Policy 101 Legislative Conference
The ISNA Policy 101 Conference in January provided an introduction to public policy. ISNA staff reviewed how a bill becomes a law and discussed ISNA's policy activities. ISNA's lobbyist provided insight into the legislative process. Attendees received presentations on the role and operations of the Indiana State Board of Nursing and Indiana Center for Nursing from Executive Directors Elizabeth Kiefner Crawford and Kimberly Harper, respectively. The afternoon included a panel discussion by ISNA members involved in various advocacy avenues. Altogether these provided a well-rounded education on the many aspects of nursing policy. Attendees left with a better understanding of how nursing policy is shaped.
Advanced Policy Legislative Conference
An enthusiastic, engaged group attended the ISNA Advanced Policy Legislative Conference in February. Senator Michael Crider and Representative Ed Clere each made time in their busy schedules to address the attendees and take questions. Breakout exercises created lively discussions on the collaborative practice agreement requirement and future policy goals. Janet Haebler, Associate Director of State Government Affairs for the American Nurses Association, provided a national perspective on evolving nurse policy issues. She also helped moderate the breakout discussions. Brian Tabor, Vice President of Government Relations for the Indiana Hospital Association (IHA), shared his take on the legislative session and IHA's current lobbying initiatives. This conference will continue to be a premiere event for sharing ways to advance Indiana's nurses. If you have suggestions regarding future ISNA event offerings, email bmiley@ indiananurses.org, we'd love to hear from you!
The 2014 Indiana General Assembly session wrapped on March 14th. On June 17th, the General Assembly will reconvene to make technical correction. Below is an overview of bills considered by the General Assembly. Titles in bold indicate the legislation passed the General Assembly, have been signed by Governor Mike Pence, and will become Indiana law upon their effective date, which is contained in each bill. Titles that are not in bold indicate the legislation was introduced, but it did not complete the legislation process to become law. These bills may be re-introduced next year in another attempt to have them become law. ISNA members received this information back in March through our weekly e-newsletter, the ISNAbler. The ISNAbler also provided weekly updates on the legislative progress of all bills impacting nursing.
"SEA" refers to Senate Enrolled Act, "HEA" means House Enrolled Act, for bill that completed the legislative process. Bills labeled "HB" and "SB" refer to bills that did not complete the legislative process. The full text of all the legislation is available at http://iga.in.gov/.
Commemorating the 100th Anniversary of IU School of Nursing House Concurrent Resolution 17: The General Assembly passed this resolution congratulating the IU School of Nursing on its achievements. Representative Ed Clere, who had two doctoral nursing students interning with him during the session, introduced the resolution. The co-authors of the resolution were Representatives Charlie Brown, Steve Davisson, Patrick Bauer, and Justin Moed. In the Senate, the resolution was introduced by Senator Patricia Miller and sponsored by Senators Michael Delph and Brent Waltz. Dean Marion Broome was given the opportunity to address the legislature during the event.
APRN Authorization to Perform Physical Exams for School Bus Driver Applicants HEA 1303: At the start of session, three separate bills were introduced providing this authorization: SB 145 (Senator Michael Crider) / SB 278 (Senator Jean Breaux) / HB 1088 (Representative Kreg Battles). Only SB 278 passed its chamber of introduction, but that bill did not receive a hearing before the House Education Committee. Fortunately, that was not the end of the story. HB 1303, which dealt with school bus inspections and signage was amended to add the content of SB 278, and passed into law. This authorizes physical exams for school bus driver applicants to be performed by any health care professional registered in the Federal Motor Carrier Safety Administration's National Registry of Certified Medical Examiners. APRNs are eligible to receive the certification for this registry, thus can be authorized to perform the exams.
CRNAs, Anesthesiologist Assistants, Pharmacy Technicians, Diabetes Educators SEA 233:
This potpourri healthcare professionals bill designates certified registered nurse anesthetists (CRNAs) as Advanced Practice Nurses (APN) under Indiana law without altering their scope of practice. The APN designation was put into Indiana statute to structure prescriptive authority. CRNA practice does not include prescribing, as defined in Indiana law, which is why CRNAs were not originally included in the designation. Nationally, the term Advanced Practice Registered Nurse includes CRNAs, Clinical Nurse Specialists, Certified Nurse Midwives, and Nurse Practitioners. Designating CRNAs as APNs under Indiana law is consistent with the national recognition. The bill also elevates pharmacy technicians and diabetes educators from certification to licensure under the pharmacy and medical licensing boards, respectively. Finally, the bill authorizes anesthesiologist assistants, an extender position similar to physician assistants, to work in Indiana.
Stock Epinephrine in Schools SEA 245 / HEA 1323: Schools will be allowed to stock and administer unassigned epi-pens. SEA 245 covers local school corporations and HEA 1323 applies to colleges and universities. SEA 245 permits all school employees to receive training in recognizing anaphylaxis and the proper administration of auto-injectable epinephrine. HEA 1323 authorizes any student, faculty member, or staff member to receive training.
INSPECT Expansion & Opioid Treatment Program Regulations HEA 1218: The possibility of expanding the INSPECT program to all prescription drugs is headed for summer study committee again. The bill calls for regulations for opioid treatment programs geared toward reducing the use of methadone. HEA 1218 reduces the threshold for requiring prior authorization for opioid treatment medications from 14 days to 7 days. The bill also requires a prescription for the purchase of insulin. INSPECT is the Indiana Scheduled Prescription Electronic Collecting & Tracking program that allows prescribers, dispensers, and law enforcement to check an individual's controlled substance prescription history. Information about INSPECT is available at www.in.gov/pla/inspect. Information about the Indiana Attorney General's initiative to reduce prescription drug abuse can be found at www. in.gov/bitterpill.
Neonatal Abstinence Syndrome SEA 408:
NAS refers to the adverse effects that occur in a newborn infant who was exposed to addictive illegal or prescription drugs while in the mother's womb. Initially, SB 408 established mandatory reporting by hospitals of data regarding NAS, however that was removed. The final version creates a government study of the issue, and also sets up a data collection pilot program for voluntary hospital participation.
Good Samaritan Licensed Health Care Services HB 1097: This bill would have provided civil immunity to individuals licensed to provide health care services who do so voluntarily in a setting other than a medical clinic or health care facility as long as they provide services within their scope of practice without gross negligence or willful misconduct. HB 1097 passed the House and Senate in different forms and did not make it out of the conference committee process. The bill can be re-introduced next year.
Medical Professionals Responding to Emergency Disasters HB 1372: This bill would have provided that licensed medical professionals, including nurses, may not be disciplined by their employer for absence or injury as a result of responding to a call for emergency management to respond to a disaster. This bill did not advance out of committee. It could be re-introduced next year.
Licensure SEA 421: The initial version of this bill created a committee to review all professional licenses, permits, and certifications in Indiana to determine which are unnecessary. Through amendment, this was replaced by a review of the necessity of licensure and an assessment of the charged fees for regulated professions, including nursing.
Sexual Assault Examinations SEA 255:
The state police are instructed to develop and distribute a standardized sexual assault examination kit. Health care providers must use the kit if practicable. SEA 255 also authorizes a forensic examination of an unconscious person suspected to be the victim of a sexual crime. Providers have civil immunity for following these procedures absent gross negligence or wanton misconduct.
Biosimilar Substitution SEA 262: Pharmacists may substitute an interchangeable biosimilar product for a prescribed biological medical product if (1) the substitute has been determined to be interchangeable by the FDA, (2) the prescriber authorizes substitution, and (3) the pharmacist informs the customer of the substitution. The pharmacist must notify the prescriber of the substitution within 10 days. A biologic medical product is a substance made by a living organism or derived from a living organism by means of recombinant DNA or controlled gene expression methods, such as a vaccine or allergenic product. A biosimilar is interchangeable with a particular biologic product, somewhat like a generic for a name brand drug, because there are no clinically meaningful differences in safety, purity, and potency.
Same-Sex marriage Amendment HJR 3: The proposed amendment to the Indiana Constitution passed the General Assembly after being amended. The change removed the sentence stating "A legal status identical or substantially similar to that of marriage for unmarried individuals shall not be valid or recognized." For constitutional amendments, identical language must pass in two separately elected legislatures, which has not occurred, to advance to the public ballot.
The 2014 legislative session has wrapped, but advocacy opportunities are year-round. The Legislative Council will meet sometime after the Primary Election to assign topics to the 17 interim study committees. Actual meetings of those committees probably won't begin until late June or July. The committees convene to gather information on issues that are the potential subject matter for bills in the next legislative session. Nurses can contact committee members to weigh in on the issues. Committee meetings are open to the public and available live via webcast. Committee topics, members, schedules, and webcasts will be available at www.in.gov/legislative. The next issue of the Bulletin will include the interim study committee topics pertinent to nursing. ISNA members will receive this information the week it's announced through the ISNAbler.
Additionally, the summer and fall represent an opportunity to reach out to your legislators about issues of concern while the landscape of the 2015 legislative session is taking shape. You can urge your legislator(s) to introduce a bill to improve Indiana law. For example, the budget passed by the General Assembly in 2013 eliminated the Nurse Scholarship Program, which provided need-based funding to over 300 undergraduate nursing students annually. Over 1 million of the nation's 2.6 million RN's are over the age of 50, and over 275,000 are over the age of 60. Indiana will face an estimated shortage of 22,076 RN's by 2020. In 2015, the General Assembly will once again be crafting a budget, and this represents an opportunity to get nurse education funding back in the budget!