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Our View: Pennsylvania nurses' drive for recognition shoudn't spark a fight

May 04, 1999

For Pennsylvania communities that don't have enough doctors to meet their residents' needs, advanced-practice nurses have filled the medical-care gap for years, working in public clinics or private practices. Now these care-givers want the state legislature to recognize their contributions by freeing them from supervision by the state Board of Medicine. A change in the law may be needed, but we question that way the proposal is being handled now.

Proponents, led by state Rep. Patricia Vance, a former nurse herself, note that 43 other states regulate nurse-practicioners through a board of nursing rather than by a physician-led medical board.

But many of these states still restrict the nurse-practicioners' ability to prescribe certain drugs, and the cost of their liability insurance, based on their present, limited authority under the law, is very low. With expanded powers would certainly come greater exposure to liability, more costly insurance and a higher risk of malpractice charges.

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In a possible move to head off such developments and to heal the rift between the nursing and physician boards, both boards have jointly proposed rules that would allow the nurse practicioners to write prescriptions without having them co-signed by a doctor. However, nurse-practicioners would still have to collaborate with doctors on patient care.

Judging by some of the statements of the proponents, although the driving force behind this bill may be an expansion of health care for the poor, it also seems motivated by the desire to get nurse-practicioners some respect from physicians.

Our problem with resolving these matters through legislation rather than through negotiation is that the process would naturally be adversarial, with both doctors and nurse-practicioners trotting out horror stories for legislative committees.

If there's going to be legislation expanding nurse-practicioners' authority- and 43 states' experience suggest that there should be - let the physician and the nursing boards draft it jointly. Perhaps if their respective boards work together on this issue, it will be a first step toward better relationships between doctors and nurse-practicioners out in the field.

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