Guest Blog: A COVID Positive for Nurse Practitioner Regulation
North Carolina Representative Gale Adcock, FNP, was gracious enough to share her decades of experience with the below guest blog. A huge thank you to NC Rep. Adcock.
In November 2004 Stanford economist Paul Romer famously said, “A crisis is a terrible thing to waste”. True to his observation, periods of societal turmoil and economic uncertainty have historically stimulated innovation. Magnetic tape recording, nylon and the ballpoint pen were all patented during the 1929-1933 Great Depression. Successful ventures DropBox, Uber, Venmo and WhatsApp launched during the 2007-2009 Great Recession. Crises also provide the impetus to tackle policy changes viewed in stable times as too difficult or even untouchable. The COVID-19 crisis—while distressing and disruptive—also presents opportunities to increase traction for full practice authority (FPA) for nurse practitioners (NPs).
Several states without FPA—including North Carolina—have temporarily waived some restrictive practice rules during the pandemic. NPs who take advantage of this opportunity can show the reasonableness of making such temporary rule changes permanent.
The Current Predicament
North Carolina NPs practice under a 1970s era law that mandates physician supervision and joint regulation by the boards of nursing and medicine, and under rules that define physician supervision as a collaborative practice agreement with a primary supervising physician, require quality improvement process meetings, and place restrictions on prescribing controlled substances. This antiquated regulatory model makes NC one of the most restrictive states in the nation for NP practice. Physician supervision and administrative minutiae like practice agreements and mandatory meetings add no proven value to patient care quality, safety or outcomes. Failure to strictly follow any of the many Rule details can result in investigation and possible disciplinary action, up to and including losing one’s approval to practice. It doesn’t have to be this way.
Nurse practitioners have FPA in 23 states and the District of Columbia. Some states have had FPA for decades (New Mexico and Arizona) while others have passed FPA legislation more recently (Minnesota, Virginia and California). Authorizing NPs to practice to the full extent of their education, certification and experience without physician supervision is supported by decades of research. Economic impact studies in Texas and North Carolina have projected positive state revenue impacts and impressive job creation. In North Carolina, as is true in all states seeking FPA, physician groups vigorously oppose this change.
Patients, Not Paperwork
During its 2020 legislative session, the NC General Assembly passed legislation addressing dramatic economic and operational impacts of the coronavirus. Several bills focused on appropriating $6.5 Billion in federal CARES Act funds required to be spent by December 31, 2020. Others targeted policy tweaks needed during the state’s operational slowdown and social distancing mandates. The first policy bill included recommendations from 4 NC House Covid-19 work groups: education, health care, economic impact, and government operations. I was a member of the health care work group. We had multiple virtual meetings and considered ideas and requests from hospitals, nursing homes, assisted living facilities, home health/hospice, nurses, dentists, pharmacists and other health care providers.
S 704, COVID-19 Recovery Act, passed the House and Senate unanimously on May 2 and became Session Law 2020-3 when signed by Governor Cooper on May 4. Temporary Flexibility for Quality Improvement Plans appears on page 23. This section suspends requirements for certain paperwork for NPs (and physician assistants) with the objective of giving these providers more time to concentrate on providing safe and effective care in a rapidly evolving health care environment.
From May 4, 2020 until December 31, 2021, NPs who were approved to practice as of February 1, 2020:
- Do not have to participate in/document Quality Improvement Process (QIP) meetings;
- Do not have to participate in/document monthly QIP meetings for the first 6 months when they change jobs or otherwise begin practice with a new primary supervising physician;
- Do not have to perform an annual review of their collaborative practice agreement and document this with a signature page;
- Do not have to complete an application or pay a fee to volunteer as an NP.
Some NP employees and NP practice owners may be unaware of these temporary but important changes. Whether an NP is an employee or an employer, there are short and long term gains from taking advantage of these rule exceptions.
In the short term, valuable time and attention can be used to quickly pivot in the planning and delivery of safe, effective, science-based care. Taking the long view, if a large number of North Carolina’s 9000 NPs take advantage of these exceptions while continuing to provide high quality care, it will add strength to our argument that these Rules are unnecessary.
Call To Action
If your practice is unaware of these Rule exceptions and/or unsure how to take advantage of them, it’s time to speak up. Bring the law to their attention, explain the benefits to the practice and providers, and strongly advocate for its use during the allotted time period.
I’m often asked what individual NPs can do to improve the practice environment. It is within the reach of all NPs to take advantage of the Rule exceptions in Session Law 2020-3. Doing this can strengthen our narrative and shorten our journey to FPA.
Gale Adcock is an FNP and member of the NC House of Representatives. For questions or comments contact the author at galeadcock@gmail.com.
Thank you again to Rep. Adcock for her contributions to the State of North Carolina as well as to the nursing profession.