Docs, APNs clash on state scope of practice measures

Scope of practice and how much authority advanced practice nurses (APNs) should have are under debate again thanks to proposed legislation in several states. 

A bill in the New Jersey legislature proposes that APNs have the authority to issue death certificates to patients under their care, according to NJ Spotlight.

Garden State doctors who oppose the bill argue they are better suited than nurses to make complex determinations about cause of death, according to the article. APNs counter that doctors are often unavailable to sign off on death certificates in a timely manner.

APNs' training qualifies them to determine cause of death and they often care for patients who die in their homes or hospice care, Judith Schmidt, president and interim CEO of the New Jersey State Nurses Association told the publication. The legislation "will help expedite the process for an already grief-stricken family," she said.

Although physicians value APNs' contributions, doctors have a better ability to deal with increasingly complex ethical decisions, according to Kennedy Ganti, M.D., of Virtua Family Medicine in Mansfield. "We want them on the front lines, but we want to make sure that we have accuracy of diagnosis," he told NJ Spotlight.

In addition, he said giving APNs more authority also disincentivizes a team-based approach, echoing arguments from physicians in New York against a similar bill.

Meanwhile, a proposal by Connecticut Gov. Dannel P. Malloy's (D) administration would allow nurse practitioners (NPs) to treat patients and prescribe medications independently, according to the New Haven Independent. The state would still require NPs work under a physician for three years under the measure, according to the article.

"We'd like to see increased access to healthcare at lower costs, and that's what this will give us," said Anne Foley, undersecretary for policy development and planning at Connecticut's Office of Policy and Management. "We really do feel that the studies are indicative that APRNs can provide comparable outcomes compared to physicians."

To learn more:
- here's the NJ Spotlight article
- read the Independent article