Nurse practitioner changes advanced

Lawmakers gave first-round approval March 24 to a bill intended to address the shortage of primary care providers in rural Nebraska.

Bellevue Sen. Sue Crawford, sponsor of LB916, said the bill would bring the Nurse Practitioner Practice Act in line with the future of collaborative models of health care to achieve the best safety and wellness outcomes for all Nebraska patients.

The bill would remove the requirement for an integrated practice agreement between a nurse practitioner and a collaborating physician. It also would remove the requirement that a nurse practitioner complete a minimum of 2,000 hours of practice under the supervision of a physician.

Crawford said the bill simply would remove a restrictive supervisory requirement that encourages nurse practitioners to leave the state. For example, she said, 70 percent of psychiatric nurse practitioners leave Nebraska to practice in other states and cite practice restrictions as the reason.

“Study after study shows that nurse practitioners provide safe and effective care in other states without this kind of agreement,” Crawford said.

A Health and Human Services Committee amendment, adopted 34-0, replaced the integrated practice agreement with a transition to practice agreement, which is defined as a collaborative agreement between a nurse practitioner and a supervising provider.

Under the amendment, a supervising provider could be a physician, osteopathic physician or nurse practitioner licensed and practicing in Nebraska. The supervising provider must be in the same practice specialty, related specialty or field of practice as the nurse practitioner being supervised.

A nurse practitioner would need to have 10,000 hours of practice to serve as a supervising provider.

Lincoln Sen. Kathy Campbell, chairperson of the committee, said Colorado is the only other state that requires nurse practitioners to have a practice agreement with a physician. She said keeping nurse practitioners in Nebraska is vital because of their focus on primary care specialties.

Syracuse Sen. Dan Watermeier supported the bill, saying nurse practitioners should be supervised by someone who provides the same patient-centered type of health care that they do. The bill’s focus, he said, is on removing unnecessary restrictions on business arrangements.

“This is not really a scope of practice [bill]. … It’s more of a scope of business. We’re not changing one thing about what this health care provider can do for the general public,” Watermeier said. “This is an example of finding a real solution for health care concerns – health care needs – for the state of Nebraska.”

Norfolk Sen. Jim Scheer offered, and later withdrew, an amendment that would have removed nurse practitioners from the list of authorized supervisors under the new transition to practice agreement. He said new nurse practitioners initially should be under the supervision of a physician.

Sen. Mike Gloor of Grand Island opposed the amendment. Gloor said he understood Scheer’s concerns, but argued that the idea of a physician at the top of a pyramid with all other health care providers subordinate to him or her was an outdated way of conceptualizing health care provision.

“It’s not the way we train and practice health care in this day and age,” he said. “It’s a circle with the patient in the middle and all of the providers work as a team to provide care to the patient.”

LB916 advanced to select file 29-2.