There’s a controversial tug-of-war in the health care industry. According to The Washington Post, in 11 states nursing groups are pushing legislation that would permit nurses with master’s degrees or higher to order and interpret diagnostic tests, prescribe medications and administer treatments without the supervision of a physician. Similar legislation is likely to be introduced in three other states. Currently, each state decides how much supervision nurses must receive from physicians.
This legislation faces strong opposition from physicians, led by the American Medical Association (AMA). This is according to an article in The Washington Post, published on March 24, 2013. Click here to read that article.
The Fight for Autonomy.
According to The Washington Post, the American Association of Nurse Practitioners (AANP) and other nursing groups are coordinating this legislation effort. These groups are receiving support from consumer advocates and state officials concerned about the possible doctor shortage.
Physicians’ groups are arguing that with little or no supervision, patient care will be compromised, according to a Bloomberg News article. The physicians’ strongest argument is the difference in education between them and advanced practice nurses (APNs). To read the Bloomberg News article, click here.
Difference in Education.
Advanced practice nurses obtain a bachelor’s degree in nursing, then spend between two and three years studying for a master’s degree. A master’s program includes extensive clinical training in addition to class work. One additional year of school is needed to get a Doctor of Nursing Practice (D.N.P.) degree.
Physicians obtain a bachelor’s degree, then continue on with four years of medical school. This is followed by at least three years in a residency program.
Laws for Nurse Supervision Differ State-by-State.
Each state regulates how much oversight nurse practitioners must have. According to Bloomberg News, in 16 states, including Colorado, New Hampshire, New Mexico and Washington, nurses can evaluate and diagnose patients, order diagnostic tests and prescribe drugs. Nurses in these states can start a practice or work in a clinic with no physician present.
Florida and Alabama nurses can’t prescribe controlled substances, including medications for pain, insomnia and attention deficit disorder and must have a supervisory agreement in place with a physician supervisor. Their practice is limited by what the physician places in the agreement.
Court Cases of Nurses vs. Doctors.
According to Bloomberg News, physicians in Iowa sued the state in 2010, after it allowed nurses with advanced training to perform a fluoroscopy, which is a radiographic procedure that takes pictures inside the body. The physicians do not believe nurses have the proper training to carry out this procedure. The case is before the Iowa Supreme Court after a lower court sided with the physicians.
Physicians sued the state of Colorado when the governor allowed nurse anesthetists to work without supervision. An appeals court sided with the nurses in 2012. There is a discussion of this case on our blog. Click here to read it.
Contact Experienced Health Law Attorneys.
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Do you think nurses with advanced degrees should be allowed to practice without the supervision of physicians? Do you think it is necessary for patient care for physicians to be present? Please leave any thoughtful comments below.
Pettypiece, Shannon. “Nurse Practitioners, Doctors in Tug-of-War Over Patients.” Bloomberg Business Week. (March 7, 2013). From: http://www.businessweek.com/printer/articles/100802-nurse-practitioners-doctors-in-tug-of-war-over-patients
Aizenman, N.C. “Nurses Can Practice Without Physician Supervision in Many States.” The Washington Post. (March 24, 2013). From: http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-in-many-states/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_story.html
About the Authors: Carole C. Schriefer is a nurse-attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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