BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 538|
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VETO
Bill No: SB 538
Author: Price (D)
Amended: 8/15/11
Vote: 21
SENATE BUS., PROF. & ECON. DEVEL. COMMITTEE : 8-1, 5/2/11
AYES: Price, Emmerson, Corbett, Correa, Hernandez, Negrete
McLeod, Vargas, Wyland
NOES: Walters
SENATE APPROPRIATIONS COMMITTEE : 6-2, 5/26/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Runner
NO VOTE RECORDED: Emmerson
SENATE FLOOR : 31-5, 6/2/11
AYES: Alquist, Berryhill, Blakeslee, Calderon, Corbett,
Correa, De Le�n, DeSaulnier, Emmerson, Evans, Fuller,
Hancock, Harman, Hernandez, Kehoe, Leno, Lieu, Liu,
Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio,
Simitian, Steinberg, Vargas, Wolk, Wright, Wyland, Yee
NOES: Anderson, Gaines, Huff, La Malfa, Walters
NO VOTE RECORDED: Cannella, Dutton, Runner, Strickland
ASSEMBLY FLOOR : 52-25, 09/01/11 - See last page for vote
SENATE FLOOR : 31-5, 9/7/11
AYES: Alquist, Berryhill, Blakeslee, Corbett, Correa, De
Le�n, DeSaulnier, Emmerson, Evans, Fuller, Hancock,
Harman, Hernandez, Kehoe, Leno, Lieu, Liu, Lowenthal,
Negrete McLeod, Padilla, Price, Rubio, Runner, Simitian,
Steinberg, Strickland, Vargas, Wolk, Wright, Wyland, Yee
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NOES: Anderson, Dutton, Gaines, Huff, La Malfa
NO VOTE RECORDED: Calderon, Cannella, Pavley, Walters
SUBJECT : Nursing
SOURCE : Author
DIGEST : This bill makes a number of changes to the
Nursing Practice Act including: (1) granting the Board of
Registered Nursing (BRN) the authority to hire
investigators and to have such investigators designated as
peace officers, (2) granting the 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, (3)
authorizing the BRN to issue a cease and desist order to a
school of nursing that has not been approved by the BRN and
to inform the Attorney General of a school which continues
to operate illegally, and (4) extending the BRN's sunset
date for four years to January 1, 2016.
Assembly Amendments (1) delete the requirement for each
school that is approved by BRN remit an annual
institutional fee to the Bureau for Private Postsecondary
Education, in an amount equal to three-quarters of one
percent of the school's annual revenues derived from
students in California, with a cap of $25,000 annually, to
be deposited in the Private Postsecondary and Vocational
Education Administration Fund; (2) require the BRN to hold
its meetings in the northern and southern parts of the
state; and (3) add to the revised definition of
"institution of higher education" private postsecondary
institutions offering an entry-level master's degree.
ANALYSIS :
Existing law:
1. Provides for the regulation of various health
professions by regulatory boards within the Department
of Consumer Affairs (DCA).
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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. Establishes within the DCA, the Division of
Investigation (DOI), to investigate alleged misconduct
by licensees of boards. Allows the Director of the DCA
to employ such investigators, inspectors, and deputies
as are necessary to investigate and prosecute all
violations of any law. States Legislative intent that
inspectors used by boards are not required to be
employees of the DOI, but may be either employees, or
under contract to the boards.
4. Provides that investigators of the DOI and the Medical
Board of California and Dental Board of California have
the authority of peace officer and that those entities
are also authorized to employ individuals who are not
peace officers to provide investigative services.
5. Specifies that the BRN consists of nine members and that
as of January 1, 2012, the BRN will sunset (is
repealed), unless a later enacted statute is enacted
prior to January 1, 2012. The BRN is subject to review
by the Legislature prior to its sunset date.
6. Specifies that the provision which provides for the
appointment of the Executive Officer for the BRN shall
be repealed as of January 1, 2012, unless a later
enacted statute is enacted before January 1, 2012.
7. States that it is the intent of the Legislature that the
BRN shall implement a diversion program for registered
nurses whose competency may be impaired due to abuse of
alcohol and other drugs, or due to mental illness, as a
voluntary alternative to traditional disciplinary
actions and so that registered nurses so afflicted may
be rehabilitated and returned to the practice of nursing
in a manner which will not endanger the public health
and safety.
8. Requires the BRN to establish criteria for the
acceptance, denial, or termination of registered nurses
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in the diversion program and that only those nurses who
have voluntarily requested to participate in the
diversion program shall participate in the program.
9. Provides that the BRN shall produce reports which
include, but are not limited to, the information
concerning the number of cases accepted, denied, or
terminated with compliance or noncompliance and to
conduct a periodic cost analysis of the program.
10.Requires the BRN to approve and regulate registered
nursing schools that are institutions of higher
education, as defined, or affiliated with an institution
of higher education, as specified. Requires 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.
11.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.
12.Establishes the Bureau of Private Postsecondary
Education (Bureau) within the DCA and provides for
Bureau oversight and regulation of California private
postsecondary institutions pursuant to the Private
Postsecondary Education Act of 2009 (Act).
13.Establishes numerous unfair business practices for
institutions covered by the 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.
14.Sets forth certain disclosure requirements pertaining to
completion, placement, licensure, and earning potential.
This bill:
1. Amends the Business and Professions Code to provide that
designated investigators of the BRN have the authority
of peace officers, as specified, and to authorize the
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BRN to employ individuals who are not peace officers to
provide investigative services.
2. Extends the operating date of the BRN and its authority
to appoint an executive officer to January 1, 2016, and
subjects the BRN to review by the appropriate policy
committees of the Legislature.
3. Requires the BRN to hold its meetings in northern and
southern California.
4. Provides that an approved school of nursing, or an
approved nursing program, 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.
5. Redefines "institution of higher education" to include,
but not be limited to, community colleges offering an
associate of arts or associate of science degree and
private postsecondary institutions offering an associate
of arts, associate of science, or baccalaureate degree
or an entry-level master's degree and not subject to the
California Private Postsecondary Education Act (PPE
Act).
6. Requires a school of nursing that is not an institution
of higher education or that is affiliated with an
institution of higher education as required by the BRN,
and that is subject to the PPE Act, to be approved by
the BRN 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 in
nursing with successful completion of an additional
course of study as approved by the BRN and the
institution involved.
7. Provides that, if an institution of higher education, an
affiliated institution, or an institution subject to the
PPE Act applies for approval of a new school of nursing,
the school of nursing shall be required to be recognized
or approved by an accrediting agency recognized by the
United States Department of Education.
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8. Specifies that the BRN's educational standards for
licensure shall be designed to require, rather than
encourage, all schools to provide clinical instruction
in all phases of the educational process.
9. Requires all private postsecondary schools of nursing
approve by the BRN to comply with, and be subject to,
requirements set forth in the PPE Act, as specified.
10.Provides that a BRN-approved institution of higher
education or private postsecondary school of nursing
shall remit fees for deposit into the BRN Fund, as
follows:
A. A fee of $5,000 for approval of a school of
nursing.
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.
11.Specifies that, if BRN determines that the annual cost
of providing oversight and review of a school of nursing
as required by this bill is less than the amount of any
fees required to be paid by that institution, the BRN
may decrease the fees applicable to that institution to
an amount that is proportional to the BRN's costs.
12.Requires the BRN to order a school to cease and desist
from offering students the ability to enroll if the BRN
has a reasonable belief that the school is allowing
students to apply for a nursing program that has not
been approved by the BRN. The BRN must also notify the
Attorney General's (AG) office that the school is
offering students the ability to enroll in a nursing
program that does not have BRN approval.
13.Provides that it is unprofessional conduct for any
registered nurse (RN) to violate, attempt to violate, or
assist or abet the violation of 12) above.
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14.Amends the Penal Code to provide that persons employed
by the BRN are peace officers if designated as such by
the Director of the DCA.
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
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
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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
BRN staff.
The current composition of the BRN is seven members who are
appointed by the Governor, one by the Senate Rules
Committee and one by the Assembly Speaker. The current
make-up of the BRN includes four public members, two
registered nurses in direct patient care practice, an
advanced practice registered nurse, a registered nurse
educator and a registered nurse administrator.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee,
approximately $30 million (BRN Fund) annually in regulatory
costs will continue to be incurred as a result of a
provision extending the sunset on the BRN.
Increased one-time revenues to the BRN Fund in the range of
$50,000 associated with approval of an estimated 10 new
nursing programs. In addition, increases annual revenues
of approximately $35,000 to the BRN Fund for ongoing
approval of these programs. The BRN Fund is continuously
appropriated.
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Increases staff costs to the Department of Justice of
$250,000 (BRN Fund) for one additional Deputy Attorney
General to handle the investigation and prosecution of
unapproved schools of nursing. These costs are difficult
to estimate and can vary greatly, depending upon the number
and complexity of cases.
SUPPORT : (Verified 9/1/11)
California Association of Nurse Anesthetists, Inc.
California Nurse Midwives Association
Kaplan Inc.
Summit Career College
GOVERNOR'S VETO MESSAGE:
"I am returning Senate Bill 538 without my signature.
The Board of Registered Nursing protects consumers and
regulates professional nursing in California and this
measure would extend the existence of this longstanding
regulatory body until 2016. Unfortunately, extraneous
harmful provisions lurk within this otherwise benign
sunset extension bill.
These provisions would dramatically expand pension
benefits for a select group of the Board's
investigators. This makes no sense fiscally and flies
in the face of much needed pension reform.
It is unacceptable to jeopardize the extension of this
Board's critical consumer protection role by allowing
these provisions to be included in this otherwise
simple sunset extension measure. The Board has existed
for 106 years without these enhanced benefits and
should continue to do so.
I would ask that as soon as it reconvenes, the
Legislature send me legislation that both restores the
Board of Registered Nursing and restores the provisions
of law relating to "bureau status" for expired boards.
In the interim, I direct my administration to take all
actions necessary under the law to protect consumers
and nurses alike until the Board is reconstituted in
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January."
ASSEMBLY FLOOR : 52-25, 9/1/11
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bradford, Brownley,
Buchanan, Butler, Charles Calderon, Campos, Carter,
Cedillo, Chesbro, Dickinson, Eng, Feuer, Fong, Fuentes,
Furutani, Galgiani, Gatto, Gordon, Hall, Hayashi, Roger
Hern�ndez, Hill, Huber, Hueso, Huffman, Lara, Bonnie
Lowenthal, Ma, Mendoza, Mitchell, Monning, Pan, Perea, V.
Manuel P�rez, Portantino, Skinner, Smyth, Solorio,
Swanson, Torres, Wieckowski, Williams, Yamada, John A.
P�rez
NOES: Achadjian, Conway, Cook, Donnelly, Fletcher, Beth
Gaines, Garrick, Grove, Hagman, Halderman, Harkey,
Jeffries, Jones, Knight, Logue, Mansoor, Miller, Morrell,
Nestande, Nielsen, Norby, Olsen, Silva, Valadao, Wagner
NO VOTE RECORDED: Bonilla, Davis, Gorell
JJA:do 1/4/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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