Author: Andrew Engel – WISCA Lobbyist (Hamilton Consulting)

For the second session in a row, the Senate has passed the “APRN Modernization” bill, which will allow advanced practice nurses to work independently.  The bill passed on a 23-9 bi-partisan vote and now moves to the Assembly.  An amendment was attached to the bill increasing the hours of experience needed for the new APRN credential, but otherwise the language passed is similar to last session’s bill that was vetoed by Governor Evers.

WISCA is watching this bill closely to make sure that any new provisions won’t negatively impact ASC’s abilities to work with APRNs, most specifically we are watching proposed amendments that relate to pain management as some proposed amendments could restrict ASC’s, especially in rural areas, from utilizing CRNA’s (see third bullet under Med Society’s proposed changes). 

The Wisconsin Nurses Association characterizes provisions in the bill as such:

·        Provides licensing for APRNs and describes the strict educational/experience requirements to obtain a license.

·        Grants title protection for APRN and the four specialties.

·        Sets the stage for future APRN Compact agreements with other states.

·        Standardizes the APRN professional titles to be consistent with the other states.

·        Gives the Wisconsin Board of Nursing greater authority in regulating APRNs and APRN graduate schools.

·        Provide technical amendments to replace Advanced Practice Nurse Prescriber (APNP) with APRN.

·        Modernizes Wisconsin’s Nurse Practice Act, § Chapter 441 to reflect the national consensus model being adopted across the country. Specifically the APRN Modernization Act;

·        Adds a definition for Advanced Practice Registered Nurse (APRN) and scope of practice.

·        Provides formal licensure for advanced practice registered nurses (APRN), recognizing the four different practice roles; Certified Nurse Midwife, Certified Registered Nurse Anesthetist, Clinical Nurse Specialist and Nurse Practitioner. Requires the licensee to hold national board certification

·        Requires graduating with a master’s degree or higher in an APRN role; and graduated from a school of nursing with national accreditation.

·        Requires demonstration of medical malpractice and liability insurance coverage.

·        Creates the conditions for an APRN to prescribe, consult, collaborate, and refer patients to other health care providers and health systems.

·        Allows currently practicing APNPs be licensed as APRNs without application.

·        Repeals §441.15 – Nurse Midwife Practice Act

·        Repeals §441.16 – Prescription Privileges for Advanced Practice Nurses

The Wisconsin Medical Society continues to oppose the bill and is calling for changes:

·        Requiring an APRN to have at least four years of real-world, team-based care experience before being allowed to practice independently. Two of those years must occur after receiving APRN certification.

·        Adding statutory certainty that certain words and terms used to connote physicians and their specialties (including words such as “physician,” “anesthesiologist” etc.) may only be used by those who have earned a medical doctor (MD) or doctor of osteopathy (DO) degree. A separate bill to achieve this goal has been introduced as Senate Bill 143, which was also on the public hearing docket.

·        Protecting patients seeking complex pain management services by requiring certified registered nurse anesthetists (CRNA) to work in collaboration with a physician specializing in pain medicine. Current law requires CRNAs to work in collaboration with a physician, with no requirements that the physician have any experience in pain medicine.

The Assembly still needs to act on the bill before it is sent to the Governor.  It is expected that there will be additional amendments brought forward, but it is unclear if there will be a compromise that paves the way to passage.