Panel backs broader powers for advanced nurses in rural areas

A Senate study committee Monday recommended the state allow advanced practice registered nurses (APRNs) broader medical authority if they work in rural, underserved counties.

Under current state law, nurse practitioners and other advanced nurses in Georgia can prescribe medications only under a collaborative agreement with a physician.


The study committee’s recommendations would allow these nurses to prescribe independently, as well as order MRIs and CT scans independently, in rural counties.

The goal of the recommendations is to entice advanced practice RNs to practice in underserved areas, said state Sen. Renee Unterman, a Buford Republican. She’s chair of the study committee on Barriers to Georgians’ Access to Adequate Healthcare, which was created by a Senate resolution.

Rural Georgia has a widespread shortage of physicians and other medical providers, which in part causes many of these areas to have worse health statistics than urban or suburban counties. Several rural hospitals have closed over the past five years, and many counties lack a sufficient medical workforce.

The panel’s report says that nine Georgia counties have no physicians, 63 have no pediatricians, 79 have no OB/GYNs, and 22 have no APRNs.

“In order to maintain the status quo, Georgia will need an additional 2,099 primary care physicians by 2030,’’ an increase of 38 percent, the report said. Based on a 2015 survey, 53.4 percent of the physician workforce in Georgia is 50 or older, and 23 percent of those physicians plan to retire in the next years, further exacerbating the shortage issue, the report says.

The maldistribution also is reflected in mental health, with about two-thirds of mental health counselors located in the metro Atlanta area.

An Advanced Practice Registered Nurse is a nurse who has obtained at least a master’s degree in Nursing. APRNs have four categories: nurse practitioners; nurse anesthetists; nurse midwives: and clinical nurse specialists.

Across the nation, 22 states allow APRNs to practice to the full extent of their licenses.

Jimmy Lewis, CEO of HomeTown Health, a rural hospital organization in Georgia, cited the shortage of physicians in supporting the panel’s recommendations.

“We need alternative sources of medicine’’ in rural areas, he said. “It’s very important, and it’s necessary.’’


But a leading physicians organization, the Medical Association of Georgia, signaled its opposition to the proposal for APRNs.

MAG’s president, Dr. Frank McDonald, Jr., said in a statement Monday that his organization “believes that APRNs should continue to work under collaborative practice agreements with physicians to ensure patient safety. MAG also believes that nurses in the state should be governed by the Georgia Composite Medical Board.”

MAG said it would need to review the study’s committee’s recommendations before it can offer additional comments.

Among the panel’s other recommendations is an expansion of a tax incentive program to allow physician assistants and APRNs to serve as preceptors and receive a tax credit for such service. The recommendations also included expansion of the Centering Pregnancy program and of telemedicine.

Unterman, who’s also chair of the Senate Health and Human Services Committee, said Monday before the unanimous committee vote, “This is a very, very complicated issue.’’

“There will be legislation coming out of this committee,” she said.


Michelle Nelson, a Georgia State University nursing professor, told GHN that the committee action “is a step in the right direction.’’

Nelson, who’s also president of the United Advanced Practice Registered Nurses of Georgia, testified at a previous committee meeting that studies have shown there’s no difference in quality of care between services delivered by an APRN and a physician.

Ashley Blackmon, an APRN, said the proposal, if enacted into law by the Georgia General Assembly, would help recruit these nurses to practice in rural communities. “It will get folks out there,’’ she said.