Nurses Week Celebrates Act 169

By Wailua Brandman
Interviewed by Melissa Moniz
Wednesday - November 11, 2009
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Wailua Brandman, Aprn-Rx Bc
President of Hawaii Association of Professional Nurses,
Oahu director-at-large of the American Psychiatric Nurses Association Hawaii

Where did you receive your schooling and training?

I went to graduate school at Yale and graduated in 1994. I became a clinical nurse specialist in adult psychiatric mental health nursing. My specialty track was consultation liaison, so my clinical was to work in a psychiatric hospital and do consultation with the staff, patients and families. I also did some independent study as a psychotherapist. Then on my way to Hawaii I stopped in California for a year and did a post-master’s certificate at Cal State Long Beach. With that part of my education I became a psychiatric nurse practitioner. And I just got word yesterday that I was made a primary care provider (PCP) with the Hawaii IPA (Independent Physicians Association). And that really was what Act 169 is about.


Can you talk more about Act 169, which was signed recently by Gov. Lingle?

It made it possible for insurance companies to recognize advanced-practice nurses as primary care providers. Traditionally that’s what we’ve been doing all along, but it’s just we weren’t recognized or reimbursed that way. So now I’ve learned that there are special codes I can use to get increased reimbursement. A lot of times my patients don’t see other providers and only see me because a lot of times these people with mental illnesses don’t communicate the same way. So now, when my patients come and they have a medical issue, I can make an assessment and I can treat it. But if I can’t then, I can refer them to someone who can. It really opens the gates.

Is Act 169 fairly new to the country or have other states already adopted it?

Parts of it other states have done, but I don’t think any other states have done an all-inclusive bill like this.

Anne Leake, Ph.D. FNP-C, percussing patient Koki Cummings’ back to check for consolidation in the lungs

How does Act 169 directly affect patients?

Patients will have greater access. For instance, some patients don’t have any insurance, so doctors generally won’t see them. Nurse practitioners are out in the community in clinics where these people without insurance can get care. If they do have insurance, then their insurance will be listing us as primary care providers. This will really enable us to be entrepreneurs. Previously we would have to collaborate with a physician, which is fine, but now physicians can simply be consultants to the APRNs. This will be particularly helpful on the Neighbor Islands, where there are few primary care providers. And there will ultimately be fewer road blocks for the patients. And what’s huge is global signature rights. In the past, patients would bring us forms because we did their examination and we weren’t allowed to sign the forms although we provided the care. Now, with Act 169, we can sign those forms. It’s much easier for the patient.

When does Act 169 go into effect?

Part of it is in effect. The PCP part went into effect. The global signature went into effect. On Oct. 1, the new requirement to have both a master’s degree and a national board certification went into effect. The only part that we aren’t able to do yet is the controlled substances because there are current administrative rules in place that regulate our prescriptive authority that are in conflict with the new law. So we need to change the rules before we practice prescriptive authority under the new law.

Do you think once this all goes through that more APRNs will go into private practice or more community centers will open up?

I think so, but it probably won’t be until the prescriptive authority part of the bill goes into effect, which probably won’t be until the end of 2010.

Are there any special events to celebrate National Nurse Practitioners Week (Nov. 8-14) in Hawaii?

Jan Towers, director of health policy and co-founder of AANP (American Academy of Nurse Practitioners) is going to meet with legislators Tuesday (Nov. 10) morning. There will be a presentation of a gubernatorial proclamation and a joint resolution recognizing Hawaii Nurse Practitioner Day, followed by a press conference. And to celebrate, an event is planned for Wednesday (Nov. 11) at the East-West Center from 5:30 to 9 p.m.


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