Nurse Practitioners Win First Round In 'Scope' Fight

TALLAHASSEE (CBSMiami/NSF) -- Despite opposition from physician groups, a House select committee Tuesday overwhelmingly approved a proposal that would give additional power to nurse practitioners, including allowing them to provide care without doctor supervision.

House Republican leaders have pushed the proposal, at least in part because they say it would help address a shortage of primary-care physicians in the state. Senate leaders have shown less enthusiasm, but Tuesday's vote was a milestone for the group of health providers technically known as "advanced registered nurse practitioners," who have long sought more authority.

"This debate will now be had because of the work we've done here,'' said Rep. Jose Oliva, a Miami Lakes Republican who is chairman of the House Select Committee on Health Care Workforce Innovation.

Physician groups, such as the influential Florida Medical Association, are lobbying against the proposal. They point to years of additional training that doctors receive to provide care and raise questions about why students would want to take on huge amounts of debt to attend medical school if they could do much of the same work as nurse practitioners.

"We're trying to solve a problem of access and affordability (of medical care), and I think this bill comes at it from a very wrong direction,'' said Rep. Gayle Harrell, a Stuart Republican who was one of the lone dissenters in a 13-2 vote by the select committee.

Advanced registered nurse practitioners have more education and training than registered nurses and contend that they already provide much of the care envisioned in the bill. Along with applying to nurse practitioners who provide primary care, the bill would apply to specialists such as nurse anesthetists.

Under current law, nurse practitioners work under the supervision of physicians, receiving approval of what are known as "protocols" that outline care. The bill still would allow nurse practitioners to work under the supervision of physicians, but it also would free them to meet criteria to work independently. Also, they could get authority to prescribe controlled substances.

Rep. Cary Pigman, an Avon Park Republican and physician who is leading the House's effort on the bill, rejected arguments about issues such as the proposed changes leading people to forgo becoming primary-care physicians.

"I see this as opening more doors,'' Pigman said. "I see no doors closing."

But the bill deals with what are known in Tallahassee as "scope of practice" issues, which physician groups typically watch very closely. Rep. Travis Cummings, R-Orange Park, described those issues as a "contact sport."

Harrell and Rep. Elaine Schwartz, a Hollywood Democrat who cast the other dissenting vote, said they think the bill goes too far in expanding the nurse practitioners' scope of practice.

"It is really much too broad for my comfort,'' Schwartz said.

"The News Service of Florida's Jim Saunders contributed to this report."