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.
BEFORE YOU GO…
… we’d like to ask for your support. More people are reading the Mississippi Business Journal than ever before, but advertising revenues for all conventional media are falling fast. Unlike many, we do not use a pay wall, because we want to continue providing Mississippi’s most comprehensive business news each and every day. But that takes time, money and hard work. We do it because it is important to us … and equally important to you, if you value the flow of trustworthy news and information which have always kept America strong and free for more than 200 years.
If those who read our content will help fund it, we can continue to bring you the very best in news and information. Please consider joining us as a valued member, or if you prefer, make a one-time contribution.Click for more info