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North Carolina lawmakers should upgrade state nursing regulations
SAVE Act provides rules we can live with
Published Thursday, May 13, 2021 11:00 pm
by Gale Adcock and Carla Cunningham

Four North Carolina lawmakers who are registered nurses filed the bipartisan SAVE Act to modernize nursing regulations across the state.

The writers are members of the North Carolina House of Representatives.

Every year from May 6 to May 12, the nation celebrates National Nurses Week. May 12 is the birthday of Florence Nightingale, the founder of modern-day nursing. Nightingale used statistical illustrations called rose diagrams (also referred to as ‘coxcomb’ diagrams) to highlight the number of unnecessary deaths during the Crimean War as a result of preventable infections.

Nightingale combined caring, determination and evidence to save soldiers’ lives. Nightingale set the tone early in the evolution of the nursing profession: to improve health and save lives, caring and care must be combined with facts.  

Along with our fellow Registered Nurses in the NC House (Reps. Donna White and Diane Wheatley), in mid-March we filed the bipartisan SAVE Act to deliver Safe, Accessible, Value-directed and Excellent care throughout North Carolina by modernizing nursing regulations.

The bill removes an antiquated requirement that nurse practitioners and certified nurse midwives have physician supervision to practice and brings the regulation of their practice, along with that of certified registered nurse anesthetists and clinical nurse specialists, into the 21st century. The bill has an impressive 102 House and Senate sponsors and cosponsors.

For nurse practitioners and certified nurse midwives, “supervision” is merely a paperwork distraction. There is no evidence that the required twice-a-year meetings and annual review of a practice agreement have any value on the delivery of care or impact on patient care outcomes.

Meanwhile, The SAVE Act is based on multiple research studies showing that these highly educated advanced practice registered nurses deliver high quality care with excellent patient outcomes. Twenty-three states and the District of Columbia have passed similar legislation for nurse practitioners (some, like New Mexico, more than 25 years ago).

Advanced practice registered nurses practicing within the full extent of their graduate education, state licensure and national certification is not a new or novel idea.

Add to this the findings of a 2015 Duke University study which concluded that lifting unnecessary state requirements would have an impact of $435 Million to $4.3 Billion on the state’s economy and create thousands of new jobs, while requiring no state funds. It’s clear The SAVE Act is all upside.

In a state with persistent health care provider shortages and lack of access to health care, especially in rural communities, we simply can’t afford to continue to underutilize advanced practice registered nurses.  Sixty-four percent of House members and 50% of senators have indicated their readiness to vote for the SAVE Act. National Nurses Week is a reminder of the essential role of nurses in health care delivery across our state and nation. It is also a call to action to pass the SAVE Act.

Rep. Gale Adcock, RN, FNP, Wake County
Rep. Carla Cunningham, RN, BSN, Mecklenburg County      


The "Baby and Company" fiasco just a few years back should put the brakes on this absurd notion to remove all medical supervision from advanced nurse practitioners. Babies DIED because of a lack of medical supervision (even when it was mandated) in an unregulated setting (as far as I know birthing centers in NC remain unregulated by NCDHHS). Healthcare conglomerates/private equity firms are already abusing contracted/employed doctors to the nth degree - and our politicians have failed to do anything about it in nearly 30 years. Healthcare "reform" is what killed rural medicine. Medical whistleblowers protection is non-existent in the private sector. Tossing unsupervised nurses into the fray is only going to devalue providers even more than they already are - and pit primary care MDs against APRNs for jobs. Sorry. Too much in medicine is broken. The politicians need to fix the broken FIRST.
Posted on May 14, 2021

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