With a lack of health care providers in Georgia, the state could increase access by turning out more advanced practice nurses and using them in more innovative ways, a Georgia Senate Study Committee heard Monday. But the state’s physician association is still strongly opposed to nurses doing more, a resistance that may finally be overcome in the next legislative session, a key state senator said.
The Senate Study Committee on Barriers to Georgians’ Access to Adequate Healthcare held a session at Augusta University to hear about the role of advanced practice nurses in the state in meeting many of those gaps of care and where more could be done. The meeting was packed with students from the AU College of Nursing, many of whom may go on to get advanced degrees and board certifications that could allow them to provider greater levels of care.
But Georgia is the “most restrictive” of all of the states in terms of what those practitioners can do and prescribe, said Dr. Suzanne Staebler, a professor at Emory University and President of National Certification Corporation. Advanced practice nurses, for instance, are not allowed to order some imaging studies or prescribe many common drugs and must sign a collaboration agreement with a physician to review their work and there is a limit on how many that physician can supervise.
As a result, many of those who graduate in Georgia go elsewhere “because it is so difficult to practice here,” Staebler said.
Medical Association of Georgia opposes expanding their scope of practice and one member said it is for the good of the patients, particularly the rural patients he sees.
“These patients are very complex,” said Dr. Scott Bohlke of Brooklet, Ga., a past president of the group. “We want the best care for these patients and I think a team approach (with the nurse practitioner) is the best way to do it.”
But Sen. Renee Unterman, R-Buford, chair of the study committee and chair of the Health and Human Services Committee, was not buying it.
“If you want to provide care to more people, why don’t you allow the people who are taught and educated to practice at their highest level?” she said. “If you have more people practicing medicine, then it allows more access to care. You don’t have to be a rocket scientist to figure this out.”
Unterman has been involved in previous battles to expand what nurses can do and the physician group has been a formidable foe to those efforts. But she said that may change next session beginning in January, particularly as people become more desperate for care and that sentiment starts “bubbling up” through rural senators and representatives that could make them more sympathetic to expanding nurse powers.
“I’m working on it,” Unterman said.
In the meantime, there are already College of Nursing projects to rotate advanced practice nurses in federally qualified health centers like Medical Associates Plus, to reach high-risk mothers and children in rural Burke and McDuffie counties and to expand the training of more behavioral health professionals, including nurse practitioners. Advanced practice nurses, for instance, can see 3,600-3,800 patients a year, about the same as a physician, for half the cost, said J.R. Richards, CEO of MAP.
The College of Nursing also has a proposal, in concert with Medical College of Georgia, to take highly trained nurse practitioners and train them alongside Emergency Medicine residents and also provide training in telemedicine. Those nurse practitioners could then staff rural Emergency Departments with the ability to consult by telemedicine with colleagues in Emergency Medicine when needed, said Dr. Beth NeSmith, chair of the Department of Physiological and Technological Nursing.
“That’s the beauty of the training program is you’ve developed a wonderful working relationship,” she told Dr. J. Patrick O’Neal, Commissoner of the Georgia Department of Public Health and a member of the study committee.
“Sounds exciting,” O’Neal said.
The project is looking for $260,000 to fund a pilot program but projects it could save a hospital $500,000, NeSmith said. She is hoping the legislature will take a look at it.
“That’s a great suggestion,” Unterman said.
“Rural hospitals in Georgia really struggle to provide urgent and emergent care to the citizens they serve,” NeSmith said.
Reach Tom Corwin at (706) 823-3213