Revision: Jan. 28, 2019, 3:46 p.m.
SB 273-FN - AS INTRODUCED
2019 SESSION
19-0847
10/03
SENATE BILL 273-FN
AN ACT relative to the regulation of nursing assistants by the board of nursing.
SPONSORS: Sen. Kahn, Dist 10; Sen. Watters, Dist 4; Sen. Reagan, Dist 17; Sen. Ward, Dist 8; Rep. McGuire, Merr. 29
COMMITTEE: Executive Departments and Administration
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ANALYSIS
This bill changes the regulation of licensed nursing assistants to certified nursing assistants, and makes administrative changes for the board of nursing.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19-0847
10/03
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
AN ACT relative to the regulation of nursing assistants by the board of nursing.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Nurse Practice Act; Definitions; Certified Nursing Assistant. Amend RSA 326-B:2 by inserting after paragraph II the following new paragraph:
II-a. "Certified nursing assistant" or "CNA" means an individual who holds a current certification through the nursing assistant registry to provide client care under the direction of a registered nurse or licensed practical nurse.
2 Nurse Practice Act; Definitions. Amend RSA 326-B:2, VI to read as follows:
VI. "Medication nursing assistant" means a [licensed] certified nursing assistant holding a currently valid certificate authorizing the delegation to the nursing assistant of tasks of medication administration.
3 Nurse Practice Act; Definitions. Amend RSA 326-B:2, VIII to read as follows:
VIII. "Nursing-related activities" means client care provided by a [licensed] certified nursing assistant directed by an APRN, an RN, or an LPN.
4 Board of Nursing. Amend RSA 326-B:3, I to read as follows:
I. The board of nursing shall comprise 11 members to be appointed by the governor with the consent of the council. Any interested individual, association, or entity may make recommendation to the governor. The members of the board shall include 5 registered nurses, one of whom shall be an advanced practice registered nurse, 2 licensed practical nurses, 2 [licensed] certified nursing assistants, one of whom shall be a certified medication [licensed] nursing assistant if possible, and 2 representative members of the public. The terms of members shall be staggered as determined by the governor and council. All terms shall be for 3 years, and no member of the board shall be appointed to more than 3 consecutive terms.
5 Board of Nursing; CNAs. Amend RSA 326-B:3, IV to read as follows:
IV. The [LNA] CNA members of the board shall be residents of this state, [licensed] certified in good standing under the provisions of this chapter, and currently engaged in nursing-related activities. These members shall have a minimum of 5 years of experience as [an LNA] a CNA, at least 3 of which shall have immediately preceded the date of their appointment.
6 Fees; Charges. Amend RSA 326-B:8 to read as follows:
326-B:8 Fees; Charges.
I. The board shall charge fees for the issuance, renewal, and reinstatement of all licenses, specialty licenses, and specialty certificates authorized by this chapter. [The board shall recover at least 125 percent of its direct expenses through licensee fees, fines, and administrative charges.]
II. The board may provide the following services and make administrative charges for:
(a) The administration of examinations required by this chapter.
(b) Verification of licensure or certification status.
(c) The sale of lists of nurse licensees and certified nursing assistants who have given their written authorization to have their names included on such lists.
(d) The actual costs of a criminal conviction record check required pursuant RSA 326-B:15.
(e) The actual cost of collection of statistical data provided to private entities.
(f) Site visits associated with nursing education programs under RSA 326-B:32.
7 Rulemaking; Reinstatement. Amend RSA 326-B:9, II to read as follows:
II. Application procedures and eligibility requirements for the reinstatement of licenses or registry certification after lapse and after disciplinary action.
8 Rulemaking; CNAs. Amend RSA 326-B:9, V-VII to read as follows:
V. The standards to be met by, and the process for approval of, education programs designed to prepare LPNs in intravenous therapy and by programs designed to prepare [LNAs] CNAs to perform tasks not addressed in the basic curriculum required for [licensure] certification.
VI. The determination of disciplinary sanctions authorized by this chapter, including the determination of administrative fines.
VII. The administration of examinations authorized by this chapter, and the manner in which information regarding the contents of any licensing or certification examinations may be disclosed, solicited, or compiled.
9 Advanced Practice Registered Nurses. Amend RSA 326-B:11, I to read as follows:
I. Advanced practice registered nursing [by nurse practitioners] shall consist of a combination of knowledge and skills acquired in basic nursing education. The APRN scope of practice, with or without compensation or personal profit, shall be limited to:
(a) Performing acts of advanced assessment, diagnosing, prescribing, selecting, administering, and providing therapeutic measures and treatment regimes;
(b) Obtaining consultation, planning, and implementing collaborative management, referral, or transferring the care of the client as appropriate; and
(c) Providing such functions [common to a nurse practitioner] for which the APRN is educationally and experientially prepared and which are consistent with standards established by a national credentialing or certification body recognized by the National Council of State Boards of Nursing and approved by the board in the appropriate APRN role and specialty.
10 Certified Nursing Assistants. Amend RSA 326-B:14 to read as follows:
326-B:14 Scope of Practice; [Licensed] Certified Nursing Assistant.
I. [An LNA] A CNA shall, with or without compensation or personal profit, practice under the supervision of an RN, APRN, or LPN.
II. [An LNA] A CNA is responsible for competency in the nursing assistant curriculum approved by the board.
II-a. [An LNA] A CNA is authorized to administer medication if:
(a) The [LNA] CNA holds a currently valid certificate of medication administration; or
(b) A licensed nurse delegates the task of medication administration to the [LNA] CNA who is employed in the home care, hospice, residential care, or adult day care setting. The board, in consultation with the commissioner of health and human services or a designee, shall adopt rules under RSA 541-A establishing standards for such delegation of medication administration which include, but are not limited to, limitations on the number of delegations per assistive personnel, training and competency requirements, documentation requirements, and medication administration error reporting requirements.
III. Following successful completion of the curriculum, a nursing assistant shall be able to:
(a) Form a relationship, communicate, and interact effectively with individuals and groups.
(b) Demonstrate comprehension related to individuals' emotional, mental, physical, and social health needs through skillful, direct nursing-related activities.
(c) Assist individuals to attain and maintain functional independence.
(d) Exhibit behaviors supporting and promoting care recipients' rights.
(e) Demonstrate observational and documenting skills required for reporting of people's health, safety, welfare, physical and mental condition, and general well-being.
(f) Provide safe nursing-related activities under the supervision of an RN or an LPN.
IV. [LNAs] CNAs may perform tasks not addressed in the basic curriculum required for [licensure] certification if they obtain additional training in the performance of such tasks through programs approved by the board. Additional tasks may be delegated provided:
(a) The task has been properly delegated to the nursing assistant by the supervising licensed nurse pursuant to RSA 326-B:28.
(b) The task has not been made exempt from nursing assistant practice.
(c) The policies of the employing health care facility allow the delegation of the task to [an LNA] a CNA.
V. Any expansion of the scope of practice shall be adopted by legislation in accordance with RSA 332-G:6.
11 Examinations. Amend the section heading and introductory paragraph of RSA 326-B:19 to read as follows:
326-B:19 [Licensed] Certified Nursing Assistant; [Licensure by] Certification by Examination. Applicants for an initial [LNA license] CNA certification shall:
12 Endorsement. Amend the section heading and introductory paragraph of RSA 326-B:21 to read as follows:
326-B:21 [Licensed] Certified Nursing Assistant; [Licensure by] Certification by Endorsement. An applicant for [licensure] certification by endorsement as a [licensed] certified nursing assistant who is currently licensed or certified in any other state or jurisdiction shall:
13 Renewal of License or Certification. Amend RSA 326-B:22 to read as follows:
326-B:22 License or Certification Renewal; All [Licensees] Applicants.
I. All license and certification renewals shall be issued biennially.
II. Any [person] licensed nurse or certified nursing assistant who intends to continue practicing as a nurse or nursing assistant shall:
(a)(1) For licensed nurses, by midnight on his or her date of birth in the renewal year submit a completed application and fees as established by the board;
(2) For certified nursing assistants, by midnight of the date placed on the nursing assistant registry submit a completed application;
(b) Report any pending criminal charges, criminal convictions, or plea arrangements in lieu of convictions;
(c) Have committed no acts or omissions which are grounds for disciplinary action as set forth in this chapter, or, if such acts have been committed and would be grounds for disciplinary action, the board has found, after investigation, that sufficient restitution has been made;
(d) Meet continuing competence requirements as defined in rules adopted under RSA 541-A;
(e) For those [licensees] applicants applying for renewal following disciplinary action, comply with all board licensure or certification requirements as well as any specific requirements set forth in the board's discipline order; and
(f) Meet other criteria as established by the board.
III. Failure to renew the license or certification on the nursing assistant registry shall result in forfeiture of the ability to practice nursing or nursing activities in the state of New Hampshire.
14 Reinstatement. Amend RSA 326-B:23 to read as follows:
326-B:23 License or Certification Reinstatement; All [Licensees] Applicants. An individual whose license or certification has lapsed by failure to renew may apply for reinstatement by meeting all requirements for renewal, or satisfying the following conditions:
I. An individual who applies for license or certification reinstatement who does not meet the continuing competence requirements shall demonstrate current nursing or nursing assistant knowledge and skill, as defined in rules adopted by the board under RSA 541-A.
II. For those [licensees] applicants applying for reinstatement following disciplinary action, compliance with all board licensure or certification requirements as well as any specific requirements set forth in the board's discipline order.
III. Application for reinstatement of a license or certification which has lapsed under this section shall include payment of a reinstatement fee and be made, and granted or denied, in accordance with rules adopted by the board pursuant to RSA 541-A.
15 Medication Administration. Amend RSA 326-B:27 to read as follows:
326-B:27 Certificate of Medication Administration for [Licensed] Certified Nursing Assistants.
I. The board may issue a certificate of medication administration to a current [LNA] CNA who:
(a) Has participated in and completed a board-approved medication administration education program;
(b) Has passed an examination approved by the board; and
(c) Has paid the certification fee.
II. Certification may be renewed on a biennial basis.
16 Obligations. Amend RSA 326-B:30 to read as follows:
326-B:30 Obligations of Licensees and Certificate Holders.
I. In response to board inquiries relevant to a licensee's or certificate holder's status or practice of nursing or nursing-related activities, each licensee or certificate holder shall provide complete and truthful information.
II. Each licensee or certificate holder shall notify the board if a license or certificate is lost or stolen.
III. Each licensee or certificate holder shall notify the board of a change of name or address within 10 days.
IV. Each licensee or certificate holder shall report to the board those acts or omissions which are violations of this chapter or grounds for disciplinary action.
17 Continuing Education. Amend the introductory paragraph of RSA 326-B:31 and RSA 326-B:31, I to read as follows:
326-B:31 Continuing Education. Applicants for license or certification renewal [and license] or reinstatement after lapse shall complete continuing education as follows:
I. An [LNA] CNA shall complete 12 hours of continuing education in programs approved by the board each year, provided that [licensees] CNAs who hold a certificate of medication administration shall complete at least 4 hours of those 12 hours in medication administration.
18 Disciplinary Action. Amend RSA 326-B:37, II(d) to read as follows:
(d) Employing fraud or deceit in procuring or attempting to procure a license or certificate to practice nursing, in filing any reports or completing client records, in representation of oneself to the board or public, in authenticating any report or records in the nurse's capacity as an APRN, RN, LPN, or [LNA] CNA, or in submitting any information or record to the board.
19 Unlawful Acts. Amend RSA 326-B:41 to read as follows:
326-B:41 Unlawful Acts. It shall be unlawful for any person or entity to:
I. Sell or fraudulently obtain or furnish any nursing diploma, license, certification, or record, or to aid and abet in such an act.
II. Practice as a [licensee] nurse without a license or when the license to do so has been revoked or suspended or when the license to do so has lapsed.
II-a. Practice as a certified nursing assistant without current status on the nursing assistant registry or when the certification has been revoked or suspended or when the certification on the registry has lapsed.
III. Use, in connection with the individual's name, any designation tending to imply licensure as an RN, an LPN, or [an LNA] certification as a CNA unless so licensed or certified.
IV. Represent or imply that the person or entity is conducting a nursing education program or a program for the education of nursing assistants which has been approved by the board when the program has not been so approved.
V. Disclose, solicit, or compile information regarding the contents of any licensing or certification examinations relative to this chapter, except as authorized by the board.
20 Penalty. Amend RSA 326-B:41-a, I to read as follows:
I. Any person who shall practice or attempt to practice as a registered nurse, advanced practice registered nurse, licensed practical nurse, or [licensed] certified nursing assistant in this state without a license or certification shall be guilty of a class A misdemeanor if a natural person or guilty of a felony if any other person.
21 School Health Services; Reference Corrected. Amend RSA 200:31 to read as follows:
200:31 School Health Personnel. Any school board may employ or contract for its district a licensed practical nurse (LPN) or [licensed nursing assistant (LNA)] certified nursing assistant (CNA) who shall hold an unencumbered current license or certification in New Hampshire, to work under the supervision of the school registered nurse in accordance with rules adopted under RSA 541-A, by the board of nursing.
22 Prohibited Overtime; Reference Corrected. Amend RSA 275:67, I to read as follows:
I. A registered nurse, a licensed practical nurse, or a [licensed] certified nursing assistant [licensed] under RSA 326-B shall not be disciplined, or lose any right, benefit, or privilege for refusing to work more than 12 consecutive hours, except as provided in paragraph II. A nurse may be disciplined for refusing mandatory overtime in a case when overtime is required under paragraph II. Any nurse who is mandated to work more than 12 consecutive hours, as permitted by this subdivision, shall be allowed at least 8 consecutive hours of off-duty time immediately following the worked overtime.
23 Repeal. RSA 326-B:2, IV, relative to the definition of licensed nursing assistant, is repealed.
24 Transition; Rules; Licenses.
I. The rules adopted for licensed nursing assistants by the board of nursing in effect on the effective day of this act shall, to the extent practicable, continue and be effective and apply to certified nursing assistants until they expire or are amended or repealed.
II. Licenses of licensed nursing assistants under RSA 326-B shall continue to be valid until they expire or are revoked or suspended as provided in RSA 326-B as amended by this act.
25 Effective Date. This act shall take effect July 1, 2019.
19-0847
1/25/19
SB 273-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to the regulation of nursing assistants by the board of nursing.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Potential Decrease of $220,000 | Potential Decrease of $220,000 | Potential Decrease of $220,000 | Potential Decrease of $220,000 |
Expenditures | $0 | $0 | $0 | $0 |
Funding Source: | [ ] General [ ] Education [ ] Highway [ X ] Other - Office of Professional Licensure and Certification Fund (RSA 310-A:1-e, I(b)) | |||
METHODOLOGY:
This bill changes the state licensing requirement for licensed nursing assistants to a certification requirement. The Office of Professional Licensure and Certification states this group of professionals will still remain certified with the national registry, but there will no longer be any revenue from licensing fees. Annual license fee revenue is approximately $220,000 per year. Losing this revenue may necessitate an increase in license fees from other professionals governed by the Board of Nursing to cover the board's operating expenses.
AGENCIES CONTACTED:
Office of Professional Licensure and Certification