April 4, 2024 – WNA Disappointed with Governor Veto of SB 145 – APRN Bill

The Wisconsin Nurses Association (WNA) wants to share our disappointment over Governor Evers’ veto of the Advanced Practice Registered Nurse Licensure Bill SB 145.  This action not only prevents licensure of over 8,000 Advanced Practice Registered Nurses, but also delays the opportunity to improve access to care for many people across Wisconsin. In the 27 states that allow APRN independent the practice, APRNs have stepped forward to open their practice to meet the healthcare needs of rural and underserved populations.

WNA will continue to educate policy makers on the benefits of APRN licensure and independent practice.  We are confident that there is a pathway to success on this bill that will be acceptable to all parties.  The healthcare workforce needs of Wisconsin necessitate innovations like this bill.  Nurses are tough; we will be back again next session to continue our work.

Special thanks and appreciation to all who advocated for the passage of the APRN Modernization Act this session. We know what the Governor wants included in the APRN bill next session. With all of our efforts, advocacy, and continued persistence we should be able to claim victory in the early 2025-26 legislative session.

Click here for the Governor’s Veto Message

February 20, 2024 – Call to Action – Request Governor Evers to sign SB 145, The APRN Modernization Act

SB 145, The APRN Modernization Act will be forwarded to Governor Evers for his decision to sign the bill.

We are in need of your advocacy. This bill impacts all nursing. If the Governor does not sign this bill, Wisconsin will continue to see APRNs move to states where they have full practice authority.

Without an APRN workforce, rural clinics are at risk to closing resulting in job losses for the nurses that are providing care in those clinics.

There is an opportunity for Wisconsin as well, if SB 145 is signed by the Governor, APRNs will establish their own clinics to meet the health care demands. This means more job opportunities for nurses to provide care close to home.

 Please contact Governor Evers TODAY and ask that he sign SB 145 when it arrives at his desk.

Please click here to access our messaging platform.

Thank you in advance for your time and support of nursing practice and care for our patients.

January 25, 2024 APRN Bill: Victory in the Assembly! On to the Governor

The Assembly passed the Senate version of the APRN Modernization Act, SB 145 today. This is the bill that WNA supported. The bill is similar to the bills that were passed by the Assembly and Senate last session. There was new content added to the bills this session that focused on criteria for APRN independent practice. There were amendments offered that we opposed and did not advance in either house. These amendments were supported by the Governor.

WNA will be offering a Legislative Update during the early part of February. Please watch for your invite.

WNA thanks to all of you who have advocated for this legislation.  It is truly appreciated.

October 21, 2023 –WNA Update on November 15, 2023 Public Hearing

The Assembly Health, Aging and Long-Term Committee held a public hearing on the APRN Modernization Act, AB 154 that also included Senate Bill 145 that was passed by the Senate on October 17, 2023. The hearing began at 10:00 am with hearings on a variety of other bills. The hearing AB 154 started at around 2:00 pm and ended at 5:00 pm

There were over fifty APRNs, APRN students, and non-nurses in attendance that registered in favor of the bill.  Testimony in favor of the bill was provided by the two bill sponsors, Rep. Gae Magnafici, Details and Senator Patrick Testin Details and Sen. Rachael Cabral-Guevera, last session’s bill sponsor in the Assembly.

Other testifiers represented the Wisconsin Nurses Association, American College of Nurse Midwives, Wisconsin Affiliate, Wisconsin Association of Nurse Anesthetists, Wisconsin Association of Clinical Nurse Specialists, Wisconsin Association for Justice, Medical Economist, Jeff Bauer, https://jeffbauerwords.com/speeches/biographical-sketch/, and others practicing as Psych-Mental Health CNS, Family Practice NP, Tribal clinic NPs and Free Clinics.  They focused on their practice and what they bring to quality care and how full practice authority can be achieved through removal of the mandated APRN and physician collaboration agreement throughout all of the statutes.

Two individuals testified in opposition. One was a physician representing the Wisconsin Chapter of the American College of Emergency Physicians, who requested that the language included in the Governor’s original bill be put back in. The language required all emergency departments to always have a certified emergency physician on staff.

The second individual was the lobbyist for the Wisconsin Medical Society. He shared support for an amendment that would require:

1. New APRN graduates wanting to establish their own independent practice have 2 years of RN experience and 2 years of physician collaboration prior to being a business owner. WNA opposes this concept as it is a restriction of trade and there is no evidence that working two years as a RN contributes to a better APRN. The roles are very different.

2. An independent practicing APRN will need to have a collaborative agreement with a physician with pain management experience in order to provide chronic pain management services.  WNA opposes this on the basis that there is no definition of chronic pain management services and there is a shortage of pain management physicians. This will limit patient access to timely and appropriate care provided by APRNs.  

3. Title protection for physicians that have the suffix “ologist” in their title. This will prevent CRNAs from changing their title to “nurse anesthesiologist”. WNA opposes any form of title protection that does not apply to nurses and needs to stay out of our nurse practice act statute 441.  

4. Independent practicing APRNs will become a part of the Injured Patient and Family Compensation Fund.  WNA supports this as it provides financial remedies related to patient harm. 

The above four proposed “amendments” suggested language was the focus of the questions asked by committee members to those individuals testifying.

WNA would like to thank the fifty (50) APRNs who attended the APRN Legislation Breakfast Briefing, had meetings with their State Assembly Representative, and submitted testimony and support for AB 154.  It was a long day.

Next Steps

It is our understanding that the Assembly Committee will hold a vote on the bill that may include the amendments in some form. The timeline will probably be in January 2024.  WNA continues to work with the Governor’s Office to share our continued concerns regarding the proposed amendments and offer consensus language.

In the meantime, WNA requests your financial support for our advocacy efforts. The WNA Advocacy Fund was established to cover the costs of advocating for the nurses of Wisconsin to advance, support and protect our practice which benefits the care of Wisconsinites. To make a contribution please go to:  https://www.cognitoforms.com/WisconsinNursesAssociation/HelpWNAAdvocateForYou

October 18, 2023 – Senate Bill 145, APRN Modernization Act passes in the Senate!  

The APRN Modernization Act passed out of the Senate yesterday on a vote of 23 -9.  Two democrats join the republicans in voting Yes and 1 republication joined the democrats in voting No.  An attempt to introduce an amendment was offered by Senator Diane Hesselbein, but it was rejected. The Hesselbein amendment would have been detrimental to achieving full practice authority.  Another amendment was passed which addressed the clinical experience needed for APRNs to practice independently. The amendment removed the requirement of having 2 years of clinical experience as a registered nurse. No other state has this requirement. The compromise was extending physician collaboration from 2 to 3 years.

The bill now goes to the Assembly where a public hearing will be scheduled in the Assembly Committee on Health, Aging and Long-Term Care.  WNA will keep you informed of the date of the public hearing, and we ask that if you can, please join us for the day.  Watch for the date of the next virtual WNA Legislative Update were more information and advocacy will be shared.

Thank you all who contacted your Senators.  It is very much appreciated.

October 5, 2023 – APRN Modernization Act, SB 145 passes out of the Senate Health Committee

SB 145, the APRN Modernization Act, was passed out of the Senate Health Committee by paper ballot yesterday. It passed on party lines; 3 yes, Republican members, and 2 noes, Democrat members. The bill may be scheduled for a vote by the full Senate within the next two weeks.  Please watch for a Call to Action.  We would like this bill to have bipartisan support. 

Thanks to those of you who reached out to your legislators this week.

WNA Action Alert!  October 2, 2023

The Senate Health Committee is scheduled to vote on passing SB 145 The APRN Modernization Act out of committee this Wednesday October 4, 2023.  

Your State Senator needs to hear from you!  Please, contact your State Senator Today – Request that SB 145 The APRN Modernization Act, be voted out of the Senate Health Committee on Wednesday October 4, 2023.

At long last, the APRN Modernization Act is gaining momentum in the legislature.

 The Senate Health Committee will be voting on whether to pass SB 145 out of Committee.  This means that if the committee members vote yes, it will be scheduled for a vote by the full senate as early as next week.

Please contact your state senator before 7:00 am on Wednesday October 4.

You can go to the WI Legislative Website  https://maps.legis.wisconsin.gov/  to find your State Senator.  The “Find my Legislator” is located on the upper right side of the webpage.  Put in your home address and the Senator’s contact information will show up. Click on the name and you will be taken to their webpage where you can find the office email link.

Let your Senator know that you are a constituent and request support for voting SB 145, out of Committee on Wednesday October 4, 2023.

Please sign-on to the petition “APRNs: Qualified to Heal”!

WNA wants to call your attention to a new website, www.QualifiedtoHeal.com, which provides information and an engagement opportunity related to the Wisconsin APRN Modernization Act. 

The website information includes:

  • A message from the sponsors of the Legislative Bills SB 145 and AB 154.
  • Description of the education and role of Advanced Practice Registered Nurses (APRN).
  • Stories from APRNs regarding their practice, approach to patient care and the need to remove a collaboration agreement with a physician.
  • Statements of support for the APRN Modernization Act.
  • Organizations supporting the APRN Bill and….
  • A link to a petition that indicates your support for the APRN Modernization Act,  SB 145 and AB 154. (Your address will not be visible to the public)

WNA is asking that you sign-on to the petition and that you share this with others, nurses, non-nurses, to sign on.  This is a powerful way of showing nurses and consumers support of APRN Practice in Wisconsin. 

Thank you in advance for your support as we strive to increase patient access to quality, safe, and timely care.

June 24, 2023 Update

WNA thanks ANA for responding to AMA’s position on APRN’s practice to be moved under Boards of Medicine. WNA’s Public Policy Council will be watching for any legislator interest in following AMA recommendation.
https://www.nursingworld.org/news/news-releases/2023/ana-refutes-med-board-aprn-oversight/

Summary of May 24, 2023 Health Committee Public Hearing on SB 145 – APRN Modernization

WNA wants to express sincere thanks to those APRNs who traveled to the State Capitol to testify and submit written testimony supporting SB 145.  The testimony was very strong and focused on access to care, what APRNs bring to the care of their patients, their educational preparation, research findings, and the need to practice without a formal documented APNP and Physician collaboration agreement.  APRNs testifying were from a variety of geographic areas of the state including rural and urban underserved areas, they represented practice areas including tribal health, long-term care, acute and primary care settings. Physicians were not present. The lobbyist who is a non-physician representing Wisconsin Medical Society testified in opposition of the bill citing safety, quality and lack of education as the reasons.

You can access the live Health Committee Hearing by going to WisconsinEye at  https://wiseye.org/player/?clientID=2789595964&eventID=2023051082

You may also want to view the second bill testimony regarding SB 143 which is the attempt by physicians to protect certain words like physician or doctor.  There was a lot of opposition raised.  A portion of this language was originally included in the APRN legislation.  SB 145 does not include it, but another bill SB 143 was created.

You can review the submitted testimony by going to: LC Hearing Materials for SB145 on 5/24/2023

WNA will keep you informed on the progress of the legislation

APRN Modernization Act SB 145 Public Hearing May 24, 2023!

The APRN Bill SB 145/AB 154 has a public hearing in the Senate Health Committee.  Date: Wednesday May 24, 2023, Time:  3:00 pm,  Location: State Capitol Room 411 South. (NOTE UPDATED TIME!)

This is very short notice but if you can attend the public hearing to either testify or come and register in support that would be incredibility helpful.

If you are unable to attend, please contact your state senator particularly if he or she is a member of the Health Committee.

WNA has provided information and resources for you to write your testimony or send an email letter.

Thank you in advance for your support in removing the required collaboration agreement with a physician.

Senator Cabral-Guevara (Chair)  – Thank her for being a co-sponsor of SB 145. Click here for sample letter and talking points.

Senator Testin (Vice-Chair) – Thank him for being the sponsor of SB 145. Click here for sample letter and talking points.

Senator Felzkowski – Thank her for being a co-sponsor of SB 145. Click here for sample letter and talking points.

Senator Jacque – Thank him for being a co-sponsor of SB 145. Click here for sample letter and talking points.

Senator Hesselbein -Ask her to support SB 145. Click here for sample letter and talking points,

Senator Carpenter – Ask him to support SB 145. Click here for sample letter and talking points.

Click here for a sample letter that you can personalize.  You can cut and paste this into your personal email to send.  You can find your legislator by going to:  https://maps.legis.wisconsin.gov/   Enter your home address in the box in the upper right-hand corner.

The information about the legislation bill can be found below:

https://www.wisconsinnurses.org/aprn-modernization-act-3/

For more information contact Gina Dennik-Champion at gina@wisconsinnurses.org

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.
  • The APRN may practice without being supervised by a physician or dentist if the Board of Nursing verifies that the APRN has completed 3,840 clinical hours of advanced practice registered nursing practice in their recognized role while working with a physician or dentist during those 3,840 hours of practice.
  • The APRN may provide pain management services only while working in a collaborative relationship with a physician or, if the APRN has qualified to practice independently, in a hospital or clinic associated with a hospital.
  • Eliminates certificates to issue prescription orders and generally authorizes APRNs to issue prescription orders.
  • A person who is certified to issue prescription orders under current law is automatically granted an APRN license with his or her appropriate specialty designation.
  • Requires APRNs who have qualified to practice independently and who practice outside a collaborative or employment relationship to participate in the Injured Patients and Families Compensation Fund.
  • 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

  1. No proposed language has been introduced.
  2. Meetings between WNA and Wisconsin Medical Society to review amended language from the 2021-2022 bills and identify areas of consensus.
  3. Meetings with WNA lobbyist and lobbyists from the Wisconsin Certified Registered Nurse Anesthetist Association and Wisconsin Certified Nurse Midwives Association to discuss language.
  4. Identified bill authors:  Senator Patrick Testin last year’s author from Stevens Point, ) and State Representative Gae Magnafici, retired RN from Dresser.
  5. WNA Public Policy Council and WNA Mutual Interest Group NP Forum Board is providing input.
  6. 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
  7. 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.

You can find history of the legislative bills from 2021-22 legislative session by clicking here.