House Status:
Senate Status:
Senate Status:
Minutes for HB2256 - Committee on Health and Human Services
Short Title
Updating scope of practice requirements for advanced practice registered nurses without a supervising physician, imposing requirements therefor and updating certain licensure requirements.
Minutes Content for Wed, Feb 17, 2021
Rachelle Colombo, Executive Director, Kansas Medical Society, provided testimony in opposition to HB2256. The removal of the requirement for a physician supervision/collaborative agreement grants nurses a scope of practice that is without statutory limitations and equivalent to that of a physician. The bill would also have nurses licensed by the Board of Nursing, despite clear overlap into the practice of medicine and surgery. The Society opposes allowing those without adequate training to practice medicine without limitations, supervision or appropriate regulation. The practice of medicine is intentionally limited to those who have completed medical school and residency and are licensed and regulated by the Board of Healing Arts. Ms. Colombo continued by stating that physicians can delegate specific medical acts to those they supervise knowing that they are responsible for the care provided under the delegation. The idea that the requirement for supervision is a barrier to practice in unfounded as Kansas is rated 3rd in the nation in the number of APRNs per capita; While claiming that 20 states have give full authority, only 3 states allow practice without collaboration. The remaining states have narrower scopes and more limitations than APRNs do in Kansas (Attachment 25). Ms. Colombo provided an issue brief from the American Medical Society in her testimony concerning independent access states (Attachment 26). Ms. Colombo included a letter from Dr. James Madara, Executive Vice President &CEO, American Medical Association, with her testimony (Attachment 27).
Dr. Jennifer Bacani McKenney, President elect, Kansas Academy of Family Physicians (KAFP), provided opposition testimony to HB2256. The one theme that continues to arise regarding medical care is that team-based care prevents disease, keeps people well and saves lives. It has never been more evident than during the pandemic. This discussion is not a turf war. It is about patient care. KAFP and Kansas statute reflects that patients are best served in a team approach. KAFP does not object to APRNs practicing at there highest level of professional training in nursing. Their training is not equal to that of a physician. This issue is not a rural issue. Rural medicine is complex. It is noted that there is a shortage of nurses in the state, not a shortage of APRNs. Most APRNs are located in urban areas. There is no indication that with this bill there will be a strong movement to rural areas. It is difficult to understand how to professions with a dramatic difference in training hours would be able to have the same scope of practice (Attachment 28).
Vicki Whitaker, Executive Director, Kansas Association of Osteopathic Medicine, provided testimony in opposition to HB2256. APRNs are trained at a graduate level for 2 to 4 years with 4,000 care hours to practice. APRNs do no residency or fellowship training. This must be contrasted with the requirements to become a physician. The amount of preparation to treat patients is not comparable. APRNs came into existence to enable physicians to care for more patients not to replace treatment by a physician. It is not in the public interest regarding safety and health to grant APRNs the right to practice medicine without a medical license, without physician oversight and under the Board of Nursing. APRNs are a valued member of the health care team. Granting them the right to practice medicine without a license is unacceptable (Attachment 29).
Dr. Kristi Clark, President, Kansas Chapter, American Academy of Pediatrics (KAAP), provided testimony in opposition to HB2256. KAAP believes that optimal healthcare includes a team approach supervised by a physician leader. It this the organizations opinion that the Board of Nursing lacks the resources to distinguish aberrant behavior from the standard of care in case of possible malpractice or malfeasance. The training of a nurse practitioner is not equivalent to that of a physician. There is also no evidence that access to healthcare will improve by allowing nurse practitioners to practice independently. Dr. Clark stated that in her opinion, the agenda driven bill, supported by a national organization, does not have the best interest of Kansans nor the health care teams taking care of them in mind (Attachment 30).
