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Gap Between Nurses, Docs Still Wide In SB 2

September 16, 2014

Legislation giving advanced practice registered nurses (APRN) the power to diagnose and prescribe received its first House hearing this morning, but isn’t necessarily any closer to getting a vote in the House Health Policy Committee.

After hearing more than 90 minutes of testimony on SB 2, Committee Chair Gail HAINES (R-Waterford) said she was struck at how significant the gap between APRNs and physicians still is despite the hard work of sponsor Sen. Mark JANSEN (R-Gaines Twp.). 

Jansen told the House Health Policy Committee that he’s changed the bill more than 20 times since he’s introduced it, but Dr. Rose RAMIRIEZ of the Michigan State Medical Society told the panel she offered Jansen about that many amendments and none have been adopted.

“That was a little disconcerting to me,” Haines said.

Haines declined to handicap the chances of the legislation emerging from her committee by year’s end, when both she and Jansen will be term limited from office. She did agree APRN standards haven’t been addressed in many years and that education requirements and job descriptions should be updated.

But she conceded she still “cringes” at the idea of APRNs diagnosing and prescribing medication. She also said she doesn’t like the idea of APRNs ordering and reading images, something currently reserved for radiologists.

Gaurang Vrindavan SHAH, associate professor of radiology at the University of Michigan, said during the hearing that he’s put in 11 more years of education than a nurse practitioner, but they would be given more powers than radiologists under this bill. 

If SB 2 passed as is, new doctors would have no incentive to stay in Michigan. That would make it difficult to keep the state’s high standard of health care, he said. 

Supporters of the bill Tuesday included Nancy GEORGE, associate professor and assistant for the DPN program at Wayne State University. She said SB 2 would reduce the costs of health care by fully utilizing the abilities of APRNs within their scope of practice. 

APRNs would be able to ease crowded primary care centers, where she said patients are being turned away from services. The bill does not allow nurse practitioners to open their own private practice. 

The bill is modeled after similar laws passed in Idaho, New Mexico and Vermont. In total, 14 other states have passed laws along those lines. 

Jansen started his testimony by putting to rest a rumor that he’s only pursuing this bill because his daughter is an APRN and he’d like to see her personally benefit. 

“That is not only insulting, it’s not true,” said Jansen, saying while she is a registered nurse, she is not an APRN and his personal interest in this issue predates her interest in nursing school. 

He said his concern is in the shortage of primary care providers across the state that is limiting residents to health care services. He quoted a statistic that Michigan is the 46th most restrictive state for APRNs to operate in and it’s time for Michigan to allow them to fully utilize their skills. 

“It’s embarrassing to allow the status quo to continue,” he said. 

Dr. Steve BELL of Newport Internal Medicine agreed Michigan has a “real problem with primary care in this state” but “this isn’t the greatest way to go about changing it.”

Nurse practitioners may not be able to detect the subtle findings that come with years of schooling and he’s concerned “that could get somebody killed.” When is a headache really a tumor, for example? It is only time and experience that can teach you that, he said. 

That said, Bell did concede that about half of his patients are seen by nurse practitioners and he does rely on their judgments.

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