AMA meeting: Physician supervision of nurses sought in all practice agreements

Carol E. Rose, MD, said advanced-practice nurses have an important role to play. But it must be a supervised one. [Photo by Peter Wynn Thompson / www.peterthompsonphoto.com]

Annual Meeting 2009

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Chicago -- Citing patient safety concerns, the American Medical Association House of Delegates wants to ensure physician supervision of advanced-practice nurses in practice agreements.

The move comes as APNs continue to play a greater role in addressing access-to-care shortages. Some state laws mandate that nurses practice in collaboration with physicians, often under a written agreement.

While doctors agree that can be a good thing, delegates expressed concern that APNs often interpret the term "collaborative" to give them authority beyond their expertise.

"If we don't address this, it will give additional ammunition to APNs to seek scope-of-practice expansions," said Alfred Herzog, MD, a psychiatrist and an alternate delegate for the Connecticut State Medical Society.

Delegates said any practice agreements should emphasize physicians' roles in leading the health care team.

In response, they directed the AMA to develop advocacy tools to help doctors address practice agreements with nurses and respond to state legislative and regulatory activities on the issue. The Association will support the development of research comparing various physician-nurse practice agreements and their respective effectiveness.

Carol E. Rose, MD, an alternate delegate for the American Society of Anesthesiologists, works regularly with nurse anesthetists, who she said play an important role in patient treatment. "But we have supervision. We talk before a case. I'm there for input ... and I'm called when things happen. That's the way patients get the best care," said Dr. Rose, a Pittsburgh anesthesiologist. "Collaboration the way nurses see it ... is not supervision."

But some delegates worried that a lack of emphasis on cooperation could alienate nurses. "We need to find ways to build bridges with all the other people providing care," said alternate delegate Lynn Parry, MD, a neurologist from Colorado.

Nurses tout new test

The debate hits at a time when some nursing organizations are touting a new doctor of nursing practice certification exam -- backed by the National Board of Medical Examiners -- as comparable to physician testing. The DNP exam relies, in part, on Step 3 of the U.S. Medical Licensing Examination.

Fearing patients could be misled, organized medicine has urged the NBME to spell out the differences between the DNP and physician tests, and then correct nurses' inaccurate claims. "These are not equivalent providers," said American Academy of Family Physicians President and delegate Ted E. Epperly, MD.

But delegates said the NBME has ignored doctors' pleas. A resolution before the house called on the AMA to withdraw representation from the NBME if the testing organization fails to act to safeguard the integrity of the physician licensure process. The resolution also sought to explore other physician testing options.

Because conversations with the NBME are ongoing, the house agreed to refer the issue. Some delegates worried that cutting ties with the NBME could jeopardize physician licensure, particularly with no other option in place.

But the fight is not over, said American Society of Anesthesiologists delegate John B. Neeld Jr., MD. "We have communicated very directly with the NBME and ... we will continue to push them."

The print version of this content appeared in the July 6, 2009 issue of American Medical News.

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