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    States push independence for NPPs: A solution to work force crisis?

    Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or [email protected] for more information.

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    Of the myriad proposed solutions to physician shortages, an expanded scope of practice for non-physician providers (NPPs) can be swiftly implemented by policymakers eager for a quick fix. Unfortunately, quick fixes usually involve shoddy workmanship and, as applied to the provision of health care, shoddy workmanship endangers patient safety.

    Seventeen states and the District of Columbia already grant advanced practice registered nurses (APRNs) “full practice” authority as of December 2013, according to the American Association of Nurse Practitioners. In these jurisdictions, essentially no distinction is made between a medical doctor’s 11 years of training and an APRN’s 6 years of education and clinical instruction. New York will become the 18th state with unsupervised APRNs on Jan. 1, 2015, when a law signed earlier this year takes effect. In legislative sessions taking place across the country this spring, more nuanced proposals promise independent practice after a certain amount of experience, whether measured in hours or years.

    Here are highlights of statewide 2014 scope of practice initiatives:

    Connecticut: SB 36 authorizes APRNs to prescribe drugs and treat patients without physician oversight after being licensed in Connecticut for 3 years. The bill, supported by Gov. Dannel Malloy (D), was approved by the state Senate April 9. The House is expected to grant favorable consideration prior to that body’s May 7 adjournment.

    Minnesota: HF 435/SF 511 allows unsupervised practice for APRNs engaged in most primary care and psychiatric specialties. Even this limited expansion is troublesome, however, in a state where the Board of Nursing routinely fails to enforce current standards. Gov. Mark Dayton (D) accused the board of being “asleep at the switch” in November 2013, when news outlets reported that some nurses have kept their licenses despite neglecting patients, stealing drugs, and practicing while impaired.

    Florida: HB 7071 creates a new “independent APRN” classification for APRNs with at least 2,000 clinical hours within a 3-year period. Legislators are also considering bills that propose a reasonable and safety-conscious expansion of physician assistants’ scope of practice. SB 1230 increases the number of physician assistants that a physician may supervise at any one time and carefully revises the circumstances under which a physician assistant is authorized to prescribe medication.

    Ohio: Gov. John Kasich (R) signed HB 139 on Feb. 8. The new law allows collaborative physician-led care to continue and grants APRNs and PAs admitting privileges if their supervisor is a medical staff member and the hospital grants the NPPs relevant credentials. The Ohio State Medical Association actively supported this measure, which also requires NPPs to notify the collaborating physician of their intent prior to admission.

    Continue to next page for more.

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    • Anonymous
      NPs want to be physicians without going through the training. . Their ultimate goal is complete independence to practice urology with less than one third of the training: it has always been true: everyone wants to do what you do as a physician without doing what you did for proper training.
    • terrisquires
      YOU DON'T KNOW THAT YOU DON'T KNOW ROSS WEBER; you DO NOT have to go medical school to PRACTICE MEDICINE--yes I said it--Practice Medicine. You can get a Master's or doctorate degree in a "specialty" area, do your residency with a physician or Nurse Practitioner or PA and then practice independently if you so choose. That adds up to 4 yrs bachelor's degree, 3 years master's or 4 yrs doctorate degree and two years residency--do the math--it's not 6 yrs like you said. Again, NP's and PA's PRACTICE medicine COMPETENTLY, EXPERTLY AS evidenced by numerous studies from the 1990's and recent studies. NP's have been practicing independently since the 1970's and doing it expertly and competently alongside PA's as well. Please get the facts before you write again--i;t's bad press and poor journalism on your part to educate your fellow physicians with inaccurate information. We practice medicine, are proud to practice medicine and do it very well "according to the research". Patient satisfaction also is rated high if that matters at all to physicians.
    • PaulaHavisto
      I am wondering if the physicians and physician groups who oppose NP independence have bothered to sit down with NPs and ask them what independence means? In the NP world I believe the NPs want to have complete control over their own profession and not have a different profession try to manage and dictate to them what they can and cannot do. Independence does not mean working in a silo. All NPs, PAs, MDs, DOs, ODs, DPMs and others collaborate as a matter of ethics and professionalism for the benefit of the patient. It is time for a forum with the PAs and NPs and the MDs and DOs sitting at the table together to discuss these issues. Why are you afraid of us? We only want to work to the full extent of what we are licensed for and within our scope of practice. We do not practice unsafely and no studies have shown that. PAs and NPs are getting residency training programs now offered by hospitals in an effort to continue to improve our knowledge AND to add to the team practice of medicine. PAs want collaborative practices and after 50 years of "supervision" it is time to cut the chains that tether us to physicians. I personally want an independent PA license that is granted to me by the medical board so that I can practice wherever I want. I want collaboration with a physician or group of physicians and hospitals. My 10 years experience as a PA working in rural care is a reason to be able to have a license that is not tethered to a physician. If my physician partner leaves the practice I am automatically out of a job, and patients lose their two PCPs. Is that fair to them and is it good medicine to abandon your patients? Think about it. PAs and NPs need 2-3 years of close collaboration (supervision) and then should be able to handle most primary care patients. Why does the medical community ignore the rich treasure they have available to them with PAs and NPs? Also, think about this...my professors were mostly physicians.....are you saying physicians educate and train unsafe practitioners? When you speak against us you are speaking against yourself.
    • KimberlySpering
      Your commentary is not backed up by any research whatsoever, as Dave Mittman rightly points out. In my practice area, the urology groups employ PAs and NPs and utilize our skills to the highest degree as appropriate. I highly doubt that the urologists there (like most) share your viewpoints. This smacks of "turf wars" through and through. Politics as usual. And guess what? "Joe Public" is starting to see through the tired rhetoric as well.
    • DavidMittman
      I am surprised that a publication like Urology Times would insinuate that PAs and NPs provide "shoddy" care. What one study do you have to say this? Surely an evidenced based publication would know that to even suggest something like this, you should have a few studies that support the premise. There are none, nana, nicht. This is about economics and power not quality of care. Unfair article, unless you only represent physicians who do not work with PAs and NPs in Urology. If so, change your title. Also, we are not non-physician practitioners. That could be my grandma or the chiropractor down the block. Advanced practice clinicians or NPs and PAs will do. That's like naming physicians "Non-PA/NP practitioners". Again, misleading, negative and unfair. Dave Mittman, PA, DFAAPA

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