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KANSAS DOCTORS HAVE BEEN RELUCTANT TO GIVE UP THEIR EXCLUSIVE PRIVILEGE OF WRITING PRESCRIPTIONS |
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Sometimes the work is harder than it needs to be. Kansas law
does not give Doll or other nurse practitioners the same degree
of autonomy they would enjoy in other states, such as
Washington, for example. With some notable exceptions, Kansas
doctors have been reluctant to give up their exclusive privilege
of writing prescriptions. So as a compromise, nurse
practitioners must develop a protocol with a local physician
that sets out in advance which drugs they will use and under
what conditions.
In rural areas, putting that compromise into practice can turn out to be a very convoluted exercise. The physician is not required to examine the patients or work in the same town as the nurse practitioner but is still legally responsible for the results. Adding to the confusion, each bottle of medicine must bear the doctor's name, not that of the nurse practitioner who ordered it. So if the pharmacist has any questions, it is the doctor, who usually has never seen the patient, who gets called. "It's a paper game, and it can inhibit the quality of care," Doll says. Nurse practitioners have tried to get the state to streamline the process but, so far, to no avail. In spite of such obstacles, the Kansas nurse-practitioner program is starting to pay off. Eight students from the Garden City area graduated this summer without ever having set foot on campus. Five of them found jobs in southwestern Kansas, including two who serve towns with fewer than 5,000 people. Like Doll, they are committed to staying in their rural communities. But by maintaining their technological ties, they remain in contact with each other and keep up with medical developments. As word of the program begins to spread, health officials from Nebraska to Australia are taking a closer look. Even some forward-thinking doctors have started to follow the nurses' lead. The University of Kansas medical school hopes to use the compressed-video network launched by the nurses to allow future medical students from rural areas the opportunity to complete as much as possible of their education right where they live. "Technology can't replace the content of what we teach," Conners says. "But it allows us to minimize the dislocations, and that's the key to keeping our rural areas healthy." That, and the ability to keep dreaming up new solutions to old problems.
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