President’s Message Oracle, January 2010
At the NPAM Fall meeting in 2006, then president Carolyn Buppert led a discussionabout legislation that would benefit NPs inMaryland. Some NPs were satisfied withthe status quo, but many agreed with Carolyn and had a “fire in the belly” to change the barriers to our practice. Hence, planning for the day when we would introduce legislation to eliminate the written agreement was begun.
Over the last few years I have learned to love and hate our legislative process inMaryland. NPAM submits legislation about NP practice; MedChi opposes NP legislation;NPAM members step up to the plate and bombard the legislators with visits,emails, faxes, and letters; an amended version of the legislation gets passed (or not); in a particularly bad year (2001), the governor vetoes the legislation; and eventually, it passes. I have come to learn that legislation usually takes several years and the efforts of hundreds, it not a thousand voting NPs.
However this year is the perfectstorm for NPs. As you all know,Marylandis in a serious health care crisis. We have over 810,000 uninsured citizens.We have an 87% shortage of primary care physicians in Southern Maryland, 67% shortage on the Eastern Shore, and 60% shortage inWestern Maryland. InBaltimore, the shortage of primary care has been long standing, andBaltimoreis a federally designated primary care physician shortage area. That shortage is not going to improve in the next 10 years. Physicians are not going into primary care in any numbers in any state in theUS.
Marylandis in the lowest quartile in quality of care measures in theUS; the lowestquartile in payment of services to providers in theUS; and the highest quartile of cost of living in theUS.Marylandhas a very high rate of health care disparity for minorities. Malpractice insurance rates and lack of tort reform have created an unhealthy practice environment.
The status quo has got to change and many stakeholders are realizing that NPs arepart of the solution. I believe that removing barriers to NP practice will help improvethe health ofMarylandcitizens. The greatest barrier is the written agreement. Thus NPAM has been working with the Maryland Coalition of Nurse Practitioners (MCNP) and has introduced legislation this month to eliminate the written agreement.The written agreement is impeding patient access to care and nurse practitioners’ ability to practice. The states that do not have written agreements, such asWashington,Wyoming,Oregon, and other western states have seen no decrease in quality of care or increase in malpractice cases.
Here are just a few problems with the written agreement:
*It takes 2-6 months to get a written agreement approved through the joint practice committee of the Board of Nursing andthe Board of Physicians (so every time you change jobs you must wait).
*Nurse practitioners who work independently often must pay a physician to sign a written agreement.
*Nurse practitioners working in rural and shortage areas often cannot find a physician at all who can sign the written agreement.
*Psychiatrists are refusing to sign written agreements for psychiatric nurse practitioners unless they are in an employmentrelationship
*The written agreement makes it difficult to make temporary or minor role changes within one’s job,such as floating to anotherarea of the hospital or outpatient site to assess flu patients.
Now is the time. Please help us remove this barrier for all NPs in Maryland.Sandra Nettina, NPAM President