Dr. Gilman`s second thought is whether the rules effectively address the proposed risks. To date, the conditions of ASP between nurses and doctors are unknown. In Pennsylvania, agreements are maintained in the nurse`s office, without the need for verification by the State Board of Nursing or the Board of Medicine. At the national level, only the names of cooperating doctors are registered. There is no evidence that the agreements contribute to reducing risk and improving safety or quality. Sometimes a nurse cannot find a cooperating doctor, which can happen in rural and outpatient settings with fewer doctors. The nurse would not be able to enter into practice in the markets that need it most. About 35% of Pennsylvania`s population reports unmet needs for basic services. Although the country has an above-average number of medical students, less than a third of them practice there. Strict professional relaxation requirements, which bind nurses to a limited number of doctors, exacerbate the labour shortage, despite well-established evidence of nurses` safety as basic providers.
Licensing laws define access to health workers and determine the availability of services in a large number of markets. In Pennsylvania, nurses must sign a CPA with two physicians to meet the state`s licensing requirements. The agreement is a written contract that sets out the services a nurse can provide and the conditions for the physician`s participation in care. A nurse without a CPA cannot practice. As Gilman said, ASAs for nurses challenge two principles of competitive representation when it comes to professional admission policy: Do the rules hurt? And does the regulations effectively address the proposed risks? In the absence of justified concerns about patient safety, patients` needs must be taken into account when debating the justification for ASAs. Two nurses who complete the same accredited postgraduate program and pass the same national certification exam are not allowed to offer patient care services in Pennsylvania compared to Maryland, for example. The documented improvement in patient outcomes in countries where nurses` professional licensing is less restrictive is likely the result of improved patient access and not variability in provider training. A signed CPA does not indicate the collaborative services made available to the nurse, if any. The model and frequency of medical cooperation is not standardized by law or regulation. Collaboration with physicians may include on-site case consultation for all meetings with a nurse or co-hearing of patient records. In Florida, the CSA study revealed significant variability in the collaborative services actually provided.
In a national study of nurses, the majority of nurses did not recognize any improvement in the safety or quality of patients on CPA. The revision of the restrictive professional license for nurses is taking place throughout the country, including Pennsylvania. In 2017, Pennsylvania reinstated laws in SB 25 and HB 100 that would allow nurses to practice without a CPA. Another debate on this issue is likely in the context of an aging population, the unmet health needs of Pennsylvanians, and advances in other countries that grant nurses independent practice. . . .