BACKGROUND PAPER FOR THEBoard of Registered Nursing(Joint Oversight Hearing, March 23, 2015, of the Senate Committee onBusiness, Professions and Economic Development and theAssembly Business and Professions Committee)IDENTIFIED ISSUES, BACKGROUND AND RECOMMENDATIONSREGARDING THECALIFORNIA BOARD OF REGISTERED NURSINGBRIEF OVERVIEW OF THEBOARD OF REGISTERED NURSING (BRN)Functions of the BRNThe Board of Registered Nursing (BRN) regulates the practice of registered nurses (RNs) inCalifornia. BRN implements and enforces the Nursing Practice Act (Act), the laws and regulationsrelated to nursing education, licensure, practice, and discipline.The BRN’s mission statement is as follows:The Board of Registered Nursing protects and advocates for the health and safety of thepublic by ensuring the highest quality registered nurses in the state of California.1BRN regulates over 414,000 licensees in California.2 In addition to licensing RNs, BRN issuespermits for pending licensees and certificates to the following advanced practice registered nurses(APRN): nurse practitioners (NPs), nurse anesthetists, nurse midwives (NMs), and clinical nursespecialists. BRN also issues furnishing numbers to NPs and NMs with furnishing authority, maintainsa list of psychiatric/mental health nurse specialists, and issues certificates to public health nurses.BRN is responsible for setting educational standards for RN, NP, and NM programs, approving suchprograms, approving continuing education providers, evaluating and licensing RN and APRNapplicants, administering discipline, managing a Diversion Program for licensees with chemicaldependencies or mental illness, and providing stakeholder information and outreach.1This revised mission statement is part of the Board’s 2014-2017 Strategic Plan, which was completed in March 2014,following recommendations from the prior Sunset Review in 2011.2California Board of Registered Nursing: Sunset Review Report 2014 (BRN Sunset), p. 104. There is some dispute as tothis figure; the former business manager for BRN’s data system, BreEZe, states that this figure should be lower, but BRNdisagrees. See The California State Auditor Report 2014-116 (Auditor Report), p. 70.1

History of the BRNCalifornia first tasked the University of California, Board of Regents with regulating nurses in 1905.BRN’s functional predecessor, the Bureau of Registration of Nurses, was created in 1913, becomingthe current BRN in 1975. The Board had been continuously in existence under various titles untilDecember 31, 2011 when it was allowed to sunset. The sunset was the culmination of a series ofevents stemming from a 2009 newspaper story critical of BRN’s enforcement efforts, “WhenCaregivers Harm: Problem Nurses Stay on the Job as Patients Suffer.”3 The investigative reportcharged that BRN often took years to act on complaints of egregious misconduct, resulting in nurseswith histories of drug abuse, negligence, violence, and incompetence continuing to provide care.When BRN did act, it often took more than three years to investigate and discipline licensees.In the wake of the Los Angeles Times revelations, the Executive Officer (EO) of BRN resigned andGovernor Schwarzenegger replaced four board members and appointed two long-time vacancies.BRN’s Supervising Nursing Education Consultant, Louise Bailey, became the EO. To adequatelyempower BRN to make the needed changes, the Legislature passed SB 538 (Price) in 2011. The billauthorized BRN’s investigators to have the authority of peace officers in order to more effectivelyprovide enforcement, in addition to extending BRN’s sunset and making a number of other changes.Establishing peace officer status and the attendant pension benefits was contrary to Governor Brown’spension reform plans and he vetoed the bill, eliminating BRN at the end of 2011.BRN became the Registered Nursing Program (Program) under an interagency agreement with theDepartment of Consumer Affairs (DCA) that provided for the continued administration of the Act “inan uninterrupted and stable manner until legislation re-establishing the Board takes effect.”4 TheProgram allowed BRN staff to continue to operate administratively with Ms. Bailey directing activitiesas the Registered Nursing Program Manager.The Board was reconstituted on February 14, 2012 and declared Ms. Bailey as the interim EO. 5 Shewas voted unanimously as the permanent EO on July 27, 2012.BRN did not get a quorum of board members, however, until May 2012, and the first Board meetingwas held on June 21, 2012. Because of this delay, numerous actions that required Board input werebacklogged.6 BRN’s member positions were completely filled by February 2014.Board CompositionBRN is composed of nine members: seven appointed by the Governor, one by the Senate Committeeon Rules and one by the Assembly Speaker. Four must represent the public at large, two must be RNs,one an APRN, one an RN educator or administrator, and one who is an RN administrator of a nursingservice.7 There is currently one vacancy to be filled by the Senate Committee on Rules.3See Charles Ornstein, Tracy Weber & Maloy Moore, When Caregivers Harm: Problem Nurses Stay on the Job as PatientsSuffer, Los Angeles Times, July 11, 2009, available at 9jul12,0,2185588.story , accessed March 3, 2015.4Interagency Agreement Between the Department of Consumer Affairs and California Board of Registered Nursing, Dec.14, 2011.5SB 98 (Committee on Budget and Fiscal Review), Chapter 4, Statutes of 2012.6BRN is statutorily required to have at least one meeting every three months. California Business and Professions Code(BPC) Section 2709. It may be argued that BRN missed only one board meeting during this transition period.7BPC § 2702.2

The current members are as ntingAuthorityFebruary 6, 2014 June 1, 2017 GovernorRaymond Mallel, Board PresidentMr. Mallel has been a private investor since 2001. He was previously thedirector of marketing and operations at Long Beach Mortgage Company andAmeriquest Bank from 1991 to 2001 and vice president of LoubellaExtendables Inc. from 1971 to 1991. Mr. Mallel served as vice president of theState Bar of California Board of Governors from 1983 to 1986 and was chair ofthe Client Security Fund at the State Bar of California from 1986 to 1990.From 1982 to 1994, he served three consecutive terms on the Medical Board ofCalifornia, including as president and vice president. Mr. Mallel is a cofounder and member of the International Executive Board for the SephardicEducational Center in Jerusalem, Israel. He also serves as president of theRaymond Mallel Foundation.Michael Deangelo Jackon, MSN, RN, CEN, MICN, Board VicePresident.May 10, 2012June 1, 2016 GovernorMr. Jackson has been a clinical nurse II in the Department of EmergencyMedicine at the University of California, San Diego Medical Center since2000. He has been an adjunct clinical faculty member in the registered nursingprogram at Southwestern Community College and an operations supervisor atScripps Mercy Medical Center. Mr. Jackson’s career also includes time as amental health worker at Scripps Mercy Medical Center from 1992 to 2000 andservice as a lance corporal in the United States Marine Corps Reserve from1989 to 1993.Beverly Hayden-Pugh, MA, RNAugust 20, 2013 June 1, 2015 GovernorMs. Hayden-Pugh is vice president and chief nursing officer at Children'sHospital Central California. Ms. Hayden-Pugh began her career withChildren's in 1983 as a staff RN in the pediatric/oncology unit. Since then, shehas served in a variety of positions at the hospital, including as thegastroenterology and multispecialty clinic manager, administrative director ofsubspecialty clinics, and executive director of the ambulatory care division.Ms. Hayden-Pugh is a member of several professional and communityorganizations, including the Association of Nurse Leaders, American Collegeof Healthcare Executives, and Nursing Leadership Council.Elizabeth (Betty) Woods, RN, FNP, MSNFebruary 6, 2014 June 1, 2018 GovernorMs. Woods is a volunteer nurse practitioner at the Jewish Community FreeClinic in Rohnert Park, Ca. Ms. Woods was previously a labor representativewith the California Nurses Association from 1994 to 2007, and worked as a NPat Kaiser Permanente, Santa Rosa from 1976 to 1994 in Family Medicine andas a member of the HIV Consult Team. From 1984 to 1994 she was anAdjunct Clinical Professor for NP students at Sonoma State University, andfrom 1982 to 1988, a NP Sexual Assault Examiner at Sonoma County3

Community Hospital. Before earning her NP certification and MSN fromSonoma State University, Woods was an ICU and medical/surgical RN.Imelda Ceja-ButkiewiczFebruary 6, 2014 June 1, 2017 GovernorMs. Ceja-Butkiewicz has been a Project Specialist at Kern County PublicHealth Services Department since 1999. She has served in multiple positions atthe Kern County Department of Public Health, including with the Medi-CalOutreach Program, Maternal Child Disability Program, Child Health andDisability Program, Kern Access to Children’s Health Program, Child’s DentalProgram, and Refugee Health Assessment Program. She is currently workingwith individuals living with HIV/AIDS.Ms. Ceja-Butkiewicz is a community advocate and has served on severalprofessional and community organizations, including the Kern HomelessCollaborative, International Women’s Program, Central Democratic PartyCommittee, Democratic Women of Kern (past President), Inyo, Kern CentralLabor Council and Service International Union local 521.Jeanette DongNovember 14,2012June 1, 2016 SpeakerMay 10, 2012June 1, 2015 GovernorMay 10, 2012June 1, 2018 GovernorMs. Dong is currently the Chief of Staff for Alameda County Board ofSupervisor Wilma Chan. Previously she served as the Associate ViceChancellor for Advancement and Workforce Development for PeraltaCommunity Colleges.Ms. Dong was educated at U.C. Berkeley and Columbia University, withfellowships at Harvard University and with the Coro Foundation.Trande Phillips, RNMs. Phillips has been a registered nurse at Kaiser Permanente Walnut CreekMedical Center in the pediatric-flex unit and the medical, surgical, hospice andoncology unit since 1983. She was a registered nurse at the MerrithewMemorial Hospital in Contra Costa County from 1979 to 1981 and the WichitaGeneral Hospital in Texas from 1971 to 1972.Cynthia Cipres Klein, RNMs. Klein is a registered nurse with the Internal Medicine/SubspecialtyDepartment of Kaiser Permanente Medical Group in Riverside, California. Shehas served in multiple positions with Kaiser, including as the RN charge nursein urgent care from 2003 to 2005 and an ambulatory care RN team leader infamily medicine, pediatrics, allergy and obstetrics and gynecology from 1998to 2003. Ms. Klein worked as a RN supervisor for U.S. Family Care West from1997 to 1998, as a general pediatric floor nurse at Miller’s Children’s Hospitalin 1996, and as a RN lead for the Universal Care Medical Group from 1992 to1995.4

The Board is vested with the authority to implement and enforce the Act, and appoints an EO to carryout its will administratively.8 The EO is responsible for managing a staff of 157, a budget of 37.6million, and must be a licensee, an uncommon requirement among all DCA health boards.9Standing and Advisory CommitteesBRN divides itself into five standing committees to focus on aspects of the Act’s requirements. Eachcommittee is comprised of two or more Board members and at least one staff liaison. The committeesconduct public meetings, review and analyze issues, make enforcement decisions, and makerecommendations to the full Board at least five times per year.The committees and functions are as follows: Administrative Committee – Considers and advises the Board on matters related to Boardorganization and administration, including contracts, budgets, and personnel. Diversion/Discipline Committee – Advises the Board on matters related to laws and regulationspertaining to the Diversion Program and Enforcement Division and reviews enforcement anddiversion related statistics. Education/Licensing Committee – Advises the Board on matters related to nursing education,including approval of prelicensure and advanced practice nursing programs, the NationalCouncil Licensure Examination for Registered Nurses (NCLEX-RN), annual school surveydata and reports, licensing unit policies and procedures, and continuing education andcompetence. Nursing Practice Committee – Advises the Board on matters related to nursing practice,including common nursing practice issues and advanced practice issues related to nursepractitioner, nurse-midwife, nurse anesthetist, and clinical nurse specialist practice. TheCommittee also reviews staff responses to proposed regulation changes that may affect nursingpractice. Legislative Committee – Advises and makes recommendations to the Board and Committees ofthe Board on matters relating to legislation affecting RNs.8BPC § 2708.BPC § 2708(b). The requirement of a licensed nurse as the BRN’s chief administrator poses a recruitment challenge forDCA. Comparative salaries for nurse administrator positions in private practice are significantly higher: liststhe median salary for “Head of Nursing” in Sacramento as 213,000. The BRN’s present EO makes 130,000, themaximum allowable salary within the DCA’s EO pay range (per DCA Division of Legislative & Regulatory Review).Following is a description for a “Head of Nursing” position: “Plans and directs all nursing personnel. Develops andimplements nursing policies, objectives, and initiatives. Reviews nursing department operations to ensure compliance withestablished standards. Ensures that all patients receive the highest quality care. Requires a master's degree in area ofspecialty and at least 15 years of experience in the field or in a related area. Familiar with a variety of the field's concepts,practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. Performs a variety oftasks. May provide consultation on complex projects and is considered to be the top level contributor/specialist. Typicallyreports to top management.” See, -Salary-DetailsSacramento-CA.aspx , accessed March 9, 2015.95

BRN is statutorily authorized to appoint Diversion Evaluation Committees and a Nurse-MidwiferyAdvisory Committee (NMAC).10 Diversion Evaluation Committees (DECs) – Each DEC is comprised of three RNs, a publicmember, and a physician who each have expertise in substance use disorders or mental illness.Currently there are 14 DECs throughout California that meet with Diversion Programparticipants on a regular basis. Nurse-Midwifery Advisory Committee (NMAC) –NMAC advises the Board on nurse-midwifepractice and education issues. NMAC is composed of at least one NM knowledgeable aboutnurse-midwifery practice and education, one physician who practices obstetrics, one RNfamiliar with nurse-midwifery practice, and one public member.The Board is also authorized, with the DCA Director’s consent, to convene advisory committees asneeded. Members of these committees may include a variety of experts and stakeholders invited byBRN. The following advisory committees have been created by the Board: Education Issues Workgroup (EIW), formerly the Education Advisory Committee – EIW wasoriginally formed in 2002 to support the goals of the Governor’s Nurse Workforce Initiative, aprogram to develop and implement proposals to recruit, train, and retain nurses. EIW is now aworkgroup whose main task is reviewing the Annual School Survey, which collectsperformance and demographic data from approved California nursing programs. EIW includesrepresentation from various prelicensure educational degree programs, nursing organizations,nursing employers, and state agencies. Nursing Workforce Advisory Committee (NWAC) –NWAC provides guidance to the Board onRN workforce surveys, recommends strategies to address disparities in workforce projections,and identifies factors in the workplace that positively and negatively affect the health and safetyof consumers and nursing staff. The Committee includes members from nursing education,nursing associations, and other state agencies. Nurse Practitioner Advisory Committee (NPAC) –NPAC advises the Board on NP educationand practice issues. NPAC is comprised of NPs who represent NP educational programs, RNsfamiliar with NP practice and education, and representatives of NP organizations. Clinical Nurse Specialist Task Force (CNS) –CNS Task Force was created and charged withestablishing categories of CNSs, developing regulations that set standards and educationalrequirements for each category, and providing consultation to Board on matters related toCNSs. The CNS Task Force includes representatives from education and different clinicalareas of CNS practice.Fiscal and Fund AnalysisAs indicated by the BRN, revenue has been stable since FY 2011/2012 when it implemented its firstfee increase in 19 years. However, expenditures have increased due to additional enforcement staff10BPC §§ 2770.2 and 2746.2.6

and the costs to process increasing numbers of discipline cases. The statutory reserve fund limit for theBRN is 24 months.11At the end of FY 2013/14, the BRN had a fund balance of 9.5 million dollars, which is a three monthreserve. This reserve is projected to decline to less than one month in FY 2015/16. The goal of theBRN is to maintain a two to four month reserve, and is thus projected to fall below that goal in2015/16. In FY 2008/2009 the BRN made a 2 million dollar loan to the General Fund that was repaidin FY 2010/11 without interest. Another loan of 11.3 million was made in FY 2011/12. 3 million ofthis loan will be repaid in FY 2014/15 and the remaining 8.3 million is scheduled for repayment in2015/16. The BRN reports that repayment of the loan is needed to fund approved Budget ChangeProposals (BCPs) as well as to support existing services and maintain a minimal reserve.Even with the loan repayments, the BRN indicates that it will still need additional funds from a feeincrease in FY 2015/16 to ensure future financial stability. The BRN has included a column for FY2016/17 in the table below to show the result if the loan repayment is not received and additionalrevenue is not obtained. If revenues decline further, the BRN believes that additional analysis ofexpenditures and reduction of temporary staff will have to be considered.Table 2. Fund ConditionBeginning Balance*Adjusted Beginning BalanceRevenues and TransfersTotal RevenueBudget AuthorityExpendituresLoans to General FundAccrued Interest, Loans toGeneral FundLoans Repaid From General FundFund BalanceMonths in ReserveFY2010/1115,281(dollars in 2,03538,04738,04700-22,207 39,48928,92628,34702,17732,163 34,21028,39927,21411,30041632,123 39,53529,27730,539054533,816 43,35734,52233,7990-31,257 43,81536,87236,8720-31,225 38,16837,35637,356002,000 11,1424.700 6,9962.900 8,9963.100 9,5583.103,000 6,9432.200 8120.30 -6,012-1.9* Beginning balance may include prior year adjustment not reflected in the table.The following table shows the amount of expenditures in each of the BRN’s program areas. The BRNdoes not break out administration costs but distributes them across all program components. During thepast four years, as in the past, the BRN has spent over 75% of its budget on enforcement anddiversion-related activities. The BRN indicates that this meets one of their primary objectives ofproviding patient protection by removing unsafe RNs from the workplace or restricting their practice.To enhance its enforcement activities, the BRN had a significant increase in the number ofenforcement staff beginning in FY 2010/11 when it was approved for 37 positions over two years.11BPC § 128.5.7

Table 3. Expenditures by Program Component*FY ALSPersonnelServices6,2541,6041,610686 10,154OE&E**15,1461,3651,3131,904 19,728(dollars in thousands)FY 2011/12PersonnelServices5,4552,2891,858605 10,207FY 2012/13OE&E**13,4361,6111,3762,083 18,506PersonnelServices3,8391,6271,414526 7,406FY 2013/14OE&E**14,0371,9311,9232,218 20,109PersonnelServices6,3182,0951,756733 10,902OE&E**14,1452,5331,9402,308 20,926Average% ofExpend67%13%11%9%100%* Administration costs are incorporated in each program component.** Operating Expenses and EquipmentFee Schedule and RevenueThe BRN is a self-supporting, special fund agency that obtains its revenues from licensing fees. TheRN license and all certifications, except NP and PHN, are renewable biennially. The primary source ofrevenues is renewal fees.The fee schedule and revenue collected over the past four years is reflected in the chart below:Table 4. Fee Schedule and Revenue(dollars in thousands)CurrentFeeAmountStatutory nueFY2013/14RevenueRN Application (Exam)RN Application (Endorsement) 150 100 150 1001,8626962,3281,1382,3191,132RN RenewalInterim PermitTemporary RN LicenseClinical Nurse Specialist(CNS)CNS RenewalNurse Midwife (NMW)NMW RenewalNurse-Midwife Furnishing(NMF)NMF RenewalNurse Practitioner (NP)Nurse Practitioner Furnishing(NPF)NPF RenewalNurse Anesthetist (NA)NA RenewalPublic Health Nurse (PHN)Psychiatric/Mental HealthNurse 130 50 50 150 50 ,808*20329384%1%1% 75 75 75 75 150 100 150 1001576333191136431811554612136*549*0%0%0%0% 50 30 75 50 30 1501116221196311105312*1100%0%0% 50 30 75 75 75NoFee 50 30 150 150 3257NoFee83206*1485*257NoFee0%1%0%0%1%Fee8% of TotalRevenue7%4%--

Continuing Education Provider(CEP)CEP RenewalInitial Program ApprovalApplicationContinuing Program ApprovalProgram Substantive Change 200 200 5,000 3,500 500 300 30052325562804833148282*0%1% 5,000n/an/an/a150% 3,500 500n/an/an/an/an/an/a050%0%* These totals include Revenue Collected in Advance as current reporting capabilities available to the BRN are not able todistinguish between revenue collected in FY 13/14 and applied to renewals for FY 13/14 or FY14/15, thus all revenuereceived in FY13/14 was included in FY13/14 YTD Revenue. As a result, renewals appear higher for FY 2013/14 thanhistorically reported.Cost Recovery and RestitutionBRN implemented a cost recovery program in 1994 which authorizes it to collect the reasonable costsof its investigation and enforcement against disciplined licensees.12 The authorizing statute requiresthe Board to request restitution and gives the administrative law judge (ALJ) discretion to set theamount. The Board may reduce or eliminate, but not increase, the cost award.There have been no significant changes to the BRN cost recovery processes since the last review. Thecost recovery is executed through the Enforcement Division’s Legal Desk, and is agreed upon throughstipulated agreements and/or probation requirements. Consequences for RNs not completing costrecovery include extending probation or placing a hold on the RN’s license until the payment isreceived in full. The amount of cost recovery ordered remained fairly consistent until FY 2013/14when it increased 53% to over 1.8 million. The amount collected increased from 48% in FY 2010/11to over 60% in FYs 2011/12 and 2012/13 and 51% in FY 2013/14.Table 11. Cost Recovery(dollars in thousands)FY 2010/11FY 2011/12FY 2012/13FY 2013/14Total Enforcement Expenditures 13,769 10,803 11,523 12,769Potential Cases for Recovery *1,1651,4482,1102,060Cases Recovery Ordered264215279428Amount of Cost Recovery Ordered 1,097 958 1,197 1,836Amount Collected 529 634 736 930* “Potential Cases for Recovery” are those cases in which disciplinary action has been taken based onviolation of the license practice act.Table 12. RestitutionAmount OrderedAmount Collected12(dollars in thousands)FY 2010/11n/an/aFY 2011/12n/an/aThe BRN does not have statutory authority to order restitution for consumers.9FY 2012/13n/an/aFY 2013/14n/an/a

Staffing LevelsThe BRN’s nearly 160 staff works in four interdependent program areas: Licensee and Administrative Services – Provides assistance to the public and licensees throughthe information/call center, mail services, cashiering, and license renewals. It also handlesBRN’s personnel, budget, and information technology concerns and provides coverage oflegislative and regulatory issues. Licensing Program – Reviews the qualifications of U.S. and international RN and APRNapplicants. Staff interfaces with examination services vendors, domestic and international RNprograms, and other states’ boards of nursing. Enforcement Division – Handles the enforcement process from complaint through penalty andis comprised of five subdivisions: Complaint Intake, Investigations, Discipline, ProbationMonitoring, and Diversion. Nursing Education – Staffed by Nursing Education Consultants (NECs) who assist new nursingschools through the approval process and monitor existing approved programs.The BRN received 37 positions dedicated to enforcement as part of the Consumer ProtectionEnforcement Initiative (CPEI) in FY 2010/11, and received another 28 enforcement positionsin 2014/15. 13 The BRN believes these staffing augmentations will result in meeting enforcementtimeline goals. However, the BRN believes that other programs require additional staffing to meet itstargets. In its Sunset Report, the BRN reported that it requested 26 additional positions from theDepartment of Finance for two of its four programs.Approval of Nursing Schools and ProgramsBRN is required by law to approve pre-licensure nursing programs. BRN’s approval ensures aprogram’s compliance with statutory and regulatory requirements. Approval of APRN programs isvoluntary and at the request of the program. Currently, there are 142 approved pre-licensure nursingprograms and 25 approved advanced practice nursing programs, as follows:Pre-licensure Programs 89 associate degree programs (11 private and 78 public) 37 baccalaureate degree programs (18 private and 19 public) 16 entry-level master’s degree programs (8 private and 8 public)APRN Programs 22 nurse practitioner programs (8 private and 14 public) 3 nurse-midwifery programs (3 public)13CPEI was DCA’s initiative to overhaul the enforcement and disciplinary processes of the healing arts boards. The goal ofthis initiative was to reduce the average enforcement completion timeline from 36 months to between 12 and 18 months.See dca/cpei/ , accessed March 5, 2015.10

Newly proposed and approved nursing programs have multiple visits by the Nursing EducationConsultant (NEC) staff. Programs are reviewed prior to initial student admission, at the completion ofthe first academic year, just prior to the graduation of the first class, five years from the date of firststudent admission, and then every five years thereafter. Regularly scheduled continuing approvalvisits to established nursing programs are currently conducted every five years, and additional visitsmay be conducted as needed.When an NEC finds a program in noncompliance, the program is placed on “deferred action” and isallowed a specific time to correct any areas of noncompliance. When a program is unable to correctthe areas of noncompliance or demonstrates a lack of progress, the program is placed on “warning”status. Being placed on warning status is a rare and serious action that indicates the Board’s intent toclose the nursing program.Any programs not approved by BRN may not operate in California and its graduates may not sit for thenursing licensing exam.LicensingRegistered Nursing (RN) license: RNs may apply for California license either by examination or byendorsement. Individuals seeking licensure by examination are required to meet BRN’s educationrequirements, which are verified by reviewing official school transcripts and/or the review of thenursing program curriculum, pass the national examination, and have a clear background.Licensure by endorsement is available to applicants who are already permanently licensed in anotherstate or U.S. territory. These individuals are eligible for licensure if they passed either the currentnational examination or its predecessor; possess an active, current and clear RN license, successfullycompleted California educational requirements, and have a clear background. Applicants licensed inother countries who have not passed the national examination are not eligible for endorsement and maybecome licensed through examination.Clinical Nurse Specialist (CNS) Certification: CNSs are RNs with advanced education who participatein expert clinical practice, education, research, consultation, and clinical leadership. BRN certificationmay be obtained by successful completion of a master’s program in a clinical field of nursing or aclinical field related to nursing with specified coursework.Nurse Anesthetist (NA) Certification: NAs are RNs who provide anesthesia services at the direction ofa physician, dentist, or podiatrist. NA applicants must provide evidence of certification by the Councilon Certification of Nurse Anesthetists and Council on Recertification of Nurse Anesthetists.Nurse-Midwife (NM) Certification: NMs are RNs who are authorized, under the supervision of alicensed physician and surgeon, to attend normal childbirth and provide prenatal, intrapartum andpostpartum care, including family planning care for the mother and immediate care for the newborn.BRN certification may be obtained by successful completion of a BRN-approved nurse-midwiferyprogram or certification as a nurse-midwife by the American Midwifery Certification Board. There isan equivalency method for applicants who completed a non BRN-approved midwifery program andwho are no

The Board was reconstituted on February 14, 2012 and declared Ms. Bailey as the interim EO. 5 She was voted unanimously as the permanent EO on July 27, 2012. BRN did not get a quorum of board members, however, unt