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2016 APRN Legislation Summary

Update: March 24, 2016  -  2016 APRN Full Practice Authority Legislation is dead.

When SB1473 (APRN Full Practice Authority) failed to advance through the legislature, we decided to move forward with a pared-down, strike-everything amendment to HB2236.  This was an effort to remove the “collaboration” language and therefore remove this obstacle to NP/CNM empanelment and reimbursement.  As part of the proposal we incorporated language presently found in the Board of Nursing rules regarding when it is appropriate to engage in consultations and make referrals.  It is our belief that the language found in HB2236 requires consultation and referrals with physicians only when it is in the best interest of the patient or when the circumstances of the patient are outside the knowledge and experience of the NP/CNM.  In our view this would not prevent referrals to other providers if the NP/CNM has the experience and knowledge to exercise the clinical judgment necessary to make an appropriate referral to a non-physician provider.  We do not believe that this language mandates that NP/CNMs can only refer and consult with physicians.

 

Although the language of the strike-everything amendment for HB 2236 has been available for more than two weeks, we have recently been informed by the Executive Director of the State Board of Nursing, that she and their lobbyist believe this language in fact would limit all referrals by NP/CNMs to physicians only.  We do not agree with that interpretation but believe that if the Board is going to take that position it creates a handicap to present NP practice which many feel is not outweighed by the removal of  both “collaboration” and the present requirement that NPs/CNMs establish a relationship with one or more physicians.   We will request that Senator Barto not move the bill forward.  This is particularly unfortunate since it probably will contribute to the political obstacles that will complicate future attempts  to remove the “collaboration” language and impact efforts on behalf of the consensus model. 

 

 

Summary

 

The Arizona Nurses Association (AzNA) has been leading the way by facilitating meetings involving leaders from all four Advanced Practice Registered Nurse (APRN) roles to strategize on how to put the recommendations contained in the IOM/RWJF landmark report, The Future of Nursing: Leading Change, Advancing Health, and the National Council of State Boards of Nursing Consensus Model into law in Arizona by allowing APRNs to practice to the full extent of their education and training.

In a historic merger of forces, the Arizona Nurse Practitioner Council, the Arizona Chapter of the American College of Nurse Midwives, The Arizona Association of Nurse Anesthetists, and Arizona Clinical Nurse Specialists have formed a collaborative partnership; the Arizona Coalition of Advanced Practice Nurses to share resources and support each other to achieve this monumental task.

 

 

On Monday, December 7th, 2015, 200 nurses rallied at the State Capitol and were witness to the achievement of the first hurdle in our journey to update the Nurse Practice. Our power when we speak with one voice was impressive and on display on December 7th. After 5.5 hours of testimony the special legislative panel voted 5-4 in favor of allowing nurses to move forward with their proposal to introduce a legislative bill for APRN full Practice Authority at the start of the 2016 AZ Legislative Session.

  

The Arizona Coalition of Advanced Practice Nurses announced Monday, February 2, 2016 the introduction of SB 1473, legislation that will modernize State regulations governing nurses with the highest education and most specialized patient focus. Hundreds of Arizona nurses and doctors, as well as groups ranging from the Goldwater Institute to AARP, are supporting the legislation because it safely removes bureaucratic burdens and expands patient access to quality care.

  

Update: March 15, 2016

The original, comprehensive proposal – SB 1473 – is dead. After an exhaustive lobbying effort, including the assistance of many Arizona nurses, it became clear we simply did not have the necessary votes to proceed.

 

The good news is that this is NOT the end of the road for us. We are moving forward with language that will fix one of the key problems impacting Nurse Practitioners and Nurse Midwives. Specifically, our proposal will remove from statute the word “collaboration” and, instead, require Nurse Practitioners and Nurse Midwives to consult with and refer to a physician whenever (1) it is necessary to protect the health of the patient or (2) the services required are beyond the knowledge of the Nurse Practitioner or Nurse Midwife. This will allow us to reflect in statute what is already in rule and remove an obstacle to insurance empanelment and reimbursement for these Advanced Practice Nurses.

 

This language will be amended onto and take the place of HB 2236. This process is known as as strike everything bill. The various medical associations have indicated they have no objection to this amendment, so we are hopeful and optimistic about our chances.

 

If you’ve been following this process, you know this is just one of multiple legislative provisions we initially sought to empower APRNs and improve patient access to care. That legislation may have come up short, but we still intend to pursue these individual proposals in the future – some as early as next year.

 

In the meantime, THANK YOU. Your support throughout this difficult process has been nothing short of an inspiration. Hundreds of you showed up for the COR hearing in December, Lobby Day in January and, once again, for the committee hearing in February. Approximately 12,000 emails were sent to legislators, and 1,000 nurses, physicians and others signed letters of support. Impressive!

 

What now? At 2 p.m. on Wednesday, March 16, the Senate Health Committee will consider our trimmed-down amendment to HB 2236. Separately, the committee will also hear the nursing compact proposal, HB 2362.

 

  • It is NOT necessary that nurses travel to the State Capitol to attend this hearing
  • If you have previously made an account at the kiosk at the Capitol, we do ask that you sign-in to support both bills via the Arizona State Legislature Website. It takes just a minute or two, and instructions are available HERE. Make sure to repeat the "request to speak" process with both HB 2236 and HB 2362.

 

Again, thank you for everything you do to support Arizona nurses.

Update: March 17, 2016

March 16th was the last day that bills could be heard in committee. 17 bills were on the Senate Health Committee agenda. After 4.5 hours of patiently waiting,HB2236, Advance Practice Registered Nurses strike everything amendmentwas finally heard.

Rory Hays, AzNA lobbyist, spoke in favor of the bill which was amended to address only the removal of the collaboration language from the Powers and Duties of the Board section of the Nurse Practice Act (NPA) and move language that described the "consult and refer" conditions from Rules to Statute. Steve Barclay, lobbyist for ArMA, advised the committee that ArMA was taking a neutral position on the revised bill.

HB2236 passed 6 votes in favor (Lesko, Hobbs, Begay, Barto, Bradley, & Pancrazi), none against, and one not voting (Yee). The bill now goes to the full Senate for a vote. If it passes the Senate, it goes directly to the full House for vote (without the requirement for hearing in a committee) and then to the Governor’s desk to be signed. Notices will be sent out when the dates for those two votes are scheduled. 

As mentioned in earlier messages, stakeholder meetings (nurses, physicians and legislators) are planned for the summer to work on proposed legislation to be introduced in the 2017 legislature. Unfinished business will be discussed. For the remainder of this year, we will continue to consult with our lobbying team and the coalition to identify what strategies worked and what new approaches may be in order. We will consult with other states who have faced similar arguments against full and direct access to APRN care and learn from their successes. It is our intention to continue to return to the legislature as many times as it takes to achieve all of the original goals for our APRN Consensus Model legislation.

Thank you for your support and feedback - it was quite an inspiration to witness the tremendous involvement of so many nurses. We will continue to need the help of each and every nurse in the remaining Senate and House votes and in the sessions to come in 2017. With strong and sustained effort, we will surely achieve all of our goals. Updates will continue to be posted here on the AzNA website as well as on facebook and twitter (links at top of page, upper left hand corner). 

 

 

Moving Ahead & How You Can Help

  to the Nurses Care 4 Arizona Campaign

In 2016, Arizona lawmakers will consider the most critical legislation in a generation affecting nurses in this state. Your donation will provide the critical resources we need to make sure Advanced Practice legislation is approved in Arizona in 2016.

   

In The News

Arizona Capitol Times

 

 

Yuma Sun

Phoenix Business Journal


News from around the Nation

 

 

APRN Full Practice Authority Sunrise Report- Approved December 7, 2015

When a profession wishes to expand its scope of practice by introducing a bill to the Legislature, it must first pass a Sunrise Review. Provided here is the Report submitted to the Arizona Legislature and the references used for supporting documentation.