Advanced registered nurse practitioners in Iowa can legally supervise fluoroscopy procedures, the state supreme court has ruled, settling controversy over what constitutes a nurse's scope of practice.

Several physician associations, including the Iowa Medical Society and Iowa Society of Anesthesiologists, petitioned state courts to invalidate rules permitting ARNPs to oversee fluoroscopy procedures performed by radiologic techs. According to court records, the petitioners expressed concern with whether ARNPs are adequately educated and trained in radiation safety, and urged the court to invalidate the rules because the medical profession hadn't recognized ARNPs as qualified to supervise fluoroscopy.

The Iowa Nurses Association, Iowa Association of Nurse Anesthetists and Iowa Department of Public Health supported ARNP's supervising fluoroscopy because they believe it improves access to health care (particularly in rural areas), enhances the safety of certain procedures, lowers healthcare costs and clarifies the authority for what had already been ongoing in parts of the state — allowed, the proponents note, by various hospital credentialing committees staffed in part by physicians.

A district court ruled ARNPs couldn't supervise fluoroscopy, but the Iowa Supreme Court recently overturned the decision, stating the district court erred in second-guessing the department of public health and nursing board on the adequacy of ARNP training to supervise imaging procedures. The supreme court cited no reports of injuries resulting from ARNP-supervised fluoroscopy, and noted that permitting ARNPs to oversee fluoroscopy "improves access to health care for rural Iowans, and helps lower costs."

The Iowa Society of Anesthesiologists says it respects the supreme court's decision, but regrets the ruling "did not recognize the wisdom of prioritizing public safety and access to state-of-the-art medical care for all Iowans." The Iowa Medical Society also voiced its disappointment with the decision, citing the dissenting opinion of Chief Justice Mark Cady: "The medical profession clearly does not approve of the procedure at issue. Every Iowa medical professional society, board or association that has weighed in on the question in this case has concluded the procedure should not be approved for registered nurses."

The American Nurses Association, however, applauds the ruling. "In today's high-demand healthcare environment, we need nurses and all other healthcare professionals working to the top level of their capabilities and licenses," says ANA President Karen Daley, PhD, RN, FAAN. "The court's decision will help Iowans get the healthcare services they need in a timely, efficient and effective way."

Daniel Cook