The Commonwealth of Kentucky is a high poverty state, with an estimate of 18.1% of families living below the poverty line, and the majority of those individuals living in rural areas of limited economic opportunity & health care access. In a time where health care reform is increasing the number of people with access to health care services, we are seeing a continued decline in primary and family practice care physicians in settings like these, due to desires to specialize and the economic issues involved in working with such populations. Less than one in five medical graduates choose primary care, and that number is declining.
PBS did a short but informative report regarding the potential for Nurse Practitioners to help in the shortage of primary care services, the video below (transcript in link)...
Watch Are Nurse Practitioners the Solution to Shortage of Primary-Care Doctors? on PBS. See more from PBS NewsHour.
Kentucky, is having one of these battles regarding the scope of practice for APRNs. And if you are in Kentucky, or even if you just care about improving access for rural communities to well trained individuals who can meet their more basic health care needs, we could use your help. We need people on both sides of the aisle to support this.
Nurse practitioners are Graduate degree nurses who have passed an accredited program in primary, pediatric or adult care (among other specialities), who are licensed by their state and who have passed a certification examination. Nearly all NPs enter Advanced practice not just with 6+ years of education but with clinical and practical experience. Research has found the care provided by family nurse practitioners comparable to that of primary care physicians. However, state law varies for what an APRN can do, and for this reason many organizations are calling for states to join in on a "Consensus model" standardizing the scope of practice, educational and certification requirements.
Sitting in the Kentucky Senate Licensing, Occupations, & Administrative Regulations Committee, is SB 51, a bill that would get Kentucky APRN's closer to that model, and patients more stable access to health care. The purpose of this legislation is the following:
AN ACT relating to nurses.
Amend KRS 314.042 to eliminate the requirement for advanced practice registered nurses to have a "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Nonscheduled Legend Drugs."
A Collaborative agreement is a contract with a physician. That declining breed I discussed earlier. But what it "is", is a piece of paper, usually a costly one for NPs, and one that takes their autonomy. This contract in no way requires the physician to provide any oversight or regulation, nor to be held legally liable for the actions of the NP. It does not add patient safety, it does not improve patient access. It limits it, by limiting the prescriptive authority to those who have these collaborative agreements. If I, as as FNP, have 200 patients I see a month (just tossing a number out...) and my physician moves, loses their license, dies, or severs the contract, suddenly those patients have a practitioner unable to prescribe their medications.
To clarify, this bill only eliminates the requirement for non-scheduled legend drugs, not the more notorious drugs of abuse. So it's about a patients' antibiotics, their insulin or their heart burn or blood pressure medicine. This is the prescriptive authority what we are talking about.
This bill is stalling. We need to make some noise, to tell the Committee and State Senators to support SB 51 and to reject further use and barriers by these "collaborative agreements" like two Republican Senators are cosponsoring also this session, SB 94. The members of the Kentucky Senate can be contacted either through Kentucky's Legislative message line (1-800-372-7181) or you can get their email HERE. Health care reform is happening, primary care needs the help. You can find out more on the impacts and how to help from the Kentucky Coalition of Nurse Practitioners & Nurse Midwives. The Democratically controlled House has passed similar legislation for the past two sessions, but it always has stopped in the Senate. This time, we have a little more support, but we could use every hand we could get.
I hope those of you who are fellow Kentuckians will take the time during this short legislative session to send a message to your Senator and Representative. Thanks for taking the time to hear about this issue.