SENATE BILL REPORT

                   SB 5805

              As Reported By Senate Committee On:

            Health & Long‑Term Care, March 1, 1999

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

Brief Description:  Completing prescriptive authority for advanced registered nurse practitioners.

Sponsors:  Senators Thibaudeau, Prentice, Deccio, Kohl‑Welles and Costa.

Brief History:

Committee Activity:  Health & Long‑Term Care:  2/22/99, 3/1/99 [DPS].

SENATE COMMITTEE ON HEALTH & LONG-TERM CARE

Majority Report:  That Substitute Senate Bill No. 5805 be substituted therefor, and the substitute bill do pass.

  Signed by Senators Thibaudeau, Chair; Wojahn, Vice Chair; Costa, Deccio, Franklin, Johnson and Winsley.

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 Substitute Bill:  Advanced registered nurse practitioners are given expanded prescriptive authority to include schedule II through IV drugs of the Uniform Controlled Substances Act.  ARNPs may order or prescribe these drugs under joint practice arrangements and collaboration with a physician or osteopathic physician.

The Medical Quality Assurance Commission, the Board of Osteopathic Medicine and Surgery and the Nurse=s Quality Assurance Commission are directed to jointly adopt a process and criteria to implement the joint practice arrangements.

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

Substitute Bill Compared to Original Bill:  The original bill set up an advisory board which was eliminated in the substitute.  The substitute bill also introduced the joint practice arrangements and authorized the consensus rulemaking.

Appropriation:  None.

Fiscal Note:  Requested on February 19, 1999.

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

Testimony For:  ARNPs have a long history of safely prescribing many drugs.  This will allow them to provide better care to patients.

Testimony Against:  Doctors need to be directly involved in these prescribing practices.

Testified:  PRO:  Jery Falley, ARNPs United; Tamara Warnke, WSNA; Dwight Bushee, WSNA; CON: Carl Nelson, WSMA.