BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1524|
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THIRD READING
Bill No: SB 1524
Author: Hernandez (D)
Amended: 3/28/12
Vote: 21
SENATE BUSINESS., PROF. & ECON. DEV. COMM. : 9-0, 4/16/12
AYES: Price, Emmerson, Corbett, Correa, Hernandez, Negrete
McLeod, Strickland, Vargas, Wyland
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Nursing
SOURCE : Author
DIGEST : This bill deletes the requirement that a
certified nurse-midwife and nurse practitioner must
complete six months of physician and surgeon supervised
experience in the furnishing or ordering of drugs or
devices.
ANALYSIS :
Existing law:
1. Establishes the Nursing Practice Act which provides for
the certification and regulation of registered nurses,
nurse practitioners and advanced practice nurses by the
Board of Registered Nursing (BRN) within the Department
of Consumer Affairs.
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2. Provides that the practice of nursing includes direct
and indirect patient services, including but not limited
to, the administration of medications and therapeutic
agents necessary to implement a treatment, disease
prevention, or rehabilitative regimen ordered by and
within the scope of licensure of a physician, dentist,
podiatrist, or clinical psychologist.
3. Provides that the practice of nursing may be performed
under "standardized procedures," as defined, for
specified functions, treatments and procedures.
4. Provides that a certified nurse-midwife may furnish or
order drugs or devices, including controlled substances,
if furnished or ordered incidentally to the provision of
family planning services, routine health care or
perinatal care, or care rendered consistent with the
certified nurse-midwife's practice; occurs under
physician and surgeon supervision; is in accordance with
standardized procedures or protocols as specified; is
issued a number by the BRN after the BRN certifies that
the certified nurse-midwife has completed at least six
months of physician and surgeon supervised experience in
the furnishing or ordering of drugs or devices and a
course in pharmacology covering the drugs or devices to
be furnished or ordered.
5. Provides that a nurse practitioner may furnish or order
drugs or devices, including controlled substances, if it
is consistent with a nurse practitioner's educational
preparation or for which clinical competency has been
established and maintained; occurs under physician and
surgeon supervision; is in accordance with standardized
procedures or protocols as specified; and the BRN has
certified prior to issuing a number, as required, that
the nurse practitioner has completed (1) at least six
months of physician and surgeon supervised experience in
the furnishing or ordering of drugs or devices, and (2)
a course in pharmacology covering the drugs or devices
to be furnished or ordered.
6. Defines the furnishing or ordering of drugs or devices
by nurse practitioners to mean the act of making a
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pharmaceutical agent or agents available to the patient
in strict accordance with a standardized procedure.
This bill:
1. Deletes the requirement that a certified nurse-midwife
must complete six months of physician and surgeon
supervised experience in the furnishing or ordering of
drugs or devices.
2. Deletes the requirement that a nurse practitioner must
complete six months of physician and surgeon supervised
experience in the furnishing or ordering of drugs or
devices.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 4/30/12)
California Association for Nurse Practitioners
California Nurse-Midwives Association
Planned Parenthood of Pasadena and San Gabriel Valley, Inc.
ARGUMENTS IN SUPPORT : According to the author's office,
existing law makes newly graduated nurse practitioners
(NPs) and certified nurse midwives (CNMs), and those moving
to California regardless of how long they have been a NP or
a CNM, subject to six months of a physician-supervised
period for the purpose of prescribing drugs or devices.
This is a barrier to employment for those practitioners
moving to California as well as for new graduates.
Increasing access to care is a key goal in California, as
we have a shortage of health care providers in underserved
areas around the state. The author's office believes that
NPs and CNMs can be a key part of providing health care to
those areas and in increasing our health care safety net.
The author's office states that NPs and CNMs are advance
practice registered nurses who are licensed, certified, and
regulated by the BRN. NPs and CNMs have an important role
in the health care delivery system; they perform
comprehensive physical exams, furnish medications, order
laboratory and other diagnostic tests, and provide health
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and wellness education and counseling. NPs and CNMs
provide care in a variety of settings including hospitals,
community clinics and private practice settings.
The author's office further states that safely furnishing
medications is a standard component of NP and CNM practice
and education. During the graduate education programs in
California, student NPs and CNMs complete pharmacology
training and have a minimum of 12 months of direct clinical
experience with a supervising NP or CNM. The students
furnish medications under direct supervision and are
evaluated as competent in furnishing/prescribing prior to
graduation based on national standards.
As stated by the author's office, the six-month supervisory
requirement is an arbitrary barrier and prevents NP and CNM
practice to the fullest extent of their training. The
requirement is redundant given that the law already
requires a) physician supervision of CNMs who are
furnishing and b) physician involvement in developing
standardized procedures for furnishing. New graduates
frequently report facing challenges in being hired without
a furnishing number. Also, NPs and CNMs who previously
worked out-of-state are also required to provide
certification of six-months of physician supervised
prescription writing, regardless of past experience.
The author's office indicates that there is no evidence
that six months of physician supervised prescription
writing actually protects the health and safety of
consumers. "There is a wealth of research, however, that
demonstrates that NPs and CNMs are safe, effective health
care professionals. The removal of this portion of statute
will significantly improve patient access to advance
practice nursing providers, without reducing any
protections for the health and safety of consumers in
California."
JJA:do 4/30/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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