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Mass. House, Senate Differ On Bill Empowering Nurses

The Massachusetts State House and flag. (Jesse Costa/WBUR)
The Massachusetts State House and flag. (Jesse Costa/WBUR)

When the Massachusetts Senate meets Thursday, Democratic leaders expect to pass a bill that would seek to address the threat of a shortage of doctors to care for coronavirus patients by allowing a variety of advanced practice nurses to treat patients without the supervision of a physician.

The expanded scope of practice for nurses would be temporary, according to the bill's author, lasting just long enough to get the Massachusetts health care system beyond the current pandemic.

The bill, however, appears to have long odds of becoming law, with senior House Democrats opposed to the idea of passing a bill to empower nurses when they believe Gov. Charlie Baker, a Republican, could accomplish the same thing by executive order.

"This is what we have heard over and over again from our hospitals and emergency health centers. They need these people in place," said Sen. Cindy Friedman, the co-chair of the Health Care Financing Committee. "I think there's more to be done, and my understanding is the state will need more people, but first and foremost it needs everyone working to the top of their license."

The bill would authorize board-certified nurse practitioners, nurse anesthetists, nurse midwives and psychiatric mental health clinical nurse specialists with at least two years of supervised practice to operate independently from an overseeing physician.

The Board of Registration in Nursing would also be allowed to waive the two-year experience requirement, if necessary. Pharmacists would also be allowed to practice as a parts of teams at hospitals or health clinics.

"As doctors come down with the virus, as they will, we need to make sure there are people who can step in and perform a number of functions," Friedman said. That includes prescribing medicines, ordering tests, and in some cases admitting patients to a hospital.

The legislation was released Tuesday by the Senate Committee on Ways and Means, and is expected to come up for a vote on Thursday when the Senate next convenes. However, even if it does pass, as expected, it's unlikely to reach Gov. Baker's desk because House leadership appears opposed.

"He doesn't need this, and to turn it into law now without vetting it and having both sides agree just sidelines the process and isn't the way we should be working in an emergency situation. We should all be on the same page following the lead of the chief executive," said House Majority Leader Ronald Mariano.

Mariano said he wrote a letter to Friedman outlining his position that Baker has authority under a 1950s law to give nurses the authority to practice independently during a state of emergency.

"We're not going to do it," Mariano said. "I don't think we should be rushing legislation through in reaction to a truly unprecedented crisis."

Friedman said that under the Senate bill the expanded authority for nurses to practice independently would expire 90 days after Baker lifts the state of emergency declaration.

While she said she was aware that the House was not on the same page as the Senate, she said the Senate had briefed the administration and believes the governor supports the effort.

"My sense is the House is not ready to go on this," Friedman said. "We have a difference of opinion on whether it's needed and whether we should be the ones to do it."

"I believe it's absolutely the responsibility of the Legislature to make sure we have statutes in place for scope of practice and we are doing everything we can to make sure people have access to health care providers and they have it with the right ones," Friedman said.

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