BILL ANALYSIS
SB 294
Page 1
Date of Hearing: June 30, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
SB 294 (Negrete McLeod) - As Amended: June 8, 2009
SENATE VOTE : 25-11
SUBJECT : Nurse practitioners.
SUMMARY : Expands the authorized functions that may be
performed by nurse practitioners (NP) practicing under standard
procedures. Specifically, this bill :
1)Expands the authorized functions that may be performed by an
NP practicing under standardized procedures to include:
a) Ordering 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;
b) Certifying disability, as specified, after performance
of a physical examination by the NP and collaboration with
a physician and surgeon; and,
c) Approving, signing, modifying or adding 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.
2)Prohibits this bill from being construed to affect the
validity of any standard procedures and protocols in effect
prior to the enactment of this bill or those adopted
subsequent to the enactment of this bill.
3)Makes legislative findings and declarations.
EXISTING LAW :
1)Establishes the Nursing Practice Act which provides for the
certification and regulation of nurses, NPs and nurse-midwives
by the Board of Registered Nursing (BRN) and requires the BRN
to establish categories and standards for nurse practitioners
in consultation with specified health care practitioners,
SB 294
Page 2
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:
a) Policies and protocols developed by a licensed health
facility, as defined, through collaboration among
administrators and health professionals including
physicians and nurses; or,
b) 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, and 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)Authorizes NPs to furnish or order drugs under certain
conditions, pursuant to standardized procedures or protocols
and under the supervision of a physician and surgeon.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "Nurse
practitioners (NPs) are licensed registered nurses who perform
their duties under standardized procedures which are developed
by the physicians and facilities they work with/in. These
duties are not delineated within the Business and Professions
Code but instead the standardized procedure is the governing
document. As a result, there are very diverse standardized
procedures in use. In some instances, third party payers,
health facility administrators, and others question what duties
a nurse practitioner may perform because they do not want to
SB 294
Page 3
review individual standardized procedures. Thus, SB 294 would
codify a few minimum duties to make it clear that NPs may
perform these duties if their standardized procedure permits
them to."
Background . Current regulations define a NP 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 by a program that conforms to BRN standards, as
specified. The Nursing Practice Act delineates nurse's scope of
practice, which includes: direct and indirect patient care
services that ensure the safety, comfort, personal hygiene, and
protection of a patient; the performance of disease prevention
and restorative measures; direct and indirect patient care
services, including, the administration of medications and
therapeutic agents necessary to implement treatment, disease
prevention, or rehabilitation regimen ordered by a physician,
dentist, podiatrist and clinical psychologist; the performance
of skin tests, immunization techniques, and the withdrawal of
blood from veins and arteries; 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; and implementation, based on observed
abnormalities, of appropriate reporting, referral, standardized
procedure, 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 and which would be within the scope of
practice of a physician and surgeon. Standardized procedures
and protocols are policies and protocols developed by a health
facility or organized health care system, and developed through
collaboration with the administration, physicians and nurses.
They must include a written description of the method used in
developing and approving them. Each standardized procedure
must: (1) be in writing and signed by authorized personnel in
the organized health care system; (2) specify which standardized
procedure functions registered nurses may perform and under what
circumstances; (3) state any specific requirements which are to
be followed by registered nurses in performing particular
standardized procedure functions; (4) specify any experience,
SB 294
Page 4
training, and/or education requirements for performance of
standardized procedure functions; (5) establish a method for
initial and continuing evaluation of the competence of those
registered nurses authorized to perform standardized procedure
functions; (6) provide for a method of maintaining a written
record of those persons authorized to perform standardized
procedure functions; (7) specify the scope of supervision
required for performance of standardized procedure functions,
such as telephone contact with the physician; (8) set forth any
specialized circumstances under which the registered nurse is to
immediately communicate with a patient's physician concerning
the patient's condition; (9) state the limitations on settings
in which standardized procedure functions may be performed; (10)
specify patient record-keeping requirements; and, (11) provide
for a method of periodic review of the standardized procedures.
If a registered nurse or NP undertakes a procedure without the
competence to do so, such an act may constitute gross negligence
and be subject to discipline by the BRN.
Suggested amendment : The committee may wish to recommend an
amendment to delete the phrase, "Notwithstanding any other
provision of law," because it is unnecessary and duplicative of
other provisions of the bill stating that it's provisions are in
addition to other functions performed under standard procedures
authorized under existing law.
Previous legislation .
AB 1436 (Hernandez) of 2008, defines the scope of practice of
NPs and authorizes a NP to provide comprehensive health care
services, as specified. This bill was heard in this Committee
but was not voted on.
SB 809 (Ashburn) of 2007, defines the scope of practice of nurse
practitioners and authorizes nurse practitioners to perform
specified acts. This bill was never heard and died in this
Committee pursuant to Joint Rule 56.
AB 1643 (Niello) of 2007, would repeal the prohibition against a
physician and surgeon supervising more than four NPs at one time
for purposes of furnishing or ordering drugs or devices. This
bill was never heard and died in the Assembly Committee on
Business and Professions.
AB X1 1 (Nunez) of 2008, would among other things, establish a
SB 294
Page 5
nine-member Task Force on Nurse Practitioner Scope of Practice
(Task Force), with specified membership, to develop a
recommended scope of practice for NPs by June 30, 2009, and
would require the Director of Consumer Affairs to promulgate
regulations, consistent with existing law, that adopt the Task
Force's recommended scope of practice by July 1, 2012. ABX1 1
failed passage in the Senate Health Committee.
AB 2226 (Spitzer) Chapter 344, Statutes of 2004, requires on and
after January 1, 2008, an applicant for initial qualification or
certification as a NP to meet specified requirements including
possessing a master's degree in nursing, a master's degree in a
clinical field related to nursing or graduate degree in nursing
and completion of a NP program approved by the BRN.
AB 2560 (Montanez) Chapter 205, Statutes of 2004, authorized a
NP to furnish drugs or devices whenever it is consistent with
their educational preparation or clinical competency.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Nurse Practitioners (sponsor)
American Federation of State, County and Municipal
Employees
California Association of Nurse Anesthetists
United Nurses Associations of California/Union of Health Care
Professionals
Opposition
None on file.
Analysis Prepared by : Ross Warren / B. & P. / (916) 319-3301