Almost everyone has had the experience of receiving a written prescription for a medication after visiting their healthcare provider’s office. Although not always used, prescriptions for medications are a common part of modern healthcare. In a typical day in the office, healthcare providers write about 20 prescriptions per day.
Georgia was the last state in the U.S. to allow Advanced Practice Nurses (APRNs), including Certified Nurse Midwives (CNMs) to write prescriptions, otherwise known as prescriptive authority. For years, CNMs could only telephone prescriptions in for their clients under a physician’s name. Although nurse-midwives and other APRNs have been shown in many studies to provide safe, evidence-based care with excellent outcomes, the fight for prescriptive authority in Georgia was a long, arduous one. Some physicians questioned if APRNs would have the training and education to write prescriptions safely. However, The 2010 Pearson Report documented that there were no increase in claims to the Healthcare Integrity and Protection Data Bank in states where advanced practice nurses had full prescriptive authority.
Many nurse-midwives in Georgia provided education, evidence, and testimony over many years supporting the need for legislative change. Their efforts were finally successful in the 2010 passage of OCGA 43-34-25. So, four years later, why is there no ‘Happy Ever After’ in Georgia on the issue of nurse-midwives and prescriptive authority?
Prescriptive authority for APRNs in Georgia is not a dream come true because the current regulations make it so difficult for nurse-midwives and other APRNs to write prescriptions that many have simply given up and gone back to calling in all prescriptions under a physicians’ name. Recent figures calculated by the Georgia ACNM Affiliate provide a glimpse into the scope of this problem among CNMs in the state. Of the 477 CNMs in Georgia with current licenses to practice from the state, only 139 had active prescriptive privileges. That means that less than 30% of CNMs in the state are taking advantage of a state law that would theoretically allow them to more easily care for their clients.
Why are so many CNMs in Georgia choosing to practice without prescriptive authority? Nurse-midwives in the state report that the state requirements are cumbersome, involving written agreements between each nurse-midwife and a delegating physician that must be updated frequently and submitted to the state. In twelve other states, nurse-midwives can prescribe independently, and in 28 other states, they can prescribe with ‘collaboration’ of a physician colleague. Georgia’s prescriptive law requiring that APRNs must have their prescriptive authority delegated by a supervising physician puts the state among the 10 most conservative prescriptive authority laws, and is seen by many CNMs as too much work for too little benefit.
Independent prescriptive authority regulations allow CNMs and other APRNs to broaden their practice to more easily care for patients in rural settings, where large physicians’ practices with the administrative and supervising physician resources to support delegated prescriptive authority regulations are few and far between. This would be very important in Georgia, where 79 counties currently have no obstetrics/gynecology providers. Georgia currently ranks near the bottom of the U.S. states in our rural provider shortage. CNMs are effective and willing to serve rural clients in Georgia. However, our state’s existing regulations for practice, including our current law for APRN Prescriptive Authority, are acting as barriers for CNMs who might help to meet the needs of underserved women.
What are your experiences with the current prescriptive authority regulations in Georgia? Are you ready for a change that might bring us closer to a happy ending for CNMs and the women of Georgia?