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Nurses striving to make for a better Mississippi

By CALLIE DANIELS BRYANT

When we step into a doctor’s office the first person we meet is a nurse who does seemingly everything in preparation: measuring and weighing, symptom-tracking, and even needle poking.

Nowadays in Mississippi it may be more common to visit a nurse than it is to visit a doctor, especially an Advanced Practice Nurse (APRN).

An APRN is a nurse who has obtained at least a master’s degree. There are four main APRN roles: registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS) and nurse practitioner (NP).  Note that while every NP is an APRN but not every APRN is an NP.

The American Association of Nurse Practitioners Scope of Practice for Nurse Practitioners (2010) describes NPs as licensed independent practitioners who practice in ambulatory, acute and long-term care as primary and/or specialty care providers.  According to their practice population focus, nurse practitioners deliver nursing and medical services to individuals, families and groups. The quality of their service is guaranteed by their completion of a formal graduate program as well as their commitment to professional self-development in continued education. Most NP programs currently award master’s degrees and post-master’s certificates, there is an increasing number of NP programs awarding doctoral degrees.

“What sets nurse practitioners apart from other healthcare providers is their unique emphasis on the health and well-being of the whole person. With a focus on health promotion, disease prevention, and health education and counseling, nurse practitioners guide patients in making smarter health and lifestyle choices, which in turn can lower patients’ out-of-pocket costs,” said Robert Ware, director of clinical improvement with Mississippi Baptist Health System, and a member of Mississippi Association of Nurse Practitioners.

The Mississippi Association of Nurse Practitioners report “approximately 5,500 APRNs in the state of Mississippi” which consists of nurse practitioners in various disciplines, approximately 900 certified registered nurse anesthetists (CRNA), and 30 certified nurse-midwives (CNM). 

All APRNs are required to be board certified in order to practice in Mississippi, and they are regulated by the Mississippi Board of Nursing.

Additionally, in Mississippi, the APRNs are required to have a collaborating physician, meaning APRNs need to have a physician who pursuant to a duly executed protocol has agreed to collaborate or consult with a nurse practitioner. APRNs do not require physician supervision however, and the physician is not required to be onsite at APRNs’ medical practice facilities.

The Board of Medical Licensure recently adopted final approval for their regulations on physicians collaborating with nurse practitioners.

The final adoption of Mississippi Code Ann. §73-43-11 (1972, as amended) dictates that “primary care physicians shall have no mileage restrictions placed on the collaborative agreement between the physician and the nurse practitioner if the following conditions are met:

» The agreement is between a primary care physician and a primary care nurse practitioner.

» The physician is in a compatible practice (e.g., same speciality, treat the same patient population) with the nurse practitioner.

» The physician utilizes electronic medical records (EMR) in their practice, and also utlilizes EMR in the formal quality improvement program.

» The physician practices with the State of Mississippi for a minimum of 20 hours per week or 80 hours per month (does not include telemedicine.)”

According to the 2016 Mississippi Board of Medical Licensure’s annual reports, there are 6,219 physicians in Mississippi, just 712 more than APRNs in Mississippi.

APRNs and physicians have common responsibilities, which include diagnosis and treatment, taking patient’s medical histories, updating charts and patient information with current finding and treatments, ordering diagnostic tests and examinations for nurses and other healthcare staff to perform, reviewing test results for abnormalities, recommending and prescribing plans of treatment, addressing concerns and answering questions that patients have on their own well-being, and educating patients and families on disease prevention and positive health choices.

With these similarities many APRNs have their own practices where they can serve local communities who may have difficulty accessing a physician.

“The majority of APRNs in Mississippi currently work in primary care. Many work in rural, underserved areas where it is difficult to retain healthcare providers. Many APRNs settle in their hometowns and have long-term practices in their communities,” Ware said.

According to Mississippi State Department of Health’s office of rural health and primary care MS primary care needs assessment last March, the travel and provider access are the major barriers to Mississippi’s healthcare.

“Mississippi is the least healthy state. We are ‘worst of worst,’ and ‘least of the best’ in majority of healthcare aspects. APRNs in Mississippi are available to fill this void. APRNs are willing to go to places no one else wants to go,” Ware said.

He listed advantages of seeing an APRN: many accept walk-ins and same day appointments as well as shorter wait-times at their offices. APRNs are more affordable than physicians, which could save on insurance and taxpayers’ costs. Many APRNs accept Medicaid, Medicare and ACA plans whereas a considerable number of physicians do not. 

However, the APRNs in Mississippi may soon be challenged by their collaboration restriction. The Health Resources and Services Administration projects a physician shortage of approximately 20,400 in 2020 due to aging and population growth, but also reported that this gap could be reduced to 6,400 with effective integration of APRNs. 

The integration is possible with granting full practice authority to APRNs. There are presently 23 states who have done  this whereas Mississippi is a reduced practice state. Those 23 states do not require APRNs to have physician collaborative agreements for their medical practice.

Ware said, “This is the model recommended by the National Academy of Medicine and the Nation Council of State Boards of Nursing. Mississippi APRNs have been actively legislating for full practice authority. State legislative and regulatory barriers prevent APRNs in Mississippi from practicing to the full potential of their education and training.”

He added the Mississippi Association of Nurse Practitioners and its lobbyist John Morgan Hughes work on behalf of nurse practitioners in the state every year to remove the collaborative agreement contract to allow full practice authority.

“Many of the senators and representatives support the full practice authority,” Ware said. “Our largest opponent is the Mississippi State Medical Association.”

In the meanwhile, many APRNs are serving the Mississippians in primary care specializations such as adult-gerontological health, family health, neonatal health, pediatric / child health, psychiatric /mental health, and women’s health. There are also APRNs who have options between acute and primary care for adult-gerontological and pediatric healthcare, and they could also pursue a sub-speciality in oncology, emergency medicine, and forensic nursing among specific fields.

One such APRN is Mickie Griffith-Autry, who is at Ovation Women’s Wellness at 4814 Lakeland Drive in Flowood.

After being a nurse for 18 years with experience including emergency room and trauma flight nursing, Griffth-Autry decided to return to the graduate nurse practitioner program at the University of Alabama-Huntsville. She earned the MSN / nurse practitioner degree from that university in 1999. 

“My children at the time were nine, seven, and six, and I wanted to provide a better life for them,” Griffith-Autry said. “The nurse practitioner program allowed me to work three 12-hour shifts on the weekend, complete my didactic and residency program in two years while continuing to care for my children during the week.”

Her interest grew in caring for aging women with a focus on hormone imbalance and sexual dysfunction, so she completed her PhD in health services from Walden University in Minneapolis, Minnesota where she completed a dissertation entitled “Pelvic floor muscle strengthening: impact on female sexual dysfunction.”

“In obtaining my advanced degree I have been able to provide well for my children who are now thriving personally and professionally in each of their chosen careers,” Griffith-Autry said.

She has always wanted to open her own practice since first days of nursing, but this dream didn’t become a reality until she was recruited to Mississippi. Now she works in partnership with two other MDs.

She said “(They) believe in quality of care that I as nurse practitioner provide and allow me to provide a specialized service to a forgotten population of aging women.”

Her practice specializes in hormone imbalance, female sexual dysfunction, urinary incontinence, interstitial cystitis, pelvic organ prolapse, well-woman exams, polycystic ovarian syndrome, recurrent urinary tract infections, and pain during intercourse. 

While she feels she cannot adequately answer the difference between her care and a physician’s, she noted that she however feels that her patients appreciate the time, diagnostic testing, and individuality of care she provides.

“Many patients tell me that ‘for the first time in many years, I feel I am being listened to,’” she said.

Griffith-Autry added that it bears importance to say that nurse practitioners should be seen and valued as an important part t the practice of medicine team approach.

“We provide an unique quality in our approach to caring for the whole patient as that is the foundation of our education,” she said. “Nurse practitioners are trained to practice within their scope of practice and with today’s healthcare crisis, (they) should be embraced as part of the solution, not part of the problem.”

Although the political debate may be ongoing on whether APRNs may have full practice or collaborative partnership with physicians, these nurse practitioners strive to serve Mississippians in many aspects of healthcare from rural accessibility to affordable healthcare to specialized healthcare in private practice or in partnership with physicians. Their role in Mississippi healthcare is noticeable, to say the least.

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17 comments

  1. Jennifer Bryan, MD

    Medical school matters. There’s a reason so many of us physicians trained rigorously and there is no shortcut to that training. As a Mississippi physician I am disappointed in the blatant bias present in this article. I believe in and respect the work of nurse practitioners but as a part of a physician led team. This article implies APRNs listen better, practice in more rural areas and accept more walk ins. None of those are accurate and are all biased and actually hurtful to a doctor who loves Mississippi and have dedicated my life to the well being of my patients.

  2. Oh I can help provide some differences!!! Doctor 20,000+ training hours. Mid level 600-1000.

  3. Anycare is not better than no care. A patient satisfied that he/she is healthy because they saw a “provider” who chopped off 5-9 years and 15000 hours of training to get to where they are compared to a physician is always going to be a risky venture. Theyll skip on things that can be a matter of life and death because they never learn them in the first place. On the other hand, referring every pimple is a common hobby of NPs. Studies show they regularly send low-quality referrals to specialists causing the patient unnecessary burdens and costs and slowing down our healthcare system further. Online Diploma mills are no substitute for medical school, please see a real doc.

  4. There is just no substitute for a physician. Training matters. Please, America do not let anyone convince you that less education is better. In Texas we have NPs staffing most Urgent Cares and Retail Based Clinics. Rarely do I see appropriate care given at these places when a patient heads their way for an acute illness after hours. The usual is an antibiotic JUST BECAUSE “all their tests were negative and JUST IN CASE”. This is frequently after only a few hours of fever. I see the patient and stop all unwarranted medicinal therapies for the child’s viral illness. Overuse of antibiotics is creating drug resistant bacteria. Antibiotics also have their own side effects which can be lethal in certain cases. I would prefer a physician who has 15000-20000 clinical hours as this is where the application of your knowledge is learned. You can not have adequate training in only 500 clinical hours. A medical residency for physicians has numerous levels of protection and back up. Intern, 2nd year resident, 3rd year resident, fellow, and attending are all seeing and discussing the patient. Think about it, physicians have 500 hours of clinical training after the first year of medical school. Then we have another 3 years to complete, and then our residencies. Given your choice would you rather have a physician fresh out of a 3 year residency program or someone with only 500 clinical hours (on the honor system)? Who do you think will provide the best care? 18000 hours of training vs 500 ? Hospitals love NP’s because they make them more money by ordering unnecessary tests (labs, xrays, CTs MRIs, etc) because they have not had enough training to know better.

  5. This article makes it sound like APRNs are flocking to do primary care in rural MS, which is a fantasy.

  6. Sounds like this was written by an NP or by someone married to one. There was no comparison in education made between NPs and physicians (hint: it’s not even close). And there was no mention of the plethora of online NP schools that require NO prior RN experience! That’s right! Graduate college with any degree, then enter a 15 month program to get your accelerated RN, then NP degree with as little as 500 clinical shadowing hours. The dog groomers at Petsmart have to have 800 hours of hands-on training, for comparison. Yes, it’s a ridiculous analogy, but so is the variability and inconsistency in NP education theee days.

  7. The newer NP’s have less training then a hair dresser. Who is fact checking these articles? Please stop trying to fool patients. We are getting saavy.

  8. Not just less training than a hairdresser but less training than a pet groomer!

  9. So much bias in this article. Physicians receive THOUSANDS of hours more training than APRNs. Think about it! Just because an NP might sit down and talk to a patient and order a million (unnecessary) tests, does NOT mean that patient is getting quality care. Does this author really assume patients are so gullible?? The level of care received from an NP is not anywhere close to that received from a physician. Nurse practitioners can serve an important role as part of a team, LED BY a physician. I applaud the Mississippi State Medical Association for blocking these ridiculous efforts to allow APRNs full practice authority.

  10. I’m so surprised at this blindfolded / one sided piece of journalism. Have you even bothered to look into how many hours of training a nurse does as compared to a physician? Bottomline , nurses are trained to carry out protocols . They are not dignosticians and are not trained to be diagnosticians. Why expect them to be good at something they are not trained to do?
    Comparison btw nurse practitioner and physicians is frankly ridiculous.

  11. Ok guys, if you have a choice to buy a genuine Louis Vuitton bag versus a fake one for THE SAME PRICE, which one will you choose? I bet I know the answer! The genuine bag was perfected using talent thathad been homed and polished for many years, sometimes generations. They put their heart and soul into the product. They train their master artisans to perfect the art of leather work. The tanning. The stitching. The logo etc. These skills are not perfected in an abbreviated manner. There are no shortcuts taken. What comes out is an impeccable outcome that is of higher quality than the knockoffs.
    The same thing could be said about the 500 hrs of training that NPs get. There is no comparison to an MD or DO who trained for at least 8 years. To perfect the skill of diagnosing diseases. There are no shortcutes. Come on guys! You know your lives are worth more than a LV bag!!!

  12. You have to ask is bad care better than no care ? I would say not . First do no harm . I want a good nurse to nurse me, and a good doctor to be my doctor and no one else.

  13. Nurse practitioners have significantly less training. They simply don’t know what they don’t know. Most schools are diploma mills without formalized training. Very scary to think about where medicine is headed. I’ll choose a physician every time.

  14. Fact check (only one of many, unfortunately, in this article): APRNs are not more affordable than physicians – for PATIENTS. They are more affordable for hospital administrators and insurance companies, because currently they can pay APRNs less than they can pay physicians in Mississippi (which makes sense – training a physician takes a lot more time and a lot more money.)

    PATIENTS pay the same amount whether they see a physician or a nurse practitioner. If a patient sees a non-physician, the difference in “affordability” is pocketed by the administrators and the insurance company.

  15. This inaccurate information is showing up more and more. At first, I laughed because no one would actually believe this. Then I realized people don’t know the difference. Just because a group wants to treat patients because they have seen it done for years doesn’t mean they should. It’s like a Holiday Inn commercial gone bad.

  16. This article is simply filled with falsehoods and seems to be a veiled attack on physicians. This is merely an advertisement.

    I have spent my entire adult life learning, doing clinical training, or practicing medicine for the benefit of patients and their families. I spent 19,000-20,000 hours of clinical training alone. That’s time taken away from family and friends to willing give for the benefits of others. I care for the entirety of my patients and their families from their medical conditions, academic struggles, social problems, and future aspirations. I do not consider my time too precious as not to give every patient that the time that he or she needs each and every time they see me.

    I know countless physicians who return to their hometowns in rural Mississippi to care for the people there. I don’t know any physician primary care clinics that do not see walk-ins and/or have after hours clinic. These are not services exclusive to nurse practitioners.

    I am not attacking nurse practitioners and have no desire to ever do so. However, I am defending and will defend the profession that I have always seen as noble and a calling. I hope and pray our patients see us for who and what we truly are: dedicated advocates for them and their well being.

  17. Alexandra Liggatt

    It is concerning to see these types of falsehoods continually perpetuated in the media. A nurse practitioner is simply not equivalent to a physician. Their degree remains a degree that focuses on nursing and not medicine. They have approximately 3% of the education and experience at time of graduation as a newly graduated physician. Most of the nurse practitioners fulfill their training online, and have almost 100% acceptance rate to their schools. Physicians acceptance rate into medical school is on average about 15%. Because before we are even allowed to privledge of studying, we must prove our worth and dedication. Over and over and over again.

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