BILL ANALYSIS
SB 294
Page 1
SENATE THIRD READING
SB 294 (Negrete McLeod)
As Amended July 1, 2009
Majority vote
SENATE VOTE : 25-11
BUSINESS & PROFESSIONS 10-0 APPROPRIATIONS 16-0
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|Ayes:|Hayashi, Emmerson, |Ayes:|De Leon, Nielsen, |
| |Conway, Eng, | |Ammiano, |
| |Hernandez, Nava, Niello, | |Charles Calderon, Coto, |
| |John A. Perez, Ruskin, | |Davis, Duvall, Fuentes, |
| |Smyth | |Hall, Harkey, Miller, |
| | | |John A. Perez, Skinner, |
| | | |Solorio, Audra |
| | | |Strickland, Torlakson |
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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
SB 294
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subsequent to the enactment of this bill.
3)Makes legislative findings and declarations.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, absorbable workload to the Board of Registered
Nursing to continue oversight of the NP scope of practice.
COMMENTS : 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
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."
Current regulations define a NP as a registered nurse (RN) 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 the Board of Registered
Nursing (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,
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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,
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.
Analysis Prepared by : Ross Warren / B. & P. / (916) 319-3301
FN: 0002746