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Minnesota advanced-practice nurses lobby to remove barrier

DULUTH — Nurses at the top level of their profession can do many of the same things doctors do: diagnose illness, manage treatment, prescribe medications, order tests.

But in Minnesota, the APRNs — advanced-practice registered nurses — can only do so under a signed agreement with a physician. Now, nursing faculty members at the College of St. Scholastica and their students are lobbying on behalf of legislation that would remove that barrier.

Instead of the so-called collaborative agreement with a doctor, the APRNs would be responsible to the Board of Nursing.

Although they say many doctors agree with them, the faculty members acknowledge opposition from the Minnesota Medical Association and the American Medical Association.

That includes Dr. David Thorson, a family doctor in St. Paul who is chairman of the MMA’s board.

“It is our position that there needs to be some maintenance of a collaborative agreement,” Thorson said in a telephone interview.

The activist nurses and the doctors who disagree with them do agree on this: There’s a growing shortage of health care services.

“I’m very worried about the physician shortage,” Thorson said. “We’re coming on to a perfect storm where a number of primary-care physicians … are getting to their retirement times.”

Laurie Ash, a certified nurse practitioner and associate professor at St. Scholastica, said studies show a shortage of 9,000 primary-care physicians in the United States last year, with the number expected to grow to 65,000 over the next 15 years.

Nurses with advanced degrees can fill much of the gap, say Ash and her colleague Cathie Miller, also an associate professor at CSS. But in Minnesota, they’re not always able to practice in the areas where they’re needed the most. That’s because they can’t always find a doctor to sign the collaborative agreement required for them to offer such services as prescribing drugs.

Ash described one CSS graduate who was a psychiatric nurse practitioner who wanted to practice in northwest Minnesota but was unable to find a collaborating psychiatrist. “I don’t know what happened to her, but she was going to quit the profession even before she started,” Ash said.

Thorson said he has heard anecdotes about APRNs who were unable to practice, but he hasn’t seen hard evidence. He also said there’s no evidence the advanced-practice nurses actually go to shortage areas.

But there is evidence, Miller and Ash say. For example, 46 Minnesota counties — including Lake and Carlton counties — receive anesthesia care only from a certified registered nurse-anesthesiologist, not from a doctor who is an anesthesiologist.

Serving in an underserved area is what Lynn Gevik has in mind.

At 50, the Duluth woman says she has reached the “give-back years” of her life, and she wants to work among an underserved population in a rural area, a reservation or the inner city.

Gevik, who founded the health care company that includes Diamond Willow Assisted Living and Keystone Bluffs Assisted Living, is in the adult-gerontology program and eventually wants to be a psychiatric nurse practitioner. Both programs are offered at CSS.

Policy matters are included in training Gevik and the other advanced-practice nursing students at CSS. Although legislation regarding APRNs won’t be heard before 2014, some members of their group already have met with legislators. Others have written letters and emails or placed calls.

One of their arguments is that 17 states already have approved similar legislation. It would put Minnesota in line with the neighboring states of Iowa and North Dakota. Talented nurses are leaving Minnesota for the states with less of a regulatory barrier, Miller said.

But the bottom line is quality of care in Minnesota, Thorson said.

“There is a significant difference in the training between physicians and advanced-practice nurses,” he said, adding that nurse practitioners would have to refer cases to specialists more often than family doctors would.

Miller and Ash point to a Columbia University health economist’s report that APRNs can manage about 85 percent of primary-care needs. They’ll gladly call on physicians for more complex cases, they said, but they want to be able to work at the level their training allows.

“We need every physician to work to the top of their license,” Ash said. “We (also) need all nurses to work to the top of their license, or we are not going to be able to handle this large influx of patients.”

Article written by John Lundy of the Forum News Service

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