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Greater autonomy for nurse practitioners right move for Pennsylvania

Luis Fábregas

For years, nurse practitioners have longed for a little independence from doctors.

They want to be able to take care of patients without what they believe is a burdensome contract with a physician who oversees them.

As it stands, nurse practitioners in Pennsylvania can practice and prescribe medications only if they sign a so-called collaborative agreement with a doctor — essentially a piece of paper showing that someone is watching over their shoulders.

Change might be on the way.

A revised bill under consideration by the House and Senate could do away with the agreement and essentially give nurse practitioners the autonomy they desire.

It’s the right thing to do at a time when primary-care doctors are in short supply.

Surely, you’ve come across nurse practitioners if you’ve been exposed to the health-care system. They’re at doctor’s offices, at hospital clinics, in intensive care units and in urgent-care centers. If they act like doctors, it’s not because they’re impostors; it’s simply because they have the knowledge and the background.

“We have the training and the experience to deal with 80 percent of the issues that occur,” Lorraine Bock, president of the Pennsylvania Coalition of Nurse Practitioners, told me.

She was referring to the bulk of what nurse practitioners do when they work in family practice: management of chronic illnesses such as diabetes, hypertension and high cholesterol, and treating acute illnesses such as upper respiratory infections. They also treat minor injuries such as ankle sprains and often provide physicals to school-age students.

Before anyone starts arguing they don’t want nurse practitioners treating complex conditions that require a physician’s skill, no one is saying that’s what nurse practitioners want.

“When we aren’t trained to deal with it, we know where to refer patients to get the care at a higher level from our physician colleagues,” Bock said.

In other words, they know their limitations. They’re not looking to insert catheters, remove gallbladders, repair hernias or perform liver transplants. They’re looking to take care of patients in a responsible manner, to make sure the health-care system doesn’t deteriorate because there aren’t enough doctors.

Critics aren’t buying that. They include Pennsylvania Medical Society President Scott Shapiro, who says eliminating the doctor-nurse practitioner agreement would risk the safety of patients. The society is particularly upset that the largest hospital group in the state — The Hospital & Healthsystem Association of Pennsylvania — has endorsed the bill granting independence to nurse practitioners. “Hospital administrators think that the costs associated with physician and nurse practitioner collaboration are eating into system profits,” Shapiro said. “Apparently, they see the elimination of these agreements as a way to save money.”

The medical society argues that patients deserve better and doctors should be at the helm of the health-care team.

When I spoke to Bock, she struck me as a sensible professional who understands the value and role of the physicians.

In a sign of good faith, nurse practitioners have agreed to amend the bill so that new graduates will have to sign an agreement with a physician until they practice for three years or 3,600 hours.

“We’re willing to make that compromise because we understand people have concerns,” Bock said. “We’re not going to practice without collaborating. We’ve always collaborated. We’re going to continue collaborating.”

And that’s something that should be applauded.

Luis Fábregas is the Tribune-Review’s deputy managing editor for news. Reach him at 412-320-7998 or [email protected].


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