APRN Independent Practice Legislation

Advocacy-Alerts-ImageOn May 26, 2016, the Ohio House of Representatives passed House Bill (HB) 216, a bill that makes revisions in the nurse practice act, but no longer grants advanced practice registered nurses (APRNs) independent practice. View a summary of the major provisions introduced in HB 216 and how those provisions changed before the bill passed the Ohio House of Representatives.

The Ohio Academy of Family Physicians, along with a strong coalition of physician associations, was able to convince the House Health Committee that APRNs should continue to be required to have a standard care arrangement with a collaborating physician. A key argument was APRN independent practice undermined the state’s efforts to advance the patient-centered medical home model of care delivery by fracturing the physician-led care team.

The bill will now move on to the Ohio Senate for consideration.

Compromises in the bill include:
  • A provision that would grant APRNs a 120 day grace period in which an APRN could establish a new collaborating physician relationship if their current collaborating physician severed the relationship
  • A provision that raises the APRN-to-physician collaboration ratio from 3-to-1 to 5-to-1
  • A provision that would allow a psychiatric APRN to collaborate with a physician who specializes in family medicine, pediatrics, or psychiatry – which should address any existing difficulty with the state’s 400 psychiatric APRNs finding psychiatrists with which to collaborate
  • Continuation of the Committee on Prescriptive Governance, but with a new, smaller committee structure – three physicians, three APRNs and a pharmacist; the pharmacist would not have a vote
  • Changing the current inclusionary formulary to an exclusionary formula.
The OAFP had strongly opposed HB 216 as introduced for the following reasons:
  • Independent practice for additional health professionals undermines team-based care creating silos and further fragmenting patient care.
  • Physicians have at least 11 years of education and training while APRNs have 5.5 to 7 years. The training of an APRN is more equivalent to a third-year medical student than a primary care physician who has completed an undergraduate degree, four years of medical school, and a three-year residency program. Patients highly value the additional education and training that physicians receive. Surveys show that 90% of patient respondents feel a physician’s additional years of medical education and training are vital to optimal patient care.
  • APRNs would have you believe that independent practice is about access to care and that if given independent practice, APRNs will flock to underserved areas to provide primary care. The truth is there is nothing, under current standard care arrangements, preventing an APRN from going to a rural community right now. Only 12% of APRNs practice in out-patient settings. Most APRNs are practicing in sub-specialties, not primary care; only an estimated 30% to 35% of APRNs practice primary care.
  • If granted independent practice, APRNs would be able to order and interpret diagnostic tests, prescribe addictive narcotics, and develop treatment plans without consulting a physician.
  • The roles of a physician and a nurse are not interchangeable.

OAFP Resources

Other Information and Resources