PRIORITY LEGISLATIVE ISSUE:
Contentious and complicated bills often times have multiple committee work sessions before potential amendments are finalized, or votes are taken. This Thursday, March 18 will be the second work session on LD 295, the so-called, “Act To Repeal Restrictions That Prohibit Certain Advanced Practice Registered Nurses from Providing Essential Health Care Services.” Bill titles often redirect members of the public from the real intent, contents, and potentially dangerous pitfalls of a bill.
Simply, the bill is a move by the Maine Nurse Practitioners Association to remove any legal requirement that newly graduated nurse practitioners complete any training or have any supervision after graduating NP school. Maine law will still require residency requirements for physicians before receiving a license to practice medicine even though under Maine law—the two professions are deemed functionally equivalent to provide independent patient care.
New laws, or changes in law, should be reserved to resolve an issue of public concern. Proponents have completely failed to identify the reason for changing the law with any factual data or evidence to back claims. The bill is a threat to public safety.
Nurse practitioners claim the current 24-month training and supervisory period is an impediment for APRNs to practice independently in rural Maine, despite the fact they have been able, under Maine law, to do so for over 20 years after the two-year training period.
Lead testimony from a member of the American Association of Nurse Practitioners (AANP) claim NPs who desire to practice in rural and underserved areas do not establish practices in rural areas and leave the state. This, despite the fact, Maine is considered a “full practice state” by the very organization she represents.
The Journal for Nurse Practitioners, the peer-reviewed nursing journal of the same American Association of Nurse Practitioners published a feature article in its November 2020 issue, Nurse Practitioner Post-Graduate Residency Program: Best Practice. The article reveals a “major problem is the shortage of NPs in primary care. This is related to high turnover due to the difficult transition from expert RN to novice NP. The authors determine the importance of residency programs, something not required, nor completed by a vast majority of currently graduating NPS. One other key point from the article:
“Several qualitative studies examined the role transition from student to novice NP; it was concluded that anxiety, stress, role confusion, self-doubt, and isolation were common characteristics found among novice NPs. This can result in professional identity confusion, loss of confidence, and impaired role development. Moreover, NPs report feeling underprepared, and find themselves relying on their prior nursing experience, rather than their NP education and training.”
Proponent claims included, “eliminating this unnecessary barrier will make Maine more competitive in recruiting nurse practitioners to meet our state’s needs,” and “Maine has a dire shortage of both RN and APRN providers.”
· Maine already has one of the highest supply of NPs in the country per capita. Data show Maine ranked sixth in the supply of nurse practitioners per 100,000 residents in the country and the highest ratio of advanced practice psychiatric nurses in the country.
Legislators on the committee and bill proponents claim experienced RNs do not need additional training and supervision after completing a nursing practice educational program. Only one—yes, you read that correctly—ONE newly graduated nurse practitioner or nursing practice student formally submitted testimony on the bill. It urged the committee to vote against LD 295. They wrote, “As a new NP I must say that I personally felt that throughout my education to obtain my masters and certification, our curriculum is weak . . . I found myself lacking basic concepts and foundation, that made me fear entering practice . . . I passed my program in the top 10th of my graduating class.”
American Medical Association research finds “a widening gap in the level of experience of recent nurse practitioner graduates compared to former graduates. In 2008, an RN typically had 8.2 years of experience before entering a nurse practitioner program. Today, nurse practitioner programs enroll RNs more quickly after completing their RN training, with many programs transitioning students straight from an RN to NP degree. This widening gap in experiential training is further exacerbated by an increase in the number of partial or fully online-only nurse practitioner programs, as well as the lack of standardization in clinical training.”
Simply put, the reasons put forth by LD 295 proponents and supportive legislators are not backed by data or evidence. However, one measure used by committee members in discussions with MMA government affairs staff was the number of contacts and comments they have received on the bill. Some have stated, “we’ve heard from more of them so I’m probably going to vote for the bill.” Whether crediting John Godfrey Saxe or Otto von Bismarck for the aphorism, “Laws are Like Sausages. Better Not to See Them Being Made” seemingly was made for LD 295. The public hearing and initial work session web links below will be real eye openers on state legislative process.
The bill text can be found here
The public hearing from Feb 18 can be watched here
All written testimony can be read here
The work session from Mar 04 can be seen here
The bill was covered in a recent Maine Medicine Weekly Update E-newsletters:
Urge Your State Legislators To Oppose The Elimination of Training for Nurse Practitioners (Feb 19)
Committee Delays Debate on Bill to Eliminate Nurse Practitioner Training (Feb 26)
CALL TO ACTION: Committee Strongly Considering Elimination of Nurse Practitioner Training (Mar 5)
While many members have already submitted comments of concern with passing LD 295 into law, it continues to be critically important for patient safety that as many MMA members as possible reach out to your own legislators and legislators on the committee to express your opposition to the bill.
Here are the members of the committee voting on the bill:
CHAIR: Senator Heather.Sanborn@legislature.maine.gov
Westbrook and part of Portland
CHAIR: Representative Denise.Tepler@legislature.maine.gov
Topsham
Senator Stacy.Brenner@legislature.maine.gov
Scarborough/Gorham
Senator Trey.Stewart@Legislature.maine.gov
Numerous towns in Aroostook County
Representative Poppy.Arford@legislature.maine.gov
Brunswick
Representative Mark.Blier@legislature.maine.gov
Limington / Standish (Part) / Buxton (Part) / Limerick (Part)
Representative Heidi.Brooks@legislature.maine.gov
Lewiston
Representative Jonathan.Connor@legislature.maine.gov
Lewiston
Representative Richard.Evans@legislature.maine.gov
Atkinson/ Brownville/ Dover-Foxcroft/ Lake View/ Medford/ Milo/ Orneville Township
Representative Kristi.Mathieson@legislature.maine.gov
Kittery
Representative Gina.Melaragno@legislature.maine.gov
Auburn
Representative Joshua.Morris@legislature.maine.gov
Leeds/ Turner/ Livermore (Part)
Representative Tracy.Quint@legislature.maine.gov
Amity/ Bancroft/ Benedicta Township/ Cary/ Glenwood/ Haynesville/ Hodgdon/ Houlton/ Macwahoc/ Orient/ Reed/ Weston/ Molunkus Township/ Silver Ridge Township/ South Aroostook
Please contact MMA Director of Communications and Government Affairs, Dan Morin at dmorin@mainemed.com or by phone at 207-480-4199 for more information or background on the bill or questions about contacting your respective Maine state legislators and committee legislators in opposition of the bill.
Regular legislative updates on MMA issues of importance can also be found Facebook and Twitter.