Discussion Begins on Two Health Care Bills


Two health care related bills heard today in the Nevada Legislature could change how Nevadans interact with physicians and nurses.

Assembly Bill 170 and Senate Bill 69 would eliminate the required collaboration between licensed physicians and advanced practice nurses, a change that proponents say would improve the accessibility of health care to Nevadans without decreasing the quality of that care.

Assemblywoman Maggie Carlton, who introduced the Assembly bill, said she was initially unsure of removing the requirement, but came to support it after being diagnosed with cancer in 2008 and being treated by advanced practice nurses.

“The system worked for me,” she says. “I don’t see the changes we have in this bill today changing that system at all.”

Advanced practice nurses are nurses who have a post-graduate education in nursing, and are qualified in Nevada to perform most medical diagnoses and prescriptions under the collaboration of a licensed physician. The proposed changes in the bill would eliminate the collaboration between the two and increase the independence of advanced practice nurses.

Both proponents and opponents of the bill agreed that Nevada is facing a health care professional shortfall.  A 2011 study by the Nevada State Office of Rural Health found that the 281,000 residents of rural Nevadan counties were served by only 215 medical doctors, two licensed psychiatrists and 1,350 registered nurses.

AB 170 would follow a change made by more than 20 other states to improve access to health care, lobbyist John Griffin stated in testimony before the Assembly committee of Commerce and Labor.

“There is not a state who has passed this legislation … that has caused any problems or any concerns that needed repeal,” Griffin says. “It’s hard to imagine how Nevada could not benefit from this legislation.”

Cutting the regulations would allow for advanced practice nurses to better serve rural areas by not having to collaborate with physicians, Las Vegas-area nurse practitioner Martha Drohobyczer said.

“There is a lack of access to care, some of which could be eliminated by the ability of an advanced practice nurse without the collaboration of a licensed physician,” Drohobyczer says. “With this agreement, we are tied to a particular person and site.”

According to Nevada State Medical Association representative, Dr. Robin Titus, this movement toward APN independence would lessen patient care by discouraging team efforts among health care professionals. She said the bill would not increase the number of APNs and only serve to isolate them from more effective team approaches.

“Removing the requirement doesn’t produce any more advanced practice nurses than we have now – it just makes the ones we have more independent and isolated,” Titus says. “Being out in a rural area without oversight is a very scary thought to me.”

Though the bill would allow for APNs to practice independently, it would not force them to do so – it neither forces nor prohibits the nurses from working with licensed physicians.

Many of the committee members questioned the claims presented during the hearing, including Assembly Speaker Marilyn Kirkpatrick, who questioned the benefit of opposing the bill for any reason other than patient care.

“If this is about the money, that doesn’t help my constituents,” she says.

Due to the extended nature of the questioning and testimony presented during the hearing, Committee Chairman David Bobzien held an informal demonstration to gauge the bill’s popularity, asking people in the crowded Assembly chamber to stand if they supported the bill. More than two thirds of audience members stood in support.

Categories: HEALTH