Update on the APRN Modernization Act April 2018

Update Presentation Items Overview of APRN Coalition Summary of our activities Identify our accomplishments Identify our barriers Next Steps The need for APRN active engagement and advocacy at the local level

WI APRN Coalition – Goals for Advancement of the APRN Modernization Act Demonstrate a unified voice for support. Provide resources and information to members, legislators and key stakeholders. Achieve a critical mass of committed and energized APRNs throughout the state willing to advocate for the passage of the APRN Modernization Act.

Summary of Activities (2017 – 2018) (June – September) APRN Coalition Committees Talking Points Cmte. created information for legislators, system CEOs, physicians and consumers. Outreach and Communication Committee mailed informational letters to 1,500 APNPs, legislative breakfast in Oshkosh, informational graphics & WI APRN member-only website. APRN Lobby Day Committee – Planned & organized October 12 APRN Coalition Lobby Day. Statewide presentations – info and recruit

Summary of Activities Rep. Mike Rohrkaste and Sen. Devin LeMahieu (September & October) Obtained Legislation Bill Sponsors Rep. Mike Rohrkaste and Sen. Devin LeMahieu (October 12 – 22) Cosponsorship Letter circulated by the Sponsors asking for legislator sign-on as cosponsor. Letter circulated in time for the APRN Coalition Lobby Day October 12, 2017. Lobby Day participants (90) met with legislators to sign-on as a cosponsor. “Call to Action” request went out to all WI APRN Coalition members and members of the various APRN associations members asking that they contact their legislator to sign-on. (

Summary of Activities 19 State Assembly Reps and 8 Senators. (October 22) – Sign-on results: 19 State Assembly Reps and 8 Senators. (October 24) Bills were introduced and assigned to the two Health Committees. AB 568 - https://docs.legis.wisconsin.gov/2017/proposals /reg/asm/bill/ab568 SB 497 - https://docs.legis.wisconsin.gov/2017/proposals /sb497

Summary of Activities (October) Meetings with DSPS, DHS, legislators, and OCI. (November 6) Bill sponsors hosted a meeting with APRN Coalition and key stakeholders (WHA, WMS, WSA, WAPA) to identify purpose and concerns. (November 9) Formal request of the Wisconsin Board of Nursing (BON) to support the legislation. (November 27) BON indicated their support only if their 19 proposed amendments were added to the legislation. Remained neutral on the collaboration language. Met with representatives from the Wisconsin Hospital Association (WHA) who wanted nine amendments in order to obtain their supp

Summary of Activities (December 4) APRN Coalition Lobbyists, WNA Legal Counsel met with Wisconsin Hospital Association (WHA) lobbyists. Discussed the nine proposed amendments offered by WHA. (December – January) Continued meetings with APRN Coalition lobbyists and APRN Coalition Legislative Committtee to develop response to WHA nine amendments.

APRN Coalition response to WHA major proposed amendments Licensure – 4 separate licenses Licensure – one APRN four roles Scope of Practice for each role include in statute Scope of Practice defined by Board of Nursing Work in collaboration with physician No collaboration (APRNs consult, collaborate and refer to meet the needs of their patients.) Clarify that collaboration is not supervision Not in current draft Licensure Authority Does Not Preempt Employer, Health Plan, Hospital Policies Not needed; APRNs are aware that employers can have their own set of practice policies Eliminate special barriers for APRN delegation of medical tasks to RNs Eliminate special barriers for APRN delegation of tasks and orders to RNs and other staff Medical malpractice coverage to include the language found in 441.16 plus Adm. Code Ins 17 – what is supervision, Not supportive of including administrative code language into statutes.

Summary of Activities (December – January) APRN Coalition Legislative Committee and Lobbyist met regularly to review and develop language that would be acceptable to WHA. (January 10) APRN Coalition lobbyist and representatives met with WHA lobbyists to share our response to the nine proposed amendments. Agreed on the following:

Summary of Activities Agreement APRN Coalition will create report that demonstrates quality care provided by APRNs. WNA legal counsel will work with WHAs legal counsel to review drafting language/instructions related to Board of Nursing nineteen recommendations.

Summary of Activities Agreement (Continued) WNA and WHA legal counsels will discuss possible language options for including collaboration. WNA legal counsel will create the response to WHA proposed amendments using “legislation drafting language”.

Summary of Activities (January 12) APRN Quality Report completed. (January 12 ) Drafting instructions r/t the Board of Nursing 19 recommendations forwarded to bill sponsors to begin development of amendments to legislative bill. (January 11 – 14) WNA legal counsel had two discussions and emails with WHA legal counsel related to conceptual collaboration language. WNA legal counsel encountered delays in hearing back from WHA.

Summary of Activities (January 14) APRN Coalition Meeting with APRN Lobbyists Reviewed current status. Identified future Health Committee public hearings: Assembly to finish end of February. One more Senate Health Committee. Due to lack of time, there was consensus to pull bill for this biennium. Bill sponsors committed to next session.

Accomplishments APRN Coalition Legislative Committee members achieved consensus on a legislative draft. Obtained bill sponsors from Assembly and Senate. Bills introduced and assigned to Health Committees. Successful APRN Lobby Day. Effective Talking Points developed and distributed. Increased awareness of the role of APRNs.

Accomplishments Legislative breakfast resulted in legislator commitment to being sponsor. 200 formal members of the Wisconsin APRN Coalition (mostly NPs and CNSs). Multiple statewide presentations to APRNs and APRN nursing students.

Barriers Bill introduced late in the session. WHA power and influence. Unable to reach consensus on collaboration language with WHA. Did not achieve a critical mass of APRNs which impacted local advocacy efforts.

Next steps APRN Coalition Legislative Committee is working on review and revisions to legislation. APRN Coalition will develop and implement a grass roots advocacy strategy for summer-winter. Reach out to legislators and other candiates during this time to increase awareness: All 99 Assembly Representatives seats are up for election. One half, 17 of the Senate seats are up for election.

Next steps Attend fund raisers (WNA will provide info, thanks to WNA lobbyist Forbes McIntosh) Attend legislator Town Hall Meetings (WNA will provide info, thanks to WNA lobbyist Forbes McIntosh) Schedule coffee meetings with your legislators and candidates. WNA will assist in the planning of legislative breakfast.

Rejoin/join the WI APRN Coalition. $50.00 per year supports: Cost of lobbyist work that include visibility at the Capitol. Provide materials that you can give to your legislators, physicians, health system CEOs and consumers. Conference call meetings of the Coalition Committees. Improved and more robust APRN Coalition website. Planning Legislative Breakfasts or Evening Receptions. 2019 APRN Lobby Day. Alerts and Call to Action. Member update calls.

Resources To rejoin/join the APRN Coalition please go to: Wisconsin Vote - will provide a listing of all the candidates and their contact information that are running for the Assembly and Senate. WNA will let you know when it is ready to view. To rejoin/join the APRN Coalition please go to: https://www.cognitoforms.com/WisconsinNursesAs sociation/RejoinJoinTheWisconsinAPRNCoalition

Thank you for your interest and invite you to support our continued efforts. “I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.” Florence Nightingale