End-of-session legislative update re: APRN practice
The 2014-15 legislative session has ended. The following bills affecting APRN practice passed this year, and are awaiting the Governer's signature (remember, he can still veto!).
HB211 - contains a provision that changes "physician" to "provider" when pharmacies put the name of the prescriber on a prescription. That means no more listing the collaborating physician instead of the actual prescriber, which caused a lot of confusion for everyone. Now the APRN or PA name will be there first, and the collaborating physician may or may not be listed second.
SB 114 - adds the Community Service Boards (CSB's) to the list of agencies exempt from the restriction that a physician may not enter into a nurse protocol agreement with more than 4 APRN's. This change will affect very few practicing APRNs. Passed as HB 436, awaiting Governor's Signature. It should be noted that many hospitals are already exempt from this requirement. My collaborating physician at Gwinnett Medical Center had about 8 NPs working under him, and we were just a small fraction of his responsibilities.
HB 362 (Clark-101, Cooper-43) allows licensed health practitioners (including nurses and APRNs) to prescribe and administer inhaled albuterol sulfate in schools. Hard to believe this was not in place earlier!!
HB 416 - the AMA's "truth in advertising" bill got resurrected this year by House representatives Carl Rogers of Gainesville and Sharon Cooper of Marietta. There now must be a sign at the front desk of physician offices and clinics alerting potential patients that nurse practitioners and physician assistants are employed there. We also now have to wear name badges that include:
1) The health care practitioner's name; and 2) The type of license or educational degree the health care practitioner holds. Although certain NPs in this State try to spin this is an opportunity to educate patients about our role, the truth is, this law is a legislative defeat. It is intended to create a heirarchy of medical providers so patients feel like they are getting second-tier care if they are assigned to see a "non-physician."
SB 115 - would have allowed PAs (but not APRNs) to prescribe the same hydrocodone combination product Schedule II drugs which were Schedule III last year, with significant MD and medical board oversight. It passed the Senate, but at the last minute was stripped from the bill that passed the House. It is disturbing that PAs came that close to getting a prescriptive authority that we were not included in. Talk to your legislators about why this is professional discrimination, and unwarranted, as physician assistants are no more qualified than APRNs are to write for controlled substances. Let them know that APRNs in other States who prescribe Level II substances are no more likely than physicians to contribute to narcotic addiction and diversion. It limits our value as employees and providers, since we can't adequately treat acute pain, insomnia, anxiety, and a host of other common family practice issues that sometimes call for Schedule II drugs.
HB 463 (Harbin-122) would have revised the State tax credit for physician preceptors to include certain non-physician providers. Currently, Georgia physicians who provide clinical training to health professions students for a minimum of three to a maximum of 10 rotations, and who are not compensated through any other source, can claim a tax deduction of $1,000 for every 160 hours of training provided, up to $10,000 a year. Students must be enrolled in one of Georgia's public or private medical/osteopathic, physician assistant, or nurse practitioner programs. According to Laura Searcy, this bill is in the House Ways and Means committee, and is expected to be acted on next session. So start contacting your legislators, preceptors! Tell them about the dire shortage of NP preceptors and how such an incentive would help practicing NPs, who are on a much tighter budget than physicians.
HB 212 (Weldon-3, Cooper-43) would have added CRNAs to the health care professionals who must be on-site at a pain management clinic in order for the clinic to provide medical treatment or services (currently MD, PA, and APRN are listed). Passed House, stalled in Senate Health and Human Services Committee.
The Ugly (Politics):
Unfortunately, many bills that would benefit nurse practitioners pass the Senate only to die in the House Health and Human Services committee, which is chaired by Sharon Cooper. Ms. Cooper, whose late husband was a physician, is opposed to the expansion of scope of practice of APRNs in Georgia. This is especially damaging to our validity, as she taught nursing for many years and has an MSN degree. Once again, nurses are our worst enemy.
I have been advised that the only way to overcome the influence of a Committe Chair is by other legislators putting pressure on her to stop blocking and ignoring bills that would allow APRNs to meet the needs of underserved Georgians. The only way those legislators will do that, is if their constituents insist on it. This goal would best be served by having our patients write letters to their representatives, giving testimony about how much they needed an NP that helped them, and how restrictive laws delayed them getting pain medication, or an MRI, or a referral, etc. Do your patients love you? Give them a pen and paper and have them send it to their legislators. Do your collaborating physicians depend heavily on you? Have them write down what it is you do all day, and how much they trust your judgment and skills, then send it to the House and Senate Health and Human Services Committees. And of course, share your own personal stories about how you can not do your job as effectively, but that will hold less sway than the two suggestions above, as it comes across as self-serving.
North Carolina NPs stormed the legislature with a study (done at Duke) showing how much money could be saved, and how many more people served, if nurse practitioners could practice without physician supervision. They now join 18 States and the District of Columbia as places where NPs can practice independently. Without some self-promotion, legislators will never be aware of the barriers that hold us back, and the price Georgians are paying because when can not serve them fully. All they hear is the Georgia Medical Association telling them how many more years of training physicians have, and equating that to an unproven superior competency in delivering care, and the unvalidated "dangers" of letting APRNs have more responsibility. Show your legislators the other side of the story. Go to their office, invite them to your clinic, show them the studies about the quality of care NPs give, and the studies about the cost savings they provide. There were only 6 of us on this legislative call, and we are lamenting how the 9,500 APRNs in Georgia lack the will to make change happen. Our opponents are happy with our apathy, and our lack of involvement keeps us from making any progress beyond a snail's pace.