BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 466|
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THIRD READING
Bill No: SB 466
Author: Hill (D)
Amended: 4/30/15
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 4/27/15
AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Nursing: Board of Registered Nursing
SOURCE: Author
DIGEST: This bill mandates the hiring of an enforcement program
monitor (EPM) to oversee the Board of Registered Nursing's (BRN)
enforcement program for two years and requires approved nursing
schools to have a process to evaluate and grant credit for
military education and experience.
ANALYSIS:
Existing law:
1) Establishes the BRN until January 1, 2016, to license and
regulate the practice of nursing. (Business and Professions
Code (BPC) § 2701)
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2) Requires the BRN's rules and regulations to provide for
methods of evaluating education, training, and experience
obtained in military service if such training is applicable
to the requirements of the particular profession or vocation
regulated by the board. (BPC § 710)
3) Requires the BRN to evaluate for registered nurse (RN)
licensure the training record submitted by any person who has
served on active duty in the medical corps of any of the
Armed Forces and completed the course of instruction required
to qualify him or her for rating as a medical service
technician--independent duty, or other equivalent rating in
his particular branch, and whose service in the Armed Forces
has been under honorable conditions. (BPC § 2736.5)
4) Requires the BRN to 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 RN. The BRN's standards shall be designed
to require all schools to provide clinical instruction in all
phases of the educational process. (BPC § 2786 (c))
5) Requires the BRN to deny or revoke the application for
approval for any nursing school which does not give student
applicants credit in the field of nursing for previous
education and the opportunity to obtain credit for other
acquired knowledge by the use of challenge examinations or
other methods of evaluation. Requires the BRN to prescribe,
by regulation, the education for which credit is to be given
and the amount of credit which is to be given for each type
of education. The word "credit" is limited to credit for
licensure only, and the BRN is not authorized to prescribe
the credit which an approved school of nursing shall give
toward an academic certificate or degree. (BPC § 2786.6)
6) States that an approved nursing program shall have a process
for a student to obtain credit for previous education or for
other acquired knowledge in the field of nursing through
equivalence, challenge examinations, or other methods of
evaluation. The program shall make the information available
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in published documents, such as college catalog or student
handbook, and online.
(16 California Code of Regulations § 1430)
This bill:
1) Deletes existing provisions of law that requires the BRN to
evaluate for RN licensure the training record submitted by
any person who has served on active duty in the medical corps
of any of the Armed Forces, and completed the course of
instruction required to qualify him or her for rating as a
medical service technician--independent duty, or other
equivalent rating in his particular branch, and whose service
in the Armed Forces has been under honorable conditions.
2) Makes permissive, rather than mandatory, that the BRN
develop regulations designed to require all schools to
provide clinical instruction in all phases of the educational
process.
3) Requires the BRN to deny the application for approval made
by, and revoke the approval given to, any school of nursing
that does not give student applicants credit in the field of
nursing for military education and experience by the use of
challenge examinations or other methods of evaluation.
4) Requires the BRN to promulgate regulations by January 1,
2017, requiring schools to have a process to evaluate and
grant credit for military education and experience.
5) States that "credit," as used in this bill, is limited to
credit for licensure only. The BRN is not authorized to
prescribe the credit that an approved school of nursing shall
give toward an academic certificate or degree.
6) Requires the BRN to review a school's policies and practices
regarding granting credit for military education and
experience at least once every five years to ensure
consistency in evaluation and application across schools.
7) Requires the BRN to post on its Internet Web site
information related to the acceptance of military coursework
and experience at each approved school.
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8) Requires the Director of the Department of Consumer Affairs
(DCA) to appoint an EPM to the BRN no later than March 31,
2016.
9) Requires the EPM to monitor and evaluate the BRN's
disciplinary system and procedures for two years, with
specific concentration on:
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, appropriate utilization of licensed
professionals to investigate complaints, the BRN's
cooperation with other governmental entities charged with
enforcing related laws and regulations regarding nurses.
10)Prohibits the EPM from exercising authority over the BRN's
discipline operations or staff. However, the BRN and its
staff shall cooperate with him or her, and the BRN shall
provide data, information, and case files as requested by the
EPM to perform all of his or her duties.
11)Requires the Director to assist the EPM in the performance
of his or her duties, and states that the EPM shall have the
same investigative authority as the Director.
12)Requires the EPM to submit an initial written report of his
or her findings and conclusions to the BRN, the DCA, 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 EPM may also provide
additional information to either the DCA or the Legislature
at his or her discretion, or at the request of either the DCA
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or the Legislature. The EPM shall make his or her reports
available to the public or the media and shall make every
effort to provide the BRN with an opportunity to reply to any
facts, findings, issues, or conclusions in his or her reports
with which the BRN may disagree.
13)Requires the BRN to pay for all of the costs associated with
EPM's employment.
Background
BRN's sunset review. The BRN is a state governmental agency
established by law to protect the public by regulating the
practice of RNs. The BRN is responsible for implementation and
enforcement of the Nursing Practice Act, the laws related to
nursing education, licensure, practice, and discipline. The
Nursing Practice Act created a nine-member Board which serves as
the BRN decision-making body. The Senate Committee on Business,
Professions and Economic Development and the Assembly Business
and Professions Committee conducted a sunset review of the BRN
in March 2015 and identified 22 issues. This bill directs
changes for two areas of concern.
Consideration of military experience. The BRN is required by
law to evaluate and credit military experience and training
towards RN licensure. Until 2000, there were parallel training
requirements in the military and civilian worlds to qualify for
the RN license examination. In 2000, the BRN determined that
the military coursework had changed and was no longer directly
transferrable. The BRN has not evaluated military coursework
since.
The BRN has effectively delegated the duty of identifying
eligible military coursework to approved RN programs, for which
the BRN is required to approve the curriculum. However,
according to the EO of the BRN, the BRN does not know to what
extent, if any, schools are providing credit for military
experience and education. The EO stated that the BRN has never
spoken to schools about accepting military coursework and
experience for credit, nor has the BRN suggested which military
coursework may be transferrable. This raises a concern about
compliance, because those schools may not have sufficient
incentives to accept military credit because it would cause
students to spend less time and money (especially lucrative GI
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Bill funding) on their programs.
This bill requires the BRN to promulgate regulations to ensure
that schools have a process to evaluate and grant credit for
previous education and clinical and theoretical knowledge
acquired through military service, and requires the BRN to
review schools' policies and practices at least once every five
years to ensure consistency in evaluation and application across
schools. This bill also requires the BRN to post on its Web
site information related to the acceptance of military
coursework and experience at each approved school.
Enforcement program concerns. Administrative law judges rely on
the Disciplinary Guidelines adopted by BRN when issuing
disciplinary orders for violations of the Nursing Practice Act,
but these guidelines have not been substantially updated in 13
years. As a result of this, and enforcement staff's lack of
coordination and communication, stakeholders note a wide range
of disciplinary case outcomes.
BRN noted in its response to the background paper that it plans
to present revised guidelines at its June 2015 board meeting.
This is a positive step, but systemic problems still remain. It
has been reported that BRN advises enforcement case managers to
treat every discipline matter on a case-by-case basis, which,
while certain nuances are inevitable, the wide variation in
disciplinary decisions reported for seemingly similar offenses
is concerning. BRN's continuing overages in its Attorney
General allowance also indicate an enforcement program in need
of restructure.
This bill requires the Director of the Department of Consumer
Affairs to hire an EPM to evaluate the BRN's enforcement program
and procedures for two years.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
One-time costs of about $350,000 over three years, to contract
for an enforcement program monitor (Board of Registered
Nursing Fund).
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Ongoing costs of about $400,000 per year for evaluations of
educational standards (Board of Registered Nursing Fund).
SUPPORT: (Verified 5/28/15)
None received
OPPOSITION: (Verified5/28/15)
California State Council of the Service Employees International
Union (SEIU California)
ARGUMENTS IN OPPOSITION: SEIU California writes, "The BRN
was allowed to sunset in 2011 when Governor Brown vetoed the
sunset extension bill passed by the legislature, as it was in
conflict with his pension reform plans. It was finally
reconstituted in 2012, and has been in operation since, with the
Board fully appointed as of February 2014. This bill fails to
propose extending the Board beyond its sunset at the end of
2015. No policy justification is given for this decision. SEIU
believes strongly that it is in the interests of public safety,
and protecting the practice of nursing through licensure,
education standards, and enforcement to continue the Board
through to 2020, as is proposed with the other Boards up for
review in 2015."
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
5/30/15 17:55:11
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