Pushing to Ease Limits on Highly Trained Indiana Nurses

Many patients at the low-income clinic in Gary where nurse practitioner Jodi Allen volunteers need common drugs like antibiotics, insulin and blood pressure pills.  

But Allen is forced to direct such patients, who often lack insurance and transportation, to an emergency room. Despite their extensive training, advanced practice registered nurses (APRNs) like Allen are forbidden by Indiana law from prescribing routine drugs unless they work under a doctor’s supervision. But there’s no physician volunteering at her nonprofit clinic.

“If someone comes in with high blood pressure or diabetes or an infection, I can’t prescribe them an inexpensive medication,” says Allen, who holds a doctorate in nursing practice and teaches at Purdue University Northwest. “I have to send them to an ER, where they may not get the right drugs and likely no follow-up care. It just prolongs the impact of their disease, which adds to costs and complications.”  

According to a 2017 Rand study done for the Coalition of Advanced Practice Registered Nurses of Indiana, giving APRNs full practice authority would increase primary care access for nearly 380,000 Hoosiers and mean 18,000 fewer ER visits.    

“AARP believes that nurse practitioners  need more latitude to serve the public,” says Ambre Marr, legislative director for AARP Indiana, which urges lawmakers to ease  limits on nursing practice.

Rules add expenses

APRNs have graduate degrees and are trained to prescribe medications. But Indiana and many other states restrict what they can do and require them to operate under a “collaborative practice agreement” with a physician, who reviews  some of their cases. 

Nurses say the oversight is unnecessary and expensive, since they must pay as much as tens of thousands to the collaborating physicians. And that’s if they can find such a doctor. Allen filled four pages with the names of prospective collaborators, but none was willing and available. 

Physicians say that they have more education and that supervision of APRNs is necessary for patient safety. Nurses point to rigorous APRN certification requirements and their code of ethics, which requires them to call in specialists when warranted.

“They are well qualified to treat routine medical issues,” says APRN Tai Morrell. “But a lot of this is about power and control.”  

Morrell wanted to take over her physician father’s medical practice when he retires. (They serve Rushville, a rural southeast Indiana city that has just two doctors.) But the prospect of a costly collaboration and other hurdles prompted Morrell to take a nursing job elsewhere.  

Tens of thousands of Hoosiers live 30 or more minutes from a provider, says Lacy Foy, manager of  Indiana’s Office of Primary Health. “Those residents rely heavily on community health centers, where they mainly are cared for by nurse practitioners,” Foy adds.   

State Sen. Ed Charbonneau (R-Valparaiso), who has championed greater APRN scope of practice, says the coronavirus pandemic highlighted provider shortages and the need for new health care options. 

Interested in advocating on behalf of patients and nurses? Call 866-448-3618 or email aarpin@aarp.org.

Melissa Preddy is a writer living in Plymouth, Michigan.

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