KENTUCKY BOARD OF NURSING 312 WHITTINGTON PARKWAY, SUITE 300 LOUISVILLE, KY 40222



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KENTUCKY BOARD OF NURSING 312 WHITTINGTON PARKWAY, SUITE 300 LOUISVILLE, KY 40222 Phone: 502-429-3300 800-305-2042 Website: http://www.kbn.ky.gov As of 2012 LICENSURE EXAMINATION APPLICATION INSTRUCTIONS INSTRUCTIONS APPLY ONLY TO KENTUCKY IF YOU NEED INFORMATION FOR ANOTHER STATE, YOU WILL NEED TO CONTACT THAT STATE DIRECTLY. When Registering for NCLEX - You Must Enter Your School s NCLEX Code YOUR EDUCATIONAL PROGRAM CODE FOR NCLEX IS: 76- NURSE LICENSURE COMPACT/MULTI-STATE LICENSE Kentucky implemented the Nurse Licensure Compact (NLC) on June 1, 2007. The NLC is a mutual recognition model for nurse licensure that permits a registered nurse or a licensed practical (vocational) nurse to hold one license in his or her home state (primary state of residency) and to practice in other compact states (referred to as remote states). Under mutual recognition, practice across state lines is allowed, whether physical or electronic, unless the nurse s license is under discipline or there exists a monitoring agreement that restricts practice across state lines. The mutual recognition model is similar to the motor vehicle driver license model that allows United States citizens to drive throughout the country on a driver s license issued by a state. In order to achieve mutual recognition, each state has to enter into the interstate compact through legislation. An RN/LPN may hold only one compact license and that license must be issued by their primary state of residence. Kentucky is one of more than twenty (20) states participating in the compact. For the seven states that surround Kentucky: Tennessee (Compact); Indiana (Non-Compact); Ohio (Non-Compact); West Virginia (Non-Compact), and Virginia (Compact). Additional information regarding the compact can be found at: https://www.ncsbn.org/nlc.htm. APPLYING FOR A NURSING LICENSE IN KY This information applies to those graduates whose primary residence is Kentucky or a non-compact state and they wish to practice in Kentucky. If you do not plan to seek initial licensure in Kentucky, do not use these instructions. Contact the state in which you will be seeking licensure for their application and instructions. This information is available at www.ncsbn.org. 1. Apply for licensure either on-line or by paper application. a. You may apply on-line at www.kbn.ky.gov, and pay the $110 fee using a MasterCard or Visa credit or debit card, or have the fee deducted from your checking account. Be sure to use the online form to request a fingerprint card from KBN if you have not received one from your program of nursing. NOTE: A street address must be provided; p.o. boxes are not accepted. b. Applicants who want to apply using a paper application must submit a Request for Paper Application available from the KBN website and the $40 paper application fee. This $40 is in addition to the application fee of $110. Following receipt of the request form and $40 fee, KBN will mail the candidate a paper application for licensure and a fingerprint card. Complete the application and return it with the fee to KBN. Personal checks and money orders are accepted. c. Take the fingerprint card to a local law enforcement agency for fingerprinting. Send the card and a check or money order made payable to the Kentucky State Police (KSP) to: The Kentucky State Police, Records Branch, 1266 Louisville Road, Frankfort, KY 40601. 2. FEES ARE NOT REFUNDABLE. 3. A Provisional License will not be issued until KBN receives: a properly completed Application for Licensure (either electronic or paper), a Kentucky Criminal History report, notification that your fingerprint card and fee were received by the Kentucky State Police, and notification that you passed the Kentucky Jurisprudence Exam. 4. The application is valid for one (1) year or until the time of testing or until the provisional license expires. If a candidate is unsuccessful on NCLEX, they must reapply to both KBN and NCLEX. 5. Obtain the criminal background information as outlined in the following section. CRIMINAL CONVICTIONS The Kentucky Board of Nursing is authorized by law to deny a license or issue a license under disciplinary conditions because of an applicant's criminal conviction record. KRS 314.091(1) states, in part: "The board [of nursing] shall have power to reprimand, deny, limit, revoke, probate, or suspend any license... to practice

nursing issued by the board or applied for in accordance with this chapter... upon proof that the person..(b) has been convicted of any felony or a misdemeanor involving drugs, alcohol, fraud, deceit, falsification of records, a breach of trust, physical harm or endangerment to others, or dishonesty..." KRS 314.031(4) requires that all misdemeanor and felony convictions occurring in Kentucky or in any other state, regardless of when they occurred, must be reported to KBN. A person has been convicted if they pled guilty, entered an Alford or nolo contendre plea, or was found guilty in any court. All criminal convictions are individually reviewed by KBN. The person must supply to KBN a certified copy of the conviction record and a letter of explanation. The letter of explanation is a personally written summary of the events that led to the conviction. It gives the person an opportunity to tell what happened and to explain the circumstances that led to the conviction. KBN will take into consideration the nature of the offense and the date of the conviction. KBN may seek to deny an application because of criminal convictions. If that happens, the applicant may request a formal hearing before a KBN Hearing Panel. The request must be in writing. The applicant will be notified of the date, time, and location of the hearing. The applicant may be represented by an attorney. The Hearing Panel will consider the request for licensure. After hearing the evidence presented, the Panel will make a recommendation to the full Board regarding the approval or denial of the application for licensure. For more information, please refer to the KBN brochure Mandatory Reporting of Criminal Convictions on the KBN web site @ www.kbn.ky.gov/formpub.htm under the Investigations & Discipline heading. CRIMINAL BACKGROUND CHECK All persons graduating from a nursing program seeking licensure by examination in Kentucky must have submitted the following background checks before the applicant will be made eligible to test 1) FBI; and 2) Kentucky Administrative Office of the Courts (AOC). ALERT: If you have had prior convictions either in or outside of Kentucky, it is strongly recommended that you begin the application process at least 2 to 3 months prior to graduation. This will allow time for the processing of the criminal background checks and Board review. 1. Federal Bureau of Investigation (FBI) Applicant Fingerprint Card and the appropriate fee required by the FBI: $16.50 (effective March 18, 2012) Personal checks and money orders are accepted payable to the Kentucky State Police. You must obtain a fingerprint card this will be mailed to you or provided at your program of nursing. The form number for the card accepted is FD-258. Take the card to a local police station, local Kentucky State Police post, or sheriff s office trained to do fingerprinting and complete the following sections of the fingerprint card. * KSP will accept digital fingerprints IF the prints are transferred to the KBN fingerprint card or any blank FD-258 fingerprint card rolled with BLACK INK only. IMPORTANT: All of the required fields must be completed on the fingerprint card in order to be processed by the FBI. If any section is not completed, the whole card will be returned to the applicant. Last, First, and Middle Name Aliases (other names that you may have previously used) Signature and Residence of Person being fingerprinted Date and Signature of Official taking fingerprints Date of Birth Citizenship Place of Birth (State or Country) Sex/Gender Race Height Weight Eye Color Hair Color Social Security Number Mail the completed card and fee to: Kentucky State Police, Records Branch, 1266 Louisville Road, Frankfort, KY 40601. DO NOT MAIL TO THE BOARD OF NURSING IT WILL BE RETURNED TO YOU. Remember: DO NOT FOLD OR STAPLE THE FINGERPRINT CARD. 2. Kentucky law requires applicants for licensure by examination to submit a state criminal background check (CourtNet) from the Administrative Office of the Courts (AOC). The cost of this report is $20 and may be obtained several ways: On-line request: If you apply online, request that the AOC e-mail your criminal history report to kbn.credentials@ky.gov. This will permit them to send the results electronically to the Board and 2

you will not need to mail separately. Complete details for completing this process on-line are found later in this packet. There is a $2.00 service charge by the AOC. Paper request: A paper copy of the form is available on the KBN website via the Licensure by Examination webpage (http://kbn.ky.gov/license/exam/). Your signature on the form authorizes AOC to send a copy of your complete criminal history report to the Kentucky Board of Nursing. CAUTION: IT MAY TAKE 2 MONTHS FOR THE AOC TO PROCESS A PAPER REQUEST FORM. In-person: The Administrative Office of the Courts accepts walk-up requests. They are located at: PRETRIAL SERVICES RECORDS DIVISION, 100 MILLCREEK PARK, FRANKFORT KY 40601. You may fax all pages, including the first page, to 502-429-3336 or mail a copy to: Kentucky Board of Nursing, Attn: Rachel Williamson, Licensure Branch, 312 Whittington Parkway, Suite 300, Louisville KY 40222 If applicable, a certified copy of court records for each misdemeanor or felony conviction in any jurisdiction, and a letter of explanation that addresses each conviction EXCEPT for traffic related misdemeanors (other than DUIs) OR misdemeanors older than 5 years, must be submitted with the application. If applicable, send a certified copy of any disciplinary action taken on any professional or business license in another jurisdiction with a letter of explanation, or report any disciplinary action pending on any professional or business license in another jurisdiction. Additional Notes: A criminal history report from any other entity will not be accepted. Include all pages received, even if the page is blank. A report must be received in all last names ever used. Failure to report any criminal convictions EVER received is deemed to be falsification of the application and subjects the applicant to disciplinary action by KBN. The application for licensure will not be processed and you will not be made eligible to sit for NCLEX or receive a Provisional License until the criminal history report is received. It is advised that persons with criminal convictions should submit all required materials to the Board at least three (3) months prior to the anticipated date of employment in Kentucky or two (2) months prior to graduation. Use this grid to determine if a criminal conviction must be reported and what documentation is required. EVIDENCE OF SUCCESSFUL COMPLETION OF A PROGRAM OF NURSING The candidate application and supporting materials will wait in the Board office until documentation of graduation is received. Evidence of completion of an approved program of nursing must be received by KBN before the Application for Licensure is accepted and the name submitted to Pearson Vue as eligible to take NCLEX and for a provisional license to be granted. Kentucky programs of nursing will electronically submit a list of graduates to KBN, generally within 2 to 4 weeks of graduation documenting successful completion of the program. Out-of-state graduates are required to have their program of nursing send either a Certified List of Out-of-State Program of Nursing Graduates form or an official transcript showing the degree earned and date the program was completed. 3

REMINDER Each year around graduation time, the Board receives a number of questions regarding when a graduate can begin to work as a nurse. According the Kentucky Nurse Practice Act, it shall be unlawful for any person to call or hold herself or himself out as or use the title of nurse or to practice or offer to practice as a nurse unless licensed or privileged under the provisions of this chapter. When a person begins working, even if they are in participating in direct patient care, such as orientation, the individual is being employed as a nurse, probably receiving compensation appropriate f or a nursing position, and are being oriented to the role of a nurse within that facility. For Kentucky graduates, the issuance of a provisional license is considered to serve as acknowledgement from the Board of Nursing that they are eligible for full license once they have been successful on NCLEX and have completed all other licensure requirements, such as criminal background check. Beginning employment as a nurse BEFORE the provisional license is issued could result in disciplinary action. Don t start your career off on the wrong foot! Question to ask: Does this position require a nursing license? Could I have been hired to work in this position without completing nursing school? If the answer is YES, wait until you have been issued a license or granted privilege to practice from another compact state. COMPLETING THE PAPER APPLICATION FOR LICENSURE If you submit a paper application, pay special attention to the sections that will need to be completed. On the instruction sheet there is an area that appears like this. Be sure to complete sections 1, 2, 3, 4, 5, 6, 7, 10, and 11 of the application. You DO NOT have to complete sections 8 or 9. JURISPRUDENCE EXAM Prior to issuance of a Kentucky RN or PN license, applicants by examination, endorsement, or reinstatement of a Kentucky license that has lapsed for one year or more, are required to successfully complete the Jurisprudence Exam. It is an Open Book" computerized exam administered by the National Council of State Boards of Nursing (NCSBN). The content of the course is based on Kentucky Nursing Laws, Regulations, and Advisory Opinion Statements. Cost of the examination is Nine dollars ($9) payable to NCSBN. NCSBN will send KBN a list of individuals who completed the exam within two (2) business days of the date the exam is taken. The Jurisprudence Exam Study Guide may be printed before accessing the examination (http://www.kbn.ky.gov/license/jpexam.htm ) or it may be viewed or printed from within the exam by clicking on the "Print Version" link. The exam consists of thirty-five (35) questions. Once you have registered and made payment to NCSBN to take the exam, it will be available for three (3) weeks. If the exam is not completed in one sitting, responses to all questions are deleted when exiting the exam. Also, if the exam is not completed within three (3) weeks, you will have to pay another $9 fee to NCSBN to access the exam. Accessing the exam: 1. First submit an application for licensure to KBN 2. Then go to the application status link to access the link to the exam. 3. If you have not done so before, you will need to establish an NCSBN Learning Extension account: New accounts: You will be taken to a login screen. Click on Create User Profile. Fill out all of the fields. Make sure you check the checkbox for the attestation statement. Click Submit. Click on Course Catalog the Jurisprudence Exam will be at the top in bold letters. Existing Accounts: You will be taken to a login screen. Log in using your existing username and password. Click on My Profile. Be sure to update your profile to include date of birth, last 4 of social security number, and application type. Scroll to the bottom of your profile and fill out all the fields. Ensure you check the checkbox for the attestation statement. Click Submit. Click on Course Catalog the Jurisprudence Exam will be at the top, in bold letters. 4

APPLYING TO TAKE THE LICENSING EXAM NCLEX In order for a candidate to receive an Authorization to Test (an ATT), a complete NCLEX application must have been submitted and processed at the testing service (Pearson Vue). This application is separate from the application for licensure sent to the state board. The NCLEX candidate bulletin is available on-line at www.ncsbn.org under the NCLEX Examinations pulldown menu. This publication provides important details about the test. Read it carefully and follow the directions precisely. Three registration options are available for a fee: By mail with a certified check, cashier s check, or money order By phone with Visa, MasterCard, or American Express Via the web (www.pearsonvue.com/nclex/) with Visa, MasterCard, or American Express Candidates are encouraged to register over the Internet. Applications received by mail are processed last and the processing time is 3 to 6 weeks. When registering, a candidate must enter their social security number and month/year the program of nursing was/will be completed, as well as the assigned program s NCSBN number. All Kentucky codes begin with 76-xxx. You will not be made eligible for NCLEX without this information. When completing the name section of the application, be sure that the name given matches the name submitted on the state board application and matches identification that will be used at the testing center. If you do not provide your social security number when registering with Pearson Vue, there may be several weeks delay in your being made eligible and receiving your ATT. Double-check the spelling of the name and address, and your date of birth. If you will be using your driver s license as your proof of ID, look to see how the name is listed on the card. If you register for the test with the full middle name and the license has only middle initial that will be acceptable. Candidates making errors or wishing to change information in the TYPE OF EXAMINATION or STATE OF LICENSURE fields will be charged a $50 fee by the testing service to correct that information. After the Board of Nursing has made the candidate eligible to test, a change of jurisdiction or test type change cannot be made. The testing service will send information for scheduling the test session. IF YOU CHANGE THE STATE OF ORIGINAL LICENSURE, YOU MUST REAPPLY TO KENTUCKY FOR LICENSURE BY ENDORSEMENT after you are licensed in another state. After you register for the examination and a state board of nursing sends Pearson Vue verification that you are eligible, you will then receive your Authorization to Test (ATT) from the testing center (Pearson Vue). Once the ATT is received, you have 90 days to schedule and take the exam. More complete details can be found on the Pearson Vue website (www.pearsonvue.com/nclex/). TESTING MODIFICATIONS FOR NCLEX CANDIDATES WITH DISABILITIES In compliance with the Americans with Disabilities Act (ADA), the Kentucky Board of Nursing provides reasonable accommodations for candidates with disabilities who will be sitting for the National Council Licensure Examination (NCLEX). Accommodations may be requested using the Special Accommodations Request Form found on the KBN website. It is recommended that you request accommodations at the time you submit your application for licensure. Candidates may register for NCLEX at any time, but should not schedule a test date until KBN notifies Pearson Vue of the accommodations that have been approved. After being made eligible to test, Pearson Vue will send your Authorization To Test (ATT), which will indicate that accommodations have been granted, but will not list those accommodations. Original documentation must also be received from the disabilities coordinator at your education program and from a qualified diagnostician with expertise in the diagnosed disability. Faxed copies will not be accepted. All tests/assessments used in the diagnostic process must be performed within two years prior to applying to KBN for licensure and must be professionally recognized adult tests/assessments resulting in a professionally recognized diagnosis. 5

LICENSE CARDS AND VALIDATION KBN no longer issues plastic license cards or paper provisional licenses. Newly licensed nurses receive an email notification that includes the license number and the expiration date. Always validate your license from the KBN web site. LICENSE RENEWAL AND CONTINUING COMPETENCY Renewal of license: Kentucky renews nursing licenses annually. Licenses issued between June 1 and October 31 will be valid until the next renewal period. It is recommended that you verify the expiration date of your license at the KBN web site. Continuing Competency Requirements: A nurse who renews a license for the first time following graduation from a prelicensure program of nursing shall utilize the following methods for continuing competency validation: (a) if employed: Seven (7) hours of continuing education from a provider approved by the board pursuant to 201 KAR 20:220 and earned during the licensure period which shall include the continuing education and Documentation of the nurse s completion of an orientation to the employer (b) If not employed or unable to provide proof of an orientation or an evaluation, the nurse may submit the following: Fourteen (14) contact hours of continuing education Or Current national certification or recertification which is related to the nurse s practice role and that shall have been initially attained during the licensure period. If issued for a period of time as evidenced by an expiration date, must have been in effect during the entire licensure period, or have been recertified during the licensure period. Or One (1) of the following during the licensure period: (a) Submission of an abstract for the completion of a nursing-related research project participated in as a principal investigator, co-investigator, or project director; (b) Publication of a nursing-related article; (c) Presentation of a nursing continuing education program that is: (1) designed and developed by the presenter; (2) presented to nurses or other health professionals; and (3) evidenced by a program brochure, course syllabi, or a letter from the offering provider identifying the licensee's participation as the presenter of the offering; (d) participation as a preceptor for at least one (1) nursing student or new employee which shall be: (1) for at least 120 hours; (2) a one-to-one relationship between the preceptor and student/employee; (3) the 120 hours can include precepting more than one (1) student or employee; and (4) there shall be documented evidence from the educational institution or preceptor s supervisor is required. AND (c) Shall earn a minimum of two (2) contact hours of HIV/AIDS education approved by the Cabinet for Health and Family Services pursuant to KRS 214.610 (graduates of Kentucky Nursing Programs receive this information within their curriculum for the initial license) and then again every ten (10) years thereafter. (d) Nurses licensed after July 15, 2010 shall earn a minimum of one and one-half (1.5) contact hours in pediatric abusive head trauma as required by KRS 314.073(7) within three (3) years of licensure. (e) A one-time requirement of a three (3) hour continuing education course on domestic violence within three (3) years of licensure as required by KRS 194A.540 (graduates of Kentucky Nursing Programs receive this information within their curriculum and are not required to provide additional documentation). PROVISIONAL LICENSE AND PRACTICE During the time that the applicant holds a provisional license, direct supervision by a licensed nurse is required until full licensure is issued. Direct supervision requires the following: RNA - Supervision by a RN or a LPNA - Supervision by a LPN, RN or a Nurse Nurse Practitioner Nurse Practitioner 6

During this period of time, the applicant must use the title: RNA - RN Applicant or LPNA - Licensed Practical Nurse Applicant. IMPORTANT WEB ADDRESSES RN/LPN License Application for Kentucky: http://kbn.ky.gov Registration for NCLEX: www.pearsonvue.com Kentucky Criminal Background Request Form: www.kbn.ky.gov/documents/courtnet.pdf Fingerprint Card request address: http://kbn.ky.gov/license/endorse/fingerprintrequest.htm Kentucky Jurisprudence Exam Information: http://www.kbn.ky.gov/license/jpexam.htm References: KRS 314.011; 051; 041; 201 KAR 20:070. Licensure by Examination. 10.20.2010 BEFORE YOU CALL US-- Check the Status of Your Application Questions have arisen as to how the new graduate can verify via the Internet the current status of their application. The following steps should be followed: Go to the Kentucky Board of Nursing Web Page: www.kbn.ky.gov. On the home page, you will see a column of hot links in the left-hand column. Click on Apply for a License. When you arrive on this page, here is a list of hot links in the column to the left in green you will see Application Status. Click on this. 7

This will take you to an Application Status page; click on Status of Your Application. Enter your Social Security Number in the space provided (no spaces). YOU MUST CLICK ON THE SEARCH BUTTON. If you hit ENTER, you will get a message that reads the page cannot be displayed. If the application is complete, the provisional license number will be displayed here. You can print this out and share with employer. If for various reasons the application is NOT complete, you will get one of the below messages. If you get one of the following messages: Name not on Certified List: Contact your program of nursing BEFORE contacting the Board to see when the list with your name was sent to the Board. Allow one (1) week from submission date for processing. Criminal Background Check Not Received: Make sure that the FBI and Kentucky AOC reports have been ordered. Application Not Received: Remember that you must submit an application to both the Board of Nursing and to Pearson Vue (for NCLEX). Submit an official transcript with the degree and date posted: Request from your college/university that they send a transcript directly from the college to the Board of Nursing. Those transcripts issued to students will not be accepted. Criminal History Review: This indicates that your criminal history has been sent to the Investigation Department of the Board and is being reviewed. Check back in a few days. You must take the Jurisprudence Exam: The candidate will need to log-in to www.learningext.com and establish an account and take the jurisprudence exam (see page 4 of this packet for more instructions). 8

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