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How One Nurse is Expanding Access to Health Care in Her Rural Florida Town

New Florida Law Championed by House Republicans Allows Qualified Advanced Practice Registered Nurses to Practice Independently

PORT ST. JOE, Fla. — On the brink of joyful tears, Monica Barfield held on to oversized scissors and snipped through the taut blue grand-opening ribbon outside New Horizon Primary Care on Monday, July 6, in rural Port St. Joe.

For Barfield, an advanced practice registered nurse (APRN) with a master's degree and 15 years of experience, practicing independently in her own primary care clinic was a pipe dream; that is until the Florida Legislature passed HB 607 in March, allowing qualified APRNs to provide primary care without physician supervision.

Florida has 278 primary care health professional shortage areas — one of which impacts the low-income population of nearby Wewahitchka, about 25 minutes north of beachside Port St. Joe.

"Finding health care in the town I am in, people out here don't have a lot of options," Barfield said. "If they don't have someone here, they have to drive an hour to see a provider. The biggest push for opening New Horizon was opening up health care for people who don't have access to it."

Prior to HB 607's passage, APRNs like Barfield had to be "supervised" by physicians. That often meant a physician who never saw the APRN's patients, never reviewed a chart, and never did a patient consultation could charge the APRN a fee to sign the required supervision paperwork.

Even a simple task like ordering supplies for her facility would need signoff from the supervising physician, Barfield said. This supervision requirement was a major barrier for APRNs who wanted to work independently to meet a need in their communities.

Monica Barfield and Rep. Shoaf at the ribbon cutting.

For this reason, HB 607 was a top priority of Speaker Jose R. Oliva, R-Miami Lakes. It was sponsored by emergency-medicine physician Rep. Cary Pigman, R-Okeechobee. 

HB 607 was signed into law by Gov. Ron DeSantis on March 11 and became effective July 1.

Currently, the Florida Board of Nursing is working on registration applications for APRNs like Barfield to fill out for autonomous practice approval. The Board of Nursing estimates it will take about 90 days to produce the registration application.

Meanwhile, Florida's new Council on APRN Autonomous Practice is working on recommendations for standards for APRNs who register with the Board of Nursing for autonomous practice.

For now, New Horizon Primary Care will be open under the supervision of friend and practicing physician Dr. Michael Barnes, who Barfield said supports her endeavor to branch out on her own.

With HB 607 in place and implemented fully by the Board of Nursing, experienced and qualified APRNs like Barfield will soon be able to help resolve the issue of primary care shortage areas in Florida — giving patients more options for quality local health care.

“This is the reason that HB 607 was passed to begin with,” said Rep. Jason Shoaf, R-Port St. Joe, just before the ribbon-cutting. “We wanted to create a situation where we had more access to health care and affordability in our rural communities.”

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