A D.C. City Council proposal to allow nurses with advanced training to provide some health care services traditionally restricted to doctors met opposition yesterday during a hearing as nurses and doctors disagreed over how such activities should be supervised.
Broadening the scope of nursing duties is part of a comprehensive council proposal to reform the District's laws regulating the health care professions. Under the proposal, nurses with advanced training could be licensed as anesthetists, midwives and nurse-practitioners, and could offer some treatment and medical diagnosis provided that they collaborate with licensed doctors.
In 1983, the council adopted a law that provided for the certification of specialized nursing professions, including midwifery. The latest proposal would allow nurses to move out of hospitals and doctors' offices to establish their own practices, as long as they meet certain collaboration requirements.
Nurses testifying yesterday during the council's Consumer and Regulatory Affairs Committee hearing said they wanted the collaboration requirement deleted, while doctors argued that hospital and doctors should be allowed to make the collaboration requirements even stricter than those now proposed.
"There is no collaboration in this bill," said Susan Jenkins, an attorney representing the District of Columbia Nurses' Association. "It is supervision that would restrict any nurse specialist from having a private practice." Jenkins specifically opposed a provision requiring that a joint committee, including three doctors, approve collaboration arrangements before an advanced registered nurse could perform diagnosis and treatment.
Doctors argued that they have the ultimate responsibility for the welfare of patients and should be allowed to go beyond the minimal standards of collaboration established by the proposal. The council's proposal would undermine the ability of hospitals to establish their own standards of care, a District of Columbia Hospital Association spokesman said.
City Council member John Ray (D-At Large), who introduced the proposal, said he wants to establish a balance within the profession. He said the government would maintain levels of control while giving nurses more freedom to use their skills, and would allow doctors to remain involved without allowing them to dictate the type of services provided by nurses.
Under the framework established by Ray's proposal, the District's Commission on Licensure to Practice the Healing Art, an independent government agency that regulates the practice of medicine, would be replaced by a board of medicine that would report to the Department of Consumer and Regulatory Affairs. Eleven other boards established by the proposal would regulate activities ranging from nursing to social work; all of the boards would be placed under the consumer department's jurisdiction.
The consumer committee also is considering a similar bill, introduced by City Council Chairman David A. Clarke at the request of the Law Revision Commission, that proposes consolidating District laws to increase consumer protections and make health care services more available.