Fill - Free fillable Arizona State Board of Nursing (Arizona State Board of Nursing) PDF form

Arizona State Board of Nursing

1740 W Adams Street, Suite 2000

Phoenix. AZ 85007

Phone: 602- 771-7800

Website: www.azbn.gov

APPLICATION FOR FULL APPROVAL OR

RENEWAL OF APPROVAL FOR BOARD APPROVED NURSING PROGRAMS

This application and the accompanying information is intended to assist your program in the approval

process. This application is a preliminary step in the process and should be mailed to the Board in a timely

manner. Site visits will not be scheduled until the complete self-study is submitted and reviewed. It may

take up to 30 days to review the self-study.

Program Name: ______________________________________________________________________

Parent Institution: _____________________________________________________________________

Other Sites___________________________________________________________________________

Address: ____________________________________________________________________________

Phone______________________________________________________________________________

Nursing Administrator_________________________________________________________________

Administrator Phone: _________________________________________________________________

Administrator Email: _________________________________________________________________

Date of last approval from the Board: _____________________________________________________

Anticipated date you will submit self-study: ________________________________________________

Preferred dates of site visit: _____________________________________________________________

Request oral report (see instructions): ☐ Yes ☐ No

______________________________________________________________________

Director of Program (Signature) Date

______________________________________________________________________

Print Name

______________________________________________________________________

Administrator of Parent Institution (Signature) Date

______________________________________________________________________

Print Name

click to sign

signature

click to edit

click to sign

signature

click to edit

INSTRUCTIONS FOR FULL APPROVAL or

RENEWAL OF APPROVAL FOR BOARD APPROVED NURSING PROGRAMS

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

Full Approval 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.

GUIDELINES FOR THE SELF STUDY:

The administrator shall submit one copy all materials to the Board of Nursing Education Consultant not

less than 30 days before the planned visit and at 4 months before expiration of provisional approval. The

materials should be single-sided, on letter size white paper, consecutively numbered and bound together.

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

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 “Application Worksheet” that contains each and every rule to be addressed: 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.

• 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

• Sample clinical contract

• 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 with the trended and aggregate results of the

evaluation of each component and actions taken by the program in response to the data

collected.

• 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)

• A chart of faculty including 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

• Curriculum evidencing congruency of program objectives/goals, level or course

objectives, and unit objectives with content. A comparison chart is recommended (see

below). Materials should include:

 Program outcomes/goals

 Course sequence

 Course descriptions

 Level objectives, if any

 Course objectives for all courses

 Unit objectives for at least one nursing course

 Course content outline for at least one nursing course

If a preceptorship experience is offered, a description of the preceptorship consistent with the Boards

advisory opinion “Preceptorship for Pre licensure Students” available at https://azbn.gov/scope-of-

practice/advisory-opinions

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 (or electronic access)

B. One copy of the nursing student handbook (or electronic access)

C. One copy of nursing program faculty handbook (or electronic access)

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

R4-19-208. Application for Full Approval of a Nursing Program

Rules are provided in the Full Approval Application Worksheet.

A. A nursing program seeking full approval shall submit an electronic and one paper copy of an

application that includes the following information and documentation:

1. Name and address of the parent institution,

2. Date the nursing program graduated its first class of students, and

3. A self-study report that contains evidence the program is in compliance with R4-19-201

through R4-19-206.

B. Following an onsite evaluation conducted according to A.R.S § 41-1009, the Board shall grant full

approval for a maximum of five years or the accreditation period for nationally accredited

programs governed by R4-19-213, to a nursing program that meets the requirements of this Article

and if approval is in the best interest of the public. A nursing program that is denied full approval

may request a hearing by filing a written request with the Board within 30 days of service of the

Board's order denying the application for full approval. Hearings shall be conducted in accordance

with A.R.S. Title 41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

R4-19-210. Renewal of Approval of Nursing Programs Not Accredited by a National Nursing

Accrediting Agency

A. An approved nursing program that is not accredited by an approved national nursing accrediting

agency shall submit an application packet to the Board at least four months before the expiration

of the current approval that includes the following:

1. Name and address of the parent institution,

2. Evidence of current institutional accreditation status under R4-19-201,

3. Copy or on-line access to:

a. A current catalog of the parent institution,

b. Current nursing program and institutional student and academic policies, and

c. Institutional and nursing program faculty policies and job descriptions for nursing

program faculty, and

4. One electronic copy and one paper copy of a self-study report that contains evidence of

compliance with R4-19-201 through R4-19-206.

B. Following an onsite evaluation conducted according to A.R.S. § 41-1009, the Board shall renew

program approval for a maximum of five years if the nursing program meets the criteria in R4-19-

201 through R4-19-206 and if renewal is in the best interest of the public. The Board shall

determine the term of approval that is in the best interest of the public.

C. If the Board denies renew al of approval, the nursing program may request a hearing by filing a

written request with the Board within 30 days of service of the Board's order denying the

application for renewal of approval. Hearings shall be conducted in accordance with A.R.S. Title

41, Chapter 6, Article 10 and 4 A.A.C. 19, Article 6.

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 be granted. A site visit will not be scheduled until the entire self-study is received

at the Board and reviewed for completeness.

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.

Plan on the site visit taking at least two 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 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 - 1/2 hour

 Director/administrator of the parent institution - 1/2 hour

 Assistant Directors (if appropriate) - 1/2 hour

 Library or resource director and tour - 15-30 minutes Faculty –1 hour

 Advisors/counselors and admissions officer for the program (optional) - 30 minutes

 Students— 1 hour--access to the consultant should be provided to all interested students - do not

select only certain students to meet the consultant

 Graduates of the program (optional)

Tours:

 Tour of parent institution Library Resource Center

 Nursing Department including classrooms, offices, skills lab (if there are multiple sites- each site

needs to be toured)

 Clinical sites (optional)

Documents to be examined on site:

This is a suggested list of documents to have on hand. The site visitor will need a quiet, secluded place to

examine the documents and about 2 hours on site. Other materials may be requested during the visit.

 Program handbook

 Regional or National Approval documents Nursing Department Budget (detailed)

 Copy of clinical/course/program evaluation tools All Course syllabi/curriculum

 All Clinical contracts Student policies Faculty policies Program policies Faculty files

 Student files

 Exams/examples of student work NCLEX Reports, if available

 Reports of results from standardized testing (e.g. HESI, ERI)

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. 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.

AFTER THE SITE VISIT:

Based on feedback at the visit, the program may revise the self-study and submit 2 bound copies of the

self-study and one electronic copy in plain Microsoft Word format without hyperlinks with consecutively

numbered pages. (See Policy on Submission of Materials to Education Committee.

The consultant will make final revisions to the 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 the

program administrator and 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 at the request of the program. 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 are encouraged to send a representative to

this meeting to present any additional information and answer questions.

2. The Board will then take action on your approval at the next regularly scheduled meeting in

compliance with open meeting law. 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 recommendation. Programs are encouraged

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. 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 full approval,

2. Grant full approval with conditions,

3. Continue provisional approval, or

4. Issue notice of deficiency.

*PLEASE NOTE THAT THERE ARE RULE CHANGES IN PROCESS*

EXAMPLES

EXAMPLE OF SELF-STUDY WORKSHEET

Rule

Met

Description of how program meets rule

requirement

Evidence

(Document/Page#)

D. The parent institution shall

center the

administrative control of

the nursing program in

the nursing program

administrator.

Met

Administrative control is centered in the nursing

administrator. Dr. Susan Smith, the administrator of the

program, provides leadership for the faculty and

facilitates decision making. Dr. Smith represents the

faculty and program at College Council meetings.

Additionally Dr. Smith prepares and submits the program

budget, is a part of the grievance process, and evaluates

all faculty according to institutional policy and Arizona

State Board of Nursing rules. Dr. Smith and the faculty

jointly determine admission, graduation, and progression

Program

Administrator Job

description; Faculty

meeting minutes;

Nursing program

Budget;

Grievance

Procedure (p. 24

Nursing Student

Handbook).

EXAMPLE OF CURRICULUM WORKSHEET--PROGRAM

Program outcomes

Level I outcomes

Level II outcomes

Level III outcomes

The graduate will work with

the patient and health team

members to establish priorities

and manage care to achieve

desired patient outcomes

The student will formulate

and implement a plan of

care for an individual

client in stable condition.

The student will

formulate and

implement a plan of

care for an acutely ill

client.

The student will collaborate with

other health care providers revise

plans of care for clients across the

lifespan to meet desired patient

outcomes and delegate selected

aspects of care to unlicensed

personnel.

EXAMPLE OF CURRICULUM WORKSHEET--COURSE

Course outcomes

Lesson Objectives

Content

Activities

The student will formulate and

implement a plan of care for an

individual client in stable

condition

The student will explicate

the components of the

nursing process.

The student will utilize the

nursing process in caring

for a single stable client

I. Components of the

Nursing process

A. Assessment

Physical assessment

Nursing Assessment

Analysis ……..etc

Group care plan Care plan

assignment Demonstration of

physical and nursing assessment

Return demo— check-off

The student will apply the

nursing process in caring

for a patient with

respiratory disorders.

Compare and contrast

nursing interventions for

clients with common

respiratory diagnoses.

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 E l ti f

Incentive spriometer demo

Suctioning Trach care

Oxygen administration Cough

and deep breathe

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

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

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Arizona State Board of Nursing (Arizona State Board of Nursing) Form

Related forms

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

Fill Online, Printable, Fillable, Blank Arizona State Board of Nursing (Arizona State Board of Nursing) Form

Related forms

First 20 documents completely FREE!