Ohio Law and Rules: Continuing Education Requirements for Relicensure

OUTCOME: The learner will demonstrate sufficient knowledge related to the Ohio CE requirements for nursing re-licensure.

1.3 Category A contact hour will be awarded with successful completion.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91).

Expires 6/11/2021

DIRECTIONS
1. Please read the study.
2. Complete the post test. To be awarded contact hours, you must achieve a score of 70% or higher.

If you have any questions, please feel free to contact Sandy Swearingen (sswearingen@ohnurses.org).

This independent study was developed by: Barbara Brunt, MA, MN, RN-BC, NE-BC, FABC
There is no conflict of interest among anyone with the ability to control content for this activity.

Ohio Law and Rules: Continuing Education Requirements for Relicensure
Written by Barbara Brunt, MA, MN, RN-BC, NE-BC, FABC

Since license renewal is coming soon for registered nurses, this program will describe the continuing education (CE) requirements for nurses as outlined in the Ohio Board of Nursing (OBN) law (ORC 4723.24) and rules (OAC 4723-14). The outcome for this activity is that licensed nurses can describe CE requirements for license renewal.

To ensure that everyone is on the same page, some of the definitions found in OAC 4723-01 are given below:

Accredited provider – an entity that has received accreditation through a nationally recognized system. An accredited provider is authorized to plan, present and award contact hours for continuing education activities.

Approved provider unit – an entity who continuing education system has been approved by an OBN approver, or who has been approved by a national accrediting body to provide continuing education in a health care field.

Blended learning – a combination of independent study materials and faculty directed.

Category A – the portion of CE that meets the one-hour requirement directly related to Chapter 4723 of the ORC and the rules of the board as described in OAC 4723-14-03. To qualify for category A, the CE must be approved by the board, an OBN approver, or offered by an OBN approved provider unit headquartered in the state of Ohio. Note: this means you cannot receive category A credit for any program that is developed by a CE provider outside of Ohio.

Contact hour – sixty minutes of continuing education. Note: contact hour is the approved terminology – this is not the same as continuing education units (CEUs). The CEU is an educational measurement utilizing criteria of the International Association for Continuing Education and Training. Nursing continuing education programs award contact hours, not CEUs.

Continuing education – a learning activity that builds upon a prelicensure or precertification education program and enables a licensee of certificate holder to acquire or improve knowledge or skills that promote professional or technical development to enhance the licensee’s or certificate holder’s contribution to quality health care and pursuit of health care career goals.The American Nurses Credentialing Center (ANCC) defines continuing education as “activities intended to build upon the educational and experiential bases of the professional RN for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the public and RN’s pursuit of their professional career goals” (ANCC, 2015, p. 44).

Faculty-directed continuing education activity – an activity in which faculty facilitate the pace and content of the activity, and the activity is one for which contact hours may be awarded. This activity may occur is setting such as a classroom, on-line, or via teleconference provided that one or more individuals is facilitating the pace of the activity.

Independent study activity – a self-paced learning activity for which contact hours may be awarded that includes both a mechanism for evaluation of learning and feedback to the learner.

Outcome-based education – education focused on educational experience leading to learning, learner confidence and ultimately, improvements in practice and patient care.

Continuing Education for Renewal

The CE requirements for renewal for registered nurses (RNs) and licensed practical nurses (LPNs) are that nurses must complete at least 24 contact hours of CE that includes at least one contact hour of Category A CE for each renewal. Requirements for Advanced Practice Registered Nurses (APRNs) are outlined later in this article. Note: for the period immediately following Ohio licensure by NCLEX examination the nurse is not required to complete any contact hours of CE for the first license renewal. After that first renewal, they are required to complete the 24-hour requirement. Nurses who have been licensed by endorsement in Ohio for less than one year must complete 12 contact hours of CE and nurses who have been licensed by endorsement in Ohio for more than one year must complete 24 contact hours of CE.

RNs and LPNs renew their license in different years. The time period for renewal for RNs is from November 1, 2017 to October 31, 2019. The time period for renewal for LPNs is from November 1, 2018 to October 31, 2020. An application for renewal is due on the fifteenth day of September of the renewal year. A late application may be submitted before the license lapses, which is on the first day of November of the renewal year.

If the license of a RN or LPN has been inactive or lapsed in Ohio for two years or more and the applicant does not hold a current, valid license in another jurisdiction, the CE requirement is more restrictive and must include the following:

1. Two contact hours of category A with learning outcomes that address scopes of practice for RNs and LPNs, standards of safe practice, and nursing delegation;

2. Six contact hours with learning outcomes that address application of the nursing process and critical thinking, clinical reasoning, or nursing judgment related to patient care;

3. Six contact hours in pharmacology with learning outcomes that include drug classifications, medication errors, and patient safety;

4. Two contact hours that include learning outcomes related to clinical or organizational ethical principles in health care; and

5. Eight contact hours that include learning outcomes related to an area relevant to the nurse’s practice.

The board performs random audits of compliance with the CE requirements. The time period for the audit will be stated in the “CE Audit” letter. If audited, the nurse will be asked to send photocopies of CE certificates or school transcripts to the board within 60 days of the mailing of the audit notice. The board requires nurses to keep proof of completion of CE for six years. Everyone should have a system to ensure they have the documentation needed for an audit. This can be as simple as putting all CE certificates together in a file folder. A nurse who fails to respond to an audit or fails to provide proof of meeting the CE requirement will not be provided a renewal application, and is not eligible for renewal, reactivation, or reinstatement of the license until all CE requirements are satisfied. These individuals must complete up to 48 hours of CE in the 48-month period immediately before the application date in order to renew, reinstate, or reactivate their license.

Documentation of Continuing Education

In order to renew, applicants must attest to completion of the CE required to meet the CE requirements to practice as a nurse. The board may require a renewal applicant to show proof of completion of CE. If the board requests proof of CE and the applicant fails to provide proof to the board before the end of the renewal period, the license shall lapse. The applicant may request a waiver to satisfy the CE requirements for one renewal period only if the nurse notifies the board in writing requesting the waiver. Once a nurse notifies the board of the intent to use the waiver, the board will not accept a withdrawal of the request. Note: The waiver cannot be used after receiving an audit notice.

Rule 4723-14-06(A), OAC specifies the proof needed. An acceptable CE document must contain your name, title of the program, date of program completion, number of contact hours, the OBN approver name and number, or name of the provider and the name of the authorized approver or the name of the approval body. For academic credit, a school transcript or grade report must include your name, the name of the school, and the dates attended, and credit hours awarded. The transcript may be unofficial.

 

Volunteer Nursing Certificate (Section 4723.24 ORC & 4723-14-03(K) OAC )

The board may issue, without examination, a volunteer’s certificate to a qualified person who is retired from practice so that the person may provide nursing services to indigent and uninsured persons at any location, including a free clinic. A person is considered retired from practice if the person’s licensed has expired with the intention of ceasing to practice nursing as a RN, LPN, or APRN for renumeration. The nurse is prohibited from accepting any form of renumeration for providing nursing services while holding a certificate. The certificate is valid for a period of two years and may be renewed.

There are specific CE requirements to renew a volunteer certificate, which are listed below:

1. Two contact hours of category A with learning outcomes that address standards of safe practice and nursing delegation;

2. One contact hour that includes content in patient abuse, patient rights, and professional boundaries;

3. Two contact hours that include content in the scope of practice of the LPN and RN;

4. Two contact hours in nursing documentation;

5. Three contact hours in principles of pain management;

6. One contact hour that addresses the application of the nursing process and critical thinking related to patient care;

7. One contact hour that include content in maintaining patient confidentiality;

8. Four contact hours in patient assessment and wound care;

9. Four contact hours in medication administration and preventing medication errors; and

10. Four contact hours relevant to the nurse’s practice setting.

Activities that can be used to meet CE Requirements

Any of the following options may be used by a nurse to satisfy the CE requirements.

1. A CE activity that has been approved by an OBN approver or provided by an approved provider unit. An OBN approver is an approver of CE headquartered in the state of Ohio that is authorized by the board to approve CE activities offered by a provider or to approve a provider unit. Category A CE must be approved by an OBN approver or offered by an OBN approved provider unit headquartered in the state of Ohio. There currently are 8 approved OBN providers, and the Ohio Nurses Association (ONA) is one of these providers. They can be identified by the following after their approval statement (OBN – applicant number-year approved) The statement for ONA is followed by (OBN-001-91), as they were the first approved OBN approver and received that designation in 1991. The law and rules outline the process to become an OBN approver and outline the reapproval process, as well as the process to approve providers of CE.

2. A CE activity approved or provided by a nationally recognized accreditation system of CE, such as the American Nurses Credentialing Center (ANCC), the Accreditation Council for Continuing Medical Education (ACCME), the International Association for Continuing Education and Training (IACET), or a national certifying organization that meets the requirements in Section 4723.46(a), ORC. Nurses can use continuing medical education (CME) to meet the CE requirements.

3. Academic credit for successful completion of a course taken through an accredited educational institution, such as a college or university. The conversion from academic credit to CE is as follows:

1 credit hour in a quarter system = 10 contact hours of CE
1 credit hour in a trimester system = 12 contact hours of CE
1 credit hour in a semester system = 15 contact hours of CE
A three-hour semester course would be the equivalent of 45 contact hours.

4. An independent study that includes both a mechanism for evaluation of learning and feedback to the learner. There is no limit to the number of contact hours obtained through independent studies. These can be taken through mail order courses or on the internet.

5. Interprofessional CE, designed for a target audience made up of members of two or more different professions. Note: Joint accreditation for interprofessional continuing education for physicians, pharmacists, nurses, physician assistants, optometrists, psychologists, and social workers is available as a provider of CE for the healthcare team. It focuses on continuing education planned by the team for the team.

6. A CE activity approved by a board or agency that regulates a health care professional or related discipline in Ohio, such as the State of Ohio Medical Board, State of Ohio Board of Pharmacy, State Board of Psychology, and the Counselor, Social Worker and Marriage and Family Therapist Board.

7. A recent addition to the law was that hours worked as a volunteer may apply toward CE for RN and APRN renewal. (Rule 4723-8-10(B)(4), OAC). A RN or APRN who serves as a volunteer for indigent and uninsured persons, without compensation, may use up to eight (8) hours of the volunteer service towards the CE requirement. One hour of CE may be awarded for each 60 minutes documented as spent providing uncompensated health care service as a volunteer. Documentation must include a signed statement from a person at the health care facility or location where the health care services were performed indicating the date and time the health care services were performed, that the recipient was indigent and uninsured and that the nurse provided services as a volunteer.

Activities that do NOT meet the OBN requirements for CE (Rule 4723-14-05(B) OAC)

The following activities/events do not meet the board requirements for CE. Note: there are some exceptions for APRNs. which will be outlined in the section on requirements for APRNs.

1. Repetition of any educational activity with identical content and course outcomes within a single reporting period;

2. Self-directed learning such as reading texts or journal articles that have not been approved as an independent study or awarded contact hours by an accredited or approved provider or provider unit;

3. Participation in clinical practice or research that is not part of a CE activity;

4. A personal development activity;

5. Professional meetings or conventions except for those portions designated as a CE activity

6. Community service

7. Volunteer service or practice that does not qualify under Rules 4723-14-03(L) or 4723-8-10(B)(4), OAC, as discussed above

8. Board-ordered CE

9. Membership in a professional organization

Additional APRN Renewal Requirements

APRNs must meet all the renewal requirements for RNs and have additional requirements specific to their role. In 2017, the board outlined licensure and CE requirements for APRNs. The term APRN includes clinical nurse specialists (CNSs), certified nurse-midwives (CNMs), certified nurse practitioners (CNPs), and certified registered nurse anesthetists (CRNAs).

Certification is now required for APRNs, with one exception (Rule 4723.41(B) (2) (b) ORC). The CNSs who, on or before December 31, 2000, obtained a master’s or doctoral degree with a major in a clinical area of nursing from an education institution accredited by a national or regional accrediting organization, the applicant is not required to have passed a certification exam. In addition, CNSs, CNMs, and CNPs may practice only in accordance with a standard care arrangement (SCA) entered into with each physician or podiatrist with whom the nurse collaborates (Rule 4723.431 ORC). The rules identify specific requirements for what is included in the SCA. A copy of the standard care arrangement shall be retained on file by the nurse’s employer.

Certified nurse midwives, certified nurse practitioners, and clinical nurse specialists can prescribe drugs and therapeutic devices through a certificate to prescribe (CTP) as outlined in Rule 4723.481, ORC. They are only allowed to prescribed drugs listed on the formulary and have limitations with schedule II controlled substances.

Similar to RNs, for the first period of renewal immediately following the initial issuance of the APRN license, the APRN is not required to complete any contact hours of CE, although they are required to maintain their national certification, with the exceptions of CNSs who were originally issued a COA on or before December 31, 2000 and are not nationally certified. Starting on November 1, 2019, to renew their license APRNs must complete 24 hours of CE for each APRN license held. For an APRN-CNP, APRN-CNS, or APRN-CNM, at least 12 of the 24 contact hours must include CE in advanced pharmacology (Rule 4723.24 (C), ORC). The 24 hours of CE required to renew each APRN license are in addition to the 24 hours of CE required to renew the RN license. Contact hours of CE completed for the APRN national certification may be used to meet the required hours.

APRNs have the same rules about what meets and does not meet the CE requirements as the RNs have. However, for APRNs, Rule 4723-14-05(C) allows APRN CE for activities that may be otherwise excluded including (1) self-directed learning such as reading or reviewing of texts or journal articles; (2) participation in clinical practice, research or mission trips; (3) professional meetings or conventions, or (4) precepting, teaching or conducting public education courses. Random audits are conducted for APRNs as they are for RNs and the same conditions apply.

Evaluating the quality of CE programs

There is no shortage of CE activities available for nurses to complete. This section will outline some tips for choosing CE programs to meet your needs and meet the OBN CE requirements for relicensure. First you need to determine your professional goals and needs. Ask yourself the question, what are the problems and issues I face that education could help resolve?

Review the promotional materials and/or brochure for the following information:

Course title/program description – does it adequately describe program content? Is the target audience identified? Is there a limit to the number of participants who can attend?

Learning outcomes – Are they stated? Do they indicate what the participant will be able to do as a result of the program? Is the number of learning outcomes reasonable for the length of the program? Is the outcome measurable and realistic for the time frame of the program? ANCC criteria focus on outcomes, rather than objectives. Although it is perfectly acceptable to use objectives, programs using ANCC criteria should list the outcome(s).

Faculty credentials – Look at the stated instructor qualifications. Is the instructor presenting within her/his area of expertise?

Disclosures -Has everyone involved in the planning disclosed relevant financial and non-financial relationships (or lack thereof) related to the course content? Disclosures help determine if the instructor may have a bias towards the products, services or practices associated with the activity. It is acceptable for an instructor to have a conflict of interest, as long as it is disclosed.

Instructional methods – Are they described? Do they include active involvement of the learner?

Credit – Does the advertising refer to contact hours? Is it offered by an OBN approved provider or a national accrediting body? Does the information indicate requirements for successful completion?

Registration fees – Are they reasonable when compared to similar programs?

Refund/cancellation policy – Is this clearly stated in the promotional materials?

Follow-up from program provider – Is there contact information if there are questions? Has the provider responded to your requests for information?

Even after reviewing promotional activities for relevance using the criteria listed above, you may find yourself attending a program that was not what you had anticipated. There may not be anything you can do about that. However, if it is a conference with multiple sessions going on at the same time, you may be able to attend a different session that you think will better meet your needs.

It is important to provide feedback to the provider of the activity at the end of the program. Take the time to share your candid, constructive feedback on the evaluation form(s) provided, if there is one. There are various ways that a provider can measure if the desired outcome was achieved, so there may not always be an evaluation form. The criteria for successful completion on the promotional materials should identify if completion of an evaluation is required to receive contact hours.

Future trends with continuing education

 The Future of Nursing Report, published by the Institute of Medicine (2011) had four key messages:

1. The need to transform practice: Nurses should practice to the full extent of their education and training (p. 29).

2. The need to transform education: Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression (p. 30).

3. The need to transform leadership: Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States (p. 32).

4. The need for better data on the health care workforce: Effective workforce planning and policy making require better data collection and an improved information infrastructure (p. 33).

Continuing nursing education is one way that nurses can practice to the full extent of their education and training.

Other trends that will be discussed in this article are a focus on outcomes, increased attention on interprofessional education activities, and unhealthy work environments.

ANCC and other organizations are focusing on outcomes as a method of evaluating CE activities. However, empirical evidence to support the unique contributions of nurses to quality outcomes is currently lacking. Nurses have a social and economic imperative to measure outcomes (Jones, 2016). Value-based purchasing (VBP) policies are predicated on the fact that what gets measured, gets managed, yet unique nursing contributions to patient outcomes is difficult to measure. Jones concluded that nurses have a social responsibility to evaluate the effect of nursing practice on patient outcomes in the areas of health promotion, injury and illness prevention, and alleviation of suffering.

No discipline works in a vacuum and more focus is being placed on education by the team for the team. There was a Joint Accreditation Leadership Summit in 2016 to allow an opportunity for jointly accredited providers to identify organizational models that were effective in promoting and improving interprofessional collaborative practice through interprofessional continuing education (IPCE). They shared success stories that demonstrated the impact of their educational efforts on optimal patient care. IPCE does not just mean bringing multiple professions together for an activity. It means educating the professions together as a team, so that learners understand their roles and goals related to patient care. Joint accreditation reduces redundancies and creates efficiencies, enabling educators to focus their attention on creating high-quality, strategic team interventions, rather than multiple, similar activities for multiple professions (Joint Accreditation, 2016).

Promotion of a healthy work environment is critical in today’s healthcare arena, where there is a constant focus on providing high quality care with diminishing resources. Events that creae an unhealthy work environment, such as incivility, bullying, and workplace violence are on the rise. This can lead to anger, decreased self-esteem, depression, stress and burnout, and have a negative effect on patient safety. Identifying factors that contribute to the occurrence is the first step in dealing with this issue. Continuing education programs can help nurses identify unhealthy situations and provide strategies on how to deal with those.

This article has outlined the CE requirements for relicensure for RNs, LPNs, and APRNs, as well as those seeking a volunteer certificate. It also provided tips on how to evaluate if a program would meet your needs and mentioned just a few trends relating to CE.

Ohio Nursing Law & Rules: Continuing Education Requirements for Re-licensure

Contact Hours Awarded: 1.3 Contact Hour Category A Law & Rules
ONA-19-06-123

References

American Nurses Credentialing Center. (2015). 2015 ANCC primary accreditation provider application manual. Silver Spring,                 MD: Author.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National                               Academies Press.
Joint Accreditation. (2016). By the team for the team: Evolving interprofessional continuing education for optimal patient care.        Report from the 2016 Joint Accreditation Leadership Summit. Chicago, IL: Author
Jones, T., (May 31, 2016). Outcomes measures in nursing: Imperatives, ideals, history, and challenges, OJIN: The Online Journal          of Issues in Nursing Vol. 21, No. 2, Manuscript 1. DOI: 10.3912/OJIN.Vol21No02Man01
Ohio Board of Nursing Law (ORC 4723.24) and Rules (OAC 4723-14). Retrieved from                                                                                  http://www.nursing.ohio.gov/Law_and_Rule.htm
Warren, J. I. & Harper, M. G. (2017). The complex healthcare environment in P. C. Dickerson (Ed) Core curriculum for nursing              professional development, (5th Ed). (pp. 16-26), Chicago, IL: Association for Nursing Professional Development.