Nurses finally get legislative support for independence

Top leadership supports a measure to let some nurses practice without a doctor’s supervision.

Nurses, physician assistants and their supporters vouched for an independent practice bill, even as House Speaker José Oliva was a no-show Wednesday. 

The Floridians Unite for Health Care coalition, with backing from the Associated Industries of Florida (AIF) and the Florida Chamber of Commerce, are supporting a longtime priority for nurses, HB 607. Avon Park Republican Rep. Cary Pigman, a medical doctor, has repeatedly filed the bill, and hopes this is the year it gets the green light.

Now Oliva — expected to show at the rally before a last-minute change — has thrown his support behind it, too. 

“Today, I am here to show my full support for this coalition, a group of advanced practice nurses and forward-thinking businessmen and associations that want to put patients first and improve access to care in Florida,” Pigman said, reading from Oliva’s prepared remarks. 

With Oliva’s backing, expect to see the bill as a bargaining chip in negotiations at the end of the Session. 

Currently, advanced practice registered nurses (APRNs) and physician assistants (PAs) require supervision from a doctor. But Pigman’s proposal would give those practitioners more independence. 

“This supervision can be essentially meaningless,” Pigman said. “At this very moment, at this podium, speaking to you in Tallahassee, I could be supervising nurse practitioners in Miami, Florida.” 

Certified Registered Nurse Anesthetists (CRNA), Certified Nurse Practitioners (CNP), Certified Nurse-Midwives (CNM) and Clinical Nurse Specialists (CNS) would all be affected, in a group of nearly 35,000 licensed APRNs who are working statewide. 

Physicians can charge thousands of dollars per month to offer APRNs and PAs the signatures they need. And Florida is one of the only states with that requirement. 

“You can see how, for some physicians, this is a lucrative business model,” Pigman said, adding that the Florida Medical Association opposes his bill. 

And for Pigman, his legislation in part addresses gender income inequality in STEM careers. The majority of physicians are men while 85% of APRNs are women. 

“This should give our opponents a real gut check,” he said. “Whether or not their dismissal of a large group of qualified and capable professional women is intentional, it is simply not OK.”

AIF president and CEO Tom Feeney said the bill could bring $1 billion in new wages, much of it to STEM careers.

“As Dr. Pigman suggested, a lot of those would be STEM careers for women and minorities of the future as we build our workforce in Florida,” he said. “And we’re excited to have opportunities open up.”

Speaking to reporters following Wednesday’s House session, Oliva lamented the fact that he couldn’t attend the conference. But he will have plenty to say in the coming weeks.

“It’s important that people see there’s a great deal of other folks that this affects very directly and also to hear their voices,” he said.

While the bill does not mandate an increase in funding for rural areas, Pigman believes savings from not paying supervising physicians will benefit underserved communities and rural hospitals.

The bill passed the House Health Care Appropriations Subcommittee last week. It now awaits a hearing in the House Health and Human Services Committee before going to the chamber floor. 

Though the measure has no Senate counterpart this Session, Republican Sen. Jeff Brandes, who filed it last year, said he supports the bill and expects it to gain traction in the Senate. Last year, the House took its major wins on health care and punted on APRN independence.

But Oliva remains confident the bill can pass both chambers without needing to compromise. He’s got the support as-is.

“I feel strongly that the Governor and the President of the Senate will give it its fair shot and we’ll look at the facts for what they are,” Oliva said. “And I think the facts are on our side.”

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