Should a nurse be your family doctor?

(MetroNews)  A legislative audit recommends that advanced practice registered nurses in West Virginia be allowed to expand the scope of their care, but the recommendations do not go as far as the APRNs want.

Legislative Auditor Aaron Allred’s report suggests that further empowering APRNs to provide more primary care would help address the doctor shortage in West Virginia.  However, Allred stopped short of suggesting the nurses could operate independent of physicians.

Currently, APRN’s are allowed to form collaborative agreements with doctors who are supposed to provide clinical supervision.  Angy Nixon, a midwife from Scott Depot and member of the Board of Nursing, called these collaborate agreements “useless.”

She added that the nurses are simply asking for more autonomy.  “There is no change or expansion in scope of practice for any APRN,” Nixon told the House of Delegates Government Organization Committee, where the audit was released Thursday.

However, Allred said the APRNs want all restrictions on writing prescriptions removed, which he fears will worsen the drug problem in West Virginia.

“Given the addiction crisis we have in West Virginia, I cannot in good conscience recommend to the Legislature that 2,149 more individuals in West Virginia be allowed to write prescriptions for Class 2 narcotics,” Allred said.

Nixon countered that since APRNs are currently not allowed to prescribe powerful pain medication, they could not be held responsible for the current problems.

Allred’s audit does suggest that APRNs be given more independence, but he added that if the nurses want to practice at the same level as a family doctor, they should have to be regulated by the state Board of Medicine, a suggestion the APRNs strongly oppose. Nixon said that would mean one profession is regulated by a board from another profession.

The debate is timely given the dramatic changes in the health care delivery system in this country.  Just in West Virginia, more than 80,000 people have signed up for health insurance under the expansion of Medicaid, but it’s unclear whether there are enough providers.  All but five of the state’s counties are deemed by the U.S Department of Health and Human Services as medically underserved or as having a shortage of health care providers.

APRNs could help fill the gap.  They are currently allowed to diagnose and treat patients, but must have a written collaborative agreement with a physician in order to prescribe medicine from a limited drug formulary.

Some states have already expanded the scope of practice of APRNs, but Allred’s report did not find research that focused on the quality of APRNs in autonomous practice.   Allred says the American Medical Association and the Association of Osteopaths oppose allowing APRNs to practice independently.

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