Guest AuthorAs an emergency medicine physician and member of the Florida Legislature, I believe I have a unique perspective on how, and in what fashion, we can work to improve our health-care delivery system and the regulatory framework it operates under.
As Vice Chairman of the House Health Care Workforce Innovation Committee, I am proud to sponsor a proposal that would seek to increase our health-care workforce and make selected health-care services more accessible and cost effective.
House Bill 7071 would, among other things, allow highly educated and specially trained Advanced Practice Registered Nurses (APRNs) to perform a wide range of services that are within their training and expertise, without the supervision of a physician.
Among these groups, Florida’s Certified Registered Nurse Anesthetists (CRNAs) would be allowed to independently administer anesthesia care and would significantly reduce the costs of care to our system, our state and our patients.
Florida has always been a leader in innovation in agriculture, business and education, with a record of continued success. But unfortunately, when it comes to health care and how we address the practice of APRNs and CRNAs, Florida ranks last in the nation.
We cannot fail to address this devastating truth any longer. The reality that we face is this: we have a health-care workforce that is not keeping pace with the needs of the future and our aging population. We are simply not producing primary care and internal medicine physicians that our population will need.
But the shortages won’t stop there. As current law stands, all specialties across the board will simply not have the manpower to provide the care Floridians will need.
I want to make this very clear. After very careful review of all the independent data that is out there, there is no evidence to demonstrate there is any difference in the safety or quality of care, or complications associated with the care, that is administered by an APRN and a physician.
APRNs do as good a job of administering the care they have been educated and trained to give as a physician does. In the case of anesthesiologists and CRNAs, no difference in outcomes and care was found in numerous case-controlled studies, which were commissioned to uncover any difference if one existed.
Anesthesiology is a technique-driven specialty. And the fact is, CRNAs are tasked, day in and day out, with administering anesthesia to patient after patient, case after case. And they do this with extreme safety and efficacy.”
Still, we continue to hear the “compromise of safety” argument being pushed over and over again. But, we have to look at the facts – which show that safety of care when administered by a CRNA and an anesthesiologist is exactly the same. We need to move beyond the typical scare points that are hindering us from making the necessary changes to our delivery system that would yield greater access and reduced costs.
I am proud of the proposal that has been put forth by my colleagues in the House as a result of extensive research and gathering of testimony. I encourage our colleagues in the Senate to look at the facts in order to bring our health-care system into the 21st century and help drive down the cost for care.
Representative Cary Pigman is a Republican from Avon Park. He is Vice Chair of the House Select Committee on Health Care Workforce Innovation.
11 comments
Raul de Los Reyes
March 11, 2014 at 10:09 pm
Totally agree
Beverley Winston
March 12, 2014 at 12:09 am
Proud to be a Nurse Practitioner delivering safe care to residents and snow birds in the state of Florida. Please help get our practice into the current century so care can be rendered in a safe, cost effective manner.
Pat
March 12, 2014 at 11:20 am
There is another insidious argument about prescriptive authority that needs to be addressed…and that is that Florida is a “pill mill” state and giving ARNPs prescriptive authority will only make it worse. The question is…is how did Florida get to be a pill mill state? Not to place the blame but it wasn’t because of ARNPs. Why should we be held accountable for mistakes made by other primary caregivers. Opens up an interesting question…if a fox killed a chicken in your pen would you kill the goat because he watched it? It’s about time that the Florida AMA stops ‘dumbing down’ NPs… a group of primary caregivers who can really make a difference in the costs and distribution of healthcare in our incredible state.
Elizabeth
March 13, 2014 at 12:43 am
I am a Family Nurse Practitioner and a Family Psychiatric and Mental Health Nurse Practitioner. I own a business in Pensacola Nurse Practitioner On Call (NPOC). We provide primary and urgent care for the patients in their homes and in Assisted Living facilities. We keep these wonderful patients out of the hospital and out of emergency rooms!
But, current barriers interfere with our ability to provide the care that reflects our education. You want examples, please call me…. These barriers prevent efficient use of tax payer dollars. Study after study proves that these barriers should be removed. (Dower, JD, 2014) (Expanding the Scope of Practice for Advanced, 2011) (Florida Tax Watch, 2014).
Why do the Legislators continue to waste taxpayer’s money debating this issue? Because the AMA has a lot more political power than the Nursing. This is not about quality patient care. This debate for the AMA is really about keeping the nursing profession under their thumb, keeping us subservient.
Even the Federal Trade Commission is in support of correcting this unfair labor practice. (Federal Trade Commission Staff Paper: Protecting America’s Consumers, 2014).
I would love to discuss this topic with you. I would love to have you take spend a day with me and see just how I care for the great citizens of Florida! I challenge anyone to this opportunity!
I would like to thank Dr Pigman for standing up to a group of bullies. And for my patients, I would like to thank him for attempting to put these residents of Florida first.
Elizabeth (Betsy) McCormack, FNP-C, FPMHNP – C.
Comprehensive Care Medical Group.
Pensacola, Florida
850-434-0077
References
Dower, JD, C. (2014). Innovative Approaches to Health Workforce: Nurse Practitioners. Florida House Select Committee on Health Caare Workforce Innovation (pp. 1-27). Tallahassee: Center for the Health Professions.
Expanding the Scope of Practice for Advanced. (2011, November). Retrieved from FloridaTaxWatch.org: http://www.floridataxwatch.org/resources/pdf/20111102ARNP.pdf.
Federal Trade Commission Staff Paper: Protecting America’s Consumers. (2014, March 7). Retrieved from Federal Trade Commission: http://www.ftc.gov/news-events/press-releases/2014/03/ftc-staff-paper-state-legislators-should-carefully-evaluate.
Florida Tax Watch. (2014, March ). Retrieved from DIAGNOSING THE DEBATE: NURSE PRACTITIONER SCOPE OF PRACTICE: http://www.floridataxwatch.org/resources/pdf/APRNBrief2014FINAL.pdf.
Pat Newell
March 13, 2014 at 6:42 pm
If all our physician employers spoke up publicly about the contributions ARNPs make to their practices, we wouldn’t be the last state to prevent us from prescribing Lomotil. But, alas, many of them do NOT belong to the state and national medical associations because their political views are diverse. When my patients ask why I cannot prescribe their sleep or pain medications, I suggest they contact their state representatives. After all, I adjust their dialysis prescriptions, order IV antibiotics, iron replacement, blood and write admission orders…
cherri jennewein
March 14, 2014 at 1:34 pm
Dear Dr. Pigman,
Thank you for your support of Nurse Practitioners. I saw the house video of you speaking out in favor of Nurse Practitioners and independent practice. You and your staff are amazing and I just want to you know I appreciate all of you.
I am a Nurse Practitioner who trained primarily in the emergency department, where collaboration and consultation is in the best interest of the patients. We all are working multidimensionally to improve healthcare for all persons.
Sincerely,
Cherri Jennewein NP-C
Horrified MD
March 28, 2014 at 5:27 pm
Horrors- Cary Pigman has lost his mind. 2 years is training no way marches the knowledge and experience gained from 4 years of med school, 3 – 5 years of residency hospital overnight call every 1 -3 nights, rounds on weekends, exposure and rotations in almost every specialty! there is just way- there are some pretty good NPS, but I have seen far too many who don’t know what they don’t know , and are all too often looking for zebras instead of recognizing run of the mill horses. There is just no way 2 years can possibly compensate for all the years of training REAL doctors go through , and those NPs who think it does are just once again showing that they truly don’t know what they don’t know. I have practiced in collaboration in my company with 2 different ones, smart and personable, but it made my work harder because I was constantly compelled to backtrack and check each patient and chart because of constantly finding importan omissions, and some shouldn’t be done commissions My take is that if they want to function and prescribe like doctore, let them go yo medical school and gain the years and experience it takes to be a REAL DOCTOR. This fantasy of being able to perform as well as an me may hit the fan when they out from under a doctor’s supervision and the malpractice suits start raining down on them with no MD to transfer the blame to when they are on their own. I cannot believe this 0pigman fellow– is he just trying to get attention and votes or has he truly lost his marbles ??? Horrified.
Horrified MD
March 28, 2014 at 5:32 pm
Excuse the typos in my post, please- I was so horrified that my fingers were typing too fast for my “speller”!
Dr David hill
May 4, 2014 at 11:00 pm
So, nurses will practice medicine without a medical license and will not work under the board of medicine. There should be a fast track pathway that allows suitably qualified nurses to become doctors. I am quite familiar with several NP programs and they are not particularly rigorous in either their academic or clinical demands. Dr. Pigman states that the APRNs allowed to practice independently will be “highly trained”. The bar has been set much too low where many will neither be highly trained or highly experienced.
Dr David hill
May 4, 2014 at 11:04 pm
And this issue is about many things but patient care is not one of them.
Elizabeth Hedaria
May 5, 2014 at 10:46 am
Well, let me say that NPs don’t just get 2 years of training. We have six years of training. Our undergraduate is in nursing, starting from the onset with pathophysiology, pharmacology, anatomy & physiology, etc. Physicians start out with an undergrad degree in who knows what – english Lit or whatever. We also have real life experience of being at the bedside with ill patients, putting our book knowledge to use in real life. So we already have years of healthcare experience behind us when the physician starts his doctoral program – very wet behind the ears. I perceive in the above posts the typical haughtiness & arrogance of the not uncommon “Doctor” that we nurse must contend with. Don’t be so willfully ignorant to think you are above making errors or killing patients. I’ve seen it first hand. My question to you is “Do you know what YOU don’t know?” Don’t insult the education of others because it is different from yours. I’m sure you probably argue that a Doctor of Osteopathic Medicine is not equal to an M.D. too. As the current colloquial expressions goes “Just Saying!”
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