Advanced practice nurses reveal agenda for independent practice

After six years of relative calm, the Coalition for Nurses in Advanced Practice emerged with guns blazing this week seeking a broad expansion of the scope of practice for advanced practice nurses.

In 2001, physicians and APNs agreed to a moratorium on scope of practice battles lasting three legislative sessions. That moratorium has now expired and on Monday, Feb. 9, CNAP stormed the Capitol with more than 400 APNs armed with reams of propaganda purporting the superiority of nurse practitioners in providing the coordinated care, patient education and proper follow-up for the management of chronic diseases. “Research supports NPs out-perform physicians in these areas,” claims one of the CNAP handouts.

Two bills filed this session would give broad prescriptive authority to APNs, virtually stripping all physician supervision of APNs from state law.

House Bill 1107 by Rep. Wayne Christian, R-Center, would give complete independent authority for nurses to practice medicine by allowing the Texas Board of Nursing to grant prescriptive authority for APNs. It would also remove all mention of APNs from the physician delegation statutes in the state Occupations Code.

H.B. 696 by Rep. Rob Orr, R-Burleson, would remove physician prescriptive delegation to APNs. Instead, the bill would institute prescriptive agreements, essentially allowing physicians and APNs to establish their own guidelines for collaboration through unlimited, open-ended contracts with no minimum standard of supervision. For instance, the parties could agree that an annual conference call would sufficiently constitute supervision over all APNs collaborating with a physician.

According to initial analysis, the bill would allow an APN to treat the full range of health problems — including the prescribing of schedule II pharmaceuticals — in a hospital, office or school so long as he or she is not barred from doing so in the prescriptive agreement.

The bill also increases the number of APNs a physician can supervise from three to eight, but if the physician sees fit, he or she may exceed even that limit. In essence, the bill allows a physician to enter into prescriptive agreements with an unlimited number of APNs.

“The fact is non-physician practitioners don’t have the training, the education or the skills to practice medicine, certainly not with the same level of quality as physicians,” said Tom Banning, TAFP CEO. “The nurses are pushing a very aggressive expansion of authority and that threatens patient safety. Lowering the standards of Texas medicine is not the right solution to address problems of access to care for Texans. TAFP needs your active participation during this legislative session to make sure we protect the quality of care in this state.”

House announces committee appointments

Speaker Joe Straus, R-San Antonio, finished what many call the toughest job of the leader of the House this week. He named the members of the 35 House committees, appointing Rep. Craig Eiland, D-Galveston, as Speaker Pro Tem, the body’s second in command. Eiland has been a longtime friend of the Academy’s, winning the TAFP Presidential Award of Merit in 2001 for his work on landmark prompt pay legislation.

TAFP will pay close attention to three House committees expected to handle health care issues, the House Committee on Appropriations, the House Committee on Insurance and the House Committee on Public Health. View a complete list of House committee assignments though the Texas Legislature’s Web site.

Article II workgroup for Senate Finance named

Four members of the Senate Finance Committee will make up the workgroup for Article II, the section of the state budget containing spending for health and human services. Those members were announced today, with Sen. Robert Deuell, R-Greenville, being awarded chairmanship. The other members are Sen. Jane Nelson, R-Flower Mound; Sen. Tommy Williams, R-The Woodlands; and Sen. Eddie Lucio, Jr., D-Brownsville.

Thanks to this week’s Physicians of the Day; volunteers still needed

Thanks to this week’s Physicians of the Day: John Egerton, M.D., and Judith Egerton, M.D., of Austin; Tamara Dominguez, M.D., of San Antonio; William Chen, M.D., of Houston; and Leonides Cigarroa, Jr., M.D., of Laredo.

The Physician of the Day program brings a family physician to the Capitol each day of the legislative session to provide health care to members of the Capitol community. TAFP still needs volunteers during the 81st Legislature, particularly Thursday, March 5, and Tuesday, March 24, as well as upcoming dates in April, May and June. View more information about the program, including the online calendar of available dates, on the Physician of the Day page of the TAFP Web site.