Commentary by Roy P. Dyson, State Senator, District 29
On Tuesday, April 13, Governor O'Malley signed into law Senate Bill 484, which I sponsored. The new law, Chapter 77, provides that nurse practitioners will no longer need an agreement with a physician to practice in Maryland.
Nurse practitioners are registered nurses with a graduate degree in advanced practice nursing. They provide a broad range of health care services. Those services include: making a comprehensive physical assessment of patients, establishing a medical diagnosis for common short term or chronic stable health problems, ordering, performing and interpreting lab tests, prescribing drugs, performing therapeutic or corrective measures, referring patient to appropriate physicians or other health care providers and providing emergency care. Nurse practitioners provide these services in a wide variety of settings with or without physician supervision.
However, under current Maryland law, a nurse practitioner cannot perform any of those services without a written agreement with a licensed physician. The current law works against providing as much health care as possible and as much access to health care as possible because without a collaborative agreement with a physician, nurse practitioners cannot provide care to patients who need it. Indeed, current law ties the nurse practitioners to physicians, so if a physician leaves a practice for whatever reason, the nurse practitioner cannot see or care for patients until a new agreement is reached.
According to the U.S. Department of Health and Human Services, allowing nurse practitioners to deliver care without a collaborative agreement with a physician expands care to medically underserved areas and provider shortage areas. Southern Maryland is the primary shortage area in Maryland.
It should be emphasized that nurse practitioners do not compete with physicians. Rather, they work hand in glove with the physician. In the ideal circumstance physicians see highly acute patients who exceed the scope of the nurse practitioner, who sees the remaining patients.
When the bill becomes effective on October 1, Maryland will join 28 other states that allow nurse practitioners to work without physician agreement. Not only will the new law provide greater access to health care in shortage areas, it will not cost the state. Instead, it will save money because it eliminates the cost of administrative review of the lengthy agreements and decreases costs to Medicaid. Under the new law, the Board of Nursing will have sole oversight for the nurse practitioners.
There are 3,200 nurse practitioners certified in Maryland. According to the chairperson for the Nurse Practitioner Association of Maryland, the state has lost between 10% and 15% of its nurse practitioners in the past few years. I am hopeful that the new law will attract more nurse practitioners to Maryland.
The new law presents a rare occurrence in law making. It provides a partial solution to increase access to health care, especially in health care shortage areas, and it does not cost the taxpayers any money.