Postcard from Hawaii: New State Legislation Brings Primary Care to Those in Need

By Gail Tiwanak

Director Hawaii State Center for Nursing

Here in Hawai’i, as in states across the U.S., we are in need of more primary health care professionals, particularly in rural areas. This is why we are so pleased that, on July 2, 2009, Hawai'i Governor Linda Lingle signed into law Act 169, which will provide Hawai’i with greater access to health care professionals, specifically Advanced Practice Registered Nurses (APRNs). This legislation was introduced in the State Senate by Senator Rosalyn Baker of Maui and in the State House of Representatives by Representative Marilyn B. Lee (a Registered Nurse on Oahu).

When developing the legislation, the Hawai’i legislature looked to the evidence. According to published studies, appropriately trained APRNs can provide high quality health care and achieve positive outcomes for patients. Moreover, APRNs are capable of providing primary health care and play an important role in meeting the growing demand for primary health care, particularly in underserved areas.

Act 169 recognizes APRNs as participating primary health care providers for insurance coverage purposes; permits APRNs to sign documents relating to health care for their patients; clarifies educational and other requirements for APRNs; and updates the authority for APRNs to write prescriptions, including controlled substances medical equipment, and therapeutic regimens, in accordance with their scope of practice.

The most important outcome of the legislation is the increased access to primary care it provides to the citizens of Hawai’I, especially those in rural areas. Previously, APRNs practicing in Hawai’i were limited by regulation in the kinds of services they could provide and for which they could receive reimbursement. This law will increase the numbers of APRNs now able to provide primary care to areas of need on all the islands of Hawai'i, with the most acute need being in the counties of Hawai'i, Maui and Kauai. Although there is a network of community health centers and critical access hospitals throughout the state, the previous limits to APRN practice and a chronic shortage of new physicians created a lack of access to care for citizens. Interests of patients will be well served because APRNs are now an essential component of the primary health care team.

We are confident that the Hawai'i State Center for Nursing has strengthened nursing’s position and role in the delivery of health care and this important development could not have been accomplished without the strong support of our champions, Senator Rosalyn Baker and Representative Marilyn Lee, and a united nursing community.

Hawaii is one of 30 states with multi-stakeholder teams working with the Center to Champion Nursing in America to increase educational capacity. Learn more about our state efforts.