The state’s medical community needs to get behind an effort to give advanced practiced nurses more independence to care for patients. Doctors are going to need their help.
Regulation of nurse practitioners has become one of the most contentious issues in the Legislature this year. Two competing bills recently were debated by a House subcommittee with nursing groups backing one bill and physicians another.
Nurse practitioners have the training to blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management. In addition to a bachelor of science degree in nursing, nurse practitioners also hold master’s degrees or doctorates, and must pass a national board certifying exam in the area of specialty in which they studied.
After achieving board certification, NPs must apply for additional credentials, such as licensing at the state and federal level. They also must earn a certain amount of continuing medical education credits and complete a specified number of clinical practice hours to maintain certification and licensing.
In other words, NPs are qualified to perform many of the day-to-day functions of an MD. With that in mind NPs argue that the state’s rules limiting how they can practice are too restrictive.
Currently, NPs have to work under a practice agreement headed by a physician, with no more than three NPs per physician. Also, the physician’s practice must be within 45 miles of where the NP works.
Physician groups say the restrictions are necessary because NPs lack the full training of a doctor. But NPs believe the rules severely restrict where they can work and give physicians anti-competitive control over them.
A physician-favored bill loosens restrictions somewhat, allowing doctors to oversee a maximum of six NPs and increasing the mileage radius to 60 miles. But nursing groups would like to see the mileage restrictions abolished altogether. The bill favored by nurses also would allow them to prescribe some drugs they aren’t allowed to prescribe now.
Nursing groups make a good case that with the increasing use of tele-medicine with secure video connections, the mileage restrictions are obsolete. Most of the oversight doctors might provide can be done online.
The problem in the near future is going to be the lack of primary health-care professionals to serve a growing number of patients. The need for primary caregivers will increase as more and more people gain insurance through the Affordable Care Act and, especially, as the baby boom generation grows older.
Around 76 million Americans were born between 1946 and 1964, and immigrants could swell that number to 80 million. Most of them will be retiring over the next 20 years at the rate of almost 10,000 a day.
That will affect health care in the U.S. in a number of ways. For one, it means that many of the nurses and physicians practicing today will be retiring, creating a shortage of qualified health providers.
More significantly, it means the need for geriatric health care will skyrocket. That will present a huge challenge to health care providers, particularly as the demand for in-home care increases, which will require more flexibility and mobility on the part of caregivers.
NPs have the training and the skills to provide the bulk of that care. They shouldn’t be unnecessarily tethered to doctors or restricted to working only within a certain radius of a doctor’s practice. That serves neither their interests nor that of their patients.
We hope lawmakers will look ahead, listen to what nurses are telling them and make a smart decision about the future of health care in South Carolina.
Nurse practitioners should be given the flexibility to treat a graying baby boom generation.