Taking Advantage of a Crisis for Political Gain is Wrong
COVID-19. A virus that no one knew about a few short months ago has now transformed virtually everyone’s life around the globe. One of the most profoundly affected has been the healthcare sector. Some of these changes have been positive. We have seen the red tape cut to allow for easier and broader access to healthcare through telehealth, and a reduction in the burdensome requirements for documentation. The seemingly arbitrary rules regarding how long a patient must be admitted to a hospital prior to discharge to a nursing facility have been waived. There has been massive expansion of medical knowledge and sharing of that knowledge at unprecedented levels. Nurses have come to the support of physicians, and physicians have stood up for proper personal protective equipment for nurses.
Unfortunately, not all change has been good.
The American Association of Nurse Practitioners (AANP) and the American Association of Anesthetists (AANA) have decided to use this time to push their political agenda for the unsupervised practice of medicine through legislation instead of education. But instead of through legislation, these organizations have pushed for unsupervised practice through executive orders, asking state Governors and even the Federal Government to give them immediate independent practice, with no physician necessarily involved.
While many see a national emergency as a time to come together in unity, others will utilize a time of crisis for political gain.
While nurses are in critical shortage in some parts of the country, the AANA has made a statement that they do not endorse the use of certified registered nurse anesthetists (CRNAs) in registered nursing roles. CRNAs, as they often are quick to share, have a one-year requirement of critical care nursing experience prior to entering CRNA school. These skills are critically needed in places like New York City, where critical care nursing shortages have led to an influx of traveling nurses to these areas with crisis pay of $3000-5000 per week.
On the other hand, we are seeing resident physicians who have had no nursing training, step up to train in critical nursing skills. They are going where they are needed, and we applaud those efforts.
Meanwhile, the AANP has successfully lobbied in several states to be granted temporary emergency unsupervised practice for Nurse Practitioners. And they are hoping to make those changes permanent. In Tennessee, on March 19, just days after the Tennessee legislators shut down a bill that would grant Nurse Practitioners independent practice, Governor Lee announced Executive Order 15 which permitted it, in direct contradiction to what Tennesseans and their legislators had expressed was appropriate for their state.
While Physician Assistants (PAs) have largely, until now, been content with their role on the medical team, there are now trending hashtags such as #inittopivot and #PAsneedFullPracticeAuthority in an attempt to utilize the crisis to expand their scope beyond their training. The American Association for Physician Assistants (AAPA) is tracking the states that have waived requirements, although they have not made an official statement of approval or dissent. While PAs have been trained in the medical model and have rotations in multiple specialties, including critical care, emergency medicine, and surgery, these rotations do not provide a basis for unsupervised practice in any specialty.
What has been, and remains, unclear, is how unsupervised practice allows nurse practitioners and physician assistants to contribute to the COVID-19 response in a way that supervised practice did not. Executive orders like this one do not encourage team-based care. Instead, these orders lead to divisiveness. Every team needs a leader and, the vast majority of patients agree, that leader should be a physician.
COVID-19 produces a disease process like none of us have seen before. NPs and CRNAs simply do not have the medical background or education in the basic sciences or advanced pathophysiology to lead the development of treatment protocols or management of these patients. While they will play an important role in nursing and as team members, in a time of crisis, during the largest pandemic we have seen in recent years, the time now is to solidify physician-led care. Lastly, we want to ensure that nurses know that we support them and recognize their efforts, exposure, and sacrifice during this time.