JEFFERSON CITY, Mo. — A new law that’s set to go into effect later this summer is expected to help Missouri’s healthcare professional shortage.
Under current state law, advanced practice registered nurses (APRN) are required to be in a collaborative practice agreement, which means nurse practitioners have a physician nearby to do their job. With these restrictions set to be lifted, it’s expected patients will have better access to healthcare.
“Getting this done is really important work for our ability to provide services in more isolated areas primarily,” Missouri Hospital Association spokesperson Dave Dillion said. “Anyone that’s called their primary care provider and are told we can see you in three weeks has felt that frustration of the lack of people in the healthcare system that can provide this type of care.”
Currently, Missouri doesn’t allow nurse practitioners to diagnose, prescribe medications or evaluate patients without a doctor signing off and that doctor must be within 75 miles.
“We’ve had some of the most restrictive policies relative to the geographic connections to the physician that manages an APRN,” Dillon said. “It will expedite the way the system works and hopefully deliver care faster and more efficiently.”
Those restrictions are set to be lifted later this summer after last week Gov. Mike Parson signed Senate Bill 157. Under the legislation, APRNs may prescribe Scheduled II controlled substances for hospice patients. Collaborating physicians are also required to meet with the APRN at least once every two weeks to go over chart reviews and participate in supervision.
“The nursing profession has advanced, but it’s been absolutely necessary because there are too few doctors presently to handle the volume of patients,” Dillon said. “They [APRNs] are the workforce multiplier, especially in primary care, where we know we’ve got physician shortages.”
Since 2014, the Missouri Hospital Association (MHA) says 18 hospitals have closed, most in rural areas. Currently, all but one of the state’s counties, Platte County, are in a health professional shortage.
“Most of these changes won’t affect the patient, they will affect the backside of healthcare,” Dillon said. “With this new law, nurse practitioners will have more ability to prescribe medicines that we see every day without having to have that validated by a physician.”
Dillon said for years, APRNs have left Missouri to go to states where there were less limitations.
“Not only can we now retain individuals who have the certification who might have been attractive to go elsewhere, but we can do the opposite which is attract more people that want to practice at the top of their license,” Dillon said.
Earlier this spring, Kirk Mathews with MO HealthNet, the state’s Medicaid program, told lawmakers during a workforce committee the state is short of 600 primary care doctors. Some nurses say the solution is changing state law.
Dillon said if you’ve been to an urgent care clinic, you’ve probably been seen by an advanced practice registered nurse. He said physicians have been opposed to the legislation in years past.
“It’s been viewed as an encroachment on that expertise, but I think physicians are starting to realize how important of a component these professionals have because also every physician hires them and works with them,” Dillon said. “I think we are seeing the world change in a way that these folks are going to play a much bigger role in healthcare in the future.”
He said APRNs can also specialize in other areas of care too besides primary care, like geriatric care or obstetrics.
According to the MHA’s 2023 Workforce Report, the statewide turnover rate in 2022 was 23.1% while in 2021 it was 24.7%. The vacancy rate among the majority of health care positions included in the report, in 2021 was 17% and in 2022 it was 14.8%. Before the pandemic in 2019, the turnover rate was 19.8% and the vacancy rate was 9.5%. Dillon said there’s a big problem that lies within the education.
The vacancy rate for staff nurse in 2022 was 17.4% compared to 19.8% in 2021. The turnover rate also decreased from 22.1% in 2021 and 19.4% in 2022.
Last month, an emergency rule went into effect, doubling the training time for some workers, like nursing aids. Nursing assistants are among the top 10 hospital professions with the highest vacancy and turnover rate.
The rule would allow unlicensed nursing aides 180 days to complete a training program, up from the current 90-day requirement. The emergency regulation goes into effect June 6 and will run through the end of the year.
Nearly 40 other states have already lifted the restriction on nurse practitioners. The law is set to go into effect Aug. 28.