Tag Archives: nurses

Task force can’t resolve doctors-versus-nurses turf war

A divisive “turf war” between doctors and nurse practitioners has broken out across Tennessee and a state task force created by state legislators to find common ground has, thus far, only illuminated the depth of the schism, reports The Tennessean.

The dispute centers on exactly what types of treatment can be provided by advanced practice registered nurses (APRN), and under what level of oversight. Tennessee is among the dozen states with the most restrictive scope of practice laws — and the reform debate is a recurring flashpoint in legislative sessions. The nurses contend they are equipped to administer many of the same primary care and preventative treatments as doctors. Further, they point to a growing primary care physician shortage across the region.

Doctors, meanwhile, question whether nurse practitioners can offer the same level of care and have opposed efforts to expand the scope of treatment, preferring legislation to reinforce physician roles in primary care.

The task force created by Sen. Becky Massey, R-Knoxville, and Rep. Jeremy Faison, R-Cosby, was designed to give doctors and APRNs — nurse anesthetists, nurse practitioners, nurse midwives and clinical nurse specialists — a forum outside of legislative session to find consensus on how to reform the rules governing treatment. The resulting recommendations could result in legislation that impacts how Tennesseans receive primary care — a key step toward improving the state’s dismal health.

Yet the debate has devolved into a fight between doctors and nurse practitioners, with both sides becoming entrenched and the task force’s meetings becoming forums for people to air individual frustrations and opinions.

“Reluctantly I say no (we haven’t made progress). We’ve met twice and we’re closer to the beginning than the end,” said Dr. John Hale, a primary care doctor in Union City, who is co-chair of the panel alongside Carole Myers, a registered nurse and associate professor at the University of Tennessee College of Nursing.

Doctors Vs. Nurses Fight Looms in Legislature

By Eric Schelzig, Associated Press
NASHVILLE, Tenn. — The growing demand for medical care that is expected to accompany the full implementation of the federal health care law in January is adding urgency to a Tennessee debate over whether nurses should be allowed to provide more independent care to patients.
Nurses currently see patients in a variety of settings ranging from private practices to retail clinics, but they want to remove a layer of supervision from physicians. Doctors’ groups oppose giving nurses more independence. A legislative fight is on the horizon.
“We’re in the ring,” said Gary Zelizer, who lobbies on behalf of doctors for the Tennessee Medical Association. “We’re warming up, but it’s coming.”
Sharon Adkins, the executive director of the Tennessee Nurses Association, said in an email that her group is “in full support of removing practice barriers and support full practice authority for all health care professionals.”
Adkins said advance practice registered nurses, or APRNs, “give as good or in some cases better care than physicians.”

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Governor Gets 4,500-Signature Petition Urging Medicaid Expansion

A group that advocates expanding TennCare to more of the state’s poor delivered a petition and stated its case to an aide to Gov. Bill Haslam on Wednesday, reports The Tennessean.
A coalition that includes the Tennessee Nurses Association, Tennessee League of Women Voters, Tennessee Health Care Campaign and the Tennessee Justice Center said it has gathered more than 4,500 signatures for an online petition calling on Haslam to offer TennCare services to everyone making 138 percent of the federal poverty level or less.
The cost would be paid in full by the federal government through 2016 and in large measure until at least 2020.
Haslam put off a decision on TennCare expansion in March, saying he wanted to continue negotiating with the federal government for a plan that would let the state offer private insurance to new enrollees. He has said he expects to know whether those negotiations will pay off by the end of summer.
Don Johnson, Haslam’s assistant director for constituent services, accepted the petition on the governor’s behalf and met with several advocates. They argued that expanding TennCare would help those who currently do not have coverage as well as rural hospitals that face service cuts or closure.


Note: News release below.

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Nurses Praise Law Increasing Penalties for Attacks on Health Care Workers

The Tennessean has a feature story on the recently-enacted state law that increases the penalty for assault when the victim is a health care provider, focused on a nurse who was attacked in 2004. The new statute, passed as HB306 and signed by the governor May 13, takes effect on July 1.
An excerpt:
“The law acknowledges our professional role,” said Jill Kinch, president of the Tennessee Nurses Association. “In a way there is a symbolic piece to this. The community is saying, ‘We value you as nurses and we are going to include you with this other profession that has this level of penalty for assault, which is the police officer.’ ”
The fines are not symbolic. People convicted of assaulting health care workers will have to pay up to $5,000 — double the normal fine.
Health care is a dangerous profession. The incidence rate for violence against health care workers is more than triple the rate for all of private industry, according to the Bureau of Labor Statistics. From 2003 to 2009, eight nurses were killed on the job in the United States, and 2,050 nonfatal assaults occurred.

Sen. Ford Denounces ‘Mean and Hateful Nurses’

State Sen. Ophelia Ford told a Senate committee Tuesday that a bill to increase penalties for assaulting health care professionals is “ludicrous,” and said she was treated by “mean and hateful nurses” in recent years.
From the Rick Locker report:
“I’m not telling it all, because it was so horrible you could not even believe it,” said Ford, D-Memphis.
She added later that she was restrained during a hospital stay during which “I didn’t even know where I was.” She said that “there are kind nurses too, and usually they know how to handle themselves.”
Senate Bill 2658, proposed by the Tennessee Nurses Association, would enhance penalties for assault and aggravated assault against health care providers acting in the discharge of their duties. It won narrow 5-4 approval in the Senate Judiciary Committee despite Ford’s objections during a 30-minute debate.
Sen. Doug Overbey, R-Maryville, said federal Bureau of Labor Statistics figures indicate that the health care sector leads all other industries in the number of employees subjected to nonfatal assaults.
But Sen. Stacey Campfield, R-Knoxville, joined Ford in arguing against the bill, saying perpetrators of assault should be punished equally regardless of who the victim is.
…Ford’s long, rambling descriptions of her experiences with extended hospital and nursing home rehabilitation stays starting in 2006 generated the most interest in the room. It was reminiscent of previous eyebrow-raising speeches in which Ford has linked personal experiences to legislation.
“I would not be in your presence today because of mean, hateful nurses, and the lower on the scale they are with the least amount of experience, the worse they are.
“Most of you know I’ve had several illnesses, back in 2008, in and out of the hospital in 2006 and 2007… I cannot tell you the horrific experience I’ve had and it was nurses who were mainly doing these things to me. I knew that such happens but I just didn’t know it was so horrible.”

DA on Shipley-Ford Investigation: ‘Political Hardball, but Not Corruption’

NASHVILLE, Tenn. (AP) — Charges will not be filed against two state lawmakers who used heavy-handed tactics to help three nurse practitioners get their licenses back, the Davidson County District Attorney General said Monday.
Bobby Reynolds II, David Stout Jr. and Tina Killebrew were accused of over-prescribing medications at the now-defunct Appalachian Medical Clinic in Johnson City, where the Tennessee Bureau of Investigation was probing patient deaths. The nurses agreed to the suspensions, but Reps. Dale Ford and Tony Shipley later pressured the Tennessee Board of Nursing to take a second look.
Ford filed a bill to create a committee that would review the board’s disciplinary actions. And Shipley tried to stall legislation that would have extended the life of the nursing board.
Davidson County District Attorney General Torry Johnson said in a news release that Shipley’s and Ford’s actions were questionable, but not criminal.
Shipley said they did nothing wrong.
“There were no questionable tactics on our part,” he said. …”All we asked was that (the nurses) be given a fair and open hearing.”

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Legislators Referee a Nurses-versus-doctors turf war

The latest effort by state legislators to referee disputes between various professional groups concerns whether nurse practitioners, physician assistants and the like can give shots of pain medication that involve an injection near the spine…. or whether a specialized, full-fledged doctor must be on hand to supervise.
So the docs have a bill (HB1896) that would make it illegal for less-qualified medical personnel to handle such a procedure. It passed the Senate earlier this year, but stalled in the House and is being studied in the off season. . TNReport and WPLN have write-ups on the turf war.
From WPLN’s Daniel Potter:
Opponents argue it’s a solution without a problem, saying there’s no evidence of harm. Sharon Adkins directs the Tennessee Nurses Association.
“The board of nursing has received no complaints against nurse practitioners who perform these procedures, nor have malpractice insurance rates raised in anyway.”
But that doesn’t mean they’re always doing as good a job as a specialized pain doctor, argues Graf Hilgenhurst, an M.D. who practices in Smyrna.
“There is a small but real risk of doing serious harm to a patient. There is a much greater risk of squandering healthcare dollars and doing no good.”
Tussles like these test the boundaries between doctors and mid-level providers, and could become more common in coming years. That’s as growing patient demand could lead more to physician assistants and nurse practitioners for care.

House Democratic Caucus Chair Mike Turner says each side is looking out for its own interest.
“We also have to decide ‘Is this a turf battle?’ Because most of the time when we see these bills they’re turf battles. And we have to decide is this a turf battle, or is this actually going to help the people of Tennessee?”
And the role of nurse practitioners and physician assistants is only growing, says Republican Matthew Hill, who chairs the House’s general subcommittee on health.
Hill says the federal healthcare overhaul will make Tennessee more reliant on such midlevel providers to offer all kinds of care. He says that means lawmakers have to make sure they’re well trained for the task.

More Information, Details on Ford-Shipley and TBI Probe

Hank Hayes has done an in-depth look at the interaction between state Reps. Dale Ford and Tony Shipley and state officials with considerable background on the Board of Nursing issues, all now the subject of a TBI inquiry.
Here’s his rundown:
Tennessee state Rep. Dale Ford couldn’t remember the date, but he recalled a meeting in his Nashville office with two top-level state officials to discuss the fate of three nurses suspended by the state Board of Nursing.
The date was March 7, 2011, and in the meeting with Ford were Dale Kelley, Gov. Bill Haslam’s former senior advisor on legislation, and state Health Commissioner Susan Cooper.
The licenses of the three nurses – Bobby Reynolds II, Tina Killebrew and David Stout, Jr. – were suspended by the state nursing board on March 11, 2010 for a “pattern of negligence or incompetence” related to dispensing drugs and contributing to the deaths of two patients at the now-closed Appalachian Medical Center (AMC) in Johnson City.
On May 5, 2011, the state agreed to a consent order reinstating those licenses. It was signed by a state legal counsel, the acting chair of the state nursing board and the nurses’ lawyers.
And now the Tennessee Bureau of Investigation (TBI) is looking into whether state lawmakers committed misconduct advocating for those nurses.
According to a Department of Health (DOH) spokeswoman, the meeting at Ford’s office was scheduled to discuss DOH’s regulatory boards.
But Ford, R-Jonesborough, said he asked Cooper to revisit the nurses’ suspensions.

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TBI Investigating Legislators in Reversing Nurse Licensing Revocation

The TBI is reportedly investigating several state legislators and the state Department of Health about possible “official misconduct and false reporting charges” in the cases of three nurse practitioners whose licenses were revoked for overprescribing drugs, then later reinstated.
WSMV-TV mentions state Reps. Tony Shipley, R-Kingsport, and Dale Ford, R-Jonesborough, in its report and quotes from a Kingsport Times-News article that appeared in May. WTFF and The Tennessean also had short stories reporting the TBI is investigating legislators, but did not name any of lawmakers.
From the WSMV story:
TBI spokeswoman Kristen Helm said the agency is “investigating the facts surrounding the nurses licenses being reinstated to determine if there was any misconduct that rises to a criminal level.”
Tennessee Department of Health spokeswoman Andrea Turner said the department is cooperating fully with the TBI investigation.
“We are providing information and responding to requests as needed to assist in this matter,” said Turner. “It is inappropriate for the department to offer further comment at this time.”
The Channel 4 I-Team spoke with Shipley, who confirmed the TBI is coming to interview him, but he does not think he’s done anything wrong and that the nursing board made the decision to reinstate the nurses’ licenses on their own.
The Channel 4 I-Team has not identified the other lawmakers being interviewed by the TBI.
According to Tennessee Department Health records, the Board of Nursing disciplined registered nurses Bobby Reynolds II, David Stout Jr. and Tina Killebrew last year based on allegations that they had provided substandard care that “caused patients harm, and in the cases of patients T.H. and A.B. contributed to their deaths.” At the time, the three nurses were employed as nurse practitioners at Appalachian Medical Center, 3010 Bristol Highway, Johnson City, according to the Times News.
During a May phone interview with The Times News, Shipley recalled he and state Rep. Dale Ford, R-Jonesborough, were “red-faced furious” with the Board of Nursing upon learning of the situation in late May or early June of last year.
According to the newspaper report, summary suspension orders put them out of a job effective March 11, 2010. Stout and Killebrew’s suspension orders were later set aside in favor of probation, according to minutes from a September 2010 meeting. Terms of their probation included signing of Tennessee Professional Assistance Program monitoring agreements, completion of certain education requirements and payment of costs and fines.
In October 2010, the board affirmed a two-year suspension of Reynolds’ advanced practice certification, voided his multi-state practice privileges and ordered his registered nursing license to be placed on probation pending a Tennessee Professional Assistance Program evaluation. If no monitoring contract was deemed necessary, the order stated probation was not required.
On May 5 of this year, the board finally agreed to retract all disciplinary action taken against the nurses and to restore their licenses to the blemish-free state that existed prior to March 11, 2010. The decision immediately followed the trio’s presentation of petitions citing new evidence concerning the two deceased patients and certain individuals whose testimony factored into the board’s decision to take action against them.