By: Chase Howard
After more than a year of debate, edits, tabling and lobbying, the Florida Legislature passed multiple bills that would allow advanced practice registered nurses (APRN) to practice independently of physicians, as well as authorize certain pharmacists to test and treat patients for the flu and strep throat, among other conditions.
Prior to passage of these bills, APRNs were required to have some level of physician supervision in order to practice. While in many cases direct supervision is not required, Florida law required that an APRN enter into a supervisory relationship with a Florida licensed physician. Specifically, the providers must draft written protocols regarding scope of practice, as well as provide certain notices to their governing boards and patients. While the requirements vary based on the type of practice, they aren’t difficult to comply with in most cases. Finding a supervising physician outside of that physician’s primary practice, however, might prove to be more difficult than it seems. The requirements also carry certain mileage restrictions, prohibiting supervision outside mile limits based on the level and type of supervision.
In an effort to provide additional healthcare providers to a growing population, the State Legislature sought a solution that would remove such restrictions and provide an opportunity for APRNs to either work either through their own practice or another employer, in rural settings, without supervision requirements. The bills focus on primary care services; however, the bills offer no such limitations for APRNs to practice in other specialties, such as dermatologic or aesthetic settings, like a medical spa. The bills would also expand the scope of services for registered nurses, certified nursing assistant and home health aides, to a certain extent.
While the bill provides for a broad scope, there are certain limitations for APRNs to qualify. To qualify, the providers would need to have completed a graduate level course in pharmacology and have 2,000 hours of supervised practice in the preceding two years. For qualifying providers, they would have the same ability to practice as a licensed physician.
The bills also expand the scope of practice for pharmacists who enter into written agreement with physicians, allowing pharmacists to treat the flu and strep throat, as well as other chronic health conditions.
The new laws will also provide significant funding to help APRNs working in certain settings with school loans.
While physician groups have lobbying against such broad changes, the Legislature moved along on the path towards agreement quickly after the House passed their version of the bills, which sent the proposed bill to the Governor’s desk for signature. Physician groups have expressed concerns over the amount of training, education and experience ARPNs receive prior to practicing. They also fear that most ARPNs will utilize the changes to open a traditional practice, or elective practice, in non-rural areas or areas of severe need.
Within hours of receiving the agreed upon bills, Governor Desantis, wasted no time in signing the bills into law, which seemingly will be in effect immediately. While there will be big changes and opportunities for all healthcare professionals, we await further guidance on the specifics. Our Firm regularly advises on supervision issues and will be prepared to advise on the forthcoming changes, including navigating the changes in supervision and legally compliant practice start-up.
