WEBVTT 00:00:06.270 --> 00:00:09.130 position:50% align:middle - [Josh] Well, good afternoon and, it's a pleasure to be here. 00:00:09.130 --> 00:00:12.680 position:50% align:middle I do want to thank the National Council for inviting us. 00:00:12.680 --> 00:00:17.750 position:50% align:middle As Kansans, we get a lot of ocean time anyhow, and so when Nicole was like, 00:00:17.750 --> 00:00:19.200 position:50% align:middle "Do you want to come down to St. Augustine?" 00:00:19.200 --> 00:00:22.340 position:50% align:middle we thought about it for a while but went ahead and accepted. 00:00:22.340 --> 00:00:27.740 position:50% align:middle But this is a wonderful place to be and appreciate the time that we have to be with you. 00:00:27.740 --> 00:00:29.550 position:50% align:middle Also, it's kind of fun. 00:00:29.550 --> 00:00:33.190 position:50% align:middle Many of us, I think, are probably used to being on panels but typically it's 00:00:33.190 --> 00:00:35.090 position:50% align:middle with people that you don't know. 00:00:35.090 --> 00:00:39.870 position:50% align:middle We all know each other really well and I think we would all call ourselves good friends. 00:00:39.870 --> 00:00:44.848 position:50% align:middle And so, we're looking forward to this and we anticipate this being a free-flowing 00:00:44.848 --> 00:00:47.310 position:50% align:middle conversation between all four of us. 00:00:47.310 --> 00:00:52.750 position:50% align:middle If you have a question in the middle of that, we may get out of hand, just hop up and ask it. 00:00:52.750 --> 00:00:56.290 position:50% align:middle We are all very comfortable taking questions at any time. 00:00:56.290 --> 00:01:01.616 position:50% align:middle We will have time at the end of this, but this will be a pretty free flowing conversation. 00:01:01.616 --> 00:01:09.788 position:50% align:middle And so with that, I'm going to kick it off with Michelle giving a little bit of a back history 00:01:09.788 --> 00:01:15.451 position:50% align:middle to this because the rest of us joined this fight a little later. 00:01:15.451 --> 00:01:20.118 position:50% align:middle But Michelle has been involved in this fight for a very, very long time. 00:01:20.118 --> 00:01:25.346 position:50% align:middle - [Michelle] All right. I'll go ahead and give you a history on our full practice authority journey. 00:01:25.346 --> 00:01:32.108 position:50% align:middle Way back when I was young, which would've been about 2008, 00:01:32.108 --> 00:01:36.698 position:50% align:middle it was at least 14 years ago, there was a group of APRN leaders in Kansas that got 00:01:36.698 --> 00:01:43.173 position:50% align:middle together after a Kansas State Nurses Association meeting and decided with the APRN consensus model 00:01:43.173 --> 00:01:49.107 position:50% align:middle language in hand, that we were going to go for full practice authority because we had the blueprint and 00:01:49.107 --> 00:01:54.307 position:50% align:middle hopes and dreams, and we were going to do this and it would be quick and easy and, you know, 00:01:54.307 --> 00:01:55.156 position:50% align:middle it would be great. 00:01:55.156 --> 00:02:02.905 position:50% align:middle Well, we went ahead and wrote a bill, a bill that fixed everything, 00:02:02.905 --> 00:02:09.755 position:50% align:middle a complete bill that was 66 pages long, and we thought it was great. 00:02:09.755 --> 00:02:18.305 position:50% align:middle So, we went ahead and presented it to legislators and we got four words from the opposition, 00:02:18.305 --> 00:02:24.775 position:50% align:middle which is Kansas Organized Medicine, saying it's a bad bill. 00:02:24.775 --> 00:02:28.145 position:50% align:middle And that was their, you know, the way they approached it. 00:02:28.145 --> 00:02:32.425 position:50% align:middle For about four years or so, we kept putting in our bill, saying, you know, 00:02:32.425 --> 00:02:37.635 position:50% align:middle "It's a great bill. It'll be super. It'll fix all the APRN problems and stuff." 00:02:37.635 --> 00:02:39.775 position:50% align:middle And they would come back with it's a bad bill. 00:02:39.775 --> 00:02:46.035 position:50% align:middle And so, we finally decided to switch gears a little bit and we worked with the Kansas State Board of Nursing, 00:02:46.035 --> 00:02:55.325 position:50% align:middle and we put together a non-threatening technical bill to change the APRN, I mean, ARMP to APRN, 00:02:55.325 --> 00:03:01.701 position:50% align:middle change our certificate to license and some other things like that to kind of set the groundwork so that we 00:03:01.701 --> 00:03:04.041 position:50% align:middle could get those things out of the way. 00:03:04.041 --> 00:03:12.041 position:50% align:middle And it was an unopposed bill and it passed, and the legislators at that point finally knew who we 00:03:12.041 --> 00:03:18.201 position:50% align:middle were and that we were legit. And so, we went ahead and kept working. 00:03:18.201 --> 00:03:23.411 position:50% align:middle After about five years, we realized our little itty bitty APRN task force needed to be more. 00:03:23.411 --> 00:03:31.551 position:50% align:middle We needed an organization that had all four roles working together so we had more numbers and we could 00:03:31.551 --> 00:03:34.737 position:50% align:middle sit across the table from organized medicine. 00:03:34.737 --> 00:03:42.473 position:50% align:middle And the thing, I don't know if any of you know Dr. Jan Towers with AANP, but she used to say, 00:03:42.473 --> 00:03:45.481 position:50% align:middle "If you're not at the table, you'll be on the menu." 00:03:45.481 --> 00:03:49.341 position:50% align:middle And she is so true. I mean, she was so right. That is so true. 00:03:49.341 --> 00:03:53.541 position:50% align:middle You have to be able to represent yourself, otherwise other people are going to make the 00:03:53.541 --> 00:03:55.251 position:50% align:middle decisions for you. 00:03:55.251 --> 00:04:02.323 position:50% align:middle So, that was very important and so we did go ahead and sit across the table and organized medicine changed 00:04:02.323 --> 00:04:06.194 position:50% align:middle the narrative to nurses versus doctors. 00:04:06.194 --> 00:04:09.371 position:50% align:middle And so for about five years, we were fighting this nurses versus doctors. 00:04:09.371 --> 00:04:17.655 position:50% align:middle The legislators would say, "Go and meet, negotiate, compromise and come back with a compromise bill." 00:04:17.655 --> 00:04:25.507 position:50% align:middle Well, we couldn't compromise because the only way that organized medicine would approve any kind of change 00:04:25.507 --> 00:04:29.938 position:50% align:middle in our statute was if APRNs went under the Board of Healing Arts. 00:04:29.938 --> 00:04:37.978 position:50% align:middle And, we couldn't do that and the only thing we would agree to is being solely regulated by the 00:04:37.978 --> 00:04:40.548 position:50% align:middle Board of Nursing. So we were at an impasse. 00:04:40.548 --> 00:04:42.842 position:50% align:middle We couldn't get anywhere with that, but they were delaying. 00:04:42.842 --> 00:04:48.044 position:50% align:middle I mean, every year they would say, you know, "This is a nurses versus doctor's issue and go work 00:04:48.044 --> 00:04:52.856 position:50% align:middle on it" and so delay, delay, delay. So, five or six years went on down the road. 00:04:52.856 --> 00:04:56.703 position:50% align:middle And then we also had a change in leadership and you have to look at that as far 00:04:56.703 --> 00:04:58.080 position:50% align:middle as your legislative leadership. 00:04:58.080 --> 00:05:05.101 position:50% align:middle We had a governor and lieutenant governor that were not interested at all in anything 00:05:05.101 --> 00:05:07.871 position:50% align:middle with full practice authority. They were against it. 00:05:07.871 --> 00:05:10.404 position:50% align:middle So, we were stalled for a little bit. 00:05:10.404 --> 00:05:20.261 position:50% align:middle The legislative leadership changed and then we were back on the track of moving forward and we put in the 00:05:20.261 --> 00:05:21.401 position:50% align:middle bill a few more times. 00:05:21.401 --> 00:05:26.561 position:50% align:middle And then about six years ago, the Certified Nurse Midwives kind of splintered off and 00:05:26.561 --> 00:05:27.911 position:50% align:middle did their own bill. 00:05:27.911 --> 00:05:32.331 position:50% align:middle Well, they were working with organized medicine in Kansas and organized medicine helped them come 00:05:32.331 --> 00:05:33.731 position:50% align:middle up with the bill. 00:05:33.731 --> 00:05:39.791 position:50% align:middle And that bill gave them independent licensure, CNMI. 00:05:39.791 --> 00:05:45.381 position:50% align:middle It's the only one in the country so it's not recognized in any other state, I don't believe. 00:05:45.381 --> 00:05:51.851 position:50% align:middle And, they were jointly regulated by the Board of Nursing and the Board of Healing Arts. 00:05:51.851 --> 00:05:58.121 position:50% align:middle So, now we have a precedent set in Kansas that some APRNs are under the Board of Healing Arts and 00:05:58.121 --> 00:06:03.211 position:50% align:middle Board of Nursing. So, the fight got much harder because of that. 00:06:03.211 --> 00:06:06.321 position:50% align:middle And we have, you know, four or five states in the country that are trying 00:06:06.321 --> 00:06:08.631 position:50% align:middle to get rid of that joint regulation. 00:06:08.631 --> 00:06:13.311 position:50% align:middle Well, here we are in Kansas with this one group ending up with joint regulation. 00:06:13.311 --> 00:06:14.871 position:50% align:middle It's like, "Oh my gosh." 00:06:14.871 --> 00:06:17.391 position:50% align:middle So, it was kind of a little bit of a nightmare. 00:06:17.391 --> 00:06:24.901 position:50% align:middle And I think to this day there are only about five or six CNMIs licensed in Kansas. 00:06:24.901 --> 00:06:30.871 position:50% align:middle So, it's been a flop. It's been awful as far as regulations. It's not working. 00:06:30.871 --> 00:06:36.181 position:50% align:middle So, eventually we need to help work on getting that resolved. 00:06:36.181 --> 00:06:39.861 position:50% align:middle But with that precedent set, it made it so hard. 00:06:39.861 --> 00:06:46.711 position:50% align:middle So, we went ahead and kept trying to compromise and we would add things to our bill, 00:06:46.711 --> 00:06:49.843 position:50% align:middle and our bill got bigger and bigger and bigger. 00:06:49.843 --> 00:06:54.801 position:50% align:middle And, it was so hard to sell that bill to legislators because they didn't understand it and they really 00:06:54.801 --> 00:06:56.931 position:50% align:middle didn't want to understand it. 00:06:56.931 --> 00:07:01.337 position:50% align:middle You know, they weren't going to read through a 70 page bill that fixed everything. 00:07:01.337 --> 00:07:06.087 position:50% align:middle So, it was kind of a problem to sell it, and it became impossible to sell it. 00:07:06.087 --> 00:07:10.987 position:50% align:middle So, we had to look at a different direction to go. 00:07:10.987 --> 00:07:17.717 position:50% align:middle So a few years ago, we changed the narrative to a patient-focused and community-driven message and 00:07:17.717 --> 00:07:28.537 position:50% align:middle developed a broad coalition of partners that were very interested in healthcare for, you know, everybody, 00:07:28.537 --> 00:07:34.597 position:50% align:middle especially Kansas is huge as far as frontier and rural areas. 00:07:34.597 --> 00:07:37.787 position:50% align:middle And then in the cities, we have a lot of underserved people. 00:07:37.787 --> 00:07:44.377 position:50% align:middle So, it's an issue across the state. It's not just in the rural areas. 00:07:44.377 --> 00:07:48.217 position:50% align:middle It's a city problem too. So anyway, we had super strong advocates. 00:07:48.217 --> 00:07:53.912 position:50% align:middle We had the Kansas Chamber of Commerce jump on board, we had the Americans for Prosperity, we had NCSBN, 00:07:53.912 --> 00:07:58.207 position:50% align:middle we had AANP, and we had AARP as our great big ones. 00:07:58.207 --> 00:08:04.193 position:50% align:middle And then we had about 25 other smaller groups in the state that helped with our cause. 00:08:04.193 --> 00:08:09.341 position:50% align:middle And the legislative focus became access to care and affordable care. 00:08:09.341 --> 00:08:12.863 position:50% align:middle And it was really hard for our opposition to fight that. 00:08:12.863 --> 00:08:15.543 position:50% align:middle And so that turned the tables. 00:08:15.543 --> 00:08:21.953 position:50% align:middle But really, our group KAPN, Kansas Advanced Practice Nurses, 00:08:21.953 --> 00:08:29.153 position:50% align:middle had been educating legislators about the APRN issues, and we'd been building strong relationships. 00:08:29.153 --> 00:08:33.963 position:50% align:middle And it was the coalition though that moved us forward. 00:08:33.963 --> 00:08:40.233 position:50% align:middle It was the coalition that developed the momentum and legislators couldn't avoid the issue anymore. 00:08:40.233 --> 00:08:43.673 position:50% align:middle They couldn't say, "Go work on it and come back with something else." 00:08:43.673 --> 00:08:54.063 position:50% align:middle It was the coalition's work with legislators and the lobbyist expertise, reading the legislature that really 00:08:54.063 --> 00:08:55.563 position:50% align:middle moved us forward. 00:08:55.563 --> 00:09:01.528 position:50% align:middle And it was their expertise recommending strategies that made all the difference in our success. 00:09:01.528 --> 00:09:08.868 position:50% align:middle Also, the experience and wisdom of Nicole Livanos with NCSBN, big plug to Nicole, 00:09:08.868 --> 00:09:18.587 position:50% align:middle and also with AANP [inaudible] and Ashley Shoe [SP] were on their state policy team, 00:09:18.700 --> 00:09:20.868 position:50% align:middle and they helped us out quite a bit too. 00:09:20.868 --> 00:09:27.708 position:50% align:middle And their knowledge of working with other states, going through this full practice authority issue was so 00:09:27.708 --> 00:09:32.338 position:50% align:middle wonderful because they could tell us when to just sit back and not respond. 00:09:32.338 --> 00:09:38.288 position:50% align:middle Because as nurses, we want to respond to everything and, you know, say the right thing and fix things and 00:09:38.288 --> 00:09:43.428 position:50% align:middle make sure everybody has the right information, when the opposition was just throwing out all kinds 00:09:43.428 --> 00:09:48.368 position:50% align:middle of softballs, I mean, curve balls as far as trying to get us to bite 00:09:48.368 --> 00:09:52.258 position:50% align:middle on different issues and splitting up our resources. 00:09:52.258 --> 00:10:03.598 position:50% align:middle So, we were very, very blessed to have the coalition that we had and working together as well as we did. 00:10:03.598 --> 00:10:09.568 position:50% align:middle And the strategies, I'm going to leave up to the experts on the legislative strategies and reading the 00:10:09.568 --> 00:10:14.068 position:50% align:middle legislature because they did such an awesome job. 00:10:14.068 --> 00:10:19.084 position:50% align:middle So with that, I'll stop the history and we'll turn it over to Elizabeth. 00:10:19.084 --> 00:10:24.048 position:50% align:middle - [Elizabeth] Okay. Can you hear me? It's taped. - [Alan] It's taped. Yeah. It is on, yeah. 00:10:24.048 --> 00:10:29.958 position:50% align:middle - Sorry. I'm Elizabeth Patton. I'm the State Director for Americans for Prosperity in Kansas. 00:10:29.958 --> 00:10:36.808 position:50% align:middle When I started with AFP, I had spent most of my career working in economic 00:10:36.808 --> 00:10:42.638 position:50% align:middle policy related to fiscal policy, taxes and spending and those types of things. 00:10:42.638 --> 00:10:49.558 position:50% align:middle But became very quickly more passionate about the regulatory environment, 00:10:49.558 --> 00:10:52.738 position:50% align:middle than any other issue because it touches so many things. 00:10:52.738 --> 00:11:00.238 position:50% align:middle And, I'm actually really glad we're here to talk to a group of folks involved in regulation because your job 00:11:00.238 --> 00:11:07.932 position:50% align:middle is so critical to making sure that we are functional as a society in so many different ways. 00:11:07.932 --> 00:11:11.322 position:50% align:middle This issue got thrown at me as the first... 00:11:11.322 --> 00:11:18.322 position:50% align:middle I didn't start lobbying for AFP when I first started with them, but eventually, I got put under the dome and 00:11:18.322 --> 00:11:24.802 position:50% align:middle this was the first issue that my predecessor gave to me and said, "Go get this done with these people." 00:11:24.802 --> 00:11:28.722 position:50% align:middle And I was like, "I've never even heard of this issue before." 00:11:28.722 --> 00:11:38.272 position:50% align:middle So, got up to speed pretty quickly, and it became clear to me that if we get this 00:11:38.272 --> 00:11:41.402 position:50% align:middle simple statute, it seems simple, it was complicated. 00:11:41.402 --> 00:11:47.742 position:50% align:middle But if we get this simple concept and the statute and the regulations right on this issue, 00:11:47.742 --> 00:11:54.872 position:50% align:middle this is empowering nurses, nurse practitioners in our state to do their jobs. 00:11:54.872 --> 00:12:02.399 position:50% align:middle We had gotten to the point in Kansas where you are asking essentially a competitor for permission to do 00:12:02.399 --> 00:12:06.759 position:50% align:middle what you are well qualified and well trained to do to serve patients. 00:12:06.759 --> 00:12:11.849 position:50% align:middle And it was an access to care issue, it was an affordability issue, and on so many fronts, 00:12:11.849 --> 00:12:17.699 position:50% align:middle this policy would make a huge difference in the lives of individuals across our state in both rural and urban 00:12:17.699 --> 00:12:26.519 position:50% align:middle areas and, it absolutely had to happen. The studies were just undeniable. 00:12:26.519 --> 00:12:32.599 position:50% align:middle You see the health outcomes and the wellness outcomes as a result of having full practice authority and just 00:12:32.599 --> 00:12:35.399 position:50% align:middle purely allowing people to do their jobs. 00:12:35.399 --> 00:12:42.029 position:50% align:middle And that became the hallmark piece of my message at AFP when it became clear that we had to also get 00:12:42.029 --> 00:12:43.299 position:50% align:middle constituents on board. 00:12:43.299 --> 00:12:48.209 position:50% align:middle We needed to have the, under-the-dome work, but we also needed to make sure that at least some 00:12:48.209 --> 00:12:52.679 position:50% align:middle people in the state, in some targeted areas understood that this was 00:12:52.679 --> 00:12:58.069 position:50% align:middle an issue that they cared about, and we could message it into different districts 00:12:58.069 --> 00:13:04.355 position:50% align:middle over the years to make sure that we were doing a really good job educating on why this mattered. 00:13:04.355 --> 00:13:11.851 position:50% align:middle And, it was about allowing nurses to do their job. It was about increasing access to care. 00:13:11.851 --> 00:13:16.425 position:50% align:middle It was about affordability, and it was about achieving all of those things 00:13:16.425 --> 00:13:19.935 position:50% align:middle without too much government getting in the way. 00:13:19.935 --> 00:13:24.456 position:50% align:middle And I'm not sure if anybody in this room has worked or is familiar with our organization. 00:13:24.456 --> 00:13:30.085 position:50% align:middle We're a national group and we're in about 36 states, but that is the hallmark of when we look at policies, 00:13:30.085 --> 00:13:36.455 position:50% align:middle especially in the regulatory space or in licensing, it's how can we empower people to do their job to their 00:13:36.455 --> 00:13:44.329 position:50% align:middle full potential but how do we get that piece right so that we are making certain that we're not swinging the 00:13:44.329 --> 00:13:49.835 position:50% align:middle pendulum too deep in one way or the other. Anyway, this became my favorite issue. 00:13:49.835 --> 00:13:56.375 position:50% align:middle I called it my white whale for a couple of years because we faced a lot of challenges getting 00:13:56.375 --> 00:13:57.875 position:50% align:middle this finally through. 00:13:57.875 --> 00:14:04.122 position:50% align:middle One thing that in my view, the opposition had done well over the years in the 00:14:04.122 --> 00:14:12.422 position:50% align:middle past is find just a couple members of leadership that were fully entrenched in opposition to our goal. 00:14:12.422 --> 00:14:24.022 position:50% align:middle And so, we had the votes in the chambers with rank and file membership, but they were able to block us in the 00:14:24.022 --> 00:14:27.132 position:50% align:middle leadership venue, which is a big deal. 00:14:27.132 --> 00:14:32.782 position:50% align:middle So, strategically we had to find opportunities to build relationships with committee chairs, with leadership, 00:14:32.782 --> 00:14:40.062 position:50% align:middle and do a lot of education with those folks, and combine that with constituents making that 00:14:40.062 --> 00:14:42.602 position:50% align:middle grassroots push as well. 00:14:42.602 --> 00:14:49.122 position:50% align:middle And coming at it from both sides so that legislators felt the pressure and understood that this really was a 00:14:49.122 --> 00:14:51.832 position:50% align:middle good solution for the state. 00:14:51.832 --> 00:14:57.474 position:50% align:middle So anyway, I could talk more about regulations, but I think we're going to get into that later. So... 00:14:57.474 --> 00:15:07.497 position:50% align:middle - Yes, regulations are so exciting. I'm not sure where to start. My wife is an APRN. 00:15:07.497 --> 00:15:12.647 position:50% align:middle I got engaged on this issue when I was working for a think tank 10 years ago. 00:15:12.647 --> 00:15:18.753 position:50% align:middle And I just texted my wife I could not remember when she graduated, but I think I got started on it before she 00:15:18.753 --> 00:15:20.149 position:50% align:middle was an APRN. 00:15:20.149 --> 00:15:28.137 position:50% align:middle And, as Elizabeth said on occupational licensing, whether it's nursing, hearing aid examiners, 00:15:28.137 --> 00:15:32.897 position:50% align:middle that barrier ought to be as low as practical. 00:15:32.897 --> 00:15:39.264 position:50% align:middle And Kansas is actually one of the better states that is ranked on occupational licensing burdens. 00:15:39.264 --> 00:15:41.607 position:50% align:middle I could say the name because it won't matter. 00:15:41.607 --> 00:15:48.145 position:50% align:middle I remember meeting with then the APRN's lobbyist, Marilyn Conley and Susan Wagel. 00:15:48.145 --> 00:15:51.887 position:50% align:middle So it might have been 10 years ago and I'd done my research. 00:15:51.887 --> 00:15:56.587 position:50% align:middle The health outcomes are the same, which I will say perplexed me. 00:15:56.587 --> 00:15:58.487 position:50% align:middle Why would the health outcomes be the same? 00:15:58.487 --> 00:16:02.919 position:50% align:middle Although it's kind of a pure economic argument, is it not? It's like the diminishing returns. 00:16:02.919 --> 00:16:05.539 position:50% align:middle I went to law school. I'm a licensed attorney. 00:16:05.539 --> 00:16:08.209 position:50% align:middle Would I be better if I went six years? 00:16:08.209 --> 00:16:14.729 position:50% align:middle And, no and I'll get into some of the things there, but I remember Susan Wagel said... She was the senate... 00:16:14.729 --> 00:16:19.554 position:50% align:middle I don't know if she was the senate president, see my mind, but she was going to be Senate president. 00:16:19.554 --> 00:16:23.769 position:50% align:middle She said, "Well, we can't do this because this will hurt the doctor's egos." 00:16:23.769 --> 00:16:30.236 position:50% align:middle And I said, "Oh, Susan, I didn't know we make public policy decisions based on a constituent's egos." 00:16:30.236 --> 00:16:34.729 position:50% align:middle I mean, the intellectual arguments are all on our sides, right? 00:16:34.729 --> 00:16:40.789 position:50% align:middle And, when we got a little bit more momentum and the chamber signed on, and I'll get to that in a second, 00:16:40.789 --> 00:16:45.895 position:50% align:middle I told one of the lobbying teams, I was like, "You cannot play nice with the medical society. 00:16:45.895 --> 00:16:49.023 position:50% align:middle They will not play nice with you. There is no negotiation. 00:16:49.023 --> 00:16:52.937 position:50% align:middle They will do anything and everything. Are you willing to punch them in the nose? 00:16:52.937 --> 00:16:56.443 position:50% align:middle Because that's usually not my style." 00:16:56.443 --> 00:17:01.006 position:50% align:middle - It's totally Alan's style. That is 100%. - Yes it is. That is Alan's style. It is. I will... 00:17:01.006 --> 00:17:05.440 position:50% align:middle - Sometimes you have to. All those cliches apply. 00:17:05.440 --> 00:17:06.450 position:50% align:middle Sugar goes further than vinegar. 00:17:06.450 --> 00:17:12.070 position:50% align:middle But KMS and I could probably talk about 15, 20 minutes on the medical society and how, 00:17:12.070 --> 00:17:16.590 position:50% align:middle and they're still trying to muck things up through the regulatory process. 00:17:16.590 --> 00:17:24.781 position:50% align:middle So you can't trust them. And there was... So we took on... Well, let me back up. 00:17:24.781 --> 00:17:30.300 position:50% align:middle So I started in the chamber in March of 2017, and I thought, "Man, this seems like a 00:17:30.300 --> 00:17:34.752 position:50% align:middle chamber issue, but yeah, my wife's an APRN, is there a conflict?" 00:17:34.752 --> 00:17:36.688 position:50% align:middle And I kind of sat on it for a year and a half. 00:17:36.688 --> 00:17:44.647 position:50% align:middle And then I finally decided our chamber members support this, we shouldn't take a position one way or the other 00:17:44.647 --> 00:17:50.933 position:50% align:middle because of my wife's profession. This is good for the chamber. It increases access, lowers costs. 00:17:50.933 --> 00:17:55.836 position:50% align:middle And we had a lot of chamber member companies that were supportive of it. 00:17:55.836 --> 00:17:58.550 position:50% align:middle And so finally said, "Of course, we're going to support this." 00:17:58.550 --> 00:18:03.173 position:50% align:middle And I remember talking to a physician, Barbara BA who's in the Senate. 00:18:03.173 --> 00:18:05.493 position:50% align:middle Oh, oh. So we had a couple of other healthcare issues. 00:18:05.493 --> 00:18:09.203 position:50% align:middle One was called the Corporate Practice of Medicine. It's different in different states. 00:18:09.203 --> 00:18:16.893 position:50% align:middle Kansas had a law that a corporation cannot practice medicine, but a corporation can't 00:18:16.893 --> 00:18:21.593 position:50% align:middle hire doctors, essentially. They could hire APRNs, I think. 00:18:21.593 --> 00:18:27.333 position:50% align:middle But we took that on because we had member companies that wanted to, bigger employers that wanted to set 00:18:27.333 --> 00:18:29.583 position:50% align:middle an onsite clinic up and hire a doctor. 00:18:29.583 --> 00:18:37.373 position:50% align:middle And, you know, there's a physician, Dr. Eply who is good-mannered about it, 00:18:37.373 --> 00:18:40.543 position:50% align:middle but he was constantly opposing it. Yeah. 00:18:40.543 --> 00:18:47.343 position:50% align:middle And he was saying when I talked about [inaudible] "Well, the physician patient relationship is so 00:18:47.343 --> 00:18:51.013 position:50% align:middle different and so sacred compared to..." And I said, "Oh, so I'm a lawyer. 00:18:51.013 --> 00:18:56.093 position:50% align:middle Do you think that's a more important relationship than the lawyer and the death row inmate? 00:18:56.093 --> 00:19:00.153 position:50% align:middle More important than the lawyer and the doctors being sued for malpractice?" 00:19:00.153 --> 00:19:04.032 position:50% align:middle I guess I just got a little tired of this holier-than-thou point of view that some docs 00:19:04.032 --> 00:19:10.642 position:50% align:middle hold themselves in. And not all. My wife is a 50% equity partner with a physician. 00:19:10.642 --> 00:19:13.162 position:50% align:middle And there are no... This is before... 00:19:13.162 --> 00:19:17.542 position:50% align:middle Oh, so she had her collaboration agreement with her business partner, which is also just kind 00:19:17.542 --> 00:19:19.912 position:50% align:middle of odd, right? 00:19:19.912 --> 00:19:24.922 position:50% align:middle So, I was talking to Barbara BA and she goes, "Well, I'm with you guys on corporate practice of medicine, 00:19:24.922 --> 00:19:26.392 position:50% align:middle but not on the independent practice." 00:19:26.392 --> 00:19:30.832 position:50% align:middle I said, " They are kind of related just lowering barriers to providing healthcare." 00:19:30.832 --> 00:19:32.392 position:50% align:middle And oh, but she went into the training. 00:19:32.392 --> 00:19:39.392 position:50% align:middle I said, "Dr. BA, it just, here's my conclusion after having looked at this." This would've been eight years. 00:19:39.392 --> 00:19:47.972 position:50% align:middle "To provide primary care, four years of medical school, three years of residency is simply vast overkill." 00:19:47.972 --> 00:19:51.802 position:50% align:middle I don't hesitate to tell that to docs. 00:19:51.802 --> 00:19:55.852 position:50% align:middle Again, should I have gone to law school for six years? And the data bears it out, right? 00:19:55.852 --> 00:20:02.094 position:50% align:middle I mean, there's data out the wazoo to use a technical term from all kinds of studies, international studies, 00:20:02.094 --> 00:20:08.114 position:50% align:middle the VA, John Hopkins, and it's just, you don't need that much. 00:20:08.114 --> 00:20:14.824 position:50% align:middle So it is also consistent with some other occupational licensing things the Chamber took on like reciprocity. 00:20:14.824 --> 00:20:23.334 position:50% align:middle There was a bill, the licensing boards can just go overboard. 00:20:23.334 --> 00:20:25.574 position:50% align:middle They're a hammer looking for a nail. 00:20:25.574 --> 00:20:29.434 position:50% align:middle And, there was a bill or an issue where there's eyebrow weaving. 00:20:29.434 --> 00:20:30.814 position:50% align:middle Have you heard of eyebrow weaving? 00:20:30.814 --> 00:20:34.164 position:50% align:middle Believe it or not, there is some relationship to independent practice. 00:20:34.164 --> 00:20:36.044 position:50% align:middle I don't know exactly what eyebrow weaving is. 00:20:36.044 --> 00:20:40.504 position:50% align:middle I just have to trim mine every once in a while since I'm getting old. 00:20:40.504 --> 00:20:46.814 position:50% align:middle But the Board of Kansas Cosmetology was going to require eyebrow weavers to have 1500 clock hours 00:20:46.814 --> 00:20:49.954 position:50% align:middle in order to do eyebrow weaving. They were doing nothing else. 00:20:49.954 --> 00:20:51.464 position:50% align:middle So we supported a bill. 00:20:51.464 --> 00:20:58.074 position:50% align:middle It ended up passing huge majorities, that says, "No, they do not have to have a license." 00:20:58.074 --> 00:21:04.166 position:50% align:middle And, my staff wouldn't let me say this, but when I do some public speaking about it, 00:21:04.166 --> 00:21:10.266 position:50% align:middle and I would just say, and a reminder because oh, I was criticized privately and publicly by legislators 00:21:10.266 --> 00:21:14.306 position:50% align:middle having a conflict of interest because my wife's an APRN and I pointed it out, "Well, 00:21:14.306 --> 00:21:18.126 position:50% align:middle my wife is not an eyebrow weaver and we're supporting that." 00:21:18.126 --> 00:21:23.256 position:50% align:middle But it got, behind the scenes, a little nasty. 00:21:23.256 --> 00:21:28.326 position:50% align:middle And, but you knew that if that's the best argument they can come up with. 00:21:28.326 --> 00:21:33.176 position:50% align:middle And I said, "Well, why don't you go talk to all these, you know, 30 member companies that were very specific." 00:21:33.176 --> 00:21:37.706 position:50% align:middle And then, when I proactively talk to member companies, I think of in Garden City. 00:21:37.706 --> 00:21:41.776 position:50% align:middle So Garden City is a city of about 30,000 in southwest Kansas. 00:21:41.776 --> 00:21:44.756 position:50% align:middle Very prosperous, but it's a long ways from anywhere. 00:21:44.756 --> 00:21:46.036 position:50% align:middle It's three hours from Wichita. 00:21:46.036 --> 00:21:48.896 position:50% align:middle I don't know, four and a half hours from Denver. 00:21:48.896 --> 00:21:53.206 position:50% align:middle All of our member companies in Garden City absolutely supported it because their physician, 00:21:53.206 --> 00:21:57.716 position:50% align:middle their primary care docs, they were full and they could not recruit anymore. 00:21:57.716 --> 00:22:02.199 position:50% align:middle Another quick story, and I'll get to some other things, maybe through the conversation. 00:22:02.199 --> 00:22:04.639 position:50% align:middle I met with the Lyons Kansas Chamber. 00:22:04.639 --> 00:22:08.729 position:50% align:middle Lyons is a small town, 3,500 people right in the middle of the state, 00:22:08.729 --> 00:22:10.949 position:50% align:middle hour and a half from Wichita. 00:22:10.949 --> 00:22:14.809 position:50% align:middle So the Lyons Chamber proactively asked me, is the chamber supporting independent practice? 00:22:14.809 --> 00:22:18.119 position:50% align:middle I said, "Yeah." They said, "Well, good." So there I, and I need to follow them. 00:22:18.119 --> 00:22:23.489 position:50% align:middle Their thought was they're going to find a Lyons native who maybe is a nurse in Wichita, 00:22:23.489 --> 00:22:29.499 position:50% align:middle pay for his or her APRN training and get them to move back to Lyons because they thought that's going to be a 00:22:29.499 --> 00:22:33.169 position:50% align:middle lot more practical than a primary care doc. 00:22:33.169 --> 00:22:37.349 position:50% align:middle And you know, it's funny when you talk to chamber members or other lay people, 00:22:37.349 --> 00:22:42.609 position:50% align:middle they just don't care about the training of a doc compared to... They just don't care. 00:22:42.609 --> 00:22:49.069 position:50% align:middle I think we were all affected with the different messages where it seems like KMS's medical size, 00:22:49.069 --> 00:22:52.569 position:50% align:middle really their only argument was training difference. Was it not? 00:22:52.569 --> 00:22:54.949 position:50% align:middle They quit talking about health outcomes because the data didn't support it. 00:22:54.949 --> 00:23:01.103 position:50% align:middle - Right. They were basically trying to use outlandish scare tactics and they repeated this frequently where 00:23:01.103 --> 00:23:06.123 position:50% align:middle they said, "Well, you're going to have nurses out in Western Kansas doing brain surgery." 00:23:06.123 --> 00:23:10.643 position:50% align:middle And we're like, "That's just not true." That's not true. 00:23:10.643 --> 00:23:14.683 position:50% align:middle - Yeah, I guess we can just start a conversation. 00:23:14.683 --> 00:23:20.113 position:50% align:middle One of the big legislative champions, Doug Blacks, his wife's an APRN. 00:23:20.113 --> 00:23:27.943 position:50% align:middle And when the lobbyist for KMS made that argument, he said, "Oh, it's such a dumb argument because it's so 00:23:27.943 --> 00:23:33.163 position:50% align:middle easy to refute." Well then, what starts stops a general practice doc from performing brain surgery? 00:23:33.163 --> 00:23:37.113 position:50% align:middle "Oh, it's our ethical code and all this stuff I mean." 00:23:37.113 --> 00:23:46.473 position:50% align:middle As Michelle stated, it was a process. I think it was 2018... No, was it '19? It was 2019. 00:23:46.473 --> 00:23:51.593 position:50% align:middle We got the bill out of the committee and that was the same year we got corporate practice medicine passed. 00:23:51.593 --> 00:23:54.883 position:50% align:middle And I know who their KMS's lobbyist was...because it is a small world. 00:23:54.883 --> 00:23:57.183 position:50% align:middle We live in the capital, a lot of mutual friends. 00:23:57.183 --> 00:24:00.929 position:50% align:middle Like that's the first time that KMS has ever been defeated. 00:24:00.929 --> 00:24:03.469 position:50% align:middle Because you know, they don't have a big aggressive legislative agenda. 00:24:03.469 --> 00:24:06.469 position:50% align:middle And then it got hung up on Medicaid expansion, etc. 00:24:06.469 --> 00:24:11.669 position:50% align:middle And then COVID kind of stopped things. But this is how shameless KMS is. 00:24:11.669 --> 00:24:15.019 position:50% align:middle And I promise I will stop. 00:24:15.019 --> 00:24:19.819 position:50% align:middle During COVID, every governor had lots of executive orders and emergency declarations to loosen 00:24:19.819 --> 00:24:23.489 position:50% align:middle up regulations right? On healthcare and lots of stuff. 00:24:23.489 --> 00:24:28.519 position:50% align:middle One of was allowing APRNs to be, to have independent practice during COVID. 00:24:28.519 --> 00:24:31.839 position:50% align:middle Well, guess who opposed it? I mean the medical society. 00:24:31.839 --> 00:24:37.599 position:50% align:middle And it's like if that doesn't just expose it I had other personal things of people trying to go around me 00:24:37.599 --> 00:24:42.559 position:50% align:middle and to our members, etc. about the chamber's position. 00:24:42.559 --> 00:24:45.939 position:50% align:middle Oh, and I would bring it up. I said I'd stop, I will, promise after one. 00:24:45.939 --> 00:24:50.409 position:50% align:middle I specifically, because I knew there was the specter of a potential conflict, 00:24:50.409 --> 00:24:56.499 position:50% align:middle brought it up at every single board member meeting, just as a reminder if anybody has any concerns about it 00:24:56.499 --> 00:24:58.569 position:50% align:middle and they're like, "Nah, no concerns." 00:24:58.569 --> 00:25:02.123 position:50% align:middle And one of our members, when we were supporting corporate practice medicine and 00:25:02.123 --> 00:25:06.953 position:50% align:middle APRN independent, one of our board members said, "What's the medical society's opposition? 00:25:06.953 --> 00:25:15.273 position:50% align:middle Is it patient care or is it competition?" I said, "Of course it's competition." 00:25:15.273 --> 00:25:20.563 position:50% align:middle So anyway, I I'm glad that we're a part of it. 00:25:20.563 --> 00:25:26.893 position:50% align:middle Oh, and the other thing for other thing with my wife, she was already a partner in a business. 00:25:26.893 --> 00:25:34.631 position:50% align:middle It affected our personal finances zero. So that was helpful that I was able to say that. 00:25:34.631 --> 00:25:38.773 position:50% align:middle - So, that's kind of the backstory of how this happened. 00:25:38.773 --> 00:25:43.723 position:50% align:middle We've got, here's a couple of slides of what we ended up with. 00:25:43.723 --> 00:25:45.783 position:50% align:middle And Michelle kind of told that story. 00:25:45.783 --> 00:25:51.103 position:50% align:middle All of us would tell you, no legislator, the budget is a big bill, 00:25:51.103 --> 00:25:56.123 position:50% align:middle otherwise people want them like five pages and they glaze over at a page and a half. 00:25:56.123 --> 00:26:03.518 position:50% align:middle And so, a 70-page bill on a healthcare issue, guaranteed no one wants to touch it. 00:26:03.518 --> 00:26:09.668 position:50% align:middle And so, this ended up being and I don't remember the actual page size once it was built into statute, 00:26:09.668 --> 00:26:15.098 position:50% align:middle but very, very paired down. You see exactly what we did in that. 00:26:15.098 --> 00:26:19.728 position:50% align:middle And that became a very simple talking point for legislators. 00:26:19.728 --> 00:26:22.778 position:50% align:middle What does this do? This just gets rid of the CPA. 00:26:22.778 --> 00:26:26.518 position:50% align:middle And there were a couple of other things that we had to put in there. 00:26:26.518 --> 00:26:31.348 position:50% align:middle But fundamentally for legislators, you have to keep it as simple as possible. 00:26:31.348 --> 00:26:33.168 position:50% align:middle We're just getting rid of the CPA. 00:26:33.168 --> 00:26:35.858 position:50% align:middle They can understand that, the collaborative practice agreement, 00:26:35.858 --> 00:26:40.055 position:50% align:middle they could understand that and that made sense to them. 00:26:40.055 --> 00:26:46.978 position:50% align:middle - Also along those lines is, you know, we had, in our statute language, 00:26:46.978 --> 00:26:49.918 position:50% align:middle we didn't even have a collaborative practice agreement language in there. 00:26:49.918 --> 00:26:56.468 position:50% align:middle We had a written protocol for prescription, writing prescriptions that went in in about 2000 00:26:56.468 --> 00:26:58.498 position:50% align:middle or 1999, something like that. 00:26:58.498 --> 00:27:05.863 position:50% align:middle Anyway, we had to have a written protocol to write prescriptions and a responsible physician. 00:27:05.863 --> 00:27:09.923 position:50% align:middle And that's where the responsible physician language was in our statute. 00:27:09.923 --> 00:27:18.153 position:50% align:middle So taking that out, we were able to get rid of our collaborative practice agreements in our state and then 00:27:18.153 --> 00:27:24.513 position:50% align:middle malpractice and national certification. So those three things. 00:27:24.513 --> 00:27:29.293 position:50% align:middle The thing that probably took up the most space was when we were writing, I mean, 00:27:29.293 --> 00:27:34.263 position:50% align:middle getting rid of that written protocol and getting rid of that responsible physician language, 00:27:34.263 --> 00:27:39.913 position:50% align:middle we also made sure that we included the controlled substances part too. 00:27:39.913 --> 00:27:47.313 position:50% align:middle So, that was a lot of page information, was just having the whole controlled substance 00:27:47.313 --> 00:27:50.883 position:50% align:middle information there, because you have to have it in there when you're doing a bill. 00:27:50.883 --> 00:27:55.553 position:50% align:middle And it was, you know, like one sentence was marked out and changed. 00:27:55.553 --> 00:28:03.654 position:50% align:middle So, it was a bill that had a lot of stuff in it, but as far as the meat of it, 00:28:03.654 --> 00:28:05.864 position:50% align:middle it was just a couple of small paragraphs. 00:28:05.864 --> 00:28:11.104 position:50% align:middle - It was streamlined and focused and that's ultimately what the chairman had asked 00:28:11.104 --> 00:28:12.454 position:50% align:middle for in the Senate committee. 00:28:12.454 --> 00:28:17.374 position:50% align:middle Because back to those large bills, he had said, "I can't get this out of my committee because there's 00:28:17.374 --> 00:28:21.584 position:50% align:middle so many things for opposition to attack on. 00:28:21.584 --> 00:28:28.294 position:50% align:middle If you say that we are removing a permission slip and allowing nurse practitioners to have full scope 00:28:28.294 --> 00:28:33.534 position:50% align:middle of practice, full practice authority, then that's all that it should do." 00:28:33.534 --> 00:28:37.334 position:50% align:middle And so, that was our goal when we were crafting that initial bill. 00:28:37.334 --> 00:28:42.764 position:50% align:middle And, I think Nicole again did a really good job of threading that needle where we had everything we 00:28:42.764 --> 00:28:44.094 position:50% align:middle needed in the bill. 00:28:44.094 --> 00:28:49.424 position:50% align:middle But it was, it was easy to explain and it really trimmed down the opportunity for other people to say, 00:28:49.424 --> 00:28:55.620 position:50% align:middle "Well, it does these other things. Can you believe what these nurses are trying to do? It's terrible." 00:28:55.620 --> 00:29:01.099 position:50% align:middle - And so, I want to get, before we run out of time, I want us to be able to, 00:29:01.099 --> 00:29:07.079 position:50% align:middle for those of you that are in states that don't have this sort of what's in our bag of tricks, 00:29:07.079 --> 00:29:08.839 position:50% align:middle for you to maybe think about. 00:29:08.839 --> 00:29:15.409 position:50% align:middle And ultimately, you will need to write whatever bill that works in your state if it even ends 00:29:15.409 --> 00:29:17.259 position:50% align:middle up being 50 pages. 00:29:17.259 --> 00:29:24.579 position:50% align:middle But I do kind of want all of us to talk through some of the things that we think worked well for us. 00:29:24.579 --> 00:29:30.509 position:50% align:middle And, some of these are things that you don't necessarily need to think about. 00:29:30.509 --> 00:29:34.569 position:50% align:middle You would, if you really make a push for this, you would build a lobbying team and that's kind 00:29:34.569 --> 00:29:36.829 position:50% align:middle of their job to figure these things out. 00:29:36.829 --> 00:29:41.229 position:50% align:middle But we want to plant these seeds in your minds because some of you may be a year or two away from it. 00:29:41.229 --> 00:29:44.419 position:50% align:middle Some of you may look at your state legislative makeup right now and be like, 00:29:44.419 --> 00:29:46.379 position:50% align:middle "We don't even have a prayer there." 00:29:46.379 --> 00:29:51.599 position:50% align:middle You'd be like Capin [SP] starting out 20 years ago. Let's just do this on the merits. 00:29:51.599 --> 00:29:55.499 position:50% align:middle And, there is actually a starting point. 00:29:55.499 --> 00:30:02.034 position:50% align:middle And the thing I will toss in to get other people to talk about this too, Elizabeth mentioned earlier, 00:30:02.034 --> 00:30:07.844 position:50% align:middle the medical society had key relationships with key members in leadership. 00:30:07.844 --> 00:30:14.334 position:50% align:middle And if you don't think that matters or is going on right now, I guarantee you your respective medical 00:30:14.334 --> 00:30:21.434 position:50% align:middle society in your state has been cultivating relationships with leadership for years, 00:30:21.434 --> 00:30:28.224 position:50% align:middle even down to they know who the doctor is back home that serves the person that's the speaker of the House, 00:30:28.224 --> 00:30:31.834 position:50% align:middle and those relationships are very valuable to them. 00:30:31.834 --> 00:30:34.904 position:50% align:middle You need a champion. 00:30:34.904 --> 00:30:44.909 position:50% align:middle Capin hit the jackpot because they met with an individual that ended up on a leadership track and 00:30:44.909 --> 00:30:48.164 position:50% align:middle for whatever reason, he wasn't like Representative Blacks that had 00:30:48.164 --> 00:30:54.174 position:50% align:middle a relationship, whose wife was an APRN. He just decided he liked this issue. 00:30:54.174 --> 00:30:59.304 position:50% align:middle But he became key. And he wasn't the speaker, but he was the majority leader in the House. 00:30:59.304 --> 00:31:02.455 position:50% align:middle But he took this issue on before that. 00:31:02.455 --> 00:31:06.775 position:50% align:middle But he would not have taken that on without, they just sort of went to this person and said, "Hey, 00:31:06.775 --> 00:31:11.865 position:50% align:middle would you like to listen to this story?" And for whatever reason, he took that on. 00:31:11.865 --> 00:31:19.595 position:50% align:middle You need a person in your respective state legislature that will take this issue on and champion it and help 00:31:19.595 --> 00:31:22.515 position:50% align:middle muscle it because this ends up being a muscle play. 00:31:22.515 --> 00:31:24.235 position:50% align:middle You're not going to win just on the merits. 00:31:24.235 --> 00:31:29.275 position:50% align:middle And you need to look for someone that's potentially going to be in leadership in the future to be able 00:31:29.275 --> 00:31:34.049 position:50% align:middle to do that. If you feel like you're years away, start finding a champion. 00:31:34.049 --> 00:31:38.095 position:50% align:middle - Right. You have to have that history with the legislators. 00:31:38.095 --> 00:31:43.555 position:50% align:middle The other thing that you have to have is organized medicine will always have more money than we will. 00:31:43.555 --> 00:31:45.325 position:50% align:middle That's just a given. 00:31:45.325 --> 00:31:51.495 position:50% align:middle And so they do have those key people that are in leadership positions that have lots of control 00:31:51.495 --> 00:31:56.945 position:50% align:middle on whether your bill will ever be heard or run on the floor or whatever. 00:31:56.945 --> 00:32:03.092 position:50% align:middle But, the thing is, those legislators were voted in by the people in their community. 00:32:03.092 --> 00:32:10.992 position:50% align:middle And you've got to get those people in the community to start talking to that legislator because 50 voices that 00:32:10.992 --> 00:32:19.362 position:50% align:middle are voters have more power than KMSs', I mean, organized medicine's donations, and you know, 00:32:19.362 --> 00:32:22.782 position:50% align:middle their physician that takes care of that legislator. 00:32:22.782 --> 00:32:29.152 position:50% align:middle So, you have to have workarounds and you have to start figuring out how to play the game because I don't know 00:32:29.152 --> 00:32:40.752 position:50% align:middle about you guys, but in nursing for 40 years plus, I have never had really any education on how to play 00:32:40.752 --> 00:32:44.902 position:50% align:middle the legislative game in health policy. 00:32:44.902 --> 00:32:49.782 position:50% align:middle You got to figure out the workarounds and these guys have the workarounds. 00:32:49.782 --> 00:32:50.932 position:50% align:middle They're the ones that have members. 00:32:50.932 --> 00:32:57.362 position:50% align:middle - I think it was key that there were legislative champions and we did have to use some muscle. 00:32:57.362 --> 00:33:04.884 position:50% align:middle The chairman of the Public Health and Welfare Committee, I don't know that she was opposed 00:33:04.884 --> 00:33:08.884 position:50% align:middle to it completely because then she ends up bending and saying, "Well, let's do the Board of Healing Arts." 00:33:08.884 --> 00:33:13.574 position:50% align:middle Right? But she just did not want to have a hearing, etc. We went around her and... 00:33:13.574 --> 00:33:19.474 position:50% align:middle We talked about it going around her a year or two years ago. 00:33:19.474 --> 00:33:22.754 position:50% align:middle COVID's fogged my memory and the speaker, "There's protocols. 00:33:22.754 --> 00:33:25.514 position:50% align:middle No, you do not go around my chairperson." 00:33:25.514 --> 00:33:30.824 position:50% align:middle We got to a point where first of all the speaker was leaving, we're going to do it. 00:33:30.824 --> 00:33:35.014 position:50% align:middle And sorry, she's not even having a hearing and said that it passed the Senate. 00:33:35.014 --> 00:33:39.474 position:50% align:middle Oh, the other thing, I wonder if we would've had a vote two or three years ago. 00:33:39.474 --> 00:33:45.024 position:50% align:middle We had really strong margins, 80 to 40. There were several folks. 00:33:45.024 --> 00:33:51.394 position:50% align:middle - It was like, it was 80 some odd to I think we, well it was 37 maybe 36, 37 in the Senate. 00:33:51.394 --> 00:33:53.084 position:50% align:middle We only have 30 members. 00:33:53.084 --> 00:33:55.455 position:50% align:middle - It was 30, yes. 30 to 7. 00:33:55.455 --> 00:33:59.813 position:50% align:middle And it's either three Democrats voted against and four Republicans or vice versa. 00:33:59.813 --> 00:34:02.601 position:50% align:middle Including, we all know that Dr. Stephan, he wimped out, he didn't even vote. 00:34:02.601 --> 00:34:05.793 position:50% align:middle - He abstained. He did wimp out. 00:34:05.793 --> 00:34:11.943 position:50% align:middle - So there was bipartisan support, rural-urban, and once you kind of got through those roadblocks 00:34:11.943 --> 00:34:16.713 position:50% align:middle as you talked to legislators, in some ways it was, I bet we could have got it pass two or three, 00:34:16.713 --> 00:34:19.913 position:50% align:middle four years ago if we could have gotten the vote. 00:34:19.913 --> 00:34:21.403 position:50% align:middle - Right. It was the... That's where we did. We had rank and file. 00:34:21.403 --> 00:34:26.923 position:50% align:middle - Legislators were just like kind of like, like all of us non-nurses are, 00:34:26.923 --> 00:34:29.393 position:50% align:middle because obviously Michelle, you know this, but it's like, "Yeah, of course this makes sense." 00:34:29.393 --> 00:34:31.573 position:50% align:middle That's how most legislators were. 00:34:31.573 --> 00:34:36.553 position:50% align:middle And, the ones, I'm trying to think of the individuals... 00:34:36.553 --> 00:34:41.473 position:50% align:middle Like I don't know what Jim Kelly's deal was, but obviously, the other ones were relationships 00:34:41.473 --> 00:34:44.983 position:50% align:middle with the medical society. Was that Jim Kelly too? Yeah 00:34:44.983 --> 00:34:50.068 position:50% align:middle - Yeah. And some of the things we did from the grassroots perspective, we had a lot of our 00:34:50.068 --> 00:34:54.653 position:50% align:middle coalition partners. We had the chamber, AARP, and AFP. 00:34:54.653 --> 00:34:59.273 position:50% align:middle And then we brought in a couple state reps where it made sense. 00:34:59.273 --> 00:35:05.265 position:50% align:middle And we did a tour back in 2019 before COVID hit, when we did five cities around the state, 00:35:05.265 --> 00:35:12.769 position:50% align:middle which isn't a lot, but we picked five key areas where we wanted to make sure that the representative in that 00:35:12.769 --> 00:35:18.405 position:50% align:middle area or the folks there had an opportunity to hear about it, but then we could get the word 00:35:18.405 --> 00:35:19.255 position:50% align:middle out in the communities. 00:35:19.255 --> 00:35:24.435 position:50% align:middle So, we paired that education tour, and when we had... 00:35:24.435 --> 00:35:28.085 position:50% align:middle We had Capin with us on that too, anyway. 00:35:28.085 --> 00:35:33.485 position:50% align:middle We paired that tour with, we did some voter education mail, we did some, 00:35:33.485 --> 00:35:38.205 position:50% align:middle my organization did some door-knocking to go talk to people in their districts about why this mattered. 00:35:38.205 --> 00:35:42.175 position:50% align:middle We did some digital ads, we did some other different types of things 00:35:42.175 --> 00:35:46.555 position:50% align:middle to help people, constituents across the state get on board. 00:35:46.555 --> 00:35:52.955 position:50% align:middle But all of those things matter when you're trying to make sure that legislators know that constituents care 00:35:52.955 --> 00:35:58.585 position:50% align:middle about the role nurses can play in solving our healthcare crisis across our country. 00:35:58.585 --> 00:35:59.585 position:50% align:middle And that is huge. 00:35:59.585 --> 00:36:04.401 position:50% align:middle - I want to ask you three on the collaboration agreement. 00:36:04.401 --> 00:36:06.821 position:50% align:middle To me, that was a strong argument. 00:36:06.821 --> 00:36:10.931 position:50% align:middle I don't know if we ended up using...because I've seen my wife's collaboration agreement. 00:36:10.931 --> 00:36:15.114 position:50% align:middle It's a two... This is her job before she owned her business, 00:36:15.114 --> 00:36:21.131 position:50% align:middle it was a two-page document that like had been xeroxed so many times you could barely read it and it 00:36:21.131 --> 00:36:23.191 position:50% align:middle just said, "We will collaborate," or something like that. 00:36:23.191 --> 00:36:28.231 position:50% align:middle I mean, it was just like, so this, the doctors are all concerned about this. 00:36:28.231 --> 00:36:32.171 position:50% align:middle And I don't know if legislators cared about that or just the permission slip. 00:36:32.171 --> 00:36:37.161 position:50% align:middle Oh, the other thing definitely got people's attention was that there are some APRNs in Kansas that were 00:36:37.161 --> 00:36:40.441 position:50% align:middle having to pay a monthly fee. And this even came up. 00:36:40.441 --> 00:36:46.401 position:50% align:middle So this is, I haven't told you this Elizabeth or Michelle or Josh, my chairman, and I were speaking 00:36:46.401 --> 00:36:51.141 position:50% align:middle to the Manhattan Chamber, that's where K-State is about chamber stuff. 00:36:51.141 --> 00:36:52.621 position:50% align:middle And they were just talking about the legislative session. 00:36:52.621 --> 00:36:57.551 position:50% align:middle So I talked about APRNs and my chairman said, "Yeah, can you believe that there are some docs that 00:36:57.551 --> 00:36:59.361 position:50% align:middle were charging APRNs?" 00:36:59.361 --> 00:37:05.005 position:50% align:middle Well, Tom Phillips, former legislator, his wife's a specialist of some kind. 00:37:05.005 --> 00:37:09.971 position:50% align:middle And a very nice guy. He walked out and said, "Well that's just, that's not the case. That doesn't happen." 00:37:09.971 --> 00:37:14.835 position:50% align:middle And another, my chairman lives in Manhattan, another physician's husband said, "Oh, 00:37:14.835 --> 00:37:18.245 position:50% align:middle that doesn't happen." I said, "Yeah, it does." It does. 00:37:18.245 --> 00:37:24.335 position:50% align:middle And in fact, there was a independent practice in Meriden, a small town outside of Topeka. 00:37:24.335 --> 00:37:28.895 position:50% align:middle Her collaborating physician was in Manhattan, hour and a half away. 00:37:28.895 --> 00:37:32.645 position:50% align:middle How much were they collaborating after the bill passed? 00:37:32.645 --> 00:37:36.965 position:50% align:middle As the bill was going through, he raised her monthly fee. 00:37:36.965 --> 00:37:41.335 position:50% align:middle And so anyway, it does happen in the states that have collaborative agreements. 00:37:41.335 --> 00:37:46.705 position:50% align:middle And I find it interesting that the specialists were aware of that because they can't defend it. 00:37:46.705 --> 00:37:53.694 position:50% align:middle - No. What was unique about Kansas is we were such a strange state and the way that it was crafted with 00:37:53.694 --> 00:38:00.191 position:50% align:middle scope of practice and collaborative practice agreements and the fact that there actually is not a supervisory 00:38:00.191 --> 00:38:04.611 position:50% align:middle requirement in law in Kansas for nurse practitioners. 00:38:04.611 --> 00:38:08.646 position:50% align:middle It's all contractual through that collaborative practice agreement. 00:38:08.646 --> 00:38:14.881 position:50% align:middle And because of that, that those looked so different from practitioner 00:38:14.881 --> 00:38:20.171 position:50% align:middle to practitioner, and that very much was the case where you have some physicians who aren't seeing 00:38:20.171 --> 00:38:26.266 position:50% align:middle any patients, they weren't needed to, and they could have 10 nurse practitioners on contract 00:38:26.266 --> 00:38:30.821 position:50% align:middle and that was their livelihood and they would charge them 10 to 20 grand a year. 00:38:30.821 --> 00:38:33.981 position:50% align:middle And that happened. That's a thing in southeast Kansas. 00:38:33.981 --> 00:38:39.381 position:50% align:middle But if that man had passed away, these nurse practitioners literally could not work 00:38:39.381 --> 00:38:42.211 position:50% align:middle in Kansas anymore. What a shame. 00:38:42.211 --> 00:38:48.321 position:50% align:middle And so, it's things like that where you think, "Look, these nurse practitioners are already doing, 00:38:48.321 --> 00:38:51.931 position:50% align:middle in most cases, the job. 00:38:51.931 --> 00:38:58.341 position:50% align:middle They're already doing essentially full practice authority and their supervising physician has never 00:38:58.341 --> 00:39:00.258 position:50% align:middle touched their patient." 00:39:00.258 --> 00:39:00.648 position:50% align:middle That wasn't... 00:39:00.648 --> 00:39:03.988 position:50% align:middle - Collaborating physician. - Collaborating physician, I'm sorry. You're right. 00:39:03.988 --> 00:39:07.988 position:50% align:middle Their collaborating physician wasn't always, sometimes never even met their patient. 00:39:07.988 --> 00:39:15.638 position:50% align:middle And it varies in some cases, some CPAs did include more collaboration. 00:39:15.638 --> 00:39:22.418 position:50% align:middle But, that's the thing is the freedom and the ability for APRNs as professionals to make that 00:39:22.418 --> 00:39:24.318 position:50% align:middle decision for themselves. 00:39:24.318 --> 00:39:29.579 position:50% align:middle You can still technically have a collaborating practice agreement if you want one in Kansas, 00:39:29.579 --> 00:39:35.298 position:50% align:middle and you feel comfortable and that's how you want to operate your practice and your business do it. 00:39:35.298 --> 00:39:41.968 position:50% align:middle But the point is, with such a physician shortage in our state and in so many states, 00:39:41.968 --> 00:39:45.438 position:50% align:middle especially in non-populous areas, but like Michelle mentioned, 00:39:45.438 --> 00:39:50.938 position:50% align:middle we have huge underserved populations in our more urban centers. 00:39:50.938 --> 00:39:57.928 position:50% align:middle But the lack of physicians in Kansas, and the fact that the growing population 00:39:57.928 --> 00:40:03.044 position:50% align:middle of providers lies in the nursing field and not in the physician field. 00:40:03.044 --> 00:40:11.014 position:50% align:middle And you think about access to care, we have to make sure we're empowering nurses nationwide 00:40:11.014 --> 00:40:12.634 position:50% align:middle to serve our communities. 00:40:12.634 --> 00:40:15.504 position:50% align:middle It's key and essential in my perspective. 00:40:15.504 --> 00:40:20.704 position:50% align:middle - So, what ended up happening, we had those roadblocks. 00:40:20.704 --> 00:40:25.814 position:50% align:middle We had tried in the House a number of times, and we had a champion in the House but couldn't get 00:40:25.814 --> 00:40:32.734 position:50% align:middle past the speaker. But, we ended up finding a strong champion in the Senate committee, the chairman, 00:40:32.734 --> 00:40:34.654 position:50% align:middle and then also the president of the Senate. 00:40:34.654 --> 00:40:40.074 position:50% align:middle And so, again, back to these things that you can do if you've got a problematic chamber, 00:40:40.074 --> 00:40:43.264 position:50% align:middle unless you're Nebraska in here, you've got two chambers. 00:40:43.264 --> 00:40:49.284 position:50% align:middle So, try to work on one of the two to build support. 00:40:49.284 --> 00:40:55.382 position:50% align:middle And we, this year when we began thought that maybe we were just going to get it through the Senate to send a 00:40:55.382 --> 00:40:59.114 position:50% align:middle message to the House that we were serious about getting this done. 00:40:59.114 --> 00:41:02.655 position:50% align:middle But as Alan was saying earlier, it would've passed three years ago. 00:41:02.655 --> 00:41:09.295 position:50% align:middle Once it came through the Senate with such a strong vote, it was very much a stone rolling down the hill. 00:41:09.295 --> 00:41:10.485 position:50% align:middle This thing was going to happen. 00:41:10.485 --> 00:41:17.795 position:50% align:middle And to our surprise then it, ran right over to the House and did the exact same thing. 00:41:17.795 --> 00:41:20.665 position:50% align:middle Again, back to things that you shouldn't have to worry about. 00:41:20.665 --> 00:41:25.805 position:50% align:middle This is why you hire lobbyists to worry about this, but we creatively stuck the bill 00:41:25.805 --> 00:41:27.273 position:50% align:middle in the Senate committee. 00:41:27.273 --> 00:41:31.245 position:50% align:middle We stuck it into a House bill so that we didn't have to go through the House committee where the chairwoman 00:41:31.245 --> 00:41:32.515 position:50% align:middle was not supportive. 00:41:32.515 --> 00:41:34.715 position:50% align:middle They could just make a motion to concur on the House floor. 00:41:34.715 --> 00:41:38.465 position:50% align:middle So, these are handy little tricks that we were able to do. 00:41:38.465 --> 00:41:40.200 position:50% align:middle We have a couple of minutes left. 00:41:40.200 --> 00:41:47.855 position:50% align:middle I did want to talk to Carol before this, but another lesson that we all learned, 00:41:47.855 --> 00:41:52.325 position:50% align:middle the medical society or your medical societies don't lose often. 00:41:52.325 --> 00:41:57.265 position:50% align:middle In Kansas, ours is very proud of the fact that they were organized prior to statehood. 00:41:57.265 --> 00:42:01.003 position:50% align:middle They've been around since 1859 and we have been a state since 1861. 00:42:01.003 --> 00:42:06.273 position:50% align:middle So they don't lose much and it ain't over until it's over. 00:42:06.273 --> 00:42:15.703 position:50% align:middle We won with strong margins and yet still proceeded to run into trouble when it went to the rule-making phase. 00:42:15.703 --> 00:42:20.983 position:50% align:middle And so Carol, if you want to say a few things about that, you were suddenly right in the thick of things 00:42:20.983 --> 00:42:23.013 position:50% align:middle after the fact. 00:42:23.013 --> 00:42:26.774 position:50% align:middle - Yeah. KMS keeps throwing sticks. 00:42:27.744 --> 00:42:29.534 position:50% align:middle - [Carol] Is this on? 00:42:29.534 --> 00:42:34.313 position:50% align:middle - No. It sounds like it's now. 00:42:34.313 --> 00:42:35.213 position:50% align:middle - Is it on now? - Yes. 00:42:35.213 --> 00:42:40.303 position:50% align:middle - Can you hear? Okay. I'm Carol from the Board of Nursing. 00:42:40.303 --> 00:42:47.103 position:50% align:middle Yeah, I just, first of all, want to say a huge thank you to everyone up there, Nicole, National Council. 00:42:47.103 --> 00:42:48.243 position:50% align:middle They did a great job. 00:42:48.243 --> 00:42:51.913 position:50% align:middle It was not easy to do in Kansas, but they did a great job. 00:42:51.913 --> 00:43:00.722 position:50% align:middle They had a lot of challenges but what the Board of Nursing was basically handed is a signed bill that had 00:43:00.722 --> 00:43:08.777 position:50% align:middle to be implemented in two and a half months. And, it required seven regulations to be revised. 00:43:08.777 --> 00:43:14.627 position:50% align:middle And maybe that's easy in your states, but it is not easy in Kansas, believe me. 00:43:14.627 --> 00:43:22.347 position:50% align:middle And just to kind of show you kind of, just recently, and it wasn't this one, 00:43:22.347 --> 00:43:24.997 position:50% align:middle it was a different one that I'm involved with too. 00:43:24.997 --> 00:43:31.217 position:50% align:middle But anyway, the regulations did not get done by the date in the bill. 00:43:31.217 --> 00:43:38.707 position:50% align:middle So, there were a couple of legislators on this committee who their solution to this is that when the 00:43:38.707 --> 00:43:47.357 position:50% align:middle regulations are not in place by the date that the bill says they have control of our budget. 00:43:47.357 --> 00:43:54.267 position:50% align:middle So their solution is to take the salary of the executive administrator, me, 00:43:54.267 --> 00:43:58.807 position:50% align:middle out of that budget for a year, and that will solve everything, 00:43:58.807 --> 00:44:04.013 position:50% align:middle even though it really wouldn't because I wouldn't be there working free. 00:44:04.013 --> 00:44:07.803 position:50% align:middle I'm the only one who does the regs, and I really doubt that the Board of Nursing is going 00:44:07.803 --> 00:44:09.823 position:50% align:middle to be able to hire somebody else for nothing. 00:44:09.823 --> 00:44:14.123 position:50% align:middle But anyway, that just kind of shows you a little bit that we were up against. 00:44:14.123 --> 00:44:20.293 position:50% align:middle So, we had no choice but to try to put temporary and permanent regs in. 00:44:20.293 --> 00:44:25.163 position:50% align:middle Temporary regs are the fastest to get through in Kansas. 00:44:25.163 --> 00:44:29.313 position:50% align:middle Permanent regs, we have to do like a 60-day comment period and all of that. 00:44:29.313 --> 00:44:33.033 position:50% align:middle So there's absolutely no way that we would've been able to get those through. 00:44:33.033 --> 00:44:36.623 position:50% align:middle So what I did first on the regs, because I wanted them to go through as fast 00:44:36.623 --> 00:44:40.633 position:50% align:middle as possible, is I sat down with our general counsel. 00:44:40.633 --> 00:44:45.852 position:50% align:middle I said, "I want to make sure that I'm understanding this correctly because we already heard about some 00:44:45.852 --> 00:44:52.203 position:50% align:middle of the issues with the collaborative agreement language not being in there and all of that." 00:44:52.203 --> 00:44:57.915 position:50% align:middle So, him and I crafted regulation changes. 00:44:57.915 --> 00:45:05.104 position:50% align:middle The timing of this all was that we did not have another board meeting until June and most of this had to take 00:45:05.104 --> 00:45:06.570 position:50% align:middle place before then. 00:45:06.570 --> 00:45:12.830 position:50% align:middle So we actually ended up having a couple of special board meetings, board presidents here. 00:45:12.830 --> 00:45:15.890 position:50% align:middle We have a very supportive board. I will say that. 00:45:15.890 --> 00:45:22.280 position:50% align:middle At the last minute if we wanted to do a special board meeting, they were really good and we could do it 00:45:22.280 --> 00:45:28.890 position:50% align:middle as fast, as long as we could give public notice and all of that. 00:45:28.890 --> 00:45:34.440 position:50% align:middle So, we actually started them through the process, I took the temporary and the permanent at the very same 00:45:34.440 --> 00:45:39.330 position:50% align:middle time because they start out together and then they branch off differently. 00:45:39.330 --> 00:45:45.290 position:50% align:middle And it kind of went back and forth a little bit through the Department of Administration as far as all the 00:45:45.290 --> 00:45:47.780 position:50% align:middle grammar and all of that then has to be perfect. 00:45:47.780 --> 00:45:53.370 position:50% align:middle And once it gets through that phase of approval, then it has to go to the attorney general's office. 00:45:53.370 --> 00:46:02.201 position:50% align:middle And there's two assistant attorney generals that look at it for legality and, it got approved through there. 00:46:02.201 --> 00:46:07.921 position:50% align:middle Okay, you need to hear that because, okay, three attorneys now have looked at this. All right. 00:46:07.921 --> 00:46:18.901 position:50% align:middle So, the next step for the temporary ones was to go in front of the state rules and reg board and all this, 00:46:18.901 --> 00:46:24.681 position:50% align:middle again, had to be in place by July 1st because that was the date that the first part of the bill. 00:46:24.681 --> 00:46:29.071 position:50% align:middle There's two different implementation dates for different things in this bill, 00:46:29.071 --> 00:46:35.341 position:50% align:middle which has been very confusing for a lot of the implementation. I will say that. 00:46:35.341 --> 00:46:42.261 position:50% align:middle So, I had never done temporary regs before, but I talk to a lot of people and they're like, 00:46:42.261 --> 00:46:45.981 position:50% align:middle "You just go there and it's no big deal." Okay? 00:46:45.981 --> 00:46:53.501 position:50% align:middle So, I show up that day for that and one of the first people I see is KMS. 00:46:53.501 --> 00:46:56.771 position:50% align:middle And I'm thinking, "Okay, so what's going on here?" 00:46:56.771 --> 00:47:01.353 position:50% align:middle But that same time I get an email from one of the people on the board that said, 00:47:01.353 --> 00:47:05.193 position:50% align:middle "You need to be aware of what's going to happen today." 00:47:05.193 --> 00:47:14.873 position:50% align:middle So, KMS basically had shown up and they had talked to some of the members on this committee or this board and 00:47:14.873 --> 00:47:22.423 position:50% align:middle gotten permission to speak also instead of just the agency that's presenting these. 00:47:22.423 --> 00:47:24.442 position:50% align:middle So, they had me speak first. 00:47:24.442 --> 00:47:27.581 position:50% align:middle So I just kind of spoke and talk about them and why we're doing them 00:47:27.581 --> 00:47:30.063 position:50% align:middle and what's included and all of that. 00:47:30.063 --> 00:47:32.993 position:50% align:middle And then they allowed KMS to come up and speak. 00:47:32.993 --> 00:47:41.913 position:50% align:middle KMS's thing in this whole, my part, the Board of Nursing part, is to cause a lot of confusion. 00:47:41.913 --> 00:47:44.003 position:50% align:middle Literally a lot of confusion. 00:47:44.003 --> 00:47:49.337 position:50% align:middle They brought their general counsel who came up and proceeded to tell everybody all about the 00:47:49.337 --> 00:47:52.627 position:50% align:middle practice of nursing. Of course, they were not saying it right. 00:47:52.627 --> 00:48:00.929 position:50% align:middle We also heard them say that the Board of Nursing was giving the authority to the APRNs to practice medicine 00:48:00.929 --> 00:48:06.759 position:50% align:middle and do surgery. You know, stuff like that. So they just kind of kept this up for a little bit. 00:48:06.759 --> 00:48:12.179 position:50% align:middle Well, you could see the confusion being created among the board members, you know, 00:48:12.179 --> 00:48:14.399 position:50% align:middle and that's exactly what they were trying to do. 00:48:14.399 --> 00:48:20.789 position:50% align:middle But unfortunately at these hearings for these regulations, you speak when you're called. 00:48:20.789 --> 00:48:25.519 position:50% align:middle So that meant that I didn't have the option to go back up and give feedback. 00:48:25.519 --> 00:48:29.429 position:50% align:middle And that was the key right there. I think that was planned that way. 00:48:29.429 --> 00:48:32.769 position:50% align:middle I really do. So there were seven regs. 00:48:32.769 --> 00:48:37.559 position:50% align:middle They approved three of them, but they did not approve the other four, 00:48:37.559 --> 00:48:42.567 position:50% align:middle which basically what we were looking at then is the APRNs could prescribe without a 00:48:42.567 --> 00:48:47.329 position:50% align:middle collaborative agreement, but they couldn't do anything else in their practice 00:48:47.329 --> 00:48:49.019 position:50% align:middle without a collaborative agreement. 00:48:49.019 --> 00:48:51.249 position:50% align:middle Everything else had to have a collaborative agreement. 00:48:51.249 --> 00:48:55.799 position:50% align:middle Now that was extremely confusing, didn't make any sense or anything else. 00:48:55.799 --> 00:49:03.367 position:50% align:middle So, I think collaboration is so very important in this because right after that hearing, 00:49:03.367 --> 00:49:08.677 position:50% align:middle the first thing I did was reach out to Nicole and I said, "You need to understand what just happened. 00:49:08.677 --> 00:49:15.507 position:50% align:middle Okay? And, I don't know what we can do other than education. 00:49:15.507 --> 00:49:21.287 position:50% align:middle I don't know if they're going to give us another chance on those four, you know?" 00:49:21.287 --> 00:49:28.218 position:50% align:middle And so, a lot of people started working then behind the scenes and everything like that. 00:49:28.218 --> 00:49:33.337 position:50% align:middle So three of them were implemented by July 1st, the others were not. 00:49:33.337 --> 00:49:41.907 position:50% align:middle And, the date that I was supposed to present the permanent ones was July 18th. 00:49:41.907 --> 00:49:49.737 position:50% align:middle Well, like two days before July 18th, I got a phone call from the chair of that records board 00:49:49.737 --> 00:49:56.367 position:50% align:middle and she said, "We've had some education and you know, I don't think it's going to be a problem for us to get 00:49:56.367 --> 00:49:58.487 position:50% align:middle those other four in place. 00:49:58.487 --> 00:50:06.957 position:50% align:middle So what we want to do is we want to have that board meet again before the other committee meets to talk 00:50:06.957 --> 00:50:11.997 position:50% align:middle about the permanent ones so we can approve your temporary ones." 00:50:11.997 --> 00:50:17.531 position:50% align:middle And that was great because that gave us more momentum to go in for the permanent ones to say the temporary 00:50:17.531 --> 00:50:18.697 position:50% align:middle ones have been approved. 00:50:18.697 --> 00:50:26.437 position:50% align:middle And they did, they called the meeting to order, no discussion, they passed them, and that was it. 00:50:26.437 --> 00:50:30.827 position:50% align:middle - And sorry, I don't want to cut you off too much, but I just... 00:50:30.827 --> 00:50:38.597 position:50% align:middle Back to if you are thinking about this in your state, there are elements of this that this is a muscle play. 00:50:38.597 --> 00:50:46.557 position:50% align:middle And, we can say this as nursing organizations, you can't say this, but as legislators, 00:50:46.557 --> 00:50:51.687 position:50% align:middle it is imperative that you keep it as simple as possible, imperative. 00:50:51.687 --> 00:50:58.917 position:50% align:middle And I promise you, they will still get confused if they are not doctors or nurses. 00:50:58.917 --> 00:51:04.899 position:50% align:middle This is a very arcane portion of the law. It is very complicated. 00:51:04.899 --> 00:51:10.966 position:50% align:middle And so, the situation that Carol was talking about, this is the rules and regs committee. 00:51:10.966 --> 00:51:13.116 position:50% align:middle It's a joint committee of House and Senate members. 00:51:13.116 --> 00:51:22.076 position:50% align:middle We had supporters that had been with us through the entire process that almost derailed the regulations 00:51:22.076 --> 00:51:26.136 position:50% align:middle from going into place because it's just difficult for them. 00:51:26.136 --> 00:51:32.056 position:50% align:middle If you are skilled at creating confusion, which we've been on all sides of all sorts of things, 00:51:32.056 --> 00:51:37.014 position:50% align:middle if we want something to pass, we're clarifying it. If I want it to stop, I'm creating confusion. 00:51:37.014 --> 00:51:39.606 position:50% align:middle I mean, that's what we do. 00:51:39.606 --> 00:51:43.217 position:50% align:middle And they created confusion and legislators had no idea what was going on. 00:51:43.217 --> 00:51:45.148 position:50% align:middle So we were making late frantic phone calls... 00:51:45.148 --> 00:51:47.876 position:50% align:middle - Oh, so many phone calls. 00:51:47.876 --> 00:51:51.548 position:50% align:middle I will say, and that's also where relationships matter. 00:51:51.548 --> 00:51:54.667 position:50% align:middle You know, Alan, we've all talked about where those relationships in leadership matter, 00:51:54.667 --> 00:51:59.756 position:50% align:middle but also with your policy champions, and having those placed in really strategic places 00:51:59.756 --> 00:52:05.254 position:50% align:middle within the capital and within the committees, and having people who you've built this mutual trust 00:52:05.254 --> 00:52:12.422 position:50% align:middle with because then those phone calls go better when you say, "Hi Barb, I really need to talk to you about what 00:52:12.422 --> 00:52:14.564 position:50% align:middle happened this morning and how we can fix it." 00:52:14.564 --> 00:52:18.544 position:50% align:middle - Barb, we're going to coffee. - Right? 00:52:18.544 --> 00:52:25.988 position:50% align:middle But that is key and essential to making sure that you're able to be successful is building that mutual 00:52:25.988 --> 00:52:30.486 position:50% align:middle trust with key legislators in lots of different places, not just one. 00:52:30.486 --> 00:52:31.904 position:50% align:middle - And following through. 00:52:31.904 --> 00:52:37.726 position:50% align:middle We maybe falsely made the assumption after you pass a Cbill with overwhelming majority, 00:52:37.726 --> 00:52:43.737 position:50% align:middle that the rules and regs passes, which usually is very sleepy. 00:52:43.737 --> 00:52:49.508 position:50% align:middle I used to sit on rules and regs and it was killer to stay awake in that joint committee. 00:52:49.508 --> 00:52:55.414 position:50% align:middle And because it normally not fireworks at all, but to the medical society's credit, 00:52:55.414 --> 00:53:02.859 position:50% align:middle they thought they saw an opportunity to derail things and we ended up being fine. 00:53:02.859 --> 00:53:04.409 position:50% align:middle But it was difficult. 00:53:04.409 --> 00:53:09.299 position:50% align:middle - Well, we're kind of fine. Go ahead, Carol and tell us the rest of the story. 00:53:09.299 --> 00:53:15.228 position:50% align:middle - Okay. So, they basically have control over the temp regs. You got to remember that. 00:53:15.228 --> 00:53:21.759 position:50% align:middle When we got to the permanent ones, you know, an hour later, they do not have control 00:53:21.759 --> 00:53:23.199 position:50% align:middle over the permanent ones. 00:53:23.199 --> 00:53:29.069 position:50% align:middle The ones that have control over the permanent ones are the Board of Nursing, and they don't like that, okay? 00:53:29.069 --> 00:53:33.829 position:50% align:middle Not the Board of Nursing, but some of the legislators do not like that these state 00:53:33.829 --> 00:53:43.899 position:50% align:middle agencies kind of have that amount of power. So, the same thing happened in that hearing. 00:53:43.899 --> 00:53:45.969 position:50% align:middle They let me talk first. Same thing. 00:53:45.969 --> 00:53:49.919 position:50% align:middle I mean, the temp and the permanent were exactly the same. 00:53:49.919 --> 00:53:55.439 position:50% align:middle They just had different implementation dates. That's it. That was the only change. 00:53:55.439 --> 00:54:01.370 position:50% align:middle So then KMS got a, I could almost tell you by heart everything they've said throughout this whole thing. 00:54:01.370 --> 00:54:03.670 position:50% align:middle And same thing, just the same spiel. 00:54:03.670 --> 00:54:11.740 position:50% align:middle They caused all this confusion and they ended it with saying, "There's a simple solution to this. 00:54:11.740 --> 00:54:18.460 position:50% align:middle The Board of Nursing just needs to take medical out of there and put nursing in. 00:54:18.460 --> 00:54:24.090 position:50% align:middle So it would no longer say medical plan of care, it would say nursing plan of care. 00:54:24.090 --> 00:54:28.610 position:50% align:middle It would not say like medical diagnosis, it would say nursing diagnosis." 00:54:28.610 --> 00:54:36.220 position:50% align:middle The nurses in the room know that the nursing care plan and nursing diagnosis for RNs, 00:54:36.220 --> 00:54:41.870 position:50% align:middle LPNs is certainly not the same as what the APRNs do, okay? 00:54:41.870 --> 00:54:44.540 position:50% align:middle But that's all the legislators heard. 00:54:44.540 --> 00:54:48.860 position:50% align:middle So they look at me and they're like, "Well, there's a solution. 00:54:48.860 --> 00:54:51.270 position:50% align:middle Just go ahead and do it." 00:54:51.270 --> 00:54:56.460 position:50% align:middle And okay, I wouldn't agree to anything. It's not my decision, okay? 00:54:56.460 --> 00:55:01.930 position:50% align:middle So, again, all they could do was give feedback to the Board of Nursing. 00:55:01.930 --> 00:55:06.180 position:50% align:middle They could not stop this going forward, and they knew that. 00:55:06.180 --> 00:55:07.790 position:50% align:middle So they provided that feedback. 00:55:07.790 --> 00:55:15.257 position:50% align:middle The feedback that they requested is that there be feedback from the Board of Nursing as to why that would 00:55:15.257 --> 00:55:19.348 position:50% align:middle not be taking place, basically, is what they said. Okay. 00:55:19.348 --> 00:55:26.030 position:50% align:middle So again, I left, I talked to Nicole and I said, "Okay, this is not just the Board of Nursing, 00:55:26.030 --> 00:55:32.723 position:50% align:middle we need feedback from everyone here to give this feedback and get it all kind of put together in a nice 00:55:32.723 --> 00:55:34.400 position:50% align:middle document and everything." 00:55:34.400 --> 00:55:38.099 position:50% align:middle So we did that. We sent it over, didn't really hear anything. 00:55:38.099 --> 00:55:41.720 position:50% align:middle And then I will tell you the best part of this for me. 00:55:41.720 --> 00:55:45.290 position:50% align:middle The very best part of this whole thing has been the public hearing. 00:55:45.290 --> 00:55:49.760 position:50% align:middle Because we had the public hearing and, you know, it's publicized. 00:55:49.760 --> 00:55:54.330 position:50% align:middle Anybody can show up and give comments. Well, you know who was there. Okay? 00:55:54.330 --> 00:55:59.253 position:50% align:middle She started calling me numerous times ahead of time to let me know that she was going to be there and 00:55:59.253 --> 00:56:01.713 position:50% align:middle give a presentation. 00:56:01.713 --> 00:56:05.463 position:50% align:middle And I said, "Fine, you know, I can't stop anything like that." 00:56:05.463 --> 00:56:13.283 position:50% align:middle So, in the room was KMS on this side, and they had their general counsel, 00:56:13.283 --> 00:56:16.543 position:50% align:middle they brought some physicians with them, okay? 00:56:16.543 --> 00:56:23.013 position:50% align:middle On this side was everybody for this, one of the legislators was there, 00:56:23.013 --> 00:56:28.573 position:50% align:middle Representative Blacks was there, and some employers and some of APRNs. 00:56:28.573 --> 00:56:34.383 position:50% align:middle So I asked them when I started the public hearing, I said, "I just need to know how many of you want 00:56:34.383 --> 00:56:38.316 position:50% align:middle to give comments so that we'll know how much time we have." 00:56:38.316 --> 00:56:43.439 position:50% align:middle And I was a little concerned because the only one that was going to give comments was KMS. 00:56:43.439 --> 00:56:48.323 position:50% align:middle And I thought, "This isn't going to go good because I can't say anything at this. 00:56:48.323 --> 00:56:50.527 position:50% align:middle I am there just to facilitate it." 00:56:50.527 --> 00:56:56.573 position:50% align:middle And their general counsel, just to kind of show you how intimidating she tried it to be. 00:56:56.573 --> 00:57:01.662 position:50% align:middle Like two days before she sent me this email and she said, "Well, I just need to know, 00:57:01.662 --> 00:57:07.462 position:50% align:middle will the board be at this or will it just be staff?" 00:57:07.462 --> 00:57:11.552 position:50% align:middle Okay, the board doesn't attend this. It's just staff, you know? 00:57:11.552 --> 00:57:14.442 position:50% align:middle But I wouldn't say that we're just staff. 00:57:14.442 --> 00:57:19.442 position:50% align:middle So anyway, I thought, "Hmm, okay, let's see how this goes." 00:57:19.442 --> 00:57:25.992 position:50% align:middle So I let her come up and she had this table and she just strung everything out, everything. 00:57:25.992 --> 00:57:30.622 position:50% align:middle Nurse Practice Act and everything. And she just kinda looks at me and I said, "Okay." 00:57:30.622 --> 00:57:33.072 position:50% align:middle I said, "What you need to understand is you have 10 minutes." 00:57:33.072 --> 00:57:37.412 position:50% align:middle And I had my phone on the timer, and I said, "It starts right now." 00:57:37.412 --> 00:57:42.532 position:50% align:middle So, she said the very same thing again for 10 minutes. 00:57:42.532 --> 00:57:44.792 position:50% align:middle And then when my timer went off, I will give her credit, 00:57:44.792 --> 00:57:48.282 position:50% align:middle she shut up and went and sat down. 00:57:48.282 --> 00:57:51.742 position:50% align:middle So then I just got up and this was kind of the best part. 00:57:51.742 --> 00:57:59.002 position:50% align:middle I said, "So I'm just double-checking before, you know, we end this, is there anybody else in the room that has 00:57:59.002 --> 00:58:01.063 position:50% align:middle decided that they want to give comments?" 00:58:01.063 --> 00:58:05.073 position:50% align:middle I said, "How about anybody else from this side, which is KMS?" 00:58:05.073 --> 00:58:10.013 position:50% align:middle " Oh, no, no." She was the spokesperson for them. I said, "Okay, fine." 00:58:10.013 --> 00:58:14.423 position:50% align:middle I said, "How about this side?" Everybody's hands went up. 00:58:14.423 --> 00:58:22.083 position:50% align:middle We now had control because she was not going to be able to give any more feedback and they all then could get 00:58:22.083 --> 00:58:25.593 position:50% align:middle up and give feedback about what she said. It was great. 00:58:25.593 --> 00:58:30.055 position:50% align:middle It was absolutely great, and there wasn't anything she could do about it. Absolutely none. 00:58:30.055 --> 00:58:38.343 position:50% align:middle So then, all of the... We had 80 pages of comments that went to our board to review before the board meeting. 00:58:38.343 --> 00:58:42.112 position:50% align:middle And then there was basically no discussion from the board. 00:58:42.112 --> 00:58:44.800 position:50% align:middle They just passed them, each of them. 00:58:44.800 --> 00:58:51.203 position:50% align:middle And so they actually, the permanent ones became implemented and in effect 00:58:51.203 --> 00:58:55.153 position:50% align:middle October 14th, and the temporary ones would've run out October 28th. 00:58:55.153 --> 00:58:57.633 position:50% align:middle So we [inaudible] That's it. 00:58:57.633 --> 00:59:01.904 position:50% align:middle But, you know, there was a lot of lessons to be learned. 00:59:01.904 --> 00:59:05.052 position:50% align:middle The implementation can be very, very challenging. 00:59:05.052 --> 00:59:10.862 position:50% align:middle Typically, we have a little bit more time than that, but Adrian and I had already talked about what we would 00:59:10.862 --> 00:59:14.790 position:50% align:middle have to do because we're going to have to make some changes to our licensing software. 00:59:14.790 --> 00:59:18.812 position:50% align:middle And those of you that work at a board of nursing, you know, you have to have vendors, 00:59:18.812 --> 00:59:21.042 position:50% align:middle you have to have a lot of people involved. 00:59:21.042 --> 00:59:27.502 position:50% align:middle So we were just kind of waiting, you know, to see the outcome of the bill and everything like that 00:59:27.502 --> 00:59:30.352 position:50% align:middle before we talked to vendors and stuff like that. 00:59:30.352 --> 00:59:35.082 position:50% align:middle But it was still, I would say it was a scramble to get it done in two and a half months. 00:59:35.082 --> 00:59:43.942 position:50% align:middle The part that got implemented on July 1st was removing the collaborative practice agreement and then the 00:59:43.942 --> 00:59:47.052 position:50% align:middle medical malpractice insurance coverage. 00:59:47.052 --> 00:59:52.052 position:50% align:middle And then what starts July 1st of 2023 is the national certification. 00:59:52.052 --> 00:59:54.962 position:50% align:middle But that has been very confusing to APRNs. 00:59:54.962 --> 01:00:02.237 position:50% align:middle The communication in this whole thing has been huge, absolutely huge, because I'm convinced there's still a 01:00:02.237 --> 01:00:08.812 position:50% align:middle lot of misinformation being fed to the APRNs out there from, I'm sure KMS. 01:00:08.812 --> 01:00:13.972 position:50% align:middle I can't prove that, but I'm sure it probably is because we get a lot of phone calls, you know, 01:00:13.972 --> 01:00:19.182 position:50% align:middle and so we've just tried to do communication, communication, communication. 01:00:20.374 --> 01:00:27.082 position:50% align:middle - Thank you, Carol. We've got this super handy timer, and we're technically out of time. 01:00:27.082 --> 01:00:30.762 position:50% align:middle This is a photo of the signing ceremony, and if you have the opportunity to do that 01:00:30.762 --> 01:00:33.252 position:50% align:middle in your state, we would certainly hope that you would. 01:00:33.252 --> 01:00:37.532 position:50% align:middle You probably wouldn't have a picture of the National Champions basketball team behind you, 01:00:37.532 --> 01:00:43.072 position:50% align:middle because that's kind of a Kansas thing, but, that's the signing ceremony. 01:00:43.072 --> 01:00:50.842 position:50% align:middle And then, that's the actual size of Kansas relative to the rest of the country in our own minds. 01:00:50.842 --> 01:00:55.444 position:50% align:middle But, I'm not in control of the time. I know you have a speaker after us. 01:00:55.444 --> 01:00:59.296 position:50% align:middle If there is someone with a burning question or something or we don't have time for any questions? 01:00:59.296 --> 01:01:03.947 position:50% align:middle Okay. So, do not ask us a question. 01:01:03.947 --> 01:01:10.005 position:50% align:middle - I want to thank Nicole and everybody for having us. This is a lot of fun and a great place to be. 01:01:13.981 --> 01:01:19.901 position:50% align:middle - And, KMS is not done. They've asked the attorney general for an opinion on all of this. 01:01:19.901 --> 01:01:24.711 position:50% align:middle And even though we had the attorney general's input from the very start, 01:01:24.711 --> 01:01:28.411 position:50% align:middle they're still asking for an opinion. So, it hasn't stopped yet. 01:01:28.411 --> 01:01:30.361 position:50% align:middle - Oh, we stand ready. We'll fight it to the end. 01:01:30.361 --> 01:01:36.851 position:50% align:middle But really appreciate everything you guys do and try to make sure we have opportunities for nurses to help make 01:01:36.851 --> 01:01:42.314 position:50% align:middle sure healthcare is affordable and accessible across the country. Thanks, guys.