State bill to ease restrictions on nurse practitioners
by Patrick McCreless
Mar 04, 2013 | 11251 views |  0 comments | 13 13 recommendations | email to a friend | print
Nurse practitioner Chase Thomas looks about the ear of a patient at Pediatrics Plus in Anniston. A new bill will ease restrictions and allow nurse practitioners to prescribe certain kinds of pain medications. (Photo by Trent Penny / The Anniston Star)
Nurse practitioner Chase Thomas looks about the ear of a patient at Pediatrics Plus in Anniston. A new bill will ease restrictions and allow nurse practitioners to prescribe certain kinds of pain medications. (Photo by Trent Penny / The Anniston Star)
A new state bill aims to ease restrictions on who can prescribe certain pain medications to increase access to care.

The Senate bill would, if passed, let certified nurse practitioners prescribe certain pain medications, allowing easier access to care for residents, particularly in rural areas where physicians are scarce. An easing of restrictions would also act as an incentive to lure more nurse practitioners to the state, increasing access to care in the process.

But the state’s nursing regulatory board opposes the bill, saying it could increase red tape for nurse practitioners by placing them under an additional regulatory agency.

The bill, which was read in the Senate for the first time Feb.19 and is currently under review by the Senate Committee on Health, is supported by the Nurse Practitioner Alliance of Alabama, the Alabama Board of Medical Examiners, which licenses physicians in the state and the Medical Association of Alabama, which represents physicians. Under the bill, nurse practitioners will be allowed to prescribe pain medications such as Valium and Loritab.

Senate President Pro Tem Del Marsh, R-Anniston, who is a co-sponsor of the bill, said the legislation will help improve health care, particularly in rural areas of the state.

“This allows nurse practitioners to provide medication when doctors aren’t there,” Marsh said. “It’s just a way to help these rural areas to disperse these drugs.”

Chase Thomas, a nurse practitioner and owner of Pediatrics Plus in Anniston agreed that easing restrictions on nurse practitioners would allow them to help more patients.

“There are so many doctors’ practices based on nurse practitioners because they aren’t able to see all the patients themselves,” Thomas said. “We fill in the gap.”

Nurse practitioners are a step beyond registered nurses, both in education and abilities. They usually work under a physician in various fields, such as pediatrics or emergency rooms. They can do many things physicians can, including order, perform and interpret diagnostic tests such as lab work and X‐rays; diagnose and treat acute and chronic conditions like as diabetes, high blood pressure, infections and injuries; prescribe medications and other treatments; and manage patients’ overall care.

However, according to the American Academy of Nurse Practitioners, Alabama places more restrictions on nurse practitioners than nearly every other state in the country. Other than being unable to prescribe pain medications, Alabama nurse practitioners must have a licensed physician oversee their activities. The restrictions have led many nurse practitioners to avoid working in the state, Thomas said.

About 1,300 nurse practitioners operate in the state — a small fraction of the approximately 148,000 nurse practitioners who operate around the country.

Naomi Wade, nurse practitioner at the Regional Medical Center for Occupational Health and Wellness, said she could see the benefits of easing prescription restrictions.

“It would give us more autonomy and independence ... and we wouldn’t have to interrupt or bother our collaborator,” Wade said, referring to physicians.

However, Wade said, easing the restrictions could also create problems with drug abusers.

“It could open the door for drug abusers by having more providers to prey upon,” Wade said.

The Alabama State Nurses Association, which promotes nursing in the state, and the Alabama Board of Nursing, which regulates nurses, oppose the bill, but not for any possible downsides to lowering restrictions on nurse practitioners. Instead, the organizations oppose the bill for giving the Board of Medical Examiners control over issuing certificates allowing nurse practitioners to prescribe pain medication.

“We do support the expansion of prescription authority of nurse practitioners … there is not enough care out there,” said Dr. John Ziegler, executive director of the Nurses Association. “But what we tried to encourage is ... put the nurse practitioners under the board of nurses so they are regulated by nurses.”

Ziegler said having nurse practitioners regulated by the nursing board and the Board of Examiners would cause undue regulatory problems for a nurse practitioner, particularly if he or she must respond to a potential license violation.

“It may take up to six months to get through two boards,” Ziegler said. “We don’t want to make it more complicated.”

Larry Dixon, executive administrator of the Board of Medical Examiners, disagreed with Ziegler, however, saying the bill only gives his board authority over the the issuance of prescription drug certification for nurse practitioners and not nurse practitioners themselves.

“The bill is very specific — there is no regulation over nurse practitioners,” Dixon said.

Dixon added that unlike the nursing board, the Board of Medical Examiners has more than 85 years experience regulating controlled substances.

“The nursing board has no experience and no system set up,” Dixon said. “The law is very specific in who can regulate a controlled substance; it’s a very difficult process that requires the most oversight.”

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.

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