Legislative: Nursing Distance Learning Programs and State Board of Nursing Authorizations

  • Denise K. Gormley, PhD, RN
    Denise K. Gormley, PhD, RN

    Dr. Gormley is an Assistant Professor and the Executive Director of the Master’s in Nursing Program at the University of Cincinnati (OH) College of Nursing. She also has administrative responsibility for the MSN distance learning program at the College which includes programs in Nurse Midwifery, Women’s Health, Family, Adult, Clinical Nurse Specialist/Nurse Educator, Psychiatric/Mental Health, and Nursing Administration.

    Dr. Gormley received her BSN, MSN, and PhD degrees from the University of Cincinnati. She has previously been employed in staff nursing and administrative/management positions at University Hospital in Cincinnati, Ohio. She has also served as Assistant Professor and Director of the Accelerated BSN program at the Northern Kentucky University (Highland Heights, KY). Her clinical expertise is in psychiatric/mental health nursing.

  • Greer Glazer, RN, CNP, PhD, FAAN
    Greer Glazer, RN, CNP, PhD, FAAN

    Dr. Greer Glazer is Dean and Professor in the College of Nursing at the University of Cincinnati Academic Health Center. She was recently Dean and Professor, College of Nursing and Health Sciences, at the University of Massachusetts (Boston). Dr. Glazer has previously she held a variety of academic positions at Kent State University (Kent, OH), Case Western Reserve University (CWRU) (Cleveland, OH), University Hospitals of Cleveland, and Tel Aviv University (Israel). She received her BSN from the University of Michigan (Ann Arbor) and her MSN (with a focus in maternal/newborn nursing) and PhD degrees from CWRU.

    Dr. Glazer is a member of the Robert Wood Johnson (RWJ) Executive Nurse Leadership Alumni Association Board and has served as Chairperson of the Political Action Committee of the American Nurses Association. She was a Fulbright Scholar to Israel and a Fulbright Selection Committee/Committee Chair for the Israel and Egypt regions. She has also received the Massachusetts Association of Registered Nurses, Excellence in Nursing Education Award; the Frances Payne Bolton School of Nursing (CWRU) Alumni of the Year Award; and the Dorothy A. Cornelius Ohio Nurses’ Association Award. Dr. Glazer has also been a member of the RWJ Executive Nurse Fellows’ Program.

    Dr. Glazer's research has focused on women’s health issues and barriers to the provision and utilization of prenatal health care services for African-American women. Recent publications have focused on minority underrepresentation in nursing and cancer health disparities. She also recently completed a United States Department of Education grant seeking to educate nurse scholars who are underrepresented minorities. Dr. Glazer is widely published in her field, is in great demand as a public speaker, and has appeared on numerous radio and television programs.

In October 2010, the United States (U.S.) Department of Education published in the Federal Register the final regulations on program integrity for Higher Education. One area of the final regulations related to state authorization of distance education programs. This regulation impacted distance learning programs that resided in one state, but offered enrollment to students in another state. It clarified the need for an out-of-state educational institution that offers distance learning, including online education or correspondence study to students, to seek State approval in all states in which they would have students. The deadline for this approval was set for July 1, 2011. For purposes of the 2011-2012 academic year, the U.S. Department of Education (DOE) agreed to consider an institution of higher education to be making a good faith effort to comply with this mandate if the institution had applied for approval, if the institution was able to document receipt of an application to the State, or if the institution had notified the Department of Education when it had been approved.

In April of 2011, after these regulations had been published, the U.S. Department of Education released a moratorium on the state authorization regulation prior to the deadline for implementation. The Department released a ‘Dear Colleague’ letter that extended the enforcement date to July 1, 2014. However, in that letter the Department of Education clarified that it still expected institutions of higher education offering distance learning programs to demonstrate good faith efforts to identify and obtain necessary State authorization before that date. Evidence of good faith efforts included any of the following: documentation that an institution has contacted a State directly to discuss programs the institution is providing to students in that State; documentation that an institution is developing a distance education management process for tracking students; an application made to a State, even if not yet approved; and documentation from a State that an application is pending. Because overall compliance with the regulation would not be required until 2014, most institutions of higher education offering distance learning programs have made these good faith efforts by contacting the State to discuss distance education programs offered in the State and to determine the State’s individual requirements for program approval.

Universities in many states are working to develop model agreements of reciprocity. In this model, if an institution of higher learning is approved in its own state, approval will be recognized by the partner state(s). Many regional compacts, including the Western Interstate Commission for Higher Education (WICHE), Southern Regional Education Board (SREB), Midwestern Higher Education Compact (MHEC), and the New England Board of Higher Education (NEBHE), are getting involved. These compact reciprocity agreements would cover many, but not all, activities in partner states. The draft agreement for state authorization reciprocity is planned for release in the summer of 2012, with final agreement in early fall, 2012.

On February 28, 2012, The U.S. House of Representatives passed H.R. 2117, the Protecting Academic Freedom in Higher Education Act, which prohibits the Department of Education from overreaching into academic affairs and program eligibility under Title IV of the Higher Education Act of 1965, by a vote of 303-114. This essentially repeals a regulation called the “state authorization rule” which ensures that colleges adhere to state laws validating that they have the authorization to operate in the state, and requires higher education institutions offering distance education programs to meet state requirements/approval in any state in which a student might be located and receiving his/her education. The Senate version of the bill has been referred to the Committee on Health, Education, Labor, and Pensions, and has not yet come to vote.

Since the initial mandate from the U.S. Department of Education, State boards of nursing have instituted or mandated similar regulations for distance learning programs that have nursing students enrolled in the State. However, the boards of nursing have not authorized a moratorium until 2014 as has the U.S. Department of Education. Many of the State boards of nursing are also requiring that the institutions of higher learning have the institutional authorization outlined above in place before the board will consider individual approval of the nursing distance learning program, even though the moratorium is in place. This has become problematic for the nursing distance learning programs because many institutions of higher education are not pursuing the authorization until they must do so in 2014, or are awaiting the final vote in the U.S. Senate. The State boards of nursing have also generally not accepted good faith efforts by nursing programs or institutions to allow students to participate in distance learning programs or to complete practicum, or clinical experiences in the State, if formal approval at both the institutional and nursing-program levels has not yet been given.

The cost for the approval process by State boards of nursing will be prohibitive over time with annual or biannual fees of up to $750 or more (sometimes for each specialty offered in a program). Additional requirements may include lengthy application procedures that include, but are not limited to, complete curricula vitae (CVs) of all faculty who teach in the program, detailed program schema with course syllabi and content outlines, and even faculty RN licensure in the State. For clinical practicum experiences, many State boards of nursing are requiring the institution to provide preceptor CVs and proof of licensure even though the clinical experience is taking place within the State, with preceptors who are licensed and certified by that State’s board of nursing.

State boards have also requested that the information on preceptors be submitted to the state board six months, or even up to one year prior to the clinical experience. For many nursing programs, this is difficult because students have not always scheduled their precepted clinical experiences early in their program of study, and because legal contracts between the clinical agency and the educational institution have not always been completed early in the program, yet these contracts must be approved.

These state board of nursing processes required for approving and authorizing nursing distance learning programs are becoming roadblocks to students’ educational advancement. This is not supportive of advancing the nursing profession, especially in light of the Institute of Medicine’s (IOM’s) recent report on the state of nursing in the US (2011) and the IOM recommendations to nursing to advance the profession and ultimately improve patient outcomes. The IOM (2011) recommendation states “Nurses should achieve higher levels of education and training through an improved educational system that promotes seamless progression” (p. 163). This key message directly discusses the need for more BSN-prepared nurses, as well as the need to increase the number and distribution of graduate-level nurses. Advanced Practice Registered Nurses (APRN) serve as nurse practitioners, certified nurse midwives, clinical nurse specialists, and nurse anesthetists. They graduate from specialized programs that are based upon the National Organization of Nurse Practitioner Faculties (NONPF) competencies and accredited by national accreditation bodies, such as the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC). The nursing distance education programs for graduate education are accredited by one or both of these two organizations, or at least need to be if their graduates desire to sit for certification examinations in their specialty area and to practice as APRNs.

The Tri-Council for Nursing (2010) has also called for an increase in nurses with advanced degrees to “serve as teachers, scientists, primary care providers, specialists, and leaders throughout the healthcare delivery system” (paragraph 3). This policy statement discusses educational possibilities to prepare the nursing workforce for advanced education. These various educational options include degree completion programs, online distance programs, accelerated, and part-time degree programs (Tri-Council for Nursing).

We believe that state boards of nursing should have knowledge of institutions of higher learning and nursing distance education programs from other states that have students in their state, and that they should authorize approval of these programs. However, our recommendation is that the Tri-Council for Nursing, the American Association of Colleges of Nursing (AACN), the National League for Nursing (NLN) and the National State Boards of Nursing recommend that state boards of nursing apply these requirements consistently across states, charge nominal fees for processing the application for approval, and allow CCNE and NLNAC accreditation to serve as a sufficient indication that the nursing program is meeting national standards for educating nurses.

Recommendations have been made to the National Council of State Boards of Nursing that would streamline the process for application for state authorization of distance learning programs. These recommendations include: (a) a standardized application process for all states, (b) reciprocity agreements between states similar to institutional- level reciprocity agreements being developed, (c) nominal monetary charges commensurate with the cost of processing the application, and (d) consent for students to continue in their educational program if good faith efforts and the required application is in place. We believe that these recommendations will allow for a smoother application process in each state, promote higher education for nurses, and support the increasing need for advanced practice nurses across the country.

Related Websites:

ACE Summary: www.acenet.edu/AM/Template.cfm?Section=HENA&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=44317

Community Letter Signed by AACN and CCNE: www.acenet.edu/AM/Template.cfm?Section=LettersGovt&CONTENTID=44288&TEMPLATE=/CM/ContentDisplay.cfm

WICHE Cooperative for Educational Technologies: http://wcet.wiche.edu and http://wcet.wich.edu/advance/state-approval

Denise K. Gormley, PhD, RN
E-mail: gormledk@ucmail.uc.edu

Greer Glazer, RN, CNP, PhD, FAAN
E-mail: Greer.Glazer@uc.edu

Citation: Gormley, D., Glazer, G., (June 7, 2012) "Legislative: Nursing Distance Learning Programs and State Board of Nursing Authorizations" OJIN: The Online Journal of Issues in Nursing Vol. 17 No. 3.