Advanced Practice Registered Nurses will be allowed to practice independent of a doctor under legislation the House sent to Gov. Dannel P. Malloy’s desk Monday for a signature.
The bill allows nurses who have been licensed and practicing with a physician for at least three years to practice independently of those physicians. Current law only allows APRNs to work in collaboration with a physician.
“It actually makes [health care] access much easier,” Rep. Peggy Sayers, D-Windsor Locks, said after the debate. “Some of the problems that APRNs have had is trying to find a physician to get that collaborative agreement.”
Under the bill, APRNs will be required to maintain an agreement with a doctor for the first three years before being permitted to practice independently.
Sayers, who is a registered nurse, said she has been working on passing the legislation since 2005 when she chaired the legislature’s Public Health Committee.
“It’s been a bill that a number of people, not just me, have worked on for a long time,” she said.
Gov. Dannel P. Malloy said the change will help Connecticut’s health care system address the demand from newly insured residents. He said access to primary care has been a challenge in some communities.
“With the healthcare industry growing and changing, the role of advanced practice registered nurses remains critical. This bill increases access to primary care across Connecticut by allowing advanced practice registered nurses to do more of what they do so well — evaluating, screening, physical examinations and management of many routine medical conditions such as hypertension, diabetes, and asthma,” Malloy said in a statement.
Rep. Prasad Srinivasan, R-Glastonbury, said didn’t disagree that the practice of medicine has changed.
“The good old Norman Rockwell painting that I’m sure many of us are familiar with where you have a very authoritative, very dictatorial doctor talking down to the mother of the child instructing her what to do,” Srinivasan, who is also a medical doctor, said. “Things have changed. Healthcare has changed. It is no longer a one-person show.”
He said the collaborative agreement may not be perfect, but “two wrongs do not make a right.” He admitted the collaborative agreement APRNs have with physicians may not be effective, but going to the other extreme and getting rid of the collaborative agreement in the fourth year is not “the way to go.” He said instead they should be working to make the collaborative agreement meaningful.
He said it wasn’t a partisan issue and it wasn’t about medical doctors or APRNs.
“The center stage is patient care. The center stage is access and the center stage is to make sure these patients are treated in an appropriate way and we do not end up in different tiers of care,” Srinivasan said.
Following the bill’s passage, the Connecticut State Medical Society released a statement expressing “extreme disappointment” in the vote. The group said the bill did not include adequate detail regarding an APRN’s three-year agreement with doctors or what education requirements would be placed on them.
“It is difficult to see how this change will improve patient care, and it does nothing to address the need for healthcare transparency in Connecticut,” Dr. Michael Saffir, the group’s president, said.
The bill passed the Senate more than two weeks ago by a 25-11 vote.
Sen. Terry Gerratana, D-New Britain, said during the debate in that chamber that it’s her experience that some doctors are less likely to accept Medicaid patients and with a growing Medicaid population under the Affordable Care Act this will give them access to care. There are also more rural parts of Connecticut where there aren’t enough doctors to see patients. Nurse practitioners have the authority to treat patients and prescribe medication.
There are about 4,000 APRNs in the state of Connecticut, according to state officials.
“I see this as an opportunity to increase the penetration of primary care,” Sen. Jason Welch, R-Bristol, said. “Unfortunately, I think as the Affordable Care Act moves forward and because of certain parts of that it’s going to be even harder to get primary care practitioners.”
Welch voted in favor of the bill, but Sen. Rob Kane, R-Watertown, said he had difficulty with the bill because it was unclear how APRN’s would differentiate themselves from medical doctors when they open their own practices.
Gerratana said there are penalties for anyone who says they are a doctor or physician or surgeon and don’t have a corresponding license. She said the APRN would need to be displayed on a badge.