Nursing bill is one that merits discussion

W E have urged lawmakers to focus on meaningful legislation this year, so credit is due Rep. Josh Cockroft for his proposal to give full practice authority to nurse practitioners and advanced practice registered nurses.

Under current Oklahoma law, those nurses are required to have a collaborative agreement with a physician to provide many health services. Nursing officials say those agreements cost nurses between $10,000 and $50,000 per year, but provide little real benefit to patients.

Toni Pratt-Reid, president-elect of the Association of Oklahoma Nurse Practitioners, said, “There’s no oversight to our practice on anything other than prescriptive needs. There might not even be a physician that communicates with us for two years.”

Officials with the Oklahoma State Medical Association, which opposes Cockroft’s legislation (House Bill 1013), disagree with that characterization. Even so, nursing officials raise some interesting points.

They note that nurse practitioners have full practice authority in 21 states (including neighboring New Mexico and Colorado) and the District of Columbia. In contrast, Oklahoma is one of 12 states requiring a physician to supervise nurse practitioners. The other 17 states have laws landing in between those two extremes.

That Oklahoma is among the most regulation-heavy states is concerning. It’s hard to believe 21 other states would adopt laws similar to HB 1013 if doing so resulted in widespread patient harm. We’ve heard no horror stories from New Mexico or Colorado. Opponents need to do more than cite isolated, anecdotal stories of problems when making their case against Cockroft’s bill; they need to demonstrate full practice authority creates systemic problems that will harm Oklahomans.

Advocates of HB 1013 also note that nurse practitioners have clinical training and advanced educations, typically having obtained a master’s or doctoral degree. And they are nationally certified. It’s not like the legislation would allow just anyone to provide medical services.

In addition, the Oklahoma State Board of Nursing would continue to have regulatory oversight of nurse practitioners.

Art Rousseau, a psychiatrist who is chairman of the Oklahoma State Medical Association's legislative committee, argues that through HB 1013, “Basically the nurse practitioner is saying, ‘I want to be a doctor.’” Yet that argument is more about protecting turf than impact on patients. Doctors who oppose this change must show it will harm something other than their business model.

Cockroft, R-Wanette, argues that reducing the regulatory burden of nurse practitioners will fuel greater access to health care treatment, particularly in rural areas. Oklahoma ranks 49th in its physician-patient ratio, and 64 of the state’s 77 counties are designated as primary care health professional shortage areas.

Passage of Cockroft’s bill is no sure thing. A similar measure failed to get a hearing last year despite having 30 coauthors. But Cockroft deserves credit. He’s focusing on a serious issue — health care access in Oklahoma. And he’s challenging the status quo regarding regulation. As we’ve often noted, much regulation is designed more to protect entrenched interests than increase public benefit, so constant review of regulatory assumptions is worthwhile.

HB 1013 may not become law this year. But regardless, this debate will not be a waste of legislators’ time.