BILL ANALYSIS                                                                                                                                                                                                    

                                                                  SB 294
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          SB 294 (Negrete McLeod)
          As Amended  July 1, 2009
          Majority vote 

           SENATE VOTE  :   25-11

           BUSINESS & PROFESSIONS   10-0   APPROPRIATIONS      16-0        
          |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     |

           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  


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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 

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