Contact: Richard Gulla
Tel: 781-434-7101
Email: rgulla@mms.org
Waltham/Boston -- August 7 -- Stating that the proposed regulations ignore significant statutory requirements and pursue a goal of diminished oversight and supervision requirements for nursing, the Massachusetts Medical Society today expressed “in the strongest possible terms” its opposition to proposed changes in regulations for advanced practice nursing in testimony before the Board of Registration in Nursing.
The statewide professional association of physicians said that while it “strongly supports and values the nursing profession and the contributions of advance practice nurses to care in the Commonwealth,” it is concerned that the actions of the Board of Registration in Nursing in proposing the new regulations are significantly “inconsistent with current laws and with the standards of good nursing practice that the Board is created to uphold.”
MMS said it believes the Board seeks to promote a particular vision of contemporary nursing rather than to fulfill its governmental function of overseeing the practice of nursing and implementing statutory changes enacted by the legislature.
Citing Massachusetts laws governing the practice of nursing, MMS said it is “concerned that the nursing board is limiting physician supervision of nurse practitioners other than nurse midwives with little or no statutory basis for this action.” The legislature recently changed statues regarding nurse midwives, allowing them expanded responsibilities, but only as part of a health care system.
In its testimony, the MMS asked the nursing board to “respect the actions of the legislature by enacting regulations that include the full legislative requirements governing nurses and not simply a selective adoption of language which advances the agenda of advocates for independent nursing practice at the expense of the patients of the Commonwealth.”
Among the areas the MMS called into question in its testimony are the following:
Practice Sites and Scope of Practice
The MMS said that, in the absence of a relationship with supervising physicians, it is concerned how the nursing board will oversee nurse practitioners to ensure that they practice in areas of health care that are consistent with their training. Without requiring physician supervision in a related specialty in the ordering of tests and therapeutics, the MMS asked, how will the nursing board assure that nurse practitioners practice in a field consistent with their training?
Delivery of Anesthesia
The MMS supported the comments of the Massachusetts Society of Anesthesiologists (MSA) and said the MSA’s points are well taken, “particularly regarding the lack of clarity in the proposed regulations between prescribing anesthesia and administering anesthesia. The MMS said the existing regulations reflect the law and good clinical practice, while the proposed regulations “leave open the possibility that the nursing board believes a certified nurse anesthetist may administer anesthesia for which no prescription or order has been written.”
Medical Marijuana Certification
The MMS indicated its dismay at the intent of the nursing board to involve nurses in certifying patients for medical marijuana. Citing Massachusetts law Chapter 369 of 2012, the MMS said the existing statute confers responsibility and authority for certifying patients solely to licensed physicians and that such certification shall be made only in the course of a bona-fide physician-patient relationship. The MMS said it strongly opposes the actions of the nursing board in direct contradiction to the plain language of the law.
Citation of Nurse Midwives
The MMS expressed further concern that the nursing board has made minimal references to statutory requirements that nurse midwives must practice in a health care system and have clinical relationships with OB-GYNs. “Regulations should clarify and specify the best practices in implementing legislative language,” the MMS testified, and “clearly the legislature, in lessening supervisory requirements for nurse midwives, meant to do so only for those nurse midwives practicing as part of a team within a system. The Board should honor this important public protection and clarify the meaning of acceptable health care systems and clinical relationships and what they require of licensees. Such areas should not be clarified in case law after patients are adversely affected by poor care.”
Process in Developing Proposed Regulations
MMS also objected to the idea that the nursing board seems to have acted independently of the Board of Registration in Medicine in developing the proposed regulations. Such action, said the MMS, “does not appear to meet the statutory requirement nor meet standards of good and open board responsible governance.” The MMS urged the nursing board to confer with the Board of Registration in Medicine on the proposed changes and to revise them to address the conflicts with state law that it raised in its testimony.
The complete testimony of the Massachusetts Medical Society may be found at www.massmed.org/testimony.
The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.
