The Health Committee of Reference met Dec. 7 to consider a major scope of practice expansion for advanced practice registered nurses proposed by the Arizona Nurses Association and affiliate nursing associations. The committee voted 5-4 to recommend the application go forward.
It is the position of the Arizona Medical Association that the nursing associations’ application poses serious concerns for patient safety. This application was also strongly opposed by the Arizona Osteopathic Medical Association, every major medical specialty society in Arizona, and the Arizona Dental Association. The application has different requests for the advanced practical registered nurses involved – most troubling is the over-arching concept to separate APRNs from physicians as part of the medical team.
It is ArMA’s position that physicians, who are required to complete rigorous extended education to fully understand medical procedures and patients’ conditions, are more fully qualified at the completion of their training than APRNs. They are ultimately held responsible for a patient’s well-being and outcome.
ArMA believes nurses are essential in the delivery of effective health care to patients. ArMA believes that doctors are essential for the best patient care, too, and that is where we see our views diverging from the nursing associations. At its core, the application says that APRNs really don’t need doctors – that APRNs can provide most all aspects of medical care to patients without the involvement of a medical doctor: that they can assess and evaluate a patient’s condition, order all types of diagnostic tests (labs, x-rays, etc.), interpret those test results, perform a diagnosis, create a treatment plan, and prescribe a wide spectrum of drugs and medical devices for that patient. And – implicitly – that APRNs can do all this in a manner that is just as thorough, extensive and comprehensive as a doctor.
APRNs do not have education and training equivalent to a medical doctor or doctor of osteopathy. MDs and DOs have much higher levels of preparation for the care they give, through the rigors of medical school and multiple years of post-graduate internship and resident training and oversight. Doctors are not considered over-qualified and over-trained to give quality medical care to patients. Yet, what the nursing associations have asked is to be given the full range of medical practice duties, and to be treated as doctors when they have fewer qualifications and less ability to carry out those responsibilities. For example, physician anesthesiologists have ten times the hours of clinical training and double the education of nurse anesthetists. There is no comparison. This application request is a recipe for compromising care and increasing the risk of bad outcomes for patients.
The application seeks additional prescribing authority for certified registered nurse anesthetists and clinical nurse specialists. All prescription drugs are complicated and potent. ArMA has serious concerns with the adequacy of CRNAs and CNS’s pharmacological knowledge and the lack of supervised clinical hours to safely justify prescribing privileges.
Currently, Arizona is already facing an opioid epidemic; we rank 12th in the nation for drug overdose death rates, and 12th in prescription misuse and abuse. Fighting drug abuse includes making sure drugs are not over-prescribed by anybody, including physicians. Adding additional less qualified providers to the list of those who may legally prescribe contributes to the problem.
At the hearing, eight of the nine committee members stated on the record that they agreed with many of the serious medical concerns we raised, and wanted to see them addressed. We will continue our dialogue with the APRNs, their nursing associations, and members of the legislature. We cannot compromise where patient care and safety are concerned.
Chic Older is executive vice president of the Arizona Medical Association.