Arizona Clinical Nurse Specialists one step closer to prescribing authority

Arizona’s House Health & Human Services Committee unanimously passed a bill out of committee last week that would give Clinical Nurse Specialists (CNSs) prescribing authority if they meet educational and training requirements and hold a national certification.

The bill, which we’ve previously listed as one of the healthcare-related bills we’ll be tracking in Arizona this session, would limit a CNS’s prescribing authority to patients in certain environments.

The list of those environments includes behavioral health inpatient facilities, recovery care centers, and certain outpatient treatment centers, among others. Each applicable institution would put in place protocols regarding what CNSs can prescribe in that particular facility.

Kathy Busby, who testified representing the Arizona Nurses Association, urged the committee to support the bill, in part, to attract more CNSs to the state.

“Over 20 states allow CNSs to prescribe, including Utah, New Mexico, and Colorado,” Busby said. “We would like to join those states in allowing CNSs to practice to the full extent of their education and training, and not lose CNSs to other states because of the limitations imposed on their practice here.”

According to the sunrise application requesting the change in scope-of-practice, there were 182 CNSs in Arizona as of last year.

Part of the argument in favor of the bill is that Nurse Practitioners (NPs), who have the authority to prescribe in every U.S. state, have similar training.

Heather Ross, a practicing nurse practitioner, explained the differences between a CNS and an NP by pointing to practice arrangements. An NP, she said, is prepared to work independently and in a private practice. A CNS works as “an expert consultant” in a collaborating team within an institution.

“We hope that, by allowing CNSs to practice to the top of their education and training, we can attract more CNSs to Arizona.”

On the other side of the issue was Steve Barclay, who represented the Arizona Medical Association and Arizona Osteopathic Medical Association at the hearing. 

Barclay said that the two physician organizations were in “respectful opposition” to the bill.

His arguments against the bill were both broad and specific. One objection was rooted in the idea that more prescribers isn’t necessarily better.

“We appreciate the restrictions that are in House Bill 2068, but we ask the fundamental question: Does it make sense to add even more prescribers into the mix — licensees with less experience in prescribing than the others preceding them?”

A more specific concern from Barclay was that different hospitals might develop differing protocols under the bill.

“That’s our biggest concern: That it’s left to the individual institution to set those standards,” Barclay said. “And what we need to have is some uniformity or consistency of standards from institution to institution.”

Rep. Jay Lawrence began questioning the motives behind the associations’ critiques before committee chair Rep. Nancy Barto (the bill’s lead sponsor) intervened.

“This is my fifth year in the Health committee in the House,” Lawrence said. “I have seen, any number of times, the doctors very protective of their profession. I would imagine that, when nurse practitioners were given prescriptive authority, the doctors fought that up until it was done. This is one of those situations where the doctors are saying, ‘There’s an intrusion into what I do.’ It is more ego than anger at the ability of the CNS.”

While every committee member ultimately voted to pass the bill out of committee with a “do pass” recommendation, Rep. Kelli Butler noted that she’d be looking for the bill to address Barclay’s  concern about the lack of standards across institutions.

“I would like to see the final bill include more specific information about how those protocols are going to be developed and reviewed,” Butler said.

Along with every other committee member, Butler gave a “yes” vote; but, she said she doesn’t want to see the bill “on the consent calendar” just yet.

Watch archived video of the committee meeting here.