Providing Access to Healthcare for Rural North Carolina
The debate over basic healthcare has become what many consider to be either a privilege or a right, but regardless of the debate, basic healthcare it is truly a need. The rising cost and lack of access have a negative impact on the health of rural North Carolina communities. The SAVE Act is a reasonable solution to a portion of the healthcare problem that would provide increased access to affordable care for those living in rural communities. It would also provide significant cost-saving solutions for the state and the facilities servicing rural North Carolina areas by allowing Advanced Practice Registered Nurses (APRN) to practice to the full extent of their training and scope of practice, without requiring a physician supervision agreement. Fully utilizing APRNs in the delivery of quality health care will perpetuate the health and well-being of communities, as well as help support local economies by producing jobs.
The purpose of this paper is to identify the North Carolina SAVE Act as reasonable option that would increase access and provide affordable quality healthcare to the underserved communities of rural North Carolina. This option allows the Advanced Practice Registered Nurse (APRN) to provide care to the community utilizing the current full scope of practice granted by the North Carolina General Assembly, the North Carolina Board of Nursing and the North Carolina Medical Board only without a physician supervision agreement.
Review of Literature
The discussion of healthcare reform is an arduous topic in our federal and local government, national and local media as well as the living rooms of America. The rising cost and lack of access have a tremendously negative impact on the health of rural North Carolina. By allowing APRNs to practice to the full extent of their training and scope of practice, without requiring a physician supervision, the underserved population in rural communities would have access to prudent and affordable healthcare.
Historical and Background of Issue
Trained nurse practitioners have been providing care to North Carolina since 1970. Their scope of practice was expanded and as of 1975 they were granted the authority to treat, diagnose and prescribe under the supervision of a physician. Since then, the North Carolina Nurse Practice Act, regarding the practice of the APRN, has not been modified despite substantial research that supports the impact of the ARPN to provide prudent cost-effective care to the undeserved communities of North Carolina. (Pollitt, 2017) The North Carolina General Assembly has been presented with the SAVE Act, a reasonable solution to a portion of the healthcare problem with a significant saving impact for the state of North Carolina but more importantly for the underserved communities of rural North Carolina and the facilities that serve them. During the last forty years over a dozen studies have proven the care APRNs deliver as equal to or better than care provided by a physician treating similar cases and The Institute of Medicine endorsed Full Practice Authority with its report,
Future of Nursing
, almost ten years ago. (Cowperthwaite, C., 2019)
Basic healthcare has become what many consider to be either a privilege or a right, but it is truly a basic need. The rural communities utilize the local hospital emergency department as their primary care option. This practice leads to costly and unaffordable expenses that ultimately drive up the cost of healthcare. By 2020, local as well as national studies have predicted that a there will be significantly fewer primary care and specialty physicians providing healthcare. Physicians are drawn to metropolitan cities and larger communities for the financial benefits thus leaving the rural communities with little to no healthcare options. As the APRN has become a vital part of the healthcare delivery system, they have also become another source of income for the “supervising” physician. The APRN must have a supervising physician agreement in order to practice and those physicians charge significant fees to the APRN for that supervision agreement which, when drilled down, consists of a couple meeting and $24,000. If more than one APRN is a part of the practice, an additional amount is charged by the supervising physician for each APRN in the group, that amount can be upwards of $500 per APRN per month. (Havlak, 2019)
Significance of Issue
The significance of modernizing the North Carolina Nurse Practice Act with the passing of the SAVE Act is important to the nursing profession, to professional nursing practice but more significantly, it is important to the public and vital in providing adequate healthcare to the underserved communities. Dr. Chris Conover from the Duke University Center for Health Policy and Inequalities Research conducted a study in 2015 that indicated North Carolina could save between $433 million and $4.3 billion per year and generate more than 3,800 jobs with legislation like the SAVE Act. (Cowperthwaite, C., 2019)
Influences to Nursing Practice
The APRN is crucial to the delivery of high-quality prudent cost-effective healthcare to communities that are underserved by physicians. The passage of SAVE Act would alleviate those shortcomings. APRNs could afford to care and serve the rural communities and grow their practice as they continue to provide the same high-quality prudent care only more cost-effeciently.
Physicians claim APRNs need supervision to maintain the safety of public health. “Scary anecdotes and hypotheticals may make for good political theater, but they are a terrible way to shape healthcare policy. Quality healthcare depends on evidence-based practice and the evidence overwhelmingly supports this legislation,” said NCNA President Elaine Scherer, MAEd, BSN, RN. (Cowperthwaite, C., 2019) In 22 states as well as the District of Columbia and our federal government facilities, Nurse Practitioners can practice without physician supervision and safety has not been an issue. (Sofer, 2017)
The SAVE Act is an immediate solution to an ongoing issue that has and will continue to have long term negative effects on the heath of North Carolinians if changes are not instituted. The public needs to continue to request from their representatives this change for the benefit of their community. North Carolina nurses should continue to advocate for their patients, the facilities that serve them and the community they care for by supporting organizations that lobby for this legislation.
APRNs have the educational background directly out of graduate programs to continue to deliver consistently safe prudent cost-effective healthcare. The SAVE Act is a simple step toward alleviating an extremely complicated issue.
The direct impact of allowing APRNs to practice to the fullest extent of their training and scope of practice without supervision is vastly beneficial to not only patients of rural communities in North Carolina but also to the economic growth of those communities. The benefits add to a heathier community and with job growth that cycles back to a thriving local economy. (Conover & Richards, 2015)
- Conover, Christopher J. & Richards, Robert. (February 2015) Economic Benefits of Less Restrictive Regulation of Advanced Practice Registered Nurses in North Carolina.
Center for Health Policy & Inequalities Research at Duke University
. Retrieved from
- Cowperthwaite, C. (2019, February 26). NC Legislators Introduce Bipartisan SAVE Act to Increase Access to Quality Healthcare. Retrieved from https://ncnurses.org/about-ncna/latest-news/nc-legislators-introduce-bipartisan-save-act/
- Havlak, Julie. (2019). Nurse Practitioners Push Back Against State Rule Requiring A Physician to Supervise them.
The Carolina Journal
. Retrieved from https://ncnurses.org/about-ncna/latest-news/nurse-practitioners-push-back-against-state-rule-requiring-a-physician-to-supervise-them/
- Pollitt, Phoebe. (2017). History of Legislation Affecting NPs in North Carolina.
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- Sand-Jecklin, K. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation.
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- Sofer, D. (2017). VA Grants Most APRNs Full Practice Authority. AJN,
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, 117(3), 14. doi: 10.1097/01.naj.0000513271.43979.37