Healthcare Access Committee Meeting
The Joint Legislative Committee on Access to Healthcare and Medicaid Expansion met this week to hear from experts on whether North Carolina should grant different types of advanced practice nurses full practice authority.
The committee, which lasted for more than three hours, allowed speakers from associations representing both physicians and nurses to give presentations about the pros and cons of granting advanced practice registered nurses (APRNs), which includes certified registered nurse anesthetists (CRNAs), certified nurse midwives (CNMs), nurse practitioners (NPs), and certified nurse specialists (CNSs), full practice authority. SB249/HB 277: SAVE Act, which was introduced by legislators in both 2019 and again in 2021, would grant APRNs full practice authority, meaning they would no longer require physician supervision. The bill did not receive a hearing during the 2019-2020 session. Tuesday's joint committee meeting was the first time components of the SAVE Act were formally discussed in a legislative committee.
Nicole Livanos, the Legislative Affairs Director for the National Council of State Boards of Nursing; Angela Mund, the President of the American Association of Nurse Anesthesiology; Amy Kohl, the Director of Advocacy and Government Affairs for the American College of Nurse-Midwives; and Dr. Vincent Guilamo-Ramos, the Dean and Vice Chancellor of the Duke University School of Nursing, gave presentations in favor of full practice authority for APRNs. These speakers gave dense presentations, stacked with statistics and case studies from other states, that demonstrated the success of granting APRNs full practice authority. In response to a question from Rep. Brian Farkas (D-Pitt), Livanos said none of the 24 states that have passed legislation similar to the SAVE Act have repealed or rolled back its provisions.
Dr. McNeil Cronin, the President of the North Carolina Society of Anesthesiologists, and Dr. Karen Smith, a family physician in Hoke County speaking on behalf of the North Carolina Medical Society, preented the case for maintaining current state law which requires physician supervision. They argued that patients are safer when physicians, whose training is often purposefuly more broad and general, are supervising their nurse colleagues. Representative Dr. Kristin Baker (R-Cabarrus), a psychiatrist, challenged studies put forward by the proponents of the SAVE Act, and asserted that giving full practice authority to APRNs neither improves access to healthcare in rural areas nor improves patient outcomes.
Legislators questioned most of the presenters about the physical presence of a supervising physician. Dr. Guilamo-Ramos spoke about the technicalities of physician supervision, and said it often means a supervising physician will come in periodically to review patient records. An APRN and their supervising physician do not have to work at the same place. “Nurse practitioners are paying for the piece of paper that the supervising physician signs,” Guilamo-Ramos asserted, “It ultimately is a cost burden and takes away from a nurse practitioner’s earnings.”
Dr. Cronin, an anesthesiologist, responded to a question from Sen. Ralph Hise (R-Mitchell), and said it was the norm for anesthesiologists to physically be in the operating room. “The supervision is direct and frequent,” said Cronin. Rep. Carla Cunningham (D-Mecklenburg) who is also a registered nurse emphasized that specialized and trained nurses “are the ones with the patient all of the time…and are the ones that make the first call when something is wrong.”
Other speakers, including those from the John Locke Foundation and the American Association for Retired People (AARP), spoke in favor of giving APRNs full practice authority. The John Locke Foundation’s Jordan Roberts said, “We have a regulatory reform issue that limits access to critical services and raises costs.” Winifred Quinn of the AARP Public Policy Institute said that the SAVE Act is “about access to care, patient choice and making the most of our scarce healthcare resources.”
The committee will meet again on Monday, April 11.
