Nurse authority expansion vetoed
Evers says plan needs stronger protections
MADISON – A legislative effort to expand the scope of authority for some Wisconsin nurses failed for the second time with a veto from Democratic Gov. Tony Evers on Thursday, although the governor said he still hoped to someday sign a version of the proposal into law.
The “APRN Modernization Act” would have created a new system that would allow registered nurses who meet certain qualifications to be licensed by the state board of nursing as advanced practice registered nurses, or APRNs. Lawmakers and nursing groups have advocated its passage for more than a decade.
Under the legislation, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse-midwives would automatically receive APRN licenses. APRNs would generally have the authority to practice independently without a collaborative or supervisory agreement with a physician, prescribe medication, delegate some tasks to other clinically trained health care workers and use the title “A.P.R.N.”
Evers also vetoed a version of the legislation passed with bipartisan support last spring, but generally supports its intent.
“I support creating an APRN license and allowing for independent practice of APRNs, and have previously pursued measures to do so that were rejected by the Legislature’s Joint Committee on Finance,” Evers wrote in his most recent veto message. “Nevertheless, several concerns I consistently raised throughout this and previous legislative sessions, which could well have been addressed during the legislative process, remain unresolved in the bill before me today.”
Evers said he objects to new licensure and practice standards that lack adequate “experience requirements, titling protections, and safeguards for patients who may be treated for chronic pain management.”
Under current law, advanced practice nurses are required to have a documented collaborative agreement with a physician. The legislation would have generally removed that requirement once an APRN had worked for three years under a physician’s supervision.
The proposal would have made Wisconsin one of more than two dozen states that grant “full practice” authority to advanced practice registered nurses. The bill’s authors estimate that Wisconsin has about 8,000 registered nurses who would qualify as
APRNs under the legislation, about 80% of whom are nurse practitioners.
Similar proposals have been introduced dating back to 2015, but the COVID-19 pandemic reinvigorated the effort. That’s in part because the collaborative agreement requirement was temporarily suspended under the state’s public health emergency. Nurses backing the legislation argued if it was OK for them to practice independently during the pandemic, there’s no reason they shouldn’t be able to continue.
In his 2023-25 budget proposal, Evers included a provision with language similar to that of the APRN bill. The measure was one of hundreds stripped from the governor’s proposal as the Legislature revised it.
The governor’s proposal would have required four years of work in collaboration with a physician or dentist. Both proposals would require APRNs providing pain management to collaborate with a physician, but the governor’s version included an additional requirement that the physician must specialize in pain medicine.
The governor’s office and physician groups have maintained that four years is an appropriate requirement, while the bill’s authors have said they wouldn’t go higher than three.
Evers’ budget also included a provision that would restrict a person without an M.D. or D.O. degree from using language representing them as a physician. That measure was not included in the APRN legislation but was introduced as a separate bill.
The proposal was backed by groups including the Wisconsin Nurses Association, the Wisconsin Association of Nurse Anesthetists, the Wisconsin Counties Association, Americans for Prosperity, the Oneida Nation and several health insurance providers.
It was opposed by groups including the Wisconsin Medical Society, the Wisconsin Academy of Family Physicians, the Wisconsin Dermatological Society, the Wisconsin Society of Anesthesiologists and the Wisconsin Chapter of the American Academy of Pediatrics.
“The message the governor sends today is clear: lobbyist cash matters more to him than the thousands of nurses caring for their patients across Wisconsin,”
said Sen. Rachael Cabral-Guevara, R-Appleton, who spearheaded the legislation with Sen. Patrick Testin, R-Stevens Point and Rep. Gae Magnafici, RDresser.
Testin called the governor’s veto “utterly ridiculous and downright irresponsible,” and said APRNs are “a vital part of our healthcare workforce” relied upon for access quality care especially in rural communities.
“When I reintroduced the bill this session after a similar version was vetoed in April of 2022, I knew that we would have to work with the governor and make some concessions if we wanted to get it across the finish line. Given the importance of this legislation, we gave Gov. Evers some of the things he wanted and made compromises in other key areas. Yet, he still made the reckless decision to turn his back on our healthcare workers and over one million Wisconsinites who live in underserved areas,” Testin said in a statement.
Meanwhile, the Wisconsin Medical Society praised the governor’s decision, saying the bill as passed by the Legislature “lacked the minimum levels of patient protections we believe are needed for a state to move toward allowing independent nursing health care practice.”
“Every Wisconsin patient deserves to know that an independent nurse practitioner has spent a reasonable minimum number of years training and gaining experience, will properly collaborate with a qualified physician if pain medicine is needed, and will not be misled by confusing and potentially deceptive advertising,” Dr. Don Lee, president of the Wisconsin Medical Society, said in a statement.
The bill passed the Senate 23-9 and passed the Assembly on a voice vote.
“Several concerns I consistently raised throughout this and previous legislative sessions, which could well have been addressed during the legislative process, remain unresolved in the bill before me today.” Gov. Tony Evers in veto message