Letter to the Editor

November 1, 2012

Dear Editor,
In the spirit of upcoming National Nurse Practitioner Week (November 11-17), I would like to take a moment to bring attention to the current situation of health care in Texas and the role of the nurse practitioner in the future of our community.
Texas is not doing an adequate job providing health care services. In June 2012, the Agency of Healthcare Research and Quality issued their annual scorecard. Texas ranked last out of every state in the country on health care services and delivery. Texas also has the highest rate of uninsured patients and ranks 47/50 in access to primary health care. A shortage of primary care physicians already exists in Texas, and this problem is only going to get worse with the dramatic expansion of healthcare in the future.
Regarding the quality of care a nurse practitioner provides, there is no evidence that the care a nurse practitioner provides is inferior to that of a physician. Over and over, it has been shown that clinical outcomes (e.g. health status, treatment practices, prescribing behaviors, etc.) are comparable between groups, and dare I say it, several studies have found that nurse practitioners have improved outcome measures related to patient follow-up, provision of screening, assessment, counseling, patient satisfaction, and time spent on consultations. No, nurse practitioners are not physicians, yet they provide quality primary health care, period.
State regulation of nurse practitioner practice has always been a struggle, especially in Texas. In 16 states and Washington DC, nurse practitioners have independent practice (meaning they can practice without connection with a physician). Another 17 states currently have "collaborative agreements" in which a nurse practitioner has a consulting and referral agreement with a physician. Texas is one of the most restrictive states on nurse practitioner practice. There are things like mandated chart reviews, mileage restrictions, on-site requirements, etc. that limit access to health care, especially in rural and medically underserved areas. These rules and restrictions are not based on any kind of quality measures or "best practices" . The Institute of Medicine has urged state legislatures to reform these laws regulating advanced practice registered nurses so that they can be allowed to practice to the full extent of their education.
“Nurse practitioners play a big part in providing primary care health care services in this community. They will be an even bigger part of the health care here as the current medical staff starts to retire. There will not be family practice physicians available to fill the community needs. Nurse practitioners already provide quality care to a large percentage of this community. The current laws surrounding their practice restrict access to health care services, as well as the ability to expand my practice to the surrounding counties that do not have any health care providers. Public awareness and state legislative reform is needed regarding this issue.”
– Robert Eaker MD
During the town forum with our State Representative Susan King, I was disheartened to hear her explanation and perspective on nurse practitioners and the state laws that currently restrict their practice and access to health care, especially in rural areas such as Nolan County. This is an extremely important issue to Sweetwater and Nolan County that deserves a knowledgeable and unbiased perspective from our State Representative, as well as increased public awareness and support.
For National Nurse Practitioner Week, I, in collaboration with Dr. Robert Eaker, encourage the residents of Sweetwater and Nolan County to write Representative Susan King and Senator Robert Duncan advocating support of a less restrictive, collaborative model of practice for nurse practitioners to provide increased access to health care in Texas. I know Texas can do better than last place. Perhaps a better analogy than Representative King's 'paralegal trying to practice law' would be that of cooking. The ingredients and recipe may be a little different, but that's okay, we can still make a good, quality apple pie. There is room in the kitchen for everyone.
Marcie Crisp
Family Nurse Practitioner
Sweetwater, Texas

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