Landmark Decision by the Iowa Supreme Court on ARNP Scope of Practice
Written by Lynn Boes - INA Legal Counsel
In a landmark decision for Nursing practice in Iowa, the Iowa Supreme Court issued an opinion finding that the Iowa Board of Nursing, not medical organizations, had the authority to define the scope of Nursing practice in the state of Iowa. The Court noted, “f the District Court’s ruling were to be upheld, it would fundamentally alter the nursing profession, as well as healthcare within Iowa, by allowing physician associations to have absolute veto power over any proposed new nursing rule, regardless of the actual opinions of Iowa physicians and of the actions of Iowa physicians in their privileging of nurses to perform various practices.”
The case was brought by the Iowa Medical Society and the Iowa Society of Anesthesiologists against the Iowa Board of Nursing and the Iowa Department of Public Health (IDPH), who were attempting to invalidate a rule adopted by each agency. The Iowa Nurses Association (along with the American Nurses Association) and the Iowa Association of Nurse Anesthetists and one medical association were granted permission to intervene.
KEY ISSUES OF THE CASE
· The rules at issue recognized the abilities of Advanced Registered Nurse Practitioners (ARNP) to supervise operators of fluoroscopy equipment, while the ARNP performed various nursing techniques such as peripheral insertion of an extended length intravenous catheter, foreign body location, precise needle location for procedures such as breast biopsy and interventional pain management. The Iowa Board of Nursing believed that it had the authority to define nursing practice in this way.
· At issue was the interpretation of Iowa Nursing Law, which allows nurses to perform additional acts “which are recognized by the medical and nursing professions and approved by the Board as proper to be performed by a registered nurse.” Iowa Code § 152.1(6)(d).
IOWA BOARD OF NURSING AUTHORITY TO DEFINE NURSING
The Iowa Supreme Court found that the Iowa Board of Nursing was granted the authority to make rules and interpret the Nurse Practice Act. The Court agreed with the reasoning of an Attorney General Opinion interpreting the phrase at issue, shortly after the Nurse Practice Act was revised in 1976. “The plain language of section 152.1(6)(d) allows the nursing board to decide whether the nursing and medical professions have recognized a particular practice of nurses.” The record before the Court had evidence that physicians approved of the practice by credentialing the nurses, forty physicians wrote in favor of the Board of Nursing rule, and the Iowa Board of Medicine did not use its power to stop the nurses from supervising fluoroscopy. Since the Board of Nursing rule was not “irrational, illogical, or wholly unjustifiable,” the Court deferred to the Nursing Board’s interpretation.
IMPACT ON HEALTHCARE ACCESS
The IDPH rule allowing ARNPs to supervise fluoroscopy was intended to improve access to healthcare (particularly in rural areas), improve patient safety, and clarify and codify existing practice. The Iowa Supreme Court rejected the physician organizations’ argument that the ARNPs had to be able to operate the equipment. “Many professionals supervise work done by others without the license or ability to do the work themselves.”
This is a win for Iowa patients and Iowa healthcare in general and Iowa nursing practice specifically! The Decision can be read in its entirety at the following website:http://www.iowacourts.gov/Supreme_Court/Recent_Opinions/20130531/11-1977.pdf
The INA would like to specifically thank the American Nurses Association for its financial and legal support, including Legal Counsel Maureen Cones and Chief Counsel, Alice Bodley who assisted in the litigation of this matter. Thanks also to the many, many nurses, physicians, hospitals and radiology staff who moved forward to meet the healthcare needs of the citizens of Iowa, and who wrote letters of support at the proper time; thanks to nurses serving in governmental roles, academia, INA members and staff who met with the medical groups for years to try to come to a solution without litigation; nurses in the Iowa Association of Nurse Anesthetists and their legal counsel Jim Carney and George Appleby, the Davis Brown Law Firm (administrative assistants who diligently and capably assisted with the filings, and attorney Jodie McDougal), along with Co-Counsel for the Iowa Board of Nursing and the Iowa Department of Public Health, Sara Scott and Chantelle Smith. This was truly a team effort with a wonderful result!
|by Kathryn Dorsey | June 4, 2013|