Legislature(2015 - 2016)BARNES 124
01/25/2016 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB53 | |
| Overview: Department of Commerce, Community and Economic Development, Division of Banking and Securities | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 53 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
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.