Senators move forward with Speaker Oliva's plan for more autonomy for advance practice registered nurses
by Christine Sexton - News Service of Florida | Feb 19, 2020
In a sign that negotiations are underway, a Senate health-care panel on Tuesday approved House Speaker Jose Oliva's top priority of the 2020 legislative session: independent practice for advanced practice registered nurses.
The Senate proposal is narrower than the House version (HB 607). But it is the first time senators have agreed to consider the idea of allowing advanced practice registered nurses to provide care independently from physicians.
Chris Nuland, a Jacksonville attorney who represents the Florida Chapter of the American College of Physicians, told The News Service of Florida he expects the proposal to evolve in the coming weeks as the annual 60-day legislative session draws to an end.
"It really is just a conversation starter, it will not be the final product," Nuland predicted.
The independent practice issue was added to a broader health-care bill (SB 1676) that was approved by the Senate Health and Human Services Appropriations Subcommittee.
It would create the Patient Access to Primary Care Pilot Program, a 10-year pilot that would allow certain advanced practice registered nurses to provide primary care services without protocols or agreements with supervising physicians.
The advanced practice registered nurses would be authorized to work in areas of the state that are considered to have health professional shortages.
"It's not going to be the wild West by any stretch of the imagination," said Sen. Ben Albritton, a Wauchula Republican who sponsored the bill and the amendment.
The bill, though, doesn't spell out the care that the nurses would be authorized to provide. Instead, it would require the Board of Medicine and the Board of Osteopathic Medicine to adopt those rules. The rules would have to address, among other things, the scope of the medical care, treatment, and services that advanced practice registered nurses could provide to patients and what services would be outside their scope of practice.
The measure also would establish a nine-member Council on Advanced Practice Registered Nurse Independent Practice, which would propose rules for the two medical boards to adopt. Three of the nine members would have to be physicians who serve on the Board of Medicine, another three members would be from the Board of Osteopathic Medicine and three members would come from the Board of Nursing.
The physician members would have to be doctors who have worked with advanced practice registered nurses under protocols in their practice. The nurses named to the council would need experience working under protocols with physicians.
To qualify for independent practice, nurses would need to have had prior protocol arrangements with supervising physicians and have had at least 10,000 hours occurring within the last six years and would need to have completed graduate-level courses in differential diagnosis and pharmacology.
Moreover, nurses who want to apply for independent practice certification would also have to show proof that they would maintain professional liability insurance coverage in an amount not less than $100,000 per claim, with a minimum annual aggregate amount of not less than $300,000 or an irrevocable letter of credit for the same amounts.
Oliva, R-Miami Lakes, has long championed independent practice for advanced registered nurse practitioners as he seeks to eliminate or reduce many health-care regulations. Attempts to contact Oliva following Tuesday's vote were not immediately successful.
Oliva has made health care a priority during his two-year term as the leader of the House. He included expanding scope of practice for nurses in his opening-day remarks for the 2020 legislative session.
"Florida is one of a handful of states that still prevent health care professionals from practicing what they are educated, trained and certified to do. In spite of truly overwhelming evidence, Florida resists," Oliva said in his speech. "This kind of protectionism on behalf of special interest groups is not just wrong, it is costly and it is dangerous."
Because of Oliva's focus on the independent practice issue, it is widely expected to be a key part of negotiations as House and Senate leaders seek to resolve a series of key issues before the March 13 end of the legislative session.
While the Senate committee moved ahead on Oliva's priority Tuesday, its proposal is more conservative than the House version. The Senate bill, for example, does not authorize independent practice for physician assistants, an issue Albritton said he would revisit.
Additionally, the Senate bill would authorize independent practice on a 10-year trial basis and would require a study on the effectiveness of the change from the Office of Program Policy Analysis and Government Accountability, a research arm of the Legislature.
Dan on February 19, 2020 at 10:12 am
When you go to a primary care physician's office or a walk in clinic in Tallahassee you see an ARNP most of the time. If that is so bad, why do the MD's and DO's use them so extensively? It is time to make primary care more accessible and affordable! Pass this bill!
Adherbal De Souza Neto on February 19, 2020 at 1:38 pm
As a APRN practicing in the State of Florida, I am glad to see progress. I would ask the Senate to avoid making restrictions. Limiting the practice of any profession is directly affecting the public it serves. Senators, as employees of all Citizens he/she serves, should think first on the premises of availability of care. Yes, safety needs to be taken into consideration. But that should hold true for all health care professions. In doing as Senate proposes in this bill, after 10,000 hours during 6 years, it would be time enough for an APRN to be not a novice when independent. This way, also MDs and DOs would have a continues flux of APRNs for a determinate period of time. Most states have much less number of hours of indirect supervision or agreement. Restrictive measures just promote migration of APRNs for states where they are valued as they should be.
Another point, as there will be 3 MDs and 3 DOs in the Council on Advanced Practice Registered Nurses, we should propose that 3 nurse practitioners, 3 CRNAs, and 3 CNMs also be part of the this Council. The most interested group is the least represented!
Finally, in the State of Florida, APRNs do have to carry malpractice insurance on the amounts mentioned in this article.
Paulette on February 20, 2020 at 3:31 am
Right on, A. De Souza Neto. I would add just a few things. In addition to primary care APNs in rural-underserved areas, also include in the pilot program APNs that are specialists in areas with shortages of physicians. As a Psychiatric Nurse (Psychiatric Nurse Practitioner), I serve a population with long wait lists for patients to be seen. I work in urban South Florida, yet this patient population is underserved. This affects children through geriatric ages. I also treat addiction, another area short of professionals to provide medication treatment. Add 3 Psychiatric Advanced Practice Nurses to that Specialty Council.
Finally, if safety is truly their issue, but not keeping the income stream that having a Nurse Practitioner provides to physicians, then de-monetize this whole system. In other words, prohibit physicians from collecting any money or fees from APNs, but require each physician to have a Protocol with a certain number of APRNs within a certain time frame. For example, within every 2 year license cycle, a physician must supervise 4 Nurse Practitioners.
It seems to me the longer we APNs wait for this privilege of Autonomous Practice, more patients in all areas of Florida and needing all kinds treatment needlessly suffer.
Gary on February 20, 2020 at 3:48 am
I would like to to the statement that APRN's have to have malpractice insurance but doctors are not required to!
Juan C Heredia on February 20, 2020 at 7:02 am
100% agree
R Campbell on February 20, 2020 at 6:48 pm
Exactly!!! They make money of the service provision, basically off the back of the NP and never lay eyes on the patient. The NP is paid by the hour and the Doc/practice gets paid by the patient.
Teresa on February 25, 2020 at 8:34 pm
I am a CRNA with over 25 years of experience. We are required to carry the same malpractice insurance as our MD anesthesiologist which is $250,000/$750,000.