New Hampshire - June 2020

Page 6 • New Hampshire Nursing News June, July, August 2020
Board of Nursing Responds to State of Emergency
On Friday, March 13, 2020, Governor Chris Sununu
signed Executive Order 2020-04 declaring a state of
emergency in response to COVID-19. Section 3 of the
Executive Order stated:
Beginning at 11:59 p.m. on Sunday, March 15,
2020 all assisted living facilities, long term care
facilities, nursing facilities, residential care facilities,
as those terms are defined in RSAs 151-151-H,
or any other similar facilities providing residential
care to elderly or infirm patients, shall prohibit
visitor access to reduce facility based transmission
of COVID-19. This prohibition shall not apply to
medically necessary personnel, visitors for residents
receiving end of life care, or visitors necessary
to provide for a residents psychosocial needs
as determined by a licensed medical care provider.
In effect, the governor's executive order caused nursing
assisted living facilities, long term care facilities, nursing
facilities, residential care facilities, and any other similar
facilities to be "locked down" to all visitors. Visitors
included nursing students. The Board of Nursing Rules
require that programs that prepare LNAs must require that
each LNA student obtain 60 hours of clinical experience
in a skilled nursing facility (Nur 704.09(i)). Yet, the majority
of locations that provide such clinical experience are
closed to all visitors, including nursing students, for the
duration of the state of emergency. For pre-licensure
LPN and RN programs, the rules currently require that
the program's curriculum be approved by the Board of
Nursing, and that any changes to the curriculum also need
to be approved, including any changes to requirements for
clinical experience (Nur 602.16).
The Board of Nursing’s Chair, Vice-Chair, Administrator
along with the Director of the Office of Professional
Licensure requested an emergency rule to address the
concerns related to the current state of emergency in New
Hampshire. A rule related to clinical experience during
a state of emergency was drafted (see Box Nur 101.04).
In an emergency meeting on March 16, 2020 the Board
of Nursing passed the rule, which was submitted and
accepted by the State of NH, and is now in effect until
September 12, 2020.
Nur 101.04 "Clinical Experience" means practice in
an inpatient, ambulatory care, or community setting
where the student provides care to patients under
the guidance of a nursing instructor or preceptor.
(a.) Clinical Experience may be substituted with
simulation and lab work during a State of
Emergency Declared by the Governor that
impacts clinical site availability; provided,
however, the Board of Nursing is notified
within twenty-four (24) hours of such
substitution. "Simulation" means a technique,
not a technology, to replace or amplify real
experiences with guided experiences that evoke
or replicate substantial aspects of the real world
in a fully interactive manner.
The rule relaxes the requirement for clinical experience
during the course of a declared state of emergency,
and allows the 60 hours of clinical experience to be
substituted with 60 hours of simulation and lab work
during the state of emergency. Nursing programs may
substitute in-person clinical with virtual simulation. The
Board must be given 24 hours’ notice of such substitution.
RN and LPN programs needing to affect changes in
curriculum delivery as a result of the transition from
in-person to online learning are also impacted by Nur
602.16. The rule relates to notification requirements for
curriculum changes, which requires three months prior
written notice when changes occur in more than 10%
of [entire program] credit hours. However as most of the
curriculum revisions necessitated by transition from inperson
to online learning relate to the last six weeks of
the Spring 2020 term the rule is less likely to be applied.
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For example a two-year
nursing program, with
two 16-week terms for
each of two years and
one 8-week summer
term has a total of 72
weeks in the program. If
this program changes from
in-person instruction to online
instruction for six weeks (of the
72 weeks) only 8.33% of the total curriculum hours are
affected. Only a Board of Nursing notification is required
if the 10% threshold is not met.
The relaxation of in-person clinical experiences have
implications for potential employers of Board of Nursing
licensees. Licensed Nursing Assistants that were trained
during the state of emergency may not have received a
comprehensive clinical experience with direct patient
care. They may require extended orientations specifically
in care needs of patients with dementia or cognitive
impairment.
The Board of Nurses has also enacted an amendment to
Nur 303.02 (d) pursuant to Emergency Rule on March
23, 2020, to extend the time period for taking the NCLEX
exam.
Nur 303.02 (d) Registered and Practical Nurse
Examinations. (d) For graduates of programs
within the US or Canadian Provinces where
the NCLEX is required, the NCLEX shall be
taken within six months of graduation from an
approved school of nursing. Notwithstanding,
during a State of Emergency declared by the
Governor, the Board shall allow Registered
and Practical Examinations to be completed
within 90 days of the Expiration of the State of
Emergency to complete this requirement.
The Governor’s Executive Order called for the temporary
authorization for out of state medical providers to provide
medically necessary services and provide services
through telehealth. The temporary licenses authorized
under this emergency order are issued to any healthcare
provider who can demonstrate a license in good standing
in another State jurisdiction. The temporary licenses are
being provided at no charge and remain valid during the
declared state of emergency. As of May 1, 2002, 1633
temporary licenses were issued to APRNs, 39 to RNs, four
to LPNs and one to an LNA.
The Executive Order declaring a state of emergency
concerns meetings of public bodies. Therefore public
sessions of the meetings of the New Hampshire Board
of Nursing are being conducted by teleconference and/
or video teleconference. Information on how to connect
and listen to the Board of Nursing meeting is posted on
the website (nhbon.org) under Board Meetings.
Staffing of nursing homes and assisted living facilities has
been dramatically impacted by COVID-19 transmission.
Senator Tom Sherman, Representative Polly Campion
RN, Lindsey Courtney, Interim Director of the Office of
Professional Licensure and Board of Nursing Administrator
Bonnie Crumley-Aybar met to develop a streamlined
process to encourage LNAs with licenses that had lapsed
within the past three years to reenter the workforce.
An outreach to nursing students who had passed
Fundamentals of Nursing was created to secure an LNA
license and practice in long term care facilities. The
$35.00 licensing fee is being waived to encourage nursing
students to become LNAs.
Bonnie Crumley-Aybar, RN, MSN is the Administrator of
the New Hampshire Board of Nursing.
For more information contact:
Dayle.Sharp@unh.edu
chhs.unh.edu/graduate-nursing