Legislation would increase nurse flexibility but questions persist

Mar. 13—Multiple Missouri bills are under consideration that would loosen regulations for nurse practitioners, but there are concerns for some.

Missouri Senate Bill 79, sponsored by Missouri Sen. Nick Schroer, R-St. Charles, would allow a nurse practitioner and collaborating physician to bypass any distance requirements, as long as their arrangement utilizes telecommunications.

The change in legislation would make a significant difference if passed, Freudenthal Home-Base Healthcare Nurse Practitioner Claire Gregson said.

"It would help immensely for me to not have to worry about how far I am from my physician because it does limit access to care when I can only be so far from that person," she said. "It would not change the delivery of care that we provide as a practice."

But that doesn't mean it's a method without drawbacks, said Dr. Christin Giordano, of Physicians for Patient Protection, a national organization.

"I don't think it's going to actually fix the whole problem," she said. "My biggest concern is that it creates this two-tiered structure where you have less supervised or less knowledgeable, less trained individuals taking care of rural patients, compared to those in a city."

Giordano said the changes in Missouri concern her with the possibility of nurse practitioners being used in place of doctors in rural Missouri.

"I supervise nurse practitioners. They are essential," she said. "We just need to figure out a way to make sure that they're providing physician care and ways to promote that in rural areas, such as telemedicine, and expanding that radius to allow them to practice."

That concern could increase further with Missouri House Bill 271, sponsored by Missouri Rep. Alex Riley, R-Springfield. The bill would allow certain nurse practitioners "with a certificate of controlled substance prescriptive authority from the Board of Nursing" to prescribe controlled substances.

While there would be flexibility, it's important to keep in mind that collaborating physicians would still be involved in the process as an oversight measure, and it might make appointments more feasible because patients wouldn't have to worry about traveling in to see a physician as often, Gregson said.

"We cannot replace the knowledge and expertise that physicians bring to the table," she said. "At least in my practice, my goal is to connect patients with specialists and make sure that they receive the whole spectrum of care that they need, and it's not meant to replace anyone, but instead to connect them to the right people."

Both stress that using telehealth resources is an important way that patients and doctors can maintain communication in areas like rural Missouri, since it allows doctors to be a part of the appointment without having to be physically present.

Alex Simone can be reached at alex.simone@newspressnow.com. Follow him on Twitter at @NPNOWSimone.