South Carolina

Lawmakers debate leeway for S.C. nurse practitioners

How much independence to give advanced practice nurses is one of the most contentious issues in the S.C. Legislature this year.

The original subcommittee hearings of the two competing bills on the subject, one backed by nursing groups and one by many physicians, drew overflow, tension-filled crowds. Debate on both bills was adjourned after several hours, and they both come up again Tuesday in a House subcommittee.

The issues involved are important and emotional.

“We’re all in agreement that we want to improve access to care,” said Rep. Murrell Smith, R-Sumter, who sponsored the physician-favored H.3508. “We’re just not in agreement what’s the best way to improve access to care.”

Currently, nurse practitioners have to work under a practice agreement headed by a physician, with no more than three nurse practitioners per physician. Also, the physician’s practice must be within 45 miles of where the nurse practitioner works.

Physician groups argue the restrictions are necessary because nurse practitioners aren’t required to have the depth and years of training required of physicians. Nurse practitioners believe the rules are so restrictive they reduce the areas where they can practice and give physicians anti-competitive control over them.

The physician-favored bill actually loosens current restrictions, allowing a physician to supervise a maximum of six nurse practitioners rather than three, and increasing the mileage radius to 60 miles.

The nurse-favored bill, H. 3078, would loosen the restrictions even more. It would do away with the mileage restriction. Stephanie Burgess, a family nurse practitioner and associate dean of nursing practice at the University of South Carolina, contends the rise of telemedicine, which allows secure video connections from long distances, makes that restriction archaic. The bill also would allow nurses to prescribe some drugs they aren’t allowed to prescribe now.