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Arizona State Board of Nursing
1740 W Adams Street, Suite 2000
Phoenix. AZ 85007
Phone: 602- 771-7800
Website: www.azbn.gov
APPLICATION FOR REFRESHER PROGRAM APPROVAL
This application and accompanying information is intended to assist your program in the approval process.
School Name: ___________________________________________________________________
Program Type (RN, PN): __________________________________________________________
Address: _______________________________________________________________________
Phone: _________________________________________________________________________
Nursing Administrator: ___________________________________________________________
Administrator Phone: _____________________________________________________________
Administrator Email: _____________________________________________________________
Course Name: ___________________________________________________________________
Course Number: _________________________________________________________________
Clock hours of Theory: ______ Credit Hours: ________ Clock hours of Clinical: ________
Instructors: _____________________________________________________________________
Proposed starting date (if applicable): ___________________________ Cost: ________________
______________________________________________________________________
Director of Program (Signature) Date
______________________________________________________________________
Print Name
______________________________________________________________________
Administrator of Parent Institution (Signature) Date
______________________________________________________________________
Print Name
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signature
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signature
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INSTRUCTIONS FOR REFRESHER PROGRAM APPROVAL
The administrator should submit 1 hard copy and one electronic copy of a written proposal to offer a
Refresher nursing program according to the time-frames in the policy: Submission of Materials to
Education Committee policy In order to help you prepare the proposal a copy of the nurse practice act
is available our website.
Should you have any questions don’t hesitate to contact us.
APPLICABLE RULES: R4-19-216. Approval of a Refresher Program
REFRESHER PROGRAM GUIDELINES
Include the worksheet document with the application that provides a narrative and evidence of meeting
the following rule requirements:
A. An applicant for approval of a refresher program for nurses whose licenses have been inactive or
expired for five or more years, nurses under Board order to enroll in a refresher program, or nurses
who have not met the requirements of R4-19-312 shall submit one electronic and one paper copy of
a completed application that provides all of the following information and documentation:
1. Applicant’s name, address, e-mail address, telephone number, and fax number;
2. Proposed starting date for the program;
3. Name and curriculum vitae of all instructors;
4. Statement describing the facilities, staff, and resources that the applicant will use to conduct the
refresher program;
5. A program and participant evaluation plan that includes student evaluation of the course,
instructor, and clinical experience; and
6. Evidence of a curriculum that meets the requirements of below.
B. A refresher program shall provide:
1. A minimum of 40 hours of didactic instruction and 112 hours of supervised clinical practice for
a licensed practical nurse program;
2. A minimum of 80 hours of didactic instruction and 160 hours of supervised clinical practice for
a professional nurse program;
3. A planned and supervised clinical experience that is consistent with course goals, and provides
an opportunity for the student to demonstrate safe and competent application of program content.
The student may spend up to 32 of the required clinical hours in a supervised lab setting
including simulation;
4. Curriculum materials including:
a. An overall program description including goals; and
b. Objectives, content, and hours allotted for each area of instruction;
c. Implemented course policies that include admission requirements, passing criteria, cause for
dismissal, clinical requirements, grievance process and student responsibilities; and
d. Program costs and length of the program.
5. Didactic instruction in current nursing care concepts and skills including:
a. Nursing process and patient-centered care;
b. Pharmacology, medication calculation, and medication administration;
c. Communication;
d. Critical thinking, clinical decision making and evidence-based practice;
e. Delegation, management, and leadership;
f. Working with interdisciplinary teams;
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g. Meeting psychosocial and physiological needs of adult clients with medical-surgical
conditions’
h. Ethics
i. Documentation including electronic health records;
j. Informatics;
k. Quality Improvement; and
l. At the program’s discretion, additional content hours in other populations of care for students
who will be engaged in clinical experiences with these populations.
C. A refresher program may adapt the curriculum to incorporate content applicable to specialty and
indirect care areas of nursing practice for students who plan to practice in those areas. The clinical
experience for such students may include indirect care, depending on the course goals and
objectives. The program shall include concepts and skills needed to deliver safe nursing care in
any adapted curriculum.
D. The Board shall approve a refresher program that meets the requirements of subsection (A), if
approval is in the best interest of the public, for a term of five years. An applicant who is denied
refresher program 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 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.
E. The refresher program sponsor shall apply for renewal of approval in accordance with subsection
(A) not later than 90 days before expiration of the current approval. The sponsor of a refresher
program that is denied renewal of 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 renewal of
approval. Hearings shall be conducted in accordance with A.R.S. Title 41, Chapter 6, and 4
A.A.C. 19, Article 6.
F. The sponsor of an approved refresher program shall provide written notification to the Board
within 15 days of a participant's completion of the program of the following:
1. Name of the participant and whether the participant successfully completed or failed the
program,
2. Participant's license, and
3. Date of participant's completion of the program
G. The Board may accept a refresher program from another U.S. jurisdiction for an individual
applicant on a case-by-case basis if the applicant provides verifiable evidence that the refresher
program substantially meets the requirements of this Section. The acceptance of the program
for an individual applicant does not confer approval status upon the program.
H. Within 30 days, a refresher program shall report to the Board changes in:
1. Name, address, electronic address, website address or phone number of the program;
2. Clinical or didactic hours of the program;
3. Program delivery method; or
4. Ownership including adding or deleting an owner.
I. The Board may take action against the approval of a refresher program under A.R.S § 32-1606
(C) and the provisions of this Article. The administrator of a refresher program whose approval
is disciplined or subject to a notice of deficiency 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, and 4 A.A.C. 19, Article 6.