75R13415 GJH-F                          

         By Moncrief                                            S.B. No. 617

         Substitute the following for S.B. No. 617:

         By Berlanga                                        C.S.S.B. No. 617

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to the practice and conduct of registered nurses.


 1-4           SECTION 1.  Article 4518, Revised Statutes, is amended by

 1-5     adding Section 8 to read as follows:

 1-6           Sec. 8.  (a)  In this section:

 1-7                 (1)  "Pilot program" means a pilot program developed or

 1-8     approved under this section.

 1-9                 (2)  "Proactive nursing peer review" means peer review

1-10     that is not initiated for the purpose of determining culpability

1-11     with respect to a particular incident.

1-12                 (3)  "Targeted continuing nursing education" means

1-13     continuing education focusing on a competency identified as one

1-14     that a significant portion of registered nurses in a particular

1-15     practice area would likely benefit from taking.

1-16           (b)  The Board may develop pilot programs to evaluate the

1-17     effectiveness of mechanisms for assuring:  (1) maintenance of

1-18     clinical competency by registered nurses in their area of practice,

1-19     including the use of proactive nursing peer review and targeted

1-20     continuing nursing education; and (2) that registered nurses

1-21     understand the laws and regulations governing the practice of

1-22     professional nursing.  The pilot programs shall be designed to test

1-23     the effectiveness of a variety of mechanisms in a variety of

1-24     practice settings.  The Board may approve pilot programs to be

 2-1     conducted by persons other than the Board.

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

 2-3     may expend funds to develop or fund pilot programs.  The Board may

 2-4     contract with, make grants to, or make other arrangements with an

 2-5     agency, professional association, institution, individual, or other

 2-6     person to implement this section.

 2-7           (d)  In developing, administering, approving, and funding

 2-8     pilot programs, the Board shall consult with the Competency

 2-9     Advisory Committee on  matters relating to ensuring the maintenance

2-10     of continued competency of registered nurses and with the Laws and

2-11     Regulations Advisory Committee on matters relating to ensuring that

2-12     registered nurses understand the  laws and regulations governing

2-13     the practice of professional nursing.

2-14           (e)  The Competency Advisory Committee is composed of the

2-15     following members appointed by the Board:

2-16                 (1)  a representative from the Texas Nurses

2-17     Association;

2-18                 (2)  a representative from the Texas Nurses Foundation;

2-19                 (3)  a representative from the Texas Organization of

2-20     Nurse Executives;

2-21                 (4)  a registered nurse representative from the  Texas

2-22     Hospital Association;

2-23                 (5)  a registered nurse representative from the Texas

2-24     Health Care Association;

2-25                 (6)  a registered nurse representative from the Texas

2-26     Association of Homes and Services for the Aging;

2-27                 (7)  a registered nurse representative from the Texas

 3-1     Association for Home Care;

 3-2                 (8)  a professional nursing educator;

 3-3                 (9)  a representative from the Consumers Union;

 3-4                 (10)  a representative from the Texas Department of

 3-5     Mental Health and Mental Retardation; and

 3-6                 (11)  any other persons appointed by the Board.

 3-7           (f)  The Laws and Regulations Advisory Committee is composed

 3-8     of the following members appointed by the Board:

 3-9                 (1)  a representative of the Texas Nurses Association;

3-10                 (2)  a representative of the Texas League for Nursing;

3-11                 (3)  a representative of the Texas Chapter of the

3-12     American Association of Nurse Attorneys;

3-13                 (4)  a representative of the Texas Organization of

3-14     Baccalaureate and Graduate Nursing Educators;

3-15                 (5)  a representative of the Texas Organization for

3-16     Associate Degree Nursing;

3-17                 (6)  a representative of the  Texas Organization of

3-18     Nurse Executives;

3-19                 (7)  a representative of the  American Association of

3-20     Retired Persons;

3-21                 (8)  a registered nurse researcher; and

3-22                 (9)  any other persons appointed by the Board.

3-23           (g)  Except as provided in this subsection, the Board, in

3-24     developing or approving a pilot program, may exempt the program

3-25     from rules adopted under this chapter.  Provisions of this chapter

3-26     relating to mandatory reporting and peer review shall apply to

3-27     pilot programs except that Section 1A, Article 4525b, Revised

 4-1     Statutes, shall not apply to programs utilizing proactive peer

 4-2     review.  The Board may establish alternative criteria for nursing

 4-3     peer review committees conducting proactive peer review.

 4-4           (h)  Beginning November 1, 1998, the Board shall issue an

 4-5     annual report of any pilot programs developed or approved and a

 4-6     status report on those programs, including any preliminary or final

 4-7     findings concerning their effectiveness.  The report shall be

 4-8     mailed to statewide associations of registered nurses, registered

 4-9     nurse educators, and employers of registered nurses that have

4-10     requested a copy.  A final report shall be issued by the Board not

4-11     later than September 1, 2000.

4-12           SECTION 2.  Section 1, Article 4513, Revised Statutes, is

4-13     amended to read as follows:

4-14           Sec. 1.  Composition of Board; Programs of Study.  The Board

4-15     of Nurse Examiners is composed of nine members appointed by the

4-16     governor with the advice and consent of the senate.  Appointments

4-17     to the board shall be made without regard to the race, color,

4-18     disability, sex, religion, age, or national origin of the

4-19     appointees.  The board shall prescribe three programs of study to

4-20     prepare professional nurse practitioners, to wit:   (1) The

4-21     Baccalaureate Degree Program--A program leading to a baccalaureate

4-22     degree in nursing conducted by an educational unit in nursing

4-23     (department, division, school, or college) which is a part of a

4-24     senior college or university; (2) The Associate Degree Program--A

4-25     program leading to an associate degree in nursing conducted by an

4-26     educational unit in nursing within the structure of a college or a

4-27     university; and (3) The Diploma Program--A program leading to a

 5-1     diploma in nursing conducted by a single purpose school usually

 5-2     under the control of a hospital.  Six of the board members must be

 5-3     Registered Nurses, three of whom shall be engaged in professional

 5-4     nurse education [and shall be representative of said three

 5-5     programs] in that one shall be a nurse faculty member in a school

 5-6     of nursing pursuing the Baccalaureate Degree Program; one shall be

 5-7     a nurse faculty member in a school of nursing pursuing the

 5-8     Associate Degree Program; and one shall be a nurse faculty member

 5-9     in a graduate school of nursing preparing Advanced Practice Nurses

5-10     [pursuing the Diploma Program].  Three members must be members of

5-11     the general public.

5-12           SECTION 3.  Article 4519a, Revised Statutes, is amended to

5-13     read as follows:

5-14           Art. 4519a.  Declaratory orders of eligibility for license.

5-15           Sec. 1.  (a)  An individual enrolled or planning to enroll in

5-16     an educational program that prepares an individual for an initial

5-17     license as a registered nurse who has reason to believe that the

5-18     individual is ineligible for the license may petition the board for

5-19     a declaratory order as to the individual's eligibility.  The

5-20     petition must state the basis for the individual's potential

5-21     ineligibility.  The board shall have the same powers to investigate

5-22     the petition and the individual's eligibility that it has to

5-23     investigate a person applying for a license.  The petitioning

5-24     individual or the board may amend the petition at any time before a

5-25     final determination is made to include additional grounds for

5-26     potential ineligibility.

5-27           (b)  If the board proposes to find the petitioner ineligible

 6-1     for a license, the petitioner is entitled to a hearing before the

 6-2     board in accordance with Subsection (a) [(b)], Article 4525,

 6-3     Revised Statutes, as amended by Section 8, Chapter 840, Acts of the

 6-4     73rd Legislature, 1993.  The board's order must set out each basis

 6-5     for potential ineligibility and the board's determination as to

 6-6     eligibility.  In the absence of new evidence known to but not

 6-7     disclosed by the petitioner or not reasonably available to the

 6-8     board at the time the order is issued, the board's ruling on the

 6-9     petition determines the individual's eligibility with respect to

6-10     the basis for potential ineligibility set out in the order.

6-11           Sec. 2.  (a)  The board may require individuals accepted for

6-12     enrollment or enrolled in an educational program preparing students

6-13     for initial licensure as registered nurses to submit information to

6-14     the board that will permit it to determine whether the individual

6-15     is aware of the conditions that may disqualify the individual from

6-16     licensure as a professional nurse upon graduation and of the

6-17     individual's right to petition the board for a declaratory order of

6-18     eligibility for licensure under Section 1 of this article.  In lieu

6-19     of requiring the individual to submit the information, the board

6-20     may require the educational program to collect and submit the

6-21     information on individuals accepted for enrollment or enrolled in

6-22     the program.  The information shall be submitted in a form approved

6-23     by the board.

6-24           (b)  If the board determines that an individual may not be

6-25     eligible for licensure upon graduation, the board shall notify the

6-26     educational program of its determination.

6-27           SECTION 4.  Article 4525, Revised Statutes, is amended by

 7-1     adding Subsection (a-1) to read as follows:

 7-2           (a-1)  Notwithstanding Subsection (a) of this section, a

 7-3     person is not entitled to a hearing on a refusal to renew a license

 7-4     if the person:

 7-5                 (1)  fails to submit an application for renewal; or

 7-6                 (2)  submits an application that:

 7-7                       (A)  is incomplete;

 7-8                       (B)  shows on its face that the person does not

 7-9     meet the requirements for renewal; or

7-10                       (C)  is not accompanied by the correct fee.

7-11           SECTION 5.  This Act takes effect September 1, 1997, except

7-12     that Section 2 takes effect January 31, 1999.

7-13           SECTION 6.  The importance of this legislation and the

7-14     crowded condition of the calendars in both houses create an

7-15     emergency and an imperative public necessity that the

7-16     constitutional rule requiring bills to be read on three several

7-17     days in each house be suspended, and this rule is hereby suspended.