Greater autonomy for nurse practitioners right move for Pennsylvania |

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].

TribLIVE commenting policy

You are solely responsible for your comments and by using you agree to our Terms of Service.

We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.

While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.

We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers

We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.

We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.

We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.

We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.