MICHIGAN Bill seeks to expand Nurse Practitioner independence.

Posted By American Med Spa Association, Friday, October 15, 2021

Bill Name: Senate Bill 680 (SB 680

Primary Sponsor: Senator Rick Outman 

Status 10/06/21 introduced and referred House Committee on Heath Policy and Human Services

AmSpa’s Take By expanding nurse practitioner’s (NPs) prescriptive authority and defining their scope of practice, this bill would effectively give NPs fully independent practice.

Outlook This bill is in the first steps of the process, and, based on the sponsor’s past records and bipartisan support for this bill, it has a high likelihood of passing. However, similar bills from prior sessions have failed to this legislature.

Analysis: Michigan nurse practitioners (NPs) currently have somewhat convoluted scope of practice and supervision requirements. They have independent practice within their nursing functions and can independently prescribe medications other than controlled substances. To prescribe controlled substances or perform procedures outside their scope of practice, they must work under the supervision and delegation of a physician. This makes for a sometimes-vague dividing line regarding whether the NP needs delegation from a physician or can perform something independently.

  As introduced, SB 680 would substantially simplify the practice landscape and provide NPs with far more independent authority. Under SB 680, when a nurse is granted the NP specialty certification, they can also be issued a controlled substance license and be able to independently issue prescriptions for schedule II – V controlled substances. This new authority also includes the ability to order and dispense complimentary starter doses of controlled substances. In addition to this broader prescriptive authority, SB 680 would add to the NP’s scope of practice. The bill would explicitly allow NPs to 1) provide assessments and exams; 2) diagnose and treat patients; 3) order and perform studies; 4) prescribe interventions and treatments within their specialty role; and 5) provide health counseling, education and promotion. These would all become part of their independent scope and could be performed without needing physician supervision. Critically, SB 680 also grants the NP the ability to supervise other nurses and health care professionals as appropriate.

  Along with the expanded scope of practice, SB 680 lists several education requirements that a nurse must possess to be granted a NP certification. These include 1) completing a nurse practitioner education program acceptable by the board; 2) completing a graduate-level course in pharmacology, pathophysiology and physical assessment along with a clinical practicum; 3) being certified by a nationally accredited certifying body; and 4) meeting any other board-approved requirements. While these requirements would be new, they are not dissimilar to the majority of NP requirements in other states.

  Finally, while SB 680 would effectively make NPs independent in Michigan, it would impose a few practice standards. NPs could only provide services to the population that would be common for a nationally certified NP with educational and experiential preparation to provide. Not surprisingly, NPs must abide by their board and certifying body’s practice standards and consult or refer to other health care professionals as appropriate. Like the educational requirements, these are very typical duties or limitations on other state’s NPs.  

In total, SB 680 appears to substantially expand the NP independent scope of practice while only imposing common and typical limitations. We will be monitoring this bill as it works its way through the legislature. If you would like additional information, to read the bill or to contact the sponsors, you can find this information through this link