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Senate panel votes to let nurse practitioners prescribe drugs, not practice independently

@tbtia

A Senate bill that would give highly trained nurses more authority, but not the independence they truly want, passed narrowly at its first committee stop today.

SB 1352 would allow specialized nurses with graduate degrees to prescribe controlled substances and involuntarily institutionalize patients with mental health issues. The Health Policy Committee approved the bill on a razor thin 5-4 vote with Republicans and Democrats on both sides of the issue.

A separate proposal in the House, HB 7071, would allow nurse practitioners to practice without a supervising doctor. But that bill is an even tougher sell in the Senate, where members have strong ties to the Florida Medical Association that is dead-set against these measures.

Rep. Denise Grimsley, R-Sebring, said the changes in SB 1352 are needed to address Florida's doctor shortage and implement changes that virtually every other state has already adopted. "We are the last state in the nation to pass this legislation," she said.

But other senators disagreed that expanding the scope of practice for highly trained nurses is the best way to address Florida's health care workforce issues. Doctors have attended medical school and received the training needed to perform certain duties that nurses have not, said Sen. Eleanor Sobel, the Hollywood Democrat who voted against the bill.

"We need to conquer the widespread use of controlled substances, not to expand them," Sobel said.

The business community, including the Florida Chamber of Commerce and Associated Industries of Florida, is supporting the efforts to give highly trained nurses more powers. But the powerful FMA, representing doctors, is opposed.

SB 1352 and HB 7071 each have two more committee stops before they are ready for a floor vote.

Comments

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Cecilia Langford, ARNP-BC

RE: Senate Panel Votes on Full-Practice for NPs
First I would like to thank the Senate and House members who have been supportive of eliminating the barriers to full practice for Nurse Practitioners. This support will pave the way for easier access to care for many vulnerable patients including Medicare/Medicaid and indigents who are now having difficulty obtaining services. A special recognition to Rep. Denise Grimsley, R-Sebring, for addressing the need for beginning with SB 1352 to address "Florida's doctor shortage and implement changes that virtually every other state has already adopted."

I am responding, also, to Senator Eleanor Sobel's response to Senate Bill 1352 that proposes controlled substance prescribing for Advanced Practice Registered Nurses (ARNPs). She implies that ARNPs would contribute to the current controlled substance problem although we had no role in the creation of the problem. She touts Physician training and overlooks the highly regarded training provided Nurse Practitioners. As Nurse Practitioners we hold advanced degrees (graduate degrees--MSN, PhD or DNP) that provide the specialized knowledge and clinical competency required to practice in numerous health care settings. Most Nurse Practitioners hold a national specialty certification that required extensive education and internships in the area of specialty. As noted by the American Association of Nurse Practitioners (AANP) “independent analyses by third-party organizations consistently confirm that nurse practitioners offer the same quality of care as physicians”. The National Governors Association, The Institute of Medicine, and other health and policy organizations, including the Heritage Foundation, recommend easing red-tape laden restrictions on Nurse Practitioners in order to improve access to quality, affordable health care. In conclusion, AANP reports, surveys consistently reveal that Nurse Practitioners are more likely than physicians to provide care in under-served and rural areas that serve Medicare/Medicaid and indigent patients. Our training as Nurse Practitioners includes assessing complex problems, diagnosing and treatment, recognizing when a referral is essential and when collaboration is needed--much in the same manner as our colleague physicians do. A final note is that 17 states and the District of Columbia provide patients with full and direct access to all Nurse Practitioner services and have a long-standing history of this approval. I hope Senator Sobel and other Florida Senate members voting against SB 1352 reconsider this decision.

Cecilia Langford, ARNP, MSN, EdD
Board Certified Psychiatric Mental Health Advanced Registered Nurse Practitioner

Dr D

After completion of over 6 times the average training nurse receive (several years of medical school, years of residency, and a few years of fellowship) I am gravely concerned that we are considering broadening nurse roles to area for which they are not trained. Nurse counterparts may soon be eligible to practice in an open access format that exceeds their current level of training. Access to care under the ACA is a valid concern, but this is not solved by expanding practice rights to those with less training. With the ever growing cost of education and training I.e. student loan debt, one is left to wonder what the true role and need for a physician is moving forward. Also what is motivation for one to undergo the additional years of training, sacrifice and expense to pursue being a physician? If this is implemented the answer is that there is no clear benefit.

As we expand responsibility of nurses are we improving the care that the ACA intended? Or simply increasing the workforce with a larger number of practitioners?

Nurses are a vital part of the medical TEAM, but without the 1000s of hours of training their physician counterparts receive they should not be the key decision maker. To forgo this fact undermines the thread underlying how the system was intended to be overseen and also the years of advanced training physicians undergo to become the doctor they are today. I forsee that enactment of this bill will foce even fewer numbers of students to pusue being a doctor, as rising medical malpractice costs, increasing costs of student loan debt, diminished opportunity will exist. Passage of this bill will result in fewer practitioners, not more as the Nursing proponents would have one believe. Fewer mean fewer caregivers and a higher burden to the system.

Dr. D
Florida

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