HARRISBURG, Pa. (Erie News Now) – In Pennsylvania, nurse practitioners have been pushing for “full practice authority” for many years. Currently, nurse practitioners are required to practice under a collaboration agreement with a physician at all times.
Nurses say one of the best ways to explain it is like being stuck with a permanent student driver’s permit. Except instead of a licensed driver in the passenger seat for a temporary duration, it’s a physician, at all times.
“I don’t need somebody sitting in my front seat telling me what I need to do anymore,” said Janice Miller, DNP, CRNP, CDE, and Associate Professor at Thomas Jefferson University.
Pennsylvania nurse practitioners are looking to cure what they call an “antiquated law.”
“Pennsylvania is experiencing a nursing shortage and we have a nursing workforce shortage and we have an advanced practice nursing shortage,” said Cheryl Schlamb, DNP, CRNP, President of the Pennsylvania Coalition of Nurse Practitioners.
A nurse practitioner since 1989, Schlamb also chairs the Department of Nursing at West Chester University and works at Chester County Occupational Health, which is affiliated with the University of Pennsylvania health system.
“Nurse practitioners are trained and educated, most of us in the state of Pennsylvania. We have 111 nurse practitioner programs within the state. We are trained to diagnose, treat, prescribe for patients. Currently, we have to have two collaborative agreements- two legal documents- to practice to the full extent of our education and training, which are cumbersome,” said Schlamb.
Experienced nurse practitioners say it limits their ability to care for patients, especially in underserved communities experiencing a primary care shortage. Schlamb says there is one doctor for every 3,500 residents in primary care shortage areas. She adds that 80 percent of nurse practitioners specialize in primary care.
According to a 2022 study by the Commonwealth Foundation, nearly 1,800 additional patients could be seen by nurse practitioners each week, if Pennsylvania adopted full practice authority.
“Let’s get these 18,000 nurse practitioners in Pennsylvania up and ready to do what they do best,” said Sen. Camera Bartolotta (R-Beaver/Washington/Greene), the sponsor of Senate Bill 25.
Bartolotta’s bill would allow qualified Advanced Practice Registered Nurses-Certified Nurse Practitioners (APRN-CNPs) to practice independent of a physician after fulfilling a three-year, 3,600-hour collaboration agreement with a physician. Although the requirements outlined in her bill may seem stern, Bartolotta says they’re necessary to ensure quality care. Nurse practitioners are on board and Bartolotta believes physicians should be too.
“This is something that we absolutely have to do. There are now 27 states that allow for full practice authority for nurse practitioners, without the strict requirements that my bill requires,” said Bartolotta. “Right now, we see a huge decline in our highly qualified nurses. They’re moving to other states, especially other states that are around Pennsylvania. They border us and they offer full practice authority,” she added.
But some physicians say there’s no need to fix the current system if it isn’t broken.
“A lot of the current models that we have for care, work,” said Dr. F. Wilson Jackson, President of the Pennsylvania Medical Society. “This is in no way restricting nurse practitioners’ ability to practice their trade and what they’re trained to do. What it does is just maintain physician oversight on what they do. We feel that patients’ care is optimized when there’s a physician as part of that care team,” he added.
Dr. Jackson believes patients benefit from collaboration with a physician. He says Bartolotta’s bill won’t necessarily alleviate the health care crisis in Pennsylvania, especially in underserved, rural areas.
“This bill would not increase the number of nurse practitioners practicing. They’re not going to have a sudden surge of nurse practitioners out there to be able to provide patient care,” said Jackson, who doesn’t believe that underserved areas in the other 27 states benefitted as much as anticipated. “If you look at the data in states where they have granted independent authority of nurse practitioners, the nurses practice in the very same densely populated communities as the physicians, they simply don’t meet that need. They don’t go to those areas,” he added.
Bartolotta and Schlamb disagree. They say having to practice under the collaboration agreement is deterring new, and experienced nurses, from pursuing or staying in the Commonwealth. They both believe it would help the 3.4 million rural residents receive more efficient, quality care in closer proximity.
“We need to keep our great nurses here in Pennsylvania, and this is a great way to do it,” said Bartolotta.
“We are trying to be expert nurses. We’re not competing with organized medicine. It’s time to unleash the workforce to assist you in taking care of patients in the Commonwealth,” said Schlamb.