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⭐Nursing Education Programs and Licensure Requirements General
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1 Nursing Education Programs and Licensure Requirements General Nursing Education Programs and Licensure Requirements General General Definition of terms As used in sections to sections , inclusive, of the Regulations of Connecticut State Agencies: (1) "Academic Semester" means the semester length as established by policy by the parent institution; (2) "Accreditation" means a level of quality achieved by educational programs and clinical facilities which have participated in voluntary evaluation by recognized agencies using predetermined criteria; (3) "Administrator" means the registered nurse educator responsible for policies, contracts, curriculum, and overall administration of a nursing education program; (4) "Admission with advanced standing" means academic credit for previous education or experience is given to a student; (5) "Advanced degree in nursing" means a master's or doctoral degree in nursing; (6) "Advanced levels of students" means students in the final year of study in a registered nursing education program; (7) "Approval" means those nursing education programs and clinical facilities that are approved by the Board of Examiners for Nursing with the consent of the Commissioner; (8) "Board" means the Connecticut Board of Examiners for Nursing; (9) "Client" means the focus of nursing care, including individuals, families, groups, and communities; (10) "Collaborative judgment" means shared decision making; (11) "Commissioner" means the Commissioner of the Department of Public Health, or his or her designee; (12) "Contact hour" means a fifty (50) or sixty (60) minute period of time spent by students in the presence of program faculty; (13) "Data collection" means the process of collecting information, observing the client, recording, and reporting to the appropriate person signs, symptoms, and other pertinent data which may indicate that the client's condition deviates from normal or that there is a change in the client's condition; (14) "Direct client care experience" means student learning that involves the provision of primary nursing services to clients; (15) "Educational outcomes" means behaviors demonstrated by the graduate of a registered nurse or practical nurse education program; (16) "Laboratory experience" means student learning that involves the manipulation of concepts or materials within a controlled environment; (17) "Licensing examination" means the examination for the licensure of registered nurses or practical nurses and shall be an examination approved by the board of examiners for nursing, with the consent of the department, such as an examination provided by the National Council of State' Boards of Nursing; (18) "Major curriculum changes" means significant deviations in content or length from a currently approved education program; (19) "Nursing education program" or "program" means a school of nursing; (20) "Nursing process" is a problem-solving approach consisting of five sequential and interrelated phases: assessment, which involves the gathering of data related to a client's health needs; diagnosis, which involves the analysis of the data obtained; planning, which involves the design of nursing interventions to address client needs; implementation, which involves performing the interventions; and evaluation, which involves determining whether the diagnosis was accurate, the plan appropriate, and the interventions effective in addressing the client's needs; (21) "Observational experience" means a structured student learning experience in which 12 Nursing Education Programs and Licensure Requirements General learners observe but do not provide direct client care services; (22) "Parent institution" means the single agency or institution that administers the nursing education program in its entirety; (23) "Precepted clinical experience" means student learning that involves the provision of primary nursing services to clients under the guidance and direction of a preceptor in collaboration with nursing education program faculty; (24) "Preceptor" means a registered nurse who guides and directs students in the provision of nursing services to clients and who meets the requirements of section (f) of the Regulations of Connecticut State Agencies. (25) "Requirements" means the minimum standards which nursing education programs must meet in order to be approved; (26) "Simulated experience" means student learning that involves interaction with computergenerated or other lifelike models of clinical nursing situations; (27) "Supervision" means the acceptance by a registered nurse educator of the responsibility and accountability for the health care delivered to clients by students under his or her onsite direction; (28) "Therapeutic nursing measures" means those actions taken to implement the plan of care for a client; (29) "Transfer" means a student with post-secondary coursework who seeks admission to a program; and (30) "Unexpected resignation" means an unanticipated resignation effective within an academic year or after hiring of faculty for an academic year has been completed. (Effective November 29, 1983; Amended January 6, 1992; December 30, 1994; May 4, 2004.) Types of programs (a) All programs that prepare the graduate for licensure by examination as a registered nurse shall be approved by the board with the consent of the commissioner. Only those programs within one of the following types of organizations are eligible for approval: (1) College or university: A program conducted by an educational unit in nursing within the structure of a college or university approved pursuant to Section 10a- 34 of the Connecticut General Statutes leading to an associate, baccalaureate or higher degree in nursing. (2) Hospital: a program conducted by a hospital licensed pursuant to Chapter 368V of the Connecticut General Statutes leading to a diploma in nursing. (3) External Degree Program in Nursing: A curriculum based on theory and clinical practice or assessment conducted by an educational unit in nursing leading to an associate, baccalaureate, or higher degree in nursing. (b) All programs that prepare the graduate for licensure by examination as a Licensed practical nurse shall be approved by the board with the consent of the commissioner. Only those programs within one of the following types of organizations shall be eligible for approval: (1) Vocational-Technical: A program conducted by the State Department of Education pursuant to Section of the Connecticut General Statutes, in cooperation with affiliating health agencies, which prepares individuals for eligibility for licensure as practical nurses. (2) Private school: A program conducted and operated by a person, board, organization, association or other entity, which prepares individuals for eligibility for licensure as practical nurses and meet the following requirements: (A) Is approved by the State Commissioner of Higher Education as a private occupational school pursuant to Section 10a-22b of the Connecticut General Statutes; and (B) Current accreditation by the Association of Independent Colleges and Schools or appropriate national accrediting association. 23 Nursing Education Programs and Licensure Requirements General (3) College or university: A program conducted by an educational unit in nursing within the structure of a college or university approved pursuant to section 10a- 34 of the Connecticut General Statutes preparing individuals for eligibility for licensure is a practical nurse. (4) Hospital: a program conducted by a hospital licensed pursuant to Chapter 368V of the Connecticut General Statutes preparing individuals for eligibility for licensure as practical nurses. (Effective November 29, 1983; Amended December 30, 1994; May 4, 2004.) Program approval Board approval, with the consent of the commissioner, shall be administered as follows: (a) Initial approval: (1) To be granted initial approval, the parent institution shall provide to the board: (A) Written notice of intent to establish a program; (B) A feasibility study for the planned program, which shall include discussion of at least the following: (i) Applicant pool; (ii) Graduate employment opportunities; (iii) Educational and clinical facilities to be utilized; (iv) Potential overlapping with other programs in the use of clinical facilities and the impact on both the proposed and existing programs; (C) A timeline for employment of administration and nursing faculty. Initial hiring of the faculty shall be completed at least two (2) months prior to the proposed starting date. The administrator shall be actively employed at least six (6) months prior to the proposed starting date. The timeline shall also identify projected future staffing needs; (D) A comprehensive plan for the development and implementation of the education program, including philosophy and educational outcomes, curricula, course outlines with plans for student evaluation, resource needs, timelines, and a systematic self-evaluation; (E) Any other information that the board may reasonably request. (2) Proposed programs significantly different from current approved programs shall provide detailed information relative to activities which provide the student with opportunities to attain defined competencies and demonstrate in ongoing evaluations that students are meeting defined educational outcomes on schedule. (3) The board shall: (A) Upon receipt of all documents provided by the program, conduct a scheduled onsite visit to review the program; (B) Upon determination that the documents and results of the onsite review were acceptable, extend initial approval to the program, with the consent of the commissioner. (4) Pending satisfactory board review of the program's educational standards, such initial approval shall remain in effect until the results of the first licensing examination for program graduates are available. At that time the board will review the results and recommend either full approval, conditional approval, or program removal. (b) Full approval: (1) Full approval is granted by the board with the consent of the commissioner after the initial period of approval based on evidence that the program is meeting its educational outcomes as demonstrated by an acceptable level of graduates' performance, as defined in subdivision (2) of this subsection. (2) An acceptable level of a program's graduates' performance shall be defined as: 34 Nursing Education Programs and Licensure Requirements General (c) (d) (e) (f) (g) (A) demonstrated mastery of nursing principles as evidenced by an average passing rate of at least 80% of students taking the licensing examination prescribed pursuant to Section of the Connecticut General Statutes, upon their first attempt after graduation, as reported from May 1 to April 30; and (B) demonstrated mastery of nursing practice as evidenced by an evaluation of graduates' achievement of the educational outcomes required by Section or , as applicable, of the Regulations of Connecticut State Agencies, in a manner approved by the board. Conditional approval: (1) Conditional approval may be granted for one year to a program previously having initial or full approval if: (A) the graduates of the program fail to achieve the standards prescribed in subsection (B) of this section; or (B) the program has initiated a major curriculum change pursuant to (C) subsection (D) of this section; or conditions previously identified in violation of these regulations or the board's recommendations continue to be unresolved and pose a risk to public health or safety, as determined by the board. (2) Special progress reports or onsite visits, or both, shall be required for programs with conditional approval, at the discretion of the board. (3) The outcome of the board's subsequent review of special progress reports or onsite visits or both may be: (A) return of the program to full approval; or (B) placement of the program on an additional one year of conditional approval; or (C) recommendation of program removal from the list of approved nursing education programs. Major curriculum changes: (1) When a program proposes major curriculum changes, the administrator shall present a comprehensive plan to the board for approval with the consent of the commissioner prior to implementation. Plans shall include: (A) rationale for the change; (B) comparison of current versus proposed curriculum; (C) explanation of the effects of the change on: (i) currently enrolled students; (ii) functions and role of graduates of the proposed program; (D) timetable for implementation of the change; and (E) plan for evaluation of the change. (2) The previously approved curriculum must remain in effect until the proposed program is approved by the board. Periodically, the board shall review each nursing education program and shall conduct onsite visits to a program when it deems necessary. When a change of administration within a nursing education program is made, notice of the appointment of the new administrator shall be submitted to the board, accompanied by a summary of qualifications of the appointee. The board shall verify that the appointee meets the qualifications of Section (b) of the Regulations of Connecticut State Agencies. Program removal. The board, after a hearing, may remove a program from the list of approved programs, and the program must suspend the enrollment of students, when: (1) The program has been on conditional approval for at least two years and has railed to correct the identified deficiencies which caused them to be placed on conditional approval; (2) The board provides written notice of such hearing to the administrator of the 45 Education Standards All Programs (h) program setting forth the particular reasons for the proposed action and fixing a late, not less than thirty days from the date of such written notice, at which time representatives of the program shall have an opportunity for a prompt and fair hearing; (3) Upon completion of the hearing the board shall make a recommendation to the commissioner regarding what action should be taken regarding the program; and (4) The commissioner approves the recommended action. Program closure. When a decision is made to close a nursing education program, the program shall notify the board and submit a written plan and timetable for termination. All requirements and standards for students shall be maintained until the last student is transferred or graduated from the program. The parent institution shall develop and implement a policy providing for the safe storage of vital program records, including transcripts of all graduates and of students who fail to graduate. The program shall notify the board of the person, by title, name and address, responsible for providing transcripts and references for students. (Effective November 29, 1983; Amended January 6, 1992; May 4, 2004.) Education Standards All Programs Administration (a) School organization (1) The authority of and administrative responsibility for the nursing education program shall be vested in the program administrator, who is responsible to the controlling body of the program either directly or indirectly through administrative channels. Each nursing education program shall have its own administrator. (2) There shall be faculty sufficient to meet the educational outcomes of the program, the learning needs of the students, and the safety of the recipients of Health Care Services. (A) The overall faculty/student ratio shall be no less than one (1) clinical faculty member for every ten (10) students engaged in direct client care experiences. (B) The preceptor to student ratio shall be no less than one (1) preceptor for every two (2) students. Preceptors shall work in collaboration with program faculty, who retain responsibility for student evaluation. The ratio of faculty to precepted students shall be no less than one (1) faculty member for every sixteen (16) students. (C) Upon written request from the program director, the board may, within its discretion and after reviewing the merits of the request, provide a temporary exception from the mandated faculty/student ratio. (3) There shall be clerical staff to meet the needs of the administration and instructional personnel. (4) Planning, selecting, directing, and evaluating of student learning experiences shall be the responsibility of the faculty. Planning of the clinical experience, including consideration of the appropriate faculty to student ratio and use of preceptors for the specific settings being utilized, shall be done in cooperation with the administrator of nursing service or the appropriate nursing personnel of cooperating health care entities. (b) Contractual agreements (1) There shall be signed contractual agreements between the nursing education program and cooperating health care entities when the program and the entities are independent. (2) Contracts shall be developed by the program and shall be reviewed annually by the cooperating health care entity. Contracts shall be renewed at least every third year. (c) Philosophy and educational outcomes 56 Registered Nursing Education (d) The philosophy and educational outcomes of the nursing education program shall: (1) Be developed by the nursing program administrator and faculty; (2) Be consistent with philosophy and objectives of the parent institution; (3) Describe the competencies of the graduate; and (4) Provide the framework for the development, implementation and periodic evaluation of the program. Students (1) There shall be written policies for admission, promotion and graduation of students which shall appear in at least one official publication of the program and which shall comply with applicable state and federal laws and regulations. (2) The nursing education program shall be responsible for verifying the satisfactory completion of a secondary school educational program, or its equivalent, for each applicant before admission. (3) Previous education shall be established by the program from transcripts obtained and kept on file. Graduation from an accredited or approved prior educational program shall be recorded. (4) Readmission and transfer. The program shall establish and adhere to written policies for transfer and readmission. The program shall determine the remaining educational experiences necessary for the student to meet the educational outcomes of the nursing education program. (5) Admission with advanced standing. Applicants with previous experience or courses of study relating to nursing may be admitted to a program preparing for registered nurse licensure or practical nurse licensure with advanced standing after an evaluation has been made by the nursing education program. (6) There shall be written policies that are implemented for safeguarding the health and well being of the students which shall include, but not be limited to, provisions for counseling and guidance and admission physical examinations and which shall comply with applicable state and federal laws and regulations. (Effective November 29, 1983; Amended January 6, 1992; May 4, 2004.) Records The nursing education program shall maintain a system of administrative records that shall include current course outlines and evaluation instruments, faculty personnel records, faculty meeting and committee meeting reports, student records, pertinent correspondence, pertinent reports, and official publications of the nursing education program. (Effective November 29, 1983; Amended May 4, 2004.) Facilities (a) The parent institution responsible for the nursing education program shall provide facilities including: a library offering resources and services, office space, conference rooms, classrooms, and nursing laboratories sufficient to meet the needs of the program. (b) Health care entities utilized by a nursing education program must provide the range of clinical nursing experiences appropriate to course objectives. (Effective November 29, 1983; Amended May 4, 2004.) Registered Nursing Education Nursing faculty (a) The faculty and administrator must maintain an active R.N. licensure in Connecticut. (b) Faculty Education and Experience (1) Except as provided in subsection (c) of this section, the administrator of the program shall be a registered nurse and shall have an earned advanced degree in nursing, teaching experience in a program in nursing, and administrative experience. 67 Registered Nursing Education (c) (d) (2) Except as provided in subsection (c) of this section, nurse faculty members in programs preparing registered nurses shall have earned advanced degrees in nursing and shall have appropriate nursing education or experience in their teaching area(s). (3) Nurse faculty members in programs preparing practical nurses shall have earned baccalaureate and master's degrees, one of which shall be in nursing, and shall have appropriate nursing education or experience in their teaching area(s) except: (A) (B) (C) faculty who meet the requirement in subsection (c) of this section; or faculty members who do not have an earned master's degree must complete a master's degree within four (4) years of hire, but shall hold a minimum of an earned baccalaureate degree in nursing upon hire and shall have three (3) years of clinical experience in nursing; and faculty members in nursing education programs requiring state teacher certification will have an additional two (2) years to complete the master's degree. Grandfathering (1) Any faculty member or program administrator employed by a nursing education program approved by the board who was employed as such on the effective date of this section, shall be determined to have met the educational degree requirements in subsection (b) of this section provided such person holds the minimum of an earned master's degree. (2) This provision shall apply even if the individual changes his or her place of employment provided that such individual remains employed in a faculty or administrative capacity in a nursing education program approved by the board. Temporary Waiver (1) The board, in its discretion, may grant a temporary waiver of the educational requirements of subdivision (b)(2) or (b)(3) of this section to address emergency situations. Such waiver shall be granted for an individual up to a maximum of two years. Emergency situations include but are not limited to: (A) (B) the discharge or unexpected resignation of a faculty member; the death of a faculty member or extended illness of a faculty member that prevents the performance of teaching or clinical responsibilities; (C) the inability to obtain faculty who satisfy the requirements of sections to , inclusive, of the Regulations of Connecticut State Agencies, even after advertising for faculty qualified as provided in subsection (b) of this section. (2) In evaluating an application for a temporary waiver requested by a nursing education program, the board may consider the following: (A) (B) Whether the program demonstrates an acceptable level of graduates' performance as defined in subsection (b) of the Regulations of Connecticut State Agencies; and Whether the faculty member to be hired possesses qualifications which include: (i) competence and experience as a registered nurse in the clinical area in which the faculty member will be teaching; (ii) a bachelor of science degree in nursing; and (iii) matriculation in a master of science in nursing program. (3) No waiver shall be granted unless at least 90% of full and part-time faculty members are in compliance with subsection (b), (c) or (e) of this section. (4) A temporary waiver may be renewed if deemed appropriate by the board, based on consideration of the conditions in subdivisions (1), (2), and (3) of this subsection, except that no waiver shall be renewed unless the faculty member is matriculated in a master of science in nursing program. 78 Registered Nursing Education (e) (f) Permanent Waiver (1) The board, in its discretion, may grant a permanent individual waiver of subsection (b)(2) of this section for faculty holding an advanced degree in a field other than nursing. (2) In evaluating a request by a nursing education program for a permanent waiver, the board shall consider the appropriateness of the advanced degree for the particular course work the faculty member engages in. Preceptors used to guide and direct advanced levels of students in registered nursing education programs shall hold an active license as a registered nurse in Connecticut or in the state in which precepting occurs, a baccalaureate degree in nursing, and a minimum of two (2) years of experience in the role or specialty being experienced by the student. (Effective September 19, 1986; Amended December 30, 1994; May 4, 2004.) Curriculum (a) The curriculum shall meet the requirements of the parent institution in which the Nursing Education Program is housed and the state requirements for eligibility of the graduate for admission to the registered nurse licensing examination prescribed pursuant to Section of the Connecticut General Statutes. (b) The curriculum shall integrate theory and clinical practice in a manner that shall cause the Nursing Education Program graduates to meet the educational outcomes for registered nursing described in Section of the Regulations of Connecticut State Agencies. (c) The minimum length of the nursing component of the program must be equivalent to four (4) fifteen (15) week academic semesters and contain a minimum of thirty-five (35) semester hours of credit in nursing. Fifty percent (50%) of contact hours shall be in supervised direct client care experiences, observational experiences and simulated experiences appropriate to the program's educational outcomes, and laboratory experiences for the acquisition and practice of clinical nursing skills. (Effective June 26, 1989; Amended May 4, 2004.) Educational outcomes A graduate of a registered Nursing Education Program shall be able to: (1) Perform the duties and responsibilities of the registered nurse within the framework of the nurse practice Act, Chapter 378 of the Connecticut General Statutes; (2) Synthesize knowledge from nursing theory and the biological, physical, social, and behavioral sciences in providing health care to clients; (3) Exercise critical thinking, ethical decision making, and independent judgment in using the nursing process to provide care to clients; (4) Apply the nursing process to design, implement, and evaluate care for clients using a variety of technologies. The scope of care shall include preventive, curative, supportive, and restorative nursing interventions in both institutional and community-based settings; (5) Develop and implement a variety of teaching and learning strategies in the provision of health teaching for clients in a variety of settings, using a variety of technologies; (6) Identify the scientific basis for assessments and therapeutic nursing measures; (7) Manage information and resources, contributing to the achievement of optimum client outcomes in a cost effective manner; (8) Use leadership, management, delegation and collaborative skills as a member of a multidisciplinary team within the health care delivery system to develop, implement, and evaluate health care provided to clients; and (9) Demonstrate professional accountability by acting as an advocate for clients and by maintaining accepted standards of nursing care for a registered nurse. (Effective November 29, 1983; Amended May 4, 2004.) 89 [REPEALED] (Repealed effective May 4, 2004) Practical Nursing Education Program Practical Nursing Education Program Curriculum (a) The curriculum shall meet the requirements of the parent institution in which the program is housed and state requirements for eligibility of the graduate for admission to the practical nurse licensing examination prescribed pursuant to Section of the Connecticut General Statutes. (b) The curriculum shall integrate theory and clinical practice in a manner that shall cause the Nursing Education Program graduates to meet the educational outcomes for practical nursing described in Section of the Regulations of Connecticut State Agencies. (c) The length of the program shall be a minimum of fifteen hundred (1500) hours over no less than ten (10) months. Fifty percent (50%) of contact hours shall be in supervised direct client care experiences and observational experiences appropriate to the Program's Educational Outcomes. (Effective November 29, 1983; Amended May 4, 2004.) Educational outcomes A graduate of a practical nursing education program shall be able to: (1) Perform the duties and responsibilities of the licensed practical nurse within the framework of the Nurse Practice Act, Chapter 378 of the Connecticut General Statutes; (2) Apply nursing principles and theories in the implementation of the plan of care for clients under the direction of and in collaboration with the registered nurse by: (A) collecting data concerning the biologic and psychosocial needs of individual clients along the wellness/illness continuum; (B) implementing therapeutic nursing measures to maintain, promote, and restore optimum health to clients within the established plan of care; (C) performing therapeutic nursing interventions based on principles from the biophysical and behavioral sciences, adapting these to the individual needs of clients as members of families and community systems; (D) using ethical decision making and judgment in providing care; (3) Assist in evaluating the effectiveness of nursing interventions, using observations and data collection to recommend changes in the plan of care; (4) Perform appropriate data collection to monitor client status in response to alterations in health, treatment of health problems, and therapeutic nursing interventions; (5) Recognize and report deviations from expected responses to alterations in health status or in the treatment of health problems; (6) Intervene appropriately in emergency situations; (7) Interact effectively with clients, families, and health team members through appropriate verbal, nonverbal, and written communications; (8) Implement the care of groups of clients, using appropriate principles of priority setting, time management, and delegation; (9) Utilize resources and the environment of care effectively to meet client needs and attain expected outcomes of care; and (10) Demonstrate individual accountability by acting as an advocate for health care consumers and by maintaining accepted standards of care for a practical nurse. (Effective November 29, 1983; Amended May 4, 2004.) Licensure Endorsement 910 Practical Nursing Education Program (a) (b) (c) (d) (e) (f) Graduate nurses from a nursing education external degree program who are licensed in another state of the United States on the basis of standards which meet or exceed the requirements of this state, shall be eligible for licensure without examination in Connecticut. Persons seeking endorsement who were graduated from an educational program which is shorter in length than the minimum length for Connecticut educational programs shall provide documentation of clinical work experience. Such work experience, when combined with their educational program, shall equal the minimum program length for nursing education programs approved in Connecticut. Such work experience must be under the supervision of a licensed registered nurse and occur after completion of the basic educational program. Nurses trained and licensed in Canada prior to 1970 who meet the current educational requirements of Connecticut shall take the licensing examination prescribed pursuant to Section of the Connecticut General Statutes. Nurses trained and licensed in Canada in or after 1970 who meet the current educational requirements of Connecticut may be licensed without examination if their Canadian licensing examination was in English. If their Canadian examination was not in English, then they must demonstrate proficiency in English pursuant to section (e). Nurses licensed in Canada on the basis of an examination in a language other than English who are seeking licensure by examination in Connecticut must demonstrate proficiency in English on an examination, and at a level, prescribed by the Commissioner with the consent of the Board. Persons licensed pursuant to section (d) shall have attained a passing score on the Canadian licensing examination prescribed by the Commissioner with the consent of the Board. The prescribed passing score shall be one deemed by the Commissioner to be equivalent to passing scores on comparable licensing examinations used in the United States. (Effective December 30, 1994) Foreign-trained Persons educated in nursing in a foreign country must successfully complete the examination offered by the Commission on Graduates of Foreign Nursing Schools prior to being accepted for examination and licensure as a Registered Nurse in Connecticut. (Effective December 30, 1994) Out-of-state programs (a) A program in nursing located in another state or territory of the United States shall be deemed approved pursuant to section of the Connecticut General Statutes, provided that: (1) said program, if a registered nursing education program, complies with the provisions of section of the regulations of Connecticut State Agencies: (2) said program is approved by the duly authorized nurse licensure board or agency of the state or territory in which it is located: and (3) said state or territory maintains licensure requirements substantially similar to or higher than those of this state. (b) A program in nursing located in another state or territory of the United States which provides clinical experience to students in cooperating health care agencies in this state shall comply with the provisions of the regulations of Connecticut State Agencies contained in subdivision (2) of subsection (a) of section and subsection (b) of section Faculty providing on-site clinical supervision to students in cooperating health care agencies in this state shall: (1) maintain an active registered nurse license in this state: (2) have earned baccalaureate and master's degrees, one of which must be in nursing: and 1011 Practical Nursing Education Program (3) have clinical experience in their teaching area. (Effective December 30, 1994) 11 View more
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