A plan to expand the powers of advanced registered nurses hasn’t yet caught on in the legislature, but eased out of a House Health panel Wednesday. The fate of bill remains cloudy, but its sponsor says even if it fails this year—the issue isn’t going away.
After initially stalling last week, a bill that would let some highly-trained nurses see patients without having the oversight of doctors, finally got moving Tuesday. House Bill 547 was the final proposal heard by the Health Innovation Subcommittee, and even though lawmakers approved it on a 9-to-4 vote, unclear whether the bill is enough of a priority, or even if it has enough support—to get through the House. Still, Republican Rep. Cary Pigman says he wants fellow lawmakers to hear him out and, “to recognize it’s a work in progress. It’s likely a multi-year work in progress.”
At issue is how much authority nurses and physician assistants should have in medical care. Right now, advanced nurses can see patients but have to be supervised by a doctor. The bill would allow those highly-trained nurses to work independently. It would also give them more prescription drug authority, and allow them to do mental health evaluations under the state’s involuntary confinement, or Baker Act Law. But that’s going too far, says Dr. Allen Pillersdorf, a cosmetic surgeon and President of the Florida Medical Association:
“This is a divisive bill," Pillersdorf said. " If you just look at this room-- we have the doctors, dental and medical students sitting on the left. We have the nurses, nurse practitioners and physician assistants sitting on the right. This is the wrong direction for medicine, we need to be collaborative.”
Doctors have long claimed letting certain nurses do basic primary care detracts from their role as physicians. That argument was the argument of Port Charlotte General Surgeon Dr. John Rioux.
“It would be unreasonable to expect the same level of expertise of medical extenders who have 5-10 years less of training. Otherwise, there would be no value in spending $150,000 to go to medical school.”
Physicians have been the main opposition to the bill. But consumer-backed groups, nurses and physician assistants and even hospitals have pushed for it. Phyllis Oeters is the Vice President For Government Relations for Baptist Health. She describes a recent visit to the Mayo Clinic in Minnesota.
“They use nurse practitioners as their primary, first-line treaters of primary care in Mayo. We looked, we saw how everyone worked together, we asked a lot of questions. And they knew that Florida was the only state that did not allow nurse practitioners to prescribe.”
There are also concerns the bill could drive up the cost of insurance—an argument Rep. Pigman, a doctor himself—says in other states that do allow nurses and physician assistants to do more work—the cost, and claims—are negligible. And he refutes the Florida Medical Association, which says the bill is disruptive to the practice of medicine.
“This is intended to be disruptive," Pigman said. "We know the bill process is a process. You have to do things to bring people to the table, and what this bill does is bring people to the table. So I welcome Dr. Pillersdorf.”
The scope-of-practice dispute is a turf battle. One fueled by a declining number of doctors, and increased demands placed on the healthcare system as more people become insured. It’s also a fight physicians may not win for much longer. While physician-based groups oppose the bill, consumer groups, hospitals, and others—like it—and say its past time Florida stopped being one of the last holdouts and let nurses do more.
*Clarification: Story has been edited slightly to clarify the proposal would apply to nurses with advanced-level training, not all nurses.