Monday, 04 March 2019 13:21

Advanced nurses could bridge rural-urban health gap, advocates say

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RALEIGH — As North Carolina’s population ages, and demands for health care rise, nurses need the freedom to do more.

A bipartisan group of lawmakers made that pitch Tuesday at a news conference, renewing a years-long push for regulatory reform. The Safe, Accessible, Value Directed and Excellent Health Care Act was introduced Tuesday in both General Assembly chambers as Senate Bill 143 and House Bill 185. Sponsors are Reps. Gale Adcock, D-Wake; Donny Lambeth, R-Forsyth; Josh Dobson, R-McDowell; Sarah Stevens, R-Surry; and Sen. Ralph Hise, R-Mitchell.

Outdated laws prevent nurses with advanced degrees from applying their whole array of clinical training in North Carolina, sponsors say. Under the bill clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners would be supervised by the N.C. Board of Nursing.

Nurses now are tethered to supervising physicians, who provide scant oversight while collecting large payments. Cutting the link with physicians would slash state health care spending between $433 million and $4.3 billion yearly, based on a 2015 report by Duke University research scholar Chris Conover.

The N.C. Medical Society, which represents physicians, has come out against the bill.

“This is a battle to remove barriers to health care that have existed for more than 40 years for nurse practitioners,” Adcock said. Residents of rural areas and medically underserved urban pockets suffer most from the stifling regulations. They have the greatest health disparities and worst economic situations.

Adcock said the state has a shortage of physicians. And they tend to practice in the wealthier parts of the state. Regulations hamstring advanced practice nurses who are trying to fill voids in coverage.

Adcock knows. She’s been a family nurse practitioner for 32 years. She has a master’s degree in nursing from UNC Chapel Hill, earned national certification, and has been an adjunct faculty member at several universities. Yet N.C. regulations bar her from performing some services she could administer in 22 other states and Washington, D.C.

She said residents are getting a raw deal. Their tax dollars subsidize training for advanced practice nurses in the UNC System, yet those graduates can’t use all their skills.

Adcock said physicians have lobbied heavily to keep the supervisory agreement with nurses. Doctors say — falsely, in her view — their supervisory role protects patient safety.

“These physicians are supervisors in name only,” Adcock said. “The truth is that decades of evidence does not support physician supervision of APRNs as a way to increase quality outcomes or improve the safe delivery of care.”

Hise cited state data showing only 16 percent of physicians graduating from UNC Health Systems practice in rural North Carolina. A rural community college nursing graduate has an 89 percent chance of practicing there.

Advanced practice nurses already provide many of the same clinical services that doctors perform.

“I will tell you for western North Carolina that I represent, it’s not a question of who does the procedure. It’s whether a procedure is done,” Hise said. Many communities can’t recruit physicians, don’t have clinics, and hospitals lack specialists. The nearest emergency department is the only weekend option.

Hise noted 160 nurses came to Raleigh Tuesday from around the state to press their representatives to back the bills. Supporters from several organizations joined the lawmakers at the news conference.

Charmaine Fuller Cooper, associate state director for AARP NC, said its 1.1 million members think the SAVE Act could expand the circle of health care providers. Baby Boomer retirees with complex needs and chronic conditions can’t wait weeks or months to see a physician. A trip to the doctor often is a full-day event.

“Nurses are the most trusted profession in this country, and in our state, and we trust nurses to give us the care that we need,” she said.

Frances Messer, president and CEO of the N.C. Assisted Living Association, says expanding services advanced practice nurses could perform would reduce medical costs for the 15,000 assisted-living residents she represents. Eighty-five percent of residents already get some level of daily care from advanced practice nurses, and the quality of care has improved, she said.