{"id":29681,"date":"2018-04-12T14:31:01","date_gmt":"2018-04-12T19:31:01","guid":{"rendered":"http:\/\/stateimpact.npr.org\/oklahoma\/?p=29681"},"modified":"2019-03-10T16:43:47","modified_gmt":"2019-03-10T21:43:47","slug":"doctors-question-push-for-more-independent-nurses-as-lawmakers-consider-how-to-fill-health-gaps","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/oklahoma\/2018\/04\/12\/doctors-question-push-for-more-independent-nurses-as-lawmakers-consider-how-to-fill-health-gaps\/","title":{"rendered":"Doctors question push for more independent nurses as lawmakers consider how to fill health gaps"},"content":{"rendered":"<div id=\"attachment_29687\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 620px;\"><a class=\"fancybox\" title=\"Lindsi Walker, a nurse practitioner, insider her office at Cordell Memorial Hospital.\" href=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner039_WEB.jpg\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-29687 size-full\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner039_WEB.jpg\" alt=\"Lindsi Walker, a nurse practitioner, insider her office at Cordell Memorial Hospital.\" width=\"620\" height=\"413\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner039_WEB.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner039_WEB-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner039_WEB-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner039_WEB-300x200.jpg 300w\" sizes=\"(max-width: 620px) 100vw, 620px\" \/><\/a><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact Oklahoma<\/p>\n<p class=\"wp-caption-text\">Lindsi Walker, a nurse practitioner, insider her office at Cordell Memorial Hospital.<\/p>\n<\/div><p>It\u2019s hard to get basic health care like shots and x-rays in rural Oklahoma. The federal government considers all but one of the state\u2019s 77 counties to have a primary care shortage. The problem is driving a legislative effort to allow highly educated nurses to fill that gap \u2014 but doctors and nurse practitioners are butting heads on who is qualified to help.<\/p><p><iframe loading=\"lazy\" src=\"https:\/\/w.soundcloud.com\/player\/?url=https%3A\/\/api.soundcloud.com\/tracks\/428800824&color=%23ff5500&auto_play=false&hide_related=true&show_comments=false&show_user=true&show_reposts=false&show_teaser=false\" width=\"100%\" height=\"150\" frameborder=\"no\" scrolling=\"no\"><\/iframe><\/p><p><!--more-->Lindsi Walker sits behind a glossy wooden desk at Cordell Memorial, a hospital on Oklahoma\u2019s western plains. She\u2019s surrounded by pictures of her family \u2014 a stethoscope hangs around her neck.<\/p><p>She was hired in February after hospital administrators tried for two and half years to attract a new primary care physician to the small, rural city. But she\u2019s not a doctor &#8211; she\u2019s a<a href=\"http:\/\/nursing.ok.gov\/prac-natlcert.pdf\"> nurse practitioner<\/a> &#8211; a highly qualified nurse trained to treat certain medical conditions.<\/p><p>\u201cI\u2019m family practice, so we see from birth to death and everything in between,\u201d Walker said. \u201cWe come in, we have a full schedule of patients that range in a variety of problems from acute illnesses, to chronic illnesses. A lot of chronic disease \u2014 diabetes, hypertension, heart disease.\u201d<\/p><p>Oklahoma is one of <a href=\"https:\/\/www.aanp.org\/legislation-regulation\/state-legislation\/state-practice-environment\">11 states<\/a> where nurse practitioners like Walker have to have a <a href=\"http:\/\/nursing.ok.gov\/rules17.pdf\">contract with a doctor<\/a> in order to diagnose, treat patients and prescribe certain drugs. The idea is that a nurse practitioner can consult with the doctor when they need to, or in case of emergency. On paper, doctors in these agreements are known as supervising physicians, but Walker says that description is misleading.<\/p><p>\u201cThere are people that I see as patients that say, we don\u2019t even know, we\u2019ve never even met who your supervising physician is,\u201d she said. \u201cThey don\u2019t see them. They don\u2019t dictate in anything in how we do our jobs.\u201d<\/p><p>In independent clinics, nurse practitioners often pay thousands of dollars every month for clinical oversight from physicians &#8211; who may not be on site &#8211;\u00a0 a requirement many nurses and clinic owners say amounts to little more than red tape.<\/p><p>Cordell Memorial CEO Landon Hise agrees. Right now, Oklahoma physicians can only supervise <a href=\"http:\/\/www.okmedicalboard.org\/download\/214\/Elig_to_sup_advpractnurse_w_presc_auth.pdf\">two nurse practitioners<\/a> at once. And since he can\u2019t get an additional physician to come to Cordell, the hospital is stuck in limbo.<\/p><p>\u201cWe have one doctor, two nurse practitioners, so at the moment we are maxed out. We cannot have any other providers unless we recruited another physician,\u201d Hise said.<\/p><p>Without another physician, Hise can\u2019t hire more nurse practitioners \u2014 unless state law is changed to give them more authority to care for patients. This <a href=\"http:\/\/nursing.ok.gov\/prac-decmak.pdf\">scope of practice<\/a> debate \u2014 basically, who gets to order and interpret tests like x-rays and prescribe some medicines \u2014 has been <a href=\"http:\/\/www.roanoke.com\/news\/politics\/general_assembly\/governor-signs-bill-giving-nurse-practitioners-more-autonomy\/article_f7feacea-e240-5523-a758-de32ccdfc9d5.html\">raging<\/a>.<\/p>\n<div id=\"attachment_29688\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 620px;\"><a class=\"fancybox\" title=\"State Sen. Ervin Yen, R-Oklahoma City, is chair of the Senate Health and Human Services committee and a cardiac anesthesiologist.\" href=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner029_WEB.jpg\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-29688 size-full\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner029_WEB.jpg\" alt=\"State Sen. Ervin Yen, R-Oklahoma City, is chair of the Senate Health and Human Services committee and a cardiac anesthesiologist.\" width=\"620\" height=\"413\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner029_WEB.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner029_WEB-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner029_WEB-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner029_WEB-300x200.jpg 300w\" sizes=\"(max-width: 620px) 100vw, 620px\" \/><\/a><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact Oklahoma<\/p>\n<p class=\"wp-caption-text\">State Sen. Ervin Yen, R-Oklahoma City, is chair of the Senate Health and Human Services committee and a cardiac anesthesiologist.<\/p>\n<\/div>\n<h3>Scope of practice<\/h3><p>For many physicians, the difference boils down to education.<\/p><p>\u201cThe training of a nurse is in nursing. The training of a physician is in medicine,\u201d said State Sen. Ervin Yen, R-Oklahoma City, chair of the Senate Health and Human Services committee. Yen is also a cardiac anesthesiologist. He says physicians have at least 10 years of medical education. <a href=\"http:\/\/nursing.ouhsc.edu\/Academics\/Masters\/MSNFamilyNursePractitioner.aspx\">Nurse practitioners<\/a> only go through six to eight years of training.<\/p><p>\u201cIt\u2019s in medical school that physicians are taught diagnosis and treatment of disease. That\u2019s what you learn in medical school. You don\u2019t learn that in nursing school,\u201d Yen said.<\/p><p>There have been tensions between doctors and nurses since the days of Florence Nightingale, but the strain increased in the 1950s. Scientific discoveries pushed physicians away from primary care and into increasingly specialized and more lucrative fields like cosmetic surgery.<\/p><p>Meanwhile, nurse practitioners have become more professional with graduate degrees, and they want to fill that primary care gap.<\/p><p>A measure to do that in Oklahoma, <a href=\"http:\/\/www.oklegislature.gov\/BillInfo.aspx?Bill=HB1013\">House Bill 1013<\/a> was filed last year. Right now it\u2019s stalled in the Senate Health and Human Services committee Senator Yen chairs. A similar bill is in the works. Bu Yen doesn\u2019t think legislation granting nurse practitioners more authority is the answer.<\/p><p>\u201cCurrently today, nurse practitioners can practice in rural Oklahoma under the supervision of a physician. Passing 1013, how does it increase nurse practitioners in rural Oklahoma? I don\u2019t think it does,\u201d he says. \u201cIt just allows them to work without supervision \u2014 it doesn\u2019t get more of them there.\u201d<\/p>\n<div id=\"attachment_29686\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 620px;\"><a class=\"fancybox\" title=\"Cordell, Oklahoma.\" href=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB.jpg\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-29686 size-full\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB.jpg\" alt=\"Cordell, Oklahoma.\" width=\"620\" height=\"413\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/04\/20180328-nurse-practitioner080_WEB-300x200.jpg 300w\" sizes=\"(max-width: 620px) 100vw, 620px\" \/><\/a><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact Oklahoma<\/p>\n<p class=\"wp-caption-text\">A billboard outside advertises the services of the hospital&#8217;s only doctor and two nurse practitioners.<\/p>\n<\/div>\n<h3>Additional autonomy<\/h3><p>Many states have granted nurse practitioners autonomy, including Colorado in 2010. But eight years later, Mark\u00a0Deutchman associate dean of <a href=\"http:\/\/www.ucdenver.edu\/academics\/colleges\/medicalschool\/education\/degree_programs\/MDProgram\/longitudinal\/tracks\/ruraltrack\/Pages\/default.aspx\">rural health at the University of Colorado School of Medicine<\/a> says the change hasn\u2019t fixed that state\u2019s rural health care problem.<\/p><p>\u201cNone of our counties that are designated as primary care health professional shortage areas have ceased being so in the time interval since this law was passed,&#8221; he said.<\/p><p>Deutchman\u00a0says expanding <a href=\"http:\/\/www.ou.edu\/tulsa\/residency\/family_medicine\/rural_track.html\">on-the-job training programs<\/a> to attract and prepare medical students who are interested in practicing in rural health could help.<\/p><p>This isn\u2019t a new problem. In the 1970s Oklahoma created the <a href=\"http:\/\/pmtc.ok.gov\">Physician Manpower Training Commission<\/a>, which provides scholarships and loan repayment to nurses and doctors to incentivize them to practice in rural areas. Right now, it has 57 doctors in underserved parts of the state, but with continued cuts to state appropriations and the recent <a href=\"http:\/\/oklahomawatch.org\/2018\/03\/05\/gme-dispute\/\">loss of federal funds<\/a>, the commission can only afford to help a limited number of providers.<\/p><p>\u201cA huge statistic, which shocks me every time I say it, is that we have one-third of our practicing physicians in Oklahoma that are over 60 years old,\u201d says Richard Evans, head of the Physician Manpower Training Commission.<\/p><p>In his experience, quality of rural life in rural areas can be a major stumbling block.<\/p><p>\u201cWe\u2019re trying to get a doc to enroll his kids in school out there, and hopefully live there for his career. And to try to get them to go to a school district that may be only going to school four days a week is a very difficult thing to do,\u201d Evans said.<\/p><p>Cordell hospital CEO Landon Hise has had similar experiences. He says getting a physician to stay for decades in a rural area is a tough sell. One major reason &#8211; being a country doctor means you\u2019re always on call.<\/p><p>\u201cHere, in rural Oklahoma, you\u2019re going to practice in your clinic during the week, you\u2019ll take an ER call at night, you\u2019re going to get stopped in the grocery store, people asking about their health, you go to church and it\u2019s going to happen there \u2014 so it\u2019s just a completely different lifestyle out here,\u201d Hise said.<\/p><p>In the meantime, Hise is making contingency plans. The single doctor on staff in Cordell wants to retire. Hise is recruiting medical students \u2014 and hoping he can convince future doctors to start their career in western Oklahoma.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>It\u2019s hard to get basic health care like shots and x-rays in rural Oklahoma. The federal government considers all but one of the state\u2019s 77 counties to have a primary care shortage. The problem is driving a legislative effort to allow highly educated nurses to fill that gap \u2014 but doctors and nurse practitioners are [&hellip;]<\/p>\n","protected":false},"author":199,"featured_media":29686,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[23],"tags":[],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/29681"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/users\/199"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/comments?post=29681"}],"version-history":[{"count":13,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/29681\/revisions"}],"predecessor-version":[{"id":31276,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/29681\/revisions\/31276"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media\/29686"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media?parent=29681"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/categories?post=29681"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/tags?post=29681"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}