CRNP Independent Practice (SB 25/HB 200)

The Issue:  This bill would allow an “advanced practice registered nurse-certified nurse practitioner” (APRN-CNP) to practice independently in Pennsylvania, providing full medical care without a collaborative agreement or supervision.
 
What YOU can do:  Reach out to your State Representative, especially if s/he is a member of the PA House Professional Licensure Committee and ask them to oppose SB 25 as passed by the Senate.  Explain that all Pennsylvanians, including those in rural and other underserved areas, deserve equally high-quality medical care.  Further, research has demonstrated that granting nurse practitioners license to practice medicine independently has not significantly increased care access in states where this has occurred, as they claim it will in PA (see below).

For more information or ways you can help, please contact Amy Davis (AmyDavisDO@aol.com), PA ACP Health & Public Policy Committee Chair, or Mr. John Nikoloff (John@pa-erg.com).
 
History: The state’s 13,700 certified nurse practitioners have been seeking independent practice for 20 years but did not have significant legislative support until 2017, when the Hospital and Health System Alliance of Pennsylvania changed its policy to endorse this action.  The Coalition of Nurse Practitioners cites their roles in Federally Qualified Health Centers and the Veteran’s Administration as examples of why this would be helpful.  They claim their independent practice would not only expand access to combat the shortage of primary care physicians but also expand care in rural and underserved areas, all with care cost savings, too.
 
SB 25/HB200 Text:  https://www.legis.state.pa.us/cfdocs/billInfo/billInfo.cfm?sYear=2019&body=S&type=B&bn=0025

Prime Sponsor:  Senator Camera Bartolotta

Summary:  As SB 25 stands now, the APRN-CNP license would basically be issued to any CRNP working under a collaborative agreement for a year following graduation from an accredited master’s, post-master’s, or doctoral nursing program in the fields of

  • “family and individuals across the lifespan”,
  • gerontology,
  • neonatology,
  • pediatrics,
  • women’s/gender-related health, or
  • mental health

and having completed a nurse practitioner program that included an examination in one of the above fields.  However, the above restrictions would be waived if the CRNP worked for three years and at least 3,600 hours under a collaborative agreement.  The proposed APRN-CNP license would be renewable every 2 years, requiring 30 credits of Continuing Education (16 of them in pharmacology if prescribing) and maintenance of certification in one of the above fields.
APRN-CNPs would also be permitted to form professional corporations with other licensed healthcare clinicians, including RNs.  Scope of practice would be limited to the nurse’s licensed field.  The APRN-CNP would be required to maintain liability insurance in his/her name but would not be eligible to participate in the MCARE fund.
One of the most often cited reasons in favor of APRN-CNP independent practice is the PA physician shortage, especially in rural areas and for patients having lower incomes.  Recent studies (e.g. Health Affairs, Jun-2018) have demonstrated those populations have experienced increased clinician access in states where Advanced Practice Nurses (APNs) were allowed independent practice.  However, analysis demonstrates these increases were not statistically significant.  The vast majority of newly independent nurses choose to practice in areas already well-served by physicians, presumably for economic reasons.

What Is PA-ACP Doing?:
PA-ACP has been leading the Primary Care Physicians' coalition opposing the independent practice of CRNPs.  CRNPs are an integral component of team-based care, adding a valuable perspective to patient care.  However, their training focus, breadth, and duration do not sufficiently prepare them for independent medical practice.  Mr. John Nikoloff and ERG Partners have been working closely with those in the PA General Assembly (PA House and Senate) on our behalf.  As expected, the State Senate passed SB 25 in a 44-6 vote on 6/12/19.  The State Senators voting against allowing nurses to practice medicine independently include Sens. John Gordner, Jake Corman, Mike Regan, Pat Browne, Kristin Phillips-Hill, and Kim Ward.  We are continuing to work closely with the PA House and Chairman David Hickernell (House Professional Licensure Committee) to ensure all patients get the best possible care.
 
National ACP Policy on NP Independent Practice: ACP advocates strongly for team-based care models and values highly the contributions of nursing as an important part of a quality healthcare model.  However, ACP is opposed to the independent practice of nurses.