NASHVILLE, Tenn. — Doctors and nurses are at odds over a controversial bill involving oversight over nurses that is making its way through the Tennessee legislature.
Julie Hamm has been an advanced practice registered nurse, or APRN, for well over a decade.
"My practice daily is to make sure the patients are taken care of daily," Hamm said.
Dr. Kevin Smith has been a Nashville physician for 25 years.
"We're always going to be about what's best for patients," said Smith.
They disagree on something called chart review.
"It's really thought to be a quality improvement process," said Smith.
"It simply doesn't make sense," said Kathleen Murphy with the Tennessee Nurses Association.
The TNA is pushing for a bill that would eliminate chart review. Right now, APRNs are required to have doctors sign off on 20% of their charts every 30 days.
Nurses call it unnecessary red tape, and they say the costs of paying for the doctor's time get passed on to patients.
"So my insurance is paying a higher rate," Murphy said. "I'm paying a copay based upon seeing a physician when really I was seen by a nurse practitioner."
They also say it's preventing nurses from opening up their own shops in underserved rural Tennessee counties.
"So if that barrier was removed, we would see more practices opening in areas where we know physicians are not going to be there anyway," Hamm said.
Doctors with the Tennessee Medical Association said that's not true.
"What we're hearing is: it's almost impossible to get a nurse to go to rural areas as well. They like to live in the cities just like the doctors do," said Smith.
Smith said chart review is about having checks and balances and ensuring quality care; having someone with more education collaborate with those who have less.
"Number one is to make sure care is being delivered as it should be and also be able to give the education to improve care after the fact," Smith said.
There are 26 states, including Tennessee, that have some form of chart review, but 24 states and Washington D.C. does not.