In October, 2011, the Iowa District Court for Polk County ruled that supervision of fluoroscopic procedures by Advanced Registered Nurse Practitioners (ARNP) is indeed beyond their scope of practice. This was primarily due to lack of sufficient training in school, and failure of the nursing board to establish a training curriculum which specifies minimum standards of safety. Prescribing fluoroscopy falls under the same umbrella as practicing medicine, which is clearly out of their scope of practice... until now.
On May 31, 2013, the Supreme Court of Iowa reversed this decision. ARNP's are now legally allowed to supervise fluoroscopic procedures, as long as they have received "special training" to do so. While Nursing Associations around the country hail the Court for its overturning of this verdict, the question comes to mind, "Do they understand the implications?" This overturning has publicly lacked the support of the ACR, the Iowa Radiological Society, The Society of Interventional Radiology, and the ASRT.
There are still a few states in the U.S. that do not require a license/registration for individuals to perform static radiographic examinations. Even in states that do require this for plain film production, they have been practicing fluoroscopic procedures without a "supervisor" of fluoroscopy for a long time... "for over 20 years" in the Iowa Court discussion. As the country moves to improve the education and accreditation of technologists performing imaging exams using radiation, this is a step in the wrong direction. Let the legal loopholes begin.
I have to wonder why the original verdict reached by Polk County was overturned since nearly the entire medical community was not in support of allowing nurses to supervise fluoro procedures. It is substantially clear that individuals involved in reversing this decision have some kind of profit to make (or to avoid losing). Why hire a trained professional (a new added expense) when the old way of doing things would only cost the nurses (not the hospitals) a little bit of money for a class on radiation safety?
It's only fair that I address the one and only problem this would require the hospitals to face if the decision was not overturned... in a time when health insurance coverage is taking its toll on the financial health of hospital organizations, this would require an increased cost to hospitals to find qualified personnel, especially in rural areas where there may be a shortage of these people to perform the job. Hospitals would encounter the issue of attracting qualified professionals to fill these needs in their areas. Even given this credit, what I'm left asking is should the difficulty of this task compromise patient safety? In my humble opinion, no.
In my professional experience working in three different states as a radiologic technologist, I have seen very strict radiation protection guidelines and very loose ones. I can't fathom the reasoning behind sacrificing a standard of safety so that (with all due respect to their traditional scope of practice) a nurse can take a short course and supervise a radiologic technologist to perform a fluoroscopic procedure. The argument, "we've been doing it for over 20 years" no longer suffices. Radiologic Technologists have at least two years of background education, and I don't believe we are even qualified to supervise a fluoroscopic procedure. I'm uncomfortable with the idea that prescribing a radiation dose for any patient is being allowed despite the opinion of both national and state-level authorities on imaging and radiation protection.
I would love to learn about the training regimen that will be introduced for ARNP's that will be proposed that will be deemed sufficient for the State of Iowa. At this time, I could not find any references. But unless this decision goes to the national Supreme Court, the citizens of Iowa will be subject to its legal system and its band-aid solution.
What's your take on this situation? Do you think the Iowa Supreme Court made a good decision to allow ARNP's to supervise fluoroscopic procedures?
Resources:
American Society of Anesthesiologists
Iowa Society of Anesthesiologists
Iowa Medical Society
ASAQH
Official Iowa Supreme Court Decision (33 pages)
No comments:
Post a Comment