Twice-Vetoed Bill to Let Nurses Practice Independently Overcomes Divisions

Legislation to allow nurses with advanced training to practice independently has overcome objections that led the measure to be vetoed twice in the last four years, the Assembly’s health committee heard Tuesday.

AB 257 would create a new health care professional category of Advanced Practice Registered Nurse (APRN). APRNs would include certified nurse-midwives, certified registered nurse anesthetists, clinical nurse specialists and nurse practitioners.

Under the bill, an APRN would be permitted to practice on their own after working under the supervision of a medical doctor.

Currently, nurse practitioners in Wisconsin must have a continuing collaboration agreement with a practicing physician. Advocates for the legislation have said such agreements  shouldn’t be necessary for a fully trained APRN, and that some nurse practitioners have faced barriers in enlisting a collaborating doctor despite their own qualifications.

The legislation to end that requirement is a goal that organizations representing the nursing profession have been pursuing for more than a dozen years in Wisconsin. There are now 28 states that have a similar standard in place, advocates said.

At Tuesday’s public hearing on the bill before the Assembly Committee on Health, Aging and Long-term Care, advocates and one-time opponents of the measure alike appeared ready to see it finally enacted this year.

“Where health care providers are even more scarce, when the difference between a good outcome or a bad outcome is on the line, access to quality, dependable health care is everything,” said Rep. Tony Kurtz (R-Wonewoc), lead author of the Assembly bill, in his hearing testimony. “Recognizing APRNs will help ease the provider shortage we feel across our state and make Wisconsin a more attractive place for these professionals to practice.”

The bill “is important to meeting the demands for health care throughout Wisconsin and in particular our rural and at-risk populations,” said Terri Vandenhouten, a nurse practitioner in Brown County.

Gov. Tony Evers vetoed a version of the APRN legislation in 2022 after it passed both houses of the Legislature, and he did so again in 2024.

This time around, Evers along with legislators from both parties spent time working through the objections that led to Evers’ previous vetoes.

“We had very good conversations with the governor’s office and came up with a compromise,” said Sen. Patrick Testin (R-Stevens Point), for whom the legislation has been a long-time goal. Testin said that “not everyone is 100% happy” with the bill in its current form — “which probably tells me we landed in a really good spot.”

As the last version of the bill was under debate, Evers laid down markers for three elements that he required before he would sign the measure: increasing the amount of training and supervision before an APRN can practice independently; requiring additional supervision for some APRN practitioners in the field of pain treatment; and ensuring that APRN practitioners didn’t use titles that might confuse patients about their credentials.

The new bill addresses all three points, said Testin.

Under the new bill, in order to be credentialed as an APRN, a nurse must have the equivalent of two years of practice under a doctor’s supervision. The new APRN must then work for another two years under a doctor’s collaborative supervision before going solo.

The bill added a requirement — sought by doctors in the field of pain medicine — requiring  APRN practitioners who treat pain syndrome and who use “invasive techniques” to work in collaboration with a pain medicine physician.

The bill also addresses the use of professional titles, which doctors have argued are sometimes improperly appropriated by providers without a physician’s credential. For an APRN to use a title, it must be one granted under Wisconsin’s nursing statutes, according to the bill.

An APRN with a doctorate may use the title of “Doctor,” but with identifying information about what field the degree is in, so patients don’t misinterpret the practitioner as being a physician.

Representatives for the medical profession who have opposed previous versions of the bill told lawmakers Tuesday they now were officially neutral.

The Wisconsin chapter of the American College of Emergency Physicians hasn’t taken a position for or against the bill, said the group’s representative, Dr. Aurora Lybeck.

While she praised the “significant strides” in adding experience requirements, provider title protection and restrictions on pain practice, Lybeck said Wisconsin should institute specific requirements to staff emergency rooms with doctors.

Mark Grapentine, the Wisconsin Medical Society’s policy advocate, also testified that the doctors’ organization was now neutral on the measure after having opposed it. His remarks all but conceded that the arguments of the bill were now over.

“We are grateful that so many bipartisan members of the Legislature and that Gov. Evers listened to the concerns that physician groups brought forward and were able to include three of those important elements in the bill that you have before you,” he said.

Rep. Lisa Subeck (D-Madison), the health committee’s ranking Democrat, told the Wisconsin Examiner that years of working on the bill as well as Evers’ role in encouraging a resolution helped the legislation reach a point where its enactment now seems likely.

“This was a good example of a bill where there was both bipartisan support and bipartisan opposition,” Subeck said. “It felt like we were a long way from getting it done, and I think the governor has really helped to get this bill moving forward.”

Bill to let qualified nurses practice independently overcomes divisions was originally published by the Wisconsin Examiner.