House health care committee defers vote on 2 nursing bills, including CRNA ‘scope of practice’ expansion effort
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Doctors and nurses coordinate hands. Concept Teamwork
Webster Barnaby, the sponsor of 1 of those bills, appeared unprepared to answer members' questions.

The House Healthcare Regulation Committee deferred votes on two bills that would have given certain advanced nurses more autonomy in the health care marketplace.

Rep. Webster Barnaby asked that a vote on his bill (HB 771) to allow about 1,100 certified psychiatric nurses to practice autonomously be deferred after committee members asked him several questions that he was unable to answer. After Barnaby requested that a vote be deferred, Committee Chair Michelle Salzman announced the committee also would not consider HB 257, though she did not explain why.

Bill sponsor Rep. Mike Giallombardo said in a statement he wanted to delay the vote to “continue discussion with committee members. All members I have spoken with are committed to addressing Florida anesthesia workforce issues.”

Both bills address “scope of practice,” a term used to describe the duties and activities that health care professionals are permitted to perform by statutes.

HB 771 gives the green light for a psychiatric nurse registered for autonomous practice to engage in the practice of psychiatric mental health services without an established physician protocol. According to a staff analysis of the bill, there currently are 3,458 psychiatric nurses registered in the state, of which 1,093 are registered for primary care autonomous practice.

Barnaby told the committee his constituents’ top concern is mental health and that the bill is necessary.

“We have a crisis in Florida and these nurses will help us solve it. This bill is legitimately put together to save the lives of Floridians and to deliver the necessary care to thousands more. Each one of our constituents will be impacted positively by this bill,” Barnaby told members.

Barnaby, though, was unable to answer questions from committee members. Rep. Christine Hunschofsky asked whether the nurses would be required to carry the same level of malpractice insurance that psychiatrists are required to carry.

Rep. Gallop Franklin asked Barnaby whether the psychiatric nurses would be required to accept insurance or if there was a requirement for the nurses to provide care in rural areas or to accept insurance. But Salzman said Franklin’s questions were outside the scope of the bill.

Rep. Joel Rudman, a physician, asked Barnaby whether there was anything in the bill that limited where the psychiatric nurses could practice.

“There’s nothing in the bill that specifically focuses on rural communities,” Barnaby said.

Barnaby asked Salzman to temporarily postpone the bill before he was asked any additional questions.

Meanwhile, HB 257 would strike a requirement that certified registered nurse anesthetists (CRNAs) have written protocol agreements with physicians. Giallombardo told Florida Politics when he filed the proposal that the bill simply eliminated paperwork requirements and was not a “scope of practice” expansion.

But opponents, including organized medicine, disagree and say the bill expands what CRNAs are authorized to do.

“We believe that the physician-led model is the safest and most cost-effective means of providing high-quality anesthesia medical care. This bill will expand the scope of practice for CRNAs and will do nothing to expand access or lower costs,” Chris Giordano, President of the Florida Society of Anesthesiologists, said in a statement.

CRNAs in Florida currently are required to practice under a supervising physician’s protocol. They can, under the on-site medical direction of a licensed physician or dentist, provide anesthesia to patients before, during and after surgery. CRNAs made a median salary of $195,610 in 2021, according to U.S. News & World Report.

Giallombardo says his legislation isn’t a scope of practice bill. CRNAs may — within the limitations set by the established protocol of the facility in which they are working — conduct pre-anesthesia evaluations, order and administer the anesthetic, monitor and interpret the patient’s vital signs, and manage the patient during surgery and in recovery.

His bill doesn’t change that. It deletes the requirement that the CRNAs have written protocols with supervising physicians.

“It’s not expanding scope, it is just simply removing that paper protocol, to make it easier, to make it more affordable, to make it more efficient,” Giallombardo told Florida Politics.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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