A Nurse Practitioner–Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

Nebraska Unicameral Legislature
Nebraska Unicameral Legislature

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A Nurse Practitioner–Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

An example of agenda setting in 2014 was an effort by the Nebraska Nurse Practitioners (NNP), a state nursing association, to find a state senator who would introduce a bill into the Nebraska unicameral legislative session to eliminate the Integrated Practice Agreement (IPA) from the Nurse Practitioner Practice Act (Nebraska Legislature, 2014).

The public hearing for the bill was held on January 31, 2014; the sponsoring state senator’s goal was for the bill to emerge from the seven-member Health and Human Services Committee with support from all or most of the members (Senator S. Crawford, personal communication, January 2014).

Spring 2014 Nebraska Unicameral Legislature

Prior to the bill’s introduction, the NNP had to undergo review by the Nebraska Credentialing Review (407) Program. This state-level review program had been created to evaluate current Nebraska health professionals who are seeking to expand their scope of practice or to evaluate the scope of practice of a new type of provider (Nebraska Department of Health and Human Services, n.d.).

As part of its review, the NNP submitted extensive documentation to three review bodies—an ad hoc Technical Review Committee appointed by the director of the Nebraska Division of Public Health, a second review by the State Board of Health, and a third review by the director of the Division of Public Health. These reviews represented input from the Department of Health and Human Services (DHHS) about possible concerns for Nebraskans in either public health or safety.

Spring 2014 Nebraska Unicameral Legislature

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Although the recommendations at the three levels are advisory, they serve to inform state senators when considering and voting on proposed legislation (D. Wesley, lobbyist, personal communication, June 2013). The NNP proposal received support at the first two levels; at the second level, the vote was 12–5 to eliminate the IPA requirement (Whitmire, 2013).

There also were recommendations with this second vote to (1) have practice requirements for the new graduate nurse practitioner (NP) and (2) have ongoing competency evaluations of all NPs. At the third level of review, the director and chief medical director of the DHHS were strongly opposed to the NNP proposal (Ruggles, 2013).

APRNs in Nebraska set the agenda with four goals in mind:

Decrease barriers to their full scope of practice

Provide more and needed access to health care (especially primary care and mental health care) in rural parts of the state

Meet the emerging primary healthcare needs associated with an increased Nebraska population having health insurance because of the Affordable Care Act

Decrease the exodus of APRNs to contiguous states that did not have such IPA agreements (Sundermeier, 2013/2014)

Spring 2014 Nebraska Unicameral Legislature

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In seeking passage of this bill, Nebraska NPs wanted to join the 17 other states and the District of Columbia that had facilitated full scope of practice availability for nurse practitioners. As noted by Bobrow and Dryzek (1987), this case study underscores the importance of contextual dimensions furthering agenda setting. As noted previously, there were four important contexts in setting this agenda topic at this time in this state.

This agenda, which was based on evidence-based practice studies and the promotion of all nurses working to their full potential, is also advocated by the National Academy of Medicine (Institute of Medicine, 2010). By providing legislative language to a state senator to introduce a bill, APRNs set the agenda in Nebraska.

A variety of strategies were implemented to further the agenda goal. This chapter’s author served as chair of the Nebraska Nurses Association’s Legislative Advocacy and Representation Committee (LARC). This committee worked in unison and collaboratively with the NNP, its lobbyist, the NNA lobbyist, and the sponsoring state senator to serve as the lead strategists and voices.

APRNs used public media to promote their perspectives. For example, following a negative review from the Nebraska DHHS, one APRN educated the public via an op-ed article about APRNs in the state’s largest newspaper (Holmes, 2013). She noted several of the previously made arguments as support for why APRNs wanted the IPA eliminated.

Spring 2014 Nebraska Unicameral Legislature

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The bill passed by a 43–0 vote during the last day of the 2014 unicameral session. However, the governor vetoed the legislation, and there was not time for the unicameral legislature to enact an override.

In early 2015, the bill was reintroduced, passed, and signed by the new governor on March 5, 2015 (Lazure, Cramer, & Hoebelheinrich, 2016). Other factors facilitating its passage included

(1) education regarding APRN capabilities along with advocacy during the campaigns of 17 new state senators;

(2) obtaining commitments from both gubernatorial candidates that they would not veto the bill if reintroduced in 2015;

(3) ongoing advocacy by the earlier noted nursing groups; and

(4) interprofessional health groups that both supported the bill and said they would testify at a public hearing. Nebraska is now one of 21 states in which nurse practitioners have full practice authority (Pohl, Thomas, Barksdale, & Werner, 2016).

Read the Case Study above to Answer the Questions Below:

1: How does the Kingdon model apply to the Nebraska case study?

2: How can all healthcare providers support one another and further some of the IOM goals or Healthy People 2030 goals using the Kingdon Model to get the policy process started?

Spring 2014 Nebraska Unicameral Legislature

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