Among the more controversial bills that Gov. Dannel Malloy recently signed into law is one that allows advanced practice registered nurses to practice independently after collaborating for three years with a licensed Connecticut physician. The measure had been at the center of a clash between healthcare professional groups. 


The Connecticut State Medical Society rallied against the bill, claiming that it opens the door to potentially inadequate care for patients.


“It is fundamentally an issue of patient safety and health-care transparency,” said CSMS President Michael Saffir, MD in a statement. He asserted that patients would be better served by a physician-APRN team approach to care.


“Studies have shown that the team-based model, where physicians and APRNs collaborated to provide coordinated patient care, is the most effective approach to quality patient care,” Saffir said. “This bill moves in the opposite direction, by removing collaboration and fragmenting the care team. It is difficult to see how this change will improve patient care, and it does nothing to address the need for health-care transparency in Connecticut.”


Of primary concern among CSMS members were nurse-practitioner educational training, practice oversight and how the three-year collaboration with a physician would be structured.


The bill, titled “An Act Concerning the Governor’s Recommendations to Improve Access to Health Care” (SB 36) passed both the House and the Senate in April.  CSMS called on Malloy to veto the measure when it got to his desk. However, the governor signed it in late May.


That was good news for Laima Karosas, health policy chair of the Connecticut Advanced Practice Registered Nurses Society (APRNS).


“It’s a wonderful thing that happened,” says Karosas. “We are exuberant because this is a long time in coming. I think there was an overwhelming cry out there where [people  said] ‘You know what? We do need all hands on deck.’”


Karosas, who is director of the nurse practitioner program at Quinnipiac University’s School of Nursing and is a clinical associate professor of nursing there, believes fear of competition might be a contributing factor for at least some resistance to the bill.


“The scope of practice remains the same, so I think their fear is unfounded,” she says. “I think the places where we work and the services we provide are just to a different clientele.”


Plus, nurse practitioners who are independent will continue to work in concert with a physician, Karosas says.


“I want to have someone I can go to [to consult with],” she says. “I see us as very complementary. I think we need to support each other. It’s a very fragmented system we have, and nurse practitioners are part of the solution.”


Karosas adds that the training and educational requirements for nurse practitioners at Quinnipiac are substantial and she does not foresee any changes because of the bill.


“No, I don’t think we’ll change at all,” she says, adding that “the world has changed tremendously” in terms of healthcare delivery needs. Through the Quinnipiac nurse practitioner program, she says, “I also think we’re keeping up with the times.”