CNAP Legislative Update #1 07

CNAP Legislative Update #1 07

CNAP Legislative Update 07 #1 – Sunset Review

Lynda Woolbert, Director of Public Policy

Coalition for Nurses in Advanced Practice

January 28, 2007

80th Texas Legislative Session Underway

The Texas Legislature convened its 80th Regular Session on January 9th. For the 140 days the Texas Legislature is in session our attention will be firmly focused on the Texas Capitol. We can expect nearly 6,000 bills to be filed, about 400 of which have the potential of affecting your practice and the health of your patients. CNAP has nineteen APNs who volunteered to review bills. These bill reviewers will read bills and give APN lobbyists their opinions about whether bills will be favorable or harm APNs or their patients. Since bill filing began on November 15, 2006, CNAP has already reviewed 62 bills this session.

In a session in which most APNs and medical organizations continue to abide by the agreement that prevents either side from initiating changes in the way APNs and physicians collaborate, the Texas Association of Nurse Anesthetists (TANA) and the Texas Society of Anesthesiologists (TSA) are under no moratorium on anesthesia issues. (For more information on the 2003 Agreement with Medical Organizations, see the History of the 2003 Session and the Agreement with Medicine). TANA already had its first Capitol Day last Wednesday during National Nurse Anesthetist Week, and TANA board members have already instigated their plan to visit the Capitol twice a week. We have heard rumors that TSA plans to file legislation to license anesthesiologist assistants. We want to be sure that TSA does not also push changes that will require physician supervision for CRNAs.

The big issue this year for all nurses in Texas is the Sunset Review of the Board of Nurse Examiners. The review process began in summer 2005 and will culminate in the passage of the BNE Sunset bill. We anticipate the bill will be filed sometime in February. There will be some major changes in the Nursing Practice Act that will affect all nurses, and Texas may join the APRN Compact. For the information that every APN needs to know about the Sunset Review, see the article, “Sunset Review Raises Issues for Nursing,” that appears later in this update.

APNs at the Capitol

There will be several opportunities for APNs to join their colleagues at the Texas Capitol during the 2007 Session. Of course, the biggest and best will be held on Monday, February 5th when CNAP holds the annual CNAP Legislative Day. APNs will meet at the Omni Hotel for a seminar that will prepare them for Capitol visits in the afternoon. Register for this event on the CNAP Website, Only twenty-five more seats are available for this event. Registration will close when those seats fill, or at midnight January 31st, whichever comes first.

Background information and handouts that will be important to review are posted on CNAP’s Website at The background information includes a Q&A that will help you be familiar with a variety of APN topics and suggests answers to questions you might be asked at the Capitol. One handout highlights the three issues that will be discussed with legislators and staff members during legislative visits.

APNs’ days at the Capitol do not end with Legislative Day. CNAP representatives also meet at the Capitol monthly during the Legislative Session and we always invite other APNs and APN students to join us. This year, we will meet on the following dates.

Wednesday, March 7th

Wednesday, April 11th

Tuesday, May 1st

APNs may register for any of these days by sending an email to telling her which day/s you will attend.

For CRNAs, there will be another Capitol Day in conjunction with TANA’s Spring Meeting. That Capitol Day will be Friday, March 30th.

In addition, Tuesday through Thursday each week, I am always happy to accompany any APNs on legislative visits at the Capitol. Just let me know when you would like to visit the Capitol and we can make arrangements to meet. Please take advantage of the many opportunities you have this session to get involved and raise the profile of APNs at the Texas Capitol.

Sunset Review Raises Issues for Nursing

Every agency in Texas undergoes a process approximately every 12 years that is referred to as Sunset Review. This is a process that almost always raises issues that result in debate and change. The Texas Board of Nurse Examiners (BNE) is undergoing that process now, and it has sparked debate and will lead to some changes in the Nursing Practice Act and the way the BNE operates. Every nurse in Texas needs to have a basic understanding of the Sunset process and the Sunset Commission’s recommendations.

Background on the Sunset Process

The Sunset Advisory Commission is composed of five State Representatives and one public member appointed by the Speaker of the House, and five Senators and one public member appointed by the Lt. Governor. To view the Sunset Advisory Commission members, go to The Sunset Commission is also supported by Executive Director, Joey Longley, and other staff members.

The purpose of the Sunset Advisory Commission and the reviews it conducts is to:

Ensure there is a need for the state agency to continue to exist;

Identify ways in which the agency might operate more efficiently;

Ensure the agency is achieving its mission; and

Identify any changes that are needed in the agency’s enabling legislation (in this case the Nursing Practice Act).

The last review of the BNE was completed in 1993, so this review would normally have occurred during the last legislative session in 2005. However, due to the consolidation of the LVN and RN Boards in 2003, the legislature postponed the Sunset Review for the BNE until the 2006 – 2007 review.

The Sunset process is a series of steps that takes approximately 21 months to complete. The first step is submission to the Commission of a Self-Evaluation Report (SER) by the agency under review. The SRE describes the agency and the way it functions in detail. In addition, the agency is required to recommend changes in its enabling legislation that are needed to bring the legislation up to date and help the agency better achieve its mission. The BNE completed this report in August, 2005.

The second step in the process is the review by Sunset Advisory Commission staff. It involves an onsite review of the agency. In spring and summer 2006, Sunset staff conducted its review of the Board of Nurse Examiners. The Sunset staff invited feedback from stakeholders. Then the staff incorporated all the information it received, and prepared the Sunset Staff Report. The Sunset staff agreed that the BNE still needs to continue and recommended some changes in agency operation and the enabling legislation (see the following section).

The fourth step in the process is a public hearing and then the Sunset Advisory Commission issues its final decisions. That public hearing occurred on November 15, 2006, and the final decisions were made on December 12th.

The fifth and final step is filing and passing the Sunset bill. The bill includes the changes in the enabling legislation that will enact the Sunset Advisory Commission’s final recommendations. The bill goes through the legislative process just as any other bill, but Sunset bills are almost assured to be passed and signed by the Governor, because if it does not pass, the agency will be abolished.

The BNE Sunset Issues

CNAP and the Texas Nurses Association had concerns about three of the staff recommendations. Two of our concerns both related to Issue 1 on nursing education. Recommendation 1.1 would reduce the BNE’s role in approving nursing programs. Issue 1.1 in the staff report recommended nursing programs, once credentialed by an agency recognized by the U.S. Department of Education, should be exempt from BNE approval. Our organizations felt that it was vital that only accreditation by a nursing accrediting body should exempt a program from approval by the board. The Commission’s final decisions include this change.

Recommendation 1.7 seemed very strange to those of us in the nursing profession. It would require the BNE to develop a process to approve hospital-based diploma programs. The nursing shortage prompted a small resurgence of diploma programs and the Sunset Commission obviously thinks it is important that Texas not miss any opportunity to bring those nurses to Texas. From the state’s perspective, diploma programs are a bargain because the state does not pay for the programs. They correctly point out that it is not the job of the BNE to protect the nursing profession or nursing students: it is to ensure that nurses entering the profession meet basic standards. This recommendation remains in the final Sunset Commission decisions.

The recommendation that garnered the most concern from CNAP was Recommendation 5.1: Clarify that individuals and organizations required to report impaired nurses must notify the Board if they suspect the nurse also committed a practice violation. Since being impaired on the job or diverting drugs would both be practice violations, this would mean that any nurse being referred for the Texas Peer Assistance Program for Nurses (TPAPN) would also have to be reported to the BNE. Most nursing authorities agreed that such a requirement would probably delay nurses obtaining treatment for addictions since once of the big incentives for these nurses is that they will not be reported to the board if they enter and successfully complete TPAPN. The final decisions reflect an important change that only impaired nurses who also commit a practice error must be reported to the board.

Recommendation 4 is the only recommendation that specifically mentions APNs. This is the recommendation for Texas to join the Interstate APRN Compact. If this recommendation is included in the final BNE Sunset Bill, it will prompt a change in the term, “Advanced Practice Nurse (APN),” to “Advanced Practice Registered Nurse (APRN).” It will enable APRNs that are licensed or authorized in their home state to practice in any other compact states without seeking additional APRN authorization or licensure. However, because of the dramatic variation in prescriptive authority among the states, the APRN compact does not address prescriptive authority. If the APRN needs to prescribe for patients outside of the home state, then the APRN would have to seek and receive prescriptive authority from that state.

Because of disagreement among our member organizations, CNAP is taking a neutral position on this issue. We think it is important for each APN to become educated on the issue and seek guidance from his/her state professional organization. To read the APRN Compact and additional information, go to the National Council of State Boards of Nursing (NCSBN) Website,

The Commissioners also received some misleading information that the nursing shortage was due to the clinical faculty to student ratio, and this prompted Commission members to adopt a new recommendation that had not been suggested by Sunset staff. The new recommendation states:

Require the Board of Nurse Examiners, in collaboration with nursing education stakeholders and the Texas Higher Education Coordinating Board, to create innovative models for nursing education that promote increased enrollment in Texas nursing programs. As a management action, the recommendation directs the Nurse Board to report back to the Sunset Commission by March 2007 regarding the Board’s efforts in creating these models so that the Legislature can make needed changes to the agency’s appropriations or statute. As a statutory change, the recommendation requires the Board to implement a statewide plan for creating these models and to report back to the Sunset Commission by September 1, 2008 regarding the plan and the Board’s efforts to increase enrollment in nursing education programs. (Motion by Senator Whitmire)

While this is somewhat repetitive of legislation that has already passed, CNAP thinks that continued emphasis on ways to increase the number of nurses will benefit the state, and therefore do not oppose including this requirement in the final BNE Sunset Bill. The bill will probably be filed sometime in February 2007.

All of the BNE Sunset reports may be accessed at At this point in the process, your time will probably best be spent by reviewing the Sunset Commission Decisions. Much more information on the Sunset process is available on the Sunset Commission’s Website, Also feel free to contact if you have questions.