Saturday, February 18, 2017

Why a nurse practitioner and why full practice authority.

In May of 2000, yes almost 17 years ago, I finished a 4 year degree in nursing. By some reports this is one of the most difficult degrees to obtain.  I would agree. When I finished my BSN I had no desire to get a higher degree in nursing. I worked as a bedside RN for 5 years before I decided to get a Master's degree in nursing. During that time I spent 36-48 hours each week doing hands on patient care.

In October 2005 I made the decision to further my nursing  education. My husband and I had moved from Fort Worth, TX to a small town in southeast OK. I was back to working night shift and we wanted to start a family. Night shift is not the best shift for a new family. So, I did some reasearch and started the Family Nurse Practitioner program through the University of Alabama at Birmingham in the spring of 2006. I was responsible for finding my own clinical sites. I quickly found there were not many nurse practitioners in my area. When I finished my program in May 2008 I had completed over 700 hours of clinical time with a physician or NP.  I still had to pass my boards. I spent 2 months review for this test and passed in July 2008. By this time I had been a RN for 8 years.

I took my first, and only, job as a Family Nurse Practitioner in September 2008. I have been doing this for over 8 years now.  I can truly say I love my job. Depending on the day I will see 15-28 patients in a day. These patients range in age from just days old to their 90's. I see patients for well checks, sick visits and management of chronic diseases. In December 2015 I obtained an additional certification in Advanced Diabetes Management through the AADE. I am covered by malpractice insurance through my employer. I also have to obtain continuing education hours every 2 years when my license renews.

Many people don't know what sets apart Nurse Practitioners from other health care professionals. We are governed by the Board of Nursing and have a nursing background. Some states have different rules regarding NPs. In the state of Oklahoma I am required to have a physician (MD or DO) sign my prescriptive authority. This physician is not required to be in the office with me. He/she does not have to review my charts or sign off on anything I do. They are not required to see my patients. I have my own patient load -many of whom request to see me when they call to make an appointment. I assess my patient, order and interpret tests and order medication. There are a few medications I cannot order- like ADHD meds and hydrocodone.

In Oklahoma, physicians are only allowed "supervise" two full time NPs at one time. In rural Oklahoma this becomes a problem and limits access to care. It took the clinic group I work with 3 years to recruit a physician to work in one of our clinics. At times they have to pay physicians to sign the supervision paperwork even though that physician does not work for our clinic group. This is money that could be used to give more services to our patients. Some NPs pay $500-1000 a month for a supervising physician. That's $6000-120000 a year.

What does full practice authority mean? It means NPs do not have to have a physician sign that paper. It does not change what I do every day. I still see patients, order and interpret tests and order medication. But it makes it easier for NPs to get jobs and open clinics. Thus improving access to care. And in a state that ranks 49/50 for access to care this is a big deal. Research shows that nurse practitioners provide safe care for their patients. HB 1013 is up for a vote in the Oklahoma House of Representatives this next week. It would grant full practice authority to nurse practitioners in our state.

Please call your representative to support HB 1013 today.