North Carolina nurses push lawmakers for changes to health care rules, with doctors opposed

Nurses from across North Carolina gathered in downtown Raleigh Wednesday to push for changes to health care legislation, in particular rallying for legislation that would give advanced practice registered nurses more authority to treat patients — a move supporters say would save on health care costs by cutting down on needless red tape.

That suggestion has long been a top issue for nursing groups, and one that's deeply opposed by doctors' groups, who have succeeded in shooting it down in recent years. Lobbying groups for nurses, doctors and hospitals are often at odds with one another — since changes that could help one group might come at the expense of the others.

Currently APRNs, who have a master’s degree and, in some cases, a doctorate, need a supervising doctor before they can offer patients some services in North Carolina. House Bill 514 would allow APRNs, including certified registered nurse anesthetists, to handle everything they’re licensed to do without supervision from doctors that, they say, is often supervision on paper alone.

Nurses have to pay doctors for supervision under the current rules, and lobbying groups for doctors have spent years fighting against any proposal to undo those rules. Some doctors make tens of thousands of dollars a year from the fees.

The push to undo those rules is backed by the North Carolina Nurses Association and lawmakers from both sides of the aisle, including Sen. Gale Adcock, D-Wake, a nurse. The legislation has been introduced previously under the name the SAVE Act.

The Nurses Association says undoing the rules could save North Carolinians more than $650 million annually on health care spending, while increasing patient access to high quality care — particularly in rural parts of the state, where there are few to no doctors.

“I cannot think of many other bills that could save North Carolina this kind of money while actually improving the healthcare system," said Sen. Ralph Hise, R-Mitchell. "More than 25 other states have already passed APRN full practice authority – and it’s been at least 20 years in some of those states – so I’m tired of hearing all these disingenuous arguments suggesting we need to study the issue a little longer."

The idea is also backed by conservative and liberal political think tanks, as well as nonpartisan groups like the AARP, which wrote on Tuesday: "By getting rid of unneeded regulations, we could increase the number providers in our state, especially in rural communities."

Groups that lobby on behalf of doctors, however, say they're concerned about risks to patient safety by letting people be treated by nurses instead of doctors.

"This General Assembly decided to require physician supervision of nurse practitioners so that people who are experiencing illness can be sure they have the best-trained and most-experienced health care team," North Carolina Medical Society Chief Executive Steve Keene said Wednesday. "To dismantle that the way HB 514 does is not a good idea ... we support healthcare teams that include all providers practicing to the full extent of their training and experience, with physician leadership. "

Several other health care bills passed through various committees Wednesday in the state Senate, including proposed bills on pricing transparency, practicing licenses and more psychiatric beds.

Some of the health care policy changes advancing closer to a vote Wednesday included:

• Senate Bill 177, to add psychiatric hosptials to HASP, a program that gives additional funding to hospitals that are under-billed by Medicaid, if they agree to take efforts to forgive medical debt held by former patients.
• Senate Bill 316, a wide-ranging bill that would upend many laws governing hospitals and their billing practices to require more transparency, more protections from patients against being put into collections for unpaid medical debt, a repeal of some certificate-of-need laws, and more.
• Senate Bill 190, which would streamline the state's rules for physician assisstants to get permission to practice in North Carolina, which supporters say will make it easier for PAs in other states to move here for work.

Gov. Josh Stein kicked off the day with a speech to nurses gathered at the Raleigh Convention Center. He said many of the policy changes they're asking legislators to approve — such as better working conditions — are well-deserved, and he noted that his recent budget proposal suggested that lawmakers put more money into efforts to train nurses and create more jobs in health care.

"You provide critical medical expertise and build meaningful relationships with people who need them," Stein said. "You work day and night to care for North Carolinians who are scared, in pain and at one of the most vulnerable moments of their lives. The work that you do is so important. We want you to succeed. We need you to succeed."