Flock of Bills seeks to change Advanced Practice Nursing in Oklahoma

Posted By American Med Spa Association, Wednesday, January 23, 2019

Five new bills introduced in Oklahoma seek to change the practice of Advanced Practice Registered Nursing (APRN). One of the bills clarifies licensing requirements for APRNs. 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.
Introduced by State Senator Adam Pugh, Senate Bill 939 (SB 939) would specify that in order to qualify for the APRN license the applicant would need to have completed a graduate level education program accredited by either the Accreditation Commission for Education in Nursing (ACEN) or the Commission of Collegiate Nursing Education (CCNE). During this education program, they must also complete at least one thousand hours clinical hours and attend campus periodically for progress and competence assessments. The current law only requires that the education program be “accredited,” but does not specify a particular accrediting body.
The next four bills would create a path for APRNs to practice independently of a physician. State Senator Greg McCortney introduced Senate Bill 917 (SB 917) which if passed would include APRNs in the definition of “practitioner,” and allow APRNs to practice without physician supervision after completing a mentorship. SB 917 just like SB 939 above would also require that APRNs complete an education program accredited by ACEN or CCNE. A Nurse Practitioner who has either been nationally certified for seven years or completed a mentorship of 10,400 hours with a physician or who has at least 10 years of experience may apply for a waiver of supervision. Once the waiver is granted and the Nurse Practitioner obtains prescribing authority, they would be able to practice without physician supervision. APRNs would have the option of choosing to continue practicing under physician supervision. 
State Senator Jason Smalley Senate Bill 839 (SB 839) and contains substantially similar provisions as SB 917. The major difference comes in the granted prescribing authority. SB 917 allows APRNs to have prescription authority for Schedule III through V controlled substances. SB 839 would also allow Nurse Practitioners to prescribe Schedule II drugs but only those used to treat attention deficits. In both bills a Nurse Anesthetist is able to prescribe on schedule II during the pre-operative or pre-obstetrical period.
Representative Chad Caldwell introduced House Bill 2349 (HB 2349), which also provides for APRNs to apply for a waiver of supervision. In order to qualify for the waiver, an APRN must receive a minimum of 10,000 hours of in-person clinical supervision over a 5 year period by a physician who has at least 10 years of experience. After submitting evidence of this supervision along with an application and a statement of competency by the physician providing prescriptive supervision the APRN can be designated as an “Unsupervised Advanced Practice Registered Nurse.” This designation is valid for 5 years and then the APRN must be re-evaluated to renew for an additional 5 years. While this unsupervised designation may seem similar to the bills above it comes with a substantial restriction. The unsupervised APRN must practice in counties with a population under 25,000. This designation may be very beneficial to patients in rural counties it will be of limited utility to APRNs.
Introduced by freshman Representative Cynthia Roe House Bill 1928 (HB 1928) would make it easier for APRNs to obtain prescriptive authority. Currently an APRN must submit a statement from the physician supervising the prescriptive authority along with their application. Under HB 1928 they would only need to submit this statement within the first 5 years of being licensed as an APRN if they have less than 10 total years of experience as a nurse or within the first 3 years as an APRN if they have more than 10 years of nursing experience.
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 Oklahoma closer to fully independent practice. Many of these bills have substantial overlap and it is extremely unlikely all of them will pass. The bill sponsors may want to coordinate among themselves to craft a single bill for the Senate and House that they can all stand behind.