Heineman vetoes nurse practitioner regulation bill

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LINCOLN, Neb. (AP) - Nurse practitioners still must collaborate with doctors in order to practice in Nebraska, after Gov. Dave Heineman vetoed a bill Tuesday that would have changed state regulations to give them more independence.

The measure would have removed the requirement that nurses have an integrated practice agreement with a collaborating physician in order to practice in Nebraska. In the final vote, legislators had approved it unanimously.

Heineman says in the future there will be a shift toward additional independence for nurse practitioners, but the option provided by the bill went too far, too quickly. In the governor’s veto letter, Heineman and Chief Medical Officer Dr. Joseph Acierno expressed concern for patients.

Both agree “adequate clinical experience is necessary for patient safety,” according to the letter.

The bill, as amended, would have put in place a transition to practice agreement. Nurse practitioners would have needed to have this agreement or show 2,000 hours of practice under such an agreement to work in the state.

Heineman said if the bill had required 4,000 hours of clinical experience, he would have signed it.

Lawmakers adjourned last week, so they cannot try to override the governor’s veto. Sen. Sue Crawford of Bellevue said the bill had widespread support from senators from both parties and she didn’t expect the veto.

The bill had been amended early on to include the transition-to-practice agreement, to address concerns such as those cited by the governor. There was no communication on whether or not it should have been 2,000 or 4,000 hours, she said.

Crawford said she will talk to lawmakers and others to decide on what is the best bill to bring forward next session.

“I think that as we start this discussion again, we will be looking at all options,” she said.

The agreement currently required by law is a barrier to practice for nurse practitioners, who may go to another state where they can practice immediately, Crawford said.

“Sometimes you just cannot get a physician in the geographic location or in the specialty to actually sign that paperwork for you,” she said.

Rural areas and psychiatric care are a couple areas facing shortages that could have benefited from the changes in the bill, Crawford said.

The Nebraska Medical Association agreed with Heineman’s veto. Dr. Kevin Nohner, the group’s president, said that safety was an issue, even with the 2,000 hours of training.

“When you are facing a complex problem, you may very well make a diagnosis because you’re fitting it into your set of experience and if that’s more limited you won’t even go outside of that box,” he said.

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