House passes new nursing regulation aimed at expanding access to care in Mississippi

• The bill grants “full practice authority” to advanced practice nurses, allowing them to treat patients without physician collaboration. The policy has been implemented in 28 other states.

With access to medical services limited across the state, especially in rural areas, the Mississippi House of Representatives passed a bill that allows advanced practice nurses (APRNs) to treat patients outside of a collaboration agreement with a physician after accruing 8,000 hours of experience.

State Rep. Samuel Creekmore (R), chair of the House Public Health Committee, described the bill as a way to address the limited access to critical healthcare. The National Institute for Health says Mississippi has the worst physician shortage in the nation, a problem projected to get worse as one-third of the state’s doctors near retirement age.

“Most of the healthcare being done in the state of Mississippi is at that mid-level healthcare area, and that’s what this bill addresses,” Creekmore described. 

Advanced practice nurses include nurse practitioners, certified nurse specialists, nurse midwives, and certified nurse anesthetists. Under current Mississippi law, these advanced practice nurses can provide care consistent with their training without the supervision of physicians. However, they are required to maintain “collaborative agreements” with physicians that require the collaborating doctor to review 10 percent of APRNs’ treatment charts once a month.

Advocates for ending the collaborative agreements have argued that they create an unnecessary expense for APRNs, cause business disruptions when a collaborating physician retires, moves or faces discipline, and do not improve the quality of care.

Under HB 849, once a licensed APRN has gained 8,000 hours of experience, he or she would be exempted from the collaborative agreement requirement. For certified nurse anesthetists (CRNAs) that requirement is heightened to 8,000 hours of actual clinical time.

“It eliminates the requirement for APRNs to maintain collaborative relationships with a physician or dentist after completing 8,000 hours of clinical practice,” Creekmore added.

Much of the debate on the bill focused on CRNAs. Creekmore explained that under current law CRNAs are already providing care to patients when the anesthesiologist is not physically present. He said the state has roughly 240 licensed anesthesiologists, but about 900 CRNAs are providing anesthesia services on a daily basis.

Creekmore also noted that in circumstances with the greatest risks of medical complications, such as prior to a surgery in a hospital, doctors are already present in the facility and capable of intervening.

Prior practice hours for APRNs will apply to the required 8,000 clinical hours.

Many Mississippians, particularly those in underserved areas, already think of advanced practice nurses as their medical providers. Nurse practitioners, for instance, in communities across Mississippi staff clinics where they see patients for common illnesses and treatment of chronic conditions without physician supervision. Creekmore said HB 849 will allow these APRNs to provide care consistent with the full extent of their training and open up more healthcare options across the state.

Currently 28 states allow nurse practitioners to have full practice authority – without collaborative agreements – according to the American Association of Nurse Practitioners. Twenty-three states allow CRNAs to practice without a collaborative agreement, according to data shared by Rep. Kevin Felsher (R) during discussion of the bill on the floor.

Before the bill came up for a vote, a total of six amendments were submitted by various representatives. While the first five failed, the sixth, submitted by Rep. Bryant Clark (D), was adopted. His amendment was to ask the Legislature to expand the rural physician scholarship program in the state from a total of 62 scholarships to 100 before the bill could take effect.

Clark estimated it would cost about the same as one Mississippi Highway Patrol Trooper school, or about $1.2 million, to expand that scholarship program. Clark said his aim was to ensure continued expansion of the state’s rural doctors. 

The bill ultimately passed the House with the required three-fifths vote by 75 to 33 and now heads to the Senate for consideration.