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TITLE 22EXAMINING BOARDS
PART 11TEXAS BOARD OF NURSING
CHAPTER 214VOCATIONAL NURSING EDUCATION
RULE §214.10Clinical Learning Experiences

(a) Faculty shall be responsible and accountable for managing clinical learning experiences and observation experiences of students.

(b) Faculty shall develop criteria for the selection of affiliating agencies/clinical facilities or clinical practice settings which address safety and the need for students to achieve the program outcomes (goals) and course objectives through the practice of nursing care or observation experiences. Consideration of selection of a clinical site shall include:

  (1) client census in sufficient numbers to meet the clinical objectives/outcomes of the program/courses; and

  (2) evidence of collaborative arrangements for scheduling clinical rotations with those facilities that support multiple nursing programs.

(c) Faculty shall select and evaluate affiliating agencies/clinical facilities or clinical practice settings which provide students with opportunities to achieve the goals of the program.

  (1) Written agreements between the program and the affiliating agencies shall be in place before clinical learning experiences begin and shall specify the responsibilities of the program to the agency and the responsibilities of the agency to the program.

  (2) Agreements shall be reviewed periodically and include provisions for adequate notice of termination and a withdrawal of participation clause indicating a minimum period of time to be given for notice of such withdrawal.

  (3) Affiliation agreements are optional for those clinical experiences which are observation only.

(d) The faculty member shall be responsible for the supervision of students in clinical learning experiences and scheduling of student time and clinical rotations.

  (1) Selected clinical learning experiences will remain unchanged unless a client's condition demands reassignment.

  (2) Reassignment must be approved with prior consent of faculty.

  (3) The student's daily client assignment shall be made in accordance with clinical objectives/outcomes and learning needs of the students.

  (4) The total number of daily assignments shall not exceed five (5) clients.

(e) Clinical learning experiences shall include the administration of medications, health promotion and preventive aspects, nursing care of persons across the life span with acute and chronic illnesses, and rehabilitative care.

  (1) Students shall participate in instructor-supervised patient teaching.

  (2) Students shall also be provided opportunities for participation in clinical conferences/debriefing.

  (3) When a high-fidelity simulation laboratory is used to meet clinical learning objectives, the faculty shall be trained in planning and guiding the experience and in debriefing and evaluating students. Programs may use up to 50% simulation activities in each clinical course.

(f) Faculty shall be responsible for student clinical practice evaluations. Clinical evaluation tools shall be correlated with level and/or course objectives and shall include a minimum of a formative and a summative evaluation for each clinical in the curriculum.

(g) The following ratios only apply to clinical learning experiences involving direct patient care:

  (1) When a faculty member is the only person officially responsible for a clinical group, the group shall total no more than ten (10) students.

  (2) Patient safety shall be a priority and may mandate lower ratios, as appropriate.

  (3) Clinical learning experiences shall be designed for students to meet clinical objectives in all clinical activities (skills and simulation laboratories and hands-on care).

  (4) The faculty member shall supervise an assigned group in one (1) facility at a time, unless some portion or all of the clinical group are assigned to observation experiences or to preceptors in additional settings.

  (5) Direct faculty supervision is not required for an observation experience.

(h) Clinical preceptors may be used to enhance clinical learning experiences after a student has received clinical and didactic instruction in all basic areas of nursing.

  (1) In courses which use clinical preceptors for a portion of clinical learning experiences, faculty shall have no more than twelve (12) students in a clinical group.

  (2) In a course which uses clinical preceptors as the sole method of student instruction and supervision in clinical settings, faculty shall coordinate the preceptorship for no more than twenty-four (24) students.

  (3) The preceptor may supervise student clinical learning experiences without the physical presence of the faculty member in the affiliating agency or clinical practice setting.

  (4) The preceptor shall be responsible for the clinical learning experiences of no more than two (2) students at a time.

(i) When faculty use clinical preceptors to enhance clinical learning experiences and to assist faculty in the clinical supervision of students, the following applies:

  (1) Faculty shall develop written criteria for the selection of clinical preceptors.

  (2) When clinical preceptors are used, written agreements between the vocational nursing education program, clinical preceptor, and the affiliating agency, when applicable, shall delineate the functions and responsibilities of the parties involved.

  (3) Faculty shall be readily available to students and clinical preceptors during clinical learning experiences.

  (4) The designated faculty member shall meet periodically with the clinical preceptors and student(s) for the purpose of monitoring and evaluating learning experiences.

  (5) Written clinical objectives shall be shared with the clinical preceptors prior to or concurrent with the experience. Written clinical objectives shall be shared with the clinical preceptors prior to or concurrent with the experience.

  (6) Clinical preceptors shall have the following qualifications:

    (A) competence in designated areas of practice;

    (B) philosophy of health care congruent with that of the nursing program; and

    (C) current licensure or privilege to practice as a licensed nurse in the State of Texas.

(j) During clinical learning experiences, programs shall not permit utilization of students for health care facility staffing.

(k) The affiliating agency shall:

  (1) provide clinical facilities for student experiences;

  (2) provide space for conducting clinical conferences for use by the school if classrooms are located elsewhere;

  (3) provide assistance with clinical supervision of students, including preceptorships, by mutual agreement between the affiliating agency and governing entity; and

  (4) have no authority to dismiss faculty or students. Should the affiliating agency wish to recommend dismissal of faculty or students, such recommendation(s) shall be in writing.


Source Note: The provisions of this §214.10 adopted to be effective February 13, 2005, 30 TexReg 545; amended to be effective May 2, 2007, 32 TexReg 2361; amended to be effective October 19, 2008, 33 TexReg 8501; amended to be effective October 21, 2012, 37 TexReg 8294; amended to be effective August 9, 2018, 43 TexReg 5072

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