Florida House Looks To Give Nurse Practitioners More Power

February 10, 2014

In an issue that could spur a health-care industry fight, a House select committee Monday will take up a 155-page bill that would give nurse practitioners independence to provide medical services without physician supervision.

House leaders say giving more authority to nurse practitioners, at least in part, could help address a shortage of primary-care physicians in Florida. The bill would apply to a group technically known as “advanced registered nurse practitioners,” who have more education and training than registered nurses. Along with applying to nurse practitioners who provide primary care, it would apply to specialists such as nurse anesthetists.

But the issue is controversial, with physician organizations such as the powerful Florida Medical Association long arguing that supervision needs to continue. Also, Senate Health and Human Services Appropriations Chairwoman Denise Grimsley, R-Sebring, said Thursday she is working on a bill that would make far less-dramatic changes than the House measure.

“We’re against it (the House bill),” Florida Medical Association General Counsel Jeff Scott said after reviewing the newly filed proposal Thursday. “I don’t think there’s any room for doubt on that one.”

The House Select Committee on Health Care Workforce Innovation has been studying the practice issues in recent weeks, including holding a lengthy hearing last month.

Jorge Valdes, president of the Florida Association of Nurse Anesthetists, told lawmakers during the hearing that members of his group have the training to provide anesthesia without physician supervision. Also, backers of the changes say nurse practitioners, including specialists such as the nurse anesthetists, already provide services without doctors being present, though they have to get approval from physicians for what are known as “protocols” that outline care.

“In Florida, anesthesiology is delivered by both anesthesiologists and CRNAs (certified registered nurse anesthetists),” Valdes said. “I’m a CRNA. I’m a professional. I’m not asking for anything additional than something I already do, (and that) is to practice my profession.”

The House bill, which will be discussed during a committee workshop Monday, would create two categories of nurse practitioners: “independent advanced practice registered nurses” and “advanced practice registered nurses.”

The advanced practice registered nurses would continue providing services under physician supervision, though they would receive additional authority to prescribe controlled substances. Nurse practitioners currently can prescribe other types of drugs, such as cholesterol medication or antibiotics.

Meanwhile, the independent advanced practice registered nurses, including the specialists, would be able to provide services without supervision if they meet criteria for experience and pharmacology training. Along with being able to prescribe controlled substances, they would have authority to make a wide range of other decisions, such as admitting and discharging patients from hospitals.

Part of the impetus for the House taking up the issue is that Florida faces a shortage of primary-care physicians. The House and Senate also are considering other steps, such as trying to encourage telemedicine, to address that issue.

“As we move into (the legislative) session, this committee will be proceeding with a bold initiative to expand access to care to Florida’s workforce and to increase the competitiveness of that workforce market,” select committee Chairman Jose Oliva, R-Miami Lakes, told the House panel last month.

Grimsley said Thursday the Senate bill would not allow nurse practitioners to immediately work without physician supervision, though it would allow them to prescribe controlled substances. She said the bill likely will set a time in the future, possibly five years, when nurse practitioners could work independently if they meet criteria. She said her bill would not allow nurse anesthetists to work independently.

Such health-care issues — known as “scope of practice” issues — frequently touch off lobbying battles in Tallahassee. As an example, optometrists and ophthalmologists battled for years about the drug-prescribing powers of optometrists, before a bill passed in 2013.

Scott, the Florida Medical Association general counsel, said the new House bill is the broadest scope-of-practice expansion he has seen, and physician groups are already preparing to fight it.

“There is no compelling health care policy goal, realized financial incentive, or access to care reason to eliminate the nearly nationwide gold safety standard of anesthesia physician supervision,” anesthesiologist Jay Epstein, president of the Florida Society of Anesthesiologists, said in a prepared statement Thursday.

by Jim Saunders The News Service of Florida


10 Responses to “Florida House Looks To Give Nurse Practitioners More Power”

  1. Gina on July 22nd, 2014 8:21 pm

    As an FNP with 4 years experience and an RN with 27, many in acute care setting- ICU, Step Down, General Medical, Oncology , and holding several certifications- I consider myself a physician extender- I am an asset to my physician and he trusts my judgment. He trusts me to make good decisions- I work to practice in his manner as he is my collaborator- not that I don’t think for my self- but that we practice with a continuity- increasing access to controlled substances when he is away to service our patients ; to sign death certificates; to baker act; to sign CMS forms, medical necessity, Pre op clearance- ( we review them all any way so he cosigns everything to prevent an issue for the patient)DNR,s, and order home heath – these are all assistive roles – we share the same patient base, I cover for him; I help him with paper work, reading labs, imaging and phone calls, I help to lighten his load- literally and figuratively. I love my collaborator- he an awesome diagnostician and a wonderful mentor- I would not lose that even if I were an independent APRN- because what I do is dependent on excellent communication and collaboration. My Dr. Is the Captain- of the ship- and just because my duties would be expanded does not make this a mutiny- this just makes me a better 1st mate. It allows me to service our patients better and provide a more complete service for my patients and may my Dr can go home before 8 pm at night.

  2. Cathy on February 14th, 2014 7:24 am

    Nurse practitioners are highly trained professional providers. Are there a few who do not provide the best care? I am sure ! However, I have seen many physicians, primary care as well as specialists, that are horrible providers, have missed diagnoses and provide only minimal care, do not give patients the time they deserve and do not listen to their patients because “they are the DOCTOR and they know what the patient needs”! They are quick to see you and happy to just provide drugs for everything ! I have also seen MANY physicians who are excellent and provide great caring individual patient care. You cannot judge ALL nurse practitioners by a bad experience just as you cannot judge all physicians in the same manner. The comment above about wanting to see a doctor for your money, not a nurse practitioner, we’ll that is your privilege and right, it is also in your power to see whomever you want. You make the appointment, make it with a doctor! No one is forced to see a nurse practitioner but my experience is that MANY patients choose to see a nurse practitioner because of they receive excellent care, develop a strong relationship to provide compassionate, individualized patient care. Nurse practitioners are much better at LISTENING to their patients and working with patients to provide very good diagnostic and preventative care. Healthcare has changed so much over the years and in order to provide equal access to all communities Nurse Practitioners are willing and able to provide care in ALL communities, for ALL patients regardless of economic status. Many primary care physicians are choosing to discontinue their practice because it is not economically practical to continue. This does not mean they are in it for the money, in fact reimbursements from insurance, Medicare and Medicaid have decreased while demands on providers have increased. I am just saying, Nurse Practitioners are a Godsend and are here, willing and ABLE to provide excellent care. Don’t stop the process that will allow Nurse Practitioners the ability to provide health care to millions of people who need it. Why is the Florida Medical Association SO AFRAID to do this? Nurse Practitioners will not eliminate their jobs and only want the right to provide health care to the citizens of Florida. Having limited narcotic prescription privileges will allow them to provide complete, conscientious care. Come on Florida, get with the picture and allow independent practice like almost every other state in the union has done!!!

  3. Mia on February 13th, 2014 9:21 am

    Sorry, I have bad experiences from physicians. Fragmented, mechanical, lack of caring from physicians killed my love one. There is no “restriction” to physician practice with this legislation. This legislation removes practice barriers for nurse practitioners so that more people have access to care. This legislation protects consumer choice. Consumers get to choose the type of health care provider they wish to care for them. You don’t need a brain surgeon to take care of every day medical conditions, to keep people healthy and functioning. Our health care system needs to utilize people to the fullest extent of their education and training. May the most appropriate person lead the team and not just based on a medical diploma. This will save the state 339 million dollars a year per OPPAGA report!

  4. Willa Fuller on February 12th, 2014 6:31 pm

    I have had quality care from both and less that adequate care from two physicians in particular. A nurse practitioner solved an eight year problem because she took the time and listened to me. On the other hand, I credit my surgeon with saving my life on the operating room table and my nurses who intervened when I had a hypertensive crisis because they knew the medications and the therapeutic responses more intimately. It is time that this ridiculous argument stops. Within both professions, they learn the basic information they need to begin practice through formal education and gain knowledge and expertise in actual practice. There have been ample scientific studies that show no difference in the quality of care between nurse practitioners and physicians. A Senate Committee has twice rendered an opinion that supports this, yet Florida lags behind as the state with the worst record in this regard. The same physicians who claim nurse practitioners are not qualified, leave patients in their care every day and reap the benefits of their skills and knowledge. Nurse practitioners can fill the gaps and care for those patients who have minimal or no access to care. This is not about power, it is about providing care to the citizens of Florida, something qualified nurse practitioners do everyday in all 50 states, several of which have removed supervisory authority with no ill effects.

  5. Better now on February 12th, 2014 5:58 pm

    It is all about choice. I choose to see who is best for me and that is a nurse practitioner. Many members of my family and friends chose to see them. Nurse practitiones have fix my blood pressure and help control my sugar when the DR. I was seeing couldn’t. Don’t limit my choice or tell me who to see. Let them do their jobs.

    With all the problems in health care I can findly place the blame on the “captain of the ship”. Why did the captain allow the ship to hit the rocks?

  6. Matthew on February 11th, 2014 8:49 pm

    I’ve always chosen NPs over other providers. I’m very satisfied with the care and services I’m provided.

  7. Donna on February 11th, 2014 2:54 pm

    If they want to perform the duties of a doctor, then they should go to medical school!

  8. Health Care on February 11th, 2014 9:30 am

    I pay to see a physician when I am ill. I, too have had bad experiences with Nurse Practitioners. When I need health care I want to see a doctor who has the most medical knowledge. There are some great nurses that I have had, also……assisting my doctor.

  9. Claire Hogan on February 10th, 2014 3:50 pm

    A Doctor is The Captain of the ship. If your job title contains ‘Nurse’, you will be supervised.

  10. Jane on February 10th, 2014 5:33 am

    Sorry I have had bad experiences with nurse practicioners. They have too much power now! Restricting access to doctors is NOT the answer to a shortage of doctors.

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