As states explore ways to improve healthcare workforce shortages, Arizona lawmakers are considering healthcare compact initiatives as a possible solution.
Arizona is considering entering into the Social Work Licensure Compact and the Advanced Practice Registered Nurse (APRN) Compact. The Arizona House Committee on Health and Human Services met last month to discuss the compacts.
Senate Bill 1036 would allow the state to join the Social Work Licensure Compact, which would allow social workers from other compact states to work in Arizona. It would also establish a Social Work Licensure Compact Commission. The commission would be required to develop, maintain, and utilize a coordinated database and reporting system that contains licensure data, adverse action, and investigative information on all licensed individuals in compact states.
Terri Waible, founder of the Center for Compassion, spoke in support of SB 1036. The center works directly with families experiencing sudden and unexpected deaths, including suicides, homicides, overdoses, active duty casualties, and accidental deaths. She has been supporting a family during their child’s murder trial in another state.
“Although I’ve supported this family for years in the process of preparing for this heartrending and impossible task, due to licensing restrictions, I’ve been entirely unable to support them mentally and emotionally during the days, weeks, and months of time surrounding the actual legal proceedings held outside of Arizona,” Waible said.
Waible’s clients have, at times, gone over six weeks without psychotherapy support, and have been retraumatized during the trial. She said SB 1036 would reduce barriers to care and support the long-term wellbeing of individuals and their families by offering continuity of care during some of life’s toughest moments.
Retired U.S. Army 1st Sgt. Dan Brown, who served for over 20 years as a disposal specialist in the bomb squad with four combat tours in Afghanistan and Iraq, said his mental health journey began 19 years into his military career.
“It is imperative to recognize the sacrifices made by our service members, and the toll military service can take on their mental health wellbeing,” Brown said. “The experiences encountered during deployment, the challenges of reintegrating into civilian life, the stigma surrounding mental health issues that also contribute to a complex landscape of veteran mental health.”
Brown lost his best friend to suicide, and noted that while significant strides have been made recently to increase access to mental health services for veterans, barriers persist. Barriers include insufficient resources, long wait times, and geographical limitations. Brown said SB 1036 would help remove these barriers.
The committee passed SB 1036 by a vote of 8-2. It was passed in the Senate in February, and is pending in the House Rules Committee.
Another proposed healthcare compact Arizona legislators voted on was SB 1295, which is the APRN Licensure Compact, and would allow APRNs from other compact states to practice there. The bill establishes a compact administrator’s commission to adopt rules and bylaws relating to operations, roles, and responsibilities for those within the compact. If passed, the bill would allow the commission to levy and collect annual assessments from each compact state to cover the cost of staff and operations.
Under SB 1295, a coordinated licensure information system would be established, which would require all participating state licensing boards to report any adverse actions.
SB 1295 sponsor Janae Shamp (R-Maricopa) cited the national need to increase access to care, and said APRNs, providers, and the Department of Defense support the bill.
“The only way that we are going to be able to continue to grow is to continue to be able to do just like the social worker’s compact just did; it’s a lot of the same thing,” Shamp said.
Joey Ridenour, executive director of the Arizona State Board of Nursing, said SB 1295 would expand access to care. It would improve patient outcomes by leveraging APRN skills; remove and reduce bureaucratic barriers to streamline the APRN licensure process; support rural and underserved areas; and encourage the utilization of healthcare resources to optimize patient care delivery nationwide, she said.
“We need to continue to remove barriers, and be competitive in the healthcare workforce arena.”
— Ridenour
Kathy Busby spoke in opposition to SB 1295 on behalf of the Arizona Nurses Association. Her concerns included commission representation, and said the bill has no requirement to appoint APRNs to the commission, but rather an executive director of a nursing board in the United States or that director’s designee.
“The compact is also not easy to get out of. It’s not [that] the governor can just withdraw; the legislature has to pass a bill, and then the governor can sign. And then six months later you can get out,” Busby said. “This compact does not address the workforce shortage in Arizona, primarily because it will not go into effect this year. There are not enough states even considering it now—they’ve gotten four states in five years.”
Utah, North Dakota, South Dakota, and Delaware are the only states that have joined the APRN Compact so far. Arizona and Maryland are the only two states with pending legislation related to the compact, and a total of seven states need to join the compact for it to be enacted.
Heather Ross, a nurse practitioner (NP) and professor of health policy at Arizona State University, spoke in opposition to SB 1295, but said APRN’s in Arizona are not opposed to compacts.
“Nurse practitioners in Arizona do not favor this compact because there are so many details that still need to be worked out,” Ross said.
Ross noted undisclosed fees related to the compact that would be levied to Arizona and the State Board of Nursing, and said it is unclear if the fees would be passed to APRNs. She said the compact would be a beneficial solution if the bill was tweaked to address this.
The bill was passed by the Senate in February, and awaits action in the House Committee of the Whole.
Those interested in learning more about health-related policy and workforce challenges in Arizona can register to attend the 2024 Arizona State of Reform Health Policy Conference, which will be held at the Renaissance Phoenix Downtown on May 14. A “Legislators Discuss Health Policy” panel will be held at 2:15 p.m., and a “Strategies to Grow the Healthcare Workforce” panel will be held at 1 p.m.
Actually Heather Ross is incorrect and a survey taken of over 14,000 Arizona APRNs showed that 93% were in favor of the compact.