California senators are expected to consider a bill in the coming weeks that would haphazardly expand the scope of practice for nurse practitioners (NP). Assembly Bill 890 proposes to give NPs full-practice authority without additional training or oversight. As someone who started his career as a nurse before going back to school to become a physician, I believe this bill as written is a big mistake.
I started on my career path as an EKG technician, working full-time on the night shift in a large 500-bed hospital, while during the day, attending a community college to become a nurse. The nursing program was staged to allow for students to work as Nursing Assistants prior to becoming a Licensed Vocational Nurse after one year, then a Registered Nurse following another year of training and didactics. I completed nursing school, passed the state licensing exams and worked as a RN in intensive care units and emergency departments for the next 14 years. I really enjoyed taking care of my critically ill patients, but I also became aware of how much I did not know at each previous level of expanding responsibility.
As I approached my 30s, my goals expanded. I decided I really wanted to diagnose, initiate, and manage patient care. The large health care foundation where I was employed as a nurse offered to send me to Nurse Anesthetist school — a two-year Master’s Program — to eventually return and work for them. But my sights were set. I wanted to be an ER doctor. So I finished my pre-med studies at the university while working as an ER nurse.
The next several years were intense. I went to medical school, graduated, and started my emergency medicine specialty training. After two years, I decided that anesthesiology was actually the critical care medicine I wanted to practice. After three more years of specialty training, I became an MD anesthesiologist. It is nearly impossible to believe that I would have practiced the same, or as comprehensively, after completing only two years of training to become an advanced practice nurse, instead of completing the seven required to be a specialty practicing medical doctor.
I had to become a doctor to realize that even after all of those many years of my experience as a critical care nurse, I had so much more to learn.
As AB 890 now reads, it shortcuts the time and training it takes to diagnose, initiate, and manage the care of patients. The collaborative care team model has worked very well when led by a specialty trained physician who has oversight (and is ultimately responsible) for the patient care of the advanced practitioners in their practice. This move to grant nurse practitioners independent practice will not increase access to care or close the provider gap, without consequences. Instead, I fear, it will shortchange all of us and our desire for the best medical care possible.
With anticipation that AB 890 will be heard in the Senate in the coming weeks, I urge you to call Sen. Dodd’s office and request that he vote “No” on AB 890. Increasing scope of practice for medical professionals should not be achieved at the cost of patient safety and expertise of care.
Dr. Robert Zellmer
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