“Doctors Versus Nurses” – Did you read it?

iStockphoto | ThinkStock + Scrubs

iStockphoto | ThinkStock + Scrubs

West Virginia broadcaster Hoppy Kercheval recently wrote up a report for WV Metro News on the continued debate about allowing APRNs more power (including the ability to write prescriptions) in hospitals.

While this is something that has been discussed in many states lately, it has yet to come to fruition in West Virginia, where there is an addiction crisis and officials are particularly nervous about giving anyone more power in the hospital.

Whether or not you live in the state, we thought you might have an interest in (and some thoughts on!) this story.

Here are some excerpts from the article:

“We normally think of doctors and nurses as working together in a collaborative environment to deliver care for their patients. However, there is a debate unfolding under the Capitol dome that may strain that relationship.

The state Nurses Association is pushing legislation that would allow advanced practice registered nurses more autonomy to provide care ‘to the full extent of their education and training.’ That means an APRN could essentially function as a family doctor.

Currently, APRNs can practice independently, but they must have a collaborative relationship with a doctor who is supposed to oversee the nurses’ work. Also, APRNs have only limited authority to write prescriptions.”

He continues…

“The debate heated up last week when Legislative Auditor Aaron Allred released a report that, among other things, raised concerns about empowering APRNs to write prescriptions for powerful pain medications.

‘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 told members of the House Government Organization Committee last Thursday.

It’s a strong point, one that is not intended to question the professionalism of APRNs, but rather to illustrate that empowering more individuals to write scripts for Hydrocodone, Oxycodone and other semi-synthetic opioids mathematically increases the chances for abuse.”

And gets to the heart of the issue for nurses…

“The audit said 16 states and the District of Columbia currently allow APRNs to practice and prescribe medications independently.

APRNs are already helping to fill a health provider gap in West Virginia and they could do more. Fifty of the state’s 55 counties are categorized in one way or another as medically underserved. Meanwhile, the Affordable Care Act is putting thousands more West Virginians on the insurance roles—as many as 137,000 by 2016 on Medicaid alone—and they are going to be looking for a family doctor.

A report released by the nurses says, ‘States with similar rural populations, such as Montana, Wyoming, Vermont, Idaho and Maine have removed restrictive APRN barriers to allow their residents improved access to primary care.’

Also, APRNs cite a RAND Corporation analysis showing they can provide primary care 20-35 percent cheaper than physicians.”

And concludes…

“The country’s two physicians’ organizations, the American Medical Association and the American Osteopathic Association oppose expanding the scope of practice of APRNs.

The Legislative audit says, ‘The AMA recognizes the value of APRNs within the healthcare delivery system, but expresses concern that the nurse practitioner does not have adequate clinical foundation for independent practice.’

Allred concluded that if lawmakers are going to allow APRNs to practice more like family physicians, then they should be under the control of the West Virginia Board of Medicine, just like the docs.

Many APRNs will tell you they are already the ‘family doctor’ for thousands of West Virginians, and that the current collaborative agreements are just more paperwork, not really physician oversight.  The question for lawmakers this session is whether they are willing to validate what nurses say they are already doing.”

Read the entire story here, then tell us: What do you think about ARPNs writing prescriptions? Long overdue? Old news? Share your thoughts in the comments below.

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3 Responses to “Doctors Versus Nurses” – Did you read it?

  1. MOFNP

    The AMA and Osteopaths are frightened of anyone encroaching on their $$$$$$$. And the comment about putting more synthetic narcotics out there is pure rubbish. Most MD’s don’t think twice when prescribing narcotics. As an NP in an ED, I am trying to curtail this behavior since patients ask for narcotic pain relief for any malady in the book! When I do not prescribe them, I have often needed the assistance of security officers to escort patients to the exit. This puts me in a fearful mode when it comes time for my shift to end (usually at night, in the darkness). Even as RN’s we are often bullied by patients. They expect to be given narcotics since it has been such a common practice for so long. I for one am okay with not prescribing them but there are those patients who legitimately need codeine for instance that I would like to provide without “permission” and signature from a collaborating MD. All about $$$$ and patient satisfaction. Give the patients what they want and they will give a stellar evaluation of their visit. I see our system becoming not based on what is good and right for the patient, but what offers them a pleasant visit. That is, most often, unfortunately, the need for narcotics. Let’s change this behavior.

  2. NurseK

    The problem is much more multi-faceted than who is prescribing narcotics. Prescription drug abuse is a problem in much of Appalachia – not just West Virginia. Wilkes County, NC implemented a multi-faceted community approach to prescription drug abuse prevention and prescription drug overdose prevention called Project Lazarus. The website is http://www.projectlazarus.com
    The results were pretty amazing (pulled from the above site) –
    “Overdose deaths are down 69% in Wilkes County between 2009 and 2011. We have had 28 straight months of steady declines in overdose deaths. Wilkes is still a little higher than the national average, but nowhere near the 6th worst in the nation we were in 2008. At the same time, Wilkes had higher opioid prescribing than the state average, with less than one percent change in how many Wilkes residents received an opioid pain reliever (7.5% to 8% each month; state average is 5.8%). In 2011, not a single Wilkes County resident died from a prescription opioid from a prescriber within the county, down from 82% in 2008. Hospital emergency department (ED) visits for overdose and substance abuse were down 15% between 2009 and 2010 in Wilkes County, while the rest of the state went up by 6.9%.

    More opioid prescriptions don’t automatically mean more deaths. It is possible to deliver good pain relief without a heavy overdose burden. But it takes the whole community to make it happen.”

  3. 7munchkins

    12 years ago, http://www.ncbi.nlm.nih.gov/pubmed/10632281

    a second opinon: http://healthaffairs.org/blog/2013/06/18/the-latest-data-on-primary-care-nurse-practitioners-and-physicians-can-we-afford-to-waste-our-workforce/

    The opiate argument is a fallacy perpetuated by a medical association who does not want to relinquish any of their power or their dollars. Physicians collaborate with one another all the time and, as a responsible FNP, I consult with physicians ANYTIME I feel the need for a second opinion as all the NPs I know do.