Senate bill would allow nurses to write more prescriptions

Wednesday, February 13, 2008 | 11:32 a.m. CST; updated 3:04 p.m. CDT, Tuesday, July 22, 2008

JEFFERSON CITY — Specially trained nurses would gain power to prescribe a wider variety of drugs under legislation that would move Missouri closer to the medicine practices of most other states.

A bill endorsed Tuesday by the Senate would grant nurse practitioners new power to write prescriptions for some controlled substances, including pain relievers such as Vicoden, muscle relaxants such as Valium and prescription-strength cough and nausea medicines.

Supporters contend it would improve access to health care, particularly in rural Missouri communities where there are few doctors. But physician groups question whether it could decrease the quality of care patients receive.

The measure is the top legislative priority of the Missouri Nurses Association, which brought hundreds of people to the Capitol to lobby on its behalf Tuesday. Although unsuccessful in several previous attempts, the group appears to have more momentum this year.

The association’s proposal was the first Senate bill to receive preliminary approval during the 2008 session. The measure now needs a second Senate vote to move to the House, where physician groups hope to slow it down or change it.

The new prescription power would apply only to advanced practice registered nurses who have agreements with doctors.

The Missouri Nurses Association says Alabama, Florida and Missouri are the only states that do not allow such nurses to prescribe some controlled substances. Missouri nurses with advance training have been able since 1993 to prescribe medicines that are not listed as controlled substances.

But “some of the ones they can’t prescribe are commonly used,” such as codeine cough medicines for children, said Jill Kliethermes, chief executive officer of the nurses group.

When nurse practitioners have to wait for a physician to sign off on those prescriptions, it can delay treatment for patients, she said. That’s especially true when the supervising physician may not be at the same clinic building as the nurse practitioner, she said.

Doctors groups reject assertions that Missouri must catch up with other states.

“Just because 47 other states do it doesn’t necessarily mean it’s the safe and right thing to do,” said Jeff Howell, the legal affairs director for the Missouri State Medical Association.

The medical association wants limits on how much nurse practitioners could prescribe — capping the amount of medicine to enough for three to five days, for example, just to fill an immediate need before the patient could see a physician, Howell said.

The Missouri Association of Osteopathic Physicians and Surgeons opposes the bill because nurse practitioners don’t have the same amount of education as doctors, said executive director Bonnie Bowles.

“It’s like we’re dumbing down health care,” she said. Allowing nurse practitioners to write prescriptions for controlled substances “is just one step closer for patients never having the ability to see a doctor.”

As originally drafted, Sen. Delbert Scott’s bill would have allowed specially trained nurses to write prescriptions for all but the most addictive drugs. But Scott, R-Lowry City, changed the bill to apply only to drugs the federal government classifies as Schedule III, IV and V. That means nurse practitioners still could not write prescriptions for such drugs as morphine or Ritalin, which is used to treat attention deficit disorder.

Howell said his group would like to further pare back the bill in the House to also exclude all Schedule III drugs, which include Vicoden and anabolic steroids.

Gov. Matt Blunt made no mention of the legislation when speaking Tuesday at a luncheon for the Missouri Nurses Association. He said in an interview afterward that he is still studying whether to support the legislation.

“I’ve heard some patient safety concerns that have been voiced by doctors,” Blunt said. But on the other hand, “the fact that in most states they’re allowed to do this is I think a pretty persuasive argument that they should be allowed to do so in Missouri.”


Nurse prescriptions is SB724


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Michael Herriges February 14, 2008 | 1:13 p.m.

Unfortunately this is not really a patient safety issue as the physicians would like people to think. The literature is replete with cases of physicians who practice incorrectly, write prescriptions the wrong way, misdiagnose and misprescribe medicines to the harm of their patients. A review of the legal literature will show that much of the harm that comes to patients comes through medical error or even malpractice; this at the hand of those who have "the advanced education" and "degrees". It happened long before Nurse Practitioners had prescribing priveleges.

I have been working in health care for over 30 years as a Nurse and now as a Nurse Practitioner. I have been fortunate to work with physicians who do the real research and are not interested in "turf wars" but in the health and safety of their patients. Nurse Practitioners have a very good overall safety and effectiveness rating. I suggest that those who think NP's are "incapable" of rendering good care or "competent" care actually look at the research. The American Academy of Nurse Practitioners has gathered independent research as well as their own that shows that NP's, practicing within the scope of their training, are safe and effective caregivers relieving physicians of the day to day illness issues so that they can really focus their advanced education, training, and experience to serve those patients that really need them.

No, it is not safety but wallets and turf that are driving the arguments against NP prescribing priveleges. Sorry to say it but that is the real underlying issue. Look at the facts and not the personal rhetoric and the answer will be made crystal clear.

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