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.