How you can help pass The SAVE Act
I’m frequently asked about the status of North Carolina’s full practice authority (FPA) bill and how NPs can help pass it. Until March 2020 my standard response to the second question was “join NCNA, volunteer for Advocacy Tuesdays, and get to know your state Representative and Senator”. There’s a lot more to say now—thanks to COVID.
When North Carolina received its first round of federal CARES Act money in early 2020, the state legislature passed an appropriations bill to disburse the funds. On the same day, we also passed a policy bill that, among other things, included waivers for certain state regulations.
In response to the statewide crisis, Speaker Moore had appointed a House Select Committee on COVID-19, composed of 4 working groups. I served on the health care working group which met virtually almost weekly for a couple months. It was clear that healthcare providers in all settings were scrambling to stay abreast of changing guidance from the CDC and NC Department of Health & Human Services as scientists learned more about the moving target that was (and in many ways still is) COVID. Based on this feedback, we added our recommendations to a 70-page policy bill that contained recommendations from all 4 working groups. The bipartisan bill passed both Chambers unanimously and was signed into law by Governor Cooper on May 4, 2020. On page 23, in a short section titled TEMPORARY FLEXIBILITY FOR QUALITY IMPROVEMENT PLANS, are important regulatory waivers for nurse practitioners. Although these same waivers apply to PAs, my comments will reference NPs only.
In summary, for NPs approved to practice before February 1, 2020, the waivers prevent the Boards of Nursing and Medicine from enforcing regulations (aka NP Rules) that require Quality Improvement Process (QIP) meetings and annual review/signing of a collaborative practice agreement (CPA). The waivers also prevent the Boards from enforcing NP Rules requiring an application and a fee for approval to practice as a volunteer in response to the COVID-19 pandemic. Originally set to expire at the end of 2021, the waivers have been extended to December 31, 2022, covering a time period of 32 months.
While all NPs must still have a CPA, during the 32-month waiver period NPs who were approved to practice prior to February 1, 2020, and their supervising physicians are exempt from the annual review and signing of the CPA. They are also exempt from holding and documenting QIP meetings—every 6 months for NPs in their current jobs or monthly for 6 months when NPs change jobs or have a change of primary supervising physician for any reason. These exemptions are intended to show that ‘physician supervision’ as defined in NP Rules is meaningless paperwork that adds no value to care or patient outcomes. More than 30 years of research make it clear that advanced practice registered nurses like NPs do not need physician supervision to deliver safe and effective care, consistent with our education and national certification. Full practice authority is not intended to nor does it in any way eliminate the natural collaboration that occurs between NPs and physicians. Collaboration is a natural part of good practice and does not need to be legislated for NPs any more than it does for physicians. As of this writing, 24 states and the District of Columbia have passed FPA legislation. FPA is a best practice in nursing regulation recommended by the National Council of State Boards of Nursing and that our state Board of Nursing is eager to adopt.
This almost 3-year waiver period is an unprecedented opportunity for NPs to create evidence that our state’s current ‘paper supervision’ doesn’t improve patient care and is a burden to individual NPs, the physicians with whom they work, and the institutions who employ them. Even the best-intentioned NP can find it challenging to comply with the paperwork requirements in NP Rules under the best of circumstances, much less during the stress of a pandemic. NPs time and attention should be concentrated on the care of people, not the creation and retention of paperwork.
I urge every eligible NP (everyone approved to practice before February 1, 2020), to take full advantage of these waivers. This is your chance to individually advance The SAVE Act. For NP practice owners this is a straight-forward, easy-to-implement decision. For NPs who are employees in inpatient or outpatient settings, it’s your responsibility to bring the waivers to the attention of decisionmakers in your workplace and to advocate for their implementation. There is a solid business case to be made for eliminating any unnecessary paperwork and red tape that detract NPs and physicians from direct patient care.
We need every bit of leverage possible to pass our FPA bill. What can you do to help pass the SAVE Act? Take advantage of the waivers!
Gale Adcock is an FNP of 35 years who is serving her 4th term in the NC House of Representatives. She is a primary sponsor of The SAVE Act.