In recent weeks, Susan Alexander has seen many patients suffering from colds and upper respiratory infections at the Priceville medical clinic where she works.
Like other certified registered nurse practitioners in the state, Alexander can diagnose illness and recommend medication to treat it. She even writes out the prescription, but often she can’t sign for it.
Alabama is one of the more restrictive states in what it allows nurse practitioners to prescribe. Most prescriptions for controlled substances have to be signed by the nurse practitioner’s collaborating physician. But in rural parts of the state, that physician is often not in the same office, which can lead to tracking the doctor down while patients wait.
“It can translate into a few extra minutes or a few hours,” Alexander said. “If you’re hurting, that could be a very long time.”
A push to expand nurse practitioners’ prescription-writing privileges has made its way to the Alabama Legislature. A proposed bill would let nurse practitioners and certified nurse midwives, with their collaborating physicians’ approval, apply for a certificate allowing them to write prescriptions for Schedule III through Schedule V controlled substances.
Those drugs could include pain relievers, antibiotics, cough medicines and diabetes medication, said state Sen. Greg Reed, R-Jasper, who is sponsoring the bill in the Senate.
“It has become clear that we have a great resource in nurse practitioners in Alabama, and other states are giving them a broader scope in their practice,” Reed said.
“We’ve been struggling to increase care in rural Alabama, and this is a way to do that.”
But some in the nursing community are speaking against Reed’s bill, not because of what it would allow them to do, but to whom it would make them accountable. The needed certification would come from the Alabama Board of Medical Examiners, not the Alabama Board of Nursing.
“I’m not sure if passing this bill the way it’s written is good for nurses,” said Lynn Aquadro, a nurse practitioner in Florence and associate professor of nursing at the University of North Alabama. “It would be two different boards that would be overseeing nurse practitioners, and nurses would be accountable to two boards, which doesn’t make sense.”
At a public hearing on the bill before it passed out of the Senate Health Committee last week, several people shared Aquadro’s concerns.
“In most states, the Board of Nursing regulates” the certification, said Carol Stewart, vice president of that board. “It is unthinkable that one profession tries to regulate another. The Board of Nursing is capable and should be the regulating body.”
Reed said that is not possible because the Board of Medical Examiners is the only one with federal authority to issue the certificates.
Bill proponents said the Board of Medical Examiners needs to have oversight because it has the investigative and arrest powers needed in cases of fraudulent prescriptions or prescription abuse.
Alexander said the bill also allows for better record keeping of who is writing prescriptions for controlled substances. Currently, while a nurse practitioner is the one recommending the medications, it is not their name on the prescriptions.
“We are health care professionals. We need to be accountable for the decisions we make,” she said.
Proponents of the bill said it could increase health care access in rural areas by expanding nurse practitioners’ abilities and willingness to practice medicine in Alabama.
“When you’re a nurse practitioner and your privileges are limited, it is harder to get citizens access to the basic health care that they need,” Alexander said.
A shortage of medical care providers is well documented in Alabama, especially rural areas.
According to the Alabama Department of Public Health, there are 60 primary care health professional shortage areas in Alabama.
Aquadro agrees with proponents that more flexibility will help nurse practitioners serve more patients.
“With the Affordable Care Act and the fact that medical schools are turning out very few primary care doctors ... there is a need for mid-level providers like nurse practitioners,” Aquadro said. “That’s the mission on nurse practitioners — to extend care in underserved areas where there aren’t enough physicians to provide care.”
Currently, only physicians and physician’s assistants can prescribe the medications this bill would allow nurse practitioners to prescribe.
Tim Byrum, a nurse practitioner at Rheumatology Associates of North Alabama, in Huntsville, and graduate faculty member at the University of Alabama in Huntsville, said nurse practitioners already know the medications they’d be allowed to prescribe. They have six to eight years of education, he said.
“We are trained to do this. We just don’t have the authorization from the state,” Byrum said.
And that’s driving nurse practitioners to other states, bill proponents said. Alabama has fewer nurse practitioners than neighboring states.
Florida is the only other state with the same prescribing restrictions.
“This is so important for us to be able to keep up with our peers,” Byrum said.
Republican and Democratic senators speak in favor of the bill, which now goes to the full Senate.
“I am for expanding health care. I’m for opening this state up so that people can serve in underserved areas,” said Sen. Linda Coleman, D-Birmingham.
Number of nurse practitioners in 2011:
Source: Kaiser Family Foundation
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