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Discussion

Endorsment and Exhibit forms

Hi guys. Ive been reading about endorsement of RN license to CA for months now and the cause of denial with applications are always the same - concurrency.

I just wanna ask you folks about the "idea" on concurrency. BtW, i was a nsg educator back in PH and of course i have a full understanding about the curriculum offered there. I noticed that CA has been using EXHIBIT FORMS as basis to check concurrency of theory and practice because many nsg schools in the philippines fall short in having a detailed documentation for the clinicals of students. While it may sound logical to use the exhibit form, cases written there are not always concurrent with the relevant subjects because the number of cases required by the prc for LICENSURE PURPOSES may not be met within the scheduled clinical rotation. Consequently, students do additional cases in compliance with the said licensure requirement which makes the exhibit (some cases) seemingly incongruent to the schedule of subjects presented on the transcript or RLE summary.

If I have to quote the B&P code of CA, the concurrency talks about the subj and its clinical portion. To determine concurrency, theory must be taken SIMULTANEOUSLY with clinicals (with appropriate number of hours).

For us PH grads, the subjects both theory and RLE can be seen in the TOR but presented in cluster - example NCM 102 and NCM 102-RLE which are both taken within the same semester. With this, TOR deemed to be insufficient document to determine whether nsg concepts within the subject were taken concurrently with the clinicals because the TOR doesnt show/itemize the nsg concepts within the given subject (not to mention also the exact dates). This gives way to the idea of a need to have other document that can support concurrency. and this what CBRN is actually doing. They are using EXHIBIT FORMS (not to mention other docs) because it show dates of SPECIFIC CASES that may be compared to relevant nsg concept - say, newborn delivery MUST be performed only when Maternity/OB concept was already taught. This strategy of using clinical exhibits is very reasonable.

But i would like to point out that EXHIBITS are not legitimate documents that equates CLINICAL PORTION of the subject. It is just a DOCUMENTATION of SPECIFIC PROCEDURES that are needed later for the application of PH nsg licensure. Obviously, a student will still finish the BSN program without the exhibits (like the case of US citizen, who doesnt have plans to practice in the PH) provided that he undergone the required curriculum - that is taking needed subjects and the recommended hrs for clinicals. If he does so, then he is a BSN graduate, but not a Phil. RN, because to become a Phil.RN, you need not only be a graduate of BSN but also passed the licensure exam which entails submission of COMPLETED EXHIBIT.

Say, a student finished his NCM 101 with 6 cases (2actual deliveries, 3assisted deliveries, 1 cordcare), does not mean that this student lacks the needed hours for the clinicals nor he is deficient of needed subjects. This student completed the number of hours needed for the subj/clinicals but was not able to finish the needed cases for LICENSURE. The completion cases that may be done in the future if this student will take the PNLE should not be regarded as part of the curriculum because the additional cases dont give merit to the TOR anymore nor the diploma granted during graduation. Completion is done for licensure purposes and not for completing the nursing curriculum. therefore, if the student doesnt have the completed exhibit forms and will not take the board exam, it doesnt make him a lesser BSN graduate. He is still a BSN graduate but unlicensed. If we have to submit the TOR of this graduate to the CGFNs, the curriculum he acquired still is comparable with BSN in the US.

So, can exhibit forms be used to check concurrency? definitely YES. However, cases should not be regarded as exact equivalent of clinical portion. a case or two congruent with the relevant nsg subject is ENOUGH information to support concurrency. The remaining cases that seemingly out of place should not automatically interpreted as not acceptable. This reason makes the exhibit form a misleading documentation to prove concurrency if

the evaluator doesnt have full grasp of the idea.

I really wonder nobody gets the same idea in the forum (or maybe i just havent find one). Or not even one made this thing clear during the meeting of CBRN with the CHED and PNA of America. Or maybe, CHED or PNA doesnt know that CBRN were using the exhibit forms in the said manner.

If you happen to read the position statement of PNA of America and CHED regarding this matter, both agree with the CBRNs regulations. While it is true that they empasize concurrency, the position statements don't talk about exhibit forms as part of curricular requirement - it is still a licensure requirement in the Phil. However, i knew from the nursing school i worked before, that the number of cases required was already reduced and that it must be completed before graduation. does it sound logical? No! first, it just means that they did not CATCH the whole point- that exhibits are not a curricular requirement, it is only a documentation. where did these changes are anchored into? what is the legal basis? is there a CHED memorandum on this? when did it start? after the joint meeting? as an educator, the most important concern in the nsg curriculum is honing the student to acquire the needed competency in each key areas of responsibilities... and not just collecting cases. Delivering a baby, doing cord care, assisting an operation are just small chunks from the truest essence of becoming a competent nurse. We have to understand that many other procedures not listed in these exhibit forms are performed- like FHT monitoring, administering MgSO4 for maternal High BP, perineal prep, etc. This should be the focus of the documentation. Improving or devising a record that supports concurrency.

But for the concern of many, this is my ONLY point - misconception/misuse of the exhibit forms.

BTW, if your RLE summary and TOR are not congruent to each other, thats a different case. This post is limited only to those who were denied based on exhibit forms. And one more thing, if you have not performed even 1 case in the scheduled clinical rotation, that makes it impossible to contest concurrency using exhibit forms. and I must admit, you should be denied on that. But for those who have at least 2 cases that were actually performed during the scheduled clinicals, it must be enough to prove concurrency.

Im sorry I have to say this, I really wonder why theres so many blahblahblah in the forum, when the main concern is actually concurrency. We just have to prove to the board concurreny of our subjects. But considering ALL cases in the exhibit form as clinical equivalent.., thats just so wrong.

Good luck to us.

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    • Featured Replies

    Yes, we have discussed this matter briefly and before.

    Yes, from the following linkage and paraphrase from the article of the "Position statement" by the Philippines Nurses Assoc of Southern California: "The Philippine delegation of CHED explained that the Philippine BSN curriculum requires concurrency of theory and related/enhancement learning experiences (RLEs), however, are not well documented in the transcripts. To help resolve the issues, the delegates will (1) arrange for an urgent meeting with all the Deans of College of Nursing to discuss and develop a template for transcripts and related documents that will reflect accurate documentation of students' educational experience..." It has been acknowledged that of the method of documentation of the PH transcripts.

    But again, the proof of burden remains with the CHED and all the PH nursing schools to provide the CA BRN evaluators with the transcripts so that they can fit within the parameters of the Exhibit forms you refer to. If the square peg doesn't fit in the circled hole, it will simply be rejected. The Exhibit forms are also meant for any local, domestic and international transcripts.

    It is up to the CHED, PRC and PNA to put something together so that it blends in with what the CA BRN requirements as the CA BRN will not make any adjustments to their several decades of rules and regulations that works well for them.

    There's no reason for the CA BRN to make exceptions to any one school/college, whether they are from CA themselves, out of state or out of the country. If one wants to work and practice in CA, then, the game rules are there and everyone must comply with them. If not, there are 49 other possible states that might fit the transcripts pattern or not as strict.

    In fact, I've had a few interesting discussions with others and the mind blowing thoughts: that it's very possible if the PH transcripts in the future still can not adjust the transcripts to reflect the PH nursing curriculum to be in compliance with the concurrency rules, CGFN evaluators may start to decline and reject the 1,000's upon 1,000's of PH grads and nurses for not complying with the same concurrency rules (of those 13 states with the known concurrency regulations) as what the CA BRN is doing.

    While you have on your title topic heading mentions "Endorsement", don't forget that this same concurrency rules also applies to any and all first-time CA applicants and it doesn't matter if you're a CA resident, out of state or out of the country person.

    ** On another note: there have been at least two PH posters who went all the way to the final Appeals process with the CA BRN, one did use the SAME argument you have so mentioned and the end result was that the application was still denied.

    Maybe someone will be reading this thread here and maybe thinking of also appealing their declined application with the CA BRN, this would be a good time for this person if so interested to have you write the argumentative points so they can present them to the CA BRN appeals panel.

    I'm sure the CA BRN and the CHED in their meeting, must know of the same Exhibit forms you mentioned as that's the whole basis point. If the CHED could not convince that the CA BRN needs to closer look at this, I think the CA BRN did and to this day, the CHED has not been able to provide the assistance that has stranded 10,000 plus PH applicants in CA alone (since the Nov. 2011 enforcement period).

    Maybe write to the person(s) in charge of the proposed changes to the Deans of College of Nursing in the PH and if they haven't already used your arguments (but seriously can't believe they already have done so) to give the PH a chance. If the person says they did try and it was not convincing to the CA BRN board, then, it's back to square one.

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    • Author

    i dont exactly understand why you are talking about deficiency of transcript. well,to me, theres nothing wrong with the structure of TOR from PH schools. If you mean about the itemization of concepts within the subjects, thats pretty normal not having a list of concepts written in the TOR. This is the reason why course description is needed when submitting your TOR for evaluation. And improving transcript to fit in with the cases in the exhibits does not make any sense because there is no problem with the TOR. If your school in PH follows the CHED policies and standards for BSN program, chances is that the BSN transcript is more than enough than the prelicensure courses offered here. Again I am not talking about the deficiency of transcript nor the number of hrs alloted for the clinicals. I am pointing out that there should be a CLEAR delineation of EXHIBIT as a LICENSURE requirement and never be regarded as PART OF THE CURRICULUM. If the exhibit will be used to check concurrency, then it must be known that not all cases were performed during the nsg program due to aforementioned reason. and given that exhibits are not a curricular requirement then the board should be opened to the idea that not all graduates can provide them a copy of this - say a US citizen who had education in PH and didnt take the local boards. In this case, the student has to produce a document that validates concurrency of theory and practice.

    To give you a better picture of my concern, below is a simple presentation of exhibit,

    Example:

    Per TOR, NCM 103 was taken SY 2007-2008, 2nd semester

    Exhibits:

    Case 1 - Dec 1, 2008

    Case 2 - Dec 7, 2008

    Case 3 - Dec 10, 2008

    Case 4 - April 3, 2011

    Case 5 - April 3, 2011

    As you see above, Case 1, 2, 3 are performed within the set schedule and they are concurrent to the subject as presented in the TOR. However, since cases 4 & 5 are obviously done years after the subject was taken(perhaps after graduation), it could be misinterpreted as not concurrent. This very point is what im trying to discuss. I knew few applicants for endorsement who were denied because of this. FYI, their clinical hours and subjects are sufficient, but since not all cases are done during the set schedule of the subject, they were still denied and advised to take again related subjects covered by the exhbits, that is MS and OB.

    Is the case above denied due to concurrency? I dont think it is. It was denied due to misinterpretation of the exhibits. Like in the above exhibit, 3 cases simultaneous to the relevant subject is a SOLID proof that there was really a CLINICAL DUTY that took place at the time when a related subject was tackled. However, since CBRN wants applicants to have all cases finished before the end of the rotation, then the basis of their denial is OBVIOUSLY not of CONCURRENCY. In this case, the student should have presented other docs that supports concurrency of theory and practice. It could be a clinical checklist with dates and signatories because this document can be counterchecked through transcript. BUT then again, since CBRN has idea already about the existence of exhibits, they automatically deny applicants with same presentation of exhibits as above.

    Now tell me, how do you understand concurrency (only) in the case above?

    Honestly, I will accept to whatever policy CBRN has to present tous but analysing the exhibit in the above manner is just wrong. It would have been better if they will just reject applicants because they are foreign graduates. By that, IEN will be warned and not waste anymore their money and time by attempting to process an application.

    anyway, thats just my concern here. denial on the basis of concurrency using the exhibit that contains 2 or 3 cases congruent to the related theory

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    Hi, there, just FYI, I'm a PH Filipina myself and well aware of being denied the ATT in CA, lol.

    I get it.

    Did you already apply and got denied? Or simply wrote to them or?

    Well, wait for your CA BRN letter from them and hoping for the best results for you. However, in the event, you are denied please do file an appeal immediately or within one year of your rejection letter. If not done by then, you will lose your rights to that process.

    It's really up to the CA BRN to make the final decision. Have your case presentation ready to go, keep us posted, please.

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    Have there been any updates on your licensing status with the CA BRN? Hope it's all good news!

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