Advance-practice nurses in South Carolina are optimistic that a bill introduced more than a year ago to expand their scope of practice will become law by the end of this legislative session.
And the measure is expected expand health care in rural parts of the state and other areas that suffer from a lack of health care providers.
The bill passed the state Senate on third reading last week and now goes to the House.
Physicians and advance-practice nurses were at loggerheads over the bill a year ago.
But they have since come to an understanding, said Stephanie Burgess, a certified family nurse practitioner, clinical professor and associate dean for practice and health policy at the University of South Carolina College of Nursing.
“The bottom line is that the physician groups ... and the nurse practitioner groups ... have come together to work out a compromise,” she told The Greenville News.
“The state ranks in the bottom of the nation, 44th, in terms of health care outcomes and access, and 33rd in primary care physician supply,” she added. “We need to do something to reach out to rural populations and the underserved.”
Previously, the South Carolina Medical Association opposed the bill.
“Our previous objection was based on concerns for patient safety and the quality of health care,” said Patrick Dennis, general counsel and senior vice president for advocacy and communications at the SCMA. “We feel this particular compromise expands access to care while also maintaining high quality of care standards.”
Supporters of the measure include AARP South Carolina, whose members can have a hard time finding a primary care provider.
“Improving access to primary health care — especially for diabetes and other chronic illnesses — is crucial,” said CEO Teresa Arnold.
“At AARP, we know that nurse practitioners do an excellent job of managing chronic health problems, provide cost-effective care, reduce health care dollars, and reduce hospitalizations,” she added. “According to the Long Term Services and Support scorecard, South Carolina ranks 50th worst in how we regulate nurses.
"Passage of the Nurse Practice Act would go a long way to getting us out of the basement.”
The compromise calls for advance-practice nurses and physicians to work out an agreement that delineates the scope of practice, Burgess said. Nurses would still need to work with a physician, but it would be more of a collaboration with more experienced nurses and more supervision for new nurses, she said.
That was a major sticking point last year.
The measure also eliminates the 45-mile practice area limit for nurses and increases the doctor-nurse ratio from 1-to-3 to 1-to-6, she said.
Both those changes will enable nurses to provide care in underserved areas, Burgess said.
“We have 19 counties with 10 or less primary care physicians, seven with five or less and one — Calhoun — with no primary care physicians,” she said. “And in our primary care practice, we would like to bring another nurse practitioner on to do behavioral health. But because of the ratio, we can’t do that. We maxed out.”
The measure also expands the ability of the state's 2,000 advance-practice nurses and midwives to prescribe Class 2 drugs, certify students as unable to attend school, refer patients to physical therapy and certify patients as handicapped, she said.
Passage of the bill will make a difference to the state, Burgess said.
“It will increase access and improve outcomes for our state and get rid of critical barriers to care," she said. “There’s a lot of momentum and rationale for it. And things aren’t working the way they are.”