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Allowing APRNs to prescribe narcotics concerns some doctors
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By Angie Hutschreider
News Tribune
Legislation that would give advanced practice nurses more discretion in prescribing drugs has raised concerns among some doctors.
Supporters say the legislation would improve access to health care, particularly in rural areas.
Opponents fear the ability to prescribe narcotics is beyond the scope of the roles performed by advanced practice nurses (APRNs).
Patty Summerford, an APRN from the rural town of Buffalo, said the passage of the bill could save some of her patients weeks of unnecessary waiting. The collaborating physician in Summerford's clinic left two years ago, and since then, there is only a physician on hand one day a week. The nearest hospital is 30 to 40 minutes away.
Dr. John D. Lucio, vice president of medical affairs of St. Mary's Health Center, said the ability of APRNs to do their jobs is not what is in question. He said overall there is no problem with the APRNs being allowed to prescribe cough medicines with codeine or hydrocodone. He said the problems centers on the ability to prescribe narcotics.
“Nurse practitioners do a good job, but I think the feeling is that some of these are strong narcotics and even get some physicians in trouble.”
Companion House and Senate bills would allow APRNs to prescribe controlled substances to their patients. The medications that APRNs currently are unable to prescribe include such medications as Tylenol with codeine, cough syrups with codeine or hydrocodone, some anti-diarrhea medications, anti-depressants, medications for pain management and anxiety and medications to help treat attention deficit disorder.
APRNs from across the state gathered at the Capitol last week to speak with senators and representatives in support of the proposals.
“Passing this bill will mean improved access to care for Missouri citizens because we will be able to better provide them the care they need,” said Elizabeth Lonberger, APRN. “Because of the restrictions, we cannot provide patients with some medications, so it increases the time between the patient finding out what they need and getting what they need.”
The bill would only allow the APRN to prescribe drugs that can be used to treat patients in their specialty. They could not prescribe anything their collaborating physician does not.
Summerford added: “It really doesn't make any sense that now I have to call a physician and suggest to him what to prescribe to a patient he may have never even seen, when I could have just written the prescription.”
However, Lucio countered: “If a patient is that bad, they need to be seen by a physician anyway.”
“The majority of physicians I know are mostly against this because they feel it is against the scope of nurse practitioners,” he added.
“One of the most common causes of disciplinary actions deals with narcotics,” Lucio said. “It could have been omission, not being fully educated on the drug, it could be almost anything. That is why some physicians don't feel comfortable giving nurse practitioners this privilege.”
Missouri is one of only three states that do not allow APRNs this privilege. Florida and Alabama are the other two.
Lonberger said this is the third year the bill has been introduced. It passed a Senate committee this year and the group is hoping it will get more than the few minutes of floor debate last year.
“We are hoping that the senators and representatives will see how important this is by us being here and speaking with them today,” Lonberger said.
“This would definitely improve care. It will be more effective, efficient and comprehensive care,” Lonberger said. “It will also help cut costs. If an APRN can write the prescription, then it will save patients repeated trips to the doctor or even to the emergency room.”
Supporters say the legislation would improve access to health care, particularly in rural areas.
Opponents fear the ability to prescribe narcotics is beyond the scope of the roles performed by advanced practice nurses (APRNs).
Patty Summerford, an APRN from the rural town of Buffalo, said the passage of the bill could save some of her patients weeks of unnecessary waiting. The collaborating physician in Summerford's clinic left two years ago, and since then, there is only a physician on hand one day a week. The nearest hospital is 30 to 40 minutes away.
Dr. John D. Lucio, vice president of medical affairs of St. Mary's Health Center, said the ability of APRNs to do their jobs is not what is in question. He said overall there is no problem with the APRNs being allowed to prescribe cough medicines with codeine or hydrocodone. He said the problems centers on the ability to prescribe narcotics.
“Nurse practitioners do a good job, but I think the feeling is that some of these are strong narcotics and even get some physicians in trouble.”
Companion House and Senate bills would allow APRNs to prescribe controlled substances to their patients. The medications that APRNs currently are unable to prescribe include such medications as Tylenol with codeine, cough syrups with codeine or hydrocodone, some anti-diarrhea medications, anti-depressants, medications for pain management and anxiety and medications to help treat attention deficit disorder.
APRNs from across the state gathered at the Capitol last week to speak with senators and representatives in support of the proposals.
“Passing this bill will mean improved access to care for Missouri citizens because we will be able to better provide them the care they need,” said Elizabeth Lonberger, APRN. “Because of the restrictions, we cannot provide patients with some medications, so it increases the time between the patient finding out what they need and getting what they need.”
The bill would only allow the APRN to prescribe drugs that can be used to treat patients in their specialty. They could not prescribe anything their collaborating physician does not.
Summerford added: “It really doesn't make any sense that now I have to call a physician and suggest to him what to prescribe to a patient he may have never even seen, when I could have just written the prescription.”
However, Lucio countered: “If a patient is that bad, they need to be seen by a physician anyway.”
“The majority of physicians I know are mostly against this because they feel it is against the scope of nurse practitioners,” he added.
“One of the most common causes of disciplinary actions deals with narcotics,” Lucio said. “It could have been omission, not being fully educated on the drug, it could be almost anything. That is why some physicians don't feel comfortable giving nurse practitioners this privilege.”
Missouri is one of only three states that do not allow APRNs this privilege. Florida and Alabama are the other two.
Lonberger said this is the third year the bill has been introduced. It passed a Senate committee this year and the group is hoping it will get more than the few minutes of floor debate last year.
“We are hoping that the senators and representatives will see how important this is by us being here and speaking with them today,” Lonberger said.
“This would definitely improve care. It will be more effective, efficient and comprehensive care,” Lonberger said. “It will also help cut costs. If an APRN can write the prescription, then it will save patients repeated trips to the doctor or even to the emergency room.”
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