Editor's note:The following story has been corrected from the original version that ran in print.
More than 600 nurses and nursing students traveled to the state Capitol from across the state for the 29th annual nurse advocacy day for the Missouri Nurses Association (MONA) on Wednesday.
There are roughly 100,000 registered nurses in Missouri, and if they were to stand in unity on one issue, they can have a tremendous amount of influence, said association President Rebecca McClanahan.
"One of my experiences early in my career that taught me a lot about the legislative process was when a governor's veto was overridden ... on the Nurse Practice Act in 1976," McClanahan said. "On that occasion the building was filled with nurses in white uniforms and caps. It is really quite a sight, and it was really motivating to me as a young nurse to see what kind of power there is in the legislative process."
The nurses were there to discuss nurse-specific issues, such as the expansion of prescriptive authority for advanced practiced registered nurses, and to contribute to larger issues such as prescription drug monitoring and Medicaid expansion.
Taking away prescriptive authority from nurse practitioners "is the exact opposite people you should be taking prescriptive authority away from," said Jade Burgess of Mercy College of Nursing. "I mean, in my particular opinion, nurses are very responsible people. I am biased, but we are, and we are held accountable via our license and via the board of nurses."
Recently, legislation was filed to change laws regarding nurse practitioners prescribing controlled substances in coordination with a physician, McClanahan said. So, because of a change in the Drug Enforcement Agency's classification of certain medications, advance-practice nurses are not able to prescribe drugs they were able to prescribe last year, she added.
The group had elected ambassadors who spoke with Lt. Gov. Peter Kinder; House Speaker John Diehl, R-Town and Country; and Rep. Jeanne Kirkton, D-St. Louis city.
Kinder briefly addressed the small group of ambassadors outside his office. He said the General Assembly will have to make a decision on Medicaid expansion, and he added, the issues affecting advance-practice nurses are important for people in rural areas who have little access to other forms of health care. He said he supports a prescription drug monitoring program, but there is only one senator blocking that legislation.
In the past, the opposition to this bill was led by Sen. Rob Schaaf, R-St. Joseph, who is a doctor. Schaaf has said his concern was prescription drug databases contain sensitive, personal information government officials don't need to know.
"I am kind of appalled that Missouri is the last state that actually does not have that monitoring," said Mary Goodrich, a registered nurse from Children's Mercy Hospital in Kansas City. "I treat so many patients that come in with other medical problems, and then you find out they are drug-addicted or they have a medicine cabinet of their own that they can have whatever they want because there is nobody to watch them if they go from Kansas City to Platte City to wherever to get their medicines ... because they are pharmacy shopping."
When the group met with Diehl, he told them there was no appetite for Medicaid expansion and he saw no pathway for expansion in a legislative body he leads.
He added the refusal to expand Medicaid was budget-based and not political. He said veterans, pregnant women and poor children would be hurt by expansion. Diehl explained to the group that with the State Children's Insurance Program (SCHIP), children who live in families up to 300 percent of the federal poverty line are covered, and under Medicaid expansion, only children up to 138 percent are covered.
However, qualifying for Medicaid does not disqualify children from the SCHIP program, said Dave Dillon of the Missouri Hospital Association. Expanding Medicaid through the federal Affordable Care Act (ACA) does move all children up to the 133 percent mark of the federal poverty line to Medicaid, but those between that and the previously mentioned 300 percent will stay in the SCHIP, according to a report from the Henry J. Kaiser Family Foundation. The ACA also strengthens the SCHIP program by adding additional federal funding to the program and creating outreach programs to increase enrollment in SCHIP, the report stated.