JEFFERSON CITY — A Senate committee debated an effort that could help attract more advanced practice registered nurses to Missouri in a hearing Wednesday.
The proposal, which would offer the nurses — known as APRNs — a license, could help in recruiting them to the state, particularly to rural areas where there is a lack of health care providers.
Missouri has over 99,000 registered nurses, according to a 2015 survey done by the Missouri Department of Health and Senior Services. According to that same survey, of those 99,000 RNs, more than 8,000 are APRNs.
APRNs are nurses with at least a master’s degree and education in specific patient populations and patient care roles—such as clinical nurse specialists, certified nurse midwifes, certified nurse practitioners or certified registered nurse anesthetists — according to the National Council of State Boards of Nursing.
In most states, both RNs and APRNs require a license, but in Missouri, APRNs only get a “document of recognition.” Lawmakers want to change that.
“We need to recognize the talent and the education that advanced practice nurses have gone through by giving them the title they would get in most other states, which is a license,” Sen. Eric Burlison, R-Springfield, said.
On Tuesday, Burlison presented Senate Bill 714 to the Senate’s Seniors, Families and Children Committee. Burlison said a bill like this is only part of addressing a larger issue, but it’s a start.
“While this doesn’t fully address the growing demand and need we have in our United States for more health care professionals, it’s a touch in the right direction,” Burlison said.
Those in support of the bill see this as a great step for nurses in Missouri. David Winton, a lobbyist for the Missouri Association of Rural Health Clinics, said Missouri is one of only 13 states that doesn’t offer licenses to APRNs, and that could be deterring nurses from wanting to practice in Missouri.
“Missouri doesn’t recognize the level of experience, effort and education (APRNs) have,” Winton said. “We will never get APRNs to come to Missouri because, why would they?”
Winton said that giving APRNs a license could be a great recruiting tool for rural areas and the state in general. Others in support said this would cause less confusion for patients as well, especially in instances when care can cross state lines.
“If I go to Illinois, I have a licensed nurse practitioner, but if I come to Missouri, they’re not licensed,” said Tammy Bartholomew, an APRN with the BJC Medical Group. “Should that be concerning to me? Should I be worried that they’re less of a provider?”
Despite a large amount of support, there were many who testified in opposition to the bill, mostly because they feared the language of it was too vague.
Those in opposition worried that the bill would statutorily expand practice for APRNs by allowing them to do more independently, and overlap with the practice of physicians and doctors. However, everyone who testified seemed to agree that APRNs should be getting a license and not simply a document of recognition.
“I wouldn’t be the doctor I am right now without my nurse practitioners,” said Mistie Mills, an OB-GYN in Columbia and representative of the Missouri chapter of the American College of Obstetricians and Gynecologists.
Some of the senators on the committee did not seem to agree with the opposition’s arguments.
“What we’re all looking for up here is what’s in the best interest of the patients,” Sen. Jill Schupp, D-Creve Coeur, said. “There are areas that are underserved, and we want to make sure that everybody is practicing to the fullest extent so that patients can be served.”
The committee also heard Senate Bill 706, sponsored by Sen. Andrew Koenig, R-Manchester. This bill has two major components. The first prohibits requiring a prescription for the drugs ephedrine, phenylpropanolamine or pseudoephedrine — common ingredients found in meth. It would still allow prescriptions to be given for these medications, but Missourians could also get them without one. Koenig said that counties in his area have ordinances that require prescriptions for these drugs.
“I feel like doing that is punishing the entire population for a small minority of people who may have used it” for illegal purposes, Koenig said. “I mean, I don’t punish all five kids for something one kid may have done,” Koenig said.
The second component of the bill establishes a voluntary prescription drug abuse registry for people aged 18 and older. Individuals could request to be put on the registry, which doctors would be able to access, and then ask to be removed after a five-year period.