Scope of Practice is 2014 Legislative Priority

Vital Signs: December 2013/January 2014

State Update

One of the top state advocacy priorities for the MMS in 2014 is scope of practice legislation. Legislation to allow optometrists and podiatrists to perform more complicated medical and surgical procedures and to grant advance practice nurses independent practice will continue to be major concerns for the Society in the coming year.

Among the most concerning of nursing scope of practice bills is legislation that would grant independent practice to nurse anesthetists and nurse practitioners, including prescriptive authority and the ability to order and interpret tests. Physician supervision would be completely eliminated and there would be no limitations in a practice setting.

Other scope of practice bills relate to midwives and nurse midwives, which would allow professional midwives to order and interpret clinical tests and obtain and administer certain drugs and medications. One proposal calls for nurse midwives to be primary care providers, able to practice medicine in any setting and with any patient population.

Psychiatric nurse mental health specialists are also seeking expanded scope of practice, including legal permission to order and interpret tests and prescribe medications.

Scope of practice has been a challenge in the regulatory arena as well. The Board of Registration in Nursing is poised to implement new regulations to allow advanced practice nurses to sign documents previously requiring a physician’s signature, and to allow nurse midwives independent practice. The MMS has been a vocal opponent of these proposed regulations.

The MMS has repeatedly urged the legislature not to expose the public, particularly our most vulnerable patients, to the independent practice of individuals with minimal training and no oversight whatsoever. Independent practice is not the model that has helped nurse practitioners in establishing their profession. Integrated, physician-led teams are the standard of care as well as the model for the future.

Any consideration of independent practice for nurse practitioners must address the lack of public protections required of nursing. Nurse practitioners are not subject to the public protections the legislature has created for the practice of medicine by physicians. Nurse practitioners do not have profiles listing their education, specialties and history of discipline, criminal convictions, or malpractice payments. They are not currently required to use the Prescription Monitoring Program or carry professional liability coverage.

In addition, unlike physicians, nurse practitioners are not subject to mandatory continuing education requirements in specific areas, such as electronic medical records and a host of other legislative mandates.

Nationally, organized nursing has been working very hard to expand scope of practice for the field, but what has been effective in other states is not necessarily appropriate for Massachusetts. The MMS will continue to urge legislators to consider the benefits to the public in maintaining the Massachusetts system of integrating nurse practitioners into a comprehensive health care team and not replace it with a legal framework for the independent practice of medicine by nurses.

—Ronna Wallace
MMS Legislative Consultant

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