Democratic Gov. Tony Evers again vetoed a bill to allow advanced practice nurses to work independently, a move that two years ago led the state nursing board chair to resign in protest.
Evers on Thursday vetoed the bill, approved by the Republican-controlled Legislature, to let nurse practitioners and other nurses with advanced training work without collaborative agreements with doctors. The measure didn’t provide “adequate experience requirements, titling protections, and safeguards for patients who may be treated for pain management,” Evers said.
The Wisconsin Medical Society and other doctor groups said nurses should have to work two years in a clinical setting plus two years as advanced practice nurses under a doctor’s supervision before qualifying for independent practice.
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The medical society also said advanced practice nurses who run pain clinics outside of hospitals should have to collaborate specifically with pain specialist doctors. The group also wants to protect specialty titles for doctors, such as “anesthesiologist.”
Those restrictions were not in the bill but were in the governor’s budget proposal last year.
“Every Wisconsin patient deserves to know that an independent nurse practitioner has spent a reasonable minimum number of years training and gaining experience, will properly collaborate with a qualified physician if pain medicine is needed, and will not be misled by confusing and potentially deceptive advertising,” the medical society said in a statement.
Gina Dennik-Champion, CEO of the Wisconsin Nurses Association, said the group will try for another bill to give advanced practice nurses “full practice authority” next Legislative session. Such nurses could expand care in rural areas and places where patients face long waits for care, she said.
“They’re willing to open up their own practices, and where they’re interested in working is where the (doctor) shortages are,” Dennik-Champion said.
After Evers vetoed a similar bill two years ago, for similar reasons, Peter Kallio, chair of the state Board of Nursing, resigned. In a letter, he told Evers that “you and your administration know very little about the day-to-day work of advanced practices (sic) nurses in Wisconsin.”
About 8,000 of Wisconsin’s 94,000 registered nurses have advanced degrees, working as nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists or certified nurse midwives.
Currently, many of them can be certified as advanced practice nurse prescribers of medications. The bill would replace that designation with a new license for advanced practice registered nurses, or APRNs. More than half of states let advance practice nurses work independently.
Three years ago, the American Association of Nurse Anesthetists changed its name to the American Association of Nurse Anesthesiology and encouraged members to refer to themselves as nurse anesthesiologists.
The Wisconsin Medical Society says that is misleading.
Jenna Palzkill, of the Wisconsin Association of Nurse Anesthetists, said last year that many younger providers believe “nurse anesthesiologist” better reflects the extent of their training.