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Several Proposed Rule Changes Posted Impacting Nurses and Nursing Home Administrators

On October 30, several proposed rule changes were published on the Iowa Legislature website. The Board of Nursing rules and Nursing Home Administrator Rules were included in these proposed rule changes are outlined below with comment letter information.

Board of Nursing:

Comments due on November 19 to

Emily DeRonde

6200 Park Ave

Des Moines, Iowa 50321

email address [email protected].

 

Chapter 5 – Continuing Education

  • Several definitions were removed that were no longer necessary.
  • Removal of the Board authority to establish continuing education requirements and practices.
  • Removed the requirement for completion of continuing education within the renewal period due to the ability to carry over hours.
  • Added 5.2(2) Up to 18 hours or 1.8 CEUs of credit may be carried over to a future license period if the licensee exceeded the minimum number of required hours for the reporting period.
  • Revised serving as a preceptor as a method of CEU fulfillment. Previously a nurse had to serve as a preceptor for a nursing student or employee transitioning into a new clinical practice area for a minimum of 120 hours which would account for 12 CEUs. However, in the proposed rules this was reduced to a minimum of 60 hours which will account for 6 CEUs.
  • Removed the sections including what continuing education credit would not be awarded for, options for continuing education, special approval process, continuing education providers and administrative rules chapters 8-20 due to duplication of Iowa Administrative Code.
  • The information on documentation that must be maintained was revised to state “Licensees are required to keep continuing education documentation for a period of four years including proof of attendance, licensee’s name, course date, title, awarded hours, and provider approval information.
  • The language related to failing to meet the continuing education requirements or timely request of an exemption was reworded.
  • Language was removed in the section that described CEU audits including what documentation was required for submission with the audit. 

Chapter 6 – Scope of Practice

  • Definitions were added including asynchronous store-and-forward transmission, licensee, and telehealth.
  • Within the Registered Nurse (RN) scope of practice, 6.2(5) was revised to remove “The initial assessment and ongoing application of the nursing process shall only be provided by the RN.”
    • Note: LeadingAge Iowa has been working for nearly two years on this critical rule change. Our advocacy efforts included significant change assessments. While the significant change assessments are not clearly spelled out in the rule change, the definition of an initial assessment included in Chapter 6.1 includes a significant change. Therefore, removing the term initial assessment also revises the scope of practice to allow Licensed Practical Nurses to complete significant change assessments.
    • Note: The rules pertaining to this scope of practice include nursing facilities as defined in Iowa Code 135C. Based on this language, it does not automatically include assisted living, adult day, and residential care providers. Previously, LeadingAge Iowa reached out to the Department of Inspections, Appeals, and Licensing (DIAL) to discuss the potential of a rule change in appropriate administrative rules. DIAL expressed they would consider changing the rules and LeadingAge Iowa sent a follow-up email to address this again.
    • The LPN scope of practice included a revision under 6.3(3)b to align with the RN scope of practice revisions. It states, “The RN is responsible for the plan of care, including verifying and interpreting the initial assessment data obtained by the LPN.” The revised rules don’t indicate what “verifying and interpreting clearly mean”, however, during a recent Board of Nursing meeting, they discussed practices such as the RN reviewing the initial assessment and ensuring appropriate orders and care plans were developed. In the comment letter, LeadingAge Iowa plans to ask for additional clarification on this.
    • In specific settings later in Chapter 6.3, the rules are also revised to remove the initial assessment language and added, “the LPN is responsible or requesting nurse consultation as needed.” The specific settings included home care, correctional facilities, and women, infant, and children (WIC) clinics.
    • Added 6.3(11)f(2) allowing the LPN to provide care, including dispensing medications such as methodone, buprenorphine, and naltrexone in opioid treatment programs or units.
    • Chapter 6.4 was added on Telehealth Services outlining practice guidelines for RNs and/or LPNs who provide telehealth services. In order for the RN and/or LPN to provide telehealth services, they must be trained and competent do so, the same standard of care will be provided whether in person or virtual, the technology platform must be HIPAA compliance, must include audio and visual devices, and appropriate recordkeeping must be maintained. 

LeadingAge Iowa submitted a comment letter in support of these rule changes along with a couple suggested changes. 

Nursing Home Administrator Rules

Comments are due by November 20 to

Jessica O’Brien

Iowa Department of Inspections, Appeals, & Licensing,

6200 Park Ave

Des Moines, Iowa 50321

Phone 515-281-6352

Jessica.o’[email protected]

 

Based on Legislative action taken during the 2024 Session, the administrative rules for Nursing Home Administrators include two proposed changes.

  • HF2013 which extends the duration of a provisional license from 12 months to 24 months included in 481-980.5.
  • HF2686 which allows a licensee to carry over up to 50% of excess continuing education hours from the previous renewal cycle. This can account for up to 20 hours of continuing education hours. This is included in 481-981.2. 

LeadingAge Iowa submitted a comment letter in support of these changes.