an advancedpractice nurse

Posted on 2008-Dec-23 at 11:10 - Post Comment

Rep. Gene Shelby, D-Hot Springs, said that in his experience as an emergency room physician, advanced practice nurses and physicians work well together.

"The nurses I've worked with value their collaborative agreements, and the physicians value what the nurses do," Shelby said. "To me it makes sense to maintain that."

Tom Lowman, an advancedpractice nurse in Jacksonville, has been in collaborative agreements with physicians for 16 years. He said he discusses patients with his collaborating physicians daily, values their opinion and relies on them to step in when patients request Schedule II drugs, such as Oxycodone or methadone, that have a high potential for abuse. State law doesn't allow advancedpractice nurses to prescribe Schedule II drugs.

Getting rid of the collaborative agreements would be a bad idea, Lowman said. He worked most of his career as a family nurse practitioner at a clinic in Monroe County.

"I was out in rural Arkansas for 15 years and faced everything from birth to death, and I just knew my limits," Lowman said.

"We have not been to medical school, we are not physicians, and we need them to back us up."

POOR HEALTH RATINGS

The legislative report also looked at overall health rankings and such health indicators as heart disease, teen birth rates, and low birth-weight babies.

Arkansas routinely does poorly on national health rankings. The state was 43rd in America's Health Rankings released Dec. 3 by the United Health Foundation, a private, nonprofit health advocacy group based in Minnetonka, Minn.

It was the first time in seven years that Arkansas had risen out of the nation's bottom five states in the rankings.

When compared with the 12 states and Washington, D.C., Arkansas has some of the highest rates of teen birth, low birthweight babies, infant mortality and heart disease deaths.

For example, nearly 250 Arkansans per 100,000 population died from heart disease in 2005, compared with a national average of 211 per 100,000 population.

Nell Smith, research analyst with the Bureau of Legislative Research, said the report isn't intended to link a state's health status to its rules regarding collaborative agreements. It's merely intended to show how different states are faring.

It highlights a large need for more health care in Arkansas. Of the state's 75 counties, 59 counties and portions of 14 other counties are designated as medically underserved. Arkansas has 82 primary-care physicians per 100,000 population, compared with a national average of 99 per 100,000.

Prater, the state legislator from Jacksonville, said better access to health care would mean better health for Arkansans. As well as working in underserved areas, advanced-practice nurses can provide care at lower cost, because it costs more to see a physician, she said.

"I just think with the fact that we're lacking and that we're [low in health rankings] here, we need to look at all avenues," Prater said.

Arkansas has a low rate of disciplinary actions, malpractice payments or other adverse actions against advanced practice nurses, she said. Since 1995, the state nursing board has taken just 17 adverse actions against advanced-practice nurses.

Wroten, with the Arkansas Medical Society, said nothing stops advanced-practice nurses from going into rural areas now. Like physicians and other health-care professionals, they tend to concentrate in urban areas.

"There is no evidence that removing the collaborative agreement will change that," Wroten said. "The answer to access is we need more doctors, we need more nurses, and we need more incentives to get them to go to the rural areas."

SEARCHING FOR CONSENSUS

In a separate but related issue, the Arkansas State Medical Board and the Arkansas State Board of Nursing are working to agree on what's required of physicians and nurses in collaborative agreements.

Last spring the medical board began discussing developing rules to outline responsibilities of physicians in collaborative agreements.

Some requirements in the medical board's Regulation 30 are: that a collaborating physician have an active practice in Arkansas; that the physician and nurse be easily able to contact one another; that the nurse and physician have comparable practices in both scope and specialty; and that the physician ensure each patient gets written notification of the collaborating physician's contact information.

Both boards have debated the rules at meetings over the past several months.

Medical board members say the rule is needed to give physicians guidance as to their responsibilities in collaborative agreements.

But nursing board members say state law places the burden of collaborative agreements on the advanced-practice nurse, and the harder you make it for physicians, the harder it will be to find physicians willing to collaborate.

Shelby said he thinks both parties made progress at a joint meeting of the medical and nursing boards Oct. 8.

"I thought they made some pretty good progress on finding common ground," he said.

The medical board has already approved its Regulation 30, but the rule won't be implemented until it's approved by the Legislature, Shelby said. Legislators would like the medical and nursing boards to come to some agreement first, he said.

Rep. Clark Hall, D-Marvell, said legislators have heard hours of debate from both sides of the issue. He would like to see them reach an agreement. Too many people are suffering from lack of proper access to health care, he said.

"It's frustrating that we're in an underserved area and we have these people fighting amongst themselves," Hall said.

Shelby said he hopes the two parties can reach consensus.

"I don't really feel like the Legislature is the best way to resolve these issues, but ultimately we might have to," he said.

buy wow gold
cheap wow gold
wow gold
cheapest wow gold
warhammer gold
warhammer powerleveling
war gold
war powerleveling
war power leveling
rose zulie

http://cms.vwowgoldoo.webnode.com/news/start-out-with-six-runes/
http://vwowgoldoo.inube.com/blog/32389/this-is-used-to-great-effect/ 

http://vwowgoldoo.inube.com/blog/32391/a-much-better-job/