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Both sides happy with nurses prescription-writing legislation

LAWRENCEVILLE - More often than not, there are winners and losers when the General Assembly passes a bill.

But representatives of both doctors and nurses say they're happy with new legislation that will allow nurse practitioners in Georgia to write prescriptions as of July 1.

Advanced practice registered nurses already are allowed to phone in prescriptions to pharmacies. But Georgia is the only state left that doesn't let them put those prescriptions in writing.

In exchange for that privilege, a compromise bill that cleared the Legislature last week includes a series of provisions sought by doctors that will add greater clarity to the relationship between APRNs and physicians than current law.

The bill was almost an 11th-hour casualty until Sen. Renee Unterman, R-Buford, attached it to related legislation she was sponsoring to get it through. It's now awaiting Gov. Sonny Perdue's signature.

APRNs have pushed for years for the right to write prescriptions, arguing that it would improve access to health care in Georgia, especially in medically under-served rural areas.

"More people will be served,'' Unterman said. "There will be a higher volume of patients seen quicker.''

The new law also is expected to increase Georgia's supply of APRNs by encouraging nurse practitioners from other states to move here, said Karen Schwartz, an APRN in Gwinnett County and chairman of a statewide grassroots committee.

"I just got an e-mail from a nurse practitioner in Florida. She said, 'Now, I can finally consider moving to Georgia,' '' said Schwartz, who has been working for the bill's passage for seven years.

Throughout that time, the Medical Association of Georgia has been opposing prescriptive authority for APRNs.

But the physicians' organization got on board this year after negotiating to win restrictions that will give doctors greater oversight in their delegation of authority to nurse practitioners than they have now. Those provisions include:

•APRNs can work only with delegating physicians in the same specialty area.

•Nurse practitioners will not be allowed to prescribe Schedule I or Schedule II drugs, which typically are the most addictive and, therefore, the most frequently abused.

•The ratio of APRNs to supervising doctors can be no greater than four to one.

•The state Medical Board - not the state Nursing Board - will regulate "protocol'' agreements between nurse practitioners and supervising physicians.

"We believe nurses ought to be able to write down prescriptions, but we had ... patient safety issues,'' said David Cook, the medical association's executive director. "We wanted to make sure that the acts delegated were done right.''

But Schwartz said APRNs also got their way on some issues. For example, a number of medical settings will be exempt from the 4-1 nurses-to-doctors ratio requirement, including many hospitals, health clinics and birthing centers.

She noted that doctors also were unable to keep in the final version of the bill a provision that would have prohibited nurses from issuing prescriptions in clinics run by CVS stores.

"We were very concerned about that,'' she said. "I think it's a great service to have, especially for people whose employers fight them getting off any time for medical treatment.''

Schwartz conceded that nurse practitioners are leery of some of the restrictions the medical association got into the bill. She said APRNs may push for changes in the new law if they run into problems after the law takes effect.

"We'll see how it plays out,'' she said. "But so far, it looks like something we can live with.''