Over the years there has been many negotiations between physicians and nurses that has preserved physician-led medical teams. ISA believes that only physicians have the clinical expertise and training to exercise independent medical judgment. Allowing non-physician practitioners to expand their scope of practice through legislation rather than education and training neither a good solution nor good public policy for improving access to quality care. Here are the highlights of those negotiations.
- Preserved physician supervision of APNs.
- Collaborative agreements required in clinical setting (outside hospital or ACTC).
- Podiatrists able to enter into collaborative agreements.
- APNs practicing in a hospital or ASTC are credentialed and subject to the rules of the facility.
- APNs may be granted privileges to select, order and administer medications including controlled substances.
- CRNAs must continue to have an anesthesiologist, physician, dentist, or podiatrist participate and agree with an anesthesia plan and remain present and available to handle complications.
- APNs may prescribe five Schedule II drugs under limited circumstances.
- APNs may be delegated prescriptive authority for any Schedule III through V controlled substances.
- APNs may prescribe Schedule II drugs under limited circumstances.
- Clarified in law that a written collaborative agreement outside of an employment arrangement may not restrict APNs from contracting with Medicare, or other health plans, nor limit geographic practice locations.
- Also clarified that the agreement may include services the collaborating physicians may provide but chooses not to perform.
- APNs may provide primary care services such as health screenings, histories and physicals, women’s health exams and school physicals as part of their routine practice or on a volunteer basis.
- PENDING LEGISLATIVE ACTION: APNs have introduced legislation to modify their title to Advanced Practice Registered Nurse (APRN). APRNs could enter into collaborative agreements with other APRNs or physicians. In addition be granted “full practice authority” after certain post-graduate provisions have been met.
- PENDING LEGISLATIVE ACTION: CRNA have introduced legislation to remove the requirement that physicians remain physically present and available during the delivery of anesthesia services by a nurse anesthetist.