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Arizona State Board of Nursing (Arizona State Board of Nursing)

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1
Arizona State Board of Nursing
1740 W Adams Street, Suite 2000
Phone: 602-771-7800
www.azbn.gov
APPLICATION FOR PROVISIONAL APPROVAL
This application and the accompanying information are intended to assist your program in
the PROVISIONAL approval process. This application is a preliminary step in the process and
should be provided to the Board along with all accompanying materials no later than 30 days
BEFORE THE REQUESTED DATE OF THE SITE VISIT. The site visit will not be scheduled
until Board staff has reviewed the entire application including the self-study.
Program Name: ____________________________________________________________
Parent Institution: ______________________________________________________________
Address: _____________________________________________________________________
Phone: ________________________________________________________________________
Nursing Administrator: ___________________________________________________________
Administrator Phone: ___________________________________________________________
Administrator Email: ___________________________________________________________
Date of Proposal Approval: ______________________________________________________
Is complete self-study included? ☐Yes ☐No If not, when will you submit it: _______________
Preferred dates for site visit: ______________________________________________________
Other Sites: ____________________________________________________________________
______________________________________________________________________
Director of Program (Signature) Date
______________________________________________________________________
Print Name
______________________________________________________________________
Administrator of Parent Institution (Signature) Date
______________________________________________________________________
Print Name
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INSTRUCTIONS FOR PROVISIONAL APPROVAL
In order to help you prepare the self-study, the following documents are available on the
Board website www.azbn.gov or at the links provided:
Nurse Practice Act (contains the Statutes & Rules)
Policy on Submission of Materials to Education Committee
Provisional Application Worksheet
Please take a moment to review the policy on: Process / Progression of New Program Approvals
Please contact us for concerns or questions during application process.
SUBMISSION GUIDELINES:
For the purposes of provisional approval it is the recommendation of the Education
Committee that the following documentation be included in the application:
1. Overall program goals
2. Curriculum plan/schedule of courses
3. Catalogue descriptions of each nursing course including clinical setting, if
applicable (e.g pediatrics, maternity, medical-surgical, mental health, special care).
4. Level/Course objectives—please provide in chart format as demonstrated below—if
the level contains 2 courses the objectives can be listed separately or combined
as one level objective. This document must demonstrate a relationship of the
objectives to the program goal and progression throughout the program.
5. General content outline for each nursing course. Content must have a logical
relationship to the objectives.
7. Unit objectives and detailed content outline for each unit or class session for first
nursing course of the curriculum. Didactic objectives must relate, but not be the same
as didactic content. See example below.
8. Credits total
9. Didactic and clinical hours for each course and totals; Clinical setting for each course.
Materials will be evaluated according to the criteria in R4-19-206 (B and C).
Include the worksheet document with the application that provides a narrative and evidence of
meeting the rule requirements.
GUIDELINES FOR THE SELF-STUDY:
The nursing program administrator shall submit one bound paper copy of all materials to the
Board of Nursing Education Consultant not less than 30 days before the requested visit. Site
visit dates will not be confirmed until the application and self- study have been reviewed
and determined to be substantially complete. Review can take up to 30 days. Programs
submitting incomplete documents will receive a “Notice of Application Deficiency” as
described in A.A.C. R4-19-102. Courtesy reviews of documents prior to official submission
will not be provided as programs have the opportunity to revise documents based on staff
feedback after the site visit. The program may schedule a consultation visit with staff prior
to the submission of documents to review requirements.
The self-study materials should be single-sided, on letter size white paper, consecutively
numbered and bound with a spiral or other similar type binding. Please do not include folders,
notebooks, or bulky materials, as they are difficult to file. You must include the following items:
I. Self-study
A. Title page with program name, address of program site, phone of parent
3
institution/administrator, e- mail address, fax number, classification of nursing program
by both educational degree (diploma, ADN, BSN) and licensure (RN/PN/Multiple exit).
B. A description and short history of the program and parent institution.
C. The Provisional Application Worksheet that contains each and every rule to be addressed:
R4-19- 207 (D) and R4-19-201 to R4-19-206 with an accompanying narrative analyzing
the extent to which the program complies with the rule. When writing the narrative, do
not just affirm that the rule is met. The evidence demonstrating compliance with the full
rule needs to be disclosed. For example there are criteria for faculty evaluation. The fact
that full-time faculty are evaluated does not address the rule until all criteria as applied to
all faculty are discussed.
D. An appendix to include supporting documents such as charts, comparison graphs, and the
evaluation plan (as described in the self-study guidelines). This is a list of documents to
include in the self-study is detailed below. Other materials may be requested during the
visit.
•
Signed facility availability forms to cover all admitted cohorts until the first cohort
graduates
•
Regional or national and state accreditation documents
•
A comparison chart of the mission and goals statements of both the program and the
parent institution showing consistency of mission and goals
•
Organizational chart(s) indicating the position of the program within the overall
structure of the parent organization and the organization within the program
•
Job description for nursing program administrator
•
Program Systematic Evaluation Plan
•
Faculty evaluation tools/forms
•
Job descriptions for faculty
•
Faculty handbook/bylaws/policies that pertain to rule compliance (just include
specific pages or paste policies)
•
Nursing student policies that pertain to rule compliance (just include specific pages or
paste policies)
•
Curriculum as specified in “Curriculum Guidelines for Provisional Approval”
•
If known, faculty name(s), AZ or multi-state compact license #, educational
background (including whether master’s degree is with a major in nursing), teaching
responsibilities, and years of patient care experience—if not known, this needs to be
submitted 60 days before the start of nursing classes.
II. Other Items: these items should be submitted to Board staff only; they do not need to be bound
into the self-study
A. One copy of the college catalogue
B. One copy of the nursing student handbook
C. One copy of nursing program faculty handbook
Following submission and review of these materials, a determination of completeness will be
made. If substantially complete, a site visit will be scheduled.
APPLICABLE RULES
Rules R4-19-201 through R4-19-207 are provided in the Provisional Application Worksheet.
PREPARING FOR THE SITE VISIT:
The purpose of the site visit is to clarify, amplify and verify the contents of the self-study
submitted to the Board. The rules (A.A.C. R4-19-201 to R4-19-207) will be used as the criteria
that must be met in order for Board approval to continue.
4
Some effort and planning will be needed to ensure a successful and efficient site visit. Contact
key persons well in advance to ensure that they are available and appraised of the importance
of the visit. The interviews are formal and participants will be informed that any responses may
be used in a report to the Board. There is no “talking off the record”. There should be no
interruptions during the interview times. Provisional site visits take an average of 7-8 hours but
may extend over 2 days.
Interview guidelines
The following meetings will need to be arranged. Suggested time frames for each meeting are
indicated. The site visitor will also need approximately 2-3 hours on site to examine documents
and access to syllabi and other documents to take off site. All original documents will be returned.
Please send a copy of the schedule to the Board office 2 weeks prior to the site visit.
Meetings and Suggested Times:
Director/dean/coordinator/chair of program - 2 hours initially and 1 hour prior to the exit
report
Immediate supervisor of the director of the program - 30-60 minutes
Director/Administrator of the parent institution - 30 minutes
Assistant Directors (if appropriate) - 15 minutes
Library or Resource Director - 15-30 minutes
Faculty if available - 1 hour
Facility Representatives who agreed to place students at their clinical facility (10-15
minutes each)
Advisors/counselors and admissions officer for the program (optional) - 30 minutes
Document review and preparation of exit report – 60-90 minutes
Exit report - 15minutes
Tours:
Tour of parent institution
Library
Resource Center
Nursing Department including
o Classrooms
o Offices
o Skills lab (If there are multiple sites- each site needs to be toured)
Documents to be examined on site
Signed clinical contracts
Mock student and faculty files
Copy of clinical/course/program evaluation tools Additional curriculum materials
EXIT REPORT:
Programs may request a preliminary oral exit report as part of the visit. Preliminary reports are
not binding and are subject to change. All personnel involved may be invited to the reading of the
preliminary oral report. The reading of the oral report is not an opportunity to debate the report
but the consultant may request assistance in the drafting of some aspects of the report and
correction of errors of fact. Programs are requested not to publish the contents of the oral report.
A written draft report will be provided to the program nurse administrator within 30 days of the
site visit. The program is requested to assist with correction of facts and may comment and
address any issues in the report.
NOTE:
5
Programs frequently show their hospitality to site visitors by providing small mementos/snacks
or a gift basket. While this gesture is appreciated, the State of Arizona has strict guidelines
regarding gifts to state employees. We kindly ask that you do not offer such items to AZBN site
visitors. (Adapted from Oklahoma Board of Nursing Guidelines for Survey Visits of Nursing
Education Programs).
AFTER THE SITE VISIT:
Based on feedback at the visit, the program may submit corrections to the self-study.
The consultant will make final revisions to her reports after the program administrator has
provided comment/correction to the draft reports and provide copies of her findings along with
the self-study to all members of the Education Committee. All communication about the program
will be directed to the nurse administrator of the program. Courtesy copies may be provided to
other individuals. Program approval is a 2- step process.
1. The self-study and consultant report is reviewed by the Education Committee in their regular
meeting for a recommendation to the Board. Programs should send a representative to this
meeting to present any additional information and answer questions. The Education
Committee will either make a recommendation to the Board regarding approval or ask the
program for additional information to be considered at a future committee meeting.
2. The Board will then take action on your provisional approval application at their next regularly
scheduled meeting in compliance with open meeting law and submission deadlines for Board
materials. The Board will consider the recommendation of the Education Committee, but the
Board is not obligated to adopt any recommendations. Decisions made by the Board may be
different than the Education Committee or Board Staff recommendation. Programs are invited
to attend the Board meeting.
You will be notified of the dates of the Education Committee and Board meetings and offered a
scheduled time that the Board will consider the application. Education Committee items are not
timed. The Board may delay the time for any reason, but will not consider the item before the
scheduled time. Following the Board meeting you will be given a letter apprising you of the board
action. The most likely options the Board may consider are:
1. Grant provisional approval,
2. Grant provisional approval upon receipt of additional documents or upon the satisfying of
certain conditions,
3. Denial of approval, or
4. Comprehensive request for additional information.
6
EXAMPLES
EXAMPLE—CURRICULUM
PROGRAM
GOAL
LEVEL I LEVEL II LEVEL III LEVEL IV
The graduate will
utilize the nursing
process to provide
effective care
across the life span
with diverse
populations.
Develop a plan of
care for an
individual client
with wellness
needs.
Develop and
implement plans of
care for adult
clients
experiencing
chronic illness.
implement a plans
of care for a
maternity client
and family and a
pediatric client and
family
Develop,
implement and
evaluate plans of
care for clients
with serious life
threatening
illnesses and for
clients with
chronic and acute
mental health
needs.
EXAMPLE OF CURRICULUM WORKSHEET—Unit plan
Course outcomes Unit Objectives Content Activities
The student will formulate
and i
mplement a plan of
car
e for an individual client
i
n stable condition
The student will
explicat
e the
co
mponents of the
n
ursing process.
T
he student will utilize the
n
ursing process in caring
fo
r a single stable client
I. Components of
the Nursing
process
A.
Assessment
B.
Physical assessment
C.
Nursing Assessment
D.
Analysis etc
Group care plan
Ca
re plan assignment
De
monstration of
ph
ysical and nursing
assess
ment
Ret
urn demo-check-off
The student will apply the
nu
rsing process in caring
fo
r a patient with
resp
iratory disorders.
Co
mpare and contrast
n
ursing interventions for
clie
nts with common
resp
iratory diagnoses.
I. Assessment of the
patient with common
respiratory disorders
A. Physical findings; lab
tests
B. Functional abilities
II. Care of the patient
with common respiratory
disorders: pneumonia,
COPD, asthma,
emphysema
III. Evaluation of care/
pr
ogress
Incentive spriometer
de
mo.
S
uctioning/Trach care
Ox
ygen administration
C
ough and deep breathe
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Completed 12 August 2020

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