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By Taylor Knopf

A sea of white coats descended on the state capital Wednesday as more than a thousand nursing students from around the state came to push lawmakers on some of the biggest health care issues of this legislative work session.

The main talking points during the N.C. Nurses Association’s “2019 Nurses Day at the Legislature” were the need for more school nurses, Medicaid expansion and the SAVE Act, a bill that would allow advanced practice nurses to treat patients without the supervision of a physician.

Sen. Ralph Hise (R-Spruce Pine) tells more than a thousand nurses gathered on the lawn outside the legislative building that they are the future of health care in NC. Photo credit: Taylor Knopf

Before walking from the Raleigh convention center to the General Assembly, Alex Miller, lobbyist for the NCNA, encouraged nurses to tell their stories to legislators and talk about their patients and what nursing means to them.

He explained that some lawmakers still have the archaic idea of nurses as the “doctor’s helper.” But in reality, they do so much more, he said. The SAVE Act would allow nurses to work, using all of their training (called “scope of practice”) without supervision from a physician, who is often offsite.

“They should be able to do what they are trained, skilled and educated to do,” said Patrick Ballantine, a member of the NCNA government affairs team.

“These regulations are so prehistoric, they are like a T-rex.” Ballantine said. “These rules are ridiculous, and there’s no reason to have them.”

Increasing lack of rural providers

Saadia Syed, a nursing student at North Carolina Central University, said she was surprised at the lack of health care coverage in the United States compared to her home country.

“Back in Pakistan, I thought in America, you would have good health insurance,” Syed said.
“But I’ve come to North Carolina, and I see the need and that’s one of the things I want to do.”

Upon graduation, she wants to move to a rural, underserved county of N.C. Specifically, she would like to practice in a  county that has lost its hospital. She’s considering Washington County.

Evony Pulliam, another N.C. Central nursing student, said the SAVE Act would do a lot for her home community in Person County, where there are no OB-GYNs. She said people from Person County drive to Durham to have their babies.

Map, data courtesy: Sheps Center for Health Policy Research at UNC Chapel Hill

The increasing lack of rural providers is one reason Miller thinks the SAVE Act has a better chance at passing this time around. Similar legislation has been introduced unsuccessfully in the past. Many physicians and their associations oppose the bill.

The legislation also has more third-party support this year, Miller said. The North Carolina chapter of AARP has given more support to this issue than in the past. Additionally, a robust lineup of lawmakers with health care experience has signed on to the bill.

Sponsor video

However, the bill has not moved in either chamber since February.

‘Permission slip’ to practice

Miller said state lawmakers are putting a lot of emphasis on making health care more affordable this session with Medicaid transformation, talk of Medicaid expansion, and proposed adjustments to the State Health Plan.

Miller believes that these efforts need to go hand-in-hand with the SAVE Act, which he said will open doors for more medical providers to work in underserved areas of the state.

There are advanced practice nurses that have moved into rural North Carolina to set up a practice and treat patients. And some, for various reasons, have lost the physician who was signing their “permission slip” to practice, and they’ve had to close, Miller said.

When asked how many times that’s happened, he couldn’t say the exact number, but replied, “One is too many.”

The NC Nursing Association brought a visual for their message that the state’s nursing law restrictions are as archaic as the T-rex. Photo credit: Taylor Knopf

“To make health care accessible, it has to be affordable and available,” he said. “So if we are not doing anything as a state to make health more available while we try to make it more affordable, then we aren’t really increasing access.”

SAVE Act bill sponsor Sen. Ralph Hise (R-Spruce Pine) told the nursing students gathered on the Halifax Mall lawn outside the legislative building that they are the future of health care in the state.

“The number of doctors is not growing in North Carolina, but our population is growing and aging and their health care needs are growing,” Hise said. “The only answer to that call in the state of North Carolina is nurses.”

He said there’s is no profession that does more to take individuals living in poverty, with “difficult backgrounds” and move them into the middle class than nursing.

“Our economy is dependent on that growth. It’s time to change that dynamic with things like the SAVE Act and allow nurses to open their own practice within their scope of practice.”

Taylor Knopf

Taylor Knopf covers rural and mental health news. She previously wrote for The News & Observer as a politics and general assignment reporter. Before that, she worked at a small daily newspaper in southern...

2 replies on “Nursing students ready to go to rural NC, but need more autonomy”

  1. Nurse practitioners have an essential place in our health system, but they do not have the equivalent of “med school light”. I work with every specialty and people of all degrees every day. There is a clear difference in knowledge and training. NPs actually need more supervision, not less.

    The studies that are often quoted showing equal care were done by the NPs using data from the 1980s where the patients were uncomplicated follow up cases that were diagnosed by physicians already, screening, etc. This is the job they were designed for.

    NPs actually go into populated specialist clinics and open medispas when independent. A fewer proportion of them go rural than physicians.

    Many of todays NPs are barely graduated from online schools with minimal clinical training. The clinical training is equivalent to 3% of a physician, and no medical school didactic courses.

    Mid-levels order significantly more imaging and lab tests than MD/DO PCPs, which is the reverse of claimed cost effectiveness. I make a ton more money from them over the past few years — why should I complain?

    The standard of care is falling — too bad state legislatures are allowing it.

    We need to create more MD/DO residency positions. We need to create incentives for doctors to go rural. We need actual mid-level supervision instead of signing 1% of charts from 100 miles away. 🙁

    (Note: previous comment moderated for length.)

    1. I totally agree with what you are saying, education level unfortunately it’s just not the same I wish it was the same. In my case I actually finished medical school and pa my board exams that I am eligible to take but unfortunately I was unable to get into residency based on board scores even though I passed everything that I can take. A lot of my friends graduated with her in the same position and have moved on.

      Either way there needs to be more residency positions created and maintained. Who ever makes these decisions are going to move forward despite what people say, oh well

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