A bill permitting an Advanced Practice Registered Nurse (APRN) to practice without having to pay a fee to a physician has received approval in a Senate committee.  The legislation also removes the “written [prescription drug] protocol as authorized by a responsible physician” requirements.

The Public Health and Welfare Committee passed SB 454 and sent it to the full Senate for consideration.  Currently, an APRN must have a collaborative practice agreement with a physician in order to practice independently, which often includes a fee paid to the doctor.  But the collaborating physician is not required to be physically present during patient examinations and the APRN is not required to consult with the physician.  In short, collaborative practice agreements do not make APRNs more capable of safely treating their nursing patients, but they do create an opportunity for physicians to extract fees from APRNs.

APRNs in Kansas number more than 7,300 and include nurse practitioners, clinical nurse specialists, registered nurse anesthetists, and nurse midwives. An APRN group endorsed the measure, citing improved access to medical care and lower costs.

Nicole Livanos with The National Council of State Boards of Nursing testified that rural areas of Kansas would benefit from the legislation:

”We know that APRNs already practice in rural areas including many of the rural communities across Kansas. There’s about nine nurse practitioners per 10,000, in Kansas in rural areas. By comparison, the Health Resources and Service Administration data finds about six primary care physicians per 10,000 Kansans in rural areas today.”

She added evidence from other states enacting similar legislation indicates APRNs will make their way to the state.

”In Arizona for example, the nurse practitioner workforce increased by 70% in the five years following the policy change and that was in rural areas. In Nebraska, they also saw a significant increase in their APRN workforce, especially in 20 primary care shortage areas. Currently, 85 of Kansas’ 105 counties are healthcare provider shortage areas. What if barriers were removed here?

“We also can look here in Kansas to see what this practice looks like; practice without barriers. The Veterans Health Administration, The Indian Health Services, and the United States military do not require these agreements in order for APRNs to practice.

Samuel MacRoberts with the Kansas Justice Institute testified previously on similar legislation that restrictions on APRNs may have constitutional issues.

“In our view, requiring an APRN to sign a collaborative practice agreement, who is otherwise qualified and licensed to practice advanced nursing, could very well violate Kansas Constitution Bill of Rights Section 1, and other provisions not discussed here. In our view, Section 1 is a natural rights clause but is best understood to protect the right to earn an honest living, free from unreasonable government interference. When “[John] Locke observed that ‘every Man has a Property in his own Person,’” he was instead referencing the right to earn an honest living.  Perhaps more importantly, Kansas’ natural rights clause was modeled after Thomas Jefferson’s use of the phrase in the Declaration of Independence, and it is evident that Jefferson’s use of the phrase, ‘life, liberty, and the pursuit of happiness’ was meant to assert this right of livelihood.”

Like The Sentinel, Kansas Justice Insitute is owned by Kansas Policy Institute.

The bill is opposed by the American Medical Association, contending patient care will suffer if the bill becomes law.

It points to the four years of medical school, plus 3-7 years of residency providing 10,000-16,000 hours of clinical training for doctors, as opposed to nurses’ 2-3 years of education resulting in 500-700 hours of clinical training.

How patient care could suffer is unclear, however, since current law requiring a collaborative practice agreement doesn’t require physician supervision.

If the legislation is approved and becomes law, Kansas will join 24 other states removing collaborative agreement restrictions on APRNs.

The Legislature is also considering eliminating another ‘pay to play’ regime for eyebrow threaders.

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