The newspaper headline in The Savannah Morning News (July 30, 2005) read, "A doctor's 'conviction' violates the law."1 Two opposing definitions for conviction can be found in Webster's dictionary: "a feeling or awareness of the rightness, truth, or certainty of what is thought, spoken, or done" versus "the proceeding or record by which a person is legally found guilty of any crime."
Dr. Jack Heneisen was convicted for his conviction and is now serving an 8-month sentence in a Georgia prison for "helping needy patients and handling an overwhelming caseload." His only regret is that "his good intentions resulted in criminal violations."1 What did he do? He signed blank prescriptions for nurse practitioners (NPs) to use on his day off. This is a crime in Georgia, the only state in which NPs do not have the authority to write prescriptions. Nurse practitioners are able to call a prescription into a pharmacy, but are not permitted to write a prescription on paper. I am having much difficulty discerning the critical difference between these two rules. The NP utilizes the same knowledge base and skills in clinical judgment to guide prescribing decisions whether the prescription is verbal or written. Probably more devastating for Dr. Heneisen than the subsequent sentencing is the loss of his medical license to practice. While we applaud his courage and integrity, we have to be saddened by the loss of a respected colleague.
How often have NPs, and physicians for that matter, "stretched" the boundaries of an individual state's scope of practice for advanced practice nurses? Sometimes rules have to be broken to garner the prerequisite recognition and acknowledgment that change is needed. The Georgia medical association and one outspoken legislator think NPs should be supervised by doctors, citing the extra 2 years in school and residency for medical doctors as proof a "more highly qualified" provider. If NPs are granted full prescriptive authority, their fear is that NPs will establish independent practices in Georgia and take away their patients (i.e., diminish their personal economic advantage). They express few concerns over the quality of care provided by NPs. The comparability of NP and physician care delivery is well documented in the literature; NPs actually excel in certain areas.
Practice Barriers
Even in states where NPs legally practice independently, there are other barriers to autonomous practice. Changes in our healthcare system and national demographics dictate a transition in how all healthcare providers are prepared. The debate goes back to the educational preparation of NPs, as in this Georgia case. Should entry level into professional practice for NPs be at the doctoral level? This is not to diminish the value of the Master's-prepared NP, who is no less clinically competent than the newly envisioned Doctor of Nursing Practice (DNP). What does this DNP look like? If there are enough DNPs, will our battles with physicians, insurers, and legislators cease to exist?
I believe the answer is "NO." As we develop practice doctorate programs, we must ensure that individuals with this new degree are easily recognized by other health professionals, consumers, legislators, credentialing bodies, and any other stakeholders. This demands consistent curricula across programs, universal competencies for graduates, and a unified presentation of the role. Can you envision The Nurse Practitioner's January Legislative Update simply stating, "This description of NP practice applies to all states?" In the meantime, let us continue to assist our Georgia NP colleagues in their fight for legislative change.
Jamesetta A. Newland, PhD, APRN, BC, FNP, FAANP
Lienhard School of Nursing, Pace University mailto:[email protected]
REFERENCE