GENERAL GOVERNMENT CABINET

Board of Nursing

(Amendment)

 

      201 KAR 20:411. Sexual Assault Nurse Examiner Program standards and credential requirements.

 

      RELATES TO: KRS 216B.400(2), (4), 314.011(14), 314.103, 314.142, 314.470, 403.707, 421.500-421.575

      STATUTORY AUTHORITY: KRS 314.131(1), 314.142(1)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 314.131(1) authorizes the Board of Nursing to promulgate administrative regulations as may be necessary to enable it to carry into effect the provisions of KRS Chapter 314. KRS 314.142(1) requires the board to promulgate administrative regulations to create a Sexual Assault Nurse Examiner Program. This administrative regulation establishes the requirements relating to a sexual assault nurse examiner course and the credentials of a sexual assault nurse examiner.

 

      Section 1. Definition. "SANE course" means a formal, organized course of instruction that is designed to prepare a registered nurse to perform forensic evaluation of a sexual assault victim fourteen (14) years of age or older and to promote and preserve the victim's biological, psychological, and social health.

 

      Section 2. SANE Course Approval Application. (1) On the form Application for Initial or Continued SANE Course Approval, the applicant for approval of a SANE course shall submit evidence to the board of completion of the requirements for course approval that consists of the following documentation:

      (a) Position description and qualifications of the nurse administrator of the SANE course;

      (b) Qualifications and description of the faculty;

      (c) Course syllabus;

      (d) Course completion requirements;

      (e) Tentative course presentation dates;

      (f) Records maintenance policy; and

      (g) Copy of certificate of course completion form.

      (2) Nurse administrator of SANE course. A registered nurse, with current, active Kentucky licensure or a multistate licensure privilege pursuant to KRS 314.470, a baccalaureate or higher degree in nursing, and experience in adult and nursing education shall be administratively responsible for assessment, planning, development, implementation, and evaluation of the SANE course.

      (3) Faculty qualifications. The course shall be taught by multidisciplinary faculty with documented expertise in the subject matter. The name, title, and credentials identifying the educational and professional qualifications for each instructor shall be provided as part of the application.

      (4) Course syllabus. The syllabus shall include:

      (a) Course prerequisites, requirements, and fees;

      (b) Course outcomes, which shall provide statements of observable competencies, which if taken as a whole, present a clear description of the entry level

behaviors to be achieved by the learner;

      (c) Unit objectives for an individual, which shall be stated in operational or behavioral terms with supportive content identified;

      (d) Content, which shall be described in detailed outline format with corresponding lesson plans and time frame, and which shall be related to, and consistent with, the unit objectives, and support achievement of expected course outcomes;

      1. The SANE course shall include:

      a. A minimum of forty (40) hours of didactic instruction pursuant to subparagraph 3. of this paragraph; and

      b. The clinical practice experience required by subparagraph 2. of this paragraph.

      2. Clinical practice. The clinical portion of the course[shall be a minimum of sixty (60) hours and] shall include:

      a. Detailed genital and anal inspection, including speculum insertion[a minimum of sixteen (16) speculum examinations], visualization techniques, and use of equipment supervised by a physician, a physician[physician’s] assistant, an advanced practice registered nurse, or a sexual assault nurse examiner until the student is deemed competent by the supervisor[– twenty-six (26) hours];

      b.[Mock] Sexual assault history taking and examination techniques with evaluation supervised by a physician, a physician[physician’s] assistant, an advanced practice registered nurse, or a sexual assault nurse examiner[- ten (10) hours];

      c. Observing live or previously recorded[relevant civil or] criminal trials, meeting with the Commonwealth Attorney or a representative from the Commonwealth Attorney’s office in order to gain an understanding of the trial process including testifying[, or similar legal experience - sixteen (16) hours];

      d. Meeting with the local rape crisis center and a rape crisis center victim advocate in order to gain an understanding of the services provided to victims by rape crisis centers and the role of an advocate[or mental health professional with expertise in the treatment of a sexually assaulted individual – four (4) hours]; and

      e. Meeting with local[members of] law enforcement officers or investigators responsible for investigating reports of rape or sexual assault in order to gain an understanding of the investigative process[- four (4) hours].

      3. The didactic portion of the course shall include instruction consistent with the Sexual Assault Nurse Examiner (SANE) Education Guidelines. It shall also include:

      a. Application of the Kentucky statewide medical protocol relating to the forensic and medical examination of an individual reporting sexual assault pursuant to KRS 216B.400(2); and

      b. The victim’s bill of rights, KRS 421.500 through 421.575[in the following topics related to forensic evaluation of an individual reporting sexual assault:

      a. The role and responsibilities of a sexual assault nurse examiner, health care professional, rape crisis, law enforcement, and judicial system personnel;

      b. Application of the statewide medical protocol relating to the forensic and medical examination of an individual reporting sexual assault pursuant to KRS 216B.400(2);

      c. Principles and techniques of evidence identification, collection, evaluation, preservation, and chain of custody;

      d. Assessment of injuries, including injuries of forensic significance;

      e. Physician consultation and referral;

      f. Medicolegal documentation;

      g. Victim’s bill of rights, KRS 421.500 through 421.575;

      h. Crisis intervention;

      i. Dynamics of sexual assault;

      j. Testifying in court;

      k. Overview of the criminal justice system and related legal issues;

      l. Available community resources including rape crisis centers;

      m. Historical development of the forensic nursing conceptual model;

      n. Cultural diversity and special populations;

      o. Ethics;

      p. Genital anatomy, normal variances, and development stages;

      q. Health care implications and interventions; and

      r. Developing policies and procedures].

      (e) Teaching methods with the activities of both instructor and learner specified in relation to the content outline, and which shall be congruent with stated course objectives and content, and reflect the application of adult learning principles;

      (f) Evaluation methods which shall be clearly defined for evaluating the learner's achievement of course outcomes, and which shall include a process for annual course evaluation by students, providers, faculty, and administration; and

      (g) Instructional or reference materials required which shall be identified.

      (5) Completion requirements. Requirements for successful completion of the SANE course shall be clearly specified and shall include demonstration of clinical competency. A statement of policy regarding a candidate who fails to successfully complete the course shall be included.

 

      Section 3. (1) Contact hour credit for continuing education. The SANE course shall be approved for contact hour credit which may be applied to licensure requirements.

      (2) Approval period. Board approval for a SANE course shall be granted for a four (4) year period.

      (3) Records shall be maintained for a period of five (5) years, including the following:

      (a) Provider name, date, and site of the course; and

      (b) Participant roster, containing at a minimum the name, Social Security number, and license number for each participant.

      (4) A participant shall receive a certificate of completion that documents the following:

      (a) Name of participant;

      (b) Title of course, date, and location;

      (c) Provider’s name; and

      (d) Name and signature of authorized provider representative.

 

      Section 4. Continued Board Approval of a SANE Course. (1) An application for continued approval of a SANE course shall be submitted on the Application for Initial or Continued SANE Course Approval at least three (3) months prior to the end of the current approval period.

      (2) A SANE course syllabus shall be submitted with the Application for Initial or Continued SANE Course Approval.

      (3) Continued approval shall be based on the past approval period performance and compliance with the board standards described in this administrative regulation.

 

      Section 5. The board may deny, revoke, or suspend the approval status of a SANE course for violation of this administrative regulation.

 

      Section 6. Appeal. If a SANE course administrator is dissatisfied with a board decision concerning approval and wishes a review of the decision, the procedure established in this section shall be followed. (1) A written request for the review shall be filed with the board within thirty (30) days after the date of notification of the board action which the SANE course administrator contests.

      (2) The board, or its designee, shall conduct a review in which the SANE course administrator may appear in person and with counsel to present reasons why the board's decision should be set aside or modified.

 

      Section 7. Requirements for Sexual Assault Nurse Examiner (SANE) Credential. (1) The applicant for the SANE credential shall:

      (a) Hold a current, active registered nurse license in Kentucky or a multistate licensure privilege pursuant to KRS 314.470;

      (b) Have completed a board approved SANE educational course or a comparable course;

      1. The board or its designee shall evaluate the applicant’s course to determine its course comparability; and

      2. The board or its designee shall advise an applicant if the course is not comparable and specify what additional components shall be completed to allow the applicant to be credentialed;

      (c)[If the applicant has completed a comparable course, complete that portion of a SANE course of at least five (5) hours which shall include those topics specified in Section 2(4)(d)3a, b, c, g, k, and l of this administrative regulation if not included in the comparable course completed by the applicant.

      1. The Office of the Attorney General may offer in cooperation with a board approved continuing education provider a course of at least five (5) hours.

      2. The course shall include those topics specified in this paragraph;

      (d)] Complete the Sexual Assault Nurse Examiner Application for Credential;

      (d)[(e)] Pay the fee established in 201 KAR 20:240;

      (e)[(f)] Provide a completed Federal Bureau of Investigation (FBI) Applicant Fingerprint Card and pay the fee required by the FBI that is within six (6) months of the date of the application;

      (f)[(g)] Provide a report from the Kentucky Administrative Office of the Courts, CourtNet Disposition System that is within six (6) months of the date of the application;

      (g)[(h)] Provide a certified copy of the court record of any misdemeanor or felony conviction as required by 201 KAR 20:370, Section 1(3); and

      (h)[(i)] Provide a letter of explanation that addresses each conviction, if applicable.

      (2) Upon completion of the application process, the board shall issue the SANE credential for a period ending October 31.

      (3) An applicant shall not be credentialed until a report is received from the FBI pursuant to the request submitted under subsection (1)(e)[(1)(f)] of this section and any conviction is addressed by the board.

 

      Section 8. Renewal. (1) To renew the SANE credential for the next period, each sexual assault nurse examiner shall complete at least five (5) contact hours of continuing education related to the role of the sexual assault nurse examiner or forensic nursing within each continuing education earning period. A provider of a board approved SANE course may offer continuing education related to the role of the sexual assault nurse examiner.

      (2) Upon completion of the required continuing education, completion of the SANE Renewal Application or Annual Credential Renewal Application: SANE with RN Compact License (Not Kentucky), as applicable, and payment of the fee established in 201 KAR 20:240, the SANE credential shall be renewed at the same time the registered nurse license is renewed.

      (3) The five (5) contact hours may count toward the required contact hours of continuing education for renewal of the registered nurse license.

      (4) Failure to meet the five (5) contact hour continuing education requirement shall cause the SANE credential to lapse.

 

      Section 9. Reinstatement. (1) If the SANE credential has lapsed for a period of less than four (4) consecutive registered nurse licensure periods, and the individual wants the credential reinstated, the individual shall apply to reinstate the credential by:

      (a) Submitting the Sexual Assault Nurse Examiner Application for Credential;

      (b) Paying the fee established in 201 KAR 20:240;

      (c) Submitting evidence of earning the continuing education requirement referenced in Section 8(1) of this administrative regulation for the number of registered nurse licensure periods since the SANE credential lapsed;

      (d) Providing a completed Federal Bureau of Investigation (FBI) Applicant Fingerprint Card and paying the fee required by the FBI that is within six (6) months of the date of the application;

      (e) Providing a report from the Kentucky Administrative Office of the Courts, CourtNet Disposition System that is within six (6) months of the date of the application;

      (f) Providing a certified copy of the court record of any misdemeanor or felony conviction as required by 201 KAR 20:370, Section 1(3); and

      (g) Providing a letter of explanation that addresses each conviction, if applicable.

      (2) An applicant shall not be credentialed until a report is received from the FBI pursuant to the request submitted under subsection (1)(d) of this section and any conviction is addressed by the board.

      (3) If the SANE credential has lapsed for more than four (4) consecutive licensure periods, the nurse shall complete a SANE course prior to reinstatement.

 

      Section 10. The board shall obtain input from the Sexual Assault Response Team Advisory Committee concerning any proposed amendment to this administrative regulation as follows:

      (1) The board shall send a draft copy of any proposed amendment to the co-chairs of the Sexual Assault Response Team Advisory Committee prior to adoption by the board;

      (2) The board shall request that comments on the proposed amendment be forwarded to the board’s designated staff person within ninety (90) days; and

      (3) At the conclusion of that time period or upon receipt of comments, whichever is sooner, the board, at its next regularly-scheduled meeting, shall consider the comments.

 

      Section 11. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) "Application for Initial or Continued SANE Course Approval", 6/2014, Kentucky Board of Nursing;

      (b) "Sexual Assault Nurse Examiner Application for Credential", 6/2014, Kentucky Board of Nursing;

      (c) "SANE Renewal Application", 6/2012, Kentucky Board of Nursing;[and]

      (d) "Annual Credential Renewal Application: SANE with RN Compact License (Not Kentucky)", 6/2014, Kentucky Board of Nursing; and

      (e) "Sexual Assault Nurse Examiner (SANE) Education Guidelines", 2015 Edition, International Association of Forensic Nurses.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky 40222-5172, Monday through Friday, 8:30 a.m. to 4:30 p.m.

 

GAIL WISE, President

      APPROVED BY AGENCY: December 11, 2015

      FILED WITH LRC: January 7, 2016 at 11 a.m.

      PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall be held on February 22, 2016 at 10:00 a.m. (EST) in the office of the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky. Individuals interested in being heard at this hearing shall notify this agency in writing five workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted until end of day, (11:59 p.m.), February 29, 2016. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.

      CONTACT PERSON: Nathan Goldman, General Counsel, Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky 40222, phone (502) 429-3309, fax (502) 564-4251, email nathan.goldman@ky.gov.

 

REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT

 

Contact Person: Nathan Goldman

      (1) Provide a brief summary of:

      (a) What this administrative regulation does: It sets the standards for Sexual Assault Nurse Examiner (SANE) programs and credentials.

      (b) The necessity of this administrative regulation: It is required by statute.

      (c) How this administrative regulation conforms to the content of the authorizing statutes: By setting standards.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: By setting standards.

      (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:

      (a) How the amendment will change this existing administrative regulation: The content of the required SANE course has been changed to conform to current needs and modern standards.

      (b) The necessity of the amendment to this administrative regulation: The changes were needed to meet new circumstances and to improve the course content.

      (c) How the amendment conforms to the content of the authorizing statutes: The Board is authorized to make these changes.

      (d) How the amendment will assist in the effective administration of the statutes: By updating the course.

      (3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation: future Sexual Assault Nurse Examiners, number unknown.

      (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:

      (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment: The applicants will take the new course.

      (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There should be little or no change in the cost.

      (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): They will be in compliance with the regulation.

      (5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:

      (a) Initially: There is no additional cost.

      (b) On a continuing basis: There is no additional cost.

      (6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: Agency funds.

      (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new or by the change if it is an amendment: No increase is needed.

      (8) State whether or not this administrative regulation established any fees or directly or indirectly increased any fees: It does not.

      (9) TIERING: Is tiering applied? Tiering was not applied as the changes apply to all equally.

 

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

 

      (1) What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? The Kentucky Board of Nursing.

      (2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation. KRS 314.131.

      (3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.

      (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? None.

      (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? None.

      (c) How much will it cost to administer this program for the first year? No additional cost.

      (d) How much will it cost to administer this program for subsequent years? No additional cost.

      Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.

      Revenues (+/-):

      Expenditures (+/-):

      Other Explanation: