Should Nurses Do More?

December 2, 2015

Investigative Reports

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Hospital

Bill would deregulate midwives, nurse practitioners

Senate bill 246, filed by Sens. Tom Davis (R-Beaufort) and Kevin Bryant (R-Anderson) would allow certified nurse midwives, nurse practitioners and clinical nurse specialists to perform more medical services without the direct written approval of a state board or licensed physician and without a physician present to supervise.

Licensing laws are often a barrier in the marketplace, and the federal government imposes restrictions unless people pay for certain licenses or certificates for permission to do their job. Under current law, nurses and midwives are restricted from doing what they know how to do for many that don’t have time to wait to see a licensed physician.

S.246 would allow midwives, nurse practitioners and clinical nurse specialists to prescribe pharmaceuticals to patients (the level of drug depending on the nurse’s training), refer patients to physical therapists, certify the claims of an individual applying for a handicap placard and more.

The Greenville Midwifery Care and Birth Center’s website asserts the organization’s belief that every woman has the right to equitable, ethical, accessible quality health care that promotes healing and health. Many nurses and midwives feel as though they have earned the right to carry out specific duties without a physician.

Barbara Davenport is a certified nurse-midwife with the Coalition for Access to Health Care. She says the “need” for physician supervision is a model of care rarely practiced in a clinical setting.

“It is the responsibility of the supervising physician to direct and review the work, records, and practice of the APRN on a continuous basis to ensure that appropriate directions are given and understood and that appropriate treatment is rendered consistent with state law,” Davenport said. “Physician ‘supervision’ is not practical, efficient or needed, so it is not really practiced.

‘Having laws that define the relationship between APRNs and MDs are a barrier and a legal liability.”

Fewer restrictions also mean more benefits to patient care, Davenport said.

“APRNs are less expensive to educate than MDs and have lower liability premiums,” she said. “A recent study at Duke showed that expanding the work force with 3,800 APRNs in North Carolina would produce annual health systems savings costs ranging from $433 million to $4.3 billion.”

“Only 12 states in the U.S. still have APRN physician supervisory language. The rest have collaborative or independent practice for APRNs, and almost all of the states with supervisoru language have current bills proposed to remove the supervisory language.”

Opposed to this bill is the South Carolina Medical Association. SCMA General Counsel J.C. Nicholson said that increased access means that nurses who don’t have as much practice in residency as doctors would be practicing on patients, and that studies show this could increase overall costs in health care.

“APRN’s and physicians work together every day, and both are very important positions. But, to say APRN’s are exchangeable with a physician is incorrect; they aren’t,” Nicholson said.

If this bill were passed, supporters believe health care costs could decrease by allowing more appropriately trained professionals to deliver medical services they’re qualified to do. Removing this government restriction will increase availability, they argue, which will in turn reduce prices.

The bill was referred to the Committee on Medical Affairs in January.

Cecilia Brown works as a research assistant/intern at The Nerve and is a senior at the University of South Carolina studying journalism and mass communications. Reach her at 803-254-4411. Ron Aiken contributed to this report.