Docs say laws allowing nurses and other practitioners greater leeway endangers patients; advanced practice nurses say they’re filling a need that will only grow under reform
Though it was dwarfed by the firestorm swirling around national healthcare reform, the long-simmering battle between nurses, doctors and specialty practitioners over who’s qualified to do which jobs has reached a new level of rancor and immediacy, those close to the issue say.
Physicians say state and federal lawmakers are increasingly putting patients at risk by allowing lesser-trained nurses, specialists and other “limited licensure” practitioners to encroach into areas of healthcare where they are not qualified to provide patient care. The American Medical Association tracked more than 300 laws in state legislatures last year to expand nurses’ powers and is already gearing up for more battles this year.
Meanwhile, many observers say federal healthcare reform will lead to a spike in interest in scope-of-practice issues nationally, as insurance reforms lead to more access to primary care—which is one of the epicenters in the struggle between advanced practice nurses and doctors over practice rights.
Physicians typically cast the debate in terms of the quality of patient care, but other observers say the argument has deep roots in financial concerns. For example, more insurers than ever are allowing advanced practice nurses, such as nurse practitioners, to bill directly for their services, and some are even paying more than the 85% reimbursement rate that nurses have traditionally received compared with physician compensation for the same services.
“They’re really scared that we’re going to do something that will take money away from them. As long as we went out and only gave healthcare to poor people, nobody said anything,” says Dee Swanson, president of the American Academy of Nurse Practitioners. “Let’s face it: We have a crisis in primary care in this country, and it’s an area that physicians have not been interested in, or there wouldn’t be a shortage.”
Cecil Wilson, a Florida internist and president-elect of the American Medical Association, says such arguments miss the larger point about patient care, and whether nurses are adding new educational requirements to go along with the additional responsibilities they’re seeking.
“We’re not talking about protecting what physicians do, this is about protecting patient safety,” Wilson says. “Our concern is that this push for expanded scope of practice is in some ways a way to try to practice medicine without getting an M.D. degree.”
As employers, hospital executives are finding themselves on increasingly unstable middle ground in the scope-of-practice struggle, as they try to balance cost on one hand and quality on the other.
Keith Barnhill, an
advanced registered nurse practitioner who
is a certified registered nurse
anesthetist, confers with one of his patients at at Grundy County
Memorial Hospital in Iowa.