Story first appeared in The San Francisco Bay Guardian.
For San Francisco’s public-sector registered nurses, this year’s Nurse’s Week was a paradox. On May 10, nurses from throughout the city gathered in the cafeteria of San Francisco General Hospital to celebrate Florence Nightingale’s birthday by bestowing gratitude and appreciation on nurses selected by their colleagues. A long-time Castro-Mission Health Center public health nurse, was one of those honored.
Upon acceptance of the award, she said that city nurses would be most appropriately honored by getting a fair contract, as well as access to appropriate Home Healthcare Supplies, Nursing Supplies and Doctor Bags. The next day a smaller gathering of nurses was back across the bargaining table from city negotiators who have proposed significant financial and working condition concessions. Decreased compensation threatens the future of nursing in the public sector by impairing recruitment and retention of highly-skilled registered nurses. Working conditions concessions are even more broadly harmful and unacceptable; it is both risky for the nurses and increases the likelihood of adverse outcomes for those nurses care for.
San Francisco DPH nurses care for the city, quite literally, and with great pride. The local nurses are also proud of San Francisco’s historically progressive record on public health. Immigrant pregnant mothers are not interrogated by immigration authorities before giving birth. Public health nurses don’t require insurance company pre-authorized visits before teaching self-care to elderly residents of downtown SROs. The quality of care given by Jail Health nurses is no less than that given to someone living in a nice house by the city’s home health nurses of Health-at-Home. Laguna Honda, one of the last municipal long-term care centers, has a beautiful new campus and San Francisco General Hospital is being noisily rebuilt thanks to voter-approved bond measures. But nice buildings and well-conceived health programs don’t care for the ill and injured, nurses do.
Nurses are professionally pragmatic; they don’t offer false hope. Patient advocacy requires great patience. This is especially true in the public sector, where the population they serve is likely to suffer from intractable extreme poverty and social marginalization. The poor don’t require less health care than wealthy individuals, in fact they require more. It’s not always pretty, but nurses know that if they are given the human resources to do so they will continue to deliver excellent patient care.
The complexity and intensity of patient care seems to be rising far faster than inflation. Aside from the issues of fairness and quality care, nurses simply don’t have enough hours or Nursing Supplies to do the repair the over-burdened fractured health system requires. Activist nurses are needed to save lives by preserving and expanding health care access. While universal single-payer health-care is elusive nationally, California nurses are optimistic that they can do better here. Women’s health is under attack nationally by fanatics who would deny cancer screening and care for rape survivors.
Nurse’s Week is over and there is a lot to do, let’s start with a fair deal for DPH nurses. It's not to much to ask for and everyone will benefit.
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Showing posts with label Nursing. Show all posts
Showing posts with label Nursing. Show all posts
14 May 2012
20 June 2010
Decision Upheld to Bar California Nurses' Strike
Sacramento Bee
The California Nurses Association vowed to continue its fight with the University of California over staffing levels, saying it won't be deterred by a San Francisco judge's ruling Friday that bars nurses from staging a one-day strike.
San Francisco Superior Court Judge Peter J. Busch prohibited the union from staging strikes at the university's five medical centers until at least Sept. 30, when the current contract between the union and the university ends.
Two days before the union was to stage a June 10 walkout at UC-run hospitals, Busch intervened by issuing a temporary restraining order requested by the state Public Employment Relations Board on behalf of the university.
On Friday, the judge made his ruling permanent, saying that there was reasonable cause for PERB to believe that a strike would violate state labor laws.
The CNA walkout was intended to protest what the union said are unsafe nurse staffing levels – a charge the university denies.
At the center of the dispute is whether the university is complying with state-mandated nurse-to-patient ratios, which require at least one nurse for every five patients – and even more for patients with higher levels of need.
The dispute over staffing levels has long been a sticking point in negotiations.
"I'm hopeful that because of the judge's ruling, the CNA will sit down at the table so we can work out a really good contract for the nurses. We can do this in earnest instead of posturing," said Carol Robinson, chief nursing officer for UC Davis Medical Center.
The CNA represents nearly 11,000 registered nurses employed by the university, including 1,800 at the UC Davis Medical Center.
University officials commended the judge's decision, but the setback upset union officials.
"We're going to continue fighting for proper staffing levels. We're not going to stop," said Beth Keane, the CNA's lead negotiator for the union's university labor contracts.
She said the union plans to file complaints with the state Department of Public Health. The state agency, however, has yet to act on a complaint filed by the union in November over staffing levels at the UC Davis Medical Center.
The university said it had already spent $8.4 million preparing for a possible walkout by nurses.
San Francisco Superior Court Judge Peter J. Busch prohibited the union from staging strikes at the university's five medical centers until at least Sept. 30, when the current contract between the union and the university ends.
Two days before the union was to stage a June 10 walkout at UC-run hospitals, Busch intervened by issuing a temporary restraining order requested by the state Public Employment Relations Board on behalf of the university.
On Friday, the judge made his ruling permanent, saying that there was reasonable cause for PERB to believe that a strike would violate state labor laws.
The CNA walkout was intended to protest what the union said are unsafe nurse staffing levels – a charge the university denies.
At the center of the dispute is whether the university is complying with state-mandated nurse-to-patient ratios, which require at least one nurse for every five patients – and even more for patients with higher levels of need.
The dispute over staffing levels has long been a sticking point in negotiations.
"I'm hopeful that because of the judge's ruling, the CNA will sit down at the table so we can work out a really good contract for the nurses. We can do this in earnest instead of posturing," said Carol Robinson, chief nursing officer for UC Davis Medical Center.
The CNA represents nearly 11,000 registered nurses employed by the university, including 1,800 at the UC Davis Medical Center.
University officials commended the judge's decision, but the setback upset union officials.
"We're going to continue fighting for proper staffing levels. We're not going to stop," said Beth Keane, the CNA's lead negotiator for the union's university labor contracts.
She said the union plans to file complaints with the state Department of Public Health. The state agency, however, has yet to act on a complaint filed by the union in November over staffing levels at the UC Davis Medical Center.
The university said it had already spent $8.4 million preparing for a possible walkout by nurses.
11 June 2010
California Nurses Rally for Higher Staffing Levels
Mercury News
Nurses at University of California hospitals around the state are rallying to demand a new contract with increased staffing levels.Thursday's rallies come after a San Francisco judge barred the 11,000 nurses from staging a one-day strike for at least two weeks. The judge agreed with UC officials that a strike would pose a health risk to patients although he did agree to consider the issue further at a June 18 hearing.
The nurses and UC officials are at odds over salaries and staffing levels, as they begin contract discussions. Nurses say staffing levels often fall below state-mandated levels during breaks or shift changes.
UC officials say they are complying with state staffing requirements.
The rallies are being held at UC hospitals in Davis, Los Angeles, San Francisco, San Diego, Irvine and Santa Monica.
18 April 2010
Facing Doctor Shortage, 28 States may Expand Nurses' Role
USA Today
CHICAGO — A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."
For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.
Those newly insured patients will be looking for doctors and may find nurses instead.
The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.
Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.
"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."
On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.
Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85% of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.
The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100% of what obstetrician-gynecologists make — and that may be just the beginning.
States regulate nurse practitioners and laws vary on what they are permitted to do:
• In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.
• In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.
• In Montana, nurse practitioners don't need a doctor involved with their practice in any way.
• Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.
• In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.
The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?
The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.
Many with the title use it with pride.
"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.
What's the evidence on the quality of care given by nurse practitioners?
The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.
"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.
Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.
The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.
The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.
"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."
In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.
One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.
Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.
That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.
But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.
The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.
"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.
The new U.S. health care law expands the role of nurses with:
• $50 million to nurse-managed health clinics that offer primary care to low-income patients.
• $50 million annually from 2012-15 for hospitals to train skilled nursing professionals with advanced degrees to care for Medicare patients.
• 10% bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.
• A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.
The American Nurses Association hopes the 100% Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.
"We know we need to get to 100% for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone for award winning nurses."
In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.
She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.
Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.
"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."
For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.
Those newly insured patients will be looking for doctors and may find nurses instead.
The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.
Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.
"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."
On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.
Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85% of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.
The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100% of what obstetrician-gynecologists make — and that may be just the beginning.
States regulate nurse practitioners and laws vary on what they are permitted to do:
• In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.
• In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.
• In Montana, nurse practitioners don't need a doctor involved with their practice in any way.
• Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.
• In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.
The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?
The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.
Many with the title use it with pride.
"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.
What's the evidence on the quality of care given by nurse practitioners?
The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.
"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.
Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.
The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.
The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.
"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."
In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.
One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.
Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.
That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.
But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.
The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.
"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.
The new U.S. health care law expands the role of nurses with:
• $50 million to nurse-managed health clinics that offer primary care to low-income patients.
• $50 million annually from 2012-15 for hospitals to train skilled nursing professionals with advanced degrees to care for Medicare patients.
• 10% bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.
• A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.
The American Nurses Association hopes the 100% Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.
"We know we need to get to 100% for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone for award winning nurses."
In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.
She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.
Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.
"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."
13 March 2010
Nursing Covering More Health Care
USA Today
FRANKFORT, Ky. — Each year, Wendy Fletcher says, she and two partners see more than 5,000 patients at their practice in Morehead, Ky.
They are not doctors, but rather registered nurse practitioners who say they are able to increase access to health care and make it more affordable.
"None of us are trying to play doctor," she said.
"If we'd wanted to be doctors, we would have gone to medical school," added nurse practitioner Melinda Staten of Louisville.
The Kentucky Medical Association claims otherwise and is fighting proposed legislation that would lift some limits on the ability of about 3,700 nurse practitioners in Kentucky to prescribe medication and perform other, mostly routine tasks such as signing a child's immunization certificate or certifying the need for employee sick leave.
Greg Cooper, a former Kentucky Medical Association president and family physician from Cynthiana, Ky., who testified against the Kentucky bill, said he objects to what he said "is this constant push by nurse practitioners to be physicians."
"It's a little bit frustrating, the way this has evolved," he said. "The family physician is the foundation of health care."
That argument has been echoed nationally by the American Medical Association, which issued a report last fall critical of the training that nurse practitioners receive.
Dealing with doctor shortage
As the debate over health care legislation continues in Washington, advocates for nurse practitioners say it is these primary care nurses who will make up for the shortage of primary care physicians and at the same time keep costs down.
According to the American Nurses Association, as of November, the median expected salary for a typical nurse practitioner in the United States was $83,293, while the median expected salary for a typical family practice physician was $160,586.
Rebecca Patton, president of the American Nurses Association, said that each year, state legislatures are seeing measures proposed that seek to increase the capabilities of nurse practitioners and in many cases eliminate a level of supervision from physicians.
Among recent examples she cited:
• In January, Ohio's Democratic Gov. Ted Strickland signed a bill that did away with the need for nurse practitioners moving to Ohio to repeat training with an Ohio physician as long as they have had prescribing privileges in another state at least one of the prior three years.
• In July 2009, Hawaii enacted a bill that gave nurse practitioners broader prescription authority that includes controlled substances.
They are not doctors, but rather registered nurse practitioners who say they are able to increase access to health care and make it more affordable.
"None of us are trying to play doctor," she said.
"If we'd wanted to be doctors, we would have gone to medical school," added nurse practitioner Melinda Staten of Louisville.
The Kentucky Medical Association claims otherwise and is fighting proposed legislation that would lift some limits on the ability of about 3,700 nurse practitioners in Kentucky to prescribe medication and perform other, mostly routine tasks such as signing a child's immunization certificate or certifying the need for employee sick leave.
Greg Cooper, a former Kentucky Medical Association president and family physician from Cynthiana, Ky., who testified against the Kentucky bill, said he objects to what he said "is this constant push by nurse practitioners to be physicians."
"It's a little bit frustrating, the way this has evolved," he said. "The family physician is the foundation of health care."
That argument has been echoed nationally by the American Medical Association, which issued a report last fall critical of the training that nurse practitioners receive.
Dealing with doctor shortage
As the debate over health care legislation continues in Washington, advocates for nurse practitioners say it is these primary care nurses who will make up for the shortage of primary care physicians and at the same time keep costs down.
According to the American Nurses Association, as of November, the median expected salary for a typical nurse practitioner in the United States was $83,293, while the median expected salary for a typical family practice physician was $160,586.
Rebecca Patton, president of the American Nurses Association, said that each year, state legislatures are seeing measures proposed that seek to increase the capabilities of nurse practitioners and in many cases eliminate a level of supervision from physicians.
Among recent examples she cited:
• In January, Ohio's Democratic Gov. Ted Strickland signed a bill that did away with the need for nurse practitioners moving to Ohio to repeat training with an Ohio physician as long as they have had prescribing privileges in another state at least one of the prior three years.
• In July 2009, Hawaii enacted a bill that gave nurse practitioners broader prescription authority that includes controlled substances.
In addition, the association cited several additional states that have bills pending that would either broaden or restrict prescription writing ability for nurse practitioners, including bills in Alabama, Colorado, Washington and West Virginia. And Alabama, Connecticut, Mississippi, Nebraska and New York have bills pending related to removing requirements for physician supervision or collaboration agreements.
'Don't see a big difference'
Nurse practitioners are "gaining traction because people are seeing how cost-effective they are," Patton said. "The primary care physician shortage is going to drive it."
Judi James, 56, who lives in Morehead, Ky., said she gets her basic medical care from a nurse practitioner and has no qualms about going to see a nurse rather than a doctor.
"I really just don't see a big difference," James said. "The nurses are the ones who take care of you anyway, not always the doctor. If I need a specialist, she'll send me there."
Each state sets up regulations for nurse practitioners. In Kentucky, for example, nurse practitioners are able to practice independently without being supervised by a physician. But in order to prescribe medicine they must obtain a signed agreement from a physician, even though that physician may not work directly with or consult with the nurse.
The Kentucky bill would allow nurses to forgo the agreement when it comes to certain medications, such as antibiotics and blood-pressure medication. Prescribing controlled drugs, such as narcotic painkillers and sedatives, would still require the physician agreement.
The Kentucky bill passed out of committee and could come to the full house for consideration as soon as Monday, said its sponsor, Rep. Mary Lou Marzian, a Louisville Democrat. Marzian said she's not sure the bill can make it through the Senate.
Twelve states, including Alaska, New Mexico, Montana, Wisconsin and Wyoming, and the District of Columbia allow nurse practitioners with a nursing degree to prescribe independently, including controlled substances, according to the American Nurses Association. In 29 states, laws require physician collaboration for prescribing controlled substances.
Some states have limits on which controlled substances can be prescribed by nurse practitioners. Laws in Florida and Alabama prohibit nurse practitioners from prescribing any controlled substances.
'Don't see a big difference'
Nurse practitioners are "gaining traction because people are seeing how cost-effective they are," Patton said. "The primary care physician shortage is going to drive it."
Judi James, 56, who lives in Morehead, Ky., said she gets her basic medical care from a nurse practitioner and has no qualms about going to see a nurse rather than a doctor.
"I really just don't see a big difference," James said. "The nurses are the ones who take care of you anyway, not always the doctor. If I need a specialist, she'll send me there."
Each state sets up regulations for nurse practitioners. In Kentucky, for example, nurse practitioners are able to practice independently without being supervised by a physician. But in order to prescribe medicine they must obtain a signed agreement from a physician, even though that physician may not work directly with or consult with the nurse.
The Kentucky bill would allow nurses to forgo the agreement when it comes to certain medications, such as antibiotics and blood-pressure medication. Prescribing controlled drugs, such as narcotic painkillers and sedatives, would still require the physician agreement.
The Kentucky bill passed out of committee and could come to the full house for consideration as soon as Monday, said its sponsor, Rep. Mary Lou Marzian, a Louisville Democrat. Marzian said she's not sure the bill can make it through the Senate.
Twelve states, including Alaska, New Mexico, Montana, Wisconsin and Wyoming, and the District of Columbia allow nurse practitioners with a nursing degree to prescribe independently, including controlled substances, according to the American Nurses Association. In 29 states, laws require physician collaboration for prescribing controlled substances.
Some states have limits on which controlled substances can be prescribed by nurse practitioners. Laws in Florida and Alabama prohibit nurse practitioners from prescribing any controlled substances.
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