MONTGOMERY — Susan Alexander has seen many patients in recent weeks with colds and upper respiratory infections at the Priceville medical clinic where she works.
Like other certified registered nurse practitioners in the state, Alexander can diagnose illnesses and recommend medication for treatment.
She even writes the prescription, but often, she can’t sign it.
Alabama is one of the more restrictive states in monitoring what it allows nurse practitioners to prescribe. Most prescriptions for controlled substances have to be signed by the nurse practitioner’s collaborating physician.
In rural parts of the state, that physician is often not in the same office. That means tracking down the physician while patients wait.
“It can translate into a few extra minutes or a few hours,” Alexander said. “If you’re hurting, that could be a very long time.”
A push to expand nurse practitioners’ prescription-writing privileges has made its way to the Alabama Legislature.
A proposed bill would allow nurse practitioners and certified nurse midwives, with their collaborating physicians’ approval, to apply for a certificate to write prescriptions for certain controlled substances. Those drugs could include pain relievers, antibiotics, cough medicines and diabetes medication, said state Sen. Greg Reed, R-Jasper, who is sponsoring the bill in the Senate.
“It has become clear that we have a great resource in nurse practitioners in Alabama, and other states are giving them a broader scope in their practice,” Reed said. “We’ve been struggling to increase care in rural Alabama; this is a way to do that.”
Some in the nursing community are speaking against Reed’s bill, not because of what it would allow them to do, but because of the board they would have to report to in the future. The needed certification would come from the Alabama Board of Medical Examiners, not the Alabama Board of Nursing.
“I’m not sure if passing this bill the way it’s written is good for nurses,” said Lynn Aquadro, a nurse practitioner in Florence and associate professor of nursing at the University of North Alabama. “It would be two different boards that would be overseeing nurse practitioners, and nurses would be accountable to two boards, which doesn’t make sense.”
At a public hearing on the bill before it passed out of the Senate Health Committee last week, several people shared Aquadro’s concerns.
“In most states, the Board of Nursing regulates (the certification),” said Carol Stewart, vice president of that board. “It is unthinkable that one profession tries to regulate another. The Board of Nursing is capable and should be the regulating body.”
Reed said that’s not possible because the Board of Medical Examiners is the only one with federal authority to issue the certificates.
Proponents of the bill said the Board of Medical Examiners should have oversight because it has the investigative and arrest powers needed in cases of fraudulent prescriptions or prescription abuse.
Alexander said the bill also allows for better recordkeeping of who is writing prescriptions for controlled substances. Currently, while a nurse practitioner is the one recommending the medications, it is not the practitioner’s name on the prescription.
“We are health care professionals; we need to be accountable for the decisions we make,” she said.
Proponents of the bill say it could increase health care in rural areas by expanding nurse practitioners’ abilities and willingness to practice medicine in Alabama.
“When you’re a nurse practitioner and your privileges are limited, it is harder to get citizens access to the basic health care that they need,” Alexander said.
A shortage of medical care providers is well documented in Alabama, especially in rural areas.
According to the Alabama Department of Public Health, there are 60 primary care health professional shortage areas in Alabama.
Aquadro agrees with proponents that more flexibility will help nurse practitioners serve more patients.
“With the Affordable Care Act and the fact that medical schools are turning out very few primary care doctors ... there is a need for mid-level providers like nurse practitioners,” Aquadro said. “That’s the mission of nurse practitioners — to extend care in underserved areas where there aren’t enough physicians to provide care.”
Currently, only physicians and physician assistants can prescribe the medications this bill would allow nurse practitioners to write.
Tim Byrum, a nurse practitioner at Rheumatology Associates of North Alabama and graduate faculty member at the University of Alabama at Huntsville, said nurse practitioners already know the medications they’d be allowed to prescribe. They have six to eight years of education, he said.
“We are trained to do this, we just don’t have the authorization from the state,” Byrum said.
That’s driving nurse practitioners to other states, proponents of this bill say. Alabama has significantly less nurse practitioners than neighboring states. Florida is the only other state with the same prescribing restrictions.
“This is so important for us to be able to keep up with our peers,” Byrum said.
Republican and Democratic senators spoke last week in favor of the bill, which now goes to the full Senate.
Mary Sell can be reached at mary.sell@TimesDaily.com.