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Kentucky Expands the Role of Nurse Practitioners

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It’s been a while since we’ve given an update on the push within the courts and legislatures to increase the responsibilities of advanced practitioners. One state, however, greatly contributed to the AP cause on Tuesday.

“Starting July 15, nurse practitioners in Kentucky who have completed a four-year collaboration with a physician will be allowed to prescribe routine medications without a doctor’s involvement, a major shift that could help improve consumers’ access to care,” Lisa Gillespie at Kaiser Health News reports.

This was not an easily won victory. It took five years, Gillespie writes, but the legislative results of that battle could provide a model for other states that are debating this same issue and “ a possible compromise for states trying to define the roles of nurse practitioners while assuaging the concerns of doctors.”

First, it’s important to clarify what the law once was. According to Gillespie, “For nearly two decades, nurse practitioners in the state have been able to prescribe drugs such as antibiotics and blood pressure medicine only if they had a collaborative agreement with a doctor, who can charge a fee for it. But if the doctor pulled out of the agreement, the nurse practitioners were forced to find other physicians or limit their practices by not prescribing. Most practices cannot survive doing only diagnostic tests and physicals.”

This new law rewards the experienced NP with greater “flexibility and sets up a framework to help those without four years of collaboration find a physician willing to oversee their work.” A six-member committee will “create a list of doctors willing to enter into these agreements. If the nurse practitioner can’t find someone from the list within 30 days, the committee must furnish a physician. After four years, NPs no longer need an agreement to prescribe most medications.”

However, NPs will still have to be under a collaborative agreement to prescribe such drugs as Adderall, oxycodone, testosterone, Ambien, and cough syrup with codeine . This caveat rankles such NP advocates as Tay Kopanos, vice president for state government affairs at the American Association of Nurse Practitioners (AANP). “Making it easier for someone to achieve an unnecessary burden to meet the requirements doesn’t negate the fact that it’s a burden.” She adding that “the collaborative agreement for controlled drugs, which are deemed more dangerous and addictive by the government, is a huge barrier.”

Kopanos feels that this piece of legislation and similar pieces in other places around the country, such as Colorado, are mere compromises that fail to “aid NPs in their transition to practice.”

Still, it is a step forward for NPs, given that “19 states require that NPs have a collaborative arrangement for the entirety of their careers, and 12 others require supervision or team management with a physician, with those nurses prescribing through the doctors, “ while “[t]he remaining 19 states and the District of Columbia allow nurse practitioners to practice independently of a physician.”

There are those who question whether the six-member committee will have the resources to be effective without getting bogged down in politics. The committee’s success will depend on whether it “can bring about the necessary level of cooperation,” Joanne Spetz, professor of health policy studies at the University of California, San Francisco, said. “Their main role will be to help ensure there are enough physicians available to collaborate while NPs develop their knowledge about prescribing and gain the confidence of the provider community.”

As physicians, what is your reaction to this development? Is this model a possible compromise in the ongoing legislative battle with advanced practitioners? And advanced practitioners, do you see this as a step forward in expanding your responsibilities or merely a compromise with little guaranteed effectiveness?

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