HNF Stories
6:00 am
Tue February 18, 2014

Vote Set on Nurse-Power Bill

UPDATE 6:30 p.m.-- The House Select Committee on Workforce Innovation approved a massive bill that would expand the authority of nurse practitioners and open a door for them to practice independently.  The vote, with only two dissents, followed testimony against the bill by a number of physician organizations.

With a key committee set to vote today on a bill allowing nurses more authority, doctor groups were sending out alerts to their members Monday, urging them to call their representative and register a protest.

Florida's Capitol in Tallahassee
Florida's Capitol in Tallahassee

But the bill has powerful support in the House Select Committee on Health Care Workforce Innovation, including that of Chairman Jose Oliva, R-Hialeah, and Vice Chair Cary Pigman, R-Sebring. Pigman, an emergency room physician, is the bill's most vocal supporter, which is ironic, as the bill's most fervent opposition comes from other physicians.

In a press release Monday, Florida Medical Association Executive VP Timothy Stapleton called the bill "an extreme measure" that overreacts to a shortage of physicians. That shortage, now in the beginning stages, is expected to grow as the population ages and the number of insured Floridians increases under the Affordable Care Act. It was the driving force behind creation of the Workforce Innovation group.

The FMA has recommended proposals to address the shortage that are less drastic, Stapleton said. He doesn't understand "why Florida lawmakers are treating access to health care as a crisis situation and a reason to jeopardize patient safety by allowing nurses to treat patients without the supervision of a physician."

FMA released results of a survey it commissioned in which 77 percent of respondents said they were satisfied with their quality of care and nearly 80 percent were satisfied with their access to care. A majority reportedly opposed allowing nurses to treat patients without physician supervision or to prescribe controlled drugs, one change the bill would make.

But at least part of the physician reaction is driven by economics, as an alert from the American College of Obstetricians and Gynecologists makes clear.  ACOG, worried about competition from nurse-midwives,  said "granting independent practice to nurses will discourage collaboration as they will then be competing economically for the same patient population."

The bill would rename what Florida law now calls "advanced registered nurse practitioners" as "advance practice registered nurses," or APRNs. This category of nurses has postgraduate training and usually at least a master's degree. Currently they practice under indirect supervision of physicians under a "protocol," written rules.

In the bill, APRNs would still follow a protocol set out by a supervising physician, but they could advance to a new level of licensure, in which they could practice without physician supervision. They would be called independent advanced practice registered nurses, or IAPRNs.

The committee is scheduled to take up the 155-page bill on Tuesday at 3:30.