nurse practitioners

MGN Online

Starting with the new year, physicians assistants and nurse practitioners will be allowed to prescribe medications without a doctor's oversight.

Office Chatter: Your Doctor Will See You In This Telemedicine Kiosk

Jun 21, 2016
Phil Galewitz/Kaiser Health News

On the day abdominal pain and nausea struck Jessica Christianson at the office, she discovered how far telemedicine has come.

Rushing to a large kiosk in the lobby of the Palm Beach County School District’s administrative building where she works, Christianson, 29, consulted a nurse practitioner in Miami via two-way video. The nurse examined her remotely, using a stethoscope and other instruments connected to the computer station. Then, she recommended Christianson seek an ultrasound elsewhere to check for a possible liver problem stemming from an intestinal infection.

Florida Senate

Bills that involve state workers' health insurance, nurse-practitioners and hospital regulations died during this week's Legislative special session because the Senate has declined to consider them.

Senate Health Policy Chairman Aaron Bean said in a statement Monday evening that his colleagues felt there wasn't time to consider major policy changes by Friday, the last day of the special session called to finish work on a state budget.

The issues contained in the House bills require "a thorough and proper vetting," said Bean, R-Fernandina Beach.

Several bills working their way through the Florida Legislature would give nurse practitioners the ability to prescribe stronger medications and clarify other duties.

A second Senate committee has approved a bill that spells out the ability of highly trained nurses, known as practitioners, to order controlled substances in the hospital.

A plan to expand the powers of advanced registered nurses hasn’t yet caught on in the legislature, but eased out of a House Health panel Wednesday. The fate of bill remains cloudy, but its sponsor says even if it fails this year—the issue isn’t going away.

Some people wanted the big bill of the 2014 legislative session to be Medicaid expansion, accepting federal funds to cover the low-income uninsured. Indeed, interfaith groups were still running phone banks and staging demonstrations up to Friday, the last day of the session.

But it was clear even before the 2014 Florida Legislature opened two months ago the measure would be ignored. Instead, lawmakers spent a lot of time debating ways to stretch the supply of primary-care providers as demand increases.

The two biggest health initiatives of the Florida House for 2014-15 both died at the hands of the Senate during the final 36 hours of this year's legislative session, which ended around 10:30 Friday night.

They were:

--Allowing nurse practitioners who have sufficient training to practice independently of physician supervision;

--Setting up a structure under the law for the growth of distance health care through  telemedicine or telehealth, terms used at various times during the session.

Florida Legislature
Florida House of Representatives

There’s a flurry of health policy activity as Florida’s 2014 Legislature comes to an end tonight.

On Thursday, the Senate didn’t budge on its ongoing opposition to giving nurse practitioners more authority.

Leaders of the Florida House, hoping to protect their pet health issues from being picked apart in the Senate,  have bundled them into a package to be introduced Thursday morning. In legislative parlance, they're creating a "train."

The idea of a train is that it's a bunch of railcars that are connected and it would be hard to remove one of them without causing them all to derail. As a practical matter, it means some lawmakers might have to accept a bill they don't like in order to get one that's a must-pass.

Florida Senate

Sen. Denise Grimsley wants to cap the so-called trauma-access fee that some trauma centers are adding to the regular charges for unsuspecting patients, the Tampa Bay Times reports.

Florida TaxWatch’s recent report, “Diagnosing the Debate,” offers data that support proposals before the Legislature that would allow nurse practitioners to practice independently from doctors, the Times/Herald Tallahassee Bureau reports.  The Florida Medical Association, which fiercely opposes the legislation, has called on TaxWatch to withdraw the report, pointing to “five serious flaws.”   TaxWatch stands by the report, saying th

  Telehealth, one of the major issues of the Legislative session, passed a key Senate committee Wednesday the way the Florida Medical Association had hoped, the News Service of Florida reports.

Carol Gentry/WUSF

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.)

Senate President Says No to Nurses

Feb 24, 2014

Don Gaetz, president of the Florida Senate,  could present a formidable obstacle to passage of a bill that would  increase the powers and independence of nurse practitioners.

News Service of Florida, which interviewed Gaetz last Friday, reported he opposes a House bill that would give advanced-practice nurses more authority, including prescribing of controlled substances. The bill would also set up a pathway to independent practice, not supervised by physicians.

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.

To the Editor:

Re: Nurse Bill Goes Too Far, Critics Say

This morning, I read “Nurse Bill Goes Too Far, Critics Say.” It is a very interesting piece. I must admit that you attempted to address both sides of the issue.

Critics of a legislative plan that would increase the authority of Florida’s nurse practitioners pushed back Monday, wondering if the massive bill would give nurses all the privileges now granted to more-educated and more-skilled physicians.

The plan -- which allows qualified nurse practitioners the ability to operate independently, without a physician’s supervision -- could be seen as a short-cut to those who want to treat patients but  don't want to go to medical school, said Rep. Elaine Schwartz, D-Hollywood.

A former nurse anesthetist says it would be a disaster if the state approves legislation lifting physician oversight of nurse practitioners, according to a column in the Gainesville Sun. Linda Young, who is training to become an anesthesiology physician, said her previous education, training and clinical experience was not enough to handle a medical crisis.

A Florida House committee will take up a bill Monday that would give nurse practitioners more independence and authority to provide medical services without a supervising physician.

The bill, which could help address the shortage of primary-care physicians, would apply to “advanced registered nurse practitioners,” a classification requiring more training and education than registered nurses, according to the News Service of Florida.

Nurse practitioners and physicians are headed for another legislative battle over the scope and care of Florida patients. The House Select Committee on Health Care Workforce Innovation on Friday heard more than three hours of testimony from doctors and advanced nurse practitioners, who want to increase their authority, according to the Florida Current. The state’s physician shortage could be lessened if they had more prescribing and diagnosing powers, nurse advocates said.

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

Nurse practitioners, who want more "autonomy," will tell a legislative committee Friday morning that granting it would benefit Floridians.

Primary-care physicians are in short supply, they'll say, so it's only sensible to make full use of nurses who have postgraduate training.

Physicians will tell the committee they agree on the need for new approaches to expand primary care. But the Florida Medical Association says "the best solution is physicians and nurses working collaboratively in a way that does not jeopardize patient safety."

Proposals to expand Florida's use of telemedicine and to increase the autonomy of nurse practitioners appear to be cooking in Tallahassee.

Two House members this week mentioned bills they are developing to address Florida's shortage of primary care physicians, according to the News Service of Florida.

A recent study published in the journal Health Affairs argues that lower costs and better savings can be achieved from loosening up restrictions on nurse practitioners. But as Bernd Wollschlaeger writes on his Florida Docs Blogs, the focus shouldn’t be on cost alone.   

Hundreds of clinics have opened in chain drugstores across the country and more are coming on line every day as the need for primary care grows and delays face those who need access to a doctor, as The Palm Beach Post reports.

The Senate unanimously approved a ban on texting-while-driving this morning, the Tampa Bay Times reports. The bill's next stop is the House.