"It is common knowledge that there is a marked lack of physicians who are willing to relocate to practice in rural areas. Therefore, the health of rural Oklahomans—and indeed, all rural Americans—is negatively impacted any time there is a barrier such as a law that the APRN must be 'supervised' by a physician."
-Dr. Patricia Thompson, Associate Professor & DNP Program Director at Northwestern Oklahoma State University
In 2017, the United Health Foundation ranked Oklahoma as the eighth most unhealthy state in the country in its annual report. Not only does the state have relatively high rates of smoking and obesity, but also access to primary care services is a growing crisis in the area. In fact, the U.S. Health Resources and Services Administration (HRSA) projected a 26.3 percent shortage of primary care physicians in Oklahoma by 2025. Fortunately, there is one solution within striking distance for the state’s legislators and citizens: expanding full practice authority to nurse practitioners.
Nurse practitioners are graduate-trained healthcare providers, and 86.6 percent of them are certified in an area of primary care. In states such as Alaska, Arizona, and Iowa, NPs enjoy full practice authority and are able to work independently in accordance with their advanced training, education, and credentialing. Since so many NPs are trained to be primary care providers, this helps to alleviate doctor shortages in those states.
Unfortunately, Oklahoma is a different story. The OK Nurse Practice Act requires NPs to have a “collaborative agreement” with a physician to prescribe even basic medications. Dr. Pat Thompson, the DNP program coordinator and an associate professor at Northwestern Oklahoma State University, points out that many physicians charge exorbitant amounts of money to maintain these agreements with NPs they oversee, even if they hardly visit the clinics or hospitals.
It’s clear why physicians are the main opponents of extending full practice authority to Oklahoma NPs. And their lobbying helped to narrowly defeat a 2018 FPA measure in the state legislature—a move one newspaper declared was “swayed by mistruths spread by physician groups.”
In November 2018, Cynthia Roe, an NP who was recently sworn into the Oklahoma House of Representatives, published an op-ed on the issue of practice authority. She explained that the hospital in her Pauls Valley district had recently closed, one of many small towns to lose access to local healthcare services. Particularly in states such as Oklahoma with reduced or restricted practice authority, if a physician retires or moves, healthcare facilities are forced to close since NPs legally require this red tape of supervision. Ms. Roe rightly explains that this “outdated requirement drives up costs for consumers, limits where nurse practitioners can work and even caps how many can work in our state.”
Given the overwhelming evidence that NPs provide cost-effective, safe healthcare for their patients, it’s time for Oklahoma to disabuse itself of these unnecessary restrictions so NPs can help alleviate the looming PCP shortage.
NursePractitionerSchools has been honored to interview over 50 NPs and professors in 2017 and 2018, and is committed to advancing the FPA cause. Read on to learn about how lifting state restrictions on NP practice authority can benefit Oklahomans.
Oklahoma is one of only 12 states that requires cumbersome physician oversight of NPs. As Dr. Thompson mentioned, the Association of Oklahoma Nurse Practitioners (AONP) has been very active in advancing the cause for FPA in the state. Not only has the group surveyed local legislators and created a list of those who are in favor of FPA, but it also provides the state’s citizens with a public speaking guide, a list of data-backed talking points, a media flier, a PowerPoint presentation, and other tools for local advocacy.
Overall, allowing NPs to work to the full extent of their training and abilities is expected to have several positive effects on the state. The AONP and others argue that granting FPA will:
To learn more about how to get involved in this issue which is critical to the health of Oklahoma’s citizens, please check out the following guides and resources: