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Oklahoma medical association opposes bill allowing nurses to prescribe without supervision


The Oklahoma State Medical Association is opposing a bill heading to Gov. Kevin Stitt., which would allow mid-level providers to prescribe certain drugs without a physician's supervision.

Senate Bill 458, authored by Sen. Brenda Stanley (R-Midwest City) and Rep. Marcus McEntire (R-Duncan), would allow advanced practice registered nurses (APRNs) to order and administer certain drugs. Those mid-level providers include certified nurse practitioners, clinical nurse specialists and certified nurse-midwives.

Under this measure, APRNs could obtain 6,240 hours of practice with physician supervision, apply for licensure through the Board of Nursing and independently prescribe Schedule III-V drugs, which include things like anabolic steroids, Ambien and Xanax.

Stanley said during the bill’s hearing on the Senate floor that it would help combat the state's physician shortage in rural areas.

“I know that rural Oklahoma is desperate for health care. … (APRNs) can treat a sinus infection. They can treat prescribed Lipitor for cholesterol,” Stanley said. “They have a wide scope, but (the bill is) just within their scope of practice.”

The Oklahoma State Medical Association Director of Government Affairs Matt Robinson disagrees.

He said this has been a national point of discussion for years. Currently, 28 states allow their nurse practitioners to prescribe medications and controlled substances under licensure.

But Robinson said it’s difficult to weigh the differences in educational, clinical and continuing education requirements necessary to become a physician versus an APRN.

“This bill requires 6,240 hours,” Robinson said. “When you're talking about a physician, and the residency and the education that they receive, it's in the neighborhood of 18,000 hours.”

Robinson said the board does support the bill’s provision saying the Oklahoma Board of Nursing, State Board of Medical Licensure and Supervision and State Board of Osteopathic Examiners would create rules surrounding this measure. Those would include governing supervision requirements for APRNs who can’t prescribe independently and limiting the amount a supervising physician can charge for supervision.

He said a main concern for physicians is misdiagnosis and mistreatment that could come from less experience. He said this could also impact costs for patients.

“That is going to cause further and enhanced health problems throughout the longevity of that patient. … That's going to also cost a lot more in the long run because you're going to be treating a lot of different ailments rather than the initial one that should have been treated in the first place,” Robinson said.

The Association of Oklahoma Nurse Practitioners posted in support of SB 458 on Facebook, saying it is a “huge win” for these providers.

APRNs are a “critical part” of the health care team, Robinson said. But he said a physician-led team is important in providing the best health care for Oklahomans.

To combat the state’s physician shortage in rural areas, The Oklahoma State Medical Association would like to see further investments in the Oklahoma Health Care Workforce Training Commission, which is working to increase access to health care workers in rural and underserved parts of the state. It provides things like aid to accredited training facilities and loan repayments.

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Jillian Taylor has been StateImpact Oklahoma's health reporter since August 2023.
StateImpact Oklahoma
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