SENATE BILL 1099 AN ACT

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1 Senate Engrossed State of Arizona Senate Forty-third Legislature First Regular Session SENATE BILL AN ACT amending sections -, -.0, -, -, -, -, -, -, -, - and -, Arizona revised statutes; repealing section -, Arizona revised statutes; amending title, chapter, article, Arizona revised statutes, by adding a new section -; amending Laws, chapter, section ; relating to the state board of nursing. Be it enacted by the Legislature of the State of Arizona: Section. Section -, Arizona Revised Statutes, is amended to read: -. Definitions In this chapter, unless the context otherwise requires:. "Approved nursing program" means a program for the educational preparation of professional and practical nurses for licensure in this state which has met standards of the board or is accredited by a national nursing accrediting agency recognized by the board.. "Board" means the Arizona state board of nursing.. "Certified registered nurse" means a registered nurse who has been certified by a national nursing credentialing agency recognized by the board.. "Conditional license" means a license that specifies the conditions under which the licensee is allowed to practice.. "Delegation" means transferring to a competent individual the authority to perform a selected nursing task in a designated situation in which the nurse making the delegation retains accountability for the delegation.. "Limited license" means a license that restricts the scope or setting of a licensee s practice.

2 S.B "Nursing assistant" means a person certified pursuant to this chapter to provide or assist in the delivery of nursing or nursing-related services under the supervision and direction of a licensed nursing staff member in a location where a nursing assistant is required by law to be certified. Nursing assistant does not include a person who: (a) Is a licensed health care professional. (b) Volunteers to provide nursing assistant services without monetary compensation... "Practical nurse" means a person who practices practical nursing as defined in this section... "Practical nursing" means the performance for compensation of services that require knowledge, skills and abilities that are acquired by completing an approved practical nursing program. The practice of practical nursing consists of participating with registered nurses in the assessment, planning, implementation and evaluation of nursing care by: (a) Providing for the emotional and physical comfort of patients. (b) Observing, recording and reporting the condition of patients. (c) Performing nursing procedures recognized by the board. (d) Assisting with the rehabilitation of patients according to the patient s care plan. (e) Assisting with maintenance of health... "Professional nursing" means the performance for compensation of any act requiring substantial specialized knowledge, judgment and nursing skill based upon the principles of the biological, physical and social sciences in: (a) The maintenance of health or prevention of illness. (b) The nursing assessment, the evaluation of the patient and the administration of care to the ill, injured or infirm. (c) The administration of medications and treatment as prescribed or authorized by a person licensed in this state to prescribe such medications and treatments or as authorized pursuant to section -. (d) The supervision and teaching of other personnel in the performance of any of the foregoing. (e) The performance of such additional acts requiring that require education and training as prescribed by the board, and which that are recognized by the nursing profession as proper to be performed by a professional nurse and which that are authorized by the board of nursing in consultation with the allopathic board of medical examiners and the board of osteopathic examiners in medicine and surgery through the rules of the board of nursing... "Registered nurse", "graduate nurse" or "professional nurse" means a person who practices professional nursing as defined in this section. - -

3 S.B "Registered nurse practitioner" means a professional nurse who is certified by the board in those areas authorized by the board through its rules for extended nursing practice and who has completed a nurse practitioner education program approved or recognized by the board... "Unprofessional conduct" includes the following whether occurring in this state or elsewhere: (a) Committing fraud or deceit in obtaining, attempting to obtain or renewing a license or a certificate issued pursuant to this chapter. (b) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission. (c) Aiding or abetting in a criminal abortion or attempting, agreeing or offering to procure or assist in a criminal abortion. (d) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. (e) Addiction to alcohol or other drugs. (f) (e) Being mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public. (g) (f) Having a license, to practice practical or professional nursing certificate, permit or registration to practice a health care profession denied, suspended, conditioned, limited or revoked in another jurisdiction and not reinstated by that jurisdiction. (h) (g) Wilfully or repeatedly violating a provision of this chapter or a rule adopted pursuant to this chapter. (i) Committing fraud or deceit in obtaining or attempting to obtain a registered nurse practitioner certificate. (j) (h) Committing an act that deceives, defrauds or harms the public. (k) (i) Failing to comply with a stipulated agreement, consent agreement or board order. (l) (j) Violating a rule that is adopted by the board and that relates to the practice of nursing pursuant to this chapter. (m) (k) Fails Failing to report an immunization to the department of health services required under as prescribed in section -. Sec.. Section -.0, Arizona Revised Statutes, is amended to read: -.0. Executive director; compensation; powers; duties The board shall appoint an executive director who is not a member of the board. The executive director is eligible to receive compensation set by the board within the range determined under section -. The executive director or the executive director s designee shall: - -

4 S.B Perform the administrative duties of the board.. Employ personnel needed to carry out the functions of the board.. Issue temporary licenses.. Perform other duties as directed by the board.. On behalf of the board, enter into a stipulated agreement agreements with a licensee for the confidential treatment, rehabilitation and monitoring of chemical dependency. The licensee who materially fails to comply with a program requirement shall be reported to the board and terminated from the confidential program. Any records of a licensee who is terminated from a confidential program are no longer confidential or exempt from the public records law. Notwithstanding any law to the contrary, stipulated agreements are not public records if the following conditions are met: (a) The licensee voluntarily agrees to participate in the confidential program prior to the initiation of an investigation. (b) The licensee complies with all treatment requirements or recommendations, including participation in alcoholics anonymous or an equivalent -step program and nurse support group. (c) The licensee refrains from the practice of nursing until the return to nursing has been approved by the treatment program and the executive director or the executive director s designee. (d) The licensee complies with all monitoring requirements of the stipulated agreement including random biological fluid testing. (e) The licensee s nursing employer is notified of the licensee s chemical dependency and participation in the confidential program and is provided a copy of the stipulated agreement. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Powers and duties of board A. The board may:. Adopt and revise rules necessary to carry into effect the provisions of this chapter.. Publish advisory opinions regarding functions of professional and practical nurses.. Issue limited licenses if it determines that an applicant or licensee cannot function safely in a specific setting.. Appoint hearing officers to preside at hearings conducted pursuant to this chapter.. Refer criminal violations of this chapter to the appropriate law enforcement agency.. Establish a confidential program for the monitoring of licensees who are chemically dependent and who enroll in rehabilitation programs that meet the criteria established by the board. The board may take further action if the licensee refuses to enter into a stipulated agreement or fails - -

5 S.B. 0 0 to comply with its terms. In order to protect the public health and safety the confidentiality requirements of this paragraph do not apply if the licensee does not comply with the stipulated agreement.. Adopt rules for the qualification and certification of clinical nurse specialists.. Adopt rules for the certification of school nurses if the state board of education does not require school nurses to be certificated pursuant to section -.0. B. The board shall:. Establish standards for schools of nursing programs and courses preparing persons for licensing under this chapter, recognize national nursing accrediting agencies and provide for surveys of schools it deems necessary.. Approve schools meeting nursing and nursing assistant training programs that meet the requirements of this chapter and of the board.. Prepare and maintain a list of approved schools nursing programs for professional and practical nurses whose graduates are eligible for licensing under this chapter as graduate registered or professional nurses or as practical nurses if they satisfy the other requirements of this chapter.. Examine, license and renew the licenses of duly qualified professional and practical nurse applicants.. Cause the prosecution of persons violating this chapter... Adopt a seal which the executive director shall keep... Keep a record of all proceedings and make an annual report to the governor on a date he directs... For proper cause, deny or rescind approval of a nursing or nursing assistant training program for failure to comply with this chapter or the rules of the board... On its own motion or on receipt of a complaint against licensees a person licensed or certified under this chapter, conduct investigations, hearings and proceedings concerning any violation of this chapter or the rules adopted by the board... Determine and administer appropriate disciplinary action as provided by this section against all licensees persons who are licensed or certified under this chapter and who are found guilty of violating this chapter or rules adopted by the board... Perform functions necessary to carry out the requirements of the nursing assistant training and competency evaluation program as set forth in the omnibus budget reconciliation act of (P.L. 0-), as amended by the medicare catastrophic coverage act of. These functions shall include: the testing and certification of nursing assistants, the approval of nursing assistant training programs and the assessment of fees in order - -

6 S.B. 0 0 to cover the costs of administering the program unless the collection of these fees is otherwise prohibited by federal law. These functions shall be performed pursuant to an interagency agreement between the director of the Arizona health care cost containment system administration and the board. The board shall use only fees it may collect from nursing assistants for the purposes prescribed by this paragraph. (a) Testing and certification of nursing assistants. (b) Maintaining a list of board approved training programs. (c) Recertifying nursing assistants. (d) Maintaining a registry of all certified nursing assistants. (e) Assessing fees... Adopt rules establishing those acts that may be performed by a registered nurse practitioner in collaboration with a licensed physician... In consultation with the state board of education, adopt rules establishing educational requirements for certification of school nurses pursuant to section -.0. The board shall issue verification of course work completion for certification pursuant to its rules... Publish copies of board rules and distribute these copies on request. C. The board may take any of the following disciplinary actions against any person licensed under this chapter:. Revoke the license to practice.. Suspend the license to practice.. Enter a decree of censure which may require that restitution be made to an aggrieved party.. Issue an order fixing a period and terms of probation best adapted to protect the public health and safety and rehabilitate the licensed person.. Impose a civil penalty, not to exceed one thousand dollars, either singly or in combination with any disciplinary action permitted under this subsection. D. Failure to comply with any final order of the board, including an order of censure or probation, is cause for suspension or revocation of a license or revocation of a certificate. E. Decisions of the board are subject to judicial review pursuant to title, chapter, article. F. The president or a member of the board designated by the president may administer oaths in transacting the business of the board. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Examinations; notice The board shall contract with a private entity to conduct licensure examinations. The board shall require as part of this contract that the entity provide notice of the examination procedure to licensees applicants. Sec.. Section -, Arizona Revised Statutes, is amended to read: - -

7 S.B Use of title or abbreviation by professional nurse Only a person who holds a valid and current license to practice professional nursing in this state may use the title "registered nurse", "graduate nurse" or "professional nurse" and the abbreviation "R.N.". No other person shall assume or claim any such titles or use such abbreviation or any other words, letters, signs or figures to indicate that the person using it is a registered, graduate or professional nurse. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Use of title by practical nurse Only a person who holds a valid and current license to practice as a licensed practical nurse in this state may use the title "licensed practical nurse" and the abbreviation "L.P.N.". No other person shall assume or claim such title, or use such abbreviation or any other words, letters, signs or figures to indicate that the person using it is a licensed practical nurse. Sec.. Repeal Section -, Arizona Revised Statutes, is repealed. Sec.. Title, chapter, article, Arizona Revised Statutes, is amended by adding a new section -, to read: -. Nursing assistants; board powers In the regulation of nursing assistants the board may:. Refer criminal violations of this article to the appropriate law enforcement agency.. File a letter of concern if the board believes there is insufficient evidence to support direct action against the nursing assistant s certificate.. Pursuant to the omnibus budget reconciliation act of (P.L. 0-) as amended by the Medicare catastrophic coverage act of, indicate on the certificate the existence of any substantiated complaints against the certificate holder.. Deny certification or recertification or revoke a certificate if a nursing assistant commits an act of unprofessional conduct. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Disciplinary action A. The board may deny any license applied for under this chapter if the applicant commits an act of unprofessional conduct. A. If an applicant for licensure or certification commits an act of unprofessional conduct, the board may deny the application. The board may issue a conditional license to an applicant for licensure who commits an act of unprofessional conduct. B. The board in its order denying the license to an applicant shall terminate and revoke any temporary permit license issued to that applicant. C. Any person aggrieved by an order of the board denying a license or certificate under the authority granted by subsection A of this section may - -

8 S.B. 0 0 apply to the board in writing for a hearing within the time prescribed in section -. The board shall grant the hearing within thirty days after the date the written request is received by the board in accordance with the following procedure:. The board shall notify the aggrieved party of the time and place for hearing the matter.. At the hearing the aggrieved party may be present and may appear in person and by counsel, may produce witnesses and evidence, may have subpoenas issued by the board and may cross-examine witnesses. D. The board may If the board finds after a hearing that a licensee has committed an act of unprofessional conduct it may do any of the following:. Revoke or suspend any the license to practice practical nursing or professional nursing issued under this chapter or.. Impose a civil penalty, censure, or place on probation any person licensed under this chapter, or otherwise discipline any person licensed under this chapter if the licensee is, after a hearing, found to have committed an act of unprofessional conduct.. Censure the licensee.. Place the licensee on probation. E. The board may revoke a certificate if it finds after a hearing that a certificate holder has committed an act of unprofessional conduct. E. F. If the board acts to modify any registered nurse practitioner s prescription writing privileges, it shall immediately notify the state board of pharmacy of the modification. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Investigation of complaint; hearing; notice A. The board on its own motion may investigate any evidence which that appears to show that a professional or practical nurse licensee or a certificate holder is or may be guilty of violating this chapter or rules adopted pursuant to this chapter. B. Any professional or practical nurse or any A licensee and a health care institution as defined in section -0 shall, and any other person may, report to the board any information such nurse the licensee, certificate holder, health care institution or individual may have which that appears to show that a professional or practical nurse licensee or certificate holder is, was or may be a threat to the public health or safety. C. The board retains jurisdiction to proceed with an investigation or a disciplinary proceeding against a person whose license or certificate expired not more than five years before the board initiates the investigation. - -

9 S.B. 0 0 B. D. Any professional or practical nurse licensee, certificate holder, health care institution or other person that reports or provides information to the board in good faith shall is not be subject to an action for civil damages as a result of reporting or providing the information, and civil liability. If requested The board shall not disclose the name of the reporter if requested shall not be disclosed unless the information is essential to proceedings conducted pursuant to this section. It is an act of unprofessional conduct for a professional or practical nurse licensee to fail to report pursuant to this section, except that a nurse who is providing therapeutic counseling for nurses who enter drug rehabilitation programs is only required to report on the nurse in the drug rehabilitation program if the nurse providing the counseling has personal knowledge of patient safety being jeopardized. The board shall may report a health care institution which that fails to report pursuant to this section to the institution s licensing agency. C. E. On receipt by the board of a written complaint charging a licensee or certificate holder with any conduct specified in section -, subsection D, an act of unprofessional conduct, the board may conduct an investigation of the complaint. For purposes of the investigation, the board may employ investigators. Evidence may be taken by deposition or affidavit. F. For reasonable cause the board may require a licensee or certificate holder to undergo any combination of mental, physical or psychological examinations or skills evaluations necessary to determine the person s competence and conduct. These examinations may include biological fluid testing. D. G. If after completing its investigation the board finds that the information provided pursuant to subsections A and B of this section is not of sufficient seriousness to merit direct action against the license of the nurse, licensee or certificate holder it may take either of the following actions:. Dismiss if in the opinion of the board the information is without merit.. File a letter of concern if in the opinion of the board there is insufficient evidence to support direct action against the license of the nurse licensee or certificate holder but sufficient evidence for the board to notify the nurse that person of its concern. E. H. If the investigation in the opinion of the board reveals reasonable grounds to support the charge, the board shall appoint a time and place for a hearing the matter and shall serve notice of the hearing with a copy of the sworn complaint on the licensee or certificate holder personally at least twenty days prior to the time fixed for before the hearing. If personal service cannot be made and this fact is certified under oath by the person authorized by the board to make service, the board shall publish a - -

10 S.B. 0 0 copy of the notice of hearing at least once a week for two successive weeks in a newspaper of general circulation in the county in which the licensee of the licensee s or certificate holder s last resided or practiced according to known address as it appears on the records of the board and shall mail a copy of the complaint and notice to the licensee s last known address as it appears on the records of the board that address. When if publication is necessary the date of the hearing shall be not less than ten days after the date of the last publication of the notice. F. I. A licensee or certificate holder shall respond in writing to the board within thirty days after the licensee that person receives the complaint and notice of the hearing. The board shall consider a licensee s person s failure to respond within this time as the licensee s an admission by default to the allegations stated in the complaint. The board may then take disciplinary actions allowed by section - this chapter without conducting a hearing. G. J. A hearing officer An administrative law judge or a panel of board members may conduct hearings pursuant to this section. H. K. At the hearing the licensee or certificate holder may be present and may appear in person and by counsel, may produce witnesses and evidence, may have subpoenas issued by the board and may cross-examine witnesses. I. L. In any matters pending before it the board may issue subpoenas under its seal and compel the attendance of witnesses and the production of relevant and necessary papers, books, records, documentary evidence and materials including hospital records, medical staff records and medical staff review committee records. Any person failing to comply with a subpoena may, upon application by the board to any superior court judge, be ordered by the judge to comply with the subpoena and upon failure to comply shall be punished as in the case of disobedience of lawful process issued by the superior court. Subpoenas shall be served in the manner required by the rules of civil procedure for the superior court. J. M. Patient records, including clinical records, medical reports, laboratory statements and reports, any file, film, other report or oral statement relating to diagnostic findings or treatment of patients, any information from which a patient or his a patient's family might be identified or information received and records kept by the board as a result of the investigation procedure outlined in this chapter are not available to the public and are not subject to discovery in civil or criminal proceedings. K. N. Hospital records, medical staff records, medical staff review committee records, testimony concerning such records and proceedings related to the creation of such records shall not be available to the public. They shall be kept confidential by the board and shall be subject to the same provisions concerning discovery and use in legal actions as are the original - -

11 S.B. 0 0 records in the possession and control of hospitals, their medical staffs and their medical staff review committees. The board shall use such records and testimony during the course of investigations and proceedings pursuant to this chapter. L. O. At the hearing the board, the panel of board members or its hearing officer the administrative law judge may administer oaths. The board, the panel of board members or its hearing officer the administrative law judge shall not be bound by strict rules of procedure or evidence in the conduct of the proceedings, but its determination shall be based upon sufficient legal evidence. M. P. If the licensee or certificate holder is found guilty by the board of any of the actions set forth in section -, subsection D, to have committed an act of unprofessional conduct, the board may revoke or suspend the license or revoke the certificate. N. Q. The board may subsequently issue A denied license may be issued or certificate and may reissue a revoked or suspended license may be reissued after the denial, revocation or suspension in the discretion of the board or certificate. O. R. If a written complaint is filed with the board against an approved nursing program or an approved nursing assistant training program and the program requests a hearing, on request the board shall hold a hearing on the complaint pursuant to the requirements of this section. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Rehearing; judicial review A. Any person aggrieved by an order of the board refusing denying, revoking or suspending a license or a certificate, and any nursing program or nursing assistant training program aggrieved by an order of the board refusing denying, revoking or suspending approval, may apply to the board for a hearing or rehearing with respect to the order within ten days after service of the order, and the board shall grant or deny the application at the next regularly scheduled board meeting. If a hearing or rehearing is granted the board or its hearing officer administrative law judge shall determine the matter within a reasonable time. B. Decisions of the board shall be subject to judicial review pursuant to title, chapter, article. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Unlawful acts A. It is unlawful for a person who is not licensed or certified under this chapter or not holding a temporary license to:. Practice or offer to practice professional or practical nursing in this state. - -

12 S.B Represent or use any title, abbreviation, letters, figures, sign, card or device to indicate that the person or any other person is a registered, graduate or professional nurse.. Represent or use any title, abbreviation, letters, sign, card or device to indicate that the person or any other person is a licensed practical nurse or a certified nursing assistant. B. It is unlawful for a person to operate a nursing program or a nursing assistant training program unless it has been approved under this chapter. C. It is unlawful for a person to aid or abet any person in any act in violation of this chapter. Sec.. Section -, Arizona Revised Statutes, is amended to read: -. Violations; classification A person is guilty of a class felony who:. Sells or fraudulently obtains or furnishes any nursing diploma, certificate, license, permit or record.. Practices or offers to practice professional or practical nursing as defined in this chapter without a valid license currently in force.. engages in any conduct prohibited in section -.. Uses in connection with that person s name any designation tending to indicate or imply that the person is a graduate, registered or professional nurse or a licensed practical nurse if that person is not currently licensed under this chapter... Operates a nursing program or a nursing assistant training program unless the program is a currently approved nursing program... Practices nursing under cover of any diploma, license, permit or record illegally or fraudulently obtained, signed or issued unlawfully or because of fraudulent representation. Sec.. Laws, chapter, section, is amended to read: Sec.. Delayed repeal A. Section of this act is repealed from and after December,. B. Section of this act is repealed from and after December,. Sec.. Administration of medication; delegation A nurse licensed pursuant to title, chapter, article, Arizona Revised Statutes, shall not delegate the ability to administer medication to nonlicensed personnel. Sec.. Delayed repeal Section of this act is repealed from and after December,. - -

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