Legislature(2015 - 2016)BARNES 124
01/25/2016 03:15 PM House LABOR & COMMERCE
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|Overview: Department of Commerce, Community and Economic Development, Division of Banking and Securities|
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SB 53-ADVANCED PRACTICE REGISTERED NURSES 3:18:24 PM CHAIR OLSON announced that the first order of business would be SENATE BILL NO. 53, "An Act relating to advanced practice registered nursing; relating to certified direct-entry midwifery; and providing for an effective date." 3:18:35 PM REPRESENTATIVE HUGHES moved to adopt the proposed House committee substitute (HCS) for SB 53, labeled 29-LS0043\P, Bruce, 1/20/16. There being no objection, Version P was before the committee. 3:18:52 PM SENATOR CATHY GIESSEL, Alaska State Legislature, speaking as the sponsor of SB 53, directed attention to the chart found in the committee packet entitled, "APRN ALLIANCE" which illustrated the current related Alaska statute and the statute changes proposed in SB 53. Senator Giessel said the bill would change the title of Advanced Nurse Practitioner (ANP) and Nurse Anesthetist (NA) to that of Advanced Practice Registered Nurse (APRN). She explained the change would bring the state into compliance with the national title conformity that is recommended by the National Council of State Boards of Nursing in order to eliminate the confusion of consumers and insurance entities. Nationally, interested parties agreed that APRN would be the "umbrella title." The aforementioned chart showed the current state situation which has Nurse Practitioner (NP), Certified Nurse Midwife (CNM), and Certified Clinical Nurse Specialist (CNS) included under the title of ANP, and a separate title for NAs. The bill creates a uniform title of APRN, under which all four of the clinical specialties would function, thus clarifying the specialties for consumers and insurers. Senator Giessel assured the committee that the bill does not change the scope of practice for any of the specialties; in fact, the bill is simply a title change, although it is lengthy because nurse practitioners serve in multiple aspects of health care, and the title corrections must be cited in many sections of statute. She offered to provide further testimony by staff and supporters of the bill. CHAIR OLSON invited Senator Giessel's staff to provide a sectional analysis of the bill. 3:22:44 PM REPRESENTATIVE COLVER noted that SB 53 is simply an update of the descriptions of nursing practices and asked, "Would you be fighting off any attempts to hijack your bill to like insert different agendas ... we can be assured that you're committed to this clean bill." SENATOR GIESSEL responded yes. REPRESENTATIVE HUGHES asked whether a nurse practitioner would be referred to as a nurse practitioner, or an APRN. She opined, the title "practitioner" depicts a higher level of scope of practice among members of the public. 3:24:48 PM SENATOR GIESSEL agreed that nurse practitioners, nurse anesthetists, clinical nurse midwives, and nurse specialists are titles known to the public and will still be used; however, for credentialing purposes such as signing a prescription, the new titles will apply. CHAIR OLSON expressed his belief that "hijacking bills" this early in the session is unacceptable. 3:25:57 PM JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State Legislature, provided a sectional analysis of SB 53 on behalf of Senator Giessel. She informed the committee that 26 sections of the bill are conforming amendments that only change the previous titles to that of APRN. The sectional analysis was as follows: section 1 allows APRNs to use their titles and initials on documents, signs, and advertising; sections 2-4 are conforming amendments; section 5 requires APRN regulations to apply to one who is a CRNA, CNS, CNP, or CNM, and makes conforming amendments; section 6 adds APRN to a list of licenses issued, and changes the term "professional nursing" to "registered nursing"; section 7 adds a new subsection that sets out the qualifications for an APRN license; section 8 repeals and reenacts AS 08.68.190 concerning license examinations to establish separate examinations for registered practitioners and APRNs; section 9 is a conforming amendment; section 10 requires the of Department of Commerce, Community & Economic Development (DCCED) to set fees, and deletes the term "vocational nursing"; section 11 removes licensed professional nurse from titles; section 12 is a new subsection authorizing the use of CRNA, CNS, CNP, and CNM, under that section; section 13 adds APRN as a person who can supervise a practical nurse; sections 14 and 16 are related to the impersonation of an APRN; section 15 requires institutions that are applying for accreditation to provide certain information; sections 17-19 are related to unlicensed practice; section 20 adds APRN to licensees who may delegate certain duties; section 21 is a conforming amendment; section 22 defines the practice of APRN nursing; sections 23 through 25 are conforming amendments; section 26 adds APRNs to persons who are considered justified in conduct that would otherwise be considered the use of force when delivering emergency medical care; sections 27 and 28 are conforming amendments; section 29 adds APRNs to licensees immune from civil liability while escorting an injured or sick person; section 30 is a conforming amendment; section 31 adds APRNs to practitioners authorized to draw blood for tests of persons charged with sex offenses; sections 32 and 33 are conforming amendments; section 34 clarifies that nurse-midwives and direct entry midwives are certified; sections 35 through 38 are conforming amendments; section 39 changes the term "registered professional nursing" to "registered nursing"; section 40 clarifies that nurse-midwives must be certified to be a provider in a hospital under AS 21.87; section 41 is a conforming amendment; sections 42 and 43 clarify that nurse-midwives are certified and make other technical amendments; sections 44 through 46 are conforming amendments; section 47 adds APRNs to the definition of health care provider in statutory provisions regarding prisons; section 48 is a conforming amendment; section 49 adds APRNs to licensees with specific training who may assess a child with respect to a waiver related to children and disabled persons under the Medicaid waiver; section 50 is a conforming amendment; section 51 adds APRNs to practitioners who are not liable for providing information to the Department of Health and Social Services (DHSS) for hearing screenings; sections 52 through 54 allow APRNs concerning mental health commitment determine if a person may be administered psychotropic medication without consent; section 55 adds APRNs to practitioners who may review a health care plan for an assisted living home resident; sections 56 through 59 are conforming amendments; section 60 repeals certain redundant statutes; and section 61 sets a new effective date. 3:34:16 PM REPRESENTATIVE HUGHES directed attention to section 7, page 5, beginning line 15, which read: Sec. 7. AS 08.68.170 is amended by adding a new subsection to read: (c) An applicant for a license to practice advanced practice registered nursing shall submit to the board, on forms and in the manner prescribed by the board, written evidence, verified by oath, that the applicant (1) is licensed as a registered nurse in the state; and (2) has successfully completed an advanced practice registered nurse education program that meets the criteria established by the board under AS 08.68.100. REPRESENTATIVE HUGHES asked why the new subsection was necessary. MS. CONWAY responded that this is the criteria to qualify for an APRN license. REPRESENTATIVE HUGHES restated her question. 3:36:12 PM LAURA SARCONE, Certified Nurse-Midwife; Co-Chair, APRN Alliance, explained that the current section relates to the qualifications of registered or practical nurse applicants; new section 7 adds a subsection that "pulls out the advanced practice registered nurse as a separate category from registered nursing and vocational nurses." 3:37:30 PM REPRESENTATIVE JOSEPHSON remarked: There is in the packet, there's a reference to - sort of a rebuttal - to Dr. Joshua Stream and I didn't see his letter. Can you give me a sense of what criticism he had? [Neither of the aforementioned documents were provided.] MS. CONWAY informed the committee that Dr. Stream provided written testimony which questioned whether nurse anesthetists were qualified to practice without doctor supervision. However, since 2003, nurse anesthetists in Alaska have practiced without doctor supervision, as this is decided by each state. She advised that Dr. Stream's comments were not germane to the bill. [CHAIR OLSON and his staff recalled that Dr. Stream's written testimony was not received by any committee member.] REPRESENTATIVE JOSEPHSON asked about the role of an anesthesiologist when a nurse anesthetist is present. 3:39:52 PM JEFF WORRELL, Certified Registered Nurse Anesthetist, informed the committee he is past president of the Alaska Association of Nurse Anesthetists, and currently works independently at a large Anchorage hospital. REPRESENTATIVE JOSEPHSON restated his question as to the need for an anesthesiologist and a nurse anesthetist. MR. WORRELL explained that in current practice both specialties are qualified to provide anesthesia services in a variety of settings; however, the training differs: a CRNA is trained first as a nurse, followed by three years of specialty training, and a physician anesthesiologist is initially trained as physician, followed by anesthesia training. He advised that the titles are different but the work is the same. REPRESENTATIVE HUGHES directed attention to the fiscal note and asked whether the fees for individual licenses would change; the sponsor indicated they would not. 3:43:22 PM JANEY HOVENDEN, Director, Division of Corporations, Business, and Professional Licensing, DCCED, answered that the fiscal note identifies three programs in her division that would be affected by the changes proposed in SB 53. The average cost would be $2,500 per regulation project, thus the fiscal note totals $7,500. Her division would attempt to garner savings by combining this work with other ongoing regulation projects. REPRESENTATIVE HUGHES asked whether there would be an adjustment of the fees charges to licensees. MS. HOVENDEN said the licensing fees for the nursing program would not be affected. 3:45:04 PM CHAIR OLSON opened public testimony on SB 53. 3:45:17 PM JULIE GILLETTE, Chair, Alaska Board of Nursing, informed the committee she is the chair of the Alaska Board of Nursing, which is fully in support of the bill. MR. WORRELL said adopting the APRN title allows for the portability of licensure across state lines, and for conformity to billing standards with other states. 3:47:03 PM CHAIR OLSON, after ascertaining no one else wished to testify, closed public testimony. 3:47:26 PM REPRESENTATIVE HUGHES moved to report the HCS for SB 53, labeled 29-LS0043\P, Bruce, 1/20/16, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HCS SB 53(L&C) was reported out of the House Labor and Commerce Standing Committee.