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North Harris Montgomery Advanced Practice Nurse Society

CNAP Legislative Updates

CNAP Legislative Update #10

Lynda Woolbert, Executive Director

Coalition for Nurses in Advanced Practice

April 16, 2011


In the Issue:

Public Health Committee Hearing APRN Bills

Also Support HB 884: Waive Sovereign Immunity for Nurses

Oppose 1893: Anesthesiologist Assistant Licensing

Register now for APRN Day at the Capitol on May 12


Hearing on Wednesday: Constituents Take Action

Last week I asked APRNs to call Representative Lois Kolkhorst, Chair of the House Public Health Committee, to ask for a hearing on our APRN prescriptive authority bills. Congratulations, MISSION ACCOMPLISHED!  Hearings on HB 708 by Rep. Hancock, HB 915 by Representatives Wayne Christian & Eddie Rodriquez, and HB 1266 by Representatives Garnet Coleman and Rob Orr are scheduled in the House Public Health Committee this Wednesday, April 20th.


APRNs, patients, and even some physicians have been advocating for these bills since they were filed.  Now it is crunch time and those of you who are constituents in the districts of House Public Health Committee members will receive an alert to email, fax or call your committee office. Calls can be particularly effective and are probably the fastest and best way to make an impression. If you have friends, family or neighbors in those districts who support this change to end physician-delegated prescriptive authority and allow APRNs to diagnose and prescribe in the Nursing Practice Act, please also ask them to call.  


There will be differences between HB 915 and HB 1266, as introduced, and the committee substitutes that the bill authors will lay out in the hearing on Wednesday. The committee substitute (CS)  for both bills are very similar to the introduced version of HB 1266 except CSHB 915 no longer requires any precepted hours before the BON may grant full prescriptive authority, and CSHB 1266 requires 2,000 hours of precepted provisional prescriptive authority (approximately 1 year working full time).


The precepted hours in CSHB 1266 may be directed by a physician or an APRN with full prescriptive authority. It does not require delegation or the current site-based restrictions. This is a one-time requirement for new graduates who have not practiced with prescriptive authority for 2,000 hours either out-of-state or in any previous APRN role or population focus. By November 1, 2011, the Board of Nursing is directed to develop an expedited process for granting full prescriptive and ordering authority to currently authorized APRNs in Texas who have prescribed for at least 2,000 hours under delegation by May 31, 2011.  A handout posted on CNAP’s Website explains the differences among all the introduced versions of the bills and their committee substitutes.


As noted in Update #8, if you are not from Austin, you may need to spend Wednesday night in order to stay until our bills are heard. The House Public Health Committee did not adjourn until 1:27 a.m. on Thursday last week. We felt extremely fortunate in 2009 for the hearing on our bills to be completed by 10:30 p.m.  It is most likely that our bills will not be heard until the House recesses for the day. That well may be sometime after 5 p.m.


Other Bills to Support or Oppose

Constituents who call a House Public Health Committee member’s office should also have two other bills on their list. Please urge the member to support HB 884 by Rep. Donna Howard, and oppose HB 1893 by Rep. Zerwas.


Support HB 884

HB 884 would give publicly-employed nurses the right to file a lawsuit for harm suffered if they are retaliated against for reporting an unsafe practitioner. This is a nursing-initiated bill similar to one that did not pass last session. The importance of this legislation was highlighted by the case involving the Winkler County nurses who were fired from a county hospital in retaliation for protected patient advocacy, in this case, filing a complaint in good faith against a physician.


Oppose HB 1893

As mentioned in CNAP Update #7, nursing opposes HB 1893 to license anesthesiology assistants for the following reasons.

1) AA licensing is not required for reimbursement or public safety. Anesthesiologists already delegate to AAs under the general authority of physicians to delegate, and hospital and ambulatory surgical center medical staff bylaws regulate any AAs that are privileged to practice in their facilities. Medicare and Medicaid already reimburse the anesthesiologist when AAs provide anesthesia under the anesthesiologist’s supervision.

2) AAs can only practice under the supervision of an anesthesiologist. Most anesthesiologists practice in suburban and urban areas and therefore licensing AAs would not improve access in rural areas where anesthesia providers are needed.

3) There are about 30 AAs in the state.  It is not cost effective to start a regulatory process for such a small group, especially in a legislative session in which Texas faces a $27 billion budget shortfall.

4) CRNAs and anesthesiologists are both proven providers, and there is already a shortage of clinical placements for anesthesiology residents and CRNA students.  There is no need to license a third category of anesthesia providers who will compete for these clinical placements.


APRN Days at the Capitol: Register Now for May 12

Most of the 22 APRNs and students at the Capitol last Thursday reported they had a great day. Our final APRN day is May 12th. If you have not yet been to the Capitol this session, please plan to attend. We begin the day at 9 a.m. in a reserved section of the Capitol Grill for a briefing. Then we visit our legislators from 10:15 a.m. – 3:30 p.m.  Click the link to register, www.cnaptexas.org/displaycommon.cfm?an=1&subarticlenbr=200.  Remember, physicians will storm the Capitol again on Tuesday, May 3rd. It is critical that APRNs are there on May 12th to answer any misconceptions that linger from those physician visits.