Maryland Academy of Advanced Practice Clinicians

Update on HB319 / SB484

Posted over 9 years ago by Elaine Crain

This announcement has 1 attachment:

Colleagues: I have had several complaints, queries and concerns about the Bill as people go to speak to, and write to, their Representatives and Senators.

I realize that not everyone knows the Bill and Nurse Practice Act as intimately as I do J so I have broken the bill down – line by line - and related it to the NPA. And yes it was a tedious as it sounds! I started at 9 am this morning! The bill can be printed off the MCNP website ( and while you’re there use the new PayPal system to donate to the cause or join the fight J).

The Bill also takes the NP Scope of Practice from regulatory (rules issued by an agency {the Board of Nursing} that the government has given authority to regulate an industry {NP practice}) to statutory (laws passed by the state government). NPs are the only MD profession to have their scope of practice regulatory instead of statutory.

If the Bill passes and is signed into law, it will take a legislative vote (and law change) to change our scope of practice. Why is this important?

The members of the Board of Nursing are appointed, not elected.

1. The Board of Nursing issues the regulations for nursing practice and can change the regulations at any time – without any input.

2. The Scope of NP practice in MD is independent at this time.

3. The wording for supervisory practice can be inserted without outside argument or dissent.

Warning, personal comments coming up - NOT affiliated with any NP organization, person or MD legislator – just me here!

4. MedChi, a group of 5000 physicians in MD, has money, power and honeyed tongues

5. Do some Critical Thinking here please…


Quick overview:

Arguments for eliminating the written agreement / collaborative agreement (CA)

1. It takes from 1-3 months to process - thus having NPs move out of MD and/or not get the positions they want/need.

2. NPs cannot volunteer their time at free clinics, church or community health care screening events, or mobile health units serving in underserved areas.

3. If there are no physicians to sign CA then NPs can’t practice anywhere – in this political climate ‘read’ in rural and low-income areas.

4. Few primary care/internal medicine doctors are graduating in MD and no students are going into the field either.

  • Not having a CA can therefore cause economic and emotional problems for NPs, their families and their patients

  • Can you say ‘Access to Care’ without snarling?

5. It costs the MD taxpayers money to have the Joint Committee exist and take time to reviews CAs.

6. According to the testimony from the representative from the Board of Physicians, the only thing the Board of Physicians checks on the CA is the physicians’ name and state of license – they ignore the rest.

  • Possible arguments against (These are the ones I have heard. I do not know them all):

1. Some NPs and physicians believe that having a formal written collaborative agreement is better that relying on a verbal one – this has not been proven to be true in any of the NP or physician literature. MCNP has a folder of this literature if you need or would like to peruse it (It’s a lot!).

2. Some NPs feel physicians will not accept patients, referred by NPs, without formal written collaborative agreement. Again this has not been proven to be true in any of the literature. My thought – physicians rely on collections to pay their bills. Collections come from patients and their insurance companies. Without patients, physicians have no income. If NPs refer their patients to MDs who might not have seen the patients in the first place (time and location included here)…get it?

3. MedChi wants to change our existing practice to a supervisory one and they seem to think the CA gives them the right to supervise NPs – it doesn’t but they keep talking like it does.

  • However they might get the fact that they can’t change a statue easily, but they may be able to influence regulation (see personal comments above)…

I have written the attached ‘breakdown’ so you can cut & paste and use the arguments when you need them. Unchanged portions of the NPA are smaller so the changes are easier to find quickly. It also contains some rather sarcastic comments – so please laugh!

There may/will be errors in this breakdown and as they are pointed out to me, nicely please – lol, I will correct and send out the corrected document.

The House Committee hearing went well. But Pete Hammond, Chair, will not let a bill out of committee if it is ‘contentious.’ So he has established a sub-committee to review and amend the bill as needed. I will let you know who is on that committee as soon as I know. If the Bill does not make it out of committee then it does not go to vote.

If any of the House Committee members are ‘yours,’ then get to them right away, find their concerns and discuss the issue (using this info if it helps). I will be happy to help you discuss with them that this is a good piece of legislation. We can schedule meetings or a conference call. Let me know.


Health and Government Operations Committee (HGO)

Chair: Peter A. Hammen.

Vice Chair: Shane E. Pendergrass

Members: Joanne C. Benson (sponsor), Sue Kullen (sponsor), Eric M. Bromwell, Patrick L. McDonough, Karen S. Montgomery (sponsor), Robert A. Costa, Dan K. Morhaim, John P. Donoghue, Shirley Nathan-Pulliam (sponsor), Donald B. Elliott, Nathaniel T. Oaks, James W. Hubbard, Joseline A. Peña-Melnyk (sponsor), Charles A. Jenkins (sponsor), Kirill Reznik (sponsor), Wade Kach, B. Daniel Riley, Nicholaus R. Kipke, Shawn Z. Tarrant, Susan W. Krebs, Veronica L. Turner

Committee Staff: Linda L. Stahr, Lisa J. Simpson, and Erin R. Hopwood

Dept. of Legislative Services. Assistant to Chair: Patrick Dooley

The Bill has been sponsored by (you should be able to click and go their page under Biograpy):

The Senate Hearing is this Wednesday at 1pm. Please come if you have time – it is an interesting process! And as always, feel free to pass this on, Elaine



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