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Florida’s fumble on full practice authority for nurse practitioners

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When the Centers for Medicare and Medicaid Services (CMS) announced its Rural Health Transformation Program (RHTP), a $50 billion, five-year federal investment to improve rural health care, it marked a pivotal shift in how states will be rewarded for removing barriers to care (Centers for Medicare & Medicaid Services [CMS], 2024).

The program’s Notice of Funding Opportunity (NOFO) opened on Sept. 15 and will close on Nov. 5, 2025, with awards announced by December 31. Part of each state’s technical score will depend on its scope-of-practice environment, specifically whether it allows nurse practitioners (NPs) to practice independently with full practice authority (FPA).

This metric recognizes what decades of research have proven: nurse practitioners provide high-quality, cost-effective, and accessible care across every setting. States that grant FPA empower NPs to evaluate, diagnose, order and interpret tests, and prescribe treatments without mandated physician oversight. Evidence shows these states experience better primary care access, especially in rural and underserved communities (Xue et al., 2021).

Florida, however, remains a reduced-practice state. Despite progress with HB 607 in 2020, allowing some autonomous primary care practice, psychiatric and many specialty NPs remain restricted by supervisory requirements. These outdated barriers do more than limit professional autonomy; they limit access for Floridians.

Studies consistently demonstrate that FPA states have stronger rural health outcomes. After states expanded NP practice authority, the number of NPs practicing in Health Professional Shortage Areas increased significantly (Xue et al., 2021). Patient outcomes remain equivalent or superior to those under physician-led care, with comparable control of blood pressure, hemoglobin A1c, and cholesterol levels.

Research also shows no increase in adverse outcomes when NPs practice independently (Grant & Ball, 2023).

The CMS RHTP uses these findings to justify rewarding states that modernize practice laws. The agency will allocate scoring points based on whether states have eliminated unnecessary physician oversight for NPs (CMS, 2024). In other words, states that empower NPs could capture millions in new federal dollars for rural infrastructure, care coordination, and workforce expansion.

If Florida does not act, it will forfeit this opportunity. The state already ranks among the lowest for primary care access, with more than seven million residents living in federally designated shortage areas (Health Resources and Services Administration [HRSA], 2023). By continuing restrictive practice laws, Florida effectively disqualifies itself from receiving higher funding scores under CMS’s criteria, sending tax dollars to states like Arizona, New Mexico, and Colorado that recognize full NP authority.

The evidence is clear: Full practice authority does not harm patients; it helps them. The Cato Institute’s 2023 analysis found no measurable increase in patient harm when NPs practiced independently (Grant & Ball, 2023). Similarly, states with FPA report shorter wait times, lower emergency-room utilization, and higher patient satisfaction (Yang et al., 2021).

Modernizing Florida’s nurse practitioner laws is not a partisan issue; it is a public health and fiscal necessity. Updating the Nurse Practice Act to grant full practice authority would immediately strengthen the state’s RHTP eligibility, improve provider distribution, and bring much-needed health care access to rural communities.

Florida has an opportunity to lead. If policymakers fail to act, they risk losing federal dollars that could transform rural care delivery and support the very communities that need it most.

The path forward is clear: empower nurse practitioners, expand access, and ensure that no Floridian is left behind in the nation’s push toward equitable rural health transformation.

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Monica Barfield, DNP, APRN, AGACNP-BC, FNP-BC, owns New Horizon Primary Care and serves as Region One director for the Florida Nurse Practitioner Network and secretary of the Florida Coalition for Advanced Practice Nurses.



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Hialeah voters head to polls as City Commission runoffs test new Mayor’s political clout

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Early voting is underway in Hialeah as two Council runoff contests will decide who rounds out a markedly different dais at City Hall.

The Group 3 and Group 4 races — featuring Jessica Castillo versus Gelien Perez and William “Willy” Marrero versus Javier Morejon, respectively — also stand to determine whether new Mayor Bryan Calvo gains early influence over the Council.

Perez and Castillo advanced to the Group 3 runoff in last month’s General Election with 40.5% and 36% of the vote, respectively, leaving one third-place candidate behind.

In Group 4, Marrero narrowly led the field with 24.8%, followed by Morejon at 23.3%. They outpaced three others in the contest.

To win outright, a candidate had to capture more than half the vote in their respective races.

The runoffs present one of the first real tests of how much sway Calvo, who made history last month as the youngest person ever elected Hialeah Mayor, will have as he prepares to take office.

He has endorsed Perez and Marrero — a strategic pairing that blends rival factions from the mayoral contest into his new governing coalition. Both ran with political slates opposing him. He told the Miami Herald last month that he’s aiming to create “a coalition to approve the agenda,” without an expectation that Perez and Matteo “will vote with (him) 100% of the time.”

If both candidates win, Calvo could enter January with a working majority on the seven-member Council and greater control over the upcoming appointment to fill Jesus Tundidor’s soon-to-be-vacant seat. Tundidor ran unsuccessfully for Mayor.

In Group 3, Perez, 35, a former city Human Resources Director and one-time mayoral aide, has campaigned on supporting first responders and small businesses, improving infrastructure and parks, expanding senior services and rejecting millage rate increases.

But her tenure as HR director drew scrutiny: a two-year Miami-Dade ethics investigation found employees under her influence received sizable raises while she acted as their real estate agent. She has not publicly responded to inquiries about the probe.

(L-R) Jessica Castillo and Gelien Perez are competing in Group 3. Images via the candidates.

Castillo, 37, has run as an independent voice focused on transparency, accountability, traffic relief, infrastructure upgrades and lower taxes. She has kept her campaign largely offline, with no website and minimal social media activity.

In Group 4, Marrero, 23, a Florida International University public administration student and former Council aide, has emphasized affordability, issues facing working families and seniors, and support for first responders.

Earlier this year, three Council members attempted to appoint him to the same seat he now seeks, but opposition from others blocked the move.

(L-R) William “Willy” Marrero and Javier Morejon aim to take the City Council’s Group 4 seat. Images via LinkedIn and Javier Morejon.

Morejon, 34, a land-use specialist with an extensive volunteer résumé, is running on infrastructure repairs, government transparency, beautification and reducing the cost of city services.

Election Day is Monday, Dec. 9. Because Hialeah elects Council members at-large, all voters can cast ballots in both races.



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Soon no Pearl Harbor survivors will be alive. People turn to other ways to learn about the bombing

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About 2,000 survivors attended the 50th anniversary event in 1991. A few dozen have showed in recent decades. Last year, only two made it. That is out of an estimated 87,000 troops stationed on Oahu that day.

Many survivors were jovial despite the occasion, happy to catch up with old friends and pose for photographs. Even so, harrowing recollections were seldom far from their minds.

In 2023, Harry Chandler gazed across the water while telling an Associated Press reporter how he was raising the flag at a mobile hospital in the hills above the base when he saw Japanese planes fly in and drop bombs. Chandler and his fellow Navy hospital corpsmen jumped in trucks to help the injured.

He spoke of seeing the Arizona explode, and of hearing sailors trapped on the capsized USS Oklahoma desperately tapping on their ship’s hull to summon rescue. He helped care for Oklahoma sailors after crews cut holes in the battleship.

“I can still see what was happening,” Chandler said. He died the next year at a senior living center in Tequesta, Florida.

The bombing has long held different meanings for different people, the historian Emily S. Rosenberg wrote in her book “A Date Which Will Live: Pearl Harbor in American Memory.”

Some say it highlights the need for a well-prepared military and a vigilant foreign policy. To some it evokes then-President Franklin D. Roosevelt administration’s “ineptitude or deceit” and the unfair scapegoating of the military. Others focus on the “treachery” of Japan or the heroic acts of individual troops, she wrote.

Asked what he wanted Americans to know about Pearl Harbor, Chandler said: “Be prepared.”

“We should have known that was going to happen. The intelligence has to be better,” he said.

Lou Conter, who was the Arizona’s last living survivor when he died last year at 102, told the AP in 2019 he liked to attend to remember those who lost their lives.

“It’s always good to come back and pay respect to them and give them the top honors that they deserve,” Conter said.

Heinrichs’ father has been six times since 2016. The former tuba player on the USS Dobbin likes to go not only to remember those killed but also in place of his late band mates; his three brothers who fought in World War II; and the now-deceased Pearl Harbor survivors he has met.

Retired National Park Service Pearl Harbor historian Daniel Martinez said the circumstances resemble the early 20th century when Civil War veterans were dying in increasing numbers. Awareness grew that soon they wouldn’t be able to share their stories of Gettysburg and other battles, he said.

Martinez knew something similar could happen with Pearl Harbor survivors and recorded their oral histories. During a 1998 convention, he conducted interviews 12 hours a day for three days. The Park Service today has nearly 800 interviews, most on video.

“They remain as a part of the national memory of a day that changed America and changed the world,” Martinez said.

The Park Service shows some in its Pearl Harbor museum and aims to include more after renovations, said David Kilton, the agency’s Pearl Harbor interpretation, education and visitor services lead.

The Library of Congress has collections from 535 Pearl Harbor survivors, including interviews, letters, photos and diaries. Over 80% are online. They are part of the library’s Veterans History Project of firsthand recollections of veterans who served in World War I onward. Many were recorded by relatives, Eagle Scouts and other amateurs interested in documenting history.

The Sons and Daughters of Pearl Harbor Survivors gives presentations in schools and marches in parades to share the stories of their families. The California chapter has added six new members this year, including two great-grandchildren of survivors.

“When they’re all gone, we’re still going to be here,” said Deidre Kelley, the group’s president. “And it’s our intent to keep the memory alive as long as we’re alive.”

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Republished with permission of The Associated Press.



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Eileen Higgins to campaign in Miami with Ruben Gallego ahead of Special Election for Mayor

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Former Miami-Dade Commissioner Eileen Higgins will continue her early voting push with several appearances across Miami alongside U.S. Sen. Ruben Gallego of Arizona on Sunday.

“As Miamians turn out for Early Voting, Commissioner Higgins will highlight her vision for restoring trust at City Hall, ending corruption, and delivering a city government that works for residents,” her campaign said.

“The day will feature a canvass launch, Early Vote stops, and a volunteer phone bank to mobilize voters ahead of the Dec. 9 election.”

Higgins, who is running to be Miami’s first woman Mayor, will make her first stop at 10:30 a.m. at the Mision Nuestar Senñora de la Altagracia church, located at 1179 NW 28th St., followed by a visit to Christ Episcopal Church at 3481 Hibiscus St. an hour later.

Then at 1 p.m., Higgins and Gallego will participate in a get-out-the-vote event in Hadley Park at 1350 NW 50th Street.

They’ll end the day’s tour with a phone bank stop at 4 p.m., the address for which, Higgins’ campaign said, can be obtained upon RSVP.

Higgins, who served on the County Commission from 2018 to 2025, is competing in a runoff for the city’s mayoralty against former City Manager Emilio González. The pair topped 11 other candidates in Miami’s Nov. 4 General Election, with Higgins, a Democrat, taking 36% of the vote and González, a Republican, capturing 19.5%.

To win outright, a candidate had to receive more than half the vote. Miami’s elections are technically nonpartisan, though party politics frequently still play into races.

Gallego, a freshman Democratic Senator, served in the U.S. House from 2015 to 2025 and as a member of the Arizona House from 2011 to 2014. He is a second-generation American, with a Colombian mother and a Mexican father, and the first Latino elected to represent Arizona in the U.S. Senate.



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