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.