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Governor Signs Prescriptive Authority Bill

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Posted September 4, 2009

Hawaii

Governor Signs Prescriptive Authority Bill
A bill to increase independent practice authority and award controlled substances prescribing rights is now law in Hawaii. Gov. Linda Lingle signed the legislation on July 2. The signing of this law means that only Florida and Alabama do not allow NPs to prescribe controlled substances.

Valisa Saunders, NP, told ADVANCE that grassroots e-mail communication by Lenora Lorenzo, NP, a regional director for the American Academy of Nurse Practitioners, and other nurse practitioners was key to maintaining the bill's momentum throughout the legislative session.

"Gathering and sharing facts and discussion on e-mail kept us focused. Lenora's frequent e-mails of progress, feedback from our legislators and reminders were helpful," Saunders explained.

Lorenzo worked closely with many groups and entities, such as the University of Hawaii School of Nursing, the Center for Nursing, Hawaii Pacific University, Hawaii Association of Professional Nurses, the Hawaii Board of Nursing and the Drug Enforcement Agency. She also cultivated relationships with key legislators Sen. Roz Baker and Rep. Marilyn Lee to make this legislation a success.

"Senator Baker and Representative Lee crafted and championed our bill and worked tirelessly on this effort," Lorenzo said. "This act is extremely important because it will strengthen Hawaii's healthcare safety net and prevent thousands of medically underserved patients from losing access to much-needed primary care services."

Although this bill is now law, the Board of Nursing (BON) will have to implement the law through its rule-making process. Current rules specifically prohibit NPs from prescribing controlled substances.

Major changes included in the new law are as follows:
  • NP prescriptive authority will be shifted to the BON. The Board of Medicine previously maintained the exclusionary formulary for prescriptive authority. No physician oversight will be necessary; "appropriate relationships" are required.
  • Global signature authority on many state forms (workers' compensation, department of health, department of human services, department of education, physical examination within scope of practice)
  • Inclusion of NPs as primary care providers on insurance provider panels
  • A requirement for graduate-level education as well as national certification to be recognized by the BON as an NP. The current law requires one or the other; now, both will be required for prescriptive authority.
Saunders hosted a reception at her home to recognize and thank key legislators for their efforts. The event also provided an opportunity for NPs to celebrate and look to the future. "We are already strategizing for our next goals," she said.

"I personally have some goals that I think will benefit us all," Saunders said, noting that at least one lawmaker is willing to sponsor legislation to update statutes related to NP practice in long-term care and home health. Saunders, who has been honored for her work in geriatrics, has contributed to draft changes that have been in revision for more than 15 years without progress.

Although nurse practitioners have been operating in long-term care facilities since 1988, they have hit a wall when attempting to provide home health. "The home health community has refused to work with APRNs for any function, despite federal regulations that allow APRNs to participate and bill for care plan oversight, because of the silence in the current statues," Saunders explained. She continues to work toward change by networking with the University of Hawaii School of Nursing and presenting information to legislators.

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