House Speaker Oliva adds his heft to the push for enhanced autonomy for nurse practitioners

Nurses and nursing organizations rally at the Capitol in Tallahassee. Credit: Issac Morgan

On the first day of the 2020 legislative session, the “Doctor of the Day” wasn’t a doctor.

Instead, Florida House Speaker Jose Oliva, a Miami Republican, underscored his drive to grant increased autonomy to nurse practitioners – sometimes referred to as advanced practice registered nurses, or APRNs – by selecting one as the chamber’s ceremonial medical professional.

She was Doreen Cassarino, who practices in Naples and holds a doctorate in nursing from Florida Atlantic University.

“This year, Dr. Cassarino enables us to break new ground by serving as the first nurse practitioner of the day,” he said. “Welcome to the Florida House, doctor.”

Cassarino was among a number of nurse practitioners who traveled to Tallahassee on Jan. 14 to observe opening day ceremonies from the House gallery and lend support to Oliva’s initiative.

“It was an honor to have been invited to come to Tallahassee to be recognized by House Speaker Oliva as the first Nurse Practitioner of the Day, a historic day for all of the nurse practitioners across our great state,” she said in an email to the Florida Phoenix.

According to Floridians Unite for Health Care, a coalition of nursing organizations, 30 states and the District of Columbia have passed bills to increase the scope of practice allowed to nurse practitioners, with additional states considering doing the same.

Oliva is pushing legislation, HB 607, that would “authorize APRNs who meet certain criteria to engage in autonomous practice and perform specified acts without physician supervision or supervisory protocol.” The criteria include minimum requirements for clinical instruction or practice under supervision by a doctor.

The bill would also lower restrictions on physician assistants, allowing them to practice independently.

The legislation has cleared two House subcommittees and is awaiting action by its final committee of reference, the Health & Human Services Committee.

Its sponsors include Health Quality Subcommittee Chairman Rep. Cary Pigman, a Republican who represents Glades, Highlands, Okeechobee, and parts of St. Lucie counties.

A related bill that focuses on physician assistants, SB 584, was filed in the Senate on the first day of session.

Pigman, an emergency room doctor, joined several nurses wearing white coats from across Florida on Wednesday for “Nurses Day” at the Capitol and told reporters that APRNs are 85 percent women.

“It’s a blessing that an issue I feel so passionate of is shared by the speaker,” Pigman said, adding: “Not one study has shown that they [nurse practitioners] are unsafe.”

Access to health care in rural areas is often difficult, nursing coalition members argued.

“We are excited that House Bill 607 provides the opportunity to increase access to safe and quality care for all Floridians,” said Nicole Livanos, senior associate in state advocacy and legislative affairs for the National Council of State Boards of Nursing. She also speaks for Floridians Unite for Health Care.

“The states that have lifted restrictions on APRNs have experienced increased access to care and cost savings to their health care systems. Florida deserves those same benefits,” Livanos said.

Existing law requires nurse practitioners to work under the supervision of medical doctors.

“Florida law requires APRNs to practice under a supervising protocol with a physician and only to the extent that a written protocol allows,” a staff analysis of the bill says.

That document notes that Florida suffers a deficit of primary, dental, and mental health care professionals in 735 “primary medical health professional shortage areas,” defined as localities with population-to-physician ratios greater than 3,000 to 1. To erase those deficits, the state would need to add 1,608 primary care, 1,230 dental care, and 376 mental health practitioners.

The legislation’s advocates argue that nurse practitioners could help to fill the breach.

“It is important to allow all practitioners to practice to the full extent of their education and training, and not place arbitrary restrictions that harm those who need access to health care the most,” Livanos told the Florida Phoenix.

Cassarino said in a written statement: “I thank the House speaker for supporting legislation this session that would allow APRNs the ability to practice to the full extent of our education and training. I am hopeful the members of the Legislature can come together this year and pass this good bill that would help increase access to care for the betterment of Florida patients.”

Nurse practitioners undergo more training than do registered nurses. According to Nurse.org, an online resource for nurses and nursing students, they qualify to prescribe medication, examine patients, diagnose illnesses, and provide treatment, much like physicians do.

However, not everyone supports the legislation. It drew a lukewarm response from Gov. Ron DeSantis when questioned by reporters following the opening day speeches.

“The devil’s in the details on some of this stuff in terms of what you’re trying to do,” DeSantis said at the time. “Obviously, I want people to be able to earn a living and do well but, at the same time, there’s no easy solution for something if someone is practicing outside of their education. So, I’m willing to look to see what they’re proposing and then we’ll go from there.”

The Florida Medical Association, representing doctors, has opposed this and similar proposals for years. Its representatives did not respond to multiple requests from the Phoenix for comment. As long ago as 2014, the organization disputed a Florida TaxWatch report endorsing greater autonomy for nurse practitioners, then seen as an alternative to Medicaid expansion.

“We are not surprised by their opposition,” Livanos said. “Physicians often collect a significant fee for entering into supervisory agreements with APRNs. Numerous studies and surveys demonstrate how profitable these restrictive regulations can be for physicians’ bottom lines, without demonstrating any benefit to patient care.”

“We are hopeful the Florida Legislature will see past the FMA opposition and vote for greater access to care and a stronger Florida economy.”