BILL ANALYSIS                                                                                                                                                                                                    �



                                                                      



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          |SENATE RULES COMMITTEE            |                   SB 122|
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                                 THIRD READING


          Bill No:  SB 122
          Author:   Price (D)
          Amended:  1/10/12
          Vote:     21

           
           SENATE BUSINESS, PROF & ECON DEVELOP COMM  :  7-0, 1/9/12
          AYES:  Price, Emmerson, Corbett, Correa, Hernandez, Negrete 
            McLeod, Vargas
          NO VOTE RECORDED:  Walters, Wyland

           SENATE APPROPRIATIONS COMMITTEE  :  7-0, 1/19/12
          AYES:  Kehoe, Alquist, Emmerson, Lieu, Pavley, Price, 
            Steinberg
          NO VOTE RECORDED:  Walters, Runner


           SUBJECT  :    Nursing

           SOURCE  :     Author


           DIGEST  :    This bill grants the Board of Registered Nursing 
          (BRN) authority to be the only agency responsible for 
          approving schools of nursing and to receive an appropriate 
          fee from applicants and for renewal of the school of 
          nursing's authorization.  In addition, this bill authorizes 
          the BRN to issue a cease and desist order to a school of 
          nursing not approved by the BRN and requires the BRN to 
          notify the Attorney General of such a school.  Lastly, this 
          bill requires meetings of the BRN to be held in northern 
          and southern California.

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           ANALYSIS  :    Existing law, the Business and Professions 
          Code:

             1.   Provides for the regulation of various health 
               professions by regulatory boards within the Department 
               of Consumer Affairs (DCA). 

             2.   Establishes the Nursing Practice Act which provides 
               for the certification and regulation of registered 
               nurses, nurse practitioners and advanced practice 
               nurses by the BRN within the DCA.   

             3.   Specifies that the BRN consists of nine members and 
               that as of January 1, 2012, the BRN   sunsets and its 
               statutory authorization becomes inoperative and is 
               repealed. 

             4.   Specifies that the provision which provides for the 
               appointment of the Executive Officer for the BRN is 
               also repealed as of January 1, 2012. 

             5.   Specifies that an approved school of nursing is one 
               that has been approved by the BRN, gives the course of 
               instruction approved by the BRN, 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 or is affiliated with 
               an institution of higher education. 

             6.   Defines "institution of higher education" as 
               community colleges offering an associate of arts or 
               associate of science degree and private postsecondary 
               institutions offering an associate of arts or 
               associate of science degree.  

             7.   Requires that a school of nursing that is not an 
               "institution of higher education," as defined, shall 
               make an agreement with an institution of higher 
               education in the same general location 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 with successful 
               completion of an additional course of study as 
               approved by the BRN and the institution involved.  

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             8.   Provides that the BRN shall determine by regulation 
               the required subjects of instruction in an approved 
               school of nursing and the amount of clinical 
               experience necessary.  

             9.   Specifies that it shall be the duty of the BRN, 
               through its executive officer, to inspect all schools 
               of nursing in this state at such times as the BRN 
               shall deem necessary, and if it is found that a school 
               is not maintaining the standard(s) required by the 
               BRN, then the BRN may request the defects to be 
               corrected and if not corrected then the BRN may remove 
               them from the approved list. 

             10.  Provides that it is unlawful for anyone to conduct 
               a school of nursing unless the school has been 
               approved as an accredited school by the BRN, or is 
               exempt as specified.  

          Existing law, the Education Code:

             1.   Establishes the Bureau of Private Postsecondary 
               Education within the DCA and provides for Bureau 
               oversight and regulation of California private 
               postsecondary institutions pursuant to the Private 
               Postsecondary Education Act of 2009 (PPE Act), 
               including a school of nursing that is not accredited 
               by accrediting agencies affiliated with the Western 
               Association of Schools and Colleges or regional 
               accrediting agencies recognized by the United States 
               Department of Education.  

             2.   Establishes numerous unfair business practices for 
               institutions covered by the PPE Act, including 
               prohibiting an institution from promising employment 
               or otherwise overstating the availability of jobs or 
               making untrue or misleading statements regarding 
               student completion, placement or expected salary 
               rates.  

             3.   Sets forth certain disclosure requirements 
               pertaining to completion, placement, licensure, and 
               earning potential.  

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          This bill:

             1.   Authorizes the BRN to issue a cease and desist 
               order to a school of nursing not approved by the BRN 
               and requires the BRN to notify the Attorney General of 
               such a school.

             2.   Requires meetings of the BRN to be held in northern 
               and southern California.

             3.   Deletes provisions requiring a school of nursing 
               that is not affiliated with an institution of higher 
               education to make an agreement with such an 
               institution for purposes of awarding nursing degrees 
               and instead requires that a school of nursing to 
               obtain BRN approval to grant nursing degrees.

             4.   Subjects a school of nursing or a new nursing 
               program seeking approval by the BRN to the following 
               fee schedule:

               A.     A fee of $5,000 for approval of a nursing 
                 program.
               B.     A fee of $3,500 for continuing approval of a 
                 new nursing program.
               C.     A fee of $500 for processing authorization of a 
                 substantive change to an approval of a school of 
                 nursing.

           Background
           
          The BRN is responsible for regulating the practice of 
          registered nurses (RNs) in California.  Currently, there 
          are almost 380,000 licensed RNs in California, with over 
          23,000 new licenses issued annually, and more than 170,000 
          licenses renewed annually.  The BRN also regulates interim 
          permittees, i.e., applicants who are pending licensure by 
          examination, and temporary licensees, i.e., out-of-state 
          applicants who are pending licensure by endorsement.  The 
          interim permit allows the applicant to practice while under 
          the supervision of an RN while awaiting examination 
          results.  Similarly, the temporary license enables the 
          applicant to practice registered nursing pending a final 

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          decision on the licensure application.  The BRN also issues 
          certificates to Clinical Nurse Specialists, Nurse 
          Anesthetists, Nurse Practitioners, Nurse-Midwives and 
          Public Health Nurses.  These titles are those most commonly 
          used by the California RNs and use of the titles is 
          protected under the Business and Professions Code. 

          The BRN also issues furnishing numbers to nurse 
          practitioners and nurse midwives to administer 
          prescriptions and lists psychiatric/mental health nurses.  
          In addition to its licensing and certification functions, 
          the BRN also regulates and approves the following entities:

                 California Pre-licensure Registered Nursing 
               Programs.
                 Nurse-Midwifery Programs.
                 Nurse Practitioner Programs.
                 Registered Nursing Continuing Education Providers.

          The BRN is responsible for implementation and enforcement 
          of the Nursing Practice Act; the laws and regulations 
          related to nursing education, licensure, practice and 
          discipline.  The BRN implements regulatory programs and 
          performs a variety of activities to protect the public.  
          These programs and activities include, setting registered 
          nurse educational standards for pre-licensure and advanced 
          practice nursing programs, issuing and renewing registered 
          nurse licenses, issuing certificates for advanced practice 
          nurses and public health nurses, taking disciplinary action 
          for violation of the Nursing Practice Act, and managing a 
          Diversion Program for registered nurses whose practice may 
          be impaired due to chemical dependency or mental illness.

          The BRN also recognizes registered nursing is an integral 
          component of the health care delivery system. The BRN 
          affects public policy by collaborating and interacting with 
          legislators, consumers, health care providers, health care 
          insurers, professional organizations, and other state 
          agencies.  The BRN takes a proactive role in structuring 
          health care and evaluating nursing trends in order to make 
          sound policy decisions.  According to the BRN, this 
          enhances the Board's ability to interpret the Nursing 
          Practice Act and establish policies for its regulatory 
          programs and activities, which are then implemented by the 

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          BRN staff.

          Due to the veto of SB 538, and the sunset of the BRN as of 
          January 1, 2012, the 9 members of the BRN have been 
          eliminated.  The Governor does intend, however, to 
          immediately reconstitute the BRN in January of 2012.  In 
          the meantime, the Governor, the former BRN and the DCA have 
          entered into an "Interagency Agreement" for the DCA and its 
          Director to assume the responsibilities, powers and duties 
          as permitted by law.

           FISCAL EFFECT  :    Appropriation:  Yes   Fiscal Com.:  Yes   
          Local:  No

          According to the Senate Appropriations Committee:

                          Fiscal Impact (in thousands)

           Major Provisions                2012-13     2013-14    
           2014-15   Fund
           Nursing school oversight
            - investigations            $50       $100      
          $100Special*
            - cease and desist actions                      $100 to 
          $200 or more in any year                               
          Special*
            - revenue                             ($120 to $160) 
          annually            Special*

          * Board of Registered Nursing Fund 

          JJA:nl  1/23/12   Senate Floor Analyses 

                       SUPPORT/OPPOSITION:  NONE RECEIVED

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