Bills to let nurses do more

By WILLIAM K. ALCORN

alcorn@vindy.com

Local advanced-practice nurses say two bills in the Ohio Legislature are pivotal to a push by those nurses to expand their authority to prescribe Schedule II drugs and provide full primary-care medicine.

House Bill 206 would enable advanced-practice nurses (APNs), after completing additional education, to prescribe Schedule II controlled medications such as Fentanyl, Oxycodone, Percocet and attention- deficit-disorder medication such as Ritalin.

House Bill 198 would create patient-centered medical home pilot projects. Passage is stalled because physicians and APNs disagree on whether the nurses should be allowed to lead pilot projects, said Deborah Hromyak, a certified nurse practitioner from Austintown.

The APNs designation, which includes certified nurse practitioners, clinical nurse specialists and certified nurse midwifes, provide about 25 percent of primary care in the United States, Hromyak said.

Hromyak and another area APN, Cheri Adams of Orwell, also a certified nurse practitioner who practices in Mahoning and Trumbull counties, say expanding their role in caring for their patients is necessary, and its time has come.

APNs work in a variety of settings, including outpatient primary care; acute care in hospitals, birthing centers and intensive-care units; private homes, hospices, nursing homes and extended-care facilities, according to the Ohio Association of Advanced Practice Nurses.

Hromyak, who worked as a registered nurse at Southside, Northside and St. Elizabeth hospitals in Youngstown, said APNs have the training and skills to provide about 90 percent of the patient care offered by a primary-care physician.

Working at Primary Health Care Associates in Youngstown, Hromyak, certified in primary adult care, said she collects patient histories, performs physical exams for males and females, diagnoses and manages acute and chronic illnesses, orders and interprets diagnostic studies, such as X-rays and EKGs, and prescribes certain medications and therapeutic interventions.

She also provides health care for employees at InfoCision in Austintown and Boardman and serves as a volunteer at the Midlothian Free Health Clinic in Bethlehem Lutheran Church.

In Ohio, APNs are required to have a collaborating physician who periodically checks the medical charts of their patients and is available for consultation. Hromyak’s is Dr. Benjamin M. Hayek.

But there are times, Hromyak said, when a patient is in extreme pain, perhaps even dying, and the APN caring for them is not permitted to prescribe the drugs they need.

If a patient is dying and needs pain medicine, nurse practitioners can write a prescription for a 24-hour supply of a Schedule II drug, but only if the patient’s doctor previously has prescribed the drug for the patient, said Hromyak.

It can be a serious situation if the patient’s physician cannot be reached, said Adams, who specializes in in-home adult patient care.

Affiliated with the Boardman office of Visiting Physicians Association, she works primarily in Mahoning and Trumbull counties. Her collaborating physician is Dr. Samir Moussa.

Adams and Hromyak received their master’s degrees in nursing and advanced-practice nurse training at Kent State University. Adams, a former medical assistant and licensed practical nurse, received a bachelor’s degree in 1995 from KSU’s School of Nursing.

Hromyak received her bachelor’s degree from the Youngstown State University School of Nursing in 1983.

APNs are registered nurses who have at least a master’s degree, speciality certification and advanced pharmacology training. They also must complete extensive clinical hours, called an externship, with a physician before being eligible to receive certificates to practice and to proscribe, Hromyak said.

Others areas in which APNs can specialize are pediatrics, geriatrics, family practice, women’s health and acute care, Adams said.

The Ohio Medical Association opposes expanding the authority of advanced-practice nurses to prescribe Schedule II drugs or allowing them to lead the state’s medical home pilot projects.

Schedule II narcotics have a high potential for abuse and dependence and trafficking and, in the OMA’s view, should be prescribed only by physicians, who have more education and expertise than APNs, said Timothy Maglione, OMA spokesman.

Likewise, Maglione said though the OMA believes HB 198 is a good bill, the organization opposes APNs’ leading pilot projects for the same reasons it opposes HB 206 — doctors have more training and expertise than APNs.

“With additional training, I think APNs should be able to prescribe Schedule II drugs,” said Adams, who is regional coordinator for the Ohio Association of Advanced Practices Nurses.

“I do the best that I can for my patients,” said Adams, who does most of her work in the homes of people for whom it is difficult to get to a doctor’s office. “I expect more from me than I think any of my collaborating doctors do.”