California NP's

Specialties NP

Published

  • Advanced Practice Columnist / Guide
    Specializes in ACNP-BC, Adult Critical Care, Cardiology.

You are reading page 4 of California NP's

LuxCalidaNP

224 Posts

Specializes in Family Practice, Urgent Care, Cardiac Ca.

@ Juan DLC: As always, thanks for your updated info and your insight. It's a disheartening speedbump, but let's hope those Dems decide to vote next time!

Pachinko

297 Posts

I'm afraid it will be amended into meaninglessness, effectively changing nothing. I just hope it doesn't make things worse.

TheOldGuy

148 Posts

Sometimes I hate being right.....

The difference is that the CMA group attacked with vigor while CANP did little to actively and aggressively lobby.....

CMA used fear, uncertainty and doubt - and was successful despite 50 years of evidence...

Despite perfect timing.

Despite tremendous need.

Despite the lack of access that millions of Californians have to quality health care.

How were they able to be successful yet again you ask?

The answer - $$

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

CANP Update:

[TABLE]

[TR]

[TD=class: td1]SB 491 to be Reconsidered

During August 13 Hearing

The Assembly Committee on Business, Professions and Consumer Protection (B&P Committee) will reconsider Senate Bill 491 at its next hearing, taking place Tuesday, August 13, at 8:30 a.m. in Room 447 of the State Capitol.

A live webcast of the hearing will be viewable on the California Channel website.

The measure to permit nurse practitioners in California to practice without physician supervision failed to garner the necessary votes for approval during the committee’s August 6 hearing. The bill’s author, Sen. Ed Hernandez (D-West Covina), requested and was granted reconsideration, providing one more opportunity to secure the committee’s approval and move the bill to the next stage of the legislative process.

Substantive amendments to the bill filed the day before the hearing succeeded in gaining the approval of such organizations as the California Association of Physician Groups (CAPG) and the California Primary Care Association (CPCA), while also prompting the influential American Federation of State, County and Municipal Employees (AFSCME) to remove its opposition. But the amendments were not enough to persuade the powerful California Medical Association, whose representatives continued to raise concerns about patient safety and the ability of nurse practitioners to provide adequate care in an autonomous setting. These arguments resonated with some members of the committee, despite the testimony of other witnesses that cited extensive research showing these fears to be unfounded.

The bill requires eight votes for passage. Of the committee’s 14 members, six voted in favor of the measure and three opposed. The other five members chose not to vote. It is from these five non-voting members that Sen. Hernandez will attempt to procure the remaining two votes needed to move the bill forward, possibly by introducing additional amendments to allay their concerns.

The five non-voting members of the committee were:

Raul Bocanegra (D-Pacoima)

Nora Campos (D-San Jose)

Richard Gordon (D-Menlo Park)

Curt Hagman (R-Chino Hills)

Chris Holden (D-Pasadena)[/TD]

[/TR]

[/TABLE]

...if you live in the jurisdiction of the above lawmakers, make sure you let them know how you feel about this bill.

Pachinko

297 Posts

Anyone want to take a stab at guessing what any proposed amendments would look like?

LuxCalidaNP

224 Posts

Specializes in Family Practice, Urgent Care, Cardiac Ca.

For anyone who is interested, there is a greaet interview with the head of FNP/PA program and Davis and Dr. Finney from CMA on KQES Live, "Forum"

myelin

695 Posts

Looks like in order to get the bill to pass, it was watered down to the point that it is now rendered useless. AARP has removed its support since it no longer will expand healthcare access in California. Depressing as hell. It makes me want to leave once I graduate.

peaceful

291 Posts

Good news today, passed 3rd time in the Assembly. We have a few more weeks to get this baby through. The Appropriations Committee is next up for vote. Then SB 491 goes on to the Assembly Floor which is comprised of 80 members for a vote. If it passes there, will go to the Senate for a final vote. Hopefully then onto the Governor. Deadline is September 13 or will die. Please call everyone you know to call their legislators. It is now crucial for each one of us to call, write, call again. Get your family, your friends to call. We made it this far, we can do this. Now is the time to get involved to make this work.

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Let me chime in on the "watered down" comment and the AARP's withdrawal of support. The problematic amendment is just one statement on the bill and it states that:

A nurse practitioner practicing pursuant to this section shall not supplant a physician and surgeon employed by a healthcare facility specified in subparagraph (A) of paragraph (1) of subdivision (a).

Personally, I don't know how to interpret that statement. "Supplant" is synonymous to "replace". Does the language only apply to nurse practitioners replacing physicians who are employed by healthcare facilities (such as a hospital for instance) but does not bar nurse practitioners from establishing their own solo practice where they are not "replacing" a physician? I would need some explanation of this before I assume things. It's vague to me.

Pachinko

297 Posts

The article I'm linking at the bottom of this post describes some of the changes as follows:

"Hernandez said the amended version of the bill no longer allows nurse practitioners to set up their own offices instead requiring that practitioners work in a “collaborative setting,” such as a hospital, clinic, independent practice association, medical group, skilled nursing facility or accountable care organization."

How they extrapolated this from the language of the bill is beyond me...I don't see that stated explicity. Here is the bill in its entirety:

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491

So this, along with the "supplanting" stuff, makes me think that:

1) NPs can practice "independently" only so long as they are not actually independent (meaning so long as they are in a facility where there are doctors around, even if those doctors are not directly supervising them).

2) NPs cannot "supplant" MDs, meaning that jobs that already employ MDs cannot be reassigned to NPs. Which, interestingly, speaks baldly to one AMA concern that has little to do with patient safety--MDs are afraid of losing their jobs.

I have no idea of whether this bill is good, bad, or meaningless at this point. At best, it's a baby step in the right direction. If it even passes, that is.

Here's the link:

http://www.utsandiego.com/news/2013/aug/13/assembly-nurse-practitioner-independant/

myelin

695 Posts

Ridiculous.

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

The prevailing interpretation is that NP's must be engaged in a team-based or group practice with physicians and can practice "independently" within that environment as long as the 4160 hrs of prior physician supervised practice is completed. Independent meaning no standardized procedures and written drug formularies as we do now. Solo practice is illegal and NP's can basically go to jail if they engage in any sort of competitive practice setting with other physicians and surgeons on their own. This is California politics at its worst. In an attempt to please everyone, the original bill has been chopped and fed to every hungry dog that want a piece for themselves (unions, physician groups, etc). CANP continues to push for this bill to pass. The national NP association (AANP), however, has now not only withdrawn support but is actually opposing this bill.

+ Add a Comment