SB 389 creates statutory carve‑outs allowing licensed vocational nurses (LVNs) to perform certain respiratory tasks and services outside traditional hospital settings, provided they complete patient‑specific training and hold task‑specific competency certifications. The measure also directs the responsible licensing board to adopt training guidelines in collaboration with the Board of Vocational Nursing and Psychiatric Technicians (BVNPT).
Why it matters: the bill expands who can deliver respiratory care in home‑ and community‑based settings (including small congregate homes, adult day health centers, and private‑duty nursing during transport), which could increase access to basic respiratory services and reduce reliance on higher‑tier respiratory practitioners — but it also creates new training, certification, oversight, and liability questions for employers, regulators, and clinicians.
At a Glance
What It Does
SB 389 exempts a list of activities from prohibitions on respiratory care and specifically authorizes LVNs to perform board‑identified respiratory tasks if they complete patient‑specific training and hold competency certifications. The bill requires the licensing board to issue training guidelines in coordination with BVNPT.
Who It Affects
Licensed vocational nurses, home health agencies and individual nurse providers, small licensed congregate and pediatric day health facilities, credentialed school nurses who supervise suctioning, and the boards that regulate respiratory care and vocational nursing.
Why It Matters
The bill narrows traditional scope‑of‑practice boundaries by permitting LVNs to take on respiratory tasks in community settings, shifting operational responsibility (training, certification, supervision) to employers and state boards and potentially changing staffing models and liability profiles.
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What This Bill Actually Does
SB 389 works by carving out exceptions to existing prohibitions on respiratory care and then layering a new, conditional authorization for LVNs to perform specific respiratory tasks. For the near term, LVNs may perform respiratory tasks if they have completed patient‑specific training that their employer considers satisfactory.
The bill then sets a transition: on or after January 1, 2028, employers must provide patient‑specific training in accordance with guidelines the respiratory licensing board will promulgate in collaboration with the Board of Vocational Nursing and Psychiatric Technicians.
The bill requires each LVN who performs these tasks to hold a current certification of competency for every respiratory task they perform; the text names two credentialing organizations — the California Association of Medical Product Suppliers and the California Society for Respiratory Care — and allows the board to identify additional organizations. SB 389 also lists the specific community and residential settings where LVNs may perform these services (small congregate living and intermediate care facilities, adult and pediatric day health centers, licensed small family homes, home health agency employment including individual nurse providers in residential homes, and private duty nursing during transport or community activities).Beyond the LVN authorization, the measure preserves a series of other non‑prohibitions: respiratory care provided as part of respiratory therapy educational programs, self‑care or gratuitous family care, emergency performance by other trained paramedical personnel, temporary respiratory services in declared epidemics or disasters, cardiopulmonary research, inhaled medication administration by properly trained child day care staff, and limited respiratory services performed by home medical device retail staff or home health agency personnel as authorized by the board.Two narrow, separate provisions are notable: first, the bill expressly permits certain long‑tenured Los Angeles County hospital employees who have done pulmonary function testing for at least 15 years to continue performing that testing; second, it confirms that LVNs may perform suctioning and other basic respiratory tasks under the supervision of a credentialed school nurse consistent with existing Education Code provisions.
The statute makes the LVN authorization operative on January 1, 2028, while leaving the content of standardized training and the list of permitted respiratory tasks to the board's forthcoming guidance.
The Five Things You Need to Know
Before January 1, 2028, an LVN may perform board‑identified respiratory tasks so long as they complete patient‑specific training that their employer finds satisfactory.
On or after January 1, 2028, an LVN must complete employer‑provided, patient‑specific training that follows guidelines the respiratory licensing board must promulgate in collaboration with BVNPT by that same date.
For each respiratory task an LVN performs the law requires a current certification of competency from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization the board designates.
The LVN authority applies only in specified community settings: small congregate living and intermediate care facilities (≤6 beds), adult and pediatric day health centers, small licensed family homes (≤6 beds), home health agencies or individual nurse providers in residential homes, and private‑duty nursing during transport and community activities.
The bill separately preserves an exception allowing persons employed by Los Angeles County hospitals with at least 15 years’ pulmonary function testing experience to continue that testing, and it authorizes LVN suctioning under a credentialed school nurse per Education Code rules.
Section-by-Section Breakdown
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Existing carve‑outs and nonprohibited activities
These clauses list activities that the statute does not prohibit — including respiratory therapy student training, patient self‑care and family caregiving, emergency performance by trained paramedics, temporary workforce expansions during epidemics or disasters, cardiopulmonary research, and inhaled medication administration by trained child day care staff. Practically, these preserve a wide range of nonlicensed or cross‑trained activity and clarify that SB 389 is additive rather than broadly deregulating respiratory care.
Temporary and transitional training rule for LVNs employed by home health agencies
Subdivision (i) creates a two‑phase approach: it allows an LVN employed by a home health agency to perform board‑identified respiratory tasks if, before January 1, 2028, they have completed patient‑specific training satisfactory to their employer. It then directs the respiratory licensing board to develop formal training guidelines in collaboration with BVNPT, which become the baseline for training on or after January 1, 2028. That places the initial training burden on employers but shifts standardization and oversight responsibility to the board.
Certification requirement, authorized LVN profile, and operative date
Subdivision (j) requires that an LVN be licensed under the usual statute, have completed patient‑specific training (initially as satisfactory to the employer), and hold a current competency certification for each respiratory task. The statute names two credentialing bodies and allows the board to accept others. It also states that the subdivision is operative January 1, 2028, marking the date when board‑promulgated guidelines must be in place and the standardized training regime takes effect.
List of permitted settings where LVNs may perform respiratory services
The text enumerates the precise community and residential venues where LVNs may perform permitted respiratory tasks: tiny congregate living and intermediate care facilities (designated six beds or fewer), adult day health centers, employment through home health agencies or as individual nurse providers in residential homes, pediatric day health and respite centers, small licensed family homes (≤6 beds), and private duty nursing for transport and activities outside the patient residence. This limits the LVN expansion to non‑acute, community contexts rather than hospitals or large facilities.
Pulmonary function testing and school nurse supervision carve‑outs
Subdivision (k) creates a narrow grandfathering clause allowing Los Angeles County hospital employees with at least 15 years’ experience performing pulmonary function testing to continue doing so. Subdivision (l) clarifies that LVNs may perform suctioning and other basic respiratory tasks when supervised by a credentialed school nurse under the applicable Education Code sections. Both are targeted exceptions that leave broader hospital and school practice governed by existing regulation and supervision requirements.
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Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Patients receiving home‑ and community‑based care: Expanded numbers of qualified personnel able to deliver basic respiratory interventions can improve access, reduce travel or hospitalization, and support continuity of care in small facilities and home settings.
- Licensed vocational nurses (LVNs): The bill expands permissible duties for LVNs in community settings, creating opportunities for skill development and potentially higher utilization of LVNs in respiratory care roles.
- Small congregate and family home operators and home health agencies: Teams in small facilities and home health employers gain workforce flexibility, making it easier to staff and deliver basic respiratory services without relying solely on respiratory care practitioners.
- Families and respite providers for home‑ and community‑based patients: Having trained LVNs authorized to perform respiratory tasks (including during transport and outings) reduces the logistical burden on families and supports community participation for patients with respiratory needs.
Who Bears the Cost
- Employers (home health agencies, small facilities, private‑duty employers): They must develop or procure patient‑specific training, verify competency certifications for each task, and maintain documentation; those costs may include trainer time, course fees, and administrative overhead.
- Licensed vocational nurses: LVNs will face the cost (time and possibly money) of obtaining task‑specific competency certifications and meeting employer training requirements, and they may encounter new professional liability risks when performing expanded tasks.
- Regulatory boards (respiratory licensing board and BVNPT): The boards must collaborate to draft, adopt, and oversee new training guidelines and recognize credentialing organizations, which will demand staff time, technical rule‑making, and enforcement resources.
- Respiratory care practitioners and professional organizations: Expanding authorized performable tasks to LVNs can shift work away from credentialed respiratory therapists, raising concerns about practice standards, market impacts, and potential scope‑of‑practice disputes.
Key Issues
The Core Tension
The central tension is between expanding access and keeping standards: SB 389 aims to increase availability of respiratory services in community settings by delegating tasks to LVNs, but doing so risks variable training quality, unclear oversight, and shifting clinical responsibility away from respiratory specialists — forcing regulators and employers to choose between immediate workforce relief and maintaining uniform, high‑quality respiratory care standards.
SB 389 trades tighter professional boundaries for operational flexibility; that trade‑off creates several implementation challenges. The bill leaves key content — which specific respiratory tasks LVNs may perform, the competency benchmarks for each task, and the criteria for accepting credentialing organizations — to the licensing board's forthcoming guidelines.
That delegation is practical but risks uneven standards across employers if guideline development is slow, under‑resourced, or lacks clear acceptance criteria for third‑party certifiers. Employers initially decide whether pre‑2028 patient‑specific training is “satisfactory,” which can produce variable quality until the board's standardization takes effect.
Liability, reimbursement, and recordkeeping are unresolved. The measure does not address malpractice or workers’ compensation implications of the task shift, nor does it specify who pays for training or certification.
Payers and auditors will need guidance on billing, supervision documentation, and whether insurers will view LVN‑delivered respiratory tasks as equivalent to services provided by licensed respiratory care practitioners. The narrow grandfather clause for Los Angeles County pulmonary function testing raises equity questions—why only that county and only employees with 15+ years—and could prompt challenges or calls for broader state‑level grandfathering or reciprocity rules.
Finally, the bill is backward‑looking in some respects (grandfathering experience) and forward‑looking in others (board guidance), creating transitional risk during the 2028 implementation window.
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