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.