Doctors fight advance-practice nurses' attempt at autonomy in SC
A bill that would give advance-practice registered nurses the ability to work without the supervision of a physician is being vigorously opposed by the state medical association.
Nurses say the bill could increase health care access in a state plagued by provider shortages while doctors say they're concerned with patient safety if there's no physician oversight.
In addition to allowing advance-practice registered nurses, or APRNs, to work without physician oversight, the bill — S345 — would eliminate the requirement that these nurses work within 45 miles of a doctor and the maximum number of nurses that a physician can work with.
It also would allow APRNs to certify students as unable to attend school, refer patients to physical therapists, certify patients as handicapped, order hospice and palliative care, and pronounce death and sign death certificates.
The bill, which was the subject of a Senate Medical Affairs Committee hearing this week, would simply permit APRNs and certified nurse midwives to practice to the level of their training, certification and licensure, said Judith Thompson, CEO of the South Carolina Nurses Association.
“It’s nothing mysterious,” she said. “For an advance-practice degree, the minimum in South Carolina is a master’s degree and we’re having more and more people at the doctoral level.”
But the South Carolina Medical Association last week urged its members to call legislators to oppose the bill. And Dr. Marshall Meadors, immediate past president of the SCMA and a physician with Primary Care Associates PC in Anderson, said the main concern is patient safety.
“At SCMA,” he said, “we strongly feel that patient safety comes first and the curriculum of an APRN is not at the level of experience to practice independently.”
Supporters of the bill, such as the South Carolina Chapter of AARP, say that APRNs provide safe, effective care when given full practice authority.
And research shows the quality of care provided by physicians and nurse practitioners, as well as their clinical outcomes, are similar, according to a policy brief in the journal Health Affairs. Those nurses also score higher in patient satisfaction, the brief shows.
Meadors said the level of experience will never be the same between physicians and APRNs and that even advance-practice nurses should not be practicing medicine. The way the bill is written now, he said, an APRN could finish school, pass the boards and begin practice.
“They are able to see patients, make a diagnosis, write prescriptions, order tests,” he said. “They do that now, but under the supervisory umbrella of a physician.”
Nurses acknowledge they have less education, but say they aren’t practicing medicine; they’re practicing nursing. And when necessary, they refer their patients to physicians.
On average, nurses complete their education and training in six years compared to 11 to 12 years for doctors, according to the Health Affairs brief.
This story was originally published March 13, 2017 at 11:33 PM with the headline "Doctors fight advance-practice nurses' attempt at autonomy in SC."