NURSES ON THE HILL
LEGISLATIVE UPDATE

Update on SB 176 / HB 184


Current Status: Our legislation HB 184 / SB 176: Increasing Access to Care for Tennesseans was heard in the Senate Commerce Committee yesterday afternoon, April 6, and was rolled to the first calendar of 2022 by bill sponsor Senator Lundberg.


To help gain support of the legislation, TNA accepted an amendment to the legislation that created a transition to prescribing. Other amendments issued by the health department were also added to the legislation. Having the prescription amendment added and on record is a great win, as it gives us on opportunity to continue to educate members on the issue leading into next year’s legislative session.


What this means: The bottom line is this: we are in a better position to continue to educate and advocate members on the importance of this legislation.    


Unlike last summer, we now know which legislators will hear our bill and will have more time to share our messages with them.


Next Steps: Our fight for legislative change is not over, but this progress could not have been made without your fervent support. The time and energy you have put in to contact these legislators and emphasize the importance of this legislation is greatly appreciated and essential to our fight. We cannot thank you enough for your efforts and look forward to your continued support as we approach the next session.


Please let us know if you have any questions. We will be in touch with further instruction regarding our strategy for the next 8-9 months.


If you would like to get more involved, please email Kathleen Murphy at kathleen.murphy@tnaonline.org.


Thank you, and onward to 2022!



 

NURSES ON THE HILL
ACTION ALERTS

CONTACT LEGISLATORS ABOUT SB176/HB184: INCREASING ACCESS TO CARE FOR TENNESSEANS

This legislation (read the full version here or the summary here) makes various changes to the licensing of and prescribing authority for advanced practice registered nurses.

WHEN: This legislation SB176/HB184 is scheduled to be heard in the House Health Subcommittee on April 6. It will also be heard in the Senate Commerce and Labor Committee on April 6. We will keep you updated if this changes. 


WHO: Emails and Phone Numbers are listed at the bottom of this page along with sample scripts to personalize your message. 


Remember: Referring to this legislation SB176/HB184 as achieving Full Practice Authority is often misunderstood.

  • This legislation would remove physician oversight of Advanced Practice Registered Nurses and keep the regulation of the profession of nursing under the Board of Nursing, thus being called full practice authority.

  • Full practice would not allow APRNs to do anything they are not currently allowed to do.


Talking Points to use in support of SB176/HB184:

  • SB176/HB184 removes unnecessary and harmful barriers – and creates new opportunities to improve access to care across the state. APRNs are educated to evaluate, diagnose, initiate, and manage treatments, including prescribing medications. It’s time to let them do that and help Tennesseans improve their health rankings and outcomes!

  • It's common sense: by removing barriers, lawmakers make it easier and more affordable for APRNs to practice. Better access to health care means better outcomes for patients. Patient health outcomes should be the yardstick for licensure rules. Multiple research studies have proven that there is no evidence that a collaborative agreement mandate has any positive impact on patient health outcomes.

  • Updating the Nurse Practice Act ends a very costly and prohibitive mandate for APRNs to pay a doctor to review charts and prescriptions several weeks after the patient is cared for. Some may say this legislation is radical. What’s radical is how the state is resisting modernizing healthcare delivery by APRN practice to the benefit of all Tennesseans. APRNs are the Future of Primary Care as 72.6% of APRNs deliver primary care nationally. By 2026, the Bureau of Labor Statistics projects that the APRNs' role will grow by 36% compared to 13% for physicians. This statistic alone indicates how Tennessee is behind the curve when it comes to healthcare delivery.

  • When APRNs are able to practice to the full extent of their education, they are able to serve more Tennesseans and provide more options for healthcare services.

Additional Information to share with Legislators:

What this Legislation SB176/HB184 Accomplishes: Removes the need for a collaborative practice agreement with a physician. Establishes the Board of Nursing as the only licensing body overseeing APRN practice. The APRN license meets the need for a fitness to prescribe. Allows APRNs to manage their practice without extra red tape and costs.


What is a collaborative agreement? Antiquated and burdensome contract between a physician and an APRN that allows the APRN to prescribe medication. It is a costly restriction mandating that the physician review patient charts of the APRN; the cost for this collaborative agreement is on average $1500/month per a recent survey conducted in Tennessee. The physician might never see the patient, yet the patient is usually billed for this mandate. There are no health or safety benefits to a patient when their chart is looked at 30 days after receiving treatment.


Why is healthcare more expensive in Tennessee?  Our laws and regulations result in higher costs for patients and taxpayers because added administrative and billing costs are passed along. Only physicians benefit from the current set up and costs of collaborative agreements.  If Tennessee wants to continue to be attractive for economic and community development, it must provide world-class, affordable healthcare services that are readily available for all Tennesseans. Removing the barriers of practice for APRNs is one of the many cost-effective ways that Tennessee can move its healthcare system into the 21st century and ensure that Tennesseans are receiving the care they need.


Shouldn’t Tennesseans be able to choose who provides and cares for their families without the hidden surprise of a caregiver they have never seen billing for their services? Unfortunately, Tennessee law currently suppresses that choice by reducing the available supply of providers and restricting the range and services they can offer, thus increasing healthcare costs. Competition in health care markets benefits Tennesseans by helping to control costs, improve quality of care, promote innovative products, services and service delivery models, and expand access to healthcare services and goods. 

Here is a sample script you can you use:

Don't forget a best practice for emailing legislators is to personalize the email. Remember to ask for their vote and include your name, address,

and THAT YOU ARE A REGISTERED NURSE!!


Dear Representative/Senator,


My name is ________________. I am a Registered Nurse. Please vote yes on SB176/HB184 by Sen. Lundberg and Rep. Ramsey.


To improve access to care during the COVID-19 pandemic, Governor Lee waived restrictions so Tennesseans could have more access and options to health care, including access to APRNs. We need to continue to allow APRNs to practice without the burden of collaborative agreements. This legislation will cut outdated, unnecessary requirements hindering APRNs from providing care to Tennesseans patients.


Less red tape means more access and more options for millions of Tennesseans living in primary care shortage areas. Please help cut red tape and allow APRNs to provide the same high-quality advanced nursing care they provide today to more patients at less cost, resulting in more access and options for Tennesseans.


APRNs WILL NOT expand their scope of practice. Over 31 states, DC and the VA system have removed barriers to APRN care, reducing costs and providing access for patients. None of them have looked back. Removing unnecessary regulations on APRNs is a no-cost solution to improving access to care.


Will you vote yes on SB176/HB184?


Sincerely,

(Your Name and degrees)

(Your Contact Information)

Contact Information for the Committee Members:

House Health Committee Members

Rep. Hall (615) 741-1350 Rep.Mark.Hall@capitol.tn.gov

Rep. Hicks (615) 741-1717 Rep.Tim.Hicks@capitol.tn.gov

Rep. Whitson (615) 741-1864 Rep.Sam.Whitson@capitol.tn.gov

Rep. Vaughan (615) 741-1866 Rep.Kevin.Vaughan@capitol.tn.gov

Rep. Williams (615) 741-1875 Rep.Ryan.Williams@capitol.tn.gov

Rep. Helton (615) 741-1934 Rep.Ester.Helton@capitol.tn.gov

Rep. Sherrell (615) 741-1963 Rep.Paul.Sherrell@capitol.tn.gov

Rep. Terry (615) 741-2180 Rep.Bryan.Terry@capitol.tn.gov 

Rep. Alexander (615) 741-2251 Rep.Rebecca.Alexander@capitol.tn.gov

Rep. Smith (615) 741-2548 Rep.Robin.Smith@capitol.tn.gov 

Rep. Hakeem (615) 741-2702 Rep.Yusuf.Hakeem@capitol.tn.gov

Rep. Kumar (615) 741-2860 Rep.Sabi.Kumar@capitol.tn.gov

Rep. Ramsey (615) 741-3560 Rep.Bob.Ramsey@capitol.tn.gov

Rep. Mitchell (615) 741-4317 Rep.Bo.Mitchell@capitol.tn.gov

Rep. Clemmons (615) 741-4410 Rep.John.Ray.Clemmons@capitol.tn.gov

Rep. Freeman (615) 741-0709 Rep.Bob.Freeman@capitol.tn.gov 

Rep. Marsh (615) 741-6824 Rep.Pat.Marsh@capitol.tn.gov 

Rep. Gant (615) 741-6890 Rep.Ron.Gant@capitol.tn.gov

Rep. Jernigan (615) 741-6959 Rep.Darren.Jernigan@capitol.tn.gov 

Rep. Leatherwood (615) 741-7084 Rep.Tom.Leatherwood@capitol.tn.gov

Rep. Boyd (615) 741-7086 Rep.Clark.Boyd@capitol.tn.gov

Senate Commerce Committee Members

Sen. Akbari (615)741-1767

Sen.Raumesh.Akbari@capitol.tn.gov

Sen. Bailey     (615) 741-3978

Sen.Paul.Bailey@capitol.tn.gov

Sen. Johnson  (615) 741-2495

Sen.Jack.Johnson@capitol.tn.gov

Sen. Niceley   (615) 741-2061

Sen.Frank.Niceley@capitol.tn.gov

Sen. Reeves    (615) 741-1066

Sen.Shane.Reeves@capitol.tn.gov

Sen. Southerland       (615) 741-3851

Sen.SteveSoutherland@capitol.tn.gov

Sen. Swann    (615) 741-0981

 Sen.Art.Swann@capitol.tn.gov

Sen. Watson   (615) 741-3227

Sen.Bo.Watson@capitol.tn.gov

Sen. Yager      (615) 741-1449

Sen.KenYager@capitol.tn.gov

If you get feedback from a legislator, let TNA know here.




CONTACT THE SENATE HEALTH & WELLNESS COMMITTEE ON SB 478 / HB 743

TNA has endorsed Senate Bill 478 / House Bill 473, which will allow APRNs and PAs to order home health services for their patients, enabling greater access to home health services and allowing patients to choose their provider.

Background:

Existing Tennessee law requires orders for home health services to be written by a physician; however, many Tennesseans, especially those in rural areas, see an advanced practice registered nurse (APRN) or physician assistant (PA) for their primary care needs.


The CARES Act, which was signed into law by President Trump, permanently changed federal law so that APRNs and PAs can now order home health services for their Medicare patients.


What does SB 478 / HB 743 do?

The bill changes the definition of home health services to allow APRNs and PAs to order home health services for their patients, aligning Tennessee law with federal law. See the legislation here.


How will SB 478 / HB 743 benefit Tennesseans?

The bill will ensure greater accessibility to home health services. The bill allows patients to choose who their provider is and does not force patients to establish new relationships with a provider they have never seen before to meet an administrative requirement.


The bill will eliminate a step in the authorization process, thus speeding up the process for approval, and improving access to home health care for patients. This will also speed up the time that it takes for home health providers to be paid for claims submitted. 

How you can help: 

We’re asking our members to show their support for this Bill by contacting the Senators on this Committee and asking them to vote YES on SB 478.

Senate Health Committee Members to Email:


Best Practices for Emailing Legislators:

  • Send a separate email to each Legislator.

  • Use the talking points but make sure to personalize the email.

  • Include your name, address, and that you are a NURSE!

  • Remember to ask for their vote: Please vote yes on SB 478!


If you get feedback from a committee member, let TNA know here!

 

COVID-19 UPDATES


Update as of December 22, 2020

Governor Lee signed Executive Order 73, which continues relief for nurse graduates who have not taken the NCLEX exam. The order does not expand relief for RNs or APRNs. 

The full order can be accessed here: Executive Order 73.

Update as of August 28, 2020

Governor Bill Lee signed Executive Order No. 59 to extend certain, targeted provisions of Executive Order Nos. 36, 38, 49, 50, 54, and 55 through September 30, 2020 to facilitate the continued treatment and containment of COVID-19 through regulatory flexibility, promoting social distancing and wearing face coverings in public places, and protecting vulnerable populations.

The full order can be accessed here: Executive Order 59.


Governor Lee also signed Executive Order Nos. 60 and 61, which extend through September 30 provisions that allow for electronic government meetings subject to transparency safeguards and remote notarization and witnessing of documents, allowing for implementation of best practices developed during COVID-19 for providing live broadcasts of electronic meetings and safely conducting in-person transactions, respectively, beginning October 1.

The full orders can be accessed here: Executive Order 60 and Executive Order 61

Update as of July 21, 2020

Sharing updated CDC guidance regarding COVID-19 via the Tennessee Department of Health. Access the full PDF here


Update as of June 29, 2020

Governor Lee has issued Executive Order 50, which extends Tennessee's State of Emergency through to August 29, 2020 and extends the provision that allows nursing students to practice under supervision without examination.

COVID-19 TNA Member Survey Results

This survey comprises the responses from 471 TNA members between March 18 and March 25. The survey sought to gauge TNA members' thoughts on their work environment's preparedness, PPE and other concerns and needs. The full survey results can be accessed here: COVID-19 Survey Results

Update as of May 12, 2020

Governor Lee has issued Executive Order 36, which allows nursing graduates who have applied and fulfilled all other requirements for licensure as a nurse, but have yet to take the National Council Licensure Exam, to practice nursing under the supervision of a licensed RN. The Order outlines that the expanded scope of practice provisions for nurses and physician assistants issued in Executive Orders 15 and 28 will not continue after May 18. 

Update as of April 17, 2020

Governor Lee issued Executive Order 28 that removed additional regulatory barriers to facilitate the treatment and containment of COVID-19. In particular, the order suspends the collaborating physician requirement for nurse practitioners and physician assistants to provide increased flexibility regarding where these professionals can provide health care services to facilitate the COVID-19 response;
allows nursing school graduates waiting to take the national nursing exam to go to work during the emergency under the supervision of a licensed nurse to boost health care resources; and allows nurse practitioners and physician assistants to write orders for home health services to address the increased need for such services, among other things.

Update as of April 13, 2020

Governor Lee issued Executive Order 27 that extends the Stay-at-Home provisions of Executive Orders 17, 21, 22 and 23 to April 30. 

Update as of March 30, 2020

The key to slowing and preventing the spread of COVID-19 is to stay at home and practice physical distancing. We've penned an open letter to Tennesseans in partnership with the Tennessee Pharmacists Association and the Tennessee Academy of Physician Assistants thanking them for staying home.

Update as of March 26, 2020

Governor Lee issued Executive Order 20, which furthered the mobilization efforts of healthcare workers by allowing retired healthcare professionals to aid in the COVID-19 response. A link to the full Executive Order can be accessed here: Executive Order 20.

Please assess your individual risk before volunteering, especially if you are in an at-risk group or have an underlying condition. 

Update as of March 19, 2020

On March 19, Governor Lee issued Executive Order 15, which allows APRNs to treat patients impacted by COVID-19 without the restrictive red tape of collaborative practice agreements. This order is in effect until May 18, and demonstrates just how essential removing these unnecessary barriers is for increasing access to care when and where it is needed most. We applaud Governor Lee for issuing this measure that will increase care for Tennesseans as healthcare providers work to slow the spread of COVID-19. 
 
A link to the full order can be accessed here: Executive Order 15 

 

PUTTING PATIENTS FIRST

THANK YOU TO OUR SUPPORTERS

Thank you to all those who have demonstrated tremendous support for legislation that removes the mandate for a collaborative practice agreement with a physician in order for Advanced Practice Registered Nurses (APRNs) to practice and care for Tennesseans. 

More information on the status of our proposed legislation can be found in the notice sent to members of the Tennessee Nurses Association

To help support legislative candidates who support nurses and our patients, please consider making a donation to the TN Nurses PAC.

We will update this site with more information on next steps in the coming weeks and months. 

RESPONSE TO THE PHYSICIANS FOR PATIENT PROTECTION GROUP OPINION PIECE

On March 26, The Tennessean issued an opinion piece from two members of the Physicians for Patient Protection Group regarding our legislation to update the Nurse Practice Act. This op-ed included several factual inaccuracies.


Our responses to these factual inaccuracies can be accessed here: TNA Response to Physicians for Patient Protection Group Opinion Piece

 

UPDATING THE NURSE PRACTICE ACT

An Introduction

Everyday access to care and options for care are increasingly becoming a great challenge to Tennesseans. We believe the most actionable and impactful solution is to clear the way for Advanced Practice Registered Nurses (APRNs - nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists) to do what they are educated and trained to do: serve communities and patients.

The only thing that stands in the way is outdated, unnecessary, costly regulation that forces career long physician oversight on APRNs. These burdensome regulations make it prohibitive for APRNs to set up practices to administer the care they are trained to do in areas that are underserved or could benefit from cost effective choice.

That’s why in 2021, the Tennessee Nurses Association and the Coalition for Access to Care for Tennessee has introduced updates to the Nurse Practice Act (SB176/HB184), which remove unnecessary and harmful regulations – and create new opportunities to improve access to care across the state.

 
 
 

Why the Need in Tennessee? Why now?

Tennessee is facing a health outcome and access to care crisis.

Since 2010, 163 rural hospitals have closed in the United States according to the Cecil G. Sheps Center for Health Services Research. Tennessee has had 13 hospitals close during this time, the second most of any state. This means that everyday access to care and options for care are becoming a greater challenge to Tennesseans across the state.

These challenges aren’t just with closing hospitals, but include physician supply and capacity to meet the needs of an aging population. By 2032, our country potentially faces a shortage of approximately 122,000 physicians as the over-65 population grows by nearly 50%, according to the Association of American Medical Colleges.

Ranked 44th in health outcomes, the state of Tennessee is one of 11 states with the highest level of restrictions placed on advanced practice registered nurses. The state law requires career-long oversight and delegation or team management by another health provider for the advanced practice registered nurse to provide patient care.

As access to care becomes increasingly difficult, Tennesseans are not getting the care they need to improve their health outcomes. Now is the time to set up proper market conditions to increase access and help Tennesseans.

 
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UNDERSTANDING OUR SOLUTION

Toolkit

As there is no shortage of information that supports the vital need for full practice for APRNs, what follows are tool kits, fact sheets, and talking points you may download to inform your conversations and share with colleagues and your legislators:

FULL PRACTICE ELEVATOR PITCH

CONTACT HEALTH COMMITTEE

WHAT IS FULL PRACTICE AUTHORITY

APRN EDUCATION FACT SHEET

LEGISLATIVE ADVOCACY PACKAGE

 

MYTHS

The following myths are often perpetuated and unfounded. Here, we will address each:

THEY SAY: “IN A TIME WHERE WE NEED MORE MEDICAL COLLABORATION, NOT LESS, THIS IS NOT THE RIGHT ACTION.”

The very charge of a nurse is collaboration. Updating the Nurse Practice Act ends a very costly and prohibitive need for Advanced Practice Registered Nurses to pay for a doctor to review charts several weeks after the patient is cared for. Advanced Practice Registered Nurses will continue to consult, refer and work closely with physicians and other healthcare providers based on the needs of their patients.

THEY SAY: “IF NURSES WANTED TO PRACTICE AS A DOCTOR THEY SHOULD GO TO MEDICAL SCHOOL.”

APRNs will practice only what they were effectively taught and trained to do. And they do it very well. All available data supports the fact that nurse practitioners have the professional acumen to match the primary care provided by physicians. Researchers have found that patients of both groups had comparable health outcomes. In fact, nurse practitioners were found to outperform doctors in measures of consultation time, patient follow-up, and patient satisfaction.

THEY SAY: "DOCTORS ARE A NECESSARY PART OF TREATMENT"

No data supports this. In fact the Federal Trade Commission reported the following: "We have not seen research suggesting that the safety or quality of primary care services declines when APRN supervision or collaborative practice requirements are lessened or eliminated."

THEY SAY: "THIS IS TOO RADICAL FOR TENNESSEE"

Tennessee is one of only 12 states with the most restrictive practice environments. And it is 44th in health outcomes. It is more radical to not allow for APRNs to practice more freely to the benefit of Tennesseans.

 

THIRD PARTY SUPPORT

There is no shortage of validating third party support for removing mandated and outdated regulation of APRNs. These can all be used to speak to the issue and share with your legislators:

  • The Federal Trade Commission: “We have not seen research suggesting that the safety or quality of primary care services declines when APRN supervision or collaborative practice requirements are lessened or eliminated.”

  • The National Governor’s Association: “Among the quality of care components that these studies measure are several process measures, among them patient’s satisfaction, time spent with patients, prescribing accuracy, and the provision of preventive education. In each of these categories, Nurse Practitioners provided at least equal quality of care to patients as compared to physicians.”

  • Institute of Medicine's Future of Nursing Report: “The contention that APRNs are less able than physicians to deliver care that is safe, effective and efficient is not supported by the decades of research that has examined this question.”

  • American Enterprise Institute: "We have reviewed sizable body of evidence related to whether there was any difference in quality of care when it was provided by APRNs rather than physicians. There is extensive empirical evidence that APRN practice outcomes are at least equivalent to those of physicians to which they are compared. And on some metrics, such as patient satisfaction, some studies have found APRN care is actually better."

  • The Cato Institute: “When physician groups argue to restrict the scope of practice of nurse practitioners, they argue that a broader scope of practice would threaten patient safety. Yet study after study has shown midlevel clinicians provide a level of quality equal to that of physicians performing the same services.”

 

GET INVOLVED

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CONTACT YOUR STATE LEGISLATORS

You can find contact information for members on the House and Senate Health Committees at the following link: House and Senate Health Committee Members

 
 

NEWS & VIEWS

Your Access to Care TN Resource Center

 
Coalition Leadership at Day on the Hill

ACCESS TO CARE TN MEMBERS

Working Towards Better Outcomes for Tennesseans

American Nurse Practitioner Association Regional Representative
American Nurse Practitioner Association – Tennessee Chapter
American Psychiatric Nurse Practitioners Association - Tennessee Chapter
Northeast Tennessee Nurse Practitioners Association
Greater Memphis Area Advanced Practice Nurses 
Middle Tennessee Advanced Practice Registered Nurses
Music City Chapter of National Academy of Pediatric Nurse Practitioners
TN Affiliate of the American College of Nurse-Midwives
Tennessee Deans & Directors Council
Tennessee Nurses Association
Tennessee Nurse Practitioner Association
VA Memphis APRN Council
West Tennessee Advanced Practice Psychiatric Nurses Association

 

VIDEOS

For more videos about this cause, please visit this page

 

EMAIL ACCESS TO CARE TN

 
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