Published April 19th, 2022 at 6:00 AM
Signed on Good Friday, a new law allows Kansas-based nurses to expand their practice and independently care for patients.
Kansas joined 25 other states in adopting what’s called “full practice.”
During the pandemic, several states had executive orders in place that provided some relief from what April Kapu, president of the American Association of Nurse Practitioners (AANP), called “outdated laws.” With this law in place, it would offer similar protections.
“(Those orders) removed some barriers to access so that nurse practitioners could provide the testing and the community … all of the vaccinations and much of the door to door,” Kapu explained. “Everything that you’ve seen throughout the pandemic.”
Nearly five weeks after it went to the House committee, Kansas Gov. Laura Kelly signed the Senate Substitute for House Bill 2279. Kelly emphasized the health care shortages across the state, particularly in rural areas.
In a release, Kelly said: “This will improve the availability of high-quality health care by empowering (Advanced Practice Registered Nurses) APRNs to reduce local and regional care gaps.”
The law would address those issues.
This means nurse practitioners who work in community health clinics, hospitals and group practices would be able to build on the work they’ve been able to do temporarily during the pandemic.
Other barriers include costly contracts in order to even work.
“For instance, we (nurses) are required to have a collaborative contract and exclusive contract with a physician. And in most cases, we have to pay for that. That’s a huge barrier for an NP to be able to practice,” Kapu said.
Latasha Reed-Conley, a Kansas City area Advanced Practice Registered Nurse (APRN), explained.
“These agreements limited opportunities for nurse practitioners and were often financially burdensome because employment was dependent on finding a physician willing to hire us,” Reed-Conley said. “They also required agreement to terms often set by physicians.”
These terms would include $10,000 in fees, all of which were paid annually by the nurse practitioner. Additionally, these contracts included what she called “unreasonable” and restrictive non-compete clauses.
“This law is about removing barriers and expanding access to care for unserved/underserved populations of patients and putting them first,” she said.
Another example was provided by Kansas City area health care leader and midwife Ginger Breedlove.
She pointed to people who had had to close down a health care practice because the physician retired or moved. In the interim there was no one there to replace that physician.
“So the entire community was unable to be served,” Breedlove said. “It simply made no sense.”
Breedlove called this law a “gamechanger.”
“A great analogy I use a lot is a family practice physician, who might refer a patient to a cardiologist, right? Because they don’t take care of certain conditions that are heart diseases, doesn’t mean they have to have a written agreement to refer to the cardiologist,” Breedlove explained. “What it means is, you work with colleagues, that it’s called team based care.”
But the bill passing was a total shock. “I don’t know how it happened,” she said.
She’s been to Topeka multiple times over the past 15 years in support of this bill. What’s more, she said, this “slipped in” with a physical therapy bill that was being proposed.
Amendments to the bill on the state website show the Senate committee’s updates to include lifting restrictive practices. It’s been years in the making, but urgent most recently. Still the full implications are unclear.
For example, Reed-Conley said the bill will have little to no effect on her practice since she works in public health.
Same goes for APRNs who work within health care systems, because those are physician-led “and will continue to be for the foreseeable future,” she added. “But it will open up additional opportunities if I wish to pursue them in the future.”
However, this will have a major impact on those who work in midwifery.
“The barrier to actual practice — in the form of a requirement to secure a CPA or abiding by ‘non-compete’ agreements — will be lifted,” Reed-Conley said. “This will actually have huge implications for midwifery care in the form of birth choice, and supporting women (and) their families in out-of-hospital births via freestanding birthing centers, home births, etcetera.”
The push that’s been years in the making means a lot for folks who’ve proposed it since the beginning.
Marilyn Douglass with Kansas Advanced Practice Nurses group recently wrote a blog urging other APRNs to call in and boost the call for Kelly’s support.
“This bill will increase APRNs practicing in Kansas, providing access to health care in rural communities and are more apt to care for the underserved,” Douglass wrote.
In a follow-up email to Flatland, Douglass said she’s been working on this bill since 2006. Upon hearing the news she was “thrilled” and “proud.”
Furthermore, Kansas has six schools of advanced practice nursing as well as a stable pipeline of APRNs who she said will now find it easier to work in Kansas, “(and) take care of Kansans.”
“It is not about a turf war, it is about taking out the barriers so that APRNs can care for Kansans,” Douglass said.
Reed-Conley agreed and added: “The collaborative nature of health care does not change with the absence of CPAs. I have a network of APRNs and physicians that I trust and collaborate with on a regular basis.
This new law could also have implications on the economy.
On average, nurse practitioners go through six years of undergraduate education and additional time in clinical settings for hands-on training, according to the Nurse Journal. Some accelerated programs average two to four years.
“There is an economic impact that goes here. If physicians feel threatened that they’ll lose patients. It’s unfortunate, but the reality is physicians who choose to work with nurse practitioners and accept their patients actually gain income from those referrals,” Breedlove explained.
There is also a clear need for more health care workers, especially these days.
The historic health care crisis added pressure to an already overwhelmed system, so the protections and expansions this law provides are a big win for those who’ve been advocating the bill for more than 15 years.
The law also has a psychological effect of reducing burnout and distress, Kapu said, which has been endemic across all health care providers in the United States.
“One thing that’s very important has been shown over and over again, that’s been related to burnout, is autonomy and being valued for what you do,” she said.
Not only will this law help folks who need care more readily but it will also mobilize more nurses to bring care to folks in otherwise underserved areas.
In the United States, one-in-five counties are health care deserts.
Roughly 23 counties in Kansas are considered “primary care deserts” affecting 32.7% of the state’s population — or 960,360 residents, according to a Sidecar Health analysis. In Missouri, 83 counties are considered “primary care deserts,” which affects around 38% of the population — or 2.4 million residents.
Breedlove echoed Kapu’s sentiments about the value of autonomy.
Breedlove said it is also important for the public to know that even though this law allows those individuals to practice without a written agreement on a piece of paper, “we still are bound by our standards of our profession.”
The law adds a fourth layer of public protection by making nurse practitioners carry malpractice insurance similar to physicians, dentists, podiatrists (and) other people that the Kansas Health Care Stabilization Fund co-insures.
Evidence bears out that by lifting certain restrictions, nurses can work better and care for more people.
“We’ve actually seen throughout the years as states have adopted full practice authority in outcome and, improve access,” Sabu said.
“When the system works, it works to improve the health of the whole community,” she said.
Vicky Diaz-Camacho covers community affairs for Kansas City PBS.