We normally think of doctors and nurses as working together in a collaborative environment to deliver care for their patients. However, there is a debate unfolding under the Capitol dome that may strain that relationship.
The state Nurses Association is pushing legislation that would allow advanced practice registered nurses more autonomy to provide care “to the full extent of their education and training.” That means an APRN could essentially function as a family doctor.
Currently, APRNs can practice independently, but they must have a collaborative relationship with a doctor who is supposed to oversee the nurses’ work. Also, APRNs have only limited authority to write prescriptions.
The debate heated up last week when Legislative Auditor Aaron Allred released a report that, among other things, raised concerns about empowering APRNs to write prescriptions for powerful pain medications.
“Given the addiction crisis we have in West Virginia, I cannot in good conscience recommend to the Legislature that 2,149 more individuals in West Virginia be allowed to write prescriptions for Class 2 narcotics,” Allred told members of the House Government Organization Committee last Thursday.
It’s a strong point, one that is not intended to question the professionalism of APRNs, but rather to illustrate that empowering more individuals to write scripts for Hydrocodone, Oxycodone and other semi-synthetic opioids mathematically increases the chances for abuse.
The audit said 16 states and the District of Columbia currently allow APRNs to practice and prescribe medications independently.
APRNs are already helping to fill a health provider gap in West Virginia and they could do more. Fifty of the state’s 55 counties are categorized in one way or another as medically underserved. Meanwhile, the Affordable Care Act is putting thousands more West Virginians on the insurance roles—as many as 137,000 by 2016 on Medicaid alone—and they are going to be looking for a family doctor.
A report released by the nurses says, “States with similar rural populations, such as Montana, Wyoming, Vermont, Idaho and Maine have removed restrictive APRN barriers to allow their residents improved access to primary care.”
Also, APRNs cite a RAND Corporation analysis showing they can provide primary care 20-35 percent cheaper than physicians.
The country’s two physicians’ organizations, the American Medical Association and the American Osteopathic Association oppose expanding the scope of practice of APRNs.
The Legislative audit says, “The AMA recognizes the value of APRNs within the healthcare delivery system, but expresses concern that the nurse practitioner does not have adequate clinical foundation for independent practice.”
Allred concluded that if lawmakers are going to allow APRNs to practice more like family physicians, then they should be under the control of the West Virginia Board of Medicine, just like the docs.
Many APRNs will tell you they are already the “family doctor” for thousands of West Virginians, and that the current collaborative agreements are just more paperwork, not really physician oversight. The question for lawmakers this session is whether they are willing to validate what nurses say they are already doing.