Controversial Montana Ruling Pits Nurses Against Labs

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MONTANA IS IN THE MIDST of an interesting feud over the scope of practice between nurses and certified laboratory professionals.

On December 11, 2000, the Montana Board of Nursing issued a declaratory ruling stating that the scope of practice for nurses included performing unwaived laboratory tests. This ruling appears to ignore the Laboratory Licensure Act, a long-standing statute passed by the Montana state legislature which establishes a higher standard for licensure than CLIA.

In response, the Montana Society of Clinical Laboratory Scientists (MTSCLS) filed a court action to obtain a preliminary injunction to stay this declaratory ruling. On February 21, a local judge refused to grant the injunction, but scheduled an expedited hearing on the full matter for March 21.

“The nursing board’s ruling erodes the very integrity of laboratory medicine,” said Carrie Biskupiak, President of the MTSCLS. “The scope of practice for nurses clearly falls short of the necessary knowledge level needed to ensure the highest degree of standards for a patient’s protection.”

Efforts To Present Evidence

Montana’s clinical lab community has made repeated efforts to present evidence on the public record that unwaived laboratory testing requires a comprehensive range of training, knowledge, skills and certification to ensure consistent results. So far, official hearings have not been receptive to that message.

“The original discussions involved the scope of practice for nursing,” noted Biskupiak. “However, emphasis then shifted to the lack of availability of trained lab professionals in rural hospitals, and claims that nurses could perform unwaived lab tests in an acceptable manner. Testimony was presented stating that nurses already do unwaived testing in some settings and there was no public record of problems resulting from this practice.”

Pharmacists’ “Lab-Grab”

The action by the Montana Nursing Board is another demonstration of the thin line that exists between a rational regulatory scheme and the power of vested interests to shape regulations to their particular needs. In recent years, pharmacists have lobbied in several states to gain the legal right to provide and perform clinical laboratory tests.

Laboratorians in Montana say they have yet to get an objective and thorough hearing on the documented evidence that non-professionals fail to properly address many of the required steps to insure a quality lab test result that can be trusted by the clinician. They hope the court hearing scheduled for March 21 will give them that opportunity.

Collectively, the events in Montana, combined with efforts by pharmacists to gain legal authorization to perform lab tests, demonstrate that other segments of the healthcare market see value in lab testing. As testing disperses from the core lab, expect to see similar battles in other states.

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