Op-Ed

Remove unneeded limits on advanced practice registered nurses

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Beyond the political rhetoric of Frankfort’s marbled walls lies a haunting and stark reality: Too many Kentuckians have limited access to health care.

More than one million Kentuckians, according to the Kaiser Family Foundation, reside in a Health Care Professional Shortage Area, where the number of health-care providers relative to the population is far below the federal standard.  

One in every four Kentuckians resides in one of 87 HPSAs, and lacks access to the most fundamental health care services — services that highly qualified, nationally board-certified Advanced Practice Registered Nurses could better provide, if not for an antiquated law.

Sen. Paul Hornback, R-Shelbyville, is looking to improve access to health care with Senate Bill 89, which would allow Kentucky to join 23 other states and the District of Columbia in overcoming this barrier to care.

Kentucky has more than 7,500 advanced practice nurses who have always been independent in clinical decision making but — again, because of Kentucky law — have been required to maintain collaborative agreements with physicians only for prescribing medications.

Those with more than four years of clinical practice need only to have the collaborative agreements for controlled substances. That piece of paper is a barrier to care for patients, an unnecessary hoop to jump for APRNs and increases the cost of licensing in our state.    

APRNs, particularly those who own and operate their own clinics, are filling the care voids throughout our state, but are still restricted because the collaborative-agreement requirement precludes them from obtaining a federal Drug Enforcement Agency number without a physician’s signature on a piece of paper.

DEA numbers are necessary, even when they are not writing prescriptions for controlled substances. APRN practice owners are often unable to purchase basic materials, such as syringes for vaccines and injectable medications for use in their clinics, because medical supply companies require the DEA certificate to fill these orders.

Many insurance companies and pharmacy-benefit managers require DEA numbers for providers as identification. In certain circumstances, insurance companies will not credential an APRN unless the collaborating physician also joins the same network. This further limits patient access to fundamental health-care services within those regions where care providers are limited.

To be clear, SB 89 does not add one single new prescriber to the roles, since APRNs can already prescribe controlled substances, including some categorized as narcotics. Nor will it change any of the prescribing limits for controlled substances already in statute or regulation. APRNs would still be required to have the collaborative agreement for their first four years of practice and a clean prescribing record before rescinding the requirement. as current law allows.

Ironically, according to the Pew Family Trust, nursing laws like the collaborative agreements actually worsen the opioid epidemic because nurse practitioners are limited in their ability to treat those suffering from addiction. Despite Gov. Matt Bevin’s push for medication-assisted therapy and current regulations allowing APRNs completing additional educational requirements to prescribe buprenorphine, access to MAT remains limited.

Kentucky’s physician shortage not only means there are fewer of them to treat patients, it also means fewer collaborators for APRNs.  

Kentucky APRNs support SB 89 because they are fully devoted to being part of the solution to the state’s health-care provider shortage and the opioid crisis. In fact, they have reduced the number of opioid prescriptions by more than two times that of all other Kentucky prescribers combined over the last two years.

The Kentucky Association of Nurse Practitioners and Nurse-Midwives fully supports regulatory oversight of all prescribers and the enhancement of the KASPER (Kentucky All Schedule Prescription Electronic Reporting) system to track controlled substance prescriptions across the state. We also support educating prescribers and all citizens about the potential dangers of controlled substances and preventing and treating addiction.

However, we vehemently oppose barriers erected in the false name of public safety that not only restrict our trade, but also harm our patients by restricting their access to care. Not every Kentucky citizen needs or benefits from controlled substances, but every Kentucky patient can benefit from high-quality, cost-effective care provided by a Kentucky APRN.  

Wendy Fletcher, DNP and APRN, is the board chair of the Kentucky Association of Nurse Practitioners & Nurse-Midwives.

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