Alabama Board of Nursing Proposed Rule Changes
Summary April 2020
ABN Administrative Code §610-X-1-.04
This proposal eliminates an outdated reference two-day Board meetings. The Board currently holds one-day Board meetings.
ABN Administrative Code §610-X-3-.02
The ABN proposes to amend this section to require nursing education programs to establish a plan to account for remediation of didactic and clinical credits missed due to program closure or clinical site unavailability as a result of an emergency, such as the COVID-19 crisis.
ABN Administrative Code §§610-X-7-.01 and 610-X-7-.11
The Board proposes rules allowing for delegation of nursing tasks to trained, qualified, and certified unlicensed personnel in licensed healthcare facilities.
Chapter 610-X-1 Nursing
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610-X-1-.04 Meetings Of The Board.
(1) A minimum of six regular meetings shall be held
each year. The annual meeting shall be the November regular
meeting.
(a) Meeting notices shall be posted on the Secretary
of State’s web site as required by the Alabama Open Meetings Act.
(b) The Board may post meetings on the Board’s web
site.
(2) Special meetings may be called at the request of
the president or upon the request of three members of the Board.
(3) A majority of the Board, including at least one
officer, shall constitute a quorum at any meeting.
(4) Requests to present information to the Board
during a Board meeting shall be directed to the Executive Officer
at least fourteen days prior to the meeting.
(5) The secretary or designee shall keep a record of
all meetings. The minutes shall be transcribed and presented for
approval or amendment at the next regular two-day meeting. The
minutes or a true copy thereof, certified by a majority of the
Board, shall be open to public inspection. The minutes shall
reflect:
(a) The time and place of each meeting of the Board.
(b) Announcement of a quorum.
(c) A statement of compliance with the Alabama Open
Meetings Act.
(d) Names of the Board members present and those who
may be absent.
(i) Late arrivals or early departures shall be
documented in the minutes.
(ii) Any Board member’s absence during deliberation or
action on agenda items.
(e) All official acts of the Board.
(f) The vote of the individual Board members except
when the votes are unanimous. When requested by a dissenting
Board member, specific reasons for the dissenting vote shall be
recorded in the minutes.
Chapter 610-X-1 Nursing
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(6) A roll call vote may be taken upon the request of
a Board member.
(7) All meetings of the Board shall be held in
compliance with the Alabama Open Meetings Act.
(8) Meetings of the Board, except executive sessions,
may be openly recorded provided the recording does not disrupt
the conduct of the meeting. Requests to record Board meetings,
or portions thereof, shall be directed to the Executive Officer
at least 15 minutes prior to the beginning of the meeting to
allow assistance with placement of equipment and personnel. Any
disruption in the conduct of the meeting shall be addressed by
either the Executive Officer, the President of the Board, or the
Board members.
(9) Board members shall be conducted in accord with
Robert’s Rules of Order except as provided by law.
Author: Alabama Board of Nursing
Statutory Authority: Code of Ala. 1975, §34-21-2.
History: Filed September 29, 1982. Amended: Filed
February 17, 1984; effective March 24, 1984. Amended: Filed
September 18, 1985; effective October 24, 1985. Amended: Filed
September 20, 2002; effective October 25, 2002. Amended: Filed
March 24, 2006; effective April 28, 2006. Amended: Filed
May 23, 2011; effective June 27, 2011.
Nursing Chapter 610-X-3
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ALABAMA BOARD OF NURSING
ADMINISTRATIVE CODE
CHAPTER 610-X-3
NURSING EDUCATION PROGRAMS
TABLE OF CONTENTS
610-X-3-.01 Definitions
610-X-3-.02 Standards For Approval
610-X-3-.03 Distance Education
610-X-3-.04 Out Of State Programs Conducting
Clinical In Alabama
610-X-3-.05 Outcome Standards
610-X-3-.06 Deficiencies
610-X-3-.07 Establishing A New Program
610-X-3-.08 Closing A Program
610-X-3-.09 Nursing Education Program Hearing
610-X-3-.10 Withdrawal Of Board Approval
610-X-3-.02 Standards For Approval.
(1) The program must be accredited by a national
nursing accrediting agency recognized by the U.S. Department of
Education by the later of January 1, 2022 or within five (5)
years of Approval by the Board.
(2) The governing institution, nursing program
administrator, and nursing faculty are accountable for the
standards, processes, and outcomes of the nursing education
program.
(3) The governing institution offering the nursing
program shall be:
(a) A postsecondary education institution that is
authorized to offer nursing education and is accredited by an
organization recognized by the U.S. Department of Education.
(b) Approved and licensed by the appropriate State of
Alabama education agency(ies), as required by law.
(4) The governing institution shall provide financial
support and resources sufficient to meet the outcomes of the
nursing education program. Resources include, but are not
Chapter 610-X-3 Nursing
Supp. 9/30/19 3-2
limited to:
(a) Financial.
(b) Educational facilities.
(c) Equipment.
(d) Learning aids.
(e) Technology.
(f) Administrative, instructional, and support
personnel.
(5) The governing institution’s administrator or
program administrator shall notify the Board, in writing, of any
substantive changes in the program, including, but not limited
to:
(a) Nursing program administrator.
(b) Governing institution administrator, President,
CEO, Chancellor, or Provost.
(c) Governance structure of the institution.
(d) Accreditation status.
(e) Ownership or merger of parent institution.
(f) School name.
(g) Relocation.
(h) Curriculum changes.
(6) There shall be an organizational chart that
depicts the authority, responsibility, and channels of
communication of the nursing program to the governing
institution and other comparable programs within the governing
institution.
(7) A nursing education program shall be administered
by a qualified program administrator who is accountable for the
planning, implementation, and evaluation of the program.
Minimum qualifications of a nursing program administrator shall
include:
Nursing Chapter 610-X-3
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(a) An active, unencumbered Alabama registered nurse
license or a multistate registered nurse license issued by a
party state, as defined in Chapter 4 of these rules.
(b) An earned graduate degree in nursing.
(c) Be academically and experientially qualified to
administer a nursing program.
(8) The governing institution and nursing program
administrator shall provide sufficient numbers of qualified
faculty to ensure that curriculum implementation and expected
program outcomes are achieved and aligned with national nursing
accrediting standards. Minimum qualifications of nurse faculty
shall include:
(a) An active, unencumbered Alabama registered nurse
license, or a multistate registered nurse license issued by a
party state, as defined in Chapter 4 of these rules.
(b) An earned graduate degree in nursing or a related
health field.
(c) Be academically and experientially qualified to
teach in the area assigned.
(9) Institutional and program policies and procedures
shall:
(a) Be written, published, and publicly available.
(b) Address students' ability to assume clinical
assignments including, but not limited to, educational
preparedness and physical, mental, and emotional behaviors.
(c) Provide opportunities for students to regularly
participate in the development, evaluation, and continuous
improvement of the program.
(d) Include a detailed plan of action for
completion of didactic and clinical hours in the event of
cessation of academic activities or loss of clinical site
availability resulting from as a result of natural disaster,
inclement weather, public health emergency, or other
unforeseen emergent interruption. Any program approved on or
before March 20, 2020 shall provide the detailed plan of
action to the Board no later than September 1, 2020.
Chapter 610-X-3 Nursing
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(10) Faculty are accountable for curriculum
development, implementation, and evaluation.
(11) The curriculum of a nursing education program
shall:
(a) Enable the student to develop the knowledge,
skills, and abilities necessary for the level, scope, and
standards of competent nursing practice expected at the level of
licensure.
(b) Comply with the standards set forth in this
chapter.
(c) Be evidence-based and outcome-focused.
(d) Provide theoretical and clinical experiences
specific to the expected scope of practice of graduates from
each type of entry level nursing education program and shall
include:
1. Content for students to attain knowledge and
competence in providing a safe and effective care environment.
2. Prevention of illness.
3. Maintenance, promotion, and restoration of
health.
4. Psychological integrity of individuals across the
life span.
5. Clinical reasoning skills to assist in
recognizing, analyzing, and applying relevant knowledge and
skills to nursing care.
6. Clinical learning experiences to provide
opportunities for students to develop cognitive, psychomotor,
and affective skills in the provision of nursing care.
(e) The curriculum content of a nursing education
program shall include:
1. Liberal arts and sciences supportive of the
nursing program.
2. Anatomy and physiology with a corresponding lab.
Utilizing a ‘virtual lab’ in lieu of a ‘hands-on’ lab is
Nursing Chapter 610-X-3
Supp. 9/30/19 3-5
considered a substantive change and requires Board notification.
3. Nursing foundations, health assessment,
pharmacology, nutrition, and community-based nursing.
4. History and trends of nursing, cultural
diversity, legal and ethical responsibilities, and nursing
practice responsibilities, including leadership, management,
delegation, and health care delivery systems.
5. Theoretical and clinical learning experiences in
the areas of adult, maternal, child, and psychiatric/mental
health nursing that includes simulation, laboratory time, and
direct patient care in a licensed health care setting. This
does not prohibit additional experience in licensed non-health
care setting.
(6) Simulation learning experiences conducted
according to acceptable faculty training standards and
guidelines which incorporate clinical objectives, student
debriefing, and evaluation are acceptable components of the
clinical experience. Simulation may not comprise the entire
clinical learning experience.
7. Safe and Effective Care Environment, Health
Promotion and Maintenance, Psychosocial Integrity, and
Physiological Integrity.
8. Microbiology for students pursuing an associate
or baccalaureate degree.
(12) The governing institution, nursing program
administrator, and nursing faculty are accountable for selecting
and evaluating the teaching methods, delivery modalities, and
processes used to achieve expected program outcomes.
(13) Clinical supervision of students shall comply
with the standards set forth in this chapter.
(a) Clinical learning experiences shall be supervised
by a registered nurse with knowledge of educational strategies
and subject matter, and who is experienced in the clinical
technologies essential to the safe practice of nursing.
(b) The clinical supervisor shall hold an
unencumbered license to practice professional nursing in
Alabama, or a multistate registered nurse license issued by a
party state, as defined in Chapter 4 of these rules.
Chapter 610-X-3 Nursing
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(c) The clinical supervisor shall be readily
accessible to assign or prescribe a course of action, give
procedural guidance, direction, and evaluation for students
engaged in the clinical learning experience.
(d) The faculty-student ratio in clinical learning
experiences shall be collaboratively determined by the
professional nursing faculty, the School of Nursing
administration, and the professional nurse administrator, or
designee, in the clinical agency. In licensed hospitals that
provide inpatient acute care, the faculty to student ratio shall
not exceed 1:8 during clinical learning experiences. The
faculty-student ratio shall be determined according to the:
1. Complexity of the educational experience.
2. Acuity of the patient(s).
3. Physical layout of the clinical setting.
4. Student’s level of knowledge and skills necessary
to provide safe patient care.
(e) The nursing education program shall work with
clinical agencies for the planning, implementation, and
evaluation of clinical experiences.
(f) Clinical learning experiences shall include the
development of skills in clinical reasoning, management of care
for groups of patients, and delegation to and supervision of
other health care personnel performed in acute care and a
variety of health care settings.
(g) Nursing faculty shall maintain responsibility and
accountability for planning, implementation, and evaluation of
all student clinical learning experiences.
(14) Nursing programs that offer only simulations or
clinical testing do not meet the requirements for providing
clinical learning experiences for nursing students.
(15) Scores on external exams shall not be utilized as
the sole criterion for barring a student who otherwise has
successfully completed all required course work from graduating
from the nursing program.
Author: Alabama Board of Nursing
Statutory Authority: Code of Ala. 1975, §34-21-2(2).
History: Filed September 29, 1982. Amended: Filed
September 21, 1984; effective October 29, 1984. Amended: Filed
Nursing Chapter 610-X-3
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July 23, 1997; effective August 27, 1997. Repealed and New
Rule: Filed July 22, 2002; effective August 26, 2002. Amended:
Filed September 27, 2004; effective November 1, 2004. Amended:
Filed September 25, 2006; effective October 30, 2006. Amended:
Filed March 12, 2007; effective April 16, 2007. Amended: Filed
September 21, 2007; effective October 26, 2007. Amended: Filed
November 19, 2010; effective December 24, 2010. Amended: Filed
March 16, 2012; effective April 20, 2012. Amended: Filed
April 21, 2015; effective May 26, 2015. Amended: Filed
November 21, 2016; effective January 5, 2017. Amended: Filed
July 25, 2019; effective September 9, 2019; operative
January 1, 2020.
Ed. Note: Rule 610-X-3-.01 was renumber to .02 as per
certification filed September 25, 2006; effective
October 30, 2006.
Nursing Chapter 610-X-7
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ALABAMA BOARD OF NURSING
ADMINISTRATIVE CODE
CHAPTER 610-X-7
STANDARDS OF NURSING PRACTICE; SPECIFIC SETTINGS
TABLE OF CONTENTS
610-X-7-.01 Definitions
610-X-7-.02 Delegation By School Nurses
610-X-7-.03 State Of Alabama Independent Living
(SAIL) Program
610-X-7-.04 Registered Nurse As Surgical First
Assistant (RNFA)
610-X-7-.05 Sexual Assault Nurse Examiner (SANE)
610-X-7-.06 Alabama Department Of Mental Health
Residential Community Programs
610-X-7-.07 Occupational Safety And Health
Administration Respiratory Standard
610-X-7-.08 Behavioral Restraint And Seclusion
610-X-7-.09 Commercial Drivers License Examinations
610-X-7-.10 Delegation Of Insulin And Glucagon
Administration In The School Setting
610-X-7-.01 Definitions.
(1) Delegation: The act of authorizing a competent
individual to perform selected nursing activities supportive to
licensed nurses in selected situations while retaining the
accountability for the outcome if the delegation is to an
unlicensed individual.
(2) Medication Assistant, Certified (MAC): Mental
health worker or unlicensed assistive personnel who has
successfully completed a Board-approved curriculum for
assistance with medications, in community residential settings.
or a comparable program in another state, and holds a valid
medication assistant certification (MACE).
(3) Medication Assistant Supervisor (MAS): A licensed
nurse who supervises Medication Assistant, Certified (MAC). in
community mental health residential settings.
(4) Medication Assistant Train the Trainer (MATT): A
registered nurse who teaches the approved curriculum for mental
health community residential settings.
Supp. 9/30/19 7-2
Chapter 610-X-7 Nursing
(5) Registered Nurse First Assistant (RNFA): A
registered nurse who, through additional education and supervised
clinical practice, has acquired knowledge, skills, and judgment
specific to providing assistance during a surgical procedure, as
directed by the attending surgeon and as defined in standardized
procedures.
(6) Sexual Assault Nurse Examiner (SANE): A
registered nurse who, through additional education and supervised
clinical practice, has acquired knowledge, skills, and judgment
specific to providing health services to sexual assault or rape
victims, including a forensics examination.
Author: Alabama Board of Nursing
Statutory Authority: Code of Ala. 1975, §34-21-2(c)(21).
History: Filed September 28, 1982. Repealed: Filed
October 29, 2001; effective December 3, 2001. New Rule: Filed
November 23, 2009; effective December 28, 2009. Amended: Filed
May 21, 2013; effective June 25, 2013. Repealed and New Rule:
Filed July 25, 2016; effective September 8, 2016.
Supp. 9/30/19 7-3
Chapter 610-X-7 Nursing
610-X-7-.11 Delegation to Medication Assistants, Certified
in Settings Other than Mental Health Residential Community
Programs.
(1) A Medication Assistant, Certified (MAC) may
perform limited medication administration tasks delegated to
the MAC by a licensed nurse in a licensed healthcare facility
other than a mental health residential community program only
as permitted by this rule.
(7) In order to perform limited medication
administration tasks delegated to the MAC by a licensed nurse, a
MAC must successfully complete a Board-approved education
program or a comparable program in another state, and hold a
valid medication assistant certification (MACE).
(2) A licensed nurse may delegate limited
medication administration tasks to a MAC in a licensed
healthcare facility only when all of the following conditions
are met:
(a) At least one licensed nurse is on the premises
of the facility at the time when the delegated limited
medication administration task occurs.
(b) The licensed nurse is accountable and
responsible for the outcome of the delegated limited
medication administration task performed by the MAC.
(c) The limited medication administration task
delegated by the licensed nurse to the MAC is based on the
patient’s/resident’s needs, as documented in the comprehensive
and/or focused assessment by the registered nurse or licensed
practical nurse and the outcome of a comprehensive assessment
determines the medications that may safely be administered by
a MAC to the patient/resident.
(d) The delegated limited medication administration
task does not require the exercise of independent nursing
judgment or intervention. Specific tasks that require
independent nursing judgment or intervention that shall not be
delegated include, but are not limited to:
1. Administration of injectable medications, with the
exception of premeasured auto injectable medications for
anaphylaxis and opioid-related drug overdose.
2. Calculation of medication dosages, other than measuring
a prescribed amount of liquid medication or breaking a scored
tablet.
3. Receipt of verbal or telephone orders from a
licensed prescriber.
Supp. 9/30/19 7-4
Chapter 610-X-7 Nursing
4. Administration of medications ordered as
needed (PRN).
5. Administration of controlled substances.
(e) Subject to all other limitations imposed by
this rule, routes of medication administration for which
the MAC may perform delegated limited medication
administration tasks may include eye, ear, nose, oral,
topical, inhalant, rectal, or vaginal.
(f) The licensed nurse delegating the medication
administration may, at any time, suspend or withdraw the
delegation of specific tasks to MAC(s).
(g) The licensed healthcare facility has authorized
delegation of limited medication administration tasks and has
complied with the requirements of this rule.
(3) The chief nursing officer or, if no such position exists within the licensed healthcare facility, an Alabama-
licensed registered nurse who has oversight responsibility for
delegation of medication administration in the facility shall:
(a) Develop facility policies and procedures related to delegation of limited medication administration tasks to the
MAC which define the responsibilities of and required training
for the delegating licensed nurse and the MAC, congruent with
these rules.
(b) Submit, annually or upon request, a report to the Alabama Board of Nursing in a format specified by the Board,
including, but not limited to:
1. Total number of patients/residents served by MACs
participating in the nurse delegation program.
2. Total number of MACs that currently participate in
the nurse delegation program.
3. Total number of MACs trained during the reporting
period.
4. Total number of licensed nurses trained in MAC
delegation during the reporting year.
5. Total number of medication errors in each category
listed below:
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Chapter 610-X-7 Nursing
i. Wrong person
ii. Wrong medication
iii. Wrong dose
iv. Wrong time/day
v. Wrong route
vi. Wrong purpose
vii. No documentation
viii. Identify and implement a quality improvement plan
for medication errors.
(c) Provide and document an initial and annual competency
validation evaluation of the MAC performing the delegated
limited medication administration tasks for all routes of
administration.
Author: Alabama Board of Nursing
Statutory Authority: Code of Ala. 1975, §34-21-2(c)(21).
History: New rule: Filed April 7, 2020.
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