Groups representing nurses and doctors met several times over the summer and fall but couldn’t reach a compromise on legislation to allow nurses with advanced training to practice on their own.
The failed negotiations threw the dispute back into the laps of Kansas lawmakers, who don’t appear eager to settle it.
After asking a series of questions at Thursday’s hearing on the nurses’ bill, Sen. Jim Denning, an Overland Park Republican, pointedly told one of its supporters that legislators don’t have the experience “to do what you’re asking us to do.”
The chairwoman of the Senate Public Health and Welfare Committee, Mary Pilcher-Cook, a Shawnee Republican, also has reservations. She said the hearing did little more than “scratch the surface” on a topic that required a lot more study.
“I don’t plan on going forward with this at this time,” Pilcher-Cook said. “I think much more discussion needs to take place.”
Lobbyists for the nurses hope to have more luck with Rep. Dan Hawkins, the new chairman of the House Health and Human Services Committee. Hawkins, a Wichita Republican, has told lobbyists on both sides he’s open to addressing the issue.
But if a bill emerges from either committee, it may not be the one the nurses are pushing. It could be an alternative measure that the Kansas Medical Society and other physician groups plan to introduce next week. That bill would task the Kansas Board of Healing Arts, which regulates doctors, and the Kansas State Board of Nursing with updating the scope-of-practice rules for advanced practice registered nurses, or APRNs.
“We felt if we could establish a process that was fair and allowed us to incrementally start addressing some of these issues in a less combative way, everybody would benefit,” said Jerry Slaughter, executive director of the medical society. “We felt it was time to look at a new approach.”
Several APRNs who attended Thursday’s hearing said the law that requires them to have a signed collaborative agreement with a doctor is preventing them from delivering the primary care they’re trained to provide, especially in underserved rural areas.
“We’re not trying to change the scope of what we do. We’re just trying to remove the barrier that is created by having to find a physician to sign that agreement,” said Merilyn Douglas, an APRN from Garden City who leads the Kansas APRN Task Force.
To doctors, the collaborative agreement isn’t a barrier, it’s a safeguard. Dr. Mary Beth Miller said she had 10,000 hours of training before she set up her practice in the small northwest Kansas community of St. Francis.
“When I started practice, I had that 10,000 hours and I was still shaking in my boots,” Miller said.
Miller said she’s opposed to allowing APRNs to practice independently because they have significantly less clinical training than doctors.
“I just have some real concerns knowing how much I didn’t know, even after 10,000 hours,” she said.
Supporters of the independent practice bill say doctors have little evidence for their concerns. The evidence, they say, is on their side.
“Research published in the New England Journal of Medicine, Health Affairs, Nursing Economics and other well-respected scientific publications has firmly established a link between APRNs and cost-effective, high-quality care,” said Monica Scheibmeir, dean of the Washburn School of Nursing.
It’s that kind of back and forth that could tempt lawmakers caught in the middle to hand the issue off to the boards that oversee doctors and nurses.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
