Nurse Practitioner Bill Would Empower Rural Communities

by | May 1, 2019

Legislation to improve access to care and address the primary care shortage in our state is unfortunately being blocked by a handful of state senators who insist on maintaining “business as usual.” The harsh reality is that this approach jeopardizes the health and wellbeing of millions of Floridians, particularly those in rural communities – and the problem is only getting worse.

With time running out, we urge the Florida Senate to pass legislation that would allow fully qualified advanced practice registered nurses (APRNs) to practice independently and provide direct care to patients. Similar policies have been adopted by more than two dozen states and U.S. territories, and it’s time for lawmakers to modernize our laws and address these looming challenges.

Under HB 821, nurse practitioners would be able to serve patients directly without the involvement of a physician, and perform certain medical tasks and functions approved by a state advisory committee of physicians and APRNs. This bill recently passed through the Florida House of Representatives with bipartisan support, but is being stalled in the Senate due to powerful lobbying interests.

By embracing expanded scope of practice for nurse practitioners, lawmakers would directly help many of Florida’s citizens who currently lack access to a regular healthcare provider, including those who live in rural areas where access to care is a major challenge.

This lack of access to primary care physicians is one of the key drivers in increased emergency room visits, and the resulting increase in costs to citizens, hospitals and Medicaid. Under current law, APRNs and nursing clinics face unnecessary barriers from regulation and government red tape, leading some to close, even when there are no other primary care providers in the area.

Something as a somber and significant as signing a Do Not Resuscitate (DNR) order or death certificate can be hindered when a nurse practitioner must find and seek authorization from his or her protocol physician. I can recall one instance when, after an elderly patient with chronic illness passed away, the physician was not available to sign a death certificate. Without a physician’s signature, the deceased’s family had to choose whether to allow their relative to sit in a morgue until the physician returned from vacation two weeks later or pay $4,000 for an autopsy to release the body earlier.

This legislation would address that issue and allow appropriately trained nurse practitioners to practice to the full extent of their training.

APRNs are dedicated and highly trained professionals who care about improving the health and quality of life of their patients – no less so than physicians. With appropriate oversight and safeguards, they are fully capable of accepting greater responsibility for providing care directly to patients without the supervision of a physician. In fact, the National Institutes of Medicine has conducted an exhaustive study of all the available research and concluded that APRNs deliver safe high-quality health care with outcomes equal to that of physicians.

It’s time for Florida to join the mainstream of modern medicine and pass these commonsense reforms. Business as usual just won’t cut it this time.

Susan Lynch is a nurse practitioner and serves as CEO of the Florida Association of Nurse Practitioners. She lives in Deltona.


  1. Jake

    This bill does not make nurse practitioners go to rural areas and it has been demonstrated in states like Arizona, who has had unsupervised practice since 2001, that NPs don’t go rural. You instead would be creating a 2-tier health system with NPs who never worked as a nurse (all online BSN/MSN direct accession programs) that have 500-700 hrs of clinicals which is often just shadowing a doctor or another NP. There is no standardization in NP education and these diploma mill NPs will hurt patients and drive up health care costs unsupervised

  2. Jake

    A better law would be to license assistant or associate physicians like Missouri. These are medical school graduates who did not match into a residency bc there are over 8000 more med school grads than there are residency slots. Florida could require them to collaborate with a board certified family physician in a rural area for 3 years. These physicians who have graduated medical school already have dramatically more education and training than nurse practitioners. Why not fix the physician shortage by actually utilizing physicians that are already trained and ready to care for patients?

  3. Herb

    The points made above deal with safety, a claim medical societies use as excuse to bar nurse practitioners (NPs) or physician assistants (PAs) to full practice. Could the system improve for residency and more guidance to nurses as there is for medical professionals? Of course, that would create an even stronger group of nurse practitioners. The medical society bars NPs and PAs because they would lose REVENUE and good workers. Revenue with contracts of eternal limitation. After a few years of experience all tend to improve and even gain expertise! Many physicians hire and depend on these professionals to make their practices work well and be profitable. What is very contradictory is that, the same ones who claim safety, promote and allow medical assistants do procedures. These professionals are not qualified to do it by law even with direct supervision! NPs and PAs are real collaborators! We need to create a legislation committee where this institution deal with anti competitive professional laws! Why does a physician have control on a professional he/she knows little about? As there are more nurses than physicians, why don’t we govern the medical profession?

  4. Trenee Wimms

    When the requirements for nurse practioner schools and practicing nurse practioners is the same as that of physicians, we can seriously consider independent practice. My Facebook timeline is frequently filled with ads for schools that promise a quick route to becoming an NP- work full time!, go from a bachelors in anything to an NP in 3 years, get for doctorate in 19 months completely on line – I have seen all of these claims and some from reputable universities. How can we trust these graduates to provide quality care when their education may have been sub-par. Medical school is 4 years full time and residency is a minimum of 3 years working 60 plus hours a week to become proficient in a specific specialty. NPs just don’t have that type of training. Yes, they may have been an excellent ICU nurse for 15 years but that does not prepare them to provide primary care or dermatology or endocrinology or a host of other areas in which NPs currently work. Full practice should come with full education. If a person wants to lead the healthcare team, they need to have the appropriate education. All patients deserve that. In the end, this isn’t really about increasing access because NPs don’t need to practice independently to so that. It is about some who want to have the role of a physician without going to medical school and about money. NPs are no more noble than any other group and they see this as an opportunity to increase their earning power and they will do what others do which is work in the location that best suits their lifestyle and pays the most money.

    • Lou

      It is ridiculous to claim that NPs meet the “same requirement that is needed for a graduate MD in Florida to obtain their medical license.” You might as well state that food truck vendors meet the same requirements because they are licensed by the state.

      NPs may provide the “same services” but that doesn’t mean they have anywhere close to the same training or provide them at the same level. They don’t.

      A better route would be paying off the student debt of doctors who will work in these communities, or find top students in these communities and send them to undergrad and D.O. schools. Rural people should not be relegated to second class care, and NPs are not doctors.

      • Anonymous

        I was originally agreeing with Trenee, and morphed my response into a rebuke of Anonymous somewhere along the way.

  5. Anonymous

    The bills we are promoting require a nurse practitioner to have 2,000 of post graduate, post passing Boards supervised practice before applying for independent licensure. This is the same requirement that is needed for a graduate MD in Florida to obtain their medical license.

    The fact is that this practice already takes place in half the country. The research shows NPs deliver safe high quality care and are not a danger to the public. The research shows increases in NPs moving into under served areas and treating under served patients. The research also shows significant decreases in Medicare costs in states that adopt NP independent practice.

    NPs are not the same as MDs, but we can and do provide many of the same services.

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