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NC lawmakers debating legislation that would allow some nurses to practice independently

Three people stand by a wood podium. A large metallic seal of North Carolina and American flags are in the background.
Colin Campbell
Sen. Joyce Krawiec, R-Forsyth, was joined by Sens. Ralph Hise, R-Mitchell, and Gale Adcock, D-Wake, for a news conference promoting the SAVE Act on Feb. 28, 2023.

A bipartisan group of state lawmakers is trying again to expand the role of advanced practice nurses – a proposal closely tied to efforts to expand Medicaid.

For years, nurses and their backers in the General Assembly have been unsuccessful in passing the SAVE Act. It would allow nurses who have met advanced educational and clinical practice requirements to work independently without having a supervising doctor.

Supporters say the change would make health care more accessible and more affordable. That’s because it’s typically cheaper to be treated by a nurse.

Last year, Senate Republicans demanded that the SAVE Act be included in any plan to expand Medicaid to more than 500,000 people. They made the same case Tuesday as the SAVE Act was filed in both the House and Senate.

“You can’t offer coverage to more people if you don’t have a workforce to deliver the care, “ said Representative Carla Cunningham, a Democrat from Charlotte. “There’s simply no way to do it without advanced practice registered nurses.”

A coalition of groups representing doctors and anesthesiologists opposes the measure. They issued a statement saying the SAVE act would disconnect doctors from patient care and create safety problems.

That argument has resonated with House leaders, and they haven’t taken any action on previous bills.

But the SAVE Act is one of the sticking points in Medicaid expansion negotiations between the House and Senate, and pressure to get a deal on Medicaid could create movement this year.

Senator Gale Adcock, a Democrat from Cary, says the state needs more nurses, but many of them are graduating in North Carolina and moving elsewhere.

“Because North Carolina makes it harder than most of the rest of the country to do the work that they went to our schools to learn how to do,” she said.

Part of their concern is the fees nurses pay to supervising doctors. Republican Senator Joyce Krawiec of Forsyth County says she knows a nurse who rarely sees her supervisor.

“Her supervising physician is still licensed in North Carolina but retired to Tennessee,” said Krawiec. “He flies in every six months, signs her documents, and she pays him $20,000 a year.”

SAVE Act supporters said Tuesday that they expect more than half of the lawmakers in both chambers will sign on as co-sponsors of the bill, but that might not be enough to get it to a vote if House leaders block the measure.

Copyright 2023 North Carolina Public Radio

Colin Campbell covers politics for WUNC as the station's capitol bureau chief.
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