A wave of 115 nurse practitioners flooded the General Assembly to meet with lawmakers about easing practice restrictions.
By Hyun Namkoong
Nurse practitioners from across North Carolina came to the General Assembly on Tuesday to advocate for loosening the grip on the way they are allowed to practice.
In light of a new study conducted by Duke University economist Chris Conover and commissioned by the North Carolina Nurses Association, nurse practitioners swarmed the legislature with optimism that they’d be able to convince lawmakers on the positive economic and health care impacts of allowing nurse practitioners to practice without license restrictions.
If lawmakers lift some of the restrictions on nurse practitioners, nurse midwives, nurse anesthetists and other “advanced practice” nurses, it could fill gaps in access to primary care providers, create at least 3,800 jobs statewide, and generate more than $20 million in income tax revenues annually, according to the study.
Nurse practitioners are trained to perform advanced care beyond that of a registered nurse. For example, nurse practitioners can write prescriptions, diagnose straightforward conditions like colds and perform routine check-ups. But in North Carolina, they have to do that under the “supervision” of a physician.
Under state law, physicians don’t have to be physically present to supervise. They are only required to have a two-times per year review of patient standards and the delivery of care. The nurse practitioner should be able to contact a physician for questions.
Brunswick county nurse practitioner Angela Bertsch said at her own health department clinic, which she recently retired from, their supervising physician lived 25 miles away.
“His requirement is that we would see him once a month,” Bertsch said. “The state statute only requires twice a year contact. Right now the supervisory agreement is a piece of paper in a drawer.”
But, physicians aren’t always willing to supervise and some nurse practitioners find themselves unable to work.
Tay Kopanos, vice president of state government affairs of the American Association of Nurse Practitioners said the bureaucracy limits patients’ ability to get direct access to care.
“Nurse practitioners can’t find a physician to do collaborative agreement or pay money to [for the supervision],” she said. “The laws for nursing here are decades old and they really haven’t kept pace with changes.”
Bertsch said one of her colleagues in a nearby clinic has been compelled to pay a physician about $16,000 for her supervision agreement.
Time for change
Kopanos said North Carolina is at a crossroads to implement some solutions that can address health care needs across the state.
She said legislation will be introduced in the coming weeks to match the educational and professional expertise of nurse practitioners to the legal limits of care they can provide in the state.
“Here in North Carolina, licensure laws limit the amount of care [nurse practitioners] can provide to patients, unless they have a mandated agreement with the physician,” Kopanos said. “This legislation will look at retiring that so that patients get full and direct access.”
Rep. Gale Adcock (D-Cary) said many nurse practitioners want to work in rural, underserved areas, something that could help ease the primary care provider shortage in the state.
After Arizona granted full autonomy to its nurse practitioners in 2001, the state saw a 73 percent increase in the number of nurse practitioners working in rural areas between 2002-07.
Adcock acknowledged that any legislation giving nurse practitioners more autonomy would likely be met with resistance and that change is hard to implement.
“When you do the same thing over and over you get the same result,” Adcock said. “And the result we’re getting in this state are huge pockets of people who have no access to health care.”
Access to primary care is important because it’s more cost-effective and easier to treat illnesses when they’re caught early on and not in advanced stages that require intensive treatment. The primary care provider shortage has led 18 states to grant full autonomy to nurse practitioners.
“If you catch diabetes early on, you may not end up on dialysis,” said Stephanie Limesand, a nurse practitioner from Gastonia who works in urgent care. “There’s such a shortage of primary care providers. We can help fill that gap.”
Tina Gordon, chief executive officer of North Carolina Nurses Association said in some areas nurse practitioners are the main option for getting care.
Gordon said the nurse practitioners met with the legislators from their own district and with members of the health and human services committee to tell them how nurse practitioners are trained, educated and experienced in providing safe and quality care.
[box style=”2″]| Where do Nurse Practioners in NC Work? |
|
| Group Medical Practice/Physician Office | 2182 |
| Group Nursing Practice | 17 |
| HMO/Insurance | 38 |
| Home Health Care | 59 |
| Hospital (Other than In-Patient, Emergency, Out-Patient) | 121 |
| Hospital Emergency | 177 |
| Hospital In-Patient | 890 |
| Hospital Out-Patient | 477 |
| Industry/Occupational Setting | 93 |
| Long Term Care | 142 |
| Medical School | 21 |
| Mental Health | 166 |
| Nursing School | 4 |
| Other | 429 |
| Public/Community Health | 367 |
| Retail Clinic | 209 |
| School Health | 40 |
| Self Employed NP | 89 |
| Grand Total | 5521 |
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NPs are also very well trained to treat complex illness and disease. This article is limiting in saying colds and viruses – though I realize it is geared to the general public. I have been practicing for many years in primary care and in psychiatry now, and I have welcomed the advise of my collaborating physicians in rare cases ( at the beginning many times in years 1 and 2, but later on in practice less than 15 times in about 10 years as an average), now I also more and more use my NP colleagues for advice. Our knowledge is expansive and complex, always in growth year after year of practice. This should be how patients and the public should see NPs, by the years they have been in practice as well as their educational preparation.