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Expanding the Roles of Nurse Practitioners Tonya AndersonAuburn University/ Auburn MontgomeryExpanding the Roles of Nurse Practitioners The Alabama legislation should expand the roles of the primary care nurse practitioner in order to provide more care to underserved areas, provide better quality of care, and to keep more nurse practitioners in-state to practice. According to article V of the Alabama Nursing Practice Act (1995), the nurse practitioner (NP) must practice under a collaborative agreement with a doctor of medicine or osteopathy. The NP may prescribe medications under the supervision of this physician, but is restricted to only legend drugs (“Nursing practice act,” 1995). Scheduled I through V drugs cannot be written (“Nursing practice act,” 1995). Recently the Nurse Practitioners bill, SB 229, was presented by Senator Greg Reed to the Senate Health Committee (Jackson, 2013). The bill gives nurse practitioners more prescription writing privileges including scheduled drugs III – V in order to increase their scope of practice in the state of Alabama (Jackson, 2013). This bill has been passed (Barrett, 2013) and when put into law will benefit not only the nurse practitioner but also the community and patients in which he/she is serving. Due to a shortage of primary care physicians, policymakers in most states have allowed the NP’s scope of practice to be extended in order to improve access to primary care. (Ginsburg, Taylor, & Barr, 2009). With current restrictions in Alabama, a physician can only enter into a collaborative agreement with no more than three full time NP’s ("Advanced practice nursing”). The physician must spend no less than 10% of the NP’s scheduled time in practice with them ("Advanced practice nursing" ). The underserved areas are at an even greater loss. These areas are underserved because it is difficult to attract physicians to the areas and many physicians will not enter into a collaborative agreement with an NP. By allowing the NP to work with less collaborative restrictions or independently, access to care would be easier in these areas. The expansion of prescription writing privileges will help the NP to provide better quality of care. Examples of this would be situations in which a patient may need a cough medication that contains codeine, a patient with diarrhea needs Lomotil, or a patient with peripheral neuropathy needs Lyrica. The NP must stop and locate the doctor to sign for these medications. In rural areas the doctor is not always in the same office which can make this task more difficult and time consuming for the nurse practitioner and patient. Although NP’s are needed in Alabama to help fill the medical void in rural areas, we may be losing them due to these restrictions. In 2011, 1,925 NP’s practiced in the state of Alabama with approximately 180,000 throughout the country (Sell, 2013). In 2013, there are currently 3,327 NP’s in collaborative practice in the state of Alabama (“Alabama board of,” 2013). Unfortunately due to the restrictions, many certified nurse practitioners are obtaining their degree then moving out of the state to be able to practice with fewer restrictions (Ehrhardt, 2008). Fewer restrictions will attract NP’s to seek employment in and better serve the state Alabama. “The Future of Nursing” study by the Institute for Medicine in 2000, recommends and supports that the federal and state legislators reevaluate the NP regulations to remove such barriers (McCreless, 2011). This would allow NP’s to practice to the full extent of their training and education and better serve the communities in which they work. Hamric, Spross, & Hanson, (2009), recommend advanced practice nurses (APN) influence the regulatory processes by engaging in current legislation related to APN, by joining advisory councils for the board of pharmacy or board of medicine, involvement in CMS discussion panels, and offering testimony at national and state hearings. Continued participation in these type venues is paramount for movement in to a more independent practice for APN’s. Nationally speaking, Alabama is among the states with the strictest regulations for practice. References Alabama board of nursing: Daily statistics. (2013). Retrieved from Board of Nursing, (n.d.). Advanced practice nursing: Collaborative practice (Chapter 610-X-5). Retrieved from website: 129Alabama Board of Nursing, (1995). Nursing practice act (Article V). Retrieved from website: 122Barrett, K. (2013, June 17). New law allows nurses, assistants to prescribe some restricted drugs. Retrieved from , J. (2008). Nursing’s advanced practitioners with Alabama’s regulations. Birmingham Medical News. Retrieved from , J., Taylor, T., & Barr, M. (2009). Nurse practitioners in primary care. American College of Physicians. Retrieved form , A. B., Spross, J. A.& Hanson, C. M. (2009). Advanced practice nursing: An integrative approach. (4th ed). St Louis, MO: Elsevier/Saunders Jackson, P. (2013, April 10). Nurse practitioners bill receives favorable report. Alabama political reporter. Retrieved from , P. (2011, October 9). Restrictions on nurse practitioners limit their service, some say. The Anniston Star. Retrieved from , M. (2013, July 9). Bill prescribes change. Decatur daily. Retrieved from ................
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