Allowing nurse practitioners to practice without oversight of physicians could help address access to care shortages in Mississippi, particularly in rural areas. However, physicians, including those in the state and American Medical Association, say there is no substitute for the advanced education and training doctors receive.
Dustin Barnes/The Clarion-Ledger
Nurse practitioners in Mississippi have taken a lot of heat lately, after several articles were printed in The Clarion-Ledger refuting our role to treat and manage patients. Most recently, a Flowood psychiatrist was quoted as saying, “Nurse practitioners are … in it, like most people, for the money.” He continues with “if the past is any indication, access to care in rural areas will be no better than what it is now.” He also believes that “quality of care is rooted in the amount of knowledge and training that one receives” and that nurse practitioners “have important roles and can be used in a primary care setting where budgetary constraints are cost-prohibitive for physician services.”
Ouch. Not only was this article fundamentally incorrect, but now every nurse practitioner in the state of Mississippi has scratched him off their referral list. It’s a sad consequence because mental health is already a much-needed service. We desperately need mental health providers that take Medicaid and are willing to see children, as well.
I am going to break down many of his statements and give them the attention that they don’t deserve.
First, we all went to school to make money in some form or fashion. At the age of 9, I knew I wanted to take care of children when I grew up, and that is exactly what I did. I have taught more parents how to correctly clean their little girls’ dirty diapers (to avoid infection) than you can even fathom. Do not discredit my life-calling as something I do just to make more money.
Second, there is no past indication, as our state has never had full practice authority nurse practitioners before. But, it will soon. There are 23 states in the U.S. that are utilizing nurse practitioners to their fullest potential. Look up the statistics and you will learn that lawmakers in other states are already trying to fix their health care shortages in their states. Research is a powerful tool.
Third, quality is not rooted in the amount of anything. Quality is a completely separate factor in health care. Hospitals send out quality care surveys to their patients, regardless of how many days they spent in the hospital or how many people cared for them. You can care for a patient with a genuine, loving heart whether that patient is your first or your 1,000th. You can hold a hand as a family member mourns even though you have never lost a patient before. Quality is a defining characteristic all on its own.
Lastly, if budget constraints and cost are what’s keeping physicians from practicing in rural areas in primary care, then the salary of the provider needs to be reconsidered. You simply will not make as much money in a rural setting as you will in the city. We get it and want to do our jobs anyway.
Now, on to more important things.
The biggest problem that I have with all of the articles that have been printed is that no one has offered a solution (other than not using nurse practitioners) to our health shortage. Naysayers have focused way too long on how to keep a finger on the group of people that trained and prepared to help fill the medical care shortage gap in our state. Yet they have failed at giving the public another credible option.
Yes, we acknowledge that our school training hours are far less than medical doctors, but please remember that most of us have worked years and years caring for patients in hospital settings, 12 hours at a time. This can easily amount to tens of thousands of hours before entering a master’s program. Our knowledge does not simply come from a school program and a degree; it was cultivated over time in settings that were intense, emotional and often critical. Nurses, by nature, do not give up easily and will fight for our patients’ best interests until we have exhausted all measures. Why is anyone opposed to this?
According to the Medicaid website, there are 722,000 people currently enrolled in Mississippi Medicaid — that doesn’t even include Medicare enrollees. If a single provider has a panel size of 2,000, we would need a total of 361 providers just to see this one group of people. The numbers speak for themselves; there simply aren’t enough providers to see everyone. So stop telling the people of this state that there is a shortage of providers. They already know. They drive hours round-trip to see a medical provider that will accept their insurance. Emergency departments are inundated with non-life-threatening illnesses due to persons not having access to a home medical clinic.
We need to work together to create solutions for this ever-growing problem, not sit and point fingers and call others unqualified. We don’t need to re-create the wheel. Other states are flourishing with full-practice nurse practitioners. Let’s closely examine their practice model and figure out what is working for them.
Having full authority means that many of us can open clinics and provide care without having the burden of having a collaborating physician sign charts once a month. This financial burden is often a heavy load for small clinics trying to survive in an ever-decreasing reimbursement world. A patient’s chart that is signed on the 31st of the month does not change the assessment/diagnosis/treatment plan that was done three weeks prior. We are not supervised on a daily basis as many would like to think. Collaborating physicians sign 10 percent of our monthly charts or 20 charts total, whichever is less.
We are capable of working in a clinic as the sole provider. We are capable of writing prescriptions, suturing wounds, performing PAP smears, and assessing and treating a plethora of diseases. If we feel like a specialist is needed, we refer. We understand our scope of practice. This is not an MD vs. NP argument. We are not trying to take anyone’s patients or step on toes. We are a valuable addition to the medical community and want to do our part.
Nurse practitioners are an intelligent, confident and caring group of professionals. We do not like to be painted as ill-trained, unequipped gold diggers. We will continue to ask for advice from trusted resources when we need to. We will continue to utilize evidence-based practice. We will continue to work on board certification requirements. We will continue to do our jobs regardless of skewed opinions. We will continue to pour our hearts into our life callings because we love what we do.
Jennifer Easley is a certified nurse practitioner.
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