>> JEFFREY MANDEL, THANKS VERY
MUCH.
>> THANK YOU FOR HAVING ME.
>> GIVEN A HEALTHCARE PROVIDER
SHORTAGE IN WISCONSIN, PROPOSED
LEGISLATION WOULD, FOR THE FIRST
TIME, CREATE A SEPARATE LICENSE
FOR ADVANCED PRACTISE REGISTERED
NURSES.
THOSE KIND OF NURSES INCLUDE
CERTIFIED NURSE MIDWIFE,
CERTIFIED REGISTERED NURSE
ANESTHETIST, CLINICAL NURSE
SPECIALIST AND NURSE
PRACTITIONER.
UNDER THE BILL, THEY WOULD BE
ABLE TO TO PRACTISE WITHOUT
PHYSICIAN OVERSIGHT.
MEDICAL SOCIETY OF WISCONSIN
OPPOSES THE MEASURE IN ITS
CURRENT FORM AND WE'LL HEAR FROM
A PHYSICIAN FROM THAT GROUP IN A
MOMENT.
BUT FIRST, WE HEAR FROM ONE OF
THE BILL'S AUTHORS AND A NURSE
HERSELF, SENATOR RACHAEL
CABRAL-GUEVARA.
THANK YOU FOR BEING WITH US,
SENATOR.
>> THANK YOU FOR HAVING ME HERE
TODAY.
>> SO WHY IN YOUR MIND SHOULD
WISCONSIN ALLOW ADVANCED
PRACTISE REGISTERED NURSES TO
PRACTISE INDEPENDENTLY WITH
REALLY FEWER RESTRICTIONS?
>> YEAH.
SO WHEN YOU LOOK AT THE
RESEARCH, THERE ISN'T A LOT OUT
THERE THAT SAYS WE CAN'T
PRACTISE AUTONOMOUSLY.
CURRENT IN THE STATE OF
WISCONSIN, WE HAVE OVER 8,000
NURSES HERE -- NURSE
PRACTITIONERS HERE IN THE STATE
OF WISCONSIN AND WE'RE DOING A
FANTASTIC JOB.
WE WORK COLLABORATIVELY WITH
PHYSICIANS AS IT IS CURRENTLY
AND WE DON'T ANTICIPATE WITH
THIS BILL PASSING WITH THE
AUTONOMY THAT WE STILL WOULDN'T
WORK IN COLLABORATION WITH
PHYSICIANS HERE IN THE STATE OF
WISCONSIN.
27 OTHER STATES DO THIS AND THE
OUTCOMES HAVE BEEN ABSOLUTELY
AMAZING.
WHEN WE TALK WITH PATIENTS,
PATIENTS ARE ALSO ASKING FOR
THIS.
THERE ARE MANY NURSE
PRACTITIONERS HERE IN THE STATE
OF WISCONSIN THAT WOULD LOVE TO
OPEN UP CLINICS WITHIN RURAL
DISTRICTS AND CURRENTLY, BY THE
WAY LEGISLATION IS WRITTEN, IT'S
ALMOST IMPOSSIBLE FOR THAT TO
HAPPEN.
AND SO BY DROPPING THESE
REGULATIONS THAT WE CURRENTLY
HAVE, IT WILL OPEN THE DOOR FOR
AFFORDABILITY, IT WILL OCHOA THE
DOOR FOR ACCESS -- DOOR FOR
ACCESS AND IT WILL CONTINUE TO
PROVIDE VALUABLE SERVICE THAT
MANY PATIENTS HERE IN WISCONSIN
SEEK.
>> SO THE WISCONSIN MEDICAL
SOCIETY WANTS SUCH NURSES TO
HAVE FOUR YEARS OF EXPERIENCE,
NOT THE TWO CALLED FOR IN THE
LEGISLATIVE BILL.
IS THAT UNREASONABLE?
>> WELL, WHEN YOU LOOK AT THE 27
OTHER STATES, NONE OF THOSE
STATES HAVE FOUR YEARS FOR
REGULATION.
EVERY STATE IS A LITTLE BIT
DIFFERENT.
ON AVERAGE, I SEE AROUND TWO,
MAYBE A LITTLE BIT MORE, MAYBE
THREE, BUT WISCONSIN WOULD BE
THE ONLY STATE THAT REQUIRES
FOUR YEARS PRIOR TO AUTONOMY,
AND SO WE'RE JUST ASKING IF
OTHER STATES ARE DOING THIS AND
THEY'RE DOING JUST FINE AND NOT
SEEING INCREASE IN CONCERN OR
LITIGATION, WHY DO WE SEEK FOUR
YEARS?
MANY NURSE PRACTITIONERS THAT
HAVE GONE ON -- MANY NURSES THAT
HAVE GONE ON TO BE NURSE
PRACTITIONERS, MOST OF THESE
INDIVIDUALS HAVE BEEN NURSES ON
THE FLOOR, HAVE WORKED WITH
PHYSICIANS, HAVE MANAGED THESE
KIND OF THINGS FOR FIVE, 10, 20
YEARS, SOMETIMES EVEN 30 YEARS
THEY'VE WORKED AS A NURSE AND
NOW WE'RE ASKING TO HAVE FOUR
YEARS OF PRIOR EXPERIENCE WHEN
NO OTHER STATE IS ASKED THAT.
>> CURRENTLY, A.P.R.N.s HAVE
TO HAVE THESE COLLABORATIVE
AGREEMENTS TO WORK WITH
PHYSICIANS.
FIRST, WHAT ARE THOSE AND WHY
DON'T YOU WANT THEM?
>> YEAH.
SO WHAT THEY ARE IS AN AGREEMENT
BETWEEN THAT NURSE PRACTITIONER
AND THAT PHYSICIAN THAT IS KIND
OF ALMOST AN OVERSIGHT.
RIGHT?
SO IF I HAD A QUESTION AND I
DIDN'T KNOW HOW TO MANAGE A
PATIENT, I WOULD CALL MY
COLLABORATING PHYSICIAN AND SAY,
"HEY, GIVE ME SOME INVITE ON
THIS."
NOW, THE CATCHER WITH THAT IS
THIS COLLABORATING PHYSICIAN
AGREEMENT IS NEVER FREE AND
THEIR COSTS CAN BE FROM A FEW
HUNDRED DOLLARS TO A FEW
THOUSAND DOLLARS OR EVEN A
PARTICULAR PERCENTAGE OF YOUR
BUSINESS.
I HAVE SEEN I THAT IN SOME
SITUATIONS.
THAT CAN BE TRICKY, PARTICULARLY
IF YOU'RE A SMALLER CLINIC, OR
THE OTHER PROBLEM IS, TO FIND
THAT COLLABORATING PHYSICIAN.
QUITE OFTEN, WHAT YOU FIND IS
PHYSICIANS NOWADAYS WORK FOR
LARGE SYSTEMS AND THOSE LARGE
SYSTEMS HAVE NON-COMPETES.
SO LET'S SAY YOU'RE A NURSE
PRACTITIONER IN A RURAL AREA OF
WISCONSIN OR EVEN AN URBAN AREA
OF WISCONSIN AND UPDATE TO OPEN
A CLINIC, WORK AUTONOMOUSLY AND
YOU START ASKING AROUND FOR EYE
COLLABORATING PHYSICIAN.
SOMETIMES IT'S IMPOSSIBLE TO
FIND IT.
YOU HAVE TO GO OUT OF STATE EVEN
TO FIND SOMEBODY THAT CAN WORK
AS A COLLABORATING PHYSICIAN
BECAUSE OF THE NON-COMPETE.
I HAD A NEIGHBOUR WHO IS A
PHYSICIAN, COULDN'T DO THIS.
I HAVE AN EX-HUSBAND WHO IS A
PHYSICIAN OF COULDN'T DO THIS.
BECAUSE OF THE NON-COMPETES THAT
ARE HERE IN THE STATE OF
WISCONSIN.
SO IT REALLY CAUSES A LOT OF
PROBLEMS, NOT ONLY FOR COST WHEN
YOU'RE TALKING ABOUT TRYING TO
PROVIDE AFFORDABLE CARE TO
PATIENTS AND YOU HAVE TO PAY
THESE EXORBITANT FEES, BUT ALSO
FINDING THAT PARTICULAR
INDIVIDUAL THAT CAN EVEN OFFER
TO DO THESE SERVICES.
>> I THINK WE NEED TO LEAVE IT
THERE A LOT MORE QUESTIONS TO
ASK, BUT THANKS VERY MUCH FOR