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Bipartisan nursing bill could help ease rural health care shortages

TOM HINDMAN l Gazette-Mail file photo

The West Virginia Citizens Action Group is a progressive organization that fights for things like environmental protection, consumer advocacy and reducing the influence of money in politics.

Americans for Prosperity is a conservative group that fights for things like less environmental regulation, pro-business policies and lower taxes. Founded and largely funded by the Koch brothers, it is a veritable poster child for the role of money in politics.

Safe to say, the two groups agree on little.

But they both agree that highly trained nurses in West Virginia should have more power to treat patients and prescribe medication without a doctor's supervision.

The two groups, and many others, argue that loosening some of the restrictions on advanced practice registered nurses will help make health care more accessible, and less expensive, especially in underserved rural areas.

Advanced practice registered nurse is kind of a catchall term that includes nurse practitioners, nurse midwives, certified nurse anesthetists and clinical nurse specialists.

Angy Nixon is a nurse midwife who owns her own practice in Scott Depot. For 13 years, she's treated expectant mothers and other patients, and seen her business expand.

Under West Virginia law, in order to write prescriptions for her patients — for things like prenatal vitamins or birth control — she needs to have a collaborative agreement with a doctor.

For 13 years, she's continually renewed such an agreement with a local doctor, each renewal typically lasting for a year or two. But that doctor recently had a heart attack, and he's planning on moving out of state. He no longer wants to sign a collaborative agreement longer than six months.

“A pregnancy lasts nine months,” Nixon said, noting that expectant mothers are reluctant to go to a midwife if her ability to treat patients could disappear in the middle of a pregnancy. “It's made it difficult for me to continue seeing patients.”

While she continues to perform other nursing services, Nixon has had to close down her prenatal services.

A bipartisan bill currently pending in the state House of Delegates (HB 4334) would allow Nixon and other advanced practice registered nurses to treat patients and prescribe medicine without a doctor's authorization. A similar bill last year went virtually nowhere.

There are currently 21 states, plus the District of Columbia, that allow advanced practice registered nurses to prescribe without a doctor's supervision.

Studies tend to show that advanced practice registered nurses can provide up to 80 percent of adult health care services and 90 percent of pediatric services just as well as a doctor, and at lower costs.

The bill had broad, coalition-spanning support at a public hearing of the House Committee on Health and Human Resources last week.

“West Virginia needs this because there are too many areas in our state that are medically underserved, there are too many people that have to travel too far to get the medical care they desperately need,” said Gary Zuckett, director of the West Virginia Citizens Action Group. “This bill's good for consumers, this bill's good for public health.”

Jason Huffman is the director of the West Virginia branch of Americans for Prosperity, which on the vast majority of issues takes the opposite position as Zuckett's group.

But Huffman also said letting advanced practice registered nurses practice independently is important to increase access to health care.

“These regulations are really standing in the way of health care professionals who could be helping West Virginians,” Huffman said. “This legislation is vital to ensure that rural and low-income mountaineers can access health services.”

In her practice, Nixon does not prescribe controlled substances, but the bill would allow advanced practice registered nurses to prescribe opioids, albeit with restrictions.

The bill limits prescriptions of Schedule II drugs, which includes potent painkillers like oxycodone and hydrocodone, to no more than a 72-hour supply.

Who's against expanding nurse's ability to prescribe, without a doctor's supervision? Largely doctors.

Of the 21 speakers at Thursday's public hearing, only four spoke against the bill. All were doctors or represented doctors.

They said that nurses do not receive the same level of training as doctors — about 1,500 hours of clinical work for nurses, compared to about 16,000 hours for a doctor, including medical school and residency. And that includes less pharmacological training on prescribing practices.

Brian Foy, executive director of the West Virginia Medical Association, said that given the state's opioid epidemic, allowing nurses to write prescriptions, without an agreement with a doctor, was the wrong move.

“Why would we want to increase the number of prescribers able to prescribe medication?” Foy said. “Especially pain medication, which in our view will only exacerbate the opioid problem.”

In West Virginia, 17 counties have a shortage of primary care providers, according to the federal Department of Health and Human Services. An additional 28 have shortages of mental health providers.

Advocates argue that allowing nurses to work without the doctors' collaborative agreement, will help ease some of those shortages, especially in rural areas.

Sam Hickman, CEO of the West Virginia chapter of the National Organization of Social Workers, said that as West Virginia's population gets older and older, demand for health care will too and shortages could become more severe.

“This is an opportunity to make quality health care available to more citizens,” Hickman said.

Reach David Gutman at, 304-348-5119 or follow @davidlgutman on Twitter.


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