Regulations continue to prevent advanced nurse practitioners from volunteering to care for sick or injured people in North Carolina.

To treat patients, nurse practitioners must fall under the supervision of a physician. In fact, nurse practitioners often meet with their supervisor only twice a year, yet still pay thousands of dollars to comply. 

The nurse practitioners have long argued the regulation hurts patients’ access to care. Elderly patients have lost their providers when their nurses’ supervisor retired. But as COVID-19 spreads, nurse practitioners say the regulation bars them from volunteering to care for the patients. 

The American Hospital Association reportedly advised hospitals to prepare for 96 million cases of COVID-19 in the U.S. in the next few months. It estimates the virus could put 1.9 million Americans in the intensive care unit, potentially causing 4.8 million hospital admissions and 480,000 deaths. The nation has fewer than 100,000 intensive care unit beds. 

COVID-19 is almost twice as contagious as seasonal flu. Elderly people and those with some chronic medical conditions are particularly vulnerable. 

Gov. Roy Cooper declared a state of emergency March 10, and the state began loosening restrictions on medical workers. Cooper allowed out-of-state licensed medical providers to practice in the state. The N.C. Medical Board expedited the licensure process to bring retirees back into the workforce. The state even temporarily waived regulatory caps on acute care beds.

But neither Cooper nor the medical board touched rules governing advanced nurse practitioners, who remain tethered to physicians.

“Even in times of disaster, you still must have a supervising physician,” said Dennis Taylor, N.C. Nurses Association president. “A lot is going to depend on what physicians are willing to do.”

Physicians don’t always have the option to supervise nurses. Physicians’ malpractice insurance doesn’t always cover anything other than regular work duties, making it difficult to volunteer as supervisors during disasters, says Taylor.

During hurricanes, advanced nurse practitioner Leslie Sharpe tried to volunteer, only to be stymied by the regulation. She couldn’t find a willing supervisor.

“We can’t even give away our services for free if we don’t have a physician with us,” Sharpe said. “I have to go find another physician to volunteer in a free clinic for underserved people. We can’t even do that. … It’s frustrating and absurd, especially when I’ve been practicing for 20 years, that I can’t step in and help.”

About 80% of the people who get COVID-19 will experience only mild symptoms, according to current estimates. But the outbreak in Northern Italy — where doctors are rationing care and accelerating graduation for nursing students — has experts rattled. The governor of New York asked the president to mobilize the military to transform military bases and college dormitories into temporary medical centers. 

“We have a very finite number of doctors and nurses who can take care of critically ill patients,” said Dr. Philip Rosoff, Duke University School of Medicine professor. “That is the bottom line. And the ability to expand to meet an anticipated demand that could rapidly ramp up is finite itself. So then you’re faced with a classic rationing problem.”

State leaders are trying to “flatten the curve” and spread hospital admissions, but the state should use available resources to prepare for a worst-case scenario, says Jordan Roberts, John Locke Foundation health care policy analyst. 

“At a time like this, where there is so much pressure on the entire health care system, some physicians are going to have their hands full,” Roberts said. “It could get to a catastrophic point, and we want to relieve as much pressure on these professionals by letting them practice up to what they’ve been trained for.”

The regulations already hurt patients’ access to rural health care, even before COVID-19 threatened to worsen rural medical shortages, says Susan Hassmiller, a senior adviser at the Robert Wood Johnson Foundation, a national provider of health care research and education grants.

“[COVID-19] will put an enormous strain on health care providers in this country. Not only a physical strain, but also a mental strain because lives are at stake,” Hassmiller said. “This is about patient access.”

The matter lies with the General Assembly. Lawmakers introduced Senate Bill 143, the SAVE Act, in 2019 to end lifetime physician supervision, but the bill hasn’t moved. The General Assembly is preparing for a special session to address the pandemic, but the state is awaiting action from Congress before convening. At press time, North Carolina remains one of 12 states that still have the restrictions.

“The law has to change. It’s really a political issue in front of the legislature now,” said nurse practitioner Victoria Soltis-Jarrett. “The law is still there, so you have to go through the motions of getting a collaborating agreement.”