House re­jects at­tempts to ex­pand nurse prac­ti­tion­ers’ au­thor­ity

Northwest Arkansas Democrat-Gazette - - NORTHWEST ARKANSAS - ANDY DAVIS

At­tempts to ex­pand Ar­kan­sas nurse prac­ti­tion­ers’ au­thor­ity to pre­scribe drugs and abil­ity to re­ceive Med­i­caid re­im­burse­ment failed to clear a House com­mit­tee on Thurs­day.

But Ar­kan­sas nurses scored a vic­tory when the House Pub­lic Health, Wel­fare and La­bor com­mit­tee re­jected a bill al­low­ing anes­the­si­ol­o­gist as­sis­tants — a po­ten­tial com­peti­tor to nurse anes­thetists — to prac­tice in the state.

Physi­cians and their ad­vo­cates spoke against the leg­is­la­tion al­low­ing ad­vanced-prac­tice nurses to pre­scribe drugs with­out over­sight from a physi­cian, to pre­scribe a greater va­ri­ety of nar­cotics and to be des­ig­nated by the state’s Med­i­caid pro­gram as pri­mary care providers.

Ad­vo­cates for the bills ar­gued they would im­prove ac­cess to med­i­cal care by al­low­ing nurse prac­ti­tion­ers to more eas­ily op­er­ate fam­ily prac­tice clin­ics in ru­ral parts of the state.

But David Wroten, ex­ec­u­tive vice pres­i­dent of the Ar­kan­sas Med­i­cal So­ci­ety, said nurses, like doc­tors, are more likely to op­er­ate in ur­ban than ru­ral ar­eas.

He said nurse prac­ti­tion­ers “have a ma­jor, im­por­tant role to play in our health care sys­tem” but should col­lab­o­rate with physi­cians.

“That’s the way that you en­sure that pa­tients get the ab­so­lute best care,” Wroten said.

Ad­vanced-prac­tice reg­is­tered nurses, in­clud­ing nurse prac­ti­tion­ers, are reg­is­tered nurses who have com­pleted a master’s de­gree in nurs­ing and have ob­tained cer­ti­fi­ca­tion from a na­tional or­ga­ni­za­tion.

House Bill 1228, spon­sored by Rep. Kim Ham­mer, R-Ben­ton, would have re­moved a re­stric­tion pre­vent­ing such nurses from pre­scrib­ing drugs such as Oxy-Con­tin and Ad­der­all clas­si­fied as Sched­ule II con­trolled sub­stances.

Hy­drocodone, which was once listed as a Sched­ule III drug, is the only Sched­ule II drug Ar­kan­sas al­lows nurse prac­ti­tion­ers to pre­scribe.

House Bill 1181, spon­sored by Rep. Dan Sul­li­van, R- Jones­boro, would have re­moved the re­stric­tion on Sched­ule II drugs while also re­mov­ing a re­quire­ment for ad­vanced-prac­tice nurses who pre­scribe drugs of any kind to en­ter “col­lab­o­ra­tive prac­tice agree­ments” with physi­cians.

Sul­li­van said 21 states don’t limit nurse prac­ti­tion­ers’ pre­scrib­ing au­thor­ity, and other states are con­sid­er­ing re­mov­ing lim­its.

“There is no rea­son for Ar­kan­sas not to move for­ward with this,” Sul­li­van said.

The com­mit­tee also re­jected Sul­li­van’s House Bill 1182, which al­lows ad­vanced-prac­tice nurses to be des­ig­nated as pri­mary care providers by the state Med­i­caid pro­gram.

The bill would have also in­creased the Med­i­caid re­im­burse­ment rate for nurse prac­ti­tion­ers from 80 per­cent to 100 per­cent of the rate paid to physi­cians.

House Bills 1228 and 1182 each fell one vote short of the 11 needed from the 20-mem­ber com­mit­tee, while HB1181 re­ceived nine fa­vor­able votes.

In a voice vote, the com­mit­tee also re­jected HB1205, by Rep. Stephen Magie, D- Con­way, to al­low anes­the­si­ol­o­gist as­sis­tants to ad­min­is­ter anes­the­sia un­der the su­per­vi­sion of an anes­the­si­ol­o­gist.

Magie said 17 states li­cense such work­ers, who must earn a bach­e­lor’s de­gree and com­plete a two-year train­ing pro­gram.

Ar­kan­sas li­censes nurse anes­thetists, who must also work un­der the su­per­vi­sion of a physi­cian, but not nec­es­sar­ily an anes­the­si­ol­o­gist.

Those nurses must com­plete a master’s de­gree in a nurse anes­the­sia pro­gram and ob­tain cer­ti­fi­ca­tion from a na­tional or­ga­ni­za­tion.

Nurse anes­thetist Anne Cousins of Pine Bluff told com­mit­tee mem­bers the care pro­vided by anes­the­si­ol­o­gist as­sis­tants is “grossly in­fe­rior.”

“When sec­onds count, Arkansans de­serve and ex­pect an anes­the­sia provider who can think and per­form in­de­pen­dently,” Cousins said.

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