Legislation would let nurses practice independently from doctors in Nevada

By Andrew Doughman

Thursday, Feb. 28, 2013 | 2 a.m.

It's possible Nevada families won't see a doctor when they visit a clinic if a bill in the Legislature passes into law. Instead, a nurse practitioner may be running the show.

The bill would remove the requirement that nurse practitioners must work under the supervision of a doctor.

Nurses say the bill is an important step to improve access to medical care in Nevada at a time when federal health care laws will soon mean hundreds of thousands of newly insured Nevadans may be seeking health care or a health clinic.

“For the average family, it’s going to increase access for people to get care,” said Matthew Khan, a family practice nurse practitioner in Reno and president of the Nevada Advance Practice Nurses Association. “We are removing a barrier.”

He said the bill would mean families would continue to visit clinics, but they might see a clinic owned and operated by nurse practitioners rather than a doctor.

Doctors, however, said this potentially reduces patient safety by removing physician oversight and accountability.

Doctors have more training and education and should lead medical care teams, said Dr. Robin Titus with the Nevada Academy of Family Physicians.

“Nevada physician assistants, nurses and other health care professionals have long worked together to meet patients' needs,” Titus said. “This has been led by a team approach with a physician at the head of the team.”

The bill does not mean nurse practitioners — a subset of nurses who have met a training and certification requirement — will perform procedures they aren’t already doing in accordance with their training.

“I’m going to see pediatrics to geriatrics,” Khan said. “Am I going to do brain surgery? No.”

It also would not stop nurses from working in the physician-led teams doctors advocate.

Nevada would join 17 other states in allowing nurse practitioners to practice independently of physicians.

“Every state that has done this, that has allowed this practice to go forward, it has worked as advertised,” said John Griffin, lobbyist for the Nevada Advanced Practice Nurses Association.

He said no state has repealed the legislation.

An Assembly committee peppered doctors and nurses with questions, trying to discern what was best for the safety of patients.

Doctors said repeatedly that a “team approach” is the best way to deliver medical care.

Griffin argued doctors have a financial incentive to preserve the law that mandates nurses to contract with doctors.

Nurses who operate without direct physician supervision must maintain a financial relationship with a doctor.

“They see a monetary gain,” Khan said. “Of course they do not want to get rid of this.”

This statement spurred a further line of questioning from legislators who became increasingly frustrated with a panel of doctors testifying before the committee.

“If this is about money, neither side wins because my constituents do not win,” said Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas.

Doctors said nurses could end up doing procedures they’re not trained to administer, and independent, nurse-led practices could “fragment” medical care in Nevada.

Assembly Majority Leader William Horne, D-Las Vegas, argued that nothing stops a “rogue nurse” from doing something illegal now, and nothing in the bill stops doctors and nurses from continuing to work together.

“I have not heard anything that this is going to make health care delivery worse,” he said to the panel of doctors. “I think it's subjective opinion on your part that it is not going to solve anything. It actually might. I haven't heard anything compelling that it will make it worse.”

Responding to concerns from doctors that independent nurse practitioners would not refer patients to doctors, Assemblyman David Bobzien, D-Reno, looked up state regulations and said nurses already have the responsibility to refer patients to physicians.

The Nevada State Board of Nursing supports the bill and has no concerns that patients will suffer any adverse effects if the 790 nurse practitioners it regulates were to practice independently of doctors, said Deborah Scott, director of the board.