Nurse practitioners say veto could dissuade job seekers from Nebraska

Nurse practitioner Colleen Murphy checks Maria Nevarez's ears as part of a physical on Aug. 8, 2011.

LINCOLN (AP) -- The governor's veto of a bill that would have allowed less oversight by physicians of nurse practitioners could limit efforts to attract more of the health care professionals to Nebraska and lessen a shortage of medical services in the state, according to nurse practitioners.

Gov. Dave Heineman vetoed the bill last week, citing concerns for patient safety. Lawmakers had unanimously approved the bill on the last day of the legislative session.

The bill would have removed a requirement that nurse practitioners have an agreement with a physician, who would be available for collaboration or referral if a patient's condition doesn't respond to treatment and requires more of a team-approach.

LaDonna Hart, president of Nebraska Nurse Practitioners, said in some cases, there may not be a physician in the area to sign the agreement. Some physicians are barred in their contracts from signing agreements with someone outside of their organization, and some might feel the agreements increase their liability.

The two health care professionals have to be in the same geographic area, according to law.

Supporters of the bill argued the so-called integrated practice agreement makes it harder to recruit and retain nurse practitioners, who could be a key part of efforts to address health care shortages in rural areas of Nebraska.

"The integrated practice agreement is a barrier to those residing in Nebraska from being able to access health care and the care provided by nurse practitioners, and it is a barrier for the nurse practitioners to provide that care," Hart said.

A study by the University of Nebraska Medical Center found an increase in the number of primary care nurse practitioners in Nebraska between 2007 and 2011, but the growth wasn't fast enough to meet an increasing demand.

Growth was also slower in rural counties than in urban counties, said Jim Stimpson, director of the Center for Health Policy at UNMC.

A separate study found there were fewer primary care physicians in the state than previously reported.

In his veto letter, Heineman and Chief Medical Officer Dr. Joseph Acierno expressed concern about patient safety, writing that "adequate clinical experience is necessary for patient safety."

However, the agreement required between nurse practitioners and doctors in Nebraska isn't demanded in the District of Columbia or 17 states, including neighboring Colorado, Iowa and Wyoming, said Tay Kopanos, vice president of State Government Affairs for the American Association of Nurse Practitioners.

Kopanos said decades of study indicate it's safe for nurse practitioners to practice without such agreements.

Many nurse practitioners haven't been able to move to rural areas because they can't find a physician, Kopanos said.

"It restricts where people can go," she said.

As health care needs grow amid federal-mandated health care insurance expansion, an aging population and more people with chronic diseases, the nation's primary care shortage will only get worse, Kopanos said.

States are becoming more aggressive in recruiting health care providers, and it's going to become more competitive for states to recruit and retain nurse practitioners, she said.

Because the bill was passed on the last day of the session, lawmakers cannot try to override the governor's veto. But Sen. Sue Crawford of Bellevue, the bill's sponsor, said she will address the issue again next session.

"We were disappointed in the veto but we are really excited and we are looking forward to a successful 2015 session," Hart said.

The bill is LB 916.

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