BILL ANALYSIS
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|Hearing Date:April 19, 2010 |Bill No:SB |
| |1119 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 1119 Author:Wright
As Amended:March 23, 2010Fiscal: Yes
SUBJECT: Health care staffing.
SUMMARY: Requires agencies that refer licensed nursing staff for
temporary employment in health facilities, including general acute
care, acute psychiatric, and special hospitals, to meet requirements
similar to those that apply to the referral of licensed nursing staff
to long-term care facilities.
NOTE : This bill has a double-referral to Senate Health Committee and
then to this Committee.
It was heard in Senate Health Committee on April 14, 2010 and passed
out on a 9 - 0 vote.
Existing law:
1) Establishes, within the Business and Professions Code, the Board of
Registered Nursing (BRN) to license and regulate the practice of
nursing.
2) Establishes the Board of Vocational Nursing and Psychiatric
Technicians (BVNPT) to license and regulate the practice of
vocational nursing and psychiatric technicians.
3) Provides for the certification and regulation of certified nurse
assistants under the Department of Public Health.
4) Requires, under the Nurse Practice Act, that every employer of a
registered nurse, including a nurse registry to verify that the
nurse is currently authorized to practice.
5) Establishes, in the Civil Code, the Employment Agency, Employment
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Counseling, and Job Listing Services Act (Act) to regulate the
business of employment agencies, including nursing registries.
6) Defines the following terms in the Act:
a) Nursing service means the assignment of a nurse, as a private
duty, self-employed, licensed registered nurse, licensed
vocational nurse, or practical nurse to render service to a
patient under the direction or supervision of a physician or
surgeon registered to practice in this state.
b) Nurses' registry means a person who engages in the business of
obtaining and filling commitments for nursing service.
c) Private duty nurse means a self-employed nurse rendering
service in the care of either a physically or mentally ill
patient under the direction of a physician or surgeon, but who is
paid by either the patient or the designated agent of the patient
and who accepts the responsibilities of a self-employed private
contractor.
7) Requires every nurses' registry to maintain a $3,000 bond issued by
a surety company admitted to do business in this state and filed
with the Secretary of State.
8) Requires a nurses' registry to provide a copy of the registry's fee
schedule and payment terms to any nurse from whom a fee or deposit
is to be received, prior to the nurse being interviewed by the
registry.
9) States that it is the duty of the nurses' registry to verify in
writing the claims as to the experience or training listed on the
application and to keep a file of those records in the nurse's
folder within the nurses' registry. Specifies that it is also the
duty of the person interviewing the jobseeker to require the
jobseeker to exhibit his or her license as issued by the BRN or the
BVNPT with a notation to be made on the application by the
interviewer that the license has been inspected and the date of
expiration of the license.
10)Requires every employment agency that refers temporary licensed
nursing staff to an employer who is a licensed long-term health
care facility to provide the employer with all of the following:
a) Written verification that the individual is in good standing
with the BRN and the BVNPT and has successfully secured a
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criminal record clearance. Requires the employment agency to
provide to the employer the individual's professional license and
registration number and date of expiration.
b) A statement that the licensed nursing staff person has had a
health examination within 90 days prior to employment with the
employment agency or 7 days after employment with the employment
agency and at least annually thereafter by a person lawfully
authorized to perform that procedure. Requires the examination
to include a medical history and physical evaluation, and for the
employment agency to also provide verification that the
individual has had tuberculosis screening within 90 days prior to
employment and annually thereafter.
11)Requires, in addition to those specified in Item #10) above, an
employment agency that makes referrals of licensed nursing staff or
certified nurse assistants for temporary employment in a long-term
health care facility to do the following:
a) Adopt policies and procedures regarding prevention of resident
or patient abuse by temporary staff.
b) Provide written verification that the individual is in good
standing with BRN or BVNPT as applicable, and has successfully
secured a criminal record clearance. The employment agency shall
provide to the employer the individual's professional license and
registration number and date of expiration.
c) Allow a temporary staff person to be responsible for a unit
only if that person has received a full orientation to the
facility.
d) Provide, upon request by the Department of Health Services, a
list of temporary employees who have been referred to a specified
facility during the period in which the facility is involved in a
labor action.
e) Require that any employee referred to a long-term care
facility be identified as a temporary staff person in the
facility's daily staffing levels required to be posted, as
specified.
f) Comply with specified advertising requirements.
12)Allows any facility or individual to refer complaints concerning
employment agencies which place licensed nursing staff in long-term
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health care facilities to the appropriate licensing, certification,
ombudsman, adult protective services, or law enforcement agency for
action.
13)Defines health care facility to include general acute care
hospital, acute psychiatric hospital, skilled nursing facility, or
intermediate care facilities, as specified.
This bill:
1) Requires employment agencies that refer licensed nursing staff for
temporary employment in health facilities, including general acute
care, acute psychiatric, and special hospitals, to meet similar
requirements that apply to the referral of licensed nursing staff
to long-term care facilities.
2) Applies the following requirements to employment agencies that
refer licensed nursing staff for temporary employment in health
facilities:
a) Provide written verification that the individual is in good
standing with the BRN and BVNPT as applicable, has successfully
secured a criminal record clearance, provide to the employer the
individual's professional license and registration number and
date of expiration.
b) Provide a statement that the licensed nursing staff person has
had a health examination within 90 days prior to employment with
the employment agency or 7 days after employment with the
employment agency and at least annually thereafter by a person
lawfully authorized to perform that procedure. Requires the
examination to include a medical history and physical evaluation.
The employment agency shall also provide verification that the
individual has had tuberculosis screening within 90 days prior to
employment and annually thereafter.
c) Adopt policies and procedures regarding prevention of resident
or patient abuse by temporary staff.
d) Provide written verification that any certified nurse
assistants or licensed nursing staff referred by the agency do
not have any unresolved allegations against them involving the
mistreatment, neglect, or abuse of a patient, including injuries
of unknown source and misappropriation of resident property.
e) Upon the request of the State Department of Health Services,
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provide a list of temporary employees who have been referred to a
specified facility during the period in which the facility is
involved in a labor action.
f) Require that any employee referred to a long-term care
facility be identified as a temporary staff person in the
facility's daily staffing levels required to be posted, as
specified.
g) Allow a temporary staff person to be responsible for a unit
only if that person has received a full orientation to the
facility.
h) Comply with specified advertising requirements.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1. Purpose. According to the Author, this bill creates screening
procedures for temporary nursing registries that provide nurses for
health care facilities that are similar to those that apply to the
referral of temporary private duty nurses, nurses working in
long-term care facilities and staff who provide telephone medical
advice. The Author cites statistics that the temporary nurse
staffing industry is estimated to range from 3,000 to 6,000
agencies nationwide. Nearly six percent of registered nurses in
the United Sates are licensed in California. Approximately 19,000
California licensed registered nurses work as temporary nurses.
Due to nursing shortages, most health care facilities rely on
temporary nurses. The Author argues that the nurse staffing
industry is poorly regulated and acts as a haven for problem
nurses. The Author asserts that most agencies do not do background
checks, allow applicants to take competency exams online, and hire
nurses without even conducting an interview. The Author cites a
December 2009 Los Angeles Times article, which found dozens of
cases where temporary agencies skimped on background checks, failed
to document qualifications, and ignored complaints concerning
problem nurses. According to the article, the lapses have allowed
problem nurses to move from hospital to hospital.
2. Background.
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a) Nurse Registries. Current law defines a nursing registry as a
person who engages in the business of obtaining and filling
commitments for nursing services. Nurse registries contract out
the services of registered nurses, vocational nurses, psychiatric
technicians or certified nurse assistants to various employers
and entities. Nurse registries, to operate in California, must
maintain a $3,000 surety bond, a copy of which is filed with the
Secretary of State. Nurse registries may contract with any
private duty nurse, who serves as an agent of the registry for
purposes of assignment. There is no regulatory oversight of
nurse registries in California, except when nursing staff are
referred to long-term health care facilities, specified
requirements must be met.
b) Requirements for Nursing Registries at Long-Term Health Care
Facilities. This bill requires employment agencies that refer
licensed nursing staff for temporary employment in health
facilities to meet similar requirements that apply to the
referral of licensed nursing staff to long-term health care
facilities. AB 1643 (Negrete McLeod, Chapter 326, Statutes of
2001) established existing requirements that nursing registries
must meet in order to refer temporary nursing staff to long-term
health care facilities. The requirements of
AB 1643 were adopted at that time because of the recognition that
no statutory or regulatory rules exist for employment agencies
that refer temporary staff to long-term care facilities in
California. At that time, there was evidence that employment
agencies have referred temporary staff without verifying that
these employees possess the necessary qualifications, or are in
good standing with the appropriate licensing boards. Similarly,
the Author of this bill cites several lapses by nursing
registries and the nurses that are referred to several facilities
as a justification for this bill.
c) Failures of Nursing Registries. On December 5, 2009, the LA
Times, in conjunction with Pro-Publica published an article
entitled "Temp Firms a Magnet for Unfit Nurses." The article
pointed out that the nursing registry industry is a $4-million
industry lacking any regulatory oversight. The article provided
several stories on the lapses of nurses that are referred by
nursing registries to various facilities in California.
Specifically, the article pointed out that nurse registries are
failing in their obligation to conduct criminal background
checks, which have allowed the employment of nurses whose
licenses are revoked, placed on probation, and have criminal
histories. Furthermore, nursing registries are also failing to
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conduct competency assessment of nursing staff, resulting in the
referral of nurses with inadequate nursing skills. Additionally,
the lack of a reporting requirement for employers of nurses,
including hospitals and nurse registries, have allowed the
shuffling of nurses from one facility to another facility, often
undetected and to the detriment of patients. The article
asserted that these failures are especially critical to states
like California where nurses are in short supply.
3. Lack of Employer Reporting Requirement for Nurses, A Barrier to
Patient Care. As the LA Times article pointed out, the lack of
reporting requirements for employers of problem nurses has resulted
in the shuffling of errant nurses from one facility to another.
Unlike nurses, employers of vocational nurses and psychiatric
technicians are required to report to the BVNPT any suspension or
termination for cause resulting from any of the following: (a) use
of controlled substances or alcohol to such an extent that it
impairs the licensee's ability to safely practice; (b) unlawful
sale of controlled substances or other prescription items; (c)
patient or client abuse, neglect, physical harm, or sexual contact
with a patient or client; (d) falsification of medical records; (e)
gross negligence or incompetence; and (f) theft from patients or
clients, other employees, or the employer. SB 1111 (Negrete
McLeod), pending in this Committee, would apply the employer
reporting requirements that exists for vocational nurses and
psychiatric technicians to nurses and other healing arts licensees.
4. Prior Related Legislation.
a) SB 360 (Yee, 2009) would have required each new direct care
registered nursing hire to receive and complete an orientation to
the hospital and patient care unit in which he or she will be
working. Would have precluded a nurse who has not completed this
orientation from being assigned to direct patient care, and would
require observation of the nurse during the orientation by a
direct care registered nurse. SB 360 was held in Senate
Appropriations Committee.
b) SB 1721 (Yee, 2008) contained provisions that are similar to
the provisions of SB 360.
SB 1721 was held in Assembly Appropriations Committee.
c) AB 1643 (Negrete McLeod, Chapter 326, Statutes of 2001)
requires employment agencies that refer temporary certified nurse
assistants or licensed nursing staff to long-term care facilities
to verify that the individuals are licensed and in good standing,
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have had health exams and TB screening, and do not have any
unresolved allegations against them. Requires these agencies to
meet other requirements pertaining to background screening,
advertising, and reporting to the Department of Public Health.
5. Policy Issue : Lack of Requirement for Nursing Registries to
Conduct Criminal Background Check. Although this bill would
require nursing registries to provide employers with a written
verification that the nursing staff has secured a criminal record
clearance, the LA Times article made it clear that nursing
registries are not consistently conducting criminal background
checks. As a result, firms have hired nurses with criminal records
and a history of misconduct. Should nursing registries require
nursing applicant to furnish fingerprints for the purpose of
conducting state and federal criminal history record checks through
the Department of Justice ?
6. Author's Amendments Accepted in Senate Health Committee To Be Taken
In This Committee. The Author agreed in Senate Health Committee to
take the following amendments:
a) Add Section 1812.545 to the Civil Code to read as follows:
(a) Every employment agency that makes referrals of licensed
nursing staff for temporary employment in a health facility shall
be certified or accredited by the Joint Commission or a
nationally recognized accrediting body that is recognized by the
federal Centers for Medicare and Medicaid Services.
(b) Every employment agency that makes referrals of licensed
nursing staff for temporary employment in a health facility shall
report the suspension or termination for cause of any licensed
vocational nurse in accordance with Business and Professions
Code, Section 2878.1, and shall report the suspension or
termination for cause of any licensed psychiatric technician in
accordance with Business and Professions Code, Section 4521.2.
(c) A health facility that receives referrals of licensed nursing
staff or certified nurse assistants from an employment agency
that sends back to the agency a licensed nurse staff person or
certified nurse assistant, or refuses placement from the agency
of a licensed nurse or a certified nurse assistant, shall provide
the agency with its reasons for doing so, and shall inform the
agency of any action that may constitute grounds for reporting
under Business and Professions Code, Section 2878.1 or Business
and Professions Code Section 4512.2.
b) Adds Co-Authors, and makes other technical, non-substantive,
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and clarifying changes.
SUPPORT AND OPPOSITION:
Support:
None on file as of April 14, 2010
Opposition :
None on file as of April 14, 2010
Consultant:Rosielyn Pulmano