BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 1119
S
AUTHOR: Wright
B
AMENDED: March 23, 2010
HEARING DATE: April 14, 2010
1
CONSULTANT:
1
Hansel/jl
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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.
CHANGES TO EXISTING LAW
Existing law:
Provides for the certification and regulation of
certified nurse assistants (CNA) under the Department of
Health Services, and licenses registered nurses under the
Board of Registered Nursing (the Board).
Requires an employment agency that refers temporary
certified nurse assistants to an employer that is a
long-term health care facility to provide written
verification that the employment agency has verified that
the certified nurse assistant is registered on the state
registry of certified nurse assistants and is in good
standing, and a statement that the certified nurse
assistant has at least six months of experience working
in a long-term health care facility.
Continued---
STAFF ANALYSIS OF SENATE BILL 1119 (Wright) Page 2
Requires an employment agency that refers licensed
nursing staff, defined to include a licensed registered
nurse (RN), licensed vocational nurse, or psychiatric
technician, to a long-term care facility to verify that
the individual is in good standing with the Board of
Registered Nursing or the Board of Vocational Nursing and
Psychiatric Technicians, as applicable, and has
successfully secured a criminal record clearance.
Requires an employment agency that refers temporary
certified nurse assistants or licensed nursing staff to
an employer who is a licensed long-term care facility to
additionally do all of the following:
--Provide a statement that the individual has had a
health examination within 90 days prior to employment
with the employment agency, or seven days after
employment with the employment agency and at least
annually thereafter, and verification that the individual
has had tuberculosis (TB) screening within 90 days prior
to employment and annually thereafter;
--Provide written verification that the individual does
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;
--Maintain a record of all advertisements, showing the
date of publication and the publication in which the
advertisement appeared, for a period of one year from the
date of the advertisement;
--Refrain from advertising or making any other
representation that it is a home health agency; and
--Adopt policies and procedures regarding prevention of
resident or patient abuse by temporary staff.
Requires 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
pursuant to federal law.
Provides that no temporary staff person referred by an
STAFF ANALYSIS OF SENATE BILL 1119 (Wright) Page 3
employment agency may
be solely responsible for a unit unless that person has
received a full orientation to the facility and the
applicable unit for which he or she is assigned.
Allows any facility or individual to refer complaints
concerning employment agencies which place licensed
nursing staff or certified nurse assistants in long-term
health care facilities to the appropriate licensing,
certification, ombudsman, adult protective
services, or proper law enforcement agency for action.
Provides for licensure of private duty nurse registry
agencies and requires nurse registries to verify nurses'
experience and training and to verify that applicants
hold current licenses.
This bill:
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.
Specifically, requires such agencies to:
--Verify that individuals referred to health facilities
are licensed and in good standing, have successfully
secured a criminal record clearance, have had health
exams and TB screening, as specified, and do not have any
unresolved allegations against them involving the
mistreatment, neglect, or abuse of a patient.
--Maintain a record of all advertisements;
--Refrain from advertising or making any other
representation that it is a home health agency;
--Adopt policies and procedures regarding prevention of
resident or patient abuse by temporary staff.
--Provide, upon the request of the State Department of
Public Health, a list of temporary employees who have
been referred to a specified health facility during the
period in which the facility is involved in a labor
action.
STAFF ANALYSIS OF SENATE BILL 1119 (Wright) Page 4
Provides that no licensed nursing staff referred by an
employment agency to a health facility may be solely
responsible for a unit unless that person has received a
full orientation to the facility and the applicable unit
for which he or she is assigned.
Makes other conforming changes.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, SB 1119 is intended to create
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.
Responsibilities of agencies and registries to screen
nursing staff
STAFF ANALYSIS OF SENATE BILL 1119 (Wright) Page 5
Under current law, nurse registries that supply private
duty nurses are required to verify the applicants'
experience or training and to verify that applicants hold
current licenses.
AB 1643 (Negrete McLeod) of 2001 (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, have had health exams
and TB screening, and do not have any unresolved
allegations against them. AB 1643 was passed in response
to concerns that increasing dependence by long-term care
facilities on nurse registries and employment agencies for
nurses and other staff was diminishing the quality of care
provided to long-term care residents. However, these
responsibilities are limited to referrals by employment
agencies to long-term care facilities.
Some employment agencies that refer health care staff are
certified by the Joint Commission, an organization that
accredits hospitals, nursing homes, ambulatory care
providers, and home care organizations. The certification
program evaluates key functional areas such as the
agencies' processes for verifying the credentials and
competencies of health care staff.
Reporting requirements related to nurses and psychiatric
technicians
Current law requires licensed vocational nurses and
psychiatric technicians to report unprofessional conduct on
the part of fellow licensees to their respective licensing
boards. Current law also requires employers of vocational
nurses and psychiatric technicians to report to these
licensing boards the termination or suspension for cause of
any licensed vocational nurse or psychiatric technician.
In addition, standards of competence for registered nurses
established by the Board of Registered Nursing encourage
RNs to report unprofessional conduct of other RNs to the
Board.
Current law additionally allows, but does not require,
facilities or individuals to refer complaints concerning
employment agencies that place licensed nursing staff or
certified nurse assistants in long-term care facilities to
licensing or certification agencies, long-term care
STAFF ANALYSIS OF SENATE BILL 1119 (Wright) Page 6
ombudsman agencies, adult protective services programs, and
law enforcement agencies.
Related bills
SB 360 (Yee) of 2009-2010 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. Held in Senate Appropriations
Committee.
Prior legislation
SB 1721 (Yee) 2007-2008 contained provisions that are
similar to the provisions of SB 360. Held in Assembly
Appropriations Committee.
SB 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, 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.
Arguments in support
AMN Healthcare, Inc., a large temporary health care
staffing agency, states that, while it subscribes to very
stringent standards regarding internal background checks
and qualifications of staff, there is room to improve on
the current requirements that apply to the industry.
COMMENTS
1. Employment agencies that refer health staff are not
licensed or regulated. As drafted, this bill would add
provisions to the Civil Code, imposing new duties on
employment agencies that refer licensed health staff to
health care facilities. While a patient or their
STAFF ANALYSIS OF SENATE BILL 1119 (Wright) Page 7
representative, or a health care facility could recoup
damages from harm caused by an agency's failure to properly
screen a licensed nurse, there is no direct oversight of
agencies, meaning that no entity inspects them or handles
complaints regarding them. While it may be beyond the
scope of the bill to provide for licensing or direct
oversight of employment agencies that refer health care
staff, a suggested amendment would be to require agencies
above a certain size to be certified or accredited by a
nationally recognized accrediting body that is recognized
by the Centers for Medicare and Medicaid Services.
2. Additional reporting requirements related to problem
nurses could help reduce churning. While the bill would
result in better screening of licensed nursing staff by
employment agencies, it could still be possible for nurses
who are refused or sent back by health care facilities to
continue to be rereferred to other facilities or to move
from one agency to another, as long as information about
the send back or refusal is not part of the licensing
record. A suggested amendment would be to require
facilities to report to the relevant licensing boards when
they send back licensed or refuse nursing staff for any of
the grounds for which they currently have to report
terminations or suspensions, and to similarly require
agencies themselves to report when they terminate or
suspend staff for cause.
3. Suggested technical amendment:
On page 4, lines 9 - 14, amend as follows:
(e) An employment agency shall require that any employee
referred to a long-term care health facility be
identified as a temporary staff person in the facility's
daily staffing levels required to be posted in accordance
with the standards set forth in Section 941 of Appendix F
of Public Law 106-554 (42 U.S.C. Sec. 1395i-3(b)(8) and 42
U.S.C. Sec. 1395r(b) (8)).
STAFF ANALYSIS OF SENATE BILL 1119 (Wright) Page 8
POSITIONS
Support: AMN Healthcare, Inc.
Oppose: None received
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