The COVID-19 Pandemic

Scope of Practice Expansions in Florida

The Florida Legislature has passed three bills that expand the scope of practice for pharmacists and advanced practice registered nurses. These bills were a top priority for House Speaker Jose Oliva (R-Miami Lakes), however, some of this legislation has not been welcomed by everyone in the healthcare community. For decades, scope of practice expansions have been vehemently opposed by the American Medical Association and Florida Medical Association, and they believe patients will be put at risk with this new legislation.

Expansions for Pharmacists

House Bill 389, sponsored by Rep. Tyler Sirois (R-Merritt Island), authorizes licensed pharmacists to enter into a collaborative pharmacy practice agreement with a physician to manage chronic conditions such as arthritis, asthma, chronic obstructive pulmonary diseases, Type 2 diabetes, HIV/AIDS, obesity or any other chronic condition. The bill also allows pharmacists to test and treat minor health conditions such as the flu, strep throat, lice, skin conditions and minor infections. There will be protocols in place that lay out instructions for treatment, and a process and schedule for the pharmacist to provide patient information to the supervising physician and the physician to review the pharmacist’s actions. The bill also states that pharmacists may not prescribe any controlled substances. It also requires pharmacists to advise

patients to follow-up with a doctor if needed. On March 11, 2020 the bill was approved by Gov. Ron DeSantis and became effective on July 1, 2020. Currently, 17 other states allow pharmacists to test and treat for conditions like the flu. State senator Travis Hutson (R-St. Augustine), hopes the new legislation will give more options for people seeking healthcare. He sponsored a similar version of the bill (Senate Bill 714). Another pharmacist related bill that was also signed into law is House Bill 599, which relates to consultant pharmacists. These pharmacists have additional specialized education and advise on the use of medication for patients in nursing homes and for individuals under the care of a licensed home health agency. With the new legislation, consulting pharmacists can go to locations such as ambulatory surgery centers, hospices, hospitals, alcohol or chemical dependency treatment centers, ambulatory care centers or nursing homes within continuing care retirement communities. The bill became effective on July 1, 2020.

Expansions for Advanced Practice Registered Nurses

The third scope of practice law that Gov. DeSantis signed is House Bill 607, which allows advanced practice registered nurses (APRNs) to operate primary care practices independently of physicians. Though only APRNs who have at least 3,000 hours of experience under a physician’s supervision are eligible to provide services under the new law. These services would also be limited to family medicine, general pediatrics and general internal medicine. Nurses would also be required to complete minimum graduate level courses in differential diagnosis and pharmacology. Certified registered nurse anesthetists, clinical nurse specialists and physician assistants were removed from the final amended version of the bill.

“Although we are disappointed that the legislation did not include certified registered nurse anesthetists, we are pleased that some of Florida’s APRNs will be able to practice autonomously,” said Jose Castillo III, Florida Association of Nurse Anesthetists President said in a statement. “Passage of this bill demonstrates Florida’s commitment to modernizing the way healthcare is being delivered in our state by ensuring that Floridians have full access to healthcare, particularly in rural areas that are often underserved.”

The bill includes a loan repayment program for APRNs who work in rural or underserved areas, county health departments, community health centers, migrant health centers or any other publicly funded healthcare programs. According to the Florida Hospital Association, studies published over the past 18 years demonstrate comparable performance between nurse practitioners and primary care physicians on clinical outcomes, including reduction of symptoms and overall health improvement. The Florida Hospital Association also says patients seen by nurse practitioners report higher rates of satisfaction.

Statistics have shown that Florida is in need of more healthcare providers. Even though Florida is the third most populated state in the country, it has the 23rd highest physician to population ratio. In its 2019 Physician Workforce Annual Report, the Department of Health indicated that 12.5 percent of Florida’s physicians reported that they were planning to retire within the next five years, which will intensify Florida’s physician shortage. Additionally, 35 percent of practicing physicians are age 60 and older. Not only does Florida have a shortage of physicians, but they are mostly concentrated in urban areas, leaving rural areas in greater need of doctors. But to some, legislation like this is not the solution to the physician shortage. The Florida Medical Association argues that even though nurses are an integral part of our healthcare system, they don’t receive the same level of education as physicians and shouldn’t practice independently. The American Medical Association (AMA) also believes that non-physician healthcare providers can provide essential patient care, but that it should be provided as part of a physician-led team. According to the AMA, “Nurses are critical to the healthcare team, but there is no substitute for the education and training of physicians. With a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage.” There is no doubt that we are in a healthcare crisis, with healthcare providers and lawmakers scrambling to provide solutions. Though we may not know if scope of practice expansions will solve these problems, working together to provide the best possible care to patients is the priority.