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                                                                  H.B. No. 1718




AN ACT

relating to the regulation of certain nursing practices, including 
circulating duties in an operating room.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter H, Chapter 301, Occupations Code, is 
amended by adding Section 301.353 to read as follows:
	Sec. 301.353.  NURSE FIRST ASSISTANTS; ASSISTING AT SURGERY 
BY OTHER NURSES.  (a)  In this section, "nurse first assistant" 
means a registered nurse who:
		(1)  has completed a nurse first assistant educational 
program approved or recognized by an organization recognized by the 
board; and
		(2)  is either:                                                        
			(A)  certified in perioperative nursing by an 
organization recognized by the board; or
			(B)  recognized by the board as an advanced 
practice nurse and qualified by education, training, or experience 
to perform the tasks involved in perioperative nursing.
	(b)  Unless the person is a nurse first assistant, the person 
may not use:
		(1)  the title "nurse first assistant" or "registered 
nurse first assistant";
		(2)  the abbreviation "R.N.F.A."; or                                   
		(3)  any other title or abbreviation that implies to 
the public that the person is qualified as a nurse first assistant 
under this section.
	(c)  A health maintenance organization or an insurer, 
including an insurer offering a preferred provider benefit plan, 
may not, by contract or any other method, require a physician to use 
the services of a nurse first assistant.
	(d)  A nurse who is not a nurse first assistant may assist a 
physician, podiatrist, or dentist in the performance of surgery if 
the nurse:
		(1)  assists under the direct personal supervision and 
in the physical presence of the physician, podiatrist, or dentist;
		(2)  is in the same sterile field as the physician, 
podiatrist, or dentist;
		(3)  is employed by:                                                   
			(A)  the physician, podiatrist, or dentist;                           
			(B)  a group to which the physician, podiatrist, 
or dentist belongs; or
			(C)  a hospital licensed or owned by the state; 
and                 
		(4)  is qualified by education, training, or experience 
to perform the tasks assigned to the nurse.
	(e)  A patient or third-party insurer may not be billed 
separately for the services performed by a nurse described by 
Subsection (d).
	SECTION 2.  Subchapter B, Chapter 241, Health and Safety 
Code, is amended by adding Section 241.0262 to read as follows:
	Sec. 241.0262.  CIRCULATING DUTIES FOR SURGICAL SERVICES.  
Circulating duties in the operating room must be performed by 
qualified registered nurses.  In accordance with approved medical 
staff policies and procedures, licensed vocational nurses and 
surgical technologists may assist in circulatory duties under the 
direct supervision of a qualified registered nurse circulator.
	SECTION 3.  Sections 301.1525, 301.1526, and 301.1527, 
Occupations Code, are repealed.
	SECTION 4.  This Act takes effect September 1, 2005.                           




______________________________              ______________________________
 
   President of the Senate                               Speaker of the House      

	I certify that H.B. No. 1718 was passed by the House on May 5, 
2005, by a non-record vote; and that the House concurred in Senate 
amendments to H.B. No. 1718 on May 27, 2005, by a non-record vote.

                                                  ______________________________
                                                     Chief Clerk of the House   

	
I certify that H.B. No. 1718 was passed by the Senate, with 
amendments, on May 25, 2005, by the following vote:  Yeas 31, Nays 
0.

                                                  ______________________________
                                                      Secretary of the Senate   



APPROVED: __________________                                                
 
                Date                                                         




 
         __________________                                              
 
              Governor