Respiratory Care Scope Issues Resurface for LVNs
CAHSAH has been working closely with the California Board of Vocational Nursing and Psychiatric Technicians (BVNPT) to ensure continuity of care for patients who are ventilator-dependent and receive care from LVNs in the home and school setting. Prior to the national public health emergency, the Respiratory Care Board of California (RCB) issued proposed regulations that would have limited LVNs to only basic respiratory tasks which the RCB would define and establish. Those regulations did not move forward at that time. Instead, the two boards began work in 2019 and issued a joint statement clarifying RCP and LVN roles relating to patient care on mechanical ventilators. CAHSAH was involved in several stakeholder meetings during this collaboration and provided nurses and families to speak about the impact of limiting LVNs who have been providing respiratory care for years under their current scope of practice.
The July 2019 published joint agreement established the status quo for now. However, the RCB continued to contend that LVNs should not be administering any ventilator services. Fast forward to 2022, the RCB decides to add language into a bill that was already out of its house of origin and in the final month of the 2021-2022 legislative session, SB 1436 was enacted into law. SB 1436 (Roth, Chapter 624), among other things, includes provisions for the training of LVNs and authorizes the boards to share information related to complaint investigations involving the performance of respiratory care by an LVN. Additionally, CAHSAH was instrumental in gaining amendments to SB 1436 prior to its passage which specify:
“SEC. 8. Section 3765 of the Business and Professions Code is amended to read: This act does not prohibit any of the following activities:
The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following: (1) Before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer. (2) On or after January 1, 2025, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2025, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.”
Since the enactment of SB 1436, the RCB has issued its proposed regulations a second time and they are virtually identical to the first set of proposed regulations. Just a few weeks ago, CAHSAH provided written testimony on the second set of regulations which is here. When the RCB issued the second set of proposed regulations they also added language into an omnibus professions bill, SB 1451, that “extends, to January 1, 2028, dates for LVNs to complete patient-specific training, and for the RCB to promulgate regulations in consultation with the BVNPT. Authorizes, beginning January 1, 2028, an LVN to perform respiratory care services identified by the RCB under specified conditions.”
CAHSAH is currently working with the BVNPT as they prepare for an October 2024 RCB meeting which will review the public comments submitted from the second proposed set of regulations. Please watch for future alerts on this important issue.