HOUSE BILL REPORT
SB 6739
This analysis was prepared by non-partisan legislative staff for the use of legislative members in
their deliberations. This analysis is not a part of the legislation nor does it constitute a
statement of legislative intent.
As Passed House - Amended:
March 4, 2008
Title: An act relating to psychiatric advanced registered nurse practitioners.
Brief Description: Granting authority to psychiatric advanced registered nurse practitioners.
Sponsors: By Senators Franklin, Prentice, Marr and Jacobsen.
Brief History:
Health Care & Wellness: 2/21/08, 2/25/08 [DPA].
Floor Activity:
Passed House - Amended: 3/4/08, 93-0.
Brief Summary of Bill (As Amended by House) |
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HOUSE COMMITTEE ON HEALTH CARE & WELLNESS
Majority Report: Do pass as amended. Signed by 12 members: Representatives Cody, Chair; Morrell, Vice Chair; Hinkle, Ranking Minority Member; Alexander, Assistant Ranking Minority Member; Barlow, Condotta, DeBolt, Green, Moeller, Pedersen, Schual-Berke and Seaquist.
Staff: Chris Blake (786-7392).
Background:
Advanced Registered Nurse Practitioners
Advanced registered nurse practitioners are registered nurses with additional formal
specialized training in areas such as pediatrics, midwifery, geriatrics, anesthesiology, and
psychiatry. Advanced registered nurse practitioners function more independently than
registered nurses and assume primary responsibility and accountability for care of their
patients. An advanced registered nurse practitioner may examine patients and establish
medical diagnoses, admit patients to health care facilities, order and interpret lab tests,
implement a plan of care for patients, prescribe medications, and refer clients to other health
care practitioners or facilities.
The Nursing Care Quality Assurance Commission recognizes a specialty designation for
psychiatric advanced registered nurse practitioners and clinical specialists in
psychiatric-mental health nursing.
Decisions Relating to the Use of Anti-psychotic Medications
Individuals suffering from mental illness who are found to be gravely disabled or present a
likelihood of serious harm have the right to refuse anti-psychotic medication. This right can
be overridden if it is determined that the failure to medicate may result in a likelihood of
serious harm or substantial deterioration of the patient or it will substantially prolong the
length of involuntary commitment and there is no less intrusive course of treatment than
medication that is in the best interests of the person. The Department of Social and Health
Services (Department) must adopt rules to address these issues which include an attempt to
obtain the informed consent of the patient and the right to refuse anti-psychotic medications
for up to 30 days unless there is an additional concurring medical opinion approving
medication.
A court may appoint a psychiatrist, psychologist, or physician to examine and testify on
behalf of a patient at a hearing to authorize the use of anti-psychotic medications. A court,
however, must appoint a psychiatrist, psychologist, or physician to testify on behalf of a
person involuntarily detained where an order for electro-convulsant therapy is being sought.
Summary of Amended Bill:
"Psychiatric advanced registered nurse practitioners" are defined as licensed advanced
registered nurse practitioners who are board-certified in advanced practice psychiatric and
mental health nursing. Psychiatric advanced registered nurse practitioners are added to the
terms "professional person" and "developmental disabilities professional" which describe
individuals that perform many of the evaluation and treatment activities for people in the
inpatient mental health system.
Psychiatric advanced registered nurse practitioners may admit individuals for examination or
treatment as a patient in a hospital.
As an alternative to a physician, the opinion of a psychiatric advanced registered nurse
practitioner may be used in determining that a person's condition constitutes an emergency
that requires the use of anti-psychotic medications prior to the occurrence of a judicial
hearing.
A psychiatrist, psychiatric advanced registered nurse practitioner, or physician in consultation
with a mental health professional with prescriptive authority is expressly authorized to
provide the concurring medical opinion to allow for the administration of anti-psychotic
medication in short-term treatment situations.
Psychiatric advanced registered nurse practitioners are added to the list of health care
providers who may be appointed by the court to testify on behalf of a patient who is the
subject of a hearing regarding the administration of anti-psychotic medications and must be
appointed when the hearing relates to the use of electro-convulsant therapy.
Appropriation: None.
Fiscal Note: Not requested.
Effective Date of Amended Bill: The bill takes effect 90 days after adjournment of session in which bill is passed.
Staff Summary of Public Testimony:
(In support) Authorizing psychiatric advanced registered nurse practitioners to perform to the
full extent of their training will alleviate delays in treatment to patients and help the shortage
of psychiatric care practitioners. Facilities in underserved areas can more adequately treat
patients when staffed with psychiatric advanced registered nurse practitioners. Public safety
is increased when involuntary detention facilities provide appropriate care to those who may
be a danger to themselves or others. This bill does not expand the scope of practice of
psychiatric advanced registered nurse practitioners, but updates the statutes to include them in
the list of professionals who work with patients who have been involuntarily detained.
(With concerns) The bill is written too broadly by expanding authority for psychiatric
advanced registered nurse practitioners. When individuals are to be forced to take
medication, a medical doctor should at least be one of the signors.
Persons Testifying: (In support) Leslie Emerick, Association of Advanced Practice
Psychiatric Nurses; Laura Hoeman; Lisa Trigg, West Seattle Psychiatric Hospital; and David
Dula, Pierce County.
(With concerns) Bob Cooper, Washington Association of Criminal Defense Attorney's and
Washington Defender Association.