Bill Text: FL S0558 | 2023 | Regular Session | Introduced

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

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Bill Title: Certified Nursing Assistants

Spectrum: Bipartisan Bill

Status: (Passed) 2023-06-16 - Chapter No. 2023-250 [S0558 Detail]

Download: Florida-2023-S0558-Introduced.html

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       Florida Senate - 2023                                     SB 558
       
       
        
       By Senator Burton
       
       
       
       
       
       12-00409B-23                                           2023558__
    1                        A bill to be entitled                      
    2         An act relating to certified nursing assistants;
    3         amending s. 400.211, F.S.; authorizing nursing home
    4         facilities to allow their registered nurses to
    5         delegate certain tasks to certified nursing assistants
    6         who meet specified criteria; providing for the
    7         designation of such certified nursing assistants as
    8         qualified medication aides; requiring qualified
    9         medication aides to complete annual validation and
   10         inservice training requirements; providing that
   11         qualified medication aides may administer medication
   12         to residents only under the direct supervision of a
   13         licensed nurse; requiring the Board of Nursing, in
   14         consultation with the Agency for Health Care
   15         Administration, to adopt rules; amending s. 400.23,
   16         F.S.; providing that the time spent by certified
   17         nursing assistants performing the duties of a
   18         qualified medication aide may not be included in the
   19         computing of certain minimum staffing ratio
   20         requirements for direct care provided to residents;
   21         amending s. 464.0156, F.S.; authorizing registered
   22         nurses to delegate to certified nursing assistants the
   23         administration of medication to residents in nursing
   24         home facilities if the certified nursing assistants
   25         meet specified criteria; amending s. 464.2035, F.S.;
   26         authorizing certified nursing assistants to administer
   27         certain medications to residents of nursing home
   28         facilities if they have been delegated such task by a
   29         registered nurse and they meet specified criteria;
   30         requiring the board, in consultation with the agency,
   31         to establish standards and procedures that a certified
   32         nursing assistant must follow when administering
   33         medication to a resident of a nursing home facility;
   34         providing an effective date.
   35          
   36  Be It Enacted by the Legislature of the State of Florida:
   37  
   38         Section 1. Subsection (5) is added to section 400.211,
   39  Florida Statutes, to read:
   40         400.211 Persons employed as nursing assistants;
   41  certification requirement.—
   42         (5) A nursing home, in accordance with chapter 464 and
   43  rules adopted pursuant to this section, may authorize a
   44  registered nurse to delegate tasks, including medication
   45  administration, to a certified nursing assistant who meets the
   46  requirements of this subsection.
   47         (a) In addition to the initial 6-hour training course and
   48  determination of competency required under s. 464.2035, to be
   49  eligible to administer medication to a resident of a nursing
   50  home facility, a certified nursing assistant must:
   51         1. Hold a clear and active certification from the
   52  Department of Health for a minimum of 1 year immediately
   53  preceding the delegation;
   54         2. Complete an additional 34-hour training course approved
   55  by the Board of Nursing in medication administration and
   56  associated tasks, including, but not limited to, blood glucose
   57  level checks, dialing oxygen flow meters to prescribed settings,
   58  and assisting with continuous positive airway pressure devices;
   59  and
   60         3. Demonstrate clinical competency by successfully
   61  completing a supervised clinical practice in medication
   62  administration and associated tasks conducted in the facility.
   63         (b) Upon completion of the training, competency, and
   64  initial validation requirements under s. 464.2035 and this
   65  subsection, a certified nursing assistant whose delegated tasks
   66  include medication administration is designated as a qualified
   67  medication aide.
   68         (c) A qualified medication aide must satisfactorily
   69  complete the annual validation and 2 hours of inservice training
   70  in medication administration and medication error prevention in
   71  accordance with s. 464.2035.
   72         (d) A qualified medication aide may administer medication
   73  only under the direct supervision of a nurse licensed under part
   74  I of chapter 464.
   75         (e) The Board of Nursing, in consultation with the agency,
   76  shall adopt rules to implement this subsection.
   77         Section 2. Paragraph (b) of subsection (3) of section
   78  400.23, Florida Statutes, is amended to read:
   79         400.23 Rules; evaluation and deficiencies; licensure
   80  status.—
   81         (3)
   82         (b)1. Each facility must determine its direct care staffing
   83  needs based on the facility assessment and the individual needs
   84  of a resident based on the resident’s care plan. At a minimum,
   85  staffing must include, for each facility, the following
   86  requirements:
   87         a. A minimum weekly average of 3.6 hours of care by direct
   88  care staff per resident per day. As used in this sub
   89  subparagraph, a week is defined as Sunday through Saturday.
   90         b. A minimum of 2.0 hours of direct care by a certified
   91  nursing assistant per resident per day. A facility may not staff
   92  below one certified nursing assistant per 20 residents.
   93         c. A minimum of 1.0 hour of direct care by a licensed nurse
   94  per resident per day. A facility may not staff below one
   95  licensed nurse per 40 residents.
   96         2. Nursing assistants employed under s. 400.211(2) may be
   97  included in computing the hours of direct care provided by
   98  certified nursing assistants and may be included in computing
   99  the staffing ratio for certified nursing assistants if their job
  100  responsibilities include only nursing-assistant-related duties.
  101         3. Certified nursing assistants performing the duties of a
  102  qualified medication aide under s. 400.211(5) may not be
  103  included in computing the hours of direct care provided by, or
  104  the staffing ratios for, certified nursing assistants or
  105  licensed nurses under sub-subparagraph 1.b. or sub-subparagraph
  106  1.c., respectively.
  107         4.3. Each nursing home facility must document compliance
  108  with staffing standards as required under this paragraph and
  109  post daily the names of licensed nurses and certified nursing
  110  assistants on duty for the benefit of facility residents and the
  111  public. Facilities must maintain the records documenting
  112  compliance with minimum staffing standards for a period of 5
  113  years and must report staffing in accordance with 42 C.F.R. s.
  114  483.70(q).
  115         5.4. The agency must recognize the use of licensed nurses
  116  for compliance with minimum staffing requirements for certified
  117  nursing assistants if the nursing home facility otherwise meets
  118  the minimum staffing requirements for licensed nurses and the
  119  licensed nurses are performing the duties of a certified nursing
  120  assistant. Unless otherwise approved by the agency, licensed
  121  nurses counted toward the minimum staffing requirements for
  122  certified nursing assistants must exclusively perform the duties
  123  of a certified nursing assistant for the entire shift and not
  124  also be counted toward the minimum staffing requirements for
  125  licensed nurses. If the agency approved a facility’s request to
  126  use a licensed nurse to perform both licensed nursing and
  127  certified nursing assistant duties, the facility must allocate
  128  the amount of staff time specifically spent on certified nursing
  129  assistant duties for the purpose of documenting compliance with
  130  minimum staffing requirements for certified and licensed nursing
  131  staff. The hours of a licensed nurse with dual job
  132  responsibilities may not be counted twice.
  133         6.5. Evidence that a facility complied with the minimum
  134  direct care staffing requirements under subparagraph 1. is not
  135  admissible as evidence of compliance with the nursing services
  136  requirements under 42 C.F.R. s. 483.35 or s. 483.70.
  137         Section 3. Subsection (2) of section 464.0156, Florida
  138  Statutes, is amended to read:
  139         464.0156 Delegation of duties.—
  140         (2)(a) A registered nurse may delegate to a certified
  141  nursing assistant the administration of oral, transdermal,
  142  ophthalmic, otic, inhaled, or topical prescription medication to
  143  a resident of a nursing home facility as defined in s. 400.021
  144  if the certified nursing assistant meets the requirements of s.
  145  400.211(5) and s. 464.2035.
  146         (b) A registered nurse may delegate to a certified nursing
  147  assistant or a home health aide the administration of oral,
  148  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  149  topical prescription medications to a patient of a home health
  150  agency licensed under part III of chapter 400 or to a patient in
  151  a local county detention facility as defined in s. 951.23(1), if
  152  the certified nursing assistant or home health aide meets the
  153  requirements of s. 464.2035 or s. 400.489, respectively.
  154         (c) A registered nurse may not delegate the administration
  155  of any controlled substance listed in Schedule II, Schedule III,
  156  or Schedule IV of s. 893.03 or 21 U.S.C. s. 812, except for the
  157  administration of an insulin syringe that is prefilled with the
  158  proper dosage by a pharmacist or an insulin pen that is
  159  prefilled by the manufacturer.
  160         Section 4. Subsections (1) and (3) of section 464.2035,
  161  Florida Statutes, are amended to read:
  162         464.2035 Administration of medication.—
  163         (1) A certified nursing assistant may administer oral,
  164  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  165  topical prescription medication to a resident of a nursing home
  166  facility as defined in s. 400.021 or may administer oral,
  167  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  168  topical prescription medication to a patient of a home health
  169  agency licensed under part III of chapter 400 or to a patient in
  170  a county detention facility as defined in s. 951.23(1) if the
  171  certified nursing assistant has been delegated such task by a
  172  registered nurse licensed under part I of this chapter, has
  173  satisfactorily completed an initial 6-hour training course
  174  approved by the board, and has been found competent to
  175  administer medication to a patient in a safe and sanitary
  176  manner. The training, determination of competency, and initial
  177  and annual validation required under this section must be
  178  conducted by a registered nurse licensed under this chapter or a
  179  physician licensed under chapter 458 or chapter 459.
  180         (3) The board, in consultation with the Agency for Health
  181  Care Administration, shall establish by rule standards and
  182  procedures that a certified nursing assistant must follow when
  183  administering medication to a resident of a nursing home
  184  facility or to a patient of a home health agency. Such rules
  185  must, at a minimum, address qualification requirements for
  186  trainers, requirements for labeling medication, documentation
  187  and recordkeeping, the storage and disposal of medication,
  188  instructions concerning the safe administration of medication,
  189  informed-consent requirements and records, and the training
  190  curriculum and validation procedures.
  191         Section 5. This act shall take effect July 1, 2023.