A Dignified Death

October 2025 | Vol. 69, No. 3
Written by Melissa P. Broyles, DO

A typical Qliq message reads, “Routine Palliative Care consult to discuss goals of care with family. Patient is Sylvia S. in ICU 468.” The chart describes a somnolent 100-year-old woman with advanced dementia, admitted due to dehydration and subsequent acute-on-chronic kidney disease. When I speak with her daughter, I learn that Ms. Sylvia, fondly called so by her students, was a beloved kindergarten teacher for forty years and a devoted mother of four. Her daughter shares that she had poor oral intake for two weeks prior to admission and had stopped eating and drinking entirely in the last two days.

At Ms. Sylvia’s bedside, she lies in peaceful stillness—frail, beautiful, and unmoving. Her heart monitor blares repeatedly, alarming for a heart rate of forty-eight, yet she does not stir. Suddenly, behind me, a determined attending physician and medical resident rush into the room with a consent form and surgical tray in hand—not due to Ms. Sylvia’s heart rate, but because they are on a different mission. To my surprise, following a specialist’s suggestion, they intend to place an access line in her neck to initiate dialysis.

Standing Firm: POMA's Commitment to Physician-Led Care

October 2025 | Vol. 69, No. 3
Written by George Wolters, DO, POMA President, and Tyler Burke, POMA Senior Director of Government Affairs

Opposition to granting independent licensure for advanced practice nurses is grounded in the realities and demands of family practice. Providing comprehensive medical care for all ages and all genders requires extensive training and experience, best delivered by a team directed by a physician. Multiple physician organizations have opposed expanded licensing efforts for decades.

Advocates for independent nurse practice claim there is no difference in outcomes between independent practice and physician-led, team-based care. Other studies contradict this claim by showing poorer outcomes, lower patient satisfaction, and higher costs associated with unsupervised nurse practice. Additionally, concerns over increased diagnostic X-ray use and overprescription of antibiotics and opioids reinforce questions of patient safety. An excellent commentary and overview, published in the Journal of Osteopathic Medicine (2024; 124(12): 555-558), is well worth the read.

In 2019, POMA and other key stakeholders began negotiations regarding the scope of practice for Certified Registered Nurse Practitioners (CRNPs) in Pennsylvania. After months of challenging and complex discussions, the parties reached an agreement on a pilot program. This program would be limited to primary care and Healthcare Practitioner Shortage Areas (HPSAs), a provision POMA believed would ensure CRNPs practiced in areas with true healthcare access needs, addressing the very gaps their advocacy claimed to target.