29mar01...0453h

26june01...1863eba

2001 SESSION

01-0407

10/01

HOUSE BILL 408-FN

COMMITTEE: Executive Departments and Administration

ANALYSIS

This bill:

I. Revises definitions concerning nursing.

II. Requires licensure of nursing assistants and adds licensed nursing assistant members to the board of nursing.

III. Increases the compensation of the board.

IV. Makes various changes to the procedures for licensure and regulation of nurses.

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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

29mar01...0453h

26june01...1863eba

01-0407

10/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand One

Be it Enacted by the Senate and House of Representatives in General Court convened:

241:1 Chapter Title. Amend the chapter title of RSA 326-B to read as follows:

REGISTERED NURSES [AND], LICENSED PRACTICAL NURSES,

AND LICENSED NURSING ASSISTANTS

241:2 Purpose; Licensed Nursing Assistants Added. Amend RSA 326-B:1, I to read as follows:

I. In order to safeguard life, health, and the public welfare of the people of this state and in order to protect the people of the state of New Hampshire from the unauthorized, unqualified, and improper application of services by individuals in the practice of nursing, it is necessary that a regulatory authority be established and adequately funded. To further this policy the practice of nursing shall be regulated through the New Hampshire board of nursing, and said board shall have the power to enforce the provisions of this chapter. Any persons who practice or offer to practice nursing or nursing-related activities, or who represent themselves as registered nurses [or], licensed practical nurses, or licensed nursing assistants without qualifying under this chapter endanger the public health.

241:3 Definition; Active in Practice. Amend RSA 326-B:2, I to read as follows:

I. "Active in [the] practice [of nursing]" means to practice nursing as an advanced registered nurse practitioner, registered nurse, or licensed practical nurse or nursing-related activities as a licensed nursing assistant for a minimum number of hours as set by the board.

241:4 Definition; Licensed Nursing Assistant. Amend RSA 326-B:2, III to read as follows:

III. "Assistant to nurses" or "[certified] licensed nursing assistant" means a person who is authorized to provide [personal] care under the direction of a registered nurse or licensed practical nurse as defined by the board of nursing.

241:5 New Paragraph; Definition; Delegation. Amend RSA 326-B:2 by inserting after paragraph VIII the following new paragraph:

VIII-a. "Delegation" means the transfer of authority for the performance of a selected task from a licensed nurse authorized to perform the task to someone who does not have the authority, at the discretion of the licensed nurse. Licensed nursing assistants shall not have authority to delegate tasks. The administration of medications shall only be delegated to persons authorized in rules adopted by the board under RSA 541-A or who have successfully completed a board-approved curriculum.

241:6 Definition; License; Licensed Nursing Assistant Added. Amend RSA 326-B:2, XII to read as follows:

XII. "License" means a current document issued by the board permitting the practice of nursing as a registered nurse or licensed practical nurse or nursing-related activities as a licensed nursing assistant.

241:7 New Paragraph; Definition; Licensed Nurse. Amend RSA 326-B:2 by inserting after paragraph XII the following new paragraph:

XII-a. "Licensed nurse" means an advanced registered nurse practitioner, registered nurse, or licensed practical nurse.

241:8 Definition; Practical Nursing. RSA 326-B:2, XVI is repealed and reenacted to read as follows:

XVI. "Practical nursing" means a scope of practice, directed by a registered nurse, advanced registered nurse practitioner, dentist, or physician, by an L.P.N. who is prepared to function as a member of the health care team by exercising sound nursing judgment based on preparation, knowledge, skills, understanding, and past nursing experience. Practical nursing by an L.P.N. contributes to the assessment, planning, implementation and evaluation of patient care. Practical nursing includes the delegation of nursing tasks that may be performed by others and which do not conflict with this chapter.

241:9 Definition; Registered Nursing. RSA 326-B:2, XVIII is repealed and reenacted to read as follows:

XVIII. "Registered nursing" means the application of nursing knowledge, judgment, and skill drawn from broad in-depth education in the biological, psychological, social, and physical sciences in assessing, diagnosing, planning, implementing, and evaluating care which promotes optimum health, wellness, and independence of the individual, family and/or community.

241:10 Board of Nursing; New Members; Licensed Nursing Assistants. Amend RSA 326-B:3, I to read as follows:

I. The board of nursing shall be composed of [9] 11 members to be appointed by the governor with the consent of the council. Suggestions for appointment may be made to the governor by any interested individual, association or entity. The members of the board shall include 5 registered nurses, one of whom shall be an advanced registered nurse practitioner, 2 licensed practical nurses, 2 licensed nursing assistants, and 2 representative members of the public. The terms of members [appointed or reappointed after June 1, 1991,] shall be staggered as determined by the governor and council [, provided that the A.R.N.P. member shall be appointed to a 3-year term. Three members shall be appointed for a term of one year, 3 for a term of 2 years, and 3 for a term of 3 years]. All [subsequent] terms shall be for 3 years, and no member of the board shall be appointed to more than [2] 3 consecutive terms.

241:11 New Paragraph; Board of Nursing; Licensed Nursing Assistants. Amend RSA 326-B:3 by inserting after paragraph III the following new paragraph:

III-a. The licensed nursing assistant members of the board shall be residents of this state, licensed in good standing under the provisions of this chapter, currently engaged in nursing-related activities, and shall have had no less than 5 years of experience as a licensed nursing assistant, at least 3 of which shall have immediately preceded the date of appointment.

241:12 Board of Nursing; Compensation Increased. Amend RSA 326-B:3, VI to read as follows:

VI. Each member of the board shall be compensated at the rate of [$50] $100 for attendance at a regular board meeting and $50 for each other day actually engaged in official duties of the board, and shall be reimbursed for actual and necessary expenses incurred in the discharge of official duties, including travel at the state employee mileage rate.

241:13 Board of Nursing; Unexpired Terms. Amend RSA 326-B:3, VII to read as follows:

VII. An appointee to a full term on the board shall be appointed by the governor with the consent of the council before the expiration of the term of the member being succeeded and shall become a member of the board on the first day following the appointment expiration date of the previous appointee. Appointees to unexpired portions of full terms shall become members of the board on the day following such appointment, and shall serve the unexpired term and then be eligible to serve full 3-year terms.

241:14 Rulemaking; Nursing Assistants. Amend the introductory paragraph of RSA 326-B:4-a, XIII to read as follows:

XIII. Establishing standards for a basic assistant to nurses education, practice, [certification] licensure, and [recertification] renewal of license program and the issuance of evidence indicating satisfactory completion of such a program, including, but not limited to:

241:15 Rulemaking; Licensed Nursing Assistants. Amend RSA 326-B:4-a, XVI to read as follows:

XVI. Establishing standards for currently licensed registered and practical nurses' and [certified] licensed nursing assistants' education and scope of practice in primary and secondary school settings, and licensed practical nurses' and [certified] licensed nursing assistants' employment restrictions in elementary and secondary school settings.

241:16 New Paragraph; Rulemaking; Delegation. Amend RSA 326-B:4-a by inserting after paragraph XVI the following new paragraph:

XVII. Establishing standards of delegation by licensed nurses to licensed and unlicensed caregivers that shall apply to all health care settings, including but not limited to acute care facilities, long-term care facilities, home care, and schools.

241:17 Qualifications for License. Amend RSA 326-B:6, III to read as follows:

III. Have graduated from a board-approved nursing education program; or demonstrate comparable nursing educational preparation recognized by the board; or have graduated from a foreign nursing program and successfully completed the CGFNS examination or a curriculum evaluation; or have graduated from a recognized Canadian nursing education program; or be a candidate who has applied for licensure in New Hampshire and who has practiced successfully for at least 2 years in the United States.

241:18 Qualifications for License. Amend RSA 326-B:7, I(d) to read as follows:

(d) Have been active in [the] practice [of nursing] within a period of 4 years from the date of application or submit evidence of completion of a re-entry program acceptable to the board.

241:19 Renewal of Licenses. Amend RSA 326-B:8, I and II to read as follows:

I. Any person licensed under this chapter who intends to practice professional nursing [or], practical nursing, or assistant to nursing in this state shall renew his or her license [prior to his] no later than the person's birthday on a biennial schedule established by the board on a renewal application furnished by the board. At least one month before the licensee's birthday [of all licensees currently licensed], the board shall mail a renewal application, in the renewal year, to the [last known] licensee's address on file with the board. Failure to receive such application shall not excuse the licensee from the requirement to renew [his] the license prior to his or her birthday. A completed application for renewal shall be required to be at the board's office no later than midnight on the licensee's birthday.

II. Any license not renewed pursuant to paragraph I is considered to have lapsed; the licensee may have his or her lapsed license reinstated on satisfactory explanation and payment of the required fee.

241:20 Temporary Licensure. Amend the introductory paragraph of RSA 326-B:9 to read as follows:

A temporary [licensure, not to exceed] license valid up to 180 days, with renewal approval at the board's discretion, shall be granted to:

241:21 Temporary Licensure; Inactive. Amend RSA 326-B:9, III to read as follows:

III. Nurses inactive for 4 years or more who are enrolled in a re-entry program upon confirmation of [most recent licensure] a license from another jurisdiction. Applicants shall be restricted to practice under the supervision of a registered nurse.

241:22 Disciplinary Actions; Misconduct. Amend RSA 326-B:12, II(a)-(f) to read as follows:

(a) The practice of fraud or deceit in procuring or attempting to procure a license [to practice nursing];

(b) Conviction of a felony or any [offense involving moral turpitude] criminal act, not including traffic offenses;

(c) Dishonest or unprofessional conduct, including, but not limited to, [intentionally] harming, abusing or exploiting a patient, defrauding or harming the public in matters related to the practice of nursing or nursing-related activities, [willfully] failing to maintain accurate and complete nursing records, acts of omission or commission when practicing nursing or nursing-related activities as set forth in rules adopted by the board pursuant to RSA 541-A, [and] or violating disciplinary orders or settlement agreements approved by the board;

(d) [Gross or repeated negligence when practicing nursing, activities ancillary to the practice of nursing, or any particular aspect or specialty thereof, or the] Presence of a mental or physical deficiency, or an established behavior pattern which is incompatible with the basic knowledge and competence expected of persons licensed to practice nursing or any particular aspect or specialty thereof;

(e) Addiction to or abuse of alcohol or other habit-forming drugs or substances which render the licensee unfit to practice nursing or nursing-related activities;

(f) [ Willful or repeated] Violations of any provision of this chapter, any substantive rule adopted by the board pursuant to RSA 541-A, or any other state or federal statute or substantive rule [applicable to the practice of nursing] reasonably related to the licensee's ability to safely practice nursing or nursing-related activities.

241:23 Reporting of Misconduct. Amend RSA 326-B:12, V to read as follows:

V. Every individual, agency, facility, institution or organization that employs [nurses] licensed nursing personnel within the state shall report to the board within 30 days any action by a nurse or nursing assistant that willfully violates paragraph II of this section. The board shall have authority, after notice and the opportunity for hearing, to impose civil penalties of up to $1,000 per violation upon persons found to have willfully violated the reporting requirements of this paragraph.

241:24 Hearings; Presiding Officer. Amend RSA 326-B:13-a, I to read as follows:

I. The board may hold adjudicative hearings concerning allegations of misconduct or other matters within the scope of this chapter. Such hearings shall be public proceedings. Any member of the board other than the public members, or any other qualified person appointed by the board, shall have authority to preside at such a hearing and to issue oaths or affirmations to witnesses.

241:25 Gender Neutral. Amend RSA 326-B:17, IV to read as follows:

IV. Nursing services by any certified unlicensed graduate nurse who has been engaged in this state in nursing the sick for hire without assuming in any way to be a registered nurse, as [his] a bona fide occupation previous to July 1, 1959 and who was certified prior to January 1, 1975;

241:26 Gender Neutral. Amend RSA 326-B:24 to read as follows:

326-B:24 Continued Competence of Nurses. The board shall establish procedures by which the individual licensee maintains [his] continued competence for relicensure. Procedures to evaluate and ensure continued competence shall be established by rules adopted by the board pursuant to RSA 541-A.

241:27 Nursing Assistant; Rulemaking; Licensure. Amend RSA 326-B:29, I to read as follows:

I. The board shall adopt a schedule of fees, adopted by rule under RSA 541-A, for examination, [registration] licensure, renewal, [recertification] relicensure, endorsement, and verification of nursing assistants.

241:28 New Section; Liability for Delegated Duties. Amend RSA 326-B by inserting after section 32 the following new section:

326-B:33 Liability for Delegated Duties.

I. A nurse licensed under this chapter who delegates a specific nursing activity or task in compliance with the rules adopted pursuant to RSA 326-B:4-a, XVII shall not be subject to disciplinary action by the board of nursing for the performance of a person to whom the nursing activity or task is delegated.

II. Caregivers who properly follow delegation orders that are made in compliance with the rules adopted pursuant to RSA 326-B:4-a, XVII shall not be subject to disciplinary action by the board of nursing for the performance of their delegated duties.

III. No person may coerce a licensed nurse into compromising patient safety by requiring the licensed nurse to delegate if the licensed nurse determines that it is inappropriate to do so. Licensed nurses shall not be subject to disciplinary action by the board of nursing for refusing to delegate nursing activities or tasks or refusing to provide the required training for delegation if the nurse determines that delegation may compromise patient safety.

241:29 Repeal. The following are repealed:

I. RSA 326-B:2, IX, relative to definition of directing.

II. RSA 326-B:2, XIV, relative to definition of medical regimen.

III. RSA 326-B:2, XV, relative to definition of nursing regimen.

241:30 Effective Date. This act shall take effect July 1, 2001.

(Approved: July 13, 2001)

(Effective Date: July 1, 2001)