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Florida, Washington Consider Expanding Non-Physician Health Care

April 26, 2019

To meet the growing demand for health care in Florida and Washington State, lawmakers have proposed bills that would expand the scope of services the government allows advanced registered nurse practitioners (ARNP) and physician assistants (PA) to perform

stethoscope and insurance docs

In Florida. H.B. 821 would authorize PAs and ARNPs to practice without the direct supervision of a physician if they meet certain criteria. As of mid-April, the bill was gaining traction in the House but the Senate had not taken it up. The legislative session is scheduled  to end May 3.

In Washington, H.B. 1432 would provide a technical fix to allow ARNPs and PAs hospital privileges. It passed unanimously in both chambers of the legislature and was awaiting the governor’s signature at press time. The bill would become effective 90 days after signing. The website for ARNP United in Washington State says its next focus will be on getting a hearing and vote on payment parity in the 2020 legislative session. 

Response to Provider Shortages

Brandon Miller, a legislative aide for Florida state Rep. Cary Pigman (R-Glades County), who introduced H.B. 821, says the bill is necessary because Florida is experiencing a shortage of primary care providers.

“Our goal is to simply allow ARNPs and PAs the ability to practice to the full extent of their training while providing the same level of quality care as our physician friends carry out,” said Miller. “As Rep. Pigman says, far too often, go in to any emergency department and you’ll see more people waiting to be seen than what the hospital can provide in a timely manner.”

Arlene Wright, an NP in Fort Myers, says it is encouraging that Pigman, an emergency room physician with firsthand experience, is championing the bill.

“He understands because he works with nurse practitioners,” said Wright. “He said anyone opposing this is basically opposing access to care.”

Miller says he is hopeful H.B. 821 will become law. “Things have moved quickly in the past, so I wouldn’t completely count it out yet,” Miller said.

Changing Mindsets

Some opponents of allowing NPs and PAs more freedom to practice claim non-physicians provide less-effective care than M.D.s. Miller says this is not true and patients will benefit if restrictions on NPs and PAs are loosened.

“We believe that is due to two factors: one being the increased advocacy by NPs over the years, and two, when opponents have asked for data that shows decreased outcomes when care is provided outside of physician supervision, none can be brought forth,” Miller said. “We believe this is because none exists.”

Twenty-three states have expanded NPs’ practicing authority so far. 

“I think you have legislators who have listened, and they’ve put aside maybe some of the more emotional rhetoric and scare tactics from lobbyists and really focused on what’s best for the population of Florida,” said Susan Perry, vice dean at the University of South Florida College of Nursing.

Who’s in Charge?

Unlike Florida, Washington has permitted NPs and PAs to practice autonomously for years. Bob Smithing, an ARNP in Kent, Washington, says PAs can effectively deliver some services outside of the direct supervision of a physician.

“No one is really autonomous in health care anymore, but full-authority practice enables us to provide high-quality care to our patients while continuing to work with physicians for specialized care,” Smithing said.

“At the beginning, we had to do a little convincing, because we had no track record, but over time we had a solid referral network,” Smithing said. “There still is a culture that believes a health care team needs to be run by physicians. We believe a health care team needs to be run by the patient. We are advisors that give recommendations, but ultimately, it is the patient’s life. We have to listen to them and listen carefully. You have to be able to listen both verbally and nonverbally, and that is a nursing skill set.”

Community Perspective

Smithing says H.B. 1432, clearing the way for NPs to practice in hospitals, is a step in the right direction.

“We need legislation that will help us to be able to practice to the maximum scope of our licensure,” Smithing said. “If we don’t, then no matter what goes on in the community we won’t be able to provide the care the way we need to.”

Smithing says communities will benefit if NPs and PAs have more freedom to manage patients’ care.

“I have never heard of a physician being driven out of practice because a nurse practitioner opened their doors,” said Smithing. “I have seen communities that have not had their health care needs met now being met because a nurse practitioner opened their doors. If an NP has to work with a physician, they have to work with their model, vision, and oversight, which may not fit the needs of the community.”

“Diversity is good, and that’s what we need in health care,” Smithing said. “We need to bring in different areas of expertise from different licensures and work together and use them.”


Ashley Bateman( from Alexandria, Virginia.


Ashley Bateman writes from Alexandria, Virginia.