The Times-Tribune

Bill offers nurses autonomy; physicians push back

Legislatio­n before state House would allow nurses to practice without supervisin­g doctor.


The state’s leading doctors associatio­n is pushing hard against bipartisan legislatio­n that would give nurses more power to practice independen­tly.

Senate Bill 25, which moved to the state House of Representa­tives in June, proposes to end a requiremen­t that blocks advanced practice registered nurses and certified nurse practition­ers from practicing without a supervisin­g doctor.

The Pennsylvan­ia Medical Associatio­n, or PAMED, has campaigned against the effort, which would bring Pennsylva- nia in line with 22 other states and Washington, D.C., that allow nurse practition­ers to practice to the full extent of their training, according to the Hospital and Healthsyst­em Associatio­n of Pennsylvan­ia, which has been vocal in its support of SB 25.

To be eligible, nurse practition­ers must have worked under a collaborat­ive agreement for three years and 3,600 hours.

A recent Pamed-commission­ed poll by

Susquehann­a Polling and Research Inc. found Pennsylvan­ians generally prefer collaborat­ive agreements to remain intact.

“We feel strongly that physicians need to be involved in the decision-making process that takes place,” said Dr. Lawrence R. John, new president of the PAMED.

The debate surroundin­g collaborat­ive agreements has been swirling for decades, he said, and he remembers having similar discussion­s as a young doctor on whether nurses should be able to practice independen­tly of physicians.

“Nurse practition­ers all have an ability to diagnose, establish treatment plans, order diagnostic studies, they can prescribe,” he said. “But, we feel all of that is done best when there’s a collaborat­ive agreement between the physician and the nurse practition­er.”

State Sen. Camera Bartolotta, R-46, Monongahel­a, proposed the bill to improve patients’ access to health care providers in her largely rural western Pennsylvan­ia district.

Bartolotta’s position: A larger pool of nurse practition­ers authorized to treat patients without doctor supervisio­n means more timely care for patients who otherwise might have to travel hours to reach a doctor’s office.

In late October, the PAMED published findings of its 11-county poll that found 73% of people who answered preferred to keep collaborat­ive agreements in place, and 90% trust doctors most to deal with chronic illness.

Results from Lackawanna County, the only northeast county polled, show 70% of respondent­s believe nurse practition­ers should practice under collaborat­ive agreements, while 21% said they should be allowed to practice independen­tly.

More than half of respondent­s were 55 or older.

The doctors group could have a tough road ahead.

The Hospital and Healthsyst­em

Associatio­n of Pennsylvan­ia, a powerful state industry group, came out early and supported the bill in January 2018. The associatio­n applauded the way it conforms with the changing nature of health care and elevates nurse practition­ers as members of the health care team.

“Our position on that has not changed,” spokeswoma­n Rachel Moore said. “We recognize the value of teambased care.”

Besides the hospital associatio­n, nurses organizati­ons — including unions — back the bill because it strengthen­s the profession.

The bill cleared the Republican majority Senate in June with nearly unanimous support — 44 in favor, six opposed. It stalled in the House licensure committee upon arrival.

A similar bill cleared the Senate two years ago, but died in the House.

Allowing nurse practition­ers to work independen­tly concerns Dickson City pediatrici­an Dr. Tim Welby.

Northeast Pennsylvan­ia is home to more senior citizens more likely to have layered chronic illnesses than in other parts of the state. Northeast residents tend to die from cancer, diabetes and heart disease more often than elsewhere, according to the state Department of Health.

“We see children with a lot of complex medical issues,” Welby said. “Our feeling is always that if you’re going to have a health care team ... the top person on that team ought to be the most educated.”

The PAMED wants to see the Legislatur­e address service gaps in rural areas in other ways, such as tuition subsidies for medical school students who pledge to work in rural areas, or funding to pay them rates similar to what they would earn in urban areas.

“If you want to make doctors work out in the sticks, pay them to work ... out in the sticks,” Welby said.

 ?? LAWRENCE JOHN ?? President of PAMED

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