Nurse practitioners lobby for prescriptive authority

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Published: February 12,2001

JACKSON — Sister Manette Durand is a nurse practitioner in “no man’s land,” an economically depressed rural area an hour south of Memphis and an hour north of Greenwood. She sees patients at the Jonestown Health Center, located in a small town five miles north of Clarksdale.

Nurse practitioners in Mississippi aren’t allowed to dispense prescriptions for narcotic medications and some other types of controlled substances. Durand says that because a doctor comes to her clinic only two days per week, that means patients who come on other days who need narcotic medications either have to wait for relief until the doctor comes or can be prescribed more expensive non-narcotic medications.

According to Durand, most patients can’t afford the more expensive alternatives. And many don’t have adequate transportation to return to the clinic later to get a prescription. Even if they can easily return to the clinic, in the meantime patients suffer. In particular Durand remembers a woman with breast cancer who had to wait two days in great pain before she could obtain painkillers.

Durand thinks that is wrong to make patients wait for pain relief, and that nurse practitioners should have the authority to dispense controlled substances. She and other nurse practitioners are backed by the Mississippi Nurses Association (MNA), which is seeking changes in the law that would allow nurse practitioners to prescribe controlled substances.

Durand said having the authority to prescribe narcotic painkillers isn’t something she would use every day. But she believes having the ability to prescribe controlled substances when needed would improve the level of care she gives to patients.

One reason that has been given for not allowing nurse practitioners to prescribe narcotic medications is that some drug addicts may visit a clinic to fraudulently obtain the narcotics. “But I can distinguish between someone who is faking a need for medicine and someone who truly has need,” Durand said. “If I have a patient who comes in with a broken leg or an occupational injury, it would be nice to be able to give them something for their pain.”

Betty Dickson, executive director of MNA, said there are 850 primary care nurse practitioners in Mississippi, and being able to write prescriptions for controlled substances has been identified as a critical issue.

Narcotics aren’t the only issue. Dickson said many nurse practitioners see patients in nursing homes, and can’t write a prescription for the best medicine for diarrhea. So the alternative is to write a prescription for an alternate drug that isn’t as effective and then wait until a physician comes to get the patient on the better medication.

“Nurses can’t prescribe a mild analgesic to patients in nursing homes, and this is a common need,” Dickson said.

The MNA petitioned the Board of Nursing to consider the problem, and the board voted to go forth and approach the Board of Medical Licensure to consider the issue. Under current law, the Board of Nursing and the Board of Medicine must jointly develop regulations that apply to nurse practitioners. Dickson said five public hearings across state were held and representatives from Board of Licensure didn’t indicate any opposition to developing rules to give nurse practitioners more authority.

“Across the state, everyone seemed in favor of it,” Dickson said.

Dickson said a compromise was reached at a legislative hearing where the Board of Nursing and the Board of Medical Licensure included language in HB 1163 that would require joint regulation governing the issue. But then Dickson believes there was some confusion among the medical profession that led to opposition from the Mississippi State Medical Association (MSMA).

“We had another bill, a separate bill, that would have eliminated joint promulgation,” Dickson said. “We agreed not to pursue that bill and to include language in HB 1163 that would require promulgation. We agreed to everything the physicians wanted.”

But MSMA opposed the proposed bill in its Legislative Report, writing that, “Remember, this arrangement is the only way to mandate that a nurse practitioner has protocol with a supervising physician. And without joint governance there is nothing to keep nurse practitioners from approving and prescribing all drugs.” Physicians were urged to lobby against the bill, HB 665, which died in committee.

The Mississippi House of Representatives passed HB 1163 on Feb. 1 by a vote of 98-17. The bill allows the Board of Medical Licensure and the Board of Nursing to move forward to allow nurse practitioners to write controlled substances. The bill now moves to the Senate for consideration.

Dickson thinks the proposed legislation would improve patient care while satisfying concerns of physicians.

MNA has letters on file from physicians who favor giving nurses the ability to prescribe more medicines. Dickson said physicians will be at the table to develop the protocol to decide under what conditions nurse practitioners will be able to prescribe controlled substances.

“You can go to a pharmacist and ask for a cough medicine with codeine, and the pharmacist can prescribe that,” Dickson said. “But nurse practitioners can’t prescribe that for a patient. What we’re trying to do is improve basic care. The nurses are not going to make money off of this. It is going to increase the nurses’ responsibilities, and increase their education requirements. But they recognize this is needed to improve patient care.”

Dickson said nurses are not asking for full prescriptive authority, but to be able to prescribe drugs in classes two to five. “But we would be willing to accept whatever the two boards worked out,” she said.

Dr. Candace Keller, president of MSMA, said the medical association believes narcotics are dangerous substances, and that patients who have a need for narcotic medications are probably sick enough that the patient needs to be taken care of by a nurse practitioner in conjunction with a physician.

“We are concerned the present legislation would allow situations in which patients might be seen and get prescriptions for narcotics and really need to have the input of the physician,” Keller said. “And the nurse practitioner might not, for whatever reason, appreciate the patient’s conditions and the need for that consultation.”

Keller said HB 1163 is too specific and ties hands of the joint committee. MSMA would rather see the Legislature say that the joint committee should be free to decide what rules and issues need to be addressed and issued rather than the Legislature mandating the rules. Besides the issue of narcotics, Keller said there are potentially many other issues that need to be addressed.

“We are certainly supportive of the nursing profession,” Keller said. “We work with nurses every day, and many of us work with nurse practitioners. We want to work with them to see that patients get the care that they need, and that they get that care in the safest possible manner. Obviously, we have some difference on this particular issue about how narcotics ought to be handled. But we want to work with nurses to find ways to provide care for the citizens of Mississippi in a high quality and safe manner.”

Contact MBJ staff writer Becky Gillette at mullein@datasync.com or (228) 872-3457.


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