A recent ruling by a Polk County district judge prohibits advanced registered nurse practitioners (ARNPs) in Iowa from supervising diagnostic procedures that involve the use of real-time X-ray images, or fluoroscopy.

On Oct. 31, Judge Artis Reis ruled that the administrative rules adopted by the Iowa Board of Nursing and the Iowa Department of Public Health in March 2010 that allowed ARNPs to supervise fluoroscopy were “invalid, illegal, void and of no effect.”

The Iowa Nurses Association is considering whether to appeal the ruling, which the American Nurses Assocation (ANA) called “a setback for patients.” The state nursing association, whose executive director recently retired, deferred to the ANA for comment.

“It would be our interepretation that the ruling simply struck down the educational requirements, and that it has no impact on the ability of ARNPs to continue supervising fluoroscopy,”said Maureen Cones, senior counsel for the ANA. Cones said it’s the first time she is aware of that a state court has made such a ruling regarding fluoroscopy, which ARNPs supervise in a majority of states.

The litigation began in June 2010 when the Iowa Medical Society (IMS) and the Iowa Society of Anesthesiologists (ISA), citing patient safety concerns, filed a petition asserting that the rules were in direct violation of Iowa code provisions that prohibit the expansion of nursing into medicine. The nine-member board of nursing had approved the rules on a 6-3 vote.

Used in conjunction with several types of medical procedures, fluoroscopy can be used to guide the insertion of a heart catheter or to display the functioning of the gastrointestinal tract. According to the IMS, the procedure can deliver potentially harmful levels of radiation and requires supervision by specially trained and qualified individuals.

Before nursing can expand into this area of medicine, there needs to be evidence of a recognized curriculum and training, Dr. Lawrence Hutchison, IMS president, said in a release. “Medicine is always open to revisiting this issue when recognized curriculum, training and standards are established,” he said.