NPs soon eligible for Independent Practice under Arkansas Act 412
Nurse practitioners are critical in today's healthcare landscape, filling gaps created by a nationwide physician shortage and global pandemic. Today, the state's 4,000-plus nursing professionals are one step closer to independent practice thanks to Act 412, which can grant full practice authority to certified nurse practitioners. In 2022, the bill will eliminate the need for a physician collaboration agreement among eligible practitioners.
"Nurse practitioners in Arkansas have been working toward this for a long time," said Wes Ward, APN, an Arkansas Nurse Practitioner Association education committee member and family nurse practitioner in Greenbrier, Arkansas. Until Act 412, Arkansas had been among 15 reduced practice states, requiring a career-long regulated collaborative agreement with a physician in order to provide patient care. In 2022, Arkansas will join the 24 states that allow full practice, permitting NPs to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. The full practice model will be a game changer for patients, particularly those in rural communities.
Meeting a need
Under the new Act, nurses will need about three years, or 6,240 hours, of practice under a collaborative agreement with a physician in order to earn the right to practice independently, and have their licenses renewed every three years. The law also allows them to "receive and prescribe drugs, medications and therapeutic devices." Ward, who estimates 2,500 of the state's 4,000 NPs will be eligible to apply for independent practice, was among a trio of providers who led a panel called "Opening Your Own Practice" at the annual Arkansas Nurse Practitioner Association conference in October. He said the three-year requirement will help nurses get their feet wet in the clinical setting before tackling the business side of practice management. "They need to learn the business end of the business," he said. "There are principles that govern running a successful practice, and we don't take business courses in nursing school."
While Act 412 won't affect day-to-day operations, Ward anticipates it will bring more care to underserved communities. "What you'll see is more nurse practitioners opening clinics in rural areas," he said, noting providers who've been forced to close if a collaborative physician retires, passes away or relocates. "By definition, a rural location may be 40 miles from the closest physician. When you remove that barrier, providers can go into rural areas without being tethered to a physician." Neal Reeves, MBA, DNP, RN-BC, Clinical Assistant Professor at the University of Arkansas for Medical Sciences College of Nursing, presented alongside Ward, addressing the state shortage of general practitioners. "As we get further out in rural communities it gets even worse," he said. "There are often nurse practitioners already living in these communities, so there's an opportunity to really improve access to care." Jeannie Finley, APN, founding member of ANPA and Ozark Wellness Clinic founder and owner, is doing just that. "The focus of medicine has really changed over the last 25 years, but access to physician colleagues is imperative," she said. "Companies have put demands on physicians that don't allow many to be in private practice anymore, so nurse practitioners are stepping up to the plate. As APRNs we're striving for a cohesive health care team, and have fewer and fewer providers these days." Finley's patients are primarily older adults, many with chronic diseases and few options in rural Ozark. "They have to have access to care," she stressed. "Physicians are so thinly spread today, but I was born and raised here, so it's not a stretch for me to practice here and care for the people I love and grew up with."
Advocating for patients
Finley, who participated in the ANPA panel, also noted that the absence of a collaborative physician doesn't override federal laws, and that NPs will still need a consulting physician in some situations. "If you have diabetes, I can't get you a pair of diabetic shoes because Medicare doesn't allow us to sign for that," she explained. "I'll always have to have a consulting physician for federal regulations, but thankfully our state is so much more progressive than the federal level. Arkansas has cutting edge thinkers who want people here to have the best." According to a release issued by Arkansas Gov. Asa Hutchinson's office, the General Assembly passed several laws this year that expand the services that nurses can offer: Act 569 allows Advance Practice Registered Nurses to serve as a primary care provider in the Medicaid Program without a physician agreement. Act 412 creates the Full Independent Practice Credentialing Committee; Act 449 allows a Certified Registered Nurse Anesthetist to work in consultation with licensed physicians, dentists, and others who are licensed to order anesthesia; and Act 607 grants full practice authority to Certified Nurse Midwives, which allows them to evaluate patients, diagnose medical conditions, and order diagnostic tests, and initiate and manage treatment and care plans; and Act 651 of 2021 mandates that when a physician prescribes opioids, the physician must also prescribe naloxone, a drug that can quickly reverse the effects of an overdose.
"We've worked very hard over the last few years to let patients know what nurse practitioners are and what we do," said Finley. At UAMS, Reeves recently led a digital health class, teaching NP students about legal and ethical aspects of telehealth. "Change in laws due to the pandemic have been very beneficial," he said, noting increased telehealth reimbursement rates since the start of COVID-19. "I'm looking forward to seeing what transpires in the next few years. The early stages are very critical to how quickly things will change." Ward is optimistic, and said he feels like the majority of physicians also are supportive of Act 412. "Physicians have more experience as an entity and have been around longer and working in rural areas," he said. "We know nurse practitioners won't be able to fill all the gaps, because the entire healthcare machine is more complicated than that. But the shortage areas will definitely start diminishing."