SECTION 215.4. Approval

(a) The progressive designation of approval status is not implied by the order of the following listing. Approval status is based upon each program's performance and demonstrated compliance to the Board's requirements and responses to the Board's recommendations. Change from one status to another is based on NCLEX-RN® examination pass rates, compliance audits, survey visits, and other factors listed under subsection (b) of this section. Types of approval include:

(1) Initial Approval.

(A) Initial approval is written authorization by the Board for a new program to enroll students, is granted if the program meets the requirements and addresses the recommendations issued by the Board, and begins with the date of the first student enrollment.

(B) The number of students to be enrolled while the program is on initial approval is determined by the Board, and the requirements will be included in the Board's Order approving the program.

(C) Change from initial approval status to full approval status cannot occur until the program has demonstrated compliance with this chapter, has met requirements and responded to all recommendations issued by the Board, and the NCLEX-RN® examination pass rate is at least 80% after a full examination year. In order to ensure the continuing success of the program, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary for continued operation and/or as a condition for changing the approval status.

(2) Full Approval.

(A) Full approval is granted by the Board to a professional nursing education program that is in compliance with all Board requirements and has responded to all Board recommendations.

(B) Only programs with full approval status may initiate extension programs and grant faculty waivers.

(3) Full with warning or initial approval with warning is issued by the Board to a professional nursing education program that is not meeting the Board's requirements.

(A) A program issued a warning will receive written notification from the Board of the warning and a survey visit will be conducted.

(B) Following the survey visit, the program will be given a list of identified areas of concern and a specified time in which to respond with a set of corrective measures. Further, in order to ensure the continuing success of the program, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary for continued operation and/or as a condition for changing the approval status.

(4) Conditional Approval. Conditional approval is issued by the Board for a specified time to provide the program opportunity to correct any areas of concern identified by the Board or from findings in the program's self-study report.

(A) The program shall not enroll students while on conditional status.

(B) The Board may establish specific criteria to be met in order for the program's conditional approval status to be changed.

(C) Depending upon the degree to which the Board's requirements are currently being or have been met, the Board may change the program's approval status or may withdraw approval. In order to ensure the continuing success of the program, the Board may, in its discretion, impose any restrictions or conditions it deems appropriate and necessary for continued operation and/or as a condition for changing the approval status.

(5) Withdrawal of Approval. The Board may withdraw approval from a program which fails to meet the Board's requirements within the specified time. A program may also elect to voluntarily close a program, as provided for in subsection (c)(12) of this section. The dean/director shall submit a plan for closure according to Board Education Guideline 3.1.7 available at https://www.bon.texas.gov and outlined in subsection (d) of this section.

(6) When a program closes by Board action or voluntary decision, the program will be removed from the list of Board approved professional nursing education programs, but students may complete the program in teach-out.

(7) A diploma program of study in Texas that leads to an initial license as a registered nurse under this chapter must have a process in place to ensure that their graduates are entitled to receive a degree from a public or private institution of higher education accredited by an agency recognized by the THECB or the TWC, as applicable. At a minimum, a graduate of a diploma program will be entitled to receive an associate degree in nursing.

(b) Factors Jeopardizing Program Approval Status.

(1) When a program demonstrates non-compliance with Board requirements, approval status may be changed, approval may be withdrawn, or the Board, in its discretion, may impose restrictions or conditions it deems appropriate and necessary. In addition to imposing restrictions or conditions, the Board may also require additional monitoring of the program. Board monitoring may include the review and analysis of program reports; extended communication with program directors; and additional survey visits. A monitoring plan may require the submission of quarterly reports of students' performance in courses and clinical learning experiences; remediation strategies and attrition rates; and reports from an assigned mentor to the program director. Additional survey visits by a Board representative may be conducted at appropriate intervals to evaluate the status of the program. The Board may alter a monitoring plan as necessary to address the specific needs of a particular program.

(2) A change in approval status, requirements for restrictions or conditions, or a monitoring plan may be issued by the Board for any of the following reasons:

(A) deficiencies in compliance with the rule;

(B) substantiated student complaints;

(C) noncompliance with school's stated philosophy/mission, program design, objectives/outcomes, and/or policies;

(D) failure to submit records and reports to the Board office within designated time frames;

(E) failure to provide sufficient variety and number of clinical learning opportunities for students to achieve stated objectives/outcomes;

(F) failure to comply with Board requirements or to respond to Board recommendations within the specified time;

(G) student enrollments without resources to support the program, including sufficient qualified faculty, adequate educational facilities, and appropriate clinical affiliating agencies;

(H) failure to maintain an 80% passing rate on the licensing examination by first-time candidates;

(I) failure of program director/dean to verify the currency of faculty licenses; or

(J) other activities or situations that demonstrate to the Board that a program is not meeting Board requirements or lacks institutional control necessary for successful student outcomes.

(c) Ongoing Approval Procedures. Ongoing approval status is determined biennially by the Board on the basis of information reported or provided in the program's NEPIS and CANEP, NCLEX-PN® examination pass rates, program compliance with this chapter, and other program outcomes. Certificates of Board approval will be sent to all Board-approved nursing programs biennially in even-numbered years.

(1) Compliance Audit. Each approved professional nursing education program shall submit a biennial CANEP regarding its compliance with the Board's requirements.

(2) NCLEX-RN® Pass Rates. The annual NCLEX-RN® examination pass rate for each professional nursing education program is determined by the percentage of first time test-takers who pass the examination during the examination year.

(A) A minimum of eighty percent (80%) of first-time NCLEX-RN® candidates is required to achieve a passing score on the NCLEX-RN® examination during the examination year.

(B) When the passing score of first-time NCLEX-RN® candidates is less than 80% on the examination during the examination year, the nursing program shall submit a Self-Study Report that evaluates factors that may have contributed to the graduates' performance on the NCLEX-RN® examination and a description of the corrective measures to be implemented. The report shall comply with Board Education Guideline 3.2.1 available at https://www.bon.texas.gov. Within one year of the submission of the Self-Study Report to the Board, the program shall provide to Board Staff evaluation data on the effectiveness of corrective measures implemented.

(3) Change in Approval Status. The progressive designation of a change in approval status is not implied by the order of the following listing. A change in approval status is based upon each program's performance and demonstrated compliance to the Board's requirements and responses to the Board's recommendations. A change from one approval status to another may be determined by program outcomes, including the NCLEX-RN® examination pass rates, compliance audits, survey visits, and other factors listed under subsection (b) of this section.

(A) A warning may be issued to a program when:

(i) the pass rate of first-time NCLEX-RN® candidates, as described in paragraph (2)(A) of this subsection, is less than 80% for two (2) consecutive examination years; or

(ii) the program has been in violation of Board requirements.

(B) A program may be placed on conditional approval status if:

(i) the pass rate of first-time candidates, as described in paragraph (2)(A) of this subsection, is less than 80% for three (3) consecutive examination years;

(ii) the faculty fails to implement appropriate corrective measures identified in the Self-Study Report or survey visit;

(iii) the program has continued to engage in activities or situations that demonstrate to the Board that the program is not meeting Board requirements and standards or lacks institutional control necessary for successful student outcomes; or

(iv) the program persists despite the existence of multiple deficiencies mentioned in subsection (b) of this section.

(C) Approval may be withdrawn if:

(i) the performance of first-time NCLEX-RN® candidates fails to be at least 80% during the examination year following the date the program is placed on conditional approval;

(ii) the program is consistently unable to meet requirements of the Board; or

(iii) the program continues to engage in activities or situations that demonstrate to the Board that the program is not meeting Board requirements and standards or lacks institutional control necessary for successful student outcomes.

(D) The Board may consider a change in approval status at a regularly scheduled Board meeting for a program on initial, full approval, full approval with warning, or conditional approval if:

(i) the program's pass rate for first-time NCLEX-RN® candidates during the examination year is at least 80%; and

(ii) the program has met all Board requirements.

(E) The Board may, in its discretion, change the approval status of a program on full approval with warning or impose a monitoring plan. The Board may restrict enrollment.

(F) The Board may, in its discretion, change the approval status of a program on conditional approval or impose a monitoring plan. The Board may restrict enrollment.

(4) Survey Visit. Each professional nursing education program shall be visited at least once every six (6) years after full approval has been granted, unless accredited by a Board-recognized national nursing accrediting agency.

(A) Board Staff may conduct a survey visit at any time based upon Board Education Guideline 3.2.2 available at https://www.bon.texas.gov.

(B) After a program is fully approved by the Board, a report from a Board-recognized national nursing accrediting agency regarding a program's accreditation status may be accepted in lieu of a Board survey visit.

(C) A written report of the survey visit, information from the program's NEPIS and CANEP, and NCLEX-RN® examination pass rates shall be reviewed by the Board at a regularly scheduled meeting.

(5) The Board will select one (1) or more national nursing accrediting agencies, recognized by the United States Department of Education, and determined by the Board to have standards equivalent to the Board's ongoing approval standards according to Board Education Guideline 3.2.3 available at https://www.bon.texas.gov. Identified areas that are not equivalent to the Board's ongoing approval standards will be monitored by the Board on an ongoing basis.

(6) The Board will periodically review the standards of the national nursing accrediting agencies following revisions of accreditation standards or revisions in Board requirements for validation of continuing equivalency.

(7) Accredited Programs. The Board may review and/or change the approval status of an accredited professional nursing education program that fails to:

(A) meet the prescribed program of study or other Board requirement;

(B) maintain voluntary accreditation with the national nursing accrediting agency selected by the Board; or

(C) maintain the approval of the state board of nursing of another state that the Board has determined has standards that are substantially equivalent to the Board's standards under which it was approved.

(8) A professional nursing education program is considered approved by the Board and exempt from Board rules that require ongoing approval as described in Board Education Guideline 3.2.3 available at https://www.bon.texas.gov if the program:

(A) is accredited and maintains voluntary accreditation through an approved national nursing accrediting agency that has been determined by the Board to have standards equivalent to the Board's ongoing approval standards;

(B) complies with Board rules from which it is not exempt; and

(C) maintains an acceptable NCLEX-RN® pass rate, as determined by the Board, on the NCLEX-RN® examination.

(9) A professional nursing education program that fails to meet or maintain an acceptable NCLEX-RN® pass rate, as determined by the Board, on NCLEX-RN® examinations is subject to review by the Board.

(10) A professional nursing education program that qualified for exemption pursuant to paragraph (8) of this subsection, but does not maintain voluntary accreditation through an approved national nursing accrediting agency that has been determined by the Board to have standards equivalent to the Board's ongoing approval standards, is subject to review by the Board.

(11) A program that voluntarily closes or from which approval has been withdrawn by the Board may submit a new proposal. A new proposal may not be submitted to the Board until at least twelve (12) calendar months have elapsed from the date the program's voluntary closure is accepted by the Executive Director or from the date of the program's withdrawal of approval by the Board.

(12) A professional nursing education program accredited by a national nursing accrediting agency recognized by the Board shall:

(A) provide the Board with copies of any reports submitted to or received from the national nursing accrediting agency selected by the Board within three (3) months of receipt of any official reports;

(B) demonstrate accountability of compliance with national nursing accreditation standards and processes and provide copies of approvals for substantive changes from the national nursing accreditation organizations after the program has followed the approval process;

(C) notify the Board of any change in accreditation status within two (2) weeks following receipt of an official notification letter; and

(D) provide other information required by the Board as necessary to evaluate and establish nursing education and workforce policy in this state.

(d) Notice of a change in a program's approval status shall be sent to the dean or director and others as determined by the Board. The chief administrative officer of the governing entity shall be notified when there is a change of approval status of the program.

Source Note: The provisions of this §215.4 adopted to be effective January 9, 2005, 29 TexReg 12190; amended to be effective February 19, 2008, 33 TexReg 1328; amended to be effective October 19, 2008, 33 TexReg 8509; amended to be effective December 27, 2010, 35 TexReg 11668; amended to be effective October 23, 2012, 37 TexReg 8304; amended to be effective August 9, 2018, 43 TexReg 5074; amended to be effective November 23, 2021, 46 TexReg 7880; amended to be effective November 30, 2023, 48 TexReg 6907