Nurse practitioners filling gap within rural health care, cite barriers

Published: May. 5, 2021 at 6:32 PM EDT
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BOWLING GREEN, Ky. (WBKO) - WBKO News continues its special report of Bridging the Great Health Divide, this month focusing on nurse practitioners.

To some, nurse practitioners are the unsung heroes of rural healthcare.

“We couldn’t work without our nurse practitioners,” said Dr. James Middleton of Mundfordville.

To them, they’re just doing their job.

“I usually see 25 to 30 patients easily a day, I could see more than that if time would allow,” said Angela Jessie, APRN, FH&L Family Practice, LLC.

Jessie has 20 years of experience as a nurse practitioner, 30 years as a nurse, opening her own clinic in Metcalfe County in 2015.

“The patients that I see here, I see completely independently, without any direction from any other physician or provider,” said Jessie.

She is one of three full-time nurse practitioners in Metcalfe County.

“When you look in rural areas, the majority of what you will find are nurse practitioners providing care to those who are in great need because either there’s just not that availability of health care, they don’t have the means to get outside of those rural areas,” said Jessie.

Data shows the number of doctors in rural communities continues to decrease, while nurse practitioners almost everywhere in southcentral Kentucky have increased.

“As the expansion happens, we get physicians assistance and then we get nurse practitioners more spread out in our communities to provide a little more service,” said Representative Michael Meredith (R-KY).

Many might wonder -- what is the main difference between a nurse practitioner and a doctor?

“Physicians are medically trained,” said Jessie. “So they’re taught more of the disease process and treating the disease process, so they don’t incorporate that personal portion of it.”

In addition to nursing school, nurse practitioners complete a master’s program with additional training. Jessie says she has nine years of education.

Nurses are known for their hands-on bedside care and so that training translates to the profession of nurse practitioners.

“We’re not just treating pneumonia, you know, maybe we’re treating pneumonia in a female who’s a single mom that needs to work as well as be treated,” explained Jessie about how NP’s care for patients.

Meanwhile, nurse practitioners like Jessie say they feel like there’s a barrier in the state of Kentucky holding them back.

“The Kentucky Medical Association has fought against nurse practitioners having our full prescriptive authority,” said Jessie.

The state currently has in place what is called a collaborative agreement. In order for a nurse practitioner to prescribe certain medications such as controlled substances, the collaborative agreement must be in place. This agreement was lifted during the pandemic.

The Kentucky Medical Association sent WBKO News the following statement about why they oppose the removal of the agreement, saying, “The current legislation does NOT alleviate access to care issues, as it relates ONLY to the prescribing of controlled substances.”

Adding, “The continued rise in APRN controlled substance prescriptions throughout 2020 is especially concerning.”

Meanwhile, nurse practitioners disagree and say their level of care is often compared to that of a physician and will become more critical as doctors become less frequent.

“We’re well known to be in those rural areas, we’re willing to go in those rural areas where physicians are not.”

In the special report airing next month, WBKO News will dive deeper into the collaborative agreement law in place that nurse practitioners say is a barrier, yet the Kentucky Medical Association says it’s critical.

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