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

The bottom line is that if you want to practice independently then the NP needs to commit to that field and having training IN THAT FIELD, then STAY in that field. That’s how every other professional/specialty does it because the amount of knowledge you need to practice just one specialty is astounding.

Not I’m a nurse one day, then I can be a dermatologist, or a neurosurgeon. Then if next week I decide I want to go practice primary care independently or work in a nursing home independently I can do that too.

Why should we allow nurses more freedom than doctors when they have less training?

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Do you know how many people are killed by MDs each year? Look it up

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Your point?

Are you suggesting that NP's would have an equal or lower ratio of malpractice deaths than doctors?

If that were true, why do we have doctors then?

edit: To be fair I did look it up, the average seems to be around 85,000 malpractice cases per year.

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Your point?

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My point is that you're saying "Oh, wait until an NP kills someone, then they'll change this back", as if physicians don't kill patients

ETA: You can't just use one case and say, "look! I told you they were incompetent!" Because if that was the case you'd have to lump physicians in there with them.

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Are physicians not held to a higher standard than NP's are?

Do they both have the same licensure process?

Do they both have similar training lengths?

I am asking redundant questions because we both know they are not the same, yet one wants to be treated as such.

That would be like me hiring an electrician to install a Telecom site. He may have years of experience and skillset, but still couldn't do the job properly and under different guidelines.

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Does the bill say that the NPs can perform the exact same work as an MD? Are we going to have NPs performing open heart surgery, renal transplants, or knee replacements? Or, are the NPs going to continue doing what they are currently doing, without their babysitter getting paid to sign off on their work?

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Actually no I have not read the entire bill. Have your senator?

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I've called his office and sent e-mails to find out if he has. I have.

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There is always a shortage in hospitals and nursing homes.

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Citation?

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What about the ER?

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This is one of the absolute last places I'd want unsupervised nurse practitioners that aren't held to the same standard as a board-certified doc.

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How many Dr. Do you know who are at the nursing home multiple hours a day everyday ?

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A handful. They bounce NH to NH, see patients regularly as required + when needed/asked for by family or nursing staff. And, of course, on the SNF side, at least weekly.

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Advanced Practice Nurses are not just mid-level providers, you are the one saying they are

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In Louisiana, they are mid-level providers. They are trying to remove the title with the bill. The burden of proof that they should do more while being unsupervised is on them.

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They are nurses, who went back to school for a multiple years

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So, in the old days, it required several hundreds to thousands of hours of clinical experience as a nurse before going back. Many programs today are online-only and allow them to attend part-time while remaining employed full-time. Here is Georgetown's online program (as an example). The full-time program is 19 months and requires 650 clinical hours (4 months and 1 week of clinical experience) while the part-time program is 27 months.
Contrasting it with medical school:
Term begins in August and ends in May with 4-6 weeks of off time before restarting in July and running through the following June (22 months) plus an additional, using LSU New Orleans as a guide, 18 months (July of 1 year rolling through to May of the 2nd year following) of clinical rotations. If averaged at 40 hours per week (and that's lowballing most of them), you're talking about ~2880 hours of patient contact before graduating from medical school. Then, you must complete a minimum of an intern year- we average 60 hours per week over a 52 week year with 2 weeks of vacation in my program. That's roughly average. There are about 3000 contact hours there, by those numbers before you are even eligible for a license. As said in a previous post, the LSBME has noted a higher instance of malpractice cases against people with a license that have not completed a residency, so they are currently looking to increase that to completion of a full residency (~9000 patient contact hours) because they don't currently feel that physicians who haven't completed a residency in the State of Louisiana are fit to treat patients.

Now, if this were the days of old where someone had 5-10 years of bedside/ICU nursing experience who was leaving that job to go to school full-time and spend a year or more under a structured academic curriculum for clinical hours, I would tend to think more like you. I still agree with you that they are trained professionals that are very capable- not once have I questioned their ability to do a darn thing. What I want, though, is equal protection under the rules for patients:

They need to be held to the same standard as physicians if they want to practice without physician oversight.

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Do they have stupid ones? YES but we all know Stupid Dr too.

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Another way of stating this argument is to say "Even people at the highest level of training can be less than great, so we should allow people with less than great training to practice at the higher level." I disagree with it because of the double standard. Hold them under one board, and I'm all for it. Make their curriculum more rigorous and have their patient contact hours significantly extended and performed in an accredited academic center rather than with any old Joe Blow doc or NP, and I'd entertain it but still think there should be one board, one standard of care for patients.

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They will be held to the standards of the state nursing board which is hands out punishments much faster than the medical board for malpractice or negligence.

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Anything to support this? My personal experience is the opposite.

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You don't know this. Most hospitals that I've worked in have several physicians in administrative positions.

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The majority of the CEO/CFO spots are held by non-clinicians in literally every instance I have been exposed to. There are usually medical members on the board, but very rarely have I seen them have hiring/firing authority.

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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.