Bevy of Bills Seeks to Change Advanced Practice Nursing in Arkansas

Posted By American Med Spa Association, Friday, March 8, 2019

Five new bills introduced in Arkansas seek to change the practice of Advanced Practice Registered Nursing (APRN). One of the bills expands prescribing privileges for APRNs. And the Four other bills would provide an avenue for APRNs to practice without the supervision of a physician, known as independent practice. These four bills all seek to accomplish substantially the same goal and will be described here in general terms with only the substantial differences being noted for each bill.
The first two Bills we’ll cover are identical versions in both the House and Senate. The Senate version, Senate Bill 189 (SB 189) is sponsored by State Senator David Wallace. The House version, House Bill 1282 (HB 1282) is sponsored by Representative Robin Lundstrum. These Bills would allow an APRN that has completed 2,000 hours of supervised practice to practice without a collaborative practice agreement with a physician. Under current rules APRNs may only practice in collaboration with a physician. The supervision needed for the 2,000 hours can be provided by a 1) physician, 2) another APRN who has already completed the 2,000 hours, or 3) gained in another state that has similar requirements to AR. Both SB 189 and HB 1282 are currently in their respective chamber’s Public Health, Welfare, and Labor Committees for further consideration. 
The next bills would create a path for APRNs to practice independently of a physician: 
Representative Michelle Gray introduced House Bill 1265 (HB 1265) which if passed would allow APRNs to apply for “full independent practice authority” after meeting certain requirements. In order to qualify for this authority an APRN would need to 1) submit a application to the Board of Medicine, 2) provide proof of practicing under physician supervision for at least 10,400 hours, 3) and provide any other information the Board requires. If successful the Board of Medicine would issue a certificate to the APRN that would allow them to practice without a collaborative agreement and with prescriptive authority that includes Schedule II-V controlled substances. HB 1265 is currently in the House Public Health, Welfare, and Labor Committee for further consideration. 
House Bill 1274 (HB 1274) introduced by Representative Aaron Pilkington would allow APRNs who practice in rural communities to do so without having a collaborative practice agreement with a physician. To qualify the APRN would need to 1) practice in a community with a population under 5,000 for 5 years, 2) pass a criminal background check, and 3) submit a letter of recommendation from an AR licensed physician. HB 1274 is currently in the House Public Health, Welfare, and Labor Committee for further consideration. 
Introduced by Representative Justin Gonzales House Bill 1267 (HB 1267) would allow APRNs to write prescriptions for Schedule II drugs in certain circumstances. As originally introduced HB 1267 would have allowed ARNs with 2,000 hours of practice to extend their prescriptive authority to include Schedule II drugs. However it was amended before it passed the House vote. Under its current language HB 1267 would allow an APRN to write a prescription for a schedule II opioid but only for a five day period and to prescribe a Schedule II stimulant only to continue a prescription originally issued by a physician who saw the patient within the last six months for the same condition. HB 1267 as amended is currently with the, you guessed it: Senate Public Health, Welfare, and Labor Committee awaiting further consideration.
The national trend has been towards giving APRNs the ability to practice nursing and prescribe medication independent from physician supervision. In that respect each of these bills would move Arkansas closer to fully independent practice. Many of these bills cover similar areas and are all currently in the same committees. It will be interesting to see which ones advance and how they are amended. We will be monitoring these Bills as they work their way through the legislative process.