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Nursing Care Quality Assurance Commission (NCQAC) Workshop Meeting Agenda

July 7, 2022 8:00 AM- 5:00 PM

LOCATION: Greater Tacoma Convention Center 1500 Commerce St, Tacoma, WA 98402, Room 316,

Registration Link:

https://us02web.zoom.us/meeting/register/tZMrde6spz8uE9fQU2imKitpdJ4l0F-gznXh MASKS REQUIRED FOR IN PERSON ATTENDEES

Commission Members: Laurie Soine PhD, ARNP, Chair Yvonne Strader, RN, BSN, BSPA, MHA, Chair

Tiffany Randich, LPN, Vice-Chair Helen Myrick, Public Member, Vice-Chair Adam Canary, LPN, Secretary/Treasurer Jonathan Alvarado ARNP, CRNA Quiana Childress, GCertHealthSc, BS, LPN Mabel Ezeonwu PhD, RN Ella B. Guilford, MSN, M.Ed., BSN, RN Dawn Morrell, RN, BSN, CCRN MaiKia Moua, RN, BSN, MPH Sharon Ness, RN Kimberly Tucker PhD, RN, CNE

Assistant Attorney General: Sierra McWilliams, Assistant Attorney General Staff: Paula R. Meyer, MSN, RN, FRE, Executive Director Chris Archuleta, Director, Operations

Gerianne Babbo, Ed.D, MN, RN, Director, Education Shad Bell, Assistant Director, Operations Amber Bielaski, MPH, Assistant Director, Licensing Debbie Carlson, MSN, RN, CPM, Director, Practice

Mary Sue Gorski, PhD, RN, Director, Advanced Practice, Research and Policy

Karl Hoehn, JD, FRE, Assistant Director, Discipline – Legal Grant Hulteen, Assistant Director, Discipline – Investigations and

WHPS Bethany Mauden, Administrative Assistant Kathy Moisio, PhD, RN, Director, Nursing Assistant Programs

Catherine Woodard, Director, Discipline and WHPS

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If you have questions regarding the agenda, please call the Nursing Care Quality Assurance Commission (NCQAC) office at 360-236-4713. Agenda items may be presented in a different order. If you wish to attend the meeting for a single item, contact our office at the number listed above and request a specific time scheduled for that item. If you have limited English language expertise call 360-236-4713 before July 1, 2022.

This meeting is accessible to persons with disabilities. Special aids and services can be made available upon advance request. Advance request for special aids and services must be made no later than July 1, 2022. If you need assistance with special needs and services, please leave a message with your request at 1-800-525-0127 or, if calling from outside Washington State, call 360-236-4052. TDD may also be accessed by calling the TDD relay service at 711. If you need assistance due to a speech disability, Speech-to-Speech provides human voicers for people with difficulty being understood. The Washington State Speech to Speech toll free access number is 1-877-833-6341.

This meeting will be digitally recorded to assist in the production of accurate minutes. All recordings are public record. The minutes of this meeting will be posted on our website after they have been approved at the September 9, 2022, NCQAC meeting. For a copy of the actual recording, please contact the Public Disclosure Records Center (PDRC) at PDRC@doh.wa.gov.

If attending remotely, please mute your connection in order to minimize background noise during the meeting.

Smoking and vaping are prohibited at this meeting.

I. 8:00 AM Opening – Laurie Soine, Chair – DISCUSSION/ACTION

II. Call to Order

A. Introductions – Kaitlyn Ward, NCSBN B. Order of the Agenda

III. 8:45 AM – 10:30 AM NCQAC’s Vision - DISCUSSION

The NCQAC works with facilitator, Katherine Boyd, to begin to vision the near future of their work. Ms. Meyer, the executive director, is retiring in the next year. The NCQAC discusses characteristics of a new executive director to assist the search committee in its work to find candidates for the position. 10:30 AM – 10:45 AM BREAK 10:45 AM – 12 Noon NCQAC’s Vision, continued 12 Noon – 1:00 PM LUNCH

IV. 1:00 PM - 2:30 PM Strategic Plan – DISCUSSION A. Academic Progression – LPN B. Nursing Assistants C. Washington Health Professional Services (WHPS) D. Communications

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2:30 PM – 2:45 PM BREAK

V. 2:45 PM – 3:30 PM Burning Issues – DISCUSSION The NCQAC discusses current issues in nursing and their regulatory impact. The NCQAC may further discuss if these issues are priority issues, resources necessary to address the issues and if the issues would take the place of current strategic initiatives.

VI. 3:30 PM – 4:00 PM Subcommittees work and roles – Sierra McWilliams – DISCUSSION The subcommittees of the NCQAC gather and analyze information and present recommendations to the full NCQAC for action. The subcommittees do not have decision making authority and therefore act on consensus to achieve the recommendations. Ms. McWilliams presents the roles of the subcommittees, their limits and how they work to bring recommendations to the NCQAC.

VII. 4:00 PM – 5:00 PM Operational Updates – DISCUSSION A. Laptops

The NCQAC issues laptop computers to all NCQAC members and pro tem members who work on disciplinary cases. Mr. Archuleta updates the members on necessary actions to keep their lap top computers current with security and access.

B. Emails C. Board Pay D. TEMS & Travel

VIII. 5:00 PM Closing

IX. 5:30 PM – 7:00 PM NCQAC and pro tem member recognition – room 315 At the end of each fiscal year, the NCQAC recognizes members completing their second term and pro tem members completing their fourth term. For the past two years, these members received their service awards, but members were not able to attend the meetings in person. The NCQAC and pro tem members who were not able to receive their service awards in person for 2020 and 2021 are invited to dinner with the current NCQAC and pro tem members.

X. 7:30 PM – 9:00 PM Public Rules Workshop for Temporary Practice Permits – Dawn Morrell, Amber Zawislak – DISCUSSION – room 316 The current Temporary Practice Permit rules are antiquated. The Licensing Subcommittee leads discussion on the current rules, current practices, and potential changes. The commission is providing an in-person and virtual opportunity for input from the public. This is the first of three public rules workshops.

Academic Progression - Updated May 2022 Goals: Evaluate the demand for licensed practical nurses and registered nurses in the state. Continue the discussion of the appropriate degree preparation for PNs.

Objectives Responsibility Resource projections (time, staff, money, etc.)

Deadlines Progress

1) Identify barriers and strengths identified by employer organizations of current models for consistent academic preparation for LPNs

Mary Sue Gorski, Jessilyn Dagum

Expand interested party discussions statewide and nationally to include broader range of employer organizations.

Expanded employer groups to convene May/June 2022

NCSBN leadership presentation held on April 19, 2021; LPN to RN Educators and LPN Employers focus groups May 2021; Convene representatives of interested states and provinces May/June 2021. October 2021 Completed LPN educator group addition LPN LTC employer Commission members

2) Develop a report using workforce data, stakeholder group input, and national collaboration.

Paula Meyer, Mary Sue Gorski, Gerianne Babbo

Pull together NCSBN input, workforce data analysis, and stakeholder input to develop a full report of progress to date

September 2022 Data gathered focus group summaries reviewed

3) Explore outcomes of existing LPN education models and expand employer input.

Paula Meyer, Mary Sue Gorski, Gerianne Babbo

Compare education outcomes identified in the Annual Education Program report across current LPN programs over four years 2017-2022 to explore trends

February 2022 through February 2024

Trend data compiled and grid of LPN programs completed. Preliminary outcomes data by June 2022.

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Communications – Updated June 2022 NCQAC Communications has identified three overarching goals, and the objectives listed in the table below directly support these goals. Objectives will be met through specific tasks outlined in our separate workplan. Year One of the biennium will be spent doing the work to achieve these goals, and year two will be spent evaluating our success/progress, as well as finalizing any work that supports the goals. Evaluation methods will be determined for each objective prior to Year Two. Goals:

• Provide exceptional communications internally and externally. • Develop and implement a strong and meaningful identity for NCQAC, to include mission, vision statement, and logo. • Ensure accessibility and inclusivity in all aspects of communication with the public and our stakeholders.

High Level Objectives Responsibility Resource projections (time, staff,

money, etc.) Deadlines Progress

Construct a new, streamlined website  

NCQAC Communications, Communications Task Force 

NCQAC Communications/WaTech staff, unit input 

Lead: Shad

Late winter 2022 

New website in development mode, usability study done. Waiting for findings and recommendations.

Revamp SharePoint for internal use by staff to include a landing page for information sharing 

NCQAC Communications 

NCQAC Communications/DOH IT staff, unit input  Lead: Shad

Spring 2022 

Waiting on DOH for next phase.

Develop and implement style guide and publication standards   

NCQAC Communications  

NCQAC Communications, leadership input  Lead: Amy

Spring 2022, most work to occur in tandem with website build 

To be completed in tandem with website build 

Develop and ensure that Language Access Plan requirements are met for

NCQAC Communications,

NCQAC Communications, leadership input  Lead: Laura

Fall 2022  DOH revamping process. Working with them to make

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publications that have accessibility requirements.   

Communications Task Force 

sure NCQAC is in compliance.

Develop and implement agency templates for a variety of purposes, such as GovDelivery PowerPoint, MS Word, Excel, Teams/Zoom meetings, etc.  

NCQAC Communications  

NCQAC Communications, leadership input  Lead: Amy

Spring 2022 

To be completed once identity is defined, which will happen in initial phase of website build 

Complete the communications visions submitted by each division.   

NCQAC Communications, Communications Task Force 

NCQAC Communications, leadership input  All

Spring 2022 

To be completed prior to July 1, 2022 – some work to be completed in tandem with website build, remainder post web launch 

Determine evaluation methods for objectives supporting goals.  

NCQAC Communications, Communications Task Force 

NCQAC Communications, leadership buyoff   Lead: Jessilyn

Summer 2022 

Transition project from Rebecca to Jessilyn

Evaluation Period   NCQAC Communications, Communications Task Force 

NCQAC Communications, leadership buyoff  All, Jessilyn

Spring 2023 

To be completed prior to July 1, 2023 

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Nursing Assistants – Established August 2021 (for 2021-2023) – UPDATED JUNE 14, 2022 Goal: Streamline nursing assistant training and testing processes, expand capacity through use of technology, and support progression into nursing as evidenced by the following outcomes:

• New training program applications consistently reviewed in 7-10 days; • Statewide first-time test-taker pass rates (average, annualized) improved to 75% for 2023 and to 80% by 2024; • Testing capacity increases to 22,932 test-takers per year (119% increase) through use of a virtual approach; • Quantitative ratings of >3.7 on a 5-point scale on electronic surveys regarding the new curriculum by training programs and

students at 6, 12, and 18 months post-implementation; and • The LPN Registered Apprenticeship Program (LPN RAP):

o Enrolls 45 students (15 at each pilot site) in three different geographical areas in 2023; and o The completion rate for students in the pilot is >85%.

Objectives Staff Responsibility Resource projections (time, staff, money, etc.)

Deadlines Progress

1—Pilot, evaluate, and refine the new nursing assistant training curriculum.

Kathy Moisio

Porsche Everson is contracted to support pilot preparation; members of the LTC Workforce Development Steering Committee and Workgroups are eager to pilot. NAPAP to review and make decisions re feedback/refinements.

• To be completed in SPRING 2022

• Four programs are piloting; all will finish by late June and provide evaluation/ feedback

2—Establish a steering committee, workgroup, and workplan for the LPN Apprenticeship Pathway; hire a Nurse Consultant to lead the LPN Apprenticeship Pathway work; and host a statewide LTC Summit to gain statewide stakeholder input on developing the pathway.

Kathy Moisio with new hire taking over the leadership role once hired

Dr. Mary Baroni has been instrumental in making connections to support the foundational work for a successful launch.

• To be completed in FALL 2021

• Completed Timely

3—Conduct public rules meetings to gather input on nursing assistant rules revisions that address curriculum and testing changes and other needed updates.

Bonnie King and Kathy Moisio

Online meetings will be used maximally to provide efficiencies of time and cost and maximize stakeholder participation.

• To be completed in SPRING to SUMMER

• Preparation in progress; dates are still TBD

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Objectives Staff Responsibility Resource projections (time, staff, money, etc.)

Deadlines Progress

4—Testing plan or contract in place for 2022, including timelines for phasing in revisions recommended from the LTC Workforce Development Steering Committee and Testing Workgroup (virtual skills testing within training programs at point of graduation, new evaluation approach, etc.).

Kathy Moisio in coordination with Contracts Unit, Paula Meyer, possibly legal staff, and the other agencies involved: DSHS and DOH/HSQA

Completion represents a challenge with other activities, but must be finished by 12/31/2 to avoid interruptions to testing. NAPAP considers, makes decisions re: final plans.

• To be ready for implementation JAN 1, 2022.

• Recommendations are included in the contract on a phase-in schedule (2022-2023)

• Contract completed/signed timely

5—Develop nursing assistant curriculum into an online-capable format

Kathy Moisio

Legislative allocations are available to support this development as a means of assuring smooth progression from NAC toward LPN as part of the LPN Apprenticeship Pathway. Also, members from the LTC Workforce Development Steering Committee and Workgroups have expressed interest in participating. NAPAP participates and/or reviews, makes decisions re: final plans.

• To be completed in SPRING 2022

• Work is in progress and slated for completion by June 30, 2022.

6—Finalize nursing assistant rules revisions, incorporating stakeholder input.

• Bonnie King with support from Kathy Moisio and others (legal staff, DOH/ HSQA staff, etc.)

NAPAP reviews, makes decisions re: final version.

• To be completed after public meetings held (see item #3)—Expected SUMMER-FALL 2022

• Work to finalize a draft and identify public meeting dates in progress

7—Develop the communication/roll-out plan regarding curriculum, testing, and rules changes for launch in September 2022.

Kathy Moisio with support from Communications staff

Online meetings will be used maximally to provide efficiencies of time and cost and maximize stakeholder participation.

• To be completed in SUMMER-FALL 2022

• First webinar for programs held in Nov. 2022 (providing preliminary information)

• Roll-out expected to

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Objectives Staff Responsibility Resource projections (time, staff, money, etc.)

Deadlines Progress

begin in late July 2022.

8—Continue LPN Apprenticeship Pathway development with steering committee and workgroup members according to timelines established in the workplan.

Marlin Galiano

• Legislative allocations cover the FTE for the new Nursing Consultant and for the costs of planning activities, contracts, etc.

• To continue through SPRING 2022 to JUNE 30, 2022 deadline

• Work is in progress and will phase into implementation July 1 onward.

9—Participate actively in legislative session in relation to the Decision Package (DP), re-introducing HB 1124 (glucometer testing by nursing assistants), and support for LPN Apprenticeship Pilot funding.

Paula Meyer and others as directed

• There is stakeholder support for re-introducing HB 1124. Senator Conway sponsored the LPN Apprenticeship Pathway planning and has expressed interest in supporting the piloting; federal grant submission may lead to funding to support piloting at one site.

• To occur in WINTER 2022

• Decision Package Passed

• HB 1124 Passed • Federal Grant

Passed (Yakima Valley College)

• These Milestones Completed Timely

10—Implement the communication/roll-out plan for curriculum/testing/rules revisions

Kathy Moisio, Stephanie Bryant, New Staff if Decision Package approved

NAPAP members and members of the LTC Workforce Development Curriculum and Testing Workgroups may have interest in participating; online presentations will be used maximally for time/cost efficiency and ease of participation by stakeholders.

• To begin in SUMMER 2022

• Roll-Out slated to begin in late July 2022

11—Begin LPN Apprenticeship Pathway approval processes (NCQAC and LNI)

New Nursing Consultant (TBD)

NPAP and LNI will provide review and decisions; NCQAC and LNI staff may also provide technical assistance as needed; steering committee and workgroup support revision work as needed.

• To begin in after plan is developed – deadline for planning is JUNE 30, 2022

• Development of a plan and timelines for work July 1-onward are in progress

12—Launch new nursing assistant curriculum and testing revisions with corresponding rules effective; Provide ongoing support, evaluation, continuous quality improvement

Kathy Moisio, Stephanie Bryant, New Staff

Contracted testing vendor or implementing entities provide direct testing services with staff overseeing performance; stakeholder feedback and NPAP

• SEPTEMBER 2022 --Onward

• Curriculum is on-target to be available to programs who want to launch

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Objectives Staff Responsibility Resource projections (time, staff, money, etc.)

Deadlines Progress

if Decision Package approved

review and decisions provide support for continuous quality improvement.

voluntarily by September 2022

• A phase-in process from Sept. 2022 to Sept 2023 is expected with a goal of all programs using as of Sept. 2023

13—Launch LPN Apprenticeship Pathway pilot in 1-3 sites (in accordance with funding, if received)

New Nursing Consultant

NPAP and LNI will provide review and decisions; NCQAC and LNI staff may also provide technical assistance as needed.

• GOAL: Academic Year 2023-2024

•

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WHPS Updated June 21, 2022 Goal: Increase the number of nurses enrolled in the Washington Health Professional Services (WHPS) program voluntarily and in lieu of discipline by 25% every two years through education, early identification, referral to treatment, and advocacy. NCQAC and WHPS staff do this by promoting the just culture model and employment retention.

Baseline from 2019: 300 nurses Projected 2021: 375 nurses Projected 2023: 469 nurses Projected 2025: 587 nurses

Will require an additional case management team for each 100 nurses added to the program.

Objectives Responsibility Resource projections Deadlines Progress Provide educational resources, including but not limited to lectures, brochures, web sites, publications/articles, newsletters, display booths, on-site consultations… (Required CEU? see Florida Statute: 64B9-5.014:3) https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B9-5

Dr. Furman WHPS staff NCQAC Communication task force

1. Publicly available outreach materials identified (e.g. NCSBN resources) and catalogued – December 2021 2. WHPS materials reviewed and updated – December 2021 3. WHPS website reviewed and updated – May 2022

Continue to work with C4PA to update materials and explore the use of social media. Investigate cost of contracting out to develop interested party training courses. Blog posted June 2022.

Host a SUD-related educational conference every two years.

Dr. Furman to coordinate 2023 SUD conference with Amy Sharer and Shad Bell.

Begin conference prep December 2022

Next conference Fall 2023

Develop education courses, modules and toolkits for interested party use.

Dr. Furman WHPS staff

Work with Communications Task Force and C4PA to

1. Work with Communications Task Force to

Blog posted beginning June 2022.

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develop resources to include on the new NCQAC/WHPS web site.

develop website and external resources. 2. Consider establishing an interested party group to help guide resource development. 3. Explore use of social media to promote WHPS services.

Support professional workforce reentry and increase employment retention by 10% through education and cooperative approach to worksite monitoring, prioritizing patient safety.

Dr. Furman WHPS staff

N/A 10% annual goal, reportable in March of each year beginning in 2022. Found in performance measures.

Dr. Furman has approached WSNA, SEIU, and UFCW to gauge current interest. Ongoing effort.

Reduce the number of nurses who withdraw from monitoring due to financial limitations by 50%.

Dr. Furman – WHPS Liaison

Explore options for making scholarship funds available for nurses in financial straits.

On hold during pandemic. Goal to reach 50% reduction in withdraws by November 2024.

Dr. Furman negotiating with SEIU and WSNA to explore scholarship opportunities.

Develop a Substance Use Disorder Review Panel (SUDRP) as an organization-based intervention tool for nurses. This will take the place of the Substance Use and Abuse Team and will connect nurses in WHPS with commission

Discipline Subcommittee; Assistant Director, Discipline – WHPS (lead on project); Assistant Director, Discipline – Legal; assigned staff attorney;

Regular meetings to develop and prepare for SUDRP implementation. SUD training for commission members who intend to participate on SUDRP. Five

Implement full SUDRP business model on July 1, 2022. Annual updates at July

Training for SUDRP commission members nearly completed.

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members (both disciplinary and for achieving milestones). The intent is to reduce noncompliance and recidivism rates and increase program completion rates.

WHPS operations manager; compliance officer.

commission members identified.

commission meetings beginning 2023.

Contracts to WHPS nurses now reflect SUDRP language. Program ready to launch July 1st.

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July 2022

Mary Sue Gorski, RN, PhD

Director, Research

Washington State Nursing Care Quality Assurance Commission

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Decline in number of LPN graduates Scope of practice questions Increasing diversity and inclusion in nursing workforce Begin discussion of LPN education and practice (Strategic Plan 2019)

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Literature review, no strong data to provide insights into the concerns about scope of practice and variability of education

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EOs from Boards of Nursing across US and Canada invited Four webinar series LPN scope of practice and education challenges (March 24 2020 through Oct 6 2020) 19 States and 6 Canadian Provinces

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Curriculum grid with representative LPN programs across states and provinces showing broad variation in program type and clinical requirements

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Educators LPN programs Employer groups LPN to RN educators

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What is the most helpful data to address identified issues?What factors negatively or positively affect program outcomes? How do academic progression pathways affect LPN workforce?

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Total graduates by selected academic year; 2016.2017 (264) 2019.2020 (214) 2020.2021 (240)

8 of 9 schools are in Western Washington, 2 rural, 2 suburban, and the remaining urban. 2 programs provide associate degrees and the remaining provide a

certificateWide variability of prerequisite credits required(Nursing Commission Annual Reports 2016-2021)

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9,489 LPNs with an active license practicing in Washington.

Highest number per capita along the I-5 corridor

49 years of age; 13.2% were male.

Under the age of 50 were more likely to be a race other than White andwere more likely to be Hispanic/Latino ethnicity than older LPNs.

Fewer LPNs per capita worked in Washington’s rural areas (100 per 100,000population) compared with urban areas (113 LPNs per 100,000 population).

40% reported working in long term care or hospice

(Stubbs & Skillman, 2020).

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More likely to have been licensed more than 10-years when compared to RNs and ARNPs

Actively practicing in WA (90.9%).

Employment setting; 33% Nursing Home/Extended Care/Assisted Living, 20% Other, 15% Ambulatory Care

Employment Specialty; 24.5% Geriatric/Gerontology, 8.5% Other Clinical Specialty, similar to the 26.6% nationally for geriatric/gerontology (NCSBN/Forum, 2020)

(Moulton & Flores, 2022)

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2019 (Stubbs & Skillman)

2021 (Moulton & Flores)

2020 NCSBN Forum

40% long term care or hospice

33% Nursing Home/Extended Care/Assisted Living,15% Ambulatory Care

28.9% Gerontology 24.5% Geriatric/Gerontology

26.6% nationally for geriatric/gerontology (NCSBN/Forum, 2020)

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WA LPN curricula across programs compared with; NCLEX pass rates Graduation numbers NCSBN national practice analysis

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LPN to RN academic progression direct transfer agreement LPN apprenticeship model Compare curricula and program outcomes over time for the Washington State LPN programs

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Gather, compile, and analyze information on LPN program curricula and program outcomes annually. Continue this important discussion of the optimum scope of practice and education preparation for LPNs in the WA state workforce

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Mary Sue Gorski(360) 915-3334marysue.gorski@doh.wa.gov

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PREPROPOSAL STATEMENT

OF INQUIRY

CODE REVISER USE ONLY

CR-101 (October 2017) (Implements RCW 34.05.310)

Do NOT use for expedited rule making Agency: Department of Health- Nursing Care Quality Assurance Commission Subject of possible rule making: WAC 246-840-095 Temporary Practice Permits. The Nursing Care Quality Assurance Commission (commission) is considering amending the length of time a temporary practice permit is effective and updating criteria to issue a temporary practice permit.

Statutes authorizing the agency to adopt rules on this subject: RCW 18.130.064, RCW 18.130.075, RCW 18.79.110, RCW 18.79.180

Reasons why rules on this subject may be needed and what they might accomplish: Nurse applicants with an out of state address, including registered nurses, advanced registered nurse practitioners, and licensed practical nurses, are required under RCW 18.130.064 to complete an FBI criminal background check prior to licensure. In 2009, the commission and the Department of Health (department) began processing FBI fingerprint background checks. The process took several months. To remedy this delay in licensure, the commission's current practice is to issue a temporary practice permit after the applicant meets all other licensure requirements aside from receipt of the FBI fingerprint background check, allowing the nurse to begin working in Washington State. Under WAC 246-840-095, the temporary practice permit is valid for 180 days or until the commission issues a permanent Washington State license to the nurse. WAC 246-840-095 also allows for an additional 180-day extension of the temporary practice permit if the department has not received the fingerprint results during the initial 180-day period. The commission intends to engage in rulemaking to decrease the length of time a temporary practice permit is effective and align the rules with the current commission practice to issue a temporary practice permit. Identify other federal and state agencies that regulate this subject and the process coordinating the rule with these agencies: None

Process for developing new rule (check all that apply): Negotiated rule making Pilot rule making Agency study Other (describe) Collaborative Rulemaking

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting: (If necessary) Name: Shad Bell Name: Address: PO Box 47864, Olympia, WA 98504-7864 Address: Phone: 13602364711 Phone: Fax: Fax: TTY: 711 TTY: Email: NCQAC.Rules@doh.wa.gov Email: Web site: www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission

Web site:

Other: Other: Additional comments: The commission will notify interested parties of rulemaking by posting information on the department website, the commission website and by use of GovDelivery. The commission will hold virtual meetings at varying times to encourage participation.

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Date: 02/25/2022 Signature:

Name: Paula R. Meyer MSN, RN, FRE Title: Executive Director, Nursing Care Quality Assurance Commission

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Nursing Care Quality Assurance Commission (NCQAC) Meeting Agenda

July 8, 2022 8:00 AM- 5:00 PM

LOCATION: Greater Tacoma Convention Center – 1500 Commerce St, Tacoma, WA 98402, Room 316

Registion Link:

https://us02web.zoom.us/meeting/register/tZAtdOCtpjssHtI3XLHocn720M3dLbba1FwB

MASKS REQUIRED FOR IN PERSON ATTENDEES

Commission Members: Laurie Soine PhD, ARNP, Chair Tiffany Randich, RN, LPN, Vice-Chair Adam Canary, LPN, Secretary/Treasurer Jonathan Alvarado ARNP, CRNA Quiana Childress, GCertHealthSc, BS, LPN Mabel Ezeonwu PhD, RN Ella B. Guilford, MSN, M.Ed., BSN, RN Dawn Morrell, RN, BSN, CCRN MaiKia Moua, RN, BSN, MPH

Helen Myrick, Public Member Sharon Ness, RN Yvonne Strader, RN, BSN, BSPA, MHA Kimberly Tucker PhD, RN, CNE

Assistant Attorney General: Sierra McWilliams, Assistant Attorney General Staff: Paula R. Meyer, MSN, RN, FRE, Executive Director Chris Archuleta, Director, Operations

Gerianne Babbo, Ed.D, MN, RN, Director, Education Shad Bell, Assistant Director, Operations Amber Bielaski, MPH, Assistant Director, Licensing Debbie Carlson, MSN, RN, CPM, Director, Practice

Mary Sue Gorski, PhD, RN, Director, Advanced Practice, Research and Policy

Karl Hoehn, JD, FRE, Assistant Director, Discipline – Legal

Grant Hulteen, Assistant Director, Discipline – Investigations and

WHPS Bethany Mauden, Administrative Assistant Kathy Moisio, PhD, RN, Director, Nursing Assistant

Programs Catherine Woodard, Director, Discipline and WHPS

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If you have questions regarding the agenda, please call the Nursing Care Quality Assurance Commission (NCQAC) office at 360-236-4713. Agenda items may be presented in a different order. If you wish to attend the meeting for a single item, contact our office at the number listed above and request a specific time scheduled for that item. If you have limited English language expertise call 360-236-4713 before July 1, 2022.

This meeting is accessible to persons with disabilities. Special aids and services can be made available upon advance request. Advance request for special aids and services must be made no later than July 1, 2022. If you need assistance with special needs and services, please leave a message with your request at 1-800-525-0127 or, if calling from outside Washington State, call 360-236-4052. TDD may also be accessed by calling the TDD relay service at 711. If you need assistance due to a speech disability, Speech-to-Speech provides human voicers for people with difficulty being understood. The Washington State Speech to Speech toll free access number is 1-877-833-6341.

This meeting will be digitally recorded to assist in the production of accurate minutes. All recordings are public record. The minutes of this meeting will be posted on our website after they have been approved at the September 9, 2022 NCQAC meeting. For a copy of the actual recording, please contact the Public Disclosure Records Center (PDRC) at PDRC@doh.wa.gov.

If attending remotely, please mute your connection in order to minimize background noise during the meeting.

Smoking and vaping are prohibited at this meeting.

I. 8:00 AM Opening – Laurie Soine, Chair – DISCUSSION/ACTION

II. Call to Order

A. Introductions B. New officers take their seats

1. Yvonne Strader, Chair 2. Helen Myrick, Vice Chair 3. Adam Canary, Secretary/Treasurer

C. Order of the Agenda D. Land Acknowledgement – Sharon Ness E. Announcements

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III. 8:10 AM Consent Agenda – DISCUSSION/ACTION

Consent Agenda items are considered routine and are approved with one single motion

A. Approval of Minutes

1. NCQAC Business Meeting – 2. Advanced Practice Subcommittee –

a. April 20, 2022 3. Discipline Subcommittee – February 15, 2022 4. Consistent Standards of Practice Subcommittee – April 1, 2022 5. Licensing Subcommittee –

a. April 19, 2022 b. No May Meeting

6. Research Subcommittee – a. April 18, 2022 b. May 16, 2022

B. Performance Measures 1. Investigations 2. Legal 3. Washington Health Professional Services (WHPS) 4. Nursing Program Approval Panel (NPAP) 5. Nursing Assistant Program Approval Panel (NAPAP) 6. Weekly Licensing Report to Gov

C. Washington Center for Nursing/NCQAC monthly meetings 1. April 2022 2. June 2022

D. Out of state travel reports 1. NCSBN IT conference, May 5-6, St. Petersburg FL; Adam Canary,

Chris Archuleta, Shad Bell 2. National Organization of Alternative Programs (NOAP), May 16-19,

Albuquerque NM; John Furman, Grant Hulteen, Paula Meyer 3. NCSBN Discipline Case Management, May 23-25, Milwaukee WI;

Catherine Woodard, Barbara Justice, Karl Hoehn

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IV. 8:15 AM – 8:30 AM NCQAC Panel Decisions – DISCUSSION

The NCQAC delegates the authority as provided by law for certain decision to a panel of at least three members. A member of the NCQAC must chair panels. Pro tem members of NCQAC may serve as panel members. The following decisions are provided for information.

A. Nursing Program Approval Panel (NPAP)

1. May 5, 2022 2. May 19, 2022 3. June 2, 2022 4. June16, 2022

B. Nursing Assistant Program Approval Panel (NAPAP) 1. May 9, 2022 2. June 13, 2022

V. 8:30 AM – 9:15 AM Chair Report – Yvonne Strader – DISCUSSION/ACTIO

A. Search Committee B. Joint Operating Agreement C. Letter from Bob Ferguson, Attorney General D. Committee chairs and members

VI. 9:15 AM – 9:45 AM Executive Director Report – Paula Meyer – DISCUSSION/ACTION

A. State Auditor Office, Prescription Monitoring Program report B. Rules Update – Shad Bell C. HELMS Update D. National Council of State Boards of Nursing Annual Meeting, August 17-

19, Board of Directors recommendations E. Electronic Signatures

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9:45 AM – 10:00 AM Break VII. 10:00 AM – 11:00 AM Subcommittee Reports – DISCUSSION/ACTION

A. Advanced Practice – Jonathan Alvarado, Chair B. Consistent Standards of Practice – Sharon Ness, Chair C. Discipline – Adam Canary, Chair

1.WRAMP transition 2.Remote testing in WHPS 3.SUDRP launched July 1st

D. Licensing – Dawn Morrell, Chair 1.Paperless Process and Requirement for Demographic Data when

HELMS is Implemented 2.Michigan English Test Recommendation

E. Research – Sharon Ness, Chair F. Education – Kimberly Tucker, Chair – Meets quarterly, no meeting held.

VIII. 11:00 AM - 11:30 AM Education – Dr. Gerianne Babbo, Dr. Kathy Moisio -

DISCUSSION/ACTION A. Education Report – Dr. Gerianne Babbo, Dr. Mary Sue Gorski

1. Clinical Placement Summit 2. Preceptorship Grant Update 3. 2020-2021 Education Report Annual Survey

B. Nursing Assistant Updates 1.Training 2.Testing

11:30 AM – 1:00 PM Lunch

IX. 12:00 PM – 1:00 PM Education Session VLBSN Nursing Program Update (Veterans, LPN BSN)– Dr. Alicia Nye, Olympic College Dr. Nye is going to provide information on the VLBSN program and progress of the first class admitted to the VLBSN program and future plans.

X. 1:00 PM – 1:15 PM Public Comment

Public comment is for public presentation of issues to the NCQAC. If the public has issues regarding disciplinary cases, please call 360-236-4713.

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XI. 1:15 PM – 2:15 PM Budget Report – Miceal Carnahan and Pam Ranes;

Adam Canary, Chris Archuleta – DISCUSSION/ACTION Ms. Carnahan and Ms. Ranes present on the allotment for the coming year and actions needed. Mr. Archuleta will present on any actions that may be needed by the NCQAC. Mr. Canary and Mr. Archuleta present on the monthly budget and expenditures. Mr. Archuleta discusses the preceptor grant funding allotment technical correction decision package.

2:15 PM – 2:30 PM BREAK

XII. 2:30 PM – 3:15 PM Washington Center for Nursing – Sofia Aragon – DISCUSSION/ACTION Ms. Aragon provides an update on the Center’s work on contract deliverables. Ms. Aragon also reports on the Critical Gap Groups and their strategic plans.

XIII. 3:15 PM Meeting Evaluation XIV. 3:30 PM Closing

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Nursing Care Quality Assurance Commission (NCQAC) Advanced Practice Subcommittee Meeting Minutes

April 20, 2022 7:00 p.m. to 8:00 p.m.

Committee Members: Jonathan Alvarado, ARNP, CRNA, Chair Laurie Soine, PhD, ARNP Lindsey Frank, CD, OB-RNC, ARNP, CNM Shannon Fitzgerald, MSN, ARNP Deb Smith DNP, ARNP, FNP-BC

Absent: Joanna Starratt, MSN, ARNP, CRNA

Kathleen Errico, PhD, ARNP, Pro Tem Megan Kilpatrick, MSN, ARNP-CNS, AOCNS Bianca Reis, DNP, MBA, ARNP, PMHNP-BC

Staff: Mary Sue Gorski, PhD, RN, Director, Advanced Practice and Research Jessilyn Dagum, Research Assistant I. 7:00 PM Opening – Jonathan Alvarado, Chair

Call to order • Introduction • Public Disclosure Statement • Roll Call

o Jonathan called the meeting to order at 7:00 PM. The Advanced Practice subcommittee members and staff were introduced. The Public Disclosure Statement was read aloud for the meeting attendees.

II. Standing Agenda Items

• Announcements/Hot Topic/NCQAC Business Meeting Updates o Jonathan, Laurie and Mary Sue attended the NCSBN APRN Round

Table conference. There was discussion on how covid-19 has affected staffing as well as diversity within the different specialties.

o Mary Sue noted the presentation on the nurse practitioner workforce was particularly impressive. The tending data took into account the changes due to covid-19 as well as in the regulatory environment.

o Laurie noted that it was interesting to hear how many states had altered scope of practice or supervisory requirements in response to the pandemic for ARNPs.

• Review of Advanced Practice Draft Minutes: March 16, 2022 o Reviewed with consensus to bring to the May commission meeting for

approval.

III. Old Business • Emergency to Permanent Rules Update

o Mary Sue gave a brief updated on the Emergency to Permanent rules. Subsection 246-840-365 and 246-840-367 were withdrawn from the Emergency to Permanent rule package at the March 11, 2022 business meeting and will go forward in separate rule making.

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• Prescriptive Authority Update o Jonathan gave a brief update on the prescriptive authority work. Mary

Sue reviewed the proposed language changes to the ARNP licensing documents that reflect prescriptive authority as an opt-out option rather than opt-in. Reviewed with consensus to bring to the May commission meeting for approval.

• ARNP National Certification Update o Mary Sue and Jessilyn gave a brief update on the ARNP national

certification work. The last warning letter was sent out on April 1, 2022 and will continue to be sent out on the first of every month. The latest number of ARNPs with missing or expired national certification was 390. The commission has included a reminder regarding this requirement on their Friday bulletin GovDelivery message.

IV. New Business

• None

V. Ending Items • Public Comment

o Louise Kaplan – Made a few suggestions to the prescriptive authority changes. Louise suggested piloting these changes with recent graduates. Mary Sue and Jessilyn will update the documents and send them back out to the group and Louise.

• Review of Actions • Meeting Evaluation – All • Date of Next Meeting – June 15, 2022 • Adjournment – 7:56 PM

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Nursing Care Quality Assurance Commission (NCQAC) Discipline Sub-committee MINUTES

February 15, 2022 3:30 pm to 5:30 pm

You can also dial in using your phone United States: +1 253-372-2181 Conference ID: 793 901 023#

Committee Members: Adam Canary, LPN, Chair - late Sharon Ness, RN absent Tiffany Randich, RN – acting chair for Adam Tracy Rude, LPN ad hoc

Dawn Morrell, RN, BSN, CCRN Yvonne Strader, RN, BSN, BSPA, MHA invited guest absent

Staff: Catherine Woodard, Director, Discipline and WHPS Karl Hoehn, Assistant Director, Discipline - Legal Grant Hulteen, Assistant Director, Discipline – Investigations and WHPS John Furman, PhD, MSN, COHN-S, WHPS Liaison Helen Budde, Case Manager absent

Teresa Corrado, LPN, Assistant Director, Discipline – Case Management/ HELMS

Barb Elsner, HSC

Shana Johnny, PhD, RN ad hoc Margaret Holm, JD, RN late Alicia Payne, WHPS – invited guest Jalali Whitten, CNA Gloria Brigham, Director Practice WSNA Amber Wiegand Sarah Dineen Anderson did not introduce

Join the Meeting from your computer, tablet or smartphone

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I. 3:30 pm opening – Adam • Call to order – digital recording announcement • Roll call

II. January 18, 2022 Minutes– Adam

• In draft format until the commission approves at the March 2022 business meeting. • Correction: nurse removed from patient care but still working. Grant: removed from

performing nursing duties altogether, but she is still employed at the facility. She is not actually working but has not been terminated.

• Recommend send on to the commission for full approval. • Tracy pointed out that Jalali is not ‘just’ a nursing assistant, but a very important part of

the health care continuum.

III. January 2022 performance measures – Grant, Karl • Investigations: monthly statistics and comparisons • Grant provided highlights. Cases in the queue are down by ten! • Tracy: what is the most common COVID compliant? Karl: large percentage are cases

that come in through the governor’s website. Violating mask mandate is common. Some provider complaints. Least common is ARNP complaints re: selling exemptions and prescribing drugs not approved to treat COVID.

• Legal: monthly statistics and comparisons • Karl provided highlights. Few more cases coming in than went out this past month.

Drafting time is improving. More than average ARNP cases. Many cases finalized with legal review only.

• WHPS: monthly participant statistics and comparisons • Grant provided highlights. Currently 276 nurses in the program; down a few from last

month. Six graduations. Case managers now number five; each has a lesser caseload as a result.

• WHPS: compliance and graduation reports – Grant provided highlights again. • Six graduations and two show no drug of choice because we have not always collected

that data. • A few people have been in the program several times. • Tracy: how far into the program did people relapse? Grant: It’s in the finer details of the

report.

IV. Substance Use Disorder Review Panel (SUDRP) program review: revised procedures – Grant, Karl, Alicia

• The final draft of specific WHPS procedures revised to reflect the SUDRP business model.

• Grant: instituting the SUDRP to replace SUAT. Streamline the process by holding one meeting to review cases and make decisions regarding significant non-compliance.

• Grant ran through the highlights of the changes. Both track changes and clean copies were in the packet. SUAT replaced with SUDRP.

• Added new mechanism where nurse would appear to explain non-compliance, be recognized for positive milestones, and graduations. Will allow the nurse and commission to be more connected. Will provide the commission with more information as they can ask the nurse questions.

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• W31.02: cleaning up language, nurse referred to SUDRP instead of referred to commission.

• W32.03: major changes regarding voluntary nurses reported for clear and present danger. Reporting to SUDRP instead of the commission. Language clean up under significant non-compliance.

• W35.02: discuss changes to contract terms. No diagnosis, six months to one year. If significant non-compliance, extend contract for how long? Discussion tabled for a more in-depth discussion. Will discuss at April meeting.

• W42.04: edits are mostly related to language. Twelve months changed to calendar year. Added language about PMP reports; SUDRP will review these reports. Clarifies dilute as a positive test and reported to SUDRP. Out of temperature range are out of compliance and referred to SUDRP.

• W46.02: graduation eligibility. Changes not related to SUDRP to align with NCSBN guidelines tabled until a later meeting. The rest is language clean-up for SUDRP. Changing language to nurse (not participant). Karl: SUDRP must approve the graduations.

• Grant thanked everyone who worked on this project. • Karl: two new procedures related to SUPRP. Created new commission procedures

setting out the composition of the panel, description of meetings, panel activities, not subject to Open Public Meetings Act, documents and agreements. Panel members (commission and staff) will have training to stay current on SUD matters.

• The second procedure is the duties and responsibilities of the panel. • Dawn concerned that the CMT has been doing this for a long time and they have a

rhythm and knowledge of the fairness of the decisions they make about nurses in the program. Karl thinks having the panel involved in the decisions will be more consistent. Tracy: panel members will have more training than those who sit on CMT. The panel can certainly rely on CMT panel members for insights.

• Re: training. Grant reported that Dr Beck is beginning to pull together resources for the training. He will begin after the commission approves SUDRP.

• Karl: implementation July 1st is the anticipated date. Would like to use updated contracts April 1st to build up the number of compliance appearances to occur after July 1st. Also, training will occur during this time. Tracy and Dawn: agree time to get going as we are ready. Karl: will collect metrics to see if the SUDRP improves graduations and lessens non-compliance.

• NCSBN Pilot Project: Dawn started the discussion and Catherine picked up more details. motion to move forward and request to participate.

• Karl on contracts: sometimes are changed to remain nimble. They are in the packet but they are likely to be changed when necessary. Alicia: changes to add NCQAC to the documents and added language re: SUDRP and personal appearances by the nurse. Tracy: wants to ensure NCQAC is in all headers before it goes to the full commission. Karl: do the members feel that all the contracts should go in the packet for the full commission, or just a sample? Tracy thinks they should go in. Karl said we use them as templates and sometimes they have to make small changes. Tracy says that’s okay. We agreed to have a representation just to say… Commission agreed.

V. Work plan review – Catherine • CCW discussed. Changes to the tasks.

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VI. Public comment – Tiffany • No comments.

VII. Anything for the good of the order? – all

• Refers to the portion of the agenda during which members may make statements or offer observations about the character or work of the subcommittee without having any particular item of business before the meeting.

• Good meeting. Great work. VIII. Closing adjourned 1715.

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Nursing Care Quality Assurance Commission (NCQAC) Consistent Standards of Practice Subcommittee Minutes

April 1, 2022 12:00 p.m. to 1:00 p.m.

Subcommittee Members Present:

Sharon Rott Ness, RN, Commission Member, Chair Helen Myrick, Public Commission Member Tiffany Randich, RN, LPN, Commission Member Ella Guilford, MSN, MEd, BSN, RN, Commission Member

Subcommittee Members Absent:

Robin Fleming, PhD, MN, BSN, BA, RN, Pro Tem Jamie Shirley, PhD, RN, Pro Tem

Staff Present: Deborah Carlson, MSN, BSEd, PMC, CPM, RN, Nursing Practice Director

Shana Johnny, DNP, MN, RN Holly Palmer, Administrative Assistant

I. 12:00 PM Opening – Sharon Ness, Chair

a. Call to Order

b. Introduction – Sharon Ness

c. Public Disclosure Statement – Ms. Ness

d. Roll Call – Deborah Carlson

II. Standing Agenda Items

a. Announcements/Hot Topics/NCQAC Business Meeting Updates

i. Shana Johnny – Update on SB 5183: Forensic Nurse Examiner Training Strategies development. Next meeting April 14, 2022 at 9:30 a.m.

ii. Ms. Johnny – Update on ESSB 5229: Health Equity Rules Workshops next meeting on April 4, 2022.

b. Review of Draft Minutes – Consensus reached to send February 4, 2022 draft minutes to the NCQAC May 13, 2022 business meeting

c. Subcommittee Work Plan Review – Ms. Carlson reviewed the work plan.

III. Old Business

a. Sexually Transmitted Infections (STI) Workgroup Update - Ella Guilford and Ms. Carlson

i. Group preparing proposal and charter; discussing initiative, funding, and timelines.

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b. Patient Abandonment Interpretive Statement Review - Interpretive statement cannot be revised into Advisory Opinion. Ms. Carlson to communicate with Bonnie King and Paula Meyer regarding process to rescind the open CR101 request to re-write rules surrounding patient abandonment.

c. Professional Boundaries

i. Use of Social Media - Ms. Carlson will prepare a statement to present at the next CSPSC meeting for discussion.

ii. Advanced Registered Nurse Practitioner (ARNP) – Prescribing for family members - Ms. Carlson will reach out to Advanced Practice group, this is an ARNP focused issue.

IV. New Business

a. Consensus reached to send Prevention and Treatment of Opioid-Related Overdoses Advisory Opinion Revision Change to NCQAC at May 13, 2022 business meeting

b. Consensus reached to send Camp Nursing Advisory Opinion Revision to NCQAC at May 13, 2022 business meeting

c. House Bill 1124 – New Legislation Concerning Nurse Delegation of Glucose Monitoring, Glucose Testing, and Insulin Injections – Time did not allow. Topic to be put on June 3, 2022 CSPSC meeting agenda

V. Ending Items

a. Open Microphone – none

b. Review of Actions

i. Ms. Carlson will reach out to Mary Sue Gorski regarding ARNP issues

ii. Ms. Carlson will discuss the open CR101 regarding patient abandonment with Paula Meyer and Bonnie King

iii. NCAO 2.10 Camp Nursing Advisory Opinion draft to May 13, 2022 NCQAC business meeting

iv. NCAO 8.02 Prevention and Treatment of Opioid-Related Overdoses Advisory Opinion draft to May 13, 2022 NCQAC business meeting

c. Meeting Evaluation

d. Date of Next Meeting – June 3, 2022

e. Adjournment – 12:59pm

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Nursing Care Quality Assurance Commission (NCQAC) Licensing Subcommittee Minutes

April 19, 2022 1: 00 pm to 2: 00 pm

Committee Members: Dawn Morrell, BSN, CCRN, RN, Chair Adam Canary, LPN Helen Myrick, Public Member Yvonne Strader, RN, BSN, BSNA, MHA

Staff: Amber Zawislak-Bielaski, MPH, Assistant Director of Licensing Shana Johnny, MN, RN, Nurse Practice Consultant, Ad- Hoc Karl Hoehn, JD, Assistant Director of Discipline- Legal Services

Lori Underwood, Licensing Supervisor This meeting was digitally recorded to assist in the production of accurate minutes. All recordings are public record. The minutes of this meeting will be posted on our website after they have been approved at the July 8, 2022, NCQAC meeting. For a copy of the actual recording, please contact the Public Disclosure Records Center (PDRC) at PDRC@doh.wa.gov. I. 1:00 PM Opening – Dawn Morrell, BSN, CCRN, RN Subcommittee Chair

• Roll Call • Call to Order - Commissioner Dawn Morrell, Commissioner Helen Myrick,

Commissioner Adam Canary, Commissioner Yvonne Strader, Mr. Karl Hoehn, Mr. Shad Bell, Dr. Shana Johnny, Ms. Amber Zawislak-Bielaski, Ms. Lori Underwood

II. Standing Agenda Items

• Announcements/Hot Topic/NCQAC Business Meeting Updates - Commissioner Morrell asked the committee if there were any topics to be discussed. No topics were brought forward.

• Approve Minutes for February 15, 2022 - Commissioner Myrick moved with a second from Commissioner Strader to approve the minutes for February 15, 2022 with corrections.

III. Old Business • Florida School Issues and Current Actions – Ms. Zawislak-Bielaski advised

that the main item to discuss regarding this issue will be addressed under the New Business section. We are limited on what we can share due to the ongoing investigations. The updates we do have can be found on our website. Ms. Zawislak-Bielaski asked Ms. Underwood if there was anything else to add. Ms. Underwood replied that there were no other updates to add.

• Temporary Practice Permit Rules – Ms. Zawislak-Bielaski advised the CR101 package was drafted and was filed. We are working with Ms. Bonnie King to plan interested party meetings. She advised that we will be having these meetings in the next few months and will send the information to the Licensing subcommittee members for optional attendance. Commissioner Morrell inquired as to how many meetings we would be having. Ms. Zawislak-Bielaski

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replied that we typically have three for rules workshops and we will send the announcements out on GovDelivery once we have those meetings scheduled.

IV. New Business • Governor’s Weekly Report – Ms. Underwood reviewed the Governor’s report

highlighting that although the report shows eight days, we are currently at a seven day turn around to issued Temporary practice permits.

• Current Challenges and Recent Accomplishments – Ms. Underwood explained that staff had been working overtime this past month to help get our numbers down. We have also hired additional temporary staff to address the upcoming graduation season. Commissioner Morrell asked if we could address why the numbers were higher before this week. Ms. Underwood explained that we have been seeing an increased number of applications. She also added that she believes these applications reflect those nurses practicing under the 70.15 and are now applying for a Washington license. Ms. Underwood also addressed the importance of these nurses practicing under the 70.15 to submit their application for a license as soon as possible as we will not be able to expedite any one applicant. Ms. Zawislak-Bielaski explained the 70.15 Emergency volunteer program to our public members attending. She also added that we have been working with Volunteer Management Team in charge of this program and requested a list to determine how many nurses are practicing in Washington with their out of state license. The list provided to our unit reflected about 10,000 nurses; about 3,000 nurses already had started or had been issued a Washington license, and roughly 7,000 nurses remain practicing with their out of state license. We began working with the Volunteer Management Team to start getting communication out to these nurses, facilities, and staffing agencies encouraging them to apply for licensure before the Emergency Proclamation comes to an end. Ms. Zawislak-Bielaski added that she also believes this increase in applications is due to the 70.15 nurses finally applying for their Washington license. Commissioner Morrell asked if any members had any other questions regarding this. Commissioner Morrell also inquired if we had any indication as to the status of the state of Emergency. Ms. Zawislak-Bielaski explained that we did not have an update; however, the Volunteer Management Team did say that they are hopeful to receive a sixty-day notice before the Emergency Proclamation is lifted and would share this information with our unit.

• ESSB 5229 Health Equity Rules and the Impact on Continuing Competency and Licensing – Dr. Shana Johnny provided an update on this. She explained that this is a bill about health equity continuing education training. It is required for all health care professionals licensed under the Title 18 RCW. This bill adds a new section in RCW under Chapter 43.70. It requires the Commission to adopt rules to require all licensees to complete health equity continuing education training. Licensees must complete this at least once every four years. The model rules will be found under 246-12 of the WAC. The Commission is tasked with developing rules around this by January 1, 2023 and the training for the Licensees will be required by January 2024. This bill is still in the implementation phase. Dr. Johnny further explained that Department of Health currently has a Health Equity Continuing Education webpage where you can view the status of rulemaking. stat RCW Dr. Johnny also provided a quick

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summary on an additional bill for Forensic Nurse Examination training strategy. This is a new bill that has been developed; it is Senate Bill 5183. It is a new program training that is funded by legislature through Washington State University. The Office of Crime Victims Advocacy is consulting with the Commission. The Washington State Department of Commerce is the lead and they are assisting the Crime Victims program in drafting best practices in training and development strategies for better access to sexual assault nurse examiners. This group has already developed best practices this year; these are located on the Department of Commerce website. Now they are tasked with developing the strategy for how people will access this training. This is where the Commission will come in. These strategies will be crafted by the Office of Crime Victims and it will go into a report to the Governor and Legislature in October 2022. There will be two more meetings regarding this Bill. There is a huge need for nurses to get training in this area. Dr. Johnny asked if there were any questions regarding these updates. Commissioner Strader inquired whether we have reached out to the Emergency Nurses Association as a lot of these nurses are emergency nurses. She explained that this organization may be able to provide ideas. Dr. Johnny advised that they do have a host of partners but was not sure if Emergency Nurses Association was one of these. Commissioner Morrell inquired if they funded this legislation to do the work. Dr. Johnny confirmed that they did, in fact, fund this and now they are looking for strategies to access to this.

• Review Procedure B45.01 Suspected Fraudulent Application Documentation Review Process – Amber Zawislak-Bielaski reviewed the procedure line by line with the subcommittee. She explained that this procedure was drafted to not be specific on a certain document, but to use with any suspected fraudulent document. The WACs were referenced in the procedure. Ms. Zawislak-Bielaski took a moment to ask if there were any questions regarding the procedure so far. A public member inquired if the subcommittee was taking questions from the floor. Commissioner Morrell explained that there would be an opportunity for public comment and questions at the end of the meeting. Ms. Zawislak-Bielaski continued to explain the proposed procedures. Commissioner Morrell inquired whether the subcommittee needed to approve this procedure and a motion to move this proposed procedure forward to the full Commission. Ms. Zawislak-Bielaski replied that we will need a motion to move this forward and another motion by the subcommittee at the Commission business meeting. Commissioner Morrell asked for a motion to move this procedure forward to the full Commission. Commissioner Strader motioned with Commissioner Myrick making the second motion to move this procedure forward. Commissioner Morrell confirmed moving this procedure to the full Commission at the next business meeting.

• HELMS – Are we ready to move forward to completely be online, no paper. Commissioner Morrell presented a topic to consider; is the Commission ready to be 100% paperless? Ms. Zawislak-Bielaski provided some background to this topic and explained that with HELMS progressing, Executive Director, Paula Meyer requested the Licensing subcommittee begin to discuss this topic and determine whether we are at a point where the Commission feels we could be 100% paperless. Commissioner Strader suggested everyone to consider what, if any circumstances there would be that would prevent any individual from using online services. Ms. Zawislak-Bielaski explained that this has been

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a topic of this discussion. Commissioners Strader, Myrick and Morrell had conversations about new graduates versus international nurses being able to use online services to apply for their license. Commissioner Strader inquired whether any other states are 100% paperless. Ms. Zawislak-Bielaski confirmed that there are several states that are totally paperless. After some discussion, Commissioner Morrell stated that she believes the Commission is ready to move forward and be paperless. She also asked if the Licensing subcommittee needed to decide on this. Ms. Zawislak-Bielaski explained that Ms. Meyer was requesting the Licensing subcommittee to review and make a recommendation to the full Commission. Commissioner Morrell asked if other subcommittee members agreed with this. Commissioners Canary, Myrick, and Strader all agreed to recommend the Commission be 100% paperless. Commissioner Morrell inquired if we will need a motion to move this forward. Commissioner Myrick motioned with Commissioner Strader second to this motion to move this forward to full Commission. Commissioner Morrell confirmed the motion to move this forward to the Commission that when HELMS is implemented, the Commission become 100% paperless.

V. Ending Items • Public Comment - Public attendee (Mike) inquired if there were any updates

on our website with regards to the Florida schools that were not accepted in Washington state. Ms. Zawislak-Bielaski responded that this was the most current update we have on those schools. He also questioned the length of time allowed for applicants to obtain transcripts (30 days). Ms. Zawislak-Bielaski spoke to this and explained that applicants can always reach out when they are having difficulty getting their transcripts to our office and we would update their files and allow additional time to complete this requirement. Commissioner Morrell asked if there were any other questions or comments from the public. Ms. Underwood read the question in the chat from public attendee, Tracy. She commented that she was waiting for the links on Health Equity Continuing Competency and Forensic Nurse Examination training. Dr. Johnny provided the links in the chat (5229 Draft Rules - 4th.pdf (govdelivery.com); 5229 Workshop 4 Presentation - PowerPoint.pdf; 5229-S.PL.pdf). Tracy also inquired where to find the expectations of meeting. She also provided a comment regarding the Commission moving to 100% paperless. She explained that she believes it is never good to have only one door. It’s always good to have a second exit or entrance. Given the nature of computers, we know that medical systems are often targets of hacking and security breaches. We need all the nurses we can get and closing that door even for just one nurse could have effects. She asked the Commission to consider this before making the decision to move 100% paperless. Commissioner Morrell thanked her for sharing her valuable thoughts and then explained the order of the meetings with public comment and questions being at the end of the meetings.

• Review of Actions – Commissioner Morrell advised that they take forward the two motions to the full Commission. She expressed her gratitude to the licensing unit and their hard work. Commission Myrick and Commissioner Strader also expressed their gratitude to the licensing unit

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• Meeting Evaluation – Commissioners Strader, Myrick, and Morrell thanked Dr. Johnny for her updates on the Health Equity Rules and the Impact on Continuing Competency and the Forensic Nurse Examination training

• Date of Next Meeting - June 21, 2022

• Adjournment at 1:58 PM

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Nursing Care Quality Assurance Commission (NCQAC) Research Subcommittee Meeting Minutes

April 18, 2022 5:00 p.m. to 6:00 p.m.

Committee Members: Sharon Ness, RN, Chair Mary Baroni, PhD, RN Yvonne Strader, RN, BSN, BSPA, MHA Katie Haerling, PhD, RN, CHSE Jamie Shirley, PhD, RN

Absent: Deb Smith DNP, ARNP, FNP-BC Staff: Mary Sue Gorski, PhD, RN, Director of Advanced Practice and Research

John Furman, PhD, MSN, CIC, COHN-S, Washington Health Professional Services (WHPS) Liaison/Research Jessilyn Dagum, Research Assistant

I. 5:00 PM Opening – Sharon Ness

Call to order • Introduction • Public Disclosure Statement • Roll Call

o Sharon called the meeting to order at 5:00 PM and introduced the Research Subcommittee members and staff. The Public Disclosure Statement was read aloud for the meeting attendees.

II. Standing Agenda Items

• Announcements/Hot Topic/NCQAC Business Meeting Updates o HB1329 – Open Mic has changed to Public Comment and will be at the

end of every Research subcommittee meeting. o Sharon reported a few highlights from the March 11, 2022 NCQAC

Business meeting. • Review of Draft Minutes: February 22, 2022

o Reviewed with consensus to bring to the May 2022 business meeting with edits corrected.

III. Old Business

• Review Work Plan o The subcommittee reviewed the work plan with consensus to revise the

document further to reflect annual activities, current initiatives and upcoming initiatives or long-term goals. The subcommittee will present its first annual report to the commission in September. The work plan will include a timeline of annual activities. Mary Sue and Jessilyn will work on revising the work plan.

o Mary suggested that a template for work plans and annual reports be created and that they standardize the communication of these templates to all subcommittees. Mary raised the question, “Should all

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subcommittees be doing annual reports to be presented at a Fall commission meeting?” The expecting ongoing activities of the subcommittees would be standardized following the commission’s timeline. Jessilyn and Yvonne will take this to the Communication Task Force for further exploration.

o Mary suggested a goal for this year would be preparing for the Research subcommittee’s first formal annual report and developing more refined templates to guide subcommittee work.

o The subcommittee will invite the Communication Task Force’s website subgroup to the next subcommittee meeting to review the subcommittee’s work plan and what communication needs there may be as well as discuss the progress of the new website.

• Internal/External Data Tracking o Mary Sue and Jessilyn gave a brief update for this initiative. The draft

procedure will be reviewed by the other NCQAC units before being presented to the subcommittee.

IV. New Business

• None

V. Ending Items • Open Microphone (as time permits) • Review of Actions • Meeting Evaluation – All • Date of Next Meeting – May 16, 2022 • Adjournment – 5:48 PM

21

Nursing Care Quality Assurance Commission (NCQAC) Research Subcommittee Meeting Minutes

May 16, 2022 5:00 p.m. to 6:00 p.m.

Committee Members: Sharon Ness, RN, Chair Yvonne Strader, RN, BSN, BSPA, MHA Katie Haerling, PhD, RN, CHSE Deb Smith DNP, ARNP, FNP-BC

Excused: Mary Baroni, PhD, RN

Jamie Shirley, PhD, RN

Guests: Shad Bell, Assistant Director, Operations Amy Sharar, Public Information Officer

Staff: Mary Sue Gorski, PhD, RN, Director of Advanced Practice and Research Chris Archuleta, Director, Operations John Furman, PhD, MSN, CIC, COHN-S, Washington Health Professional Services (WHPS) Liaison/Research Jessilyn Dagum, Research Assistant

I. 5:00 PM Opening – Sharon Ness

Call to order • Introduction • Public Disclosure Statement • Roll Call

o Sharon called the meeting to order at 5:00 PM and introduced the Research Subcommittee members and staff. The Public Disclosure Statement was read aloud for the meeting attendees.

II. Standing Agenda Items

• Announcements/Hot Topic/NCQAC Business Meeting Updates o Sharon shared highlights from the May 13, 2022 business meeting.

• Review of Draft Minutes: April 18, 2022 o Reviewed with consensus to bring to the July 2022 business meeting for

approval.

III. Old Business • Review Work Plan

o The subcommittee reviewed the updated work plan with consensus to accept the workplan for the upcoming year. Mary Sue highlighted a few major updates and work plan items. The subcommittee’s work plan is organized by immediate, short term, mid-term and long-term goals.

IV. New Business • Communication Task Force Website Team

o New Website Update

22

Shad gave an update on the history and progress of the new website. The subcommittee toured the new nursing commission website and provided input on the website’s organization and layout. The group also discussed future plans for the Research page on the new website.

V. Ending Items • Public Comment • Review of Actions • Meeting Evaluation – All • Date of Next Meeting – To be Announced • Adjournment – 5:57 PM

23

Participant Case ID

Program Start Date Entry Reason

Anticipated Completion

Date

Incident Date

Incident Type Drug(s) WHPS Action(s) Taken Referred to

CommissionDrug of choice and Diagnosis Notes

15-8-S/RN-05745 9/15/2015 Order (Agreed/Final) 2/18/2025 4/27/2022 Missed Test/No

ShowAdditional Test Scheduled; Counselor Notified; Other - See Notes; PSG

Facilitator Notified; Referred for Evaluation; Referred to the Commission 5/24/2022 AlcoholEvaluation received, recommendation for outpatient treatement

16-5-S/RN-05215 7/25/2016 Referral Contract 4/29/2024 4/29/2022 Positive Drug Screen Oxycodone

Additional Test Scheduled; Ceased/Removed from Practice; Contract Extended; Medication Restriction Reinstated; PSG Facilitator Notified; Referred for Evaluation; Referred to the Commission; Terminated from

Employment; WSM Notified

5/24/2022 OpiatesEvaluation received, recommendation for Intensive Outpatient

17-03-RN-04613B 4/6/2022 APUC 6/3/2022 4/5/2022 Missed Test/No Show Other - See Notes; Self Test opiates

18-1-PO/RN-05337 2/8/2018 Order (Agreed/Final) 10/19/2023 4/12/2022 Positive Drug

Screen Alcohol Ceased/Removed from Practice; Counselor Notified; Other - See Notes; PSG Facilitator Notified; Referred for Evaluation; WSM Notified Alcohol

18-3-S/RN-05365 5/4/2018 Referral Contract 5/3/2023 4/11/2022 Missed Test/No Show Additional Test Scheduled; Other - See Notes Cocaine

1969-05-2845B 3/16/2022 Order 3/15/2023 4/5/2022 Missed Test/No Show Other - See Notes; Self Test

1971-01-7851 12/10/2021 RC 12/9/2026 4/6/2022 Positive Drug Screen

Alcohol; Opiates

Counselor Notified; Other - See Notes; PSG Facilitator Notified; Referred for Evaluation; Referred to the Commission 5/16/2022

4/22/2022 Missed Test/No Show Additional Test Scheduled; Other - See Notes; PSG Facilitator Notified

4/26/2022 Missed Test/No Show Additional Test Scheduled; Other - See Notes

4/29/2022 Missed Test/No Show Other - See Notes

4/23/2022 Relapse Alcohol Other - See Notes

1974-10-3234 12/10/2021 STID 12/9/2026 4/17/2022 Positive Drug Screen Alcohol Other - See Notes alcohol

1975-08-9237 8/26/2020 Voluntary 9/15/2025 4/25/2022 Positive Drug Screen Alcohol Additional Test Scheduled; Counselor Notified; Other - See Notes; PSG

Facilitator Notified; Referred for Evaluation alcohol

1979-04-6725 11/4/2020 STID 7/14/2026 4/19/2022 Positive Drug Screen

Alcohol; Amphetamine Additional Test Scheduled; Other - See Notes Opiates

1974-03-0509 3/25/2020 Voluntary 4/16/2025 alcohol

WHPS Non-Compliance Report April 2022

24

1983-01-0821 5/20/2020 Referral Contract 5/19/2025 4/5/2022 Missed Test/No Show Other - See Notes; Self Test Alcohol

25

Participant Case ID

Program Start Date Entry Reason

Anticipated Completion

Date

Incident Date Incident Type Drug(s) WHPS Action(s) Taken Referred to

CommissionDrug of choice and

Diagnosis Notes

15-8-S/RN-05745 9/15/2015Order

(Agreed/Final) 2/18/2025 5/2/2022 Missed Test/No Show

Additional Test Scheduled; Counselor Notified; Other - See Notes; PSG Facilitator Notified; Referred for Evaluation; Referred to the

Commission5/24/2022 Alcohol

1974-10-3234 12/10/2021 STID 12/9/2026 5/4/2022 Positive Drug Screen Alcohol Other - See Notes Alcohol

1965-07-6843B 2/9/2022 Referral Contract

2/8/2026 5/17/2022 Missed Test/No Show Additional Test Scheduled; Other - See Notes Opiates

1975-08-9237 8/26/2020 Voluntary 9/15/2025 5/11/2022 Missed Test/No Show Additional Test Scheduled; Other - See Notes Alcohol

17-1-S/RN-50269 1/25/2017Referral Contract 10/8/2023 5/12/2022 Missed Test/No

Show Additional Test Scheduled Alcohol

1968-10-4976 8/7/2021 Voluntary 8/6/2026 5/9/2022 Other Non-compliance Other - See Notes; Referred for Evaluation Alcohol

1983-08-1342 9/22/2021 RC 9/21/2026 5/20/2022 Positive Drug Screen Alcohol

Additional Test Scheduled; Ceased/Removed from Practice; Other - See Notes; PSG Facilitator Notified; Referred for Evaluation;

Referred to the Commission; WSM Notified6/2/2022 Opiates Continued use related to

incident on 5/4/2022

15-8-S/RN-05745 9/15/2015Order

(Agreed/Final) 2/8/2025 5/5/2022 Positive Drug Screen Alcohol Counselor Notified; Other - See Notes; PSG Facilitator Notified;

Referred for Evaluation; Referred to the Commission 5/24/2022 Alcohol

1969-05-2845B 3/16/2022 Order 3/15/2023 5/24/2022 Positive Drug Screen Alcohol Other - See Notes Alcohol

5/31/2022 Positive Drug Screen Additional Test Scheduled; Other - See Notes

5/17/2022 Positive Drug Screen

Additional Test Scheduled; Other - See Notes; PSG Facilitator Notified

1975-08-9237 8/26/2020 Voluntary 9/15/2025 5/2/2022 Relapse Alcohol Additional Test Scheduled; Counselor Notified; Other - See Notes; PSG Facilitator Notified; Referred for Evaluation Alcohol

3 incidents in May, all related to admitted relapse

(continued use)

1988-05-9862 9/17/2021 APUC 9/16/2026 5/31/2022 Positive Drug Screen Alcohol

Ceased/Removed from Practice; Counselor Notified; MRO Review Requested; PSG Facilitator Notified; Referred for Evaluation; WSM

NotifiedCannabanoids (THC)

1983-08-1342 9/22/2021 RC 9/21/2026 5/4/2022 Positive Drug Screen Alcohol

Additional Test Scheduled; Ceased/Removed from Practice; Counselor Notified; Other - See Notes; PSG Facilitator Notified;

Referred for Evaluation; Referred to the Commission; WSM Notified6/2/2022 Opiates

1984-08-0293 3/25/2019 Pending 5/26/2024 Alcohol Opiates

WHPS Non-Compliance May 2022

26

1975-08-9237 8/26/2020 Voluntary 9/15/2025 5/13/2022 Positive Drug Screen Alcohol Counselor Notified; Other - See Notes; Referred for Evaluation Alcohol

1974-10-3234 12/10/2021 STID 12/9/2026 5/16/2022 Missed Test/No Show Other - See Notes; Referred to the Commission 5/27/2022 Alcohol

16-9-PO/RN-05250 10/26/2016 Order

(Agreed/Final) 4/15/2023 5/3/2022 Missed Test/No Show Additional Test Scheduled; Other - See Notes Alcohol

17-12-RN-05349 2/6/2018 Referral Contract 2/5/2023 5/17/2022 Missed Test/No

Show Additional Test Scheduled; Other - See Notes Alcohol

1976-11-2892 12/14/2020 Referral Contract 12/20/2025 5/31/2022 Employment

NoncomplianceAdditional Test Scheduled; Ceased/Removed from Practice; Other -

See Notes; Testing Frequency Increased; WSM Notified Alcohol

27

Participant: Case ID

Participant: Participation Type

Participant: Program Start Date

Participant: Program

Discharge Date

Participant: License Type

1700B Referral Contract 4/25/2017 4/24/2022 RN1965-11-9317 STID 4/16/2020 4/15/2022 RN1958-03-3254 Order 5/24/2019 4/1/2022 RN

17-3-S/RN-50281 Referral Contract 4/3/2017 4/2/2022 RN17-3-RN-50285 Voluntary 4/5/2017 4/8/2022 RN

April 2022 WHPS Graduation Report

28

Participant: Case ID

Participant: Participation Type

Participant: Program Start Date

Participant: Program

Discharge Date

Participant: License Type

1995-03-0900 Referral Contract 5/25/2021 5/24/2022 RN16-2-S/LPN-05570B Referral Contract 4/6/2016 5/17/2022 LPN

17-3 V/RN-50301 Voluntary 5/10/2017 5/11/2022 RN17-3-S/RN-50284 Referral Contract 5/15/2017 5/21/2022 RN17-3-V/RN-50288 Voluntary 5/8/2017 5/13/2022 RN15-08-PO/ARNP-

05595B Order (Agreed/Final) 9/2/2015 5/19/2022 ARNP

May 2022 WHPS Graduation Report

29

As of June 13, 2022, the average pending applications per day was at 1,176 and down from 1,653 the previousweek. The current processing time to issue a temporary practice permit (TPP) is nine days (including weekends andholidays, also down from 12 days the first week of June 2022. NCQAC began tracking COVID-related complaintssince March 2020. Specific to the week of June 6, 2022, NCQAC’s Case Management Team reviewed no COVID-related cases.

The first chart below reflects the monthly nursing application volumes, application processing times, and staffinglevels for NCQAC over the last two years. The NCQAC received 3,383 new applications during the May 2022, makingthis our second highest application month on record. To address this increase in application volume, the NCQAChired additional temporary staff and an additional licensing unit lead to assist with final approvals.

The second chart on this report reflects the monthly outputs from the NCQAC. In May 2022, the NCQAC issued a total of 2,554 new nursing licenses (2,158 endorsements, 242 examinations, and 154 combined ARNPs/NTECs). In addition, 10,707 nursing renewals were completed.

Note: *Temporary practice permits (TPP)are issued to nursing applicants who meet all licensure requirements, except for the FBI fingerprint background check. A preliminary background check is completed on all applications received by the NCQAC.

Nursing Care Quality Assurance Commission (NCQAC) COVID-19 Response for Nurse Licensure Weekly Update: Monday, June 13, 2022

30

INVESTIGATIVE PERFORMANCE MEASURES Apr-21 Apr-22

% of Change Mar-22 Apr-22

% of Change

Cases Reviewed at CMT 159 114 -28% 211 114 -46%Cases Opened to Investigation 34 42 24% 109 42 -61%Open Cases in Investigation Queue 564 446 -21% 491 446 -9%Average Caseload per Investigator 47 41 -14% 41 41 0%Total Investigations Completed 87 94 8% 112 94 -16%Percentage of Cases Completed w/in Time Lines Target 77% PM 2.2

49% 59% 10% 59% 59% 0%

Percentage of Investigations Opened Beyond 170 days Target 23% PM 2.4

71% 54% -17% 55% 54% -1%

Investigations Completed per Investigator PM 3.1

7.3 8.5 17% 9 8.5 -5%

Task Back Assigned 7 7 0% 13 7 -46%# of COVID Cases Reviewed/Opened at CMT 14/0 7/5 11/7 7/5

31

INVESTIGATIVE PERFORMANCE MEASURES May-21 May-22

% of Change Apr-22 May-22

% of Change

Cases Reviewed at CMT 168 161 -4% 114 161 41%Cases Opened to Investigation 43 43 0% 42 43 2%Open Cases in Investigation Queue 513 425 -17% 446 425 -5%Average Caseload per Investigator 47 39 -17% 41 39 -5%Total Investigations Completed 80 73 -9% 94 73 -22%Percentage of Cases Completed w/in Time Lines Target 77% PM 2.2

54% 74% 20% 59% 74% 15.0%

Percentage of Investigations Opened Beyond 170 days Target 23% PM 2.4

73% 54% -19% 54% 54% 0.0%

Investigations Completed per Investigator PM 3.1

6.7 6.6 -1% 8.5 6.6 -22%

Task Back Assigned 5 3 -40% 7 3 -57%# of COVID Cases Reviewed/Opened at CMT 17/2 6/1 14/0 6/1

32

Type of Measure Month Baseline April May June Q Avg.Average Caseload per Attorney 45.92 48

Caseload/ Case volume Cases Assigned to Legal 41.33 63TOTAL Finalized Cases 56.33 34Average of Finalized Cases per Attorney (Target 10 per month) 14.08 6

PerformancePercentage of Legal Reviews Sent to RCM in 30 Days or less (Target 77%)

78.33% 63%

Document drafting time: Percentage of Drafts to AAG or SOA Served in 30 Days or less (Target 77%)

86.67% 67%

Percentage of Cases involving an ARNP 6.00% 18%

Number of Cases forwarded to AAG 10.67 14

Finalized with Legal Review only 21.00 20

Work Type/ComplexityFinalized by Default or Final Order After Hearing 12.00 2

Finalized by STID, AO or APUC (Settlements) 19.00 1

Other (releases, reinstatements) 4.33 9

Nursing Care Quality Assurance CommissionLegal Unit Performance Measures

FY 2022 (Q4)Karl Hoehn, Legal Manager

33

Type of Measure Month Baseline April May June Q Avg.Average Caseload per Attorney 45.92 48 46

Caseload/ Case volume Cases Assigned to Legal 41.33 63 80TOTAL Finalized Cases 56.33 34 40Average of Finalized Cases per Attorney (Target 10 per month) 14.08 5.70 5.70

PerformancePercentage of Legal Reviews Sent to RCM in 30 Days or less (Target 77%)

78.33% 63% 76%

Document drafting time: Percentage of Drafts to AAG or SOA Served in 30 Days or less (Target 77%)

86.67% 67% 60%

Percentage of Cases involving an ARNP 6.00% 18% 16%

Number of Cases forwarded to AAG 10.67 14 5

Finalized with Legal Review only 21.00 20 22

Work Type/ComplexityFinalized by Default or Final Order After Hearing 12.00 2 3

Finalized by STID, AO or APUC (Settlements) 19.00 1 7

Other (releases, reinstatements) 4.33 9 8

Nursing Care Quality Assurance CommissionLegal Unit Performance Measures

FY 2022 (Q4)Karl Hoehn, Legal Manager

34

License Type 2021 2022 2021 2022

ARNP 16 21

RN/LPN 13 5 279 245

NTTotal 13 5 295 266

License Type 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022

ARNP 1 2 1 1 1 2 6 7 4 5

RN/LPN 11 11 65 54 30 10 90 96 24 25 35 28

NT

Total  12 13 66 55 31 12 96 103 24 25 39 33Total Monitoring 268 241

License Type 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022

ARNP 1 1 1 1 1 1 1

RN/LPN 2 1 7 6 1 8 8 6 6

NT

Total  2 2 7 6 2 1 9 9 6 6 1 1Total Monitoring 27 25

License Type 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022

ARNP 3 1 1

RN/LPN 1 1 1 1 3 5

NT 1

Total 0 0 3 1 1 1 0 1 1 1 4 5 0 0

Total Discharge 9 9

2021 2022

104 60

108 51

106 56

48

51

7 5

71 39

New Intake

WHPS Monthly Report ‐ April 2022

Offered/

Refused

Referred Back 

to NCQAC

Current 

Monitoring

APUC Order Pending RC

Not  

Appropriate

Pending 

Discipline

Voluntary 

Withdrawal

Successful 

Completion

APUC

4

53

Order Pending

Stage

NT

Total

11

203

Melissa Fraser

Heidi Collins

Lori Linenberger

Shelley Mezek

Alicia Payne

UnemployedEmployed

Employment Measures (In‐State)

License Type

ARNP

RN/LPN

2

58

2022

Employed Unemployed

2021

13

169

Referral Type ‐ Monitoring (In‐State)

Average from Inquiry to Intake ‐ Target 7 Days

Average from Intake to Monitoring ‐ Target 45 Days

Case Manager Caseload 

(Intake & Monitoring)

Performance Measures

Discharge Type

Referral Type ‐ Monitoring (Out‐of‐State)RC STID Voluntary

Deceased

STID Voluntary

Percentage ‐ Target 72%

Grand Total

76%

274

60

22%

239

24%

57182214

78%

35

License Type 2021 2022 2021 2022

ARNP 15 20

RN/LPN 6 8 279 239

NTTotal 6 8 294 259

License Type 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022

ARNP 1 2 1 1 1 2 6 7 3 5

RN/LPN 12 10 61 52 26 14 97 91 24 25 34 27

NT

Total  13 12 62 53 27 16 103 98 24 25 37 32Total Monitoring 266 236

License Type 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022

ARNP 1 1 1 1 1 1

RN/LPN 2 1 7 6 1 8 7 7 6

NT

Total  2 1 7 6 2 1 9 8 7 6 1 1Total Monitoring 28 23

License Type 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022 2021 2022

ARNP 1 1

RN/LPN 1 1 2 1 5 1 1 7 5

NT

Total 1 1 2 1 5 0 0 1 1 1 7 6 0 0

Total Discharge 16 10

2021 2022

105 55

102 51

101 54

49

50

7 4

55 43

Percentage ‐ Target 72%

Grand Total

77%

272

62

23%

235

23%

53182210

77%

Referral Type ‐ Monitoring (In‐State)

Average from Inquiry to Intake ‐ Target 7 Days

Average from Intake to Monitoring ‐ Target 45 Days

Case Manager Caseload 

(Intake & Monitoring)

Performance Measures

Discharge Type

Referral Type ‐ Monitoring (Out‐of‐State)

RC STID Voluntary

Deceased

STID Voluntary

RN/LPN

1

61

2022

Employed Unemployed

2021

14

168

Stage

NT

Total

11

199

Melissa Fraser

Heidi Collins

Lori Linenberger

Shelley Mezek

Alicia Payne

UnemployedEmployed

Employment Measures (In‐State)

License Type

ARNP 3

50

Order Pending

New Intake

WHPS Monthly Report ‐ May 2022

Offered/

Refused

Referred Back 

to NCQAC

Current 

Monitoring

APUC Order Pending RC

Not  

Appropriate

Pending 

Discipline

Voluntary 

Withdrawal

Successful 

Completion

APUC

36

*Letters mailed within 30 days of NPAP meeting

*Letters mailed within 30 days of NPAP meeting

0 1 2 3 4

6/2/2022

5/19/2022

5/5/2022

4/21/2022

Days After Meeting

Mee

ting

Date

sNPAP A & B Panel Meetings*

Post NPAP Meeting Letter Draft Letters Mailed Post Reciept of Draft

0 1 2 3 4

5/19/2022

4/21/2022

3/17/2022

Days After Meeting

Mee

ting

Date

s

NPAP A Panel Meetings*

Post NPAP Meeting Letter Draft Letters Mailed Post Reciept of Draft

37

*Letters mailed within 30 days of NPAP meeting

*Letters mailed within 30 days of NPAP meeting

0 1 2 3 4

6/2/2022

5/5/2022

Days After Meeting

Mee

ting

Date

sNPAP B Panel Meetings*

Post NPAP Meeting Letter Draft Letters Mailed Post Reciept of Draft

0 1 2 3 4 5 6

3/3/2022

2/10/2022

11/18/2021

Days After Meeting

Mee

ting

Date

s

Emergency Meetings*

Post NPAP Meeting Letter Draft Letters Mailed Post Reciept of Draft

38

Data and Performance Measures Related to Nursing Assistant Training Programs

Descriptive Data:

Descriptive Data:

0

19

1213

7

21

JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC2021

Number of Director/Instructor Applications(For Existing Programs)

11

2123

18

11

28

JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC2021

Total Number of Director/Instructor Applications(Existing and New Programs Combined)

YTD = 72 2021 = 78

YTD = 112 2021 = 100

39

Performance Measure:

Descriptive Data:

*Does not include 2nd/subsequent reviews of revised applications

1 1 1 1 1

JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC2021

Director/Instructor Applications (For Existing Programs)

Average Days Receipt to Evaluation Response

Target: < 5 Days5 5

3

1

3

2 2

3

JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC2021

Number of New* Program Applications

YTD = 14 2021 = 4

40

Performance Measure:

*Does not include 2nd/subsequent reviews of revised applications

47 7 7

12 11

JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC2021

New* Program ApplicationsAverage Number of Days Receipt to Evaluation

Target: < 30 Days 30

41

WCN/NCQAC CHECK IN Meeting April. 19, 2022 2 PM

Agenda

Present: Paula Meyer, Sofia Aragon, Frank Kohel, Bethany Mauden

Topics Discussion Action Needed Call to order - 2:07pm

Helms – The Tough Questions Miranda and Amy created a communication plan – advantages there will be only one source. No way I will give my personal information to the government. – issues due to incomplete applications for renewals or licensure. Hold people to the standards – Will stop people from moving forward until they answer the questions. Will the staff be able to waive the questions? Not at this time.

WCN can encourage completion of the questionnaire. June 17 board meeting to be discussed. Paula would like to speak to their boards. Paula will attend the June 17th WCN board meeting to provide a brief sketch of consequences /rules/exceptions.

Nurses Week webinars on Demand, Supply and Education

May 6 – Demand – Webinar May 10 - Supply – Webinar May 11 - Education – Webinar

Sofia will give talking points. Sofia will invite Mary Sue, Geri and Paula. May 6 – Demand – Mary Sue May 10 - Supply - Paula May 11 Education – Geri

Posting/release of Demand, Supply, and Education reports

WCN would like to give links to the reports prior to the meetings (on the registration)

Paula approves giving links to the reports on the registrations and NCQAC can circulate advertisement of the webinars with the links. To be sent via GovDelivery.

Next steps Critical Gaps Can form Future of Nursing plans. Checking/sharing progress – strategic plan, education goals, common areas/themes working on – planning on floating to Mary Sue.

42

Topics Discussion Action Needed Update on Future of Nursing convening plans

Would like to change the due date to the end of the year, due to not being able to find a location. May need to be pushed to September.

Sofia will reach out to Jonnita to update the timelines in the contract to the end of the year.

Other? • HELMS to go live – June 2023 • NCLEX new generation to also go live – June 2023 • Executive Director search

o Workshop – July 7, 2022 Business Meeting – What the relationship should be between the commission and the executive director.

o Post Executive Director Position in September, January top 3 candidates for interview.

o Presentations/interview at January meeting. o Decision to be made in March, with start date May 1, 2023 with overlap

with Paula for a few weeks.

Meeting Closed – 2:45pm

Next Meeting – June 9 – Sofia agenda, Frank minutes

Approved:

43

WCN & NCQAC Meeting

Thursday, June 9, 2022 (3:00 pm to 4:00 pm)

Washington Center for Nursing Office Minutes

Present: Sofia Aragon, Paula Meyer, Bethany Mauden, Frank Kohel

Topics Discussion Action Needed Call to Order

3:06 pm call to order. Review the agenda

Overall plan for critical gaps meeting on 6/30

Sofia and Una had an initial meeting to plan the 6/30 critical gaps meeting. Use this time to share and celebrate accomplishments; what went well and what are the challenges. Will include time to begin a discussion and consensus workshop on how we can work together to improve access to clinical practice education for nursing students and practicing nurses. WSHA has also been invited a recommended by Paula. Clinical partners such as clinical consortium, NWONL, and CNEWS will join for at least this portion. The discussion will be about clinical practice broadly to include community health as well as acute care. Agenda will be finalized with larger planning group that includes Geri Anne Babbo, Mary Sue Gorski, Katie Eilers, and Doreen Hersh. Katie and Dorene are involved in Critical Gaps as well as Future of Nursing convening scheduled for 9/20.

Add update about NCQAC clinical practice funds to June 30th meeting agenda. Invite Darcy Jaffe and Chelene Whitaker to the June 30th meeting.

Discussion with BOD board on 6/17 meeting

Paula would like to discuss with WCN Board Next generation NCLEX and HELMS project. What would be a successful launch of both and how the WCN Board can help. What do we do if someone chooses not to do it? This would result in incomplete renewals and nurses won’t be licensed. HELMS will generate automated response letters. No appeal processes. WCN and NCQAC communications staff have worked on a communication plan. This will also have implications for nursing workforce data collection through HELMs.

Present the HELMS Communication Plan at 6/17 WCN Board Meeting.

44

Update on new DOH team and need for orientation?

Meeting with DOH Quarterly Meeting on June 16th. Sofia would appreciate any suggestions on an orientation for the new DOH participants? DOH is interested in having NCQAC do contract monitoring again. Bethany could manage the contract with the panel of Dawn Morrell and Barbara Schicking continuing in their review role. WCN to give feedback about this option. DOH contracts office has not responded to WCN e-mails that included routine communications. Includes emails sent by WCN Finance Associate Theresa Berry dated 3/30/22 regarding plan for additional surcharge funds accumulated, a 4/12/22 request for the 09L – FY22 Qtr. 3 report (surcharge report) and a 5/13/22 Second request for the 09L – FY22 Qtr. 3 report (surcharge report) which normally accompanies the quarterly invoices, and the 3rd Qtr. DOH Invoice for Jan - March 2022. We are at Year 2 of the contract now. The end of 2022 would be a good time to discuss future deliverables and check-in on current report template with Dawn and Barbara. In addition, surcharge levels have been higher the last several years. The fixed distribution of $137,000 is based on expenditure levels in 2015. A discussion is needed to review for adjustments needed to be more consistent with surcharge revenue.

DOH contract monitoring will be included in WCN 6/17 BOD discussion with Paula. Theresa Berry at meeting regarding contract finance issues and best way for communication.

July 8, 2022, NCQAC Meeting – WCN Update 2:30 to 3:00pm – Meeting in Person at the Tacoma Convention Center

WCN update to the Nursing Commission from 2:30 to 3pm. Sofia can present the final Critical Gaps plan/spreadsheet submitted as a deliverable. Discussion of materials for the NCQAC packet for this discussion.

WCN report to NCQAC July 8, 2022, from 2:30 pm to 3:00 pm. Materials for NCQAC meeting include spreadsheet of Critical Gaps group activities, and strategic directions one pager for diversity

Cancel June 28, 2022, WCN/NCQAC Meeting

This meeting will need to be cancelled.

45

Other updates Paula noted Yvonne Strader is the new Nursing Commission Chair; Helen Myrick is new

Vice Chair.

Next Meeting

Schedule for August going forward will be scheduled. July 26, 2022, from 4:00 pm to 5:00 pm for next meeting.

Submitted by: Frank Kohel

Approved: Sofia Aragon

46

National Organization of Alternative Programs (NOAP) 2022 Annual Education Conference

May 16 – 19, 2022

Albuquerque, New Mexico

John Furman

PURPOSE: Attend the 2022 NOAP education Conference. The NOAP mission is to promote public safety through participation of healthcare professionals in monitored rehabilitation and recovery as an alternative to license discipline; emphasizing fitness to practice and retention of competent professionals.

OUTCOME: Attended the following sessions:

• The Legalization of Marijuana’s Impact on Health Care Professionals • ATD Program Sharing - Changes Since COVID • Mental Health and Wellness Healthcare Workers (moderated this session) • Individual and Organizational Strategies to Foster Resilience in Health Care

Professionals • Business meeting and luncheon (presented on the NOAP Research Committee) • Boundary Violations: What to look for… and what to do about it • Native American Perspectives on Spirituality • Through the Looking Glass: The Legacy of Florence Nightingale in the Time of Covid • MRO Toxicology Panel • An Unlikely Addict One Nurse’s Story Through SUD (moderated this session) • Treatment Provider Panel - Treatment in COVID Times

Significant interaction and sharing with many States monitoring programs.

RECOMMENDATION: NOAP promotes public safety through participation of healthcare professionals in monitored rehabilitation and recovery as an alternative to license discipline; emphasizing fitness to practice and retention of competent professionals. It serves as the leading forum for research, advocacy, education, and policy development among Alternative to Discipline Programs.

Guiding values:

• Promotion of Public Safety • Retention of health care professionals • Education and research to establish best practices

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• Equality: NOAP opposes the stigmatization of healthcare professionals solely based on the diagnosis of a medical illness.

The NOAP education Conference is the preeminent nursing (and other health professionals) alternative to discipline monitoring/health program. It provides valuable education and program sharing opportunities. I recommend Washington Health services presence at this conference. John Furman PhD, MSN, COHN-S June 7, 2022

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National Organization of Alternative Programs (NOAP) 2022 Annual Education Conference

May 16 – 19, 2022

Albuquerque, New Mexico

Paula R. Meyer

PURPOSE: The title of the annual conference was Supporting the Healthcare Professional in the “New Normal”. Sessions included: Mental Health and Wellness Healthcare Workers, Boundary Violations, Native American Perspectives on Spirituality, MRO Toxicology, Treatment Provider Panel, One Nurse’s Story, and a comparison of Florence Nightingale’s legacy to nursing during COVID.

OUTCOME: Individual and Organizational Strategies to Foster Resilience in Health Care Professionals was presented by Dr. Connie Smith-Fassler DNP, MHA, RN, CNML and Steve Nuanez, LCSW, University of New Mexico Hospitals. Dr. Smith-Fassler and Mr. Nuanez emphasized the importance of staff feeling heard. Resilience is an emerging competency for leaders. They stressed the need for work/life balance and to expect this from staff. They shared the four Rs:

Realizing that trauma is prevalent and a reality for everyone on your team Recognizing the signs of trauma and how to support the person Responding to team members Resisting re-traumatization: when someone makes a mistake, don’t punish them more The speakers both talked about changing the culture in healthcare related to self-care. There is a stigma around taking care of ourselves and can be seen as shame/blame rather than valuing ourselves as health care providers. Both speakers stressed the importance of regular – and meaningful – communication with staff. Both speakers said rather than just asking “How are you doing”, act on the requests when they are voiced. Be employee well being champions: support activities to support people. Compassionate colleagues are especially important. All peers were trained in compassionate care and know available resources. A phrase they used: Bring your loving presence to a colleague. RECOMMENDATION: Our staff just completed a challenging two year period with COVID and the demands for licensing and discipline. Using this to care for them is essential.

This year’s conference was exceptional. The speakers were dynamic, engaging and gave information that is immediately applicable.

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NCSBN Discipline Case Management Conference

May 23 – 25, 2022 Milwaukee, WI

Karl Hoehn

(Catherine Woodard and Barb Justice also attended)

PURPOSE: The conference focused on strategies to improve investigation, monitoring and enforcement. The intended audience includes investigative staff, state attorneys, and board members who work with discipline.

OUTCOME: I attended all plenary sessions and the legal-oriented breakout sessions for the most part. Conference sessions are available at https://www.ncsbn.org/16607.htm. Some of the most valuable sessions in my opinion were:

• Carl Erik Fisher, MD, whose book The Urge: Our History of Addiction gave a most personal and enlightening account of the topic and his personal journey. Recommended reading.

• Investigation and Discipline of Multistate Licensees, Alice Henley, JD, LLM (Alabama). The latest updates on the compact and lessons on states coordinating investigations, with discussion on certain compact commission rules.

• Safe Harbor for Unsafe Nursing Assignments, Dusty Johnson, JD, Texas BON. This is a unique approach Texas has taken to shield nurses who feel forced to accept unsafe assignments. The nurse can declare a potential assignment as unsafe. The goal is to stimulate discussion and problem solving to make the situation safe. If that is not possible, the nurse has protection from discipline. Nursing peer review committees established in facilities review and report violations to the board.

• Decision-Makers’ Fact-Finding and Lessons for Agency Counsel, Michael Head, JD, Administrative Health Officer, KY, ret’d. This well-researched and scholarly presentation touched on history and philosophy, and some of the practical lessons on avoiding bias in decision making was quite valuable.

RECOMMENDATION: This is one of the two most valuable conferences for board attorneys (the other being FARB’s Regulatory Law Seminar). I encourage attendance whenever possible.

I thank the commission for the opportunity to attend this conference.

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NCSBN Discipline Case Management Conference May 23/25, 2022 Milwaukee, WI

Catherine Woodard (writing this critique)

Karl Hoehn, Barbara Justice

PURPOSE: Strategies to enhance investigation, monitoring, and enforcement. The intended audience is investigative staff, state attorneys, and board members who work with discipline cases.

OUTCOME: The highlights of the conference included:

o Keynote speaker Carl Erik Fisher, MD, who presented from his book The Urge: Our History of Addiction. Attendees also received a copy of the book. Significant insights into the disease of substance use disorder, spoken through the eyes of an alcoholic who was navigating med school, internship, and residency.

o Investigating a Nurse with Suspected SUD; a Guide for Nurse Leaders and Hospital Administration, presented by staff form the North Carolina Board of Nursing. The presentation was thorough and thoughtful, and I realized our staff is already meeting or exceeding all of their recommendations.

o Challenges to Substance Use Disorder Monitoring during the Pandemic. Panel discussion. This was enlightening to see how other jurisdictions dealt with the same challenges we faced.

o Trauma Informed Interview Process. A modern-day departure from the traditional methods of interviewing that embraces current science and the effects of trauma on the brain.

RECOMMENDATION: Always attend. The content each year makes this a valuable conference for anyone doing discipline work. Plus, the opportunities for networking are plentiful and we took full advantage of that.

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NCSBN Discipline Case Management Conference

May 23, 25, 2022

Milwaukee, Wisconsin

Barbara Justice, HCI3

PURPOSE: Provide information and training regarding the investigation and coordination of resources related to diversion complaints.

OUTCOME: The conference had several excellent speakers on a variety of subjects relevant to diversion issues in the medical environment. My personal favorite was the keynote address on how to navigate Trauma Influenced Interviews.

RECOMMENDATION: All Around Excellent Conference NCSBN did an excellent job providing participants with excellent speakers and resources to provide strategies to enhance investigations, client monitoring and discipline enforcement efforts. There was a broad base of topics which provided opportunity for participants to choose break-out sessions with information that most specifically related to their areas of interest. All the speakers and small group facilitators in sessions that I attended were exceptional, both in knowledge and presentation.

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Washington State Nursing Care Quality Assurance Commission NPAP DECISION SUMMARY REPORT Date: May and June 2022 Updated 6/3/2022

Actions Number Added for this

reporting period

2020 Panel Actions

YTD

2019 Totals

2018 Totals

Instate Approved Programs

Out of State Approved Programs

Letter of Determination:

7 LPN Programs

25 ADN

Programs

5 ADN Programs

2 LPN-BSN Programs

Intent to Withdraw Approval

17 RNB

Programs

12 BSN

Programs

Conditional Approval

3 1 15 BSN Programs

25 RNB Programs

Deny Approval 3 3 9 123 Post BSN Programs

38 Total BSN Programs

Letter of Decision:

3 Refresher Programs

285 MSN Programs

Approval – Programs

1 56 35 86 124 DNP Programs

Approval – Sub Change

5 67 8 16 1 EdD Nursing

Education Program

Plan of Correction (POC) Required

7 21 6 1 Refresher Programs

Acceptance of Submitted Documents or POC

4 91 26 16

Additional Documents or Actions Required

31 8 78

Deferred Action 1 34 15 46

Removal of Conditional Approval

1

Limit Student Enrollment

2 4

Voluntary Closure

2

Require Monitoring Report

10 1

Site Visit Report 15 8 Removal of Moratorium on admissions

1 1

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Covid-19 Curriculum Adjustments

92

Other 7 Approvals-Miscellaneous (non-program)

4

Monitoring Report:

Accept 5 4 28 Not Accept 1 Deferred Out-of-State DL Student Waivers:

Accept 5 9 5 Deny Deferred Complaints: Open 5 5 7 Closed 13 2 4 Defer 1 Complaint Investigation Reviewed:

Accept Investigation Report

4

No Action Required

3

Action required 2 Licensing Education Exemption (Waiver) Request:

Exemption Request Approved

13 5

Exemption Request Denied

2 2

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Snapshot of Approved Nursing Assistant Training Programs (June 2022)

Trend Indicator in Program Numbers: ___ Notable Increase _X_ Stable ___ Notable Decrease

Comments: Program numbers have ranged 180-200 total over last six years, but increased to >200 as 2019 came to a close and in early 2020. With the impact of COVID-19, the number of programs decreased temporarily to <200. As of June 2022, the program numbers are at 205..

Number of Nursing Assistant Training Programs (All Types) 205 • Traditional Programs 16 • Home Care Aide Alternative/Bridge Programs 21 • Medical Assistant Alternative/Bridge Programs 11 • Medication Assistant Certification Endorsement (MACE) Programs 11

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NAPAP REPORT 2022

*Program approvals for January 2022 adjusted from 2 to 3 for a program approved pending completion, which occurred at a later date.

Activity

JAN

10+20

FEB

14+28

MAR

14

APR

11

MAY

9

JUNE

13

JULY

11

AUG

8

SEP

12

OCT

10

NOV

14

DEC

12

YTD

Programs Applications Approved 3 3 2 1 1 1 11

Program Applications Deferred 2 1 3 6

Program Applications Denied

Program Change Requests Approved 2 1 3

Program Change Requests Deferred

Program Change Requests Denied

Program Complaints Reviewed 3 3

Program Complaints Opened 1 1

Program Complaints Closed 2 2 4

Site Visit Summaries Reviewed 1 1

Investigative Reports Reviewed 2 2

POC/DPOC or Program Condition Reviewed 2 1 3

Additional Documents/Program Actions Required

2 1 2 3 8

Intent to Change Program Status (Full to Conditional or Conditional to Full)

Intent to Withdraw Program Approval 1 1

Program Director/Instructor Applications Requiring Panel Review

Other Review or Process Decisions 6 9 6 6 6 10 43

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Nursing Care Quality Assurance Commission

Executive Director Search Committee Charter

The Nursing Commission (NC) will create a search committee with the purpose of assisting the NC in selecting a candidate for the Executive Director position. The committee will be comprised of the two Commissioners, two Pro-Tem members (who have previously served as Commissioners), and four Commission Staff. The NC Executive Director will serve as an ad hoc member of the committee. A designated staff member will be identified to serve as an assistant to the committee. The committee members will be appointed by the 2021-2022 NC Chair with the approval of the NC.

The 2022-2023 NC Chair and a Commission staff member will co-chair the committee. Members of the search committee, any staff assisting the committee, and any others designated by the search committee chair shall keep in confidence all materials associated with the search. All application material are confidential under Public Records Act, so should be treated accordingly. RCW 42.56.250(2).

The Commission staff co-chair of the committee will assist the search committee in developing and presenting a budget for the search process. The search committee will conduct a search process to seek the best-qualified candidates. Committee work will include:

-Drafting standardized review criteria that each committee member will use to evaluate candidate applications

-Individually review all candidate applications. There is to be no cross-discussion of candidates between committee members.

-Drafting a set of interview questions

-Narrowing the search to the top (eight) candidates based upon application and conduct two-hour screening interviews

-Narrow the search to the top (three) candidates.

-Assist in the arranging of commission, staff and perhaps interested parties interviews of the top (three) candidates

-Gather feedback from commissioner and staff panels

-Utilizing and assimilating feedback from panel interviews the search committee will rank and present the top candidates to the Commission for approval; it also will explain why this leader best meets the criteria for this position as established by the Commission.

-The search committee will work with DOH HR to establish parameters of a potential compensation and benefits package.

-The committee chairs will work with the then-current NC Chair, Executive Director, and the newly hired Executive Director regarding timing and details of the communication to announce the name of the new Executive Director to members, staff, and other constituents.

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-Upon commencement of employment the committee duties will cease, and the committee will disband.

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Bob Ferguson

ATTORNEY GENERAL OF WASHINGTON 1125 Washington Street SE – PO Box 40100 – Olympia, WA 98504-0100

May 16, 2022 Sent via Electronic Mail Washington Medical Commission Attn: Melanie de Leon, Executive Director Washington State Board of Osteopathic Medicine and Surgery Attn: Renee Fullerton, Executive Director Washington State Nursing Care Quality Assurance Commission Attn: Paula Meyer, Executive Director Washington State Pharmacy Quality Assurance Commission Attn: Marlee O’Neill, Acting Executive Director Greetings:

The Washington Medical Commission, the Washington State Board of Osteopathic Medicine and Surgery, the Washington State Nursing Care Quality Assurance Commission and the Washington State Pharmacy Quality Assurance Commission are responsible for providing licenses for medical providers in Washington state. This process generally involves a criminal background check, and convictions for certain crimes can disqualify a provider from obtaining a license to practice medicine in Washington.

As you know, many states and the United States Supreme Court are poised to restrict or eliminate the right to full access for reproductive and gender-affirming care. Over the past 50 years, Washingtonians have consistently affirmed this right. As leaders in protecting the health and safety of all residents of our state, I write to ask for your assistance in ensuring that medical providers who come to Washington to practice are not penalized for providing appropriate care in states where that care is prohibited or criminalized. Now is the time to send a clear message that Washington welcomes health care providers from other states who come here to provide medically appropriate care that may be criminalized where they currently practice.

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ATTORNEY GENERAL OF WASHINGTON

May 16, 2022 Page 2 You have discretion when considering licensure applicants who have criminal convictions or other disciplinary actions. Providers and the public will both benefit from a clear statement that you will not take action or disqualify from licensure providers solely based on violation of laws criminalizing care in other states but whose care otherwise meets Washington’s standard of care. I ask that you communicate that you will use your discretion to evaluate each case on its facts, consistent with your longstanding practices. A clear statement will benefit providers and the public by providing assurance that those who provide high quality essential care will not be turned away from this state. Washington is a leader in protecting reproductive rights. In 1970, with Referendum 20, Washington was the first state to legalize abortion in the first four months of pregnancy,1 under the condition that a woman seek permission from her husband. Roe v. Wade eliminated this requirement in 1973. In 1991, Washington voters passed Initiative 120, the Reproductive Privacy Act, which codified Roe in state law.2 In 2018, the Legislature passed the Reproductive Parity Act, which requires insurance plans to cover abortions and abortion care if they cover maternity care.3 Notably, a leaked draft of the initial majority opinion in the U.S. Supreme Court case Dobbs v. Jackson Women’s Health will, if adopted as drafted, overrule the federal right to abortion provided in Roe and allow states to decide whether to restrict or ban abortion. Many states already have abortion restrictions that will be effective immediately if Roe is overturned, and some of these states and others are considering more restrictive laws that would deny patients essential care.4 States across the country have laws restricting or eliminating access to abortion and criminalizing anyone who provides or aids an abortion, or anyone who chooses to end their pregnancy. While the Dobbs case concerns the right to abortion, the far-reaching and extreme assertions in the draft opinion has deeply harmful implications for many other rights. Additionally, Washingtonians recognize the importance of access to gender-affirming care. State law prohibits insurance companies from discrimination based on gender identity. In response to

1 Saldanha, Alison. “The history of abortion rights in Washington state.” The Seattle Times, May 5, 2022, https://www.seattletimes.com/seattle-news/data/the-history-of-abortion-rights-in-washington-state/ (last accessed May 10, 2022). 2 Saldanha, Alison. “The history of abortion rights in Washington state.” The Seattle Times, May 5, 2022, https://www.seattletimes.com/seattle-news/data/the-history-of-abortion-rights-in-washington-state/ (last accessed May 10, 2022). 3 S.B. 6219, “Concerning health plan coverage of reproductive health care,” 2017-18 Legislative Session, https://app.leg.wa.gov/billsummary?BillNumber=6219&Year=2017 (last accessed May 10, 2022). 4 In 2021, Texas passed S.B. 8, which provides that anyone who performs, induces, or attempts abortion is guilty of a second-degree felony if the fetus survives and a first-degree felony if the fetus dies.4 A first-degree felony is punishable by up to life in prison and up to a $10,000 fine (see https://statutes.capitol.texas.gov/Docs/HS/pdf/HS.170A.pdf). At least one Washington clinic has provided an abortion to a patient who traveled from Texas after S.B. 8 was enacted (see https://www.guttmacher.org/article/2021/11/new-evidence-texas-residents-have-obtained-abortions-least-12-states-do-not-border). In Tennessee, anyone who performs or attempts to perform an abortion is guilty of a Class C felony, punishable by between three and 15 years in prison and a fine up to $10,000 (see https://www.politico.com/news/2022/05/06/potential-abortion-bans-and-penalties-by-state-00030572). Many other states have passed or are considering similar legislation that would eliminate access to abortion.

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ATTORNEY GENERAL OF WASHINGTON

May 16, 2022 Page 3 the practice of insurers classifying gender-affirming treatments as not medically necessary even when recommended by a doctor, and therefore not required to be covered, in 2021, the Legislature passed a bill5 requiring insurers to cover gender-affirming care beginning in January 2022.6

Gender-affirming care is similarly under attack. For example, the Idaho House of Representatives recently passed a bill adding language to an existing law banning female genital mutilation that makes it a felony to perform gender-affirming surgery on transgender youth, punishable by up to life in prison.7 The bill, which has not yet passed the Idaho Legislature, also proposes to make it illegal for parents or anyone else to take a minor across state lines for gender-affirming care.8 This is unacceptable. The Washington Medical Commission, the Washington State Board of Osteopathic Medicine and Surgery, the Washington State Nursing Care Quality Assurance Commission and the Washington State Pharmacy Quality Assurance Commission are on the front line of the fight to ensure that all Washingtonians have access to the care that they need, regardless of their identity. I also recognize your commitment to make sure that appropriate care is provided to anyone who comes to Washington seeking care that is not available in the state where they live. I would be happy to meet with you to discuss this request. Thank you for your commitment to ensuring that all Washingtonians have access to the care they need. Sincerely,

BOB FERGUSON Attorney General RWF/jlg

5 Santos, Melissa. “Insurers in WA must cover transgender health care under new bill.” Crosscut.com, May 7, 2021, https://crosscut.com/equity/2021/05/insurers-wa-must-cover-transgender-health-care-under-new-bill (last accessed May 10, 2022). 6 S.B. 5313, “Concerning health insurance discrimination,” 2021-22 Legislative Session, https://app.leg.wa.gov/billsummary?BillNumber=5313&Year=2021&Initiative=false (last accessed May 13, 2022). 7 Ridler, Keith. “Idaho House Oks Gender Reassignment Surgery Ban for Minors.” Associated Press, March 8, 2022, https://www.usnews.com/news/best-states/idaho/articles/2022-03-08/idaho-bill-bans-gender-reassignment-surgery-for-minors (last accessed May 10, 2022). 8 Romo, Vanessa. “A third of trans youth are at risk of losing gender-affirming care, study says.” KUOW, March 21, 2022, https://www.kuow.org/stories/a-third-of-trans-youth-are-at-risk-of-losing-gender-affirming-care-study-says (last accessed May 10, 2022).

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Washington State Regulation of Health Professionals and Abortions FAQ The U.S. Supreme Court is expected to release an opinion in June 2022 that could impact the current Roe v. Wade ruling. The professional health care regulators of the State of Washington recognize that if Roe v. Wade is impacted it could raise practice concerns for our licensees.

The Washington State Medical Commission, Board of Osteopathic Medicine and Surgery, Nursing Care Quality Assurance Commission, and Pharmacy Quality Assurance Commission wrote these frequently asked questions (FAQ) to clarify how Washington regulators will continue to address this matter regardless of the U.S. Supreme Court’s ruling.

What is the history of abortion laws in Washington state? Washington became one of the first states to decriminalize abortion before Roe v. Wade in 1970 with Referendum 20. In 1991, Initiative 120 was passed. Initiative 120 ensures that “the state may not deny or interfere with a pregnant individual’s right to choose to have an abortion prior to viability of the fetus, or to protect her life or health.” The Reproductive Parity Act became law in June 2018. This legislation improved access to reproductive health benefits and preventive services for all Washingtonians. It also specified that health plans may not limit abortion services, and that if health coverage includes maternity care it also must provide coverage permitting abortion. The Affirm Washington Abortion Access Act, effective June 9, 2022, helps to preserve a pregnant person’s access to abortion care. This legislation expands the list of providers statutorily authorized to terminate pregnancies and updates the language from 1991’s Initiative 120 to include transgender, non-binary and gender expansive people as those who are eligible to receive abortion care. It ensures Washington abortion care providers will be able to serve any person who comes to the State of Washington seeking abortion services.

Will abortions remain legal in Washington state? Yes.

The law in Washington states, “every individual possesses a fundamental right of privacy with respect to personal reproductive decisions” including “the fundamental right to choose or refuse to have an abortion.” (RCW 9.02.100)

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Further, state law makes it clear that no one may interfere with either a pregnant individual's right to choose an abortion prior to fetal viability or a health care practitioner’s right to provide an abortion. (RCW 9.02.110). For more on viability see below.

Under current state law state regulators cannot inhibit, prevent, hamper or interfere with a health care professional, acting within their scope of practice, from providing an abortion that meets the state standard of care.

What is an abortion and at how many weeks may an abortion be performed? Washington law defines abortion as “any medical treatment intended to induce the termination of a pregnancy except for the purpose of producing a live birth.” (RCW 9.02.170)

In Washington, abortions are legal up to the point of fetal viability or to protect the life or health of the pregnant individual. (RCW 9.02.110) Viability is defined as “the point in the pregnancy when there is a reasonable likelihood of the fetus's sustained survival outside the uterus without the application extraordinary medical measures.”

Viability is determined by the judgement of a physician, PA, ARNP or other health care provider acting within the provider's scope of practice on the particular facts of the case. (RCW 9.02.170)

Additionally, Washington legally considers a practitioner’s good faith judgement as a defense for violations of RCW 9.02. This means that should viability or the health of the pregnant individual be in question, providers acting in good faith are generally safeguarded.

How do state regulators determine discipline and licensure if Roe v. Wade is overturned?

The ruling does not affect the way health profession regulators operate in Washington State.

Washington regulators are complaint-based. Each complaint presented to a state health care regulator will be evaluated based on its own unique facts and circumstances, as is currently the practice.

The Uniform Disciplinary Act (UDA) defines standards of discipline, licensure and powers given to health care regulators and the Secretary of Health. UDA section RCW 18.130.180 details what constitutes unprofessional conduct. Health profession regulators use their discretion, regarding both licensure and discipline to apply these laws.

In Washington, performing an abortion by means found in RCW 9.02.170, which does not harm the pregnant person and is before the viability of the fetus, does not equal a UDA violation.

Generally, Washington does not discipline or refuse licensure based solely on the status of licensure or discipline in another state.

Who may perform an abortion in Washington state? A physician (MD), osteopathic physician (DO), physician assistant (PA), advanced registered nurse practitioner (ARNP), or other health care provider acting within the provider's scope of practice may

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provide an abortion as defined in RCW 9.02.170 within their scope of practice. (EHB 1851, Chapter 65, Laws of 2022)

Additionally, Washington regulation mandates that all hospitals with emergency rooms provide emergency contraception as a treatment option to any woman who seeks treatment as a result of a sexual assault. (WAC 246-320-286)

Providers can refer patients and the public to the Washington State Department of Health website for a compendium of resources regarding who can provide abortions, insurance coverage mandates, privacy laws and more: DOH Abortion Resources webpage.

May a pharmacist dispense hormonal, non-hormonal, or emergency contraceptives in Washington State?

Yes, a pharmacist may dispense hormonal, non-hormonal, or emergency contraceptives pursuant to a valid prescription or chart order. As with all other prescribed medications, pharmacists must comply with all applicable laws and rules when dispensing hormonal, non-hormonal, or emergency contraceptives, including the requirement to ensure a prescribed contraceptive is safe and appropriate for each patient (WAC 246-945-305(2).

Any complaints received by the Pharmacy Commission related to the dispensing of hormonal, non-hormonal, or emergency contraceptives by pharmacists will be reviewed and assessed. The Pharmacy Commission will evaluate each complaint on its facts and circumstances.

Several boards and commissions are united – here’s how. The following professional health care regulators recognize that the while a U.S. Supreme Court ruling could impact the rights of pregnant individuals nationally, the laws in Washington state would not be changed by such a ruling. For information on how each commission is addressing this issue, please click on the following links:

• Washington Medical Commission • Board of Osteopathic Medicine and Surgery • Nursing Care Quality Assurance Commission • Pharmacy Quality Assurance Commission

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Case Disposition

Panel

Each member of the

NCQAC may serve as a

chair

Substance Use Disorder Review

Panel

TBD

Chair Tucker, Kim, Chair

Myrick, Helen, Chair

Tucker, Kim, Chair Alvarado, Jonathan, Chair

Morrell, Dawn, Chair

Ness, Sharon, Chair Canary, Adam, Chair

Myrick, Helen, Chair, Public Member

Strader, Yvonne, Chair

Rude, Tracy Chair must be a NCQAC member

Ness, Sharon, Chair

Canary, Adam, Chair

Brown, Fionnuala Soine, Laurie Childress, Quiana Soine, Laurie (NP)

Canary, Adam Myrick, Helen Public Member

Public Member needed

Alvarado, Jonathan, ARNP

Myrick, Helen Baroni, Mary Soine, Laurie Morrell, Dawn

Fought, Sharon Baroni, Mary Rude, Tracy Soine, Laurie Myrick, Helen Guilford, Ella RN Member

Ness, Sharon Strader, Yvonne, RN Canary, Adam Kimberly Tucker Haerling, Katie Ness, Sharon

Benson, Julie Guilford, Ella Graham, Sandra Hoeksel, Renee Frank, Lindsey (CNM)

Randich, Tiffany LPN Member

Morrell, Dawn LPN Ness, Sharon Canary, Adam Baroni, Mary Strader, Yvonne

Mulligan, Anne Murray, Amy Brown, Fionnuala Kilpatrick, Megan (CNS)

Public Member needed

Shirley, Jamie Pro Tem

Childress, Quiana Meyer, Paula, Staff

Childress, Quiana Guilford, Ella Shirley, Jamie Rude, Tracy

Hoeksel, Renee Babbo, Gerianne, Staff

Moisio, Kathy, Staff

Benson, Julie Fitzgerald, Shannon (NP)

Underwood, Lori, Staff

Fleming, RobinPro Tem

Randich, Tiffany Sharar, Amy Staff ARNP New Public Member

Gorski, Mary Sue, Staff

Hulteen, Grant, staff

Cochrell, Patty Joan Owens Hulteen, Grant, Staff

Myrick, Helen, ad hoc

Hoehn, Karl, Staff Attorney

Johnny, Shana Staff Rude, Tracy New Public Member

Holm, Margaret Staff (Ad hoc)

Hoehn, Karl, staff

Babbo, Gerianne, Staff

Talkington, Tim, Staff Attorney

Bayne, Miranda, Staff Attorney

Rude, Tracy, ad hoc Gorski, Mary Sue; Staff

Johnny, Shana, Staff (Ad hoc)

Carlson, Deborah (Ad Hoc) Staff

Woodard, Catherine, Staff

Staff Morrell, Dawn Dagum, Jessilyn; Staff

Nolet, Adena, staff

Bear, Sarah, Staff Sparks, Janell, Staff

Seanna Reichold, Staff Attorney (as able)

Babbo, Gerianne, Staff

Dagum, Jessilyn; Staff

Palmer, Holly Staff Hulteen, Grant, Staff

Budde, Helen, Staff

Myrick, Helen Johnny, Shana (Ad hoc)

Bacon, Cicely, staff

Talkington, Tim, Staff Attorney

Sara Kirschenman Staff Attorney

Sparks, Janell; Staff

Bear, Sara, Staff Hoehn, Karl, Staff Attorney

Hoehn, Karl, Staff

Ness, Sharon

Sara Kirschenman Staff Attorney

Llacuna, Alana, Staff

Talkington, Tim, Staff Attorney

Furman, John, Staff

Batchelder, Lynn, sStaff Alvarado, Jonathan (NP)

Sparks, Janell, Staff Sara Kirschenman Staff Attorney

Budde, Helen, Staff

Margaret Holm, Staff

Randich, Tiffany

Moisio, Kathy, ad hoc

Elsner, Barbie, Staff

Soine, Laurie

Reichold, Seana, ad hoc

Holm, Margaret Staff (Ad Hoc)

Strader, Yvonne

Bayne, Miranda, ad hoc

Childress, Quiana

Holm, Margaret (ad hoc)

1st Friday every other month; 12-1pm; Microsoft Teams meeting

3rd Tuesday Every Other Month; 3:30-5:30pm; Microsoft Teams meeting

Every Thursday During Session; 5-6pm; Microsoft Teams meeting

Every Tuesday 8:30-10am; Microsoft Teams meeting

3rd Monday of every month; 5-6pm; Microsoft Teams meeting

3rd Thursday; 10am-12pm; Microsoft Teams meeting

1st Thursday of Month; 10am-12pm; Microsoft Teams meeting

2nd Monday every month; 3:00-5:00pm; Microsoft Teams meeting

3rd Wednesday every month; 7-8pm; Microsoft Teams meeting

4th Friday of every month; 9:30-10:30am; Microsoft Teams meeting

Quarterly

Consistent Standards of Practice Subcommittee

Discipline Subcommittee Legislative Panel Case Management Panel Research Subcommittee NPAP Panel A NPAP B NA-PAP Advanced Practice Subcommittee

Licensing Sub-Committee Education Subcommittee

66

Nursing Care Quality Assurance Commission Washington Administrative Code (Rules) Agenda

Updated: June 16, 2022

# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

1 RN, ARNP, NA (Emergency rulemaking)

Kathy Moisio Bonnie King

3/14/2022: 246-840-930 246-841-405

Amending specific training requirements for Nursing Assistants Registered (NARs) and Home Care Aides (HCAs). The Nursing Care Quality Assurance Commission (commission) is adopting an emergency rule to allow a registered nurse delegator to delegate nursing tasks to a NAR or HCA without verifying the NAR or HCA has completed basic caregiver training in accordance with WAC 246-840-930(8)(b). To align with the corresponding NAR rule, the commission is adopting emergency language in WAC 246-841-405(2)(a) to remove the requirement that a NAR must show proof of completion of the basic caregiver training before performing any delegated nursing task. (Emergency rules expire every 120 days and must be re-filed, if necessary).

WSR: File: 7/12/2022 WSR: 22-07-046 Filed: 3/14/2022

2 NT, LPN, RN, ARNP Nurses (Emergency rulemaking)

Debbie Carlson, Gerianne Babbo, Mary Sue Gorski Bonnie King

9/9/2022 Revised: 246-840-365, 367 5/13/2022 Revised: 246-840-365, 367, 533 1/14/2021 Revised:

Amend specific credential and license requirements for Nurse Technicians (NT), Licensed Practical Nurses (LPN), Registered Nurses (RN), and Advanced Registered Nurse Practitioners (ARNP) in response to the COVID-19 pandemic and the critical demand for healthcare professionals. (Emergency rules expire every 120 days and must be re-filed, if necessary).

WSR: File: 9/9/2022 WSR: 22-11-047 Filed: 5/13/2022 WSR: 22-03-056 Filed: 1/14/2022 WSR: 21-19-092 Filed: 9/17/2021

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# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

246-840-010, 365, 367, 533, 840 9/17/2021 Revised: 246-840-010, 365, 367, 533, 840, 930 4/24/2020 Original: 246-840-010, 125, 210, 240,361, 365, 367, 533, 534, 840, 930

WSR: 21-12-012 Filed: 5/20/2021 WSR: 21-04-005 Filed: 1/20/2021 WSR: 20-22-024 Filed: 10/23/2020 WSR: 20-14-065 Filed: 6/26/2020 WSR: 20-10-014 Filed: 4/24/2020

3 NAR, NAC Nursing Assistants (Emergency rulemaking)

Kathy Moisio Bonnie King

1/14/2022 Revised: 246-841-420, 470, 490, 500, 510, 555 6/26/2020 Original: 246-841-405, 420, 470, 490, 500, 510, 555

Amend specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) in response to the COVID-19 pandemic and the critical demand for healthcare professionals. (Emergency rules expire every 120 days and must be re-filed, if necessary).

WSR: File: 9/9/2022 WSR: 22-11-049 Filed: 5/13/2022 WSR: 22-03-055 Filed: 1/14/2022 WSR: 21-19-091 Filed: 9/17/2021 WSR 21-12-011 Filed: 5/20/2021 WSR 21-04-004 Filed: 1/20/2021 WSR 20-22-023, Filed: 10/23/2020

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# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

WSR 20-14-066 Filed: 6/26/2020

4 NT, LPN, RN, ARNP Fees (Standard rulemaking)

Chris Archuleta Fiscal Staff (HSQA) Bonnie King

246-840-990 The Secretary of the Department of Health in consultation with NCQAC is considering an increase in licensure fees for professions under its regulation. A fee increase is needed to address the increasing costs associated with the agency’s new Healthcare Enforcement and Licensing Modernization Solution (HELMS) database, the need to increase staffing levels to meet the new legislative mandate to process nurse licenses in seven days or less, and an increase in workload associated with implementing solutions addressing the nursing assistant and long-term care crisis.

WSR:21-23-053 Filed: 11/10/2021 Note: The NCQAC voted at the 9/9/2021 meeting to begin the standard rulemaking process.

WSR: 22-10-104 Filed: 5/4/2022 Note: The DOH hearing is scheduled for 6/13/2022 at 2 pm.

5 NA Standards of Practice & NAC Training Program Standards (Standard rulemaking)

Kathy Moisio Bonnie King

Chapter 246-841 WAC (amend) Chapter 246-842 WAC (repeal)

Legislated work by NCQAC with key interested parties in 2018-2020 resulting in a final Long-Term Care Report to the Legislature (June 2021) confirmed the need for updating rules. The coronavirus disease 2019 (COVID-19) pandemic magnified the need and urgency for changes to eliminate barriers to career advancement for nursing assistants to help address the nursing assistant shortage in health care. NCQAC believes standardizing curriculum in training programs will also result in standardizing scope of practice across work settings.

WSR: 21-05-021 Filed: 2/8/2021 Note: The Nursing Assistant Program Approval Panel (NAPAP) is drafting language for interested parties to consider in public workshops.

6 NA Secretary Authority Rules (Standard rulemaking)

Ross Valore (HSQA) Kathy Moisio Bonnie King

246-841-520, 720

Chapter 246-841 WAC is being revised. Within the chapter are three sections which are under the authority of the DOH Secretary: WAC 246-841-520 Expired

WSR: 22-08-019 Filed: 3/28/2022

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# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

licenses, 720 Mandatory reporting, 990 Fees. WAC 246-841-520 and 720 need revisions to align with the rest of the chapter revisions which are ongoing. See # 6 above.

7 ARNP Scope of Practice (Standard rulemaking)

Mary Sue Gorski Jessilyn Dagum

246-840-300, 700 through 710, other related sections in 246-840 WAC

The rules were opened in response to an April 3, 2018, petition about scope of practice for advanced registered nurse practitioners.

WSR: 19-01-002 Filed: 12/5/2018 Note: Workshops on the concepts were held 1/22, 23, 24/2019. The Advanced Practice Subcommittee drafted language. Additional public workshops were held 1/26 and 2/7/2022.

8 ARNP 2018 Opioid Prescribing (Standard rulemaking)

Mary Sue Gorski Jessilyn Dagum

Chapter 246-840-WAC

The rules were opened to address concerns expressed by Washington state long-term care associations and advanced practice nursing associations about the implementation of the 2018 opioid prescribing rules. On December 21, 2018, the NCQAC adopted Interpretive Statement (NCIS 2.00), Application of WAC 246-840-4659 to nursing homes and long-term acute care hospitals. Interpretive statements are not enforceable and not subject to discipline under the Uniform Disciplinary Act. Opening the rule provides the opportunity for additional stakeholder engagement, rule clarification, and possible amendments to address identified concerns.

WSR: 19-15-092 Filed: 7/22/2019 Note: Advanced Practice Subcommittee receiving feedback from the Long-term Care community and considering an Interpretive Statement regarding E-prescribing.

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# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

9 ARNP Inactive and Expired Licenses (Standard rulemaking)

Mary Sue Gorski Jessilyn Dagum

246-840-365, 367

Concerns expressed at the 3/11/2022 CR-102 rules hearing (see Emergency to Perm Rules above) caused the commission to remove 365 and 367 from consideration. They voted to begin a new CR-101 process and consider adding other rule sections.

WSR: 22-12-090 Filed: 6/1/2022 Note: The NCQAC approved filing a Preproposal at the 3/11/2022 meeting.

10 NT, LPN, RN, ARNP Temporary Practice Permits (Standard rulemaking)

Amber Zawislak, Debbie Carlson, Gerianne Babbo Bonnie King

246-840-095 When the department and commission first began completing FBI fingerprint background checks on out-of-state applicants the process took several months. To remedy this delay in licensure, the commission issues a temporary practice permit after the applicant meets all other licensure requirements, allowing the nurse to begin working in Washington State. Under WAC 246-840-095, the temporary practice permit is valid for 180 days or until the commission issues a permanent Washington State license to the nurse. WAC 246-840-095 also allows for an additional 180-day extension of the temporary practice permit if the department has not received the fingerprint results during the initial 180-day period. The commission intends to engage in rulemaking to shorten the length of a temporary practice permit and to align the internal NCQAC process with WAC language.

WSR: 22-06-057 Filed: 2/25/2022 Note: NCQAC approved filing a Preproposal in a 2017 commission meeting.

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# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

11 NT Nursing Technician Definition (Expedited rulemaking)

Gerianne Babbo Tim Talkington Bonnie King

246-840-010 The commission Education Subcommittee determined the proposed rules are needed in order to align rule language with the statute, RCW 18.79.340 regarding requirements for nursing program approval.

Expedited WSR: 22-12-092 Filed: 6/1/2022 Public comment period ends 8/1/2022 CR-105 expires 180 days after publication. Must file CR-103P Before 11/28/2022

WSR: File: File before 11/28/2022

12 RN, ARNP, NA Legislation SHB 1124 Governor signed 3/11/22 Effective 7/1/2022 (Standard rulemaking)

Debbie Carlson, Bonnie King

246-840-010, 700, 910, 920, 930, 940, 950, 960

1124-S.PL.pdf (wa.gov) Nurse Delegation of Glucose Monitoring, Glucose Testing, and Insulin Injections (c) Except as authorized in (b) or (e) of this subsection, a registered nurse may not delegate the administration of medications. Except as authorized in (e) or (f) of this subsection, a registered nurse may not delegate acts requiring substantial skill and may not delegate piercing or severing of tissues. Acts that require nursing judgment shall not be delegated. (e) For delegation in community-based care settings or in-home care settings, a registered nurse may delegate nursing care tasks only to registered or certified nursing assistants under chapter 18.88A RCW or home care aides certified under chapter 18.88B RCW. (v) When delegating insulin injections under this section, the registered nurse delegator must instruct the individual regarding proper injection procedures and the use of

WSR: Filed: Note: At a commission meeting held on May 13, 2022, the commission voted to begin the rulemaking process for nursing rules. Note: NA rules in progress will incorporate language for NAs. See #5 above.

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# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

insulin, demonstrate proper injection procedures, and must supervise and evaluate the individual performing the delegated task (()) as required by the commission by rule. If the registered nurse delegator determines that the individual is competent to perform the injection properly and safely, supervision and evaluation shall occur at (()) an interval determined by the commission by rule. (f) The delegation of nursing care tasks only to registered or certified nursing assistants under chapter 18.88A RCW or to home care aides certified under chapter 18.88B RCW may include glucose monitoring and testing.

13 RN, LPN, ARNP, NA, NT Legislation ESSB 5229 effective 7/25/2021 (Standard rulemaking)

Debbie Carlson, Shanna Johnny, Kathy Moisio HSQA Bonnie King

5229-S.SL.pdf (wa.gov) Health Equity & Continuing Competency The law, effective 7/25/2021, in Section 2 requires rule-making authorities for each health profession to adopt rules requiring a licensee to complete health equity continuing education training at least once every 4 years. The new law is very prescriptive. DOH is to develop model rules in consultation with boards and commissions by 1/1/2023 with minimum standards for continuing education. Information about available courses must be available to licensees by 7/1/2023 and include a course option that is free of charge.

WSR# 21-20-011 Filed by DOH: 9/23/2021 Note: HSQA is taking the lead and a representative(s) of NCQAC is participating in development. After model rules are developed, NCQAC will begin a rulemaking process fall of 2022.

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# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

Rules Effective 2021-2022 1 NT, LPN, RN, ARNP

Emergency to Permanent Rules (Standard rulemaking)

Debbie Carlson, Gerianne Babbo, Mary Sue Gorski, Shana Johnny Jessilyn Dagum

3/11/2022 246-840-533, 930 9/17/2021 Original 246-840-365, 367, 533, 930

Create permanent rules from some of the previous emergency rules. The NCQAC first adopted emergency rules in response to COVID-19 in April 2020. They were refiled multiple times while permanent language is being developed.

WSR: 21-19-104 Filed: 9/17/2021 Note: Public workshops held 11/3 & 11/8/2021. CR-102 hearing scheduled for 3/11/2022.

WSR: 22-04-081 Filed: 1/31/2022 Note: CR-102 hearing held 3/11/2022. WAC 246-840-365, 367 removed and will be included in a new CR-101.

WSR: 22-12-026 Filed: 5/23/2022 Note: Effective 9/9/2022 to coincide with expiration of emergency rule.

2 LPN/NT Practice Opportunities (Standard rulemaking)

Debbie Carlson, Gerianne Babbo, Shana Johnny Jessilyn Dagum

246-840-010, 840, 850

Allow LPN students practice opportunities. NCQAC's legislative panel completed a review of the benefits of apprenticeship programs. The panel recommended opening rules to grant LPN students the same opportunity as registered nurse (RN) students to obtain a nurse technician credential.

WSR: 20-11-044 Filed: 5/18/2020 Note: Workshops 10/5, 9/2020. NCQAC approved rule language for (CR-102) on 3/12/2021.

WSR 21-20-058 Filed: 9/28/2021 Note: Hearing held 11/12/2021. CR-103 to be filed with an effective date of 5/15.

WSR: 22-04-082 Filed: 1/31/2022 Note: Effective 5/13/2022 to coincide with expiration of emergency rule.

3 NT, LPN, RN Continuing Competency (Standard rulemaking)

Amber Zawislak, Shana Johnny, Debbie Carlson, Gerianne Babbo, Mary Sue Gorski Bonnie King

WAC 246-840-111, 120, 125, and 200 through 260

The Nursing Care Quality Assurance Commission (commission) is adopting amendments to the continuing competency rules and requirements for active, inactive, expired, and retired active credential statuses. This reduces the continuing education hours from 45 hours to eight hours, the active practice hours from 531 to 96 hours and the reporting period from a three-year cycle to an annual cycle. These changes applied to the retired active rule, the active credential rule, the reactivation from expired rule, and the reactivation from inactive rule. The commission also adopted

WSR: 19-01-001 Filed: 12/5/2018

WSR: 21-04-096 Filed: 2/1/2021

WSR: 21-11-032 Filed: 5/12/2021 Effective 6/12/2021

74

# Profession

Staff Content Experts Rules Staff assigned

WAC Sections

Purpose for Rule Making

CR-101 Preproposal

CR-102 Proposal & CR-105 Expedited

CR-103P Permanent

CR-103E Emergency 120-day limit WSR means Washington State Register

changes that now allow the commission to choose to audit licensees based on a random audit, or as part of the disciplinary process and the language for extensions is removed as it is no longer needed.

4 NT, LPN, RN, ARNP, NA Aids Education & Training (Expedited rulemaking)

Debbie Carlson, Gerianne Babbo, Mary Sue Gorski, Kathy Moisio Bonnie King

WAC 246-840-025, 030, 045, 090, 539, 541, 860, 905, 246-841-490, 578,585 and 610

Section 22, paragraph (11) of ESHB 1551 repeals RCW 70.24.270-Health Professionals-Rules for AIDS education and training. This repeal no longer requires health professionals to obtain AIDS education and training as a condition of licensure. The amendment of the impacted rules is to help reduce stigma toward people living with HIV/AIDS by not singling out AIDS as an exceptional disease requiring special training and education separate from other communicable health conditions.

Expedited WSR: 20-18-045 Filed: 8/28/2020

WSR: 21-04-016 Filed: 1/22/2021 Effective 2/22/2021

Future Rulemaking from Legislation

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Summary of Recommendations to the 2022 Delegate Assembly

Board of Directors Recommendations: 1. Approve the proposed Strategic Initiatives for the years 2023-2025 and amendments to the

narrative statements associated with NCSBN values. Rationale: The proposed strategic initiatives and changes to the values narrative statements

have been developed through a process of consultation commencing with an initial kick-off meeting by the BOD in October 2021. The proposed changes have been subject to consultation with members at the Midyear Meeting as well as an opportunity to submit written comment and are presented for adoption as required by the NCSBN Bylaws Article 4 Section 3 that state that the Delegate Assembly, the membership body of the NCSBN, shall provide direction for the NCSBN through resolutions and enactments, including adoption of the mission and strategic initiatives.

Fiscal Impact: Consequences will be incorporated into FY2023-25 budgets.

2. Approve the College of Registered Nurses of Saskatchewan (CRNS) as an Exam User Member of NCSBN.

Rationale: An Exam User Member is a jurisdictional board of nursing that has an organizational

mandate exclusively related to the regulation of the profession and protection of the public and uses the pre-licensure exam developed by NCSBN, which is approved by the Delegate Assembly as an Exam User Member of NCSBN. CRNS has made legislative changes to their mandate that focuses upon acting in the public interest.

Fiscal Impact: Incorporated into the FY23 budget. Funding for one member to attend Midyear and Annual Meeting estimate: $3000 annually Use of the resource fund: up to $3000 per request

3. Approve the College of Registered Nurses of Alberta (CRNA) as an Exam User Member of

NCSBN. Rationale:

An Exam User Member is a jurisdictional board of nursing that has an organizational mandate exclusively related to the regulation of the profession and protection of the public and uses the pre-licensure exam developed by NCSBN, which is approved by the Delegate Assembly as an Exam User Member of NCSBN. CRNS has made legislative changes to their mandate that focuses upon acting in the public interest.

Fiscal Impact: Incorporated into the FY23 budget.

Funding for one member to attend Midyear and Annual Meeting estimate: $3000 annually

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Use of the resource fund: up to $3000 per request Leadership Succession Committee (LSC) Recommendations:

4. Present the 2022 Slate of Candidates.

Rationale:

The Leadership Succession Committee has prepared the 2022 Slate of Candidates with due regard for the qualifications required by the positions open for election, fairness to all candidates, and attention to the goals and purpose of NCSBN. Full biographical information and application responses for each candidate are posted in the Business Book under the Report of the Leadership Succession Committee.

Fiscal Impact:

Incorporated into the FY23 budget. NCLEX Examination Committee (NEC) Recommendations: 5. Approve the 2023 NCLEX-RN Test Plan.

Rationale: Following the analysis of survey results from the 2021 RN Practice Analysis, the draft NCLEX-RN test plan was developed and sent to NCSBN’s regulatory bodies for review and feedback. Subsequently, the draft documents were presented to the Board of Directors. The 2023 NCLEX-RN Test Plan will be presented at annual meeting for review and approval by the Delegate Assembly.

Fiscal Impact: Incorporated into the FY22 budget.

6. Approve the 2023 NCLEX-PN Test Plan.

Rationale: Following the analysis of survey results from the 2021 PN Practice Analysis, the draft NCLEX-PN test plan was developed and sent to NCSBN’s regulatory bodies for review and feedback. Subsequently, the draft documents were presented to the Board of Directors. The 2023 NCLEX-PN Test Plan will be presented at annual meeting for review and approval by the Delegate Assembly.

Fiscal Impact: Incorporated into the FY22 budget.

References:

A. Proposed Strategic Initiatives for 2023-2025 and amendments to NCSBN Values narrative statements.

B. College of Registered Nurses of Saskatchewan (CRNS) Exam User Member Application C. College of Registered Nurses of Alberta (CRNA) Exam User Member Application D. 2022 Slate of Candidates E. Proposed 2023 NCLEX-RN Test Plan – Strikethrough Copy

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F. Proposed 2023 NCLEX-RN Test Plan – Clean Copy G. Proposed 2023 NCLEX-PN Test Plan – Strikethrough Copy H. Proposed 2023 NCLEX-PN Test Plan – Clean Copy

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A

Promote agile regulatory systems for relevance and 

responsiveness to change.

B

Champion regulatory solutions to address borderless health care 

delivery.

C

Strengthen the capacity, capability, diversity and 

engagement of regulatory leadership.

D

Pioneer competency assessments to support the future of health care and the advancement of regulatory excellence.

NCSBN's purpose, vision, and mission all focus on the pursuit of excellence in public protection through supporting and empowering its members with the necessary research to take evidence‐informed decisions and action. Recognizing the fast pace of change occurring in the health sector environment as well as demands from governments to reform occupational licensure, NCSBN needs to be on the cutting edge of change and evolution of contemporary regulatory systems. Leveraging the expertise of NCSBN's membership, and acknowledging we cover more than 27% of jurisdictions in the world, we need to be a thought leader, fully supportive and committed to the optimal delivery of jurisdiction‐based, evidence‐informed regulation. NCSBN must build on its global reach, critically distilling best practices and promoting these for the benefit of public protection worldwide thereby maximizing the adoption of contemporary regulatory processes for the benefit of all jurisdictions and all those the profession serve.

NCSBN maintains its leadership in the development of solutions to support borderless health care through its work on the nurse licensure compacts and the technological infrastructure to coordinate licensure information across jurisdictions. The use of technology,  education, increased consulting, and service delivery across borders requires an enhanced focus on this critical regulatory challenge to the provision of safe and equitable patient care. Being cognizant of the legislative process, keeping an eye on current and emerging issues, responding quickly to crises, as well as being knowledgeable of where and how regulators can get involved will help accelerate the achievement of safe, effective and efficient regulatory solutions within and across jurisdictional borders fit for our complex, dynamic, digital age.

NCSBN’s success in achieving its vision, mission, and objectives is directly proportionate to the active engagement and leadership of our members, partners, and government. NCSBN is committed to developing programs and services that support nurse regulatory body performance and facilitate sharing of best practice, mentoring of talent, and diffusion of expertise within and across professions. This initiative builds a global community of regulators concentrating on: Addressing the specific needs of executive officers, staff, board members and partners. Embracing and responding to generational changes in regulation and the policy environment. Leveraging the role of the regulator in complex interdependent systems that collectively secure public safety 

and minimize barriers to necessary change.

NCSBN provides state‐of‐the‐art competency assessments that are psychometrically sound, secure, and legally defensible, but in today's world they also need to provide fidelity. Maintaining the industry benchmark for consistency and value, and defining future development and application, requires a team effort. Areas of focus include launching our enhanced precision next generation measurement exam.  Additionally, COVID‐19 has taught us many lessons about the strengths and weaknesses of our current exam access and delivery system. Accordingly there is a need to work on optimizing approval processes and delivery of the NCLEX® to candidates using technology. As career pathways change the way competence is assessed, maintained, and articulated across a career, it also needs to evolve if the workforce is to remain fit for the future.

The COVID‐19 Pandemic has accelerated the pace of change and the need for reform.

Increased demands for occupational licensure modernization that is responsive to changing needs, proportionate to risk of public harm and optimized to minimize regulatory barriers to service provision.

NCSBN produced and has built upon the Regulation 2030 roadmap offering clarity over the trends to be addressed, and these need to be pursued if public safety is to be assured.

Changing population demographics, health care needs, artificial intelligence, technology, diversity, equity and inclusion, as well as increasing numbers and severity of chaotic events, all demand regulators work together in new ways.

Maldistribution and shortages of workers combined with increased frequency of unpredicted demands due to natural and man‐made disasters.

Increased interest in trade agreements and the use of remote health care delivery.

Need for agreed principles or global standards for articulated nursing licensure and telehealth practice.

Increased demands for access to equitable, affordable safe services within and across disciplines.

Increased mobility of nurses and new models of nurse led services.

Rapid turnover of leadership in regulatory boards has resulted in loss of corporate memory.

Equip members with the skills necessary and information to bring about regulatory reform and optimize the contribution of regulators to the occupational licensure policy landscape.

Increase pipeline of potential candidates for staff and governance roles. Specific and targeted education toward competencies required to be an efficient, effective and progressive regulator.

Provide tools to members in challenging regulatory, highly‐scrutinized environments.

Technology will continue to increase in power capability, connectivity, and fidelity.

Interoperability, data security, emerging technology, and big data analytics will feature more prominently in proportionate risk‐based regulatory systems that will draw upon and interface with real‐time service delivery.

Initial and continuing competence requirements to facilitate redesign of services and support equitable public safety will remain a priority.

There will be an increased need for mechanisms to calibrate the differentiated and overlapping competence of nursing across and within jurisdictions as well as in relation to shared competencies with other disciplines.

Strategic Initiative Narrative Rationale

Proposed NCSBN 2023‐2025 Strategic Plan

VisionLeading regulatory excellence worldwide.

MissionNCSBN empowers and supports nursing regulators in their mandate 

to protect the public.

ValuesCollaboration | Excellence | Innovation | Integrity | Transparency

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Proposed Amendments to NCSBN Values Narrative Statements

Collaboration: Forging solutions through respect, diversity, inclusion, and collective strength of all stakeholders Excellence: Striving to be and do our best in rapidly changing environments Innovation: Embracing change as an opportunity to better organize endeavours for all and turn new ideas into action Integrity: Doing the right thing for the right reasons through honest, open and ethical dialogue Transparency: Demonstrating and expecting openness, clear communiction, and equity and accountbility of processes and outcomes

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NCSBN Exam User Member Application

Organization Information

Organization Description

1. List all the professions the organization regulates:

2. List the number of persons regulated (by profession):

3. Describe the authority under which the organization regulates:

Full Legal Name of Organization

Chief Staff Person Credentials

Email Address Direct Phone Number

Organization Mailing Address

City State Country Postal Code

Organization Physical Address (if same as mailing address, enter “N/A”)

City State Country Postal Code

Organization Main Phone Number Organization Email Address Website

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4. Include the organization’s mission statement in the space below:

5. Is this a membership organization?

6. List the date the organization was founded:

7. Does the jurisdiction currently use a prelicensure exam developed by NCSBN?

Yes

No

7a. If yes, list the specific exam(s) the jurisdiction uses:

7b. If yes, how long has the jurisdiction used the exam(s)?

8. Is the organizational mandate exclusively related to the regulation of the profession and protection of the public?

9. Describe why the organization wants to be an NCSBN Exam User Member:

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10. Is the organization incorporated?

Yes

No

10a. If yes, check one of the following:

For-profit

Nonprofit

11. List the number of staff working within the organization:

12. How many members are on the organization’s governing board?

13. If the organization is not determined to be eligible for Exam User Membership, would it be interested in applyingfor Associate Membership?

Upon completion submit this application form via email to memberrelations@ncsbn.org along with a copy of the organization’s Bylaws as an attachment.

By signing this application the undersigned understands that, if approved for membership, applicants are required to abide by NCSBN bylaws and the NCSBN Board Policy Manual. Failure to pay annual exam user membership fee of $750 USD may result in termination of status. Decisions of the NCSBN Delegate Assembly regarding membership are final.

______________________________________________________ ____________ Signature Title Date

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2022 Slate of Candidates The following is the slate of candidates developed and adopted by the Leadership Succession Committee. Each candidate profile is taken directly from the candidate’s application form. The Candidate Forum will provide the opportunity for candidates to address the 2022 Delegate Assembly. Board of Directors

President-Elect Phyllis Johnson Mississippi Area III Lori Scheidt Missouri Area II

Director-at-large (4 positions) Peggy Benson Alabama Area III Lori Glenn Michigan Area II Tony Graham North Carolina Area III Sherri Sutton-Johnson Florida Area III Sue Tedford Arkansas Area III Carol Timmings Ontario Exam User

Leadership Succession Committee

Area II Member Tammy Buchholz North Dakota Area II Linda Stones Nebraska Area II

Area IV Member Kimberly Hopkins Delaware Area IV Linda Kmetz Pennsylvania Area IV

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DETAILED INFORMATION, as taken directly from application forms and organized as follows: 1. Name, Jurisdiction, Area 2. Present board of nursing position, board of nursing name 3. Application Questions

• Board of Directors: 1) Describe your professional, regulatory, and community experience. 2) What characteristics make you a strong fit to fulfill the responsibilities of the

Board of Directors? 3) Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan,

identify one initiative and describe how you would contribute to the organization’s achievement of that initiative.

• Leadership Succession Committee: 1) Describe your professional and community experience related to leadership

succession planning and/or recruitment strategies. 2) What personal attributes and involvement in NCSBN (e.g., attending NCSBN

meetings/conferences, subject matter expert panelist, participation on networking calls, and NCBSN committee member) make you a strong fit for the Leadership Succession Committee?

3) What does leadership mean to you and identify the attributes of effective leaders?

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Board of Directors President-Elect Phyllis Johnson, DNP, RN, FNP-BC Executive Officer, Mississippi Board of Nursing

1. Describe your professional, regulatory, and community experience.

Phyllis Polk Johnson is the CEO/Executive Director of the Mississippi Board of Nursing. She brings 40 years of experience in nursing and health care leadership to her role. Board certified as a Family Nurse Practitioner, she has held numerous clinical and managerial responsibilities. Phyllis is a member of several professional organizations, including the Mississippi Association of Nurse Practitioners, Mississippi Nurses Association, American Nurses Association, and Sigma Theta Tau International Nursing Honor Society. She currently serves on the Board of Directors as President-Elect of the National Council of State Boards of Nursing (NCSBN). Selected as one of the 50 Leading Businesswomen in the state of Mississippi by the Mississippi Business Journal in 2018, Phyllis was chosen as the 2019 Mississippi Business Journal Businesswoman of the Year in 2019. As recognition of her leadership, the Mississippi Legislature honored her with a Resolution acknowledging her achievements. She received the Visionary Leadership Award from the Madison County Business League and Foundation in 2021. Appointed to the Governor’s Opioid and Heroin Drug Task Force in December 2016, Phyllis has been instrumental in developing rules and regulations at the Board pertaining to the prescribing practices of Advanced Practice Nurses. Other appointments include the Governor’s COVID-19 Advisory Board, MS Southwest Chapter of the American Red Cross, the NCSBN National Licensure Compact Executive Committee, the Mississippi Board of Medical Licensure’s Advisory Committee for Physician Assistants, the Advisory Committee for the Project Change Initiative of My Brother’s Keeper, Jackson State University COVID-19 Mitigation Community Advisory Board, Madison County Business League and Foundation, and the MS University for Women Foundation Board. In 2013, Phyllis retired from the United States Navy Reserves at the rank of Commander. She is a proud member of Delta Sigma Theta Sorority, Inc., where she is active in the Jackson MS Alumnae Chapter.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of Directors? I have always had a desire to serve and have been fortunate to hold leadership positions at the local, state, and national level. I would characterize myself as a servant leader and someone who motivates and empowers others to lead in order to reach their full potential. Over the past year, I have had the distinct pleasure to serve in the capacity of President-Elect for the NCSBN. Additional roles of service include Area III Director on the NCSBN Board of Directors (2020) and member of the Nurse Licensure

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Compact (NLC) Executive Committee for two years (2018-2020). Through my participation on the BOD and the NLC Executive Committee, I feel that I demonstrate the characteristics needed to fulfill the responsibilities of the Board of Directors and the position of President-Elect. The Board and staff of the Mississippi Board of Nursing are supportive of this endeavor and understand the commitment that it entails. I embody the core values of honor, courage, and commitment in all my endeavors personally and professionally. These values coupled with integrity are the epitome of any leadership position and these are the characteristics I strive to display daily.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative and describe how you would contribute to the organization’s achievement of that initiative. Of the four strategic initiatives within the NCSBN 2020-2022 Strategic Plan, Strategic Initiative 1 is one that I have a vested interest in. The focus of this initiative is to promote agile regulatory systems for relevance and responsiveness for change. Currently, I am contributing to the organization's achievement of this initiative by serving as the Board Liaison to Objective 1. Objective 1 focuses on the development, piloting, and evaluation of a regulatory excellence accreditation system to improve the effectiveness of nursing regulatory boards and strengthen public protection. My involvement also includes meetings with the Project Sponsor to review the focus of the work, data collection, and to provide input related to the quantitative and qualitative metrics received. Utilizing the Trello collaborative web-based project management platform, I've been able to participate in discussions with members of other BON agencies who are involved in this project. Progress on each objective is reported at each Board meeting which allows the opportunity to keep abreast of the work on the other initiatives in the strategic plan. Clearly, uniformity among jurisdictions in the development of regulations and best practices will have a significant impact on decreasing the workforce issues for regulatory entities. As a result of the work of members serving on this initiative, a thematic analysis of existing sunrise provisions was published in the Journal of Nursing Regulation as a supplement in October 2021. The report provided an overview of one sub-goal of the analysis of existing sunrise provisions in the United States and their application. Additionally, it provided a contrast of these provisions and reviews with similar processes and outputs in other jurisdictions and countries.

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President-Elect Lori Scheidt, MBA-HCM Executive Director, Missouri State Board of Nursing

1. Describe your professional, regulatory, and community experience.

During my tenure, I was afforded the opportunity to perform nearly every position within our Board due to vacancies. These varied leadership experiences, along with my determination to improve nursing regulation and public protection led to my tenure as the Executive Director of the Missouri State Board of Nursing; a position I have served in since 2001. I earned an Associate in Arts from Columbia College in 1997, a Bachelor of Science in Computer Information Management from William Woods University in 2000 and an MBA in Healthcare Management from Western Governors University in 2012. I also became Just Culture certified in 2013. I have taken 13 ICRS courses and will earn my ICRS credential in April 2022. I currently serve on the NCSBN Board the Area II Director. I had the privilege to serve two years as vice-chair of the Nurse Licensure Compact Administrators. I have served on numerous NCSBN committees as follows:

- Chair, NLC Compliance Committee 2020-Present - NLC Technology Task Force 2020-Present - Chair, Fraud Detection Committee 2015 - Discipline Effective Practices Subcommittee 2014-2015 - Chair, Member Board Agreement Review Committee 2013 - Nurse Licensure Models Committee 2011-2012 - Awards Panel 2004-2006 - CORE 2005 - Nursys Advisory Panel 2003-2004 - Test Service Technical Subcommittee 2001-2002 - Examination Committee 1997-2000 - NCLEX Evaluation Task Force 1996 - Committee for Special Projects (CAT) 1995

I am a member of the Missouri Healthcare Workforce Coalition. Through my leadership, our Board has been awarded a Governor’s Award for Quality and Productivity for improvements in nursing investigations and NCSBN’s Regulatory Achievement Award in 2012. I received the NCSBN Outstanding Achievement Award, Meritorious Service Award and R Louis McManus Award.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of

Directors? An adverse health event in my family fueled my passion for public protection work. I believe in what we do and our ability to make a difference. I am motivated and actively engaged in the organization. I

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possess the duty to care, duty of loyalty and duty of obedience to continue to be a contributing member of the board. I am a strategic thinker and believe my strong and varied board operations background adds perspective and balance to the Board. I am also very driven. If there is a challenge, I will work hard to find a solution. I had my first job when I was 12 years old and haven’t stopped working since that time. I am a hard worker and will continue to work hard to further the mission of the National Council of State Boards of Nursing. I pledge to continue to actively listen to the membership and remain engaged with all aspects of the organization. I have the support of the board members and office team members in my state.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative

and describe how you would contribute to the organization’s achievement of that initiative. As Area II Director, I remain actively engaged in working on the strategic initiative to champion regulatory solutions to address borderless health care delivery. Specifically, I have been working with the NCSBN team to analyze education credentials for internationally-educated nurses to determine gaps in fraud detection and how we might address those by utilizing an exchange of nurse licensure, discipline and education information beyond borders. I am seeking re-election to continue this important work! We have surveyed nursing regulatory bodies to get a snapshot of current requirements and processes. I participated in the review and revision the Fraud Detection Manual and Resource Manual on the Licensure of Internationally Educated Nurses. The next steps will be to review credential evaluation agency processes including how identity, education and international licenses are verified. Ultimately, we should be able to determine any gaps in processes. The final outcome would be to enhance public protection and streamline licensure processes for internationally educated nurses. We also need to tackle how our U.S.-educated nurses can more efficiently obtain authorization to practice in other countries. Regulatory boards need to continue to rise to the challenge to offer flexible regulatory options without sacrificing public protection. We need to continue to develop strategic alliances with other agencies and international partners. Having a more thorough understanding of how education and licensure works in other disciplines and countries will widen our body of knowledge and potential solutions. By thinking outside the traditional box, NCSBN can help form these alliances and research various regulatory options to keep the public safe while increasing numbers in the workforce. For NCSBN to accomplish these goals, they need experienced members on the Board of Directors, like myself, with vast regulatory experiences and a strong work ethic to continue moving NCSBN forward.

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Director-at-large Peggy Benson, MSN, RN, MSHA, NE-BC Executive Officer, Alabama Board of Nursing

1. Describe your professional, regulatory, and community experience.

My 42 years of professional nursing and executive leadership experience make me an ideal candidate to serve on the Board of Directors for CLEAR. My experience includes having served as both a member and President of the Alabama Board of Nursing (ABN) in the early 2000’s, and later returning to the ABN as Deputy Director and then Executive Officer, a position I have held since 2015. In both of those roles, my professional nursing experience provided me important insight into the effects of regulatory decisions on nurses and healthcare organizations. That experience includes service as Chief Nursing Officer, Director of Critical Care and Medical Surgical Nursing for a five-hospital system, and Vice President and Director of Human Resources. Since assuming the ABN Executive Officer role, I have served on the NCSBN Model Acts and Rules/Standards Committee resulting in new models rules and Acts development and approval in 2021. In addition, I serve on NCSBN Strategic Initiative Objective One: Working Toward a Regulation Accreditation System. I mentor new Executive Officers and have worked with NCSBN staff to update current NCSBN mentoring tools. I serve as the NLC Commissioner for Alabama, and I am a member of the NLC policy committee. As the ABN Executive Officer, I led our organization through the implementation of the NLC in Alabama. In 2019, NCSBN awarded the Regulatory Achievement Award to the ABN. In Alabama, My experience has prepared me well to serve on the Board of Directors. I have also served on the following CLEAR committees as follows: Regulatory Agency Administration, Executive Leadership for Regulators and the International Relations Committee.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of Directors? When I took over as ABN Executive Officer in 2014, I created a New Direction for the ABN, the purpose of which was to create a paradigm shift in the ABN’s regulatory practice by taking concrete actions to promote transparency, collaboration, education, engagement, and active involvement of ABN board members and staff. Following my transformational leadership style of management and the principles of continuous quality improvement ensures that our organization is constantly evolving and expanding to support the Board’s licensees and promote public protection. This has enabled us to move quickly to adapt to changes in the regulatory environment, most recently in addressing the numerous impacts of the global pandemic on the nursing profession. I hold myself and my leadership team to high standards of hard work, honesty, trustworthiness, and integrity. We seek to do the right thing for the right reasons, and we approach each new challenge by asking not just “Can we do it?”, but also, “Should we do it?” I devote time to mentoring the ABN leadership team, which creates synergistic returns in

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moving our agency forward. The same personal characteristics and leadership skills that have allowed me to drive change at the ABN over the last several years will enable me to immediately contribute to the Board of Directors in achieving NCSBN’s strategic objectives and mission.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative and describe how you would contribute to the organization’s achievement of that initiative. Strategic Initiative One A: of the NCSBN 2020-2022 Strategic Plan calls for NCSBN “to promote agile regulatory systems for relevance and responsiveness to change.” Never has this strategic initiative been more critical. The landscape for nursing regulation has changed in unprecedented ways over the past two decades, and NCSBN’s forward-thinking, evidence-based work has helped state boards of nursing to rise to the occasion. From promoting the Nurse Licensure Compact, to developing the next-generation NCLEX, to educating state board of nursing members and staff regarding legal and policy issues, NCSBN provides state boards of nursing with important tools. Boards of nursing have leveraged these tools as they address issues arising from the Covid-19 global pandemic, but the pandemic has also exposed the need for even more agile regulatory systems. For instance, in the span of one week, many nursing education programs were forced to halt nursing clinicals and find new and different ways to ensure students’ clinical competence. Nursing educators looked to their regulators for assistance, and boards of nursing had to gather information and make real-time decisions to assist the programs. In Alabama, we met with stakeholders, talked with accrediting agencies, and issued guidance to programs to provide clarity on options for clinical instruction. We also decided that we needed to ensure that programs planned for future emergencies, so we promulgated rules to require programs to develop emergency plans. The pandemic has further exposed the negative effects of practice barriers for advanced practice nurses and the need to further clarify standards of practice for telehealth. In Alabama, I worked with other regulatory boards and the Alabama Governor’s Office to ease regulatory barriers for cross-jurisdiction practice and advanced practice nursing through a Governor’s proclamation. With the emergency proclamation ending, we have leveraged the progress made to incorporate some of those changes into permanent advanced practice nursing regulations. NCSBN is perfectly positioned to marshal the evidence and experience of its membership to meet these challenges. My approach to management of nursing regulation in the pandemic shows that I view challenges as opportunities for change. The NCSBN Board must lead from the front, and I can use the skills I have honed as a transformational leader at the ABN to help NCSBN continue to proactively address regulatory implications of changes in the healthcare system.

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Director-at-large Lori Glenn, DNP, CNM, C-EFM, RN Board Member, Michigan Board of Nursing

1. Describe your professional, regulatory, and community experience.

My nursing journey began in 1987 when I graduated from Mercy College of Detroit with a BSN. I practiced as a RN in NICU and Labor and Delivery and became a Certified Nurse Midwife in 1993. Since then, I have practiced in various roles as a nurse midwife, currently working part time as a triage provider and laborist. My full-time position as faculty at the University of Detroit Mercy began in 2007. I earned my Doctor of Nursing Practice in 2012. As a nurse educator I have taught at all levels; been the coordinator and director of programs; served in multiple leadership positions at college and university levels; and developed, proposed, and launched the first direct entry master's program in the state of Michigan. I am an appointed member of the ANA-Michigan’s Legislative Committee and serve on board of the Michigan Affiliate of the American College of Nurse Midwives. My journey in nursing regulation began in 2017 when I was appointed as the midwife board member of the Michigan Board of Nursing. I was reappointed to my second and final 4-year term in 2021. I am currently the chair of the education committee, vice-chair of the general board, and a member of the rules committee. I am active in disciplinary processes, reviewing allegations and acting as conferee for disciplinary conferences. I was awarded a scholarship by NCSBN to George Washington University's Health Policy and Media Engagement for Nurses certificate program, which I completed in 2020. Additionally, I have completed the inaugural certificate program of NCSBN's International Center for Regulatory Scholarship.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of Directors? I am poised to bring multiple perspectives as a member of the Board of Directors. As a nurse midwife, I bring experience in practice and can articulate the benefits of consistent licensure and regulatory standards as outlined in the APRN Consensus Model and through the APRN Compact. As an educator who has developed programs, participated in regulatory approval and accreditation activities, and led NCLEX® quality improvement, I provide a valuable perspective about standards for high-quality education to ensure that competent nurses are prepared to join the nursing workforce. As a regulator, I have led the education committee to find consensus while anticipating issues relevant to statutory requirements for schools of nursing. I bring valuable experience in discipline matters for entry RNs and APRNs, especially those directly impacted by the COVID-19 pandemic. Opportunities offered by

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NCSBN have expanded my knowledge and skills in governance, regulation, and negotiation, and health care policy so that I can contribute to meeting the strategic initiatives of NCSBN as a Director at Large.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative and describe how you would contribute to the organization’s achievement of that initiative. Strategic Initiative A: Promote agile regulatory systems for relevance and responsiveness to change. The Covid-19 pandemic tested the agility of regulatory boards to respond during a major public health emergency. One of the projects I completed while at GWU was an emergency response plan for boards of nursing that could be utilized across jurisdictions. It included descriptions of each members’ role, a communication plan, steps to take in addressing the emergency, and a disciplinary guide. Beyond the emergency response, members of the NCSBN board must continue to evaluate the impact of the pandemic on discipline and education so the future nursing workforce attains the highest level of professionalism, continues to expand, and achieves stability. The strain of pandemic work has profoundly impacted nurses. Boards of nursing report a dramatic increase in the number of licensees brought before disciplinary bodies for substance use disorder as well as psychiatric and mental illness. Practicing nurses at all levels have been affected by severe staffing shortages, limited resources, and moral distress, which impact their ability to exercise due care and avoid allegations of incompetence and negligence. NCSBN should continue to utilize workforce, discipline, and outcome data to track these trends and respond with evidence-based recommendations. This will assist regulatory bodies with protecting the public while supporting the well-being of affected nurses, who deserve the opportunity to take meaningful action that allows them to continue practicing safely. Additionally, limitations in preparing entry level nurses in clinical settings continue to challenge schools of nursing. Outcomes such as NCLEX pass, employment, and retention rates need to be monitored closely and incorporated with nursing education best practice evidence along with standards from accrediting bodies. The Board of Directors can formulate recommendations so regulatory bodies can modify and enhance existing rules governing nursing education programs to better serve students and the public. Strategic Initiative C: Expand the active engagement and leadership potential of all members. For those of us in states where nursing boards have term limits, the ability to contribute as national level leaders is limited. Developing the skill set and knowledge to be effective in my role as a regulator has taken time. I have benefited from the resources offered by NCSBN through the GWU Health Policy program and ICRS. The APRN, Disciplinary, and Education networks provide valuable resources that contribute to my work as a regulator. As a Director at Large, I would encourage NCSBN to continue these programs providing opportunities to grow regulatory knowledge, leadership skills, and a network of support. I would also pursue ways to expand opportunities for those who may have limited time to contribute at the national level.

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Director-at-large Tony Graham, CPM Chief Operations Officer, North Carolina Board of Nursing

1. Describe your professional, regulatory, and community experience.

I have nearly 20 years of service in nursing regulation and over 15 years of service as a military leader. I currently serve as the Chief Operations Officer of the North Carolina Board of Nursing. I have had the privilege of serving on NCSBN (NATIONAL COUNCIL OF STATE BOARDS OF NURSING) Agreement Review Committee (2012), Chaired the Leadership Succession Committee (2013-2017) and currently serve on the Finance Committee (2020-present) and NLC (Nurse Licensure Compact) Education and Training Committee (2018-present). My service on these various committees provided me with a greater insight into NCSBN strategic initiatives, fiscal policies, internal controls, and outcome measures. I am confident that my experience with and knowledge of the organization will be invaluable in this position. I am actively involved in community activities through church and local organization’s outreach ministries. Additionally, I serve on the Leadership Team for the Leukemia and Lymphoma Society. In 2020 I was nominated for man-of-the year. I raised over $25,000 to support blood cancer treatment, research, and education.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of Directors? I am a certified Public Manager with over 30 years of leadership experience. I have served in both state and federal government. I have a strong working knowledge of development and implementation of policies and regulations. I understand the importance of a strong, supported strategic plan. I have been a part of the development process as well as monitoring objectives and initiatives to ensure success. I have been actively involved with numerous local organizations and committees throughout the United States and several internationally. I am highly skilled in working with groups and understanding group dynamics. I understand the importance of planning, communicating, and educating. I have been an active participant in NCSBN workshops, conferences, and training sessions for over ten years. As a member as well as chair of LSC I actively engaged with the membership to encourage participation and act as an ambassador within the membership. I feel this would make me an excellent fit to fulfil the responsibilities of Director at Large.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative and describe how you would contribute to the organization’s achievement of that initiative. “Expand the active engagement and leadership potential of all members.” Active engagement includes strong, consistent communication using a variety of resources. If the pandemic has taught us anything, it has taught us that we cannot continue to do the same things the same way and expect different results. We must be flexible, strategic, and consistent in our actions. The membership is changing, and

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the engagement techniques must adjust accordingly. It is vital to engage with the members where they are and recognize not everyone is in the same place. NCSBN offers numerous articles, videos, and workshops to support leadership growth. The opportunities are there! I would use experiences and techniques learned from workshops and training to empower members to reach beyond their comfort zone and allow the leader within to emerge.

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Director-at-large Sherri Sutton-Johnson, DrPH, MSN-ED, RN, CCHW Education Unit Director, Florida Board of Nursing

1. Describe your professional, regulatory, and community experience.

My regulatory experience began in 2008 when I began employ as a Nursing Education Consultant with the Florida Board of Nursing. I have had the awesome pleasure of serving as the Education Unit Director at since 2012. I’ve been fortunate to enjoy a lengthy and rewarding nursing career as I’ve entered my 31st year as a licensed professional nurse with experience in various health care settings and 31 years of employment with the state of Florida. My initial transition from education to practice began as a psychiatric and medical surgical nurse in rural Gadsden County, Florida in 1992. From there, I began to seek opportunities for professional development in other areas and was fortunate to find my niche in public health nursing for the next 11 1/2 years as a Senior Community/School Health Nurse for the Gadsden County Health Department. Again, feeling a need to challenge myself professionally, I worked for 1 year as an RN Case Manager for a local hospice. My educational pursuits began at the Florida State University where I received both a Bachelor and Master of Science degree. Most recently on May 2, 2020, I received a Doctor of Public Health degree with a concentration in Health Education and Behavioral Health from the Florida Agricultural & Mechanical University. I served as a member of the Medical Marijuana Regulatory Guidelines Committee from 2016-2018 and am currently a member of the NLC Research Committee. Additionally, I've completed courses offered by the International Center for Regulatory Scholarship (ICRS). I’m active in several educational, ecclesiastical, civic and community organizations. Community involvement includes but is not limited to population health and related social determinants of health.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of Directors? You can’t teach what you don’t know, and you can’t lead where you don’t go…I try to live by this motto when interacting with direct reports and other colleagues. A leader’s ability to lead is predicated on the ability to recognize his/her strengths and weaknesses and willingness to put the time in to ensure the product is relevant, accurate and sustainable. I possess the following characteristics that make me a strong fit and will assist in the fulfillment of responsibilities of the Board of Directors: loyalty, purposeful drive, attention to detail, vision, diligence, flexibility, perseverance, dependability, honesty, integrity, effective communication skills, willingness to learn new things, adopt new innovations, an approachable & pleasing disposition and the ability to be receptive to others’ differences and ideas. My professional and life experiences and team approach when met with a task afford me the confidence and fortitude to meet any challenge. The act of being an effective listener is also a characteristic I possess that is an integral component of brainstorming and problem-solving. Life happens, and at times, we find that no pieces fit together perfectly. However, the eagerness to accept people where they are, learn from it and

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being receptive to ideals, differences and working together respectfully, an optimal outcome will be amenable to all with opportunities for improvement, as deemed necessary.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative and describe how you would contribute to the organization’s achievement of that initiative. Certainly, all four initiatives are essential to NCSBN’s mission and values related to public safety and protection. After careful review, I’ve selected Strategic Initiative B: Champion regulatory solutions to address borderless healthcare delivery, to expound upon. Never has the necessity for borderless healthcare delivery become more relevant than the present, as we’re globally tackling the impact of a global pandemic. My contribution on Board of Directors would include embracing ideas and concepts relative to evidence driven and sustainable interventions. My experience as a collaborator with legislative staff, educational institutions, accrediting bodies, educational and healthcare professional organizations and other stakeholders during this challenging and unprecedented times, has rendered an impressive understanding of not just thinking out of the box, but what paths to forge to ensure continuity of quality nursing education, nursing care and safety to all health care consumers. Gone are the days when leaders and policy makers of any description are confined to the four walls of an office or board room. It is imperative for nursing regulators, educators, administrators and executives to increase visibility and enhance our job skills by embracing new technologies of communication and work distribution. Those efforts should include the utilization of virtual platforms and social media to effectively communicate policy development and implementation. This initiative brings to the forefront the necessity to become and remain an active voice when addressing ever-evolving regulatory issues, guidelines and respective modifications, accordingly. Flexibility is key when faced with emerging obstacles and essential technological advances for safely delivered healthcare, regardless of the manner of delivery.

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Director-at-large Sue Tedford, MNSc, APRN Executive Director, Arkansas State Board of Nursing

1. Describe your professional, regulatory, and community experience.

Throughout my 40-plus years as a nurse I have held leadership roles in clinical practice, education, and regulation. I began my career as a bedside ICU nurse then moved into the role of an educator. I have been employed by the Arkansas State Board of Nursing for twenty years. I began my experience as a regulator in the position of Director of Education which was followed by my appointment as Executive Director in 2010. Upon employment with ASBN, I immediately became involved with NCSBN activities. In 2003 I presented at one of the NCSBN meetings on criminal background checks. Since that time, I have participated in various NCSBN committees and task forces such as the Editorial Advisory Pool, Continued Competence Task Force (chair 2007-2008), Nursys Committee, CORE, NLCA Data Analysis Subcommittee, and NLC Executive Committee (Treasurer, Vice-Chair, and Chair). I am currently serving on the NCSBN 45th Anniversary Committee. At the local level I am currently serving on the PANS/PANDA Advisory Council, Arkansas Staffing Solutions Committee, and the Community Health Worker Commission. In 2020 I was named one of the Great 100 Nurses by the Great 100 Nurses Foundation. In 2010 I received the NCSBN Exceptional Contribution award and in 2003 I was named Nurse of the Year by the Arkansas Nurses’ Association. I have presented a many national, state, and local meetings on various topics related to nursing regulation. The sharing of information empowers others.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of Directors? I have experience serving on other Board of Directors. From 2013-2016 I served on the Executive Board of the Arkansas Action Coalition. With the assistance of one other member of the Arkansas Action Coalition, we transformed the action coalition into the Arkansas Center for Nursing, a 501c3 corporation. I served for two years as the initial President of the Board of Directors for the Center for Nursing and continue to serve on the Board. I have also served on the Executive Committee of the Nurse Licensure Compact; first as Treasurer, then as Vice-Chair, and then as the first Chair of the enhanced Nurse Licensure Compact. Both experiences have required me to take a vision and make it a reality. This required a lot of insight, collaboration, and willingness to listen. I believe teamwork is critical to the success of any idea, project, or task. Everyone on the team has a critical role and I work hard to ensure they are contributing members toward the task at hand. I am goal orientated and will do the work needed to accomplish the goal.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative and describe how you would contribute to the organization’s achievement of that initiative.

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All of the strategic initiatives within the NCSBN 2020-2022 Strategic Plan are critical for NCSBN to continue to grow in the needed direction. However, Strategic Initiative B: Champion regulatory solutions to address borderless health care delivery, is the one that I will focus on. The pandemic brought so many changes to every aspect of our lives, some good and some not so good. In health care we saw a great need for increased mobility of nurses, whether it was physically or virtually. States who were not a member of the NLC had more difficulty with getting nurses into their facilities quickly due to the requirements for licensure. Promoting borderless health care must include safeguards for public protection. During the pandemic there were states that allowed any nurse with a license from another state work in their facility. If a violation of the Nurse Practice Act occurred, they quickly realized that nobody had jurisdiction over the nurse, and very little could be done about the violation. Obviously public protection did not occur. The NLC addresses this issue because both the licensing state and the state in which practice occurs has jurisdiction over the nurse and can address any potential violation of the Nurse Practice Act. The states who have not joined the NLC have deep rooted beliefs against the compact and it requires great skill in conflict management to help them understand the principles upon which the compact is built.

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Director-at-large Carol Timmings, RN, BScN, Med Chief Quality Officer, College of Nurses of Ontario

1. Describe your professional, regulatory, and community experience.

I am a highly experienced executive nursing leader with a career that has spanned clinical, public health, policy and regulatory sectors within the health system in Canada. Recognized for my abilities to lead in dynamic and complex health and public sector landscapes, I am a relational leader with exemplary partnership building skills and the ability to embrace diverse perspectives while advancing a common purpose and collective action. Currently serving as the Chief Quality Officer at College of Nurses of Ontario, which regulates approximately 188,000 nurses in accordance with the provincial Regulated Health Professions Act and the Nursing Act. Responsible for executive leadership of the Quality Portfolio in leading the development and operational implementation of the regulatory functions of professional standards, registration, quality assurance and professional conduct. Accountable for ensuring appropriate resources and support to the statutory committees of our Board of Directors in the development of fair, enforceable and transparent bylaws and regulations governing nursing practice in the public interest. Accountable for strong and effective fiscal stewardship of the operational budget as well as human resource planning to ensure teams comprise the diversity of competence and capacity to successfully achieve our strategic organizational key performance outcomes. In addition, I enjoy actively contributing to national and international regulatory excellence through board and committee participation in the Canadian Nurse Regulatory Collaborative, the Canadian Council of Nurse regulators, the National Council of State Boards of Nursing – National Examination Committee and the International Nursing Regulator Collaborative. Additionally, I have served on numerous provincial advisory committees and governance boards including in the previous role of Board President for the Registered Association of Nurses of Ontario.

2. What characteristics make you a strong fit to fulfill the responsibilities of the Board of Directors? My interest in joining the NCSBN Board of Directors as a Director-At-Large, follows three years of experience engaging with NCSBN in areas of examination development of a new practical nurse regulatory exam for Ontario as well as my current membership on the NCSBN National Examination Committee. As a result of both opportunities, I have experienced a strong alignment with the mission and vision of NCSBN in leading regulatory excellence worldwide. I have lived the positive culture of shared learning and witnessed the positive impact we have as regulators when we collaborate internationally. Throughout my nursing career I have developed a depth and range of knowledge, skills and competencies which would complement a director role. My experience as Chief Quality Officer for the largest health professions regulator in Canada, has afforded me numerous opportunities to

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collaborate both within the regulatory sector and with a broad range of health care and professional stakeholders. My system thinking abilities allow me to understand the complex factors and overall context influencing public safety. Actively listening and learning from a range of perspectives, while integrating my own thinking and insights, has contributed to notable regulatory innovations in areas such as entry to practice, professional standards modernization and professional conduct. I played a key leadership role in the development of our bold new strategic plan and have motivated and galvanized staff efforts to achieve impressive outcomes for both nursing applicants and the public. My inclusive and relational leadership approach is consistently acknowledged by a broad range of colleagues and has been recognized as central to the mentorship I have provided throughout the many facets of my professional and community life. I am confident that I can bring valuable contributions to the Board as we dedicate time and energy to advancing public protection in dynamic health care environments.

3. Of the four strategic Initiatives within the NCSBN 2020-2022 Strategic Plan, identify one initiative and describe how you would contribute to the organization’s achievement of that initiative. The NCSBN strategic plan for 2020-2022 is an inspiring and ambitious plan which aligns well with my long standing professional and personal commitment to protecting and acting in the public safety interest. As a value-based nursing leader, who spent much of my nursing career in public health, my transition to regulatory work approximately three years ago has been a natural and fulfilling career transition. Some of our regulatory accomplishments across Canada have already been guided and influenced by NCSBN’s work including regulatory examinations and the planning for implementation of Nursys Canada. As such, strategic initiative number one stands out as an area where I can share knowledge and experiences which will contribute to achieving organizational objectives within this initiative. College of Nurses of Ontario, together with other Canadian member boards of nursing, have championed improved regulatory processes as a result of our active involvement in NCSBN. By sharing best evidence and emerging practices internationally, I believe we can develop innovative solutions for some of the most complex public protection challenges before us. The global pandemic shone a light on the need for regulatory agility and change around the world. The mobility and need for an increased nursing workforce presents both policy gaps as well as opportunities to advance solution based regulatory processes which enhance public safety. There is a great deal of innovation and modernization work underway across regulatory bodies and we have the opportunity to evaluate and build a new evidence base which could be shared internationally. As a Director-At-Large my contributions would be to bring my regulatory leadership and governance experience as well as an inquiring mind. I will bring an openness to ask important questions and a willingness to share knowledge and experiences as we work together to improve nursing regulation. I have always believed that “leading is learning” and as a new member of the Board of Directors I would embrace this opportunity to both lead and learn with Board colleagues as we work together to advance the mission and vision of NCSBN.

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Leadership Succession Committee Area II Member Tammy Buchholz, DNP, RN, CNE, FRE Associate Director for Education, North Dakota Board of Nursing

1. Describe your professional and community experience related to leadership succession

planning and/or recruitment strategies. I serve in the role of Associate Director for Education with the North Dakota Board of Nursing and am responsible for monitoring and oversight of ND prelicensure nursing education programs, Nurse Refresher Courses, LPN IV Therapy Programs, distance nursing education program recognitions, continuing education approvals, NCLEX RN and PN testing and pass rate monitoring, and the NDBON Nursing Education Loan program. I have worked continuously as a nurse for the past 31 years. My specialty practice area has changed several times throughout my career, with my primary focus in the past ten years being nursing education and regulation. Prior to joining the North Dakota Board of Nursing in 2015, I was an assistant professor of nursing for a baccalaureate program for 9 years. I am involved with the NDBONs succession planning and assisting with the agency’s continuous improvement efforts through thoughtful and deliberate strategic planning. I believe it is important to be involved and serve in many capacities as a professional nurse. I have had the honor of being involved with many organizations and committees throughout my career and continue to serve in that capacity as opportunity presents. I served on several college committees and assisted with recruitment of new faculty while working in nursing education, and I currently serve on committees for the NDBON, ANA, NDNA, NLN, CNEA, a private university in ND and the ND Center for Nursing. I have published at the state level and have presented on nursing education topics at the state, regional, and national levels. In 2015 I earned the designation of certified nurse educator (CNE) from the National League for Nursing (NLN). I completed a Doctor of Nursing Practice (DNP) in Educational Leadership degree summer of 2020.

2. What personal attributes and involvement in NCSBN (e.g., attending NCSBN meetings/conferences, subject matter expert panelist, participation on networking calls, and NCBSN committee member) make you a strong fit for the Leadership Succession Committee? The culture of the NDBON encourages early involvement with NCSBN and networking with our fellow nursing regulation colleagues across the country and globe. I have embraced this culture and strive to be involved in NCSBN opportunities as I am able. I have had the privilege of being a member of the Leadership Succession Committee for the past two years, and the honor of being appointed as the

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chairperson this past year. I was appointed to the NLC Research Committee and selected to serve as the chairperson in fall 2020. A highlight of mine from my work with NCSBN was in August 2019 being awarded the status of Fellow of the IRE after completing the fellowship program requirements as a member of the 2018 cohort and sharing the findings from my IRE research study, Board of Nursing Rules Permitting use of Educationally Underqualified Nursing Faculty: An Exploratory Study of Use and Possible Impact on Outcomes at the 2019 NCSBN Annual Meeting as a poster presentation. I participated in the NCSBN Subcommittee for the Role and Competencies of the Education Consultant, in 2019. I had the opportunity to present as part of the IRE Panel: Hot Topics in Nursing Education at the 2018 IRE Annual Conference and Scientific Symposium regarding the Faculty Shortage. I participate in monthly Education Knowledge Network meetings, Discipline Knowledge Network meetings, APRN Knowledge Network meetings and Practice Knowledge Network meetings monthly as able. I attend Mid-year, Annual, Scientific Symposium, NCLEX meetings each year or as our NDBON schedule allows. In addition to my education focus, I also attended the 2019 Antitrust and Regulation Forum and the Board of Nursing Investigator Training in 2018.

3. What does leadership mean to you and identify the attributes of effective leaders? The leadership attribute descriptors I find most fitting for me, are authentic, servant, transformational, adaptive, team, and ethical. I would describe leadership in terms of the five principles of ethical leadership discussed by Northouse (2016). They are: 1) respect, 2) service, 3) justice, 4) honesty, and 5) community. The two principles that I consider most important are respect and honesty. I appreciate describing leadership as a process because it allows for different approaches and styles as is needed for the situation encountered. I believe that the process of becoming a leader is enhanced through mentorship and coaching and I have had some amazing individuals who took the time to mentor and encourage me throughout my nursing career. Growth comes not when we do things that are familiar to us, but when we take a leap of faith and step outside our comfort zone when pursuing new challenges. It is so important to challenge ourselves to grow as leaders and professionals to continue to be the best that we can be and use our gifts and talents to their full potential. Sometimes we need someone we trust to give us a nudge and promise to be there to guide us along a new path. Because I have been so richly blessed by others who have invested time and energy in coaching and mentoring me, I am compelled to pay those kindnesses forward. It would be an honor, privilege, and a joy to have the opportunity to continue to serve on the Leadership Succession Committee and encourage fellow nursing regulation colleagues to embrace their gifts and talents and pursue leadership roles within the organization. Andrew Carnegie: “Teamwork is the ability to work together toward a common vision. ... It is the fuel that allows common people to attain uncommon results. By working together and encouraging one another I believe that NCSBN will continue to attain uncommon results. It is through the continued intentional focus on leadership succession that NCSBN will conquer challenges and reach new heights. It would be an honor to continue to serve on the Leadership Succession Committee and contribute to the organization’s efforts to encourage and grow NCSBN’s leaders of the future.

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Area II Member Linda Stones, MS, RN Vice President, Nebraska Board of Nursing

1. Describe your professional and community experience related to leadership succession

planning and/or recruitment strategies. I have been a nurse for over 30 years. I have served in the Nebraska Nurses Association as Chair of the Legislative Advocacy and Representation Committee as well as President of the Political Action Committee. As Chair of the LARC, it required significant recruitment of individuals to testify on behalf of the organization and individuals to serve on our committee. As President of the PAC, I have solicited donations as well as members to serve on the PAC. I currently work as the Director of Nursing in a large tertiary care facility in Nebraska. Succession planning and leadership development are key aspects of my current role. I have served on a committee that developed and implemented a program to develop future leaders in our organization. This responsibility included curriculum development and candidate selection The Emerging Leader Program has been in place for over 5 years and has produced about 100 individuals of which over 50% have been promoted into leadership positions in our organization. As a member of the Nebraska BON, I serve as Vice President and have chaired the practice committee. I also lead a group of individuals to advance the APRN consensus model adoption in Nebraska. I have also started a program for board member development. I select a regulatory nursing journal article for each meeting and lead a discussion with the board members. I also serve on the board of a critical access hospital and am the board representative on the quality committee. I help lead a program in my church to address food insecurities in our committee. I am currently serving on a search committee for our new pastor. Engagement in my profession and in my community are very important to me.

2. What personal attributes and involvement in NCSBN (e.g., attending NCSBN meetings/conferences, subject matter expert panelist, participation on networking calls, and NCBSN committee member) make you a strong fit for the Leadership Succession Committee? My involvement with NCSBN is limited. I have participated in several of the virtual meetings of NCSBN. I have served on the Nebraska Board of Nursing for 3 years. When joining the NBON, I identified a gap in my knowledge and started the ICRS program. I have completed 8 ICRS courses and will attend the graduation program in April, 2022. While serving on the Nebraska BON, I am leading a group of individuals to pass legislation to align Nebraska with the NCSBN APRN Consensus Model. This required me to bring together individuals from multiple stakeholders, prepare and testify in several

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meetings and address concerns voiced by the AMA. I have done a lot of different things in my nursing career, mostly advocating for the profession. I love nursing. I have never regretted getting into nursing and feel obligated to give back to a profession who has served me so well. If elected to the NCSBN Leadership Succession Committee, I will do whatever it takes for the committee to meet our objectives. I can be an advocate for the ICRS program and help promote this program with other NCSBN members.

3. What does leadership mean to you and identify the attributes of effective leaders? Leadership is really about understanding the strategic objectives of an organization, understanding the expectations, opinions and ideas of the membership, reconciling the gaps, and creating energy and synergy through a shared vision to achieve outcomes. Leadership requires the ability to listen and understand, to communicate and clarify, and the courage to entertain a dissenting view. It requires you to suspend your personal desires to represent the group. Leadership requires intentional reflection to understand the unspoken bias that can seep into decisions and to learn from actions. My leadership has been influenced by some significant mentors and authors along the way. First and foremost is Dr. W. Edwards Deming, who I had the chance to meet during my Master’s program at Johns Hopkins University. From him an appreciation that most issues are process problems and not people problems. From him an understanding that systems are perfectly designed to produce the outcomes that they achieve. To produce different outcomes, one must look at changing processes, typically not people. A more recent influence has been Cy Wakeman and her Reality Based Leadership model. No matter what our circumstances, we must find a way to succeed. This was critical when leading my team through the pandemic. Cy also reminds me that change is difficult for those that are unready and that the ego, really has no place in leadership. Last but not least is my father’s influence, anything worth doing requires your best effort and that you are never finished learning. I have had the fortune to serve in many leadership roles and activities. From lobbying in Washington DC on health related issues, serving in leadership roles in my professional association, mentoring new nurses, serving on a church committee to fight food insecurity in our small community, leading a group of parents to provide a safe environment for our kids following prom – all of these opportunities and experiences have developed who I am today. Not all were successful, some included hard lessons learned but all contribute to making a positive difference in my world. If elected to a NCSBN Leadership Succession Committee, I will give 100% to assist the committee in meeting the objectives laid out before us by the Board of Directors and to represent the membership in accomplishing these tasks.

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Area IV Member Kimberly Hopkins, MSN, RN President, Delaware Board of Nursing

1. Describe your professional and community experience related to leadership succession

planning and/or recruitment strategies. My professional and community experiences come from my tenure on the Board of Education. I have served as a member of the Seaford School Board of Education for six years. I have served as the Vice President for the last two years. During my time on the board, we were responsible for hiring a new superintendent and filling a vacant school board seat. In searching for both roles, we promoted transparency by allowing the public to be present during the interviewing process for the new board member and in the hiring process for a superintendent for the district. Before the previous Superintendent left, we as a board decided to create an Assistant Superintendent Role to assist the Superintendent but also to allow them to become aware of the superintendent’s role. In doing this the current Superintendent was able to transition into the role after the retirement of the previous superintendent. This made the transition easier for the current superintendent which allowed for minimal disruption in the district and community.

2. What personal attributes and involvement in NCSBN (e.g., attending NCSBN meetings/conferences, subject matter expert panelist, participation on networking calls, and NCBSN committee member) make you a strong fit for the Leadership Succession Committee? During my time on the Delaware Board of Nursing, I have had the privilege to network with leaders from other states, territories, and members of NCSBN. I have attended the President’s meetings since being elected president last year. I have attended virtual Annual Meetings and I was a delegate last year. Most recently I attended the Mid-Year meeting in St. Louis. I joined the board in September 2019 and by March 2020, COVID 19 prevented us from meeting in person. Because of this, the majority of my meetings were telephonic or via Microsoft Teams. Despite the need to pivot, I still made sure I participated in calls with my video so that my colleagues would be able to connect with me and know who I am. The attribute that makes me qualified to be on the LSC is that I am teachable. I am open to listening to others’ thoughts and collaborating to come to the best outcome for all. I can pivot when things arise that are out of my control such as a Pandemic. I am not afraid to speak to others and form connections that will allow me to offer Delaware the best related to nursing practice and education as I also Chair the Practice and Education Committee.

3. What does leadership mean to you and identify the attributes of effective leaders?

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Leadership means that there is a vision beyond today, tomorrow, and the next few years. It means that one has gained the trust of their staff that even if the staff cannot understand the decisions being made at that time, they can see that the vision will lead to a promising outcome. That is trust. Leaders must have effective followers. Leaders transform others from who they were when they first encountered them. Leaders see opportunities for growth in others and push them to get uncomfortable to get there. They observe and identify attributes in their staff, mentees to build upon. Leaders encourage others to grow by helping guide them through processes by expressing lived experiences and expressing what they would have done differently. Effective leaders build relationships with their staff by getting to understand their strengths and weaknesses. Leaders also care about the surrounding community as often decisions being made do affect the stakeholders. Attributes that I have as a leader are transparency, fairness, honesty, being ethical, and advocacy.

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Area IV Member Linda Kmetz, PhD, MN, RN Chair, Pennsylvania State Board of Nursing

1. Describe your professional and community experience related to leadership succession planning and/or recruitment strategies. As a nursing program director, I developed a robust Leadership Professional Development Plan to identify faculty with talent and interest in moving into formal leadership positions. Using the 9 Box Grid, I regularly conduct Talent Management Reviews with all of my faculty to identify leadership potential. Once faculty with high potential are identified, I start individual conversations with them to determine their interest in further development as a leader. In the event the faculty member has no interest, I then conduct a "Stay Interview" to re-recruit them, emphasizing how much I appreciate them and value their contribution to the school. Faculty with an interest in being promoted complete a Gap Analysis to identify specific leadership competencies they wish to develop. I them assign them to an experienced leader as a mentor and I continue to coach them along their leadership journey. I have been successful in succession planning and developing a strong leadership "bench". My faculty are regularly promoted to Advanced Educators and my Advanced Educators are regularly promoted to Directors. In my community, my most significant example of leadership succession and recruitment involves Camp Raising Spirits, an annual three-day event for individuals with cancer and their caregivers, sponsored by the Greater Pittsburgh Chapter of the Oncology Nursing Society. The event is managed entirely by volunteers, posing unique leadership challenges. Many volunteers had tightly held beliefs about how to implement the project and unfortunately that led us to exhaust our treasury and put the future of camp in jeopardy. Respectfully and gently, I was able to recruit and mentor new volunteer talent and effectively role model how to successfully raise sustainable funds so Camp can continue into the future. Succession planning involving volunteers many have been the pinnacle of my career in leadership.

2. What personal attributes and involvement in NCSBN (e.g., attending NCSBN meetings/conferences, subject matter expert panelist, participation on networking calls, and NCBSN committee member) make you a strong fit for the Leadership Succession Committee? As Chair of the Pennsylvania State Board of Nursing and a Board member since 2013, I have attended almost every NCSBN Mid-Year and Annual meetings, President's Networking Calls as well as several IRE meetings. I served as a member of the Model Rules, Acts and Standards Committee (MARS) from 2016 to 2021 and currently serve as a member of the NCLEX Item Review Committee (NIRSC). If elected to the Leadership Succession Committee, I will be able to serve my entire two-year term as my term on the Pennsylvania State Board of Nursing expires October 2025. Four particular attributes of mine are particularly relevant to my seeking a position on the Leadership Succession Committee: Humility, Mindfullness, Resilience and Perseverance. I was raised to be humble and to "never forget

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where you came from". As a first generation college graduate with immigrant grandparents, I grew up with modest means. The mantra in my home was "be thankful for what you have". Humility continues to be a guiding force in my life. Mindfullness is an attribute I have learned through the tutelage of Dr. Barry Kerzin, personal physician to the Dali Lama. Through daily meditation and journaling, I practice "living in the moment" rather than always being so future oriented. I have a great deal of resilience having had the same employer for almost 30 years. I have seen mergers, nursing excess, nursing shortage, a pandemic, new leadership and much more in my career. I have also persevered through many tragic personal life events (death of both of my parents and my 55 year old sister and a divorce). I have been able to not only persevere but thrive because of my faith and my inner sense of being a calm, kind and confident person. These are attributes I will bring to the Leadership Succession Committee.

3. What does leadership mean to you and identify the attributes of effective leaders? To me, leadership is the ability to be kind, caring and thoughtful and to let others emerge as the next generation of leaders. As simple as this statement seems, effective leadership is a matter of setting one's pride aside because successful leaders are real people who are aware of their own vulnerabilities. I have been fortunate throughout my career to have been mentored by some exceptional leaders. Some of the most significant lessons I have learned about attributes of effective leaders are as follows: We are nothing as leaders if we don't have the trust of those we lead. Taking the time to listen to the people we lead is essential to creating trusting relationships. Admitting that we don't always have answers to all of the questions that are asked of us or "mastering the art of the apology" also instills trust. Following up with the answers sends a clear message of caring and establishes trust. Feedback is a gift. The ability to give clear, kind feedback is an essential quality of effective leaders. Being sincere and speaking from the heart helps those we lead see their strengths and their areas for development. An honest, kind conversation coming from a place of caring ensures feedback is positively received. Practicing "a tap on the shoulder". Successful leaders continuously scout for talent. In order to inspire the next generation of leaders, effective leaders need to give those with potential a "tap on the shoulder". We must intentionally let others emerge as leaders and coach and develop them to be the next generation of leaders. Succession planning requires us not only to give up control but be willing to care enough to invest in another person's success. Find Joy in your life. Successful leaders are forgiving of themselves and are kind to themselves. Being able to find joy in life by finding the things that "keep us going" makes us better leaders and better people. Expressing gratitude through journaling or daily meditation enables us to become warm and compassionate leaders. The ability to laugh at one's self. This sends a clear message to our followers that we are human and vulnerable and that's OK. The ability to tell funny stories about our shortcomings helps us form connections with those we lead. Humor allows us to demonstrate that we are not perfect and it makes all of us smile!! Those I lead are a reflection of me.

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201923 NCLEX-RN® Test Plan 1

National Council Licensure Examination 2

for Registered Nurses 3

(NCLEX-RN® EXAMINATION) 4

Introduction 5 Entry into the practice of nursing is regulated by the licensing authorities within each of the National 6 Council of State Boards of Nursing (NCSBN) member board jurisdictions (state, commonwealth, province, 7 and territorial boards of nursing). To ensure public protection, each jurisdiction requires candidates for 8 licensure to meet set requirements that include passing an examination that measures the competencies 9 needed to perform safely and effectively as a newly licensed, entry-level registered nurse. NCSBN develops 10 a licensure examination, the National Council Licensure Examination for Registered Nurses (NCLEX-RN®), 11 which is used by member board jurisdictions to assist in making licensure decisions. 12

Several steps occur in the development of the NCLEX-RN Test Plan. The first step is conducting a practice 13 analysis that is used to collect data on the current practice of the entry-level nurse (Report of Findings from 14 the 201721 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice, NCSBN, 201722). Twelve 15 Twenty-Four thousand newly licensed registered nurses are asked about the frequency, and importance 16 and clinical judgment relevancy of performing nursing care activities. Nursing care activities are then 17 analyzed in relation to the frequency of performance, impact on maintaining client safety, and client care 18 settings where the activities are performed. This analysis guides the development of a framework for entry-19 level nursing practice that incorporates specific client needs as well as processes fundamental to the practice 20 of nursing. Clinical judgment is one of the fundamental processes found to possess a high level of relevance 21 and importance in the delivery of safe, effective nursing at the entry-level. 22

Entry-level nurses are required to make increasingly complex decisions while delivering patient care. These 23 increasingly complex decisions often require the use of clinical judgment to support patient safety. NCSBN 24 has conducted several years of research and study to understand and isolate the individual factors that 25 contribute to the process of nursing clinical judgment. These isolated factors are represented in the NCLEX 26 Test Plan and subsequently delivered as examination items. A more detailed description of clinical 27 judgment can be found in the Integrated Processes section. 28

The second step is the development of the NCLEX-RN Test Plan, which guides the selection of content and 29 behaviors to be tested. The NCLEX-RN Test Plan provides a concise summary of the content and scope of 30 the licensing examination. It serves as a guide for examination development as well as candidate 31 preparation. The NCLEX® examination assesses the knowledge, skills, and abilities, and clinical judgment 32 that are essential for the entry-level nurse to use in order to meet the needs of clients requiring the 33 promotion, maintenance or restoration of health. The following sections describe beliefs about people and 34 nursing that are integral to the examination, cognitive abilities that will be tested in the examination and 35 specific components of the NCLEX-RN Test Plan. 36

Beliefs 37 Beliefs about people and nursing underlie the NCLEX-RN Test Plan. People are finite beings with varying 38

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capacities to function in society. They are unique individuals who have defined systems of daily living 39 reflecting their values, motives and lifestyles. People have the right to make decisions regarding their health 40 care needs and to participate in meeting those needs. The profession of nursing makes a unique 41 contribution in helping clients (individual, family or group, including significant others and population) 42 achieve an optimal level of health in a variety of settings. For the purposes of the NCLEX Examination, a 43 client is defined as the individual, family, or group which includes significant others and population. 44

45

Nursing is both an art and a science, founded on a professional body of knowledge that integrates concepts 46 from the liberal arts and the biological, physical, psychological and social sciences. It is a learned profession 47 based on knowledge of the human condition across the life span and the relationships of an individual with 48 others and within the environment. Nursing is a dynamic, continually evolving discipline that employs 49 critical thinking and clinical judgment to integrate increasingly complex knowledge, skills, technologies, 50 and client care activities into evidence-based nursing practice. The goal of nursing for client care is 51 preventing illness and potential complications; protecting, promoting, restoring, and facilitating comfort; 52 health; and dignity in dying. 53

The registered nurse provides a unique, comprehensive assessment of the health status of the client, 54 applying principles of ethics, client safety, health promotion and the nursing process, the nurse then 55 develops and implements an explicit plan of care considering unique cultural and spiritual client 56 preferences, the applicable standard of care and legal instructions. The nurse assists clients to promote 57 health, cope with health problems, adapt to and/or recover from the effects of disease or injury, and 58 support the right to a dignified death. The registered nurse is accountable for abiding by all applicable 59 member board jurisdiction statutes related to nursing practice. 60

Classification of Cognitive Levels 61 Bloom’s taxonomy for the cognitive domain is used as a basis for writing and coding items for the 62 examination (Bloom, et al., 1956; Anderson & Krathwohl, 2001). Since the practice of nursing requires 63 application of knowledge, skills, and abilities, and clinical judgment; therefore, the majority of items are 64 written at the application or higher levels of cognitive ability, which requires more complex thought 65 processing. 66

Test Plan Structure 67 The framework of Client Needs was selected for the examination because it provides a universal structure 68 for defining nursing actions and competencies and focuses on clients in all settings. 69

Client Needs 70 The content of the NCLEX-RN Test Plan is organized into four major Client Needs categories. Two of the 71 four categories are divided into subcategories: 72

Safe and Effective Care Environment 73 Management of Care 74 Safety and Infection Control 75

Health Promotion and Maintenance 76 Psychosocial Integrity 77 Physiological Integrity 78 Basic Care and Comfort 79

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Pharmacological and Parenteral Therapies 80 Reduction of Risk Potential 81 Physiological Adaptation 82

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Integrated Processes 85 The following processes are fundamental to the practice of nursing and are integrated throughout the 86 Client Needs categories and subcategories: 87

Caring – interaction of the nurse and client in an atmosphere of mutual respect and trust. In 88 this collaborative environment, the nurse provides encouragement, hope, support and 89 compassion to help achieve desired outcomes. 90

Clinical Judgment - the observed outcome of critical thinking and decision making. It is an 91 iterative process with multiple steps that uses nursing knowledge to observe and assess 92 presenting situations, identify a prioritized client concern, and generate the best possible 93 evidence-based solutions in order to deliver safe client care (detail description of the steps 94 below). 95

Communication and Documentation – verbal and nonverbal interactions between the nurse and 96 the client, the client’s significant others and the other members of the health care team. Events 97 and activities associated with client care are recorded in written and/or electronic records that 98 demonstrate adherence to the standards of practice and accountability in the provision of care. 99

Culture and Spirituality – interaction of the nurse and the client (individual, family or group, 100 including significant others and population) which recognizes and considers the client-101 reported, self-identified, unique and individual preferences to client care, the applicable 102 standard of care and legal instructions. 103

Nursing Process – a scientific, clinical reasoning approach to client care that includes 104 assessment, analysis, planning, implementation and evaluation. 105

Teaching/Learning – facilitation of the acquisition of knowledge, skills and attitudes promoting 106 a change in behavior. 107

Clinical Judgment 108 The nurse engages in this iterative multi-step process that uses nursing knowledge to observe and assess 109 presenting situations, identify a prioritized client concern, and generate the best possible evidence-based 110 solutions in order to deliver safe client care. Clinical judgment content may be represented as a case study 111 or as an individual stand-alone item. A case study is where six items are associated with the same client 112 presentation, share unfolding client information, and address the steps in clinical judgment. 113

Recognize Cues – identify relevant and important information from different sources (e.g., 114 medical history, vital signs). 115

Analyze Cues – organize and connect the recognized cues to the client’s clinical presentation. 116 Prioritize Hypotheses – evaluate and prioritize hypotheses (urgency, likelihood, risk, difficulty, 117

time constraints, etc.). 118

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Generate Solutions – identify expected outcomes and use hypotheses to define a set of 119 interventions for the expected outcomes. 120

Take Action – implement the solution(s) that address the highest priority. 121 Evaluate Outcomes – compare observed outcomes against expected outcomes. 122

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Distribution of Content 124 The percentage of test questions assigned to each Client Needs category and subcategory of the NCLEX-125 RN Test Plan is based on the results of the Report of Findings from the 201721 RN Practice Analysis: Linking 126 the NCLEX-RN® Examination to Practice NCSBN, 201722), and expert judgment provided by members of the 127 NCLEX Examination Committee. 128

Client Needs Percentage of Items From Each Category/Subcategory

Safe and Effective Care Environment Management of Care 17-23%15-21% Safety and Infection Control 9-15%10-16%

Health Promotion And Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity Basic Care and Comfort 6-12% Pharmacological and Parenteral Therapies 12-18%13-19% Reduction of Risk Potential 9-15% Physiological Adaptation 11-17%

129 130

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113

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NCLEX-RN examinations are administrated adaptively in variable length format to target candidate-135 specific ability. To accommodate possible variations in test length, content area distributions of the 136 individual examinations may differ up to ±3% in each category. 137 138

139 NCLEX-RN examinations are administrated adaptively in variable length format to target candidate-140

Management of Care18%

Safety and Infection Control 13%

Health Promotion and Maintenance

9%Psychosocial Integrity

9%

Basic Care and Comfort

9%

Pharmacological and Parenteral Therapies

16%

Reduction of Risk Potential 12%

Physiological Adaptation 14%

DISTRIBUTION OF CONTENT FOR THE NCLEX-RN® TEST PLAN

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specific ability. To accommodate possible variations in test length, content area distributions of the 141 individual examinations may differ up to ±3% in each category. 142 143 Overview of Content 144 All content categories and subcategories reflect client needs across the life span in a variety of settings. 145

Safe and Effective Care Environment 146 The nurse promotes achievement of client outcomes by providing and directing nursing care that enhances 147 the care delivery setting in order to protect clients and health care personnel. 148

Management of Care – providing and directing nursing care that enhances the care delivery setting 149 to protect clients and health care personnel. 150 Related content includes but is not limited to: 151 Advance Directives/Self-

Determination/Life Planning Advocacy Case Management Client Rights Collaboration with Interdisciplinary

Team Concepts of Management Confidentiality/ Information Security Continuity of Care

Assignment, Delegation and Supervision Establishing Priorities Ethical Practice Informed Consent Information Technology Legal Rights and Responsibilities Organ Donation Performance Improvement (Quality

Improvement) Referrals

152 153 Safety and Infection Control – protecting clients and health care personnel from health and 154

environmental hazards. 155 Related content includes but is not limited to: 156

Accident/Error/Injury Prevention Emergency Response Plan Ergonomic Principles Handling Hazardous and Infectious

Materials Home Safety

Reporting of Incident/Event/Irregular Occurrence/Variance

Safe Use of Equipment Security Plan Standard Precautions/Transmission-

Based Precautions/Surgical Asepsis Use of Restraints/Safety Devices

Health Promotion and Maintenance 157 The nurse provides and directs nursing care of the client that incorporates the knowledge of expected 158 growth and development principles; prevention and/or early detection of health problems, and strategies 159 to achieve optimal health. 160

Related content includes but is not limited to: 161 Aging Process Ante/Intra/Postpartum and

Newborn Care

Health Screening High Risk Behaviors Lifestyle Choices

115

Developmental Stages and Transitions

Health Promotion/Disease Prevention

Self-Care Techniques of Physical Assessment

Psychosocial Integrity 162 The nurse provides and directs nursing care that promotes and supports the emotional, mental and social 163 well-being of the client experiencing stressful events, as well as clients with acute or chronic mental illness. 164

Related content includes but is not limited to: 165 Abuse/Neglect Behavioral Interventions Chemical and Other

Dependencies/Substance Use Disorder

Coping Mechanisms Crisis Intervention Cultural Awareness/Cultural

Influences on Health End of Life Care Family Dynamics Grief and Loss

Mental Health Concepts Religious and Spiritual Influences on

Health Sensory/Perceptual Alterations Stress Management Support Systems Therapeutic Communication Therapeutic Environment

166

Physiological Integrity 167 The nurse promotes physical health and wellness by providing care and comfort, reducing client risk 168 potential and managing health alterations. 169

170 Basic Care and Comfort - providing comfort and assistance in the performance of activities of daily 171

living. 172 Related content includes but is not limited to: 173

Assistive Devices Elimination Mobility/Immobility Non-Pharmacological Comfort

Interventions

Nutrition and Oral Hydration Personal Hygiene Rest and Sleep

Pharmacological and Parenteral Therapies - providing care related to the administration of 174 medications and parenteral therapies. 175 Related content includes but is not limited to: 176

Adverse Effects/Contraindications/ Side Effects/Interactions

Expected Actions/Outcomes Medication Administration Parenteral/Intravenous Therapies

116

Blood and Blood Products Central Venous Access Devices Dosage Calculation

Pharmacological Pain Management Total Parenteral Nutrition

177

Reduction of Risk Potential - reducing the likelihood that clients will develop complications or 178 health problems related to existing conditions, treatments or procedures. 179 Related content includes but is not limited to: 180

Changes/Abnormalities in Vital Signs

Diagnostic Tests Laboratory Values Potential for Alterations in Body

Systems Potential for Complications of

Diagnostic Tests/Treatments/ Procedures

Potential for Complications from Surgical Procedures and Health Alterations

System Specific Assessments Therapeutic Procedures

181 Physiological Adaptation - managing and providing care for clients with acute, chronic or life 182

threatening physical health conditions. 183 Related content includes but is not limited to: 184

Alterations in Body Systems Fluid and Electrolyte Imbalances Hemodynamics Illness Management

Medical Emergencies Pathophysiology Unexpected Response to Therapies

Administration of the NCLEX-RN® Examination 185 The NCLEX-RN Examination is administered to candidates by computerized adaptive testing (CAT). CAT 186 is a method of delivering examinations that uses computer technology and measurement theory. With 187 CAT, each candidate’s examination is unique because it is assembled interactively as the examination 188 proceeds. Computer technology selects items to administer that match the candidate’s ability. The items, 189 which are stored in a large item pool, have been classified by test plan category and level of difficulty as 190 well as a representative amount of clinical judgment items. After the candidate answers an item, the 191 computer calculates an ability estimate based on all of the previous answers the candidate selected. The 192 next item administered is chosen to measure the candidate’s ability in the appropriate test plan category. 193 This process is repeated for each item, creating an examination tailored to the candidate’s knowledge and 194 skills while fulfilling all NCLEX-RN Test Plan requirements. The examination continues with items 195 selected and administered in this way until a pass or fail decision is made. 196 197 All registered nurse candidates must answer a minimum of 75 85 items. The maximum number of items 198 that a registered nurse candidate may answer is 265 150 during the allotted sixfive-hour time period. Of 199 the minimum length exam, 52 of the items will come from the eight content areas listed above in the 200 stated percentages. Eighteen of the items will be comprised of three clinical judgment case studies. Case 201 studies are item sets composed of six items that measure each of the six domains of the NCSBN Clinical 202 Judgment Measurement Model (CJMM). The remaining 15 items will be unscored, pretest items. These 203 pretest items can be composed of clinical judgment case studies or standalone items. The maximum 204 sixfive-hour time limit to complete the examination includes the tutorial, sample questions and includes 205

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all breaks. Candidates may be administered multiple choice items, case studies, as well as items written 206 in alternate formats. These formats may include but are not limited to multiple response, fill-in-the-blank 207 calculation, ordered response, and/or hot spots. All item types may include multimedia such as charts, 208 tables, and graphics, sound and video. All items go through an extensive review process before being 209 used as items on the examination. 210 211 212 More detailed information about the NCLEX examination, including information on the Next Generation 213 NCLEX, CAT methodology, the candidate bulletin and Web tutorials can be found at the website: 214 NCLEX.com. A more detailed description of the item types can be found in the NCLEX Tutorial section on 215 the website. 216 217 Examination Security and Confidentiality 218 Any candidate that violates test center regulations or rules, or engages in irregular behavior, misconduct 219 and/or does not follow a test center administrator’s warning to discontinue inappropriate behavior may 220 be dismissed from the test center. Additionally, exam results may be withheld or cancelled and the 221 licensing board may take other disciplinary action such as denial of a license and/or disqualifying the 222 candidate from future registrations for licensure. Refer to the current candidate bulletin for more 223 information. 224 225 Candidates should be aware and understand that the disclosure of any examination materials including 226 the nature or content of examination items, before, during or after the examination is a violation of law. 227 Violations of confidentiality and/or candidates’ rules can result in criminal prosecution or civil liability 228 and/or disciplinary actions by the licensing agency including the denial of licensure. Disclosure of 229 examination materials includes but is not limited to discussing examination items with faculty, friends, 230 family, or others. 231 232

233

118

Bibliography 234 235 236 237 Anderson, L. W., & Krathwohl, D. R. (eds). (2001). A taxonomy for learning, teaching, and assessing. A 238 revision of Bloom’s taxonomy of educational objectives. New York: Addison Wesley Longman, Inc. 239 240 Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational 241 objectives: The classification of educational goals. Handbook I. Cognitive Domain. New York: David McKay. 242 243 National Council of State Boards of Nursing. (2017). Report of findings from the 2017 RN practice analysis: 244 linking the NCLEX-RN® examination to practice. Chicago: Author. 245 246 National Council of State Boards of Nursing. 20142021). Model nursing administrative rules. Chicago: 247 Author. 248 249 National Council of State Boards of Nursing. (20142021). Model nursing practice act. Chicago: Author. 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269

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2023 NCLEX-RN® Test Plan 1

National Council Licensure Examination 2

for Registered Nurses 3

(NCLEX-RN® EXAMINATION) 4

Introduction 5 Entry into the practice of nursing is regulated by the licensing authorities within each of the National 6 Council of State Boards of Nursing (NCSBN) member board jurisdictions (state, commonwealth, province, 7 and territorial boards of nursing). To ensure public protection, each jurisdiction requires candidates for 8 licensure to meet set requirements that include passing an examination that measures the competencies 9 needed to perform safely and effectively as a newly licensed, entry-level registered nurse. NCSBN develops 10 a licensure examination, the National Council Licensure Examination for Registered Nurses (NCLEX-RN®), 11 which is used by member board jurisdictions to assist in making licensure decisions. 12

Several steps occur in the development of the NCLEX-RN Test Plan. The first step is conducting a practice 13 analysis that is used to collect data on the current practice of the entry-level nurse (Report of Findings from 14 the 2021 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice, NCSBN, 2022). Twenty-Four 15 thousand newly licensed registered nurses are asked about the frequency, importance and clinical 16 judgment relevancy of performing nursing care activities. Nursing care activities are then analyzed in 17 relation to the frequency of performance, impact on maintaining client safety, and client care settings where 18 the activities are performed. This analysis guides the development of a framework for entry-level nursing 19 practice that incorporates specific client needs as well as processes fundamental to the practice of nursing. 20 Clinical judgment is one of the fundamental processes found to possess a high level of relevance and 21 importance in the delivery of safe, effective nursing at the entry-level. 22

Entry-level nurses are required to make increasingly complex decisions while delivering patient care. These 23 increasingly complex decisions often require the use of clinical judgment to support patient safety. NCSBN 24 has conducted several years of research and study to understand and isolate the individual factors that 25 contribute to the process of nursing clinical judgment. These isolated factors are represented in the NCLEX 26 Test Plan and subsequently delivered as examination items. A more detailed description of clinical 27 judgment can be found in the Integrated Processes section. 28

The second step is the development of the NCLEX-RN Test Plan, which guides the selection of content and 29 behaviors to be tested. The NCLEX-RN Test Plan provides a concise summary of the content and scope of 30 the licensing examination. It serves as a guide for examination development as well as candidate 31 preparation. The NCLEX® examination assesses the knowledge, skills, abilities, and clinical judgment that 32 are essential for the entry-level nurse to use in order to meet the needs of clients requiring the promotion, 33 maintenance or restoration of health. The following sections describe beliefs about people and nursing that 34 are integral to the examination, cognitive abilities that will be tested in the examination and specific 35 components of the NCLEX-RN Test Plan. 36

Beliefs 37 Beliefs about people and nursing underlie the NCLEX-RN Test Plan. People are finite beings with varying 38

120

capacities to function in society. They are unique individuals who have defined systems of daily living 39 reflecting their values, motives and lifestyles. People have the right to make decisions regarding their health 40 care needs and to participate in meeting those needs. The profession of nursing makes a unique 41 contribution in helping clients (individual, family or group, including significant others and population) 42 achieve an optimal level of health in a variety of settings. For the purposes of the NCLEX Examination, a 43 client is defined as the individual, family, or group which includes significant others and population. 44

45

Nursing is both an art and a science, founded on a professional body of knowledge that integrates concepts 46 from the liberal arts and the biological, physical, psychological and social sciences. It is a learned profession 47 based on knowledge of the human condition across the life span and the relationships of an individual with 48 others and within the environment. Nursing is a dynamic, continually evolving discipline that employs 49 critical thinking and clinical judgment to integrate increasingly complex knowledge, skills, technologies, 50 and client care activities into evidence-based nursing practice. The goal of nursing for client care is 51 preventing illness and potential complications; protecting, promoting, restoring, and facilitating comfort; 52 health; and dignity in dying. 53

The registered nurse provides a unique, comprehensive assessment of the health status of the client, 54 applying principles of ethics, client safety, health promotion and the nursing process, the nurse then 55 develops and implements an explicit plan of care considering unique cultural and spiritual client 56 preferences, the applicable standard of care and legal instructions. The nurse assists clients to promote 57 health, cope with health problems, adapt to and/or recover from the effects of disease or injury, and 58 support the right to a dignified death. The registered nurse is accountable for abiding by all applicable 59 member board jurisdiction statutes related to nursing practice. 60

Classification of Cognitive Levels 61 Bloom’s taxonomy for the cognitive domain is used as a basis for writing and coding items for the 62 examination (Bloom, et al., 1956; Anderson & Krathwohl, 2001). Since the practice of nursing requires 63 application of knowledge, skills, abilities, and clinical judgment; therefore, the majority of items are written 64 at the application or higher levels of cognitive ability, which requires more complex thought processing. 65

Test Plan Structure 66 The framework of Client Needs was selected for the examination because it provides a universal structure 67 for defining nursing actions and competencies and focuses on clients in all settings. 68

Client Needs 69 The content of the NCLEX-RN Test Plan is organized into four major Client Needs categories. Two of the 70 four categories are divided into subcategories: 71

Safe and Effective Care Environment 72 Management of Care 73 Safety and Infection Control 74

Health Promotion and Maintenance 75 Psychosocial Integrity 76 Physiological Integrity 77 Basic Care and Comfort 78 Pharmacological and Parenteral Therapies 79

121

Reduction of Risk Potential 80 Physiological Adaptation 81

82

83

Integrated Processes 84 The following processes are fundamental to the practice of nursing and are integrated throughout the 85 Client Needs categories and subcategories: 86

Caring – interaction of the nurse and client in an atmosphere of mutual respect and trust. In 87 this collaborative environment, the nurse provides encouragement, hope, support and 88 compassion to help achieve desired outcomes. 89

Clinical Judgment - the observed outcome of critical thinking and decision making. It is an 90 iterative process with multiple steps that uses nursing knowledge to observe and assess 91 presenting situations, identify a prioritized client concern, and generate the best possible 92 evidence-based solutions in order to deliver safe client care (detail description of the steps 93 below). 94

Communication and Documentation – verbal and nonverbal interactions between the nurse and 95 the client, the client’s significant others and the other members of the health care team. Events 96 and activities associated with client care are recorded in written and/or electronic records that 97 demonstrate adherence to the standards of practice and accountability in the provision of care. 98

Culture and Spirituality – interaction of the nurse and the client (individual, family or group, 99 including significant others and population) which recognizes and considers the client-100 reported, self-identified, unique and individual preferences to client care, the applicable 101 standard of care and legal instructions. 102

Nursing Process – a scientific, clinical reasoning approach to client care that includes 103 assessment, analysis, planning, implementation and evaluation. 104

Teaching/Learning – facilitation of the acquisition of knowledge, skills and attitudes promoting 105 a change in behavior. 106

Clinical Judgment 107 The nurse engages in this iterative multi-step process that uses nursing knowledge to observe and assess 108 presenting situations, identify a prioritized client concern, and generate the best possible evidence-based 109 solutions in order to deliver safe client care. Clinical judgment content may be represented as a case study 110 or as an individual stand-alone item. A case study is where six items are associated with the same client 111 presentation, share unfolding client information, and address the steps in clinical judgment. 112

Recognize Cues – identify relevant and important information from different sources (e.g., 113 medical history, vital signs). 114

Analyze Cues – organize and connect the recognized cues to the client’s clinical presentation. 115 Prioritize Hypotheses – evaluate and prioritize hypotheses (urgency, likelihood, risk, difficulty, 116

time constraints, etc.). 117 Generate Solutions – identify expected outcomes and use hypotheses to define a set of 118

interventions for the expected outcomes. 119

122

Take Action – implement the solution(s) that address the highest priority. 120 Evaluate Outcomes – compare observed outcomes against expected outcomes. 121

122

Distribution of Content 123 The percentage of test questions assigned to each Client Needs category and subcategory of the NCLEX-124 RN Test Plan is based on the results of the Report of Findings from the 2021 RN Practice Analysis: Linking the 125 NCLEX-RN® Examination to Practice NCSBN, 2022), and expert judgment provided by members of the 126 NCLEX Examination Committee. 127

Client Needs Percentage of Items From Each Category/Subcategory

Safe and Effective Care Environment Management of Care 15-21% Safety and Infection Control 10-16%

Health Promotion And Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity Basic Care and Comfort 6-12% Pharmacological and Parenteral Therapies 13-19% Reduction of Risk Potential 9-15% Physiological Adaptation 11-17%

128 129

130

131

132

123

133 NCLEX-RN examinations are administrated adaptively in variable length format to target candidate-134 specific ability. To accommodate possible variations in test length, content area distributions of the 135 individual examinations may differ up to ±3% in each category. 136 137 138 139 Overview of Content 140 All content categories and subcategories reflect client needs across the life span in a variety of settings. 141

Safe and Effective Care Environment 142 The nurse promotes achievement of client outcomes by providing and directing nursing care that enhances 143 the care delivery setting in order to protect clients and health care personnel. 144

Management of Care – providing and directing nursing care that enhances the care delivery setting 145 to protect clients and health care personnel. 146 Related content includes but is not limited to: 147 Advance Directives/Self-

Determination/Life Planning Advocacy Case Management Client Rights Collaboration with Interdisciplinary

Team Concepts of Management Confidentiality/ Information Security Continuity of Care

Assignment, Delegation and Supervision Establishing Priorities Ethical Practice Informed Consent Information Technology Legal Rights and Responsibilities Organ Donation Performance Improvement (Quality

Improvement) Referrals

Management of Care18%

Safety and Infection Control 13%

Health Promotion and Maintenance

9%Psychosocial Integrity

9%

Basic Care and Comfort

9%

Pharmacological and Parenteral Therapies

16%

Reduction of Risk Potential 12%

Physiological Adaptation 14%

DISTRIBUTION OF CONTENT FOR THE NCLEX-RN® TEST PLAN

124

148 149 Safety and Infection Control – protecting clients and health care personnel from health and 150

environmental hazards. 151 Related content includes but is not limited to: 152

Accident/Error/Injury Prevention Emergency Response Plan Ergonomic Principles Handling Hazardous and Infectious

Materials Home Safety

Reporting of Incident/Event/Irregular Occurrence/Variance

Safe Use of Equipment Security Plan Standard Precautions/Transmission-

Based Precautions/Surgical Asepsis Use of Restraints/Safety Devices

Health Promotion and Maintenance 153 The nurse provides and directs nursing care of the client that incorporates the knowledge of expected 154 growth and development principles; prevention and/or early detection of health problems, and strategies 155 to achieve optimal health. 156

Related content includes but is not limited to: 157 Aging Process Ante/Intra/Postpartum and

Newborn Care Developmental Stages and

Transitions Health Promotion/Disease

Prevention

Health Screening High Risk Behaviors Lifestyle Choices Self-Care Techniques of Physical Assessment

Psychosocial Integrity 158 The nurse provides and directs nursing care that promotes and supports the emotional, mental and social 159 well-being of the client experiencing stressful events, as well as clients with acute or chronic mental illness. 160

Related content includes but is not limited to: 161 Abuse/Neglect Behavioral Interventions Chemical and Other

Dependencies/Substance Use Disorder

Coping Mechanisms Crisis Intervention Cultural Awareness/Cultural

Influences on Health End of Life Care Family Dynamics Grief and Loss

Mental Health Concepts Religious and Spiritual Influences on

Health Sensory/Perceptual Alterations Stress Management Support Systems Therapeutic Communication Therapeutic Environment

125

162

Physiological Integrity 163 The nurse promotes physical health and wellness by providing care and comfort, reducing client risk 164 potential and managing health alterations. 165

166 Basic Care and Comfort - providing comfort and assistance in the performance of activities of daily 167

living. 168 Related content includes but is not limited to: 169

Assistive Devices Elimination Mobility/Immobility Non-Pharmacological Comfort

Interventions

Nutrition and Oral Hydration Personal Hygiene Rest and Sleep

Pharmacological and Parenteral Therapies - providing care related to the administration of 170 medications and parenteral therapies. 171 Related content includes but is not limited to: 172

Adverse Effects/Contraindications/ Side Effects/Interactions

Blood and Blood Products Central Venous Access Devices Dosage Calculation

Expected Actions/Outcomes Medication Administration Parenteral/Intravenous Therapies Pharmacological Pain Management Total Parenteral Nutrition

173

Reduction of Risk Potential - reducing the likelihood that clients will develop complications or 174 health problems related to existing conditions, treatments or procedures. 175 Related content includes but is not limited to: 176

Changes/Abnormalities in Vital Signs

Diagnostic Tests Laboratory Values Potential for Alterations in Body

Systems Potential for Complications of

Diagnostic Tests/Treatments/ Procedures

Potential for Complications from Surgical Procedures and Health Alterations

System Specific Assessments Therapeutic Procedures

177 Physiological Adaptation - managing and providing care for clients with acute, chronic or life 178

threatening physical health conditions. 179 Related content includes but is not limited to: 180

126

Alterations in Body Systems Fluid and Electrolyte Imbalances Hemodynamics Illness Management

Medical Emergencies Pathophysiology Unexpected Response to Therapies

Administration of the NCLEX-RN® Examination 181 The NCLEX-RN Examination is administered to candidates by computerized adaptive testing (CAT). CAT 182 is a method of delivering examinations that uses computer technology and measurement theory. With 183 CAT, each candidate’s examination is unique because it is assembled interactively as the examination 184 proceeds. Computer technology selects items to administer that match the candidate’s ability. The items, 185 which are stored in a large item pool, have been classified by test plan category and level of difficulty as 186 well as a representative amount of clinical judgment items. After the candidate answers an item, the 187 computer calculates an ability estimate based on all of the previous answers the candidate selected. The 188 next item administered is chosen to measure the candidate’s ability in the appropriate test plan category. 189 This process is repeated for each item, creating an examination tailored to the candidate’s knowledge and 190 skills while fulfilling all NCLEX-RN Test Plan requirements. The examination continues with items 191 selected and administered in this way until a pass or fail decision is made. 192 193 All registered nurse candidates must answer a minimum of 85 items. The maximum number of items 194 that a registered nurse candidate may answer is 150 during the allotted five-hour time period. Of the 195 minimum length exam, 52 of the items will come from the eight content areas listed above in the stated 196 percentages. Eighteen of the items will be comprised of three clinical judgment case studies. Case studies 197 are item sets composed of six items that measure each of the six domains of the NCSBN Clinical 198 Judgment Measurement Model (CJMM). The remaining 15 items will be unscored, pretest items. These 199 pretest items can be composed of clinical judgment case studies or standalone items. The maximum five-200 hour time limit to complete the examination includes all breaks. Candidates may be administered 201 multiple choice items, case studies, as well as items written in alternate formats. All item types may 202 include multimedia such as charts, tables, and graphics. All items go through an extensive review process 203 before being used as items on the examination. 204 205 206 More detailed information about the NCLEX examination, including information on the Next Generation 207 NCLEX, CAT methodology, the candidate bulletin and Web tutorials can be found at the website: 208 NCLEX.com. A more detailed description of the item types can be found in the NCLEX Tutorial section on 209 the website. 210 211 Examination Security and Confidentiality 212 Any candidate that violates test center regulations or rules, or engages in irregular behavior, misconduct 213 and/or does not follow a test center administrator’s warning to discontinue inappropriate behavior may 214 be dismissed from the test center. Additionally, exam results may be withheld or cancelled and the 215 licensing board may take other disciplinary action such as denial of a license and/or disqualifying the 216 candidate from future registrations for licensure. Refer to the current candidate bulletin for more 217 information. 218 219 Candidates should be aware and understand that the disclosure of any examination materials including 220 the nature or content of examination items, before, during or after the examination is a violation of law. 221 Violations of confidentiality and/or candidates’ rules can result in criminal prosecution or civil liability 222 and/or disciplinary actions by the licensing agency including the denial of licensure. Disclosure of 223

127

examination materials includes but is not limited to discussing examination items with faculty, friends, 224 family, or others. 225 226

227

128

Bibliography 228 229 230 231 Anderson, L. W., & Krathwohl, D. R. (eds). (2001). A taxonomy for learning, teaching, and assessing. A 232 revision of Bloom’s taxonomy of educational objectives. New York: Addison Wesley Longman, Inc. 233 234 Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational 235 objectives: The classification of educational goals. Handbook I. Cognitive Domain. New York: David McKay. 236 237 National Council of State Boards of Nursing. (2017). Report of findings from the 2017 RN practice analysis: 238 linking the NCLEX-RN® examination to practice. Chicago: Author. 239 240 National Council of State Boards of Nursing. 2021). Model nursing administrative rules. Chicago: Author. 241 242 National Council of State Boards of Nursing. (2021). Model nursing practice act. Chicago: Author. 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262

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20203 NCLEX-PN® Test Plan 1

National Council Licensure Examination for Practical/Vocational Nurses 2

(NCLEX-PN® Examination) 3

Introduction 4 Entry into the practice of nursing is regulated by the licensing authorities within each of the National Council of State Boards of 5 Nursing (NCSBN®) member board jurisdictions (state, commonwealth, and territorial boards of nursing). To ensure public 6 protection, each jurisdiction requires candidates for licensure to meet set requirements that include passing an examination that 7 measures the competencies needed to perform safely and effectively as a newly licensed, entry-level practical/vocational nurse 8 (LPN/VN). NCSBN develops a licensure examination, the National Council Licensure Examination for Practical/Vocational 9 Nurses (NCLEX-PN®), which is used by member board jurisdictions to assist in making licensure decisions. 10 11 Several steps occur in the development of the NCLEX-PN® Test Plan. The first step is conducting a practice analysis that is used 12 to collect data on the current practice of entry-level practical/vocational nurses (Report of Findings from the 201821 LPN/VN 13 Practice Analysis: Linking the NCLEX-PN® Examination to Practice [NCSBN, 201922]). There were 1224,000 newly licensed 14 practical/vocational nurses asked about the frequency, importance, and clinical judgment relevancy and priority of performing 15 nursing care activities. Nursing care activities are then analyzed in relation to the frequency of performance, impact on maintaining 16 client safety and client care settings where the activities are performed. This analysis guides the development of a framework for 17 entry-level nursing practice that incorporates specific client needs, as well as processes that are fundamental to the practice of 18 nursing. Clinical judgment is one of the fundamental processes found to possess a high level of relevance and importance in the 19 delivery of safe, effective nursing at the entry-level. 20 Entry-level nurses are required to make increasingly complex decisions while delivering patient care. These increasingly complex 21 decisions often require the use of clinical judgment to support patient safety. NCSBN has conducted several years of research and 22 study to understand and isolate the individual factors that contribute to the process of nursing clinical judgment. These isolated 23 factors are represented in the NCLEX Test Plan and subsequently delivered as examination items. A more detailed description of 24 clinical judgment can be found in the Integrated Processes section. 25 The next step is the development of the NCLEX-PN Test Plan, which guides the selection of content and behaviors to be tested. 26 Variations in jurisdiction laws and regulations are considered in the development of the test plan. The NCLEX-PN Test Plan 27 provides a concise summary of the content and scope of the licensure examination. It serves as a guide for examination 28 development, as well as candidate preparation. The NCLEX® examination assesses the knowledge, skills, and abilities and 29 clinical judgment that are essential for the entry-level practical/vocational nurse to use in order to meet the needs of clients 30 requiring the promotion, maintenance or restoration of health. The following sections describe beliefs about people and nursing 31 that are integral to the examination, cognitive abilities that will be tested in the examination, and specific components of the 32 NCLEX-PN Test Plan. 33

Beliefs 34 Beliefs about people and nursing influence the NCLEX-PN Test Plan. People are finite beings with varying capacities to function 35 in society. They are unique individuals who have defined systems of daily living that reflect their values, cultures, motives and 36 lifestyles. Additionally, people have the right to make decisions regarding their health care needs and to participate in meeting 37 those needs. The profession of nursing makes a unique contribution in helping clients (i.e., individuals, family, or group) achieve 38 an optimal level of health in a variety of settings. For the purposes of the NCLEX Examination, a client is defined as the 39 individual, family, or group which includes significant others and population. 40 41 Nursing is both an art and a science, founded on a professional body of knowledge that integrates concepts from the liberal arts 42 and the biological, physical, psychological and social sciences. It is a learned profession based on an understanding of the 43 human condition across the life span and the relationships of an individual with others and within the environment. Nursing is a 44 dynamic, continually evolving discipline that employs critical thinking and clinical judgment to integrate increasingly complex 45 knowledge, skills, technologies and client care activities into evidence-based nursing practice. The goal of nursing for client care 46 is preventing illness; promoting comfort; protecting, promoting, and restoring health; and promoting dignity in dying. 47 48

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The LPN/VN uses “specialized knowledge and skills which meet the health needs of people in a variety of settings under the 49 direction of qualified health professionals” (NFLPN, 2003). Considering unique cultural and spiritual client preferences, the 50 applicable standard of care and legal considerations the LPN/VN uses a clinical problem-solving process (the nursing process) to 51 collect and organize relevant health care data, assist in the identification of the health needs/problems throughout the client’s life 52 span and contribute to the interdisciplinary team in a variety of settings. The entry-level LPN/VN demonstrates the essential 53 competencies needed to care for clients with commonly occurring health problems that have predictable outcomes. 54 “Professional behaviors, within the scope of nursing practice for a practical/vocational nurse, are characterized by adherence to 55 standards of care, accountability of one’s own actions and behaviors, and use of legal and ethical principles in nursing practice” 56 (NAPNES, 2007). 57

Classification of Cognitive Levels 58 Bloom’s taxonomy for the cognitive domain is used as a basis for writing and coding items for the examination (Bloom et al., 59 1956; Anderson & Krathwohl, 2001). The practice of practical/vocational nursing requires application of knowledge, skills, and 60 abilities, and clinical judgment; therefore, the majority of items are written at the application or higher levels of cognitive ability. 61

Test Plan Structure 62 The framework of Client Needs was selected because it provides a universal structure for defining nursing actions and 63 competencies for a variety of clients across all settings and is congruent with state laws/rules. 64

Client Needs 65 The content of the NCLEX-PN Test Plan is organized into four major Client Needs categories; two of the four categories are 66 divided into subcategories: 67

68 69 Safe and Effective Care Environment 70 Coordinated Care 71 Safety and Infection Control 72

73 Health Promotion and Maintenance 74

75 Psychosocial Integrity 76

77 Physiological Integrity 78 Basic Care and Comfort 79 Pharmacological Therapies 80 Reduction of Risk Potential 81 Physiological Adaptation 82

Integrated Processes 83 The following processes are fundamental to the practice of practical/vocational nursing and integrated throughout the Client Needs 84 categories and subcategories: 85

86 Caring – interaction of the practical/vocational nurse and client in an atmosphere of mutual respect and trust. In this 87

collaborative environment, the practical/vocational nurse provides support and compassion to help achieve desired 88 therapeutic outcomes. 89 90

Clinical Judgment – the observed outcome of critical thinking and decision making. It is an iterative process that uses 91 nursing knowledge to observe and assess presenting situations, identify a prioritized client concern, and generate the 92 best possible evidence-based solutions in order to deliver safe client care (detailed description of the steps below). 93

94 Clinical Problem-Solving Process (Nursing Process) – a scientific approach to client care that includes data collection, 95

planning, implementation and evaluation. 96

131

97 98

Communication and Documentation – verbal and nonverbal interactions between the practical/vocational nurse and the 99 client, as well as other members of the health care team. Events and activities associated with client care are validated 100 in written and/or electronic records that reflect standards of practice and accountability in the provision of care. 101 102

Culture and Spirituality – interaction of the nurse and the client (individual, family or group, including significant others 103 and population) which recognizes and considers the client-reported, self-identified, unique and individual preferences to 104 client care, the applicable standard of care and legal considerations. 105 106

Teaching and Learning – facilitation of the acquisition of knowledge, skills and attitudes to assist in promoting a change 107 in behavior. 108

Clinical Judgment 109 The nurse engages in this iterative multi-step process that uses nursing knowledge to observe and assess presenting situations, 110 identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care. 111 Clinical judgment content may be represented as a case study or as individual stand-alone items. A case study is where six 112 items are associated with the same client presentation and share unfolding client information. 113 Recognize Cues – identify relevant and important information from different sources (e.g., medical history, vital signs). 114 Analyze Cues – organize and connect the recognized cues to the client’s clinical presentation. 115 Prioritize Hypotheses – evaluate and prioritize hypotheses (urgency, likelihood, risk, difficulty, time constraints, etc.). 116 Generate Solutions – identify expected outcomes and use hypotheses to define a set of interventions for the expected 117

outcomes. 118 Take Action – implement the solution(s) that address the highest priority. 119 Evaluate Outcomes – compare observed outcomes against expected outcomes. 120

121

Distribution of Content 122 The percentage of test items assigned to each Client Needs category and subcategory in the NCLEX-PN Test Plan is based on 123 the results of the study Report of Findings from the 201821 LPN/VN Practice Analysis: Linking the NCLEX-PN® Examination to 124 Practice (NCSBN, 201922), and expert judgment provided by members of the NCLEX® Examination Committee. 125

126 127

128

129

Client Needs Percentage of Items from each Category/Subcategory

Safe and Effective Care Environment Coordinated Care 18-24% Safety and Infection Control 10-16%

Health Promotion and Maintenance 6-12%

Psychosocial Integrity 9-15%

Physiological Integrity Basic Care and Comfort 7-13% Pharmacological Therapies 10-16% Reduction of Risk Potential 9-15% Physiological Adaptation 7-13%

132

130

NCLEX-PN examinations are administered adaptively in variable length format to target candidate-specific ability. To 131 accommodate possible variations in test length, content area distributions of the individual examinations may differ up to ±3% in 132 each category.133

Coordinated Care21%

Safety and Infection Control

13%

Health Promotion and Maintenance

9%

Psychosocial Integrity12%

Basic Care and Comfort

10%

Pharmacological Therapies

13%

Reduction of Risk Potential

12%

Physiological Adaptation

10%

Distribution of Content for the NCLEX-PN® Test Plan

133

Overview of Content 134 All content categories and subcategories reflect client needs across the life span in a variety of settings. 135 136 Safe and Effective Care Environment 137 The practical/vocational nurse provides nursing care that contributes to the enhancement of the health care delivery setting and 138 protects clients and health care personnel. 139 140

141 Coordinated Care – The practical/vocational nurse collaborates with health care team members to facilitate effective 142

client care. 143 144

Related content includes, but is not limited to: 145 146

Advance Directives Advocacy Assignments/Delegation Client Rights Collaboration with Interdisciplinary Team Concepts of Management and Supervision Confidentiality/Information Security Continuity of Care

Establishing Priorities Ethical Practice Informed Consent Information Technology Legal Responsibilities Performance Improvement (Quality Improvement) Referral Process Resource Management

147 Safety and Infection Control – The practical/vocational nurse contributes to the protection of clients and health care 148

personnel from health and environmental hazards. 149 150

Related content includes, but is not limited to: 151 152

Accident/Error/Injury Prevention Emergency Response Plan Ergonomic Principles Handling Hazardous and Infectious

Materials Home Safety

Reporting of Incident/Event/Irregular Occurrence/Variance

Least Restrictive Restraints and Safety Devices Safe Use of Equipment Security Plan Standard Precautions/Transmission-Based

Precautions/Surgical Asepsis

153 154

Health Promotion and Maintenance 155 The practical/vocational nurse provides nursing care for clients that incorporate the knowledge of expected stages of growth and 156 development, and prevention and/or early detection of health problems. 157

158 Related content includes, but is not limited to: 159

160 Aging Process Ante/Intra/Postpartum and Newborn Care Community Resources Data Collection Techniques Developmental Stages and Transitions

Health Promotion/Disease Prevention High Risk Behaviors Lifestyle Choices Self-care

161 162

134

163 Psychosocial Integrity 164 The practical/vocational nurse provides care that assists with promotion and support of the emotional, mental and social well-165 being of clients. 166

167 Related content includes, but is not limited to: 168

169 Abuse or Neglect Behavioral Management Coping Mechanisms Crisis Intervention Cultural Awareness End-of-Life Concepts Grief and Loss

Mental Health Concepts Religious and Spiritual Influences on Health Sensory/Perceptual Alterations Stress Management Substance Use and Other Disorders and

Dependencies Support Systems Therapeutic Communication Therapeutic Environment

170 Physiological Integrity 171 The practical/vocational nurse assists in the promotion of physical health and well-being by providing care and comfort, reducing 172 risk potential for clients and assisting them with the management of health alterations. 173

174 Basic Care and Comfort – The practical/vocational nurse provides comfort to clients and assistance in the performance 175

of activities of daily living. 176 177

Related content includes, but is not limited to: 178 179

Assistive Devices Elimination Mobility/Immobility Nonpharmacological Comfort Interventions

Nutrition and Oral Hydration Personal Hygiene Rest and Sleep

180 Pharmacological Therapies – The practical/vocational nurse provides care related to the administration of medications 181

and monitors clients who are receiving parenteral therapies. 182 183

Related content includes, but is not limited to: 184 185

Adverse Effects/Contraindications/Side Effects/Interactions

Dosage Calculations

Expected Actions/Outcomes Medication Administration Pharmacological Pain Management

186 Reduction of Risk Potential – The practical/vocational nurse reduces the potential for clients to develop complications 187

or health problems related to treatments, procedures or existing conditions. 188 189

Related content includes but is not limited to: 190 191

Changes/Abnormalities in Vital Signs Diagnostic Tests Laboratory Values Potential for Alterations in Body Systems

Potential for Complications of Diagnostic Tests/Treatments/ Procedures

Potential for Complications from Surgical Procedures and Health Alterations

Therapeutic Procedures 192

135

Physiological Adaptation – The practical/vocational nurse participates in providing care for clients with acute, chronic or 193 life-threatening physical health conditions. 194 195 Related content includes but is not limited to: 196

197 Alterations in Body Systems Basic Pathophysiology Fluid and Electrolyte Imbalances

Medical Emergencies Unexpected Response to Therapies

Administration of the NCLEX-PN® Examination 198 The NCLEX-PN Examination is administered to candidates by computerized adaptive testing (CAT). CAT is a method of 199 delivering examinations that uses computer technology and measurement theory. With CAT, each candidate’s examination is 200 unique because it is assembled interactively as the examination proceeds. Computer technology selects items to administer that 201 match the candidate’s ability. The items, which are stored in a large item pool, have been classified by test plan category and 202 level of difficulty as well as a representative amount of clinical judgment items. After the candidate answers an item, the 203 computer calculates an ability estimate based on all of the previous answers the candidate selected. The next item administered 204 is chosen to measure the candidate’s ability in the appropriate test plan category. This process is repeated for each item, 205 creating an examination tailored to the candidate’s knowledge and skills while fulfilling all NCLEX-PN Test Plan requirements. 206 The examination continues with items selected and administered in this way until a pass or fail decision is made. 207 208 All practical/vocational nurse candidates must answer a minimum of 85 items. The maximum number of items that a 209 practical/vocational nurse candidate may answer is 205 150 during the allotted five-hour time period. Of the minimum length 210 exam, 52 of the items will come from the eight content areas listed above in the stated percentages. Eighteen of the items will be 211 comprised of three clinical judgment case studies. Case studies are item sets composed of six items that measure each of the 212 six domains of the NCSBN Clinical Judgment Measurement Model (CJMM). The remaining 15 items will be unscored, pretest 213 items. These pretest items can be composed of clinical judgment case studies or standalone items. The maximum five-hour time 214 limit to complete the examination includes the tutorial, sample questions and all breaks. Candidates may be administered 215 multiple choice items, case studies, as well as items written in alternate formats. These formats may include but are not limited to 216 multiple response, fill-in-the-blank calculation, ordered response, and/or hot spots. All item types may include multimedia, such 217 as charts, tables, and graphics, sound and video. All items go through an extensive review process before being used as items 218 on the examination. 219 220 More detailed information about the NCLEX examination, including information on the Next Generation NCLEX, CAT 221 methodology, the candidate bulletin and Web tutorials can be found at the website: NCLEX.com. A more detailed description of 222 the item types can be found in the NCLEX Tutorial section on the website. 223

224

Examination Security and Confidentiality 225

Any candidate that violates test center regulations or rules, or engages in irregular behavior, misconduct and/or does not follow a 226 test center administrator’s warning to discontinue inappropriate behavior may be dismissed from the test center. Additionally, exam 227 results may be withheld or cancelled and the licensing board may take other disciplinary action, such as denial of a license and/or 228 disqualifying the candidate from future registrations for licensure. Refer to the current candidate bulletin for more information. 229 Candidates should be aware and understand that the disclosure of any examination materials including the nature or content of 230 examination items, before, during or after the examination is a violation of law. Violations of confidentiality and/or candidates’ rules 231 can result in criminal prosecution or civil liability and/or disciplinary actions by the licensing agency including the denial of licensure. 232 Disclosure of examination materials includes, but is not limited to discussing examination items with faculty, friends, family, or 233 others. 234

235 236

136

Bibliography 237 238 Anderson, L. W. & Krathwohl, D. R. (Eds). (2001). A taxonomy for learning, teaching, and assessing. A revision of Bloom’s 239 taxonomy of educational objectives. New York: Addison Wesley Longman, Inc. 240 241 Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational objectives: The 242 classification of educational goals. Handbook I. Cognitive Domain. New York: David McKay. 243 244 National Association for Practical Nurse Educators and Service (NAPNES). (2007). Standards of practice and educational 245 competencies of graduates of practical/vocational nursing programs. Silver Spring, MD: Author. 246 247 National Council of State Boards of Nursing (201922). Report of the findings from the 201821 LPN/VN practice analysis: Linking 248 the NCLEX-PN examination to practice. Chicago, Author. 249 250 National Council of State Boards of Nursing. (201222). NCSBN Model Act. Chicago: Author. 251

252 National Federation of Licensed Practical Nurses, Inc. (NFLPN). (200315). Nursing practice standards for the licensed 253 practical/vocational nurse. Raleigh, NC: Author. 254 255 256 257

137

2023 NCLEX-PN® Test Plan 1

National Council Licensure Examination for Practical/Vocational Nurses 2

(NCLEX-PN® Examination) 3

Introduction 4 Entry into the practice of nursing is regulated by the licensing authorities within each of the National Council of State Boards of 5 Nursing (NCSBN®) member board jurisdictions (state, commonwealth, and territorial boards of nursing). To ensure public 6 protection, each jurisdiction requires candidates for licensure to meet set requirements that include passing an examination that 7 measures the competencies needed to perform safely and effectively as a newly licensed, entry-level practical/vocational nurse 8 (LPN/VN). NCSBN develops a licensure examination, the National Council Licensure Examination for Practical/Vocational 9 Nurses (NCLEX-PN®), which is used by member board jurisdictions to assist in making licensure decisions. 10 11 Several steps occur in the development of the NCLEX-PN® Test Plan. The first step is conducting a practice analysis that is used 12 to collect data on the current practice of entry-level practical/vocational nurses (Report of Findings from the 2021 LPN/VN Practice 13 Analysis: Linking the NCLEX-PN® Examination to Practice [NCSBN, 2022]). There were 24,000 newly licensed practical/vocational 14 nurses asked about the frequency, importance, and clinical judgment relevancy of performing nursing care activities. Nursing care 15 activities are then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings 16 where the activities are performed. This analysis guides the development of a framework for entry-level nursing practice that 17 incorporates specific client needs, as well as processes that are fundamental to the practice of nursing. Clinical judgment is one of 18 the fundamental processes found to possess a high level of relevance and importance in the delivery of safe, effective nursing at 19 the entry-level. 20 Entry-level nurses are required to make increasingly complex decisions while delivering patient care. These increasingly complex 21 decisions often require the use of clinical judgment to support patient safety. NCSBN has conducted several years of research and 22 study to understand and isolate the individual factors that contribute to the process of nursing clinical judgment. These isolated 23 factors are represented in the NCLEX Test Plan and subsequently delivered as examination items. A more detailed description of 24 clinical judgment can be found in the Integrated Processes section. 25 The next step is the development of the NCLEX-PN Test Plan, which guides the selection of content and behaviors to be tested. 26 Variations in jurisdiction laws and regulations are considered in the development of the test plan. The NCLEX-PN Test Plan 27 provides a concise summary of the content and scope of the licensure examination. It serves as a guide for examination 28 development, as well as candidate preparation. The NCLEX® examination assesses the knowledge, skills, abilities and clinical 29 judgment that are essential for the entry-level practical/vocational nurse to use in order to meet the needs of clients requiring the 30 promotion, maintenance or restoration of health. The following sections describe beliefs about people and nursing that are 31 integral to the examination, cognitive abilities that will be tested in the examination, and specific components of the NCLEX-PN 32 Test Plan. 33

Beliefs 34 Beliefs about people and nursing influence the NCLEX-PN Test Plan. People are finite beings with varying capacities to function 35 in society. They are unique individuals who have defined systems of daily living that reflect their values, cultures, motives and 36 lifestyles. Additionally, people have the right to make decisions regarding their health care needs and to participate in meeting 37 those needs. The profession of nursing makes a unique contribution in helping clients (i.e., individuals, family, or group) achieve 38 an optimal level of health in a variety of settings. For the purposes of the NCLEX Examination, a client is defined as the 39 individual, family, or group which includes significant others and population. 40 41 Nursing is both an art and a science, founded on a professional body of knowledge that integrates concepts from the liberal arts 42 and the biological, physical, psychological and social sciences. It is a learned profession based on an understanding of the 43 human condition across the life span and the relationships of an individual with others and within the environment. Nursing is a 44 dynamic, continually evolving discipline that employs critical thinking and clinical judgment to integrate increasingly complex 45 knowledge, skills, technologies and client care activities into evidence-based nursing practice. The goal of nursing for client care 46 is preventing illness; promoting comfort; protecting, promoting, and restoring health; and promoting dignity in dying. 47 48

138

The LPN/VN uses “specialized knowledge and skills which meet the health needs of people in a variety of settings under the 49 direction of qualified health professionals” (NFLPN, 2003). Considering unique cultural and spiritual client preferences, the 50 applicable standard of care and legal considerations the LPN/VN uses a clinical problem-solving process (the nursing process) to 51 collect and organize relevant health care data, assist in the identification of the health needs/problems throughout the client’s life 52 span and contribute to the interdisciplinary team in a variety of settings. The entry-level LPN/VN demonstrates the essential 53 competencies needed to care for clients with commonly occurring health problems that have predictable outcomes. 54 “Professional behaviors, within the scope of nursing practice for a practical/vocational nurse, are characterized by adherence to 55 standards of care, accountability of one’s own actions and behaviors, and use of legal and ethical principles in nursing practice” 56 (NAPNES, 2007). 57

Classification of Cognitive Levels 58 Bloom’s taxonomy for the cognitive domain is used as a basis for writing and coding items for the examination (Bloom et al., 59 1956; Anderson & Krathwohl, 2001). The practice of practical/vocational nursing requires application of knowledge, skills, 60 abilities, and clinical judgment; therefore, the majority of items are written at the application or higher levels of cognitive ability. 61

Test Plan Structure 62 The framework of Client Needs was selected because it provides a universal structure for defining nursing actions and 63 competencies for a variety of clients across all settings and is congruent with state laws/rules. 64

Client Needs 65 The content of the NCLEX-PN Test Plan is organized into four major Client Needs categories; two of the four categories are 66 divided into subcategories: 67

68 69 Safe and Effective Care Environment 70 Coordinated Care 71 Safety and Infection Control 72

73 Health Promotion and Maintenance 74

75 Psychosocial Integrity 76

77 Physiological Integrity 78 Basic Care and Comfort 79 Pharmacological Therapies 80 Reduction of Risk Potential 81 Physiological Adaptation 82

Integrated Processes 83 The following processes are fundamental to the practice of practical/vocational nursing and integrated throughout the Client Needs 84 categories and subcategories: 85

86 Caring – interaction of the practical/vocational nurse and client in an atmosphere of mutual respect and trust. In this 87

collaborative environment, the practical/vocational nurse provides support and compassion to help achieve desired 88 therapeutic outcomes. 89 90

Clinical Judgment – the observed outcome of critical thinking and decision making. It is an iterative process that uses 91 nursing knowledge to observe and assess presenting situations, identify a prioritized client concern, and generate the 92 best possible evidence-based solutions in order to deliver safe client care (detailed description of the steps below). 93

94 Clinical Problem-Solving Process (Nursing Process) – a scientific approach to client care that includes data collection, 95

planning, implementation and evaluation. 96

139

97 98

Communication and Documentation – verbal and nonverbal interactions between the practical/vocational nurse and the 99 client, as well as other members of the health care team. Events and activities associated with client care are validated 100 in written and/or electronic records that reflect standards of practice and accountability in the provision of care. 101 102

Culture and Spirituality – interaction of the nurse and the client (individual, family or group, including significant others 103 and population) which recognizes and considers the client-reported, self-identified, unique and individual preferences to 104 client care, the applicable standard of care and legal considerations. 105 106

Teaching and Learning – facilitation of the acquisition of knowledge, skills and attitudes to assist in promoting a change 107 in behavior. 108

Clinical Judgment 109 The nurse engages in this iterative multi-step process that uses nursing knowledge to observe and assess presenting situations, 110 identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care. 111 Clinical judgment content may be represented as a case study or as individual stand-alone items. A case study is where six 112 items are associated with the same client presentation and share unfolding client information. 113 Recognize Cues – identify relevant and important information from different sources (e.g., medical history, vital signs). 114 Analyze Cues – organize and connect the recognized cues to the client’s clinical presentation. 115 Prioritize Hypotheses – evaluate and prioritize hypotheses (urgency, likelihood, risk, difficulty, time constraints, etc.). 116 Generate Solutions – identify expected outcomes and use hypotheses to define a set of interventions for the expected 117

outcomes. 118 Take Action – implement the solution(s) that address the highest priority. 119 Evaluate Outcomes – compare observed outcomes against expected outcomes. 120

121

Distribution of Content 122 The percentage of test items assigned to each Client Needs category and subcategory in the NCLEX-PN Test Plan is based on 123 the results of the study Report of Findings from the 2021 LPN/VN Practice Analysis: Linking the NCLEX-PN® Examination to 124 Practice (NCSBN, 2022), and expert judgment provided by members of the NCLEX® Examination Committee. 125

126 127

128

129

Client Needs Percentage of Items from each Category/Subcategory

Safe and Effective Care Environment Coordinated Care 18-24% Safety and Infection Control 10-16%

Health Promotion and Maintenance 6-12%

Psychosocial Integrity 9-15%

Physiological Integrity Basic Care and Comfort 7-13% Pharmacological Therapies 10-16% Reduction of Risk Potential 9-15% Physiological Adaptation 7-13%

140

130

NCLEX-PN examinations are administered adaptively in variable length format to target candidate-specific ability. To 131 accommodate possible variations in test length, content area distributions of the individual examinations may differ up to ±3% in 132 each category.133

Coordinated Care21%

Safety and Infection Control

13%

Health Promotion and Maintenance

9%

Psychosocial Integrity12%

Basic Care and Comfort

10%

Pharmacological Therapies

13%

Reduction of Risk Potential

12%

Physiological Adaptation

10%

Distribution of Content for the NCLEX-PN® Test Plan

141

Overview of Content 134 All content categories and subcategories reflect client needs across the life span in a variety of settings. 135 136 Safe and Effective Care Environment 137 The practical/vocational nurse provides nursing care that contributes to the enhancement of the health care delivery setting and 138 protects clients and health care personnel. 139 140

141 Coordinated Care – The practical/vocational nurse collaborates with health care team members to facilitate effective 142

client care. 143 144

Related content includes, but is not limited to: 145 146

Advance Directives Advocacy Assignments/Delegation Client Rights Collaboration with Interdisciplinary Team Concepts of Management and Supervision Confidentiality/Information Security Continuity of Care

Establishing Priorities Ethical Practice Informed Consent Information Technology Legal Responsibilities Performance Improvement (Quality Improvement) Referral Process Resource Management

147 Safety and Infection Control – The practical/vocational nurse contributes to the protection of clients and health care 148

personnel from health and environmental hazards. 149 150

Related content includes, but is not limited to: 151 152

Accident/Error/Injury Prevention Emergency Response Plan Ergonomic Principles Handling Hazardous and Infectious

Materials Home Safety

Reporting of Incident/Event/Irregular Occurrence/Variance

Least Restrictive Restraints and Safety Devices Safe Use of Equipment Security Plan Standard Precautions/Transmission-Based

Precautions/Surgical Asepsis

153 154

Health Promotion and Maintenance 155 The practical/vocational nurse provides nursing care for clients that incorporate the knowledge of expected stages of growth and 156 development, and prevention and/or early detection of health problems. 157

158 Related content includes, but is not limited to: 159

160 Aging Process Ante/Intra/Postpartum and Newborn Care Community Resources Data Collection Techniques Developmental Stages and Transitions

Health Promotion/Disease Prevention High Risk Behaviors Lifestyle Choices Self-care

161 162

142

163 Psychosocial Integrity 164 The practical/vocational nurse provides care that assists with promotion and support of the emotional, mental and social well-165 being of clients. 166

167 Related content includes, but is not limited to: 168

169 Abuse or Neglect Behavioral Management Coping Mechanisms Crisis Intervention Cultural Awareness End-of-Life Concepts Grief and Loss

Mental Health Concepts Religious and Spiritual Influences on Health Sensory/Perceptual Alterations Stress Management Substance Use and Other Disorders and

Dependencies Support Systems Therapeutic Communication Therapeutic Environment

170 Physiological Integrity 171 The practical/vocational nurse assists in the promotion of physical health and well-being by providing care and comfort, reducing 172 risk potential for clients and assisting them with the management of health alterations. 173

174 Basic Care and Comfort – The practical/vocational nurse provides comfort to clients and assistance in the performance 175

of activities of daily living. 176 177

Related content includes, but is not limited to: 178 179

Assistive Devices Elimination Mobility/Immobility Nonpharmacological Comfort Interventions

Nutrition and Oral Hydration Personal Hygiene Rest and Sleep

180 Pharmacological Therapies – The practical/vocational nurse provides care related to the administration of medications 181

and monitors clients who are receiving parenteral therapies. 182 183

Related content includes, but is not limited to: 184 185

Adverse Effects/Contraindications/Side Effects/Interactions

Dosage Calculations

Expected Actions/Outcomes Medication Administration Pharmacological Pain Management

186 Reduction of Risk Potential – The practical/vocational nurse reduces the potential for clients to develop complications 187

or health problems related to treatments, procedures or existing conditions. 188 189

Related content includes but is not limited to: 190 191

Changes/Abnormalities in Vital Signs Diagnostic Tests Laboratory Values Potential for Alterations in Body Systems

Potential for Complications of Diagnostic Tests/Treatments/ Procedures

Potential for Complications from Surgical Procedures and Health Alterations

Therapeutic Procedures 192

143

Physiological Adaptation – The practical/vocational nurse participates in providing care for clients with acute, chronic or 193 life-threatening physical health conditions. 194 195 Related content includes but is not limited to: 196

197 Alterations in Body Systems Basic Pathophysiology Fluid and Electrolyte Imbalances

Medical Emergencies Unexpected Response to Therapies

Administration of the NCLEX-PN® Examination 198 The NCLEX-PN Examination is administered to candidates by computerized adaptive testing (CAT). CAT is a method of 199 delivering examinations that uses computer technology and measurement theory. With CAT, each candidate’s examination is 200 unique because it is assembled interactively as the examination proceeds. Computer technology selects items to administer that 201 match the candidate’s ability. The items, which are stored in a large item pool, have been classified by test plan category and 202 level of difficulty as well as a representative amount of clinical judgment items. After the candidate answers an item, the 203 computer calculates an ability estimate based on all of the previous answers the candidate selected. The next item administered 204 is chosen to measure the candidate’s ability in the appropriate test plan category. This process is repeated for each item, 205 creating an examination tailored to the candidate’s knowledge and skills while fulfilling all NCLEX-PN Test Plan requirements. 206 The examination continues with items selected and administered in this way until a pass or fail decision is made. 207 208 All practical/vocational nurse candidates must answer a minimum of 85 items. The maximum number of items that a 209 practical/vocational nurse candidate may answer is 150 during the allotted five-hour time period. Of the minimum length exam, 210 52 of the items will come from the eight content areas listed above in the stated percentages. Eighteen of the items will be 211 comprised of three clinical judgment case studies. Case studies are item sets composed of six items that measure each of the 212 six domains of the NCSBN Clinical Judgment Measurement Model (CJMM). The remaining 15 items will be unscored, pretest 213 items. These pretest items can be composed of clinical judgment case studies or standalone items. The maximum five-hour time 214 limit to complete the examination includes all breaks. Candidates may be administered multiple choice items, case studies, as 215 well as items written in alternate formats. All item types may include multimedia, such as charts, tables, and graphics. All items 216 go through an extensive review process before being used as items on the examination. 217 218 More detailed information about the NCLEX examination, including information on the Next Generation NCLEX, CAT 219 methodology, the candidate bulletin and Web tutorials can be found at the website: NCLEX.com. A more detailed description of 220 the item types can be found in the NCLEX Tutorial section on the website. 221

222

Examination Security and Confidentiality 223

Any candidate that violates test center regulations or rules, or engages in irregular behavior, misconduct and/or does not follow a 224 test center administrator’s warning to discontinue inappropriate behavior may be dismissed from the test center. Additionally, exam 225 results may be withheld or cancelled and the licensing board may take other disciplinary action, such as denial of a license and/or 226 disqualifying the candidate from future registrations for licensure. Refer to the current candidate bulletin for more information. 227 Candidates should be aware and understand that the disclosure of any examination materials including the nature or content of 228 examination items, before, during or after the examination is a violation of law. Violations of confidentiality and/or candidates’ rules 229 can result in criminal prosecution or civil liability and/or disciplinary actions by the licensing agency including the denial of licensure. 230 Disclosure of examination materials includes, but is not limited to discussing examination items with faculty, friends, family, or 231 others. 232

233 234

144

Bibliography 235 236 Anderson, L. W. & Krathwohl, D. R. (Eds). (2001). A taxonomy for learning, teaching, and assessing. A revision of Bloom’s 237 taxonomy of educational objectives. New York: Addison Wesley Longman, Inc. 238 239 Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational objectives: The 240 classification of educational goals. Handbook I. Cognitive Domain. New York: David McKay. 241 242 National Association for Practical Nurse Educators and Service (NAPNES). (2007). Standards of practice and educational 243 competencies of graduates of practical/vocational nursing programs. Silver Spring, MD: Author. 244 245 National Council of State Boards of Nursing (2022). Report of the findings from the 2021 LPN/VN practice analysis: Linking the 246 NCLEX-PN examination to practice. Chicago, Author. 247 248 National Council of State Boards of Nursing. (2022). NCSBN Model Act. Chicago: Author. 249

250 National Federation of Licensed Practical Nurses, Inc. (NFLPN). (2015). Nursing practice standards for the licensed 251 practical/vocational nurse. Raleigh, NC: Author. 252 253 254 255

145

DEPARTMENT OF HEALTH NURSING CARE QUALITY ASSURANCE COMMISSION

PROCEDURE

Title: Electronic/Digital Signatures for Actions Number: H18.01

Reference:

Contact: Chris Archuleta Management Analyst 5 Nursing Care Quality Assurance Commission (NCQAC)

Effective Date: August 1, 2018 Date Reviewed: July 2018

Supersedes: H 54.01 Electronic/Digital Signature for Disciplinary Actions, September 9, 2016

Approved: Paula R. Meyer, MSN, RN, FRE Executive Director Nursing Care Quality Assurance Commission

PURPOSE:

Certain NCQAC action documents require the signature of the chair of the NCQAC panel. Staff may use electronic (digital) signatures of the chair as approved and directed.

PROCEDURE:

A. At every July meeting of the NCQAC, members who may chair disciplinary panels or programapproval panels sign an authorization to use electronic/digital signature form (attached).

B. The designated NCQAC staff member converts the original signatures to an electronic/digitalsignature as approved by each member and keeps them in a secure folder.

C. When there is occasion to use an electronic/digital signature, the staff must forward a request byemail to the appropriate NCQAC member to use their electronic/digital signature.

D. The request to the NCQAC member must include a copy of the proposed document and aspecific request to use the electronic/digital signature.

E. The NCQAC member sends back a reply email approving the use of the digital signature if thedocument is approved.

F. The NCQAC staff inserts the electronic/digital signature on the document.G. Both emails must be saved with the original document and the electronically signed document to

a secure folder.H. The NCQAC staff sends the digitally signed document to the appropriate person, and a copy to

the signing NCQAC member.

146

Authorization to use Electronic/Digital Signature By signing this authorization form, you agree your electronic signature (hereafter referred to as your "E-Signature") is the legal equivalent of your manual/handwritten signature and authorize NCQAC staff, when you direct, to apply your electronic signature as described in this procedure. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You further agree that applying your E-signature to a record amounts to verification of your identity and to knowledge of the contents of the documents signed. You will notify the Executive Director immediately if you learn that someone may have improper control of your signature image file. Date:

Legal Name, Credentials

147

STATE OF WASHINGTON

DEPARTMENT OF HEALTH

NURSING EDUCATION PROGRAMS 2020-2021 ANNUAL SCHOOL REPORT

STATISTICAL SUMMARY AND TRENDS ANALYSIS

DOH 669-269 (Revised May 2021)

Public Health – Always Working for a Safer and Healthier Washington

148

Acronyms AD-RN .......... Associate Degree in Nursing – Registered Nurse AD-MS .......... Associate Degree in Nursing to Master of Nursing ARNP ............ Advanced Registered Nurse Practitioner BSN ............... Bachelor of Science in Nursing – Registered Nurse PN............... ... Licensed Practical Nurse PN-RN ........... Licensed Practical Nurse to Associate Degree in Nursing Programs GE.................. Graduate Entry Programs – Registered Nurse MSN............. . Master of Science Nursing NCLEX®...... . National Council Licensure Examination NCQAC........ . Nursing Care Quality Assurance Commission RN ................. Registered Nurse RNB ............... Registered Nurse Bachelor (Bachelor’s degree programs for licensed RNs) PMC .............. Post Master’s Certificate Nurse DNP ............... Doctorate of Nursing Practice MN ................ Master of Nursing MS ................. Master of Science NA Nursing Assistant

149

Nursing Programs Annual Report

2020-2021 ACADEMIC YEAR

Introduction

Background

The Nursing Care Quality Assurance Commission (NCQAC) requires all nursing education programs to provide information annually [WAC 246-840-520(3)]. This report summarizes 2020-2021 academic year survey data from approved Washington State nursing programs and out-of-state programs approved for clinical placement of students. Selected data trends are highlighted. This report combines results from three different surveys; 1) the in state prelicensure nursing program survey administered by the National Council of State Boards of Nursing (NCSBN), 2) the in state post-licensure program survey administered by the NCQAC and, 3) the out-of-state program survey administered by NCQAC. Twelve universities and 29 community and technical colleges (CTC) with approved nursing schools in Washington State completed the pre-licensure and post-licensure surveys as applicable. There are eight of the AD-RN programs offer a pathway from LPN to AD. Ninety-four out of state schools approved for clinical placements completed the out-of-state survey during the 2020-2021 academic year. These 94 colleges and universities reported on a total of 242 approved programs (49 prelicensure and 193 post-licensure). The report will combine, when possible, prelicensure and post-licensure student and faculty program information provided by nursing schools in the state of Washington. The more limited but valuable out-of-state program results are provided after the in-state program information. When appropriate, Washington state responses will be compared to national benchmarks and selected research findings. Finally, there is a summary and analysis of the annual survey findings, with a list of recommended actions based on these results and trend analysis.

Nurse Workforce

Workforce Survey Analysis

Beginning in January 2018, nurses (LPNs, RNs and ARNPs) in Washington State were informed of a requirement to complete an online survey with questions about their demographics, work characteristics, and education history when they renewed their nursing license or applied for a new license. The initial analyses for RNs, LPN, and ARNPs with an active Washington State license was completed on May 31, 2019 (Stubbs 2020). A second analyses for RNs, LPN, and ARNPs with an active Washington State license was released May 2022 (WCN 2021). A more complete picture of the nursing workforce can be appreciated combining the results of the Workforce Survey Analysis (WCN 2021) with this Nursing Programs Annual Report.

150

In-State Programs

Forty-one approved nursing schools in Washington State completed the annual survey. There are seven licensed practical nurse (PN) programs, and 25 associate degree RN (AD-RN) programs. Eight of the AD programs also offer an LPN to AD pathway. Five universities and four community colleges offer RN to BSN (RNB) programs. Nine universities offer Bachelor of Science in nursing (BSN) programs. Two ADN to MSN (AD-MS) programs, one program offering master’s degree graduate entry to the RN (GE), one program indicating “other” and one master’s degree advanced registered nurse practitioner (ARNP) and six other master’s programs. Finally, there are six post-master’s certificate (PMC) programs, six doctoral of nursing practice (DNP) and two Ph.D. programs. The undergraduate and graduate programs specifics are outlined below.

Undergraduate Programs

The number of pre-licensure graduates show impressive increases across programs despite the challenge of the pandemic year. In 2020-2021, practical nursing programs (PN) had 315 graduates representing an increase after five years of decline, the number of AD-RN graduates has also increased to 1689 in 2020-2021and the number of BSN program graduates to 1124. Those completing GE degrees are included in these graduation numbers because they are prelicensure programs, however, the GE student and faculty demographics are included with the graduate program results. The graduates of RNB programs increased to 1310 during this academic and pandemic year.

Table 1. In State Undergraduate Graduates

PN AD BSN/GE/other RNB 2016-2017 264 1741 895 987 2017-2018 226 1506 854 1319 2018-2019 232 1507 867 1191 2019-2020 238 1561 941 1209 2020-2021 315 1689 1124 1310

Figure 1: Total Undergraduate Program Graduates by Type of Program

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Table 1 and Figure 1 above provide undergraduate and GE/other program graduations for comparison to the past five years. There is a significant increase in graduates from all program types except the RNB. The Institute of Medicine Report (IOM) [2010], titled The Future of Nursing, identifies nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Washington State has been a leader in successful strategies for academic progression from AD to BSN. The impressive increases in prelicensure graduates at all levels illustrates the commitment of nursing faculty to providing a highly educated nursing workforce.

RN to BSN 2020-2021 The number of RN to BSN enrollment in Washington schools started to rise sharply in 2013-2014 academic year and continued to rise to a high in 2017-2018 with 2582 students enrolled in RNB programs, a significant increase from the previous year reported. There are 1310 RNB graduates this year representing a levelling off graduates over the last two years. Figure 2 gives a little different picture of the results of these successful academic progression strategies on increasing the number of RNs with BSN degrees. The number of RN to BSN graduates are combined with BSN and GE graduate to represent the total BSN prepared RNs in 2020-2021. This can be compared with the ADN prepared RN graduates. Although an imperfect comparison, it can provide some insight into the changing nursing education landscape in the state.

Figure 2: Comparing ADN and total BSN graduate trends (RN)

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Graduate Programs Table 3 and Figure 3 outline the masters and doctoral graduates by type of program combining graduates into 2 master’s categories and one doctoral for illustration. The 289 MN graduates preparing for specialties that do not require an ARNP and 64 RN to MS graduates are combined. One hundred-eight master’s prepared advanced registered nurse practitioners graduated in 2020-2021 and are combined with the 24 post-master’s certificates in nursing (PMCN) graduates. Also, programs reported 413 DNP and 37 PhD for a total of 450 graduates with a nursing doctorate in 2020-2021. The total number of graduates from master’s and doctoral programs for three years is outlined below.

Table 3. Master’s and Doctoral Total Number of Graduates by Program

MSN/ADMN Non ARNP MSN/ARNP/PMCN PhD/DNP

2018-2019 550 163 162

2019-2020 264 101 382

2020-2021 353 132 450 *Post Master’s Certificate in Nursing Although there were graduates from graduate entry (GE) programs during 2020-2021, the GE graduates were reported with undergraduate pre-licensure programs, so they are not included in the graduation numbers below. It is important to recognize the increase in graduates across programs in post-licensure programs is also noteworthy given the challenges of the pandemic.

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Figure 3: Total Number of Master and Doctoral Graduates by Program

Individual specialty programs are provided in Table 4. The graduates prepared in different specialty areas meet needs across the state in primary care, education, research, and other areas of practice. The number of graduates by program and specialty area are outlined below from three types of programs and 12 different specialty areas.

Table 4. In-State Post licensure Graduates by Program and Selected Specialty Areas 2020-2021

2020-2021 CNS FNP ANP MHNP PNP GNP MW ANES ED Adm POP Oth

ARNP-MN 0 44 0 35 0 0 0 0 0 0 0 0

MSN 0 0 0 0 0 0 0 0 104 135 9 15

ARNP- DNP 2 139 35 36 15 7 17 12 0 6 0 11

TOTALS 2 183 35 71 15 7 17 12 104 141 9 26

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Faculty and Student Race

The 2020-2021 academic survey was completed by nursing programs impacted by the unprecedented Covid-19 pandemic in its second year. Washington State nurse educators are committed to the goal of assuring faculty and students reflected the diversity of the Washington State residents they serve. These efforts have accelerated with commitment to infuse all work with goals of equity and inclusion.

Figure 4: Percent of Faculty and Student Race Compared with WA State Population

Figure 4 above illustrates the differences between Washington State population patterns compared with students and faculty. There have been some improvements in diversity of students and pos-licensure faculty. Table 5 below provides the 2020-2021 percentage comparisons of student and faculty race with Washington State population. Eighty-five percent of prelicensure fulltime and part time faculty members are White/Caucasian, 8 percent Asian, 4 percent black/African American. Seventy eight percent of post licensure faculty are White/ Caucasian 6 percent Asian, 7 percent black/African American. The figure below illustrates that prelicensure and post-licensure students are more in line than faculty with the diversity of the state population in the variable of race/ethnicity.

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Table 5: Percent of Faculty and Student Race Compared with WA State Population

Race / Ethnicity WA St Pop Estimates 2021

Stud Pre-licensure

Stud Post-licensure

Faculty Pre-licensure

Faculty Post-licensure

White Caucasian 65 65 70 85 78 American Indian / Alaskan Native

2 1 2 1 1

Asian 10 17 15 8 6 Black/ African American 4 6 7 4 7 Native Hawaiian / Other Pacific Islander

1 3 1 1 0

Hispanic / Latino 13 12 13 4 10 Mixed Race 5 7 6 1 8

Faculty Retention

Table 6 outlines important information on faculty retention. Nursing programs reported in 2020-2021 that 12 percent of full-time faculty are expected to retire in the next five years compared to 22 percent the year before. There are 10 percent of faculty reported to have resigned in the last year compared to 5 percent the previous year. Retaining full time faculty in this time of transition is a major concern.

Table 6: Full Time Faculty Turnover 2019-2020 and 2020-2021

Academic Year Percent expected to retire in 5 years Percent who resigned

2020-2021 12 10 2019-2020 22 5

Faculty Salary

A barrier to successful recruitment and retention of nursing faculty members is inadequate compensation. Respondents answered the following questions. What are the contract lengths and associated salary ranges for your full-time nursing faculty? The largest number of programs reported nine-month contracts. The average salary ranges for nine- and 12-month contracts at community colleges and universities have been collected and are currently being validated to provide the most accurate picture across CTC and Universities. The validated salary information will be available by September 2021.

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Out-of-State Programs The out-of-state nursing program approval process for student clinical placement in Washington State began in 2012. Initial data were gathered by calendar year in 2013 and 2014. The out-of-state survey was revised to reflect the academic year beginning 2014-2015 so it could be reported with the data from in-state programs to offer a more complete picture of nursing education program capacity in the state. Because the approval process relates to clinical placements only, the data gathered are different from that gathered from the in-state programs. The student numbers reflect student clinical placement only and do not currently include graduation numbers. Since many of these students may remain in the state after graduation, we plan to track Washington state graduation rates starting year 2020-2021. There are a total of 528 tracks in 109 colleges and universities from other states who are approved in the state of Washington for clinical placement. Ninety-four approved colleges and universities completed the survey and indicated they had clinical placements in one or more tracks. Table 9 outlines there were 49 prelicensure programs and 193 post-licensure program tracks totaling 242 tracks with clinical placements this year.

Table 9: Out of State Programs and Student Clinical Placements 2020-2021 College/University (94 total) Total Programs Total Clinical Students Prelicensure 49 1068 Post licensure 193 788 Totals 242 1856

During the academic year 2020-2021, forty-nine programs with clinical students in Washington State preparing graduates for initial PN or RN licensure completed the survey. Two practical nurse (PN) programs four associate degree RN (AD-RN) programs, two graduate entry (GE), and 18 schools have students in Bachelor of Science in nursing (BSN) programs. The remaining programs with clinical students prepare graduates to advance their education post-licensure. There are 23 RN to BSN (RNB) programs, eight associate degree to master’s (AD-MS), 46 master’s programs preparing for ARNP licensure (NP-MN) and 43 other master’s programs (MSN). Finally, there are 38 post master’s certificate programs (PMC), 53 doctoral of nursing practice (DNP) and five Ph.D. programs. The total number of programs by type is outlined below in Table 11 providing the previous five years results for comparison.

Table 11: Number and Types of Out of State Programs with Clinical Site Placements

PN

AD-RN

BSN

RNB

AD-MS

GE

MSN

NP-MN

PMC

DNP

PhD

Total

2016-2017 4 6 28 22 14 3 35 39 30 42 8 231 2017-2018 4 6 30 19 5 1 37 38 32 39 7 218 2018-2019 3 6 28 33 6 4 41 41 34 51 8 252 2019-2020 1 6 29 30 9 5 39 43 37 44 9 252 2020-2021 2 4 18 23 8 2 43 46 38 53 5 242

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Out-of-State Student Statistics

The number of students placed in clinical by out of state programs is illustrated below showing trends for the last five years. Approved out-of-state programs completing the survey provided 1856 clinical site placements for students in the 2020-2021 academic year reflecting an increase from a total of 1,738 students in 2019-2020. Prelicensure program clinical placements from out of state programs preparing students for PN or RN licensure returned to previous numbers after a significant decline last year. The ARNP MN program placements have continued to increase particularly in the last two years as well as an increase in DNP programs.

Table 10: Students with Clinical Site Placement from Out of State Programs by Program Type

PN

AD-RN

BSN

RNB

AD-MS

GE

MSN

NP-MN

PMC

DNP

PhD

Total

2016-2017 48 198 354 249 19 0 313 137 31 66 2 1,417 2017-2018 126 309 400 163 6 0 440 145 40 85 0 1,714 2018-2019 168 276 534 240 4 8 139 516 185 191 0 2,261 2019-2020 20 163 206 107 3 0 61 557 61 94 1 1,738 2020-2021 126 235 551 155 1 1 86 532 51 114 4 1,856

Summary/Analysis

Washington State nurse educators made the commitment in 2011 for a higher educated and more diverse nursing workforce, when the Council for Nurse Education in Washington State (CNEWS) and the Washington Center for Nursing (WCN) collaborated to develop a Master Plan for Nursing Education (WCN, 2014). The commitment has been reinforced with the work of Action Now! and the Critical Gap workgroups addressing the gaps in the nursing workforce. This report highlights trends in the direction to meet these goals as well as refocused goals and priorities due to the pandemic. Diversity/Inclusion

The survey results indicate there are continued challenges meeting our commitment to a more diverse nursing workforce. Our experiences in the pandemic have further illustrated the urgency of assuring our faculty and students reflect the population they serve. Providing a nursing faculty workforce that reflects the diversity of their students and the population of Washington State is essential. A diverse nursing workforce can help improve patient and population health outcomes, particularly related to reducing disparities in health. The undergraduate student diversity closely resembles Washington residents, and graduate students are showing some positive changes. However, the nursing faculty diversity is furthest from the state population and there has been little change over the past four years (NAM 2021).

Academic Progression Access to academic progression for nurses at all levels from nursing assistant (NA) to PhD is important. Nurse educators in Washington have responded with increased enrollments, creative strategies, and increased education capacity. Thanks to these significant efforts of nurse educators, the capacity needs for RNB programs

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are being met at this time. There are several projects examining LPN academic progression and significant work has been ongoing standardizing nursing assistant curriculum. Enrollment and graduations in graduate programs have shown impressive increases responding to the shortage of nurse faculty, primary care providers, and researchers. Our state mirrors national trends with more ARNP students moving to DNP programs from MSN programs. Approval of out-of-state programs tracks for clinical placements helps ensure quality and additional capacity in high-need areas, however availability of quality clinical placements for all nurses provides a significant challenge for both in state and out of state programs.

Faculty

The overall educational preparation of all faculty (full time and adjunct) needs to be increased to meet state (WAC 246-840-523) and national (CCNE 2017) standards for a master’s degree in CTC and a doctorate in universities. Faculty must complete graduate studies potentially accruing additional debt and further straining income inequities. In addition to the imperative to increase nursing faculty education level, there are impending retirements and vacancies. Salary trends for university nursing faculty are being tracked, validated, and will be shared in September.

Recommendations Diversity/Inclusion Play key leadership role as the Nursing Commission to support the closure of the identified critical gaps in the nursing workforce. Provide resources and time to infuse concepts of diversity and inclusion in this work, as well as all ongoing work of the Commission. Faculty Recruitment and Retention Work to increase University faculty salaries and examine workload. Support and sustain current funding level of Community and Technical College nursing faculty and additional education for faculty. Academic Progression

Continue to support strategic initiative on LPN academic progression, scope of practice, and education.

Workforce Data Continue to serve on the leadership team to close the critical gaps in the nursing work force to assure the right mix of nurses to meet the needs of Washington state residents, using supply, demand, and education data to inform actions, meet goals and evaluate progress.

Conclusions

Now is the time to learn from the difficulties of the pandemic and accelerate our progress providing the educational mix of nurses for safe and quality care in Washington State. The complex multiple education pathways in nursing provide multiple opportunities to increase the overall education level of nurses. Across settings, nurses are being called upon to coordinate care and to collaborate with a variety of health professionals, including physicians, social workers, physical and occupational therapists, and pharmacists, most of whom hold master’s or doctoral degrees. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (NAM 2021) renews the focus on the education preparation of nurses as well as challenges nurses to be leaders in the urgent work to advance heath equity. RNB, masters, and doctoral enrollments and graduations have continued to increase, adding to a

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higher educated workforce, but we must continue to accelerate our progress to meet the growing health care needs of the residents of Washington State including LPN and nursing assistants’ academic progression. The Nursing Commission is one of four lead organizations to address critical gaps in the nursing workforce and will continue to advance the goals of health equity so essential to this work.

References

Auerbach, DI, Staiger, DO (2017) How fast will the registered nurse workforce grow through 2030? Projections in nine regions of the country, Nursing Outlook.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.nap.edu/catalog/12956.html

National Academy of Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity from https://doi.org/10.17226/25982 Stubbs BA, Skillman SM. (2020) Washington State’s 2019 Registered Nurse Workforce. Center for Health Workforce Studies, University of Washington, March 2020.

Washington State Office of Financial Management (OFM) Estimates retrieved April 5, 2021 from: https://ofm.wa.gov/washington-data-research/population-demographics/population-estimates/estimates-april-1-population-age-sex-race-and-hispanic-origin.

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STATE OF WASHINGTON

DEPARTMENT OF HEALTH Nursing Care Quality Assurance Commission PO Box 47864 Olympia, WA 98504-7864

Nursing Assistant Certification Examination

June 13, 2022

Submitted by: Paula R. Meyer MSN, RN, FRE Executive Director, Nursing Care Quality Assurance Commission Paula.meyer@doh.wa.gov

360-236-4714

Issue

Due to an ongoing backlog resulting from the COVID-19 pandemic, most nursing assistants in Washington—while trained--are still unable to complete the certification examination and become certified within usual timelines (120 days or 4 months). Washington has taken and continues to take proactive steps to facilitate timely certification examinations for all nursing assistants; however—it is clear that our state will not succeed in achieving this goal unless the end of the federal CMS waiver is extended beyond June 5, 2022. With the staffing crisis in nursing homes, losing any nursing assistants from the workforce poses serious risks to the health and safety of Washington’s nursing home residents.

Background

Nursing assistants are essential to supporting the health and welfare of nursing home residents, among the most vulnerable in Washington’s population. The COVID-19 crisis hit Washington’s nursing homes first. The impact of COVID-19 has been and continues to be disproportionately devastating to long-term care facilities, including nursing homes. The Nursing Care Quality Assurance Commission (NCQAC) has statutory authority for nursing assistant training and certification examinations in Washington State (RCW 18.88A.060), in compliance with federal regulations (42 CFR § 483.152 and 42 CFR § 483.154). Pandemic Response: Early Actions Taken

In March 2020, the NCQAC took immediate, active steps to support nursing assistants’ completion of training and continued entry into the workforce as a top priority:

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• The NCQAC allowed and continues to allow all nursing assistant training programs to implement a “live online” or synchronous format for teaching classroom/theory content (skills competency evaluation continues to be held in-person in skills labs).

• The NCQAC allowed and continues to allow nursing assistant training programs to award

clinical hours’ credit for work hours in a nursing home under the following circumstances: o Employment begins after the nursing assistant completes required training; and

o The nursing assistant works under the supervision of a licensed nurse who evaluates

and documents competency for all tasks assigned and care provided.

These actions have supported the continued flow of trained nursing assistants into the workforce at a time of severe staffing crises.

Barriers to Competency Evaluation

Unfortunately, issues surrounding the state certification examination have been harder to resolve than training issues. In Washington, due to safety concerns, the certification examination was completely unavailable from mid-March 2020 until September 2020. When the certification exam did become available again, it was a slow start for a number of reasons:

• Due to high COVID-19 case rates, not all areas of the state could open and conduct the skills portion of the certification examination.

• Even when areas opened, changes in case rates and unexpected outbreaks caused closures and cancellations of the certification examination.

• Many of the registered nurse (RN) evaluators—unemployed for 6 months—left their evaluator jobs and obtained employment elsewhere. Recruitment has been and continues to be a challenge due to the high demand for RNs, intense wage competition, and a need to keep examination costs feasible for nursing assistants.

• The safety protocols for the skills portion of the certification examination—while necessary—require more time for the evaluation of each candidate and more time for cleaning and disinfecting between candidates.

• Finally, while the NCQAC had already moved the written portion of the certification examination to an online format, many of the examination centers were college-based, and colleges restricted campus traffic during the pandemic--which left nursing assistants with few options.

In terms of statistics (see slide below), Washington saw a dramatic drop in the number of candidates who completed the certification examination in 2020 compared to pre-pandemic

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numbers in 2019: Specifically, there was an 83% drop in written test-takers (due to closure of college exam centers) and a 61% drop in skills test-takers. Even by the end of 2021, the number of Washington test-takers was still down by 26% and 39%, respectively, for the written and skills portions of the certification examination, compared to 2019.

Pandemic Response: Additional Actions

Again, the NCQAC continued to try to resolve these issues in a number of ways:

• One step was to move the written portion of the certification examination to a secure, remote,online format students can take from home or other convenient location. This step took timefor the certification examination vendor to put in place, but was launched in June 2021.After some usual glitches—and an unexpected change in the vendor—this option is nowworking well.

• In terms of the skills portion of the certification examination, the NCQAC put together a“mass examination plan” in early 2021. The plan aimed to accelerate skills testing byholding weekend-long testing events at the network of college nursing program sites in ourstate using “rapid RN evaluator training” of clinical faculty from the nursing programs. TheNCQAC sought COVID-19 funding to implement the plan, but there was no match in termsof stipulated use for the funds Washington received.

• The NCQAC continues to work with the certification examination vendor on strategies toexpand capacity for skills testing in Washington.

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o One of the strategies is moving to a virtual skills testing model, which will occur atpoint of students’ graduation. This means the students will take the skills portion ofthe certification examination in their training program skills lab on the date of theirgraduation with an RN evaluating them virtually from a different location. Virtualskills testing has been in the planning stage for more than a year, includinginvestigation of appropriate technology to assure success and security. Beta testing ofthis model is slated to begin in Washington in July 2022. This plan will remove thetime and cost of traveling to examination sites (for RN evaluators and nursingassistants), allowing each RN to evaluate more nursing assistants overall. It will alsoremove the current waiting period students experience between graduation and takingthe certification examination.

o The certification examination vendor has hired a national recruiting firm to increasethe number of RN evaluators overall. It is encouraging to note that severalevaluators have been added recently; however, because we lost so many during thepandemic, we are still not quite at baseline (although a few more are in the on-boarding process).

Conclusion

Improvement in Washington’s capacity to implement the certification examination for nursing assistants has been slow; and—currently—Washington is functioning at about 80% of its pre-pandemic capacity. While this is progress, it still means only 80% of current nursing assistant graduates can take the certification examination timely. At this rate, Washington is still functioning in deficit--unable to work through the challenging backlog, which only continues to grow.

The backlog is a result of 2+ years of pandemic conditions. At minimum, it will take the same amount of time to gain capacity and work through the backlog. An extension of the 1135 waiver is imperative in this regard.

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STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

AND

DEPARTMENT OF HEALTH

June 24, 2022 David Wright, Director, Quality, Safety, and Oversight Group, CMS Karen Trist, Director, Survey and Operations Group, CMS Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Dear Mr. Wright and Ms. Trist, The Washington State Department of Social and Health Services and the Washington State Department of Health are submitting this joint letter to request a state level extension of the 1135 federal waiver for 42 CFR §483.35(d) to allow more time for Nursing Assistants-Registered (NA-Rs) to work in skilled nursing facilities while they complete their Nursing Assistant-Certified (NA-C) credential. As of June 6th, this federal waiver terminated, allowing 120 days for NA-Rs to complete their NA-C training, testing, and certification in order to continue working in skilled nursing facilities. There are approximately 23,000 nursing assistants in Washington state, a large portion of them serve approximately 13,000 residents of skilled nursing facilities. Nursing assistants are essential to supporting the health and welfare of nursing home residents, among the most vulnerable in Washington’s population. The COVID-19 crisis hit Washington’s nursing homes first. The impact of COVID-19 has been, and continues to be, disproportionately devastating to long-term care facilities, including nursing homes. During the Public Health Emergency, Washington state experienced a decrease in the number of available trainers and available testing sites. Some training and testing sites closed their doors during the “lockdown” period and never reopened. Those sites that did return to training and testing prospective NA-Cs were required to adhere to infection control standards that limit the capacity of the training and testing sites. Many of these guidelines remain in effect at this time and limit how many individuals can participate in a program or a test at the same time due to space limitations and physical distancing guidelines. This workforce is largely made up of low-income workers who are black and brown women and migrants (roughly fifty-three percent of the workforce). Over sixty percent of the residents served in skilled nursing facilities are funded through Medicaid.

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Skilled nursing facilities also play a critical role in facilitating and ensuring timely discharges from acute care hospitals. Without full operation and staffing of the nursing facility pipeline, acute care hospitals fill with patients and are unable to admit and attend to those who truly require a hospital level of treatment.

Quality of care is of utmost importance in our long-term care facilities, and we are working to increase capacity of testing, training, and certification sites statewide. Ensuring that direct care workers are appropriately trained and credentialed is a high priority for Washington and our provider network. However, in the timeline allowed, we simply cannot get through the backlog of nursing assistants who still require certification. Without these workers, the long-term care system in Washington state is at risk of failure.

Please grant the State of Washington the authority to extend this 1135 waiver in order to allow more time to clear this backlog of workers needing to complete their certification. Sincerely, Jilma Meneses Dr. Umair Shah Secretary, Secretary of Health Department of Social and Health Services Washington State Department of Health

Cc: Stephanie Magill, Long Term Care Branch Manager, San Francisco and Seattle Survey and

Enforcement Division, CMS Ingrid Ulrey, Regional Director, Health and Human Services, Region 10

Lee Fleisher, Chief Medical Officer and Director, Center for Clinical Standards and Quality, CMS Evan Shulman, Director, Division of Nursing Homes, CMS Bea Rector, Interim Assistant Secretary, DSHS Aging and Long-Term Support Administration Paula Meyer, Executive Director, Nursing Care Quality Commission, Department of Health Mike Anbesse, Director, DSHS Aging and Long-Term Support Administration, Residential Care Services

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Issue: Need for Extension of Federal 1135 Waiver to Allow Nursing Assistants-Registered

To Become Certified

Overview On April 7, 2022, the Centers for Medicare and Medicaid issued a Quality Survey Oversight Memo giving notice that the waiver that allows Nursing Assistant-Registered (NA-R) to work in skilled nursing facilities (SNF) without the training and credentialing waived during the Public Health Emergency (PHE) would end June 6th. This means that to remain eligible to work in skilled nursing facilities, NA-Rs have 120 days (October 4th) to complete training, testing, and certification to become Nursing Assistants-Certified (NA-C). We have known about this for a few months and have been working with the associations representing nursing facilities, the nursing facilities themselves, and Washington State Department of Health to determine how to get all workers qualified within the timeframes. In the timeline allowed, we have determined that we simply cannot get through the backlog of nursing assistants who still require certification and without these workers, the long-term care system in Washington state is at risk of failure. CMS has said that if an NA-R or SNF can demonstrate that they have done everything possible to complete requirements, but have been unable to do so, there is a waiver available. CMS has not issued any guidance as to how the waiver process will work. We have sent a joint letter from the Secretary of the Washington State Department of Social and Health Services and the Secretary of Health to CMS to request a state level extension of the 1135 federal waiver of 42 CFR §483.35(d) to allow for additional time to work through this backlog. With this briefing, we are requesting advocacy at the federal level to engage the congressional delegation in problem solving this issue. We are aware that we are not the only state that is trying to resolve this.

Problem Based upon survey data from 40% of facilities we can extrapolate an estimate that approximately 210 individuals must complete training and testing, 715 individuals must complete testing and credentialing, and 100 individuals await the completion of the credentialing process by October 4, 2022. These are cumulative numbers so roughly 900 people need to get through testing and 1000 through credentialing. In addition to this pressure, NA-C staff are employed in many long-term care (LTC) settings and other health care facilities including assisted living facilities, Adult Family Homes, and hospitals adding to the demand for staff training and testing indicating much greater numbers than presented for SNFs alone.

Adding to the difficulty with training and testing, during the PHE Washington State experienced a decrease in the number of available trainers and available testing sites. Some training and testing sites closed their doors during the “lockdown” period and never reopened. Those sites that did return to training and testing prospective NA-Cs were required to adhere to infection control standards that limit the capacity of the training and testing sites. Many of these guidelines remain in effect at this time and limit how many individuals can participate in a program or a test at the same time due to space limitations and physical distancing guidelines.

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It is clear that there is not enough capacity to get all workers in the backlog certified by the due date.

Impacts • There are approximately 23,000 nursing assistants in Washington state, a large portion of them serving

approximately 13,000 residents of skilled nursing facilities.

• This workforce is largely made up of low-income workers who are black and brown women and migrants (roughly fifty-three percent of the workforce). Over sixty percent of the residents served in SNFs are funded through Medicaid.

• SNFs play a critical role in facilitating and ensuring timely discharges from acute care hospitals (who are also affected by the NA-C staffing shortage). Without full operation and staffing of the nursing facility pipeline, acute care hospitals fill with patients and are unable to admit and attend to those who truly require a hospital level of treatment.

DSHS Actions

DSHS has worked with the industry to survey SNFs to collect data on the number of workers who need to complete training, testing, and credentialing. From the data collected through the survey, roughly 900 people need to get through testing and 1000 through credentialing no later than October 4th. DSHS has also partnered with the Washington State Nursing Care Quality Assurance Commission (Nursing Commission), Department of Health, and the stakeholder associations to strategize interventions to assist the workforce in becoming qualified within the timeframes.

Contact Amy Abbott Office Chief of Policy, Training and Quality Assurance DSHS, Aging and Long-Term Support Administration (360) 725-2489 amy.abbott@dshs.wa.gov

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80 - Nursing Care Quality Assurance Commission

Original 21-23 Allotments

Allotment Adjustment - Correct 21-23

Control #'s

2022 Supplemental -

Total Provisos & DPs

2022 Supplemental -

Other Increases*

Total 21-23 + 2022 Supp

Allotments*

Total Projected Expenses

Projected Variance

2022A - Salaries and Wages 5,927,376 77,571 488,196 6,493,143 6,078,217 414,926 B - Employee Benefits 1,824,744 33,716 201,087 2,059,547 1,884,950 174,597 C - Professional Service Contracts 97,200 - 97,200 38,643 58,558 E - Goods and Services 908,413 29,368 5,658 943,439 981,028 (37,589) G - Travel 88,020 - 88,020 16,904 71,116 J - Capital Outlays 61,200 (48,792) 23,792 36,200 44,105 (7,905) N - Grants, Benefits & Client Services 3,060 - 3,060 51,668 (48,608) T - Intra-Agency Reimbursements 1,781,524 (52,359) 73,470 1,802,635 1,555,503 247,132

2022 Total Direct Costs 10,691,537 10,136 815,913 5,658 11,523,244 10,651,017 872,227 2022 Indirect Costs 2,961,908 2,858 230,087 1,614 3,196,467 2,842,762 353,706

2022 Grand Total 13,653,445 12,994 1,046,000 7,272 14,719,711 13,493,779 1,225,933

2023A - Salaries and Wages 6,152,412 (563,028) 885,943 75,632 6,550,959 7,027,258 (476,299) B - Employee Benefits 1,993,260 (303,167) 342,119 33,605 2,065,817 2,312,766 (246,949) C - Professional Service Contracts 104,700 - 104,700 69,999 34,701 E - Goods and Services 911,099 77,693 53,487 1,042,279 1,231,138 (188,859) G - Travel 91,980 - 91,980 91,980 - J - Capital Outlays 63,600 11,896 75,496 75,500 (4) N - Grants, Benefits & Client Services - - - 48,000 (48,000) T - Intra-Agency Reimbursements 1,854,903 111,981 1,966,884 1,933,415 33,469

2023 Total Direct Costs 11,171,954 (866,195) 1,429,632 162,724 11,898,115 12,790,056 (891,941) 2023 Indirect Costs 3,096,195 (244,267) 357,408 40,681 3,250,017 3,072,444 177,573

2023 Grand Total 14,268,149 (1,110,462) 1,787,040 203,405 15,148,132 15,862,500 (714,368)

21-23 Biennium Total 27,921,594 (1,097,468) 2,833,040 210,677 29,867,843 29,356,279 511,565

*Preliminary estimate - excludes additional allotment for COLA/lump sum payments; awaiting OFM guidance on distribution methodology

2021-23 Projected Variance

02G - Health Professions Account

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NURSING BUDGET STATUS REPORT – May 2022

2021-2023 BIENNIUM:

This report covers the period of July 1, 2021, through May 31, 2022, eleven months into the biennium, with thirteen months remaining. The NCQAC budget is underspent by 7% and the current revenue balance is $5.8M.

REVENUES:

The recommended revenue balance or “reserve” should be 12.5% of biennial budgeted allotments, or approximately $4.3 million. NCQAC continues to operate above the recommended reserve balance and May revenues continue the trend of exceeding projections. As a result, revenues currently outpace projections by approximately 8%, or just over $1M. This is due in part to the continued high volume of endorsement applications and volunteer nurses applying for licensure to remain in Washington after the emergency.

BUDGET/ALLOTMENTS:

The agency posted all indirect charges; therefore, this report contains actuals, and no estimates required. The allotment adjustments discussed in the previous segment and the allotments granted in the 2022 supplemental budget have been uploaded and are reflected in this report. For the most part expenses continue to follow recent trends.

Highlights:

o The AG bill continues to come in above budget due to ongoing litigation. o Salaries and Benefits are now trending below allotment due to the addition of the allotments

granted to the NCQAC in the 2022 supplemental budget in response to the legislative mandate to process licenses in seven days or less and the crisis in long term care.

o FBI Background Checks are charged based on actual files processed and due to a several weeks backlog in the DOH FBI unit, actual charges lag.

o HP Investigations, Legal Services, Public Disclosure – these service unit costs are charged based on actual hours or files reviewed. The allotments are based on the activity from the previous biennium. To date actual use appears to be lower than last biennium.

FISCAL OUTLOOK:

The combination of revenues exceeding projections and underspending the budget has resulted in a gain of more than $1.5 M to our revenue balance to date. However, there are several upcoming key expenditures that will impact the revenue balance. NCQAC still owes $5.4M for HELMS to be withdrawn in the 21-23 biennium. The approval of the licensing and LTC decision packages grants us the additional spending authority, however, it does not include the funding (dollars) needed to support the work. As a result, we anticipate the reserve balance dropping below recommended levels in FY23. In response, NCQAC requested the secretary open a CR-101 to increase fees. At the April special meeting, the NCQAC approved recommending fee increases to the secretary. The secretary held the rules hearing in June. The CR-103 was submitted and new fees are on track to be implemented on November 1, 2022 (See attached graph).

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EXPENDITURES TYPES BIENNIAL BUDGET/ALLOTMENT EXPENDITURES VARIANCE % SPENTBUDGET TO-DATE TO-DATE TO-DATE TO-DATE

DIRECT EXPENDITURES:FTEs (average) 81.375 81.38 75.69 5.68 93.01%Staff Salaries & Benefits $16,455,614 $7,372,455 $7,055,934 $316,521 95.71%Commission Salaries $604,615 $275,000 $233,863 $41,137 85.04%Goods & Services $597,803 $268,741 $216,077 $52,664 80.40%Rent $830,031 $355,834 $261,216 $94,618 73.41%Attorney General (AG) $1,533,730 $616,613 $710,934 ($94,321) 115.30%Travel $180,000 $80,685 $9,569 $71,116 11.86%Equipment $111,696 $31,100 $39,005 ($7,905) 125.42%IT Support & Software Licenses $367,476 $153,221 $115,817 $37,404 75.59%TOTAL DIRECT $20,680,965 $9,153,649 $8,642,417 $511,232 94.41%

$135,414SERVICE UNITS:FBI Background Checks $527,013 $235,371 $188,806 $46,565 80.22%Office of Professional Standards $435,023 $171,714 $177,432 ($5,718) 103.33%Adjudication Clerk $213,498 $95,100 $50,297 $44,803 52.89%HP Investigations $86,601 $36,568 $21,385 $15,183 58.48%Legal Services $39,570 $16,490 $11,612 $4,878 70.42%Call Center $164,978 $69,800 $71,271 ($1,471) 102.11%Public Disclosure $382,476 $170,218 $144,796 $25,422 85.06%Revenue Reconciliation $180,909 $80,472 $82,773 ($2,301) 102.86%Online Healthcare Provider Lic - Staff $305,352 $136,664 $133,952 $2,712 98.02%Online Healthcare Provider Lic - Cont $195,792 $89,738 $96,127 ($6,389) 107.12%Suicide Assessment Study $40,800 $18,700 $7,048 $11,652 37.69%TOTAL SERVICE UNITS $2,572,012 $1,120,835 $985,497 $135,338 87.93%

INDIRECT CHARGES:Agency Indirects (16.9%) $3,867,636 $1,708,233 $1,495,864 $212,370 87.57%HSQA Division Indirects (11.3%) $2,582,297 $1,140,491 $1,068,968 $71,523 93.73%TOTAL INDIRECTS (28.2%) $6,449,933 $2,848,724 $2,564,832 $283,893 90.03%

GRAND TOTAL $29,702,910 $13,123,208 $12,192,745 $930,463 92.91%

NURSING REVENUE To-DateBEGINNING REVENUE BALANCE $4,257,14719-21 REVENUE TO-DATE $13,788,79819-21 HELMS ASSESS. TO-DATE $019-21 EXPENDITURES TO-DATE $12,192,745ENDING REVENUE BALANCE $5,853,200

Nursing Care Quality Assurance Commission2021-23 Budget Status Report (Health Professions Account)

For the period of July 1, 2021 through May 31, 2022

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Profession Fee Type Current Fees Proposed Fees HEAL-WA Surcharge WCN Surcharge Total FeeAdvanced Registered Nurse Practitioner Applications $125 $130 $130(ARNP renewal is every 2 Years) Renewals $125 $130 $130Licensed Practical Nurse Applications $64 $69 $16 $5 $90

Renewals $64 $69 $16 $5 $90Registered Nurse Applications $99 $124 $16 $5 $145

Renewals $99 $124 $16 $5 $145Nursing Technician Applications $25 $25 $25

Renewals $25 $25 $25

FY16 FY17 FY18 FY19 FY20 FY21 FY22 FY23 FY24 FY25 FY26 FY27 FY28Revenue 8,968,629 9,460,426 11,813,707 12,353,477 13,042,446 13,893,210 14,244,377 16,419,070 17,941,539 18,401,404 18,874,038 19,359,974 19,859,460Expenditure 9,069,664 9,582,807 10,318,652 10,552,286 12,874,913 15,851,083 16,637,270 18,667,532 16,581,234 17,174,723 17,791,952 18,433,871 19,101,464Ending Balance 2,873,629 2,751,248 4,246,303 6,047,493 6,215,026 4,257,154 1,864,261 (384,201) 976,104 2,202,785 3,284,871 4,210,974 4,968,970Target Reserve 2,330,000 2,487,000 2,604,000 2,604,000 3,286,000 3,286,000 3,737,000 3,737,000 4,219,000 4,219,000 4,528,000 4,528,000 4,862,000Variance to Target Reserve 543,629 264,248 1,642,303 3,443,493 2,929,026 971,154 (1,872,739) (4,121,201) (3,242,896) (2,016,215) (1,243,129) (317,026) 106,970

(10,000,000)

(5,000,000)

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

Nursing Care Quality Assurance CommissionFinancial Forecast with Proposed Fee Increase

Revenue Expenditure Ending Balance Target Reserve Variance to Target Reserve

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CRITICAL GAPS TEAMS: COMPILED 2022 PLANS

DIVERSITY Team Leads: Katie Eilers and Victoria Fletcher Team Members: Victoria Fletcher, Katie Eilers, Paula Meyer, Sofia Aragon, Angelina Flores-Montoya

Project Lead(s) Launch/1st Step January February March April May June July August September October November December Accomplishment Budget and resources

Obtain data from NCQAC, analyze data, draft trend analysis report, Angelina

Nursing education trends draft report reviewed by WCN Diversity Advisory Committee and WCN BOD, presented by Angelina Flores-Montoya

Nursing education trends draft report presented to NCQAC, including Paula Meyer and key staff by Angelina Flores-Montoya

Present nursing education trends report at CNEWS meeting, Spokane, WA, Angelina, Sofia?

By the end of the 2nd qtr 2022, Present NCQAC nursing education data trend analysis to Critical Gaps Steering Committee and CNEWS groups

Calendar a presentation to NCQAC and also at CNEWS conference by Angelina Flores-Montoya and Sofia Aragon

Draft agreement to include diverse voices in Critical Gaps work, circulate to Paula and Sofia

WCN and NCQAC to develop an agreement to include diverse voices in Critical Gaps leadership.

Present agreement to Critical Gaps Steering Committee

By the end of the 2nd qtr 2022, WCN/NCQAC, Critical Gaps Steering Committee will adopt guiding principles for engagement and centering BIPOC voices in the work. Sofia and Paula to propose and develop

Paula and Sofia to identify budget and resources

Assess DEI impact of current nursing regulations, define review process, identify review group, Paula, NCQAC, WCN

Sofia and Paula develop a plan for assessment of NCQAC regulations for DEI impact

Paula and Sofia present a plan to WCN board, NCQAC, and critical gaps groups

By the end of 3rd qtr 2022, Sofia and Paula are to have a plan to how to assess WAC's for DEI impacts, Identify WAC's to potentially amend, Paula, NCQAC, WCN (collaborator)

Sofia and Paula to determine resources needed to support this process

Continue participation in Children's pilot project, meet with NWONL to gain support for leadership mentorship initiative

Identify at least three health systems to initiate a leadership mentorship program, with Children's program as one model

By the end of 4th qtr 2022, 3 other health systems will be approached to potentially adopt the Children's Hospital Leadership mentorship model. NOWNL and WCN

Brief CNEWS on "community of interest' discussion at Critical Gaps Steering Committee meeting

Sofia to introduce Community of Interest discussion at the April CNEWS conference as part of sharing the nursing education trends report

Propose to CNEWS a presentation of nursing schools or programs who have identified a community of interest for DEI strategies.

By the end of the 4th qtr 2022, CNEWS to host a discussion on "community of Interest" approach to DEI strategies. This will include how CNEWS and/or individual members will include community voices that reflect those most affected and identify communities of interest to focus DEI strategies.

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EDUCATION Team Lead: Mary Baroni Team Members:

Project Lead(s) Launch/1st Step January February March April May June July August September October November December Accomplishment Budget and resources

SBCTC LPN Academic Progression LPN-RN & LPN-BSN DTA pathways approved

The LPN-RN & LPN-BSN DTA pathways will be approved for implementation by the SBCTC, COP, & ICW by summer 2022.

SBCTC

SBCTC LPN Academic Progression Early DTA adopter PN Programs identified

By the end of 2022, at least one CTC currently offering LPN education will begin implementation process for LPN-RN and/or LPN-BSN DTA

Premera Grant Team Leads

LPN Academic Progression LPN-BSN Pilot Programs approved by SBCTC & NCQAC

All 4 LPN-BSN Pilot Programs will be approved for implementation by SBCTC & NCQAC by Fall 2022.

Premera Foundation Grant

Kim Tucker, Kara LaValley, Kristen Hosey, Teri Woo

LPN Academic Progression 1st cohort of LPN-BSN students at CBC, GRC & WVC and 2nd cohort at SMU admission

First cohort of LPN-BSN students at CBC, GRC, & WVC and 2nd cohort at SMU will be admitted by the end of 2022.

Premera Foundation Grant

Mary Baroni LPN Academic Progression End of term focus groups with each cohort

End of term focus groups will be conducted with each semester/quarter for first cohort of LPN-BSN students at pilot schools as they launch. This will include the first cohort of LPN-BSN students at Saint Martin University in spring 2022 and fall 2022 and any of the other three programs that may launch in fall of 2022.

Premera Foundation Grant

Marlin Galliamo & Kathy Moisio

LPN Academic Progression LPN Apprenticeship Pathway development

The LPN Apprenticeship Pathway will be developed and submitted to the state legislature by the end of 2022.

Premera Foundation Grant

Premera Grant Director Dr. Diana Meyer, Tiffany Smith-Fromm

Holistic Admissions Development of Open Access Resource PowerPoint on holistic admissions

An open access resource Open Access Resource PowerPoint on holistic admissions will be developed by Premera Grant Consultants by summer 2022.

Premera Foundation Grant

Premera Grant Director Dr. Diana Meyer, Tiffany Smith-Fromm

Holistic Admissions CNEWS Survey CNEWS Survey CNEWS Survey CNEWS Survey CNEWS Survey A CNEWS survey of nursing education programs’ knowledge of and/or use of holistic admissions will be developed, distributed, and analyzed by the end of 2022 by Premera Grant

Premera Foundation Grant

Premera Grant Team Leads Kim Tucker (Columbia Basin College), KaraLynn LaValley (Green River College), Kristen Hosey (Wenatchee Valley College), Teri Woo (St. Martin University)

Holistic Admissions Implementation of Holistic Admissions at 4 LPN-BSN pilot schools (already implemented at SMU)

Holistic Admissions will be implemented as all 4 LPN-BSN pilot schools by the end of 2022.

Premera Foundation Grant

Premera Grant Director Dr. Diana Meyer, Tiffany Smith-Fromm

Holistic Admissions Development of student focused Open Access Resource video on holistic admissions & creating a strong application.

Development of student focused Open Access Resource video on holistic admissions and creating a strong application will be in development and completed by February 2023.

Premera Foundation Grant

Premera Grant Team and Consultants

Holistic Admissions Confirmation of presentation on Holistic Admission

A presentation on holistic admissions at CNEWS Spring 2023 meeting will be confirmed by the end of 2022.

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Carrie Miller, Lauren Bibin, Katie Haerling, Jocelyn Ludow, Tiffany Zyniewicz

Simulation Simulation Task Force contacts with Premera Grant for consultation & development of Open Access Resource Simulation on rural disaster management.

The Washington Simulation Task Force will integrate into ongoing Critical Gaps in Nursing Education beginning with initial presentation on December 21, 2021.

Premera Foundation Grant

Carrie Miller, Lauren Bibin, Katie Haerling, Jocelyn Ludow, Tiffany Zyniewicz

Simulation Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force consultation & development of Open Access Resourse

Simulation Task Force will contract with Premera Grant for consultation & development of OAR Simulation on rural disaster management.

Premera Foundation Grant

Dr. Kate Haerling Simulation NCSBN funded Simulation Study Analysis Completed

NCSBN Funded Simulation Study Data Collection will be completed by the end of May 2022.

NCSBN

Dr. Kate Haerling Simulation NCSBN funded Simulation Study Analysis Completed

NCSBN Funded Simulation Study Analysis will be Completed by the end of September 2022.

NCSBN

Dr. Kate Haerling Simulation NCSBN Simulation Study Finding Presented to Criticial Gaps in Nursing Education Group

NCSBN Simulation Study Findings will be presented to Critical Gaps in Nursing Education Group by the end of 2022.

NCSBN

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ADVANCE PRACTICE Team Lead: Deborah Smith Team Members: Laurie Soine, Louise Kaplan, Mary Moller, Kathy Manion, Frank Kohel, Anne Mason, Melissa Hutchinson, Megan Kilpatrick, Mary Sue Gorski, Karl Hoehn

Project Lead(s) Launch/1st Step January February March April May June July August September October November December Accomplishment Budget and resources

Obtain ARNP Demand Data Approval from Critical Gaps leadership team to move forward with the project – goal April 15, 2022

Meet with designated commission or agency/organization staff to plan a stakeholder meeting or survey to develop questionnaire – goal first week of May

Stakeholder meeting convened or survey distributed – goal first week of JuneQuestionnaire finalized for distribution – goal end of June

Survey implemented – goal end of July

Identify short and long term needs for ARNPs. Use demand data to also help identify areas of the state that need assistance in improving recruitment and retention of a more diverse ARNP workforce

The cost for this project is in-kind from the agency whose staff is designated to facilitate

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COMMUNITY HEALTH Team Lead: Suzanne Swadner Team Members: Suzanne Swadener, Jamie Shirley, David Reyes, Katie Johnson, Cathy MeuretTBD

Project Lead(s) Launch/1st Step January February March April May June July August September October November December Accomplishment Budget and resources

Suzanne Swadener Jamie Shirley David Reyes Katie Johnson Cathy Meuret TBD

Work with UW PI's to identify participants and support roles for planning and implementing "So You Want to be a Population Health Nurse"

Work with UW PI's to identify participants and support roles for planning and implementing "So You Want to be a Population Health Nurse" HRSA grant project. Resource: Communication strategy and tools, scheduling coordination, time - resources needed in all project steps

Continue work on planning committee

Continue work on planning committee. Identify roles in communication planning and implementation

Identify roles and Subject Matter Experts to participate in planning conference sessions and breakout groups

Participate in conference. Identify and plan for post-conference follow up (e.g. mentors, site visit hosts, etc)

Identify and plan for post-conference follow up (e.g. mentors, site visit hosts, etc)

To increase BIPOC nursing student awareness of and interest in careers in nursing education and public health nursing and their roles in addressing social determinants of health and health disparities

UW HRSA Grant

Suzanne SwadenerJamie ShirleyDavid ReyesKatie JohnsonCathy MeuretTBD

Identify Subject Matter Experts for RWJF Project

Work with Mary Sue Gorski to ID plan for recruitment

Begin recruitment with committee member Subject Matter Experts

RWJF

Robin Fleming Explore brief summary of school nurse policies impacting practice. Focus at agency level on roles, practice settings and current funding methodologies

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LONG TERM CARE Team Lead: Tatiana Sadak, Lauri St. Ours Team Members: Melinda Schultz Misrak Mellsie, RN, MSN, Jessica Duggar, LPN, Adam Canary, LN/LNHA, Chukk Nielson, RN, BSN, Mindy Schaffner, PhD, MSN-CNS, RN, Anne Richter, MS, BSN, RN, Tracy Rude, LPN, Jamie Hernandez, Nova Gottman

Project Lead(s) Launch/1st Step January February March April May June July August September October November December Accomplishment Budget and resources

Recruited a UW SoN DNP student and Started developing LTC residency web resource (focus on leadership opportunities for nurses from diverse backgrounds)

Completed the development of the LTC residency web resource

Recruited UW SoN DNP student to continue developing LTC residency

DNP student is matched with LTC facility that is interested in implementing the residency pilot

Initial LTC Residency data is collected and disseminated

UW SoN

Secured funding from HCA/DSHS and started a pilot of the LTC externship with UW SoN UG students (recruited a diverse cohort: 1/3 male, 1/3 BIPOC.

Successfully completed the first quarter of the externship, collected outcomes data

Completed the pilot of the LTC Externship

Disseminated findings of the LTC Externship

Secured funding for the second year of LTC externship

Recruited a new cohort of externs and started year 2 pilot in LTC with focus on memory care units

Quarter 1 LTC Externship data is collected and disseminated

HCA/DSHS

Developed diversity goals and applied for funding to Hilman Foundation. Proposal - to develop protocols for conducting systematic needs assessments for addressing racism and cultural incompetence in LTC

If funded, will start the project on assessing needs and developing targeted interventions for addressing racism in LTC

If not funded, will pursue other funding sources

If funding is secured will conduct preliminary data analysis

Hilman Foundation

Conduct listening sessions with BIPOC LTC nurses and direct care staff to identify diversity goals (recruit through Nurses of color organizations and WACHA conference)

Identify perceived barriers to meaningful leadership opportunities for diverse nurses in LTC

Identify perceived barriers to the retention and job satisfaction of BIPOC nurses

Hilman Foundation

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RURAL Team Lead: Cori Anne Garcia-Hansen Team Members:

Project Lead(s) Launch/1st Step January February March April May June July August September October November December Accomplishment Budget and resources

Cori Ann Garcia

Reconvene Rural Critical Gaps groups and include new non-nursing partners such as DOH Office of Rural Health

Present to the Northwest Rural Health Confrence

Review available demand, supply, and nursing education data from WCN

Compile available data and research to develop a policy brief.

By December 31, 2022 explore a revised version of the Rural Outreach Nurse Education Program to include elements of the Public Heatlh Service Corp, including elements to recruit diverse nurses

Cori Ann Garcia

Review available data from the WA State Hospital Association

Review available demand, supply, and nursing education data from WCN

Compile availble data and research to develop a policy brief.

By December 31, 2022, the workgroup will present available data on rural workforce nursing needs to policy makers and funders.

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Nursing Ed

Long Term Care

Advance Practice

Diversity

Rural

Community Health

Nursing Ed

Long Term Care

Advance Practice

Diversity

Rural

Community Health

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Michigan English Test (MET) for Licensing Foreign-Trained Nurses

Executive Summary

Michigan Language Assessment is seeking recognition of the Michigan English Test (MET) as an approved examination that foreign-educated nurses can use to demonstrate English language proficiency when seeking licensure in your state.

The MET is the successor exam to the Michigan English Language Assessment Battery (MELAB), recognized for that purpose by a number of nursing boards across the country. Several state boards of nursing, such as Florida, Idaho, Michigan, Nebraska, North Dakota, Oklahoma and Wyoming, have recently approved the MET as an accepted credential to demonstrate English language proficiency for internationally educated nurses.

The MET, developed by Michigan Language Assessment, is an internationally recognized standardized assessment that measures the test taker’s proficiency in reading, writing, listening, and speaking English for academic or professional use. The MET reports a score ranging from 0 to 80 for each of the four skills and an overall score, the average of the four section scores, that ranges from 0 to 80.

The proposed MET passing score for foreign-trained nurses is an overall score of 55 with a minimum speaking

section score of 55.

Michigan Language Assessment: Who We Are

Michigan Language Assessment is a not-for-profit collaboration between the University of Michigan and Cambridge Assessment English, two institutions with long histories and leadership roles in the field of language assessment, language teaching, and applied linguistics research. Michigan has been developing and offering English exams internationally more than 65 years and Cambridge more than 100. Our exams are developed to the highest professional standards, backed by ongoing research and development, and recognized by higher education institutions, organizations, and regulatory bodies worldwide. For further information, see www.michiganassessment.org.

The MELAB, Precursor to the MET

Michigan Language Assessment is also the developer of the MELAB, the precursor exam to the Michigan English Test and an exam used for many years for the screening of nurses in the United States and Canada. The suitability of the test and the proposed performance standards/cut scores on MELAB were supported by a standard setting study jointly conducted with NCSBN and published as an NCLEX Technical Brief (Qian, Woo, Banerjee, 2014; see Appendix 1).

Michigan Language Assessment discontinued administration of the MELAB in July 2018, and offers its successor test the MET, the subject of this proposal. Comparability studies that show the relationship between MELAB and MET scores validate the recommended MET score (55) to meet the required ability level identified in the NSCBN study. Research studies have been conducted that relate scores on MELAB and MET so that it is possible to recommend MET scores for nurses that represent the requisite ability level identified in the NSCBN study.

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The Michigan English Test (MET)

The MET is a complete language assessment designed to assess proficiency in English as a foreign language for those who will need to use English for academic or professional use. Developed over 10 years ago, the MET is a revised and improved version of MELAB, and includes the assessment of integrated reading skills, the ability to make meaning across multiple texts, and a standardized multi-stage speaking test - all skills that are critical for healthcare workers. The MET is written using American English, though it does not disadvantage test takers who use other English dialects.

The MET is developed in accordance with the highest standards in educational measurement. Rigorous quality procedures are followed during item and test form development. The reliability of scores of each section of the MET is consistently above .90. The exam comprises four sections covering the different language skills (listening, reading, writing, and speaking) and takes approximately 2¾ hours to complete. The test items reflect the wide range of situations in which test takers will need to use English: public spaces, workplace settings, and educational settings.

The MET is constructed to assess English proficiency from high beginning to advanced levels. It covers the intermediate and advanced proficiency levels that are most appropriate for professional and academic contexts (levels B2 and C1 on the Common European Framework of Reference for Languages, or CEFR). The test tasks intentionally involve a varietyof registers and text types, as success in a professional or academic setting depends on the ability to cope with both formal and informal language and with many different types of written and spoken texts.

The MET test items and tasks are designed to enable assessment of all four skills in English. Table 1 shows some of the subskills that are assessed in the listening, reading, writing, and speaking sections of the test. In addition, the exam requires test takers to engage a wide range of relevant cognitive processes and to perform relevant language functions, following established theories of language proficiency. For details on how the MET test sections cover these cognitive processes and language functions, see Appendix 2.

The MET is also more widely available than MELAB, both in terms of where the test is offered and how frequently it is offered. With the October 2021 launch of MET Digital, it is securely offered almost any day of the year, anywhere in the world, at authorized test centers or remotely using ProProctor(R)'s AI and human proctoring platform and services.

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Table 1: Assessment Focus of Each Section of the MET

Listening Reading Writing Speaking

• Understand and identifymain ideas and speaker’spurpose.

• Understand vocabularyand supporting details

• Draw inferences andconclusions

• Understand pragmaticimplications and rhetoricalfunctions

• Understand main idea andidentify purpose

• Identify supporting details

• Understand vocabulary incontext

• Draw inferences andconclusions

• Understand rhetoricalfunction

• Synthesize ideas

• Answer questions about apersonal experience,including supportingdetails

• Express and support anopinion/position on anissue

• Express relevant ideasusing a range of accurateand appropriatevocabulary andgrammatical structures

• Develop content usingappropriate cohesivedevices and creating alogical progression ofideas

• Convey information abouta picture

• Describe a personalexperience

• Give and support anopinion

• State advantages anddisadvantages

• Present a convincingargument

• Express ideas intelligiblyand fluently

• Develop relevant contentusing a range of accurateand appropriatevocabulary andgrammatical structures

For additional information as well MET's transformation to a digital format, see About the MET.For the most recent MET annual test report, see 2019 MET Annual Report. For information about our new partnership with Prometric, see our Press Release.

Test Availability and Test Security

The MET's high quality, global availability and affordability make it attractive to those seeking a recognized language qualification. The MET is recognized as an English language credential by a growing list of ministries of education and institutions of higher education, which rely on its validity, reliability and security features.

The MET has been securely administered at our authorized test centers in more than 30 countries and starting in October 2021 the exam transitioned to a highly secure digital format administered worldwide. Test takers have the option to schedule an in-center exam date at our traditional authorized test centers or Prometric's vast global test center network, or to schedule an at-home exam, securely administered on Prometric's ProProctor test delivery platform. They can schedule an exam in as little as 48 hours in advance of the test window and receive their results in as few as five business days.

Test security is prioritized at every stage of the MET development and administration process. Each test taker receives a unique test form. MET Digital is developed and scored by Michigan Language Assessment and is securely administered by authorized test centers or with live human proctors and additional AI technology for at-home administrations. The exams are human developed, proctored and scored, with additional AI security-enabled technology for at-home administrations. And we have built in an array of pre- and post-administration checks tosupport the integrity of outcomes.

We have also updated the way that we share exams results. Accompanying the transformation to a digital platform, we now release MET results to test takers within five days. And via our new Michigan Customer Portal, test takers select where to send their results, thereby authorizing institutions to securely view and download individual exam results.

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MET Scoring and Recommended Minimum MET Score for Foreign-Educated Nurses

MET scaled scores range from 0 to 80. Score reports include four section scores (listening, reading, speaking and writing) and an overall score showing the average of all sections. Score reports also include descriptive information regarding English language proficiency for each of the distinct score ranges (A2 to C1) to help recognizing organizations interpret test results. These scores are robustly related to particular levels of the CEFR, the most commonly used global benchmark of language ability. See Appendix 3 for a sample score report.

The NCSBN standard setting panel mentioned earlier recommended accepting a MELAB score of 78 to 81, with a speaking test score of 3. The Board of Directors ultimately recommended a score of 81 with a speaking test score of 3. Based on research relating MET scores to MELAB scores, including statistical analysis of common tasks between the two tests, a MELAB score of 81 corresponds to an MET overall score of 55. Thus, Michigan Language Assessment proposes setting the minimum 4-skill MET overall score for foreign-educated nurses at 55 with a minimum speaking section score of 55. For full reports of relevant studies, see:

Linking the MET Writing Test to the CEFR Setting Cut Scores on the CEFR for MET MELAB & MET Concordance Table

Contact Information

General inquiries: info@michiganassessment.org

Julie Monteiro de Castro Stakeholder Relations and Recognition Manager Monteirodecastro.J@michiganassessment.org

Dr. Gad LimDirector of Assessment Lim.G@michiganassessment.org

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Table of Contents

P. 6 Appendix 1-Setting an English Language Proficiency Passing Standard for Entry-Level NursingPractice Using the Michigan English Language Assessment Battery

P. 11 Appendix 2-Cognitive Functions and Language Functions Covered in the MET

P. 16 Appendix 3-MET Sample Score Report

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Appendix 1

Setting an English Language Proficiency Passing Standard for Entry-Level Nursing Practice Using the Michigan English Language Assessment Battery

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www.ncsbn.org 1

The Michigan English Language Assessment Battery (MELAB) is a complete language proficiency assessment for advanced-level users of English as a second or foreign language who will need to use English for academic and professional use. It is a secure test program, administered worldwide at authorized test centers and is recognized by a growing list of academic institutions and professional organizations across North America and beyond. To provide member boards with another option for evaluating the English language proficiency of internationally-educated applicants, the National Council of State Boards of Nursing (NCSBN®) conducted a standard-setting study in October 2012 to establish the MELAB passing standard, as related to entry-level nursing practice.

Similar standard setting exercises targeting entry-level nurses have been performed for other English language proficiency tests. In 2003, NCSBN conducted its first English language proficiency workshop with the Test of English as a Foreign Language Computer-based Test (TOEFL® CBT). An updated TOEFL passing standard was set in a standard setting workshop in 2008 as a new version of the test, TOEFL Internet-based Test (TOEFL iBT™), became the primary choice for TOEFL candidates. In 2004, a similar standard setting workshop was conducted with the International English Language Testing System (IELTS™) examination. In 2009, the Pearson Test of English (PTE) Academic was launched, and a standard setting workshop was also held in the same year.

Such exercises define a legally defensible passing standard for boards of nursing. They also make English language proficiency qualifications portable across member jurisdictions. This technical brief describes the MELAB standard-setting process and the NCSBN recommended passing standard.

The MELABThe MELAB was developed to measure the English language proficiency of non-native English speakers intending to study or work in an English-medium environment. Owned and developed by Cambridge Michigan Language Assessments (CaMLA), the test is developed in accordance with the highest standards in educational measurement. Rigorous quality procedures are followed during item and test form development and the test is administered following standardized procedures, including strict security measures. All writing sections and speaking test examiners are trained and monitored.

The examination comprises four sections covering the different language skills (listening, reading, writing, and speaking) and takes approximately 2¾ hours to complete. The test items reflect the wide range of situations in which test takers will need to use English: public spaces, workplace settings and educational settings. The topics are varied, require no specialized content knowledge or experience and represent a variety of opinions. The format of the test is shown in Table 1.

Setting an English Language Proficiency Passing Standard for Entry-Level Nursing Practice Using the Michigan English Language Assessment Battery

Hong Qian, PhD Psychometrician, NCLEX® Examinations

Ada Woo, PhDDirector of Measurement and Testing, NCLEX® Examinations

Jayanti Banerjee, PhD Research Director, Cambridge Michigan Language Assessments

October 2014NCLEX® TECHNICAL BRIEF

Table 1. Structure of PTE Academic

Section Time ActivitiesNumber of

Items

Writing 30 minutesAn essay based upon one of two topic choices.

1 task

Listening 35-40 minutesAudio recordings of short conversations and talks are followed by multiple choice questions.

60

Reading and use of English

75 minutes

Reading passages are followed by multiple-choice comprehension questions. Use of English is tested through a combination of discrete and integrated tasks.

100

Speaking 15 minutesTest takers engage in a conversation with an examiner.

–

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Each section of the MELAB is scored separately and reported on the score report. The report also provides an overall score that is the average of the writing, listening and reading sections. The speaking test result is reported separately on a scale 1 – 4. This may include a plus (+) or minus (-); for instance, a test taker may be awarded a 3+ or a 4-. The overall MELAB score ranges from 0 to 99.

Selection for the MELAB Standard Setting Panel The composition of a subject matter expert (SME) panel of judges is critical to the success of the standard setting workshop (Cizek & Bunch, 2007). It is important to assemble

“a sufficiently large and representative group of judges” (AERA/APA/NCME, 1999, p. 54). For the MELAB standard-setting workshop, 11 SMEs were recruited from the four NCSBN geographic areas to serve on the standard-setting panel. The panel was composed to include: (1) nurses who speak a primary language other than English, (2) nursing regulators, (3) nursing educators, and (4) consumers of nursing services. In all, the standard setting panel was quite diverse, representing nine NCSBN member boards of nursing, one NCSBN associate member board of nursing and five languages. Table 2 contains a description of the panel composition.

Table 2. Characteristics of Panelists

Panelist Characteristic Category % (N)

GenderFemale 81.8 9

Male 18.2 2

Nursing license1

Registered nurse (RN) 80.0 8

Licensed practical/vocational nurse (LPN/VN)

20.0 2

NCSBN geographic region

I 27.3 3

II 9.1 1

III 36.4 4

IV 18.2 2

Associate Member 9.1 1

Years of post licensure experience2

1 to 10 years 30.0 3

11 to 20 years 20.0 2

21 to 30 years 20.0 2

31 to 40 years 20.0 2

41 or more years 10.0 1

Primary language

English 45.5 5

Spanish 18.2 2

Tagalog 18.2 2

Filipino 9.1 1

German 9.1 1

Job title

Staff Nurse/Clinical Practice 36.4 4

Board of Nursing Regulator 18.2 2

Nursing Educator 36.4 4

Community Consumer 9.1 1

1 One panelist, representing consumer of nursing services, did not hold a nursing license..

2 Among the 10 panelists who are licensed nurses, average years of post-licensure experience is 22.3 years (SD = 14.9 years).

Standard-Setting ProceduresThe first portion of the workshop was spent educating the panelists on the MELAB assessment and language acquisition process. The panelists were provided a description of the format of the test and a demonstration of the items on the test. This presentation was followed by a discussion of the language acquisition process and a review of common English proficiency language frameworks. The panelists were then provided instruction on the standard setting methods and process. At the beginning of standard setting pertaining to each section, the panelists participated in a discussion of how much English proficiency was required in that language skill to safely and effectively perform entry-level nursing activities. From the discussion, the panelists generated a list of tasks related to that specific language skill that they deemed necessary for safe and effective

entry-level nursing practice (Appendix A). After reaching a consensus, the panelists were asked to review actual MELAB items and make a recommendation for a passing standard.

Two standard setting methods were used to set passing standards for the four sections: the modified Angoff and the extended Angoff methods. These methods are commonly used in certification and licensure contexts (Cizek & Bunch, 2007). The central idea of the Angoff method is for judges to provide ratings on the basis of a “minimally competent candidate.” Judges are asked to define what a “minimally competent candidate” would know and be able to do. In the modified Angoff method, judges are asked to consider how many out of 100 minimally competent candidates would answer the item correctly. This is appropriate for 188

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the receptive skills (Listening and Reading sections). The panelists reviewed MELAB items and made a judgment for each. The panelists estimated the probability (out of 100) that an entry-level nurse with minimally acceptablelanguage skills would be able to answer the item underreview correctly.

In the extended Angoff method, rather than estimating the proportion of minimally competent candidates who will correctly answer an item, judges estimate the number of points minimally competent candidates will need to obtain on each item. This is appropriate for the productive skills (Writing and Speaking sections) where the test-takers have to produce open-ended responses, which are then assessed by raters, using a set of predetermined criteria. For the writing section, the standard setting panelists received a pack of test-taker responses, one at every score profile on the rating rubric (ranging from basic English users to proficient English users). They independently reviewed the responses and considered whether an entry-level nurse with minimally acceptable English language skills, as defined through panel discussions, would be able to provide a response similar to one of the sample candidates. For the speaking section, the panelists listened to short speaking test extracts that represented performances at every score profile on the rating rubric. As in the writing section, the panelists considered whether an entry-level nurse with minimally acceptable English language skills, as defined through panel discussions, would be able to provide a response similar to one of the sample candidates.

Within both standard setting methods, the panelists were asked to provide two rounds of ratings. In the first round, the panel members estimated the ability of candidates or the difficulty of items in relation to the hypothesized linguistic requirements for entry-level nurses. The first round was followed by a period of discussion and feedback. The panelists then provided their second round and final ratings on the same set of items.

Standard-Setting Panel RecommendationsFor all four sections of the MELAB, panelists were able to come to a consensus on a recommended standard. In their post-meeting feedback, the panelists indicated that they understood the standard setting process and were confident in their ratings. In all the skill categories, the round two recommendations were more consistent as compared to round 1. This suggests that the panelists converged in their opinions as the workshop progressed.

As indicated earlier, test takers receive a score for each section of the MELAB. The writing, listening, and reading scores are averaged to produce a total score. This score is used for decision-making. The speaking score is reported separately for decision making. Table 3 lists the MELAB total score and speaking score that the panel recommended.

In order to gauge whether the recommended MELAB scores are in line with the standards set in the TOEFL studies, the results from the MELAB workshop were compared to pre-vious results. According to a study conducted by CaMLA, the MELAB passing standards recommended by the stan-dard setting panel are comparable to the NCSBN-endorsed TOEFL passing standards. NCSBN recommended an overall cut score of 560 on the TOEFL PBT, 220 on the TOEFL CBT and 84 on the TOEFL iBT. A minimum speaking score of 26 was advised on the TOEFL iBT. The findings from the study suggest that the NCSBN recommendations on the PBT, iBT and CBT all fall within the same score range. As shown in Ta-ble 4, the score range corresponds to a MELAB score range of 78-81.

NCSBN Board of Directors (BOD) DeliberationThe NCSBN Board of Directors (BOD) reviewed and discussed results from the MELAB standard setting workshop. They reviewed background on the MELAB and procedures used in the standard setting workshop. The BOD then considered the passing standards recommended by the MELAB standard setting panel, as well as the potential pass/fail impact of these recommendations. After weighing all available evidence, including comparability to other NCSBN-endorsed English proficiency standards and BOD’s own knowledge about the nursing profession, they concurred with the standard setting panel’s recommendation of an overall passing standard of 81 and a speaking section score of 3.

ConclusionsNCSBN’s recommendation regarding the English proficien-cy passing standard of an overall score of 81 with a speaking score of 3 is consistent with the previous English proficiency passing standards recommended for other English language tests and the level of English proficiency needed to perform entry-level nursing safely and effectively. Additionally, this recommendation is consistent with the NCSBN policy po-sition on international nurse immigration, which states that “domestic and international nurses need to [be] proficient in written and spoken English skills” (NCSBN, 2003, as cited in Woo, Dickison & de Jong, 2010). Boards of nursing can use this information to make decisions regarding the level of English proficiency needed for entry-level RNs and LPN/VNs in their jurisdictions.

Table 3. Summary of Panel Recommendations

Total (Reading, Listening, Writing) Speaking

78-81 3

Table 4. Comparison of MELAB and TOEFL Score Ranges

MELAB TOEFL PBT TOEFL iBT TOEFL CBT

78-81 560-577 83-91 220-233

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Appendix A: English Language Tasks Performed by Entry-Level Nurses

Reading Listening Writing Speaking

� Advance directives

� Reading reports and charts

� Medication orders

� Equipment instructions

� Medication labels

� References material

� Research/evidenced-based practice

� Infection control practices

� Patient safety

� Physician consultation

� Narrative notes

� Memos/emails/correspondences

� Continuing education

� Data reports

� Patient feedback

� Clarifying information

� Cultural differences

� Discern

� Phone conversations

� Unscripted conversations

� Communicating with colleagues

� Receiving feedback and direction

� Receiving report of lab values

� Receiving doctor’s orders

� Initial assessment

� Client report

� Nursing care plan

� Client consent to care

� Nurse’s note

� Phone order-clarify

� Client interview

� Client education

� Physical assessment

� Client report

� Collaboration

� Rapid response/Code Blue

� Clarifying language

� Socialization in profession

� Medical terminology

� Client advocacy

ReferencesAmerican Educational Research Association, American Psychological Association, National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Psychological Association.

Cizek, G. J., & Bunch, M. B. (2007). Standard setting: A guide to establishing and evaluating performance standards on tests. Thousand Oaks, CA: Sage.

Woo, A., Dickison, P., & de Jong, J. (2010). Setting an English Language Proficiency Passing Standard for Entry-Level Nursing Practice Using the Pearson Test of English Academic. Retrieved October 29, 2014 from https://www.ncsbn.org/NCLEX_technicalbrief_PTE_2010.pdf

©2014 The National Council of State Boards of Nursing (NCSBN®) is a not-for-profit organization whose members include the boards of nursing in the 50 states, the District of Columbia and four U.S. territories — American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are 21 associate members.

Mission: NCSBN provides education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection. (Mission Statement Adopted by Delegate Assembly 2010)

National Council of State Boards of Nursing, Inc.

111 E. Wacker Drive, Suite 2900, Chicago, IL 60601-4277

312.525.3600 | International Calls: +1.312.525.3688

Testing Services: 312.525.3750 | www.ncsbn.org

190

Appendix 2

Cognitive Functions and Language Functions Covered in the MET

191

Appendix 2: Cognitive Functions and Language Functions Covered in the MET

The MET tasks are designed so that as test takers respond to the test questions, they are required to use cognitive functions and perform language functions that are relevant to real-world professional and academic contexts. Tables I through IV below show how MET test sections cover the different cognitive processes involved in each of the four language skills, following well-established theories. It can be seen that these processes are engaged in one or more MET test tasks.

Table I: Listening cognitive processes (Field, 2013) in MET Listening

Inpu

t de

codi

ng

Lexi

cal s

earc

h

Pars

ing

Mea

ning

co

nstr

uctio

n

Disc

ours

e co

nstr

uctio

n

Short Conversation x x x x

Longer Conversation x x x x x

Short Talk x x x x x

Table II: Reading cognitive processes (Khalifa & Weir, 2009) in MET Reading

Reco

gniz

ing

wor

ds

Acce

ssin

g le

xis

Synt

actic

pa

rsin

g

Esta

blis

hing

pr

opos

ition

al

mea

ning

Infe

renc

ing

Build

ing

men

tal

mod

els

Crea

ting

text

ual

repr

esen

tatio

n

Crea

ting

inte

rtex

tual

re

pres

enta

tion

Grammar x x x x

Extended Passage x x x x x x x

Thematically-Linked Passages

x x x x x x x x

Table III: Speaking cognitive processes (Field, 2011) in MET Speaking

Conc

eptu

al-

izat

ion

Gra

mm

atic

al

enco

ding

Phon

olog

ical

en

codi

ng

Phon

etic

en

codi

ng

Self-

mon

itorin

g

Part 1 x x x x x

Part 2 x x x x x

Part 3 x x x x x

Table IV: Writing cognitive processes (Shaw & Weir, 2007) in MET Writing

Mac

ropl

anni

ng

Org

aniz

atio

n

Mic

ropl

anni

ng

Tran

slat

ion

Mon

itorin

g

Revi

sing

Task 1 x x x x x x

192

Information about how the MET assesses important listening and reading functions can be seen in Tables V and VI below. Where writing and speaking are concerned, the amount of available time for testing prevents coverage of every possible function related to these skills. Nevertheless, in line with other English proficiency exams, the MET samples a wide range of key functions. The MET Writing and Speaking sections require description, narration, exposition, and argumentation, a broad enough coverage to allow a good evaluation of test takers’ productive language abilities.

Table V: Language functions (Bejar et al., 2000) in MET Listening U

nder

stan

d im

port

ant d

etai

ls

Und

erst

and

mai

n id

eas,

topi

cs, g

oals

Und

erst

and

key

voca

bula

ry

Und

erst

and

com

mun

icat

ive

func

tion

of u

tter

ance

s

Mak

e in

fere

nces

ab

out r

elat

ions

hips

am

ong

idea

s

Short Conversation x x x x x

Longer Conversation x x x x x

Short Talk x x x x x

Table VI: Language functions (Khalifa & Weir, 2009) in MET Reading

Find

in

form

atio

n

Basi

c co

mpr

ehen

sion

Read

ing

to le

arn

Read

ing

to

inte

grat

e

Grammar

Extended Passage x x x

Thematically-Linked Passages x x x x

193

References

Bejar, I. I., Douglas, D., Jamieson, J., Nissan, S., and Turner, J. (2000). TOEFL 2000 listening framework: A working paper. ETS Research Memorandum RM-00-07. Princeton, NJ: Educational Testing Service.

Field, J. (2011). Cognitive validity. In L. Taylor (Ed.), Examining speaking: Research and practice in assessing second language speaking (pp. 65-111). Cambridge: Cambridge University Press.

Field, J. (2013). Cognitive validity. In A. Geranpayeh & L. Taylor (Eds.), Examining listening: Research and practice in assessing second language listening (pp. 77-151). Cambridge: Cambridge University Press.

Khalifa, H., & Weir, C. J. (2009). Examining reading: Research and practice in assessing second language reading. Cambridge: Cambridge University Press.

Shaw, S., and Weir, C. J. (2007). Examining writing: Research and practice in assessing second language writing. Cambridge: Cambridge University Press.

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Appendix 3

MET Sample Score Report

196

• The purpose of the Michigan English Test (MET) is to evaluate general English profi ciency in educational, social, and workplace contexts.

• The MET is aimed at levels A2 to C1 of the Common European Framework of Reference (CEFR). See reverse for an explanation of how section scores on the MET correspond to the CEFR.

• The overall score and CEFR level reported are averages of the sections tested.

• A section score of X means the test taker was exempt from that section. A section score of 0 means the test taker did not attempt the section, or their answer was not on topic.

• MET scores represent a test taker’s English language profi ciency at the time the test was taken and are valid as long as the test taker’s level of profi ciency does not change. Because language profi ciency can change over time, score users are advised to consider the test taker’s experience with English since the time of the test administration in addition to the test scores themselves.

• Michigan Language Assessment reserves the right to update results or test taker information.

• Institutions may verify test results at: MichiganAssessment.org.

General Information

Test Taker

Results

Michigan English TestScore Report

Registration Number Date of Test (mm/dd/yy)

SAMPLE NAME

000000001

BOGOTA COLOMBIA

04/25/19

01/01/89

City Country

Full Name Birthdate (mm/dd/yy)

SCORE: 51 CEFR: B1SectionListeningReadingSpeakingWriting

Score52515447

CEFRB1B1B2B1

SPACEFOR

PHOTO

SPACE FORCENTER LOGO/SEAL

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000000001

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000000001

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Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

000000001

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

000000001

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

BOGOTA

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

BOGOTA

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

BOGOTA

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

BOGOTA

01/01/89

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

01/01/89

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

01/01/89

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

01/01/89

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Full Name Birthdate (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

04/25/19

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

04/25/19

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Results

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Results

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

LINE FOR ADDITIONAL IDENTIFICATION INFORMATION

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

LINE FOR ADDITIONAL IDENTIFICATION INFORMATION

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Registration Number Date of Test (mm/dd/yy)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

City Country

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Results

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Results

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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COLOMBIA

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

COLOMBIA

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PHOTO

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SCORE:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SCORE:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

LINE FOR ADDITIONAL IDENTIFICATION INFORMATION

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LINE FOR ADDITIONAL IDENTIFICATION INFORMATION LINE FOR ADDITIONAL IDENTIFICATION INFORMATION

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LINE FOR ADDITIONAL IDENTIFICATION INFORMATION

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SCORE:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SCORE: 51

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

51

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SCORE:

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SCORE: 51

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

51 CEFR:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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51

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

51 CEFR:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR:Section

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Section

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CEFR:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR: B1

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

B1Section

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SectionListening

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Listening

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

B1

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B1

Listening

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

ListeningReading

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Reading

Score

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Score

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Reading

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Reading52

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

52CEFR

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

General Information

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Speaking

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Speaking51

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51

CEFR

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CEFRB1

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B1

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General Information

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

General Information

Writing

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Writing54

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

54B1

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

B1

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• The purpose of the Michigan English Test (MET) is to

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• The purpose of the Michigan English Test (MET) is to

General Information

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General Information

47

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47

B1

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B1

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• The purpose of the Michigan English Test (MET) is to

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• The purpose of the Michigan English Test (MET) is to evaluate general English profi ciency in educational,

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evaluate general English profi ciency in educational, social, and workplace contexts.

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social, and workplace contexts.

General Information

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General Information

47

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47B2

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B2

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• The purpose of the Michigan English Test (MET) is to

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The purpose of the Michigan English Test (MET) is to evaluate general English profi ciency in educational,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

evaluate general English profi ciency in educational, social, and workplace contexts.

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social, and workplace contexts.

• The MET is aimed at levels A2 to C1 of the Common

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• The MET is aimed at levels A2 to C1 of the Common

B1

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B1

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• The purpose of the Michigan English Test (MET) is to

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The purpose of the Michigan English Test (MET) is to evaluate general English profi ciency in educational,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

evaluate general English profi ciency in educational, social, and workplace contexts.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

social, and workplace contexts.

• The MET is aimed at levels A2 to C1 of the Common

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• The MET is aimed at levels A2 to C1 of the Common European Framework of Reference (CEFR). See reverse

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European Framework of Reference (CEFR). See reverse

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• The purpose of the Michigan English Test (MET) is to

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The purpose of the Michigan English Test (MET) is to evaluate general English profi ciency in educational,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

evaluate general English profi ciency in educational, social, and workplace contexts.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

social, and workplace contexts.

• The MET is aimed at levels A2 to C1 of the Common

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The MET is aimed at levels A2 to C1 of the Common European Framework of Reference (CEFR). See reverse

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

European Framework of Reference (CEFR). See reverse for an explanation of how section scores on the MET

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

for an explanation of how section scores on the MET

• MET scores represent a test taker’s English language

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• MET scores represent a test taker’s English language

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The MET is aimed at levels A2 to C1 of the Common

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The MET is aimed at levels A2 to C1 of the Common European Framework of Reference (CEFR). See reverse

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

European Framework of Reference (CEFR). See reverse for an explanation of how section scores on the MET

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

for an explanation of how section scores on the MET correspond to the CEFR.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

correspond to the CEFR.

• The overall score and CEFR level reported are averages of

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of

• MET scores represent a test taker’s English language

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• MET scores represent a test taker’s English language profi ciency at the time the test was taken and are valid

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profi ciency at the time the test was taken and are valid

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The MET is aimed at levels A2 to C1 of the Common

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The MET is aimed at levels A2 to C1 of the Common European Framework of Reference (CEFR). See reverse

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

European Framework of Reference (CEFR). See reverse for an explanation of how section scores on the MET

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

for an explanation of how section scores on the MET correspond to the CEFR.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

correspond to the CEFR.

• The overall score and CEFR level reported are averages of

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of the sections tested.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

the sections tested.

• MET scores represent a test taker’s English language

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• MET scores represent a test taker’s English language profi ciency at the time the test was taken and are valid

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

profi ciency at the time the test was taken and are valid as long as the test taker’s level of profi ciency does not

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

as long as the test taker’s level of profi ciency does not change. Because language profi ciency can change

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

change. Because language profi ciency can change

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

European Framework of Reference (CEFR). See reverse

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

European Framework of Reference (CEFR). See reverse for an explanation of how section scores on the MET

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

for an explanation of how section scores on the MET

• The overall score and CEFR level reported are averages of

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of the sections tested.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

the sections tested.

• A section score of X means the test taker was exempt from

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• A section score of X means the test taker was exempt from

• MET scores represent a test taker’s English language

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• MET scores represent a test taker’s English language profi ciency at the time the test was taken and are valid

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

profi ciency at the time the test was taken and are valid as long as the test taker’s level of profi ciency does not

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

as long as the test taker’s level of profi ciency does not change. Because language profi ciency can change

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

change. Because language profi ciency can change over time, score users are advised to consider the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

over time, score users are advised to consider the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of the sections tested.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

the sections tested.

• A section score of X means the test taker was exempt from

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• A section score of X means the test taker was exempt from that section. A section score of 0 means the test taker did

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

that section. A section score of 0 means the test taker did

• MET scores represent a test taker’s English language

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• MET scores represent a test taker’s English language profi ciency at the time the test was taken and are valid

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

profi ciency at the time the test was taken and are valid as long as the test taker’s level of profi ciency does not

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

as long as the test taker’s level of profi ciency does not change. Because language profi ciency can change

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

change. Because language profi ciency can change over time, score users are advised to consider the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

over time, score users are advised to consider the test taker’s experience with English since the time of the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

taker’s experience with English since the time of the test administration in addition to the test scores themselves.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

administration in addition to the test scores themselves.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of

• A section score of X means the test taker was exempt from

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• A section score of X means the test taker was exempt from that section. A section score of 0 means the test taker did

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

that section. A section score of 0 means the test taker did not attempt the section, or their answer was not on topic.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

not attempt the section, or their answer was not on topic.

profi ciency at the time the test was taken and are valid

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

profi ciency at the time the test was taken and are valid as long as the test taker’s level of profi ciency does not

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

as long as the test taker’s level of profi ciency does not change. Because language profi ciency can change

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

change. Because language profi ciency can change over time, score users are advised to consider the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

over time, score users are advised to consider the test taker’s experience with English since the time of the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

taker’s experience with English since the time of the test administration in addition to the test scores themselves.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

administration in addition to the test scores themselves.

• Michigan Language Assessment reserves the right to

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• Michigan Language Assessment reserves the right to

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• The overall score and CEFR level reported are averages of

• A section score of X means the test taker was exempt from

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• A section score of X means the test taker was exempt from that section. A section score of 0 means the test taker did

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

that section. A section score of 0 means the test taker did not attempt the section, or their answer was not on topic.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

not attempt the section, or their answer was not on topic.

change. Because language profi ciency can change

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

change. Because language profi ciency can change over time, score users are advised to consider the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

over time, score users are advised to consider the test taker’s experience with English since the time of the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

taker’s experience with English since the time of the test administration in addition to the test scores themselves.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

administration in addition to the test scores themselves.

• Michigan Language Assessment reserves the right to

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• Michigan Language Assessment reserves the right to update results or test taker information.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

update results or test taker information.

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• A section score of X means the test taker was exempt from

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• A section score of X means the test taker was exempt from that section. A section score of 0 means the test taker did

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

that section. A section score of 0 means the test taker did not attempt the section, or their answer was not on topic.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

not attempt the section, or their answer was not on topic.

over time, score users are advised to consider the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

over time, score users are advised to consider the test taker’s experience with English since the time of the test

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

taker’s experience with English since the time of the test administration in addition to the test scores themselves.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

administration in addition to the test scores themselves.

• Michigan Language Assessment reserves the right to

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• Michigan Language Assessment reserves the right to update results or test taker information.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

update results or test taker information.

• Institutions may verify test results at:

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

• Institutions may verify test results at:

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that section. A section score of 0 means the test taker did

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that section. A section score of 0 means the test taker did not attempt the section, or their answer was not on topic.

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not attempt the section, or their answer was not on topic.

taker’s experience with English since the time of the test

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taker’s experience with English since the time of the test administration in addition to the test scores themselves.

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administration in addition to the test scores themselves.

• Michigan Language Assessment reserves the right to

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• Michigan Language Assessment reserves the right to update results or test taker information.

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update results or test taker information.

• Institutions may verify test results at:

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• Institutions may verify test results at: MichiganAssessment.org.

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MichiganAssessment.org.

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not attempt the section, or their answer was not on topic.

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not attempt the section, or their answer was not on topic.

• Michigan Language Assessment reserves the right to

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• Michigan Language Assessment reserves the right to update results or test taker information.

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update results or test taker information.

• Institutions may verify test results at:

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• Institutions may verify test results at: MichiganAssessment.org.

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MichiganAssessment.org.

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• Institutions may verify test results at: MichiganAssessment.org.

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MichiganAssessment.org.

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© Cambridge Michigan Language Assessment 2019

For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score CEFR Level Description64 and above C1 Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

53 – 63 B2Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content. (Council of Europe, 2001: 68)

40 – 52 B1 Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

27-39 A2 Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

26 and below Below A2

MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score CEFR Level Description

64 and above C1Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as well as stated opinions. (Council of Europe, 2001: 70)

53 – 63 B2 Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

40 – 52 B1 Can read straightforward factual texts on subjects related to his/her fi eld and interest with a satisfactory level of comprehension. (Council of Europe, 2001: 69)

27-39 A2 Can understand short, simple texts containing the highest frequency vocabulary, including a proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

26 and below Below A2

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score CEFR Level Description64 and above C1 Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

53 – 63 B2Can use the language fl uently, accurately and effectively on a wide range of general, academic, vocational or leisure topics, marking clearly the relationships between ideas. (Council of Europe, 2001: 74)

40 – 52 B1 Can communicate with some confi dence on familiar routine and nonroutine matters related to his/her interests and professional fi eld. (Council of Europe, 2001: 74)

27-39 A2 Can communicate in simple and routine tasks requiring a simple and direct exchange of information on familiar and routine matters. (Council of Europe, 2001: 74)

26 and below Below A2

MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score CEFR Level Description

64 and above C1Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

53 – 63 B2Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options. (Council of Europe, 2001: 62)

40 – 52 B1 Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

27-39 A2 Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,” and “because.” (Council of Europe, 2001: 61)

26 and below Below A2

The Common European FrameworkThe main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main levels:

A1–A2 Basic User B1–B2 Independent User C1–C2 Profi cient User

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The Common European Framework

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The Common European Framework

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The Common European FrameworkThe main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The Common European Framework

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The Common European FrameworkThe main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main levels:

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levels:

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The Common European Framework

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The Common European FrameworkThe main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main levels:

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levels:

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The Common European Framework

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The Common European FrameworkThe main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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A1–A2 Basic User

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A1–A2 Basic User

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score

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Scaled Score

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A1–A2 Basic User

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A1–A2 Basic User

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score

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Scaled Score CEFR Level

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CEFR Level64 and above

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64 and above

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B1–B2 Independent User

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B1–B2 Independent User

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2CEFR Level

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CEFR Level64 and above

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64 and above

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B1–B2 Independent User

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B1–B2 Independent User

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

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The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

C1

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C1 Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

53 – 63

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53 – 63

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B1–B2 Independent User

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B1–B2 Independent User

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE The main purpose of the Common European Framework of Reference (CEFR) is to provide a common basis for the elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

elaboration of language syllabi, examinations, and textbooks. The CEFR describes language profi ciency at six main

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

53 – 63

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53 – 63 B2

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B2Can understand recordings in standard dialect likely to be encountered in social, professional,

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Can understand recordings in standard dialect likely to be encountered in social, professional,

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C1–C2 Profi cient User

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C1–C2 Profi cient User

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Listening Scores that correspond to CEFR Levels C1, B2, B1, and A2Description

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DescriptionCan follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

Can understand recordings in standard dialect likely to be encountered in social, professional,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content.

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or academic life and identify speaker viewpoints and attitudes as well as the information content.

40 – 52

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40 – 52

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C1–C2 Profi cient User

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C1–C2 Profi cient User

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Description

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DescriptionCan follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

Can understand recordings in standard dialect likely to be encountered in social, professional,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content.

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or academic life and identify speaker viewpoints and attitudes as well as the information content. (Council of Europe, 2001: 68)

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(Council of Europe, 2001: 68)

B1

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B1

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C1–C2 Profi cient User

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C1–C2 Profi cient User

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

Can understand recordings in standard dialect likely to be encountered in social, professional,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content.

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or academic life and identify speaker viewpoints and attitudes as well as the information content. (Council of Europe, 2001: 68)

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(Council of Europe, 2001: 68)Can understand the main points of clear standard speech on familiar matters regularly encountered

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Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

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in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

27-39

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27-39

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

Can understand recordings in standard dialect likely to be encountered in social, professional,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content.

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or academic life and identify speaker viewpoints and attitudes as well as the information content. (Council of Europe, 2001: 68)

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(Council of Europe, 2001: 68)Can understand the main points of clear standard speech on familiar matters regularly encountered

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Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

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in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

A2

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A2 Can understand and extract the essential information from short, recorded passages dealing with

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Can understand and extract the essential information from short, recorded passages dealing with

26 and below

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26 and below

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

Can understand recordings in standard dialect likely to be encountered in social, professional,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

or academic life and identify speaker viewpoints and attitudes as well as the information content.

Can understand the main points of clear standard speech on familiar matters regularly encountered

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)Can understand and extract the essential information from short, recorded passages dealing with

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

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predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

26 and below

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26 and below Below A2

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Below A2

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MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

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Can follow most lectures, discussions, and debates with relative ease. (Council of Europe, 2001: 67)

Can understand recordings in standard dialect likely to be encountered in social, professional,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content.

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or academic life and identify speaker viewpoints and attitudes as well as the information content.

Can understand the main points of clear standard speech on familiar matters regularly encountered

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)Can understand and extract the essential information from short, recorded passages dealing with

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

Below A2

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Below A2

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MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Scaled Score

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand recordings in standard dialect likely to be encountered in social, professional, or academic life and identify speaker viewpoints and attitudes as well as the information content.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

or academic life and identify speaker viewpoints and attitudes as well as the information content.

Can understand the main points of clear standard speech on familiar matters regularly encountered

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)Can understand and extract the essential information from short, recorded passages dealing with

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Scaled Score CEFR Level

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CEFR Level

64 and above

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

64 and above

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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or academic life and identify speaker viewpoints and attitudes as well as the information content.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

or academic life and identify speaker viewpoints and attitudes as well as the information content.

Can understand the main points of clear standard speech on familiar matters regularly encountered

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)Can understand and extract the essential information from short, recorded passages dealing with

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2CEFR Level

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR Level

64 and above

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

64 and above

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Can understand the main points of clear standard speech on familiar matters regularly encountered

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand the main points of clear standard speech on familiar matters regularly encountered in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

in work, school, leisure, etc., including short narratives. (Council of Europe, 2001: 66)Can understand and extract the essential information from short, recorded passages dealing with

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

C1

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C1Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

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Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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Can understand and extract the essential information from short, recorded passages dealing with

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Reading Scores that correspond to CEFR Levels C1, B2, B1, and A2

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

professional, or academic life, identifying fi ner points of detail including attitudes and implied as well as stated opinions. (Council of Europe, 2001: 70)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

well as stated opinions. (Council of Europe, 2001: 70)

53 – 63

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53 – 63

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Can understand and extract the essential information from short, recorded passages dealing with

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand and extract the essential information from short, recorded passages dealing with predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

predictable everyday matters that are delivered slowly and clearly. (Council of Europe, 2001: 68)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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Description

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

DescriptionCan understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

professional, or academic life, identifying fi ner points of detail including attitudes and implied as well as stated opinions. (Council of Europe, 2001: 70)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

well as stated opinions. (Council of Europe, 2001: 70)

B2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

B2 Can read with a large degree of independence, adapting style and speed of reading to different texts

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Can read with a large degree of independence, adapting style and speed of reading to different texts

40 – 52

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40 – 52

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Description

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

DescriptionCan understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

professional, or academic life, identifying fi ner points of detail including attitudes and implied as well as stated opinions. (Council of Europe, 2001: 70)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

well as stated opinions. (Council of Europe, 2001: 70)Can read with a large degree of independence, adapting style and speed of reading to different texts

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

40 – 52

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40 – 52 B1

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

B1

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

professional, or academic life, identifying fi ner points of detail including attitudes and implied as well as stated opinions. (Council of Europe, 2001: 70)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

well as stated opinions. (Council of Europe, 2001: 70)Can read with a large degree of independence, adapting style and speed of reading to different texts

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a satisfactory level of comprehension. (Council of Europe, 2001: 69)

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satisfactory level of comprehension. (Council of Europe, 2001: 69)

27-39

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27-39

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

professional, or academic life, identifying fi ner points of detail including attitudes and implied as well as stated opinions. (Council of Europe, 2001: 70)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

well as stated opinions. (Council of Europe, 2001: 70)Can read with a large degree of independence, adapting style and speed of reading to different texts

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a satisfactory level of comprehension. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

satisfactory level of comprehension. (Council of Europe, 2001: 69)

A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

A2 Can understand short, simple texts containing the highest frequency vocabulary, including a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a

26 and below

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

26 and below

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

professional, or academic life, identifying fi ner points of detail including attitudes and implied as

Can read with a large degree of independence, adapting style and speed of reading to different texts

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a satisfactory level of comprehension. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

satisfactory level of comprehension. (Council of Europe, 2001: 69)Can understand short, simple texts containing the highest frequency vocabulary, including a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

26 and below

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26 and below Below A2

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Below A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand in detail a wide range of lengthy, complex texts likely to be encountered in social, professional, or academic life, identifying fi ner points of detail including attitudes and implied as

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

professional, or academic life, identifying fi ner points of detail including attitudes and implied as

Can read with a large degree of independence, adapting style and speed of reading to different texts

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a satisfactory level of comprehension. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

satisfactory level of comprehension. (Council of Europe, 2001: 69)Can understand short, simple texts containing the highest frequency vocabulary, including a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

Below A2

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Below A2

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Scaled Score

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a satisfactory level of comprehension. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

satisfactory level of comprehension. (Council of Europe, 2001: 69)Can understand short, simple texts containing the highest frequency vocabulary, including a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Scaled Score CEFR Level

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR Level64 and above

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

64 and above

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read with a large degree of independence, adapting style and speed of reading to different texts and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

and purposes, and using appropriate reference sources selectively. (Council of Europe, 2001: 69)Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a satisfactory level of comprehension. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

satisfactory level of comprehension. (Council of Europe, 2001: 69)Can understand short, simple texts containing the highest frequency vocabulary, including a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2CEFR Level

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR Level64 and above

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

64 and above C1

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

C1

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can read straightforward factual texts on subjects related to his/her fi eld and interest with a

Can understand short, simple texts containing the highest frequency vocabulary, including a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

C1

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

C1 Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

53 – 63

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53 – 63

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can understand short, simple texts containing the highest frequency vocabulary, including a proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

proportion of shared international vocabulary items. (Council of Europe, 2001: 69)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Speaking Scores that correspond to CEFR Levels C1, B2, B1, and A2

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

B2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

B2Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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Description

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

DescriptionCan express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can use the language fl uently, accurately and effectively on a wide range of general, academic, vocational or leisure topics, marking clearly the relationships between ideas.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

academic, vocational or leisure topics, marking clearly the relationships between ideas. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

(Council of Europe, 2001: 74)

40 – 52

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40 – 52

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Description

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

DescriptionCan express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can use the language fl uently, accurately and effectively on a wide range of general, academic, vocational or leisure topics, marking clearly the relationships between ideas.

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academic, vocational or leisure topics, marking clearly the relationships between ideas. (Council of Europe, 2001: 74)

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(Council of Europe, 2001: 74)

B1

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B1 Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

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Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

27-39

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27-39

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Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can use the language fl uently, accurately and effectively on a wide range of general, academic, vocational or leisure topics, marking clearly the relationships between ideas.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

academic, vocational or leisure topics, marking clearly the relationships between ideas. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

(Council of Europe, 2001: 74)Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/her interests and professional fi eld. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

her interests and professional fi eld. (Council of Europe, 2001: 74)

27-39

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27-39 A2

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A2

26 and below

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26 and below

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Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can use the language fl uently, accurately and effectively on a wide range of general, academic, vocational or leisure topics, marking clearly the relationships between ideas.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

academic, vocational or leisure topics, marking clearly the relationships between ideas.

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/her interests and professional fi eld. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

her interests and professional fi eld. (Council of Europe, 2001: 74)

A2

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A2 Can communicate in simple and routine tasks requiring a simple and direct exchange of information

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Can communicate in simple and routine tasks requiring a simple and direct exchange of information on familiar and routine matters. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

on familiar and routine matters. (Council of Europe, 2001: 74)

26 and below

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26 and below

MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

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Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can use the language fl uently, accurately and effectively on a wide range of general, academic, vocational or leisure topics, marking clearly the relationships between ideas.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

academic, vocational or leisure topics, marking clearly the relationships between ideas.

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/her interests and professional fi eld. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

her interests and professional fi eld. (Council of Europe, 2001: 74)Can communicate in simple and routine tasks requiring a simple and direct exchange of information

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate in simple and routine tasks requiring a simple and direct exchange of information on familiar and routine matters. (Council of Europe, 2001: 74)

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on familiar and routine matters. (Council of Europe, 2001: 74)

Below A2

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Below A2

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can express him/herself fl uently and spontaneously, almost effortlessly. (Council of Europe, 2001: 74)

Can use the language fl uently, accurately and effectively on a wide range of general,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can use the language fl uently, accurately and effectively on a wide range of general, academic, vocational or leisure topics, marking clearly the relationships between ideas.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

academic, vocational or leisure topics, marking clearly the relationships between ideas.

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/her interests and professional fi eld. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

her interests and professional fi eld. (Council of Europe, 2001: 74)Can communicate in simple and routine tasks requiring a simple and direct exchange of information

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate in simple and routine tasks requiring a simple and direct exchange of information on familiar and routine matters. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

on familiar and routine matters. (Council of Europe, 2001: 74)

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2Scaled Score

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Scaled Score

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academic, vocational or leisure topics, marking clearly the relationships between ideas.

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academic, vocational or leisure topics, marking clearly the relationships between ideas.

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/her interests and professional fi eld. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

her interests and professional fi eld. (Council of Europe, 2001: 74)Can communicate in simple and routine tasks requiring a simple and direct exchange of information

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate in simple and routine tasks requiring a simple and direct exchange of information on familiar and routine matters. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

on familiar and routine matters. (Council of Europe, 2001: 74)

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2CEFR Level

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

CEFR Level

64 and above

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64 and above

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Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

Can communicate in simple and routine tasks requiring a simple and direct exchange of information

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate in simple and routine tasks requiring a simple and direct exchange of information on familiar and routine matters. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

on familiar and routine matters. (Council of Europe, 2001: 74)

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

64 and above

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

64 and above

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Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate with some confi dence on familiar routine and nonroutine matters related to his/

Can communicate in simple and routine tasks requiring a simple and direct exchange of information

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can communicate in simple and routine tasks requiring a simple and direct exchange of information on familiar and routine matters. (Council of Europe, 2001: 74)

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

on familiar and routine matters. (Council of Europe, 2001: 74)

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

C1

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

C1Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

expanding and supporting points of view at some length with subsidiary points, reasons and

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

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Can communicate in simple and routine tasks requiring a simple and direct exchange of information

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Can communicate in simple and routine tasks requiring a simple and direct exchange of information

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

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MET Writing Scores that correspond to CEFR Levels C1, B2, B1, and A2

Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues,

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and

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expanding and supporting points of view at some length with subsidiary points, reasons and relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

53 – 63

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53 – 63

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Can communicate in simple and routine tasks requiring a simple and direct exchange of information

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Can communicate in simple and routine tasks requiring a simple and direct exchange of information

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Description

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DescriptionCan write clear, well-structured texts of complex subjects, underlining the relevant salient issues,

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and

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expanding and supporting points of view at some length with subsidiary points, reasons and relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

B2

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B2Can write an essay or report which develops an argument, giving reasons in support of or against

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Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options.

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a particular point of view and explaining the advantages and disadvantages of various options.

40 – 52

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40 – 52

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues,

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and

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expanding and supporting points of view at some length with subsidiary points, reasons and relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)Can write an essay or report which develops an argument, giving reasons in support of or against

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Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options.

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a particular point of view and explaining the advantages and disadvantages of various options. (Council of Europe, 2001: 62)

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(Council of Europe, 2001: 62)

40 – 52

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40 – 52

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues,

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and

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expanding and supporting points of view at some length with subsidiary points, reasons and relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)Can write an essay or report which develops an argument, giving reasons in support of or against

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Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options.

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a particular point of view and explaining the advantages and disadvantages of various options. (Council of Europe, 2001: 62)

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(Council of Europe, 2001: 62)

B1

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B1 Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

27-39

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27-39

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues,

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

expanding and supporting points of view at some length with subsidiary points, reasons and relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)Can write an essay or report which develops an argument, giving reasons in support of or against

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Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options.

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a particular point of view and explaining the advantages and disadvantages of various options. (Council of Europe, 2001: 62)

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(Council of Europe, 2001: 62)Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

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by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

A2

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A2

26 and below

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26 and below

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues,

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Can write clear, well-structured texts of complex subjects, underlining the relevant salient issues, expanding and supporting points of view at some length with subsidiary points, reasons and

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expanding and supporting points of view at some length with subsidiary points, reasons and relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)Can write an essay or report which develops an argument, giving reasons in support of or against

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Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options.

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a particular point of view and explaining the advantages and disadvantages of various options.

Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

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by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,” and “because.” (Council of Europe, 2001: 61)

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and “because.” (Council of Europe, 2001: 61)

26 and below

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26 and below Below A2

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Below A2

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)

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relevant examples, and rounding off with an appropriate conclusion. (Council of Europe, 2001: 61)Can write an essay or report which develops an argument, giving reasons in support of or against

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Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options.

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a particular point of view and explaining the advantages and disadvantages of various options.

Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

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by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,” and “because.” (Council of Europe, 2001: 61)

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and “because.” (Council of Europe, 2001: 61)

Below A2

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Below A2

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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Can write an essay or report which develops an argument, giving reasons in support of or against

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Can write an essay or report which develops an argument, giving reasons in support of or against a particular point of view and explaining the advantages and disadvantages of various options.

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

a particular point of view and explaining the advantages and disadvantages of various options.

Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE

Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

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by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,” and “because.” (Council of Europe, 2001: 61)

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and “because.” (Council of Europe, 2001: 61)

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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a particular point of view and explaining the advantages and disadvantages of various options.

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a particular point of view and explaining the advantages and disadvantages of various options.

Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

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by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,” and “because.” (Council of Europe, 2001: 61)

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and “because.” (Council of Europe, 2001: 61)

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

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by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest,

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Can write straightforward connected texts on a range of familiar subjects within his/her fi eld of interest, by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)

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by linking a series of shorter discrete elements into a linear sequence. (Council of Europe, 2001: 61)Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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Can write a series of simple phrases and sentences linked with simple connectors like “and,” “but,”

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© Cambridge Michigan Language Assessment 2019

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© Cambridge Michigan Language Assessment 2019

For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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© Cambridge Michigan Language Assessment 2019

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© Cambridge Michigan Language Assessment 2019

For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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For more information about MET scores, including verifi cation of scores, visit MichiganAssessment.org.

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© Cambridge Michigan Language Assessment 2019

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© Cambridge Michigan Language Assessment 2019

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© Cambridge Michigan Language Assessment 2019

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© Cambridge Michigan Language Assessment 2019

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