APPLICATION FOR APPROVAL/RE-APPROVAL OF EDUCATION PROGRAM(s) FOR REGISTERED NURSES PROVIDING EXAMINATIONS TO VICTIMS OF SEXUAL OFFENSES

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1 Please select one: Initial approval Re-approval APPLICATION FOR APPROVAL/RE-APPROVAL Agency offering the Program Name of Agency Program Coordinator Address City, State, Zip Contact Number Address Program (submit separate application for each program) Title of Program Length of Program Total Program Hours Anticipated date of first offering Number and frequency of program offerings projected times per year x year(s) over the next three years Number of learners anticipated in each program offering NOTE: For RNs, licensed in another state, but not currently licensed in North Carolina, the North Carolina Board of Nursing must be given advance notice of the name of each student, the jurisdiction in which the student is licensed, the license number, and the expiration date in order to grant student status to an individual who does not hold a North Carolina nursing license prior to his/her participation in the clinical component of this program. Please refer to paragraph (a) (4) of attached Rule 21 NCAC CONTINUING EDUCATION PROGRAMS. Faculty List name and qualifications [or submit resumes] for Program Coordinator and each RN faculty member; include North Carolina license/certificate number. Nurse Faculty (list names below): Faculty/Learner Ratio Page 1 of 8

2 Attach the following to this application: A) Description of education program, including: * objectives and how shared with learner * content of education program * teaching methodologies * time allotted for didactic content and hours for clinical learning experiences * location and description of space for didactic experiences * equipment available for presentation of course * plan for evaluation by: o provider o learner B) Name and location of resource(s) for clinical learning experiences. *describe how clinical experience obtained. C) Copy of certificate of completion to be awarded to participants. *Please refer to 21 NCAC (b)(7) Guidelines for Continuing Education Programs (attached) IMPORTANT NOTE RE: INFORMATION TO FILE AND SEND A list of RNs who successfully complete the program and their certificate number shall be kept on file in your agency. (Note: If RN is not licensed in North Carolina, include state of licensure and license/certificate number for each.) A copy of the list of RNs who successfully completed the program shall be sent to the North Carolina Board of Nursing with the two year renewal information for this education program or when the education program is no longer offered. WE CERTIFY THAT THE INFORMATION IN THIS APPLICATION, INCLUDING ATTACHMENTS, REPRESENTS OUR AGENCY-SPONSORED EDUCATION PROGRAM, FOR WHICH NORTH CAROLINA BOARD OF NURSING APPROVAL IS BEING REQUESTED. Approval/Re-approval is not official until your agency receives the NCBON SANE initial/re-approval letter. Signature of Director (Coordinator of Program) Signature of Director of Agency Date Date Please mail application and corresponding information to: North Carolina Board of Nursing ATTN: Practice Coordinator PO Box Page 2 of 8

3 NORTH CAROLINA BOARD OF NUSRING 21 NCAC CONTINUING EDUCATION PROGRAMS (a) Definitions. (1) Continuing education in nursing is a planned, organized learning experience taken after completion of a basic nursing program which prepares a nurse to perform advanced skills. Types of learning experiences that may be considered continuing education as defined in Subparagraph (a)(3) of this Rule include: (A) a non-degree oriented program; (B) a course(s) or component(s) of a course(s) within an academic degree-oriented program; or (C) an advanced academic degree-granting program which prepares the registered nurse for advanced practice as a clinical nurse specialist, nurse anesthetist, nurse midwife or nurse practitioner. (2) Programs offering an educational experience designed to enhance the practice of nursing are those which include one or more of the following: (A) enrichment of knowledge; (B) development or change of attitudes; or (C) acquisition or improvement of skills. (3) Programs are considered to teach nurses advanced skills when: (A) the skill taught is not generally included in the basic educational preparation of (B) the nurse; and the period of instruction is sufficient to assess or provide necessary knowledge from the physical, biological, behavioral and social sciences, and includes supervised clinical practice to ensure that the nurse is able to practice the skill safely and properly. (4) Student status may be granted to an individual who does not hold a North Carolina nursing license but who participates in a clinical component of a continuing education programs in North Carolina when: (A) (B) (C) (D) (E) the individual possesses a current unencumbered license to practice nursing in a jurisdiction other than North Carolina; the course offering meets one of the following criteria: (i) is part of an academic degree-granting nursing program which has approval in a jurisdiction other than North Carolina or national accreditation; or (ii) is offered through an in-state academic institution which has Board approval for basic nursing education program(s) or national accreditation for advanced nursing education program(s); or (iii) is approved by the Board as a continuing education offering, thereby meeting the criteria as defined in Paragraph (b) of this Rule; the individual receives supervision by a qualified preceptor or member of the faculty who has a valid license to practice as a registered nurse in North Carolina; the course of instruction has a specified period of time not exceeding twelve months; the individual is not employed in nursing practice in North Carolina during participation in the program; and Page 3 of 8

4 (F) the Board has been given advance notice of the name of each student, the jurisdiction in which the student is licensed, the license number, and the expiration date. (b) Criteria for voluntary approval of continuing education programs in nursing. (1) Planning the educational program shall include: (A) definition of learner population; for example, registered nurse, licensed practical nurse, or both; (B) identification of characteristics of the learner; for example, clinical area of practice, place of employment, and position; and (C) assessment of needs of the learner; for example, specific requests from individuals or employers, pre-tests, or audits of patient records. (2) Objectives shall: (A) be measurable and stated in behavioral terms; (B) reflect the needs of the learners; (C) state desired outcomes; (D) serve as criteria for the selection of content, learning experiences and evaluation of achievement; (E) be achievable within the time allotted; and (F) be applicable to nursing. (3) Content shall: (A) relate to objectives; (B) reflect input by qualified faculty; and (C) contain learning experiences appropriate to objectives. (4) Teaching methodologies shall: (A) utilize pertinent educational principles; (B) provide adequate time for each learning activity; and (C) include sharing objectives with participants. (5) Resources shall include: (A) (B) faculty who have knowledge and experience necessary to assist the learner to meet the program objectives and are in sufficient number not to exceed a faculty-learner ratio in a clinical practicum of 1:10. If higher ratios are desired, sufficient justification must be provided; and physical facilities which ensure that adequate and appropriate equipment and space are available and appropriate clinical resources are available. (6) Evaluation must be conducted: (A) by the provider to assess the participant's achievement of program objectives and content and will be documented; and (B) by the learner in order to assess the program and resources. (7) Records shall be maintained by the provider for a period of three years and shall include a summary of program evaluations, roster of participants, and course outline. The provider shall award a certificate to each participant who successfully completes the program. (c) Approval process. (1) The provider shall: (A) (B) make application on forms provided by the Board no less than 60 days prior to the proposed enrollment date; present written documentation as specified in (b)(1) through (b)(7) of this Rule; and Page 4 of 8

5 (C) notify the Board of any significant changes relative to (b)(1) through (b)(7) of this Rule; for example, changes in faculty or total program hours. (2) Approval is granted for a two year period. Any request to offer an approved program by anyone other than the original provider must be made to the North Carolina Board of Nursing. (3) If a course is not approved, the provider may appeal in writing for reconsideration within 30 days after notification of the disapproval. If the course is not approved upon reconsideration, the provider may request, within 10 days, a hearing at the next regularly scheduled meeting of the Board, or no later than 90 days from the date of request, whichever shall come first. (4) Site visits may be made by the Board as deemed appropriate to determine compliance with the criteria as specified in Paragraph (b) of this Rule. (5) The Board shall withdraw approval from a provider if the provider does not maintain the quality of the offering to the satisfaction of the Board or if there is misrepresentation of facts within the application for approval. (6) Approval of continuing education programs will be included in published reports of Board actions. A list of approved programs will be maintained in the Board's file. History Note: Authority G.S (b); ; Eff. January 1, 1984; Amended Eff. October 1, 1992; October 1, 1991; October 1, 1989; January 1, Page 5 of 8

6 SANE LAW GENERAL ASSEMBLY OF NORTH CAROLINA AN ACT TO ALLOW THE ESTABLISHMENT OF PROGRAMS TO TRAIN LICENSED REGISTERED NURSES TO CONDUCT MEDICAL EXAMINATIONS OF VICTIMS OF SEXUAL OFFENSES, TO CONDUCT MEDICAL PROCEDURES TO COLLECT EVIDENCE FROM THE VICTIMS, AND TO ALLOW DIRECT PAYMENT TO NURSES WHO PROVIDE THIS SERVICES. Medicine and Allied Occupation Nursing Practice Act Section 1. G.S reads as written: Standards for nursing programs. (a) A nursing program may be operated under the authority of a general hospital, or an approved postsecondary educational institution. The Board shall establish, revise, or repeal standards for nursing programs. These standards shall specify program requirements, curricula, faculty, students, facilities, resources, administration, and describe the approval process. Any institution desiring to establish a nursing program shall apply to the Board and submit satisfactory evidence that it will meet the standards prescribed by the Board. Those standards shall be designed to ensure that graduates of those programs have the education necessary to safely and competently practice nursing. The Board shall encourage the continued operation of all present programs that meet the standards approved by the Board. (b) Any individual, organization, association, corporation, or institution may establish a program for the purpose of training or educating any registered nurse licensed under G.S , , or in the skills, procedures, and techniques necessary to conduct medical examinations for the purpose of collecting evidence from the victims of first-degree rape as defined in G.S , seconddegree rape as defined in G.S , statutory rape as defined in G.S A, first-degree sexual offense as defined in G.S , second-degree sexual offense as defined in G.S or attempted first-degree or second-degree rape or attempted first-degree or second-degree sexual offense as defined in G.S The Board, pursuant to G.S (b)(14) and, in cooperation with the North Carolina Medical Board as described in G.S. 90-6, shall establish, revise, or repeal standards for any such program. Any individual, organization, association, corporation, or institution which desires to establish a program under this subsection shall apply to the Board and submit satisfactory evidence that it will meet the standards prescribed by the Board. (1981, c. 360, s 1; 1987, c. 827, s. 1; 1991, c. 643, s. 5; , s. 1.) Page 6 of 8

7 Medicine and Allied Occupation Nursing Practice Act Section 2. G.S reads as written: Prohibited acts. It shall be a violation of this Article, and subject to action under G.S , for any person to: (1) Sell, fraudulently obtain, or fraudulently furnish any nursing diploma or aid or abet therein. (2) Practice nursing under cover of any fraudulently obtained license. (3) Practice nursing without a license. This subdivision shall not be construed to prohibit any licensed registered nurse who has successfully completed a program established under G.S (b) from conducting medical examinations or performing procedures to collect evidence from the victims of offenses described in that subsection. (4) Conduct a nursing program or a refresher course for activation of a license, that is not approved by the Board. (5) Employ unlicensed persons to practice nursing. (1981, c. 360, s. 1; 1991, c. 643, s. 7; 1993, c. 198, s. 10; , s. 2.) Insurance General Regulations Section 3. G.S reads as written: Nurses' services. (a) No agency, institution or physician providing a service for which payment or reimbursement is required to be made under a policy governed by Articles 1 through 64 of this Chapter shall be denied such payment or reimbursement on account of the fact that such services were rendered through a registered nurse acting under authority of rules and regulations adopted by the North Carolina Medical Board and the Board of Nursing pursuant to G.S and (b) A licensed registered nurse who has successfully completed a program established under G.S (b) may receive direct payment for conducting medical examinations or medical procedures for the purpose of collecting evidence from victims of offenses described in that subsection if the payment would have otherwise been permitted. (1973, c. 437; 1991, c. 720, s. 37; 1993, c. 347, s. 1; 1995, c. 94, s. 2; , s. 1; , s. 3.) Executive Organization Act of 1973 Adjunct Committees of the Governor s Crime Commission Section 4. G.S. 143B reads as written: 143B Victim assistance. (a) Only victims who have reported the following crimes are eligible for assistance under this Program: first-degree rape as defined in G.S , second-degree rape as defined in G.S , first-degree sexual offense as defined in G.S , second-degree sexual offense as defined in G.S , or attempted first-degree or second-degree rape or attempted first-degree or second-degree sexual offense as defined in G.S Assistance is limited to immediate and short-term medical expenses, ambulance services, and mental health services provided by a professional licensed or certified by the State to provide such services, not to exceed one thousand dollars ($1,000) incurred by the victim for the medical examination, medical procedures to collect evidence, or counseling treatment which follow the attack, or ambulance services from the place of the attack to a place where medical treatment is provided. Assistance not to exceed fifty dollars ($50.00) shall be provided to victims to replace clothing that was held for evidence tests. (b) With the exception of assistance authorized under subsection (e) of this section, assistance for expenses authorized under this section is to be paid directly to any hospital, ambulance service, attending physicians, or mental health professionals providing counseling, upon the filing of proper forms. Page 7 of 8

8 (c) Assistance shall not be awarded unless the rape, attempted rape, sexual offense, or attempted sexual offense was reported to a law-enforcement officer within 72 hours after its occurrence or the Secretary finds there was good cause for the failure to report within that time. (d) Upon an adverse determination by the Secretary on a claim for medical expenses, a victim is entitled to judicial review of that decision. The person seeking review shall file a petition in the Superior Court of Wake County. (e) In lieu of any payment which may otherwise have been made under subsection (b), assistance for expenses for services authorized under this section that are provided for the purpose of collecting evidence from victims of crimes identified in G.S (b) may be paid directly to any licensed registered nurse who has successfully completed a program approved under G.S (b). The Secretary shall adopt rules to facilitate the payments authorized under this subsection and to encourage, whenever practical, the use of licensed registered nurses trained under G.S (b) to conduct medical examinations and procedures. (1981, c. 931, s. 2; 1981 (Reg. Sess., 1982), c.1191, s. 16; 1983, c. 715, ss. 1, 2; , s. 4; , s. 19.4(n).) Page 8 of 8

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