Posted on 09/23/2014 8:36:27 AM PDT by MichCapCon
Michigan’s medical community is split over legislation that would give nurses with advanced training the authority to prescribe some medications.
Essentially, physician groups are working to prevent nurses from gaining responsibilities that are currently reserved only for doctors.
Senate Bill 2 would allow Advanced Practice Registered Nurses (APRNs) in Michigan to write prescriptions for patients without physician approval. This new authority would be limited to the particular nurse's scope of practice.
Michigan is one of 21 states that do not recognize APRNs. In 16 states and Washington, D.C., these nurses are allowed to practice autonomously with regard to providing diagnosis and treatment, and write prescriptions independently.
Those who support the legislation argue that it would help address the shortage of medical professionals that currently exists and is expected to grow. Those opposed to Senate Bill 2 argue that it would reduce the quality of health care patients receive by permitting APRNs to act as physicians without the appropriate education, certification and training.
The bill’s sponsor is Sen. Mark Jansen, R-Gaines Twp., who introduced the measure back on Jan. 16, 2013. It was passed narrowly by the Senate with a 20-18 vote on Nov. 13, 2013, and has now been in the House Health Policy Committee for nearly 10 months. It received its first hearing in that committee this past week, but the context of that hearing was that no vote would be taken on the measure.
Capitol Confidential asked Rep. Gail Haines, R-Waterford, who chairs the House Health Policy Committee, if the length of time the bill has been in committee signaled that she was opposed to the legislation.
“I’ve never been one to avoid holding hearings just because I’m on the fence,” Rep. Haines said. “I wanted to make sure I’d given Sen. Jansen ample time to work this bill. I haven’t seen a tremendous amount of support for it in the House. It would amend the public health code and it involves some complicated issues. APRNs have not been mentioned in Michigan’s health code since 1965. Several concerns have been raised about it.”
“There is no doubt that we’re on the verge of seeing a lot of new innovations in the field of health care,” Rep. Haines continued. “But whether this should be one of them is debatable.”
Capitol Confidential asked Sen. Jansen if the prospect of physician shortages under Obamacare was one of his primary reasons for introducing Senate Bill 2.
“I started on this three years ago, which was even before I was sure that we would really have that public health care change,” Sen. Jansen said. “So, I’d say that there are other reasons in addition to that which will continue to create shortages of doctors. That’s why I think we should involve all of our qualified people and allow them to do what they are qualified to do.”
The Michigan State Medical Society, which includes a membership of 14,000 physicians, is leading the battle in the legislature against Senate Bill 2. Its allies in the effort include the Michigan Academy of Family Physicians, the Michigan Radiological Society, the Michigan Osteopathic Association and the American Congress of OBGYN.
On the other side of the issue are other groups within the medical community that are urging lawmakers to support Senate Bill 2. They include the Michigan Primary Care Association, the Michigan Association of Health Plans, the Michigan Pharmacists Association, the Michigan Nurses Association and Spectrum Health.
One of the key arguments for Senate Bill 2 is the idea that continuing to limit the scope of practice of registered nurses will give them less reason to stay in Michigan or move to Michigan, worsening the shortage of medical professionals in the state.
With issues such as allowing these nurses to prescribe drugs, the question inevitably arises as to whether and to what degree opposition might involve one group (physicians) protecting its turf against what it sees as the encroachment of another (APRNs).
“It appears that those who oppose the bill see it as putting the proverbial camel’s nose in the tent,” Sen. Jansen said. “It is usually that way with issues that involve turf. But I really don’t see how they can be concerned that the nurses would set up their own shops. Insurance companies will not reimburse for this, so I couldn’t create that kind of situation even if I wanted to.”
“I’ve tried to work with them,” Sen. Jansen added. “I’ve changed this bill 23 times. This is really about providing care. As we have less and less doctors we’ll need to find more ways to utilize other qualified people.”
Dr. Kenneth Elmassian, immediate past-president of MSMS, said that opposition to Senate Bill 2 is based on protecting public health, not defending turf.
“The issue is preventing nurses from being allowed to perform as if they were physicians. It has nothing to do with protecting turf,” Elmassian said. “Senate Bill 2 is really all about the nurses’ agenda and Sen. Jansen’s agenda. We have a tremendous amount of respect for nurses; they are a vital part of the physician-led team. But they are not physicians and it is not in the best interest of public health to let them practice as though they were.”
If the bill isn’t passed in 2014, a new bill would likely be introduced in 2015 and the process would start all over again. Sen. Jansen will be termed out of the legislature by that time. Capitol Confidential asked Sen. Jansen if it is realistic to believe Senate Bill 2 could get passed and sent to the Governor before the end of this year.
“Right now I am anticipating that it could still get done this year,” Sen. Jansen said. “If it doesn’t, I’m hoping another legislator will carry on after I’m gone. I’ve spent time bringing Rep. Peter McGregor, R-Rockford, up to date on this issue. It looks like he will be, more or less, taking my place in the Senate.”
In addition to allowing APRNs to prescribe drugs to patients, Senate Bill 2 would also do the following:
Prescribe APRN license fees, and a method for review and adjustment. Require an APRN to enter into a mentorship agreement if he or she had been licensed or certified for less than four years. Allow an APRN to issue a complementary starter dose of a prescription drug or Schedule 2 to 5 controlled substance. Create the APRN Task Force. Revise the membership of the Michigan Board of Nursing. Allow the Board of Nursing to require a licensee under Part 172 (nursing) to provide evidence of the completion of continuing education or competency courses, for license renewal. The measure would also amend the code to include a licensed APRN among the individuals who may refer a patient for speech-language pathology services or occupational therapy, and among those who may prescribe physical therapy.
Iffin’ it is all the same with you, I’ll just write my own OXYCODONE script. 90 days should be OK with 3 refills.
OK Rush, we know its you.
I could see this for Nurse Practitioners... the ones I have met have been better than the doctors they work with.
I have seen doctors ignore perfectly good advice from nurses, who have seen something that would be useful information for a doctor, if he were not too high and mighty to accept it from a lowly nurse.
Personally, I believe a 10-year RN has about 60% of the capability of a regular MD. I don’t know where the “do not pass” line is in that scenario, where ARN’s should not be allowed to tread.
I *do* think (and maybe my first sentence should be rewritten as) that ARN’s could do the great majority of work in terms of diagnosis and general injury patch-up that real MDs can do (and every doctor I have asked has generally agreed)
I *do* think that the Mexican model of “neighborhood clinics” would be an excellent thing to try in the US. Especially since half our population is going in that direction anyway.
See her 879 page book:
Prescription for Nutritional Healing
Accompanied by the Encyclopedia of Herbal Medicine by Andrew Chevallier.
Can you meet my housekeeper out in the parking lot to pick up my script?
It’s coming. Inevitable fallout from Obamacare.
A relative of mine in nursing school has been given training on how to conduct a full physical. Proof in my mind that the majority of health care will be turned over to paraprofessionals in the future.
My question isn't whether or not a nurse should be able to write an antibiotics prescription for an earache (IMO, they should...).
Nope, my question is a little deeper. I think that the gov't should be making things easier for docs to do their jobs, so that we *don't* have a shortage of doctors. Instead, we've got governmental over-regulation, and are driving qualified people away from the profession.
So, I suppose that these particular pols found the correct answer, but asked the wrong question. Just my $0.02.
They’re just recognizing that good doctors will not abide within the system of Obamacare,
and more providers will have to be “defined” into the system.
Nurses are not paraprofessionals.
Nurses have been trained how to do full physicals for decades.
I’ve seen some nurse practitioners who are excellent. I’ve seen some who are frightenly bad.
Unfortunately we’re going to be treated by nurses in the future. They cost much less than docs and there’s no incentive to keep anybody alive who is over 50.
Yup. Right in one.
My two bits? Does my kid need to see an ER trauma doc to get an earache diagnosed and treated? Nope. Some of the "paraprofessional changes" are probably a good thing.
But, when the earache doesn't go away, and evolves into a headache, and nausea, and profuse bleeding, and so on and so on (you get the idea) ... will my kid be able to receive critical treatment from a full-fledged doctor?
I'd guess "Probably Not" or at least not without a long wait. *That's* where Obamacare has the system heading, and frankly, that's what scares me the most. Medical costs don't scare me - I can always find more money, somewhere, somehow.
But, if there are no docs available.... (None, in this particular case, means "none", as in, there are no medical practioners available for the problem in my local AND extended area...a possiblesituation that liberals just can't seem to wrap their heads around) ....I can't just pick up a couple of courses on open-heart surgery at the local community college.
This is what I worry about at night when I can't sleep. :-)
/rant off. thanks for listening.
You have hit upon one of the rationales behind the ACA: breaking the medical cost curve. A family practice doctor earns let's say $150,000 a year. A nurse practitioner earns $85,000. The math is simple plus the government gets extra powers to rule over your life. A win win situation for a bureaucrat.
My wife is a NP and can write prescriptions for ANY medication(even the C2 drugs). This is in VA though.
Until recently, they couldn’t Rx the more ‘high risk’ medications, but they changed the laws/regulations for NPs and PAs in our state, allowing them to do so. She’s pretty strict about it though. If someone has a REAL issue, she’ll help them, but she has a very sensitive ‘BS Detector’, and will politely tell someone that’s just looking for “dope” to hit the road.(not in those exact words of course lol)
A provider can't write a prescription for themselves, or they are SUPPOSED to(ESPECIALLY for that class of medicine). I guess they theoretically COULD, but they would get caught, and lose their license. Also, for that class of medicine, they limit the quantity to a 30 day supply, and refills aren't allowed.
Don't spread ignorance/misconceptions, though I believe you were being sarcastic. ;^)
1)Nurse
2)Doctor she works for
3)Hospital she works in
4)Company that made the medication
5)All of the above
Seriously, this does raise liability issues. If nurses take over the patient care to this extent, are they now liable for malpractice? Maybe they already are, I'm no medical expert or lawyer either.
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