BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                    SB 98|
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                              UNFINISHED BUSINESS


          Bill No:  SB 98
          Author:   Senate Budget and Fiscal Review Committee
          Amended:  1/26/12
          Vote:     21

           
          SENATE VOTE NOT RELEVANT

           ASSEMBLY FLOOR  :  Not available


           SUBJECT  :    Budget Trailer Bill:  Board of Registered 
          Nursing

           SOURCE :     Author


           DIGEST  :    This bill establishes, until January 1, 2016, a 
          new Board of Registered Nursing and vests the new board 
          with the same powers as the previous board of the same name 
          which was repealed on January 1, 2012.

           Assembly amendments  delete the Senate version of the bill, 
          which expressed Legislative intent to enact statutory 
          changes related to the Budget Act of 2011, and instead add 
          the current language.

           ANALYSIS  :    

          Existing law:

          1. Provides for the regulation of various health 
             professions by regulatory boards within the Department 
                                                           CONTINUED





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             of Consumer Affairs (DCA). 

          2. Establishes the Nursing Practice Act, which provides for 
             the certification and regulation of registered nurses, 
             nurse practitioners, and advanced practice nurses by the 
             BRN within the DCA. 

          3. Establishes within the DCA, the Division of 
             Investigation (DOI), to investigate alleged misconduct 
             by licensees of boards.  Allows the Director of the DCA 
             to employ such investigators, inspectors, and deputies 
             as are necessary to investigate and prosecute all 
             violations of any law.  States Legislative intent that 
             inspectors used by boards are not required to be 
             employees of the DOI, but may be either employees or 
             under contract to the boards.

          4. Provides that investigators of the DOI and the Medical 
             Board of California and Dental Board of California have 
             the authority of peace officers and that those entities 
             are also authorized to employ individuals who are not 
             peace officers to provide investigative services.

          5. (Repealed) Specifies that the BRN consisted of nine 
             members and that as of January 1, 2012, the BRN sunsets 
             (and be repealed), unless a later enacted statute were 
             to be enacted prior to January 1, 2012.  This did not 
             occur.  The BRN is subject to review by the Legislature 
             prior to its sunset date.  

          6. Specifies that the provision, which provided for the 
             appointment of the Executive Officer for the BRN will be 
             repealed as of January 1, 2012, unless a later enacted 
             statute was enacted before January 1, 2012.

          This bill:

          1. Restores the Board of Registered Nursing (BRN) and 
             establishes a new sunset date of January 1, 2016.

          2. Establishes the BRN within the DCA.

          3. Re-establishes the terms of office for the nine members 
             of the BRN at four years, but with staggered initial 







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             appointments in order to have staggered terms going 
             forward, as follows:

             Senate appointment - public member:  four years
             Assembly appointment - public member:  four years
             Governor's appointments:
             #1 - public member:  one year
             #2 - public member:  five years
             #3 - RN #1:  two years
             #4 - RN #2:  three years
             #5 - nurse educator:  four years
             #6 and #7 - nurse administrator and advanced practice 
             nurse:  Governor's choice on which one serves two years 
             and which one serves three years for their initial 
             terms.

          4. Ratifies the interagency agreement between the BRN and 
             the Director of Consumer Affairs.

          5. Provides for an interim executive officer until the BRN 
             appoints a permanent executive officer, and deems that 
             interim executive officer to be the same person who was 
             serving as executive officer before the BRN expired.

          6. Appropriates to the BRN unencumbered funds in the Board 
             of Registered Nursing Fund (Fund) that were appropriated 
             to the BRN in the 2011 Budget Act and $1,000 from the 
             Fund for the purpose of administering the Nursing 
             Practice Act.

           Comments
           
          The BRN is responsible for regulating the practice of 
          registered nurses (RNs) in California.  Currently, there 
          are almost 380,000 licensed RNs in California, with over 
          23,000 new licenses issued annually, and more than 170,000 
          licenses renewed annually.  The BRN also regulates interim 
          permittees, i.e., applicants who are pending licensure by 
          examination, and temporary licensees, i.e., out-of-state 
          applicants who are pending licensure by endorsement.  The 
          interim permit allows the applicant to practice while under 
          the supervision of an RN while awaiting examination 
          results.  Similarly, the temporary license enables the 
          applicant to practice registered nursing pending a final 







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          decision on the licensure application.  The BRN also issues 
          certificates to Clinical Nurse Specialists, Nurse 
          Anesthetists, Nurse Practitioners, Nurse-Midwives and 
          Public Health Nurses.  These titles are those most commonly 
          used by the California RNs and use of the titles is 
          protected under the Business and Professions Code.  The BRN 
          also issues furnishing numbers to nurse practitioners and 
          nurse midwives to administer prescriptions and lists 
          psychiatric/mental health nurses.  In addition to its 
          licensing and certification functions, the BRN also 
          regulates and approves the following entities:  (1) 
          California Pre-licensure Registered Nursing Programs; (2) 
          Nurse-Midwifery Programs; (3) Nurse Practitioner Programs; 
          and, (4) Registered Nursing Continuing Education Providers.

          The BRN is responsible for implementation and enforcement 
          of the Nursing Practice Act -- the laws and regulations 
          related to nursing education, licensure, practice, and 
          discipline.  The BRN implements regulatory programs and 
          performs a variety of activities to protect the public.  
          These programs and activities include, setting registered 
          nurse educational standards for pre-licensure and advanced 
          practice nursing programs, issuing and renewing registered 
          nurse licenses, issuing certificates for advanced practice 
          nurses and public health nurses, taking disciplinary action 
          for violation of the Nursing Practice Act, and managing a 
          Diversion Program for registered nurses whose practice may 
          be impaired due to chemical dependency or mental illness.

          Recognizing that registered nursing is an integral 
          component of the health care delivery system, the BRN seeks 
          to affect public policy by collaborating and interacting 
          with legislators, consumers, health care providers, health 
          care insurers, professional organizations, and other state 
          agencies.  According to the BRN, this enhances the Board's 
          ability to interpret the Nursing Practice Act and establish 
          policies for its regulatory programs and activities, which 
          are then implemented by the BRN staff.

          The former composition of the BRN included seven members 
          who were appointed by the Governor, one by the Senate Rules 
          Committee and one by the Assembly Speaker.  The Board 
          included four public members, two registered nurses in 
          direct patient care practice, an advanced practice 







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          registered nurse, a registered nurse educator, and a 
          registered nurse administrator.

          The former statute included a sunset on the BRN of January 
          1, 2012 and no subsequent legislation was passed and signed 
          to extend the sunset.  This is due in part to the fact that 
          there was legislation last year (SB 538 ÝPrice]) to extend 
          it to 2016, as this bill does, however SB 538 contained 
          additional provisions that made changes to the operation of 
          the BRN, related to pension benefits, which the Governor 
          objected to and therefore vetoed the bill.  In his veto 
          message, the Governor asked the Legislature to send him 
          legislation to restore the BRN as soon as possible. 

          The dissolution of the BRN means that substantial work in 
          the area of licensing, disciplinary action, and general 
          nursing practice oversight cannot continue.  The BRN 
          adopts, amends or rejects proposed decisions by 
          administrative law judges who hear cases on nurse 
          discipline.  Now, judges' decisions will automatically take 
          effect if no board action is taken in 100 days.  The BRN 
          also approves or rejects settlements reached between 
          attorneys representing nurses accused of misconduct and 
          deputy attorneys general representing the board.  Those 
          cases also will be subject to approval by administrative 
          judges whose decisions are final if the board takes no 
          action in 100 days.  The DCA continues to do the staff 
          work, such as processing licensing applications and 
          investigating complaints.

           FISCAL EFFECT  :    Appropriation:  Yes   Fiscal Com.:  Yes   
          Local:  No


          JJA:do  2/1/12   Senate Floor Analyses 

                       SUPPORT/OPPOSITION:  NONE RECEIVED

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