BILL NUMBER: SB 491 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 16, 2013
AMENDED IN SENATE APRIL 1, 2013
INTRODUCED BY Senator Hernandez
FEBRUARY 21, 2013
An act to amend Sections 2835.5, 2835.7, 2836.1, 2836.2, and
2836.3 of the Business and Professions Code, relating to healing
arts.
LEGISLATIVE COUNSEL'S DIGEST
SB 491, as amended, Hernandez. Nurse practitioners.
Existing law, the Nursing Practice Act, provides for the licensure
and regulation of nurse practitioners by the Board of Registered
Nursing. Existing law requires an applicant for initial qualification
or certification as a nurse practitioner who has never been
qualified or certified as a nurse practitioner in California or in
any other state to meet specified requirements, including possessing
a master's degree in nursing, a master's degree in a clinical field
related to nursing, or a graduate degree in nursing, and to have
satisfactorily completed a nurse practitioner program approved by the
board. Existing law authorizes the implementation of standardized
procedures that authorize a nurse practitioner to perform certain
acts, including, among others, ordering durable medical equipment,
and, in consultation with a physician and surgeon, approve,
sign, modify, or add approving, signing, modifying, or
adding to a plan of treatment or plan for an individual
receiving home health services or personal care services.
This bill would revise these provisions by deleting the
requirement that those acts be performed pursuant to a standardized
procedure or in consultation with a physician and surgeon. The bill
would also authorize a nurse practitioner to perform specified
additional acts, including, among others, diagnosing
patients, performing therapeutic procedures, examining
patients and establishing a medical diagnosis and prescribing
drugs and devices. The bill would require that, on and after July 1,
2016, an applicant for initial qualification or certification as a
nurse practitioner hold a national certification as a nurse
practitioner from a national certifying body recognized by the board.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Nurse practitioners are a longstanding, vital, safe,
effective, and important part of the state's health care delivery
system. They are especially important given California's shortage of
physicians, with just 16 of 58 counties having the federally
recommended ratio of physicians to residents.
(b) Nurse practitioners will play an especially important part in
the implementation of the federal Patient Protection and Affordable
Care Act, which will bring an estimated five million more
Californians into the health care delivery system, because they will
provide for greater access to primary care services in all areas of
the state. This is particularly true for patients in medically
underserved urban and rural communities.
(c) Due to the excellent safety and efficacy record that nurse
practitioners have earned, the Institute of Medicine of the National
Academy of Sciences has recommended full independent practice for
nurse practitioners. Currently, 17 states allow nurse practitioners
to practice to the full extent of their training and education with
independent practice.
(d) Furthermore, nurse practitioners will assist in addressing the
primary care provider shortage by removing delays in the provision
of care that are created when dated regulations require a physician's
signature or protocol before a patient can initiate treatment or
obtain diagnostic tests that are ordered by a nurse practitioner.
SEC. 2. Section 2835.5 of the Business and Professions Code is
amended to read:
2835.5. (a) A registered nurse who is holding himself or herself
out as a nurse practitioner or who desires to hold himself or herself
out as a nurse practitioner shall, within the time prescribed by the
board and prior to his or her next license renewal or the issuance
of an initial license, submit educational, experience, and other
credentials and information as the board may require for it to
determine that the person qualifies to use the title "nurse
practitioner," pursuant to the standards and qualifications
established by the board.
(b) Upon finding that a person is qualified to hold himself or
herself out as a nurse practitioner, the board shall appropriately
indicate on the license issued or renewed, that the person is
qualified to use the title "nurse practitioner." The board shall also
issue to each qualified person a certificate evidencing that the
person is qualified to use the title "nurse practitioner."
(c) A person who has been found to be qualified by the board to
use the title "nurse practitioner" prior to January 1, 2005, shall
not be required to submit any further qualifications or information
to the board and shall be deemed to have met the requirements of this
section.
(d) On and after January 1, 2008, an applicant for initial
qualification or certification as a nurse practitioner under this
article who has not been qualified or certified as a nurse
practitioner in California or any other state shall meet the
following requirements:
(1) Hold a valid and active registered nursing license issued
under this chapter.
(2) Possess a master's degree in nursing, a master's degree in a
clinical field related to nursing, or a graduate degree in nursing.
(3) Satisfactorily complete a nurse practitioner program approved
by the board.
(e) On and after July 1, 2016, an applicant for initial
qualification or certification as a nurse practitioner shall, in
addition, hold a national certification as a nurse practitioner from
a national certifying body recognized by the board.
SEC. 3. Section 2835.7 of the Business and Professions Code is
amended to read:
2835.7. (a) Notwithstanding any other law, in addition to any
other practices authorized in statute or regulation, a nurse
practitioner may do any of the following:
(1) Order durable medical equipment. Notwithstanding that
authority, nothing in this paragraph shall operate to limit the
ability of a third-party payer to require prior approval.
(2) After performance of a physical examination by the nurse
practitioner, certify disability pursuant to Section 2708 of the
Unemployment Insurance Code.
(3) For individuals receiving home health services or personal
care services, approve, sign, modify, or add to a plan of treatment
or plan of care.
(4) Assess patients, synthesize and analyze data, and apply
principles of health care at an advanced level .
(5) Manage the physical and psychosocial health status of
patients.
(6) Analyze multiple sources of data, identify alternative
possibilities as to the nature of a health care problem, and select,
implement, and evaluate appropriate treatment.
(7) Make independent decisions in treating health conditions.
(8) Diagnose patients and perform diagnostic and therapeutic
procedures.
(7) Examine patients and establish a medical diagnosis by client
history, physical examination, and other criteria.
(9)
( 8) Order, furnish, or prescribe drugs or
devices pursuant to Section 2836.1.
(10)
(9) Refer patients to other health care providers
when appropriate due to the limits of the nurse practitioner'
s knowledge, experience, or educational preparation. as
provided in subdivision (b).
(11)
(10) Delegate to a medical assistant.
(12)
(1 1) Perform additional acts that require
education and training and that are recognized by the nursing
profession as proper to be performed by a nurse practitioner.
(13)
(12) Order hospice care as appropriate.
(14)
(13) Perform procedures that are necessary and
consistent with the nurse practitioner's training and education.
(b) A nurse practitioner shall refer a patient to a physician or
another licensed health care provider if the referral will protect
the health and welfare of the patient, and shall consult with a
physician or other licensed health care provider if a situation or
condition occurs in a patient that is beyond the nurse practitioner's
knowledge and experience.
(b)
(c) A nurse practitioner shall maintain medical
malpractice insurance.
SEC. 4. Section 2836.1 of the Business and Professions Code is
amended to read:
2836.1. (a) Neither this chapter nor any
other provision of law shall be construed to prohibit a nurse
practitioner from furnishing, ordering, or prescribing drugs or
devices when all both of the following
apply:
(a)
(1) The drugs or devices that are furnished, ordered,
or prescribed are consistent with the practitioner's educational
preparation or for which clinical competency has been established and
maintained.
(b) (1)
(2) (A) The board has certified
in accordance with Section 2836.3 that the nurse practitioner has
satisfactorily completed a course in pharmacology covering the drugs
or devices to be furnished, ordered, or prescribed under this
section.
(2)
(B) Nurse practitioners who are certified by the board
and hold an active furnishing number and who are registered with the
United States Drug Enforcement Administration, shall complete, as
part of their continuing education requirements, a course including
Schedule II controlled substances based on the standards developed by
the board. The board shall establish the requirements for
satisfactory completion of this subdivision.
(c)
(b) A nurse practitioner shall not furnish, order, or
prescribe a dangerous drug, as defined in Section 4022, without an
appropriate prior examination and a medical indication, unless one of
the following applies:
(1) The nurse practitioner was a designated practitioner serving
in the absence of the patient's physician and surgeon, podiatrist, or
nurse practitioner, as the case may be, and if the drugs were
prescribed, dispensed, or furnished only as necessary to maintain the
patient until the return of his or her practitioner, but in any case
no longer than 72 hours.
(2) The nurse practitioner transmitted the order for the drugs to
a registered nurse or to a licensed vocational nurse in an inpatient
facility, and if both of the following conditions exist:
(A) The nurse practitioner had consulted with the registered nurse
or licensed vocational nurse who had reviewed the patient's records.
(B) The nurse practitioner was designated as the practitioner to
serve in the absence of the patient's physician and surgeon,
podiatrist, or nurse practitioner, as the case may be.
(3) The nurse practitioner was a designated practitioner serving
in the absence of the patient's physician and surgeon, podiatrist, or
nurse practitioner, as the case may be, and was in possession of or
had utilized the patient's records and ordered the renewal of a
medically indicated prescription for an amount not exceeding the
original prescription in strength or amount or for more than one
refill.
(4) The licensee was acting in accordance with subdivision (b) of
Section 120582 of the Health and Safety Code.
(d)
(c) Use of the term "furnishing" in this section, in
health facilities defined in Section 1250 of the Health and Safety
Code, shall include the ordering of a drug or device.
(e)
(d) "Drug order" or "order" for purposes of this
section means an order for medication which is dispensed to or for an
ultimate user, issued by a nurse practitioner as an individual
practitioner, within the meaning of Section 1306.02 of Title 21 of
the Code of Federal Regulations. Notwithstanding any other provision
of law, (1) all references to "prescription" in this code and the
Health and Safety Code shall include drug orders issued by nurse
practitioners; and (2) the signature of a nurse practitioner on a
drug order issued in accordance with this section shall be deemed to
be the signature of a prescriber for purposes of this code and the
Health and Safety Code.
SEC. 5. Section 2836.2 of the Business and Professions Code is
amended to read:
2836.2. All nurse practitioners who are authorized pursuant to
Section 2836.1 to prescribe, furnish, or issue drug orders for
controlled substances shall register with the United States Drug
Enforcement Administration.
SEC. 6. Section 2836.3 of the Business and Professions Code is
amended to read:
2836.3. (a) The furnishing of drugs or devices by nurse
practitioners is conditional on issuance by the board of a number to
the nurse applicant who has successfully completed the requirements
of paragraph (2) of subdivision (b) of Section 2836.1. The
number shall be included on all transmittals of orders for drugs or
devices by the nurse practitioner. The board shall make the list of
numbers issued available to the Board of Pharmacy. The board may
charge the applicant a fee to cover all necessary costs to implement
this section.
(b) The number shall be renewable at the time of the applicant's
registered nurse license renewal.
(c) The board may revoke, suspend, or deny issuance of the numbers
for incompetence or gross negligence in the performance of functions
specified in Sections 2836.1 and 2836.2.