Jerry Kopel

KOPEL: LEGISLATORS VET NURSING OCCUPATION

DORA suggests new regulation over RNs, LPNs, APNs and CNAs

It doesn’t always happen, but this time the executive branch “suggested” and the legislative branch “agreed.”

The Department of Regulatory Agencies’ review of the nursing occupation pretty well dominated Senate Bill 239 by Sen. Lois Tochtrop, D-Thornton, and Rep. Jim Riesberg, D-Greeley.

The bill ends a 30-year practice of deciding whether a registered nurse or a licensed practical nurse is qualified for a new or renewed license to practice by proving this following negative:

For the past year, the applicant can prove he or she “is not addicted to any controlling substance ... or is not a regular user of the same without a prescription ... and that the applicant is not habitually intemperate in the use of intoxicating liquor.”

DORA summarizes “... rather than requiring applicants to disclose any current or recent addictions to drugs or alcohol, the wording ... requires applicant to affirmatively prove they are not addicted at the time of application.”

That language as been repealed, leaving in place an answer to the question, “Are you addicted to a controlling drug or overuse of intoxicating liquor?”

The Colorado Nursing Board regulates most of Colorado’s health care workforce, including 10,091 licensed practical nurses and 56,918 registered nurses. The state Medical Examiners Board regulates 20,000 physicians and physician assistants, and the Dental Board regulates 8,500 dentists and hygienists. The Chiropractic Board regulates 3,000 licensees.

The bill also expands the disciplinary authority of the board. Previously, applicants seeking renewal who failed to completely answer renewal questions weren’t disciplined unless the failure was done “negligently or willfully.” Those descriptive words were excised. Now, anyone who doesn’t answer the question completely has violated the statute.

Also, any crime committed by a licensee now must be reported to the board within 45 days of final conviction.

The board also has several new responsibilities and powers, including:

• The ability to levy fines. A licensee who violates the disciplinary statutes can be fined from $250 to $1,000 for each violation.

• Transparency. Any disciplinary action taken by the board regarding an applicant “shall be open to the public inspection pursuant to the open record provisions of Article 72 of Title 24.”

• A longer wait time before licensing. The bill replaces the current one-year wait time between submission of an application and its approval, with a two-year wait if the applicant is seeking approval of a new license required by prior disciplinary action or failure to actively practice.

A great deal of language was added to the statute relating to practical nurses who want to achieve the status of “advance practical nurse.” These medical professionals are able to prescribe drugs. It could be called an “all or nothing at all” approach.

Tochtrop, a registered nurse, successfully amended SB 239 to include some highly technical changes in APN regulation, including:

• National certification from an appropriate accrediting agency (suggested by DORA);

• Having a collaborative agreement with a physician or APN for as much as 8,000 hours of oversight and training over the course of 10 years — which might, or might not, include payment to the mentor or receptor. (A receptor receives and communicates ideas and suggestions for training or correcting the APN applicant.)

• A requirement that an independent APN has insurance of not less than a half million dollars per claim, with aggregated liability of $1,500,000 (suggested by DORA).

The board itself will have more diversity geographically and specialties with no need for Senate confirmation. The term of board members is increased from three years to four years.

Seven of the board members must have been actively employed in a health occupation during the three years prior to appointment. Two members representing the public cannot have been either employed in a health occupation or have received income either directly or indirectly from a health occupation.

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A separate bill, Senate Bill 138, by Sen. Betty Boyd, D-Lakewood, and Rep. Sara Gagliardi, D-Arvada, has continued the regulation of certified nurses aides by the Nursing Board, as recommended by the DORA. The most recent DORA statistics show that in July 2007, there were nearly 30,000 CNAs in Colorado. The Nursing Board can decide to be assisted by a CNA advisory board.

Amendments in SB 138 closely followed changes in SB 239 on the grounds for discipline concerning use of drugs or alcohol. The new CNA regulation states that failure to respond factually and in a timely manner to a complaint, or failure to report within 45 days after a criminal conviction, is grounds for discipline.

Illegal use of the CNA title is a violation. There is a transparency (open record) of a disciplinary decision, and double the waiting period (two years) for practice after certain disciplinary actions. The Nursing Board determines the boundaries of training and what type of training is needed to become a CNA who is allowed to administer medication.

DORA summarized that “nurses aides provide basic, essential care to the nation’s sickest and most vulnerable citizens. Working with very ill, disoriented or cognitively impaired patients can also be emotionally draining.”

Jerry Kopel served 22 years in the Colorado House.