03/10/2015 01:30 PM Senate LABOR & COMMERCE

           SB  53-ADVANCED PRACTICE REGISTERED NURSES                                                                       
                                                                                                                                
2:14:22 PM                                                                                                                    
CHAIR  COSTELLO announced  the consideration  of SB  53. "An  Act                                                               
relating  to advanced  practice registered  nursing; relating  to                                                               
certified direct entry midwifery;  and providing for an effective                                                               
date." She  stated her intention  to hear the  introduction, take                                                               
public testimony, and hold the bill for further consideration.                                                                  
                                                                                                                                
SENATOR  CATHY  GIESSEL,  sponsor,  SB 53,  explained  that  this                                                               
legislation  updates  the  statutory  title  of  "Advanced  Nurse                                                               
Practitioner"  to "Advanced  Practice  Registered Nurse"  (APRN).                                                               
This change  would bring  Alaska statutes  into alignment  with a                                                               
national movement  to standardize  the titles  for this  level of                                                               
primary care provider.                                                                                                          
                                                                                                                                
2:17:01 PM                                                                                                                    
JANE  CONWAY,  Staff,  Senator  Cathy  Giessel,  paraphrased  the                                                               
following sectional analysis for SB 53:                                                                                         
                                                                                                                                
     Section 1  amends AS  08.02.010 and  adds APRNs  to the                                                                    
     list  of professions  that are  required  to use  their                                                                    
     professional  titles  on  stationery, signs,  or  other                                                                    
     advertising.                                                                                                               
                                                                                                                                
     Sections 2-4 are conforming  amendments that change the                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
2:17:42 PM                                                                                                                    
     Section 5 amends AS 08.68.100(a)  by requiring that the                                                                    
     Board  of  Nursing   regulations  pertaining  to  APRNs                                                                    
     include  the   practices  of  APRNs  who   practice  as                                                                    
     certified  registered   nurse  anesthetists,  certified                                                                    
     clinical    nurse    specialists,    certified    nurse                                                                    
     practitioners,  or certified  nurse midwives  and makes                                                                    
     conforming amendments.                                                                                                     
                                                                                                                                
     Section  6  amends  AS  08.68.160  by  adding  advanced                                                                    
     practice  registered  nursing  to the  licenses  issued                                                                    
     under  AS  08.68  and changes  the  term  "professional                                                                    
     nursing" to "registered nursing."                                                                                          
                                                                                                                                
     Section 7  adds a new  subsection to AS  08.68.170 that                                                                    
     sets out  the qualifications  for an  advanced practice                                                                    
     registered nursing license.                                                                                                
                                                                                                                                
     Section 8 repeals and  reenacts AS 08.68.190 concerning                                                                    
     license  examinations  and  adds an  advanced  practice                                                                    
     registered   nursing  examination   to  the   licensing                                                                    
     examinations conducted under AS 08.68.                                                                                     
                                                                                                                                
     Section  9 is  a  conforming amendment  that changes  a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to advance practice registered nurse."                                                                                     
                                                                                                                                
     Section  10  amends  AS 08.68  by  adding  a  paragraph                                                                    
     requiring  the Department  of  Commerce, community  and                                                                    
     Economic Development  to set  fees related  to advanced                                                                    
     practice  registered nursing  and deletes  "vocational"                                                                    
     nursing.                                                                                                                   
                                                                                                                                
     Section   11  amends   AS   08.68.230(a)  by   removing                                                                    
     "licensed   professional   nurse"   from   the   titles                                                                    
     authorized for persons licensed under AS 08.68.                                                                            
                                                                                                                                
     Section   12  amends   AS  08.68.230   by  adding   new                                                                    
     subsections   authorizing  the   use   of  the   titles                                                                    
     "advanced   practice   registered  nurse",   "certified                                                                    
     registered  nurse   anesthetist",  "certified  clinical                                                                    
     nurse specialist",  "certified nurse  practitioner", or                                                                    
     "certified nurse midwife" and associated initials.                                                                         
                                                                                                                                
2:19:16 PM                                                                                                                    
     Section  13   amends  AS  08.65.265  to   add  advanced                                                                    
     practice  registered nurses  to the  persons authorized                                                                    
     to supervise a practical nurse.                                                                                            
                                                                                                                                
     Section 14  adds impersonation of an  advanced practice                                                                    
     registered nurse  as a grounds for  denial, suspension,                                                                    
     or revocation of a nursing license.                                                                                        
                                                                                                                                
     Section 15 requires institutions  that are applying for                                                                    
     accreditation  of  advanced practice  registered  nurse                                                                    
     training to  provide certain  information to  the Board                                                                    
     of Nursing.                                                                                                                
                                                                                                                                
     Section 16  adds impersonation of an  advanced practice                                                                    
     registered nurse  as a grounds for  denial, suspension,                                                                    
     or revocation of  a certificate to practice  as a nurse                                                                    
     aide.                                                                                                                      
                                                                                                                                
     Sections   17-19  add   advanced  practice   registered                                                                    
     nursing  to  the  licenses issued  by  the  board,  and                                                                    
     change the  term "professional nursing"  to "registered                                                                    
     nursing"  in AS  08.68.360 -  08.68.390, which  declare                                                                    
     the unlicensed  practice of  nursing a  public nuisance                                                                    
     and provide for injunctive relief.                                                                                         
                                                                                                                                
     Section 20 adds advanced  practice registered nurses to                                                                    
     the licensees who may delegate certain nursing duties.                                                                     
                                                                                                                                
     Section  21 is  a conforming  amendment that  changes a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to  "advance practice  registered  nurse"  and makes  a                                                                    
     related technical change.                                                                                                  
                                                                                                                                
     Section 22  defines the  practice of  advanced practice                                                                    
     registered nursing.                                                                                                        
                                                                                                                                
     Section 23-25  are conforming amendments that  change a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance  practice registered nurse" and  make other                                                                    
     related technical amendments.                                                                                              
                                                                                                                                
2:20:45 PM                                                                                                                    
     Section 26 adds advanced  practice registered nurses to                                                                    
     persons who  are considered  justified in  conduct that                                                                    
     would  otherwise be  considered the  use of  force when                                                                    
     delivering emergency medical care.                                                                                         
                                                                                                                                
     Sections 27-28 are conforming  amendments that change a                                                                    
     statutory  reference from  "advanced nurse  practioner"                                                                    
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 29 adds advanced  practice registered nurses to                                                                    
     those licensees immune from civil  liability for an act                                                                    
     or omission  in delivering patient care  services while                                                                    
     escorting an  injured or sick  person whose life  is in                                                                    
     danger in a conveyance that is not an ambulance.                                                                           
                                                                                                                                
     Section  30 is  a conforming  amendment that  changes a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 31 adds advanced  practice registered nurses to                                                                    
     those practitioners authorized to  draw blood for tests                                                                    
     of persons charged with sex offenses.                                                                                      
                                                                                                                                
     Sections 32-33 are conforming  amendments that change a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance practice registered nurses."                                                                                   
                                                                                                                                
     Section  34 clarifies  that  nurse-midwives and  direct                                                                    
     entry midwives are certified.                                                                                              
                                                                                                                                
     Sections 35-38 are conforming  amendments that change a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance  practice registered nurse" and  make other                                                                    
     related technical 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 under AS 21.87.                                                                                 
                                                                                                                                
     Section  41 is  a conforming  amendment that  changes a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Sections  42-43   clarifies  that   nurse-midwives  are                                                                    
     certified and makes other technical amendments.                                                                            
                                                                                                                                
     Sections 44-46 are conforming  amendments that change a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 47 adds advanced  practice registered nurses to                                                                    
     the  definition of  health care  provider in  statutory                                                                    
     provisions concerning prisons.                                                                                             
                                                                                                                                
     Section  48 is  a conforming  amendment that  changes a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 49 adds advanced  practice registered nurses to                                                                    
     licensees  with particular  training who  may assess  a                                                                    
     child  with respect  to the  waiver  under a  statutory                                                                    
     provision concerning  home and community  based medical                                                                    
     assistance.                                                                                                                
                                                                                                                                
     Section  50 is  a conforming  amendment that  changes a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to  "advance practice  registered  nurse"  and makes  a                                                                    
     related technical change.                                                                                                  
                                                                                                                                
     Section 51 adds advanced  practice registered nurses to                                                                    
     practitioners   who  are   not  liable   for  providing                                                                    
     information  to the  Department  of  Health and  Social                                                                    
     Services  for  the  purpose of  providing  services  to                                                                    
     certain children and makes a related technical change.                                                                     
                                                                                                                                
2:23:18 PM                                                                                                                    
     Sections 52-54 add  advanced practice registered nurses                                                                    
     to  practitioners who  may  under statutory  provisions                                                                    
     concerning  mental health  commitment,  determine if  a                                                                    
     person  may  be  administered  psychotropic  medication                                                                    
     without   the  person's   consent,  and   add  advanced                                                                    
     practice registered nurses  with particular training to                                                                    
     the  definition  of  mental  health  professionals  for                                                                    
     those statutory provisions.                                                                                                
                                                                                                                                
     Section 55 adds advanced  practice registered nurses to                                                                    
     practitioners who may review a  health care plan for an                                                                    
     assisted living home resident.                                                                                             
                                                                                                                                
     Sections 56-59 are conforming  amendments that change a                                                                    
     statutory reference from  "advanced nurse practitioner"                                                                    
     to "advance practice registered nurse."                                                                                    
                                                                                                                                
     Section 60 repeals specific statutes.                                                                                      
                                                                                                                                
     Section 61 sets July 1, 2015 as the effective date for                                                                     
     the bill.                                                                                                                  
                                                                                                                                
2:24:33 PM                                                                                                                    
CHAIR COSTELLO  asked if this legislation  will require currently                                                               
practicing nurses to get additional certification.                                                                              
                                                                                                                                
SENATOR GIESSEL answered no.                                                                                                    
                                                                                                                                
CHAIR COSTELLO asked if she'd heard any opposition to the bill.                                                                 
                                                                                                                                
SENATOR GIESSEL answered no.                                                                                                    
                                                                                                                                
2:25:09 PM                                                                                                                    
CHAIR COSTELLO asked Ms. Chambers to speak to the fiscal note.                                                                  
                                                                                                                                
SARA  CHAMBERS,  Operations  Manager, Division  of  Corporations,                                                               
Business  and  Professional  Licensing, Department  of  Commerce,                                                               
Community and  Economic Development  (DCCED), explained  that the                                                               
fiscal note anticipates the statutory  and regulation changes the                                                               
six boards  within the division will  have to make to  conform to                                                               
the  APRN Consensus  Model.  The fiscal  note  is a  conservative                                                               
estimate based on the cost  of an average regulations project for                                                               
a moderately  sized board,  which is  $2,500. The  division would                                                               
like to work with the board  in articulating these changes to the                                                               
other  boards that  are affected  and encourage  them to  include                                                               
changes in  any existing regulation  projects to reduce  the cost                                                               
to licensees.                                                                                                                   
                                                                                                                                
CHAIR  COSTELLO asked  if this  will affect  any fees  the boards                                                               
collect from the licensees.                                                                                                     
                                                                                                                                
MS. CHAMBERS answered no.                                                                                                       
                                                                                                                                
2:27:26 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:28:50 PM                                                                                                                    
CARRIE  DOYLE, DNP,  Clinical Nurse  Specialist representing  the                                                               
Alaska Clinical Nurse  Specialist Association, Anchorage, Alaska,                                                               
testified in support  of SB 53. She stated  that nationwide there                                                               
are  four  types  of  advanced  practice  registered  nurses.  In                                                               
Alaska,  three  of the  categories  operate  under the  title  of                                                               
advanced  nurse practitioner  while nurse  anesthetists are  in a                                                               
separate category  of clinician in Alaska  statute. As previously                                                               
mentioned, the APRN  Consensus Model is a  nationwide movement to                                                               
include all four specialties under  the title of advance practice                                                               
registered  nurse.   It  seeks  uniformity  in   APRN  licensure,                                                               
accreditation, certification,  and education. This  will expedite                                                               
insurance  reimbursement by  eliminating confusion  about service                                                               
providers and will  allow APRNs from other states  to more easily                                                               
obtain licensure  in Alaska. SB 53  does not change the  scope of                                                               
practice for  ANPs and  nurse anesthetists;  they will  just have                                                               
the new name of advanced practice registered nurse (APRN).                                                                      
                                                                                                                                
2:31:41 PM                                                                                                                    
CHAIR COSTELLO opened public testimony.                                                                                         
                                                                                                                                
2:31:52 PM                                                                                                                    
ARLENE  BRISCOE, Legislative  Chair,  Alaska Nurses  Association,                                                               
Anchorage, Alaska stated support for SB 53.                                                                                     
                                                                                                                                
2:32:44 PM                                                                                                                    
CHAIR  COSTELLO,  discerning  there  were  no  other  testifiers,                                                               
closed public testimony  and held SB 53 in  committee for further                                                               
consideration.