The state of Kentucky categorizes nurse practitioners (NPs) and nurse midwives (NMs) as advanced practice registered nurses (APRNs). They provide both special and primary health care services with full independence or semiautonomous. Kentucky nurse practitioners require no physician supervision to practice so long as they have the proper national and state certificate/ license whereby they can enjoy medical engagements in consistence with the advanced Nursing Practice (ANP) standards. This legal standing thus gives the NPSs some freedom in their practice. However, when it comes to the issue of prescribing drugs in the Bluegrass State, NPs must have a collaborative agreement with a physician who acts as the supervisor. The two collaborative practice agreements include prescription of controlled substances and non-scheduled drugs. The Kentucky Board of Nursing refers to the agreements as CAPA-NS documents. Further, for prescription of controlled substances, the NP requires certification and licensure for at least a year. If an NP meets specific requirements after four years of practice under the collaborative agreement, they may be allowed to prescribe independently. Also, NPs cannot sign death certificates in Kentucky.
The restrictions placed on the Kentuckian NPs and NMs limit them from practicing within their full scope and educational preparation and training. The practice barriers on the NPs further restrict access to health by the Kentuckian citizens because they bar the NPs from prescribing to dispensing and even accepting and distributing medication samples. Therefore, the restrictions need to be eliminated for cost reductions on healthcare to the Kentuckians and increase their access to highly skilled and quality care. Notably, in the past, Kentucky Senate Bill had been proposed to see to a rescission of the collaborative practice rule, so that nurse practitioners gain ultimate freedom in their scope of practice. However, the bill failed.
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There exist physician collaboration issues in the state. Physicians willing to enter into collaborative prescribing agreements with APRNs are few. As a result, the latter have difficulty establishing their practice in the state’s underserved areas. Additionally, physicians have the notion that once they enter into collaborative agreements with NPs, they then become liable for their practice. As a result, it makes them shy away from signing such pacts.
The nursing profession has evolved differently in states due to varying issues and needs. A sense of clarity, therefore, lacks among states. Additionally, having varying scopes of practice from those that existed at the birth of the profession and from other countries is deemed as putting patients’ safety at risk. Therefore, this limits NPs from practicing independently.
To address nurse practitioner practice issues, there should be a change in how professional associations view things. With the US healthcare landscape rapidly evolving, the shortage of primary healthcare professionals has been a concern. Therefore, permitting NPs to practice to their full scope will buffer the workforce needed to meet the state's healthcare needs while contributing their unique skills to community-based care. The focus should not be on what a nurse or a physician can do, but rather on what patients need and who can be able to address to them effectively. Both professions should work collaboratively and foster relationships that permit the evolution of their practices and roles, founded on respect for each other. Regulatory and legislative changes should also be supported to abolish restrictions on NPs as informed by research and evidence-based results.
References
Blackwell, C. W., & Neff, D. F. (2015). Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States. Journal of the American Association of Nurse Practitioners , 27 (10), 552-557.
Brown, T. (2018). Nurse Practitioners: Solution to the Primary Care Shortage. Retrieved 27 July 2020, from https://www.medscape.com/viewarticle/904384#vp_1
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018, June). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute.
Timmons, E. J. (2017). The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care. Health policy , 121 (2), 189-196.
