1. Current Statutory Authorization for APRN’s October 2, 2015

2. Reading Statutes The courts apply the plain meaning of language when they interpret statutes/Acts and language is key. Courts read Acts as a whole, they don’t pick and choose or focus on certain provisions. The courts apply logic principles to any language/process they are interpreting.

3. Reading Statutes Health Care Practice is engaged in by many disciplines which requires courts to look at all of the Practices as a whole. The Healing Arts language existed first, it is broad and controls other disciplines by carving out defined areas of medical practice for other disciplines and situations.

4. Definition of Healing Arts 65-2802. Definitions. …(a) The healing arts include any system, treatment, operation, diagnosis, prescription, or practice for the ascertainment, cure, relief, palliation, adjustment, or correction of any human disease, ailment, deformity, or injury, and includes specifically but not by way of limitation the practice of medicine and surgery; the practice of osteopathic medicine and surgery; … A very broad definition but has more specificity than nursing. Compare this to Nursing at KSA 65-1113 and 1130.

5. Definition of Medicine and Surgery 65-2869. Persons deemed engaged in practice of medicine and surgery. …(b) Persons who prescribe, recommend or furnish medicine or drugs, or perform any surgical operation of whatever nature by the use of any surgical instrument, procedure, equipment or mechanical device for the diagnosis, cure or relief of any wounds, fractures, bodily injury, infirmity, disease, physical or mental illness or psychological disorder, of human beings. Another very broad definition and has more specificity than the nursing definition.

6. License as MD/DO Required 65-2803. License prerequisite to practice of the healing arts; exceptions; penalty. …(a) It shall be unlawful for any person who is not licensed under the Kansas healing arts act or whose license has been revoked or suspended to engage in the practice of the healing arts as defined in the Kansas healing arts act. … No others can practice the healing arts unless an exception/authorization allows it.

7. Exceptions to Physician Licensure  65-2872. Persons not engaged in the practice of the healing arts. The practice of the healing arts shall not be construed to include the following persons: …  (m) Nurses practicing their profession when licensed and practicing under and in accordance with the provisions of article 11 of chapter 65 of the Kansas Statutes Annotated, and amendments thereto, and any interpretation thereof by the supreme court of this state.  Paragraph (m) Includes APRNs and RNs. Nursing has its own basic scope definition at KSA 65-1113 which controls/differentiates nursing.

8. Exceptions to Physician Licensure 65-2872(g) Persons whose professional services are performed under the supervision or by order of or referral from a practitioner who is licensed under this act. … This language allows for the use of protocols/delegation by physicians to other individuals which includes APRNs.

9. Physicians may allow others to practice Medicine and Surgery Protocols or Delegation Required 65-28,127. Licensees who … accept responsibility for, enter into practice protocols with or delegate acts which constitute practice of healing arts to others; … (a) Every responsible licensee who … accepts responsibility for, enters into practice protocols with, or who delegates acts which constitute the practice of the healing arts to other persons shall: …

10. 65-28,127 continued Authorize by protocol or delegate 3)…only those acts and functions which the responsible licensee knows or has reason to believe can be competently performed by such person and is not in violation of any other statute or regulation; 4) …only those acts and functions which are within the normal and customary specialty, competence and lawful practice of the responsible licensee;

11. APRNs and Statutorily Authorized Scope Nursing Board established by Legislative action in 1913 (BOHA in 1912) Legislature Defines scopes of practice and sets grounds for discipline of licenses after investigation. The KNPA begins at KSA 65-1113 et. seq. and includes many interrelated statutes. It includes KSA 65-1113 and KSA 65-1130 both of which apply to APRN.

12. Statutory Nursing Scope applies to APRN/RN KSA 65-1113…(b) “Diagnosis” in the context of nursing ….shall be construed as distinct from a medical diagnosis. … (c) “Treatment” means the selection and performance of those therapeutic measures essential to effective execution and management of the nursing regimen, and any prescribed medical regimen. The statute language differentiates Nursing and Medicine

13. Statutory APRN Scope KSA 65-1130 (c)(3) Authorizes the Board to …Define the role of advanced practice registered nurses and establish limitations and restrictions of such role. … The definition does not differentiate practice of APRN from RN. The statute does not authorize medical diagnosis or the practice of medicine by APRNs so a vehicle for authorization (collaborative agreement/delegation or protocol) is required.

14. Statutory APRN Scope KSA 65-1130(d) An advanced practice registered nurse may prescribe drugs pursuant to a written protocol (precise and detailed) as authorized by a responsible physician. The statute ties APRN practice to protocols and physicians who have accepted responsibility as identified in the language of the Healing Arts Act.

15. Statutory APRN Scope Currently to cross into the practice of medicine requires some type of exception or authorization under the Healing Arts Act. Some have argued that protocols are only required for prescribing drugs. A court will most likely not find it logical that to prescribe drugs requires protocols but to make a medical diagnosis, order diagnostic tests among other medical acts does not.

16. Statutory Language Changes Needed for Independent Practice APRNs need a statutory definition of practice that makes it different than the RN/LPN in 65-1113. The language defining the Healing Arts needs to paralleled in the definition of Advanced Practice Nursing so it is clear to the courts when they interpret and so no vehicle for authorization (protocols/collaborative agreement) is required/necessary.

17. HB 2122 and SB 69 All APRN Roles Introduced by the APRN Task Force (not affiliated with KSBN) Requires National Certification Removes the requirement for written protocols May plan, diagnose, order and execute a healthcare plan Requires a 2,000 hour transition to full practice HB 2122-introduced and no hearing or action http://www.kslegislature.org/li/b2015_16/measures/hb2122/ http://www.kslegislature.org/li/b2015_16/measures/hb2122/ SB 69-a hearing was held-no action after the hearing http://www.kslegislature.org/li/b2015_16/measures/sb69/ http://www.kslegislature.org/li/b2015_16/measures/sb69/ Board of Nursing supported these bills

18. SB 2280-APRN in the Role of Nurse Mid-Wife Introduced by Nurse Mid-Wives in Kansas Requires National Certification Section 6 list what the Nurse Mid-Wife is authorized to do without collaborative agreement Requires a 1,500 hour transition to full practice Bill can be reviewed at http://www.kslegislature.org/li/b2015_16/measures/h b2280/ http://www.kslegislature.org/li/b2015_16/measures/h b2280/ Informational hearing held- no action taken Board of Nursing did not support this bill as written

19. HB 2205 and SB 218 All APRN Roles Introduced by the Kansas Medical Society Board of Nursing and the Board of Healing Arts will jointly adopt rules and regulations relating to the role of APRN Requires the boards to establish a joint APRN advisory committee attached to the board of nursing HB 2205-Introduced-no hearing or action http://www.kslegislature.org/li/b2015_16/measures/hb2205/ http://www.kslegislature.org/li/b2015_16/measures/hb2205/ SB 218-no action after the hearing http://www.kslegislature.org/li/b2015_16/measures/sb218/

20. Future of Legislative Bills 2016 is a “Carry Over” year They remain alive and could be worked Future is unknown The Board of Nursing will continue to monitor and work with stakeholders

21. Questions

22. Mary Blubaugh MSN, RN Executive Administrator Mary.blubaugh@ksbn.state.ks.us 785-296-5752 Mary.blubaugh@ksbn.state.ks.us