All nurses with an active Texas license are required to demonstrate continuing competency for relicensure. The mission of the Board of Nursing (BON) is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely. In 1991, rules were adopted requiring nurses to complete 20 contact hours of continuing nursing education (CNE) every two years for relicensure. CNE is defined as programs beyond the basic nursing preparation that are designed to promote and enrich knowledge, improve skills, and develop attitudes for the enhancement of nursing practice, thus improving health care to the public [§216.1 (12)]. In 2009, rules were adopted to allow nurses to demonstrate competency through achievement of an approved national nursing certification in the nurse’s area of practice or completion of 20 contact hours of CNE. In 2010, rule changes require contact hours to be in the nurse’s area of practice. If the nurse does not have a current area of practice, the nurse refers to the prior area of practice. Each nurse reactivating an inactive or delinquent license must also submit verification of 20 contact hours completed in the two years prior to reactivation, or have a current approved national nursing certification. In these types of situations the nurse would refer back to the most previous area of practice.

One method to demonstrate compliance with the continuing competency requirements is to attain, maintain or renew an approved national nursing certification in the nurse’s area of practice. A certification must be in nursing and have the approval of a national certification accreditation agency recognized by the Board to count as continuing competency for licensure renewal. There are two primary certification accreditation agencies: Accreditation Board for Specialty Nursing Certification (ABSNC) and National Commission for Certifying Agencies (NCCA). A national nursing certification that has been approved by ABSNC, that is attained, maintained or renewed during the licensure renewal cycle and is in the nurse’s area of practice, will be accepted to demonstrate the nurse’s continued competence. Although NCCA does provide another avenue for certification, not all NCCA certifications are in the area of nursing practice. The National Association for Practical Nurse Education & Service, Inc (NAPNES) offers two certifications for LVNs that have been approved by the Board for demonstration of continuing competency: Pharmacology and Long-Term Care. In October of 2011, two additional certifications were approved by the Board, one for LVNs and one for RNs that are offered by the Developmental Disabilities Nurses Association.

One method to demonstrate compliance with the continuing competency requirements is to complete twenty (20) contact hours, of CNE in the nurse’s area of practice every two years coinciding with the nurse’s license renewal. A contact hour is defined as 60 minutes of a clock hour. The CNE hours must be earned within the two-year period immediately preceding the license renewal, beginning with the first day after the renewal month until the last day of the subsequent renewal. For example, if you are to renew your license in December 2012 (your birth month), the CNE hours must be earned between January 1, 2011 and December 31, 2012. Additional hours earned may not be carried over to the next renewal period.

To count toward licensure renewal, a program must have been approved by one of the credentialing agencies recognized by the Board. The credentialing agencies have met nationally-predetermined criteria to approve programs and providers of CNE. The Board recognizes the following credentialing agencies and providers:

American Academy of Nurse Practitioners (AANP);
American Association of Critical-Care Nurses (AACN);
American Association of Nurse Anesthetists (AANA);
American College of Nurse Midwives (ACNM);
American Nurses Credentialing Center (ANCC);
Category I Continuing Medical Education (for APRNs only);
Emergency Nurses Association (ENA);
National Association for Practical Nurse Education and Service (NAPNES);
National Association of Pediatric Nurse Practitioners (NAPNAP);
National Federation of Licensed Practical Nurses (NFLPN);
Colleges and Universities; and
Other State Boards of Nursing.
These organizations, in turn, approve other CNE providers. For example, most of the state nursing associations such as the Texas Nurses Association and many of the nursing specialty organizations are accredited through the American Nurses Credentialing Center. Thus, these programs would be accepted.

In addition, the Board also recognizes the Licensed Vocational Nurses Association of Texas (LVNAT) and the Texas League of Vocational Nurses (TLVN) as providers of CNE for LVNs.

Academic courses must be within the framework of a curriculum that leads to an academic degree in nursing or any academic course relevant to nursing practice. An academic course taken for credit may be used to meet BON continuing competency requirements if a grade of C or better or “pass” on a pass/fail system is achieved. One academic semester hour is equal to 15 contact hours; one academic quarter hour is equal to 10 contact hours. Prerequisite courses, such as mathematics, government, anatomy, physiology, etc., cannot be counted to meet any part of the continuing competency requirements for a nurse.

PLEASE NOTE: Successful completion of either initial or renewal courses such as Advanced Cardiac Life Support, Advanced Trauma Life Support, and Pediatric Advanced Life Support, may be counted for CNE credit, if a specific course meets requirements as listed above and in compliance with Rule 216

Self-Paced/Online CNE Programs are acceptable for CNE credit if approved by one of the credentialing organizations recognized by the BON, and provided they meet any other criteria specified in Rule 216.

Activities Not Acceptable for CNE Credit
The following activities are not acceptable for continuing education credit:

In-service programs that provide specific information about the work setting’s philosophy, procedures;
On-the-job training and equipment demonstration;
Refresher courses designed to update knowledge;
Orientation programs designed to introduce employees to a specific work setting;
Courses focusing on self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, or yoga;
Economic courses for financial gain, e.g., investments, retirement, preparing resumes and techniques for job interviews;
Liberal Art courses in music, art, philosophy, etc., when unrelated to patient/client care; or
Courses for lay people.
Auditing Process
The Board conducts random audits to determine compliance with the continuing competency requirements. Written notice is mailed 90 days prior to the renewal dates for nurses chosen randomly by computer. A nurse audited for continuing competency compliance may not renew his/her license until proof of compliance with the continuing competency requirements is received by the Board. Noncompliance will result in a fine being assessed in addition to renewal fees.

When you renew your license, you will be asked if you have completed the required 20 hours of CNE within the previous two-year period or have a current national nursing certification and have complied with any targeted CNE requirements. If you have not obtained the required CNE or have not attained, maintained or renewed an approved national nursing certification, you cannot renew your license until requirements are met. Proof of compliance with continuing competency requirements must also be submitted to renew a delinquent license, reactivate a license from inactive status, or when petitioning the Board for reinstatement of a revoked or surrendered license. Each nurse is responsible for maintaining his/her own records of continuing competency compliance. In general, records should be kept for two renewal periods (four years).

Evidence of completion of CNE for forensic evidence collection should be maintained indefinitely.

First Time Renewals
A nurse newly licensed in Texas either by examination or by endorsment from another state is exempt from the continuing competency requirement for the first licensure renewal. A nurse’s initial license may be valid for a period ranging from six (6) to 29 months, depending on the licensee’s birth date. Following the first license renewal, the nurse must meet continuing competency requirements for the subsequent biannual renewal periods.

Late Renewals
If you allow your license to expire, you will be required to show proof of completion of 20 hours of CNE, including any targeted CNE requirements, or achievement, maintenance or renewal of an approved national nursing certification within the past two years and completion of any targeted CNE requirements. This applies whether you have been delinquent for one day or longer.

Requirements for Advanced Practice Registered Nurse (APRN)
A licensee who is authorized by the Board to practice as an Advanced Practice Registered Nurse (APRN) is required to obtain 20 contact hours of targeted continuing education in the advanced practice role and population focus area recognized by the Board or attain, maintain, or renew the national certification recognized by the Board as meeting the certification requirement for the APRN role and population focus area of licensure; this will satisfy the requirements to renew both your RN license and APRN authorization. The Board approves four broad categories of APRNs including Clinical Nurse Specialist (CNS), Nurse Midwife (CNM), Nurse Anesthetist (CRNA), and Nurse Practitioner (NP). In addition to the 20 contact hours of continuing education in the advanced practice role and population focus area or renewal of the certification as specified, an APRN who has Prescriptive Authority must also complete at least five additional contact hours in pharmacotherapeutics within the preceding two years. Category I Continuing Medical Education (CME) contact hours will meet requirements for continuing competency for APRNs. Academic courses may be utilized to meet continuing competency requirements if they are targeted to the APRN role and population focus area for which they are licensed.

Inactive/Retired/Volunteer Retired Status
If you are not practicing nursing, you may place your license on inactive status when you receive your license renewal notification. Continuing education is not required as long as you are inactive. Should you wish to reactivate and you have been inactive for less than four years, you must show proof of completion of 20 hours of CNE, or attainment, maintenance, or renewal of a national nursing certification within the two years prior to your request for reactivation. If you have not practiced nursing in any jurisdiction for four or more years, and have not been practicing as a nurse in another state, in addition to the CNE hours, you will be required to complete a nursing refresher or extensive orientation course. The requirements for reactivating a retired license are the same as those for inactive status.

A nurse may request “volunteer retired nurse” authorization [Section 301.261 of the Nursing Practice Act (NPA)]. Rule 216.3(e) requires a nurse who wishes to provide only voluntary charity care to obtain 10 hours of CNE for each two year authorization renewal cycle. An APRN authorized as a volunteer retired RN in a specific APRN role and specialty may renew his/her volunteer retired advanced practice authorization through completion of 20 hours of continuing education targeted to the APRN’s role and specialty.

Many CNE offerings can be located on the internet. You may also contact local colleges, universities, nursing schools, or large hospitals to find out about their schedule of offerings and to be placed on their mailing list. Many nursing journals contain a schedule of offerings. Your professional nursing association is another resource.

Forensic Evidence Collection CNE
Effective September 1, 2005, the NPA was amended, adding the CNE requirement: Forensic Evidence Collection in Continuing Education. This targeted CNE requirement applies to all nurses practicing in emergency department (ED) settings as either their home unit, floating, contracted, or other duties that involve functioning in an ED setting or role. This is a one-time requirement per nurse effective September 1, 2006. There is no expiration date for this requirement under Texas Occupations Code § 301.306 (NPA), thus any nurse working in the ED must comply and maintain the course completion certificate indefinitely.

Frequently asked questions on this targeted CNE may be viewed on the BON web page at http://www.bon.state.tx.us/practice/faq-forensicevidence.html  FAQ.

Please retain this informational material for a quick reference on continuing competency (CC). Feel free to copy it and share it with others. The rule specific to CC for nurses is 22 Tex. Admin. Code Chapter 216. A copy of the CC rule may be downloaded from the BON web site. Additional copies of this brochure may be obtained by downloading it from the Texas Board of Nursing’s web site located at www.bon.texas.gov. You may also send a stamped, self-addressed envelope to the Board’s office, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, Attn: C.N.E.