Since President Barack Obama’s re-election re-affirmed that the Patient Protection and Affordable Care Act will be implemented, many health care providers are struggling with the law’s more practical realities.

It is estimated that an additional 30 million Americans will become eligible to receive health insurance by 2014. In light of the health care profession’s current shortage of providers, advanced practice registered nurses in Michigan are working to pass legislation to expand their practicing rights.

Nursing Prof. emeritus Joanne Pohl, who testified before Michigan state Senate’s Health Policy Committee in June about the issue, said current Michigan regulations do not allow APRNs to practice under their own license. Instead, they must work in collaboration with physicians who are regularly pressed for time and could benefit from greater APRN responsibility.

She added that it has been more than 30 years since any revisions have been made to these regulations.

The legislation would allow APRNs — defined as nurse practitioners, nurse midwives or clinical nurse specialists — to practice under an independent license without a physician’s supervision. She noted that the push to pass the bill is not an effort to eliminate collaboration with physicians, but rather to allow caregivers to decide when that partnership is necessary.

Eighteen states and the District of Columbia recently passed legislation similar to to the policy.

“We believe collaboration is part of professional ethics for every (health) discipline,” she said. “It’s not that we don’t like or agree with collaboration. We think (all health care professionals) should be collaborating when they need to. But they are the ones who professionally know when they need to (collaborate).”

Pohl said the current regulation system likely adds to the financial burdens of health systems because patients may be seen by both a physician and an APRN, which takes time and isn’t always necessary.

She added that data shows the current requirements are not based on evidence that APRNs lack the necessary education to make decisions about prescribing medication or other elements of practicing.

Pohl said all careers the bill defines as APRNs require a master’s degree or higher, and though advanced practice registered nursing is a relatively new profession, the APRNs are constantly working toward self-regulation.

Pohl said APRNs have made significant progress in the last 45 years with regard to self-regulation and that the quality of care provided has been cost-effective, with a high rate of patient satisfaction.

Pohl said the bill is particularly important as more aspects of the Affordable Care Act will be implemented next year. She said regulations that increase the standard of patient care are a priority, since the shortage of health care professionals is not expected to improve quickly.

“You want regulations that protect patients, but the current regulations really don’t do that,” she said.

She added that there is no evidence supporting the fact that patients in Michigan get better care than they would in a state with more progressive regulations of ARPNs.

“We think this would be a real opportunity to increase access to care,” Pohl said.

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