SENATE, No. 1857

 

STATE OF NEW JERSEY

 

INTRODUCED MARCH 3, 1997

 

 

By Senator MARTIN

 

 

An Act providing for the licensure and regulation of hemodialysis technicians and supplementing chapter 9 of Title 45 of the Revised Statutes.

 

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

    1. This act shall be known and may be cited as the "Hemodialysis Technicians' Licensing Act."

 

    2. As used in this act:

    "Board" means the State Board of Medical Examiners.

    "Dialysis facility" means a hemodialysis clinic or unit of a health care facility or another entity which provides hemodialysis services.

    "Department" means the Department of Health and Senior Services.

    "Direct supervision" means the supervision by a licensed physician or registered professional nurse of dialysis treatment in the same room in which the treatment is being performed.

    "Health care facility" means a facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).

    "Hemodialysis technician" means a person who is employed by a dialysis facility, for the purpose of participating in the direct treatment of patients undergoing hemodialysis. Hemodialysis technician responsibilities include performing venipuncture, insertion of fistula needles, measurement and evaluation of vital signs, administration of local anesthetics, heparin, sodium chloride solutions and plasma expanders, evaluation of fluid status, management of common complications of dialysis, and documentation of this care in the patient record. The role of the technician regarding patient care and the administration of medications by a hemodialysis technician is pursuant to protocol established by the medical director of the dialysis facility.

    "Hemodialysis technician trainee" means a person who is engaged in the study of hemodialysis technique, theory and practice in a training program approved pursuant to the provisions of this act.

    "Graduate hemodialysis technician trainee" means a person who has completed a training program approved pursuant to the provisions of this act but who has not completed the examination requirement.

    3. a. No person shall practice, nor hold himself out to be able to practice, as a hemodialysis technician unless he is licensed in accordance with this act. No person shall act, nor hold himself out as being able to act as a hemodialysis technician trainee or graduate hemodialysis technician trainee unless he is authorized to do so in accordance with this act.

    b. A hemodialysis technician licensed pursuant to the provisions of this act is authorized to participate in patient treatment only under the direct authorization of the patient's physician.

 

    4. a. The board shall license an applicant as a hemodialysis technician if the applicant is of good moral character and has successfully completed the training and examination requirements of this act. Each applicant shall submit to the board evidence of his qualifications in a form prescribed by the board, and shall pay to the board at the time of application a fee, as determined by the board.

    b. Each dialysis facility shall make available to the department the names of individuals they employ as hemodialysis technicians and evidence that those persons have completed the approved training and successfully passed the approved examination. Evidence of completion of the training program shall include the particular type of dialyzer and equipment upon which the individual was trained.

    c. The board shall establish such rules and regulations as are necessary to effectuate its duties under this act.

 

    5. The board shall maintain a register of all applications for licensure hereunder, which register shall include but not be limited to:

    a. The name and residence of the applicant;

    b. The date of the application; and

    c. Information as to whether the applicant was rejected or licensed and the date of that action.

    The board shall annually compile a list of hemodialysis technicians, which list shall be available to the public.

 

    6. Each dialysis facility operating dialysis equipment or supplying the equipment and the technicians to operate the equipment shall submit to the department for review and approval, a training program and final examination for hemodialysis technicians. The training program shall include training in the administration of local anesthetics, heparin, plasma expanders, and sodium chloride solutions. It shall include training in the measurement of vital signs, venipuncture techniques, and in cardiopulmonary resuscitation procedures. In addition to training in clinical practice, the program shall include didactic training in the care of the end stage renal disease patient. Each dialysis facility shall administer a final examination designed to accurately test proficiency in both clinical procedures and theoretical knowledge of patient care but, in lieu thereof, this examination may be administered by a public educational institution. The final examination shall include all aspects of the training program, including the proper administration of medications. Any training program affiliated with a State approved educational facility shall be granted automatic departmental approval for its final examination and either the hemodialysis examination offered by the Board of Nephrology Examination for Nurses and Technicians (BONENT) or the National Association of Nephrology Technicians (NANT) shall also be granted automatic departmental approval as a final examination for the purposes of this section.

 

    7. Beginning six months after the adoption of rules and regulations pursuant to section 13 of this act, a dialysis facility providing dialysis services without an approved training program and final examination shall not train personnel until it submits and receives approval for a training program and examination by the department. A training program and final examination shall be approved or rejected by the department within 30 days after submission thereof to the department. The department shall not enforce the provisions of this section with respect to any dialysis facility which has submitted a training program and examination for departmental approval which has not been acted upon by the department.

 

    8. a. A person employed as a hemodialysis technician on the effective date of this act may continue to practice as a hemodialysis technician but shall become licensed within 18 months of the effective date of this act as a hemodialysis technician. During this 18-month period, direct supervision of the person's work is not required by this act but may be required by the dialysis facility.

    b. A person is exempt from the training requirements of this act if he has at least one year of experience as a hemodialysis technician and has passed either the BONENT or the NANT examination, or other approved examination.

 

    9. a. A hemodialysis technician trainee and a graduate hemodialysis technician trainee may perform the responsibilities of a hemodialysis technician only under direct supervision and for a maximum of one year.

    b. A person who fails a final examination:

    (1) Shall be classified as either a graduate hemodialysis technician trainee or a hemodialysis technician trainee, as appropriate;

    (2) Shall be under direct supervision whenever involved in direct patient care and shall administer the medications listed in section 6 of this act only under this direct supervision; and


    (3) Shall successfully complete the examination within six months of taking the first examination, or cease to perform the responsibilities of a hemodialysis technician.

 

    10. a. In addition to any other requirements for licensure, at the time of renewal, an applicant shall execute and submit a sworn statement made on a form provided by the board that the license for renewal has not been revoked, suspended or not renewed by the board.

    b. Each applicant shall present satisfactory evidence when seeking license renewal that in the period since the license was issued or last renewed any continuing education requirements have been completed as specified by the board.

 

    11. a. The board shall by rule or regulation establish, prescribe or change the fees for licenses, renewals of licenses or other services provided by the board pursuant to the provisions of this act. Licenses shall be issued for a period of two years and be biennially renewable, except that the board may, in order to stagger the expiration dates thereof, provide that those licenses first issued or renewed after the effective date of this act shall expire or become void on a date fixed by the board, not sooner than six months nor later than 29 months after the date of issue.

    b. Fees shall be established, prescribed or changed by the board to the extent necessary to defray all proper expenses incurred by the board and any staff employed to administer this act, except that fees shall not be fixed at a level that will raise amounts in excess of the amount estimated to be so required.

    c. All fees and any fines imposed by the board shall be paid to the board and shall be forwarded to the State Treasurer and become part of the General Fund.

 

    12. a. The department may impose any of the disciplinary actions under section 13 of P.L.1971, c.136 (C.26:2H-13) according to the procedures therein against any health care facility which violates any of the provisions of this act.

    b. The provisions of P.L.1978, c.73 (C.45:1-14 et seq.) shall apply to this act.

 

    13. Pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) the department shall, within six months of the effective date of this act, adopt rules and regulations necessary to effectuate the purposes of this act including, but not limited to, prescribing the minimum training standards for hemodialysis technician licensure.

 

    14. This act shall take effect immediately.

 

STATEMENT

 

    This bill provides for the licensing of hemodialysis technicians. The State Board of Medical Examiners shall be responsible for the licensing of these individuals. In addition, the bill provides that the Department of Health and Senior Services shall prescribe minimum training standards and approve examinations required for hemodialysis licensure.

    A hemodialysis technician is a person who is employed by a hemodialysis clinic or unit of a health care facility or another entity which provides hemodialysis services, for the purpose of participating in the direct treatment of patients undergoing hemodialysis. Hemodialysis technician responsibilities include performing venipuncture, insertion of fistula needles, measurement and evaluation of vital signs, administration of local anesthetics, heparin, sodium chloride solutions and plasma expanders, evaluation of fluid status, management of common complications of dialysis, and documentation of this care in the patient record. The role of the technician regarding patient care and the administration of medications by a technician is pursuant to protocol established by the medical director of the dialysis facility.

    Over the past decade, increasing numbers of end stage renal disease patients have been treated with some form of dialysis, either peritoneal or hemodialysis.

    Initially, these treatments were performed almost exclusively by physicians and professional nurses. However, as routine procedures became more defined, and treatment complications better understood, delivery of care by well trained lay individuals became possible. Dialysis by trained lay persons, such as spouses, permitted patients the freedom of treatment in a home setting with the added benefit of reduced costs.

    As evidence accumulated that a lay dialysis helper could perform safe and effective treatments with minimal supervision, many hospitals began to employ similarly trained individuals as staff members. Hence, the "hemodialysis technician" evolved.

    In the evolution, much confusion and controversy has developed regarding the role of these renal team members. This bill is intended to clarify and define the appropriate scope of their responsibilities and to assure that the persons engaged in this field as hemodialysis technicians are capable of serving the public properly.

 

 

                             

 

"Hemodialysis Technicians' Licensing Act."