By:  Zedler (Senate Sponsor - Nelson)                             H.B. No. 1718
	(In the Senate - Received from the House May 6, 2005; 
May 12, 2005, read first time and referred to Committee on Health 
and Human Services; May 19, 2005, reported favorably, as amended, 
by the following vote:  Yeas 8, Nays 0; May 19, 2005, sent to 
printer.)


COMMITTEE AMENDMENT NO. 1                                                By:  Nelson


On page 2, line 6, amend House Bill 1718 (Engrossed) by adding new 
SECTION 2 to read as follows and renumber the subsequent sections 
appropriately:
	SECTION 2.  Subchapter B, Chapter 241, Health and Safety 
Code, is amended by adding Section 241.0262 to read as follows:
	Section 241.0262.  CIRCULATING DUTIES FOR SURGICAL 
SERVICES.  Circulating duties in the operating room must be 
performed by qualified registered nurses.  In accordance with 
approved medical staff policies and procedures, licensed 
vocational nurses and surgical technologists may assist in 
circulatory duties under the direct supervision of a qualified 
registered nurse circulator.


A BILL TO BE ENTITLED

AN ACT


relating to the regulation of certain nursing practices.                    
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter H, Chapter 301, Occupations Code, is 
amended by adding Section 301.353 to read as follows:
	Sec. 301.353.  NURSE FIRST ASSISTANTS; ASSISTING AT SURGERY 
BY OTHER NURSES.  (a)  In this section, "nurse first assistant" 
means a registered nurse who:
		(1)  has completed a nurse first assistant educational 
program approved or recognized by an organization recognized by the 
board; and
		(2)  is either:                                                        
			(A)  certified in perioperative nursing by an 
organization recognized by the board; or
			(B)  recognized by the board as an advanced 
practice nurse and qualified by education, training, or experience 
to perform the tasks involved in perioperative nursing.
	(b)  Unless the person is a nurse first assistant, the person 
may not use:
		(1)  the title "nurse first assistant" or "registered 
nurse first assistant";
		(2)  the abbreviation "R.N.F.A."; or                                   
		(3)  any other title or abbreviation that implies to 
the public that the person is qualified as a nurse first assistant 
under this section.
	(c)  A health maintenance organization or an insurer, 
including an insurer offering a preferred provider benefit plan, 
may not, by contract or any other method, require a physician to use 
the services of a nurse first assistant.
	(d)  A nurse who is not a nurse first assistant may assist a 
physician, podiatrist, or dentist in the performance of surgery if 
the nurse:
		(1)  assists under the direct personal supervision and 
in the physical presence of the physician, podiatrist, or dentist;
		(2)  is in the same sterile field as the physician, 
podiatrist, or dentist;
		(3)  is employed by:                                                   
			(A)  the physician, podiatrist, or dentist;                           
			(B)  a group to which the physician, podiatrist, 
or dentist belongs; or
			(C)  a hospital licensed or owned by the state; 
and                 
		(4)  is qualified by education, training, or experience 
to perform the tasks assigned to the nurse.
	(e)  A patient or third-party insurer may not be billed 
separately for the services performed by a nurse described by 
Subsection (d).
	SECTION 2.  Sections 301.1525, 301.1526, and 301.1527, 
Occupations Code, are repealed.
	SECTION 3.  This Act takes effect September 1, 2005.                           



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