Nurse practitioners can’t do as much in Pennsylvania as in Maryland or New York. Is that bad?
HARRISBURG, Pa. (WHTM) — Pennsylvania is caught in a vicious cycle of nurse practitioners (NPs) who aren’t allowed to do everything they’re capable of doing — which causes them to flee for other states, meaning even less medical care, say NPs who rallied at the capitol Tuesday.
“We have to have a signed, written, collaborative agreement with at least two physicians on file in Harrisburg,” said Janice Miller, a Philadelphia-area nurse practitioner who is president-elect of the Pennsylvania Coalition of Nurse Practitioners and also teaches college-level courses. “This prevents a lot of nurse practitioners from being able to see patients in rural communities, where doctors have retired or doctors are leaving, and there is no health care left for the residents and the community.”
Miller spoke alongside a bipartisan group of legislators, who support a state senate bill and a companion house bill that would align Pennsylvania with 27 other states that allow NPs to practice independently, a freedom also known as “full practice authority.” NPs in those states can — for example — prescribe certain medications without supervision.
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Doctors charge for the supervision they provide in states like Pennsylvania, even though NPs say in some cases, they rarely see or have never even met the doctors under whom they practice. Miller said the lack of indepedent NP practices in Pennsylvania means unnecessary waits for medical attention by patients with routine issues NPs could easily diagnose and treat, if they were allowed to do so.
“And in Pennsylvania, we’re losing nurse practitioners all the time because we are surrounded by states who have full practice authority — in Maryland, in Delaware, in New York,” Miller said.
But physicians say the rules in places like Pennsylvania exist for a reason.
“We all recognize the valuable care that all of the members of our health care team provide — and that goes for nurses, nurse practitioners or our physician assistants,” said Dr. Kristen Sandel, an emergency medicine doctor who is president of the Pennsylvania Medical Society. But doctors “do have the expertise to provide, care and to direct the team in the right direction for patients in Pennsylvania.”
Sandel said doctors get between 12,000 and 15,000 hours of clinical education, compared to about 750 hours for NPs.
She said it’s true that some doctors don’t provide hands-on supervision of NPs, but she said there’s still value in leaving the judgment of whether or not to do so to the doctors.
“Some physicians that have worked with a nurse practitioner for years and have a significant amount of trust in their care and their direction of patient care will give those nurse practitioners a lot of leeway in their practice environment, “Sandel said. “But there are nurse practitioners that are fresh out of school.”
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Miller, on the other hand, didn’t disagree that doctors have more education than NPs, but she said NPs have the education they need to do their jobs.
“Nurse practitioners are trained, and all the focus of their clinical education is for that specific population,” she said. “So I never spent six months in a surgery rotation I’m never going to use as a primary-care nurse practitioner.”
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