ications that have complex interactions and potential side effects
that are less predictable than controlled substances, despite claims
to the contrary. Physicians finally presented how physician-led
team-based care, along with efficient applications of technology, can
dramatically reduce the impact of physician shortages. In hopes of
improving collaborative agreements in Kentucky, KMA and KAFP
offered to develop a clearinghouse of physicians who would be
willing to work with nurses who lose their collaborating physicians
through no fault of their own, and the organizations recommended
building on legislation proposed in the Senate for the previous two
years regarding improving the collaborative agreement in a way
that would allow for better transparency and for efficient and fair
resolution of grievances, including complaints of excessive fees.
After further discussions revealed that the KCNPNMW was
committed to eliminating rather than improving the collaborative
agreement, and proposals to develop a Joint Medical/Nursing Board
while holding independently prescribing APRNs and physicians to
the same professional liability standards were deemed non-starters
for further discussion, physicians proposed the following: (a) form
a Joint Advisory Committee made up of equal parts Kentucky
Board of Nursing and Kentucky Board of Medical Licensure, and
charge it with monitoring APRN-written prescriptions, developing
a standardized collaborative agreement form, and advising each
Board on the issue; (b) develop a process for APRNs who wish to
practice and prescribe independently that includes a requirement to
complete several years of meaningful collaborative practice with a
physician who specializes in the APRNs area of focus; (c) incentivize
APRNs to serve in one of Kentucky’s approximately 80 medically
underserved areas by establishing a rural/underserved area carve out
for nurses who opt to prescribe without a collaborative agreement;
and (d) allow APRN’s to maintain the protection of their existing
collaborative agreements as the default.
The final agreement that is now law was made within the confines
of a smaller group that Dr. Waldridge and I were not a part of. In
essence, it establishes a requirement for a newly graduated APRN to
maintain a collaborative agreement for four years, after which time
the APRN may opt to prescribe independently in any part of the
state with no stipulation about his or her area of practice. Meaningful
collaboration is not required during any part of the process. The Joint
Advisory Committee will be established with no definitive authority
to make recommendations regarding collaborative agreements or
prescribing, and it will not monitor prescriptions written by APRNs
who have opted out of the collaborative agreement requirement.
It may, however, develop a standardized collaborative agreement
form, and hopefully it will opt to do that in a manner that provides
transparency and guidance without being unnecessarily restrictive.
(See 2014 Senate Bill 7.)
The combination of focused physician engagement, enhanced
professional lobbying, and dedicated legislative champions allowed
for compromise with physician input on the APRN collaborative
agreement issue. Ultimately, however, KCNPNMW, the group that
had been the most active -- both in Frankfort where policy is made
and in