Debate Continues on APRN Scope of Practice Legislation

(January 28, 2016) The Ohio House Health and Aging Committee continues to debate the merits of HB 216 and two possible substitute versions that would allow advanced practice registered nurses (APRNs) to practice independently without a standard of care agreement with a physician.

A panel of APRNs supporting the bill testified, Jan. 20. Prior to the hearing, the OOA, in collaboration with other medical associations, sent a joint-letter (HB 216 Letter) to members of the Committee making it clear that the physician organizations are opposed to the current legislation and existing substitute drafts, but committed to working with the sponsor, State Rep. Dorothy Pelanda, to resolve issues of concern.

During the hearing, Committee members voiced concerns about independent practice, the differences in education between physicians and APRNs and whether eliminating standard of care agreements between physicians and APRNs would actually improve access in under-served areas of the state.

Rep. Terry Johnson, DO  (R-McDermott), said he was worried about the impact independent practice could have on the quality of care.  He said he spent about 13 years in training to become a doctor, while APRNs only have 6-8 years of study and would essentially have the same scope of practice as a physician under the proposed bill.

"It just sort of rubs me the wrong way that we're moving in a direction where people think that we can train people to cover all these different things and expect to get the same quality of care," he said.

The APRN panel responded by saying that most APRNs have had nine years of experience as a nurse before training to be an APRN.  Physician groups have pointed out to legislators that nurses can practice as an APRN with a bachelor's degree, an on-line masters degree, and a much shorter clinical training period than physicians. 

Johnson also said it didn't appear that ARPNs were leaving the state because of practice limitations or inability to find collaborating physicians. He pointed out the Ohio Board of Nursing conducted a workforce survey in 2015. He said over 13,000 APRNs participated in the study, and only 21 APRNs indicated they could not find employment. 

"Doesn’t this show that the collaborative health care model in place for Ohio is working?" he asked.

The APRNs have charged that physicians charge high fees to ARPNs for them to serve as a collaborating physician.  They presented a fact sheet to legislators with unsubstantiated quotes from APRNs in the field as evidence, which raised more questions than it answered.

Rep. Steve Huffman, MD, pointed out that alternate proposals from the physician community have been suggested to improve access, like increasing the number of APRNs that a physician can collaborate with.  Rep. Jim Butler (R-Oakwood) suggested the addition of a grace period if an APRN loses a collaborating physician to avoid a disruption in patient care.

Rep. Barbara Sears (R-Maumee) pointed out that collaborating physicians and APRNs do not have to practice at the same location, so APRNS could be in more rual areas of the state while their physicians are in an urban location.

"We're really not actually seeing a plan that improves access a lot of times," said Rep. Sears.

Committee members also expressed concern about easing location restrictions on where APRNs can write Schedule II drugs, since the state already has a prescription drug abuse epidemic. A date for opponent testimony from physician associations has not yet been confirmed. 
 

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