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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Nurse practitioners: the cure for primary care shortages

COD Newsroom


Primary health care is no longer limited to the family doctor. With the growing popularity of clinics like the new Mizzou Quick Care, nurse practitioners are becoming more involved in providing primary care.

Phyllis Zimmer, a family nurse practitioner in Seattle and the President of the Nurse Practitioner Healthcare Foundation, said convenient care began as a way to make healthcare accessible to more people.

"When you start looking at what that practice has become, I think of it as a gateway," Zimmer said. "It's a beginning place for somebody who doesn't have a primary care home, who should get hooked up with our healthcare system."

Clinics are just one way that nurse practitioners are becoming more involved in primary care. And they’re not just used for convenience. Many times, a nurse practitioner is the only local primary care option for a rural population.

Zimmer said this outstanding need for primary care is an ailment nurse practitioners can cure.

"As we think about what we need for the future, with the number of patients that are demanding and needing quality services and with the changes that healthcare reform has provided, there's just an urgent need to use our entire healthcare workforce to the highest level possible," Zimmer said.

But in the state of Missouri, opportunities for nurse practitioners are limited.

Even in areas with a shortage of health professionals, nurse practitioners have to work within 50 miles of a collaborating physician. This doctor also has to review the nurse practitioner’s charts once every two weeks and sign off on at least 10 percent of these charts. Missouri nurse practitioners have several restrictions on what medicines they can prescribe. They aren’t even allowed to sign a death notice.

Dr. Marilyn Rantz is a professor at the Sinclair School of Nursing. Rantz and several other nursing professors recently studied how nurse practitioners’ scope of practice affected health outcomes. They found that fewer restrictions on scope of practice were associated with fewer hospitalizations and better management of chronic illnesses.

"If people have access to the nurse practitioner and access to care, then they will get the advice to help them choose the right course of action," Rantz said. "It's all aobut having access to providers who have the time to spend with people and the time to explain all of the options and help them make the right choice."

Only 12 states still have restricted scope of practice for nurse practitioners. Of states with advanced practice laws, Missouri is one of the most restrictive. Rantz said Missouri won’t see benefits like reduction in healthcare costs or improved access to care until Missouri nurse practitioners can practice to the full extent of their training.

"The advanced practice laws were passed in the 80's in this state," Rantz said. "It's time that we evaluate how we compare to other states and encourage increased access to care in our state by lining up with states such as Iowa and other full-practice states."

As more people become eligible for primary care services and the healthcare field moves toward a more patient-centered care model, Zimmer said nurse practitioners are a good option for user-friendly healthcare.

"Nurses bring to that advanced practice role the whole base of what it means to be a nurse," Zimmer said. "[We have] the patient advocacy perspective, tuning in to all of the patient's needs, not just the problem of the day. We do a very good job with patient education, really tuning into the health literacy of that patient."

Hope Kirwan left KBIA in September 2015.
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