Bipartisan NC lawmakers take another stab at granting nurses more autonomy

Lawmakers in North Carolina took another stab at moving a proposal that has failed multiple times that would grant nurse practitioners more independence in their practice.

While the proposal moved forward in a bill, it was met with reticence from various lawmakers who expressed concerns about potential issues with patient safety and more.

The proposal – tacked to the bottom of House Bill 681 and debated in a Senate health committee — would allow nurse practitioners who meet educational and clinical practice requirements to practice without physician supervision.

To gain this autonomy, these nurses would have to have worked under the supervision of a physician or a qualified nurse practitioner for at least 4,000 hours and not have been disciplined by the Board of Nursing in the past five years.

“This would bring North Carolina into the mainstream of regulation of advanced practice nurses,” said Democratic Sen. Gale Adcock, who is a nurse practitioner from Cary.

Controversy around the new provisions

This new language is akin to language included in another bill filed last year in the Senate and House known as the SAVE Act.

The SAVE Act would have granted full-practice authority for Advanced Practice Registered Nurses. A nurse practitioner is a type of APRN.

It failed to pass either chamber, and bills like it in the past have also failed despite bipartisan support. In 2022, the Senate passed the SAVE Act but the House did not take it up.

Across the country, at least 27 other states have passed similar legislation to the SAVE Act, according to the North Carolina Nurses Association.

North Carolina lawmakers in favor of the act have said it would help expand services in the state, particularly in rural areas.

They’ve also said that advanced nurses are often charged thousands of dollars for supervision services by physicians which amount to little more than a twice-yearly check-in, as previously reported by The News & Observer.

But critics warn against granting too much independence, including Sen. Sydney Batch, a Democratic lawmaker from Apex.

“As an attorney who had an all-day trial on Monday, my paralegals helped me prepare for the trial, but there’s no universe in which they would have been able to actually represent my client effectively in that court hearing, despite the fact that many of them have been a paralegal for years and years and years,” said Batch.

“I think we just need to be very thoughtful about what we’re doing and make sure that the actual patients are being cared for,” she said.

Sen. Joyce Krawiec, a Republican from Kernersville, defended the choice to tack the provisions onto another bill, saying that “the data is overwhelming that there is no safety issue and we’re not the first team on the court.”

Considering this years-long debate, “I think it’s time to stop talking and start doing something … but we have some that aren’t willing to come to the table,” she said.

Against the bill is the North Carolina Patient Safety Association, a group of medical professionals that advocates for physician-led health care.

Last year they spoke out against the SAVE Act, saying that the bill would remove physicians from patient care, risk patient safety and raise health care costs without increasing access to care.

The group has a list on its website of various physician groups, including the NC Medical Society and the NC Society Of Anesthesiologists, that oppose the SAVE Act.

Other provisions in the bill

House Bill 681, in its original format, focused solely on paving the way for the state to join the Interstate Medical Licensure Compact, helping expedite licensure for physicians who want to practice in other states. The original provisions have already passed the House and did not face criticism in the Senate committee on Wednesday.

Sen. Mike Woodard, a Durham Democrat, said he continued “to have a lot of concerns” with the new provisions in the bill and that he wished the original bill could have moved forward alone.

The new provisions “are issues we’ve talked about for over a decade around here” and “we’ve had many conversations in this committee and then on the floor and one-on-one,” but “I feel like this cake is not quite baked yet. So we’re not quite ready to start slicing it up and serving it.”

Among other provisions, the amended bill also would:

▪ require anesthesiologists working with certified registered nurse anesthetists to comply with certain procedures in order to obtain insurance reimbursement, which the bill says are consistent with federal laws.

▪ require in-network health care facilities to notify patients of any out-of-network charges

▪ prohibit most nonhospital health care facilities from charging facility fees.

The amended bill passed the committee and now goes to the finance committee.