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.