SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities.
I'm Sarah Hexem, Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse Led Care Consortium.
This is Part 2 of our special two-part series about scope of practice regulations for nurse practitioners. If you haven’t heard Part 1, we recommend you listen to that episode first and then come back to this one.
In the United States, 26 states now grant full practice authority to nurse practitioners. That means NPs, who are -with-advanced-degrees can deliver healthcare without restrictions. Whereas 13 states have what we’ll talk about as reduced practice and 11 states have restricted practice.
In the spring of 2022, New York and Kansas became the most recent states to grant full practice authority.
On this episode, we’re going to hear more about how those two states moved towards full practice authority and what that might mean for states like Pennsylvania where there’s reduced scope of practice regulations. We’ll also talk about some of the current obstacles in the way of full practice authority and the future of primary care needs.
Joining us for this conversation are Dr. Tay Kopanos and Pennsylvania State Senator Camera Bartolotta.
Tay is a nurse practitioner and the vice president of state government affairs for the American Association of Nurse Practitioners. And Camera Bartolotta is a Republican State Senator representing southwestern Pennsylvania’s 46th District.
So Tay, Camera, Welcome to At the Core of Care.
TAY: Thank you. Great to be with you.
CAMERA: Thanks so much, Sarah.
SARAH: So while the majority of the country has granted full practice authority, let's start with a brief snapshot of scope of practice regulations that currently exist for nurse practitioners and what the different levels mean. Tay, can you give us a quick breakdown of these different regulatory levels that include full practice, reduced practice, restricted practice?
TAY: Absolutely. Across the country, nurse practitioners are recognized in all 50 states, DC and US territories. In all of those states, they diagnose, treat, manage and prescribe for their patients. But different state laws authorize that differently. As you've mentioned, 26 states, DC and two territories have full practice authority, meaning the state authorizes those nurse practitioners to provide all those services directly to patients without requiring an external regulator relationship with someone else. In states that have reduced practice authority, that permission to provide care is based on having a contract or collaborative agreement with a physician. If an NP doesn't have that contract, it is illegal for them to provide care. In the states that are restricted, those states require delegation or supervision before an NP can provide those services to a nurse practitioner. So really, it’s a significant challenge because NPs are prepared to provide all of their services wherever their patient is located. But tying their ability to legally provide those care to a relationship outside of their own skill set really diminishes our ability to care for patients nationwide.
SARAH: And in Pennsylvania, which was the focus of part one of this special series, there's currently reduced practice for NPs. So that means NPs can act as independent care providers as you were describing: prescribe medicine, order tests, assess and diagnose patients make referrals, but only if they have something called a collaborative agreement with at least two physicians, although we did see that dialed back a little bit during the pandemic.
As we heard from nurse practitioner Lynn Heard on part one, she had a long-term collaborative agreement with the same family physician for I think it was 25 years. And then he closed the practice two years ago, during the pandemic, and since then she hasn't been able to obtain a collaborative agreement with any new physicians. So she has stopped seeing almost all of her longtime patients because she can no longer prescribe the medications without this collaborative agreement. Here's how Lynn described her situation to us on part one.
LYNN: “I mean I have that background and experience. I've been doing it for a long time. And now all of a sudden, my hands are tied. And I think that's what lawmakers need to understand is that, you know, we're not coming right out of school and saying, Okay, I can be an independent practitioner, you know, you have to have that experience and that comfort with it in order to provide quality care.”
So Camera, this one goes to you and the proposed full practice authority legislation that you've been trying to push through the Pennsylvania General Assembly for multiple years now.
Tell us how your legislation would enable NP-s in Pennsylvania to practice fully?
CAMERA: Well, my bill, Senate Bill 25, would allow qualified nurse practitioners to operate independently of a physician after they fulfil a three year and 3600 hour collaboration agreement with a physician before being allowed to move on and hang their shingle and do what they do best. And only in their own specialty. They can't do you know all types of different practices, it's right in their own lane.
My bill also would say that nurse practitioners would include advanced registered nurse practitioners, certified nurse practitioners but would elevate the status of these nurse practitioners. And as you said, currently, in order to practice, a nurse practitioner must secure a business contract that's called a collaborative agreement with not one but two physicians. And as you just stated, in an example, a lot of these physicians are not treating new patients, they're not taking them in or they're retiring. And a lot of the problems that nurse practitioners find when trying to find a physician to sign a collaborative agreement is that general practitioners are going into specialty fields, and they're not taking on nurse practitioners. Plus a lot of these doctors who aren't taking new patients or if they are, they don't take things like Medicaid. So it's vital right now, in this post almost COVID world with how strapped Pennsylvania is with our great health care professionals, especially nurses. We are so short staffed in so many of our rural and urban areas, that this bill is more needed now than ever before. Also, research shows that nurse practitioners tend to stay in the areas where they grew up, where they know neighbors and friends. So the personal relationship is second to none when it comes to certified nurse practitioners and staying in their areas. So the bill that I have and have been trying to put across the finish line for years is something again, more needed now than ever before.
SARAH: Now Tay, given that neighboring New York recently granted full practice authority, and is in many ways of comparable state to Pennsylvania, you know, I think about the urban areas, the rural areas. Tell us what dynamics there tipped the scales, how did they move toward full practice authority? And rom your perspective, what were the roadblocks? What was the barrier, and then sort of how were they able to move beyond that and get to full practice authority in New York?
TAY: You know, I think New York and Pennsylvania, along with some other states share a lot of characteristics. They have a high population need. They have nurse practitioners that are willing, and they dated laws that stand in the way of them delivering care. Similar to Pennsylvania that nurse practitioners in New York had been working for over a decade to move legislation forward and be able just to provide care to patients. One of the things that was unique to New York when compared to Pennsylvania is the state of New York fully waived all of the requirements for collaborative agreements for nurse practitioners during the COVID pandemic and state of emergency. In fact, today, the COVID Waiver that was initiated earlier in the pandemic is still in place while the state moves to make full practice authority regulation. So one of the key differences between New York and Pennsylvania is New York had this two year test drive. We call it an extended test drive at AANP, where they were actually able to see under probably some of the most severe and pressing conditions, what removing those barriers would look like. And so New York had the opportunity to test drive, see how safe and effective it was. And they were able to move forward based on that. The state and the legislature realized, if they didn't move forward, they would actually move back. And patients who had experienced expanded access during the COVID pandemic state of emergency would lose that. The thing that I do want to stress is that we don't think states need to have these extended test drives or these pilot programs before they move forward. We already know that we have 40 years of experience in other states that have already gone through the test drive, they've shown that this is a proven track record for success. And so right now, we're just calling on states to move forward. Because states that wait are states that are continuing to delay care.
SARAH: So Camera, how do you respond to New York's trajectory vis a vis Pennsylvania? To what extent is it similar? And in which ways maybe not?
CAMERA: Well, again, it's very similar in the fact that as Tay said during the waiver period, during COVID, it was very clear that nurse practitioners who are allowed to practice with autonomy, provided great care to much needed populations. And I love the fact that she said, Look, we don't need to test drive, we've been test driving this for 40 years. And in Pennsylvania, we have an issue with some, ‘oh, let's do a pilot program.’ No, the rest of the country has been doing a pilot program. Let's look to that. In Pennsylvania, we did waive a little bit during COVID. The thing that they waived was, oh, instead of two physicians to have a collaborative agreement, you only need one. It was still very prohibitive. And to the point of New York, allowing this, we're going to be seeing even more of our highly educated, very efficient, wonderful nurse practitioners go outside of Pennsylvania, seeking full autonomy, because now it's just any place but Pennsylvania. And we see that with too many industries. But with the bill here in Pennsylvania, the difference would be that the requirements are more stringent than any of the other states. And it would be something that would benefit Pennsylvania by keeping nurses here, and not having them go to all of these other states that have finally awakened to the fact that this is a really great idea, and has proven so for over 40 years now.
TAY: To Senator Bartolotta’s point, if you change it, they will come. That is a trend that we have seen across the country. When Nevada changed their health care law, they more than doubled the number of nurse practitioners in their state and their board of nursing tracked where those folks came from. And a large majority of those nurse practitioners came from states with reduced and restricted practice. And Pennsylvania is now at a place where you have Maryland, Delaware, New York at your borders, making it pretty easy for people to pretty quickly commute daily across the state line and be able to provide all the care that their education prepared them for without these unnecessary bureaucratic hurdles. And so, you know, now is even more critical because states who fail to act will, you know, fail to get the workforce that they need and continue to export workers to other states.
SARAH: And Camera, you had mentioned that that 3600 hour requirement is actually I think the most restrictive transition to practice requirement. I think Kansas, right, they moved forward without that level. Tay, could you speak a little bit about the trend we're seeing relating to transition to practice and how Pennsylvania is falling within that overall landscape?
TAY: The trend that we're seeing actually isn't quite following the Pennsylvania landscape. The trend that we're seeing is there are 19 jurisdictions that have no time in practice requirements after licensure for NPs to practice. Totally understand the legislative dynamic, where some legislators are doing this step off from the process that they had before, that it may make some legislators feel more engaged and more likely to move forward with that legislation. In Kansas, the reverse actually happened. The nursing community for years had been going to the table trying to negotiate with a medical community and would put up, you know, two years in a time in practice as a step away, or three years as a time in a step away. And the legislators in Kansas came to the realization that one party was not holding up their end of the bargain, and that negotiating on that particular area in Kansas, was just delaying patient care. So the legislators there said, you know, what, we're not going to look for a compromise, we're going to just move fully for full and direct access to our patients and ensure that regardless of where someone lives, they get access to care. Part of that thinking in Kansas was the fact that if we require clinicians to spend time in a relationship with someone else, before they're able to practice their profession, very often they find those relationships in urban and suburban areas. And we know that if people are tethered to another provider in an urban and suburban area, their spouses get jobs, their kids get linked into the community, and it makes it harder for them to move to rural and underserved communities down the road. So again, while we have seen a trend of some states requiring time in practice, as a political compromise, to get the legislature to move forward and engage, we also see states that, again, 19 jurisdictions without them as a way to again, get more care to more people in more places.
CAMERA: To your point, again, Tay, that, that a lot of these nurse practitioners are in rural and very faraway places. And a lot of those areas have one doctor. And I represent Greene County and Washington County. And there was this wonderful, delightful woman who got me interested in this particular legislation years ago. And she since passed, but she literally told me that at one time she was paid in chickens. This is not a long, long time ago. So we're talking about people who desperately need good quality health care with people they trust. Because too many times these folks will not get on a public bus and travel an hour away to get to a physician that just might happen to take on a new patient and also takes Medicare or Medicaid, any of those things. It's very difficult for some of our people who live far away from urban centers and a plethora of physicians from which to choose. So this is really vital to bring good health care into these rural areas. But on that point, too, a lot of these urban areas, there are a lot of elderly people who have no transportation, they don't have friends or relatives that can take them to an appointment or not. And they get used to seeing a physician and when that person either moves away, closes practice or passes away. They stop getting health care. That can't happen. We have too many wonderful nurse practitioners who are ready, willing and able to be an army of excellent health care providers throughout the whole Commonwealth.
SARAH: And in Part 1 of our special series, several longtime patients of nurse practitioner Lynn Heard also shared this perspective. Patient Susan Donces even asked this question about scope of practice regulations in Pennsylvania.
SUSAN: “I'd like to know who's pushing back? Like why? Maybe those people that are pushing back have never been, like me, just to a nurse practitioner.”
SARAH: Camera, how would you answer Susan's question?
CAMERA: It's very interesting, because you can tell that it's a little bit of a political football, because what it was first initiated, even before I got into the legislature was Pat Vance. Senator Pat Vance was a nurse in her prior life. And she was very passionate about this particular issue and she had this legislation out now this is pre 2014 when I first started in the law legislature. But there are so many organizations and groups that are in favor of this process this legislation, and then it's the doctors’ association, who's not keen on it. And I can understand that to a certain point. But I think, again, and it's not all doctors, I have some doctors who are thrilled about it. And they really rely heavily on their nurse practitioners and need them in their offices or an extension of, and it's a wonderful thing to see. But I think, knowing that the long long list of folks that are very much in favor of it, and have been very vocal. I think that the political pressure is getting to a little bit more of a tipping point. And so you know, when you have chairs of certain committees that are not in favor of it, and they hold onto it, and that's one person who's in charge of allowing a bill to either proceed through that committee, or it just stays on a shelf and gets dusty. So things are in flux, and things shift around. And sometimes, when the stars align, and you have all the right people in place, then you can move things forward. But I know that last session, this bill passed the Senate with an overwhelming majority. So it's a very well-liked piece of legislation. And I really hope that we can get it on the floor again.
SARAH: Yeah, and it's hard because you know, I hear the 3600 hour piece, you know, we talk about transition to practice as Tay talked about ending up being this political compromise. And it's really hard to hear about compromises when you're talking about people, and you're talking about care, and you're talking about workforce. And I think even in Pennsylvania, so you know, I've been watching this as well, recognizing that there was a compromise, if we're going to call it that, right, a few years back and to see it, you know, still not moving forward.
One of the most disappointing pieces of this, when we're thinking about the people who are not getting care, is the framing of doctors versus nurses. And we see the exact opposite in practice. We see doctors and nurse practitioners working truly collaboratively, really being a team. And that's what people need.
TAY: Well, and I think, you know, to your point, Sarah, I mean, that is the crux of the misunderstanding with some folks. And unfortunately, I think it comes down to the framing that was used for the regulatory model all these years ago, of calling it a collaborative agreement. Because this is a business agreement. Without this business agreement in place, someone can't practice their profession, that profession is providing care. This is not an agreement that says, you know, I'm going to work cooperatively in a shared way to consult, collaborate and refer for the best of patients. That consult, collaborate and refer is an aid to all healthcare providers, and is required for all of nursing and all healthcare providers. And where we really have a challenge is articulating to other policymakers to understand we are not removing collaboration, we're removing a business agreement. And we remove that business agreement, we allow more providers to get to more places. We allow those farmers and ranchers not to have to drive an hour away, to get care for their blood pressure, and they can get back to the ranch instead of deferring care. And so, you know, articulating what we are really retiring here is outdated, burdensome regulation, not health care, community and providers working together. So I appreciate you calling that out.
CAMERA: And also, one of the things people need to understand is that the way things are right now in Pennsylvania, it is literally giving one healthcare profession veto power over another. You don't have that anywhere else in the medical profession. And these individuals, the nurse practitioners are going to be under the State Board of Nursing and, you know, fully licensed and fully regulated the whole thing, it's just opening up a door and, you know, removing the bushel from the light, if you want to call it that. So I think it's, it's a way to take the thumb off of this vast, massive amount of great people who can provide good care. And you know, post-COVID, we need this more than ever. And a lot of people don't understand that there are nurse practitioners out there that are involved in child psychology and social work and working with people with mental health issues and depression and all sorts of things. And now more than ever before we desperately need that.
SARAH: So going back to Kansas, how are the dynamics in New York, similar or different from Kansas? To what extent were you seeing other factors at play, because they really did have a different journey to full practice authority.
TAY: You're right, the different states had different needs. And they had different communities that they wanted to serve. But at the end of the day, they were still looking at a deficit of healthcare providers to meet the healthcare needs in their state. And I think both states took this approach that said, we need all of the above. I mean, every time this issue comes up, we hear that we need to fund more residencies, that we need more medical schools that we need to provide more student loan payment to physicians and more opportunity to recruit physicians to the state and rural areas. And we do need all of those issues in all of those states. But again, we also need more nurse practitioners. And we need to lower the barrier of entry in places that we don't need it around other health care providers. And so the legislatures in both states, even though they approach them differently, came to the same conclusion that at the end of the day, we need everyone and all the skill sets that they're able to provide. And there is you know, 40 years of evidence and experience in other states that have safely removed these barriers, improved access to care, saw some health care cost reduction as a result, and looked at the evidence that kind of correlates. States that full practice authority tend to do better when it comes to the numbers of nurse practitioners working in rural and underserved areas, the ability to grow their healthcare workforce. They have lower costs in general for their Medicare and Medicaid population, primarily because those people can get earlier access to care. They have lower hospital readmissions. And so those legislatures, while they approached it slightly differently in both states, both realized at the end of the day, more access to care, lower cost of care, all of the above, we just need to make a way to get all health care providers on deck and out in the community to utilize them.
SARAH: And Camera, hearing that, where do you see Pennsylvania falling in that spectrum of need?
CAMERA: We have such a diversity of populations in the Commonwealth. From Greene County that I represent the entire county has about 35,000 people in it. And there are folks that have family farms with 500 acres, and they're the only home that's on there, or you have downtown Philadelphia, which is incredibly dense with population. And the need is the same throughout. One thing that is something I need to be sure to educate folks on when talking about legislation in Pennsylvania. Again, Tay, you brought it up that this is not a competition between doctors and nurses. That's not it at all. Nurses are not trying to become doctors. They want to use their knowledge, their education, their authority, and the advanced practice title law requires that they complete clinical curriculum and clinical practicum hours to become a nurse. Then, prior to the advanced clinical curriculum and practicum hours that are required to be an NP. They're nationally accredited. They undergo peer review, clinical outcome evaluations, rigorous national certification, which requires maintaining certification competency every five years throughout their whole career. And they adhere to a code of ethical practices. So these are things that some people just don't understand. The level here of the education, these individuals have master's degrees, many, many, many of them. So, I think it's a matter of educating people on the level of expertise, and the wonderful care they can provide. And making sure that the legislature understands that so that when it comes to committees and time to vote this legislation out, they get it. And they understand the need for it.
SARAH: I love that you called out, you know, it’s not the practice of medicine. I mean, it's the practice of advanced practice nursing. And we even see that in that evidence, we see that in those 40 years that nurse practitioners have great outcomes when it comes to chronic disease management and patient satisfaction, and a lot of the really hallmarks of healthcare quality that we're increasingly paying attention to. So I agree, and think, you know, it's not about nurse practitioners practicing medicine, it's about nurse practitioners practicing nursing, and the value that that brings.
Zooming out for a moment and thinking about the future of primary care in the United States, we know that most medical students aren’t going into primary care and that the significant share of physicians currently working in primary care are approaching retirement age.
On top of that, you take a state like Pennsylvania where we have an aging population as well as many rural areas with less medical care access compared to urban areas…although as we’ve discussed access to care in care in urban areas is often challenged as well.
Given all those dynamics, we know the majority of NPs actually deliver primary care, and tend to treat more vulnerable populations and harder to reach populations.
Tay, how do you put all of this altogether in terms of thinking about the future of primary care?
TAY: Looking at the workforce, nurse practitioners continue to be a growing healthcare workforce and are the number one workforce dynamic in primary care that is growing. It's estimated that over the next five years, one in three primary care providers will be a nurse practitioner. I think as we're looking at the workforce, what we're really looking at is, how are we going to effectively use people where they are located. And so, one of the most important lessons that has come out of COVID is our healthcare system was broken before. And we know now where we need to fix it. We need to build in efficiencies so that we're utilizing everyone at the top of their license, that we're retiring outdated, bureaucratic barriers that stand in the way of patients getting care. But we've also learned that we need to take care of the clinician and help prevent burnout and help improve their investment in their health care profession. Literature has shown that when health care providers are able to bring their full education and are empowered to make health care decisions, they are more likely to stick with that profession, be engaged in that profession, and be more productive. So, when states are looking at this as a comprehensive level, when they're looking at how can they use their workforce most effectively, they want to remove those barriers. Because one of the other things the pandemic has told us is that our nursing workforce is willing to be mobile. We had nurses crossing state lines to help out during the pandemic. We had nurses moving across the country. And now that nurses have experienced that flexibility and freedom of practicing at the top of their profession, they may be more likely to move to a state that they can, you know, practice to the top of their education. And so, I am concerned about some states that continue to restrict it, that their workforce may continue to be more narrowed, because now they are competing at a different level with states that have full practice authority and more opportunities for their nursing workforce.
SARAH: I wonder Camera, you know Tay talks about the healthcare system being broken? How might nurse practitioners fix that? How could they be a solution?
CAMERA: Well, we're really good in Pennsylvania about exporting, highly educated individuals. We export entrepreneurs, technology, all kinds of things, because we make it very difficult for those kinds of people to want to stay here for a myriad of reasons. But when it comes to good health care, we have some of the best training available for medical fields and for nurses, for doctors, we have that in Pennsylvania. But when they graduate, they graduate out of Pennsylvania, because they're looking for something better than what we have to offer here. One thing, too, is that post-COVID, we understand that we have a whole ton of individuals who ignored their health care. They were terrified to go to the doctor, they ignored mild heart attacks, mild strokes, all sorts of testing wasn't done. If it isn't an emergency, don't go to the hospital. Well, we have people that are suffering those consequences now for what might be a lifetime of a medical situation that could have been taken care of early on. So now more than ever, we need to have people who can monitor those kinds of things, diabetes, heart issues, all sorts of things. And nurse practitioners are on the frontlines of that. They are the people who can be out there who can take those patients and see them on a much more regular basis. Because again, they're not as costly as a regular doctor's visit many times and you can actually get in to see them more frequently and on a more regular basis. And yes, our population is aging at a dramatic rate. We are losing young families in Pennsylvania, the ones that are left are individuals who are on fixed incomes, who are more elderly, and that population is growing all the time. So these nurse practitioners could be a huge support for them. The other thing, too, is that nurse practitioners have to pay every single year. It's costly to pay for a collaborative agreement, for at least now it's down to one physician instead of two. But trying to pay for that every single year, as well, it adds up. So why wouldn't we have nurses who we're exporting them to all of our neighboring states that are much more welcoming, and give these individuals the reward that they so richly deserve.
TAY: As the Senator was speaking, a couple of other states came to mind some states that have had full practice for a long time. Several years ago, the governor of New Mexico said, if you want to come to New Mexico come, we will license you within five days. And in fact, she sort of issued a call to action to nurse practitioners in the state of Texas, she said, We're full practice, come next door, we want you. And at AANP, we have several members who drive over the border every day to provide care in the state of New Mexico from Texas, because it is easier for them to provide care. Several of them have opened businesses, most of them in primary care. When she was speaking, I was also thinking about Nebraska, since they became full practice. Nurse Practitioners grew in 25 of their rural counties, a lot of them are along the southern border, bordering Kansas. So many Kansas NPs up until this recent piece of legislation, found it easier to go next door into the state of Colorado or up north into Nebraska. And so when we're looking at exporting talent, it is a real considerable brain drain and a healthcare provider challenge for states to hold on. And so as I'm looking at the future of what we're going to see and trends for healthcare workforce, I think we're going to see states competing. And so we've already got half the nation that is opening their welcome mats and saying, Hey, nurse practitioners come here, the remaining states, I think they're going to have challenges. So the longer states wait, it's going to be harder for them to compete with that pool.
And then also, Senator Bartolotta mentioned Pennsylvania schools. Pennsylvania nurse practitioner schools are well-known throughout the country, for high quality graduates, and they are in high demand. So other states are actively recruiting Pennsylvania graduates to come practice in their state, and it's a lot easier for them to compete against Pennsylvania, when they can say, come here, we want you to practice the fullness of your education. You just spent, you know, 10s of 1000s of dollars and years of your life investing in your education, our state will let you use it. Pennsylvania may not. And so, I really think that that competitive advantage, it's not just about patients, it's about, you know, growing Pennsylvania from an economic standpoint. If you don't have health care providers, it's harder to recruit teachers, bankers, other businesses to the area if there isn't a health care provider. So each of these pieces feeds into the other. And so the Senator is right. This is not just about health care, it's about the economic health and viability of states and their communities moving forward.
SARAH: And how much would it cost? This often comes up in the political conversations about, you know, everything seems to have a costs, increasing access to care is going to have a cost, right? What would this cost for Pennsylvania?
CAMERA: Well, I think that's a question I don't think I have the answer to. But I think the benefits would far outweigh whatever cost it might be. The cost right now is the fact that we're losing nurse practitioners to other states. And so one of the big issues in hospitals today is the fact that we have nurses again, to your point Tay, burned out. They can't get staffing in hospitals. So many of our nurses are double shifted, and they're just exhausted and past the point of wanting to get up and go to work again. But the cost is losing nurse practitioners to other states around us to losing those families whose children would be going to our schools, whose spouses would be going to work or starting a business or creating jobs. And on and on and on and on. We're losing a huge pool of very highly trained, experienced, wonderful individuals, and the exodus from Pennsylvania should be reversed. We should be welcoming to all of these highly-educated, highly-trained people to stay here. We have to stop exporting talent.
TAY: One of the things that we hear around the country is moving forward with full practice authority is a no-cost, no-delay solution to help improve health care access around the country, we're not asking for more money to educate more folks. We're not asking for new programs to be implemented. We're actually asking to retire bureaucracy that can actually save states money, may save Pennsylvania's money because you are having boards having to regulate a piece of paper that doesn't improve health care costs. So there is no cost in moving forward in this direction to move forward. But as Senator Bartolotta clearly articulated, there is substantial cost in not moving forward both to the workforce, the recruitment, the patients and the delayed care that surrounds this issue. So it's a no cost to move forward. But there are significant costs to delaying for sure.
SARAH: So closing us out, Camera, from a policy standpoint, looking at the political climate in Pennsylvania, we're coming up on an election year. Realistically, what's needed to make this happen in the Pennsylvania legislature?
CAMERA: I think it's just making sure that people who are affected and I don't just mean the nurse practitioners themselves. I'm talking about patients who have been going to nurse practitioners for years, and they really appreciate that quality care, that personal connection, the personal attention that they get from nurse practitioners and the success they have seen with that relationship. They need to reach out to their legislators across all of Pennsylvania. Call your state representative, call your state senator, call the leaders of the caucuses in Pennsylvania, reach out send emails, smoke signals, if you got them. We need to know that this affects you. Too many times I hear legislators say ‘Well, I haven't gotten phone calls about that issue. I haven't gotten any emails about that issue.’ And tell your legislators how very important this issue is to you, your family. If you're a patient, if you're a nurse practitioner, you want to stay here you want to raise your family here. You enjoy the care, we need to hear those voices, it makes a huge, huge difference.
SARAH: Tay, I want to give you a chance. Any other final thoughts?
TAY: It's Nurses Week when we're recording this. And so, you know, I was thinking earlier today, you know, nurses we serve at that intersection of health care policy and patient care. And so every day we see where existing law either allows patients to get access to the care they need, or stands in the way. And part of our responsibility as nurses is to ensure that we are telling the stories of our patients, that we continue to advocate for them. It's something that we do every day, whether it's with an insurance company or with the patient or with a healthcare system to ensure a patient gets what they need. Telling these stories at the legislature is just advocacy on a different level. As Senator Bartolotta said, legislators don't understand it's an issue until we raise the issue and help them understand where policy is intersecting with patients and where it's a problem. And so, on this Nurses Week, I would challenge my colleagues, pick up the phone, send an email, tell the story of our patients, because that is what has helped other states be successful is telling the stories of patients. So legislators get to see that broad view of this isn't about one profession against another. This is about how do we use everyone in the health care arena, to meet these health care needs of our patients and move forward.
SARAH: I really want to thank both of you for joining us. And for the ongoing fight. I mean, it and it has been a fight and it shouldn't be when we're talking about the health of the state, the health of people, the health of the economy. So just want to thank both of you for continuing to advocate on behalf of all of us.
TAY: Thank you Sarah, it was great to be here.
CAMERA: Thanks so much for doing this, Sarah.
SARAH: If you still haven’t listened to Part 1 of our special coverage, don’t forget to it check it out. You’ll hear how longtime family nurse practitioner Lynn Heard has been unable to find new collaborative agreements with a physician for two years now and has paused her search. You’ll also hear from her patients whose care has been disrupted.
LYNN: “I’ve actually paused the search. I did have some that had offered, it was more than I could afford. Some wanted a fee. I never had to pay a fee before. So in Pennsylvania, you need two, so for one physician it was 500 a month. So if you had to get a second one, that's $1,000 a month. I was doing this part time. I was really just trying to meet the needs of patients, provide them with health care that they really were comfortable with. And I couldn't afford $1,000 a month or more.”
CREDITS
SARAH: Support for this episode comes from the Pennsylvania Action Coalition.
You can find our most current and past episodes of At the Core of Care wherever you get your podcasts or at paactioncoalition.org.
You can stay up to date with us on social media @PAAction and @NurseLedCare.
At the Core of Care is produced by Stephanie Marudas of Kouvenda Media and mixed by Brad Linder.
I'm Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us.
