Legislature(2001 - 2002)
02/27/2002 01:40 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SB 283-REGULATION OF NURSING
CHAIRWOMAN GREEN asked Senator Wilken to present SB 283.
SENATOR GARY WILKEN, sponsor of SB 283, read the following
sponsor statement.
SB 283 is submitted at the request of the state board
of nursing. It will reconcile current nursing industry
standards with Alaska state law and maintain efficient
management of licensed nurses in our state.
Specifically, it does three things: 1) it codifies the
authority of licensed nurses to delegate certain basic
tasks to unlicensed assisted personnel; 2) it extends
the duration of a temporary nursing license from 4 to 6
months; and 3) it updates the statutory language
authorizing the issuance of licenses by endorsement.
These statutory adjustments are the result of a
diligent effort by the state board of nursing. They
will serve to tighten, clarify and improve their
ability to regulate and manage the delivery of safe and
effective health care to the citizens of Alaska. There
is no known opposition or negative impact of these
adjustments. Please support the state board of nursing
by enacting this beneficial legislation.
SENATOR WILKEN commented that he got involved in this issue
through a friend but he faced this issue when he worked on long
term care. He believes this bill will help to provide better
service and broaden the reach of the nurses that benefit Alaska
today.
CHAIRWOMAN GREEN acknowledged that she has one question that just
arose, that pertains to a decision by the board of nursing or one
of its subcommittees to not deliver over-the-counter supplements
that are prescribed by medical doctors. She feels it is ironic
to pass on nursing duties to other employees when nurses do not
have to adhere to a physician's decision. She said she would
like someone to provide her with the statute or regulation that
provides that written authority before passing the bill out of
committee.
SENATOR WILKEN named several people who were available to testify
and who may be able to answer that question.
MS. LYNN HARTZ, member of the Board of Nursing, stated support
for SB 283. SB 283 is essentially a "clean up" bill that brings
nursing statutes up to date with current nursing practice. It
moves the licensing by endorsement provision from one section to
another, which will correct a loophole that could allow a non-
nurse to apply for licensure. SB 283 also increases the length
of time for a temporary nursing license from four to six months
to allow extra time to get the results of a criminal background
check. It also gives licensed nurses the authority to delegate
nursing duties to other personnel and the Board of Nursing the
authority to write regulations outlining safe delegation
practices. Last year, the Board of Nursing was told that nurses
do not have statutory authority to delegate to unlicensed,
assistive personnel (UAP), therefore the board could not write
regulations about delegation. The board had always assumed that
nurses had the authority to delegate to unlicensed assistants and
even published a position statement on the subject in 1993. An
example of a duty that a nurse might delegate to a nurse's aide
is to run a urine test on a patient. Nurses' aides have no legal
scope of practice since they have no license to practice. The
legal source of the authority to do the task is the licensed
nurse. Without this legislation, UAPs would have no legal basis
to continue to perform nursing tasks for patients at hospitals.
2:55 p.m.
CHAIRWOMAN GREEN stated that about three years ago, nurses were
being required to pass on certain authorities to assistants and
some nurses chose not to. She asked if SB 283 could force a
nurse to assign a duty to an assistant that he or she would not
otherwise choose to do.
MS. HARTZ said it will not and, in fact, SB 283 will strengthen
the nurses' ability to make those judgments and not force them to
delegate an unsafe task.
CHAIRWOMAN GREEN asked what provision in SB 283 will give nurses
that protection.
MS. HARTZ said that to delegate a task that a nurse felt was
unsafe would be considered unprofessional conduct by statute.
CHAIRWOMAN GREEN said she just wanted to be sure that this bill
cannot be construed to mean that an employer could require a
nurse to delegate a task unwillingly.
MS. HARTZ said she does not believe it could. The bill also
gives the Board of Nursing the authority to write regulations,
which they want to do to prevent that from happening.
CHAIRWOMAN GREEN asked if it is an assumption that the Board of
Nursing will be writing the regulations as she saw no mention of
it in the bill.
MS. HARTZ referred Chairwoman Green to Section 5 of SB 283,
specifically the phrase, "under regulations adopted by the
board."
MS. PAT SENNER, President of the Alaska Nurses Association,
stated full support for SB 283. She noted in the past 10 years,
there has been an explosion of the types of UAPs that nurses are
being asked to delegate tasks to. Because these people are
unlicensed, no quality assurance exists to ensure that the
education UAPs received is adequate for the task they are being
asked to do. Employers often ask nurses to be the quality
assurance component and to make sure that the people they are
asked to supervise perform their tasks in an adequate manner and
have been trained properly. She pointed out that often tasks
would be assigned to UAPs on a case-by-case basis, only when the
supervising nurse is sure the UAP is able to provide adequate
care.
CHAIRWOMAN GREEN asked if a nurse might not dispense medicine
prescribed by a doctor, including non-prescription drugs.
MS. SENNER said the nurse always has the responsibility to review
medication orders given by a physician for safety reasons.
Therefore, even when a doctor prescribes medication, nurses are
responsible for making sure it is safe to give to that patient.
Court cases have occurred around the nation in which a nurse
administered an improper medication prescribed by a doctor and
nurses have been charged with murder. In one case, six different
errors were made but the nurse was held accountable for the one
improper medication error. She said the issue is not really
over-the-counter medicines, it is with medications that are not
FDA approved, usually herbal medicines. She recently attended a
urology conference where this topic and the following example
were discussed. An herbal medicine containing estrogen was given
to advanced cancer patients yet estrogen can lead to blood clots.
The problem with this and similar scenarios is that the nursing
profession is dealing with unregulated herbal medications that
often contain more ingredients than those listed on the label,
some of which could be harmful to the patient.
MS. NANCY SANDERS, a member of the Board of Nursing, agreed with
Ms. Hartz's synopsis of the bill.
CHAIRWOMAN GREEN asked where the authority to not dispense
something prescribed by a physician exists in statute or
regulation.
MS. SANDERS cited 12 AAC 44.770, which relates to unprofessional
conduct and added that some of the preparations being discussed
are not covered in nursing education programs because they are
not drugs.
MS. MARY WEYMILLER, a licensed practical nurse, said that while
SB 283 is a cleanup bill, it is an important one for the Board of
Nursing to develop regulations for state nursing practices. She
urged members to support the measure.
MS. CATHERINE REARDON, Director of the Division of Occupational
Licensing, Department of Community and Economic Development,
stated support for SB 283.
SENATOR WARD asked for more information about the 4 to 6 month
extension.
MS. REARDON said the Board has adopted regulations requiring
criminal background checks for initial licensure for a nurse or a
nurse aide. The background check includes state and FBI
fingerprint checks. The turnaround time, particularly for
fingerprint checks, is sometimes unpredictable so the Board wants
to make sure that temporary licenses do not expire while waiting
for results to come back. In about 7 percent of cases,
fingerprints are not readable and must be redone.
SENATOR WARD said he thought the could be done faster with new
technology.
MS. REARDON said it is an anticipated problem for nurses. The
division does fingerprint checks for collection agents and has
had experiences where people have had to send in fingerprints a
third time. She noted that usually the FBI turnaround time is
very quick but she suspects when they have other priorities, the
process may be slower. Sometimes it takes several months for the
FBI to send a response saying the fingerprints were unreadable.
The board's intention is to avoid a situation in which a nurse
can no longer go to work through no fault of the nurse. She
hypothesized that the technology may be better but the volume of
requests for fingerprint checks has grown.
There being no further questions or testimony, SENATOR WARD moved
SB 283 from committee with individual recommendations and its
zero fiscal note. There being no objection, the motion carried.
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