Debate rages between NPs and docs on whether nurses should operate independently

Debate rages between NPs and docs on whether nurses should operate independently

A contentious debate regarding whether or not nurse practitioners should have more freedom and be less tethered to doctors continues. Earlier this month, Pennsylvania lawmakers announced they will once again file a bill to loosen the legal ties between them.

According to the Morning Calltwo Pennsylvania state senators, Camera Bartolotta, a Republican, and Lisa Boscola, a Democrat, will refile a bill – the first iteration of which was introduced nearly 10 years ago – that will call for nurse practitioners to fulfill a three-year, 3,600-hour physician collaboration period. After that, nurse practitioners would be free to provide care independently, in their specific areas of expertise.

In 26 states currently, nurse practitioners have full practice authority.

Cheryl Schlamb, a nurse practitioner and the president of the Pennsylvania Coalition of Nurse Practitionerstold MedCity News that the lessons learned from the pandemic should provide a push for lawmakers to take the bill even farther in the legislature this time.

During the Covid-19 pandemic, each nurse practitioner was allowed to be tethered to only one physician, compared to two before the pandemic.

“If we proved ourselves during the pandemic with one, why can’t we do more good work without added restriction?” Schlamb contended.

In the debate between physicians and nurse practitioners, what is lost is what’s in the best interest of the patient, Schlamb argued. In her opinion, the restrictions are preventing patients from accessing the care they need. Last year, there was one nurse practitioner in rural Pennsylvania in psychiatry and the two attending physicians she was tethered to retired. Patients with mental health issues couldn’t be seen until the practice could obtain two more providers.

“That left patients with no access to care,” Schlamb said.

Meanwhile, physicians counter that nurse practitioners don’t have the training to operate independently. One physician, Dr. Purvi Parikh, a member of Physicians for Patient Protectionan organization standing for physician-led healthcare, said the pandemic showed that.

“The average nurse practitioner has only 5% of the clinical training that a brand new internal medicine doctor has or a brand new primary care doctor, [and] that doesn’t even account for you know, people who are in their specialties or people who are been practicing obviously for many years and have that luxury of experience,” said Dr. Parikh.

She was treating patients in hard-hit New York City during the height of the pandemic in 2020 and said that nurse practitioners weren’t operating any differently than they would have even if those restrictions had not been lifted that gave them more autonomy.

“So when that Covid-19 response was occurring, the physician-led teams were still in place and there was nothing that [nurse practitioners] could do extra having that ‘autonomy’ that they were not able to do prior to those restrictions being lifted,” Dr. Parikh said.

Another finding during the pandemic was that many nurses who were brought to New York to assist during the height of the crisis didn’t have experience in acute care or infectious disease, she said. They were still functioning under that physician-led team model so it “almost didn’t make sense to lift the restrictions because they were still able to help and help immensely, but under physician supervision,” Dr. Parikh said.

She contends that patient outcomes are worse and access is not improved when nurse practitioners practice independently and pointed to a 10-year retrospective study from the Hattiesburg Clinic in Virginia that looked at cost data for 33,000 patients. The study showed an increased cost for patients when nurse practitioners operated independently.

Dr. Bryan N. Batson, a co-author of the study and CEO of Hattiesburg Clinic, told the American Medical Association in his published findings that the additional costs had to do with a combination of several factors. They included more ordering of tests, more referrals to specialists, and more emergency department utilization when NPs practiced independently.

Though it has become a polarizing issue, Schlamb said it’s not about doctors versus nurses.

“I’m not competing to be a physician. I’m an expert nurse. That’s why we collaborate and refer when things are out of our scope and have a collaborative agreement that is a legal mandate that I do that,” Schlamb said.

Photo: Hiraman, Getty Images

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