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the collaborative agreementsPosted on 2008-Dec-23 at 11:07 - Post CommentPhysician groups disagree. They say the collaborative agreements provide vital protections for patients. Doctors have more training and more expertise, and advanced-practice nurses shouldn't be allowed to operate without their collaboration, said David Wroten, executive vice president of the Arkansas Medical Society. Doctors have at least four years of college, four years of medical school and three years of residency training. An advanced-practice nurse has at least a master's degree. "They don't have the training and the background that physicians have," Wroten said. "This would put [advanced practice nurses] into the state with no one looking over their shoulder. "It's a benefit to the nurses to have that supervision, and it's a safety valve to the public." Whether to remove the collaborative-agreement requirement is expected to be debated by legislators during the forthcoming session, which starts next month. The rule's been in place since 1995. Arkansas has 1,451 advanced-practice nurses. Of those, 874 are allowed to prescribe medication. A 50-page legislative report released Thursday examines rules, overall health and select health statistics in the 12 states and Washington, D.C., that don't require such agreements. Five states, including Montana and Oregon, never required collaborative agreements. The remaining seven states repealed collaborative agreement requirements, starting with Alaska in 1984, according to the report. At least three other states - Vermont, Nebraska and New York - are considering or have recently considered changing their rules. Prater, a registered nurse who leaves office at the end of the month because of term limits, said she hopes the report will pave the way for further discussion. She presented the report Thursday to a joint meeting of the Senate and House committees on Public Health, Welfare and Labor. "I just want to make sure we're looking at it in an openminded way," Prater said. "I think there are different things happening nationwide, and I think we should always look at what other states are doing." Faith Fields, executive director of the Arkansas State Board of Nursing, said the report is a helpful tool in considering the issues. "It's a beginning to look at what areas we need to look at in terms of removing barriers to health care," Fields said. Linda McIntosh, an advancedpractice nurse and co-chairman of the Arkansas Nurses Association Health Policy Council, said she and two other advancedpractice nurses opened a family-practice clinic in Des Arc in Prairie County in 2005. Healthcare Plus, now part of St. Vincent Health System, provides health care in an underserved area of the state, stays open extended hours six days a week and has staff on call 24-hours a day for patients, she said. More than half of the clinic's patients are uninsured or on Medicare or Medicaid. "It's made a difference in thousands of people's lives," she said. But opening the clinic wasn't easy, McIntosh told legislators Thursday. She and her partners spoke to several physicians before finding one willing to sign a collaborative agreement. Getting all the necessary financing and approvals to open the clinic took more than a year. McIntosh said she feared the clinic would close if they lost their collaborating physician. More nurses would open clinics if the rule were eliminated, and that would mean greater access to health care, McIntosh said. She estimated there are fewer than 10 primary care clinics run by advanced-practice nurses in the state.
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