Joint Practice Agreement No Longer Required
"This bill grants advanced registered nurse practitioners the authority to prescribe certain drug classes without a joint-practice arrangement with physicians. This bill is consistent with a Department of Health study that concluded these nurses are well-qualified to assume independent prescriptive authority." Governor Christine Gregoire, April 13, 2005.
2005 Legislative Wrap Up
HB 1479 - Removal of Joint Practice Agreement for Schedule II-IV drugs
This bill passed in the House and Senate unanimously after a strong grassroots effort by many ARNPs across the state. This success can also be attributed to the hard work and coordination of the ARNP Coalition, which includes ARNPs United, WA State Nursing Association (WSNA), the WA Chapter of American College of Nurse Midwives (ACNM), the WA Association of Nurse Anesthetists (WANA), and the Association of Advanced Practice Psychiatric Nurses (AAPPN).
Professional Liability Bills
Many bills were introduced and none passed, proving to be a very contentious and challenging issue to address. 2 initiatives were placed on the November 2005 ballot (one written by the WA State Medical Association and the other written by the Washington State Trial Lawyers Association), neither of which passed.
2005 Legislative Agenda
Removal of Joint Practice Agreement for Schedule II-V RxA
In 2000, ARNPs fought for and achieved full prescriptive authority (RxA) for Schedules II-IV (controlled substances). The bill's passage depended on a compromise measure demanded by its major opponent, the Washington State Medical Association. We agreed to the compromise, which mandated a Joint Practice Agreement (JPA) between the prescribing ARNP and a physician. The Washington State Department of Health (DOH) and the federal Drug Enforcement Administration (DEA) completed rules writing for full RxA in the fall of 2001.The sample JPA developed by the DOH (and utilized by most ARNPs) simply states that a relationship must exist between the ARNP and a physician for consultation about the use of these drugs if/when the ARNP needs to do so. It does not require that the ARNP consult with that physician, and so was really just a formality. In fact, completion of this agreement is unnecessary for nurse practitioners to provide competent care.
At the time of the bill's writing and passage, we gave notice that we would prove ourselves to be safe practitioners, and would in the near future promote legislation to remove the JPA. That time is now!
Professional Liability Insurance
Increases in professional liability insurance costs affect us all. For example, because obstetric coverage is so costly, many certified nurse-midwives (and their consulting obstetricians) have been forced out of practice, leaving women without the services they need and the choices they deserve. To protect access to healthcare, AUWS supports:
- Alternative dispute resolution such as binding arbitration or mediation
- Reduction in the statute of limitations for birth events to seven years (now 18 years)
- A cap on non-economic damages of $1,000,000 with an annual adjustment for inflation (we do not support a cap on economic damages)
- "Blame-free, system-wide" programs aimed at the reduction of errors made in the provision of health care
- Increased public disclosure of liability insurers' business practices, claims experiences and coverage determinations
AUWS will continue to "monitor" (keep tabs on) bills that can affect ARNPs and their patients, with an emphasis on legislation affecting:
- Access to women's health care
- Access to health care and nutrition for children
- Mental Health care coverage, as a member of the Mental Health Parity Coalition