BILL ANALYSIS C.S.H.B. 883 By: McDonald (Zaffirini) Health and Human Services 5-22-95 Senate Committee Report (Substituted) BACKGROUND The statutes enacted by the 42nd and 52nd legislatures governing the Board of Nurse Examiners and the Board of Vocational Nurse Examiners respectively, do not address the changes associated with the modern health care industry. Legislation introduced in response to the Sunset Commission review of the two boards by the 73rd Legislature attempted to amend the laws to conform with current practice. Despite these attempts, however, the licensure act does not provide a comprehensive guideline for the administration and regulation of licensees by both boards. PURPOSE As proposed, C.S.H.B. 883 clarifies the licensing procedures for a registered nurse and a licensed vocational nurse. RULEMAKING AUTHORITY It is the committee's opinion that rulemaking authority is granted to the Board of Nurse Examiners under SECTION 12 (Section 8, Article 4525b, V.T.C.S.) and to the Board of Vocational Nurse Examiners under SECTION 17 (Section 7(e), Article 4528c(g), V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 2(a), Article 4513, V.T.C.S., to require a member of the Board of Nurse Examiners to be actually engaged in the nursing profession for at least three of the five years, rather than just for three years, preceding the appointment. SECTION 2. Amends Section 3, Article 4518, V.T.C.S., to include good professional character in the list of requirements for an applicant for registration as a registered nurse (RN). SECTION 3. Amends Section 1, Article 4525b, V.T.C.S., to redefine "nursing peer review committee" and "peer review." Defines "nurse" and "nursing." SECTION 4. Amends Section 1A, Article 4525b, V.T.C.S., to distinguish between the requirements for a nursing peer review committee that conducts a review that only involves the practice of professional nursing, a review that involves only the practice of vocational nursing, and a review that involves the practice of both professional nursing and licensed vocational nursing. Redesignates existing Subdivisions (4) and (5) as Subdivisions (5) and (6). Makes conforming changes. SECTION 5. Amends Section 1B, Article 4525b, V.T.C.S., to require a nurse, rather than specifying an RN, who, as a temporary agency nurse, faculty member or similar personnel, practices nursing, rather than specifying professional nursing, for an entity other than the one that employs or directly compensates the nurse to be subject to peer review by both. SECTION 6. Amends Section 2, Article 4525b, V.T.C.S., to make conforming changes. SECTION 7. Amends Sections 3(a)-(c), Article 4525b, V.T.C.S., to make conforming changes. SECTION 8. Amends Section 4(a), Article 4525b, V.T.C.S., to make a conforming change. SECTION 9. Amends Section 5, Article 4525b, V.T.C.S., to make conforming changes. SECTION 10. Amends Section 6, Article 4525b, V.T.C.S., to make a conforming change. SECTION 11. Amends Section 7(a), Article 4525b, V.T.C.S., to make a conforming change. SECTION 12. Amends Article 4525b, V.T.C.S., as follows: Sec. 8. CONSULTATION IN ADOPTION OF RULES. Requires the Board of Nurse Examiners to consult with the Board of Vocational Nurse Examiners (board) in adopting rules under this article. SECTION 13. Amends Chapter 7, Title 71, V.T.C.S., by adding Article 4525d, as follows: Art. 4525d. PROTECTION FOR REFUSAL TO ENGAGE IN CERTAIN CONDUCT. (a) Prohibits a person from suspending, terminating, or otherwise disciplining or discriminating against an RN who refuses to engage in an act or omission relating to patient care that would constitute grounds for reporting the nurse to the Board of Nurse Examiners, if the nurse notifies the person at the time of the refusal that the reason is that the action or omission constitutes grounds for reporting the nurse or is a violation of this chapter or a Board of Nurse Examiners' rule. (b) Sets forth circumstances under which an act by a person under Subsection (a) does not constitute a violation of this article. (c) Authorizes an appropriate licensing agency to take action against a person who violates this article. (d) Defines "person." SECTION 14. Amends Article 4527d(a), V.T.C.S., to make conforming changes. SECTION 15. Amends Section 5, Article 4528c, V.T.C.S., by amending Subsection (g) and adding Subsection (u), to authorize the board's separate fee for the survey of approved programs to be allocated to cover the cost of implementing the survey. Requires the board to disseminate, at least twice a year, information that is of significant interest to Licensed Vocational Nurses (LVNs) and their employers. Requires the information to include summaries of final disciplinary action taken against LVNs by the board since its last dissemination of information. SECTION 16. Amends Sections 6(a) and (d), Article 4528c, V.T.C.S., as follows: (a) Requires an applicant for an LVN license to present evidence that the applicant holds a high school diploma issued by an accredited secondary school or equivalent educational credentials, rather than that the applicant has had at least two years of high school or its equivalent. Deletes a provision requiring application for examination by the board or its delegate to be made at least 30 days prior to the examination. (d) Provides that a temporary permit issued to an applicant who fails the examination expires on the date the examination result is reported to the board, rather than on the date indicated on the permit. SECTION 17. Amends Section 7, Article 4528c, V.T.C.S., to delete a provision requiring an applicant to qualify for a temporary license to practice as an LVN by endorsement to submit to the board a notice of sponsorship of the applicant by the holder of a Texas health care profession license under whom the applicant will practice. Requires the board to adopt rules to address the practice of vocational nursing by a vocational nurse who holds a license issued by another state who is in this state on a nonroutine basis for a period not to exceed five days or 120 hours to provide care to a patient who is being transported into, out of, or through this state. Deletes existing Subsection (d) to make conforming changes. SECTION 18. Amends Section 10, Article 4528c, V.T.C.S., by adding Subsection (h), to apply Article 6252-13c, V.T.C.S. to the board, and to provide that the board is a licensing agency for purposes of that article. SECTION 19. Amends Article 4528c, V.T.C.S., by adding Section 10G, as follows: Sec. 10G. TEMPORARY SUSPENSION OF LICENSE. (a) Requires the board or a three-member committee of the board to suspend the license of an LVN if the majority of the board or committee members determine that an LVN would constitute by practicing nursing a continuing and imminent threat (threat) to the public welfare. (b) Authorizes a license to be suspended without notice or hearing on the complaint under certain circumstances. (c) Requires the State Office of Administrative Hearings to conduct a preliminary hearing within a certain time period if probable cause exists that a threat to the public is still occurring. Requires that office to conduct a final hearing by the 91st day after the temporary suspension order. SECTION 20. Amends Article 4528c, V.T.C.S., by adding Section 10H, as follows: Sec. 10H. INFORMATION; SUBPOENAS. (a) Requires each person to respond to any request for information from the board and to any subpoena issued by the board and prohibits a perform from refusing, denying, or resisting the request or subpoena unless either requests information subject to the attorney-client privilege of confidentiality. Provides that no other privilege applies to a board proceeding. (b) Sets forth authorized methods for serving a subpoena issued by the board. (c) Authorizes the board to pay a fee for photocopies subpoenaed at the board's request to cover the cost of copying. (d) Requires the board to protect the identity of patients named in the information received by the board, to the extent possible. SECTION 21. Amends Article 4528c, V.T.C.S., by adding Section 10I, as follows: Sec. 10I. PEER REVIEW. Subjects a vocational nurse license under this Act to peer review under Article 4525b, V.T.C.S. SECTION 22. (a) Makes application of Section 6, Article 4528c, V.T.C.S., as amended by this Act, prospective beginning September 1, 1995. (b) Provides that Sections 10G and 10H, Article 4528c, V.T.C.S., as added by this Act, take effect January 1, 1996. Requires the board to adopt rules to implement those sections by December 31, 1995. SECTION 23. Emergency clause. Effective date: upon passage.