Legislative Lash Out: NP Scope of Practice Laws in the News

Nurse practitioners have taken to the news in the past few months.  2014 has brought new NP legislative concerns to the table with many states looking to grant nurse practitioners more independence in their practice.  Recently, Florida and Pennsylvania introduced bills to the house that would improve the practice environment for nurse practitioners working in these states.

Currently, Pennsylvania state law requires that nurse practitioners practice under physician supervision.  Senate Bill 1063, sponsored by Sen. Patricia H. Vance, seeks to to elimiate the supervision requirement.  Proponents of the bill say that nurse practitioners already enjoy a large degree of autonomy in the state so in reality little change would occur with the bill's passing.  While NPs are required to work under a physician, current law does not outline a structure under which supervision must occur.  A nurse practitioner may go weeks or months without consulting the MD in charge.  

Billing considerations are also a part of Senate Bill 1063.  In Pennsylvania, nurse practitioners are state certified rather than licensed.  This creates billing hassles with insurance companies as some do not formally recognize certified NPs as primary care providers.  Billing complexities are often a barrier to nurse practitioners opening their own practices.  The proposed legislation advocates licensing rather than certification for NPs to eliminate billing obstacles. 

Although Pennsylvania is facing a physician shortage, 5,000 primary care physicians in the state are projected to retire over the next five years, the Pennsylvania Medical Society opposes the bill.  The group argues patient safety could be compromised if nurse practitioners are granted independence.  NPs counter that statistics show similar outcomes between physicians and nurse practitioners.  Given Pennsylvania's looming primary care shortage and the estimated 55,000 residents projected to become insured under the Affordable Care Act, legislators are seriously considering passing the bill.

In Florida, Senate Bill 1352 proposes similar changes to NP scope of practice laws.  The bill, if approved, would allow nurse practitioners to practice without physician supervision including the ability to prescribe controlled substances.  Florida is currently the only state that does not grant NPs this right.

While supporters of Pennsylvania's bill are optimistic it will pass, the situation in Florida is a different story.  Sen. Don Gaetz, president of the Florida Senate, strongly opposes NP independent practice.  "If you want to be a doctor, go to medical school" he says.  Sen. Gaetz is aware of the pending primary care shortage but proposes filling the need by expanding medical-residency programs and upping pay for primary care physicians.

Nurse practitioner scope of practice laws are a hot topic given the changing healthcare landscape.  The issue is not a partisan one, but largely an NP vs. MD debate with physician organizations the most outspoken opponents to nurse practitioner autonomy.

Do you think we will see all 50 states eventually pass laws granting nurse practitioners autonomy?  Do you agree that nurse practitioners should be able to practice independently?

 

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Comments

Shortage of providers here in CA, but have to have vague, ridiculous "collaborative agreement" that serves no purpose. This legislation has been challenged many times, but never goes through because of MD groups. But, why? We aren't competing with them! We have a shortage!

Stephie

Physicians go to med school for many years and don't want to work in primary healthcare because there is no money in it any more. It pays less and less because of cuts to medicare and medicaid. We are only trying to do the job they don't want to do. I went to 2 yrs of school to get my Associate Degree in Nursing, then 2 more years to get my Bachelors degree in nursing, now 2 more years to get my Nurse Practitioner degree, not to mention I have worked for 20 years as an ICU nurse. I think I am plenty capable of treating runny noses and infected ears in a clinic setting. I am not asking to take care of complicated heart patients, lung disease patients, cancer patients. I know my limits and when I will need to refer to a higher level of care. Evidence and research has proven that nurse practitioners are adequately trained to provide care in retail clinics and do so at lower cost than physicians (Spetz, Parente, Town, & Bazarko, 2013). Care provided at clinics is based on evidenced based protocols and is of similar quality between nurse practitioners and physicians and there is no evidence that this poses any danger to the public like the medical society would have us believe (Spetz et al., 2013).
References
Spetz, J., Parente, S. T., Town, R. J., & Bazarko, D. (2013). Scope-of-practice laws for nurse practitioners limit cost savings that can be achieved in retail clinics. Health Affairs, 32(11), 1977-84. Retrieved from http://search.proquest.com/docview/1458313121?accountid=159007

kellie

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