Help increase healthcare access for Kentuckians by supporting nurse practitioners

Published 4:41 pm Thursday, October 7, 2021

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                              Dr. Julie Ossege and Dr. Sheila Melander

We, as Advanced Practice Registered Nurses and healthcare providers, would like to increase access to healthcare for all residents of the commonwealth. There are over 9,000 Advanced Practice Registered Nurses (APRN’s), who are nurse practitioners and nurse midwives licensed in the state of Kentucky.   APRN’s provide primary care, specialty care and hospital care to thousands of Kentuckians daily. And we do it very well.

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APRN’s practice under our own licenses and are regulated by the Kentucky Board of Nursing. We also currently prescribe medications under two separate collaborative agreements with physicians.  One agreement is for non-controlled medications like antibiotics, and medications for asthma, high blood pressure, or diabetes.

The other agreement is for prescribing controlled medications like those for pain and anxiety. This agreement also allows APRNs to accept more types of insurance coverage and order medications and medical supplies. These supplies could include oxygen, immunizations, insulin, and other drugs needed in any well-equipped office setting.

During 2020, a COVID-19 state of emergency was declared, temporarily suspending the Collaborative Agreement for Prescriptive Authority for Controlled Substances (CAPA-CS) mandate to keep from interrupting healthcare to those who needed it. This suspension improved access to care for thousands of Kentuckians.

Results from a University of Kentucky College of Nursing study in the fall of 2020 showed that while the collaborative agreements were suspended, 130 APRNs in Kentucky (or 30 percent of those who took the survey) were able to accept new patients into their practices. In addition, 59 APRNs were able to accept insurances they were not able to with the collaborative agreements in place. That is a lot of Kentuckians accessing healthcare!

A 2021 report by the National Academy of Medicine states that territories and states where NPs have full authority to practice has improved quality of care and decreased access to care issues. States with APRN practice barriers have higher costs, more chronic disease burden, more access to care issues, and inequities in the geographic location of primary care providers (Cunningham &Williams, 2021; Wakefield, Williams, Menestrel &Flaubert, 2021)

According to the Bureau of Health Workforce, in December of last year Kentucky had 178 primary care healthcare provider shortage areas and would require 184 providers in each area to remove that designation. More than 1.3 million Kentuckians live in these areas and are at risk of accessing needed preventative and life-saving care.  Allowing APRNs increased prescribing authority will help alleviate this gap in accessible care because there are APRNs currently practicing in these shortage areas. Removing the controlled substance agreement for APRNs will make Kentucky more attractive to primary care providers willing to practice in healthcare shortage areas and allow continued increases in access to care in all areas.

Let’s not go backwards. We need to permanently remove the collaborative agreements that are preventing APRNs from providing much-needed care. In particular, the controlled substance prescribing agreement must be dissolved, since it can restrict accepting patients with certain insurances and limit the ability to order necessary medications and medical supplies.

The solution is clear. Removing the requirements for the controlled substance prescribing agreement can improve access to care statewide and facilitate healthcare for all.

For the fourth year in a row, nursing organizations in Kentucky have attempted to change the law and increase access to care by removing the prescribing agreement.  Join us in advocating for this change that can increase access to care for thousands of Kentuckians in a time when they need it most.

Show your support by contacting your representative or senator, and let them know you support APRNs.

Find your state legislator here,

This article is by Julie Ossege, PhD, FNP-BC, FNAP, FAANP, associate professor at the University of Kentucky College of Nursing and Sheila Melander, PhD, APRN, ACNP-BC, FCCM, FAANP, FAAN, associate dean of MSN & DNP faculty & practice affairs and a William S. & Elizabeth M. Morgan Professor for Professional Nursing Practice at the UK College of Nursing.  This article represents the opinions of the authors and not that of the University of Kentucky.