Several measures passed during the 2023 legislative session will lead to improved access to quality health care for all Missourians.
To address ongoing health care provider workforce shortages, the Missouri Chamber of Commerce and Industry supported HB 115 and HB 402. This legislation reduces certain regulatory burdens for advanced practice registered nurses (APRNs), allowing them to practice to the full extent of their education and training.
The Missouri Chamber supported these provisions in an effort to improve health care access for rural and underserved communities, an essential factor in local economic development. Nurse practitioners and hospital systems from across the state also testified in favor of the bills.
APRNs are licensed to practice in Missouri as a certified clinical nurse specialist, certified nurse midwife, certified nurse practitioner, or certified registered nurse anesthetist. APRNs complete a graduate nursing degree program in addition to completing training to be licensed as a registered nurse (RN) – usually a bachelor’s degree program. Missouri law requires APRNs to practice in a collaborative practice arrangement with a licensed physician.
The governor waived several regulatory requirements for APRNs during the pandemic in order to ease the burden on the overextended health care system. These bills make several of those temporary waivers permanent. Under the new law, APRNs will have greater flexibility with regard to the amount of time their collaborating physician must be physically present. APRNs also can more easily obtain a waiver to practice outside the current 75-mile radius restriction from their collaborating physician. Supporters said this geographic proximity requirement was out of date because many health care services are now provided through telehealth. The geographic proximity requirement for telehealth services was removed.
“Advanced practice registered nurses are a growing presence in the health care workforce,” said Sarah Willson, vice president of clinical and regulatory affairs at the Missouri Hospital Association. “However, Missouri’s licensure system has sometimes limited the ability of these highly trained health care providers to work to the full scope of their training.”
Willson noted that what lawmakers adopted created a formal category of licensure through Missouri’s State Board of Nursing and expanded the ability of APRNs to practice in certain areas of care.
“Unshackling APRNs from some of the state’s restrictions will create important opportunities to maximize their value within the clinical environment and extend access to care in additional communities,” Willson said. “Many states have less restrictive laws for APRNs, creating a disincentive for these highly educated health care providers to practice in Missouri. Given Missouri’s ongoing primary care shortages, these are important caregivers for our system.”
BJC HealthCare was among the organizations that testified in favor of HB 402. Tommye Austin is BJC’s chief nursing executive and senior vice president of patient care.
“Having more APRNs available, especially in acute care, means the wait for primary care patients isn’t as long,” Austin said. “If I’m a physician, I can see 20-30 patients a day. With the APRN there, the doctor could be able to see up to 40 patients a day.
“Say a congestive heart failure patient leaves the hospital and needs to do follow-up with their primary care office,” Austin continued. “If they can’t get an appointment, there’s a high probability they might not follow their doctor’s orders or fail to ask a question about their prescriptions. If there’s an APRN in that office, chances are much better those patients’ needs can be addressed, because the APRN can help them, and it’s less likely that patient will be readmitted to the hospital.”
Allowing patients to recover at home under the supervision of an APRN instead of returning to the hospital for follow-up appointments is another reason hospitals support expanding the practice of APRNs, according to Austin.
“With the right care, costs can be reduced for patients and hospitals,” Austin said.
One of the big selling points for lawmakers to approve this legislation was the help it can bring to rural and medically underserved areas, sometimes described as “health care deserts.”
“The APRNs would still have to have a connection with a physician, but patients would be better able to get the primary care they need,” Austin said. “It’s a wonderful way for someone to develop their nursing career. I’ve trained APRNs for the emergency room where we couldn’t function without them. Patients come in at different levels and if they are deemed at a lower level of care, an APRN can attend to them.”
The legislation also contains provisions that expand the definition of “hospital” to include rural emergency hospitals. This modification allows struggling rural hospitals to access a wider array of federal funding options.