Legislature(2001 - 2002)
03/14/2002 01:35 PM Senate L&C
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
HB 276-REGULATION OF NURSING
SB 283-REGULATION OF NURSING
CHAIRMAN STEVENS announced HB 276 and SB 283, companion bills, to
be up for consideration. He said they would use the working draft
of HB 276 for discussion.
REPRESENTATIVE PEGGY WILSON, sponsor of HB 276, said:
HB 276 is essentially a cleanup bill that brings the
nursing statutes up to date with current nursing
practice in three different ways. One, it gives
licensed nurses the authority to delegate duties to
other unlicensed personnel. Two, it increases the
length of time available for a temporary nursing
license from four to six months just for the criminal
justice background checks. It takes a little longer now
than it used to because of that. And three, it changes
the wording regarding licensure by endorsement and
brings the wording in statute into compliance with
what's already being done in the division. I have the
whole nursing board behind me, so…
SENATOR TORGERSON asked if there was a definition of "assistive
personnel" in section 5 where it says they can delegate to
unlicensed assistive personnel.
REPRESENTATIVE WILSON replied that meant unlicensed assistive
personnel, like nurses aides or someone else that would be
working with a patient or a client.
SENATOR TORGERSON asked if that was defined in statute. He had no
objection to the way it was written in the sponsor statement -
unlicensed assistive personnel (UAPs) such as aides and
technicians -
MS. LYNN HARTZ, a nurse practitioner and member of the Board of
Nursing, responded:
Whether there is a definition in statute that
determines who is an unlicensed assistive personnel -
no, because by definition unlicensed assistive
personnel is someone who doesn't have a certificate or
a license to practice and has been historically and
currently. Perhaps I could back up a little bit, if I
may. I had some testimony that might help explain this
as far as giving licensed nurses the authority to
delegate nursing duties to other personnel. This came
about when the Board of Nursing was drafting
regulations on delegation last year and we were told at
that time that nurses did not have the authority to
delegate to assistive personnel whom in general we call
UAPs (someone without a license or certificate in this
state). Therefore, the Board could not write
regulations about delegation. The Board had always
assumed that nurses had this authority to delegate to
unlicensed assistants and it even published a position
statement on that with our statutes and regs in 1993.
So that's why we view it as a cleanup section because
it's giving the Board of Nursing and nurses the
authority we thought we already had.
An example of delegation might be a nurse asking a
nurses aide to run a urine test on a patient. The
nurse's aide has no legal scope of practice. Hence the
term unlicensed assistive personnel. The legal source
of the authority to do the nursing task, in this case a
urine test, is the licensed nurse, because the nurse
does have a legal scope of practice in the state. So
the nurse transfers or delegates that authority to the
unlicensed person, in this case to do a urine specimen.
Without the ability for the nurse to delegate nursing
tasks, the unlicensed assistants have no authority to
act. Therefore, without this legislation the UAPs who
are called patient care technicians at Providence
Hospital have no legal basis to continue to perform
nursing tasks that are delegated.
At the municipality of Anchorage, UAPs are called
family service aides. It seems to be that since they
are unlicensed and certificated, different employment
agencies give them different terminology. So, at
Anchorage Health Department, they are called family
service aides. They would not be able to perform
nursing tasks delegated by public health nurses. We do
have unlicensed assistive personnel defined, but it's a
part of the position statement written in 1993, which
the Board of Nursing was told it didn't have the
authority to write, because we didn't have statutory
authority to delegate to unlicensed assistive
personnel.
SENATOR TORGERSON said he would feel better if somewhere it said
"supervised". "Right now you can go out and get somebody off the
street and give them a job. That's the part that I don't like."
MS. HARTZ said the safety component is under the regulations
promulgated by the Board. There would be supervision by
registered and licensed nurses.
SENATOR AUSTERMAN said he understood that those regulations
hadn't been adopted yet.
MS. HARTZ replied, "Just because we don't have the statutory
authority to write regulations."
CHAIRMAN STEVENS said, "But you have the regulations."
MS. HARTZ responded, "We have some proposed regulations that
we've been working on, yes, that deal with supervision, yes."
CHAIRMAN STEVENS asked, "Are they ready to be adopted as
regulations now, then?"
MS. HARTZ replied, "No. I would say we still want to work on them
some more."
SENATOR TORGERSON said he didn't care what they had, he thought
it should be in the bill. "Supervised delegation" would be one
fix for defining the level of personnel you can do this to.
"Right now it's wide open."
CHAIRMAN STEVENS asked about the concept of section 5 going into
affect once the regulations are promulgated.
REPRESENTATIVE WILSON replied that's the main reason for the
bill. The nurses have the regulations, but there is nothing in
statute saying they could adopt them.
SENATOR AUSTERMAN said the Board currently has the authority to
write regulations.
MS. HARTZ replied, "Not regarding delegation of authority and yet
it's being done daily currently in public health hospitals,
clinics."
SENATOR DAVIS asked if the unlicensed personnel were certified to
work in a hospital. Someone indicated they aren't. She asked if
they could cover the issue by limiting the authority to people
who are employed by the facility.
SENATOR AUSTERMAN said that a hospital could use a janitor in
that instance.
MS. HARTZ responded that it was professionally inappropriate for
an RN to delegate in an inappropriate or unsafe manner. They have
been telling people while they are in this gray area of practice
to please go by appendix D in the back of the statutes, which
deals completely with delegation and licenses to personnel. They
would like to refine that and that is what she meant when she
said they didn't have those regulations ready to go.
CHAIRMAN STEVENS asked if this practice has already been going
on, why do they need it in statute.
MS. HARTZ replied that was a good question and the Nursing Board
was under the misapprehension that nurses had that authority all
along and that's why that appendix was written in 1993. The Board
submitted regulations to the Department of Law and were advised
them and the Attorney General that that needed to be in statute.
CHAIRMAN STEVENS asked if there's liability involved with
administering any sort of tests, does the liability trail follow
the delegation of authority and has anyone ever sued an
institution for having an adverse reaction to a drug.
MS. HARTZ replied that it is the nurse's responsibility. Her
license would be at stake if something like that happened. The
three categories of unlicensed assistive personnel are identified
as follows:
Those who nurses supervise and to whom they delegate
some activities to, those who nurses teach, but do not
supervise to those who are not directly or indirectly
supervised or taught by nurses.
SENATOR TORGERSON said he thought they should adopt the suggested
language and that would clarify the whole thing. He suggested
replacing section 5 with some of the language.
SENATOR TORGERSON moved a conceptual amendment on page 60 where
the unlicensed assisted personnel is defined. There were no
objections and that amendment was adopted.
MS. NANCY DAVIS, Chief, Public Health Nursing, supported HB 276,
because it brings a number of protections to the public. The
language is good in terms of licensure and it makes a lot of
sense for them to look carefully at endorsement licensure and
making sure that there are current competencies. They are also
supportive of the delegation of nursing functions, because it's a
critical element of nursing practice already. It's essential to
rural health care, especially in this state, in that there aren't
licensed practitioners in all the villages and there are a lot of
health care that needs to occur through delegation.
MS. PATRICIA SENNER, President, Alaska Nurses Association,
supported SB 283. She said over the past 10 years there has been
an increase in the number and type of ancillary unlicensed health
care workers that RNs and LPNs delegate duties to and have
oversite over the work they perform.
It is imperative that we have regulations from the
Board of Nursing covering delegation of nursing tasks.
Nurses rarely hire or train the unlicensed personnel
they are required to work with, yet their employers
require them to make sure these persons perform the
tasks delegated to them in a safe and accurate manner.
Because these individuals are unlicensed, there is no
regulatory body overseeing their training and
competency.
In terms of the definition of unlicensed assistive personnel, she
said, there are family members who are hired under the Choice
program who take care of the patient and in those cases, they
would come under the authority of a registered nurse. It would be
different than a family member doing this out of the goodness of
their heart. She didn't know if there was wording saying the
caregiver had to be employed.
SENATOR TORGERSON was looking at the statute and said that it was
silent on that issue. Maybe they needed to think about that.
REPRESENTATIVE WILSON said the fact that it's not mentioned means
that it would mean anyone, whether they were employed or not.
SENATOR TORGERSON said:
That's not what this says. Not to belabor it. It says,
'The term also includes, but is not limited to
orderlies, assistants, attendants and technicians. For
the purposes of this delegation criteria, unlicensed
and assistive personnel do not include family members
of the client immediate family or guardians. So we have
to change that to say "may include" if we want to be
inclusive.
MS. REARDON asked why they need to go any further than the first
sentence of that definition, which says:
Unlicensed assistive personnel are individuals who are
not authorized to perform nursing acts or tasks that
are regulated by the Board of Nursing except pursuant
to legal delegation by a nurse.
SENATOR TORGERSON proposed amendment #2 to delete "do not" and
insert "may".
The Board is going to have to define it anyway because
those regulations were wrong for what they were doing
for delegation to people who were home and were family
members. If they're delegating that now, that can't
happen because they would be under the same law.
CHAIRMAN STEVENS asked why the regulations do not include members
of the client's immediate family.
MS. REARDON replied that this language never became regulation,
so it didn't go through the legal review process. "These are just
an advisory opinion of the Board of Nursing."
She said the reason it didn't include family members is because
of the last sentence, which says:
Family members and guardians have performed and
continue to perform these activities without specific
delegation.
I suspect they were trying not to constrict what family
members could do, since the rest of this advisory
opinion puts constraints and guidelines and rules about
the delegation.
She thought they were trying to say for family members it could
be a more flexible system.
CHAIRMAN TORGERSON said they don't write laws or regulations by
saying historically this is what happens. His conceptual
amendment left the last sentence out.
CHAIRMAN STEVENS asked if there were any objections to the
conceptual amendment.
TAPE 11, SIDE B
SENATOR DAVIS said they shouldn't put family members in there,
because they could come back on the nurses. "How can they
supervise them if they're doing it at home. The nurses are in the
hospitals working…"
SENATOR TORGERSON said he thought the family members were being
paid, which is a big difference and he didn't think they were
performing procedures.
MS. SENNER said that was the point she was making.
Family members are trained by nurses and other health
care professionals to do all kinds of advanced care,
giving I.V.s or someone comes home on a respirator and
the family member takes care of the respirator. The
issue only comes into play when they are hired, such as
under the Choice program and then they do come under
the authority of a nurse.
She thought they should say: "Unlicensed assistive personnel or
individuals who are hired to perform health care services."
You would have the employment part in there, too.
SENATOR TORGERSON said they could do that by regulation. His
objective was to define the personnel and he thought they had
done that by adopting the definitions. There is still clearly a
role for the Board of Nursing to play and the regulatory process
to implement this law.
CHAIRMAN STEVENS said there were no further objections to
amendment #2 and it was adopted.
REPRESENTATIVE WILSON supported the amendments.
SENATOR TORGERSON moved to pass SCSHB 276(L&C) from committee
with individual recommendations. There were no objections and it
was so ordered.
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