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Bill giving nurses more authority passes House

– For 20 years, Mary White saw instances of valuable minutes fly by while a patient needing immediate care waited to get a doctor’s signature for medication.

But if a bill makes it through the Senate, that could significantly help alleviate the current and projected healthcare workforce shortage in Florida and give nurses more leeway in administering patient assistance and save valuable time.

Friday, the Florida House of Representatives passed the bill (CS/CS/HB 7113) that expands the range of practice for Advanced Registered Nurse Practitioners (APRN), who have post-graduate college degrees in nursing, by permitting them to prescribe controlled substances if they follow a supervising physician’s protocol.

Most importantly, the bill allows certified nurse practitioners who meet certain criteria to register as “Independent Nurse Practitioners” and practice without physician supervision. Independent Nurse Practitioners may also prescribe controlled substances on their own, based on an “exclusionary formulary” or drugs they can’t prescribe.

“I worked as a Certified Nurses Assistant and sometimes it was hard to get hold of the doctor. If a nurse practitioner can fullfil some of the doctor’s obligations, that would be great. I’ve seen patients about die because they couldn’t find a doctor fast enough to change medications,” said White, who worked in Avon Park.

The House passed the bill 74-42, generating support from both sides of the aisle.

According to the Florida Association of Nurse Practitioners, Florida has a shortage of primary care physicians and three million Floridians have inadequate access to basic health care. Twenty-one percent of Floridians are uninsured and eight million Floridians are medically “disenfranchised.” In Florida, there are about 14,000 Advanced Registered Nurse Practitioners in the state and they are registered nurses who have master’s and doctoral degrees.

In general, HB 7113 does not address Certified Registered Nurse Anesthetists or certified nurse midwives – only certified nurse practitioners; it allows nurse practitioners to prescribe controlled substances, but only under a physician’s supervision via a written protocol; and it limits controlled substance prescribing by independent nurse practitioners not supervised by physicians by allowing a committee of physicians, nurses and a pharmacist to make a list of drugs nurse practitioners may not prescribe.

Diana Chizmas, an APRN at Florida Hospital Heartland Medical Center- Care Now, said she was pleased to hear the bill has passed the House and feels it will get through the Senate as well. She said Florida Hospital already has bylaws in place for doctor supervision but the bill would be helpful in an APRN’s ability to prescribe controlled medications and wouldn’t affect bylaws.

Florida Hospital currently has about 250 physicians, five physicians assistants and six APRNs on staff and Chizmas said as far as the medical workforce shortage, it would free up nurses to fill in some of the doctors’ duties.

“It’s only going to benefit everyone. It’s another step in being able to provide quality care,” said Chizmas, who’s worked as an APRN for Care Now for six years. “If it passes, it’s another step in the process in offering the best health care.”

Florida Rep. Cary Pigman, R-Avon Park, vice chair of the House Select Committee on Health Care Workforce Innovation and emergency medicine physician, said Monday the Senate companion bill (SB 1276), was placed on the Special Order Calendar -- the list of bills on second reading to be taken up in session on a particular day and was presented by Sen. Denise Grimsley, R-Sebring.

That bill will allow three hospitals whose trauma centers are being challenged -- Regional Medical Center. Bayonet Point in Pasco County, Blake Medical Center in Manatee County and Ocala Regional Medical Center in Marion County - to remain open but face new fee restrictions.

Pigman said the bill is important because Florida’s shortage of primary care providers will only worsen and the state is the “most restrictive” in the U.S. for allowing nurse practitioners the to use all of their training.

Pigman said current law requires a nurse practitioner to establish a supervisory relationship with a physician, even if that physician is not working with the nurse practitioner and just signs charts at the end of the month.

He said many times the supervisory relationship requires the nurse practitioner to pay a significant fee to the physician, with this additional cost being absorbed into the overall health care system.

“Florida residents do not benefit from this increased expenditure,” he said. “I believe the new authorities granted to certain Independent Nurse Practitioners under this bill will enhance access to good primary care for Florida residents. In all the states that already grant these authorities, there is no evidence of harm or adverse outcomes.”

Besides giving nurses more flexibility in their duties, the bill would also enact more telemedicine regulations, and allow out-of-state physicians to practice telemedicine in Florida only if they have a Florida medical license.

The bill may have a hard time passing through the Senate. Senators may decide to peel off unpopular portions of the bill or ignore its nearly 100 pages all together. In addition to the APRN and trauma center portions of the bill, it also combines about 12 other health care topics, including virtual doctor visits and independence for the APRNs.

Comment from Highlands Regional Medical Center wasn’t available Monday.


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