(published 3/23/00  - this time the edited version was worse than the
original for a variety of reasons, not entirely my editor's fault)
Let nurse practitioners prescribe meds
by Mischa Gelman

   Ohio recently passed a law.  Such a law exists in 12 of the 50 states
of our nation, though not in Pennsylvania. This law will improve the
health care of the state's citizens without added cost, burden or risk.
Now, ask yourself: "Would I want this law here?" Sadly, you don't need
much imagination to conjure up such a scenario, as it is the situation in
our present time in regards to whether nurse practitioners can prescribe
medications independently. The doctors associations, greedily fighting for
their own special interests, have denied nurse practitioners this ability
in law, fighting over a turf issue instead of caring about the best needs
of the patient. 
   Every state now allows nurse practitioners some prescription rights,
now that Georgia and Illinois have realized the way in the past two years.
In Pennsylvania, though, the rules and regulations were never set in place
by the Boards of Medicine and of Nursing. 43 of the 50 states of the
union (not including Pennsylvania) let nurse practitioners dispense
drug samples. We have seen some expansion of nurse practitioner rights,
but obviously not enough.
   In many rural and impoverished areas, nurse practitioners are the
primary source of health care, making it vitally important that they be
given the right to prescribe. In Greene County of Pennsylvania,
there is only one geriatrician, one gynecologist and one health clinic.
This speaks of an underserved population - if the authority of nurse
practitioners were increased, perhaps some of the likely gaps in service
would decrease as well. Pennsylvania has thousands of nurse practitioners,
the fourth most of any state in the nation - doesn't it make sense to
empower them, to help fill the gaps in the health care? Doctors talk a lot
about how they are overworked and can only spend fifteen minutes or so
with each patient. Wouldn't expanding the rights of nurse practitioners
free up their time more and ensure higher quality care for all
Pennsylvanians?
   It is not as if nurses were unqualified in terms of knowledge of
pharmacology. Nurse anesthetists make judgement calls in regards to meds
all the time, a fact gladly accepted by their patients, whose lives have
been saved by a result in numerous instances. Nurse practitioners in 12 of
the other states of the union have the ability to treat their patients
with whatever medication they judge to be most appropriate for handling
the situations of their clients, and in every state they have at least 
some prescription powers. Some states ensure high quality nurse
practitioner care by mandating continuing education in pharmacology,
given the rapid changes in the area of medication. Even in Pennsylvania,
nurse practitioners already routinely give out medications, with a doctor
merely signing off on them. Frequently, doctors even provide nurse
practitioners with *blank, pre-signed prescription forms*, obviously
entrusting their medical knowledge to be adequate. If the bureacratic
barrier were absent, the doctors and nurse practitioners involved would be
saved the hassle. Is it worth it simply for the sake of the prestige of
the doctors?
   Also, not all doctors even opposed this change. Many individual
physicians have been instrumental in fighting for this common-sense
improvement to health care. Rather, the problem is with the American
Medical Association, which has fought good health care since the
Shepherd-Towner Act of the 1910s. Why are we letting an industry trade
group prevent Pennsylvanians from getting the care they deserve? Research
for the past 30 years, after all, has shown the effectiveness of nurse
practitioners in terms of cost, access, client satisfaction and clinical
outcomes.
   Thankfully, some legislators realize the problem. House Bill 50 is now
in the state legislature, and would help ensure that nurse practitioners
can independently prescribe medications. Many co-sponsors have withdrawn
their backing under pressure, unfortunately. If the bill is passed, our
state no longer need be the laughing stock of others with more sensible
health care systems. If it fails, well, we will have seen another victory
of the special interests over the public interest.
   You can get information to contact your state legislator at
http://www.house.state.pa.us/   

   Mischa Gelman dedicates this column to former co-worker Wendy
Henderson, Pitt alumnus and pediatric nurse practitioner, and all the
other NPs and NP students who helped with hammering out the flaws in this
column.