APRN Modernization Act

APRN Modernization Act Reintroduced!

The APRN Modernization Act, LRB LRB-0589/1, was introduced on March 8 by Senator Patrick Testin who is the bill sponsor. The LRB was sent to all legislators asking that they sign on as co-sponsor. WNA wants to thank all who contacted your legislators asking that they sign on as co-sponsor. WNA will let you know when there is a bill number. We are anticipating a public hearing in mid to late April and will send out a Call to Action.

Overview of the APRN Modernization Act

The APRN Modernization Act

Provides separate licensure that supports the protection of the public by describing and defining the practice, role, responsibilities, and accountabilities of Advanced Practice Registered Nurse (APRN).
Modernizes antiquated language to reflect current APRN practice and responsibilities.
Eliminates unnecessary barriers that have proven to provide no value to the delivery and safety of APRN care and services.
Set a high standard of safety in caring for our patients through Board of Nursing oversight.

Current Patient Access to Health Care

Wisconsin is witnessing a shortage of physicians in our population-dense and rural communities prior to, during, and the post COVID-19 public health emergency. This is creating long wait times for individuals to access quality care in the most appropriate cost-effective setting. We are seeing increased utilization of APRNs to support access to health care throughout all of Wisconsin’s communities. Research repeatedly demonstrates that APRNs provide safe, high-quality care with equivalent outcomes to their physician counterparts. This is why they are in such high demand.

Key components of the APRN Modernization Act

Modernizes Wisconsin’s Nurse Practice Act, § Chapter 441 to reflect the national consensus model being adopted across the country.
Reflects a practice model that has been adopted in 27 other states. Source: AANP https://storage.aanp.org/www/documents/advocacy/State-Practice-Environment.pdf
Provides separate licensing for Advanced Practice Registered Nurses (APRN). Resulting in licensure for LPN, RN and APRN.
The APRN license identifies the four practice roles: Certified Nurse Midwife, Certified Registered Nurse Anesthetist, Clinical Nurse Specialist and Nurse Practitioner
Requires APRN educational programs to have national accreditation.
Hold and maintain national board certification in their practice role.
Requires the individual to graduate with a master’s degree or higher in an APRN role or a post-master’s certificate,
Adds a definition for Advanced Practice Registered Nurse (APRN) and scope of practice.
Requires the APRN to provide and carry medical malpractice and liability insurance coverage.
Reinforces the practice standard that APRNs will consult, collaborate and refer patients to other health care providers when the care their patient exceeds their expertise.
Grants title protection for APRN and the four specialties; Certified Nurse Midwife, Certified Registered Nurse Anesthetist, Clinical Nurse Specialist and Nurse Practitioner.
Gives the Wisconsin Board of Nursing authority in regulating APRN nursing programs.
Adds language of the employer right to have practice requirements as a condition of employment.
Repeals §441.15 – Nurse Midwife Practice Act.
Repeals §441.16 – Prescription Privileges for Advanced Practice Nurses.
Provide technical amendments to replace Advanced Practice Nurse Prescriber (APNP) with APRN for over 50 State Statutes.

Other information

Wisconsin’s Nurse Practice Act, State Statute 441, is relatively silent when it comes to defining the role and responsibility of advanced practice registered nurses (APRNs).
Legislation recognized advanced practice registered nurses in 1995 when subsets of these practitioners were granted prescriptive authority. Wisconsin State Statute 441.16 was created to allow advanced practice nurse to prescribe medications under the conditions defined. APRNs practice beyond the realm of prescriber work. Clarity regarding their legal definition and role are needed.
According to a report of the U.S. Federal Trade Commission, APRNs play a critical role in alleviating provider shortages and expanding access to health care services for medically underserved populations by commenting on how the requirements for physician collaboration for licensure creates scope of practice restrictions and may eliminate APRNs as an important source of safe, lower-cost competition. Such a reduction of competition may lead to a number of anticompetitive effects.
Currently in Wisconsin, Advanced Practice Registered Nurses cannot provide pharmacologic-related care without having a documented collaborative relationship with a physician. This has become an artificial barrier effectively giving one group of health care professionals the ability to restrict access to the market by another, competing group of health care professionals, thereby denying health care consumers the benefits of greater competition and access to care. The APRN physician collaboration requirement is currently suspended because of the COVID-19 public health emergency. APRNs practicing independently who have ceased their documented physician relationship are saving substantial dollars each month while continuing to provide, safe, quality and accessible care.
Wisconsin’s population is aging. The workforce predictions from Wisconsin Hospital Association show a dire need for health care providers now–and worsening in the near future. APRNs have proven themselves ready and able to fill those needs, particularly in rural and urban underserved areas. APRNs provide access to care at no added cost to the state, no delay in the benefit to the consumer or the state and are a solution.

Other resources and materials:

Click here for Legislator handout attachment

What the APRN Modernization Act Accomplishes

The APRN Modernization Act is a legislative proposal that is sponsored by Representative Rachael Cabral-Guevara and Senator Patrick Testin. The language is very similar to the legislative bills from the last legislative session. The benefit of this legislative proposal supports includes the following:

Protects the public with truth and transparency about the responsibility and accountability of APRN practice through separate licensure.
Modernizes antiquated language to reflect current APRN practice and responsibilities.
Eliminates unnecessary barriers that have proven to provide no value to the delivery and safety of APRN care and services.
Set a high standard of safety in caring for our patients.

Wisconsin is witnessing a shortage of physicians in our population dense and rural communities prior to, during, and post COVID-19 public health emergency. This is creating long wait times for individuals to access quality care in the most appropriate cost-effective setting. You are finding utilization of APRNs to meet the health care needs in the majority of legislator’s communities. Research repeatedly demonstrates that APRNs provide safe, high-quality care with equivalent outcomes to their physician counterparts. This is why they are in such high demand.

The language in the APRN Modernization Act

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

Other information

Wisconsin’s Nurse Practice Act, State Statute 441, is relatively silent when it comes to defining the role and responsibility of advanced practice registered nurses (APRNs).
Legislation recognized advanced practice registered nurses in 1995 when subsets of these practitioners’ were granted prescriptive authority. Wisconsin State Statute 441.16 was created to allow advanced practice nurse to prescribe medications under the conditions defined. APRNs practice beyond the realm of prescriber work. Clarity regarding their legal definition and role are needed.
According to a report from the U.S. Federal Trade Commission, APRNs play a critical role in alleviating provider shortages and expanding access to health care services for medically underserved populations by commenting on how the requirements for physician collaboration for licensure creates scope of practice restrictions and may eliminate APRNs as an important source of safe, lower-cost competition. Such a reduction of competition may lead to a number of anticompetitive effects.
Currently in Wisconsin, Advanced Practice Registered Nurses cannot provide pharmacologic-related care without having a documented collaborative relationship with a physician. This has become an artificial barrier effectively giving one group of health care professionals the ability to restrict access to the market by another, competing group of health care professionals, thereby denying health care consumers the benefits of greater competition and access to care. The APRN physician collaboration requirement is currently suspended because of the COVID-19 public health emergency. APRNs practicing independently who have ceased their documented physician relationship are saving substantial dollars each month while continuing to provide, safe, quality and accessible care.
Wisconsin’s population is aging. The workforce predictions from Wisconsin Hospital Association show a dire need for health care providers now–and worsening in the near future. APRNs have proven themselves ready and able to fill those needs, particularly in rural and urban underserved areas. APRNs provide access to care at no added cost to the state, no delay in the benefit to the consumer or the state and are a solution that has a track record of 50 years of success.

Current activity as of January 30, 2023

No proposed language has been introduced.
Meetings between WNA and Wisconsin Medical Society to review amended language from the 2021-2022 bills and identify areas of consensus.
Meetings with WNA lobbyist and lobbyists from the Wisconsin Certified Registered Nurse Anesthetist Association and Wisconsin Certified Nurse Midwives Association to discuss language.
Identified bill authors: Senator Patrick Testin last year’s author from Stevens Point, ) and State Representative Gae Magnafici, retired RN from Dresser.
WNA Public Policy Council and WNA Mutual Interest Group NP Forum Board is providing input.
WNA has planned communication to legislators about the importance of the APRN Modernization Act at our February 28, 2023 at APRN Lobby Day and WNA’s Nurses Day at the Capitol scheduled for Wednesday March 8th
WNA Public Policy Council sponsored the following webinar on January 26, 2023: Wisconsin’s New Legislature – What Nurses Need to Know You can access the webinar by going to: COMING SOON 2023 Levigvstlative Webinar with Bob Welch.

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