1-1           By:  Moncrief                                    S.B. No. 617

 1-2           (In the Senate - Filed February 17, 1997; February 20, 1997,

 1-3     read first time and referred to Committee on Health and Human

 1-4     Services; March 13, 1997, reported adversely, with favorable

 1-5     Committee Substitute by the following vote:  Yeas 11, Nays 0;

 1-6     March 13, 1997, sent to printer.)

 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 617                 By:  Moncrief

 1-8                            A BILL TO BE ENTITLED

 1-9                                   AN ACT

1-10     relating to the licensure and regulation of nurses, including the

1-11     development of certain pilot programs by the Board of Nurse

1-12     Examiners.


1-14           SECTION 1.  Article 4518, Revised Statutes, is amended by

1-15     adding Section 8 to read as follows:

1-16           Sec. 8.  (a)  In this section:

1-17                 (1)  "Pilot program" means a pilot program developed or

1-18     approved under this section.

1-19                 (2)  "Proactive nursing peer review" means peer review

1-20     that is not initiated for the purpose of determining culpability

1-21     with respect to a particular incident.

1-22                 (3)  "Targeted continuing nursing education" means

1-23     continuing education focusing on a competency identified as one

1-24     that a significant portion of registered nurses in a particular

1-25     practice area would likely benefit from taking.

1-26           (b)  The Board may develop pilot programs to evaluate the

1-27     effectiveness of mechanisms for assuring:  (1) maintenance of

1-28     clinical competency by registered nurses in their area of practice,

1-29     including the use of proactive nursing peer review and targeted

1-30     continuing nursing education; and (2) that registered nurses

1-31     understand the laws and regulations governing the practice of

1-32     professional nursing.  The pilot programs shall be designed to test

1-33     the effectiveness of a variety of mechanisms in a variety of

1-34     practice settings.  The Board may approve pilot programs to be

1-35     conducted by persons other than the Board.

1-36           (c)  Subject to appropriations by the legislature, the Board

1-37     may expend funds to develop or fund pilot programs.  The Board may

1-38     contract with, make grants to, or make other arrangements with an

1-39     agency, professional association, institution, individual, or other

1-40     person to implement this section.

1-41           (d)  In developing, administering, approving, and funding

1-42     pilot programs, the Board shall consult with an advisory committee

1-43     consisting of:

1-44                 (1)  one representative each from the Texas Nurses

1-45     Association, Texas Nurses Foundation, Texas League for Nursing,

1-46     Texas Chapter of the American Association of Nurse Attorneys, Texas

1-47     Organization of Baccalaureate and Graduate Nursing Educators, Texas

1-48     Organization for Associate Degree Nursing, and Texas Organization

1-49     of Nurse Executives;

1-50                 (2)  one registered nurse representative each from the

1-51     Texas Hospital Association, Texas Health Care Association, Texas

1-52     Association of Homes and Services for the Aging, and Texas

1-53     Association for Home Care;

1-54                 (3)  one representative each from the American

1-55     Association of Retired Persons and the Consumers Union;

1-56                 (4)  one representative each from the Texas Department

1-57     of Health and the Texas Department of Human Services who is

1-58     familiar with the facility or agency compliance survey process;

1-59                 (5)  one representative from the Texas Department of

1-60     Mental Health and Mental Retardation; and

1-61                 (6)  other persons appointed by the Board.

1-62           (e)  Except as provided in this subsection, the Board, in

1-63     developing or approving a pilot program, may exempt the program

1-64     from rules adopted under this chapter.  Provisions of this chapter

 2-1     relating to mandatory reporting and peer review shall apply to

 2-2     pilot programs except that Section 1A, Article 4525b, Revised

 2-3     Statutes, shall not apply to programs utilizing proactive peer

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

 2-5     peer review committees conducting proactive peer review.

 2-6           (f)  Beginning November 1, 1998, the Board shall issue an

 2-7     annual report of any pilot programs developed or approved and a

 2-8     status report on those programs including any preliminary or final

 2-9     findings concerning their effectiveness.  The report shall be

2-10     mailed to statewide associations of registered nurses, registered

2-11     nurse educators, and employers of registered nurses that have

2-12     requested a copy.  A final report shall be issued by the Board not

2-13     later than September 1, 2000.

2-14           SECTION 2.  Section 1, Article 4513, Revised Statutes, is

2-15     amended to read as follows:

2-16           Sec. 1.  Composition of Board; Programs of Study.  The Board

2-17     of Nurse Examiners is composed of nine members appointed by the

2-18     governor with the advice and consent of the senate.  Appointments

2-19     to the board shall be made without regard to the race, color,

2-20     disability, sex, religion, age, or national origin of the

2-21     appointees.  The board shall prescribe three programs of study to

2-22     prepare professional nurse practitioners, to wit:   (1) The

2-23     Baccalaureate Degree Program--A program leading to a baccalaureate

2-24     degree in nursing conducted by an educational unit in nursing

2-25     (department, division, school, or college) which is a part of a

2-26     senior college or university; (2) The Associate Degree Program--A

2-27     program leading to an associate degree in nursing conducted by an

2-28     educational unit in nursing within the structure of a college or a

2-29     university; and (3) The Diploma Program--A program leading to a

2-30     diploma in nursing conducted by a single purpose school usually

2-31     under the control of a hospital.  Six of the board members must be

2-32     Registered Nurses, three of whom shall be engaged in professional

2-33     nurse education [and shall be representative of said three

2-34     programs] in that one shall be a nurse faculty member in a school

2-35     of nursing pursuing the Baccalaureate Degree Program; one shall be

2-36     a nurse faculty member in a school of nursing pursuing the

2-37     Associate Degree Program; and one shall be a nurse faculty member

2-38     in a graduate school of nursing preparing Advanced Practice Nurses

2-39     [pursuing the Diploma Program].  Three members must be members of

2-40     the general public.

2-41           SECTION 3.  Article 4519a, Revised Statutes, is amended to

2-42     read as follows:

2-43           Art. 4519a.  Declaratory orders of eligibility for license.

2-44           Sec. 1.  (a)  An individual enrolled or planning to enroll in

2-45     an educational program that prepares an individual for an initial

2-46     license as a registered nurse who has reason to believe that the

2-47     individual is ineligible for the license may petition the board for

2-48     a declaratory order as to the individual's eligibility.  The

2-49     petition must state the basis for the individual's potential

2-50     ineligibility.  The board shall have the same powers to investigate

2-51     the petition and the individual's eligibility that it has to

2-52     investigate a person applying for a license.  The petitioning

2-53     individual or the board may amend the petition at any time before a

2-54     final determination is made to include additional grounds for

2-55     potential ineligibility.

2-56           (b)  If the board proposes to find the petitioner ineligible

2-57     for a license, the petitioner is entitled to a hearing before the

2-58     board in accordance with Subsection (a) [(b)], Article 4525,

2-59     Revised Statutes, as amended by Section 8, Chapter 840, Acts of the

2-60     73rd Legislature, 1993.  The board's order must set out each basis

2-61     for potential ineligibility and the board's determination as to

2-62     eligibility.  In the absence of new evidence known to but not

2-63     disclosed by the petitioner or not reasonably available to the

2-64     board at the time the order is issued, the board's ruling on the

2-65     petition determines the individual's eligibility with respect to

2-66     the basis for potential ineligibility set out in the order.

2-67           Sec. 2.  (a)  The board may require individuals accepted for

2-68     enrollment or enrolled in an educational program preparing students

2-69     for initial licensure as registered nurses to submit information to

 3-1     the board that will permit it to determine whether the individual

 3-2     is aware of the conditions that may disqualify the individual from

 3-3     licensure as a professional nurse upon graduation and of the

 3-4     individual's right to petition the board for a declaratory order of

 3-5     eligibility for licensure under Section 1 of this article.  In lieu

 3-6     of requiring the individual to submit the information, the board

 3-7     may require the educational program to collect and submit the

 3-8     information on individuals accepted for enrollment or enrolled in

 3-9     the program.  The information shall be submitted in a form approved

3-10     by the board.

3-11           (b)  If the board determines that an individual may not be

3-12     eligible for licensure upon graduation, the board shall notify the

3-13     educational program of its determination.

3-14           SECTION 4.  Subsection (a), Article 4525, Revised Statutes,

3-15     as amended by Section 8, Chapter 840, Acts of the 73rd Legislature,

3-16     1993, is amended to read as follows:

3-17           (a)  The board may refuse to admit persons to the licensing

3-18     examination, to issue or renew a license, or to issue a temporary

3-19     permit for any of the reasons for which the board may take

3-20     disciplinary action against a registered nurse under Subsection (b)

3-21     of this article.  If the board proposes to refuse to admit a person

3-22     to the examination, to issue or renew a license, or to issue a

3-23     temporary permit, the board shall notify the person of the basis

3-24     for its decision.  Except as provided in this subsection, a [A]

3-25     person who is refused admittance to the examination or the renewal

3-26     or issuance of a license or temporary permit is entitled to a

3-27     hearing before an administrative law judge of the State Office of

3-28     Administrative Hearings.  A person is not entitled to a hearing on

3-29     a refusal to renew a license if the person:  (1) fails to submit an

3-30     application for renewal; or (2) submits an application that is

3-31     incomplete, shows on its face that the person does not meet the

3-32     requirements for renewal, or is not accompanied by the correct fee.

3-33           SECTION 5.  This Act takes effect September 1, 1997, except

3-34     that Section 2 takes effect January 31, 1999.

3-35           SECTION 6.  The importance of this legislation and the

3-36     crowded condition of the calendars in both houses create an

3-37     emergency and an imperative public necessity that the

3-38     constitutional rule requiring bills to be read on three several

3-39     days in each house be suspended, and this rule is hereby suspended.

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