By:  Moncrief                                          S.B. No. 617

                                A BILL TO BE ENTITLED

                                       AN ACT

 1-1     relating to the licensure and regulation of nurses, including the

 1-2     development of certain pilot programs by the Board of Nurse

 1-3     Examiners.


 1-5           SECTION 1.  Article 4518, Revised Statutes, is amended by

 1-6     adding Section 8 to read as follows:

 1-7           Sec. 8.  (a)  In this section:

 1-8                 (1)  "Pilot program" means a pilot program developed or

 1-9     approved under this section.

1-10                 (2)  "Proactive nursing peer review" means peer review

1-11     that is not initiated for the purpose of determining culpability

1-12     with respect to a particular incident.

1-13                 (3)  "Targeted continuing nursing education" means

1-14     continuing education focusing on a competency identified as one

1-15     that a significant portion of registered nurses in a particular

1-16     practice area would likely benefit from taking.

1-17           (b)  The Board may develop pilot programs to evaluate the

1-18     effectiveness of mechanisms for assuring:  (1) maintenance of

1-19     clinical competency by registered nurses in their area of practice,

1-20     including the use of proactive nursing peer review and targeted

1-21     continuing nursing education; and (2) that registered nurses

1-22     understand the laws and regulations governing the practice of

1-23     professional nursing.  The pilot programs shall be designed to test

 2-1     the effectiveness of a variety of mechanisms in a variety of

 2-2     practice settings.  The Board may approve pilot programs to be

 2-3     conducted by persons other than the Board.

 2-4           (c)  Subject to appropriations by the legislature, the Board

 2-5     may expend funds to develop or fund pilot programs.  The Board may

 2-6     contract with, make grants to, or make other arrangements with an

 2-7     agency, professional association, institution, individual, or other

 2-8     person to implement this section.

 2-9           (d)  In developing, administering, approving, and funding

2-10     pilot programs, the Board shall consult with an advisory committee

2-11     consisting of:

2-12                 (1)  one representative each from the Texas Nurses

2-13     Association, Texas Nurses Foundation, Texas League for Nursing,

2-14     Texas Chapter of the American Association of Nurse Attorneys, Texas

2-15     Organization of Baccalaureate and Graduate Nursing Educators, Texas

2-16     Organization for Associate Degree Nursing, and Texas Organization

2-17     of Nurse Executives;

2-18                 (2)  one registered nurse representative each from the

2-19     Texas Hospital Association, Texas Health Care Association, Texas

2-20     Association of Homes and Services for the Aging, and Texas

2-21     Association for Home Care;

2-22                 (3)  one representative each from the American

2-23     Association of Retired Persons and the Consumers Union;

2-24                 (4)  one representative each from the Texas Department

2-25     of Health and the Texas Department of Human Services who is

 3-1     familiar with the facility or agency compliance survey process;

 3-2                 (5)  one representative from the Texas Department of

 3-3     Mental Health and Mental Retardation; and

 3-4                 (6)  other persons appointed by the Board.

 3-5           (e)  Except as provided in this subsection, the Board, in

 3-6     developing or approving a pilot program, may exempt the program

 3-7     from rules adopted under this chapter.  Provisions of this chapter

 3-8     relating to mandatory reporting and peer review shall apply to

 3-9     pilot programs except that Section 1A, Article 4525b, Revised

3-10     Statutes, shall not apply to programs utilizing proactive peer

3-11     review.  The Board may establish alternative criteria for nursing

3-12     peer review committees conducting proactive peer review.

3-13           (f)  Beginning November 1, 1998, the Board shall issue an

3-14     annual report of any pilot programs developed or approved and a

3-15     status report on those programs including any preliminary or final

3-16     findings concerning their effectiveness.  The report shall be

3-17     mailed to statewide associations of registered nurses, registered

3-18     nurse educators, and employers of registered nurses that have

3-19     requested a copy.  A final report shall be issued by the Board not

3-20     later than September 1, 2000.

3-21           SECTION 2.  Section 1, Article 4513, Revised Statutes, is

3-22     amended to read as follows:

3-23           Sec. 1.  Composition of Board; Programs of Study.  The Board

3-24     of Nurse Examiners is composed of nine members appointed by the

3-25     governor with the advice and consent of the senate.  Appointments

 4-1     to the board shall be made without regard to the race, color,

 4-2     disability, sex, religion, age, or national origin of the

 4-3     appointees.  The board shall prescribe three programs of study to

 4-4     prepare professional nurse practitioners, to wit:   (1) The

 4-5     Baccalaureate Degree Program--A program leading to a baccalaureate

 4-6     degree in nursing conducted by an educational unit in nursing

 4-7     (department, division, school, or college) which is a part of a

 4-8     senior college or university; (2) The Associate Degree Program--A

 4-9     program leading to an associate degree in nursing conducted by an

4-10     educational unit in nursing within the structure of a college or a

4-11     university; and (3) The Diploma Program--A program leading to a

4-12     diploma in nursing conducted by a single purpose school usually

4-13     under the control of a hospital.  Six of the board members must be

4-14     Registered Nurses, three of whom shall be engaged in professional

4-15     nurse education [and shall be representative of said three

4-16     programs] in that one shall be a nurse faculty member in a school

4-17     of nursing pursuing the Baccalaureate Degree Program; one shall be

4-18     a nurse faculty member in a school of nursing pursuing the

4-19     Associate Degree Program; and one shall be a nurse faculty member

4-20     in a graduate school of nursing preparing Advanced Practice Nurses

4-21     [pursuing the Diploma Program].  Three members must be members of

4-22     the general public.

4-23           SECTION 3.  Article 4519a, Revised Statutes, is amended to

4-24     read as follows:

4-25           Art. 4519a.  Declaratory orders of eligibility for license.

 5-1           Sec. 1.  (a)  An individual enrolled or planning to enroll in

 5-2     an educational program that prepares an individual for an initial

 5-3     license as a registered nurse who has reason to believe that the

 5-4     individual is ineligible for the license may petition the board for

 5-5     a declaratory order as to the individual's eligibility.  The

 5-6     petition must state the basis for the individual's potential

 5-7     ineligibility.  The board shall have the same powers to investigate

 5-8     the petition and the individual's eligibility that it has to

 5-9     investigate a person applying for a license.  The petitioning

5-10     individual or the board may amend the petition at any time before a

5-11     final determination is made to include additional grounds for

5-12     potential ineligibility.

5-13           (b)  If the board proposes to find the petitioner ineligible

5-14     for a license, the petitioner is entitled to a hearing before the

5-15     board in accordance with Subsection (a) [(b)], Article 4525,

5-16     Revised Statutes, as amended by Section 8, Chapter 840, Acts of the

5-17     73rd Legislature, 1993.  The board's order must set out each basis

5-18     for potential ineligibility and the board's determination as to

5-19     eligibility.  In the absence of new evidence known to but not

5-20     disclosed by the petitioner or not reasonably available to the

5-21     board at the time the order is issued, the board's ruling on the

5-22     petition determines the individual's eligibility with respect to

5-23     the basis for potential ineligibility set out in the order.

5-24           Sec. 2.  (a)  The board may require individuals accepted for

5-25     enrollment or enrolled in an educational program preparing students

 6-1     for initial licensure as registered nurses to submit information to

 6-2     the board that will permit it to determine whether the individual

 6-3     is aware of the conditions that may disqualify the individual from

 6-4     licensure as a professional nurse upon graduation and of the

 6-5     individual's right to petition the board for a declaratory order of

 6-6     eligibility for licensure under Section 1 of this article.  In lieu

 6-7     of requiring the individual to submit the information, the board

 6-8     may require the educational program to collect and submit the

 6-9     information on individuals accepted for enrollment or enrolled in

6-10     the program.  The information shall be submitted in a form approved

6-11     by the board.

6-12           (b)  If the board determines that an individual may not be

6-13     eligible for licensure upon graduation, the board shall notify the

6-14     educational program of its determination.

6-15           SECTION 4.  Subsection (a), Article 4525, Revised Statutes,

6-16     as amended by Section 8, Chapter 840, Acts of the 73rd Legislature,

6-17     1993, is amended to read as follows:

6-18           (a)  The board may refuse to admit persons to the licensing

6-19     examination, to issue or renew a license, or to issue a temporary

6-20     permit for any of the reasons for which the board may take

6-21     disciplinary action against a registered nurse under Subsection (b)

6-22     of this article.  If the board proposes to refuse to admit a person

6-23     to the examination, to issue or renew a license, or to issue a

6-24     temporary permit, the board shall notify the person of the basis

6-25     for its decision.  Except as provided in this subsection, a [A]

 7-1     person who is refused admittance to the examination or the renewal

 7-2     or issuance of a license or temporary permit is entitled to a

 7-3     hearing before an administrative law judge of the State Office of

 7-4     Administrative Hearings.  A person is not entitled to a hearing on

 7-5     a refusal to renew a license if the person:  (1) fails to submit an

 7-6     application for renewal; or (2) submits an application that is

 7-7     incomplete, shows on its face that the person does not meet the

 7-8     requirements for renewal, or is not accompanied by the correct fee.

 7-9           SECTION 5.  This Act takes effect September 1, 1997, except

7-10     that Section 2 takes effect January 31, 1999.

7-11           SECTION 6.  The importance of this legislation and the

7-12     crowded condition of the calendars in both houses create an

7-13     emergency and an imperative public necessity that the

7-14     constitutional rule requiring bills to be read on three several

7-15     days in each house be suspended, and this rule is hereby suspended.