TALLAHASSEE, Fla. – In a year when he was able to pass bills that he says will bring needed disruption to health care in Florida, House Speaker Jose Oliva couldn’t muscle through one of his top priorities: allowing advanced practice registered nurses to work independently from physicians.
But Oliva promised to try again during the 2020 legislative session, despite resistance from Gov. Ron DeSantis and Senate President Bill Galvano.
“I think that’s an important component to access and affordability,” Oliva said. “And I think we have to continue to have that discussion.”
The Republican businessman from Miami Lakes made health care a top priority for his two-year tenure as leader of the House. In his remarks to start this year’s session in March, he said the issue of health care in the state is a “five-alarm fire” and promised to reduce regulations.
By the time the session ended Saturday, he was able to steer through the Legislature several contentious health care proposals, including a measure (HB 21) that would repeal the state’s certificate-of-need regulatory process for new hospitals and “tertiary” services. The long-controversial CON process has required hospitals to receive state approval before they can build facilities or add the specialized medical services.
Oliva said Florida took a “quantum leap” in passing the CON bill and in other measures that could allow the importation of prescription drugs from Canada and create a legal framework for “telehealth” services.
But he was unable to push through a bill (HB 821) that would allow advanced practice registered nurses and physician assistants to work without direct supervision from doctors.
Gov. Ron DeSantis, who backed most of Oliva’s health care agenda, is expected to sign all of the other bills into law. But in April, he said he was skeptical of expanding the role of nurses.
“My general view is that if you go to medical school and you go through all that training to become a doctor, be a doctor,” DeSantis said.
“My mom’s a nurse, so I have great regard for nurses,” he added. “But it’s a different thing. And so, I would have to really be convinced that kind of expanding scope of practice would be good.”
The Florida Medical Association opposes Oliva’s efforts to expand the roles that advanced nurses and physician assistants can play without direct physician supervision.
The FMA, a powerful physicians’ group, was the first statewide organization to endorse DeSantis’s bid for governor last year. The FMA PAC endorsed DeSantis in the Republican primary just two days after President Donald Trump announced his support of DeSantis.
Meanwhile, Oliva said an “educational process” is needed to combat a perception about giving more authority to advanced nurses.
“People have a perception that what is being asked of them is to allow nurse practitioners to practice to the degree that a doctor practices rather than to the extent of their training,” Oliva said. “Once a perception is in your mind, it is difficult to remove it from there.”
But as session closed at the end of last week, there was still resistance.
Galvano, who noted some of the health care measures he sponsored in the past, said he is willing to “have discussions.” But the Bradenton Republican said that the bills passed during the 2019 session were what he and other Republicans viewed as “reasonable” proposals.
FMA Counsel Jeff Scott noted that proposals to expand the advanced nurses’ scope of practice have been routinely filed over the years. That won’t change any time soon, he said.
“I certainly expect to see it back next year,” Scott said.
Elizabeth Markovich has been working as an advanced registered nurse practitioner for 30 years.
ARNPs have either master's degree or doctoral degree, but are not medical doctors.
Markovich said regulations, which require a doctor to sign on just about everything they do, end up hurting patients in the end.
"When we want someone to even show up and do physicals at a school for free and volunteer, we need a physician to provide so-called supervision, even though they are not there," Markovich said.
A doctor may supervise 10 or more practitioners, charging them each $1,000 a month, just for his signature.
In the hurricane-ravaged Panhandle, ARNP Stan Whittaker believes having the authority to practice within their training would have meant quicker care for injured residents.
"This protocol is antiquated and outdated," Whittaker said.
In 22 other states, ARNPs are offered full practice authority. Florida remains one of the most restrictive states for ARNPs.