BILL ANALYSIS �
SB 1524
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Date of Hearing: June 12, 2012
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
SB 1524 (Hernandez) - As Amended: June 6, 2012
SENATE VOTE : 35-0
SUBJECT : Nursing
SUMMARY : Deletes a requirement that certified nurse-midwives
(CNMs) and nurse practitioners (NPs) complete at least six
months of physician-supervised experience in the furnishing or
ordering of drugs or devices. Specifically, this bill :
1)Deletes a requirement that CNMs and NPs complete at least six
months of physician-supervised experience in the furnishing or
ordering of drugs or devices.
2)Provides that, in the case of NPs, a physician and surgeon may
determine the extent of supervision necessary in the
furnishing or ordering of drugs and devices, as specified.
3)Makes a technical correction.
EXISTING LAW
1)Establishes the Nursing Practice Act which provides for the
certification and regulation of registered nurses (RNs) and
advanced practice RNs, including CNMs and NPs by the Board of
Registered Nursing (BRN) within the Department of Consumer
Affairs.
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.
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4)Provides that a CNM 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; and, is
conditional on the issuance of a furnishing number by the BRN
after the BRN certifies that the CNM 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 an NP may furnish or order drugs or devices,
including controlled substances, if it is consistent with an
NPs 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 furnishing number, as required,
that the NP 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.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author, "(Current law
requirements to complete at least six months of
physician-supervised experience in the furnishing or ordering of
drugs or devices) is a barrier to employment for new graduates
and those moving to California. 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. NPs and CNMs
can be a key part of providing health care to those areas, and
increasing our health care safety net.
"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 physician supervision of CNMs who are
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furnishing and 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 physician
supervised prescription writing, regardless of past experience.
"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 healthcare
professionals. The removal of this portion of statute will
significantly improve patient access to advanced practice
nursing providers, without reducing any protections for the
health and safety of consumers in California."
Background . NPs and CNMs are advanced practice RNs who are
licensed, certified, and regulated by the BRN. NPs and CNMs
play 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 and
wellness education and counseling. NPs and CNMs provide care in
a variety of settings including hospitals, community clinics,
and private practice settings.
According to the author, 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.
The author also notes that existing CNM statute clearly states
that CNMs may only furnish drugs and devices when "furnished or
ordered incidental to care rendered, consistent with the CNM's
educational preparation or for which clinical competency has
been established or maintained."
Support . The California Association for Nurse Practitioners
writes, "The six-month supervision requirement puts up an
ineffective and arbitrary barrier to allowing primary care
providers to begin practicing after they graduate from school.
In today's fast-paced health care environment, many physicians
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prefer to hire NPs who have already fulfilled this requirement,
placing new graduates and NPs who have been practicing in other
states at a disadvantage. As a result, this antiquated
requirement has become a barrier preventing access to care as it
delays NPs from entry into California's health care workforce.
Educational programs have evolved significantly since this law
was enacted. California's NP educational programs include
physician supervised training in ordering drugs and devices
prior to graduation, making this provision no longer necessary.
"Further, under existing law, physicians retain the authority to
create specific supervision requirements in the standardized
procedures developed with the NPs they are working with. SB
1524 does not change or undermine this authority."
Opposition . The California Chapter of the American College of
Cardiology states, "Furnishing or prescribing medications is one
of the most important aspects of treating a patient. Being able
to understand when to prescribe a medication and what the
appropriate medication to prescribe will have a significant
impact on the health of a patient.
"Under current law, the six month supervisory certification
period is valuable time spent with a physician to ensure the NP
and CNM better understands how to safely prescribe medications
for patients. We believe it is critical for the safety of
patients for NPs and CNMs to complete this six month period
after they graduate from their training program. To eliminate
this requirement will only result in patient safety being
marginalized.
"Lastly, after graduating from medical school, physicians are
required to go through a similar program in their residency that
is 12 months long before they may prescribe medications on their
own."
Related legislation .
AB 2348 (Mitchell) of 2012 allows RNs to dispense drugs or
devices upon an order issued by a CNM, NP, or physician
assistant (PA) if the RN is functioning within a licensed
primary care clinic, and allows RNs to dispense and administer
specified hormonal contraceptives if the RN is functioning
within a licensed primary care clinic, as specified. This bill
is pending in Senate Rules Committee.
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SB 1338 (Kehoe) of 2012 clarifies that NPs, CNMs and PAs may
assist in performing an abortion if authorized within their
practice to do so, and can perform an abortion by "medication"
or "aspiration techniques." This bill was held in Senate
Business, Professions and Economic Development Committee.
Previous legislation .
SB 809 (Ashburn and Runner) of 2007 makes a number of changes to
the NP scope of practice, including allowing NPs to prescribe
drugs and deleting the requirement for physician supervision and
standardized procedures and protocols for furnishing or ordering
drugs. This bill was held in Senate Business, Professions and
Economic Development Committee.
SB X1 24 (Ashburn) of 2007 was substantially identical to SB
809. This bill was held in Senate Health Committee.
SB 614 (Figueroa), Chapter 266, Statutes of 2005, authorizes
CNMs to furnish or order Schedule II controlled substances under
conditions applicable to the furnishing or ordering of Schedule
III, IV, or V controlled substances, as specified.
AB 2560 (Montanez), Chapter 205, Statutes of 2004, removes the
restrictions on NPs as to the healthcare settings and areas in
which they may furnish or order drugs or devices for patients,
and allows the NP to furnish or order drugs and devices whenever
it is consistent with their educational preparation or clinical
competency.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association for Nurse Practitioners
California Nurse-Midwives Association
Planned Parenthood of the Pacific Southwest
United Nurses Associations of California/Union of Health Care
Professionals
Opposition
California Academy of Family Physicians
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California Chapter of the American College of Cardiology
Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301