re: SB 435 would allow advanced practice nurses to not work under a physician

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The reason NPs won’t allow themselves to fall under the medical board is because they don’t want their scope of practice dictated by the MDs. I can only imagine what NPs scope of practice would be if they fell under LSBME

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I understand this argument. What I've never found anywhere, though, is what the "scope" of APRNs is as defined by any sort of authority figure.


I fear you may be misreading or not understanding what the position I had taken before was (though it's quite possible that you weren't responding to me at all):
There is no such thing as a "scope of practice" and you can do whatever you're confident doing so long as you take on the liability of doing it at the level of a board-certified physician in that field.
That's the way we do it. If I wanted to perform open-heart surgery in my clinic, I could do it. I would probably have a hard time finding the patient and anesthesia to go along with it. I'd probably have a tough time getting myself to go along with it. But it's not against the law for me to do it, nor should it be.

ETA: Notice I said in my clinic, because I DEFINITELY would not get a hospital to allow me priveleges. This is a "hidden" failsafe in the hospital system is that there is a credentialling committee that looks into someone's qualifications before allowing them to perform a procedure or have the ability to do certain things in the hospital itself- so for example if they found that Doctor A had a bad rate of complications on his central lines, they could revoke his privileges which (s)he then must report when reapplying for licensure annually. Even within this bill, that failsafe still exists. And if a hospital allows these priveleges and sees no difference in care, more power to them. But there is nothing to support that claim, and this is not what I would consider a "safe" and efficacious way of trying it out to see if it works. The nursing home bit is different, yet similar. "Let us try it and see how it shakes out" just does not seem like a good argument for gained privileges in healthcare

Bad outcomes should be tied to the standard of care by an expert- they're going to happen and can't always be prevented, so as long as you accept the risk, treat the patient, and work within the scope you are comfortable in, you should be fine, regardless of the level of training you've got.


Now, when it comes down to handing out "sentences" for malpractice, you're probably right that a panel made up of MDs would not be able to fairly impose sanctions on someone with a different degree. I still think it would be fairly good/cool/positive/innovative to have a board made up of all the members of healthcare that took these cases on and, if need be, clearly defined the scope of practice where the lines get blurred, because as of now it is being defined by our state legislature.

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It’s a moot point. It’s never going to happen. NPs will continue to stay under the nursing board and as such will determine what their scope of practice will be.

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Sadly, I agree. But I sure would love to see a publication on what exactly the "scope" of their practice is.