Physician Supervision Under Attack

Contact your State Senator today

Multiple bills filed at the North Carolina General Assembly this session would remove physician supervision requirements for many non-physician practitioners. Among the most aggressive of these proposals is one introduced by Senator Ralph Hise, SB 695, Modernize Nursing Practice Act, which enhances the already broad authority of the North Carolina Board of Nursing. SB 695 proposes to include adding advanced practice registered nurse (APRN) licensure for nurse practitioners, certified nurse midwives and clinical nurse specialists. In addition, the legislation proposes to expand the APRN scope of practice beyond the current RN scope of practice by authorizing:

  • Conducting an “advanced assessment” (a new defined term in the Act);
  • Delegating and assigning therapeutic measures to assistive personnel;
  • Performing other acts that require education and training consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies and experience.

The bill also specifically permits the following areas of focus for APRN practice:

  • The family or individual across the life span
  • Adult gerontology
  • Neonatal
  • Pediatrics
  • Women’s health
  • Psychiatric or mental health

The practical implications of the sweeping changes in SB 695 are not yet understood. It is our belief that if this bill is not modified to impose limits on the proposed changes that the quality and cost benefits of physician supervision are at risk.

Another assault on physician supervision is SB 240, Define Scope of Practice of CRNAs, by Senator Jim Davis. The bill proposes to eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). SB 240 proposes to define the practice of nursing by a CRNA as including the following components:

  • Perform nurse anesthesia activities in collaboration with a physician, dentist, podiatrist or other lawfully qualified health care provider with each provider contributing his or her respective area of expertise consistent with the lawful scope of practice and according to established policies, procedures, practices and channels of communication that lend support to nurse anesthesia activities;
  • Define the roles and responsibilities of the certified registered nurse anesthetist within the practice setting;
  • Maintaining individual accountability of the outcome of individual actions.

These bills are expected to be heard next week in the Senate Health Committee when the legislature returns from its spring recess.

The value of physician supervision and the contributions to patient safety made by physicians are being questioned. It is important that you contact your legislator and tell them the important role of physician supervision in protecting patients in our healthcare system.

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