Missouri Nurse Winter 2022/2023

I n the United States (US), the demand for nurse practitioner primary healthcare providers is increasing (Dall et al., 2019). By 2030, researchers predict a shortage of up to approximately 43,100 primary care providers in the U.S. due to an estimated 48% growth in the number of people over age 65, current primary care physicians retiring, and reduced numbers of physicians specializing in primary care (Dall et al., 2019; Knight, 2019). Lack of primary healthcare providers are especially a problem in lower-income urban and rural areas that have trouble hiring and retaining enough primary healthcare providers (Venhuizen & Pritchard, 2017). Regulatory restrictions in Missouri prevent nurse practitioners from practicing to the full of extent of their education and training. In Missouri, nurse practitioners are not licensed as Advanced Practice Registered nurses, they are given a “document of recognition” and are not explicitly regarded in state policy as primary care providers. Nurse practitioners practice on their RN license with delegation from their collaborating physician. Written collaborative practice agreements between physicians and nurse practitioners are mandatory (Missouri Division of Professional Registration, 2022). Collaborative practice agreements in Missouri must outline geographic practice areas for the physician and nurse practitioner as well as privileges, chart review, identification of patients that can be seen or must be referred and prescriptive authority (Missouri Division of Professional Registration, 2022). State legislation that reduces regulatory restrictions on nurse practitioners and grants full practice authority to nurse practitioners may assist rural and urban counties in

increasing access to primary care providers that have trouble attracting and retaining enough primary care providers (Davis et al., 2018; Xue et al., 2018). According to the American Association of Nurse Practitioners (2022a), “Full practice authority is the authorization of nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments—including prescribed medications—under the exclusive licensure authority of the state board of nursing.” As of 2022, 26 states and the District of Columbia have reduced regulatory restriction on nurse practitioners and allowed full practice authority for nurse practitioners (AANP, 2022b). Missouri currently ranks 42nd in health outcomes. 109 of 114 Missouri counties are Primary Care Health Professional Shortage Areas (HPSA). All 114 Missouri counties are Mental Health HPSAs. Full practice authority for nurse practitioners will improve healthcare access, healthcare outcomes and have economic benefits for Missouri residents. Patients in states with full practice authority generally have a primary care provider within a 30-minute travel distance as compared to patients in states with regulatory restrictions (DePriest et al., 2020; Neff et al., 2018). Reducing regulatory restrictions for nurse practitioners is also correlated with improved rates of routine primary care appointments, enhanced patient satisfaction, and reduced emergency department use (DePriest et al., 2020; Traczynski & Udalova, 2018). Additionally, patients of nurse practitioners have less frequent preventable hospital admissions, all cause readmissions within 30 days, inappropriate visits, and fewer low value MRIs associated with lower back pain (Buerhaus et al, 2018).

The University of Missouri Sinclair School of Nursing received a U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services grant spanning multiple years, to prevent re hospitalizations from nursing homes. The results of this multi phase study conducted in Missouri demonstrated that when a full time nurse practitioner is employed by nursing homes, early interventions for residents with declining conditions are noted and managed earlier, reducing potentially avoidable hospitalizations by 50% and all cause cannot be hired by a nursing home. However, if full practice authority for nurse practitioners is implemented throughout Missouri, there is a potential $53.9 million savings across the state (Rantz, 2021). To improve primary care access and quality for residents of Missouri and reduce regulatory restrictions, nurse practitioners plan to continue to fight for Full Practice Authority. In 2023, Senator Nick Schroer has agreed to work with nurse practitioners by introducing the Regulatory Reduction bill. This bill would grant authority to the Missouri State Board of Nursing to create rules regarding licensure, renewal procedures, required fees, and the discipline of nurse practitioners. The Regulatory Reduction bill would also allow the Missouri State Legislature to improve primary care access and quality in areas that have difficulty attracting and retaining enough primary care providers (Davis et al., 2018; Xue et al., 2018) because nurse practitioners are more likely than physicians to locate in geographic areas with above average poverty and below-average health outcomes (Buerhaus et al, 2018; Davis et al., 2018). hospitalizations by 32%. Under current law, nurse practitioners

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