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June 2012
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Nurse practitioners get more rights under law

BY LAUREL BLACKlblack@paducahsun.com

A recently enacted Kentucky law has expanded the rights of nurse practitioners in the commonwealth.

Local practitioners say the move will provide patients with better access to care, but not everyone in the medical community embraces the idea.

The measure, which went into effect July 15, gives nurse practitioners who have worked with a physician for four years the right to prescribe routine medications, such as those used to treat diabetes and blood pressure, without a doctor's involvement.

"We want to be as independent as we can, because that gives better access to patients," said Amy Fennel, a nurse practitioner at the Paducah Neurosurgical Center. "Nurse practitioners are very good providers. We're very educated, we're experienced,"

The nurse practitioner community generally favors greater independence, and laws expanding the roles of nurse practitioners also passed this year in Connecticut, Minnesota and New York.

According to the American Association of Nurse Practitioners, or AANP, 19 states and the District of Columbia allow nurse practitioners full autonomy. This means they're allowed to evaluate patients,  order and interpret diagnostic tests, and initiate and manage treatments - including prescribing medications - under the exclusive licensure authority of the state board of nursing. Neither Kentucky nor Illinois are among those 19 states. 

As the population in the United States grows and ages, providers worry over a physician shortage - as many as 130,600 by 2025, according to the Association of American Medical Colleges - and some providers believe nurse practitioners could fill that gap if granted more independence.

"The more independent we can be as far as legality, the more we can help patients get good health care," Fennel said.

But the idea has met with opposition from organizations such as the American Medical Association. The AMA argues in support of physician-led teams, stating that nurse practitioners lack the education and training to practice on their own.

"Nurses are critical to the health care team, but there is no substitute for education and training," said Dr. Rebecca J. Patchin, a board member with the AMA. "Physicians have seven or more years of postgraduate education and more than 10,000 hours of clinical experience. Most nurse practitioners have just two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three-year medical residency. These additional years of physician education and training are vital to optimal patient care, especially in the event of a complication or medical emergency,"

Local practitioners say their roles are different from those of physicians, and that practicing independently is well within the scope of their training.

Fennel has been practicing for about 13 years and has been working with neurosurgeons Theodore Davies and Thomas Gruber for five. She believes the presence of two nurse practitioners on their staff allows for patients to be seen for more routine procedures when the physicians are called into surgery, making the patient care process more efficient.

"It's not about us trying to do somebody else's job. It's just that we want to be able to do our job as well as we can," she said.

Elizabeth Scheidler, a nurse practitioner with Mercy Primary Care in Lyon County, echoed the sentiment.

"We're considered a mid-level provider," said Scheidler, who was a nurse for 12 years before training to become a nurse practitioner. "What makes us unique in our care (is) we take that nursing background and apply more advanced training to it."

She said the training of a nurse practitioner is more patient-focused and less specialized than that of a physician. That makes them a good fit for the current health care climate, where primary care physicians are at a premium, particularly in rural areas.

Kentucky's law addresses only prescription of non-scheduled medications; controlled substances still require a collaborating physician. And there's still a ways to go before nurse practitioners are able to practice with complete autonomy in the state.

For the time being, Scheidler says, the new law "is a good compromise."

Contact Laurel Black, a Paducah Sun staff writer, at 270-575-8641, or follow @LaurelFBlack on Twitter.

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