A bill sought by the Maine Nurse Practitioner Association (MNPA) to eliminate delegation by physicians was accepted by the legislative council for consideration. Anne Perry, a nurse practitioner who is the state representative representing Calais, sponsored the bill. The next steps for this bill include hearings, committee voting and then consideration in the House and Senate.
MNPA and the legislative committee, which includes 10 NP members, has been researching the delegation issue since 2003, said Liz Duke, NP, cochairwoman of the MNPA legislative committee.
The language in question states that "A certified nurse midwife or certified nurse practitioner who is approved by the board as an advanced practice registered nurse may choose to perform medical diagnosis or prescribe therapeutic or corrective measures when these services are delegated by a licensed physician." The paragraph was written in the 1990s, when NPs in Maine were allowed independent practice. "Apparently, some NPs wanted to stay under supervision," Duke says.
"In the interim, what has happened in Maine is that most hospitals, and some other employers, have made delegation a condition of employment," Duke says. But NPs continue to practice within their individual scopes, in collaboration with all the other members of the healthcare team in hospitals. Duke also noted that Maine's Board of Nursing (BON) and Board of Licensure in Medicine have differing definitions of delegation.
"The BON has told us that this means, in their opinion, for example, an adult NP could evaluate and treat children if under delegation. The Board of Licensure in Medicine has told us that they think delegation is being a 'physician extender' and allows NPs to 'do more,' including assisting in surgery without first assist training."
The BON continues to encourage NPs to use a "scope-of-practice decision tree," but MNPA thinks the law's wording puts NP scope at risk, Duke says.
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