State Nursing Boards

[W222]

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I receive the ASA newsletter every month and the first section I always check out is the legal/PAC section. I have noticed an alarming trend in many of the pieces within this sections where state nursing boards simply make a decree from on high and it thereby gives nurses in that state some new authority, be it regarding scope of practice of CRNAs or NPs. Now, the question I have is how in the f%@king world are they getting away with this? Seriously, if this power grab was going on at say the level of paralegals suddenly being allowed to fully represent clients in court simply because their governing body said they could no one would stand for it.

How is it that a nursing board can now say their members are qualified to practice in areas that are clearly beyond the historical scope of practice of nurses? (Note: I am simply asking a rhetorical here, I seriously want to know how this gets done and how state med boards justify allowing this to continue.)

 

[sonn]

The government has promised more care than it is willing to pay for, thus it needs more and cheaper providers. When Obama care gets rolling they will be looking to cut costs where ever that can, that will include the de-doctoring of health care and a massive expansion of nursing. With Obama care the government will gladly let a nurse do anything a doctor used to do so long as they are cheaper.


The state medical board is a government agency just like the state nursing board with the power to regulate. They can do just about what ever they want to, their only oversight is the legislature, the courts and the governor. So the only way to stop a run away nursing board is to have the legislature and governor pass specific laws limiting the practice of nursing.

 

[jwk]

Fortunately, these moves are being challenged in court. Louisiana courts blocked CRNA's from doing pain management a while back.

Besides using the courts, these issues can also be approached at the legislative level.

 

[geauxg8rs]

It will be great when midlevel= doc. They will get to do all of the bread and butter and will balk at anything "challenging." These sicker patients will get sent to the doctor for their "expertise." Cannot wait, life will be more exciting.

 

[Socrates25]

I receive the ASA newsletter every month and the first section I always check out is the legal/PAC section. I have noticed an alarming trend in many of the pieces within this sections where state nursing boards simply make a decree from on high and it thereby gives nurses in that state some new authority, be it regarding scope of practice of CRNAs or NPs. Now, the question I have is how in the f%@king world are they getting away with this? Seriously, if this power grab was going on at say the level of paralegals suddenly being allowed to fully represent clients in court simply because their governing body said they could no one would stand for it.

How is it that a nursing board can now say their members are qualified to practice in areas that are clearly beyond the historical scope of practice of nurses? (Note: I am simply asking a rhetorical here, I seriously want to know how this gets done and how state med boards justify allowing this to continue.)

The trick is that they define everything as "nursing" and not medicine. Since the state nursing boards have sole authority to regulate the practice of "nursing" then the medical boards have little to no say about it.

So, they define intubation, scripting meds, ordering MRIs, sewing lacs, doing surgery as "nursing" and not the practice of medicine.

Its quite brilliant isnt it?

 

[JackADeli]

I too find the trend troubling from the "doctor of NP" based on a portion of USMLE to the expanding scopes with NP schooling via internet, etc...

The bigger problem, IMHO is us. Great, we talk some trash on the web. We do it about residency, about healthcare reform, etc.... but why do physicians not have the most highly financed, disciplined, and focused lobby??? The problem is us. Alsmost any specialty could have an exceedingly high financed lobby if they chose to organize.

 

[proman]

It's to the judicial and/or legislative branches to limit this kind of mission creep. Remember this when judges come up for election.

 

[JonnyG]

I too find the trend troubling from the "doctor of NP" based on a portion of USMLE to the expanding scopes with NP schooling via internet, etc...

The bigger problem, IMHO is us. Great, we talk some trash on the web. We do it about residency, about healthcare reform, etc.... but why do physicians not have the most highly financed, disciplined, and focused lobby??? The problem is us. Alsmost any specialty could have an exceedingly high financed lobby if they chose to organize.

It goes to the nature of the profession. You set up your own practice or with one other person and worked in your own little world. It is only in the last twenty years that there was a need for a lobby. Unfortunately most of the docs who have money right now are of the independent generation. As more younger docs come into practice the focus changes.

 

[W222]

The trick is that they define everything as "nursing" and not medicine. Since the state nursing boards have sole authority to regulate the practice of "nursing" then the medical boards have little to no say about it.

So, they define intubation, scripting meds, ordering MRIs, sewing lacs, doing surgery as "nursing" and not the practice of medicine.

Its quite brilliant isnt it?

When will nursing entail doing 4V CABGs or cranis for tumors? I can't wait to see that, and from a group who typically takes comparative anatomy using pigs or cats.

 

[JackADeli]

I too find the trend troubling from the "doctor of NP" based on a portion of USMLE to the expanding scopes with NP schooling via internet, etc...

The bigger problem, IMHO is us. Great, we talk some trash on the web. We do it about residency, about healthcare reform, etc.... but why do physicians not have the most highly financed, disciplined, and focused lobby??? The problem is us. Alsmost any specialty could have an exceedingly high financed lobby if they chose to organize.

It goes to the nature of the profession. You set up your own practice or with one other person and worked in your own little world. It is only in the last twenty years that there was a need for a lobby. Unfortunately most of the docs who have money right now are of the independent generation. As more younger docs come into practice the focus changes.

There has actually been a need for speaking out/lobby for a very, very long time. It has not happened overnight.

As to the nature of the profession.... as I said, the problem is us. The nature is to whine and cry in the corner and not speak up.... no leadership, no discipline, no organization. This allows us to remain at the mercy of malpractice, HMOs, insurance, medicare/medicaid, etc, etc....

Again, I know of exceedingly few physicians (attendings) that couldn't contribute at least $1k a year to an advocacy group/lobby. It is about priorities. If it matters, do something about it. Nursing contributes to their unions AND lobbies and we know they often make less then the average physician. We are sitting on the sidelines crying and that is not noble it is pathetic.

 

[cfdavid]

Interesting. Some of you know there's been a pretty heavy debate in the CC forum about mid-levels etc.

I JUST sent out an email to a friend stating my 3 current and future philanthropic recipients. There may be exceptions but I'm going to make the following on recurrent (albeit modest for now) payments.

In no particular order:
1) the ASA
2) animal wellfare (historicaly the humane society)
2) freedom promoting/fighting organizations like the NRA

*****Here's what I view as a LARGE part of the problem, and we can use the above 3 as a perfect example.

2 out of the 3 are out of very strong, personal beliefs. Each of us has our own, obviously. So, these come straight from the heart. One is driven by a sense of suffering in this world, and a desire to mitigate that suffering. Another is driven by a sense of increasing Federalism and Orwellianism it seems we find ourselves in......

So, am I likely to STOP donating to the Humane Society and the NRA when I retire?? Hardly, given the means (which is very relative). Why?? Because these are very core beliefs/values which are DRIVEN BY A SENSE OF PURPOSE WHICH IS LARGER THAN ONESELF.

O.k., you get the point. So, what about the ASA? Most/Many view such things as generally good to support during the time which those organizations represent them. To a large extent, this is natural. So, professionals join and contribute during their careers and even then perhaps not AS VIGOROUSLY as they would put their weight behind something "bigger than" his/her self.

In reality, supporting the ASA is benefitial (assuming they are successful advocates) to it's members. It can have a direct financial impact on the INDIVIDUALS within the organization (kind of a play on terms, I know). But, isn't this about something which is truly bigger than individual gain (with underlying financial risks/rewards)??

Surely. But, we can't expect folks to throw their support behind the ASA with the gusto in which people contribute to other "causes". And that's what's key. We need to begin to truly believe that to support physician professional organizations and PACs as being part of a BIGGER PICTURE. It's nothing new to BS about patients rights. But, at what point will mid-level enchroachment TRULY begin hindering patient care???

Do we not have a MORAL obligation to advocate on behalf of patients (which nurses so often claim is their own domain)? Do we not have the MORAL obligation to ensure that, when available, a board certified physician, whom studied hard sciences as undergrads, did 4 years of medical school, an accredited/REAL residency, followed by written +/- oral boards???

Indeed we do. Can it also be self-serving to advocate for ones profession? Maybe, but it doesn't need to be viewed in such ways.

So, rather than constantly being on the defensive, where advocating on OUR behalf becomes the focus, we should ALWAYS be on the offensive, advocating on behalf of patient rights and the standard of care. The right of patients to have physicians (and not wanna be's) direct their treatment/care.

There is a huge psychological difference, and I would argue that a REAL paradigm shift would do wonders for physicians to 1) increase contributions which DO work (look at other successful lobbies and try telling me they don't work in the face of often insurmountable financial odds), and 2) ***provided attendings, residents, and med students WITH THE MORAL HIGH GROUND (this is SO important with respect to advocacy) to "argue" on behalf of patients.

More on point #2..... We have the ability to SHIFT THE DEBATE away from turf wars and financial sh.t. With a general paradigm (weren't we speaking of MBA-dom jargon??) shift, we will then have that critical moral high ground with which to fight.

So, it becomes less about the big bad physicians trying to keep nurses down and "in their place" than it becomes about caring physicians whom are willing and able to provide the highest level of care to the benefit of patients and their/our families. ****This transcends any "petty" turf war squabbling.

Regarding the moral high ground; This allows the physician (and those in training) to point out that patients deserve the highest standard of care. It KEEPS THE FOCUS ON THE PATIENT. It allows one to speak even to seasoned mid-levels without THEM shaping the debate around "access to care" and "physician greed" and anecdotes etc etc. ****All a med student/resident/attending needs to say to any militant mid-level (clearly not all are such) is that, very simply and calmly, "Well, what I really want to see is patients getting the very best care available. Who wouldn't?"

Nobody wants to be seen as the big bad wolf, oppressing well intentioned mid-level providers. So, this shift will allow US to begin shaping the debate, and not being constantly on the defensive or having the debate being shaped by the "opposition". In fact, we should stear clear of all debates or frames of arguement based upon that very opposition. They should not even come up, and if engaged by a militant NP, CONTROL the conversation be STICKING TO PATIENT ADVOCACY. Do not allow them to drag you into being the big, bad wolf, which so often happens. So, take the MORAL HIGH GROUND. Keep it simple. Keep the debate focused not on individual gain, or zero sum games between different "providers" and stick soley to the patient.

I'm ranting now, but think about what this ATTITUDE change (sick of using "paradigm"....) can do for our "cause".

Cheers,

cf

 

[ProRealDoc]

It's to the judicial and/or legislative branches to limit this kind of mission creep. Remember this when judges come up for election.

But it is up to us to put the pressure on these bodies through aggressive lobbying. The nurses do it all the time. Last time I was in Washington, DC the AANA and its cronies were there as well.