Policy

Prescriptive power of Ohio nurses may change; bill seeks great role for circulating nurses

House Bill 206 would allow advanced practice nurses to prescribe Schedule II controlled substances: highly addictive drugs like oxycodone and morphine. It is among a handful of measures under consideration in the final months of the legislative session that could change nurses’ duties in Ohio. Other items likely to be considered by state lawmakers include legislation to require certain nurses to oversee all surgical procedures in their entirety.

COLUMBUS, Ohio — The state legislature will soon consider — and likely approve — a bill to expand the power of advanced practice nurses (APNs) to prescribe powerful pain medications.

That bill, House Bill 206, is among a handful of measures under consideration in the final months of the legislative session that could change nurses’ duties in Ohio. Other items likely to be considered by state lawmakers include legislation to require certain nurses to oversee all surgical procedures in their entirety.

Legislators return to work on Tuesday after almost a month’s recess.

“What we have to understand is that there is inevitably going to be health care reform nationally, and when you have that kind of expansion, we must change the way we do business in the health-care community,” said Democratic State Rep. Barbara Boyd, who chairs the House Health Committee.

Boyd is also the lead sponsor on House Bill 206 and said she plans to move the bill out of her committee “as soon as possible.” It would allow advanced practice nurses to prescribe Schedule II controlled substances: highly addictive drugs like oxycodone and morphine. More than 30 states have laws that allow APNs to prescribe medications. Ohio’s hesitancy hinges on the addictive nature of the drugs, which makes them ripe for abuse.

The Ohio State Medical Association (OSMA) has opposed the bill — and still does – largely because of that concern. The association wants a provision to specify in what locations, such as hospitals and hospices, APNs could prescribe the drugs.

But interest groups think there have been enough compromises to allow the bill to make it through both General Assembly chambers and on to Gov. Ted Strickland. For example, most legislators agree the final legislation would explicitly keep advanced practice nurses from prescribing these tightly controlled drugs at health clinics run out of convenience stores, like MinuteClinics in CVS drug stores.

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In addition, proponents say the shortage of primary-care doctors has made expanding the power of APNs inevitable. These nurses hold at least master’s degrees, and in almost a dozen states are regularly allowed to take on many of the roles of primary-care physicians. The Ohio Nurses Association says half of the state’s 8,000 advanced practice nurses, in collaboration with doctors, already take on some duties of primary-care physicians.

Withholding the power to prescribe Schedule II drugs  from APNs also degrades the quality of care, said Carol Savrin, director of the master’s program at the Case Western Reserve University College of Nursing. Pediatric nurses often are a primary contact for children who have attention deficit hyperactivity disorder (ADHD) and who need Schedule II drugs. Savrin said it’s critical for nurses involved in hospice care to help cancer patients in severe pain.

“What is really important in the nurse practitioner’s role is relating to the patient, establishing the relationship and developing that relationship,” Savrin noted. “If you can’t treat someone when they are in pain, that trust disappears.”

Boyd points out that last year, similar legislation was moved out of the Health Committee by a 17-4 margin. That indicates that she may have the bipartisan support to win passage of her bill in both legislative chambers. It was passed late in the session and was never voted on.

The Ohio Nurses Association also thinks it has the votes to win passage this year.

Less clear is what could happen to House Bill 205, a measure that would require a circulating nurse — whose job it is to monitor procedures — to oversee all procedures in their entirety that occur in operating and invasive procedure rooms in hospitals and ambulatory surgical centers. That legislation could move through the House Health Committee but would face formidable opposition in the House and Senate.

Both the OSMA and Ohio Hospital Association both oppose the measure, noting that nearly all hospitals already follow such a procedure. They also say that staffing requirements would damage the flexibility to manage patients who have a variety of severe afflictions. And requiring nurse circulators’ presence in invasive procedure rooms could increase staffing costs  for managing minor radiology procedures.

Tim Maglione, the OSMA’s senior director of governmental relations, said such a measure could increase the cost of care without significantly increasing patient safety. “As health care gets more and more expensive, we want to make sure we’re doing things in the most efficient way, and with the most benefit for both quality and cost,” Maglione said.

Proponents of the legislation are concerned about ambulatory surgical centers, where the use of nurse circulators is less consistent. And it’s also not clear how many circulating nurses currently stay for  entire procedures.

“All the time, there needs to be an advocate for the person who cannot advocate for themselves,” legislative sponsor Rep. Tom Letson said.

In addition to those pieces of legislation, nursing organizations had been pushing to make advanced practice nurses part of a proposed scholarship program that would reward physicians who choose to enter primary care, though that change is unlikely to happen.

Nursing interest groups also are watching legislation that would create a form to document medical orders for life-sustaining treatment and make changes to do-not resuscitate orders.

[Front-page photo courtesy of Flickr user prudencebrown21]