Health Law Blog: Landmark Decision for the Iowa Nursing Practice

by Davis Brown Law Firm

In a landmark decision for the Iowa Nursing practice, the Iowa Supreme Court issued an opinion on May 31, 2013 finding that the Iowa Board of Nursing, and not medical organizations, had the authority to define the scope of Nursing practice in the State of Iowa.

In this case, captioned as Iowa Medical Society, et. al., v. Iowa Board of Nursing, et. al. (slip opinion can be found here), the Iowa Medical Society and Iowa Society of Anesthesiologists brought an action against the Iowa Board of Nursing and the Iowa Department of Public Health, who were attempting to invalidate a rule adopted by each agency. The Iowa Nurses Association, represented by the Davis Brown Law Firm; the Iowa Association of Nurse Anesthetists; and one medical association were granted permission to intervene. The rules at issue recognized the abilities of Advanced Registered Nurse Practitioners (ARNP) to supervise operators of fluoroscopy equipment, while the ARNP performed various nursing techniques such as peripheral insertion of an extended length intravenous catheter, foreign body location, precise needle location for procedures such as breast biopsy and interventional pain management. At issue was the interpretation of Iowa Nursing Law, which allows nurses to perform additional acts “which are recognized by the medical and nursing professions and approved by the Board [of Nursing] as proper to be performed by a registered nurse.” Iowa Code § 152.1(6)(d).  The Board of Nursing asserted that the medical profession had recognized the practice by physician participation in credentialing the nurses in the hospitals where the services were provided; this credentialing practice went back several years. The medical organizations disagreed that the medical profession recognized the supervision of fluoroscopy by the ARNP. The Supreme Court rejected their argument, found in favor the Board of Nursing and various Nursing associations, and cited approvingly to the following Iowa Nurses Association’s  argument, “[I]f the District Court’s ruling were to be upheld, it would fundamentally alter the nursing profession, as well as healthcare within Iowa, by allowing physician associations to have absolute veto power over any proposed new nursing rule, regardless of the actual opinions of Iowa physicians and of the actions of Iowa physicians in their privileging of nurses to perform various practices.”

The Court found that the Iowa Board of Nursing was, in fact, granted the authority to make rules and interpret the Nurse Practice Act and that physician-based associations do not have absolute veto power over such rules. In particular, the Court agreed with the reasoning of an Attorney General Opinion interpreting the phrase at issue, shortly after the Nurse Practice Act was revised in 1976: “The plain language of section 152.1(6)(d) allows the nursing board to decide whether the nursing and medical professions have recognized a particular practice of nurses.” The record before the Court included evidence that physicians approved of the practice by credentialing the nurses, forty physicians wrote in favor of the Board of Nursing rule, and the Iowa Board of Medicine did not use its power to stop the nurses from supervising fluoroscopy. Accordingly, and since the Board of Nursing rule was not “irrational, illogical, or wholly unjustifiable,” the Court deferred to the Nursing Board’s interpretation.

The Supreme Court also found that Iowa Department of Public Health’s rule allowing ARNPs to supervise fluoroscopy was intended to improve access to healthcare (particularly in rural areas), improve patient safety, and clarify and codify existing practice. The Court specifically rejected the physician organizations’ argument that the ARNPs had to be able to operate the equipment, noting “many professionals supervise work done by others without the license or ability to do the work themselves.”

With its decision, the Supreme Court upheld the Iowa Administrative Code regulations adopted by the Iowa Board of Nursing and Iowa Department of Public Department, thereby allowing ARNPs and CRNAs around the state to continue their practices utilizing fluoroscopy.

This is a win for Iowa patients, Iowa healthcare in general, and Iowa nursing practice specifically! Please feel free to contact us if you have any questions.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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