Remove outdated laws on advanced practice RNS
Instead of protecting citizens and ensuring them access to health care, the regulations serve as barriers that impede access to needed health care services.
We are two nurses who have long promoted access to needed health care services and the removal of unnecessary and outdated regulations that prevent nurse practitioners and other advanced practice registered nurses (APRNS) from providing those services efficiently. We now see a shift that may portend a much-needed change in our quest for regulatory change. At recent meeting of the Senate Commerce and Labor Committee, Senate Bill 176, which is focused on APRN practice, was discussed.
This latest bill to remove unnecessary and outdated restrictions on APRN practice, such as requiring monthly chart audits by physicians and having to pay physicians monthly to maintain a collaborative practice agreement, did not move out of committee.however, the Senate bill sponsor, Jon Lundberg, and the committee chair, Paul Bailey, heralded a change in approach. The transition began with Lundberg sharing the Tennessee Medical Association’s refusal to meet with the bill sponsors, including Rep. Bob Ramsey and Tennessee Nurse Association principals. In defending the unwillingness to meet, a TMA representative said, “There is no common ground. There is no room for discussion.”
Lundberg called for an end of the “business model” codified in regulations that benefit physicians but disadvantage patients and APRNS. Sen. Bo Watson said in response, “Sometimes, the arrogance of these groups gets ahead of them and it is our [the Tennessee General Assembly’s] responsibility to determine what the policies will be.”
Task force could pave new way forward
Bailey defined a new approach by suggesting the committee convene a task force. The task force would be charged with letting state legislators — instead of special interests — chart a path forward for less restrictive regulations regarding APRN (and physician assistant) practice.
The original purpose of Tennessee state regulations governing APRNS
has been lost. Instead of protecting citizens and ensuring them access to health care, the regulations serve as barriers that impede access to needed health care services. APRNS, including certified nurse practitioners, nurse-midwives, nurse anesthetists and clinical nurse specialists, offer a choice of health care services that arehigh-quality,cost-effective andrated highly by people who receive care from APRNS. Since the regulations are harmful to Tennesseans, they should be removed.
APRN practice restrictions are harmful because theyimpose unnecessary barriers to needed health care services and squander a needed resource. States with outdated APRN practice barriers do not have higherquality care than the states that have removed APRN practice barriers.a recent study concludes that removing APRN practice barriers does not adversely affect the quality and vice versa. Barriers to APRN practice reduce patient access to high-quality health care, delay needed health care, limit patient choice, diminish efficiency and add cost to the health care system.
We urge you to contact your state representative and senator to tell them you do not want your choice of health care provider restricted unnecessarily.
Barriers impede access to care
Regulatory barriers may be stateor federal-based and result from governmental policies that limit APRNS from practicing based on their education and preparation. Data from thenational APRN Practice and Pandemic Survey conducted in 2020, with 7,467 APRNS from all 50 states, including 553 respondents from Tennessee, found several state barriers that impede access to care. Examples of specific Tennessee barriers include unnecessary physician signature requirements, medication prescribing bureaucracy and mandatory physician chart reviews. Additional barriers include physicians refusing to accept patients for consultations or referrals if an APRN sends them and requiring only physicians to sign disability forms or durable medical supply orders. APRNS face difficulties with reimbursement, including lack of payment parity or the need for a physician’s signature for the care provided.
The collaborating physician’s payment requirement is particularly burdensome, ranging from $1,500 to $5,000 or more monthly.as of March 21, the average annual pay for a collaborative physician in Nashville is $74,085 a year. Additionally, there is no limit to the number of APRNS a physician can serve as a collaborator — therefore physician compensation rather than the healthcare of Tennesseans is a relevant issue.
Tennessee isone of the 11 most restrictive states for APRN practice. Since 2010 when the Institute of Medicine called for removing APRN practice barriers, many state legislatures have responded. In 2010,only 13 states were classified as unrestricted.
Thirteenadditional states have been added to the list in the ensuing time, and many other states have made incremental progress towards unrestricted practice. Tennessee has made negligible progress. The Tennessee state requirements for collaborative practice and supervision limit patient access to much-needed care. Tennessee should remove unnecessary and outdated regulatory barriers to benefit Tennesseans.
In light of the state’shealth and health care disparities andunder-resourced health care system in many areas of the state,the removal of unnecessary regulatory barriers to APRN practice isimportant. We urge you to contact your state representative and senator to tell them you do not want your choice of health care provider restricted unnecessarily. Tell them you want to allow Tennessee APRNS to practice commensurate with their education and training, as they do in most states around the country. This change is long overdue.
Ruth Kleinpell, PHD, RN, FAAN, FAANP, FCCM is the Independence Foundation Professor of Nursing Education Associate Dean for Clinical Scholarship and professor at Vanderbilt School of Nursing. Carole R. Myers, PHD, RN, FAAN, is a professor at the University of Tennessee in the College of Nursing & Department of Public Health.