On February 10, the Ohio House of Representatives Health and Aging Committee heard testimony from physicians and representatives from a coalition of health care organizations opposed to House Bill 216 (HB 216). The proposed legislation would eliminate the requirement for advanced practice registered nurses (APRNs), certified registered nurse anesthetists (CRNAs) and certified mid-wives to collaborate with a physician and expand their scope of practice. The bill would also allow APRNs to independently prescribe addictive Schedule II drugs from virtually any location and without consulting a physician. The medical groups and physicians believe HB 216 would fragment the team-based care model and jeopardize patient safety.
“Ohio’s physicians value the abilities and contributions of APRNs and all nurses. However, HB 216 goes too far and upsets the collaborative, team-based model of care,” said Tim Maglione, Ohio State Medical Association (OSMA) senior director. “The Ohio legislature has strongly encouraged and supported collaboration when other scope issues were considered. When physician assistants sought to expand their practice and pharmacists moved to revise their consult agreements, the OSMA supported these bills because they recognized the optimal care model based on collaboration.”
“APRNs, CRNAs and certified mid-wives are trained in a significantly narrower skill set than a physician,” said Ami Orr, MD, a pediatrician from Findlay, OH. While many patients can be adequately managed within that narrow range, there will be many occasions when knowledge and experience outside of those skill sets will be required.”
“We continue to be willing to work with the nursing community to improve access for safe and efficient care for all Ohioans using a collaborative model,” said Geraldine Urse, DO, of Columbus, OH, president-elect of the Ohio Osteopathic Association. “We believe there are many provisions in HB 216 that can strengthen the team approach. However, we strongly believe continuing to create and incentivize health care professionals to practice in independent silos is not in the best interest of patients.”
“Administering anesthesia is not only about insuring that a patient is comfortable during a procedure, but also about the management of a patient’s medical problems before, during, and after the surgery,” said Erica Stein, MD, an anesthesiologist from Columbus. “Extensive education and training allow physicians to manage complex medical problems in the operating room, immediately, and safely, when seconds count. I value the assistance of CRNAs in the operating room as we each have our role in the anesthesia care team and that serves the patient best – a team.”
“We believe that APRNs provide a valuable and necessary service working in collaboration with physicians when caring for a patient,” said Steven Schneir, MD, a physician practicing psychiatry in Columbus. “Health care works best when there is a team-based approach to patient care, with multiple health care professionals working together under the direction of a physician. Ohio is moving to more of a team-based and integrated approach to care. By permitting APRNs to practice independently, team-based care is further fragmented.
“I stand before you not only as a nurse and a medical student, but a patient myself, like all of us,” said Elizabeth Snajdar, a licensed registered nurse and first-year medical student from Dublin, OH. “I also speak as a medical student and future physician who has pledged to uphold the principles of the Hippocratic Oath, especially to ‘do no harm.’ Supporting this bill would jeopardize that most important pledge.”
Visit the APRN independent practice legislation page of the OAFP website for more information and resources.