Healthcare is expensive, it is polarizing, and it is one of the most regulated industries in the world. As one of the biggest issues being tackled at every level of government, it behooves us to look closely at this complex system to identify outdated policies that overcomplicate healthcare and increase costs.Advanced Practice Registered Nurses (APRNs) are some of the low-hanging fruit of healthcare overregulation, but since they are not well understood by the public, the opportunities they provide have gone largely unnoticed. I should know. As a nurse practitioner, I am one of the four types of nurses that make up APRNs (along with clinical nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists).That is why I, along with a bipartisan group of 43 legislators in North Carolina’s House and Senate, have sponsored House Bill 88, the Modernize Nursing Practice Act (its Senate companion is Senate Bill 73). This bill gives North Carolina a chance to address its glaring access-to-care problem while maintaining a high level of safety and reducing costs.The main goal of this legislation is to remove superfluous regulations that force APRNs to be “supervised” by a physician. This requirement can cost thousands of dollars, cost that is passed along to patients without providing any tangible benefit to the patient.Supporters of the status quo would have you believe that physician supervision is a crucial safeguard for patients. To be blunt, it is not at all. Supervising physicians do not have to actually see patients of APRNs or review their treatment plans. In fact, APRNs and “supervising” physicians are not required to be in the same physical location or even talk to each other for months at a time. I personally know an APRN practicing in rural southeastern North Carolina who is “supervised” by a physician in Lake Norman, more than 200 miles away.Using patient safety to cloud the issue masks the reality that APRNs already provide safe and effective care that they are specifically educated and highly qualified to do on their own. Dozens of peer-reviewed studies have shown that when granted Full Practice Authority (regulatory jargon for working without supervision) APRNs provide care that is at least as safe as that of physicians. Even the Institute of Medicine recommends that every state in the country scrap such antiquated regulations.H.B. 88 does not expand the scope of care that APRNs can provide. It does not attempt to turn APRNs into physicians. It simply allows APRNs the authority to do the professional work they already do without unnecessary red tape. When caring for a patient whose health issues go beyond an APRN’s knowledge and skills, the APRN would still refer the patient to the appropriate specialist, just like you would expect any physician to do and just as APRNs already do today.Dr. Chris Conover, a health economist with the Duke Center for Health Policy and Inequalities Research, has studied this issue closely. In 2015, he determined that easing burdensome regulations on APRNs would save North Carolina at least $433 million (and potentially up to $4 billion) per year. Those are staggering numbers that should demand attention on their own, even before you consider the added benefits of increased access while sustaining safety and quality.”North Carolina residents consequently would enjoy better access to care of equivalent or better quality even as the health system sheds some avoidable costs (e.g., hospitalizations) in the process,” said Dr. Conover. “It is rare that any policy change offers gains across all three major dimensions of the North Carolina health system’s performance.”It has been nearly 40 years since legislators updated the Nursing Practice Act in any meaningful way, yet the health care landscape has changed drastically. Current “supervision” regulations are costly, they are unnecessary, and they do not reflect the way we should provide health care in 2017. It is time for North Carolina to pass the Modernize Nursing Practice Act.State Rep. Gale Adcock is a Democrat who represents western Wake County.
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