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Thu February 27, 2014
Why Nurses Want More Power
A bill that would give nurse-practitioners more authority is one of the two big health issues being pushed by the House Select Committee on Health Care Workforce Innovation, which aims to increase access to primary care.
The other big issue of the session, which starts March 4, is telemedicine: Ironing out how it could be paid for and regulated. (See Health News Florida's: Telemedicine Ready for Reboot.)
The nurse-power bill has already run into flak, even before the session has started, with Senate President Don Gaetz saying he plans to vote against it.
Last week, the House committee passed the nurse-power bill 13-2, despite protests from physicians, as Health News Florida reported.
This radio story about the issue, which aired on WUSF on Thursday, is scheduled to air on other stations around the state in coming days.
Here is the script:
(Host Carson Cooper): Nurse practitioners: They’re not doctors but they’re a notch above registered nurses with special training in basic primary care, like performing physical exams and prescribing certain drugs, if they’re allowed to, and in Florida they are not. As Carol Gentry reports, an effort is under way in legis to change that:
(Carol Gentry): I’ve come to Brandon Outreach Clinic to see George Peraza Smith. He’s a nurse practitioner, which means he holds extra training and schooling beyond a registered nurse. In fact, he holds a doctorate in nursing practice, which took him an extra 41/2 years after he graduated from college.
He specializes in gerontology; part of his job is to check on patients in nursing homes. But when he finds they’re in pain, he said, he can’t prescribe the medicine they need.
“I would write a script (prescription), I would have to take the script, drive from South Tampa Rehab over on Manhattan all the way to Hyde Park, my physician provider would sign it, then I would take it back and give it.”
The painkilling drugs that those nursing home patients sometimes need can be diverted and sold on the street. So they’re controlled drugs. And in Florida, nurse practitioners can’t prescribe them. So he drives.
"Because I just don’t want them to suffer. But not everybody can and will do that."
Doesn’t the nursing home have someone who can prescribe the painkiller? A doctor?
“There’s always a medical director and that’s what they say, well the medical director can sign, well the medical director is not housed in the nursing home.”
Florida is the only state that won’t let nurse practitioners prescribed controlled drugs, according to a map on the wall of a House committee that’s been meeting in Tallahassee. Rep. Matt Hudson:
“The map behind me is pretty illustrative, we stick out pretty distinctly on the primary care issue, without question or hesitation. Frankly, a blind man in a snowstorm could see we need to expand the scope in that area. “
He’s talking about the scope of practice for registered nurses who get advanced training. Some do primary care, some are midwives, and some give anesthesia in surgery.
Rep. Cary Pigman explains the bill he’s been working on for months:
“Number one, the bill expands the scope of practice of Florida’s advanced practice nurses to allow them to prescribe controlled substances, sets standards for that practice, and brings us in line with the rest of country.
“Number two, the bill allows advance practice nurses to practice without supervision if they choose to do so and if they meet certain criteria.”
The Chamber of Commerce supports this bill; they like the idea of creating Independent Advanced Practice RNs. But it has drawn furious response from the Florida Medical Association and two dozen other medical groups, who say it isn’t safe.
Dr. Michael Zimmer of St. Petersburg says the nurse practitioners who work under his supervision do a good job.
“But the important point is that our patients have an expectation that they have access to a physician-led team that’s trained in modern medicine and can trust that team to deliver quality care without sacrificing that quality.”
It just so happens that Rep. Pigman is also a doctor, but he disagrees with Zimmer and the medical association. Rep. Pigman cites research that says advanced practice RNs have outcomes as good as MDs.
Pigman also has first-hand experience working with advanced RNs in a whole range of settings, from teaching hospitals to rural areas to overseas, in active combat zones. (He’s in the Army Reserve)
“In all of these circumstances, I’ve worked side by side with advance practice registered nurses. I believe in the safety and the benefits of this bill with the full breadth of my heart.”
The bill passed a special House committee on health care workforce innovation 13-2. But the doctors have a powerful lobby, so anything could happen when the legislative session starts March 4.