Nurse practitioner changes considered

The Health and Human Services Committee heard testimony Jan. 22 on a bill intended to address the shortage of primary care providers in rural Nebraska.

LB107, introduced by Bellevue Sen. Sue Crawford, would remove the requirement for an integrated practice agreement between a nurse practitioner and a collaborating physician and replace it with a transition to practice agreement.

Crawford said the bill was identical to one she sponsored last session, which passed on a 43-0 vote before being vetoed by former Gov. Dave Heineman.

The bill would replace the integrated practice agreement with a transition to practice agreement. The agreement would provide that the nurse practitioner and the supervising provider practice collaboratively within the framework of their respective scopes of practice.

A supervising provider is defined as a physician, osteopathic physician or nurse practitioner licensed and practicing in the same practice specialty, related specialty or field of practice. A nurse practitioner would be required to have 10,000 hours of practice to qualify as a supervising provider.

Crawford said the current practice agreement requirement restricts trade and does not improve patient outcomes – particularly in rural areas. She said there are parts of the state where Nebraskans may be without a primary care provider as a result.

“Small business owners are often unable to find a physician willing to sign an integrated practice agreement,” she said.

Nurse practitioner Kelley Hasenauer testified in support of the bill, saying the change would allow her to provide continuity of care to her patients should anything happen to the physician with whom she has an integrated practice agreement.

Nurse practitioners are skilled clinicians, she said, and the current requirement is an unnecessary barrier to their ability to provide health care access to rural Nebraskans.

“Our outcomes and cost effectiveness are well-proven in study after study,” Hasenauer said.

Cathy Phillips, a psychiatric nurse practitioner in Hastings, also testified in support. Nurse practitioners are the sole health care providers in many counties, she said, and allowing them full practice authority would bring Nebraska in line with 19 other states and the District of Columbia.

“Health care legislation should be evidenced based,” Phillips said.

Richard Blatny of the Nebraska Medical Association opposed the bill, saying nurse practitioners are mid-level providers who lack the necessary hours of clinical training to practice unsupervised. He said patients themselves often do not realize how complicated their cases may be.

“Your constituents – the citizens of Nebraska – expect you to pass bills that protect them, not put them in harm’s way,” Blatny said.

Richard Wurtz, a family medicine physician, also testified in opposition. Physicians and nurses are trained differently, he said, and patients could incorrectly assume that a health care provider has been trained as a doctor if he or she is allowed to practice without supervision.

“You’re opening a Pandora’s box with this bill,” Wurtz said.

The committee took no immediate action on LB107.