2.1 Definitions "Advanced assessment" means the taking by an advanced practice registered nurse (APRN) of the history, physical and psychological assessment of a patient's signs, symptoms, pathophysiologic status and psychosocial variations in the determination of differential diagnoses and treatment.
"Board" means the Delaware Board of Nursing.
"Board Approved Nursing Education Program" as used in these regulations and Title 24, Chapter 19 means a nursing school in Delaware approved by the Board, any nursing school accredited by CCNE, ACEN, NLN CNEA, or a school outside of Delaware approved by its respective Board of Nursing and listed on that Board's website.
"Clinical learning experiences" means the planned, faculty-guided learning experiences that involve direct contact with patients.
"Competence" means the ability of the nurse to integrate knowledge, skills, judgment, and personal attributes to practice safely and ethically in a designated role and setting in accordance with the scope of nursing practice.
"Comprehensive nursing assessment" means collection, analysis and synthesis of data performed by an RN used to establish a health status baseline, plan care and address changes in a patient's condition.
"Conditional Approval" means the status granted to a program that is determined to be deficient in a specified area or areas. When this determination is made by the Board, written notice shall be sent to the program specifying the deficient areas, and the time limit within which the deficiencies are to be corrected. May apply to any program either holding "full" or "initial" approval and may also apply to Delaware Board-approved RN or LPN Refresher Programs.
"Debriefing" means an activity that follows a simulation experience, is led by a facilitator, encourages participant's reflective thinking, and provides feedback regarding the participant's performance.
"Focused nursing assessment" means recognizing patient characteristics by an LPN/VN that may affect the patient's health status, gathering and recording assessment data and demonstrating attentiveness by observing, monitoring, and reporting signs, symptoms, and changes in patient condition in an ongoing manner to the supervising registered nurse or physician.
"Full Approval" means the status granted to a program that meets the requirements of the Law and the Rules and Regulations of the Board. Continuation of full approval is contingent upon annual review of the program and continuing to meet the criteria.
"Initial Approval" means authorization to admit students and enter into contractual agreements for clinical facilities. It is granted only after an application has been submitted, reviewed and a survey visit made by the Board. No students shall be admitted to the program until the institution has received written notification that initial approval has been granted. Failure to comply will delay initial approval.
"National Accrediting Agency for Nursing Education" means a national accrediting agency for nursing education that is recognized by the Council on Postsecondary Accreditation and by the U.S. Department of Education.
"Nursing Education Program" is defined in 24 Del.C. Ch. 19.
"Patient-centered health care plan" means, in collaboration with patient, the identification of desired goals, strategies for meeting goals and processes for promoting, attaining and maintaining optimal patient health outcomes.
"Preceptor" means a nurse, who holds a BSN or higher degree, and a valid license to practice. Clinical preceptors shall have demonstrated competencies in the area of practice to which the student is assigned. Clinical preceptors may be used to accomplish faculty directed clinical learning experiences.
"Simulation" means a technique to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.
"Supervision" means provision of guidance or oversight by a qualified nurse for the accomplishment of a nursing task or activity with initial direction of the task or activity and periodic inspection of the actual act of accomplishing the task or activity.
2.4 Nursing Education Standards All nursing education programs shall meet these standards:
* The purpose and outcomes of the nursing programs shall be consistent with the Nurse Practice Act and Board promulgated administrative rules, regulations and other relevant state statutes.
* The purpose and outcomes of the nursing program shall be consistent with generally accepted standards of nursing practice appropriate for graduates of the type of nursing program offered.
* The input of consumers shall be considered in developing and evaluating the purpose and outcomes of the program
* The nursing program shall implement a comprehensive, systematic plan for ongoing evaluation that is based on program outcomes and incorporates continuous improvement principles.
* The curriculum shall provide diverse didactic and clinical learning experiences consistent with program outcomes.
* Faculty and students shall participate in program planning, implementation, evaluation and continuous improvement.
* The nursing program administrator (Director) shall be a professionally and academically qualified Registered Nurse with institutional authority and administrative responsibility for the program. (Section 2.4.1.5 - Administrator Qualifications)
* Professionally, academically and clinically qualified nurse faculty shall be sufficient in number and expertise to accomplish program outcomes and quality improvement. (Section 2.4.1.6 - Faculty Qualifications)
* The fiscal, human, physical, clinical and technical learning resources shall be adequate to support program processes, security and outcomes.
* Program information communicated by the nursing program shall be accurate, complete, consistent and readily available.
* A systematic evaluation plan of the curriculum is in place.
* At a minimum, 35% of the total faculty (including all clinical adjunct, part-time, or other faculty) are employed at the institution as full-time faculty.
* The nursing program administrator shall be consistent in a nursing program, with no more than 3 nursing program administrators in 5 years.
2.4.1 Required Criteria for Nursing Education Programs - The organization and administration of the nursing education shall be consistent with the law governing the practice of nursing. The nursing education program shall be an integral part of a governing institution with appropriate accreditation. The following minimum criteria serve to support the implementation of the Nursing Education Standards: 2.4.1.1 Annual Report 2.4.1.1.1 By December 1 of each year, a copy of an annual report of the nursing education program shall be sent to the Board, using the format supplied by the Board. The report will include information from the previous academic year and is required of new programs as well. This is a comprehensive education program self-evaluation and shall include but not be limited to:2.4.1.1.1.1 Students' achievement of program outcomes.2.4.1.1.1.2 Evidence of adequate program resources including fiscal, physical, human, clinical and technical learning resources; and the availability of clinical sites and the viability of those sites to meet the objectives of the program.2.4.1.1.1.3 Multiple measures of program outcomes for graduates. These may include but are not limited to NCLEX pass rates, student and/or employer surveys, etc.2.4.1.1.1.4 Evidence that accurate program information for consumers is readily available.2.4.1.1.1.5 The head of the academic institution and the administration support program outcomes2.4.1.1.1.6 Program administrator and program faculty meet Board of Nursing qualifications and are sufficient to achieve program outcomes.2.4.1.1.1.7 Evidence that the academic institution assures security of student information.2.4.1.2 School Records 2.4.1.2.1 A nursing education program shall maintain a system of records which shall contain all data relating to approval by any agency or body. The data shall include, but not be limited to, course outlines, minutes of faculty and committee meetings, pertinent correspondence, reports of standardized tests and survey reports. Such data shall be available to the Board representatives during the course of a survey or site visit subject to applicable provisions of state and federal law.2.4.1.3 Student Records 2.4.1.3.1 The school shall maintain a record for each student subject to applicable provisions of law, such records shall be available to Board representatives during the course any survey or site visit.2.4.1.3.2 A final transcript for each student shall be retained in the permanent records of the school.2.4.1.3.3 Provision shall be made for the protection of records against loss, destruction and unauthorized use.2.4.1.4 School Bulletin or Catalogue2.4.1.4.1 Current information about the school shall be published periodically and distributed to students, applicants for admission and to the Board. It should include a general description of the program, philosophy and objectives of the controlling institution and of the nursing programs, admission and graduation requirements, fees, expenses, and financial aid, educational facilities, living accommodations, student activities and services, curriculum plan, course descriptions, process for addressing student complaints and/or grievances and faculty staff roster.2.4.1.5 Administrator and Faculty Qualifications 2.4.1.5.1 Administrator qualifications in a program preparing for LPN licensure shall include: 2.4.1.5.1.1 A current, active, unencumbered Delaware RN license or compact (multi-state) license, and meet requirements in the state where the program is approved or accredited.2.4.1.5.1.2 A minimum of a master's degree in nursing from a nationally accredited program.2.4.1.5.1.3 Experience in nursing practice and shall give evidence of ability in providing leadership.2.4.1.5.1.4 Experience in nursing education including teaching and learning principles for adult education and curriculum development and administration.2.4.1.5.2 Administrator qualifications in a program preparing for RN licensure shall include: 2.4.1.5.2.1 A current, active, unencumbered Delaware RN license or compact (multi-state) license, and meet requirements in the state where the program is approved or accredited.2.4.1.5.2.2 For a baccalaureate degree program, the administrator shall hold an earned doctoral degree in nursing or related field and a master's degree in nursing from a nationally accredited program. For an associate degree or diploma program, the administrator shall hold a minimum of a master's degree in nursing from a nationally accredited program.2.4.1.5.2.3 Experience in nursing practice and shall give evidence of ability in providing leadership.2.4.1.5.2.4 Experience in nursing education including teaching and learning principles for adult education and curriculum development and administration.2.4.1.5.3 The number of faculty members shall be sufficient to prepare the students for licensure, to achieve the objectives as stated in the school's application, and reasonably proportionate to: 2.4.1.5.3.1 Number of students enrolled2.4.1.5.3.2 Frequency of admissions2.4.1.5.3.3 Education and experience of faculty members (current experience in all specialties must be represented among the faculty and must correspond with the primary teaching responsibilities assigned)2.4.1.5.3.4 Number and location of clinical facilities2.4.1.5.3.5 Total responsibilities of the faculty members2.4.1.5.3.6 The faculty-to-student ratio shall not exceed 1:8 for inpatient settings where faculty directly supervise students during the delivery of patient care.2.4.1.5.4 Qualifications and responsibilities for faculty member positions shall be defined in writing.2.4.1.5.5 Written personnel policies shall be consistent with the policies of the sponsoring institution.2.4.1.5.6 Faculty assignments shall allow time for class and laboratory preparation, teaching, program evaluation, improvement of teaching methods, guidance of the students, participation in faculty organizations and committees, attendance at professional meetings, and participation in continuing education activities.2.4.1.5.7 Principal functions of the faculty shall be to: 2.4.1.5.7.1 Develop the philosophy and objectives of the nursing program2.4.1.5.7.2 Develop, implement, evaluate and revise the curriculum2.4.1.5.7.3 Participate in the recruitment, admission and retention of students in the nursing program2.4.1.5.7.4 Establish criteria for promotion and completion of the program in nursing2.4.1.5.7.5 Evaluate student achievement on the basis of established criteria2.4.1.5.7.6 Recommend successful candidates for degree, diploma and other forms of recognition2.4.1.5.7.7 Participate in appropriate activities of the controlling institution2.4.1.5.8 The nursing faculty shall hold a current, active, unencumbered Delaware RN license or compact (multi-state) license and meet requirements in the state where the program is approved and/or accredited.2.4.1.5.9 Clinical faculty shall hold a license or privilege to practice and meet requirements in the state or jurisdiction of the students' clinical site.2.4.1.5.10 Qualifications for nursing faculty who teach in a program leading to licensure as an LPN: 2.4.1.5.10.1 Have a minimum of a baccalaureate degree in nursing2.4.1.5.10.2 Have current clinical experience2.4.1.5.10.3 Have preparation in teaching and learning principles for adult education, including curriculum development and implementation2.4.1.5.10.4 Have current knowledge of licensed practical nursing practice2.4.1.5.11 Qualifications for nursing faculty who teach in a program leading to licensure as a registered nurse: 2.4.1.5.11.1 Have a minimum of a master's degree in nursing2.4.1.5.11.2 Have current clinical experience2.4.1.5.11.3 Have preparation in teaching and learning principles for adult education, including curriculum development and implementation2.4.1.5.12 Adjunct clinical faculty employed solely to supervise clinical nursing experiences of students shall have a minimum of a baccalaureate degree in nursing with the majority holding a master's degree in nursing or actively enrolled in a master's degree in nursing program.2.4.1.5.13 Interdisciplinary faculty who teach non-clinical nursing courses shall have advanced preparation appropriate to those areas of content.2.4.1.5.14 Clinical preceptors shall have demonstrated competencies related to the area of assigned clinical teaching responsibilities and will serve as a role model and educator for the student. Clinical preceptors may be used to enhance faculty-directed clinical learning experiences. Clinical preceptors must be licensed or privileged to practice as a nurse at or above the level for which the student is preparing in the state or jurisdiction where they are precepting students.2.4.1.5.15 Organization 2.4.1.5.15.1 The nursing faculty shall attend regular meetings of the faculty for the purpose of developing, implementing and evaluating the nursing curriculum.2.4.1.5.15.2 Committees shall be established as needed to meet the responsibilities and accountabilities of the department.2.4.1.5.15.3 Written rules or bylaws shall govern the conduct of nursing faculty meetings and committees.2.4.1.5.15.4 Minutes, guided by an agenda, of faculty and committee meetings and will include: conclusions made following discussions, recommendations and actions as well as timeline for evaluation and follow-up.2.4.1.5.15.5 Provisions shall be made for nursing student membership and participation on faculty committees and in committee meetings as appropriate.2.4.1.5.15.6 Where nursing practice/education (advisory) committees are established, their functions and relationship to the board of control and to the program shall be clearly defined2.4.1.5.15.7 Written rules shall govern the activities of the nursing practice/education (advisory) committee and minutes of the meetings shall be on file in the administrative office of the program.2.4.1.5.16 Online education program faculty teaching didactic content for a program with a physical presence in Delaware should be licensed or privileged to practice as a nurse at or above the level for which the student is preparing.2.4.1.5.17 Online education program faculty teaching in a DE clinical facility as a clinical instructor or preceptor must be licensed or privileged to practice as a nurse at or above the level for which the student is preparing.2.4.1.6 Students 2.4.1.6.1 Students shall be provided the opportunity to acquire and demonstrate the knowledge, skills and abilities for safe and effective nursing practice, in theory and clinical experience with faculty oversight.2.4.1.6.2 All policies relevant to applicants and students shall be available in writing.2.4.1.6.3 Students shall be required to meet the health standards and criminal background checks as required.2.4.1.6.4 Students shall receive faculty instruction, advisement and oversight.2.4.1.6.5 Students shall be held accountable for the integrity of their work.2.4.1.6.6 Admission, Promotion and Graduation 2.4.1.6.6.1 Policies and procedures related to the selection and admission of students are the responsibility of the individual school.2.4.1.6.6.2 Students shall be admitted on the basis of established criteria and without discrimination as to age, race, religion, sex, sexual preference, national origin, or disability.2.4.1.6.6.3 There shall be written policies for the admission and re-admission of students.2.4.1.6.6.4 Schools granting advanced standing after admission via challenge examinations, College Level Examination Program, teacher made tests or any other method shall have written criteria for granting course credit. Course credits attained through one of these mechanisms or transferred in from another institution shall not represent more than fifty (50) percent of the credits required for graduation.2.4.1.6.6.5 The policies for promotion, retention and graduation shall be published in the school catalogue or in other appropriate documents that are available to students.2.4.1.6.6.6 All candidates in a program that requires applicants to be registered nurses must be licensed in Delaware or hold a current, valid compact (multi-state) license if any clinical experiences occur in the State.2.4.1.7 Curriculum 2.4.1.7.1 The curriculum of the nursing education program shall enable the student to develop the nursing knowledge, skills and abilities necessary for the level, scope and standards of competent nursing practice expected at the level of licensure. The curriculum will be revised as necessary to maintain a program that reflects advances in health care and its delivery.2.4.1.7.2 LPN and RN programs shall provide for concurrent or correlated theory and clinical practice in the physical or mental health care of individuals of all ages the nursing care of mothers and newborns, children, adults, the aged, individuals with mental health problems, and individuals in diverse settings, not necessarily in separate courses.2.4.1.7.3 Clinical experiences shall include preventive aspects of illness, nursing care of persons with acute and chronic illnesses, and rehabilitative care. Opportunities shall be provided for the student to participate in patient teaching in a variety of settings with individuals, families, and groups.2.4.1.7.4 A minimum of 200 hours of clinical experience is required for LPN students and a minimum of 400 hours of clinical experience is required for RN students. LPN clinical does not equate to RN clinical and may not be substituted or included for RN clinical in an educational program nor as RN clinical practice to meet the practice hour requirement for relicensure. Simulation - high fidelity or standardized patient - clinical scenarios may be substituted for traditional clinical experiences but must not exceed 50% of the program's clinical hours per course. 2.4.1.7.4.1 The program shall have an organizing framework that provides adequate fiscal, human, and material resources to support the simulation activities.2.4.1.7.4.2 Simulation activities shall be managed by an individual who is academically and experientially qualified. The individual shall demonstrate continued expertise and competence in the use of simulation while managing the program.2.4.1.7.4.3 There shall be a budget that will sustain the simulation activities and training of the faculty.2.4.1.7.4.4 The program shall have appropriate facilities for conducting simulation. This shall include educational and technological resources and equipment to meet the intended objectives of the simulation.2.4.1.7.4.5 Both didactic and clinical faculty involved in simulations shall have training in the use of simulation, and shall engage in on-going professional development in the use of simulation.2.4.1.7.4.6 The program shall demonstrate that the simulation activities are linked to programmatic outcomes.2.4.1.7.4.7 The program shall have written policies and procedures on short-term and long-term plans for integrating simulation into the curriculum; method of debriefing each simulated activity; and a plan for orienting faculty to simulation.2.4.1.7.4.8 The program shall develop criteria to evaluate the simulation activities. Students shall evaluate the simulation experience on an ongoing basis.2.4.1.7.4.9 The program shall include information about its use of simulation in its annual report to the Board of Nursing.2.4.1.7.5 The curriculum, as defined by nursing education, professional and practice standards, shall include:2.4.1.7.5.1 Experiences that promote the development and subsequent demonstration of evidence-based clinical judgment, skill in clinical management, and the professional commitment to collaborate in continuously improving the quality and safety of the healthcare system for patients.2.4.1.7.5.2 Evidence-based learning experiences and methods of instruction, including distance education methods, consistent with the written curriculum plan.2.4.1.7.5.3 Coursework including, but not limited to:2.4.1.7.5.3.1 Content in the biological, physical, social and behavioral sciences to provide a foundation for safe and effective nursing practice;2.4.1.7.5.3.2 Content regarding professional responsibilities, legal and ethical issues, history and trends in nursing and health care; and2.4.1.7.5.3.3 Didactic content and supervised clinical experience in the prevention of illness and the promotion, restoration and maintenance of health in patients across the lifespan and from diverse cultural, ethnic, social and economic backgrounds. Patient experiences will occur in a variety of clinical settings and will include:2.4.1.7.5.3.3.1 Integrating patient safety principles throughout the didactic and clinical coursework.2.4.1.7.5.3.3.2 Implementing evidence-based practice to integrate best research with clinical expertise and patient values for optimal care, including skills to identify and apply best practices to nursing care.2.4.1.7.5.3.3.3 Providing patient-centered, culturally competent care that recognizes that the patient or designee is the source of control and full partner in providing coordinated care by: 2.4.1.7.5.3.3.3.1 Respecting patient differences, values, preferences and expressed needs.2.4.1.7.5.3.3.3.2 Involving patients/designees in decision-making and care management.2.4.1.7.5.3.3.3.3 Coordinating and managing patient care across settings.2.4.1.7.5.3.3.3.4 Explaining appropriate and accessible interventions to patients and populations that may positively affect their ability to achieve healthy lifestyles.2.4.1.7.5.4 Collaborating with interprofessional teams to foster open communication, mutual respect, and shared decision-making in order to achieve quality patient care.2.4.1.7.5.5 Participating in quality improvement processes to monitor patient care outcomes, identify possibility of hazards and errors, and collaborate in the development and testing of changes that improve the quality and safety of health care systems.2.4.1.7.5.6 Using information technology to communicate, mitigate error and support decision making.2.4.1.7.6 Faculty supervised clinical practice shall include development of skills in direct patient care; making clinical judgments; care and management of both individuals and groups of patients across the lifespan; and delegation to and supervision of, as appropriate to level of education, other health care providers. 2.4.1.7.6.1 Clinical experiences shall be supervised by qualified faculty.2.4.1.7.6.2 All student clinical experiences, including those with preceptors, shall be directed by nursing faculty.2.4.1.7.6.3 Measurement of students' competencies shall focus on the students' demonstration of care management and decision making skills when providing patient care in a variety of clinical situations and care settings.2.4.1.7.7 Delivery of instruction by distance education methods must be consistent with the program curriculum plan and enable students to meet the goals, competencies and outcomes of the educational program and standards of the BON.2.4.1.8 Evaluation 2.4.1.8.1 Evaluation as a basis for curriculum revision and change in practices is a continuous process and an inherent responsibility of the faculty. The degree to which the faculty accomplishes its objectives shall be determined through evaluation of curriculum content, teaching methodologies, clinical and other learning experiences, student progress, success of graduates on the licensing examination, promotion, retention and degree of nursing competence of the graduate.2.4.1.9 Education Facilities2.4.1.9.1 Classrooms, laboratories, and conference rooms shall be adequate in number, size and type for the number of students and educational purposes for which the rooms are used.2.4.1.9.2 Offices 2.4.1.9.2.1 Offices shall be available and adequate in size, number and type to provide faculty with opportunities for uninterrupted work and privacy for conferences with students.2.4.1.9.2.2 Space for clerical staff, records, files and other equipment shall be adequate for the needs of the program.2.4.1.9.3 Learning Resources2.4.1.9.3.1 Learning resources must be recent, pertinent and sufficient to meet the learning needs of students and faculty.2.4.1.9.3.1.1 Provisions shall be made for regular additions to and deletions from the resource collection.2.4.1.9.3.1.2 Learning facilities and policies shall be conducive to effective use.2.4.1.9.4 Clinical Facilities2.4.1.9.4.1 The clinical facility to which the student is assigned for clinical practice is considered an integral part of the nursing program. 2.4.1.9.4.1.1 Clinical facilities shall be selected by the faculty to provide learning experiences essential to achieve the stated purposes of the program and the stated objectives for each clinical course. They may include, but are not limited to: 2.4.1.9.4.1.1.1 Inpatient facilities such as acute care hospitals, specialized hospitals, long term and extended care facilities.2.4.1.9.4.1.1.2 Outpatient facilities such as hospital based clinics, community health centers, mental health clinics and physician offices.2.4.1.9.4.1.1.3 Other community based opportunities such as home health, hospices, health maintenance organizations, day care centers, schools/school systems, senior centers and correctional facilities.2.4.1.9.4.1.2 The following criteria for clinical facility use must be met: 2.4.1.9.4.1.2.1 There shall be an environment in which effective learning can take place and in which the student is recognized as a learner.2.4.1.9.4.1.2.2 There shall be an adequate number of qualified professional and other nursing personnel not including the student, to ensure safe care of the patient.2.4.1.9.4.1.2.3 There shall be a sufficient number and variety of patients to provide adequate learning experiences.2.4.1.9.4.1.3 Hospital facilities shall be accredited by the Joint Commission or the American Osteopathic Association. Other facilities such as specialized hospitals, long term and extended care facilities and community health agencies shall be licensed or accredited by the appropriate approving authority.2.4.1.9.4.1.4 Facilities used for clinical experience shall be approved by the Board prior to the assignment of students. Approval shall be based on information provided by the school on forms furnished by the Board. A visit by Board representatives to the clinical site may be scheduled.2.4.1.9.4.1.5 Use of clinical facilities in another state or jurisdiction requires written notification to that jurisdiction's Board of Nursing. Likewise, out of state schools requesting use of clinical facilities in Delaware will notify the Board prior to utilization.2.4.1.9.4.1.5.1 Out of state programs must submit, prior to utilization of a Delaware clinical facility: proof of program approval by a respective State Board of Nursing or accreditation of the program by a nationally recognized accrediting body; copies of written agreements with every clinical agency being utilized; program requirements for clinical faculty or preceptors, if used; name of faculty/preceptor and sites where assigned; copy of current Delaware or compact (multi-state) licensure for faculty/preceptor.2.4.1.9.4.1.6 Written agreements between the school and agencies involved shall: 2.4.1.9.4.1.6.1 Ensure that the faculty is ultimately responsible for the students' learning experiences.2.4.1.9.4.1.6.2 Provide for continuous planning for students in cooperation with appropriate nursing staff of the agency.2.4.1.9.4.1.6.3 Provide adequate space for the number of students and faculty to conduct educational conferences.2.4.1.9.4.1.7 Observational experiences shall be planned in cooperation with the agency to meet the stated objectives.2.4.1.10 Services 2.4.1.10.1 There shall be written policies for student welfare as related to health, counseling and guidance, financial aid, and residence life, if offered.2.4.1.10.2 There shall be well-defined written policies governing payment and refund of tuition and other fees.2.4.2 Purpose of New Nursing Education Program Approval. The State requires that new nursing education programs be approved in order to: promote the safe practice of nursing by implementing standards for individuals seeking licensure as registered nurses and licensed practical nurses; grant legal recognition to nursing education programs that the board determines have met the standards; assure graduates that they meet the education and legal requirements for the level of licensure for which they are preparing and to facilitate their endorsement to other states and countries; assure continuous evaluation and improvement of nursing education programs; provide the public and prospective students with a list of nursing programs that meets the standards established by the Board.