1     
NURSING EDUCATION PROGRAM AMENDMENTS

2     
2023 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Rosemary T. Lesser

5     
Senate Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill makes amendments related to the practice of nursing.
10     Highlighted Provisions:
11          This bill:
12          ▸     amends definitions;
13          ▸     amends Board of Nursing (board) duties; and
14          ▸     requires nursing education programs to meet minimum education standards in order
15     for the education program to qualify graduates of the program for the various
16     nursing licenses.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          58-31b-102, as last amended by Laws of Utah 2022, Chapter 277
24          58-31b-201, as last amended by Laws of Utah 2018, Chapter 318
25          58-31b-601, as last amended by Laws of Utah 2022, Chapter 382
26     

27     Be it enacted by the Legislature of the state of Utah:
28          Section 1. Section 58-31b-102 is amended to read:
29          58-31b-102. Definitions.
30          In addition to the definitions in Section 58-1-102, as used in this chapter:
31          (1) "Administrative penalty" means a monetary fine or citation imposed by the division
32     for acts or omissions determined to be unprofessional or unlawful conduct in accordance with a
33     fine schedule established by division rule made in accordance with Title 63G, Chapter 3, Utah
34     Administrative Rulemaking Act, and as a result of an adjudicative proceeding conducted in
35     accordance with Title 63G, Chapter 4, Administrative Procedures Act.
36          (2) "Applicant" means an individual who applies for licensure or certification under
37     this chapter by submitting a completed application for licensure or certification and the
38     required fees to the department.
39          [(3) "Approved education program" means a nursing education program that is
40     accredited by an accrediting body for nursing education that is approved by the United States
41     Department of Education.]
42          [(4)] (3) "Board" means the Board of Nursing created in Section 58-31b-201.
43          [(5)] (4) "Diagnosis" means the identification of and discrimination between physical
44     and psychosocial signs and symptoms essential to the effective execution and management of
45     health care.
46          [(6)] (5) "Examinee" means an individual who applies to take or does take any
47     examination required under this chapter for licensure.
48          [(7)] (6) "Licensee" means an individual who is licensed or certified under this chapter.
49          [(8)] (7) "Long-term care facility" means any of the following facilities licensed by the
50     Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
51     Inspection Act:
52          (a) a nursing care facility;
53          (b) a small health care facility;
54          (c) an intermediate care facility for people with an intellectual disability;
55          (d) an assisted living facility Type I or II; or
56          (e) a designated swing bed unit in a general hospital.
57          [(9)] (8) "Medication aide certified" means a certified nurse aide who:
58          (a) has a minimum of 2,000 hours experience working as a certified nurse aide;
59          (b) has received a minimum of 60 hours of classroom and 40 hours of practical training
60     that is approved by the division in collaboration with the board, in administering routine
61     medications to patients or residents of long-term care facilities; and
62          (c) is certified by the division as a medication aide certified.
63          [(10)] (9) (a) "Practice as a medication aide certified" means the limited practice of
64     nursing under the supervision, as defined by the division by rule made in accordance with Title
65     63G, Chapter 3, Utah Administrative Rulemaking Act, of a licensed nurse, involving routine
66     patient care that requires minimal or limited specialized or general knowledge, judgment, and
67     skill, to an individual who:
68          (i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
69     disability; and
70          (ii) is in a regulated long-term care facility.
71          (b) "Practice as a medication aide certified":
72          (i) includes:
73          (A) providing direct personal assistance or care; and
74          (B) administering routine medications to patients in accordance with a formulary and
75     protocols to be defined by the division by rule made in accordance with Title 63G, Chapter 3,
76     Utah Administrative Rulemaking Act; and
77          (ii) does not include assisting a resident of an assisted living facility, a long term care
78     facility, or an intermediate care facility for people with an intellectual disability to self
79     administer a medication, as regulated by the Department of Health by rule made in accordance
80     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
81          [(11)] (10) "Practice of advanced practice registered nursing" means the practice of
82     nursing within the generally recognized scope and standards of advanced practice registered
83     nursing as defined by rule and consistent with professionally recognized preparation and
84     education standards of an advanced practice registered nurse by a person licensed under this
85     chapter as an advanced practice registered nurse. "Practice of advanced practice registered
86     nursing" includes:
87          (a) maintenance and promotion of health and prevention of disease;
88          (b) diagnosis, treatment, correction, consultation, and referral;
89          (c) prescription or administration of prescription drugs or devices including:
90          (i) local anesthesia;
91          (ii) Schedule III-V controlled substances; and
92          (iii) Subject to Section 58-31b-803, Schedule II controlled substances; or
93          (d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
94     related services upon the request of a licensed health care professional by an advanced practice
95     registered nurse specializing as a certified registered nurse anesthetist, including:
96          (i) preanesthesia preparation and evaluation including:
97          (A) performing a preanesthetic assessment of the patient;
98          (B) ordering and evaluating appropriate lab and other studies to determine the health of
99     the patient; and
100          (C) selecting, ordering, or administering appropriate medications;
101          (ii) anesthesia induction, maintenance, and emergence, including:
102          (A) selecting and initiating the planned anesthetic technique;
103          (B) selecting and administering anesthetics and adjunct drugs and fluids; and
104          (C) administering general, regional, and local anesthesia;
105          (iii) postanesthesia follow-up care, including:
106          (A) evaluating the patient's response to anesthesia and implementing corrective
107     actions; and
108          (B) selecting, ordering, or administering the medications and studies listed in this
109     Subsection [(11)(d)] (10)(d);
110          (iv) other related services within the scope of practice of a certified registered nurse
111     anesthetist, including:
112          (A) emergency airway management;
113          (B) advanced cardiac life support; and
114          (C) the establishment of peripheral, central, and arterial invasive lines; and
115          (v) for purposes of this Subsection [(11)(d)] (10)(d), "upon the request of a licensed
116     health care professional":
117          (A) means a health care professional practicing within the scope of the health care
118     professional's license, requests anesthesia services for a specific patient; and
119          (B) does not require an advanced practice registered nurse specializing as a certified
120     registered nurse anesthetist to obtain additional authority to select, administer, or provide
121     preoperative, intraoperative, or postoperative anesthesia care and services.
122          [(12)] (11) "Practice of nursing" means assisting individuals or groups to maintain or
123     attain optimal health, implementing a strategy of care to accomplish defined goals and
124     evaluating responses to care and treatment, and requires substantial specialized or general
125     knowledge, judgment, and skill based upon principles of the biological, physical, behavioral,
126     and social sciences. "Practice of nursing" includes:
127          (a) initiating and maintaining comfort measures;
128          (b) promoting and supporting human functions and responses;
129          (c) establishing an environment conducive to well-being;
130          (d) providing health counseling and teaching;
131          (e) collaborating with health care professionals on aspects of the health care regimen;
132          (f) performing delegated procedures only within the education, knowledge, judgment,
133     and skill of the licensee;
134          (g) delegating nursing tasks that may be performed by others, including an unlicensed
135     assistive personnel; and
136          (h) supervising an individual to whom a task is delegated under Subsection [(12)(g)]
137     (11)(g) as the individual performs the task.
138          [(13)] (12) "Practice of practical nursing" means the performance of nursing acts in the
139     generally recognized scope of practice of licensed practical nurses as defined by division rule
140     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and as
141     provided in this Subsection [(13)] (12) by an individual licensed under this chapter as a
142     licensed practical nurse and under the direction of a registered nurse, licensed physician, or
143     other specified health care professional as defined by division rule made in accordance with
144     Title 63G, Chapter 3, Utah Administrative Rulemaking Act. Practical nursing acts include:
145          (a) contributing to the assessment of the health status of individuals and groups;
146          (b) participating in the development and modification of the strategy of care;
147          (c) implementing appropriate aspects of the strategy of care;
148          (d) maintaining safe and effective nursing care rendered to a patient directly or
149     indirectly; and
150          (e) participating in the evaluation of responses to interventions.
151          [(14)] (13) "Practice of registered nursing" means performing acts of nursing as
152     provided in this Subsection [(14)] (13)by an individual licensed under this chapter as a
153     registered nurse within the generally recognized scope of practice of registered nurses as
154     defined by division rule made in accordance with Title 63G, Chapter 3, Utah Administrative
155     Rulemaking Act. Registered nursing acts include:
156          (a) assessing the health status of individuals and groups;
157          (b) identifying health care needs;
158          (c) establishing goals to meet identified health care needs;
159          (d) planning a strategy of care;
160          (e) prescribing nursing interventions to implement the strategy of care;
161          (f) implementing the strategy of care;
162          (g) maintaining safe and effective nursing care that is rendered to a patient directly or
163     indirectly;
164          (h) evaluating responses to interventions;
165          (i) teaching the theory and practice of nursing; and
166          (j) managing and supervising the practice of nursing.
167          [(15)] (14) "Registered nurse apprentice" means an individual licensed under
168     Subsection 58-31b-301(2)(b) who is learning and engaging in the practice of registered nursing
169     under the indirect supervision of an individual licensed under:
170          (a) Subsection 58-31b-301(2)(c), (e), or (f);
171          (b) Chapter 67, Utah Medical Practice Act; or
172          (c) Chapter 68, Utah Osteopathic Medical Practice Act.
173          [(16)] (15) "Routine medications":
174          (a) means established medications administered to a medically stable individual as
175     determined by a licensed health care practitioner or in consultation with a licensed medical
176     practitioner; and
177          (b) is limited to medications that are administered by the following routes:
178          (i) oral;
179          (ii) sublingual;
180          (iii) buccal;
181          (iv) eye;
182          (v) ear;
183          (vi) nasal;
184          (vii) rectal;
185          (viii) vaginal;
186          (ix) skin ointments, topical including patches and transdermal;
187          (x) premeasured medication delivered by aerosol/nebulizer; and
188          (xi) medications delivered by metered hand-held inhalers.
189          [(17)] (16) "Unlawful conduct" means the same as that term is defined in Sections
190     58-1-501 and 58-31b-501.
191          [(18)] (17) "Unlicensed assistive personnel" means any unlicensed individual,
192     regardless of title, who is delegated a task by a licensed nurse as permitted by division rule
193     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and the
194     standards of the profession.
195          [(19)] (18) "Unprofessional conduct" means the same as that term is defined in
196     Sections 58-1-501 and 58-31b-502 and as may be further defined by division rule made in
197     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
198          Section 2. Section 58-31b-201 is amended to read:
199          58-31b-201. Board.
200          (1) There is created the Board of Nursing that consists of the following 11 members:
201          (a) nine nurses in a manner as may be further defined in division rule; and
202          (b) two members of the public.
203          (2) The board shall be appointed and serve in accordance with Section 58-1-201.
204          [(3) The board shall carry out the duties and responsibilities in Sections 58-1-202 and
205     58-1-203 and shall:]
206          [(a) (i) recommend to the division minimum standards for educational programs
207     qualifying a person for licensure or certification under this chapter;]
208          [(ii) recommend to the division denial, approval, or withdrawal of approval regarding
209     educational programs that meet or fail to meet the established minimum standards; and]
210          [(iii) designate one of its members on a permanent or rotating basis to:]
211          [(A) assist the division in reviewing complaints concerning the unlawful or
212     unprofessional conduct of a licensee; and]
213          [(B) advise the division in its investigation of these complaints.]
214          [(b)] (3) The board shall:
215          (a) carry out the duties and responsibilities in Sections 58-1-202 and 58-1-203;
216          (b) consult with the division regarding the duties described in Section 58-31b-601,
217     including to create minimum performance standards; and
218          (c) designate one member on a permanent or rotating basis to:
219          (i) assist the division in reviewing complaints concerning the unlawful or
220     unprofessional conduct of an individual licensed under this chapter; and
221          (ii) advise the division in investigating a complaint.
222          (4) A board member who has, under Subsection [(3)(a)(iii),] (3)(c), reviewed a
223     complaint or advised in its investigation may be disqualified from participating with the board
224     when the board serves as a presiding officer in an adjudicative proceeding concerning the
225     complaint.
226          Section 3. Section 58-31b-601 is amended to read:
227          58-31b-601. Minimum standards for nursing programs to qualify graduates --
228     Temporary approval to qualify graduates for licensure -- Minimum standards for
229     medication aide training to qualify persons for certification.
230          [(1) Except as provided in Subsections (2) and (3), to qualify as an approved education
231     program for the purpose of qualifying graduates for licensure under this chapter, a nursing
232     education program shall be accredited by an accrediting body for nursing education that is
233     recognized by the United States Department of Education.]
234          [(2) (a) The division, in consultation with the board, may approve a nursing education
235     program for up to five years, for the purpose of qualifying graduates for licensure under this
236     chapter, if the program:]
237          [(i) holds candidacy or is in the process of applying for candidacy for the accreditation
238     described in Subsection (1);]
239          [(ii) has been denied initial accreditation after holding candidacy for the accreditation
240     described in Subsection (1); or]
241          [(iii) is no longer accredited under Subsection (1); and]
242          [(b) has not previously received a term of approval granted by the division.]
243          [(3) (a) For a nursing education program that has previously received a term of
244     approval granted under Subsection (2), the division may reapprove the nursing education
245     program for the purpose of qualifying graduates for licensure if:]
246          [(i) the reapproval is for a period that does not exceed five years; and]
247          [(ii) a minimum of 12 months has passed since the day on which the previous term of
248     approval expired.]
249          [(b) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act,
250     the division, in consultation with the board, shall make rules to implement Subsection (3)(a).]
251          [(4)] (1) (a) The division in consultation with the board shall:
252          (i) in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act,
253     develop minimum performance standards for nursing education programs in the state to qualify
254     graduates for licensure under this chapter; and
255          (ii) except as provided in Subsection (1)(b)(iii), approve a program described in
256     Subsection (1)(a)(i) if the program meets the minimum performance standards.
257          (b) The division in consultation with the board may:
258          (i) survey nursing education programs;
259          (ii) develop curriculum requirements for nursing education programs; and
260          (iii) exempt a nursing education program from the minimum performance standards for
261     a period of time determined by the division in order for the program to come into compliance
262     with the minimum performance standards.
263          (c) The division shall consult with the board before taking any of the following actions:
264          (i) approving a nursing education program;
265          (ii) denying a nursing education program approval;
266          (iii) revoking a nursing education program's approval;
267          (iv) surveying a nursing education program;
268          (v) developing curriculum requirements for nursing education programs; and
269          (vi) exempting a nursing education program from the minimum performance standards
270     for a period of time determined by the division in order for the program to come into
271     compliance with the minimum performance standards.
272          (2) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and
273     the provisions of this chapter, the division in consultation with the board shall make rules
274     defining the minimum standards for a medication aide certified training program to qualify a
275     person for certification under this chapter as a medication aide certified.