[NPInfo] St. Louis Post Dispatch

[Dena]

Dave--
Perhaps PAs weren't mentioned because the legislative issue being discussed
doesn't here concern them??? What are the PAs in Missouri doing to help the
NPs' cause?
Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of David Mittman
Sent: Monday, November 05, 2007 12:36 PM
To: ACC Listserv; NPinfo
Subject: [NPInfo] St. Louis Post Dispatch

2 things caught my attention:
One-the docs letter which I presume was first.
Two-no mention of the PA profession in either letter-We need to teach this
lady the value of coalitions.
Dave
Should nurse practitioners be able to prescribe controlled drugs in
Missouri?


10/31/2007


With a shortage of physicians, nurse practitioners can help fill the void.

Terry McQuaide, advanced nurse practitioner, Esse Health

As an advanced nurse practitioner with offices in Illinois and Missouri, I
have a unique perspective. My Illinois patients receive more efficient care
for issues such as bronchitis and acute back pain based on that state's law
regarding prescribing authority.

It is well established that care coordinated by a primary care physician or
nurse practitioner is higher quality and less costly for the patient and the
insurer. There is a shortage of primary care physicians, and nurse
practitioners are part of the solution to increase access to quality care. I
work in collaboration with a physician to manage all aspects of care for
hundreds of patients with chronic and acute illnesses.
Advertisement


It should be emphasized that restrictions are in place to curb abuse of
narcotics < not because nurse practitioners do not have the skills to
prescribe. In fact, nurse practitioners have in-depth training in
pharmacology and are scrutinized, as are physicians, to ensure appropriate
protocols are followed when prescribing any medication.

To put this in perspective: treatment for bronchitis can include cough syrup
with codeine, and back pain may require a pain medication. In Illinois,
after examination and diagnosis, I can write these prescriptions. In
Missouri, I need to delay the patient and interrupt the physician to have
him prescribe the medications. This creates unnecessary delays and may
require extra trips for the patient.

Allowing nurse practitioners to practice fully in partnership with
physicians will benefit patients by increasing access to quality care with
no negative impact in quality or safety.

Restrictions to nurse practitioners writing prescriptions hurts health care.

Karen Kelly, associate professor and coordinator, Continuing Education at
the School of Nursing, SIU Edwardsville

In 47 states, including Illinois, nurse practitioners are licensed under the
states' nurse practice acts to prescribe scheduled drugs. Illinois advanced
practice nurses gained prescriptive privileges for schedule III-V drugs in
1998. In Illinois, the Nurse Practice Act "sunsets" every 10 years and must
be reviewed and renewed by the Illinois General Assembly.

The 2007 Illinois Nurse Practice Act, a product of the most recent "sunset,"
includes expansion of the prescriptive privileges of advanced practice
nurses to include schedule II drugs, for example Ritalin or narcotic pain
medications such as Demerol and Darvon. According to the American Academy of
Nurse Practitioners, only Missouri, Alabama, and Florida do not grant
advanced practice nurses scheduled drug prescriptive privileges. Even
Georgia, the last state to grant prescriptive privileges, grants scheduled
drug prescriptive privileges.

A significant body of research demonstrates the safety and efficacy of the
drug prescribing practices of advanced practice nurses. This restriction on
prescriptive privileges creates barriers to access to health care for those
patients who receive their care from advanced practice nurses. This
restriction, for example, prevents nurse practitioners who care for hospice
patients from managing patients' pain with narcotics. Additional
intervention by a physician is required for pain management, adding to the
cost and time needed to provide pain relief for hospice patients.

It is time for the Missouri legislature to allow nurse practitioners and
other advanced practice nurses, such as nurse anesthetists, to prescribe
scheduled drugs as allowed in all the states that surround Missouri.
----------------------------------------------------------------------------
----------------------------------------------------------------------------
------------
Wisdom of Missouri's restrictions on nurses prescribing passes test of time.

Dr. Sam Hawatmeh, internist, St. Louis

Controlled substances are essentially narcotics and other addictive drugs;
they are dangerous. They must be prescribed only after a thorough medical
evaluation < not a nursing evaluation and with continued medical
re-evaluation < to consider dangerous interactions and side effects. The
Missouri General Assembly decided 12 years ago to not allow nurses to
prescribe these drugs. That wisdom has withstood the test of time.

Current law defines an advanced practice nurse as one with education beyond
basic nursing education certified by a nationally recognized professional
organization as having a nursing specialty. State approval via the Board of
Nursing is not required!

This means that any "nationally recognized" professional organization could
produce certifications for various nursing specialties, and immediately
qualify advanced practice nurses in Missouri. All would have controlled
substance prescriptive authority.

The nurses argue they would prescribe only pursuant to a collaborative
practice arrangement with a physician. However, it is important to
understand that such arrangements have no common standards and are not
closely regulated.

There also is a very real concern about illegal diversion of these drugs. At
a time when we're doing everything possible to restrict the availability of
dangerous drugs and substances used to manufacture meth?amphetamines, it is
incongruent to dramatically expand the number of individuals who can
prescribe these substances.

But the bottom line is patient safety. Controlled substances should be
prescribed only by licensed physicians, podiatrists and dentists.

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************