With the COVID-19 surge coming, is it finally time to expand practice rights for nurse practitioners? | Tuesday Morning Coffee

April 7, 2020 7:13 am

(Capital-Star file)

Good Tuesday Morning, Fellow Seekers.

Pennsylvania’s nurse practitioners have spent years trying to convince state lawmakers to approve legislation that would allow them to provide medical care without the oversight of a physician.

A bill that would give them that power cleared the Senate last June, and it’s been sitting in a state House committee ever since.

With hospital and health centers facing an unprecedented demand for health care practitioners because of the COVID-19 pandemic, the organization that represents Pennsylvania’s nurse practitioners has called on Gov. Tom Wolf to use his executive power to allow them expanded practice rights — without the standard signed agreements with at least two supervising physicians.

“We have one mission: to care for patients during this COVID-19 pandemic. It is a time for all hands-on deck. Yet there are nurse practitioners today in Pennsylvania who are unable to work due to outdated regulations. We urge Governor Wolf to go one step further, similar to the other governors, to waive the restrictive barriers and put our NPs to work immediately,” Dr. Adele Caruso, the president of the Pennsylvania Coalition of Nurse Practitioners, said in a statement.

Nurse practitioners, who are sometimes referred to as certified registered nurse practitioners or advanced practice nurses, hold graduate degrees, and can provide some of the same services as a physician. They include, according to the coalition:

  • “Ordering, performing and interpreting diagnostic tests;
  • Diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections and injuries;
  • Prescribing medications and other treatments and
  • Managing a patient’s care.”

The state has already loosened some rules for nurse practitioners, including allowing nurse practitioners who are licensed in one practice area to practice in other areas during the pandemic.

The administration also reduced the number of signed agreements that nurse practitioners must have with physicians from the current two, down to one, according to the Department of State, which oversees licensing laws for scores of professions and trades ranging from barbers and beauticians to doctors and nurses.

Governors in five states, including neighboring New York and New Jersey, have signed executive orders allowing full practice rights for nurse practitioners, Caruso’s group said in its statement. A further 22 states “have permanently abolished [the signed agreement] mandate.”

Capital-Star file

The fight over practice rights for nurse practitioners is one of the Capitol’s longest-running legislative battles. The bill that cleared the Senate in June marked the fourth try by nurse practitioners to get their practice rights expanded.

Nurse practitioners argue that the agreements hobble their ability to practice. That’s because nurse practitioners and physicians often work for the same employer.

And when nurse practitioners leave, the agreements are canceled and it can often take months to get a new one in place. In the meantime “their ability to practice is effectively suspended,” the nurse practitioners’ coalition said in its statement.

In its statement, the nurse practitioners coalition notes that the Senate bill, sponsored by Sen. Camera Bartolotta, R-Washington, has the backing of “almost every major health care stakeholder group in Pennsylvania.”

Those groups include the Hospital and Healthsystem Association of PennsylvaniaAARP Pennsylvania, the Pennsylvania Homecare Association and SEIU Healthcare Pennsylvania, the coalition said in its statement.

The highly influential Pennsylvania Medical Society, which represents physicians, has long opposed the bill, contributing to its continued defeat. The society hasn’t changed its mind, even in the midst of the pandemic.

The society’s president, Dr. Lawrence John, told the Capital-Star that “physicians have been focusing on saving lives and protecting health care workers.”

(Photo via

“During these unprecedented times, that requires doctors, nurses and [physician assistants] working together as a team,” John continued. “[Certified Registered Nurse Practitioners] deliver excellent care while working within the health care team, but they do not have the same training as physicians, especially when it comes to treating patients with complex medical needs.”

John added that “During the COVID-19 crisis, removing the statutorily required collaborative agreement will not expand the number of [nurse practitioners] providing care nor will it serve to reduce the impact of the virus. Now is not the time to advocate for clinical changes unrelated to COVID-19.”

In an email, the Wolf administration seemed to suggest that it had gone as far as it could for the nurse practitioners with the waivers it had previously granted.

“Over the past few weeks, the Department of State has requested and been granted by the governor a wide array of temporary licensing waivers for health care professionals in Pennsylvania,” Wanda Murren, a spokesperson for the Department of State, told the Capital-Star. “These waivers offer significant flexibility for nurses, and are described at the links below. The Department has recommended these regulatory waivers under the authority provided by the Governor’s Disaster Declaration, and does not have the authority to waive other requirements that are imposed by statute.”

(WikiMedia Commons)

Our Stuff.
Despite some progress in combating COVID-19, Gov. Tom Wolf hasn’t ruled out extending the current stay-at-home order past its expiration date at the end of AprilElizabeth Hardison reports.

In her ongoing series of interviews with women running for office in 2020, Associate Editor Cassie Miller chats with Ruth Moton, a Black Republican, who’s running against Democratic state Rep. Brian Kirkland in Delaware County’s 159th House District.

Erie County has entered the community spread phase of the pandemic, Erie Correspondent Hannah McDonald reports.

Philadelphia police lieutenant who planned to retire this year is the first city employee to die of COVID-19, our partners at the Philadelphia Tribune report. And the pandemic has sparked an increase in incidents of domestic violence in the city.

Planned Parenthood’s PAC has issued a rare co-endorsement in a western Pennsylvania House race. Our partners at the Pittsburgh Current have the details.

On our Commentary Page today, Wayne Campbell (Party on, Garth! – wait wrong one) of the Pa. State Grange says the COVID-19 pandemic should finally spur the General Assembly to expand high-speed internet access statewide. And Zach Shamberg of the Pennsylvania Health Care Association says lawmakers should do this one thing if they want to help the state’s nursing home heroes. 

Gov. Tom Wolf at a March 12 press conference announcing Pennsylvania’s new COVID-19 response strategies. (Source: Commonwealth Media Services)

The Inquirer
 looks at the Wolf administration’s approach to COVID-19-related prisoner release bills making their way through the General Assembly.
On any Saturday, Pittsburgh’s Strip District is usually packed with tourists and partygoers. Not now. Pittsburgh City Paper tells the story in photos.
PennLive looks at what might happen to State College’s economy if Penn State’s football season gets canceled.
Nearly 50 employees and residents at one Lehigh Valley nursing home have tested positive for COVID-19, the Morning Call reports. Two people have died.

Here’s your #Pittsburgh Instagram of the Day:

Volunteers in Philadelphia are sewing face masks, even as they try to avoid ‘Facebook Jail,’ WHYY-FM reports.
The PA Post looks at the growing push among Pennsylvania Republicans to allow businesses to reopen.
Some pockets of rural America are less vulnerable to economic fallout from COVID-19 — at least for now, reports.
Politico explains how the lack of racial and demographic data is making it harder to fight the pandemic.

What Goes On.
The House gavels in at 11 a.m., the Senate at 1 p.m.
The House Appropriations Committee meets at 9:30 a.m.
The Senate Appropriations Committee meets at the call of the chair.
Time TBD: Daily COVID-19 briefing.

Heavy Rotation.
Here’s a banger from Jess Glynne that had us dancing around the living room last night. It might not be a bad way to start a Tuesday morning, either. It’s ‘Hold My Hand,’ caught live at The Eden Sessions in Cornwall, U.K., in 2016.

Tuesday’s Gratuitous Baseball Link.
Former Detroit Tigers star Al Kaline died Monday at the age of 85Kaline was known as ‘Mr. Tiger,’ for a career that spanned 67 years with just one ball club.

And now you’re up to date.

Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.