California controversy continues over changes in licensing policies

In California, it’s hard to keep track of the action without a scorecard. Controversial changes are being proposed for licensing reg- istered nurses.

Interim permits. The Board of Registered Nursing has proposed changing regulations that would extend interim permits for up to 24 months. (The current permit period is about four to six months.) Interim permits allow those who apply for the state board exam to function as RNs until results of the licensing exam are reported, although they may not use the title. While they are administering professional care, permitees must be supervised by an RN “present and available in the institution.” Hear- ings were planned in July on this and other proposed regulation changes.

Foreign nurses. Speedily approved in the state sentate, Senate Bill 61 7 would allow the nursing board to grant a license to any appli- cant licensed as a nurse in a foreign country. The board would have wide latitude in deter- mining whether an applicant needs additional education.

At first, the bill applied only to Australia, Ire- land, New Zealand, and the United Kingdom, but it was quickly amended to include other countries. In June, the bill had moved to the State Assembly, where it was assigned to a subcommittee chaired by Jean Moorhead, a state legislator who is also a nurse.

Licensing exam. The nursing board has proposed a change in policy for those who get failing scores on the state board exam. Cur-

Legislation & -9

rently, applicants have 24 months to pass all five subjects in the exam. If they do not meet this deadline, they must retake the entire exam. The board wants to remove this time limit, allowing applicants to keep taking the parts they fail indefinitely.

If California continues to use the National State Board Test Pool Examination, this pro- posal would have limited effect. Beginning in 1982, the state board exam will be com- prehensive and given in only one part.

But California is weighing whether it will con- tinue participating in the state board exam. A study by a state agency found the exam had an “adverse impact‘’ on minorities. Now it must be proven “job related” or it will be illegal under state law. (Administered by the National Coun- cil of State Boards of Nursing, the state board exam is used in all 50 states.) The California nursing board asked the legislature for money to investigate the feasibility of developing its own nursing licensure exam.

While the exam is under study, the board has not notified those who receive low scores on the exam of failure. This allows them to continue working under interim permits.

These proposals are part of a continuing story that began when Jerry Brown was elected governor. The governor has said that he believes professional licensing tends to be self-serving and blocks access to occupations by some groups. First there was Project lat- rogenesis. The 1979 study by the Department of Consumer Affairs examined ways to en- courage career mobility, combat a nursing shortage, and increase minority opportunity.

Then came Senate Bill 666. A career ladder concept would have allowed nursing assis- tants to become practical nurses, and practical nurses to become RNs without further educa-

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tion. Before it was defeated in committee in January 1980, the bill had created a statewide furor among RNs.

The furor hasn’t died down. Nurses are at- tending state board meetings. They planned a rally for the July 18 hearing in Sacramento and were organizing for two other hearings that month in Los Angeles and San Francisco. Tricia Hunter, RN, a member of AORN of San Diego and the National Legislative Committee is keeping California chapters up-to-date.

Disturbed about the effect of withholding fail- ing scores and extending current interim per- mits, the California Society of Nursing Service Administrators joined the deans and directors of baccalaureate and higher degree programs in suing the Board of Registered Nursing. They charged the board with “lowering standards of nursing practice in California and violating existing regulations.” A judge was expected to rule on whether the suit was valid.

A state senator has introduced a resolution asking for a legislative analysis of the nursing exam and the interim permit policy. He is ask- ing the board to forestall action until the analysis is completed next summer. Jean Moorhead has inserted language in state budget legislation to prohibit the nursing board from taking action.

Nurses are struggling hard to stay in the same place with federal funds for nursing edu- cation.The amount appropriated for the 1981 fiscal year was $106.2 million. President Rea- gan wanted to rescind $63.2 million of that. Congress went along with cutting only $26 mil- lion, leaving $89.2 million.

For next year, the bill for a new Nurse Train- ing Act in the House (HR 2004) got caught up in a battle between Democrats and Republi- cans in mid-June. Democrats, led by Rep John Dingell (D-Mich), favored a health budget package with $91 million for nursing. Republi- cans were pushing a package with $40 million. Their leader was James T Broyhill (R-NC). There was some talk of going with the Presi- dent’s much lower request for $15.2 million, reported Delores Farr of the American Nurses’ Association Washington office. Meanwhile, the Senate Labor and Human Relations Committee had pegged $50.2 million for nurse training.

8 When Congress passed the Nurse Training Act Amendments of 1979, legislators said some basic questions needed to be answered about federal funds for nursing education. Is there a need to continue a funding program for nursing education? Does training more nurses ensure an adequate supply if nurses later leave the profession for other reasons? Is gov- ernment assistance helpful in encouraging nurses to work in underserved areas? What kinds of nursing education programs would benefit from continued support? What form would this government aid take?

Congress called for a broad two-year study of these and other issues. The Institute of Medicine of the National Academy of Sciences was assigned the task. The study began in February, and a preliminary report to Con- gress was due in July. The deadline for the final report is January 1983.

At a hearing in May, a wide variety of nursing and health care organizations offered their views on the subject. Among those testifying were the American Nurses’ Association, cost- setting commissions, the American Hospital Association, trade unions organizing health care workers, nursing schools, and individual nurses who work in underserved rural and urban areas. Specialty groups that appeared were the nurse-midwives and occupational health nurses.

Chairman of the study committee is Arthur E Hess, scholar in residence at the Institute of Medicine.

Watch for news of this important report, be- cause it will help determine how decisions about federal funds are made in the future.

Patricia Patterson Associate editor

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