Nurse Practitioners Flex Their Political Muscle

With the new Affordable Care Act soon to kick into high gear, millions of new patients will suddenly be knocking on doctors' offices for all types of care.  That will put a huge strain on medical providers—especially on doctors who aren’t multiplying at the same rate as new patients.

Toni DiChiacchio, a family nurse practitioner and owner of Health Thru Care LLC in Morgantown, West Virginia noted that 40 percent of all patients admitted to a nearby hospital lack primary care providers.

One solution is to take the load off doctors by giving nurse practitioners (NP) more power to see patients autonomously. A state's performance evaluation review division would have to change its policy on scope of practice.

DiChiacchio said that more than a dozen states already allow nurse practitioners to practice entirely autonomously. She admitted that the liability issue poses a challenge, but said that 40 years of research has demonstrated that patients seen by nurse practitioners encounter no greater risk that those seen by physicians. "Patients likely will continue to see physicians, but it would be nice for them to have another choice," said DiChiacchio.

Dr. Hoyt Burdick, president of the West Virginia Medical Association argues that healthcare should rely more on cooperation and teamwork. "Even residencies are focused on collaboration and systems, so there's a move toward team-based care," said Burdick. "The movement for nurses to treat patients without doctors on their team comes at a time when medical care is shifting toward a team-based approach. Eliminating collaborative practice agreements promotes further isolated individuals in a fragmented system," said Burdick.

Some states are re-writing and re-defining nurse practitioner roles and expanding prescription rules so nurse practitioners can prescribe drugs for chronic conditions. Groups like the West Virginia Medical Association are working collaboratively with other groups to develop a list of chronic conditions.

While DiChiacchio noted that nurse practitioners must collaborate, she insists nurses could participate more in a patient’s health care. This would allow doctors to use more of their knowledge and experience, which is often not used to the fullest extent.

In California, Senate Bill 1524 advocated by California Association for Nurse Practitioners, may soon become law. If passed, it would remove the six-month delay for nurse practitioners to receive authorization to provide medication to their patients.

Current law stipulates that NPs have six months of supervised experience before they’re allowed to administer medications to their patients. This has prevented patient access to care, since it delays NPs from entering California’s health care workforce. The restriction also keeps experienced NPs from entering the state, since it applies to out-of-state NPs regardless of their previous length of practice. The new measure passed both houses of the legislature by overwhelming margins and now awaits action by Gov. Jerry Brown. If signed into law, the bill would take effect January 1, 2013.

If you’re a nurse practitioner, you should be aware that the battle is being waged to give you more power to see patients autonomously and to administer medications to your patients.