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Independent nurse practice wrong move for Floridians

Another year, another legislative attempt to grant nurse practitioners the right to practice independently in Florida. According to a report on a local NPR station this morning, Representative Cary Pigman’s fourteenth attempt to bypass a patient’s right to be treated by a physician passed its first committee hearing and is on its way to be heard by the House.


Pigman, an emergency physician, claimed that allowing nurses to practice independently would help with a health care shortage in Florida, particularly in underserved areas. However, the report failed to mention several important facts. First, Florida is not only short of physicians. Like most of the United States, Florida is desperately short of nurses. By encouraging more nurses to move into a “provider” role, Pigman’s bill would have a negative impact on the supply of bedside nurses.


Secondly, while Pigman claims that allowing nurses to practice independently will fill the need for primary care in underserved areas, studies have consistently shown that states with independent practice have not this promised increase in rural health shortage areas. Instead, independent nurse practitioners end up working in the exact same places as physicians. Additionally, less nurse practitioners are entering into primary care. More and more, nurse practitioners are forgoing primary care to work in specialty offices. In fact, in areas with independent practice, it is not uncommon to see nurse practitioners opening cosmetic practices offering botox and fillers rather than bread-and-butter primary care medicine.


Today’s report included testimony from a nurse practitioner with “three decades of experience.” The nurse practitioner bemoaned the fact that she could not treat patients without physician oversight and insisted that “five decades” of research has shown that nurse practitioner care is equivalent to that of physicians.


However, she failed to mention two problems. First, while this particular nurse practitioner has vast experience and knowledge, most newly graduating nurse practitioners do not. In fact, while physicians are required to have 15,000 hours of training and experience before being permitted to treat patients independently, nurse practitioners are required to complete just 500 hours. Unlike medical school, many nurse practitioner programs are 100% online, and clinical experience lacks the standardization required of physician trainees.


Regarding the claim that research has shown nurse practitioner equivalency with physicians, an important detail is being omitted: Every single study that has ever claimed to show nurse practitioner safety and efficacy has been performed in a setting in which nurses were supervised by a physician. There are absolutely no studies that show nurse practitioner safety and efficacy when practicing independently.


Moreover, most of the studies that purport to show nurse practitioner safety were of low quality, often following healthy patients over very short time frames, with one often-cited study having a time frame of only two weeks. These studies are not appropriately designed to show whether nurse practitioners, especially practicing independently, can safely and effectively care for patients over the course of a lifetime in a primary care role.


There is no doubt that Florida needs more physicians and nurses. Legislators would be better off focusing their efforts on ways to increase the supply of both critically important professions, rather than trying to pass off one as the other.


Rebekah Bernard MD is a family physician in Fort Myers, Florida and the president of Physicians for Patient Protection.


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