BILL ANALYSIS
------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 294|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
THIRD READING
Bill No: SB 294
Author: Negrete McLeod (D)
Amended: 3/31/09
Vote: 21
SENATE BUS., PROF. & ECON. DEVEL. COMMITTEE : 6-1, 4/13/09
AYES: Negrete McLeod, Corbett, Oropeza, Romero, Walters,
Yee
NOES: Aanestad
NO VOTE RECORDED: Wyland, Correa, Florez
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Nurse practitioners
SOURCE : California Association of Nurse Practitioners
DIGEST : This bill authorizes entities delivering health
care services to establish standardized procedures that
expand the duties of a nurse practitioner as specified.
ANALYSIS :
Existing law:
1. Establishes the Nursing Practice Act which provides for
the certification and regulation of nurses, nurse
practitioners and nurse-midwives by the Board of
Registered Nursing (BRN) and requires the BRN to
establish categories and standards for nurse
CONTINUED
SB 294
Page
2
practitioners in consultation with specified health care
practitioners, including physicians and surgeons.
2. Defines the practice of nursing as those functions,
including basic health care, that help people cope with
difficulties in daily living that are associated with
their actual or potential health or illness problems,
and that require a substantial amount of scientific
knowledge or technical skill, as specified.
3. Defines standardized procedures to mean either of the
following:
(1) Policies and protocols developed by a licensed
health facility, as defined, through collaboration
among administrators and health professionals
including physicians and nurses.
(2) Policies and protocols developed through
collaboration among administrators and health
professionals, including physicians and nurses, by
an organized health care system which is not a
licensed health facility. Specifies that the
policies and protocols shall be subject to any
guidelines for standardized procedures that the
Medical Board of California (MBC) and the BRN may
jointly promulgate. If promulgated, the guidelines
shall be administered by the BRN.
4. Defines by regulation that a nurse practitioner is a
registered nurse who possesses additional preparation
and skills in physical diagnosis, psychosocial
assessment, and management of health-illness needs in
primary health care, and who has been prepared in a
program that conforms to BRN standards, as specified.
Defines primary health care as that which occurs when a
consumer makes contact with a health care provider who
assumes responsibility and accountability for the
continuity of health care regardless of the presence or
absence of disease.
5. Prescribes standards and conditions for the use of the
title "nurse practitioner." Prohibits a person from
advertising or holding himself/herself out as a nurse
SB 294
Page
3
practitioner who is not a licensed nurse and does not
meet the standards for a nurse practitioner as
established by the BRN.
6. Authorizes nurse practitioners to furnish or order drugs
under certain conditions, pursuant to standardized
procedures or protocols and under the supervision of a
physician and surgeon. Prohibits construing physician
and surgeon supervision to require physical presence of
the physician, but does include: (1) collaboration on
the development of the standardized procedure, (2)
approval of the standardized procedure, and (3)
availability by telephonic contact at the time of
patient examination by the nurse practitioner.
7. Requires an applicant for disability to establish
medical eligibility for disability benefits to be
supported by a certificate of a treating physician or
practitioner that establishes sickness, injury, or
pregnancy of an employee.
This bill:
1. Authorizes the implementation of standardized
procedures, pursuant to existing law, allowing a nurse
practitioner to perform the following functions:
(1) Order durable medical equipment, subject to any
limitations set forth in the standardized
procedures. Specifies that this authority does not
limit the ability of a third-party payor to require
prior approval.
(2) Certify disability, as specified, after
performance of a physical examination by the nurse
practitioner and collaboration with a physician and
surgeon.
(3) Approve, sign, modify or add to a plan of
treatment or plan of care for individuals receiving
home health services or personal care services
after consultation with the treating physician and
surgeon.
SB 294
Page
4
2. Specifies that the functions specified in item #1) above
are in addition to any other practices that meet the
general criteria set forth in statute or regulation for
inclusion in standardized procedures developed through
collaboration among administrators and health
professionals, including physicians and surgeons and
nurses.
3. Specifies that this bill should not be construed to
affect the validity of any standardize procedures and
protocols in effect prior to the enactment of this
section or those adopted subsequent to enactment of this
bill.
4. Makes legislative findings and declarations on the need
to clarify that standardized procedures and protocols
may include specified services and functions.
Background
Scope of Practice of Nurse Practitioners . Current
regulations define a nurse practitioner as a registered
nurse who possesses additional preparation and skills in
physical diagnosis, psychosocial assessment, and management
of health-illness needs in primary health care, and who has
been prepared in a program that conforms to BRN standards,
as specified. The Nursing Practice Act enunciates the
scope of practice of nurses, and it states that the
practice of nursing includes: (1) direct and indirect
patient care services that ensure the safety, comfort,
personal hygiene, and protection of a patient; (2) and the
performance of disease prevention and restorative measures;
(3) direct and indirect patient care services, including,
but not limited to, the administration of medications and
therapeutic agents, necessary to implement a treatment,
disease prevention, or rehabilitation regimen ordered by
and within the scope of licensure of a physician, dentist,
podiatrist and clinical psychologist; the performance of
skin tests, immunization techniques, and the withdrawal of
blood from veins and arteries; (4) observation of signs and
symptoms of illness, reactions to treatment, general
behavior, or general physical condition, and determining
whether the signs, symptoms, reaction, behaviors, or
general appearance exhibit abnormal characteristics; (5)
SB 294
Page
5
and implementation, based on observed abnormalities, of
appropriate reporting, or referral, or standardized
procedure, or changes in treatment regimen in accordance
with standardized procedures, or the initiation of
emergency procedures. Standardized procedures are the
legal mechanism for RNs and NPs to perform functions which
otherwise would be considered the practice of medicine.
Standardized procedures guidelines are to be adhered to by
RNs and NPs when performing medical functions. The
standardized procedures must be developed collaboratively
by nursing, medicine, and administration in the organized
health care system where they will be utilized. The
Medical Practice Act includes diagnosis of mental or
physical conditions, the use of drugs in or upon human
beings and severing or penetrating tissue of human beings
as the practice of medicine. The performance of any of
these functions by a registered nurse or nurse practitioner
requires a standardized procedure.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 4/29/09)
California Association of Nurse Practitioners (source)
California Association for Health Services at Home
United Nurses Association of California/Union of Health
Care Professionals
ARGUMENTS IN SUPPORT : According to the Sponsor, the
California Association of Nurse Practitioners (CANP), this
bill codifies specific minimum duties that a nurse
practitioner may perform under a standardized procedure.
Existing law authorizes nurse practitioners (who are
registered nurses who have advanced education and training
and have been certified by the BRN as a nurse practitioner
to provide services beyond the scope of a registered nurse
utilizing the standardized procedure. The standardized
procedure is developed collaboratively with the physician
and the facility that the nurse practitioner works with.
CANP points out that existing law is silent on which
specific duties a nurse practitioner may perform and
instead allows these duties to be delineated in the
standardized procedure, which serves as the governing
SB 294
Page
6
document outlining the duties a nurse practitioner may
perform in his or her practice setting. Many physicians
rely upon nurse practitioners to handle the routine health
care needs of their patients and delegate great
responsibility to them. However, because ambiguity exists
in current law as to what duties may be performed under a
standardized procedure, many nurse practitioners experience
bureaucratic barriers which then delay consumers access to
timely care. For example, a physician may authorize a
nurse practitioner to order durable medical equipment for
his or her patients as needed and may have outlined this in
the standardized procedure. However, because existing law
is silent on the ability of nurse practitioners to order
these supplies, third party payers and suppliers often
reject an order placed by a nurse practitioner. This
typically results in the patient being required to come
back to the office, be seen by the physician, and then the
physician must re-place the order; all of this results in a
delay in the patient receiving needed care.
JJA:do 4/29/2009 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****