Nurse Practitioners: End Limits on Providing Care in Pennsylvania

Nurse practitioner Lynn Heard sometimes saw whole families in her office—kids, parents and grandparents showing up together so they didn’t have to find transportation more than once.

“I like that family interaction,” said Heard, 64, who has lived her entire life in Covington Township, outside of Scranton.

But when the doctor with whom Heard had worked for more than two decades left their family practice last spring, she could not find a new physician to sign a collaborative agreement, as required by Pennsylvania law. She had to tell her patients to go elsewhere, even though she was the only provider many of them had ever seen. “It was heartbreaking,” Heard said.

Advanced practice registered nurses (APRNs) like Heard are trained to diagnose and treat patients, but the state requires the oversight of a doctor for them to prescribe medicine. Nurse practitioners say finding one to enter an agreement can be difficult and cost as much as $1,000 a month in fees—and doesn’t help patients.

AARP Pennsylvania and the state’s APRNs are pressing lawmakers to give nurse practitioners full practice authority, as 23 states and Washington, D.C., already do. Most other states have waived or loosened oversight during the coronavirus pandemic.

Bills sponsored by state Sen. Camera Bartolotta (R-Monongahela) and state Rep. Jesse Topper (R-Bedford) to give nurse practitioners such authority failed last year but are expected to be reintroduced this session.

Need for care grows

The pandemic has exacerbated the shortage of primary care providers, especially in rural areas, said Teresa Osborne, AARP Pennsylvania advocacy manager.

“If the need didn’t exist already, it’s even more evident now,” Osborne said. “We can no longer afford to sideline these qualified APRNs from using all their training and skills to provide access to needed care.”

Studies show that nurse practitioners, who have master’s degrees or doctorates, are more likely than physicians to provide primary care to older adults and low-income families.

There are more than 15,000 nurse practitioners in the state. Giving them full practice authority would immediately improve access to care for Pennsylvanians, Osborne said.

Many, like Heard, have worked in the same community for years, said Cheryl Schlamb, president of the Pennsylvania Coalition of Nurse Practitioners.

“We’re invested in our communities,” Schlamb said. “We’re dedicated to where we live.”

They are asking only to be allowed to do what they are trained and licensed to do, she said.

But the Pennsylvania Medical Society, which represents doctors, opposes ending the requirement for physician oversight.

“A collaborative agreement with a physician is not a burden but an assurance that deeper medical expertise is immediately available in the care of patients,” the organization said.

Schlamb said real oversight is often lacking and some nurse practitioners have never even met their collaborating doctors:

“A collaborative agreement is not the same as collaborating,” said Schlamb.

Heard is now a full-time school nurse, but she stays in touch with former patients who still call her, hoping she can see them.

“It’s very frustrating,” she said. “I love taking care of people.”

Hilary Appelman is a writer living in State College.

More on nurse practitioners and their role in health care:

Jo Ann Jenkins: Let's end antiquated laws that limit what nurse practitioners can do