SENATE BILL REPORT

                   SB 5232

              As Reported By Senate Committee On:

           Health & Long-Term Care, January 30, 1998

Title:  An act relating to completion of prescriptive authority for advanced registered nurse practitioners.

Brief Description:  Completing the prescriptive authority of advanced registered nurse practitioners.

Sponsors:  Senators Wood, Prentice, Deccio, Franklin, Fairley, Thibaudeau, Kohl and McAuliffe.

Brief History:

Committee Activity:  Health & Long‑Term Care:  2/4/97, 2/28/97 [DPS]; 1/22/98, 1/30/98 [DP2S, DNP] .

SENATE COMMITTEE ON HEALTH & LONG-TERM CARE

Majority Report:  That Second Substitute Senate Bill No. 5232 be substituted therefor, and the second substitute bill do pass.

  Signed by Senators Deccio, Chair; Wood, Vice Chair; Fairley and Franklin.

Minority Report:  Do not pass.

  Signed by Senators Benton and Wojahn.

Staff:  Rhoda Jones (786-7198)

Background:  Advanced registered nurse practitioners (ARNP) are registered nurses with formal specialized training which qualifies them to function more independently than a registered nurse in a variety of health care specialities.  ARNPs may have specialities in such areas as pediatrics, geriatrics, midwifery, anesthesiology, neonatology.  They must maintain a current certification in their specialized field in order to practice independently.

ARNPs have authority to prescribe legend drugs and controlled substances contained in schedule V of the Uniform Controlled Substances Act, Chapter 69.50 RCW.  ARNPs are required to have 30 hours of education in pharmacotherapeutics related to their scope of specialized and advance practice.  All ARNPs, except nurse anesthetists, are prohibited from prescribing schedules I through IV.  Certified registered nurse anesthetists may prescribe schedule II through IV drugs limited to those drugs which are to be directly administered to patients who require anesthesia. 

In 1991 legislation proposed expanding the authority of ARNPs to prescribe Schedules II through IV.  The Department of Health conducted a sunrise review to analyze issues of health and safety related to this request.      

Summary of Second Substitute Bill:  Advanced registered nurse practitioners are given expanded prescriptive authority to include schedule II through IV drugs of the Uniform Controlled Substances Act.

Advanced registered nurse practitioners may prescribe these drugs under a joint practice arrangement with a physician licensed under 18.71 or 18.57 RCW.  The Medical Quality Assurance Commission, the Board of Osteopathic Medicine and Surgery, and the Nursing Care Quality Assurance Commission are directed to jointly adopt rules by consensus implementing prescriptive authority for ARNPs authorized in this bill.  Conditions pertaining to prescriptive authority authorized in this bill do not apply to certified registered nurse anesthetists.

The dispensing of schedules II through IV controlled substances is limited to a maximum of a 72-hour supply of the prescribed controlled substance.

A temporary advisory committee is established to assist the Nursing Care Quality Assurance Commission implement this act.  Membership includes three advanced registered nurse practitioners with prescriptive authority, one physician, a pharmacist and the executive directors of their respective commissions and boards.

The Nursing Care Quality Assurance Commission must prepare a report to the Legislature, due January 1, 2000, on the implementation of this act.

Second Substitute Bill Compared to Original Bill:  Advanced registered nurse practitioners may prescribe these drugs under a joint practice arrangement with a physician licensed under 18.71 or 18.57 RCW.  The Medical Quality Assurance Commission, the Board of Osteopathic Medicine and Surgery, and the Nursing Care Quality Assurance Commission are directed to jointly adopt rules by consensus implementing prescriptive authority for ARNPs authorized in this bill.  Conditions pertaining to prescriptive authority authorized in this bill do not apply to certified registered nurse anesthetists.

Appropriation:  None.

Fiscal Note:  Available.

Effective Date:  Ninety days after adjournment of session in which bill is passed.

Testimony For:  ARNPs are highly trained in their specialties and must have the ability to provide medications to serve their patients.  Current restrictions compromise patient care.

Testimony Against:  These drugs require the direct supervision of physicians.

Testified:  Patti Varley, Harry Kerchner, ARNPs United (pro); Sharon Kiehn, Mike Jackson, Grant Mental Healthcare (pro); Carl Nelson, WSMA (con); Jeff Larsen, WA Osteopathic Medical Association (con).