Scope of APRNs practice in other countries is broader than their practice with advance practice credentials in Michigan



Bill Identity

Senate Bill 0002 (2013) seeks to amend the 1978 PA 368 (the public health code) to license the advanced practice registered nurses (APRNs) including, but not limited to nurses and midwives (Senate Bill No. 2, n.d).
The bill was sponsored by Senator Mark C. Jansen who is the chairman of the (Reforms, Restructuring, and Reinventing) committee and a Republican member of the Michigan State Senate.
The Bill was completed on April 25th,

Current Status Of The Bill

Senator Jansen introduced the Bill on January 16, 2013 (Senate Bill No. 2, n. d).
The Senate made some changes on the Bill from January 16, 2013 to November 13, 2013.
The House read the Bill on November 13, 2013 and was referred to the Committee on Health Policy which is still pending
Overall, the Bill has progressed by 50 %.
The Bill Presents an Healthcare Issue

HIV issue

Section 5119 requires individuals seeking marriage licenses to undertake a HIV test (Senate Bill No. 2, n. d).
If the applicant tests positive, the test results will be shared to the potential marriage partner.
Such Bill grants the healthcare practitioner discretion to disclose the applicants HIV information without the applicant’s consent.
However, disclosure of HIV information should only be allowed for healthcare purpose (Gable, 2007).
As such, sharing such information prior to marriage licensing is a controversial healthcare issue.

Brain Drain in Nursing Profession.

Some argue that it is probable that the Bill will introduce strict requirements and increase cost for healthcare practitioners.
This is likely to make some nurses to move to different countries thereby affecting the provision of healthcare services in Michigan.

Intends and Specifications of the Bill

Overall, the aim of the bill is introduce amendments on the public health’s code to offer licensure of APRNs (Senate Bill No. 2, n. d).
This implies that, the APRNs would operate under new rules which directly affect their daily operations.
The Bill outlines areas which each nurse will be allowed to operate and requirements for each practitioner.
As such, people will have to proof to the Licensing and Regulatory department that, they are qualified to provide the specified healthcare service.
This might force such practitioners to retrain to comply with article 15 (occupants) on the Bill.
Similarly, the Bill requires the licensing and regulatory affairs board to renew the APRN licensing which is currently held by the RN license.
Such requirement might interfere with the provision of healthcare services in the country.

Implications of the Bill for Nursing Profession and Public
The Bill Will Improve The Quality and Accessibility of Public Healthcare

Currently, Michigan law does not recognize APRNs (Senate Bill No. 2, n. d).
Therefore, licensing APRNs will increase accessibility of healthcare in the country.
The Bill will also prevent individuals from practicing nursing unless authorized or certified.
In addition, individuals will further be expected to show proof of their preparedness to assume accountability and responsibility for healthcare maintenance practices (Senate Bill No. 2, n. d).
Such provisions will ensure a high quality healthcare since services will be provided by qualified and willing practitioners.
Although the Bill will not impact the local public finances, individuals seeking license as APRN will be required to license and application fee.
It is not know how many people will seek and apply for the license.
However, all the revenue from the fees will be accredited to the health professions regulatory fund (HPRF) thereby lowering the costs associated with issuing the licenses and accessing the healthcare.

The graph illustrates the physicians view regarding costs, quality, and access implications of APRNs licensure;

Source: (Jonson, 2011)

The Bill will Increase Cost For Healthcare Nursing Professionals

While it will retain the current application processing fee of $ 24, it will increase specialty certification fee to $40 from the current $14 (Senate Bill No. 2, n. d).
This might bar or demoralize people from pursuing nursing profession.
Similarly, under part 172, the Bill requires nursing board, to ensure that, nurses seeking license renewal offer satisfactory evidence that, during the last two years prior the license renewal, they completed competency courses approved by the board.
While such condition is expected to improve healthcare services, it might set high standard for nurses thereby making them develop negative attitude toward the nursing profession.


Michigan should establish an independent nursing practice.
The country’s public health code can achieve this by setting regulatory standards, defining the practice capacity for APRNs, and allowing them independence to practice and to prescribe drugs within their training, educational, practice, and national certification context (Barberio, 2010).
The Bill will improve the quality and accessibility of healthcare also address the shortage of medical professions in Michigan by using APRNs.
Nonetheless, it is important to note that, the scope of APRNs practice in other countries is broader than their practice with advance practice credentials in Michigan.
Similarly, there are increasing concerns regarding the fact that registered nurses (RNs) have started leaving Michigan for other countries where they belief they will have autonomy in their profession.
However, through an independent nursing practice, RNs will not only have an opportunity to attain greater autonomy in their practice, but also specialize and maximize client care (Barberio, 2010).
This will improve the healthcare quality in the country without forcing RNs to provide particular services which they not might be willing to offer.
The graph below show that, about 50 % of physicians somewhat agree that, NPs independence will decrease the average quality of healthcare.

Sources: (Johnson, 2011)

Independence practice will also enable nursing professionals to focus their knowledge and skills on their interest areas thereby increasing the quality of healthcare in Michigan.
About 22 States and Columbia Districts currently allow nurses independence in diagnosis and treatment (Barberio, 2010).
Additionally, these States are considering eliminating practice scope barriers for APRNs to enable them set up independent practices.


Barberio, J., A., (2010). Establishing an independent nursing practitioner practice. Retrieve 27, January, 2014, from,

Gable, L., World Bank & World Bank. (2007). Legal aspects of HIV/AIDS: A guide for policy and law reform. Washington, D.C: World Bank.

Johnson, R., W. (2011). Initiative on the future of nursing: physicians’ opinions about the impact of allowing NPs to practice independently. Retrieved 27, January, 2014, from,

Jonson, R., W. (2011). Initiative on the future of nursing: physicians’ opinions on effect of independent APRN practice on access, cost, and quality. Retrieved 27, January, 2014, from,

Senate Bill No. 2. (n.d). Retrieved 27, January, 2014, from,




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