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New Mexico governor wants to recruit Oklahoma's nurse practitioners

New Mexico Gov. Susan Martinez seeks to recruit Oklahoma's nurse practitioners. Unlike Oklahoma, New Mexico allows nurse practitioners to practice with “full authority,” not requiring them to have a physician sign off on care in order for them to have prescriptive authority.
by Jaclyn Cosgrove Modified: December 1, 2013 at 3:00 pm •  Published: December 1, 2013

Cox is the physician supervisor for a nurse practitioner in Grove, a city of 6,600 in northeast Oklahoma. More than 1,200 doctors in Oklahoma are supervising about 1,000 nurse practitioners, according to data from the state medical board.

Cox said he saw a need for a medical professional to help treat people, and he felt like supervising a nurse practitioner would be a way of doing his part to address the provider shortage in his area.

“The No. 1 reason I see people in the ER is because they can't get into a doctor's office,” Cox said. “There just aren't health care providers to serve the need, but our nurse practitioners have liberal prescribing authority.”

Nurse practitioners in Oklahoma are not allowed to prescribe certain drugs, including oxycodone, a strong pain medication, and Adderall, a drug prescribed to children with attention deficit hyperactivity disorder.

Tulsa nurse practitioner Mindy Whitten said such restrictions regularly create a problem at her job.

Whitten works at an urgent care medical office, a setting where health care providers regularly prescribe Schedule II drugs like oxycodone. If a medical doctor isn't at the office when a patient who is allergic to codeine and hydrocodone comes in suffering pain, there aren't many other options for her to prescribe.

“I don't have a pain medicine I can write for them because the next one is oxycodone, and that is a Schedule II drug,” Whitten, the legislative chairwoman of the Oklahoma Nurse Practitioners, said. “I have to tell them, ‘I'm sorry, I can't write a prescription for you. You'll have to go over to the ER.'”

Another obstacle that nurse practitioners face is in paying physicians for signing off to supervise them, she said.

For example, some physicians charge nurse practitioners between $2,000 and $3,000 each month, she said. It's a charge they wouldn't have to pay if they lived in states like New Mexico.

“Nurse practitioners are starting their own clinics in rural and underserved communities,” she said. “If I'm going to pay $24,000 a year, I can live in New Mexico and not worry about it and own my own practice.”

Dr. Gabriel Pitman, a trustee on the board of the Oklahoma Osteopathic Association, said if a doctor is playing a role and is available to a nurse practitioner, they deserve compensation for participating in the nurse practitioner's practice.

Under Oklahoma law, a physician supervising a physician assistant is required to be on site at the clinic for a certain amount of time each week, whereas with nurse practitioners, a physician isn't required to be at the clinic.

Pitman, an Oklahoma City neurologist, said a physician is necessary to supervise a nurse practitioner or physician assistant because they aren't as rigorously trained as medical doctors and doctors of osteopathic medicine.

In Oklahoma, nurse practitioners are required to have a master's degree along with clinical hours. Requirements are expected to change in 2015 to require a doctorate.

The Oklahoma Osteopathic Association supports nurse practitioners and physician assistants in the roles they serve in the health care system — just not without supervision, he said.

“We feel that a physician must always serve as the team leader, as they are the only comprehensively trained health care professional prepared to make a diagnosis and establish a treatment plan,” he said. “We feel direct access to nonphysician health care professionals endangers patients' health. We feel direct access also puts the patient in the unfortunate and confusing position of being forced to choose among the series of health care professionals, not all of whom are adequately trained to make well-informed diagnoses.”

by Jaclyn Cosgrove
Medical and Health Reporter
Jaclyn Cosgrove writes about health, public policy and medicine in Oklahoma, among other topics. She is an Oklahoma State University graduate. Jaclyn grew up in the southeast region of the state and enjoys writing about rural Oklahoma. She is...
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