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H.B. 399






Chief Sponsor: Rebecca D. Lockhart

Senate Sponsor: Sheldon L. Killpack

             8      LONG TITLE
             9      General Description:
             10          This bill amends the Nurse Practice Act.
             11      Highlighted Provisions:
             12          This bill:
             13          .    changes the status of Medication Aide Certified from a pilot program to an ongoing
             14      certification by the Division of Occupational and Professional Licensing;
             15          .    amends definitions;
             16          .    permits the use of the restricted funds in the Nurse Education and Enforcement
             17      Fund for reviewing and approving nurse education and medication aide certified
             18      education programs;
             19          .    authorizes the division to issue citations for unlawful or unprofessional conduct;
             20          .    moves the authority to impose a penalty from one code section to another code
             21      section; and
             22          .    makes technical amendments.
             23      Monies Appropriated in this Bill:
             24          None
             25      Other Special Clauses:
             26          None
             27      Utah Code Sections Affected:

             28      AMENDS:
             29          58-31b-102, as last amended by Laws of Utah 2007, Chapter 57
             30          58-31b-103, as enacted by Laws of Utah 1998, Chapter 288
             31          58-31b-401, as last amended by Laws of Utah 2006, Chapter 291
             32          58-31b-503, as last amended by Laws of Utah 2006, Chapter 291
             33          58-31b-601, as last amended by Laws of Utah 2006, Chapter 291
             34          63-55b-158, as last amended by Laws of Utah 2006, Chapters 46 and 291
             35      REPEALS:
             36          58-31b-301.6, as enacted by Laws of Utah 2006, Chapter 291
             37          58-31b-402, as last amended by Laws of Utah 2002, Chapter 290
             39      Be it enacted by the Legislature of the state of Utah:
             40          Section 1. Section 58-31b-102 is amended to read:
             41           58-31b-102. Definitions.
             42          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             43          (1) "Administrative penalty" means a monetary fine or citation imposed by the division
             44      for acts or omissions determined to constitute unprofessional or unlawful conduct in
             45      accordance with a fine schedule established by rule and as a result of an adjudicative
             46      proceeding conducted in accordance with Title 63, Chapter 46b, Administrative Procedures
             47      Act.
             48          (2) "Applicant" means a person who applies for licensure or certification under this
             49      chapter by submitting a completed application for licensure or certification and the required
             50      fees to the department.
             51          (3) "Approved education program" means a nursing education program that meets the
             52      minimum standards for educational programs established under this chapter and by division
             53      rule in collaboration with the board.
             54          (4) "Board" means the Board of Nursing created in Section 58-31b-201 .
             55          (5) "Consultation and referral plan" means a written plan jointly developed by an
             56      advanced practice registered nurse and a consulting physician that permits the advanced
             57      practice registered nurse to prescribe schedule II-III controlled substances in consultation with
             58      the consulting physician.

             59          (6) "Consulting physician" means a physician and surgeon or osteopathic physician and
             60      surgeon licensed in accordance with this title who has agreed to consult with an advanced
             61      practice registered nurse with a controlled substance license, a DEA registration number, and
             62      who will be prescribing schedule II-III controlled substances.
             63          (7) "Diagnosis" means the identification of and discrimination between physical and
             64      psychosocial signs and symptoms essential to the effective execution and management of
             65      health care.
             66          (8) "Examinee" means a person who applies to take or does take any examination
             67      required under this chapter for licensure.
             68          (9) "Licensee" means a person who is licensed or certified under this chapter.
             69          (10) "Long-term care facility" means any of the following facilities licensed by the
             70      Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
             71      Inspection Act:
             72          (a) a nursing care facility;
             73          (b) a small health care facility;
             74          (c) an intermediate care facility for the mentally retarded;
             75          (d) an assisted living facility Type I or II; or
             76          (e) a designated swing bed unit in a general hospital.
             77          (11) "Medication aide certified" means a certified nurse aide who:
             78          (a) has a minimum of 2,000 hours experience working as a certified nurse aide;
             79          (b) has received a minimum of [40] 60 hours of classroom and [20] 40 hours of
             80      practical training that is approved by the division in collaboration with the board, in
             81      administering routine medications to patients or residents of long-term care facilities; and
             82          (c) is certified by the division as a medication aide certified.
             83          (12) (a) "Practice as a medication aide certified" means the limited practice of nursing
             84      under the supervision, as defined by the division by administrative rule, of a licensed nurse,
             85      involving routine patient care that requires minimal or limited specialized or general
             86      knowledge, judgment, and skill, to an individual who is ill, injured, infirm, developmentally or
             87      physically disabled, mentally disabled, or mentally retarded, and who is in a regulated
             88      long-term care facility.
             89          (b) "Practice as a medication aide certified":

             90          (i) includes:
             91          [(i)] (A) providing direct personal assistance or care; and
             92          [(ii)] (B) administering routine medications to patients in accordance with a formulary
             93      and protocols to be defined by the division by rule[.]; and
             94          (ii) does not include assisting a resident of an assisted living facility to self administer a
             95      medication as regulated by the Department of Health by administrative rule.
             96          (13) "Practice of advanced practice registered nursing" means the practice of nursing
             97      within the generally recognized scope and standards of advanced practice registered nursing as
             98      defined by rule and consistent with professionally recognized preparation and education
             99      standards of an advanced practice registered nurse by a person licensed under this chapter as an
             100      advanced practice registered nurse. Advanced practice registered nursing includes:
             101          (a) maintenance and promotion of health and prevention of disease;
             102          (b) diagnosis, treatment, correction, consultation, and referral for common health
             103      problems;
             104          (c) prescription or administration of prescription drugs or devices including:
             105          (i) local anesthesia;
             106          (ii) schedule IV-V controlled substances; and
             107          (iii) schedule II-III controlled substances in accordance with a consultation and referral
             108      plan; or
             109          (d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
             110      related services upon the request of a licensed health care professional by an advanced practice
             111      registered nurse specializing as a certified registered nurse anesthetist, including:
             112          (i) preanesthesia preparation and evaluation including:
             113          (A) performing a preanesthetic assessment of the patient;
             114          (B) ordering and evaluating appropriate lab and other studies to determine the health of
             115      the patient; and
             116          (C) selecting, ordering, or administering appropriate medications;
             117          (ii) anesthesia induction, maintenance, and emergence, including:
             118          (A) selecting and initiating the planned anesthetic technique;
             119          (B) selecting and administering anesthetics and adjunct drugs and fluids; and
             120          (C) administering general, regional, and local anesthesia;

             121          (iii) postanesthesia follow-up care, including:
             122          (A) evaluating the patient's response to anesthesia and implementing corrective
             123      actions; and
             124          (B) selecting, ordering, or administering the medications and studies listed in
             125      Subsection (13)(d); and
             126          (iv) other related services within the scope of practice of a certified registered nurse
             127      anesthetist, including:
             128          (A) emergency airway management;
             129          (B) advanced cardiac life support; and
             130          (C) the establishment of peripheral, central, and arterial invasive lines; and
             131          (v) for purposes of Subsection (13)(d), "upon the request of a licensed health care
             132      professional":
             133          (A) means a health care professional practicing within the scope of the health care
             134      professional's license, requests anesthesia services for a specific patient; and
             135          (B) does not require an advanced practice registered nurse specializing as a certified
             136      registered nurse anesthetist to enter into a consultation and referral plan or obtain additional
             137      authority to select, administer, or provide preoperative, intraoperative, or postoperative
             138      anesthesia care and services.
             139          (14) "Practice of nursing" means assisting individuals or groups to maintain or attain
             140      optimal health, implementing a strategy of care to accomplish defined goals and evaluating
             141      responses to care and treatment. The practice of nursing requires substantial specialized or
             142      general knowledge, judgment, and skill based upon principles of the biological, physical,
             143      behavioral, and social sciences, and includes:
             144          (a) initiating and maintaining comfort measures;
             145          (b) promoting and supporting human functions and responses;
             146          (c) establishing an environment conducive to well-being;
             147          (d) providing health counseling and teaching;
             148          (e) collaborating with health care professionals on aspects of the health care regimen;
             149          (f) performing delegated procedures only within the education, knowledge, judgment,
             150      and skill of the licensee; and
             151          (g) delegating nurse interventions that may be performed by others and are not in

             152      conflict with this chapter.
             153          (15) "Practice of practical nursing" means the performance of nursing acts in the
             154      generally recognized scope of practice of licensed practical nurses as defined by rule and as
             155      provided in this Subsection (15) by a person licensed under this chapter as a licensed practical
             156      nurse and under the direction of a registered nurse, licensed physician, or other specified health
             157      care professional as defined by rule. Practical nursing acts include:
             158          (a) contributing to the assessment of the health status of individuals and groups;
             159          (b) participating in the development and modification of the strategy of care;
             160          (c) implementing appropriate aspects of the strategy of care;
             161          (d) maintaining safe and effective nursing care rendered to a patient directly or
             162      indirectly; and
             163          (e) participating in the evaluation of responses to interventions.
             164          (16) "Practice of registered nursing" means performing acts of nursing as provided in
             165      this Subsection (16) by a person licensed under this chapter as a registered nurse within the
             166      generally recognized scope of practice of registered nurses as defined by rule. Registered
             167      nursing acts include:
             168          (a) assessing the health status of individuals and groups;
             169          (b) identifying health care needs;
             170          (c) establishing goals to meet identified health care needs;
             171          (d) planning a strategy of care;
             172          (e) prescribing nursing interventions to implement the strategy of care;
             173          (f) implementing the strategy of care;
             174          (g) maintaining safe and effective nursing care that is rendered to a patient directly or
             175      indirectly;
             176          (h) evaluating responses to interventions;
             177          (i) teaching the theory and practice of nursing; and
             178          (j) managing and supervising the practice of nursing.
             179          (17) "Routine medications":
             180          (a) means established medications administered to a medically stable individual as
             181      determined by a licensed health care practitioner or in consultation with a licensed medical
             182      practitioner; and

             183          (b) is limited to medications that are administered by the following routes:
             184          (i) oral;
             185          (ii) sublingual;
             186          (iii) buccal;
             187          (iv) eye;
             188          (v) ear;
             189          (vi) nasal;
             190          (vii) rectal;
             191          (viii) vaginal;
             192          (ix) skin ointments, topical including patches and transdermal;
             193          [(x) gastronomy or jejunostomy tubes;]
             194          [(xi)] (x) premeasured medication delivered by aerosol/nebulizer; and
             195          [(xii)] (xi) medications delivered by metered hand-held inhalers.
             196          (18) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-31b-501 .
             197          (19) "Unlicensed assistive personnel" means any unlicensed person, regardless of title,
             198      to whom tasks are delegated by a licensed nurse as permitted by rule and in accordance with
             199      the standards of the profession.
             200          (20) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-31b-502 and
             201      as may be further defined by rule.
             202          Section 2. Section 58-31b-103 is amended to read:
             203           58-31b-103. Education and enforcement fund.
             204          (1) There is created within the General Fund a restricted account known as the "Nurse
             205      Education and Enforcement Fund."
             206          (2) The account shall be nonlapsing and consist of:
             207          (a) administrative penalties imposed under Section [ 58-31b-402 ] 58-31b-503 ; and
             208          (b) interest earned on monies in the account.
             209          (3) Monies in the account may be appropriated by the Legislature for the following
             210      purposes:
             211          (a) education and training of licensees or potential licensees under this chapter;
             212          (b) enforcement of this chapter by:
             213          (i) investigating unprofessional or unlawful conduct;

             214          (ii) providing legal representation to the division when legal action is taken against a
             215      person engaging in unprofessional or unlawful conduct; and
             216          (iii) monitoring compliance of renewal requirements;
             217          (c) survey nursing education programs throughout the state; [and]
             218          (d) education and training of board members[.]; and
             219          (e) review and approve nursing education programs and medication aide certified
             220      training programs.
             221          Section 3. Section 58-31b-401 is amended to read:
             222           58-31b-401. Grounds for denial of licensure or certification and disciplinary
             223      proceedings.
             224          (1) Grounds for refusal to issue a license to an applicant, for refusal to renew the
             225      license of a licensee, to revoke, suspend, restrict, or place on probation the license of a licensee,
             226      to issue a public or private reprimand to a licensee, and to issue cease and desist orders shall be
             227      in accordance with Section 58-1-401 .
             228          (2) If a court of competent jurisdiction determines a nurse is an incapacitated person as
             229      defined in Section 75-1-201 or that he is mentally ill as defined in Section 62A-15-602 , and
             230      unable to safely engage in the practice of nursing, the director shall immediately suspend the
             231      license of the nurse upon the entry of the judgment of the court, without further proceedings
             232      under Title 63, Chapter 46b, Administrative Procedures Act, regardless of whether an appeal
             233      from the court's ruling is pending. The director shall promptly notify the nurse in writing of the
             234      suspension.
             235          (3) (a) If the division and the majority of the board find reasonable cause to believe a
             236      nurse who is not determined judicially to be an incapacitated person or to be mentally ill, is
             237      incapable of practicing nursing with reasonable skill regarding the safety of patients, because of
             238      illness, excessive use of drugs or alcohol, or as a result of any mental or physical condition, the
             239      board shall recommend that the director file a petition with the division, and cause the petition
             240      to be served upon the nurse with a notice of hearing on the sole issue of the capacity of the
             241      nurse to competently, safely engage in the practice of nursing.
             242          (b) The hearing shall be conducted under Section 58-1-109 and Title 63, Chapter 46b,
             243      Administrative Procedures Act, except as provided in Subsection (4).
             244          (4) (a) Every nurse who accepts the privilege of being licensed under this chapter gives

             245      consent to:
             246          (i) submitting to an immediate mental or physical examination, at the nurse's expense
             247      and by a division-approved practitioner selected by the nurse when directed in writing by the
             248      division and a majority of the board to do so; and
             249          (ii) the admissibility of the reports of the examining practitioner's testimony or
             250      examination, and waives all objections on the ground the reports constitute a privileged
             251      communication.
             252          (b) The examination may be ordered by the division, with the consent of a majority of
             253      the board, only upon a finding of reasonable cause to believe:
             254          (i) the nurse is mentally ill or incapacitated or otherwise unable to practice nursing with
             255      reasonable skill and safety; and
             256          (ii) immediate action by the division and the board is necessary to prevent harm to the
             257      nurse's patients or the general public.
             258          (c) (i) Failure of a nurse to submit to the examination ordered under this section is a
             259      ground for the division's immediate suspension of the nurse's license by written order of the
             260      director.
             261          (ii) The division may enter the order of suspension without further compliance with
             262      Title 63, Chapter 46b, Administrative Procedures Act, unless the division finds the failure to
             263      submit to the examination ordered under this section was due to circumstances beyond the
             264      control of the nurse and was not related directly to the illness or incapacity of the nurse.
             265          (5) (a) A nurse whose license is suspended under Subsection (2), (3), or (4)(c) has the
             266      right to a hearing to appeal the suspension within ten days after the license is suspended.
             267          (b) The hearing held under this Subsection (5) shall be conducted in accordance with
             268      Sections 58-1-108 and 58-1-109 for the sole purpose of determining if sufficient basis exists
             269      for the continuance of the order of suspension in order to prevent harm to the nurse's patients or
             270      the general public.
             271          (6) A nurse whose license is revoked, suspended, or in any way restricted under this
             272      section may request the division and the board to consider, at reasonable intervals, evidence
             273      presented by the nurse, under procedures established by division rule, regarding any change in
             274      the nurse's condition, to determine whether:
             275          (a) he is or is not able to safely and competently engage in the practice of nursing; and

             276          (b) he is qualified to have his license to practice under this chapter restored completely
             277      or in part.
             278          (7) Nothing in Section 63-2-206 may be construed as limiting the authority of the
             279      division to report current significant investigative information to the coordinated licensure
             280      information system for transmission to party states as required of the division by Article VII of
             281      the Nurse Licensure Compact in Section 58-31c-102 .
             282          (8) For purposes of this section [and Section 58-31b-402 ]:
             283          (a) "licensed" or "license" includes "certified" or "certification" under this chapter; and
             284          (b) any terms or conditions applied to the word "nurse" in this section [or Section
             285      58-31b-402 ] also apply to a medication aide certified.
             286          Section 4. Section 58-31b-503 is amended to read:
             287           58-31b-503. Penalty for unlawful conduct and unprofessional conduct.
             288          (1) Any person who violates the unlawful conduct provision specifically defined in
             289      Subsection 58-1-501 (1)(a) is guilty of a third degree felony.
             290          (2) Any person who violates any of the unlawful conduct provisions specifically
             291      defined in Subsections 58-1-501 (1)(b) through (f) and 58-31b-501 (1)(d) is guilty of a class A
             292      misdemeanor.
             293          (3) Any person who violates any of the unlawful conduct provisions specifically
             294      defined in this chapter and not set forth in Subsection (1) or (2) is guilty of a class B
             295      misdemeanor.
             296          [(4) Subject to Subsection (5), the division may assess administrative penalties in
             297      accordance with the provisions of Section 58-31b-402 for acts of unprofessional or unlawful
             298      conduct or any other appropriate administrative action in accordance with the provisions of
             299      Section 58-31b-401 .]
             300          [(5) If a licensee has been convicted of violating Section 58-31b-501 prior to an
             301      administrative finding of a violation of the same section, the licensee may not be assessed an
             302      administrative penalty under this chapter for the same offense for which the conviction was
             303      obtained.]
             304          (4) (a) Subject to Subsection (6) and in accordance with Section 58-31b-401 , for acts
             305      of unprofessional or unlawful conduct, the division may:
             306          (i) assess administrative penalties; and

             307          (ii) take any other appropriate administrative action.
             308          (b) An administrative penalty imposed pursuant to this section shall be deposited in the
             309      General Fund as a dedicated credit to be used by the division for the "Nurse Education and
             310      Enforcement Fund" as provided in Section 58-31b-103 .
             311          (5) If a licensee has been convicted of violating Section 58-31b-501 prior to an
             312      administrative finding of a violation of the same section, the licensee may not be assessed an
             313      administrative fine under this chapter for the same offense for which the conviction was
             314      obtained.
             315          (6) (a) If upon inspection or investigation, the division concludes that a person has
             316      violated the provisions of Sections 58-31b-401 , 58-31b-501 , or 58-31b-502 , Chapter 1,
             317      Division of Occupational and Professional Licensing Act, Chapter 37, Utah Controlled
             318      Substances Act, or any rule or order issued with respect to these provisions, and that
             319      disciplinary action is appropriate, the director or the director's designee from within the
             320      division shall:
             321          (i) promptly issue a citation to the person according to this chapter and any pertinent
             322      administrative rules;
             323          (ii) attempt to negotiate a stipulated settlement; or
             324          (iii) notify the person to appear before an adjudicative proceeding conducted under
             325      Title 63, Chapter 46b, Administrative Procedures Act.
             326          (b) Any person who is in violation of a provision described in Subsection (6)(a), as
             327      evidenced by an uncontested citation, a stipulated settlement, or a finding of violation in an
             328      adjudicative proceeding may be assessed a fine:
             329          (i) pursuant to this Subsection (6) of up to $10,000 per single violation or up to $2,000
             330      per day of ongoing violation, whichever is greater, in accordance with a fine schedule
             331      established by rule; and
             332          (ii) in addition to or in lieu of the fine imposed under Subsection (6)(b)(i), be ordered
             333      to cease and desist from violating a provision of Sections 58-31b-501 and 58-31b-502 , Chapter
             334      1, Division of Occupational and Professional Licensing Act, Chapter 37, Utah Controlled
             335      Substances Act, or any rule or order issued with respect to those provisions.
             336          (c) Except for an administrative fine and a cease and desist order, the licensure
             337      sanctions cited in Section 58-31b-401 may not be assessed through a citation.

             338          (d) Each citation issued under this section shall:
             339          (i) be in writing; and
             340          (ii) clearly describe or explain:
             341          (A) the nature of the violation, including a reference to the provision of the chapter,
             342      rule, or order alleged to have been violated;
             343          (B) that the recipient must notify the division in writing within 20 calendar days of
             344      service of the citation in order to contest the citation at a hearing conducted under Title 63,
             345      Chapter 46b, Administrative Procedures Act; and
             346          (C) the consequences of failure to timely contest the citation or to make payment of
             347      any fines assessed by the citation within the time specified in the citation; and
             348          (iii) be served upon any person upon whom a summons may be served:
             349          (A) in accordance with the Utah Rules of Civil Procedure;
             350          (B) personally or upon the person's agent by a division investigator or by any person
             351      specially designated by the director; or
             352          (C) by mail.
             353          (e) If within 20 calendar days from the service of a citation, the person to whom the
             354      citation was issued fails to request a hearing to contest the citation, the citation becomes the
             355      final order of the division and is not subject to further agency review. The period to contest the
             356      citation may be extended by the division for cause.
             357          (f) The division may refuse to issue or renew, suspend, revoke, or place on probation
             358      the license of a licensee who fails to comply with the citation after it becomes final.
             359          (g) The failure of an applicant for licensure to comply with a citation after it becomes
             360      final is a ground for denial of license.
             361          (h) No citation may be issued under this section after the expiration of six months
             362      following the occurrence of any violation.
             363          Section 5. Section 58-31b-601 is amended to read:
             364           58-31b-601. Minimum standards for nursing programs -- Medication aide
             365      training.
             366          (1) A nursing education program shall be affiliated with an accredited institution of
             367      higher education in order to be approved by the division.
             368          (2) The minimum standards a nursing program shall meet to qualify graduates for

             369      licensure under this chapter shall be defined by division rule.
             370          (3) [(a)] In accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking
             371      Act, and the provisions of this chapter, the division shall make rules defining the minimum
             372      standards for a medication aide certified training program to qualify a person for certification
             373      under this chapter as a medication aide certified.
             374          [(b) A medication aide certified training program shall include a minimum of 40 hours
             375      of classroom and 20 hours of practical training.]
             376          Section 6. Section 63-55b-158 is amended to read:
             377           63-55b-158. Repeal dates -- Title 58.
             378          [Section 58-31b-301.6 , Medication Aide Certified Pilot Program, is repealed May 15,
             379      2010.]
             380          Section 7. Repealer.
             381          This bill repeals:
             382          Section 58-31b-301.6, Medication aide certified pilot program.
             383          Section 58-31b-402, Authority to assess penalty.

Legislative Review Note
    as of 2-1-08 11:18 AM

Office of Legislative Research and General Counsel

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