print this pageNursing Law continued
Further evidence that an unlicensed individual can perform services including catheterization, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications is contained in Health and Safety Code sections defining Certified Nurse Assistant, the November 1994 policy statement entitled Unlicensed Assistive Personnel and in the Welfare and Institutions Code sections entitled In-Home Supportive Services.
Article 9 of Chapter 2 of Division 2 of the Health and Safety Code is entitled Training Programs in Skilled Nursing and Intermediate Care Facilities. These are the only sections dealing with "Nurse Assistant" or "Certified Nurse Assistant". Subsection (a) of Section 1337, contains an acknowledgment by the Legislature that direct patient care in skilled nursing and intermediate care facilities is currently rendered largely by Certified Nurse Assistants. Subdivision(d)(1) of Section 1337 defines a Nurse Assistant as "any unlicensed aide, assistant, or orderly, who performs nursing services directed at the safety, comfort, personal hygiene, or protection of patients in a skilled nursing or intermediate care facility". Subdivision(d)(3) of Section 1337 defines a Certified Nurse Assistant as "any person who holds himself or herself out as a Certified Nurse Assistant, and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed the requirements of this article. These services shall not include any services which may only be performed by a licensed person..." Article 9 also establishes minimum training requirements of at least 60 classroom hours of training on basic nursing skills and at least 100 hours of supervised and on-the-job training clinical practice.
Although Section 1337 makes it clear that the term Certified Nurse Assistant only applies to those performing the services in a health facility, the description has been used in cases to describe a training level for an individual who could take over administration of a patient's attendant care needs, including catheterization, skin puncture, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications care. Since Section 2861 of the Business and Professions Code makes it clear that any person can perform the services performed by a Licensed Vocational Nurse, any person, including a Certified Nurse Assistant could take care of a patient's attendant care needs.
Additional evidence of the ability of Certified Nurse Assistants to do catheterization, skin puncture, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications care is contained in a November 1994 policy statement from the State of California Department of Consumer Affairs, Board of Registered Nursing entitled Unlicensed Assistive Personnel. Under Business and Professions Code section 2715, the Board of Registered Nursing is empowered to adopt, amend, or repeal rules and regulations as may be reasonably necessary to enable it to carry into effect the provisions of the Nursing Practice Act. The policy is not a statement of what unlicensed personnel can or cannot do on their own, but is rather an explanation as to how Registered Nurses should assign care tasks to unlicensed personnel. The policy statement indicates the tasks which are judged by the direct care Registered Nurse that do not require the professional judgement of a Registered Nurse may be assigned to others if they meet certain criteria. The criteria include that the task be considered routine care for the patient, pose little risk for hazard, include little or no modification from one client care situation to another, be performed with predictable outcome, and not inherently involve ongoing assessment or decision making which could not logically be separated from the procedure itself. Services including catheterization, bowel care, tube feeding, ventilator care, tracheostomy care suctioning and assistance with self-administration of medications care meet all these requirements.
Article 7 of Chapter 3 of Part 3 of Division 9 of the Welfare and Institutions Code is entitled In-Home Supportive Services. Section 12300 sets up a program to provide in-home-supportive services for people in need of those services. Section 12300 defines supportive services as including personal care services. Subsection (c) includes within personal care services catheterization, skin puncture, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications. Section 12300.1 authorizes supportive services, which include catheterization, skin puncture, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications, and paramedical services, which include the inserting of a medical device into a body orifice, activities requiring sterile procedures, or other activities requiring judgment based on training given by a licensed health care professional to be rendered by a provider under the direction of a licensed healthcare professional. It also authorizes the services to be performed by a family member. Obviously, if these services could only be provided by a licensed health care provider the Legislature would not have authorized for services to be rendered by a person under the direction of a licensed health care professional.