Amended in Senate April 23, 2015

Amended in Senate April 20, 2015

Senate Bill No. 466

Introduced by Senator Hill

February 25, 2015

An act to amend Sections begin delete 2736.5, 2786, end delete begin insert 2786 end insert and 2786.6 of, begin delete to add Section 2736.7 to, end delete and to add and repeal begin delete Section end delete begin insert Sections end insert 2711 begin insert and 2736.7 end insert of, the Business and Professions Code, relating to nursing.

LEGISLATIVE COUNSEL’S DIGEST

SB 466, as amended, Hill. Nursing: Board of Registered Nursing.

The Nursing Practice Act provides for the licensure and regulation of registered nurses by the Board of Registered Nursing within the Department of Consumer Affairs, and requires the board to appoint an executive officer to perform duties delegated by the board. The act authorizes the board to take disciplinary action against a certified or licensed nurse or to deny an application for a certificate or license for certain reasons, including unprofessional conduct.

This bill would require the Director of the Department of Consumer Affairs to appoint a board enforcement program monitor no later than March 31, 2016, as specified. The bill would require the enforcement program monitor to monitor and evaluate the nursing disciplinary system and procedures and specifically concentrate on improving the overall efficiency and consistency of the enforcement program, including, but not limited to, assuring consistency in the application of sanctions or discipline imposed on licensees. The bill would make these provisions inoperative on March 31, 2018, and would repeal these provisions on January 1, 2019.

begin delete

The act authorizes any person who has served on active duty in the medical corps of the Armed Forces of the United States and who successfully completed the course of instruction to qualify him or her for rating as a medical service technician--independent duty, or other equivalent rating, and whose service in the Armed Forces was under honorable conditions to submit the record of that training to the board for evaluation. The act requires the board to grant a license to that person if he or she meets specified qualifications and the board determines that his or her education would give reasonable assurance of competence to practice as a registered nurse in this state. The act requires the board to maintain records of those applicants, including, but not limited to, applicants who are rejected from examination.

end delete begin delete

This bill would revise and recast this provision to authorize a person who has successfully completed the course of education, training, or experience to qualify him or her for rating as a medical service technician--independent duty, or other equivalent rating to submit that record for evaluation, and would require the board to provide that person with a list of coursework, if any, that the applicant must complete to be eligible for licensure. This bill would require the board to issue a license to that person if he or she meets specified qualifications and the board determines that his or her education, training, or experience would give reasonable assurance of competence to practice as a registered nurse in the state. The bill would delete the requirement on the board to maintain records of certain applicants. The bill, on or before January 1, 2017, would also require the board to issue regulations in conjunction with the Military Department that identify the Armed Forces education, training, or experience that is equivalent or transferable to the curriculum required for licensure by the board.

end delete

The act requires the board to maintain a list of approved schools or programs of nursing in this state, as specified, and provides that an approved school or program of nursing is one that has been approved by the board and meets certain academic requirements. The act requires the board to deny an application for approval of, and to revoke the approval given to, any school of nursing that does not give student applicants credit for previous education and the opportunity to obtain credit for other acquired knowledge by the use of challenge examinations or other methods of evaluation.

This bill would instead require the board to deny or revoke approval of a school of nursing that does not give student applicants credit for previous education and the opportunity to obtain credit for other clinical and theoretical knowledge acquired through experience by the use of challenge examinations or other methods of evaluation. The bill would require the board, by January 1, 2017, to promulgate regulations begin delete detailing acceptable evaluation criteria for clinical and theoretical knowledge acquired through prior experience. The bill would also authorize the board to determine, upon review and recommendation, that an applicant for licensure as a registered nurse who acquires his or her education or a portion thereof at a school that is not approved or has been previously disapproved by the board is eligible for a registered nurse license if the applicant meets specified criteria, including, but not limited to, that he or she was previously licensed as a vocational nurse. end delete begin insert requiring schools seeking approval to have a process to evaluate and grant credit for education and clinical and theoretical knowledge acquired through prior experience. The bill would require the board to review a school’s policies and practices regarding granting credit for previously acquired education and clinical and theoretical knowledge at least once every 4 years to ensure consistency in evaluation and application across schools. The bill would require the board to post on its Internet Web site information related to the acceptance of military coursework and experience at each approved school. The bill would also require the board, by January 1, 2018, to prepare a report to the Legislature examining the barriers to California licensure for practitioners who cannot meet California licensure requirements due to insufficient academic or clinical preparation, but who are licensed and practicing in other states. end insert

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.  

Section 2711 is added to the Business and
Professions Code, to read:

2711.  

(a) (1) The Director of Consumer Affairs shall appoint
a board enforcement program monitor no later than March 31,
2016. The director may retain an independent contractor for this
appointment by a personal services contract. The Legislature hereby
finds that the services described in this section are a new state
function, pursuant to Section 19130 of the Government Code.

(2) The director shall supervise the enforcement program
monitor and may terminate or dismiss the enforcement program
monitor from the appointment.

(b) (1) The enforcement program monitor shall monitor and
evaluate the nursing disciplinary system and procedures and
specifically concentrate on improving the overall efficiency and
consistency of the enforcement program. The director shall specify
further duties of the program monitor.

(2) The monitoring duty shall be on a continuing basis for a
period of no more than two years from the date of the enforcement
program monitor’s appointment and shall include, but not be
limited to, the following areas:

(A) Improving the quality and consistency of complaint
processing and investigation.

(B) Assuring consistency in the application of sanctions or
discipline imposed on licensees.

(C) The accurate and consistent implementation of the laws and
rules affecting discipline, including adhering to the Consumer
Protection Enforcement Initiative complaint priority guidelines as
described in the memorandum dated August 31, 2009, by Brian J.
Stiger titled “Complaint Prioritization Guidelines for Health Care
Agencies.”

(D) Staff concerns regarding disciplinary matters or procedures.

(E) Appropriate use of licensed professionals to investigate
complaints.

(F) The board’s cooperation with other governmental entities
charged with enforcing related laws and regulations regarding
nurses.

(3) The enforcement program monitor shall exercise no authority
over the board’s discipline operations or staff. However, the board
and its staff shall cooperate with the enforcement program monitor,
and the board shall provide data, information, and case files
requested by the enforcement program monitor to perform all of
his or her duties.

(4) The director shall assist the enforcement program monitor
in the performance of his or her duties, and the enforcement
program monitor shall have the same investigative authority as
the director.

(c) The enforcement program monitor shall submit an initial
written report of his or her findings and conclusions to the board,
the department, and the Legislature no later than September 1,
2016, and every six months thereafter, and be available to make
oral reports to each, if requested to do so. The enforcement program
monitor may also provide additional information to either the
department or the Legislature at his or her discretion or at the
request of either the department or the Legislature. The
enforcement program monitor shall make his or her reports
available to the public or the media. The enforcement program
monitor shall make every effort to provide the board with an
opportunity to reply to any facts, findings, issues, or conclusions
in his or her reports with which the board may disagree.

(d) The board shall pay for all of the costs associated with the
employment of an enforcement program monitor.

(e) This section shall become inoperative on March 31, 2018,
and as of January 1, 2019, is repealed.

begin delete

SEC. 2.  

Section 2736.5 of the Business and Professions Code
is amended to read:

2736.5.  

(a) Any person who has served on active duty in the
medical corps of any of the Armed Forces of the United States and
who has successfully completed the course of education, training,
or experience required to qualify him or her for rating as a medical
service technician--independent duty, or other equivalent rating
in his or her particular branch of the Armed Forces, and whose
service in the Armed Forces has been under honorable conditions,
may submit the record of that education, training, or experience
to the board for evaluation toward licensure.

(b) After making an evaluation pursuant to subdivision (a), the
board shall provide an applicant with a list of coursework, if any,
that the applicant must complete to be eligible for licensure.

(c) If an applicant meets the qualifications of subdivision (a)
and paragraphs (1) and (3) of subdivision (a) of Section 2736, and
if the board determines that his or her education, training, or
experience would give reasonable assurance of competence to
practice as a registered nurse in this state, he or she shall be granted
a license upon passing the standard examination for licensure.

(d) The board shall, by regulation, establish criteria for
evaluating the education, training, or experience of applicants
under this section.

(e) On or before January 1, 2017, the board shall, by regulation
and in conjunction with the Military Department, identify the
Armed Forces education, training, or experience that is equivalent
or transferable to the curriculum required for licensure by the
board.

SEC. 3.  

Section 2736.7 is added to the Business and Professions
Code, to read:

2736.7.  

Upon review and recommendation, the board may
determine that an applicant for licensure as a registered nurse who
acquired his or her education or a portion thereof at a school that
is not approved or has been previously disapproved by the board
is eligible for a registered nurse license if the applicant meets all
of the following criteria:

(a) Was previously licensed as a licensed vocational nurse.

(b) Has successfully completed a nursing education program
accredited by the Accreditation Commission for Education in
Nursing, Commission on Collegiate Nursing Education, or other
accreditation entity approved by the board.

(c) Has not held a healing arts license that has been the subject
of disciplinary action by a healing arts board of this state or by
another state, federal territory, or Canadian province.

(d) Holds an unencumbered registered nursing license issued
by another state licensing board or agency.

(e) Has continuously practiced as a licensed registered nurse
for the equivalent of five full-time years in an acute care hospital
setting before the date of application.

(f) Demonstrates clinical experience as a registered nurse in
medical-surgical, including geriatrics, psychiatric-mental health,
obstetrics, and pediatrics.

(g) Has not been the subject of a disciplinary action by a nursing
licensing authority or of adverse judgments or settlements resulting
from the practice of nursing that the board determines constitutes
a pattern of negligence or incompetence.

(h) Is not subject to denial of licensure under Division 1.5
(commencing with Section 475).

end delete

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 2736.7 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 2736.7. end insert   

(a) The board shall, by January 1, 2018, prepare a
report to be submitted to the Legislature examining barriers to
California licensure for practitioners who cannot meet California
licensure requirements due to insufficient academic or clinical
preparation, but who are licensed and practicing in other states.

(b) The report required by this section shall be submitted in
compliance with Section 9795 of the Government Code.

(c) Pursuant to Section 10231.5 of the Government Code, this
section is repealed on January 1, 2022.

end insert

begin delete SEC. 4. end delete
begin insert SEC. 3. end insert   

Section 2786 of the Business and Professions Code is
amended to read:

2786.  

(a) An approved school of nursing, or an approved
nursing program, is one that has been approved by the board, gives
the course of instruction approved by the board, covering not less
than two academic years, is affiliated or conducted in connection
with one or more hospitals, and is an institution of higher
education. For purposes of this section, “institution of higher
education” includes, but is not limited to, community colleges
offering an associate of arts or associate of science degree and
private postsecondary institutions offering an associate of arts,
associate of science, or baccalaureate degree or an entry-level
master’s degree, and is an institution that is not subject to the
California Private Postsecondary Education Act of 2009 (Chapter
8 (commencing with Section 94800) of Part 59 of Division 10 of
Title 3 of the Education Code).

(b) A school of nursing that is affiliated with an institution that
is subject to the California Private Postsecondary Education Act
of 2009 (Chapter 8 (commencing with Section 94800) of Part 59
of Division 10 of Title 3 of the Education Code), may be approved
by the board to grant an associate of arts or associate of science
degree to individuals who graduate from the school of nursing or
to grant a baccalaureate degree in nursing with successful
completion of an additional course of study as approved by the
board and the institution involved.

(c) The board shall determine by regulation the required subjects
of instruction to be completed in an approved school of nursing
for licensure as a registered nurse and shall include the minimum
units of theory and clinical experience necessary to achieve
essential clinical competency at the entry level of the registered
nurse. The board’s begin delete standards shall end delete begin insert regulations may end insert be designed to
require all schools to provide clinical instruction in the educational
process.

(d) The board shall perform or cause to be performed an analysis
of the practice of the registered nurse no less than every five years.
Results of the analysis shall be utilized to assist in the
determination of the required subjects of instruction, validation of
the licensing examination, and assessment of the current practice
of nursing.

begin delete SEC. 5. end delete
begin insert SEC. 4. end insert   

Section 2786.6 of the Business and Professions Code
is amended to read:

2786.6.  

(a) The board shall deny the application for approval
made by, and shall revoke the approval given to, any school of
nursing that either:

(1) Does not give to student applicants credit, in the field of
nursing, for previous education and the opportunity to obtain credit
for other clinical and theoretical knowledge acquired through prior
experience by the use of challenge examinations or other methods
of evaluation.

(2) Is operated by a community college and discriminates against
an applicant for admission to a school solely on the grounds that
the applicant is seeking to fulfill the units of nursing required by
Section 2736.6.

(b) The board shall begin delete prescribe, by regulation, the education for
which credit is to be given and the amount of credit that is to be
given for each type of education, including clinical and theoretical
knowledge acquired through prior experience. end delete begin insert promulgate
regulations by January 1, 2017, requiring schools to have a process
to evaluate and grant credit for previous education and clinical
and theoretical knowledge acquired through prior experience,
including that gained from military service. end insert The word “credit,” as
used in the preceding sentence, is limited to credit for licensure
only. The board is not authorized to prescribe the credit that an
approved school of nursing shall give toward an academic
certificate or degree. begin delete The board shall promulgate regulations
detailing acceptable evaluation criteria for clinical and theoretical
knowledge acquired through prior experience by January 1, 2017. end delete

begin insert

(c) The board shall review a school’s policies and practices
regarding granting credit for previous education and clinical and
theoretical knowledge acquired through prior experience at least
once every four years to ensure consistency in evaluation and
application across schools. The board shall post on its Internet
Web site information related to the acceptance of military
coursework and experience at each approved school.

end insert