BILL ANALYSIS                                                                                                                                                                                                    







         ----------------------------------------------------------------------- 
        |Hearing Date:June 17, 2013         |Bill No:AB                         |
        |                                   |1028                               |
         ----------------------------------------------------------------------- 


                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                              Senator Ted W. Lieu, Chair
                                           

                        Bill No:        AB 1028Author:Patterson
                        As Amended:June 10, 2013 Fiscal:   Yes

        
        SUBJECT:  Vocational nursing:  interim permits.
        
        SUMMARY:  Permits an applicant for a vocational nursing license to  
        submit an application for an interim permit (IP) at the same time they  
        submit an application for the required licensing examination and  
        requires the California Board of Vocational Nursing and Psychiatric  
        Technicians (BVNPT) to decide whether to issue the permit and, if the  
        BVNPT deems to, issue the IP within 60 days of receiving the  
        application.

        Existing law:
        
        1) Provides for the licensure and regulation of Licensed Vocational  
           Nurses (LVNs) and psychiatric technicians by the BVNPT.  (Business  
           and Professions Code (BPC)  2849 et seq.)

        2) Defines the scope of practice for LVNs and states they may:  
        (California Code of Regulations  2518.5)

            a)    Use and practice basic assessment (data collection);

            b)    Participate in planning;

            c)    Execute interventions in accordance with the care plan or  
              treatment plan;

            d)    Contribute to evaluation of individualized interventions  
              related to the care plan or treatment plan;

            e)    Perform basic nursing services as specified;





                                                                        AB 1028
                                                                         Page 2




            f)    Administer medications;

            g)    Apply communication skills for the purpose of patient/client  
              care and education; and

            h)    Contribute to the development and implementation of a  
              teaching plan related to self-care for the patient/client.

        3) Outlines the requirements that an applicant for a license as a  
           vocational nurse must meet in order to be granted an IP by the  
           BVNPT.  (BPC  2872.2 et seq.)
        4) Specifies that if the BVNPT receives an application for licensure  
           as a vocational nurse, no later than four months after completion  
           of a the BVNPT approved nursing program, the BVNPT may issue an IP  
           authorizing the applicant to practice vocational nursing pending  
           the results of the first licensing examination, or for a period of  
           nine months, whichever occurs first.  (BPC  2872.2)

        5) Specifies that the fee to be paid for an IP shall be in an amount  
           no less than forty dollars ($40) and may be fixed by the BVNPT at  
           an amount no more than fifty dollars ($50).  
        (BPC  2895(g)) 

        This bill:

        1) Specifies that an applicant may submit an application for an IP at  
           the same time the applicant submits their application for the  
           licensing examination.

        2) Indicates that the BVNPT shall make a decision whether to issue the  
           IP, and if the BVNPT decides to issue the IP, they will issue the  
           IP within 60 days of receiving the completed application.

        FISCAL EFFECT:  This bill has been keyed "fiscal" by Legislative  
        Counsel.  According to the Assembly Appropriations Committee analysis  
        dated May 1, 2013, if half of the licensure applicants seek an IP,  
        costs for increased workload to the BVNPT are estimated at $42,000 in  
        2013-2014 and $76,000 ongoing.  These costs should be offset by the  
        BVNPT's $40.00 IP fee, which would increase revenue by approximately  
        $86,040 in the first year and $172,080 ongoing.

        COMMENTS:
        
        1. Purpose.  This bill is sponsored by the Author.  According to the  
           Author, vocational nursing applicants are currently experiencing  





                                                                        AB 1028
                                                                         Page 3



           extraordinary delays with application processing times.  The  
           current wait time [for an interim permit] is actually 8 to12  
           weeks?The BVNPT states that there would then be an additional 4-5  
           weeks processing time before the interim permit could be issued.   
           As a result of this lengthy process, the BVNPT has also stated that  
           they have not actually issued any of these interim permits in over  
           2 years.  AB 1028 aims to ensure that these critical health care  
           providers can begin working in a timely manner once they have  
           finished schooling and have entered the licensing process with the  
           BVNPT by speeding up the process by which they can apply for and  
           receive an interim permit while they complete all board exams.

        2. Background.   Current Processes for Issuing Interim Permits.   
           Presently, a vocational nursing student who has completed their  
           training program may apply to take the licensing examination.   
           Provided that the application for licensure is received by the  
           BVNPT no later than four months after completion of a  
           board-approved nursing program and clearance from the Department of  
           Justice, the BVNPT may issue an IP authorizing the applicant to  
           practice vocational nursing, pending the results of the licensing  
           examination, or for a period of nine months, whichever occurs  
           first.  If the applicant passes the examination, the interim permit  
           shall remain in effect until the license is issued by the BVNPT or  
           for a maximum period of six months after passing the examination,  
           whichever occurs first.  If the applicant fails the examination,  
           the interim permit shall terminate upon notice by certified mail,  
           return receipt requested, or if the applicant fails to receive the  
           notice, upon the date specified in the interim permit, whichever  
           occurs first.  An interim permittee shall not use any title or  
           designation other than "vocational nurse interim permittee."

            Supervision.   A permittee shall function under the supervision of a  
           LVN or a registered nurse (RN), who shall be present and available  
           on the premises during the time the permittee is rendering  
           professional services.  The LVN or RN may delegate to the permittee  
           any function taught in the permittee's basic nursing program.

            Delays in Issuing Interim Permits  .  According to the BVNPT website,  
           it takes approximately 
           3-4 weeks to process an IP.  However, the BVNPT acknowledges that  
           it currently takes 8-12 weeks.  This is due primarily to staffing  
           shortages.  

        3. Will This Measure Increase IP Applicants?  The BVNPT has not  
           received an application for an IP in over two years.  However, the  
           Author believes that this measure will result in an increase in IP  





                                                                        AB 1028
                                                                         Page 4



           applications.  The Author states that many applicants do not apply  
           for IPs because the BVNPT does not advertise IPs on its Web site.   
           Since raising this issue, the BVNPT has agreed to begin listing  
           information about IPs on its Web site.  However, the Author  
           believes that the additional provisions in this measure will also  
           help to ensure that individuals apply for IPs.  For example,  
           currently the BVNPT only alerts applicants about the option for  
           applying for an IP  after  the applicant's licensure application has  
           been submitted to and processed by the BVNPT.  This measure would  
           allow an applicant to apply for the IP at the  same time  they apply  
           for licensure.  Additionally, it is the Author's belief that the  
           time it takes the BVNPT to process the IP is a deterrent to  
           applicants.  This is because by the time the IP application is  
           processed, the applicant's licensure application may be close to  
           completion thus making the IP useless.  By decreasing the BVNPTs 90  
           day IP application processing time to 60 days, the Author hopes  
           that applicants will be more inclined to apply for an IP while they  
           wait for their licensure application to be processed. 

        4. Arguments in Support.  The  California Association for Health  
           Services at Home  , the  California Hospital Association  and the  
            Hospital Corporation of America  all support the bill.  In their  
           letter they write, "The Affordable Care Act?emphasizes allowing all  
           providers to function at the top of their education and training,  
           and delivering care in teams. The ability for vocational nurses to  
           work under an interim permit could enhance this access."  They also  
           add, "While the supply of registered nurses is presently stable, 50  
           percent of California's RN's with active licensees are over the age  
           of 50 and are predicted to retire or reduce hours as the economy  
           improves?Therefore, introducing vocational nurse into the workforce  
           as interim permittees to maximize their availability and increase  
           their significance in the care of Californians is crucial." 

           The  Association of California Healthcare Districts  (ACHD) states in  
           their letter, "The majority of California's Healthcare Districts  
           are located in rural areas, and many have a difficult time  
           recruiting qualified individuals into their workforce.  By  
           increasing the prospective workforce, Healthcare Districts will be  
           able to offer their communities increased patient care.  As ACHD  
           supports long-term solutions to increase the potential workforce  
           for healthcare professionals within all areas of California to ease  
           workforce shortages, we strongly urge your support of this  
           important measure."


        





                                                                        AB 1028
                                                                         Page 5



        SUPPORT AND OPPOSITION:
        
         Support:  

        Association of California Healthcare Districts
        California Association for Health Services at Home
        California Hospital Association
        Hospital Corporation of America

         Opposition:  

        None on file as of June 12, 2013.


        Consultant:Le Ondra Clark, Ph.D.