BILL ANALYSIS
SB 1119
Page 1
Date of Hearing: June 29, 2010
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
SB 1119 (Wright) - As Amended: June 23, 2010
SENATE VOTE : 30-0
SUBJECT : Health care staffing.
SUMMARY : Requires temporary licensed nursing employment
agencies to verify a nurse's fitness to work, requires certain
reporting of unfit nurses, and specifies penalties for failures
to do so. Specifically, this bill :
1)Requires temporary licensed nursing employment agencies
provide an employer with verification of a nurse's fitness to
work.
2)Requires every employment agency that makes referrals of
licensed nursing staff for temporary employment in a health
facility or certified nurse assistants (CNAs) for temporary
employment in a long-term health care facility to 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.
3)Requires an employment agency that makes referrals of licensed
nursing staff for temporary employment in a health facility,
or CNAs for temporary employment in a long-term health care
facility to adopt policies and procedures regarding prevention
of resident or patient abuse by temporary staff.
4)Requires the employment agency to provide written verification
to the long-term health care facility or health facility that
any CNAs 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.
5)States that an employment agency that refers licensed nursing
staff for temporary employment in a health facility shall have
the same duty to report the suspension or termination for
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cause of any licensed vocational nurse (LVN) or licensed
psychiatric technician (LPT), as specified.
6)Requires a health facility that makes a report of an unfit
nurse to send a copy of the report to the employment agency
that placed the relevant LVN or LPT with the health facility.
7)Permits any facility or individual to refer complaints
concerning employment agencies which place licensed nursing
staff in health facilities or CNAs in long-term health care
facilities to the appropriate licensing, certification,
ombudsman, adult protective services, or proper law
enforcement agency for action.
8)States that any employment agency that violates this bill is
subject to a civil penalty of up to $5,000 for each violation,
and of up to $10,000 for each willful or knowing violation.
9)States that the civil penalties may be assessed and recovered
through a civil action brought in the name of the people of
the State of California by the Attorney General (AG), by any
district attorney, or any city attorney.
10)Requires any civil penalties recovered pursuant to this bill
to be deposited in the State Treasury, with respect to an
action brought by the AG, in the treasury for the county, with
respect to an action brought by a district attorney, or the
city treasury with respect to an action brought by a city
attorney.
11)Clarifies that the sanctions authorized under this bill shall
be separate from, and in addition to, all other remedies,
either civil, administrative, or criminal, provided by law.
12)Defines "health facility" to mean any facility, place, or
building that is organized, maintained, and operated for the
diagnosis, care, prevention, and treatment of human illness,
physical or mental, including convalescence and rehabilitation
and including care during and after pregnancy, or for any one
or more of these purposes, for one or more persons, to which
the persons are admitted for a 24-hour stay or longer. The
definition of "health facility" includes a "long-term health
care facility."
13)Defines "nursing service" as the temporary assignment of a
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licensed registered nurse (RN), LVN, or LPT to render nursing
and basic care services to one or more patients at a health
facility.
14) Makes technical changes.
EXISTING LAW :
1)Provides for the certification and regulation of CNA under the
Department of Public Health (DPH), and licenses RN under the
Board of Registered Nursing (BRN).
2)Requires an employment agency that refers temporary CNAs to an
employer that is a long-term health care facility to provide
written verification that the employment agency has verified
that the CNA is registered on the state registry of CNAs and
is in good standing, and a statement that the CNA has at least
six months of experience working in a long-term health care
facility.
3)Requires an employment agency that refers licensed nursing
staff, defined to include a licensed RNs, LVN, or LPT, to a
long-term care facility to verify that the individual is in
good standing with either the Board of Vocational Nursing and
Psychiatric Technicians (Board) or BRN, as applicable, and has
successfully secured a criminal record clearance.
4)Requires an employment agency that refers temporary CNAs or
licensed nursing staff to an employer who is a licensed
long-term care facility to additionally do all of the
following:
a) 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
screening within 90 days prior to employment and annually
thereafter;
b) 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;
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c) 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;
d) Refrain from advertising or making any other
representation that it is a home health agency; and,
e) Adopt policies and procedures regarding prevention of
resident or patient abuse by temporary staff.
5)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.
6)Provides that no temporary staff person referred by an
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.
7)Allows any facility or individual to refer complaints
concerning employment agencies which place licensed nursing
staff or CNAs in long-term health care facilities to the
appropriate licensing, certification, ombudsman, adult
protective services, or proper law enforcement agency for
action.
8)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.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "Due to
nursing shortages, most healthcare facilities rely on temporary
nurses. The healthcare staffing industry is poorly regulated and
acts as a haven for problem nurses. While many agencies have
extremely high standards and are very conscientious with their
background checks and placements, many agencies are very loose
in their procedures and allow problem nurses to continue to be
placed in facilities repeatedly."
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Background . 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 RNs, LVNs, LPTs or CNAs to various employers and
entities. To operate in California, nurse registries must
maintain a $3,000 surety bond. 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.
On December 5, 2009, the Los Angeles Times in conjunction with
Pro-Publica, published an article entitled "Temp Firms a Magnet
for Unfit Nurses." The article provided several stories on the
professional lapses of nurses who are referred by nursing
registries to various facilities in California. Specifically,
the article claimed 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. Further,
nursing registries are also failing to conduct competency
assessments of nursing staff, resulting in the referral of
nurses with inadequate nursing skills.
Employers of LVNs and LPTs are required to report to the Board
any suspension or termination for cause resulting from any of
the following: (1) use of controlled substances or alcohol to
such an extent that it impairs the licensee's ability to safely
practice, (2) unlawful sale of controlled substances or other
prescription items, (3) patient or client abuse, neglect,
physical harm, or sexual contact with a patient or client, (4)
falsification of medical records, (5) gross negligence or
incompetence, and (6) theft from patients or clients, other
employees, or the employer.
AB 1643 (Negrete McLeod), Chapter 326, Statutes of 2001,
requires employment agencies that refer temporary CNAs 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
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care residents. However, these responsibilities are limited to
referrals by employment agencies to long-term care facilities.
This bill seeks to expand these provisions to all health
facilities.
Previous legislation : SB 1721 (Yee) of 2008 contained
provisions that are similar to the provisions of this bill. SB
1721 was held in Assembly Appropriations Committee.
AB 1643 (Negrete McLeod), Chapter 326, Statutes of 2001,
requires employment agencies that refer temporary CNAs 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.
Arguments in support . The National Association of Travel Health
Organizations (NATHO) writes, "As the association representing
most of the largest healthcare staffing agencies in the United
States, NATHO asks its members to subscribe to a very high
background check and qualification standards. However, NATHO
also believes that there is room to improve on the existing
statutory requirements governing the industry."
Arguments in opposition . The California Nurses Association
writes, "We appreciate the author's intent to resolve problems
with temporary nurse staffing agencies. However, this bill does
not get to the heart of the matter, which is that nurse staffing
agencies are not properly regulated, and that health facilities
are not performing proper competency validation of temporary
nurses they hire. Absent proper regulation and enforcement of
the staffing agencies, as well as legislation and policies to
strengthen the competency validation process for temporary
nurses, the piecemeal solutions proposed by this bill will not
provide additional public protection."
REGISTERED SUPPORT / OPPOSITION :
Support
AMN Healthcare, Inc.
Axis Healthcare Staffing
Axis Medical Staffing, Inc.
Cambridge Healthcare
Cirrus Medical Staffing
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Clinical One
Core MedStaff
Emerald Health Services
Favorite Healthcare Staffing
First Class Nurses, Inc.
Liberty Healthcare Corporation and affiliates
Master Staffing
MedStaff Alternatives
Med-Staff Oklahoma
National Association of Travel Health Organizations
NR Professional Staffing Solutions
Onward Healthcare, Inc.
O.R. Nurses, Inc.
PROCEL Temporary Services, Inc.
RNS Incorporated
Travel Nurse Across America, LLC
Travel Nurse Solutions
Trinity Healthcare Staffing Group, Inc.
Trustaff
Several individuals
Opposition
American Nurses Association of California
California Nurses Association
Analysis Prepared by : Sarah Weaver / B.,P. & C.P. / (916)
319-3301