I respectfully request that you and the Department of Health declare an executive order to temporarily suspend physician supervisory protocols for APRNs so that they may serve in critical needed areas now and in the coming weeks of this COVID-19 pandemic. I also ask that additional protections be authorized in the form of sovereign immunity for those front-line workers responding to this crisis. As you are acutely aware, our state is under a state of emergency and all health care providers who are willing and able are needed to help screen and treat patients.

Advanced practice registered nurses (APRN) are able to help evaluate patients; make diagnoses; order, perform and interpret diagnostic tests; initiate and manage treatments, including prescribing medications and non-pharmacologic treatments; and coordinate care and provide patient counseling and education to patients, families and communities.

Federally, the VA hospitals and clinics have expedited the implementation of their model for autonomous APRN practice nationwide in preparation of surge needs to come. As you know being a Navy reservist, APRNs currently serving in the military, those staffing new field hospitals nationwide, and those on both the USNS Mercy and USNS Comfort have full practice authority and no protocol requirement. The military is also now seeking to reactivate healthcare professionals, including both APRNs who have retired and those in the Reserves, with the full faith and support of the federal government as to their qualifications, education, and training. Currently, protocols:

• Severely delay and restrict out-of-state APRNs from volunteering to help Florida in cases of emergent need

• Prevent Florida's APRNs from volunteering in places of surge capacity, as many protocol physicians are not willing to extend their protocol to help fill critically needed areas.

• Create increased legal liability - if the protocol physician becomes incapacitated or dies, the APRN is unable to provide care at all due to risk of prosecution. At a time where more care providers are needed to help fill critically needed areas serve, this is dangerously inefficient.

• Do not allow protections under law against retaliatory prosecution for front-line workers in the midst of this crisis.

Emergency preparedness is vital at this time and protections need to be established in a crisis. It is dangerous to wait until we reach our peak to act. As the governor, you have the experience and knowledge of this availability of resources beforehand, so choosing not to implement these recommendations only delays care and treatment to the detriment of Floridians. Many other states have taken this emergency action already.

By allowing  nurse practitioners (NP) to work as they have been educated and trained, our healthcare teams will be enhanced and community needs met, especially by bringing certified psychiatric mental health NPs on board to screen and assist with the growing mental health issues that are evolving from the stress, deaths, and the fear of unknown this disease brings.

Waiving this statutory requirement now would ensure that Florida can act quickly during this crisis to meet the needs of Floridians. If there is anything that can be done to expedite a solution and bring more hands-on deck I can assure you that APRNs will immediately bring the additional resources needed to this fight. Again I implore you to issue an executive order to suspend APRN-physician protocols temporarily and extend the protections of sovereign immunity.