Scope of Practice Debate Moves to Regulatory Process
With a package of bills approved by the General Assembly and signed by the governor, it may seem like the end of the road for changes to the scope of practice of certified registered nurse practitioners (CRNPs).
But the journey is far from over, and the Pennsylvania Medical Society is concerned about where proposed changes could go during the regulatory process.
After intense negotiations, the State Society and CRNPs reached a compromise making relatively modest changes in the scope of practice of these health care providers and, most importantly, not authorizing independent practice models. The law retains physician oversight through collaborative agreements with CRNPs, meaning a physician’s working relationship with and responsibilities toward CRNPs would essentially remain the same.
All parties in the negotiations–the governor, physicians, and CRNPs–said they were satisfied that the measures protected patient safety while improving access to health care.
The CRNPs agreed to the compromises because they added specific services to the list of those they could perform within their collaborative agreements.
However, the State Board of Nursing is drafting regulations removing the ratios of physicians to CRNPs and expanding a CRNP’s authority to prescribe scheduled drugs.
While acknowledging the valuable, integral role that CRNPs play in the health care team, the State Society is concerned about changes that remove, water down, and gloss over existing provisions pertaining to collaboration or physician oversight.
The draft regulations lack an appropriate physician to CRNP ratio protection and appropriate safeguards on CRNP prescribing of controlled substances.
The Society will be addressing these concerns through comments to the regulatory review agencies, the attorney general, and legislative committees during the regulatory review process. The Society also will be working with concerned specialty organizations and other groups to gather research and information.
Once the regulations are published, the Society will inform physicians about the comment process.
Last Updated: 11/5/2007