81st Legislative Session - January 13 - June 1, 2009
HB 1107 by Rep. Wayne Christian (R-Center, HD #9) and Eddie Rodriguez (D-Austin, HD #51) was the centerpiece of our 2009 legislative agenda. This bill used model language adopted by the National Council of State Boards of Nursing to move APNs’ authority to establish a medical diagnosis and prescribe drugs and medical devices to the Texas Board of Nursing. As a result, we called this initiative, Nursing Board-Granted Prescriptive Authority.
It was the first time in 14 years that a legislator filed this type of prescriptive authority legislation, so it was the first time in 14 years that we truly had the opportunity to ascertain legislators’ understanding, attitudes, and fears involved in making this change. Many APNs were surprised that making a change that seems so logical to us is so frightening to legislators.
While the years APNs have spent visiting their legislators certainly helped, we found true understanding of the functions that APNs perform is still low. Legislators still had a hard time understanding how much APNs can do, at least in part, because they really don’t understand how much independent action RNs take. While they see RNs as educated and important, we have failed to help them know that RNs do not just passively follow doctors’ orders. This lesson will help shape our strategy during the Interim, and help us forge even stronger alliances with our RN colleagues.
We also learned that Rep. Wayne Christian is an eloquent and dedicated champion for APNs. If NPs need concrete evidence that time spent educating legislators is the path to success, listen to Rep. Christian’s opening and closing remarks on HB 1107 at the House Public Health hearing on April 14th. Time spent by NPs with Rep. Rodriguez paid huge dividends when he volunteered to joint author HB 1107. This meant we had a coalition of one of the most conservative and one of the most liberal representatives in the Texas House.
We knew it would be an uphill struggle for HB 1107, but we thought HB 696 by Rep. Rob Orr (R-Burleson, HD #58) and its companion bill, S.B. 680 by Sen. Glenn Hegar (R-Katy, SD #18) would fare much better. The bills kept diagnosis and prescribing as delegated tasks but allowed physicians much more autonomy in deciding where to delegate prescriptive authority and how to supervise those delegated functions.
SB 680/HB 696 succumbed to the power of the Texas Medical Association and the myths and realities behind that power. The medical associations made outrageous claims about the effects of S.B. 680 and H.B. 696, essentially claiming they were independent practice bills that would allow APNs to have the same scope of practice as physicians. Obviously, we countered those claims, but ultimately, opposition from medical organizations killed the bill.
In part, that may have happened because legislators had a bill that TMA did agree to support, SB 532 by Sen. Dan Patrick (R-Houston, SD #5), the retail clinic bill. Medical associations effectively fed into the universal human fear of change, and convinced key legislators that making baby steps to give APNs more prescriptive authority is all legislators should do. SB 532 passed and was sent to the Governor on June 1, 2009. (Click the link for detailed information on SB 532.)
2009 was a difficult session for those of us who believe so strongly in the power of APNs to improve health care for Texans. But we will use these difficult times and the lessons we learned to make us stronger and more effective. CNAP must become much more effective in motivating APNs to visit their legislators regularly and get involved in political campaigns.
Success requires that all APNs accept the personal challenge to use the Interim to educate legislators and the physicians with whom we work. APNs must help legislators understand:
1. Their practices and the health care services they provide daily to improve health for the legislator’s constituents;
2. The health care challenges that Texas faces and that baby steps are not going to address those challenges; and
3. Supervision has no impact on patient outcomes. Despite the fact that medical associations have no evidence to support their positions that physician supervision of prescriptive authority improves patient outcomes, APNs must overcome the general belief that supervision assures quality of care.
APNs must also continue to educate physicians who delegate prescriptive authority. We already knew that many physicians are afraid of medical associations, the Texas Medical Board, and antagonizing their peers, but we did not fully appreciate how prevalent and ingrained those feeling are. Most physicians do not want to do anything to draw unwanted attention, so writing a letter or making phone calls to support any bill that TMA opposes feels threatening. APNs must help physicians overcome fears and understand that:
1. Site-based restrictions TMA and other medical organizations support impose restrictions on exercising their independent medical judgment;
2. Reducing legal supervision requirements reduces any potential liability for care delivered by the NP; and
3. Removing legal restrictions on how physicians and APNs work together will allow physicians and APNs to deliver health care more effectively, and can boost the income potential for physicians who employ APNs.
To access handouts and background information to assist in writing letters and visiting legislators and staff, see the Legislative Guide.
For week by week details of the 2009 Legislative Session and a Summary of the Bills enacted that will affect APNs, see 2009 Legislative Updates & Summary.
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