Modernize Nursing Practice Act sparks debate between nurses and physicians

House Bill 88 would eliminate the requirement for nurse anesthetists to sign a collaborative supervision agreement with a physician


RALEIGH — A bipartisan group of state lawmakers discussed House Bill 88 in committee this week, which seeks to update laws regarding the practices of nurses in the state, especially when it comes to administering anesthesia. The Modernize Nursing Practice Act came before the House Health Committee for discussion Wednesday, giving committee members an opportunity to review the bill’s details and listen to public comment both for and against the measure.

“I want to stress: We are not asking for an expansion of the scope of practice for nurse anesthetists in any of this legislation,” said Dobson. “We are not asking for them to be able to do anything that they are not currently authorized to do in North Carolina.”

The section of most public interest would codify in statute the relationship required between nurse anesthetists and anesthesiologists. Currently, the law does not directly address that relationship and courts have deemed its clarification a legislative responsibility. As it stands now, Certified Registered Nurse Anesthetists (CRNA) must sign a supervision agreement with a physician to practice in the state, but the supervision often only means meeting as little as twice a year.

By codifying language that allows CRNA’s to select, order and administer anesthesia drugs, H.B. 88 has drawn the ire of anesthesiologists who feel the act would unwisely loosen supervision to the point of endangering patient safety.

“It eliminates longstanding North Carolina law that protects patients and the public by insuring that a physician supervises a nurse anesthetist when providing anesthesia care to patients,” said Dr. Robert Paul Reiker, a Raleigh anesthesiologist, during the public comment period. “The fundamental education and training of physicians and nurses are different.”

According to Dobson, hospitals in his district and many around the state operate with no anesthesiologist even on staff, and those roles are performed safely and effectively by CRNA’s already without negative effects to patient safety.

Julie George, director of the N.C. Board of Nursing, agrees with the efforts to modernize the nursing act and feels the collaborative supervision agreements is an unnecessary barrier to CRNA practice.

“In order for North Carolina, I believe, to fully reap the benefits of our nursing workforce, updating our regulations is essential,” said George, adding that of all the studies that have examined the issue of nurses administering anesthesia, not one has found a reduction in patient outcomes.

Other proponents of the bill argued Wednesday that anesthesiologists’ opposition to H.B. 88 amounts to mere protectionism, adding that some physicians earn up to $60,000 a year in passive income for sponsoring collaborative agreements with CRNA’s. The bill is scheduled for committee votes this week.


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