Representative Raymond P. Ward proposes the following substitute bill:




Chief Sponsor: Raymond P. Ward

Senate Sponsor: Kirk A. Cullimore


8     General Description:
9          This bill addresses delegation of the performance of health care services.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms and modifies definitions;
13          ▸     requires the Division of Occupational and Professional Licensing, in consultation
14     with the Department of Health, to identify by administrative rule health care
15     services that a health care provider is not required to delegate before an unlicensed
16     individual may perform the services;
17          ▸     subject to certain requirements, allows an individual's caregiver to delegate the
18     performance of routine nursing care for the individual to an unlicensed individual;
19     and
20          ▸     makes technical changes.
21     Money Appropriated in this Bill:
22          None
23     Other Special Clauses:
24          None
25     Utah Code Sections Affected:

26     AMENDS:
27          58-31b-102, as last amended by Laws of Utah 2019, Chapter 233
28     ENACTS:
29          58-1-307.1, Utah Code Annotated 1953
30          58-31b-308.1, Utah Code Annotated 1953

32     Be it enacted by the Legislature of the state of Utah:
33          Section 1. Section 58-1-307.1 is enacted to read:
34          58-1-307.1. Delegation of health care services -- Division duties.
35          The division, in consultation with the Department of Health, shall identify by rule made
36     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, a list of health
37     care services that an unlicensed individual may perform without delegation by a health care
38     provider, as defined in Section 78B-3-403, regardless of the setting or licensing of the facility
39     in which the health care services are performed.
40          Section 2. 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] be unprofessional or unlawful conduct in
45     accordance with a fine schedule established by division rule made in accordance with Title
46     63G, Chapter 3, Utah Administrative Rulemaking Act and as a result of an adjudicative
47     proceeding conducted in accordance with Title 63G, Chapter 4, Administrative Procedures Act.
48          (2) "Applicant" means [a person] an individual who applies for licensure or
49     certification under this chapter by submitting a completed application for licensure or
50     certification and the required fees to the department.
51          (3) "Approved education program" means a nursing education program that is
52     accredited by an accrediting body for nursing education that is approved by the United States
53     Department of Education.
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, except as provided in Subsection 58-31b-803(4), a

57     consulting physician that permits the advanced practice registered nurse to prescribe Schedule
58     II controlled substances in consultation with 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 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] an individual who applies to take or does take any
67     examination required under this chapter for licensure.
68          (9) "Licensee" means [a person] an individual who is licensed or certified under this
69     chapter.
70          (10) "Long-term care facility" means any of the following facilities licensed by the
71     Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
72     Inspection Act:
73          (a) a nursing care facility;
74          (b) a small health care facility;
75          (c) an intermediate care facility for people with an intellectual disability;
76          (d) an assisted living facility Type I or II; or
77          (e) a designated swing bed unit in a general hospital.
78          (11) "Medication aide certified" means a certified nurse aide who:
79          (a) has a minimum of 2,000 hours experience working as a certified nurse aide;
80          (b) has received a minimum of 60 hours of classroom and 40 hours of practical training
81     that is approved by the division in collaboration with the board, in administering routine
82     medications to patients or residents of long-term care facilities; and
83          (c) is certified by the division as a medication aide certified.
84          (12) "Pain clinic" means the same as that term is defined in Section 58-1-102.
85          (13) (a) "Practice as a medication aide certified" means the limited practice of nursing
86     under the supervision, as defined by the division by [administrative] rule made in accordance
87     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, of a licensed nurse, involving

88     routine patient care that requires minimal or limited specialized or general knowledge,
89     judgment, and skill, to an individual who:
90          (i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
91     disability; and
92          (ii) is in a regulated long-term care facility.
93          (b) "Practice as a medication aide certified":
94          (i) includes:
95          (A) providing direct personal assistance or care; and
96          (B) administering routine medications to patients in accordance with a formulary and
97     protocols to be defined by the division by rule made in accordance with Title 63G, Chapter 3,
98     Utah Administrative Rulemaking Act; and
99          (ii) does not include assisting a resident of an assisted living facility, a long term care
100     facility, or an intermediate care facility for people with an intellectual disability to self
101     administer a medication, as regulated by the Department of Health by [administrative] rule
102     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
103          (14) "Practice of advanced practice registered nursing" means the practice of nursing
104     within the generally recognized scope and standards of advanced practice registered nursing as
105     defined by rule and consistent with professionally recognized preparation and education
106     standards of an advanced practice registered nurse by a person licensed under this chapter as an
107     advanced practice registered nurse. [Advanced practice registered nursing] "Practice of
108     advanced practice registered nursing" includes:
109          (a) maintenance and promotion of health and prevention of disease;
110          (b) diagnosis, treatment, correction, consultation, and referral for common health
111     problems;
112          (c) prescription or administration of prescription drugs or devices including:
113          (i) local anesthesia;
114          (ii) Schedule III-V controlled substances; and
115          (iii) Subject to Section 58-31b-803, Schedule II controlled substances; or
116          (d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
117     related services upon the request of a licensed health care professional by an advanced practice
118     registered nurse specializing as a certified registered nurse anesthetist, including:

119          (i) preanesthesia preparation and evaluation including:
120          (A) performing a preanesthetic assessment of the patient;
121          (B) ordering and evaluating appropriate lab and other studies to determine the health of
122     the patient; and
123          (C) selecting, ordering, or administering appropriate medications;
124          (ii) anesthesia induction, maintenance, and emergence, including:
125          (A) selecting and initiating the planned anesthetic technique;
126          (B) selecting and administering anesthetics and adjunct drugs and fluids; and
127          (C) administering general, regional, and local anesthesia;
128          (iii) postanesthesia follow-up care, including:
129          (A) evaluating the patient's response to anesthesia and implementing corrective
130     actions; and
131          (B) selecting, ordering, or administering the medications and studies listed in
132     Subsection (14)(d); and
133          (iv) other related services within the scope of practice of a certified registered nurse
134     anesthetist, including:
135          (A) emergency airway management;
136          (B) advanced cardiac life support; and
137          (C) the establishment of peripheral, central, and arterial invasive lines; and
138          (v) for purposes of Subsection (14)(d), "upon the request of a licensed health care
139     professional":
140          (A) means a health care professional practicing within the scope of the health care
141     professional's license, requests anesthesia services for a specific patient; and
142          (B) does not require an advanced practice registered nurse specializing as a certified
143     registered nurse anesthetist to enter into a consultation and referral plan or obtain additional
144     authority to select, administer, or provide preoperative, intraoperative, or postoperative
145     anesthesia care and services.
146          (15) "Practice of nursing" means assisting individuals or groups to maintain or attain
147     optimal health, implementing a strategy of care to accomplish defined goals and evaluating
148     responses to care and treatment[. The practice of nursing] and requires substantial specialized
149     or general knowledge, judgment, and skill based upon principles of the biological, physical,

150     behavioral, and social sciences[, and]. "Practice of nursing" includes:
151          (a) initiating and maintaining comfort measures;
152          (b) promoting and supporting human functions and responses;
153          (c) establishing an environment conducive to well-being;
154          (d) providing health counseling and teaching;
155          (e) collaborating with health care professionals on aspects of the health care regimen;
156          (f) performing delegated procedures only within the education, knowledge, judgment,
157     and skill of the licensee;[ and]
158          (g) delegating [nurse interventions] nursing tasks that may be performed by others [and
159     are not in conflict with this chapter.], including an unlicensed assistive personnel; and
160          (h) supervising an individual to whom a task is delegated under Subsection (15)(g) as
161     the individual performs the task.
162          (16) "Practice of practical nursing" means the performance of nursing acts in the
163     generally recognized scope of practice of licensed practical nurses as defined by division rule
164     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and as
165     provided in this Subsection (16) by [a person] an individual licensed under this chapter as a
166     licensed practical nurse and under the direction of a registered nurse, licensed physician, or
167     other specified health care professional as defined by division rule made in accordance with
168     Title 63G, Chapter 3, Utah Administrative Rulemaking Act. Practical nursing acts include:
169          (a) contributing to the assessment of the health status of individuals and groups;
170          (b) participating in the development and modification of the strategy of care;
171          (c) implementing appropriate aspects of the strategy of care;
172          (d) maintaining safe and effective nursing care rendered to a patient directly or
173     indirectly; and
174          (e) participating in the evaluation of responses to interventions.
175          (17) "Practice of registered nursing" means performing acts of nursing as provided in
176     this Subsection (17) by [a person] an individual licensed under this chapter as a registered
177     nurse within the generally recognized scope of practice of registered nurses as defined by
178     division rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking
179     Act. Registered nursing acts include:
180          (a) assessing the health status of individuals and groups;

181          (b) identifying health care needs;
182          (c) establishing goals to meet identified health care needs;
183          (d) planning a strategy of care;
184          (e) prescribing nursing interventions to implement the strategy of care;
185          (f) implementing the strategy of care;
186          (g) maintaining safe and effective nursing care that is rendered to a patient directly or
187     indirectly;
188          (h) evaluating responses to interventions;
189          (i) teaching the theory and practice of nursing; and
190          (j) managing and supervising the practice of nursing.
191          (18) "Routine medications":
192          (a) means established medications administered to a medically stable individual as
193     determined by a licensed health care practitioner or in consultation with a licensed medical
194     practitioner; and
195          (b) is limited to medications that are administered by the following routes:
196          (i) oral;
197          (ii) sublingual;
198          (iii) buccal;
199          (iv) eye;
200          (v) ear;
201          (vi) nasal;
202          (vii) rectal;
203          (viii) vaginal;
204          (ix) skin ointments, topical including patches and transdermal;
205          (x) premeasured medication delivered by aerosol/nebulizer; and
206          (xi) medications delivered by metered hand-held inhalers.
207          (19) "Unlawful conduct" means the same as that term is defined in Sections 58-1-501
208     and 58-31b-501.
209          (20) "Unlicensed assistive personnel" means any unlicensed [person] individual,
210     regardless of title, [to whom tasks are] who is delegated a task by a licensed nurse as permitted
211     by division rule made in accordance with Title 63G, Chapter 3, Utah Administrative

212     Rulemaking Act, and [in accordance with] the standards of the profession.
213          (21) "Unprofessional conduct" means the same as that term is defined in Sections
214     58-1-501 and 58-31b-502 and as may be further defined by division rule made in accordance
215     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
216          Section 3. Section 58-31b-308.1 is enacted to read:
217          58-31b-308.1. Delegation of nursing care by a responsible caregiver.
218          (1) As used in this section:
219          (a) "Patient" means an individual who is receiving nursing care from a responsible
220     caregiver.
221          (b) "Responsible caregiver" means a patient's spouse, adult child, parent, foster parent,
222     or legal guardian who is primarily responsible for providing nursing care to the patient.
223          (c) "Unlicensed direct care worker" means any unlicensed individual, regardless of
224     title, who is 18 years of age or older and to whom a responsible caregiver delegates under this
225     section.
226          (2) A responsible caregiver may delegate to an unlicensed direct care worker the
227     performance of nursing care for a patient if:
228          (a) the nursing care is provided to the patient at the residence in which the patient and
229     responsible caregiver regularly reside;
230          (b) the patient's condition is stable;
231          (c) the responsible caregiver routinely provides the nursing care for the patient;
232          (d) the nursing care is considered routine care for the patient; and
233          (e) performance of the nursing care:
234          (i) poses little potential hazard for the patient; and
235          (ii) is generally expected to produce a predictable outcome for the patient.
236          (3) Before an unlicensed direct care worker may perform nursing care delegated under
237     Subsection (2), the responsible caregiver shall train the unlicensed direct care worker to
238     perform the nursing care and verify the unlicensed direct care worker is able to competently
239     perform the nursing care for the patient after training is complete.