SB26 SD1.DOC

SECTION 1. The legislature finds that advanced practice registered nurses are qualified and competent practitioners. The legislature finds that the department of commerce and consumer affairs requires advanced practice registered nurses to pay multiple fees for deposit into the compliance resolution fund. The legislature also finds that the department does not require members of other professions under its authority to pay comparable multiple fees into the compliance resolution fund. An advanced practice registered nurse is currently required to pay fees for initial issuance and each renewal of a license as a registered nurse, initial issuance and each renewal of a license as an advanced practice registered nurse, and initial issuance and each renewal of a certificate of prescriptive authority as an advanced practice registered nurse.

The multiple fee assessment imposed on advanced practice registered nurses creates unnecessary barriers to advanced practice registered nurses' licensure and practice. The department of commerce and consumer affairs has not provided justification for assessing advanced practice registered nurses in this manner. Accordingly, the purpose of this Act is to eliminate excessive fees for advanced practice registered nurses.

SECTION 2. Section 457-8.5, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Effective October 1, 2009, the board shall grant recognition as an advanced practice registered nurse to a nurse who has:

(1) A current, unencumbered license as a registered nurse in this State;

(2) An unencumbered license as a registered nurse in all other states in which the nurse has a current and active license;

(3) An unencumbered recognition as an advanced practice registered nurse or similar designation in all other states in which the nurse has a current and active recognition as an advanced practice registered nurse;

(4) Completed an accredited graduate-level education program leading to a master's degree as a certified registered nurse anesthetist, a nurse midwife, a clinical nurse specialist, or a nurse practitioner;

(5) A current, unencumbered certification of having passed a national certification examination that measures role and population-focused competencies and is recognized by the board;

(6) Maintained continued competencies through recertification in role and population-focused competencies through a national certification program recognized by the board;

(7) Acquired advanced clinical knowledge and skills preparing the nurse to provide direct care to patients through a significant educational and practical concentration on the direct care of patients;

(8) Demonstrated a greater breadth of knowledge, a greater synthesis of data, greater complexity of skills and interventions, and greater role autonomy than demonstrated by a registered nurse;

(9) Been educationally prepared to assume responsibility and accountability for health promotion and maintenance and to assess, diagnose, and manage patient problems through the use and prescription of pharmacologic and non-pharmacologic interventions;

(10) Acquired clinical experience of sufficient depth and breadth to reflect the intended license; and

(11) Paid the appropriate fees[.]; provided that the appropriate fees shall consist only of fees that are authorized under section 457-7 for registered nurses and the center for nursing fee established by section 3 of Act 198, Session Laws of Hawaii 2003."

SECTION 3. Section 457-8.6, Hawaii Revised Statutes, is amended to read as follows:

"§457-8.6 Prescriptive authority for advanced practice registered nurses. (a) The board shall grant prescriptive authority to qualified advanced practice registered nurses and shall designate the requirements for advanced nursing practice related to prescriptive authority. The board shall determine the exclusionary formulary for qualified advanced practice registered nurses who are granted prescriptive authority.

(b) The department of commerce and consumer affairs shall establish a joint formulary advisory committee composed of:

(1) Two persons licensed as advanced practice registered nurses and appointed by the board;

(2) Two persons licensed in medicine by the Hawaii medical board and appointed by the Hawaii medical board;

(3) Three persons licensed as pharmacists and appointed by the board of pharmacy;

(4) One representative of the University of Hawaii John A. Burns school of medicine appointed by the dean of the University of Hawaii John A. Burns school of medicine; and

(5) One representative from a school of nursing with an advanced practice registered nurse program.

The joint formulary advisory committee shall recommend the applicable formulary for persons recognized under this section. The board shall consider the recommendations of the joint formulary advisory committee in adopting the formulary. The appropriate working relationship with licensed physicians shall be reflected in rules adopted by the board in accordance with chapter 91.

(c) The board shall establish nursing requirements for education, experience, and national certification pursuant to rules adopted in accordance with chapter 91.

(d) Advanced practice registered nurses shall be considered qualified if they have met the requirements of section 457-8.5(a), and have met the advanced pharmacology requirements for initial prescriptive authority pursuant to rules adopted by the board. Only qualified advanced practice registered nurses authorized to diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources and, only as appropriate, to the practice specialty in which the advanced practice registered nurse is qualified, may:

(1) Prescribe and administer over the counter and legend drugs, and controlled substances pursuant to this chapter and to chapter 329; provided that an advanced practice registered nurse shall not request, receive, or sign for professional controlled substance samples;

(2) Prescribe, order, and dispense medical devices and equipment; and

(3) Plan and initiate a therapeutic regimen that includes nutritional, diagnostic, and supportive services including home health care, hospice, and physical and occupational therapy.

(e) Notwithstanding any law to the contrary, no advanced practice registered nurse shall be required to pay a fee relating to the grant of prescriptive authority."

SECTION 4. Section 457-9, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The license of every person licensed, recognized, or granted prescriptive authority shall expire on June 30 of every odd-numbered year and shall be renewed biennially, except as provided in this section. Biennially in each odd-numbered year, the board shall make available an application for renewal of license before the deadline set forth by the board to every person to whom a license was issued or renewed during the biennium. The applicant shall complete the application and submit it to the board with a renewal fee, if applicable, and all required documents on or before the deadline set by the board. The applicant shall provide documents from proper agencies or parties of any criminal conviction or any disciplinary action taken or pending in this State or any other state in the United States or any territory or possession under the jurisdiction of the United States within the two years prior to application for renewal of license. As part of the license renewal process, each applicant shall be required to complete a survey developed by the Hawaii state center for nursing as deemed necessary by the Hawaii state center for nursing. Upon receipt of the application and fee, if applicable, the board shall verify the accuracy of the application and issue to the applicant a certificate of renewal for the biennium expiring two years hence on the deadline set by the board. The renewal shall render the holder thereof a legal practitioner of nursing for the period stated on the renewal form."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

THE SENATE	S.B. NO.	26
TWENTY-SIXTH LEGISLATURE, 2011		S.D. 1
STATE OF HAWAII