Bill Text: CA SB1042 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health facilities and clinics: clinical placements: nursing.

Spectrum: Moderate Partisan Bill (Democrat 5-1)

Status: (Engrossed - Dead) 2024-08-15 - August 15 hearing: Held in committee and under submission. [SB1042 Detail]

Download: California-2023-SB1042-Amended.html

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Amended  IN  Senate  April 03, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 1042

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Introduced by Senator Roth
(Coauthor: Senator Caballero)

February 07, 2024

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An act to amend Section 128735 of, and to add Article 1 (commencing with Section 127750) to Chapter 1 of Part 3 of Division 107 of, of the Health and Safety Code, relating to health facilities. nursing.

LEGISLATIVE COUNSEL'S DIGEST

SB 1042, as amended, Roth. General acute care hospitals: Health facilities and clinics: clinical placements: nursing.

Existing law establishes the Department of Health Care Access and Information (HCAI) to oversee health planning and health policy research, including the health care workforce research and data center. Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs for the licensure and regulation of nurses. Existing law provides for the licensure and regulation of health facilities and clinics, as defined, by the State Department of Public Health.

Existing law requires an organization that operates, conducts, owns, or maintains a health facility, and the officers thereof, to make and file with HCAI certain reports, including balance sheets and other financial statements. Existing law sets forth related reporting provisions for clinics.

This bill would require a health facility or clinic that offers prelicensure clinical placement slots to meet with representatives from an approved school of nursing or approved nursing program, upon request by the school or program, to discuss the clinical placement needs of the school or program. The bill would require a nursing school or program to report to the board the beginning and end dates of the academic term for each clinical slot needed by a clinical group with content area and education level, and the number of clinical slots that the school or program has been unable to fill. The bill would require the board to submit that information to HCAI.

The bill would require a health facility or clinic to prepare and submit to HCAI a report, with updates, on clinical placements for nursing students. Under the bill, the report would include, among other things, the estimated number of days and shifts available for student use for each type of licensed bed or unit. The bill would require HCAI to post the report on its internet website in a manner that allows for the information in the report to be cross-referenced against the above-described information from the nursing school or program.

The bill would authorize the board, upon request by a nursing school or program, to assist in finding and securing clinical placement slots to meet the clinical placement needs of that school or program, by conferring with health facilities or clinics within the appropriate geographic region of each school or program in an attempt to match available clinical placement slots with needed slots and to create additional clinical placement slots to meet school or program demands. If the board attempts to meet clinical placement needs, the bill would require the board to prioritize the clinical placement needs of the approved nursing schools or programs of community colleges and California State University campuses.

The bill would prohibit any attempt to create or secure additional clinical placement slots by the board, a health facility, or a clinic from supplanting or disrupting the clinical placement of any nursing student for whom a clinical placement is already in progress or has already been scheduled.

The bill would condition implementation of its provisions on an appropriation. The bill would also make related legislative findings.

Existing law establishes the Department of Health Care Access and Information in the Health and Welfare Agency to oversee health planning and health policy research, such as the health care workforce research and data center. Existing law, the Nursing Practice Act, establishes the Board of Registered Nurses within the Department of Consumer Affairs for the licensure and regulation of the practice of nursing.

This bill would require a health facility, as defined, that offers prelicensure clinical placement slots upon the request of an approved school of nursing or an approved nursing program, as defined, and regardless of whether the school or program is public or private, to meet with representatives of the school or program to discuss the clinical placement needs of the school or program. The bill would require an approved school of nursing or an approved nursing program, regardless of whether the school or program is public or private, to notify the department and the board of the beginning and end dates of the academic term for each clinical slot needed by a clinical group with content area and education level and the number of clinical slots that the school or program has been unable to fill by March 1 of each year.

Existing law requires an organization that operates, conducts, owns, or maintains a health facility, and the officers thereof, to make and file with the department specified reports, including, among others, balance sheets detailing the assets, liabilities, and net worth of the health facility at the end of its fiscal year.

This bill would further require a report on clinical placement date that includes specified information, including, among other things, the estimated number of days and shifts available for student use for each type of licensed bed or unit. The bill would require the department to post the data in this report with the information required in the March 1 report described above on the department’s internet website in a manner that allows for specified information in both reports to be cross-referenced against each other.

The bill would also require the department and board to utilize the data in both reports described above to work to meet the clinical placement needs of approved schools of nursing or approved nursing programs, regardless of whether the school or program is public or private, by conferring with health facilities within the appropriate geographic region of each school or program in an attempt to match available clinical placement slots with needed slots and to create additional clinical placement slots to meet school or program demands. In meeting these requirements, the bill would require the department and board to prioritize the clinical placement needs of the approved schools of nursing or approved nursing programs of community colleges and California State University campuses.

The bill would require a health facility to provide the department with written justification if it cannot provide additional slots and would require the department, in collaboration with the board, to notify the health facility of the department’s acceptance or rejection of the health facility’s justification. The bill would require the department to post all written justifications and outcomes on the department’s internet website. The bill would also prohibit any attempt to create or secure additional clinical placement slots by the department, board, or a health facility from supplanting or disrupting the clinical placement of any nursing student for whom a clinical placement is already in progress or has already been scheduled.

The bill would also make certain findings and declarations of the Legislature.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 The Legislature finds and declares all of the following:

(a) To graduate from a nursing school or program, students must complete units in both theoretical coursework and hands-on clinical experience. Existing law requires that 500 of a nursing student’s clinical hours be in a direct patient care model in a clinical setting approved by the Board of Registered Nursing (BRN).

(b) Direct patient care means providing services to a live patient, which can include both in-person and telehealth services. As a result, clinical placements occur within a health facility, clinic, or other health care setting and require agreements between nursing schools or programs and the health care partners for placement of students.

(c) The availability of student placements for clinical experiences is based on clinical settings, such as hospitals or clinics, that are willing to accept and teach students. The settings must have staff that are qualified to teach and supervise students, and often develop contracts with partnering schools or programs to outline responsibilities, liability, and expectations. As a result, clinical placements are often difficult to find.

(d) The California State Auditor Report 2019-120 on the BRN found that, due to a lack of reliable data, the BRN lacked critical information about the location and availability of clinical placement slots. Therefore, the California State Auditor recommends that the BRN require nursing schools or programs to annually update information about the clinical settings that they use for student placements.

(e) Collecting data on clinical placement needs of nursing schools or programs and comparing the data with the availability of clinical placement slots at health facilities or clinics would provide the information necessary for the BRN to properly match scarce clinical placements with the nursing students who need them.

SEC. 2.

 Article 1 (commencing with Section 127750) is added to Chapter 1 of Part 3 of Division 107 of the Health and Safety Code, to read:

Article  1. Nursing Clinical Placements

127750.

 For purposes of this article, the following definitions apply:

(a) “Approved school of nursing” and “approved nursing program,” or variations thereof, have the same meaning as set forth in Section 2786 of the Business and Professions Code.

(b) “Board” means the Board of Registered Nursing, unless otherwise specified.

(c) “Clinic” has the same meaning as set forth in Section 1200. “Clinic” includes a primary care clinic and a specialty clinic, as described in Section 1204.

(d) “Department” means the Department of Health Care Access and Information, unless otherwise specified.

(e) “Health facility” has the same meaning as set forth in Section 1250.

127751.

 Implementation of this article shall be subject to an appropriation made by the Legislature for the purpose of this article.

127752.

 (a) A health facility, or a clinic, that offers prelicensure clinical placement slots shall, upon request by an approved school of nursing or an approved nursing program and regardless of whether the school or program is public or private, meet with representatives from the school or program to discuss the clinical placement needs of the school or program. The health facility or clinic and the school or program shall work together in good faith to meet the demands of the school or program to educate and train nursing students.

(b) By the end of its respective academic term, an approved school of nursing or an approved nursing program, regardless of whether the school or program is public or private, shall report to the Board of Registered Nursing the following information:

(1) The beginning and end dates of the academic term for each clinical slot needed by a clinical group with content area and education level.

(2) The number of clinical slots that the school or program has been unable to fill.

(c) (1) Following receipt of the information required by subdivision (b) and utilizing the data reported pursuant to Section 127753, the board may, upon request by an approved school of nursing or approved nursing program, assist in finding and securing clinical placement slots to meet the clinical placement needs of that school or program, regardless of whether the school or program is public or private, by conferring with health facilities or clinics within the appropriate geographic region of each school or program in an attempt to match available clinical placement slots with needed slots and to create additional clinical placement slots to meet school or program demands.

(2) If the board attempts to meet clinical placement needs pursuant to paragraph (1), the board shall prioritize the clinical placement needs of the approved schools of nursing or approved nursing programs of community colleges and California State University campuses.

(d) Any attempt to create or secure additional clinical placement slots by the board, a health facility, or a clinic pursuant to this section shall not supplant or disrupt the clinical placement of any nursing student for whom a clinical placement is already in progress or has already been scheduled.

(e) This section shall not be construed to limit, prevent, or justify the approval or denial of new schools of nursing or the expansion of approved nursing programs.

127753.

 (a) A health facility, or a clinic, shall prepare a report on clinical placements for nursing students. The health facility or clinic shall submit the report to the Department of Health Care Access and Information, with updated reporting at the times as the department shall require, on a form specified by the department in accordance with, if applicable, the systems of accounting and uniform reporting required by Part 5 (commencing with Section 128675).

(b) The report described in subdivision (a) shall include, but not be limited to, all of the following information:

(1) Estimated number of days and shifts available for student use for each type of licensed bed or unit.

(2) Number of days and shifts being utilized for student use for each type of licensed bed or unit.

(3) Name of the academic institution with an approved school of nursing or nursing program utilizing each type of licensed bed or unit.

(4) Average daily patient census per type of licensed bed or unit.

(5) Average daily number of registered nurses staffing each type of licensed bed or unit.

(c) If a prelicensure clinical placement slot is available or filled for a period of time that begins in one reporting period, but ends in another reporting period, the slot shall be reported for the period in which the student began the clinical placement and not for the reporting period in which the student ended the clinical placement.

(d) (1) The Board of Registered Nursing shall submit the information described in subdivision (b) of Section 127752 to the department.

(2) The department shall post the report described in this section with the information described in subdivision (b) of Section 127752 on the department’s internet website in a manner that allows for the information described in subdivision (b) of this section to be cross-referenced against the information described in subdivision (b) of Section 127752.

SECTION 1.

The Legislature finds and declares all of the following:

(a)To graduate from a nursing program, students must complete units in both theoretical coursework and hands on clinical experience. The Board of Registered Nursing (BRN) regulations require that 75% of a nursing student’s clinical hours be in a direct patient care model.

(b)Direct patient care means providing services to a live patient, which can include both inperson and telehealth. As a result, most clinical placements occur within a health care facility and require agreements between nursing programs and the health facility partners for placement of students.

(c)The availability of student placements for clinical experiences is based on clinical facilities, such as hospitals or clinics that are willing to accept and teach students. The facilities must have staff that are qualified to teach and supervise students, and often develop contracts with partner educational programs to outline responsibilities, liability, and expectations. As a result, clinical placements are often difficult to find.

(d)The California State Auditor Report 2019-120 on the Board of Registered Nursing found that due to a lack of reliable data, the BRN lacked critical information about the location and availability of clinical placement slots. Therefore, the California State Auditor recommends that the BRN require nursing programs to annually update information about the clinical facilities they use for student placements.

(e)Collecting data on nursing programs’ clinical placement needs and comparing it with the availability of clinical placement slots at health facilities would provide the information necessary for the BRN and the Department of Health Care Access and Information to properly match scarce clinical placements with the nursing students that need them.

SEC. 2.Article 1 (commencing with Section 127750) is added to Chapter 1 of Part 3 of Division 107 of the Health and Safety Code, to read:

1.Nursing Clinical Placements

127750.

(a)A health facility, as defined in Section 1250, that offers prelicensure clinical placement slots shall, upon the request of an approved school of nursing or an approved nursing program and regardless of whether the school or program is public or private, meet with representatives from the school or program to discuss the clinical placement needs of the school or program. The health facility and the school or program shall work together in good faith to meet the demands of the school or program to educate and train nursing students.

(b)By March 1 of each year, an approved school of nursing or an approved nursing program, regardless of whether the school or program is public or private, shall report to the Department of Health Care Access and Information and the Board of Registered Nursing the following information:

(1)The beginning and end dates of the academic term for each clinical slot needed by a clinical group with content area and education level.

(2)The number of clinical slots that the school or program has been unable to fill.

(c)(1)Following receipt of the information required by subdivision (b) and utilizing the data reported pursuant to subdivision (h) of Section 128735, the department and board shall work to meet the clinical placement needs of all approved schools of nursing or approved nursing programs, regardless of whether the school or program is public or private, by conferring with health facilities within the appropriate geographic region of each school or program in an attempt to match available clinical placement slots with needed slots and to create additional clinical placement slots to meet school or program demands.

(2)In meeting the requirements of paragraph (1), the department and board shall prioritize the clinical placement needs of the approved schools of nursing or approved nursing programs of community colleges and California State University campuses.

(d)If a health facility cannot provide additional slots, the health facility shall provide the department with written justification of its lack of capability or capacity within 30 days. The department shall, in collaboration with the board, notify the health facility within 30 days of its acceptance or rejection of the health facility’s justification. The department shall post all written justifications and outcomes on the department’s internet website.

(e)Any attempt to create or secure additional clinical placement slots by the department, board, or a health facility pursuant to this section shall not supplant or disrupt the clinical placement of any nursing student for whom a clinical placement is already in progress or has already been scheduled.

(f)For purposes of this section, “approved school of nursing” and “approved nursing program,” or variations thereof, have the same meaning as set forth in Section 2786 of the Business and Professions Code.

(g)Nothing in this section shall be construed to limit, prevent, or justify the approval or denial of new schools of nursing or the expansion of approved nursing programs.

SEC. 3.Section 128735 of the Health and Safety Code is amended to read:

128735.

An organization that operates, conducts, owns, or maintains a health facility, and the officers thereof, shall make and file with the department, at the times as the department shall require, all of the following reports on forms specified by the department that are in accord, if applicable, with the systems of accounting and uniform reporting required by this part, except that the reports required pursuant to subdivision (g) shall be limited to hospitals:

(a)A balance sheet detailing the assets, liabilities, and net worth of the health facility at the end of its fiscal year.

(b)A statement of income, expenses, and operating surplus or deficit for the annual fiscal period, and a statement of ancillary utilization and patient census.

(c)A statement detailing patient revenue by payer, including, but not limited to, Medicare, Medi-Cal, and other payers, and revenue center.

(d)A statement of cashflows, including, but not limited to, ongoing and new capital expenditures and depreciation.

(e)(1)A statement reporting the information required in subdivisions (a), (b), (c), and (d) for each separately licensed health facility operated, conducted, or maintained by the reporting organization.

(2)Notwithstanding paragraph (1), a health facility that receives a preponderance of its revenue from associated comprehensive group practice prepayment health care service plans and that is operated as a unit of a coordinated group of health facilities under common management may report the information required pursuant to subdivisions (a) and (d) for the group and not for each separately licensed health facility.

(f)Data reporting requirements established by the department shall be consistent with national standards, as applicable.

(g)A Hospital Discharge Abstract Data Record that includes all of the following:

(1)Date of birth.

(2)Sex.

(3)Race.

(4)ZIP Code.

(5)Preferred language spoken.

(6)Patient social security number, if it is contained in the patient’s medical record.

(7)Prehospital care and resuscitation, if any, including all of the following:

(A)“Do not resuscitate” (DNR) order on admission.

(B)“Do not resuscitate” (DNR) order after admission.

(8)Admission date.

(9)Source of admission.

(10)Type of admission.

(11)Discharge date.

(12)Principal diagnosis and whether the condition was present on admission.

(13)Other diagnoses and whether the conditions were present on admission.

(14)External causes of morbidity and whether present on admission.

(15)Principal procedure and date.

(16)Other procedures and dates.

(17)Total charges.

(18)Disposition of patient.

(19)Expected source of payment.

(20)Elements added pursuant to Section 128738.

(h)(1)A report on clinical placement data that includes, but is not limited to, all of the following information:

(A)Estimated number of days and shifts available for student use for each type of licensed bed or unit.

(B)Number of days and shifts being utilized for student use for each type of licensed bed or unit.

(C)Name of the academic institution with an approved school of nursing or nursing program utilizing each type of licensed bed or unit.

(D)Average daily patient census per type of licensed bed or unit.

(E)Average daily number of registered nurses staffing each type of licensed bed or unit.

(2)If a prelicensure clinical placement slot is available or filled for a period of time that begins in one reporting period, but ends in another reporting period, the slot shall be reported for the period in which the student began the clinical placement and not for the reporting period in which the student ended the clinical placement.

(3)The department shall post the information specified in paragraph (1) with the information specified in subdivision (b) of Section 127750 on its internet website in a manner that allows for the information in subparagraphs (A) to (C), inclusive, of paragraph (1) to be cross-referenced against the information specified in subdivision (b) of Section 127750.

(i)It is the intent of the Legislature that the patient’s rights of confidentiality shall not be violated in any manner. Patient social security numbers and other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).

(j)A person reporting data pursuant to this section shall not be liable for damages in an action based on the use or misuse of patient-identifiable data that has been mailed or otherwise transmitted to the department pursuant to the requirements of subdivision (g).

(k)A hospital shall use coding from the International Classification of Diseases in reporting diagnoses and procedures.

(l)On or before July 1, 2021, the department shall promulgate regulations as necessary to implement subdivision (e). A health facility that receives a preponderance of its revenue from associated comprehensive group practice prepayment health care service plans and that is operated as a unit of a coordinated group of health facilities under common management shall comply with the reporting requirements of subdivisions (b), (c), and (e) once the department finalizes related regulations.