>> JEFFREY MANDEL, THANKS VERY MUCH.

>> THANK YOU FOR HAVING ME.

>> GIVEN A HEALTHCARE PROVIDER SHORTAGE IN WISCONSIN, PROPOSED LEGISLATION WOULD, FOR THE FIRST TIME, CREATE A SEPARATE LICENSE FOR ADVANCED PRACTISE REGISTERED NURSES.

THOSE KIND OF NURSES INCLUDE CERTIFIED NURSE MIDWIFE, CERTIFIED REGISTERED NURSE ANESTHETIST, CLINICAL NURSE SPECIALIST AND NURSE PRACTITIONER.

UNDER THE BILL, THEY WOULD BE ABLE TO TO PRACTISE WITHOUT PHYSICIAN OVERSIGHT.

MEDICAL SOCIETY OF WISCONSIN OPPOSES THE MEASURE IN ITS CURRENT FORM AND WE'LL HEAR FROM A PHYSICIAN FROM THAT GROUP IN A MOMENT.

BUT FIRST, WE HEAR FROM ONE OF THE BILL'S AUTHORS AND A NURSE HERSELF, SENATOR RACHAEL CABRAL-GUEVARA.

THANK YOU FOR BEING WITH US, SENATOR.

>> THANK YOU FOR HAVING ME HERE TODAY.

>> SO WHY IN YOUR MIND SHOULD WISCONSIN ALLOW ADVANCED PRACTISE REGISTERED NURSES TO PRACTISE INDEPENDENTLY WITH REALLY FEWER RESTRICTIONS?

>> YEAH.

SO WHEN YOU LOOK AT THE RESEARCH, THERE ISN'T A LOT OUT THERE THAT SAYS WE CAN'T PRACTISE AUTONOMOUSLY.

CURRENT IN THE STATE OF WISCONSIN, WE HAVE OVER 8,000 NURSES HERE -- NURSE PRACTITIONERS HERE IN THE STATE OF WISCONSIN AND WE'RE DOING A FANTASTIC JOB.

WE WORK COLLABORATIVELY WITH PHYSICIANS AS IT IS CURRENTLY AND WE DON'T ANTICIPATE WITH THIS BILL PASSING WITH THE AUTONOMY THAT WE STILL WOULDN'T WORK IN COLLABORATION WITH PHYSICIANS HERE IN THE STATE OF WISCONSIN.

27 OTHER STATES DO THIS AND THE OUTCOMES HAVE BEEN ABSOLUTELY AMAZING.

WHEN WE TALK WITH PATIENTS, PATIENTS ARE ALSO ASKING FOR THIS.

THERE ARE MANY NURSE PRACTITIONERS HERE IN THE STATE OF WISCONSIN THAT WOULD LOVE TO OPEN UP CLINICS WITHIN RURAL DISTRICTS AND CURRENTLY, BY THE WAY LEGISLATION IS WRITTEN, IT'S ALMOST IMPOSSIBLE FOR THAT TO HAPPEN.

AND SO BY DROPPING THESE REGULATIONS THAT WE CURRENTLY HAVE, IT WILL OPEN THE DOOR FOR AFFORDABILITY, IT WILL OCHOA THE DOOR FOR ACCESS -- DOOR FOR ACCESS AND IT WILL CONTINUE TO PROVIDE VALUABLE SERVICE THAT MANY PATIENTS HERE IN WISCONSIN SEEK.

>> SO THE WISCONSIN MEDICAL SOCIETY WANTS SUCH NURSES TO HAVE FOUR YEARS OF EXPERIENCE, NOT THE TWO CALLED FOR IN THE LEGISLATIVE BILL.

IS THAT UNREASONABLE?

>> WELL, WHEN YOU LOOK AT THE 27 OTHER STATES, NONE OF THOSE STATES HAVE FOUR YEARS FOR REGULATION.

EVERY STATE IS A LITTLE BIT DIFFERENT.

ON AVERAGE, I SEE AROUND TWO, MAYBE A LITTLE BIT MORE, MAYBE THREE, BUT WISCONSIN WOULD BE THE ONLY STATE THAT REQUIRES FOUR YEARS PRIOR TO AUTONOMY, AND SO WE'RE JUST ASKING IF OTHER STATES ARE DOING THIS AND THEY'RE DOING JUST FINE AND NOT SEEING INCREASE IN CONCERN OR LITIGATION, WHY DO WE SEEK FOUR YEARS?

MANY NURSE PRACTITIONERS THAT HAVE GONE ON -- MANY NURSES THAT HAVE GONE ON TO BE NURSE PRACTITIONERS, MOST OF THESE INDIVIDUALS HAVE BEEN NURSES ON THE FLOOR, HAVE WORKED WITH PHYSICIANS, HAVE MANAGED THESE KIND OF THINGS FOR FIVE, 10, 20 YEARS, SOMETIMES EVEN 30 YEARS THEY'VE WORKED AS A NURSE AND NOW WE'RE ASKING TO HAVE FOUR YEARS OF PRIOR EXPERIENCE WHEN NO OTHER STATE IS ASKED THAT.

>> CURRENTLY, A.P.R.N.s HAVE TO HAVE THESE COLLABORATIVE AGREEMENTS TO WORK WITH PHYSICIANS.

FIRST, WHAT ARE THOSE AND WHY DON'T YOU WANT THEM?

>> YEAH.

SO WHAT THEY ARE IS AN AGREEMENT BETWEEN THAT NURSE PRACTITIONER AND THAT PHYSICIAN THAT IS KIND OF ALMOST AN OVERSIGHT.

RIGHT?

SO IF I HAD A QUESTION AND I DIDN'T KNOW HOW TO MANAGE A PATIENT, I WOULD CALL MY COLLABORATING PHYSICIAN AND SAY, "HEY, GIVE ME SOME INVITE ON THIS."

NOW, THE CATCHER WITH THAT IS THIS COLLABORATING PHYSICIAN AGREEMENT IS NEVER FREE AND THEIR COSTS CAN BE FROM A FEW HUNDRED DOLLARS TO A FEW THOUSAND DOLLARS OR EVEN A PARTICULAR PERCENTAGE OF YOUR BUSINESS.

I HAVE SEEN I THAT IN SOME SITUATIONS.

THAT CAN BE TRICKY, PARTICULARLY IF YOU'RE A SMALLER CLINIC, OR THE OTHER PROBLEM IS, TO FIND THAT COLLABORATING PHYSICIAN.

QUITE OFTEN, WHAT YOU FIND IS PHYSICIANS NOWADAYS WORK FOR LARGE SYSTEMS AND THOSE LARGE SYSTEMS HAVE NON-COMPETES.

SO LET'S SAY YOU'RE A NURSE PRACTITIONER IN A RURAL AREA OF WISCONSIN OR EVEN AN URBAN AREA OF WISCONSIN AND UPDATE TO OPEN A CLINIC, WORK AUTONOMOUSLY AND YOU START ASKING AROUND FOR EYE COLLABORATING PHYSICIAN.

SOMETIMES IT'S IMPOSSIBLE TO FIND IT.

YOU HAVE TO GO OUT OF STATE EVEN TO FIND SOMEBODY THAT CAN WORK AS A COLLABORATING PHYSICIAN BECAUSE OF THE NON-COMPETE.

I HAD A NEIGHBOUR WHO IS A PHYSICIAN, COULDN'T DO THIS.

I HAVE AN EX-HUSBAND WHO IS A PHYSICIAN OF COULDN'T DO THIS.

BECAUSE OF THE NON-COMPETES THAT ARE HERE IN THE STATE OF WISCONSIN.

SO IT REALLY CAUSES A LOT OF PROBLEMS, NOT ONLY FOR COST WHEN YOU'RE TALKING ABOUT TRYING TO PROVIDE AFFORDABLE CARE TO PATIENTS AND YOU HAVE TO PAY THESE EXORBITANT FEES, BUT ALSO FINDING THAT PARTICULAR INDIVIDUAL THAT CAN EVEN OFFER TO DO THESE SERVICES.

>> I THINK WE NEED TO LEAVE IT THERE A LOT MORE QUESTIONS TO ASK, BUT THANKS VERY MUCH FOR