted and made readily accessible.

D. The Agency Plan for Regulatory Review will be available and distributed to all interested parties following Board meetings and at state conferences where stakeholders or constituent attendance may be expected.

E. The Board will send rule review information to persons or groups having filed requests for information or notification of proposed changes to Board rules.

F. Board newsletters shall give notice to the public, constituents and stakeholders that they may participate in the Board's rule review process via the web site or by contacting the Board.

G. At least one public hearing seeking input on Board rules will be held as specified in section IV, paragraph E, subsection 2a., of this plan.

VII. Exceptions to Review Requirements (EO8:II.A.4)

The Board may require exceptions to the regulatory review requirements in certain

circumstances.

A. Rules mandated by state or federal law over which the Board does not have the authority or legal right to modify or change will be exempt from review. The Board will note all such instances in its Agency Assessment and Final Report to the Governor's office.

B. Iowa Administrative Code 655, Chapter 8 "Petitions for Rule Making" establishes the processes involved when making petitions for rule making. These rules were adopted in 1999 to implement Iowa Code sections 17A.3 to 17A.7 as amended by 1998 Iowa Acts, chapter 1202. The Attorney General's office drafted these uniform rules for compliance with this statutory mandate and the Board adopted these uniform rules. There have been no significant changes to the underlying authority for this statute or these rules since these rules were adopted. For this reason, the Board has determined that these rules are exempt from review.

C. Iowa Administrative Code 655, Chapter 9 "Declaratory Orders," establishes procedures for the filing of petitions for declaratory orders and identifies the rights and responsibilities of the petitioner and the Board in such proceedings. These rules were adopted in 1999 to implement Iowa Code section 17A.9 as amended by 1998 Iowa Acts, chapter 1202. The Attorney General's office drafted uniform rules for compliance with this statutory mandate and the Board adopted these uniform rules. There have been no significant changes to the underlying authority for this statute or these rules since the rules were adopted. For that reason, the Board has determined that these rules are except from review.

D. Iowa Administrative Code 655, Chapter 10, "Agency Procedure for Rule Making," establishes the processes involved with the amendment and adoption of Board rules. These rules were adopted in 1999 to implement Iowa Code sections 17A.3 to 17A.7 as amended by 1998 Iowa Acts, chapter 1202. The Attorney General's office drafted uniform rules for compliance with this statutory mandate and the Board adopted these uniform rules. There have been no significant changes to the underlying authority for this statute or these rules since the rules were adopted. For that reason, the Board has determined that these rules are exempt from review.

E. Iowa Administrative Code 655, Chapter 11, "Examination of Public Records," establishes the processes involved with the examination of public records. These rules were adopted in 1999 to implement Iowa Code section 17A .3, as amended by 1998 Iowa Acts, chapter 1202. The Attorney General's office drafted uniform rules for compliance with this statutory mandate and the Board adopted these uniform rules. There have been no significant changes to the underlying authority for this statute or these rules since the rules were adopted. For that reason, the Board has determined that these rules are exempt from review.

F. Iowa Administrative Code 655, Chapter 14, "Fair Information Practices" establishes procedures to facilitate broad access to public records. These rules were adopted in 1999 to implement Iowa Code section 17A.3, as amended by 1998 Iowa Acts, chapter 1202. The Attorney General's office drafted uniform rules for compliance with this statutory mandate and the Board adopted these uniform rules. There have been no significant changes to the underlying authority for this statute or these rules since the rules were adopted. For that reason, the Board has determined that these rules are exempt from review.

G. The Board may identify other instances where uniform rules were adopted and may determine if those rules should also be exempt from review. The Board will note all such instances in its Agency Assessment and Final Report to the Governor's office.

VIII. Process for On-going Review of Rules

The Board is committed to ensuring that all rules adopted during and after implementation of the Agency Plan satisfy the "review requirements" embodied in Executive Order Number 8, and the "principles" embodied in Executive Order Number 9. Towards this end, the Board will implement the following process.

A. All rules proposed or amended during or after the regulatory review plan has been implemented will be reviewed according to the criteria of need, clarity, intent and statutory authority, cost, and fairness enumerated in section V of this plan.

B. The Board will comply with Executive Order Number 9 and its regulatory principles to ensure effective on-going agency planning, public involvement in rulemaking, and to avoid potential duplication and inefficiency in its rulemaking. The Board will develop and utilize a rulemaking analysis form that addresses the regulatory principles and will file the rule making analysis with the rule-making docket for all rules adopted after the date this Agency Plan is approved.

C. By August 1 of each year, the Board will comply with Executive Order Number 9 by creating and submitting to the Administrative Rules Coordinator a Regulatory Plan that states the Board's regulatory objectives and priorities for that fiscal year. The Regulatory Plan shall list each potential rule under active consideration or development expected to be issued in proposed or final form in that year and shall specify the need for each planned action. The Regulatory Plan may omit those rules that do not have a substantial impact on personal legal rights, privileges or duties.

D. The Board will comply with Executive Order Number 9 by creating and maintaining a rule-making docket for each pending rule making proceeding. The docket will be published on the Board's web site and shall be otherwise available to the public to encourage involvement in the rule making process.

E. The Board will make all members of its staff available to the Quality in Rule-making Committee established pursuant to Executive Order Number 10 for training to formulate and draft high quality rules. The Board will accede to the decision of the Director of the Department of Management on Board staff participation in any education program of the Committee.

IX. Schedule for Regulatory Review

The Board's schedule for regulatory review is prioritized according to any currently known or anticipated updates needed to Board rules, followed by chapters with the largest impact on public health and safety or Board concerns. The schedule also considers any recent substantial amendments or review of the rules while maintaining logical organization and rule groupings by similar subject matter. The following schedule outlines the Board's plan for review.

Chapter Date Review Begins Anticipated Completion Date Comments and Rationale for Priority of Review
655 IAC      
Chapter 1 Administrative and Regulatory Authority June 2000 September 2000 The Board is aware of needed updates to these rules, which have not been reviewed for 12 years. These rules have little impact on public health and safety, but do impact Board operation.
Chapter 2 Nursing Education Programs December 2000 September 2001 These rules have an impact on public health and safety. These rules were revised by a consumer committee in 1987 and have undergone several revisions. These rules were slated for review/revision in 2001.
Chapter 3
Licensure to Practice—RNs/LPNs
June 2000 September 2000 These rules have no direct impact on public health and safety, but do impact Board operations.
Chapter 4
Discipline
March 2001 June 2001 These rules have direct impact on public health and safety; they establish parameters for licensure discipline. This entire chapter was revised in 1999, incorporating the model rules for licensure discipline.
Chapter 5
Continuing Education
March 2000 September 2000 These rules have an impact on public health and safety. These rules were developed by a consumer committee in 1992 and have undergone several revisions. The process for review and revision began in 1999.
Chapter 6
Nursing Practice for RNs/LPNs
March 2001 June 2001 These rules have an impact on public health and safety. These rules recently underwent a consumer committee review with extensive revisions in 1997. Utilizing the same process, further amendments were adopted in 1998.
Chapter 7
Advanced Registered Nurse Practitioners
December 2000 June 2001 These rules have an impact on public health and safety. These rules recently underwent a consumer committee review with extensive revisions in 1998. Rules are reviewed annually for revision purposes.
Chapter 12 RN Certifying Organizations/
Utilization and Cost Control Review
December 2000 June 2001 These rules have not been reviewed since development by a consumer committee with Board adoption in 1990, with subsequent revision in 1993. Logical groupings prioritize these rules with advanced practice rules (i.e., Ch. 7).
Chapter 13
Disciplinary Hearing Costs
March 2001 June 2001 These rules do not have an impact on public health and safety or Board operations. The rules were developed in 1993. The underlying code authority has not changed. Logical groupings prioritize these rules with licensure discipline.

X. Inventory

The Board will prepare an inventory list that identifies, by topical area, the location (chapter, paragraph, etc.) in which the Board or Board rules are listed or mentioned in the Iowa Code and the Iowa Administrative Code. The Board will submit this inventory list to the Governor's office no later than November 1, 2000.

XI. Agency Assessment

The Board will review the statutes and rules listed in its inventory and identify those items that should be changed. The Board will submit, by November 1, 2001, an Agency Assessment to the Governor's office. The Assessment shall include the following information.

A. A report for each grouping of reviewed rules that includes, in concise form, the objectives of the rule grouping, the effectiveness of the rules in achieving those objectives, a description of any written criticisms of the rule grouping received within the past five years, and a summary of any existing records of petitions for waivers from the rules.

B. Based upon public input and Board review, a written list of recommended modifications to each rule grouping that will satisfy the regulatory principles and criteria for regulatory review will be prepared and submitted as part of the Agency Assessment. Recommendations will also include written rationale for each proposed modification.

XII. Governor's Office Conference and Implementation Schedule

The executive director for the Board will meet with the Administrative Rules Coordinator to review the recommendations submitted by the Board in its Agency Assessment Report to determine which recommendations to pursue. The Board will prepare a final schedule for implementing any approved rule modifications by July 1, 2002, and will appear before the Administrative Rules Review Committee as necessary on selected rule changes.

XIII. Final Report

The Board will submit by December 31, 2002, a Final Report to the Governor's office. The Final Report will summarize the results of the Board's regulatory review and will document any rule changes that have been made pursuant to the review.

XIV. Resource Allocation

The regulatory review process will directly involve five agency staff members. These individuals include the Executive Director (PSE 4) and four associate directors (chief health professions investigator and three nursing standards representatives). Each person will be responsible for the rule groupings associated with their respective area. Staff members were working at full capacity before the addition of these new responsibilities. Consequently, they will need to devote approximately one-third of their work time to address this rule review project. This increased workload will cause professional staff to be less responsive to the public. It will also decrease the monitoring of sanctioned licensees by enforcement staff. Work accomplished by the nursing standards representatives will be slowed, relative to ensuring compliance with laws and regulations regulating practice, nursing education and continuing education issues. This includes the review of education programs and continuing education providers. In addition to personnel resources, the Board anticipates it will need to commit significant budget resources to cover additional printing and mailing costs, communication charges related to public hearings held on the Iowa Communications Network, and support costs related to committee travel. If the appropriation for the Board cannot be increased to support these necessary expenditures, it may become necessary to reduce Board-related services.