2013 Legislative Session: A Nursing Perspective

1. 2013 Legislative Session: A Nursing Perspective

2. Overview of the Session - Senate • Looks much the same as 2011 • Same leadership - Lt. Gov. Dewhurst • 19 Republicans; 12 Democrats • Republicans 2 short of 2/3 majority of 21 • 6 new members – 20% • 3 physicians; 1 pharmacist 2

3. Overview of the Session - House • Looks somewhat different than 2011 • Leadership same – Speaker Strauss • 40 new members – 27% • 66 freshman or sophomore legislators – 44% • More ideologically driven • 95 Republicans; 55 Democrats • Republicans 5 short of 100 needed for super majority • 3 RNs ; 3 physicians; 1 paramedic • Rep. Donna Howard (D-Austin) • Rep. Susan King (R-Abilene) • Rep. Stephanie Klick (R-Ft. Worth) 3

4. Overview of the Session - Bill Volume • Number of bills expected to be filed • 2011 Session - 3865 HBs; 1931 SBs 5796 Total • 2009 Session - 4836 HBs; 2583 SBs 7419 Total • Deadline to file bills - 60th day (Friday, March 8) • Number of bills filed as 2/8/2013 - 1146 HBs; 460 SBs • Expected to be filed – 6000-7000 bills • 4000 bills in next 28 days (141 bills/day including Sat & Sun) • Monitoring of Bills 4

5. Overview of the Session - Bill Volume • Number of bills filed in previous sessions • 2011 Session - 3865 HBs; 1931 SBs 5796 Total • 2009 Session - 4836 HBs; 2583 SBs 7419 Total • Deadline to file bills (60thday ) was March 8 • 3852 HBs; 1816 SBs 5668 Total • Bills Passed (HBs & SBs) • 2009 Session 1459 (19.7%) • 2011 Session 1379 (23.8%) • 2013 Session ?? 5

6. Legislative Process

7. Strategy for Legislative Success • Appreciating that process does affect substance • Key hurdles controlled by a very few legislators • Delay can kill a bill 7

8. Strategy Implications of Process • Collaboration/compromise encouraged • Must know opposition and support for bill • Opportunities must be exploited • Long term, multi-session presence favored • Long term, multi-session strategies needed 8

9. Some Potential Strategy Pitfalls • Letting desire for perfect prevent achieving good • Reluctance to identify alternatives that might represent significant progress towards desired “perfect” • Believing that “educating” legislators will be enough • Lack of effective and efficient decision-making 9

10. TNA & Nursing’s Legislative Agenda • TNA • Governmental Affairs Committee • Nursing Legislative Agenda • NLAC • Content • Nursing initiated legislation • Nursing supported health policy legislation • Oh my gosh! Did you see that bill? Nursing can’t live with that! 10

11. Nursing Initiative - Workplace • Preventing violence against nurses • Bill covers ER personnel • Some mental health advocacy groups likely will oppose • Assuring publicly-employed nurses equal right to access courts to redress retaliation • Not issue of making illegal – is already illegal to retaliate • Issue is should publically-employed nurses have same remedies as privately-employed nurses • Notification of parents if no school nurse

12. Nursing Initiative - APRN Rx Authority • First Success of 2013 Session! • Agreement with medicine to replace current site-based approach with a simpler, more flexible prescriptive authority agreement model • SB 406 by Nelson; HB 1055 by Kolkhorst • SB 406 passed on Local & Uncontested Calendar on 3/13 • Will now go to House

13. Diagram of current law

14. Diagram of SB 406 Rx Agreement Model

15. Nursing Initiative – Regulation of Nursing • NPA Amendments • Mandatory criminal background checks for students • Making deferred disciplinary action pilot permanent • Confidentiality of BON orders referring nurses to TPAPN • Self-Directed, Semi-Independent Status (“SDSI”) • TMB, TSBP, BON • Initiative of coalition of professional associations • BON Appropriations • Executive director salary • TPAPN funding

16. Nursing Initiatives - Education • Maintaining Special Funding • $30.0 mil – Professional Nursing Shortage Reduction Fund

17. Initiatives by Others - Nursing Supports • RNs administering meds & treatments ordered by therapeutic optometrists • Loan repayment for nursing faculty • Uniform admission system

18. Initiatives by Others - Nursing Opposes • Unknown but there always are some “Oh my gosh! Did you see that bill!” • Some that have been filed • Mandated ratio bill by CNA/NNOC • Anesthesiologists assistants licensing • BSN offered by community college pilot

19. Initiatives by Others - Nursing Undecided • BSN offered by community college pilot • APRN Medicaid services paid at APRN rate

20. Health Care Policy Coalitions • Texas Public Health Coalition • Immunizations • Smoking Cessation • Healthy Eating • Cancer Prevention & Cure • Texas Women’s Health Coalition • Preventative care for women • CHIP Coalition • Mental Health Advocacy Coalition

21. Why Should Nursing Participate? • Whether or not nursing participates, decisions affecting nurses and their patients will still be made • But …without nursing input • Nursing has benefited from participating • Not happen otherwise • What if nursing had not been involved since 1907 • Health care policy needs nursing’s perspective 21

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