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Nursing Board Revamp Referred Back to Committee

Attempts to gut the nursing board and stitch it back together fell apart in the House Thursday after lawmakers from both sides of the aisle asserted the proposal went too far.

The Board of Nursing will dissolve June 30 without some sort of nod from the Legislature to continue setting standards for the profession. But the board has become notorious for butting heads with the General Assembly.

“In the last two years we’ve been round and round from the abuses of our nurses by that board, period,” said bill sponsor Rep. Tony Shipley, R-Kingsport, who wants to revamp the panel and says some of those issues “have been worked out” in his bill.

“There’s absolutely no retaliatory premise in this,” he continued.

Shipley and Rep. Dale Ford, R-Jonesborough, were the focus of a Tennessee Bureau of Investigation probe for pressuring the Board of Nursing last year to rescind disciplinary action against three area nurses the board had punished for allegedly over-prescribing medication. Ultimately, though, the Davidson County District attorney who requested the TBI investigation ultimately concluded the legislators broke no laws.

The board also went toe-to-toe with Hendersonville Republican Debra Maggart in 2009 and 2010. The fight was over the Legislature wanting to expand authority for administering drugs to nursing-home patients, a rule the board for a time refused to enforce, saying it wasn’t safe for the public. Critics of the board said its members were just trying to protect what they regard as their own turf — that the dispute was more about shielding the economic interests of registered nurses than patient safety.

But House lawmakers in the medical profession said they’re worried SB2313’s requirement that members be chosen geographically from the state’s nine congressional districts is too narrow.

“I think that this bill may have some retaliatory intent, and that does concern me,” said Rep. Joanne Favors, the nursing board’s chief defender and herself an experienced nurse.

Selecting members based on where they live, namely outside urban areas, will mean “problems in the future with selecting people who would be the most representative of what we need in this state,” said the Chattanooga Democrat, contending major nursing schools and hospitals reside in the state’s big cities.

Shipley argues the current board is too “Nashville Basin-centric,” and wants to ensure nurses from rural corners of the state are equally represented on the panel. Members of other professional boards with geographic selection rules usually break up the appointments by the three grand divisions.

The governor currently appoints members to the board with help from recommendations by the profession’s interest groups, such as the Tennessee Nurses Association, which also takes issue with the “geographic distribution being that tightly controlled.”

“If we get hamstrung into doing just the congressional districts, we’ll find qualified people, but… it’s incredibly difficult to find people who have the ability to spend time away from their workplace,” said Sharon Adkins, executive director of the nurses association. She said the association is OK with other terms of the bill, such as shortening the amount of time members can sit on the board.

Pharmacist and state Rep. David Shephard, D-Dickson, and Republican Rep. Joey Hensley, a doctor from Hohenwald, also expressed reservations.

Shephard contends the conflict of interest requirements banning members who have a direct or indirect financial interest in health care services would be too stringent given that nurses naturally benefit from the medical industry. Hensley added he disliked the switch that could weight the board more heavily with advanced practice nurses, a classification of registered nurse.

In a narrow 47-44 vote, lawmakers agreed to send the bill back to the Government Operations Committee, with 14 Republicans siding with the Democrats. The measure cleared the Senate earlier this month on a 20-9 vote, so the ball is entirely in the House’s court.

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Lawmakers Refereeing ‘Turf Battle’ Over Pain-Management Care

The question of who exactly should be legally authorized to shoot powerful medications into easily injured areas of the body, like a patient’s spine, dominated talk on Capitol Hill Thursday.

Lawmakers heard testimony from the medical community about rules governing the tricky job of pain management.

Members of a House Health and Human Resources subcommittee are studying the implications of HB1896, a bill that limits when nurse practitioners and other caregivers with advanced training can administer “interventional” pain medications, which are injected within a half-inch of the spinal cord.

Under the proposal, which won committee approval in the Senate but stalled in the House, these nurses would only be able to perform the procedures under the supervision of specialists.

Lawmakers walked away from their four-hour discussion generally in agreement to add government mandates for better training of nurse practitioners, assistants and physicians alike as they try to defuse a war among the competing health care occupations.

“Sometimes though, these are turf battles, and money’s involved. And it’s whether which side is going to end up with the most procedures to make the most money,” said Rep. Mike Turner, the House Democratic Caucus chairman and a member of the panel examining who can perform the pain-management procedures.

“We have to determine which is which, whether this is the best medical procedure or we’re just settling a dispute between two or three occupations,” Turner said. The debate among the medical professionals is “pretty volatile,” he added, with physicians on one side and the nurse practitioners and physician assistants on the other.

“We do not believe that a few weeks of training can possibly equate a three-year residence and a year of fellowship in training,” said Dr. Joe Browder, speaking for the Tennessee Medical Association. The TMA argues that the procedure should be done by doctors, not nurses or assistants.

Opponents of HB1896, including state associations of physician assistants and nurse anesthetists, argue that restricting non-physicians from performing the procedures is anti-competitive and unnecessary. Opponents believe such a move would reduce options for patients at a time when more people will begin seeking health care as Baby Boomers age and the Patient Protection and Affordable Care Act is scheduled to start taking effect.

“This bill is a solution to a problem that doesn’t exist,” said Sharon Adkins, executive director of the Tennessee Nurses Association. “Our focus needs to be on access to the provision of quality patient care, not the pocketbook of the provider.”

The nursing industry is no stranger to debates on Capitol Hill. Last year it went to blows with the Legislature after the state Nursing Board refused to implement new laws regarding lower-level nurses issuing medications in the way the General Assembly intended.

Rep. Matthew Hill, who chaired the subcommittee meeting, called Thursday’s discussions a “starting point.” The Jonesborough Republican said he expects to amend the original bill with an eye toward requiring more extensive training for anyone performing the procedures while hoping the two sides will seek to meet each other halfway.