Expand nurses’ practice to improve patient care
The Affordable Care Act has added 2.5 million Californians to our health care system, but there aren’t enough primary care physicians here, especially in rural areas, to care for them. Removing barriers to nurse practitioners providing care and patient services would give more Californians access to health care while controlling costs.
That’s what Senate Bill 323, introduced by Sen. Ed Hernandez, D-West Covina (Los Angeles County), seeks to do by allowing nurse practitioners to practice without direct supervision of a physician in a number of specific settings — a clinic, a general hospital, county medical facilities, rural clinics, a medical group, psychiatric hospitals and others. Current rules were put in place decades ago when the state first began licensing nurse practitioners to provide many services once provided only by physicians. Changes in the practice of medicine, the advanced training and education nurse practitioners receive today and new federal policies make those rules outdated. Not only are the old rules unwieldy in today’s modern medical workplace, where good care is also efficiently provided care, but they add unnecessary cost and delays.
The proposed changes would directly benefit patients, especially those newly granted health insurance who tend to be older and sicker. For example, allowing a nurse practitioner to prescribe a nebulizer without tracking down a physician for a signature on a busy night in a clinic might keep an asthmatic child out of the emergency room over the weekend. Granting the ability to order home oxygen or a hospital bed could allow a hospitalized patient to return home sooner, freeing up scarce and expensive hospital beds. Allowing a nurse practitioner in a rural clinic to perform simple treatments for which he or she was fully trained but that are not specifically covered in the documents that define practice would deliver care faster. A patient forced to wait perhaps weeks to get an appointment with a doctor in areas where medical need far outstrips the number of physicians runs the risk of further complications.
Yet Hernandez’s bill faces formidable opposition from physicians. SB323 is more modest than a 2013 attempt to change the rules but even small expansions to the nurse practitioners’ scope of practice would benefit patients and keep health costs under control — something we all want as consumers and taxpayers. The California Medical Association argues that the bill will not increase the number of nurse practitioners serving in rural areas. It also says the proposed legislation asks nurse practitioners to exercise independent clinical judgment, which their training does not prepare them to do, thus putting patients at risk and raising medical costs.
The experience of the 21 states that have expanded the authority of nurse practitioners contradicts that view. So do studies by the Institute of Medicine, which found that nurse practitioners deliver the same quality of care as physicians. Expanding the authority of California’s 18,000 nurse practitioners is not just about control in the medical setting: it’s also about providing good quality, affordable health care that makes California attractive to business. That’s why the Federal Trade Commission has warned states against limiting the scope of nurse practitioners’ practice.
This is the third try to change the law so that nurse practitioners can do what they are trained to do. The Legislature needs to allow these changes to modernize California health care.