Legislature(2001 - 2002)
02/20/2002 03:25 PM House L&C
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 276-REGULATION OF NURSING Number 010 CHAIR MURKOWSKI said the first order of business would be HOUSE BILL NO. 276, "An Act relating to nursing, nurses, and nurse aides." Number 017 REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, sponsor, presented HB 276 to the committee. She explained that HB 276 is a "simple bill" that just brings the nursing statutes current in three areas. One area gives licensed nurses the authority to delegate duties to other personnel. This legislation also increases the length of time for a temporary nursing license from four to six months, due to the length of time required to do a criminal background check. The third area changes the wording regarding the licensure by endorsement and basically brings the statutes into compliance with what is already being done. Number 041 CHAIR MURKOWSKI asked Representative Wilson if it is her intention for the committee to adopt the proposed committee substitute (CS). REPRESENTATIVE WILSON responded in the affirmative. Number 044 REPRESENTATIVE ROKEBERG moved to adopt the proposed CS for HB 276, version 22-LS0979\J, Lauterbach, 1/24/02, as the working document. There being no objection, Version J was before the committee. CHAIR MURKOWSKI asked Representative Wilson if she knew to whom a nurse might delegate certain functions, and what kind of functions these are. Number 066 REPRESENTATIVE WILSON said that would cover a lot different areas." She drew on her experience as a nurse in the school system and offered an example of a disabled child who had to be catheterized every eight hours. Since it was a school of 4,000 students, it was very difficult for her to get there once a day to do that. However, she'd taught the classroom aide how to do it. If a nurse spends the time to ensure that the person knows how to do a specific procedure and has practiced it, then a nurse can delegate to that person, with supervision, on how to do a certain thing. This could take place in a hospital, nursing home, long-term care setting, or many other settings. CHAIR MURKOWSKI asked if this could involve administering prescription medication. REPRESENTATIVE WILSON said no. Number 100 REPRESENTATIVE ROKEBERG stated that the language in HB 276 makes him nervous because basically it allows the department, by regulation, to allow any licensed practitioner to delegate those duties that are encompassed in that license. He asked who is responsible for that person to whom the duty has been delegated as far as liability is concerned. REPRESENTATIVE WILSON deferred to Ms. Fulton, who was waiting to testify via teleconference. Number 119 REPRESENTATIVE ROKEBERG asked Representative Wilson if there are current regulations for anything like this. REPRESENTATIVE WILSON responded that there are statutes and that the Board of Nursing has its own regulations, which are very specific regarding what can and cannot be done. REPRESENTATIVE ROKEBERG asked if those regulations relate to the scope of delegation. REPRESENTATIVE WILSON responded in the affirmative. Number 135 DOROTHY FULTON, Executive Administrator, Board of Nursing, testified via teleconference, noting that she is also a nurse. She explained that a nurse is responsible for what he/she delegates and will only delegate duties that can be delegated. Some nursing duties can't be delegated. She said the board will develop those regulations when the statute changes. She told the committee that nurses have always delegated; the licensed practical nurse (LPN) position was developed because it was a person to whom a registered nurse (RN) could delegate. She added, "It's an unwritten part of nursing duties - is to delegate. And we've always delegated." She said it came up that nurses have the statutory [purview] to do so. She explained that nurses have the regulatory authority to regulate duties for assisted living homes, but not for any other setting. REPRESENTATIVE ROKEBERG said that scares him because the nurses have regulatory authority, but no statutory authority for nursing homes. MS. FULTON mentioned the assisted-living setting. She then explained that the Board of Nursing has "another position statement, if we ... determined that we didn't have the regulatory authority to delegate, ... that ... is not legal and binding." The nurse is responsible for what she delegates. The condition of a patient whose care can be delegated has to be chronic and stable, and not in the acute-care setting. The nurse has to do the assessment and has the full responsibility for what duties are delegated, to whom the duties are delegated, and the training that should occur between the nurse and the unlicensed individual. Number 178 MS. FULTON mentioned that the [Board of Nursing] has had a lot of support from communities, hospitals, and other facilities for nurses to be allowed to delegate some duties to unlicensed people. It needs to be controlled, however, which is why it is being requested [through HB 276]. REPRESENTATIVE WILSON emphasized that this isn't different or unusual, but is something nurses do all across the United States, in every state. [Alaska's] statutes don't currently allow for this, and [the Board of Nursing] wants to make sure they do. Number 196 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Community & Economic Development, testified before the committee. She said, "First, it was requested by the Board of Nursing, as strongly supported by the division." Delegation is the most significant part of the legislation for the board, whereas other matters [in HB 276] are more of a "cleanup." She agreed that delegation has occurred throughout time by nurses. The Board of Nursing had begun what she thought was a very valuable process of trying to write regulations, and to explain to nurses and the community what could be delegated and how it could be done safely and correctly. MS. REARDON explained that as the Board of Nursing worked on those regulations over the past few years, it came up against the response from the Department of Law - which has to approve regulations - that while this is great public policy, there isn't statutory authority to write such regulations. That triggered coming to the legislature to request statutory authority. Number 225 MS. REARDON, in response to Representative Rokeberg's question, noted that a statute gives the authority just for assisted living homes. When assisted living home legislation passed a few years ago, there was reference to the ability to delegate as long as the delegation is in accordance with board regulations. Therefore, under that statutory authority, the board was able to adopt [regulations] governing assisted living homes. She continued: But for the rest of the nursing world, there apparently is not the statutory authority to write regulations. ... Several years ago [the Board of Nursing] issued advisory opinions - appendices that are in ... our little statute and regulation booklets - that give guidance on delegation in other settings that aren't assisted living settings. But those advisory opinions or guidelines don't have any force of law, and so a nurse looking at them can't be comfortable that if they follow them, they're ... doing the legally right thing. And, also, it is difficult to discipline someone for not following them, because they ... don't have any legal authority. Thus the effort to actually put things in [regulation], go through a public comment period, and ... have that official process. MS. REARDON mentioned that the [Board of Nursing] has continued to work on what it would like to have in regulation if this statute passes. The proposal that it has been working on sets out those things that cannot be delegated because too much expertise is needed to do them. Other things can be delegated under very specific circumstances, but only to specific people, not just to any employee who fits a certain category. She said she thinks this is really positive because currently delegation is occurring and "that's how the health care industry works." MS. REARDON continued by stating that even if [HB 276] doesn't pass, delegation without any kind of structure will continue to occur. She offered that if the legislature were to decide that no delegation is allowed, hospitals and facilities all across the state would have to find about five times as many nurses to hire, because there is a nursing shortage. Number 270 MS. REARDON explained that since she isn't a nurse, she has tried to learn about this [issue] by listening over the years. What she believes the Board of Nursing views as a nursing function - and what requires the nursing education - is the decision-making process, not just the physical care. Therefore, defining nursing, and eliminating the things nurse aides might do, isn't a way around the statutory problem. For example, when washing a patient, the nursing part is deciding whether that is an appropriate patient to wash in that manner. So while it is important to allow people who aren't RNs to do things such as wash [patients] or change dressings, it should be under the delegation of a nurse who has decided it is appropriate. MS. REARDON explained that the time when everybody in the hospital had an RN by his/her side all the time [is gone], and the Board of Nursing is trying to find a responsible way of establishing those rules. She added, "It would be the board, not the department." Number 303 REPRESENTATIVE HALCRO asked how the delegation issue coincides with the attempt to improve telemedicine in rural Alaska, for example. He asked if this actually helps deliver that service. MS. REARDON replied, "I think that it helps in that some entity is given the ability to establish the rules." She explained that there are community health aides in a lot of villages who have a different status. She said she thinks [the community health aides are] granted through other federal and state laws, about which she is not very knowledgeable. She stated, "Whether they have to receive delegation from nurses, or whether they're able to operate under other authorities, we don't license them." Number 320 REPRESENTATIVE ROKEBERG asked why the provisions for the criminal safety check of the Federal Bureau of Investigation (FBI) were removed from the original bill. MS. REARDON said since [HB 276] was introduced, it was found that the board had authority to do that through regulation. She explained that through a Department of Public Safety (DPS) statute "we were able to meet the FBI's threshold through regulation," and it no longer was necessary to put it in the bill. The board has adopted regulations requiring fingerprints for initial licensure; those regulations have made it through the first level of Department of Law review - the agency attorney - and still has to pass through the regulations attorney. She offered her expectation that very soon it will "make it through all the way, and into effect." REPRESENTATIVE ROKEBERG asked if it wouldn't be faster to just put it in statute now. MS. REARDON explained that since this can be done through regulations, they can be more flexible and be adjusted over time. Number 347 CAMILLE SOLEIL, Executive Director, Alaska Nurses Association, testified via teleconference, saying the reason [the Alaska Nurses Association is] supporting [HB 276] is that it clarifies the boundaries of delegation for RNs. She reported that many nurses have complained of pressure to delegate duties to personnel in facilities when they are unaware of the personnel's training or experience. She explained that a nurse who feels uncomfortable delegating to someone can refer to the board's regulations that say the nurse shouldn't be delegating in this situation. Number 365 NANCY SANDERS, Member, Board of Nursing, testified via teleconference. She said the unlicensed personnel are being supervised by the nurses, and it doesn't change the accountability of the nurse for the delegated tasks. Number 376 PATRICIA SENNER, President, Alaska Nurses Association, testified via teleconference, noting that she is also a registered nurse. She explained that the Board of Nursing has been looking at revising its regulations regarding delegation because the old regulations were unclear. She offered that the [Alaska] Pioneers' Home nurses were a classic example in that their employers were forcing them to delegate tasks they did not feel comfortable with, and they had no control over the individuals that they were being asked to delegate to. She stated, "So we are highly supportive of this bill." Number 386 NANCY DAVIS, Chief, Nursing Section, Division of Public Health, Department of Health & Social Services, testified before the committee. She reported that she did participate in analyzing [HB 276] and that the department is supportive because it thinks the overall issue is consumer protection, in addition to clarifying nursing practice. She said there are public health nurses all over the state who work in village situations where it's critical to apply judgment and be able to delegate functions and tasks that can be delegated. She explained that it is also important to have statutory authority behind that so that a nurse can decide not to delegate when that's in the best interest of the patient. She stated, "So our department is in support of this bill." CHAIR MURKOWSKI asked Ms. Davis to address Representative Halcro's concern about how [HB 276] might impact telemedicine. MS. DAVIS explained that the development of telemedicine in rural Alaska has been done primarily through "the community health aide and tribal agencies." Public health nursing is a partner in the development of telemedicine, and [the Department of Health & Social Services] participates with them. She stated that the authority for community health aide practitioners to practice comes through the tribal health corporations, and "at a certain level of training, they can become federally certified and they don't fall under state certification rules." She offered that the [Department of Health & Social Services] works with community health aide practitioners, who provide primary care at the village level, on a daily basis. She stated: I think that the regulation development will be an interesting one, especially for public health nursing staff in how it addresses the relationship between registered nurses licensed in Alaska and community health aide practitioners who are governed through the tribal health system. Number 426 REPRESENTATIVE ROKEBERG asked if deleting Section 1 of the original bill, which was the public safety check and the fingerprinting, is the only difference between Version J and the original bill. REPRESENTATIVE WILSON highlighted the changes: the new wording of the title makes it tighter and more specific; the fingerprint section was deleted [because] the Department of Law decided the Board of Nursing had the statutory authority [to do this]; the temporary-permit wording was changed from four to six months; a few unnecessary words were deleted in the last two sections; and "it was mentioned, from the division staff, ... the effective date." Number 439 REPRESENTATIVE WILSON, in response to a remark from Representative Rokeberg, explained that the Department of Law wants what is in the appendix of the regulations of nursing to be in statute. MS. REARDON added that the appendices are those advisory opinions on delegation she'd referred to earlier. The Department of Law indicated several years ago that those advisory opinions aren't regulations and have no force of law. She explained that when the board went to try to make regulations, they were told they couldn't. The regulations that the board was able to do were the fingerprint regulations, not because of any reference to fingerprinting in Title 8, but because the nursing statutes give the board the authority to deny people for certain things in their backgrounds. The FBI, in order to run fingerprint checks, requires that there is a state statute that mandates it, because it wants to control or limit the number of fingerprints it is sent by states. MS. REARDON said she believes the wording in the public safety statutes that allows for fingerprinting is "for interested persons". Part of the definition of interested persons is people who work with vulnerable populations. She added, "Through that whole chain, there was enough statutory authority to satisfy the FBI, and therefore we didn't need to have it in ... here." Number 465 REPRESENTATIVE ROKEBERG said, "It costs a lot ... [to] move a bill through this legislature, but it costs a lot of money to help promulgate regulations too." CHAIR MURKOWSKI asked if [the Board of Nursing] would still be promulgating its regulations with the [adopted] fingerprinting. REPRESENTATIVE ROKEBERG said, "You would have to. You have a statute. You wouldn't have to promulgate regulations, but there could be other regulations that are attached." CHAIR MURKOWSKI asked, "Don't you have to do the regulations with regard to the delegation?" MS. REARDON replied in the affirmative, adding that the regulations would have to be promulgated anyway to adopt new regulations for the charge for each fingerprint check. REPRESENTATIVE ROKEBERG commented, "It's the old thing: who runs the shop here, the legislature or the executives? So it's a separation-of-powers issue on who's doing what. It's regulations versus the statute." Number 477 REPRESENTATIVE MEYER moved to report CSHB 276, version 22- LS0979\J, Lauterbach, 1/24/02, out of committee with individual recommendations and the accompanying zero fiscal note. There being no objection, CSHB 276(L&C) was moved from the House Labor and Commerce Standing Committee.
| Document Name | Date/Time | Subjects |
|---|