New Bills Threaten Physician Supervision of Mid-Levels

The General Assembly is considering several bills this session that would remove physician supervision requirements for many non-physician practitioners. Among the most aggressive of these proposals is one introduced by Sen. Ralph Hise, SB 695, Modernize Nursing Practice Act, which enhances the already broad authority of the North Carolina Board of Nursing.

Now is the time to contact your state senator to explain why physician supervision helps ensure the safety of your patients. Our current law allows nurses to expand their expertise well beyond their formal education by working side by side with a supervising physician. In fact, advanced practice nurses in North Carolina can perform any medical act approved by a supervising physician. The current supervision law allows nurses to practice to the fullest extent possible, while maintaining the safety net of physician expertise vital to patient safety. Contact your legislator now.

SB 695 proposes to include adding advanced practice registered nurse (APRN) licensure for nurse practitioners, certified nurse midwives and clinical nurse specialists. In addition, the legislation proposes to expand the APRN scope of practice beyond the current RN scope of practice by authorizing these mid-level practitioners to:

  • Conduct an “advanced assessment” (a new defined term in the Act);
  • Delegate and assign therapeutic measures to assistive personnel;
  • Perform other acts that require education and training consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies and experience.

The bill also specifically permits the following areas of focus for APRN practice:

  • The family or individual across the life span
  • Adult gerontology
  • Neonatal
  • Pediatrics
  • Women’s health
  • Psychiatric or mental health

The practical implications of the sweeping changes in SB 695 are not yet understood. It is our belief that if this bill is not modified to impose limits on the proposed changes, the quality and cost benefits of physician supervision are at risk.

Another assault on physician supervision is SB 240, Define Scope of Practice of CRNAs, by Sen. Jim Davis. The bill proposes to eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). SB 240 proposes to define the practice of nursing by a CRNA as including the following components:

  • Perform nurse anesthesia activities in collaboration with a physician, dentist, podiatrist or other lawfully qualified health care provider with each provider contributing his or her respective area of expertise consistent with the lawful scope of practice and according to established policies, procedures, practices and channels of communication that lend support to nurse anesthesia activities;
  • Define the roles and responsibilities of the certified registered nurse anesthetist within the practice setting;
  • Maintaining individual accountability of the outcome of individual actions.

The value of physician supervision and the contributions to patient safety made by physicians are being questioned. It is important that you tell legislators the important role physician supervision plays in protecting patients in our health care system. Take Action Now >>

 
 

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