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Will House panel OK a bill allowing advanced RNs to practice without MDs’ oversight?

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At its last scheduled meeting of the year, the House Health Innovation Subcommittee will consider a bill to allow advanced registered nurse practitioners to practice independently from physicians.

Sponsored by physician and state Rep. Cary Pigman, HB 547 was temporarily deferred at the panel’s meeting last week when it appeared that it was going to fail.

The committee will tackle the bill again today when it meets at 9 a.m. It is the only bill on the agenda. Today’s vote is expected to be razor thin, with just one vote separating HB 547 from passing or failing.

The bill would allow certain advanced registered nurse practitioners to have independent practices that are registered with the state and not have to practice under the protocol of a physician. Pigman said the bill would go far to help address Florida’s looming specialty physician shortage.

The bill lays out what Pigman described as a “pathway to independence.” Only advanced nurse practitioners would be able to practice independently if they completed a graduate level pharmacology course and had 2,000 clinical nurse practitioner hours within a three-year period immediately preceding the submission of the application.

Pigman’s bill would allow advanced registered nurse practitioners to admit patients to hospitals, long-term care facilities, skilled nursing facilities, hospices and intermediate care facilities for the developmentally disabled as well as manage their patients’ care. They would be able to prescribe drugs, including most controlled substances. They also would be able to provide signatures, stamps, certification affidavits or other endorsements that otherwise by law are required to be provided by a physician.

“My world view is physicians are highly successful. My world view is physicians work best when they work collegially and respectfully with other professions,” Pigman said.

He added that his opinion is at odds with organized medicine, which he said is “physician-centered. It’s not patient-centered,” Pigman said. “It’s parochial. It’s resistant to change and it’s almost ossified.”

Rafael Miguel, a Tampa anesthesiologist, testified against the measure, telling committee members that the expansive scope of practice isn’t necessary. He told the committee that Florida’s reputation as the pill mill capital was a national embarrassment. “The last thing we need is a lesser trained group of individuals to be able to write prescriptions for steroids.”

American College of Physicians lobbyist Chris Nuland opposed the measure as did the Florida Medical Association.

Bill sponsor Pigman was able to beat back an unfriendly amendment by state Rep. “Doc” Renuart that would have struck the ability for nurses to practice independently from but would have kept intact an advanced registered nurse practitioners’ ability to prescribe, something that the advanced registered nurse practitioners have pursued unsuccessfully  for years. Additionally, it has been an issue Renuart, also a doctor, has opposed for years.

Florida Nurses Association lobbyist Alisa LaPolt called it a 180- degree turn. “He’s coming half way and that was pretty surprising,” she said.

Though the Renuart amendment was defeated, subcommittee chairman state Rep. Ken Roberson  moved to temporarily defer the bill after six of the committee members said they “were down” on the bill in its current iteration.

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